Critical questions:

1. How are sports injuries classified and managed?

2. How does sports medicine address the demands of specific athletes?
3. What role do preventative actions play in enhancing the wellbeing of the athlete?
4. How is injury rehabilitation managed?






CQ1: How are sports injuries classified and managed?

Ways to classify sports injuries

(acronym: SHIDO soft tissue, hard tissue, indirect, direct, overuse)

- Direct and indirect

Direct: caused by external blow or force
Example: shoulder dislocated caused by football tackle
Example: broken bone caused by collision between two hockey players

Indirect: caused by intrinsic (internal) force. Actual injury can occur some distance (away) from impact
Example: sprinter tearing hamstring during race
Example: volleyball player causing stress to ligaments in knee joint
Example: footballer falling on outstretched hand, resulting in dislocated shoulder

- Soft tissue and hard tissue

Soft tissue: all tissue other than bones and teeth. Can be muscle, tendons, ligaments, cartilage, skin, blood
vessels, organs, nerves
Examples:
Skin: abrasions, lacerations, blisters
Muscle: tears, strains, tendonitis
Ligament: sprains, tears

Hard tissue: injuries involving damage to bones and teeth
Example: Fractures, avulsions (piece of bone removed from skeleton, dislodged tooth), dislocations

- Overuse (chronic)

Overuse: result from excessive and repetitive force being placed on bones and other tissues. That is, doing
too much exercise without sufficient recovery, poor technique or poor footwear/equipment)
Example: shin splints, tendonitis, stress fractures

Soft tissue injuries

(acronym: BLACIT blisters, laceration, abrasion, contusion, inflammatory, tears)

- Tears, sprains, contusions

Tear: when ligaments or tendons are stressed beyond the normal range of movement
~ Sprain: when a ligament is stretched beyond its normal range of movement and tearing of
fibers occurs
~ Strain: when a muscle or tendon is stretched beyond its normal range of movement
Contusion: (bruise) caused by the crushing of soft tissue

- Skin abrasion, laceration, blisters

Skin abrasion: caused by scrapes and grazes (eg. netball player falling on dry, hard surface of
court)
Laceration: when sharp objects slice through skin (eg. hurdler hitting the hurdle and lacerating
skin on their shin)
Blister: a result of continued friction, as fluid bilds up under the skin (eg. cross country runner with
loose, ill-fitting shoes)

NOTE:
Ligament: attaches bone to bone
Tendon: attaches bone to muscle
- Inflammatory response

Inflammatory response: when the site of the injury becomes inflamed, activating a self-healing process.
May last 3-4 days, depending on extent of damage

Progresses through the following stages:

1. Inflammatory stage:
Pain, redness, swelling around injured area
Loss of function and mobility
Damage to cells and surrounding tissues
Increased blood flow to area
Leakage of fluid causing swelling (oedema)
Formation of many blood vessels to promote healing

2. Repair and regenerative stage (3 days > 6 weeks)
Elimination of debris
Formation of new fibres
Production of scar tissue

3. Remodelling stage (6 weeks > months)
Scar tissue formation

Hard tissue injuries

Any damage to bones and teeth

Fractures:
Stress fracture: small crack in bone
Closed fracture: doesnt pierce the skin
Open fracture: bone protrudes through skin
Complicated fracture: bone disturbs

Dislocation: two bones at a joint are completely displaced from each other

Manage soft tissue injuries/hard tissue injuries

Soft tissue injuries Hard tissue injuries
Immediate management:
Danger:
- To the patient and first aider

Bleeding:
- Needs to be controlled immediately

Cleansing:
- Of the skin injury using clean water, saline
or diluted antiseptic

Dressings:
- Can be adhesive/non-adhesive but cannot
become damp and apply pressure and
elevate the area to reduce bleeding

Apply RICER
DRSABCD
- Danger: to athlete and self
- Response: ask questions to establish if
athlete is conscious
- Send: send for help (call 000)
- Airways: ensure airways are clear
- Breathing: ear to mouth and listen for
breathing, watch for rise and fall of chest
- Compressions: if not breathing, then being
cpr process = 2 breaths followed by 30
compressions on athletes chest
- Defibrillation: apply defibrillator if possible
and follow voice prompts

Immobilisation
- Immobilise the joint above and below the
fracture
- Splint (to another limb or firm straight
Rest:
- Remove player from play
- Inhibit further movement
- No further participation

This will reduce bleeding to the injury and prevent
further injury

Ice:
- Apply ice over area for 20-30mins every
2hrs
- Can be: loose in wet towel, frozen gel pack,
immersion in cold water bucket

This will decrease swelling, pain and enzyme
activity. However, it cannot be applied to open
wounds as this reduces blood supply (which
provides nutrition) to the area

