File Name: sports injury assessment and rehabilitation .zip
Sports injuries occur during exercise or while participating in a sport. Children are particularly at risk for these types of injuries, but adults can get them, too. Read on to learn more about sports injuries, your treatment options, and tips for preventing them in the first place. Different sports injuries produce different symptoms and complications. The most common types of sports injuries include:.
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon.
The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself.
Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages.
Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed.
World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport.
A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.
This has consequently intensified the physical and emotional burden of sports, increased the training and practice regimens required, and exposed those involved in this quest to a higher risk of injury. In modern competitive sport, injured athletes are under pressure to return to competition as early as possible, which is often a demand for both the sportsperson and the team management.
Athletes also stand a chance of losing their place in the team due to the highly competitive scenario and naturally come under higher pressures to return. Thus, compared to traditional rehabilitation after injury, sports injuries rehabilitation requires more care, a highly structured and sports-specific approach, which should prepare both the athlete and the injured tissue for the following physical and psychological demands at the highest level of sport.
The growing popularity of the recently incepted hockey, football, and kabaddi leagues in India is evidence of a growing sports culture in a country predominantly favoring cricket. These sports are fast paced, played over a short timeline, and often pose a high fatigue and injury risk to the involved athletes. Studies from around the world emphasize the relation between the demands of the sport and the risks of injury.
This article attempts to update the sports rehabilitation personnel about available options and need based interventions for athletes, which could be applied even in the underdeveloped world. Injuries in sport can occur through contact or noncontact mechanisms and maybe of an acute or overuse nature. Epidemiological studies have revealed no significant decrease in sports-related injuries over the past two decades, despite the heightened insight into injury mechanisms, prevention programs, and load monitoring techniques in athletes.
In a study spanning over 16 years, Hootman et al. The majority of the injuries were contact injuries, with significantly higher numbers being observed during competition compared to training injuries. Of the 15 sports, they analyzed that football Gridiron had the highest injury rate with competitive wrestling being the second largest. Over the year period, the authors also observed that the increased physical demand, participation, and change of rules had a substantial effect on injury trends.
A prime example of such a correlation between injury trends and the demand for the sport is evident on observing the changing injury profile in elite level cricketers since the introduction of the shorter, yet physically demanding, T20 format of the game. Dhillon et al. Over the past ten cricket seasons, Orchard et al. Tirabassi et al. Over an 8-year observation, the authors demonstrated lower limb injuries to be the most predominant with the highest incidence in football followed by gymnastics and wrestling.
The site of injury could be sports specific, with upper limb injuries predominant in throwers and bowlers, while lower limb injuries predominate in games such as football. In a previous study by us in , 7 we evaluated the incidence of knee injuries in 24 different sports in India, in a study spanning 5 years. Similar to other studies, we observed a significantly higher injury rate during competition as compared to injuries during training. However, we found that a noncontact mechanism of injury was more predominant, with soccer and kabaddi injuries being the two most prevalent.
In addition, we found that of all the injured athletes, only The time lost from sport averaged A detailed analysis of the lower return to sports rate in India is beyond the scope of this paper; however, we can state that further studies are needed to examine and critique the injury management, rehabilitation, and return to competition programs and protocols administered in our country to shed light on the possible shortcomings.
It is evident that injuries and returning to the sport after that are major concerns among athletes and their treating clinicians, with a risk-free return to the competition being the top priority of rehabilitation.
This review aims to present an evidence-based approach to sports injuries followed the world over, incorporating that high-quality interventions and protocols initiated minutes after an acute injury, up to the time the athlete fully returns to competition. It serves as a framework upon which readers can construct individualized rehabilitation programs for athletes at all levels, as a perfect recipe protocol does not exist. In modern sports injury management, a team approach involving the sports physician, physiotherapist, strength and conditioning coaches, sports psychologist, nutritionist, coach, and the athlete is critical.
