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OBJECTIVE:
A the end of the chapter the student will able to understand the principles of
assessment, diagnosis and treatments of sports injuries (On field and off field)
INTRODUCTION:
HOPS HISTORY OBSERVATION PALPATION SPECIAL TESTS
HOPS- HISTORY
History: Attitude, mental condition, and perceived physical state.

Stated by the athlete.

Primary Complaint

Mechanism of Injury

Characteristics of the Symptoms

Limitations

Past History

HOPS- OBSERVATION
Measurable objective signs

Appearance

Symmetry

General Motor Function

Posture and Gait

Deformity, swelling, discoloration, scars, and general skin condition

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HOPS- PALPATION

Rule out FX (fracture)

Skin temperature

Swelling

Point tenderness

Crepitus

Deformity

Muscle spasm

Cutaneous Sensation (nail bed refill)

Pulse

HOPS- SPECIAL TESTS

FUNCTIONAL TESTS
MOVEMENT EXAMINATION:

Active Range of Motion (AROM)

Passive Range of Motion (PROM)

MOTOR EXAMINATION:

Resisted Manual Muscle Testing (RROM)

STRESS TESTS
Ligamentous Instability Tests
Special Tests

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NEUROLOGICAL EXAMINATION:
Dermatomes
Myotomes
Reflexes
Peripheral Nerve Testing

SPORT-SPECIFIC FUNCTIONAL TESTING:

Proprioception
Motor Coordination

SPORT-SPECIFIC SKILL PERFORMANCE:

Throw the football,
baseball,

softball,

javelin

Kick the soccer ball,

football,

opponent

SOAP SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

SOAP- ASSESSMENT

It includes the subjective assessment (HOPS) and planning of the treatment

Analyze and assess the individuals status and prognosis

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SOAP- Plan
1. Immediate treatment given
2. Frequency and duration of treatments and modalities and evaluation
3. On-going patient education
4. Criteria for discharge/return to play
ON THE FIELD ASSESSMENT

History:
Location of Pain
Presence of abnormal neurological signs
Mechanism of Injury
Associated sounds (snap, crack, pop)

Observation:
Check the surrounding area
Body positioning
Movement of the athlete
Level of responsiveness
Primary survey
Inspection for head or neck trauma
Inspection of the injured body part

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Palpation
Joints
Bones
Soft tissue
Skin temperature

Functional Testing
Active Range of Motion (AROM)
Passive Range of Motion (PROM)
Resistive Range of Motion (RROM)
Weight Bearing

Stress Testing
Ligamentous stability
Neurological Testing
Cutaneous
Motor

Moving the Athlete

Ambulatory Assist
Manual Conveyance
Spine Board
Pool Extraction

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PRINCIPLES OF MANAGEMENT IN SPORTS INJURIES

GRADING OF SOFT TISSUE INJURY
Grade 1 (First degree)
Grade 2 (Second degree)
Grade 3 (Third degree)
GRADE 1
-

mild pain at the time of injury or within the first 24 hours

mild swelling, local tenderness and pain occur when the tissue is stressed

Grade 2
-

moderate pain stop activity

torn fibers increased mobility

Stress and palpation of the tissues greatly increases the pain.

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Grade 3
-

near complete or complete tear of the tissue with severe pain

Stress to the tissue is usually painless.

MANAGEMENT OF SPORTS INJURIES:

CONSERVATIVE
Immobilization
Mobilization
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Rehabilitation
SURGICAL
Considerations

indications / rationale

special precautions

communication with the patient and surgeon

GUIDELINES FOR PRE-OPERATIVE MANAGEMENT

PATIENT EDUCATION
General plan of care
Wound care
Special precautions / contraindications
Use of assistive or supportive equipment
Bed mobility
Post-operative exercises

Deep-breathing and coughing exercises

Active ankle exercises

Gentle muscle-setting exercises

GUIDELINES FOR POST-OPERATIVE MANAGEMENT

MAXIMUM PROTECTION PHASE

Electromodalities and hydromodalities

Exercises

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Relaxation exercises
Active ankle movements
Deep breathing and coughing exercises
Muscle setting exercises
CPM or ROM exercises (operated areas)
Active or resistive exercises (un operated areas)

Patient education
Safe positioning & limb movements
Precautions
Wound care
Adaptive equipment and assistive devices

MODERATE PROTECTION / CONTROLLED MOTION PHASE

Teach patient to monitor the exercise program.