Compression:
- Apply elastic bandage firmly to injured area
(check continually to ensure not cutting off
circulation)
- Leave for up to 72 hours (depending on
injury severity)

This will decrease bleeding and swelling in the area

Elevation:
- Elevate injured area above heart level (eg.
Pillow under injury) for approx. First 72
hours (where appropriate)

This will decrease bleeding, swelling and throbbing

Referral:
- Refer a doctor or specialist for further
diagnosis

This will increase understanding of nature and
extent of injury and allow athlete guidance in a
rehabilitation program

And avoid HARM

Heat:
- Do not apply heat for at least 48 hours as
this increases bleeding

Alcohol:
- Do not consume alcohol as this increases
swelling

Running:
- Do not run as the weight and impact will
object - plank of wood)
- Padding between splint and body to fill any
natural hollows from curves in limb
- Slings to immobilise arm (low = forearm,
high = entire arm)

Control bleeding:
- Pressure on nearby pulse point
- Bandage
- Antiseptic
- Dressing
- (use gloves: reduce risk of infection)

Manage shock:
- Reassure/calm
- Send for help (000)/refer
- Lay the person down, if possible
- Treat obvious injuries
- Keep person warm and comfortable

IES:

- Ice: may not be able to place ice directly on
the injured site, but around the injured site
is acceptable
- Elevation: of the limb above the heart level
in order to reduce blood rushing to the
injured site, therefore, decreasing swelling,
deformity and heat around the injured
area.
- Support: injured area using a bandage
followed by immediate medical attention
(referral, such as x-ray, if unable to
complete totaps)

No HARM

Heat:
- Do not apply heat for at least 48 hours as
this increases bleeding

Alcohol:
- Do not consume alcohol as this increases
swelling

Running:
- Do not run as the weight and impact will
cause further injury

Massage:
- Direct massage is discouraged for the first 72
hours as the pressure causes bleeding to
increase

For teeth
- Splint to adjacent tooth (allfoil) or placed in
NB> Rehab process:
Use pain as an
indicator of
progression, ie:
no pain =
continue
pain = stop
cause further injury

Massage:
- Direct massage is discouraged for the first 72
hours as the pressure causes bleeding to
increase
milk or salvia
- Refer immediately to dentist / doctor for
further treatment


Immediate treatment aims to:
Reduce swelling
Prevent further damage
Ease pain

Long-term treatment aims to:
Restore flexibility
Regain full function
Prevent reoccurrence
Return player to activity asap.

Assessment of injuries

- TOTAPS (Talk, Observe, Touch, Active and Passive movement, Skills test)

Letter Detail - TOTAPS
T
Talk
Find out exactly what happened (nature)
Ask questions:
What day is it? (shows level of consciousness)
How much does it hurt? (scale 1 > 10)
What happened? Has it happened before? Did you hear anything?
O
Observe
Look at injury for obvious signs of swelling, heat, deformity (compare both sides of body)
Look at face colouring (pale = loss of blood, shock, pain)
T
Touch
Ask permission to feel injured site
Palpate gently (detect swelling, heat, deformity)
Move from outside towards the injury (discover extent)
A
Active
movement
Ask player to perform a range of joint movements (flexion, extension, rotation)
Look for movement restrictions
P
Passive
movement
Assessor physically mobilises the joint using range of movements aimed at identifying
painful areas and any instability in joint (flexion, extension, rotation)

S
Skills
Player performs skill required during game (sidestep, etc).
Ensure skills are progressive (stand > walk > jog > run > change direction > specific skills)
If player can perform satisfactorily, the player can return to the game.

CQ2: HO DOES SPORTS MEDICINE ADDRESS THE DEMANDS OF SPECIFIC
ATHLETES?

Children and young athletes
(acronym: MOTA)

- Medical conditions (asthma, diabetes, epilepsy)

Asthma
Definition: respiratory condition in which the casualty suffers the onset of constricted passages in
the lower airway and it becomes progressively difficult to breathe
Triggers: exercise, dust, pollen, tobacco smoke
Symptoms: wheezing, breathlessness, tight chest
Management: give asthmatic children a gradual warm-up. If asthma is triggered follow the
Asthma Action Plan sit child upright, 4 puffs of a reliever inhaler (best with spacer), wait 4
minutes > if no improvement call 000 and repeat 4 by 4

POSITIVES NEGATIVES
Knowledge and understanding of the nature of
asthma > increased communication, socialization
and teamwork skills > feel normal > increased self-
esteem > increased participation in fitness > reduced
risk of lifestyle disease/s
If not monitored and controlled sport may become
a negative experience > assessment from doctor
before participation and inform coach > breathing
exercises and gradual warm up prior to
involvement > monitor throughout participation >
have preventers (relievers) and water readily
available to reduce risk of severe attacks

