Managing sports injuries

MANAGINGMANAGING
SPORTSSPORTS
INJURIESINJURIES

PREVENTION OFPREVENTION OF
INJURY IS BETTERINJURY IS BETTER
THAN CURETHAN CURE
potentially between 30 – 50% ofpotentially between 30 – 50% of
sports injuries are preventablesports injuries are preventable

Sporting injuries comeSporting injuries come
from three main areas:from three main areas:
 Human (54%)Human (54%)
 Muscle weaknessMuscle weakness and imbalanceand imbalance
 Inadequate warm up and cool downInadequate warm up and cool down
 SpectatorsSpectators
 CollisionCollision
 Improper techniqueImproper technique
 Terrain (31%)Terrain (31%)
 Uneven groundUneven ground
 Obstructions on groundsObstructions on grounds
 Wet and/or slippery groundsWet and/or slippery grounds
 Equipment (15%)Equipment (15%)
 Unsafe protective equipmentUnsafe protective equipment
 Inadequate, ill fitting protective equipmentInadequate, ill fitting protective equipment
 Unpadded fixturesUnpadded fixtures

PRINCIPLES OF
PREVENTION 1.
Prevent the
incident occurring
in the first place
2.
Prevent
complications
arising from the
incident
6.
Prevent your
intervention being
harmful to the
athlete
3.
Prevent death
5.
Prevent delay in
the athlete’s
recovery
4.
Prevent the
athlete becoming
worse

ELEMENTS IN THEELEMENTS IN THE
PREVENTION OFPREVENTION OF
INJURYINJURY
Warm UpWarm Up
Athletes should warm up beforeAthletes should warm up before
allall trainings and competitions astrainings and competitions as
close to the commencement asclose to the commencement as
possible. They should warm uppossible. They should warm up
with 5 – 10 minutes of lightwith 5 – 10 minutes of light
activity, stretching and specificactivity, stretching and specific
skills of the sport – until theyskills of the sport – until they
have a light sweat.have a light sweat.
 Warm up:Warm up:
 Helps prepare the mind and bodyHelps prepare the mind and body
for exercisefor exercise
 Increases body and muscleIncreases body and muscle
temperaturetemperature
 Increases the blood and oxygenIncreases the blood and oxygen
to the working musclesto the working muscles
 Increases flexibilityIncreases flexibility
StretchingStretching
Stretching should be performedStretching should be performed
during warm up and cool downduring warm up and cool down
and should follow ‘Guidelines forand should follow ‘Guidelines for
safe stretching’.safe stretching’.
 Stretching:Stretching:
 Lengthens muscles so there isLengthens muscles so there is
minimal strain during exerciseminimal strain during exercise
 Reduces the risk of injuryReduces the risk of injury
 Maintains flexibility so musclesMaintains flexibility so muscles
can respond effectively duringcan respond effectively during
sporting activitysporting activity

Elements in the prevention of injuryElements in the prevention of injury
continued……continued……
Cool DownCool Down
Athletes should graduallyAthletes should gradually
reduce activity for 5 – 10reduce activity for 5 – 10
minutes following training orminutes following training or
competition, followed by staticcompetition, followed by static
stretching.stretching.
 Cool down:Cool down:
 Prevents pooling of the bloodPrevents pooling of the blood
in the limbs, which can leadin the limbs, which can lead
to dizziness and faintingto dizziness and fainting
 Aids the removal of wasteAids the removal of waste
products from the muscles egproducts from the muscles eg
lactic acidlactic acid
 Helps maintain flexibilityHelps maintain flexibility
 Enhances recoveryEnhances recovery
 Reduces muscle sorenessReduces muscle soreness
and stiffnessand stiffness
Skill DevelopmentSkill Development
The higher the skill level theThe higher the skill level the
lower the rate of injury,lower the rate of injury,
therefore skill developmenttherefore skill development
and technique is crucial.and technique is crucial.

