Ways to classify Sports injuries

Injuries are a commonplace aspect of participating in any kind of physical activity. Typically, injuries are more likely to occur in contact sports, like rugby league or soccer, but they can also result from the overuse of particular movements, such as running, in other athletic activities.

Sports injuries are usually classified as either direct or indirect (cause), soft tissue or hard tissue (location) or as acute and overuse injuries (type).

Direct and Indirect

Direct injuries are caused by an external force or collision, which is produced by a source outside of the body. For example: an injury caused when a ball or an opposing player makes contact with the athlete’s body. Direct injuries can cause fractures, sprains, bruising, dislocation and internal bleeding.

Other examples of a direct injuries are the occurrence of a broken bones as a result of mistimed intercepts in soccer or falling awkwardly after a tackle in a game of AFL, putting stress on an outstretched arm and causing a break or shoulder dislocation.

Indirect injuries are the result of either an internal force, within the body, or excessive force, from outside it. Muscle tears caused by inadequate warm ups or lifting weights which are too heavy are both examples of indirect injuries. These type of injuries can also occur when athletes demonstrate poor technique, have imbalance in their muscles, perform ballistic movements or possess weakness in a particular area of their muscle.

Indirect injuries may also occur after or apart from the bodies contact with external forces. For example, when sprinting the hamstring can tear, even though it is extended away from the contact point of the ground. The injury is caused by the excess strain placed on the muscles, ligaments and tendons.

Soft and Hard Tissue

Soft tissue injuries occur when there is damage to muscles, ligaments, tendons, skin, organs and blood vessels. Common types of soft tissue injuries include:

• muscle strains (i.e. over-stretching a quad muscle when kicking a ball in soccer)

• ligament damage (i.e. extending a joint beyond the normal range of motion, like when an ankle is caught under body after an awkward tackle)

• grazes and blisters

Soft tissue injuries may be classified as acute, meaning that they occur suddenly, or chronic, meaning they develop over time. The most common form of soft tissue injuries are a tears or strain to muscles and ligaments.

Hard tissue injuries occur when there is damage to the bones or teeth. These type of injuries are often more serious and severe than soft tissue injuries. Examples of hard tissue injuries include:

• dislocation (i.e. dislocating a knee after an awkward tackle)

• fractured bones (usually the result of excessive force such as a heavy collision)

• tooth loss (caused by an external blow to the mouth caused by a player or object)

Overuse injuries

Overuse injuries are caused by repetitive or damaging movements, which, over time, develop into more serious injuries. They typically result from low impact activities such as walking or jogging and are often dismissed in the early stages, as they generally present as mild pain. If an athlete chooses to ignore these symptoms and doesn’t allow time for the body to heal, greater problems can arise.

Shin splints, which involve a build-up in pain in the shin area, are an example of an overuse injury. Overuse injuries typically occur as a result of poor technique or a high workload on a particularly area of the body and can lead to stress fractures.

The opposite of overuse injuries are acute injuries. Acute injuries result from an instant or sudden force, which causes damage to the body, for example, a dislocated shoulder or sprained ankle.

Soft Tissue Injuries

Soft tissue injuries occur frequently and are commonly experienced by athletes in all sports. The severity of these injuries will depend of the type of damage caused to the internal structure of the body. According to the 2014 AFL injury report, hamstring strains are the most common type of injury seen in the AFL.

Tears, Sprains and Contusions

A soft tissues tears can occur after excessive stretching of the tissue or due to an excessive external force, which may cause severing.

There are three types of tears in soft tissue:

1. Sprain

Sprains occur when the joint capsule and its connecting ligaments are stretched beyond the normal range of motion. This type of injury is also described as a torn ligament fibre. Ligaments are designed to be rigid and relatively in-elastic, connecting bone to bone and providing stability to the joint. Sprains are often assessed as either grade 1 (small or slight tear), grade 2 (partial tear), or grade 3 (a complete rupture).

Injuring this area can cause damage to the stability of the joint, leading to pain, swelling and the inability to complete normal movements. It is important that athletes seek proper rehabilitation management to regain stability, strength and reduce any scar tissue that has formed. This can be a slow process.