Diabetes
Type 1: the pancreas stops making insulin. Without insulin, the bodys cells cannot turn glucose
(sugar) into energy
Type 2: the pancreas makes some insulin but it is not produced in the amount your body needs
and it does not work effectively
If sugar levels in a diabetic arent maintained, they can have a hypoglycemic or hyperglycemic
episode which can lead to loss of consciousness
~ Hypoglycemia: low blood sugar (glucose) level
Symptoms: increased HR, sweating, shakiness, anxiety and confusion, dizziness
Treatment: fast-acting carbs (jellybeans) followed by additional carbs (bread)
~ Hyperglycemia: too high a blood sugar (glucose) level
Symptoms: thirst, vomiting, excessive urination, rapid breathing and pulse,
drowsiness
Treatment: seek medical advice

Coaches should allow diabetics to take food breaks to refuel blood glucose levels (before, during,
after physical activity)

POSITIVES NEGATIVES
(Same as asthma above)
Exercise can help maintain blood glucose levels and
decrease insulin dosages required
The long-term benefit of exercise is weight loss
which can lead to reduced risk of type 2 diabetes
(Same as asthma above)
Diabetic athletes must ensure adequate/balanced
diet complete with low-medium GI foods


Epilepsy
Definition: a central nervous system disorder in which the nerve cell activity in the brain is
disturbed, causing a seizure during which can lead to loss of consciousness
Management during seizure:
~ Dont try to restrain the person, but move away any objects which may cause harm
~ One the seizure has finish, move the person into recovery position (on their side)
~ Loosen any tight clothing and reassure (monitor progress)
~ If seizure lasts over 5minutes call an ambulance

POSITIVES NEGATIVES
(Same as asthma and diabetes above)

(Same as asthma above)
Avoid collision sports and others, such as rock
climbing, swimming alone, scuba diving


- Overuse injuries (stress fractures)

Definition: occur as a result of repetitive stress is placed on a body part (bone, tendon, muscle)
without adequate time for the body to heal and repair. Can be related to: poor technique, poorly
fitted equipment, limited recovery time, muscle weakness, imbalance and/or a change in the
training environment (eg. running on grass to running on concrete)
Examples: shin splints, tennis elbow, stress fractures
Stress fractures: tiny cracks in a bone caused from repetitive activities with little or no rest (eg.
running)
Allowing children to participate in a variety of sports will reduce the chance of an overuse injury
by allowing different muscles to be used at different times, reducing the repetitive strain on the
body part. Ensuring adequate warm up and cool down and rest between training will also reduce
the risk of overuse injuries

- Thermoregulation

Thermoregulation: action by the hypothalamus in the brain in responding to changes in body
temperature and initiating appropriate mechanisms (eg. vasoconstriction or vasodilatation) to
maintain core body temperature around 37C
Children do not have the same ability as adults to thermoregulate, placing them at greater risk
(eg. dehydration on hot days), because children:
~ are less metabolically efficient
~ have greater SA (skin exposure to the environment) and, therefore, lose heat and gain
heat more quickly
~ sweat 2.5 times less than adults
~ have less muscular development and, thus, are less able to generate heat through
muscular activity

children should not exercise longer than 30minutes in extreme weather conditions. It is suggested
that children and young athletes shouldnt participate in physical activity in temperatures
exceeding 34C

- Appropriateness of resistance training

Resistance training increases the athletes physical and emotional wellbeing via improvements in:
~ Strength
~ Motor performance
~ Injury protection
~ Self-esteem
~ Body image
~ General health (eg. reduced risk of CVD)

Children and young athletes should being resistance training using their own body weight (eg.
squats, pull-ups, push-ups) and progress to weights as the body adapts


Adult and aged athletes
(acronym: Happy Friendly Folks)

- Heart conditions

As people age, the efficiency of their cardiovascular system declines meaning heart conditions are more
prevalent. Older athletes should avoid strenuous exercise and exercise at approximately 60-75% MHR for
30minutes 3-5 times/week

Examples of exercises
Walking
Cycling
Golf (without cart)
Lawn bowls
( join NSW Masters )

Benefits include improved:
Self-esteem
Independence
Sleep patterns
Social interaction and enjoyment
Exercise can improve the heart and reduce high blood pressure over time
~ For best results, exercise needs to be combined with a balanced diet (low fat / salt intake)

Risk factors
Atherosclerosis and arteriosclerosis
Hypertension (high blood pressure)
Smoking and sedentary lifestyle (obesity and diabetes type II)
~ Adult and aged people need to seek medical advice before starting an exercise program

Considerations
Aged fatigue more easily and take longer to recover, therefore adequate time and consideration
must be given
FITT principles: frequency 3-5, intensity 60-75%MHR, time 30mins, type aerobic