FitnessFitness
Fitness is important because it allowsFitness is important because it allows
the athlete to perform at their bestthe athlete to perform at their best
and assists in injury prevention.and assists in injury prevention.
While injuries can occur at any timeWhile injuries can occur at any time
they are more likely to occur at thethey are more likely to occur at the
end of the sporting activity becauseend of the sporting activity because
the athlete is tire, less able to copethe athlete is tire, less able to cope
with physical demand and lesswith physical demand and less
capable of performing skills to ancapable of performing skills to an
adequate level due to fatigue.adequate level due to fatigue.
 Components of fitness include:Components of fitness include:
 Cardiovascular endurance (heart andCardiovascular endurance (heart and
lungs delivering oxygen to thelungs delivering oxygen to the
muscles over time)muscles over time)
 Muscular endurance (musclesMuscular endurance (muscles
continuing work over an extendedcontinuing work over an extended
period of time)period of time)
 Strength (muscles producing forceStrength (muscles producing force
against resistance)against resistance)
 Speed (to move as fast as possible)Speed (to move as fast as possible)
 Power (producing maximum force inPower (producing maximum force in
the shortest time)the shortest time)
 Flexibility (range of movement aroundFlexibility (range of movement around
a joint)a joint)
Improving fitness:Improving fitness:
Involves the principle of overload, theInvolves the principle of overload, the
body must work harder than it is usedbody must work harder than it is used
to, adapt to this higher level and thento, adapt to this higher level and then
improve. This must be doneimprove. This must be done
gradually; therefore only one FITTgradually; therefore only one FITT
factor should be increased at a time.factor should be increased at a time.
 FF FrequencyFrequency (number of(number of
session per day/week)session per day/week)
 II IntensityIntensity (how hard the(how hard the
exercise is performed)exercise is performed)
 TT TimeTime (length of time at the(length of time at the
intensity required)intensity required)
 TT TypeType (exercise must be(exercise must be
specific to fitness component)specific to fitness component)

Rules of the gameRules of the game
Many rules are written for the safetyMany rules are written for the safety
of the game, therefore athletesof the game, therefore athletes
should learn both the written andshould learn both the written and
unwritten rules of the game.unwritten rules of the game.
Coaches should emphasise goodCoaches should emphasise good
sportsmanship and fair play andsportsmanship and fair play and
discourage violence or dangerousdiscourage violence or dangerous
techniques.techniques.
Sporting grounds/areasSporting grounds/areas
Environments should be safe, beEnvironments should be safe, be
sure of the following:sure of the following:
 Level and firmLevel and firm
 Free from obstructions eg sprinklerFree from obstructions eg sprinkler
headsheads
 Permanent fixtures should bePermanent fixtures should be
padded, flexible and highly visiblepadded, flexible and highly visible
 Spectators should be well away fromSpectators should be well away from
the playing areasthe playing areas
 Adequate matting is provided whereAdequate matting is provided where
necessarynecessary
 Have safe ground markingsHave safe ground markings
EquipmentEquipment
Check equipment for:Check equipment for:
 Properly erected/constructedProperly erected/constructed
 Stable or movable if necessaryStable or movable if necessary
 Properly anchoredProperly anchored
 Padded as appropriatePadded as appropriate
 Checked before being used, especially ifChecked before being used, especially if
supporting body weightsupporting body weight
Change roomsChange rooms
Should be:Should be:
 Clean and tidyClean and tidy
 Adequate size for the number of athletesAdequate size for the number of athletes
using themusing them
 Have adequate soap, paper towel, rubbishHave adequate soap, paper towel, rubbish
bins, brooms, disinfectant available at allbins, brooms, disinfectant available at all
times.times.

Protective equipmentProtective equipment
Should be:Should be:
 Designed to protect againstDesigned to protect against
injuryinjury
 Light and comfortable to wearLight and comfortable to wear
 In good conditionIn good condition
 Correctly assembledCorrectly assembled
 Correctly worn by the athleteCorrectly worn by the athlete
 An appropriate size and fit andAn appropriate size and fit and
not interfere with functionnot interfere with function
 Appropriate for the sport andAppropriate for the sport and
conditions encounteredconditions encountered
Taping and BracingTaping and Bracing
Taping and bracing can help toTaping and bracing can help to
reduce injury or the chance ofreduce injury or the chance of
injury by restricting theinjury by restricting the
movement of the joint. It ismovement of the joint. It is
effective in prevention andeffective in prevention and
reducing the severity of injuries.reducing the severity of injuries.
Fluid replacementFluid replacement
When exercising it is important toWhen exercising it is important to
replace lost fluids, especially inreplace lost fluids, especially in
the heat, otherwise it can lead tothe heat, otherwise it can lead to
dehydration, fatigue, reduceddehydration, fatigue, reduced
performance, heat illness andperformance, heat illness and
even death.even death.
When exercising in heat or humidWhen exercising in heat or humid
conditions: take it easy, wearconditions: take it easy, wear
loose, light coloured clothing thatloose, light coloured clothing that
permits air flow and drink before,permits air flow and drink before,
during and after activity.during and after activity.
 Note: It is possible to becomeNote: It is possible to become
dehydrated in cooler conditionsdehydrated in cooler conditions
 Children and elderly are moreChildren and elderly are more
susceptible to heat illness sosusceptible to heat illness so
must be closely monitored in hotmust be closely monitored in hot
and humid conditions.and humid conditions.