2. Strain

Strains occur when the muscle fibres or tendons are overstretched or torn to some degree. This type of injury can be quite painful and will often result in bruising around the injured site. Tearing a hamstring by sprinting is an example of a strain. Strains can also be categorised as a grade 1, 2 or 3, depending on the severity of the injury and the number of fibres affected.

3. Contusions

Contusions are caused by a direct force or blow to an area of soft tissue on the body. For example, when an opponent’s knee strikes into the quadriceps of another player during a game of soccer. Contusions are typically described as corks, bruises or haematomas and these type of contact injuries can result in internal bleeding.

Skin abrasions, Lacerations and Blisters

Skin Abrasions

Skin abrasions occur when a force impacts the skin, causing superficial damage, no deeper than the epidermis layer of skin, although there may be slight bleeding. An example of this is when a Netballer falls over on the court. The hard surface (i.e. the force) in conjunction with the athlete’s momentum causes the skin to scrape and/or split. If the netballer has fallen on an outside court, foreign materials, such as dirt, may lodge itself into the abrasion. Treatment will involve thorough cleaning and the application of a non-stick dressing to keep the abrasion clean.

Lacerations

A laceration is an irregular tear in the skin, which leaves an open wound. Extra care is required for this type of cut to ensure the prevention of further infection. Any laceration that measures over 1 cm must be referred to a doctor, particularly in the case of a mouth or head injury.

Blisters

When fluid collects underneath the epidermal (or surface) layer of the skin and consistent rubbing occurs, blisters will form. Wearing in new shoes, extended use of equipment or an activity that requires high intensity and quick changes of direction can often result in blistering. The best treatment for blisters is rest although second skin dressings can also be applied.

Inflammatory Response

The inflammatory response is initiated when the body is injured. The purpose of this process is to protect the body and fight against any damaging substances, rid the site of dying or dead tissue cells and aid in the regeneration and repair tissue cells.

There are 3 phases of inflammatory response:

Phase 1 – The inflammatory stage:

During this phase blood flow increases to the area causing pain and swelling around the site of injury. This phase is characterized by a lack of movement and damage to the cells and surrounding tissue area.

Phase 2 – The repair and regenerative stage:

The second phase starts after the initial 48 hours and can last anywhere from 3 days to 6 weeks. During this stage damaged tissue is broken down, fibres are repaired and scar tissue forms

Phase 3 – The remodelling/ repair stage:

The final phase can take months as scar tissue production is increased and replacement tissue is strengthened.

The inflammatory response can last for up to five days, depending on the severity of the injury. It is important to seek immediate treatment for all soft tissue injuries to prevent any further damage and manage any pain the athlete may be suffering from.

Over time, treatment of these injuries can help to restore strength and flexibility, regain function, ensure the return the athlete back to their sport and prevent any reoccurrence of the injury.

When providing immediate treatment of skin injuries gloves, antibacterial wipes, sterile bandages should be used to control and avoid infection. Pressure, elevation and rest can help to control bleeding.

The RICER principle (Rest, Ice, Compression, Elevate, Referral) outlines the full range of methods which should be immediately applied to manage soft tissue injuries:

Rest: It is important to make the athlete as comfortable as possible. This may involve lying down to decrease blood flow to the injured site.

Ice: Ice, or a cold pack, should be applied to the injured site to reduce swelling, pain and vasoconstriction of blood vessels.

Compression: A firm bandage wrapped over the injured site, as well as above and below the injury, will constrict and reduce the swelling.

Elevation: The injured site must be raised above the level of the heart to restrict blood flow and reduce bleeding, swelling and pain.

Referral: After initial treatment it is essential to refer the athlete to a qualified professional (i.e. doctor/physio) so they can diagnose the injury as early as possible, provide further treatment and suggest rehabilitation plans.

Use of the HARM acronym is an effective way to remember strategies to avoid:

Heat, Alcohol, Running, Massage

Soft Tissue Injuries

Soft tissue injuries occur frequently and are commonly experienced by athletes in all sports. The severity of these injuries will depend of the type of damage caused to the internal structure of the body. According to the 2014 AFL injury report, hamstring strains are the most common type of injury seen in the AFL.

