SPORTS INJURIES SPORTS by suchenfz

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									SPORTS
INJURIES
 Injury – Bruising/Contusion
• A bruise is an area of bleeding beneath the skin. The
  size of the bruise is proportional to the amount of
  bleeding and not the severity of the injury.
• Symptoms
• It hurts at the site of the injury
• There might be swelling or bruising
• Restricted movement is not common
• Cause
• Body contact or collision with an object in a sporting
  situation like a tackle in football or rugby, common in
  contact sports.
• Prevention
• Protective equipment, for example padding.
• Treatment
• R.I.C.E (use crutches)
• Massage
• Ultra sound and electrical stimulation
                     Injury – Strains
•   Tearing of the muscle tissue due to being excessively stretched or over
    worked.
•   1st degree strains involve minimal muscle tearing
•   2nd degree strains involve more muscle tearing
•   3rd degree strains involves a total tear
•   Symptoms
•   Sudden pain at the site of the injury
•   Difficulty in contracting the muscle, Pain and swelling or bruising in the
    muscle
•   Causes
•   Attempting a workout or exercise at a high intensity without sufficient warm
    up.
•   Attempting a workout while suffering from fatigue, example: injuries in
    football happen in the latter stages when the player is fatigued. Impaired
    reflexes,
•   Prevention
•   Sufficient warm up and cool down.
•   Developing the level of fitness required for the sport.
•   Graduated training programme.
•   Treatment
•   R.I.C.E method for mild strains.
•   Severe strain requires medical attention and possibly surgery.
•   Anti-inflammatory medication, Ultra sound treatment, Sports massage
Injury – Sprains
•    Sprains are injuries to a ligament. These
injuries can range from small tears to
complete ruptures; this causes the joints
that the ligament supports to become
loose and unstable. Damage also results in
swelling and pain around the joint.
•    Severity is graded by degrees :-
•    1st degree – Little damage
•    2nd degree – Partial tearing of the ligament
•    3rd degree – Complete tear in two or more places
•    Symptoms
•    Pain – Swelling - Some loss of circulation




•   Causes
•   Excessive flexibility in an individual.
•   Training on a mild injury.
•   Joint being moved beyond its normal range of movement but is partly or wholly dislocated.
•   Body contact.
•   Prevention
•   Correct footwear and equipment. Good technique.
•   Playing within the rules of the sport.
•   Treatment
•   Mild sprain – R.I.C.E
•   Anti-inflammatory drugs
•   Physical therapy (ultra sound and heat treatment)
                        Injury – Cramp
• A sudden, uncoordinated, sustained contraction in a
  muscle causing it to become very tight and extremely
  painful.
• Causes
• Muscle damage - Dehydration
• Low blood glucose levels
• Restriction of blood supply to the muscles
• Poor training and preparation
• Unbalanced diet
• Prevention
• Warm up and cool down - Proper balanced diet
• A well graduated training programme
• Take in plenty of fluids before and after exercise
• Treatment
• Gentle static stretching
• Gentle massage - Rest
Injury – Fracture
•   Simple Fracture (closed)
•   This is where the bone breaks cleanly without puncturing the skin.
•   Compound Fracture (open)
•   This is where the bone does not break cleanly. The result is a
    shattering of the bone with the ends poking through the skin. This
    fracture is more serious because it can result in bone infections.
•   Green Stick Fracture
•   This is when a bone does not break completely. It can be compared to
    when a green twig breaks, it is incomplete with the twig splintering.
    This is more common in children.
•   Causes
•   Collisions
•   Body Contact (excessive force) in contact sports.
•   Hit by an object - Over training.
•   Training too soon after an injury to that body part.
•   Prevention
•   Graduated training programme
•   Protective equipment (skin pads)
•   Treatment
•   Don’t move casualty
•   Send for help
•   Keep casualty warm - Medical treatment
SIMPLE FRACTURE
COMPOUND FRACTURE
GREEN STICK FRACTURE
             Injury – Dislocation
• Temporary complete separation of the bones forming a joint.
  The result is immobility or instability of that joint. When
  dislocation occurs ligaments and muscle tendons are torn
  resulting in the bone and joint to come apart.