SunshineSunshine
Australia’s harsh conditions,Australia’s harsh conditions,
especially between 11 am and 3 pmespecially between 11 am and 3 pm
can be harmful. The Australiancan be harmful. The Australian
Cancer Society recommends:Cancer Society recommends:
Slip on a shirtSlip on a shirt
Slop on some sunscreenSlop on some sunscreen
Slap on a hatSlap on a hat
Wrap on a pair on sunglassesWrap on a pair on sunglasses
ColdCold
When exercising in the cold considerWhen exercising in the cold consider
the following:the following:
 Plan properly and avoid long breaksPlan properly and avoid long breaks
 If long breaks occur re warm upIf long breaks occur re warm up
 Wear warm clothingWear warm clothing
 Dress in layers to trap heatDress in layers to trap heat
 The layer closest to the body shouldThe layer closest to the body should
be a natural fibre (wool or cotton)be a natural fibre (wool or cotton)
 Cover heads, face and hands toCover heads, face and hands to
reduce heat lossreduce heat loss
 Wear wind and waterproof outerWear wind and waterproof outer
clothingclothing
Appropriate management of existingAppropriate management of existing
illness/injuryillness/injury
When ill or injured an athlete shouldWhen ill or injured an athlete should
not train as it can cause tissue andnot train as it can cause tissue and
organ damage and further damage toorgan damage and further damage to
the injury.the injury.
 Before returning to sports, athletesBefore returning to sports, athletes
should ensure:should ensure:
 The doctor or physio has given themThe doctor or physio has given them
clearanceclearance
 The injured part has full range ofThe injured part has full range of
movementmovement
 Injured area has full strengthInjured area has full strength
 The injured area is pain freeThe injured area is pain free
 There is no inflammation of theThere is no inflammation of the
injured areainjured area
Personal HygienePersonal Hygiene
Bathing reduces body odour, keepsBathing reduces body odour, keeps
skin healthy, is soothing to the skin,skin healthy, is soothing to the skin,
prevents chafing and preventsprevents chafing and prevents
blocked pores. Hand washingblocked pores. Hand washing
reduces the risk of spreadingreduces the risk of spreading
infection or illness. This is importantinfection or illness. This is important
for the health of the athlete.for the health of the athlete.

Group hygieneGroup hygiene
Golden RuleGolden Rule
DO NOTDO NOT
SHARESHARE
 DO NOT share towels, razors,DO NOT share towels, razors,
sponges, face washers, watersponges, face washers, water
bottles or any other equipment thatbottles or any other equipment that
may contain body fluidsmay contain body fluids
 Discourage communal bathingDiscourage communal bathing
areas such as spasareas such as spas
 Ban spitting or urinating in teamBan spitting or urinating in team
areasareas
 Do not put hands in water bucketsDo not put hands in water buckets
 Proper use of water bottles, nozzleProper use of water bottles, nozzle
should not touch the lipsshould not touch the lips
 All clothes, equipment and surfaceAll clothes, equipment and surface
areas contaminated by blood mustareas contaminated by blood must
be treated as potentially infectiousbe treated as potentially infectious
and treated accordinglyand treated accordingly
 All athletes should be vaccinatedAll athletes should be vaccinated
against Hep Bagainst Hep B
 All group areas should be dry andAll group areas should be dry and
clean with adequate supplies ofclean with adequate supplies of
cleaning products.cleaning products.
Balanced competitionBalanced competition
Competitions should not simply byCompetitions should not simply by
age groups, try to balance through:age groups, try to balance through:
 AgeAge
 SizeSize
 StrengthStrength
 SkillSkill
 GenderGender
 DisabilityDisability
 HeightHeight
 WeightWeight
Common SenseCommon Sense
Tells you it is far better to preventTells you it is far better to prevent
than manage!!!!than manage!!!!