Tears, Sprains and Contusions

A soft tissues tears can occur after excessive stretching of the tissue or due to an excessive external force, which may cause severing.

There are three types of tears in soft tissue:

1. Sprain

Sprains occur when the joint capsule and its connecting ligaments are stretched beyond the normal range of motion. This type of injury is also described as a torn ligament fibre. Ligaments are designed to be rigid and relatively in-elastic, connecting bone to bone and providing stability to the joint. Sprains are often assessed as either grade 1 (small or slight tear), grade 2 (partial tear), or grade 3 (a complete rupture).

Injuring this area can cause damage to the stability of the joint, leading to pain, swelling and the inability to complete normal movements. It is important that athletes seek proper rehabilitation management to regain stability, strength and reduce any scar tissue that has formed. This can be a slow process.

2. Strain

Strains occur when the muscle fibres or tendons are overstretched or torn to some degree. This type of injury can be quite painful and will often result in bruising around the injured site. Tearing a hamstring by sprinting is an example of a strain. Strains can also be categorised as a grade 1, 2 or 3, depending on the severity of the injury and the number of fibres affected.

3. Contusions

Contusions are caused by a direct force or blow to an area of soft tissue on the body. For example, when an opponent’s knee strikes into the quadriceps of another player during a game of soccer. Contusions are typically described as corks, bruises or haematomas and these type of contact injuries can result in internal bleeding.

Skin abrasions, Lacerations and Blisters

Skin Abrasions

Skin abrasions occur when a force impacts the skin, causing superficial damage, no deeper than the epidermis layer of skin, although there may be slight bleeding. An example of this is when a Netballer falls over on the court. The hard surface (i.e. the force) in conjunction with the athlete’s momentum causes the skin to scrape and/or split. If the netballer has fallen on an outside court, foreign materials, such as dirt, may lodge itself into the abrasion. Treatment will involve thorough cleaning and the application of a non-stick dressing to keep the abrasion clean.

Lacerations

A laceration is an irregular tear in the skin, which leaves an open wound. Extra care is required for this type of cut to ensure the prevention of further infection. Any laceration that measures over 1 cm must be referred to a doctor, particularly in the case of a mouth or head injury.

Blisters

When fluid collects underneath the epidermal (or surface) layer of the skin and consistent rubbing occurs, blisters will form. Wearing in new shoes, extended use of equipment or an activity that requires high intensity and quick changes of direction can often result in blistering. The best treatment for blisters is rest although second skin dressings can also be applied.

Inflammatory Response

The inflammatory response is initiated when the body is injured. The purpose of this process is to protect the body and fight against any damaging substances, rid the site of dying or dead tissue cells and aid in the regeneration and repair tissue cells.

There are 3 phases of inflammatory response:

Phase 1 – The inflammatory stage:

During this phase blood flow increases to the area causing pain and swelling around the site of injury. This phase is characterized by a lack of movement and damage to the cells and surrounding tissue area.

Phase 2 – The repair and regenerative stage:

The second phase starts after the initial 48 hours and can last anywhere from 3 days to 6 weeks. During this stage damaged tissue is broken down, fibres are repaired and scar tissue forms

Phase 3 – The remodelling/ repair stage:

The final phase can take months as scar tissue production is increased and replacement tissue is strengthened.

The inflammatory response can last for up to five days, depending on the severity of the injury. It is important to seek immediate treatment for all soft tissue injuries to prevent any further damage and manage any pain the athlete may be suffering from.

Over time, treatment of these injuries can help to restore strength and flexibility, regain function, ensure the return the athlete back to their sport and prevent any reoccurrence of the injury.

When providing immediate treatment of skin injuries gloves, antibacterial wipes, sterile bandages should be used to control and avoid infection. Pressure, elevation and rest can help to control bleeding.

The RICER principle (Rest, Ice, Compression, Elevate, Referral) outlines the full range of methods which should be immediately applied to manage soft tissue injuries:

Rest: It is important to make the athlete as comfortable as possible. This may involve lying down to decrease blood flow to the injured site.

Ice: Ice, or a cold pack, should be applied to the injured site to reduce swelling, pain and vasoconstriction of blood vessels.