• Causes
• Direct blows
• Extreme movement beyond a
  joints normal range of movement,
  example, falling on the joint.
• Prevention
• Protective equipment.
• High level of fitness for the sport.
• Treatment
• Injury should be referred to a doctor for repositioning.
                              Injury – Tendinitis
                   (Example tennis elbow, Achilles tendinitis)
•   Inflammation of a tendon, in tennis elbow it is the inflammation of the tendon that attaches
    to the lateral epicondyle on the outside of the elbow.
•   Symptoms
•   Swelling - Tender to touch
•   Symptoms in tennis elbow include :
•   Pain on the bony (lateral epicondyle) on the outside of the elbow
•   Weakness in the wrist
•   Pain in the outside of the elbow when you bend the hand back at wrist
•   Causes
•   Most tendinitis injuries are caused by chronic overuse
    during activities that produce high compression or twisting forces.
•   In tennis elbow tendinitis is caused by :
•   A bad backhand technique which puts a
    lot of pressure on the elbow.
•   Prevention
•   Cut back on training
•   Correct technique
•   Using a forearm brace for a weak elbow
•   Treatment
•   Rest, ice
•   Ultra sound, acupuncture
•   Laser treatment
•   Steroid injection can also be prescribed
    Injury – Prepatellar Bursitis (Housemaid’s knees)
• A bursa is a small fibrous filled sack usually found around joints.
  Bursea minimise the amounts of friction between the joints during
  movement, it can become inflamed after chronic overuse.
• Symptoms
• Pain directly over the affected area
• Swelling in the area of pain
• There is pain when pressure is applied to the swollen area




•   Causes
•   Excessive kneeling activities or a blow to the knee
•   Prevention
•   Never do squats below a 90 degree angle of the knee
•   Treatment
•   Rice and application of a doughnut pad to the affected area
   Injury -Compartment Syndrome
• A compartment is a section of the body containing a group of
  muscles. An example is the lower leg, which encloses its muscles
  four main compartments with a firm capsule surrounding each
  compartment. A compartment syndrome occurs because there is
  only a certain amount of space in each compartment and this is
  reduced during a heavy training schedule by a pressure build up.
  In acute cases it is caused by a fluid build up during training in the
  muscle group, increasing the pressure in the compartments.
• Symptoms
• Muscles may be tight and/or swollen
• Pain in the muscles and inflammation
• Causes
• Direct blow, kick or punch to the muscle causing it to bleed and
  swell rapidly
• Build up of fluid in the muscle groups which increases the intra-
  muscular compartment pressure
• Hard training surfaces - Build up of pressure from training
• Prevention
• Graded exercise/training programme
• Treatment
• Elevation, compression, massage, anti inflammatory and anti
  diuretic drugs to reduce swelling and eliminate excess fluids
 Injury - Plantar Fascitis/Arch strain
• Overstretching, inflammation and or a tearing of a
  broad band of connective tissue that runs from the
  heel into the toes. This band called the plantar fasia
  aids in supporting the arch, preventing the
  elongation of the foot.
• Symptoms
• Pain on the bottom of the foot towards the region of
  the heel
• Causes
• Overuse from jumping or running
• Prevention
• Graded training programme
• Treatment
• R.I.C.E
• Anti-inflammatory medication
• Orthotic device can be made for a re-occurring
  plantar fascitis
   Injury - Abrasion
• In dermatology, an abrasion
  is superficial damage to the
  skin, generally not deeper
  than the epidermis. Although
  it can give mild bleeding.
  Mild abrasions do not scar,
  but deep abrasions may lead
  to the development of
  scarring tissue.
• Most commonly, abrasion
  injuries occur when exposed
  skin comes into moving
  contact with a rough surface
  causing trauma to the upper
  layers of the epidermis.
        Injury - Concussion
• Concussion, or mild traumatic brain injury
  (MTBI), is the most common and least serious
  type of traumatic brain injury. A milder type of
  diffuse axonal injury, concussion involves a
  transient loss of mental function. It can be
  caused by acceleration or deceleration forces, or
  by a direct blow. Concussion is generally not
  associated with penetrating injuries.
• The body contains three different types of cartilage: articular,
  which covers joint surfaces; fibrocartilage, which is found in the
  knee meniscus and vertebral disk; and elastic cartilage, which
  is found in the outer ear. They are distinguished by structure,
  elasticity and strength. Cartilage is a complex, living tissue that
  lines the bony surface of joints. It provides shock absorption,
  enabling the joints to withstand weight bearing through the
  range of motion needed to perform daily activities as well as
  athletic endeavors.
                 Injury - Blister
• A blister or bulla is a defense mechanism of the human
  body. It consists of a pool of lymph and other bodily
  fluids beneath the upper layers of the skin. It may be
  formed in response to burns or friction, and helps to
  repair damage to the skin. If a blister is punctured, it
  forms an open wound and should be bandaged to
  prevent bacteria and dust from entering the wound which
  could result in inflammation.
          Injury – Shin Splints
• Shin splints is the general name given to pain at
  the front of the lower leg. Shin splints is not a
  diagnosis in itself but a description of symptoms
  of which there could be a number of causes. The
  most common cause is inflammation of the
  periostium of the tibia (sheath surrounding the
  bone). Traction forces occur from the muscles of
  the lower leg on the periostium.
• Shin splints is an overuse injury and can be
  caused by running on hard surfaces or running
  on tip toes. It is also common in sports where a
  lot of jumping is involved. If you over pronate
  then you are also more susceptible to this injury.
              Injury – Back Pain