AA- or AROM exercise; PJM

Gentle massage across the maturing scar

Dynamic exercise against light resistance

Light functional activities

MINIMUM PROTECTION / RETURN TO FUNCTION PHASE

Reinforce self-monitoring

Joint stretching and self-stretching techniques

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Gradual but progressive incorporation of improved muscle performance, mobility,

and balance into functional activities

GENERAL PRECAUTIONS

Avoid positions / activities that could compromise the integrity of the surgical
repair.

Keep the wound clean.

Avoid vigorous stretching or resistance exercises with soft tissues for at least 6
weeks to ensure adequate healing.

Modify level and selection of physical activities.

GUIDELINES FOR RETURN TO PRACTICE AND PLAY

Athlete must have regained full, pre-injury strength

Athlete must have regained full, pre-injury range of motion (some surgeries only
allow you to get close to full ROM).

Athlete must have regained full, pre-injury speed.

Athlete must have regained full, pre-injury balance and proprioception.

Athlete must have regained full, pre-injury muscle mass.

Athlete must be FULLY confident in their rehabilitation.

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MODEL QUESTIONS:
MULTIPLE CHOICE QUESTIONS:
1. What is HOPS concept of assessment in sports?
A. History objective palpation special test
B. History observation palpation special test
C. History observation palpation specific test
D. History objective palpation specific test
2. What is SOAP concept of assessment in sports?
A. Subjective objective assessment planning
B. Special test observation analysis planning
C. Subjective observation assessment planning
D. Special test observation assessment planning
3. In what way the SOAP concept differs from HOPS concept of assessment in
sport?
A. Planning for treatment
B. Analysis of the problem
C. Setting the goal of treatment
D. All of the above
4. What is sports specific performance testing in sports assessment?
A. Testing the skills necessary for the sports
B. Testing the sports specific functional testing
C. Both A & B
D. Only A
5. What is a Grade II soft tissue injury in sports/
A. Mild microscopic rupture of tissues
B. Up to partial rupture of the tissues
C. Complete rupture of the tissues
D. None of the above
6. What is the criterion for return to play after rehabilitation following a injury in
sports?
A. Athlete must have regained full, pre-injury strength
B. Athlete must have regained full, pre-injury range of ROM
C. Athlete must have regained full, pre-injury speed, balance and
proprioception.
D. All of the above
7. Which one of the following is not necessary during On field sports assessment?
A. Checking the previous history of the injury
B. Checking the ROM
C. Checking the local area of injury
D. Checking the myotomes
8. During the maximum protection phase the injured part should be
A. Immobilized
B. Mobilized
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C. Strengthened
D. None of the above
9. Which one of the following is not involved in the SOAP planning
A. Frequency and duration of treatments and modalities and evaluation
B. On-going patient education
C. Criteria for discharge/return to play
D. None of the above
10. Which one of the following in not involved during the minimum protection phase
of rehabilitation.
A. Reinforce self-monitoring
B. Joint stretching and self-stretching techniques
C. Improved muscle performance, mobility, and balance into functional
activities
D. None of the above

SHORT ESSAY
1. Explain the SOAP concept of assessment in sports injuries
2. Explain the HOPS concept of assessment in sports injuries
3. Describe the grading of soft tissues injuries and explain the signs and symptoms
in each of them
LONG ESSAY
1. Explain the principles of assessment in sports injuries.
2. Describe the principles of treatment in sports injuries.
BOOK REFERENCE:
1. Peter Brukner and Karim Khan 3rd ed (2005) Clinical Sports Medicine
2. Carolyn Kisner & Colby (2004) 4th edition Therapeutic Exercise Foundation
and techniques FA Davis.

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