QUICK ON FIELD APPROACHQUICK ON FIELD APPROACH
TO THE INJURED ATHLETETO THE INJURED ATHLETE
SS STOPSTOP
TT TALKTALK
OO OBSERVEOBSERVE
PP PREVENT FURTHER INJURYPREVENT FURTHER INJURY
Severe injury – get helpSevere injury – get help
Less severe – RICER regimeLess severe – RICER regime
Minor injury – play onMinor injury – play on

A DETAILEDA DETAILED
ASSESSMENT OF THEASSESSMENT OF THE
INJURED ATHLETEINJURED ATHLETE
 TT TALKTALK
 OO OBSERVEOBSERVE
 TT TOUCHTOUCH
 AA ACTIVE MOVEMENTACTIVE MOVEMENT
 PP PASSIVE MOVEMENTPASSIVE MOVEMENT
 SS SKILL TESTSKILL TEST

A SUMMARY OF THE APPROACH TOA SUMMARY OF THE APPROACH TO
AN INJURED ATHLETEAN INJURED ATHLETE
If it is preventable – prevent it!!!If it is preventable – prevent it!!!
Once it has happened –Once it has happened –
DANGERDANGER Control dangers then assessControl dangers then assess
injured athleteinjured athlete
LIFE THREATLIFE THREAT Use DRABCUse DRABC
INITIAL INJURYINITIAL INJURY Use STOPUse STOP
ASSESSMENTASSESSMENT
DETAILED INJURYDETAILED INJURY Use TOTAPSUse TOTAPS
ASSESSMENTASSESSMENT
INITIALINITIAL Manage appropriatelyManage appropriately
MANAGEMENTMANAGEMENT REFERREFER
STEP1
STEP2
STEP3
STEP4
STEP5

ASSESSING THEASSESSING THE
MANAGEMENT OFMANAGEMENT OF
INJURIESINJURIES
One is the most important with five being the least important.One is the most important with five being the least important.
1.1. Life EssentialLife Essential – such as unconscious, airway obstruction,– such as unconscious, airway obstruction,
breathing difficulty or haemorrhage.breathing difficulty or haemorrhage. To be covered in ‘DealingTo be covered in ‘Dealing
with Serious Injuries’.with Serious Injuries’.
2.2. Protected non-life essential internal organsProtected non-life essential internal organs – such as spinal– such as spinal
cord, gastro-intestinal organs, kidney and external genetalia.cord, gastro-intestinal organs, kidney and external genetalia.
To be covered in ‘Dealing with Serious Injuries’.To be covered in ‘Dealing with Serious Injuries’.
3.3. Hard tissue injuriesHard tissue injuries – such as fractures and dislocations– such as fractures and dislocations
4.4. Soft tissue injuriesSoft tissue injuries – such as muscle strains and ligament– such as muscle strains and ligament
sprainssprains
5.5. Body surface damageBody surface damage – such as skin abrasions, lacerations,– such as skin abrasions, lacerations,
or infections.or infections.

INJURYINJURY
CYCLECYCLE
Prevention
Incident
Phase
Prevention of
Recurrence
Acute
Phase
Rehabilitation
Definitive
Care

HARD TISSUE INJURIES - fracturesHARD TISSUE INJURIES - fractures
A fracture is a break in the bone, which can be as simple as aA fracture is a break in the bone, which can be as simple as a
small crack with no visible deformity, or complex, in that itsmall crack with no visible deformity, or complex, in that it
may affect life support close to the site of the fracture.may affect life support close to the site of the fracture.
Common causes of fractures:Common causes of fractures:
CAUSE DEFINITION EXAMPLE
Direct contact with
Others
Implements
The ground
The bone is struck directly,
breaking at the point of impact
Forearm is hit by a hockey stick,
resulted in a fractured ulna
Indirect force on a body part Force is indirectly applied to the
bone causing a fracture away from
the point of impact.
Landing on an out stretched arm,
resulting in a fracture of the
clavicle.
Inappropriate muscular action, for
example forceful contraction
Muscles contract forcefully and
strongly pull on bones causing a
fracture
An athlete jumping from a height,
landing on their feet and
fracturing their patella.
Overuse, repeated trauma The repeated use (overuse) of a
joint causes small fractures in the
bone called stress fractures
A runner who trains long
distances may develop a stress
fracture of a bone in the foot.