Compression: A firm bandage wrapped over the injured site, as well as above and below the injury, will constrict and reduce the swelling.

Elevation: The injured site must be raised above the level of the heart to restrict blood flow and reduce bleeding, swelling and pain.

Referral: After initial treatment it is essential to refer the athlete to a qualified professional (i.e. doctor/physio) so they can diagnose the injury as early as possible, provide further treatment and suggest rehabilitation plans.

Use of the HARM acronym is an effective way to remember strategies to avoid:

Heat, Alcohol, Running, Massage

Hard Tissue Injuries

Hard tissue injuries involve damage to the bones or teeth and are caused as a direct result of force applied to the body, resulting in fractures, dislocations and other breakages. Typically, medical assistance is required immediately when these types of injury occur.

Fractures

These are two main classifications for fractures:

1. Simple (closed) Fractures

This type of fracture is characterised by a complete break of the bone, which remains underneath the skin.

2. Compound (open) Fractures

Compound fractures occur when the bone breaks and protrudes through the skin.

These are broad classifications; there are many more types of fractures including greenstick, hairline, complicated and depressed.

Signs/Symptoms of fractures:

There are a variety of signs and symptoms, which may indicate the occurrence of a fracture or break including:

– Pain

– The break may be audible/heard

– Deformity

– Swelling

– Loss of strength/function

If athletes experience or display any of the above symptoms it is important to seek medical advice straight away. Injury management of fractures may involve the use of DRSABCD, rest, immobilisation of the area to prevent further injury (possibly by applying a splint or sling), control of bleeding and treatment for shock.

Dislocations

Dislocations are caused by the movement or dislodgment of a bone at a joint and commonly affect the joints of fingers, shoulders and knees.. The results are painful and often noticeable because of disfigurement at the site of injury. The tendons and ligaments of the injured site are also affected as dislocations stretch and tear muscle fibre around the bone.

When a dislocation occurs, the bone is forced out of the joint. Until it is physically placed back into its rightful position, it will remain out. Dislocation can cause significant weakness in the joint, even after the bone has been reinserted, increasing the chance of reoccurrence each time.

A subluxation occurs when a joint momentarily ‘pops out’ and ‘pops’ back in. This can happen instead of a dislocation and can still cause a lot of damage and weaken the surrounding ligaments by over stretching them.

Common signs and symptoms of dislocation include:

– Swelling

– Deformity

– Pain

– Lack of functionality

Injury management of dislocation involves the protection of the injured site, with a splint or sling to immobilise the joint. After the site of injury has been secured, ice, elevation and bandages can be applied to reduce swelling and provide support.

Seeking quick medical assistance is important. The injury should be x-rayed to ensure that there is damage to the surrounding nerves as a result of resetting the joint.

Hard Tissue Injuries

Hard tissue injuries involve damage to the bones or teeth and are caused as a direct result of force applied to the body, resulting in fractures, dislocations and other breakages. Typically, medical assistance is required immediately when these types of injury occur.

Fractures

These are two main classifications for fractures:

1. Simple (closed) Fractures

This type of fracture is characterised by a complete break of the bone, which remains underneath the skin.

2. Compound (open) Fractures

Compound fractures occur when the bone breaks and protrudes through the skin.

These are broad classifications; there are many more types of fractures including greenstick, hairline, complicated and depressed.

Signs/Symptoms of fractures:

There are a variety of signs and symptoms, which may indicate the occurrence of a fracture or break including:

– Pain

– The break may be audible/heard

– Deformity

– Swelling

– Loss of strength/function

If athletes experience or display any of the above symptoms it is important to seek medical advice straight away. Injury management of fractures may involve the use of DRSABCD, rest, immobilisation of the area to prevent further injury (possibly by applying a splint or sling), control of bleeding and treatment for shock.

Dislocations

Dislocations are caused by the movement or dislodgment of a bone at a joint and commonly affect the joints of fingers, shoulders and knees.. The results are painful and often noticeable because of disfigurement at the site of injury. The tendons and ligaments of the injured site are also affected as dislocations stretch and tear muscle fibre around the bone.