- Fractures/bone density

As people age, so do their bones (lose bone density = osteoporosis) > higher risk of a fracture if they fall

Weight training and/or weight-bearing activities (walking) increase bone density and improves
agility, balance and coordination which help prevent falls
Contact sports should be avoided as a knock or fall significantly increases the risk of injury)

- Flexibility/joint mobility

Joint mobility is often restricted due to inflexibility. Flexibility decreases with age because of a loss
in elasticity of muscles, tendons and ligaments and can lead to arthritis (osteoarthritis / rheumatoid
arthritis) which further restricts the exercise options available to adults and aged athletes
Inflexibility and lack of joint mobility can also increase the risk of falls and, thus, lead to injury
Exercises for flexibility: regular slow stretching (static or PNF), yoga, pilates, tai chi
Exercises for joint mobility: swimming, aqua aerobics

Female athletes
(acronym: BIEP)

- Eating disorders

Female athletes often have added pressure to look good (desired physique) and maintain ideal
body weight and shape which can result in eating disorders
Examples: anorexia nervosa, bulimia nervosa
Restrictions in food intake, alongside a high frequency of training and noticeable weight loss can
lead to a range of serious health risks, including:
~ Loss of energy (leading to less energy for muscular contractions = reduced performance)
~ Irregular menstrual cycles (can lead to amenorrhea periods stop or reduce significatntly
to 3-4 times per year)
~ Weak bones (can lead to osteoporosis)
~ Abnormal heart rhythm
~ Dehydration (impacting thermoregulation and reducing performance)
~ Starvation and malnutrition (can lead to hospitalisation)

Treatment:
~ Anorexia and bulimia: seeking medical assistance,
increasing education regarding the signs and symptoms of the
diseases, providing assistance (coaches, friends, family) to deal with
athletic performance stress and develop a positive self-image and
self-esteem, encouraging personal best rather than perfection
~ Amenorrhea: increasing body fat %, reducing exercise
output, eating more lean red meat, hormone treatment

- Iron deficiency

Iron: an essential mineral needed for the formation of RBCs that carry 02 to working muscles
(haemoglobin)
Iron deficiency anaemia: iron stores are depleted > haemoglobin levels drop > 02 is unable to be
transported around the body (and to working muscles) = fatigue, tiredness, breathlessness =
reduced performance
RDI intake - (females need 2x iron as males):
~ Female 14-18: 15mg
~ Female 19-50: 18mg
Treatment includes eating foods high in iron (haem iron), such as:
~ Meat, seafood and poultry
Or non-haem iron (lower iron foods), such as:
~ Legumes and nuts
~ Whole grains and cereals
~ Dark green leafy vegetables
~ Eggs
Or iron supplements can be used (however, they are not absorbed into the body as efficiently as
food with natural sources of iron)

- Bone density

Bone density: the strength and thickness of bones. The strength of a persons bones is dependent on
calcium intake, exercise and diet
Maximum bone density occurs by age 30, with most bone mass achieved during puberty. If
insufficient calcium is consumed, bones become frail and brittle = osteoporosis (more common in
females due to loss of blood in menstruation cycles or amenorrhea which would mean the female
has low oestrogen levels)
Treatment and management: consuming foods high in calcium (cheese, milks, almonds, avocado,
yoghurt), participating in weight-bearing exercise and possibly taking calcium supplements
RDI:
~ Females 14-18: 1300mg
~ Females 51+: 1300+mg

- Pregnancy

Mild-moderate exercise is safe and beneficial for pregnant women and the baby
Benefits:
~ Reducing risk of CVD
~ Reducing risk of type 2 or gestational diabetes
~ Reducing risk of excessive weight gain
Stages of skill acquisition:
Cognitive: identification
and understanding of the skill. The focus
is on what to do.
Associative: focuses on the idea
of practice and learning how to perform
the skill
Autonomous: executing a
skill automatically, fluently and
instinctively. Outside influences do not
affect the outcome
~ Improving self-esteem, self-image and wellbeing
~ Improving physiological functioning which will meet the increased demand for 02 and
energy required for the baby
Considerations:
~ Mothers health status
~ Stage of pregnancy
~ Type of sport participating in and the risk of injury to the mother and baby (eg. contact
sports, such as hockey, should be avoided after the first trimester. Non-contact sports, such
as swimming, is considered safe throughout the pregnancy)
~ Anti-discrimination laws in Australia allow pregnant women to play sport and have the
ability to be selected in a team
~ Weather: the mother must be careful in hot and humid weather (dehydration risk) as well
as cool climates (hypothermia risk)
~ Take care of muscles as hormonal changes during pregnancy lead to relaxed ligaments

CQ3: WHAT ROLE DO PREVENTATIVE ACTIONS PLAY IN ENHANCING THE
WELLBEING OF THE ATHLETE?