FRACTURESFRACTURES
 Types of fractures include:Types of fractures include:
 ClosedClosed – the bone is fractured but there is no cut or– the bone is fractured but there is no cut or
wound at the fracture sitewound at the fracture site
 OpenOpen – a jagged end of the fractured bone protrudes– a jagged end of the fractured bone protrudes
through the skin OR there is a cut near the fracture sight,through the skin OR there is a cut near the fracture sight,
though the bone does not penetrate the skinthough the bone does not penetrate the skin
 ComplicatedComplicated – the fractured bone damages the local– the fractured bone damages the local
tissues or organs that it protects eg a lung punctured bytissues or organs that it protects eg a lung punctured by
a fractured rib.a fractured rib.
 Signs and symptoms of a fracture:Signs and symptoms of a fracture:
 PainPain
 Reduced movement or inability to move the injured partReduced movement or inability to move the injured part
 Local bony tenderness at the injury siteLocal bony tenderness at the injury site
 DeformityDeformity
 Irregular alignment of the limbIrregular alignment of the limb
 SwellingSwelling

MANAGEMENT OF AMANAGEMENT OF A
FRACTUREFRACTUREThe major objective is –The major objective is –
Minimise movement of the injured body part by:Minimise movement of the injured body part by:
 Immobilising the jointImmobilising the joint aboveabove the fracturethe fracture
 Immobilising the jointImmobilising the joint belowbelow the fracturethe fracture
 Support the injured area using a splint or slingSupport the injured area using a splint or sling
1.1. Immobilise and support the injured area using a splint or slingImmobilise and support the injured area using a splint or sling
2.2. Where an ambulance is close at hand (less than 45 minutes), it isWhere an ambulance is close at hand (less than 45 minutes), it is
recommended that fractures be managed in the position found torecommended that fractures be managed in the position found to
prevent further damage. This can be achieved with padding ratherprevent further damage. This can be achieved with padding rather
than splinting.than splinting.
3.3. Check for signs of impaired circulationCheck for signs of impaired circulation
4.4. Seek qualified helpSeek qualified help
5.5. Arrange transport to the hospitalArrange transport to the hospital
6.6. ‘‘RICER’ regime and NO ‘HARM’ if appropriate for the injury and if itRICER’ regime and NO ‘HARM’ if appropriate for the injury and if it
does not aggravate the pain.does not aggravate the pain.

FRACTUREFRACTURE Splinting:Splinting:
 Choose an appropriate splint – the body, the other limb, a smooth, firm object longChoose an appropriate splint – the body, the other limb, a smooth, firm object long
enough to extend beyond the joint above and below the fractureenough to extend beyond the joint above and below the fracture
 Pad the splint at the sites of contact and any hollowsPad the splint at the sites of contact and any hollows
 Tie the splint to the injured limb above and below the fractureTie the splint to the injured limb above and below the fracture
 Immobilise the joints above and below the fracture by tying the splint at those jointsImmobilise the joints above and below the fracture by tying the splint at those joints
 Immobilise the fracture site and provide further support by bandaging above and belowImmobilise the fracture site and provide further support by bandaging above and below
the fracturethe fracture
 Check for signs of impaired circulationCheck for signs of impaired circulation
Air splint:Air splint:
An air splint is easy to apply, provides support and is comfortable. However, they canAn air splint is easy to apply, provides support and is comfortable. However, they can
leak, are often not returned to medical clinics, are difficult to re-clean and sterilise, canleak, are often not returned to medical clinics, are difficult to re-clean and sterilise, can
impair circulation if inflated too much and do not support upper arm or upper legimpair circulation if inflated too much and do not support upper arm or upper leg
injuries.injuries.
If they are used carefully place the injured limb in the splint, do up the zipper, inflateIf they are used carefully place the injured limb in the splint, do up the zipper, inflate
until firm (ensuring you can touch the limb through the splint) and check circulation anduntil firm (ensuring you can touch the limb through the splint) and check circulation and
sensation.sensation.
Slings:Slings:
 Low arm sling – provides support for the forearm and maintains it in a horizontalLow arm sling – provides support for the forearm and maintains it in a horizontal
positionposition
 High arm sling – provides support for the arm and elevates the forearmHigh arm sling – provides support for the arm and elevates the forearm
 Improvisation – proper slings are best but improvising is an alternativeImprovisation – proper slings are best but improvising is an alternative
 Knots – when bandages and slings are being used, use reef knots as they do notKnots – when bandages and slings are being used, use reef knots as they do not
tighten and can be quickly released.tighten and can be quickly released.