When a dislocation occurs, the bone is forced out of the joint. Until it is physically placed back into its rightful position, it will remain out. Dislocation can cause significant weakness in the joint, even after the bone has been reinserted, increasing the chance of reoccurrence each time.

A subluxation occurs when a joint momentarily ‘pops out’ and ‘pops’ back in. This can happen instead of a dislocation and can still cause a lot of damage and weaken the surrounding ligaments by over stretching them.

Common signs and symptoms of dislocation include:

– Swelling

– Deformity

– Pain

– Lack of functionality

Injury management of dislocation involves the protection of the injured site, with a splint or sling to immobilise the joint. After the site of injury has been secured, ice, elevation and bandages can be applied to reduce swelling and provide support.

Seeking quick medical assistance is important. The injury should be x-rayed to ensure that there is damage to the surrounding nerves as a result of resetting the joint.

Assessment of Injuries

The TOTAPS method (Talk, Observe, Touch, Active movement, Passive Movement, Skills Test) is an effective way to assess the nature and extent of an injury to a player and make a decision as to whether or not the athlete who is injured can resume playing.

Talk: The athlete should be asked a range of questions to establish what happened and how they were feeling. Potential questions include: Where is the pain? Did you hear anything? What happened to cause it? Is this the first time this has happened?

Observe: The injured site must be carefully inspected identify any signs of swelling and deformity. It can help to compare the injured site to the other side of the body. (E.g., compare one ankle to the other, to assess an ankle injury). Signs of deformity or swelling are an indication of either soft or hard tissue damage, which means further assessment and treatment from a professional is required.

Touch: If observation fails to yield results the next step involves feeling around the injured site to identify any deformity or swelling. Gentle pressure should be applied from the outside of the injury before slowly working in.

Active Movement: The athlete will need to test movement around the injured site by performing actions such as flexion, extension and rotation to determine whether the mobility of the joint has been affected. If there is no pain whilst the athlete is performing the movement by themselves then they need to complete an isometric contraction before the athlete can move ahead to the last step. If the assessor feels that the athlete does not have a full range of movement, they should progress to the next stage.

Passive Movement: If full range of movement is not evident, the assessor or sports trainer needs to physically mobilise the joint to test the range of motion and identify any instability and painful areas. The athlete must be watched to see if they exhibit signs of discomfort.

Skills Test: The final stage requires the athlete to complete sport specific movements that mimic those which are performed during the game. For example, walking, jogging, side stepping, changing direction and jumping. If the athlete can complete these and the assessor is satisfied, then they can return to play. During this test the assessor must watch the athlete for any signs of discomfort or favour towards one side. At this stage, strapping may be used to reinforce the injured site.

The athlete must complete and pass all assessment procedures in order to be considered fit enough to return to the playing field.

If the athlete is unable to complete any of the requirements from TOTAPS, then they should be referred to a medical professional for further treatment. The assessment of the injury can be stopped at any time if it is evident that the athlete is feeling pain and cannot return to the field.

Children and Young Athletes

Young athletes and young children have particular needs and require additional attention when performing in any sport or physical activity. It is also important that all athletes, parents, coaches, and support staff are aware of any conditions that children or young athletes suffer from.

Specifically, there needs to be greater focus on managing debilitating medical conditions such as asthma, epilepsy and diabetes, which are increasing in number.

Medical Conditions

Asthma

Asthma is characterised by difficulty breathing, wheezing, coughing or shortness in breath and can negatively affect an athlete if not managed properly.

Exercise can sometimes induce an asthma attack. Attacks are triggered by the way airways leading to the lungs become dilated during the exercise but constrict once the activity has finished, causing tightness in the chest area and breathing difficulties.

However, asthma should not be used as an excuse to avoid doing any exercise at all; many elite athletes are asthmatic. Regular exercise may actually be beneficial to asthmatics as it improves their endurance and lung capacity. Swimming is particularly effective as there is less impact on the nerve endings, which can cause the constriction of the airways.