   Common causes of back pain
• Most back pain is caused by strains
  and minor injury rather than serious
  injury, and is often called 'simple back
  pain'. Although the pain often comes
  suddenly and can be triggered by a
  particular movement, the causes may
  have been building for some time.
  EXTRINSIC
      &
  INTRINSIC
RISK FACTORS
COACHING & LEADERSHIP
     A good leader should possess the following qualities :

 •   An ability to bring out the best in people
 •   Enthusiasm and knowledge about their activities
 •   A desire to help participants achieve their potential
 •   An open-minded and fair attitude

     A leader needs to gain the respect and trust of the
     participants. Leaders need to be :

 •   Well organised
 •   Able to organise and direct other people effectively
 •   Able to organise equipment and facilities safely
 •   Able to demonstrate effective leadership skills
 •   Able to communicate effectively
    Children respond to leaders who :

• Are friendly, happy, patient, understanding and have a
  sense of humour
• Have credibility in their sport
• Are firm but fair
• Provide appropriate encouragement
• Help them develop their skills

    Children do not respond to leaders who :

•   Shout
•   Constantly say well done, irrespective of effort of skill
•   Constantly criticise
•   Appear indecisive
         Extrinsic Risk Factors
                   The Warm Up
• A warm up is intended to raise the body
  temperature and prepare a player
  physiologically and psychologically to compete
  in a competitive game. Research has suggested
  that the optimum duration of the warm up
  period, before flexibility or functional activities
  are undertaken, should be between 15 and 20
  minutes. This should consist of a gradual
  increase in intensity until the player is working
  at 70% of maximal heart rate. A warm up at this
  intensity has the effect of allowing an increase
  in the range of movement of the joints and
  improving aerobic performance. This means the
  player becomes more flexible and running
  efficiency improves.
                        Cool Down