Physical preparation:
(acronym: Physically Prepare Some Women)

Preparing the body before competition will improve an athletes ability to respond to changing conditions
without injury, and enhance their overall performance

- Pre-screening

Pre-screening must be performed before a person undertakes any training program to help with
detecting medical and/or physical issues that may alter type and intensity of training required for
the athlete (e.g. a person with a long, thin neck should not be placed in the front row of a rugby
league or rugby union team)
Questions are used to discover health (medical conditions, injuries, fitness levels, training history,
motivations)
Assess the individual strengths/weaknesses and whether exercise is suitable or potentially
hazardous

- Skill and technique

Relates to the efficiency (ease and precision) of the movement/s
performed in an activity
Good technique will improve performance and reduce risk of
injury

- Physical fitness

Physical fitness should be related to the sport (eg. cardiovascular fitness for cross country runners)
Physical tests, such as the beep test for VO2 max can be used by a coach to monitor an athletes
physical fitness
A lack of physical fitness places the athlete at risk of injury (eg. participating in gymnastics with a
lack of flexibility would increase the likelihood of a muscle tear)

- Warm up, stretching and warm down

Warm up
- An appropriate warm up should prepare the body for physical activity. Warm up routines need to
be specific to the nature of the sport. (eg. a warm up for a game of touch needs to include running
with changes of direction, forwards and backwards running and ball passing)
- A good warm up gradually prepares the body for the demands that will be faced during
participation in the sport.
- A cool down eases the body into recovery and reduces the severity of soreness. A cool down should
not be as intense as a warm up.

Cool down
- A cool down eases the body into recovery and reduces the severity of soreness.
- A cool down should not be as intense as a warm up.

Stretching
- Stretching is an essential part of any warm up and cool down.
- For warm ups, generally dynamic stretching is more effective. It gradually prepares the muscles
and joints for activity and ranges of motion they may experience in the sport. Failure to stretch in
a warm up may result in a muscular tear or joint sprain by forcing a joint beyond its range of
motion.
- For cool downs, generally static stretching is most effective. Failure to stretch as part of a cool
down will increase the incidence of soreness (DOMS) and can affect further participation.

Sports policy and the sports environment:

(acronym: REMPS rules, modified rules, matching opponents, protective equipment, safe)

- Rules of sports and activities

The policies and rules of sports and activities assist the flow of play and help protect participants
from injury. Governing sporting bodies will have policies for safe participation (eg. heat and storm
policies) Policies may also involve supervision requirements of young people to ensure safety and
protective equipment (eg. the NSW DET doesnt allow spiked footwear in primary school cross
country)
The rules of sport are essential for fair, competitive and organised play. Without rules, there would
be an abundance of arguments and injuries (eg. in hockey you cannot raise the stick above the
waist)

- Modified rules for children

Modified rules for children are used to make the game a little easier to participate in as there are
less rules to slow down the game. The main reason rules are modified is for the safety and
wellbeing of the child
Example: Netta netball is for children 8-10 years, allowing players to hold the ball up to 5 seconds,
take two steps whilst holding the ball (reducing the chances of jarring and falls) and have goal
post with a reduced height (increasing their ability to score)

- Matching of opponents (eg. growth and development, skill level)

Age limits and ranges are set for many sports to match athletes' cognitive and physiological abilities.
This helps reduce the chance of injury as athletes are competing against opponents with similar
decision making skills and physical attributes.
Example: boxing and some rugby union/league competitions have weight restrictions to match
opponents and prevent injuries caused by collision or impact with a much larger opponent.
Matching skill level is another way sports can reduce the risk of injury. This is usually done by sorting
athletes into divisions or grades. This reduces the chance of injury as athletes are competing against
opponents with similar skills and abilities.

- Use of protective equipment

Protective equipment is designed to reduce the risk of injury to all players. The equipment must fit
correctly, be appropriate to the sport and not interfere with participation in the sport
Coaches and parents need to reinforce the importance of constantly wearing protective
equipment

Examples:
Mouthguards are compulsory in a rugby league, rugby union, hockey and boxing. They protect
the players' teeth from shattering, tongue from being bitten and other mouth injuries.
Shin pads protect players' shins from hard tissue injuries in sports such as soccer, hockey and rugby
union.
Hard helmets protect hard and soft tissue injuries to the head in sports such as baseball, grid iron,
skiing and ice hockey.