Most importantly the rehabilitation needs to follow a biopsychosocial approach. Therefore, reviewing the current literature regarding the particular sport will aid in providing the clinicians with the understanding of common types of injury, the mechanism behind them, and the current management protocols being used globally.
Documentation of baseline measures is paramount to compare outcomes to a preinjury level. Baseline measures are usually undertaken during the preparticipation assessments and ideally done at the beginning of the sporting season.
The rehabilitation team can then use these as a guide when making any decision regarding return to competition. The primary aim is a return to sports at a preinjury physical and emotional level and to prevent reinjury. It is important to have an end goal in mind, preferably using baseline measures and player attributes documented at preparticipation, and work backward from where you want the player to be.
The key points in the rehabilitation program should be planned and charted out. In addition to injury-specific rehabilitation, it is important to eliminate risk factors and identify why the injury happened in the first place.
Another issue of note is the prevention of overall deconditioning, which has to be factored in when designing the rehabilitation protocol. For this, it is important to have baseline data in as many athletes possible, thus signifying the importance of routine screening of athletes and the documentation of their physical status. However, this may not be possible at all levels in most Indian sports and is not available at the amateur level.
Strength and conditioning should aim to achieve power, strength, and endurance somewhat higher than what it was preinjury, as we have to factor in preventive measures for reinjury.
Return to the sport can be interpreted differently by different members of the rehabilitation team; therefore, the clinician needs to specify in what capacity the athlete will be returning.
We need to transition from rehabilitation into competition gradually so that athletes do not get injured as soon as they return. The player needs to complete a full training session with the team a few days before game day and should be symptom free throughout the training.
One debate is how much of the game he should play in his first match after recovery; this depends on the demands of the sport and the position that he plays. For example, a goalkeeper coming back from lower limb injury could play an entire game, whereas a center forward with the same injury could face limited playing time. Similarly, a goalkeeper with a shoulder injury will have different transitions back into competition as compared to a center forward with a shoulder injury.
This further cements the argument for an individualized and tailored rehabilitation approach to athletes. Another determinant is the time of the competition and these players return; some phases, such as finals or playoffs of an important series, require more physical loads on the body compared to normal league games. Injury is the biggest risk factor for a reinjury.
Once athletes are back competing, careful monitoring is required. The importance of monitoring the physical load on players returning to competition is highlighted later in the review, and further, reading on monitoring of acute-chronic workload ratio is highly recommended.
Monitoring the physical workload on athletes assists the clinicians in determining the optimum transition back to sport while ensuring minimal reinjury risk.
The rehabilitation is based on an active rehabilitation model, with the aim of avoiding prolonged immobilization, which has potentially detrimental effects on muscle tone, strength, and structure. The key factor, however, is tissue healing, and it is important to keep the natural healing process in mind while constructing a program.
Since the remodeling phase lasts for over a year, it would be wise to monitor the athlete and continue an ongoing strength and conditioning program for as long as all fitness goals are not met. Traditionally, clinicians have been employing a protocol inclusive of protection, rest, ice, compression, and elevation P. E with the aim of avoiding further tissue damage, reducing associated pain, edema, and attempt to promote the healing process.
Keeping the end goal of risk-free injury performance, it is proposed that clinicians follow a protocol inclusive of protection, optimal loading, ice, compression, and elevation P. E in the acute care setting for athletes.
Introductory loading should involve a return to full weight bearing, which can also be achieved through hydrotherapy or weight-assisted treadmills. Obviously, we need to protect the injured tissue from further damage, but we cannot allow detraining in the other areas, and simultaneous conditioning of the rest of the body needs to go on. Despite their being only Level IV and Level V studies, low-intensity pulsed ultrasound and neuromuscular electric stimulation are still used in the clinical setting in an attempt to manage inflammation and promote tissue healing.
In addition to the physical requirements, the multidisciplinary team needs to address the mental and emotional demands of elite sport as well.