• A Cool Down allows a gradual decrease in
  temperature, heart rate and blood pressure, back to
  resting levels. By gently working the major muscle
  groups, waste products are actively removed. During
  the gentle exercise of the cool down the body releases
  hormones that counter the effects of adrenaline and
  allow rest and sleep after exercise. Because of the
  increase in tissue temperature the post-exercise period
  is an ideal time to stretch and improve or maintain joint
  range of movement and flexibility.
• Players may not feel like doing a cool down after a
  strenuous game, but they must understand that
  because of the possible benefits mentioned above it is
  worth doing. By getting into the habit from an early age,
  players will be more disciplined about performing a cool
  down.
           Safety Checklist
• Leaders should take all the possible steps to
  ensure the safety of their participants.
  Equipment and facilities should be checked
  before starting a session:
• General safety points:
• Where are the fire exits ?
• Where is the fire assembly point ?
• Where is the first aid box kept ?
• What are the emergency procedures ?
• Where is the nearest telephone, and is there a
  number to dial to obtain an external line ?
• Where are the toilets / showers ?
    Outdoor facilities:
•   Is the surface suitable ?
•   Are there any dangerous objects such as such
    as broken glass ?
•   Is the condition of the surface safe (is the grass
    cut, is it too wet and muddy) ?
•   Is the area big enough ?
•   Are goal posts secured ?
     Indoor facilities:
•   Is the surface clean, dry, and free from
    dangerous objects ?
•   Are all radiators covered by padding ?
•   Is the lighting adequate ?
•   Is there adequate ventilation ?
•   Are all goal posts secured ?
    Equipment:
•   Inspect the equipment before and after use.
•   Ensure that the equipment is correctly stored
•   Maintain the equipment
•   Report any broken equipment
    Participants :
•   Are they correctly dressed ?
•   Are they wearing the correct footwear ?
•   Have they removed all jewellery and watches ?
•   Establishing good discipline and enforcing rules are an
    essential part of making a session safe and enjoyable.
    Rules :
•   Rules should be clearly defined at the beginning of each
    activity.
•   Fair play should be encouraged at all times.
•   Game rules should be adapted according to the facilities,
    group size and participants involved.
INTRINSIC RISK FACTORS
   •   Overuse injuries occur/build up over
       a period of time due to the stresses
       imposed on specific sites of the body
       by that activity. The stress is
       prolonged further by an imbalance
       between training/competitions and
       recovery. A typical scenario would
       be for a busy aerobics instructor to
       feel a slight tenderness in his/her
       Achilles tendon after a class. This
       might go away but return after the
       next class.
   •   This cycle repeats itself until the
       injury gets gradually worse as time
       goes on until the soreness can be
       felt constantly both during and after
       taking a class, thereby preventing
       the instructor from taking further
       classes properly.
   •   Overuse injuries are common in
       aerobic activities involving repetitive
       movements over a long period of
       time(marathon running). The most
       common sites that are susceptible to
       overuse injuries are the tendons of
       the shoulders, wrists, hips, knees
       and ankles.
LIMB LENGTH DIFFERENCES
       MUSCLE IMBALANCE
BEFORE BEGINNING ANY STRENGTH TRAINING PROGRAM, WE EVALUATE A
NUMBER OF AREAS, LOOKING AT MUSCLE LENGTH AND TENSION. BY
EVALUATING THE NECK, SHOULDERS, SPINE, HIPS, AND LEGS, WE CAN
ASSESS IF THERE ARE ANY EXISTING ALIGNMENT PROBLEMS WITH YOUR
BODY. THIS IS ACCOMPLISHED THROUGH VISUAL INSPECTION AND
COMPARED TO AN ANATOMICAL POSTURALLY CORRECT MODEL.
ADDITIONALLY WE USE AN EVALUATION TOOL CALLED A PALPATION METER.
THIS ALLOWS US TO COMPARE DISTANCES BETWEEN THE SCAPULA AND
SPINE, MEASURES FRONTAL AND SAGITAL PLANE HIP ANGLES, AND
POSSIBLE BONE LENGTH DISCREPANCIES. THE RESULTS FROM THESE
ASSESSMENTS ARE USED TO DESIGN A CORRECTIVE EXERCISE PROGRAM,
WHOSE GOAL WILL BE TO IMPROVE AND CORRECT ANY IMBALANCES OR
WEAKNESSES THAT HAVE BEEN FOUND.
• Muscular tightness is
  postulated as an intrinsic
                                  MUSCLE
  risk factor for the
  developement of a muscle      TIGHTNESS
  injury. Muscle flexibility
  testing can identify soccer
  players at risk for
  musculoskeletal lesions.
  One-hundred-and-
  seventeen male amateur
  soccer players aged 4 to
  29 were examined for
  former injuries and
  muscular flexibility by
  using Janda's "functional
  muscular diagnostic".
  Muscle injuries and ankle
  lesions predominated
  among the injuries. The
  "functional muscular
  diagnostic" is suitable for
  screening muscular
  flexibility in soccer
  players.
                        FLEXIBILITY