- Safe grounds, equipment and facilities

grounds and facilities need to be appropriate for the activity and equipment needs to be in working
order (eg goal posts should be well-padded and the ground should be well-secured from spectators)
safe grounds are characterized by a level and firm playing surface that is free from obstruction. Any
likely dangers must be appropriately covered or removed (eg. sprinkler head, broken glass)
when the nature of the surface is changed by weather conditions, additional dangers need to be
assessed for injury risk

Environmental considerations:

(acronym: Clothes TAG climatic conditions, temperature regulation, acclimatisation, guidelines for fluid)

- Temperature regulation (eg. convection, radiation, conduction, evaporation)

Controlling the body's core temperature is important for peak performance in sport and to
prevent illness.
The human body can only withstand slight variances in its normal core temperature of 37 degrees
Celcius.
Lower core body temperature = risk of hypothermia
Higher core body temperature = risk of hyperthermia


Air is moved across the body (eg. wind)
Heat loss = wind is cooler than the surface of the body. The cooler
and stronger the wind, the greater the effect
Heat gain = the air movement is warmer than the body


The transfer of heat to and from the atmosphere.
Heat loss = surrounding atmosphere is cooler than the body
Heat gain =atmosphere is warmer than the body


Heat is transferred from the skin to an object or from an object to
the skin.
Heat loss = ice pack on skin
Heat gain = skin contact with clothes

Heat is lost through perspiration (sweating)


- Climatic conditions (eg. temperature and humidity, wind, rain, altitude, pollution)

Climatic conditions can affect a performance in training and competition, and can possibly hamper an
athlete's participation in sport in extreme conditions.

Temperature and humidity
High temperature and high humidity = risk of dehydration and hyperthermia as the bodys ability
to release heat through evaporation is limited
Symptoms: dizziness, lack of coordination or fatigue would affect performance
To prepare, an athlete would need to increase fluid intake, acclimatise to the conditions
beforehand, take regular breaks in the shade and wear appropriate clothing.

Wind
Lower temperatures and high wind = risk of lowering their core body temperature and suffering
hypothermia
Athlete will suffer an increased risk of muscle strains, breathing difficulties and unable to move
efficiently
To prepare, an athlete would need to warm up properly, acclimatise to the conditions beforehand
and wear appropriate clothing.

Rain
Warmer weather = rain may help with temperature regulation
Colder weather = rain will lower core body temperature
Rain affects an outside playing surface for an athlete = conditions become slippery which increases
the risk of injury due to falls, collisions from not being able to stop effectively and lack of control of
sporting equipment.

Altitude
At altitude, oxygen in the air is thinner
Negatives: for endurance events (eg. running) = general reduction in aerobic capacity 3-3.5% for
every 300m level above 1500m (above sea level). Solar radiation is stronger = more sun protection
stratgeies needed (eg. sunscreen)
Positives: for short duration activities (eg. high jump) benefit due to reduce resistance
Athletes should acclimatise in training when competition is in altitude conditions. Generally an
athlete must train at a higher altitude for around 2-3 weeks in order to get the effect of increased
haemoglobin in RBCs. This effect usually only lasts about just over 1week so the athlete must plan
ahead

Pollution
Pollution causes irritation to the upper respiratory tract and reduced 02 transport capacity in the
blood > reduced amount of 02 to working muscles > reduced efficiency to create energy through
breaking down ATP molecules > reduced performance
Short term symptoms may include = coughing, wheezing, watery eyes and trouble breathing
Avoid cigarette smoking and avoid exercise during rush hours in cities and when pollution levels
are high

- Guidelines for fluid intake

Appropriate hydration is vital for temperature regulation and maintaining athletic performance
Approximately 57% of the total body weight of the average person is water
Fluid replacement before, during and after exercise is extremely important as even a small loss of
fluid can affect an athlete's performance as a result of dehydration
2% loss of body fluid = 20% loss in muscle efficiency
>15% = increased risk of death
(ie) approx. 1-2L drunken gradually in the 3-4 hours before the event, at least 500mL 30mins
before event, 200mL every 15mins during competition, after competition drink water until body
weight before competition is reached

- Acclimatisation

Acclimatisation involves preparing the body to perform in the climatic conditions that will be
experienced during an event (eg. heat, altitude, cold) and helps to prevent injury
(eg) Preparing for an event at a higher altitude will mean that the athlete will need to live and
train at a higher altitude for approx. 2-3 weeks before the event to get the benefits of increased
RBCs (^ haemoglobin) and capillarisation in muscle cells, resulting in increased 02 exchange and
CO2 removal from the body = increased muscular efficiency and, hence, performance

Taping and bandaging:

(acronym: PII preventative, isolation, immediate management)

- Preventative taping

Prophylactic (preventative) taping is used to reduce severity of injury to the ligament, lower the
recurrence of injury, or re-injury, and give additional support while making certain movements
Athletes who participate in sports which place extreme pressure on joints will often use
preventative taping even if they have not suffered from a previous injury.
(eg) volleyball players often tape their fingers to prevent dislocation and other tissue damage
Advantage is that when a joint over-extends, the tape pulls on the skin of the athlete making
them more aware of the joint position quickly, allowing the athlete to correct the situation

- Taping for isolation of injury

When an injury has occurred, taping is useful to limit the movement of the muscles and joints involved.
Limiting movement prevents further damage to the area, restricts swelling and eases pain
(eg) Figure of six: to support and reinforce one side of the ankle. Starts as a stirrup and crosses to
form a six.