It is recommended that elite athletes undergo psychologically 21 and nutritional interventions 22 early in the program, to ensure all well-being, and provide the injured tissues with high quality nutrients to allow optimum healing.
Progression of interventions to the next phase of rehabilitation is strictly based on achieving a predetermined set of functional criteria, timelines of which would differ regarding individual athletes. Table 1 shows an example of such predetermined criteria that an athlete with a muscle injury would need to full fill to progress to the next phase in the rehabilitation continuum. Details of medical intervention during rehabilitation such as medication, nonsteroidal anti-inflammatory drugs, and injections are beyond the scope of this review.
However, many issues come into play and the occasional use of steroid injections for some acute conditions, or platelet-rich plasma injections for some healing situations are something to be kept in mind.
Nutritional optimization is essential for healing and again is beyond the scope of the current article. Rehabilitation involving strength and conditioning in athletes could be highly variable as compared to the general population. Rupture or injury to the ACL is one of the most common lower limb injuries seen in sports, with potential career ending outcomes as some athletes may fail to achieve preinjury level of performance.
While progressive loading plays a key role in an efficient RTP, the clinicians need to monitor for undue overloading. In a systemic review in , Drew and Finch 30 demonstrated a significant relationship between excessive training loads and risk of reinjury. However, their review also exhibited a protective effect against injury when optimal loading was employed.
Weiss et al. Load monitoring using devices such as global positioning satellite GPS and accelerometers external and rate of perceived exertion RPE and heart rate monitoring internal are commonly employed in the US, the UK, Australia and are methods that should be considered at various levels in India as well. The incorporation of wearable sensory technology such as accelerometers and GPS devices allows the clinicians and athlete to monitor their physiological load and movement patterns both in training and competition and aid in preventing reinjury by keeping the load demand in check, all the while aiding in a timely RTP.
Once the rehabilitation criteria for the reconditioning phase have been fulfilled, a decision to RTP needs to be taken. As a clinician and a member of the rehabilitation team, it is important to understand that the decision of returning to the sport is not one taken in isolation.
Although a collaborative decision needs to be made by the entire rehabilitation team, the athlete himself is the final judge on RTP. Nonetheless, the responsibility of a safe and timely return to sport lies on the shoulders of the clinicians and coaches in the rehabilitation team. The strategic assessment of risk and risk tolerance StAART is a theoretical framework that aids the clinicians in making informed decisions while gradually returning the athletes to their respective sport.
To ensure a graded progression of physical demands of the sport, Creighton et al.
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding.
Return from athletic injury can be a lengthy and difficult process. The injured athlete commonly receives care from several providers during rehabilitation. As their condition improves, injured athletes resume strength and conditioning programs and sport-specific activities in preparation for return to play. Until full medical clearance is provided to return to sport and the athlete is psychologically ready to return to play, the injured athlete remains a patient regardless of who is developing and supervising each component of the recovery process. An understanding of and commitment to the plan of care for each athlete, as well as communication among health care providers, strength and conditioning specialists, coaches, and the athletes, are essential to the safest and most efficient recovery from injury. The injured athlete commonly receives care from several providers, including physicians, athletic trainers, physical therapists, and strength and conditioning specialists. At some point in the recovery process, athletes return to strength and conditioning programs and resume sport-specific activities in preparation for return to play.
Name and explain the general components that comprise a complete history of a musculoskeletal injury or illness. Differentiate between visual observation and inspection at the primary injury site. Describe the various tests included in the physical examination of an injury. Develop an emergency medical systems plan for an athletic training facility. Identify the responsibilities of each member of the on-site sports medicine team in providing emergency care at an athletic event.
Two popular evaluation methods are. Foundations of Athletic Training. Page 5. CHAPTER 5 Injury Assessment. 89 the HOPS format and the SOAP note format.
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents.
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Injuries in sport happen; however, your recovery time can depend on the severity of the injury, effective management and accurate diagnosis.Reply
Differentiate between the history of the injury, observation and inspection, palpation, and.Reply