HARD TISSUE INJURIES –HARD TISSUE INJURIES –
dislocationsdislocations
A joint is the place where two bones meet, allowingA joint is the place where two bones meet, allowing
movement and consists of the bones, joint capsule,movement and consists of the bones, joint capsule,
ligaments, fluid and cartilage. A dislocation is when theligaments, fluid and cartilage. A dislocation is when the
bones are forced out of position and may result inbones are forced out of position and may result in
tissue damage and/or fractures. A subluxation is atissue damage and/or fractures. A subluxation is a
partial dislocation where the bones or parts of the bonepartial dislocation where the bones or parts of the bone
surfaces are still in contact.surfaces are still in contact.
Signs and symptoms:Signs and symptoms:
 PainPain
 Inability to move the joint / loss of functionInability to move the joint / loss of function
 SwellingSwelling
 DeformityDeformity
 Muscle spasmMuscle spasm
 Tenderness over the injured jointTenderness over the injured joint
 The athlete holding their limb in a preferred positionThe athlete holding their limb in a preferred position

DISLOCATIONDISLOCATIONThe management of a dislocation is the same as that ofThe management of a dislocation is the same as that of
a fracture.a fracture.
The management of a dislocation involves theThe management of a dislocation involves the
following steps:following steps:
1.1. Immobilise and support the injured area using a splint or slingImmobilise and support the injured area using a splint or sling
2.2. Check for signs of impaired circulationCheck for signs of impaired circulation
3.3. Seek qualified helpSeek qualified help
4.4. Arrange transport to the hospitalArrange transport to the hospital
5.5. ‘‘RICER’ regime and NO ‘HARM’ if appropriate for the injury and if itRICER’ regime and NO ‘HARM’ if appropriate for the injury and if it
does not aggravate the pain.does not aggravate the pain.
Due to the deformity associated with dislocations:Due to the deformity associated with dislocations:
 pad the injury to the body, other limb or splint before being tiedpad the injury to the body, other limb or splint before being tied
for immobilisationfor immobilisation
 It may not be possible to effectively immobilise someIt may not be possible to effectively immobilise some
dislocations, therefore allow the athlete or support person todislocations, therefore allow the athlete or support person to
keep the injured area in the position of most comfort, and thenkeep the injured area in the position of most comfort, and then
pad appropriately.pad appropriately.

DISLOCATIONSDISLOCATIONS
Common dislocations:Common dislocations:
 Shoulder – are common because of the structure of the joint, firstShoulder – are common because of the structure of the joint, first
time dislocations may have fractures and nerve damage. Refertime dislocations may have fractures and nerve damage. Refer
to a doctor for relocation – DO NOT ATTEMPT THEto a doctor for relocation – DO NOT ATTEMPT THE
RELOCATION.RELOCATION.
 Fingers – may be associated with fractures, refer to a doctor forFingers – may be associated with fractures, refer to a doctor for
relocation.relocation.
 Patella – are not overly common but occur more often in teenagePatella – are not overly common but occur more often in teenage
athletes, some relocate spontaneously as the muscle spasmathletes, some relocate spontaneously as the muscle spasm
relaxes, however they still require medical attention.relaxes, however they still require medical attention.
Why not to relocate a dislocation:Why not to relocate a dislocation:
 The potential for fractures to existThe potential for fractures to exist
 The muscles that cross the joint usually go into very forcefulThe muscles that cross the joint usually go into very forceful
spasm, thus anaesthetic is often needed for relocationspasm, thus anaesthetic is often needed for relocation
 The damage to ligaments or impingement of nervesThe damage to ligaments or impingement of nerves

DISLOCATIONSDISLOCATIONS
Common complications associated withCommon complications associated with
dislocations:dislocations:
The potential complications are the same as aThe potential complications are the same as a
fracture and also include:fracture and also include:
 Bleeding – there may be bleeding in the jointBleeding – there may be bleeding in the joint
 Possible fractures – sometimes the inability to movePossible fractures – sometimes the inability to move
the joint is due to a fracture not the dislocation. Hencethe joint is due to a fracture not the dislocation. Hence
all dislocations should be immobilised, supported andall dislocations should be immobilised, supported and
not moved/relocated without x-ray.not moved/relocated without x-ray.
 Ligament damage – dislocation usually results in tornLigament damage – dislocation usually results in torn
or ruptured ligaments around the joint and/or reducedor ruptured ligaments around the joint and/or reduced
stability at the joint, which may cause the joint to bestability at the joint, which may cause the joint to be
more prone to further dislocations.more prone to further dislocations.
ALL DISLOCATIONS MUST BE REFERRED FORALL DISLOCATIONS MUST BE REFERRED FOR
PROPER ASSESSMENT AND FOLLOW UP.PROPER ASSESSMENT AND FOLLOW UP.