• Flexibility refers to the ability to easily bend an object or the ability to
  adapt to different circumstances. Flexibility is used as a term and
  measurement in many different sciences.
• Many times this term is used in regards of muscles and thier elasicity.
  There are many different ways to increase muscle flexibility. Many
  exercises contribute to the increasion of flexibilty. Stretching
  everyday may increase your ability and help prevent injuries
 RANGE OF
TREATMENTS
EMERGENCY & IMMEDIATE TREATMENT
• First Aid is the skilled application of accepted
  principles of treatment when injury or sudden
  illnesses occur, using facilities or materials
  available at the time. It is the approved method
  of treating a casualty until placed, if necessary,
  in the case of a doctor or removed to hospital.
• First Aid has four important parts :
• Assessing the situation
• Dedicating what is wrong with the casualty
  (diagnosis)
• Giving immediate and appropriate treatment
• Disposing of the casualty - to doctor, hospital or
  home as appropriate treatments
                              D.R.A.B.C.

   If somebody has collapsed and you do not know whether they are
   conscious or not, these are the five steps to dealing with the situation.
Step 1 – D – Danger
• Check for danger to yourself if you are going to tackle a situation.
   Approach with caution and send somebody to get help. Example, are
   there any dangers around the casualty like live electric wires?
Step 2 – R – Response
• By gently shaking the casualty and shouting ‘can you hear me?’ you
   can check for a response. If they are conscious find out if they are in
   pain and proceed with R.I.C.E if the injury is manageable. If the
   casualty is unconscious move on to step three.
Step 3 – A – Airway
• Raise the chin and tilt head back to open the airway fully, remove any
   obstructions that could block the airway.
Step 4 – B - Breathing
• Kneel down with head to the side and listen for breathing while at the
   same time looking to see if the casualty’s chest is moving up and
   down. If the casualty is breathing proceed with R.I.C.E and then place
   casualty in to the recovery position. If not step five.
Step 5 – C – Circulation
• Feel for the carotid pulse in the neck, if there is no pulse give mouth to
   mouth ventilation to restore breathing also give cardiac massage and
   mouth to mouth ventilation to restore circulation and breathing.
                               R.I.C.E
    When dealing with injuries there is going to be bleeding,
   swelling and inflammation. These symptoms are best
   controlled by the R.I.C.E method.
Rest
• The healing process is best when stress is reduced. Carrying
   on with an activity that uses the injured body part only
   increases the stress.
Ice
• Applying ice to the injured body part constricts the blood
   vessels and slows down bleeding, inflammation and deadens
   some of the pain. Ice should never be directly applied to the
   skin as it can cause ice burns. Cold running water can be used
   if there is no ice.
Compression
• By using compression (tubi-grip, bandaging) on the injured
   body part the pressure exerted decreases swelling in the
   injured body part.
Elevation
• Elevation limits swelling by counteracting the effect of gravity
   which pools blood and fluids down to around the injured body
   part.
                   Resuscitation
• Cardio-pulmonary
  resuscitation, or CPR for
  short, is a life-saving
  technique which combines
  rescue breathing and
  chest compressions to
  maintain a supply of
  oxygenated blood around
  the body, most importantly
  to the brain. It’s important
  to remember that there
  are different CPR
  techniques for babies
  (aged up to 12 months)
  and children (aged
  between one and seven).          Try The interactive test
                                   which puts you
                                   virtually at the scene of
                                   an accident.
INJURIES, BLEEDING AND
        SHOCK



