A FOOTBALLER FELL IN THE FIELD WITH SEVERE PAIN IN THE KNEE JOINT.
A ) WHAT ARE THE COMMON INJURIES YOU WOULD LOOK FOR ?
B ) HOW WOULD YOU MANAGE THEM ?
A 9 INTRODUCTION
1 The overall injury rate in football is 8.1 injuries per 1000 athletes
2 Football players are nearly seven times more likely to be injured in a game than in practice
3 Ligament sprains are the most common injury reported accounting for more than 30 % of all injuries with the lateral ligaments of ankle and medial collateral ligament of knee most commonly affected
4 Concussion makes up 7.4 % injuries in college players
5 The greatest risk of adverse effects are more in preseason ( 9.7 / 1000 ) than inseason ( 7.8 / 1000 ) and post season ( 4.1 / 1000 )
6 The greater risk of injury is during General play ( 23.9 % ) followed by Running plays ( 18 % ) and Passing plays ( 14.9 % )
INJURY % BREAK DOWN
1 CONCUSSION - 7.4 %
2 HEAD , FACE AND NECK - 4.3 %
3 UPPER LIMB - 16.9 %
4 TORSO AND PELVIS - 11.9 %
5 LOWER LIMB - 50.4 %
6 OTHER - 9.1 %
A ) MOST COMMON INJURIES
1 Hamstring strains
2 Knee ligament injuries - ACL , PCL
3 Meniscus tears
4 Patellofemoral pain syndrome
5 Chondromalaciae patellae
6 ITB syndrome
7 Plica syndrome
8 Ankle sprain
9 Achilles tendonitis
10 Jumper’s knee
11 Medial knee ligament sprain
12 Shin splints
13 Metatarsal stress fractures
B ) MANAGEMENT
I - ACUTE
1 The PRICE principles are the gold standard set for treating acute sports injuries.
2 The acronym stands stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.
A) Protection
1 Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively.
2 There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon vv imp
3 One way this can be achieved is using a support or splint.
B ) Rest
1 In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored.
2 It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
3 An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
4 If an injury is sustained during sporting activity some athletes have a tendency to ‘run it off’. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases this is not true and is not advisable vv imp
C ) Ice
1 Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries.
2 It is cheap, easy to use and requires very little time to or expertise to prepare.
3 The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways -
A ) Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
B ) Reduces pain (pain gate theory)
C ) Reduces muscle spasm
D ) Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
E ) Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel.
F ) The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”.
G ) DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
H ) There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee.
I ) The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it.
D ) Compression
1 Applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury.
2 Compression can be applied through a number of methods.
3 The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation
1 Elevation of the injured limb is the final principle of PRICE but is equally as important as the other
2 Elevation allows gravity to drain the fluid away from the injured site.
3 This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
RED FLAGS
1 Severe pain, especially on walking
2 Severe swelling (oedema)
3 Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia)
4 a “loss of feeling” (anaesthesia).
5 Unable to complete normal daily activities after the initial 72 hours
PREVENTIVE STRATEGIES
1 Warm Up
A ) Warming up is often overlooked but should be part of your injury prevention routine.
B ) A good warm up will -
1 Increase the temperature of muscles - they work better at a temperature of 40 degrees.
2 Increase blood flow and oxygen to muscles.
3 Increase the speed of nerve impulses - making you faster.
4 Increase range of motion at joints reducing the risk of tearing muscles and ligaments.
5 Warm up will not only help avoid injury but will also improve performance.
6 A warm up should consist of -
A ) Gentle jog to circulate blood and oxygen supplying the muscles with more energy to work with.
B ) Stretching to increase the range of motion at joints
C ) Sports specific exercises and drills.
D ) The warm up should last between 15 and 30 minutes.
E ) Do not warm up too early.
F ) The benefits are lost after about 30 minutes of inactivity.
2 Cool Down
A ) This is also often overlooked in favour of the bar but can help avoid injuries and boost performance.