SOFT TISSUE INJURIESSOFT TISSUE INJURIES
TYPE CAUSE INJURY
ACUTE
INJURIES
Injuries that occur from a known,
or sometimes unknown incident.
Symptoms and signs develop rapidly.
(i) Bruise
(haematoma)
Direct force applied to the body, such
as being hit or kicked, or making
contact with player, implement etc.
Compression of soft tissue, resulting in damage to soft tissue
and bleeding into the tissue eg bruise (haematoma)
May bruise any soft tissue (muscle, skin & fat,
periosteum)
(ii) Sprain Joint is forced beyond its normal range
of motion
Ligament fibres are torn
Categorised according to severity
•First degree (mild) – very few fibres are torn
•Second degree (moderate) large number of fibres are torn
•Third degree (severe) –a complete rupture of the ligament
(iii) Strain Muscle is overstretched or
contracts too quickly
The muscle and/or tendon fibres
are torn.
Categorised according to severity
•First degree
•Second degree
•Third degree
OVERUSE
INJURIES
Injuries that develop over a period
of time. Symptoms and signs develop
slowly
i. continual, repetitive movements Inflammation and pain eg bursitis
ii. Repeating the movement following a
minor acute injury which was not noted
and which is then aggravated by the
repeated action.
Repeated stress and microtrauma to soft tissue
eg shin splints, tennis elbow

AIMS OF MANAGEMENT OFAIMS OF MANAGEMENT OF
 Minimise tissue damageMinimise tissue damage
 Minimise inflammationMinimise inflammation
 Prevent further tissue damagePrevent further tissue damage
 Early and efficient removal of blood clot and tissueEarly and efficient removal of blood clot and tissue
swellingswelling
 Minimise scarring of damaged tissueMinimise scarring of damaged tissue
 Regain full function before returning to playRegain full function before returning to play
 Enable the doctor or physiotherapist to make an earlyEnable the doctor or physiotherapist to make an early
diagnosis because the swelling will be lessdiagnosis because the swelling will be less
 Reduce rehabilitation timeReduce rehabilitation time
 Minimise the seriousness of the injuryMinimise the seriousness of the injury
 Allow rehabilitation to begin soonerAllow rehabilitation to begin sooner
 Allow early and complete return to sportAllow early and complete return to sport

INITIAL MANAGEMENT TOINITIAL MANAGEMENT TO
(first 48 – 72 hours)(first 48 – 72 hours)
RR RESTREST
II ICEICE
CC COMPRESSIONCOMPRESSION
EE ELEVATIONELEVATION
RR REFER AND RECORDREFER AND RECORD

RICERRICER
R – Rest the athleteR – Rest the athlete
 How – remove athlete from the field without further damaging andHow – remove athlete from the field without further damaging and
rest from the activity causing the injuryrest from the activity causing the injury
 Why – movement will increase blood flow to the injured site, mayWhy – movement will increase blood flow to the injured site, may
cause blood clots to dislodge & begin bleeding again and may causecause blood clots to dislodge & begin bleeding again and may cause
further damagefurther damage
I – Ice applied to the injuryI – Ice applied to the injury
 Apply ice directly over the injured site and surrounding tissue for 20 –Apply ice directly over the injured site and surrounding tissue for 20 –
30 minutes every 2 hours,30 minutes every 2 hours,
 How – in a wet towel or plastic bag, in a frozen cup of waterHow – in a wet towel or plastic bag, in a frozen cup of water
continuously moving over the site (ice massage) or a freezer gel bagcontinuously moving over the site (ice massage) or a freezer gel bag
with a wet towel between the pack and the skinwith a wet towel between the pack and the skin
 Why – Ice decreases swelling and painWhy – Ice decreases swelling and pain
 Remember – check the athlete and move the ice around to avoid;Remember – check the athlete and move the ice around to avoid;
cooling too fast, superficial tissues cooling and not deeper areas andcooling too fast, superficial tissues cooling and not deeper areas and
oversensitivity to ice. Reassure that the initial cold pain will subsideoversensitivity to ice. Reassure that the initial cold pain will subside
and do not apply ice direct to the skin to avoid ice burns.and do not apply ice direct to the skin to avoid ice burns.
 Do not apply ice to – diabetics, persons with cardiovascular orDo not apply ice to – diabetics, persons with cardiovascular or
circulation problems, persons with Raynaud’s phenomenon andcirculation problems, persons with Raynaud’s phenomenon and
other diseases, special body area eg eyes.other diseases, special body area eg eyes.