  Injury is one of our nations most
   serious problems. Injuries that
    damage, disable and kill are
 caused by different types of force.
         TYPES OF BLEEDING



•   EXTERNAL BLEEDING is either:
•   Arterial bleeding
•   Venous bleeding
•   Capillary bleeding
•   INTERNAL BLEEDING : can range from a
    minor to a major life threatening problem
        SPECIFIC INJURIES
• Wrap a severed body      • To control nosebleed,
  part in sterile gauze      have victim lean forward
                             and pinch nostrils
  and put in plastic bag
                             together
  on ice.
                           • If tooth is knocked out
• Do not remove an           place sterile dressing
  impaled object             directly in it’s place
• Bandage around it to     • Injuries to the mouth may
  support in place           cause breathing
                             problems- loose teeth
  MEDICAL PROFESSIONALS




        Treatment of new and recurrent injuries :

• Of all new injuries 73.6 % are not treated by medical
  professionals
• Of all new injuries treated, 39.9% are treated by family
  doctors
• 2.4% of these injuries are treated by sports clinics
• 5.0% are treated by physiotherapists
• 24% are treated by hospital casualty departments
• 3.1% are treated by other medical related services.
Physiotherapists
• Physiotherapists identify and maximise
  movement potential through health promotion,
  preventive healthcare, treatment and
  rehabilitation.
• The skills used by physiotherapists include
  manual therapy, therapeutic exercises, medical
  screening, drill work, conditioning work and the
  application of electrophysical modalities.
• Physiotherapists often help sportsmen and
  women recover from injury, return to full fitness
  and avoid further injuries.
Gary Lewin is the physiotherapist for the England football team. This interview

gives an insight into England’s medical preparations for the 2006 World Cup.

 • Gary you have been England’s
   physiotherapist since 1996 and this
   will be your third World Cup Finals.
   In what way will your experiences
   from France in 1998 and Japan in
   2002 influence your planned medical
   cover for the squad during Germany
   2006?
 • "You always gain from the experience
   of previous tournaments and our
   planning for 2006 has been meticulous.
   Dr Leif Sward (the England doctor) has
   been visiting the facilities regularly and
   he is kept updated with the fitness
   status of all of our players."
  What are the training and rehabilitation facilities like at
  England’s World Cup headquarters in Baden Baden?
• "They are excellent. We have set up a full gymnasium, working
  with Technogym, at the site of two indoor tennis courts. It will cater
  for all of our rehabilitation needs and for all of the fitness work that
  is required by our fitness coach.

  "We have also set up an area by the pool where the players
  will do a recovery day the morning after a match. There is a
  private training pitch, which has been re-laid and improved to
  a very high standard.
• "There is a hospital on site, with all of the scanning modalities we
  could possibly need.“

  What equipment will you be taking out to the England World
  Cup headquarters?
• "Full rehabilitation facilities with the help of Technogym.
• "All forms of electrotherapy.
• "All necessary medication and other medical requirements such as
  strappings, dressings etc."
  What will happen if one of the England players gets injured during the
  tournament and needs to be referred to another medical specialist, or
  for a scan? Will they come back to England?
• "Dr Sward is an orthopaedic surgeon and we have all scanning facilities on
  site at Baden Baden. "We would decide depending on the type of injury and
  liaise with the relevant club, to decide which consultant the player would
  see.“

  This year is your 20th as the head physiotherapist at Arsenal. What
  happens to the normal Premiership club rivalry when you are treating
  the England players from Manchester United, Liverpool, Chelsea etc?
• "There isn’t any. You get to know the players really well and they build up a
  trust with you. Therefore, medically it doesn’t matter which club they play
  for.“

    You’ve been at the heart of the England set up for the past ten years
    and have been on the bench for every big game. What are your most
    memorable moments from past World Cups?
•   "1 Drawing with Italy in Rome in 1997 (to qualify for the 1998 World Cup).
•   "2 Beating Argentina in Japan 2002.
•   "3 My 100th game as England's physiotherapist against Azerbaijan at St
    James Park earlier this year.
•   "4 The last match at Wembley."
              Doctor :
• Doctors treat acute injuries as
  they occur and prescribe
  medication and often refer clients
  for diagnostic tests or specialists’
  opinions.