B ) The aim of the cool down is to -
1 Gradually lower heart rate.
2 Circulate blood and oxygen to muscles, restoring them to the condition they were in before exercise.
3 Remove waste products such as lactic acid.
4 Reduce the risk of muscle soreness.
5 The cool down should consist of a gentle jog followed by light stretching.
3 Sports Massage
A ) Getting a regular sports massage can flush the muscles of waste products and release tight knots, lumps and bumps in muscles that if left may cause strains and tears.
B ) It is possible for a good sports massage therapist to identify potential trouble spots long before they become injuries.
4 Equipment
Not having the proper equipment for playing can cause injury. The ideal football boot should have - vv imp
1 A rigid heal counter
2 Good depth in the upper
3 A flexible forefoot
4 A wide sole and be slightly curved in shape.
5 Shin pads are also an essential piece of kit.
5 Nutrition and Hydration
A ) Proper nutrition is important.
B ) A bad diet will prevent you from recovering from training sessions making you more prone to injury.
C ) A balanced diet is what you should aim for -
1 Carbohydrate is important for refueling muscles.
2 Protein rebuilds muscles.If you become dehydrated then less blood will flow through muscles.
3 The muscles will be more prone to injury.
4 Vitamins and minerals are required for a number of reasons related to recovery.
6 Fitness
A ) This includes general conditioning, aerobic fitness and muscular strength.
B ) If you are in good condition then you are less likely to get injuries.
C ) Strong muscles are less likely to tear.
D ) A player that can keep going for the full 90 minutes is less likely to be late in a tackle.
E ) Good all-round conditioning will balance the body and help avoid necessary injuries.
F ) Vv imp Footballers can get stronger hip flexor muscles through repeated kicking on one side. This twists the pelvis and lower back causing other problems including recurrent hamstring injuries.
II - CHRONIC
A ) KNEE LIGAMENT DAMAGE - ACL / PCL INJURY
1 Conservative
A ) QUADRICEPS STRENGTHENING EXERCISES
B ) VMO AND HAMSTRING STRENGTHENING
2 ACL RECONSTRUCTION PROCEDURE
A ) using semi t alone or with gracilis ( Single bundle, doubl , quadrupule ) based on the requirements of athletes
B ) LARS PROCEDURE -
A ) using torn ACL ( *** )
THESE ALL SHOULD BE FOLLOWED BY POST SURGICAL REHAB
B ) MENISCAL INJURIES
1 The meniscus can be torn anterior to posterior, radially (parrot beak), or can have a bucket handle appearance.
2 In the older adult, the tear may be due to a natural age-related degeneration of the meniscus or a rough arthritic femoral bone surface tearing into the softer meniscus
3 In this case, surgery may be required to attend to both the meniscal repair and to repair the damaged joint surface.
4 Depending on the type of meniscus tear, meniscus repair may be complicated.
5 A large meniscus tear that is inadequately treated may cause premature degenerative bony (arthritis) changes.
6 Meniscal blood supply is limited as meniscus receives its nutrition from blood and synovial fluid within the joint capsule
A ) meniscus has two distinct regions that affect their ability to heal. We call these the Red Zone and the White Zone.
1 Red Zone
A ) The red zone has blood supply, whereas the the white zone doesn’t have a blood supply and won’t heal naturally. The outside of the meniscus has a blood supply from the synovial capsule. Lateral meniscal tears may heal without the need for surgery.
2 White Zone
A ) The inside of the meniscus gets its nutrition from the synovial fluid.
B ) Due to this, tears of the inner meniscus do not usually heal due to a lack of blood supply to trigger an inflammatory response. These injuries often require surgery.
7 meniscal tear will commonly take up to six or eight weeks to fully heal.
8 if surgery is required, surgery is usually performed arthroscopically (via a fibre-optic camera about the size of a pencil) to either resect (remove) the torn fragment or repair (stitch) a tear in the outer zone.