🏋🏼Sports Medicine Unit 6 – Acute Sports Injuries: Assessment & Care

What's This Unit About?

• Focuses on the immediate assessment, care, and management of acute sports injuries that occur during physical activity or athletic competition
• Covers the initial steps taken by sports medicine professionals (athletic trainers, physical therapists, physicians) to evaluate and treat injured athletes on the field or sidelines
• Emphasizes the importance of quick and accurate decision-making to ensure the safety and well-being of the injured athlete
• Includes the recognition of potentially life-threatening conditions that require immediate medical attention (cervical spine injuries, head trauma, heat stroke)
• Discusses the role of emergency action plans (EAPs) in coordinating the response to acute sports injuries
• Highlights the significance of effective communication among sports medicine team members, coaches, and emergency medical personnel
• Explores the principles of acute injury management, including the RICE protocol (Rest, Ice, Compression, Elevation)
• Addresses the psychological aspects of acute injury care, such as reassuring the athlete and managing pain and anxiety

Key Concepts and Definitions

• Acute injury: sudden onset of pain or disability resulting from a specific traumatic event (ankle sprain, shoulder dislocation)
• Chronic injury: gradual onset of pain or disability due to repetitive microtrauma or overuse (stress fractures, tendinitis)
• Primary survey: initial assessment of the injured athlete's airway, breathing, circulation, and level of consciousness (ABC's)
• Secondary survey: head-to-toe evaluation of the injured athlete to identify specific injuries and determine the need for further medical care
• Concussion: a brain injury caused by a blow to the head or body that results in temporary cognitive, physical, and emotional symptoms
  • Graded using scales such as the Glasgow Coma Scale (GCS) or the Sport Concussion Assessment Tool (SCAT)
• Fracture: a break in the continuity of a bone, classified as open (compound) or closed (simple)
• Dislocation: complete separation of the articular surfaces of a joint, often accompanied by ligament damage
• Sprain: stretching or tearing of ligaments that support a joint, graded on a scale of 1 (mild) to 3 (severe)
• Strain: stretching or tearing of muscle fibers or tendons, classified as grade 1 (mild), grade 2 (moderate), or grade 3 (severe)

Common Acute Sports Injuries

• Ankle sprains: injury to the ligaments that stabilize the ankle joint, often caused by inversion (rolling the ankle inward)
  • Lateral ankle sprains (involving the anterior talofibular and calcaneofibular ligaments) are the most common
• Knee injuries: include ligament sprains (ACL, MCL, PCL, LCL), meniscal tears, and patellar dislocations
  • ACL tears often occur during non-contact deceleration, pivoting, or landing movements
• Shoulder dislocations: most commonly anterior dislocations, resulting from a fall on an outstretched arm or a direct blow to the shoulder
• Concussions: can occur in contact and non-contact sports, with symptoms such as headache, dizziness, confusion, and memory loss
• Fractures: common sites include the wrist (distal radius), ankle (lateral malleolus), and fingers (phalanges)
• Muscle strains: frequently involve the hamstrings, quadriceps, and groin muscles, often due to eccentric overload or overstretching
• Heat illness: includes heat cramps, heat exhaustion, and heat stroke, which can be life-threatening if not promptly recognized and treated
• Dental injuries: such as tooth fractures, avulsions, and luxations, more common in contact sports (hockey, rugby, boxing)

Initial Assessment Techniques

• Ensure scene safety and assess the athlete's responsiveness using the AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Perform a primary survey to evaluate the athlete's airway, breathing, and circulation (ABC's)
  • Check for signs of airway obstruction, abnormal breathing patterns, and pulse quality
• Conduct a secondary survey to identify specific injuries and determine the need for further medical care
  • Use the SAMPLE mnemonic to gather important information: Signs/Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading up to the injury
• Assess the athlete's level of consciousness and orientation using the Glasgow Coma Scale (GCS) or Maddocks questions for suspected concussions
• Palpate the injured area for tenderness, deformity, and crepitus (grinding sensation), which may indicate a fracture
• Evaluate the range of motion, strength, and stability of the affected joint or limb
• Perform special tests specific to the injured area (Lachman test for ACL tears, Apprehension test for shoulder instability)
• Monitor vital signs (heart rate, blood pressure, respiratory rate) and assess for signs of shock (cool, clammy skin; rapid pulse; altered mental status)