      Orthopaedic Surgeon :
• Doctors often refer athletes to
  specialist surgeons who are
  experts on specific injuries and
  are able to diagnose and operate
  on problems identified. Area of
  specialisation includes the spine,
  foot, knee and shoulders.
     Top 5 Soccer Injuries

1.   HAMSTRING STRAIN
2.   SPRAINED ANKLE
3.   KNEE CARTILAGE TEAR
4.   HERNIA
5.   ANTERIOR CRUCIATE
     LIGAMENT
  Case Study : Roy Keane’s injury




                        Sunday 18th September 2005
• Manchester United and the Republic of Ireland have been dealt a huge
  blow, after captain Roy Keane broke the third metatarsal in his left foot
  during United’s 0-0 draw with Liverpool on Sunday.
• Keane now looks certain to miss Ireland’s crucial final World Cup qualifier
  against Switzerland on 12 October, as the metatarsal fracture is likely to
  rule him out of action for at least two months.
• The treatment of metatarsal fractures varies depending on the type and
  location of the fracture. If the fracture is due to direct trauma and the
  fracture fragments are well aligned then the treatment is immobilisation
  and non-weight bearing for 6 - 8 weeks. Immobilisation can be achieved
  using a plaster cast or a removable plastic pneumatic boot.
• The removable boot is better for a sporting
  individual, because the boot can be removed for
  physiotherapy treatment, which is aimed at
  preventing stiffness in the ankle joints. In addition,
  cardiovascular fitness can be maintained by
  performing non-weight bearing exercises in a
  swimming pool.

• On rare occasions, metatarsal fracture fragments
  are not well aligned and sometimes show a poor
  healing capacity. In these circumstances,
  orthopaedic consultants would favour surgical
  fixation. A small incision is made on the top of the
  foot and a small screw is placed down the middle of
  the fractured bone. With this method a return to
  sporting activity is usually possible after 6 - 8 weeks.