RICERRICER
C – Compression applied to the injuryC – Compression applied to the injury
 How – apply a firm, elastic, non-adhesive bandage over the ice packHow – apply a firm, elastic, non-adhesive bandage over the ice pack
to hold it in place and provide compressionto hold it in place and provide compression
 Why – reduces swelling and bleeding at the injury siteWhy – reduces swelling and bleeding at the injury site
 Remember – look for numbness, tingling, coldness and pale blueRemember – look for numbness, tingling, coldness and pale blue
skin when compressing as these are signs that the bandaging is tooskin when compressing as these are signs that the bandaging is too
tight. Reapply not as tight and once ice is completed reapply a drytight. Reapply not as tight and once ice is completed reapply a dry
bandage.bandage.
E – Elevate the injured areaE – Elevate the injured area
 How – raise the injured area above the level of the heart whereverHow – raise the injured area above the level of the heart wherever
possible (when applying ice, when at home, between rehabilitationpossible (when applying ice, when at home, between rehabilitation
exercises)exercises)
 Why – elevation decreases bleeding, swelling and painWhy – elevation decreases bleeding, swelling and pain
R – Refer and recordR – Refer and record
 How – refer to a health care professional for diagnosis andHow – refer to a health care professional for diagnosis and
management, record observations, assessment and initialmanagement, record observations, assessment and initial
managementmanagement
 Why – to obtain an accurate and definitive diagnosis and forWhy – to obtain an accurate and definitive diagnosis and for
continuing management and rehabilitation.continuing management and rehabilitation.

INITIAL MANAGEMENT TOINITIAL MANAGEMENT TO
SOFT TISSUE INJURIES cont…SOFT TISSUE INJURIES cont…
HH HEATHEAT
AA ALCOHOLALCOHOL
RR RUNNING OR EXERCISINGRUNNING OR EXERCISING
MM MASSAGEMASSAGE

In the first 48 – 72 hours theIn the first 48 – 72 hours the
following factors should befollowing factors should be
avoided:avoided:H – HeatH – Heat
Such as sauna spa, hot water bottle, hot showerSuch as sauna spa, hot water bottle, hot shower
and baths, hot liniment rubs as it increases theand baths, hot liniment rubs as it increases the
bleeding to the area.bleeding to the area.
A – AlcoholA – Alcohol
As it increases swellingAs it increases swelling
R – RunningR – Running
Any exercise too soon can make the injury worseAny exercise too soon can make the injury worse
M – MassageM – Massage
Any use of massage and heat rubs in the first 48Any use of massage and heat rubs in the first 48
– 72 hours increases swelling and bleeding and– 72 hours increases swelling and bleeding and
disrupts the healing process.disrupts the healing process.

REHABILITATIONREHABILITATION
Rehabilitation of an athlete is to ‘return the athlete to the previous levelRehabilitation of an athlete is to ‘return the athlete to the previous level
of fitness, skill and competition’.of fitness, skill and competition’.
Rehabilitation:Rehabilitation:
 Begins during the definitive care of an injuryBegins during the definitive care of an injury
 Continues through to prevention of further injuriesContinues through to prevention of further injuries
 Is based on the ‘SAID’ principleIs based on the ‘SAID’ principle
SS SpecificSpecific
AA Adaptation toAdaptation to
II ImposedImposed
DD DemandsDemands
 The more you do something the easier it becomes, provided there is noThe more you do something the easier it becomes, provided there is no
painpain
 Practice must be perfect and specific to the requirements of the athlete toPractice must be perfect and specific to the requirements of the athlete to
achieve progressachieve progress
 As the skills become easier, progress to a more difficult task, until itAs the skills become easier, progress to a more difficult task, until it
becomes easy, and then progress again.becomes easy, and then progress again.
Rehabilitation programs are generally set by a doctor or physiotherapist.Rehabilitation programs are generally set by a doctor or physiotherapist.

Managing sports injuries

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