- Bandaging for immediate treatment of injury

Bandaging is more commonly used for the treatment of soft tissue injuries
Bandaging can help reduce swelling, support a joint or muscle and restrict movement
Generally, elastic bandages or slings are used. To be effective, the correct technique and firmness
need to be applied to the injured area.

CQ4: HOW IS INJURY REHABILITATION MANAGED?

NB> Rehab process:
After each graduated exercise
(stretching, conditioning and TBF) the
athlete needs to participate in stretching
and then return to ice
Rehabilitation procedures

(acronym: Pets Get Truly Ugly)

Designed by physiotherapists or sports specialists with specific activities for injured site
Aim:
Monitoring and restoring normal function of injured site
Prevent reinjury
Return pre-injury level of physical fitness (optimal function to return to game faster)
Reestablish confidence in use of injured area in competitive
arena

Progressive mobilisation
- Starts straight away and continues for up to 2 days
- Involves light stretches and rotations (gentle, controlled movements) to reduce buildup of scar
tissue and, therefore, increase ROM
- Reduces atrophy , increases athletes full ROM in injured area as prolonged immobilisation can
lead to atrophy of bone, muscles, tendons, ligaments and cartilage

Graduated exercise
This incorporates stretching conditioning and maintenance of Total Body Fitness.

Stretching
- Slow static stretches and PNF stretching (gently)
- Time of stretch gradually increases from 5-10 seconds to 20-30 seconds
- Increases elasticity of muscle fibers to reduce further injury and increases circulation to the site
(providing nutrition to injured area > assisting the recovery process)

Conditioning
- Enables athlete to keep in shape during rehab stage, reduces swelling and pain and prevents
muscular atrophy
- Athlete should continue to exercise uninjured muscle groups (applying progressive overload)
- The principle of PO must be applied: moving from partial weight-bearing to full weight-bearing
and from isometric (no change in muscle length) to isokinetic (uses uniform resistance hydraulic
machines) which will ensure strength is developed in both the agonist and antagonist muscles

Total body fitness (TBF)
- Aims to return athlete to pre-injury state of mental and physical fitness
- Must be specific to sport/activity and not endanger recovery process
- Use: treadmills, rowing machines, stationary bikes, swimming, weights, walking, light jogging

Taping:
- Encouraged for increased confidence/support and may decrease chances of re-injury
- EG: Kinesio taping: thin, stretchy, elastic cotton strip with an acrylic adhesive. It is almost identical
to human skin in thickness and elasticity, allowing it to be worn without binding, constricting or
restricting movement.

Training
- Once TBF and CONFIDENCE in injured area is achieved, full training can be resumed in order to
prepare the athlete for the physical and psychological demands of competition
- Specific focus on game skills and technique and PO
- Training needs to be structured to progressively increase the demands of the athletes injured tissue
and should be varied (catering for injury extent and to maintain motivation/interest)
- Once athlete displays full fitness and coordinated movements and skills (can be shown through
testing), they are permitted to resume competition it is suggested that the player starts at a
lower level (eg. AFL player starting back in reserves prior to reentering senior team)

Use of heat and cold
- Depends on injury (as to which techniques are used)

Cold (cryotherapy)
- Applying ice immediately after injury is best as cold shrinks up blood vessels (vasoconstriction)
which decreases bleeding, swelling (inflammation) and pain
- e.g. ice packs in wet towel, ice gels, ice bath
- usually applied up to 4 days following injury

Heat (thermotherapy)
- Can be used when internal bleeding has stopped (approx. 48 hours after injury)
- Can assist in healing injuries by stimulating blood flow (and, hence, the inflammation response)
- Relaxes, relieves sore muscles and tendons, therefore, increasing elasticity to prevent re-injury
- e.g. hot packs, whirlpools, spas

Return to play

(acronym: WIMPPE: warm up, indicators, monitoring, psychological, policies, ethical)

- If athlete returns to play too soon after injury = risk of re-injury

*This process wouldnt start until AFTER the athlete finished hospital treatment (if needed operation, etc)*

Indicators or readiness to return to play

Athlete must be pain free and have a degree of mobility
- Physical tests (specific to sport and skills) are used as indicators
- Normal rom and fitness levels must also be present