• Fracture healing can become impaired with age, but
  34 year old Keane’s high level of fitness will
  compensate for that. With Keane’s determination
  and desire to succeed there should be little chance
  that this injury is career threatening, and he should
  return towards December.
   Case Study :              Monday 10th October 2005
                       • Everton's dismal start to the
Lee Carsley's injury     season was recently compounded
                         when Lee Carsley was ruled out
                         for six weeks after having a second
                         operation to cure a knee ligament
                         problem.
                       • The Republic of Ireland
                         international originally had surgery
                         during the summer after he
                         suffered medial knee ligament
                         damage during the final match of
                         last season against Bolton in May.
                       • The thirty one year old was
                         expected to return for the start of
                         the season, but he suffered a
                         recurrence of his injury during
                         Everton’s pre season trip to
                         Thailand. The Toffee’s medical
                         team were concerned that this
                         injury was not clearing up as
                         quickly as they expected, so it was
                         decided that a second operation
                         was required.
• Everton head physio Mick Rathbone
  revealed, "For some reason the
  ligament had been repeatedly
  strained. It was healing; but it wasn't
  re-attaching itself back to the bone.
• Explaining the latest surgical
  procedure Rathbone said, "The
  surgeons literally pinned it back to
  the bone, sutured it and hopefully
  that is the end of it."
• Rathbone continued, "We gave it
  time beyond the realms of
  reasonableness. We gave it so
  many opportunities but it wasn't
  going to heal. We found that he was
  getting as close to finishing his
  rehabilitation as is possible. But in
  terms of kicking long, he couldn't do
  it.”
• Ligaments link bones to other bones and
  provide support to joints. They allow a
  normal range of movement to occur
  within a joint, but prevent unwanted
  movement that would render the joint
  unstable. In order to fulfil this function,
  ligaments must possess immense
  mechanical tensile strength. Ligaments
  consist of a protein substance called
  collagen. The organisation of collagen
  fibres gives the ligament its tensile
  strength.
• When ligament tissue is examined under
  a microscope the collagen fibres can be
  seen to be arranged in a longitudinal
  pattern to resist the stresses that are
  placed upon the ligament. The
  arrangement of the collagen fibres means
  that a great deal of force is required to
  damage ligaments. In a collision sport
  like football this force is generated by
  opposition players or when a player
  catches his foot in the turf and his whole
  body weight goes over one joint. This
  force produces structural damage to the
  joint capsule and ligaments, which is
  known as a ligament sprain.
• Inflammation follows trauma to collagen fibres
  and lasts for 3-5 days, depending on the
  severity of the injury. Chemicals are released
  which produce pain, and there is bleeding in
  the tissues. This, together with fluid from
  damaged cells, produces swelling within the
  joint, putting pressure on nerve endings and
  causing more pain.
• Rehabilitation time can be greatly reduced by
  appropriate treatment in this acute stage. This
  consists of protecting the injured part from
  further damage (e.g. the use of crutches and /
  or a brace), rest from activity involving the
  injured part, ice, compression, elevation and
  the administration of anti-inflammatory
  medication.
• In cases where the ligament becomes
  detached from the bone and doesn’t re-
  attach, then surgery is indicated. Surgical
  fixation can be achieved using 4.5 millimeter
  screws that are fixed into the bone. So long
  as the ligament remains in one piece, then no
  further healing is required, although the bone
  bruising induced by inserting the screws
  usually takes six weeks to settle. At that point
  football related activities can be resumed and
  the player can work back towards full fitness.
  TREATMENT
      &
REHABILITATION

 PROGRAMME
                        Anterior Cruciate Ligament
• The bone structure of the knee joint is formed by the femur, the tibia,
  and the patella. The ACL is one of the four main ligaments within the
  knee that connect the femur to the tibia. The knee is essentially a
  hinged joint that is held together by the medial collateral (MCL), lateral
  collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL)
  ligaments. The ACL runs diagonally in the middle of the knee,
  preventing the tibia from sliding out in front of the femur as well as
  providing rotational stability to the knee (Figure 1).
• ACL surgery begins with an
  arthroscopic examination of the inside
  of your knee. In many ways,
  arthroscopic surgery has
  revolutionized the process of ACL
  reconstruction (and orthopedic sports
  medicine in general). This surgical
  technique uses three very small
  incisions that are about 1/4 of an inch
  in length to create "portals" into the
  knee. A fiber-optic light source
  illuminates the inside of the knee and
  a video camera feeds an image to a
  monitor so that the surgeon can see
  inside the knee. A sterile saline
  solution is continuously pumped
  through the knee via a cannula so that
  the operative field is always clear.
Arthroscopy allows an orthopaedic surgeon to diagnose and treat knee
disorders by providing a clear view of the inside of the knee with small
incisions, utilizing a pencil-sized instrument called an arthroscope. The
scope contains optic fibres that transmit an image of your knee
through a small camera to a television monitor. The TV image allows
the surgeon to thoroughly examine the interior of your knee and
determine the source of your problem. During the procedure, the
surgeon also can insert surgical instruments through other small
incisions in your knee to remove or repair damaged tissues.
After the surgeon inspects the knee for damage to the
cartilage or the menisci, the remnants of the torn ACL
are removed with a high-speed shaver. This tool is a
very specialized device that is used to remove torn
ligaments or torn pieces of cartilage from the knee.
The surface of the intercondylar notch where the ACL
normally attaches to the femur is then prepared with a
high-speed burr so that the proper location for the
tunnel for fixation can be seen clearly.
REHABILITATION OF INJURIES

								
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