On-Field Emergency Care

• Activate the emergency action plan (EAP) and summon emergency medical services (EMS) if necessary
• Assess and manage any life-threatening conditions (airway obstruction, severe bleeding, shock) using basic life support (BLS) techniques
• Immobilize the cervical spine if a neck injury is suspected, using a rigid cervical collar and spine board
• Control bleeding using direct pressure, pressure dressings, or tourniquets in severe cases
• Treat fractures and dislocations with splinting and immobilization to prevent further injury and reduce pain
  • Use vacuum splints, air splints, or improvised splints (SAM splints, cardboard, magazines) to immobilize the affected limb
• Apply the RICE protocol (Rest, Ice, Compression, Elevation) for acute soft tissue injuries to reduce swelling and pain
• Remove the athlete from play and monitor for signs of concussion, following a standardized concussion protocol (SCAT, ImPACT testing)
• Initiate rapid cooling measures for athletes with suspected heat illness, such as removing excess clothing, applying ice packs, and providing cold fluids

Treatment and Management Strategies

• Collaborate with the sports medicine team to develop an individualized treatment plan based on the specific injury and the athlete's goals
• Use therapeutic modalities such as cryotherapy, thermotherapy, and electrical stimulation to manage pain, reduce swelling, and promote healing
  • Apply ice for acute injuries (20 minutes every 2 hours) and heat for chronic conditions (15-20 minutes before activity)
• Prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics to control pain and inflammation, under the guidance of a physician
• Implement a progressive rehabilitation program that addresses flexibility, strength, proprioception, and sport-specific skills
  • Begin with range of motion exercises and gradually progress to resistive exercises and functional activities
• Utilize manual therapy techniques (soft tissue mobilization, joint mobilization) to improve tissue quality and restore normal joint mechanics
• Incorporate neuromuscular training and injury-specific exercises to address any identified deficits and reduce the risk of re-injury
• Educate the athlete on proper body mechanics, technique, and the importance of adhering to the rehabilitation plan
• Regularly reassess the athlete's progress and adjust the treatment plan as needed to ensure optimal outcomes

Rehabilitation and Return-to-Play Protocols

• Establish clear, objective criteria for progression through each phase of rehabilitation and return to play
  • Use functional tests (single-leg hop test, Y-Balance test) and sport-specific drills to assess readiness
• Follow a gradual, step-wise approach to return the athlete to their pre-injury level of activity
  • Advance from simple, low-impact exercises to more complex, high-impact activities as tolerated
• Ensure the athlete has regained full range of motion, strength, and neuromuscular control before initiating sport-specific training
• Implement a sport-specific conditioning program to improve cardiovascular endurance, power, and agility
• Incorporate psychological skills training (goal setting, imagery, relaxation techniques) to build confidence and reduce anxiety about returning to play
• Collaborate with coaches and other stakeholders to develop a plan for the athlete's safe reintegration into team activities
• Monitor the athlete closely during the initial phases of return to play for any signs of pain, swelling, or decreased performance
• Establish a plan for ongoing injury prevention and maintenance, including proper warm-up, stretching, and strength training routines

Prevention and Risk Reduction

• Develop and implement a comprehensive pre-participation physical examination (PPE) program to identify athletes at increased risk for injury
  • Screen for musculoskeletal abnormalities, cardiovascular conditions, and other medical issues that may affect safe participation
• Educate athletes, coaches, and parents on proper training techniques, equipment use, and injury prevention strategies specific to their sport
• Encourage athletes to maintain proper nutrition, hydration, and sleep habits to support optimal performance and recovery
• Implement a standardized warm-up program that includes dynamic stretching, activation exercises, and sport-specific drills to prepare the body for activity
• Ensure that athletes have access to proper protective equipment (helmets, padding, mouthguards) and that it is well-maintained and fitted correctly
• Monitor environmental conditions (heat, humidity, lightning) and adjust practice or competition schedules as needed to ensure athlete safety
• Develop and practice emergency action plans (EAPs) for various scenarios (severe weather, catastrophic injuries) to ensure a coordinated and efficient response
• Foster a culture of open communication and encourage athletes to report any pain, discomfort, or concerns about their health and well-being to the sports medicine staff