Monitoring progress

- To monitor progress, results from a pre-test (taken before injury occurred) could be compared to
post-tests (after injury was sustained)
- Establishes areas of weakness for increased focus and improvement

Psychological readiness
- Trauma from sustaining the injury may affect an athletes ability to participate
- Can be measured through discussion and observation of behaviour (informal means)
- Taping can also provide support and proprioceptive awareness > acting as a psychological form of
treatment

Specific warm up procedures
- Must target the injured area (muscles must be warm, stretched and ready for physical activity to
prevent further damage)
- Extra time and care might be needed (to increase blood flow to area)

Return to play policies and procedures
- Coaches and sports administrators must establish guidelines for athlete (varies within sports)
- Duty of care must be considered and policies may seek medical clearance (eg. Head injuries)
- Eg: afl recommends if a player loss consciousness from a head injury, the player must wait 1-2
weeks before returning to competition (more severe = more time off)

Ethical considerations

Pressure to participate
- Internal: boredom, drive for success, fear of losing team position, sense of letting down team
- External: coach, media, sponsors (ie: financial) may force athlete to return to competition before
injury is completely healed (increasing risk or re-injury)

Use of painkillers
- Increases the likelihood of further damage to an existing injury due to the painkiller masking the
body's natural response.

Critically examine policies and procedures that regulate the timing of return to play,
considering questions such as:

- Why arent such policies applied to all sports?

Sporting policies and procedures are developed by governing bodies within sports, and therefore, have
control over those rules and regulations that determine when a player is ready to return to play as they
eliminate the subjectiveness of the decision and ensure the wellbeing of the athlete. These may include
the incorporation and passing of numerous protocols such as physical and medical tests by the athlete in
order to determine their readiness to return to the competitive sporting environment. The return-to-play
policies vary with each sport and due to their differing natures and level of intensities, not all policies
would fit well or be feasible in all sports. For example, a contact sport such as rugby league would have
differing return-to-play policies in comparison to marathon running due to much more severe injuries at
risk due to high impacts, whilst marathon running is a non-contact sport that may not have as many
severe injuries at risk. This will ultimately determine the healing process and the governing bodies who
determine these rules and regulations. An example of a policy that regulates a persons readiness to
return to play is that in the National Football League, where it is mandatory that if a player is concussed
that they take 1 week off before returning to play to ensure optimal recovery. This is similar to the
International Rugby Boards policy, except three weeks of rest is given to the concussed athlete.

What also determines the severity and extent of the regulation of policies and the personnel who have a
responsibility in determining the athletes readiness to return to play is the level of competition, where
elite athletes would have to abide by serious policies and protocols if suffered an injury in comparison to
amateur athletes. For example, the extreme heat policy in tennis is abided by elite athletes, particularly
those in the Australian Open, as their health and wellbeing is at risk, however, this is not always abided by
amateur competitions.

- Who should have the ultimate responsibility for deciding if an athlete returns to competition?

Ultimately, the responsibility for the athletes return to the sporting environment is a conjoined one, where
the decision is supplemented with medical personnel, coaches, sporting organisations (for elite athletes)
and in all cases, the athlete. For elite athletes who may represent official sporting organisations, there
may be specific testing protocols in place that must be passed by the athlete in order to return to play.
For example, an elite runner who has fractured their ankle and is preparing to return to play may need
to undergo x-rays, discussions, fitness assessments and physical tests before being allowed to return to play.
Therefore, by having a conjoined decision, experienced knowledge and advice is given and considered to
ensure the safe wellbeing of the athlete prior to returning to competition and therefore, producing an un-
biased decision. There is always the risk of re-injury or further damaging the injury if just the athlete
determines their readiness, as they may lie or cover the pain to return to play, but risk themselves being
further injured due to a lack of recovery. Therefore, medical advice and professional decision must be
taken into consideration.

- Should athletes be allowed to use painkillers in order to compete when injured?

An athlete is subject to various internal and external pressures that might influence their decision to return
to play, such as sponsorship, boredom, media pressure, expectations from family and a drive for success.
By hasting their decision, the athlete is voluntarily making themselves vulnerable to re-injury or further
complications. Before returning to play, the questions about whether the injury is pain-free, it can move
in its full ROM and whether the injured area has regained full strength needs to be considered. These
external or internal pressures may result in the athlete taking drastic measures, such as pain killers, in
order to mask the pain and appear to be ready to return to competition. With the advancement of
technology, drugs can be taken in order to hasten the process of return to play. However, the
ramifications of this is that they prolong the healing process, and what appears to be numb to the athlete,
may appear to cause further damage to the injured area later on. This pain can take away focus, motor
skill execution and movement efficiency, however, the threats and pressures of returning to play may be
too much for the athlete. Therefore, although there may be benefits and consequences, the decision is
dependent on the athlete and their ethical considerations.