Measures to control asthma include:

– Performing a gradual warm up and cool down when exercising

– The use of the Ventolin medication before exercise

– Gradually increasing exercise intensity

– Avoiding potential triggers, such as colds, and environmental factors, like pollen

– Staying hydrated

To help athletes manage their condition or deal with an attack it can help to:

– Talk to them and encourage them to relax

– Ensure they have 4 puffs of reliever (use spacer if available)

– Wait for 4 minutes; if the person isn’t breathing in a normal controlled manner after that, provide another four puffs of the reliever. If this doesn’t work, call an ambulance and repeat the initial treatment.

Diabetes

There are two types of diabetes which can affect children and young athletes.

Type 1: Type 1 diabetes, also known as an insulin dependent diabetes, and develops when the body is unable to produce insulin. Insulin is a hormone, which facilitates the movement of glucose through the body, enabling energy production.

Type 2: Type 2 diabetes is the more common variety and occurs when the body cannot create sufficient amounts of insulin or cannot use it efficiently.

Young athletes and children who have been diagnosed with diabetes may also suffer from the following conditions:

Hypoglycaemia, or low blood sugar, is a condition, which is triggered low insulin and energy levels. If blood glucose levels fall below normal athletes need to consume sugary foods, like lollies and soft drinks, to help quickly return levels to normal. Symptoms of hypoglycaemia include shaking, dizziness, confusion and a rapid pulse. When an episode occurs, athletes should be carefully monitored as it will be necessary to call emergency if their condition doesn’t improve.

Hyperglycaemia, or high blood sugar, is triggered when too much insulin is created. As insulin levels increase they pass through the urine. As a result, the athlete will likely show signs of thirst due to the dehydration and constant urination.

It is extremely important to manage and monitor the diet of a diabetic athlete. Athletes with this condition must use a mixture of food, injections and exercise to balance their insulin levels and ensure they are able to perform athletically. Exercise increases the amount and rate of sugar utilised by the body meaning that a young athlete must carefully monitor their insulin levels to ensure they maintain their blood sugar levels.

Exercise is beneficial for young people who suffer from diabetes. However, the condition must be monitored closely and controlled through changes to activity intensity so that any associated risks are minimised. Working with a doctor to create a management plan can be an effective strategy.

Epilepsy

Epilepsy is a neurological disease, which triggers seizures, or episodes, where disturbed messages are sent from the brain to the body. They are classified as either petit mal, which presents like a short loss of consciousness or disconnection, or grand mal, which are characterised by violent, uncontrolled shaking.

Being epileptic should not discourage a young person from exercise or becoming involved in sport. The first step in epilepsy management involves protecting people suffering seizures from any potential harm to themselves. If an athlete is suffering a grand mal seizure, they should not be restrained. Instead it important to ensure the area is as safe as possible and allow the seizure to finish.

Children or young athletes with epilepsy need to ensure that their coaches, trainers and other parents are aware of their condition and know how to respond to an episode. It is important that the athletes work with their doctors to assess the type of activities that they can participate in and the risks involved. Certain sports, such as water and contact sports, may not suitable or safe for patients who suffer from regular seizures or episodes.

Overuse Injuries (stress fractures)

Overuse injuries occur when repeated movements cause stress to soft tissue, resulting in discomfort and damage. These stress fractures develop over a period of time and are the result of smaller injuries, which have had insufficient time to recover and heal properly between sessions.

Overuse injuries are commonly experienced by children due to the different rates of growth between bone and muscle. They can be caused by growth spurts, extra-long training sessions for elite athletes (training load and intensity), poor technique or using equipment, which is the wrong size or weight.

Due to the increased demands placed on young athletes, especially those who excel or participate in multiple sports year-round, overuse injuries are becoming more common. Athletes are expected to train more frequently and at a higher intensity, placing more stress on pressure on the body.

‘Shin splints’ are an example of an overuse injury. This condition causes discomfort as a result of constant training or running on harder surfaces. Osgood-Schlatter Syndrome, a growing pain, which affects teenagers and commonly causes knee pain, is another example of an overuse injury.

If a child or young athlete has a suspected overuse injury, it is important seek assistance and treatment from a medical professional. Typical treatments include:

– The application of RICER principles

– Up to 8 weeks of rest

– Icing the injury to reduce inflammation

– Continuing to exercise using low impact activities such as swimming or cycling

– Learning correct technique to improve the body’s mechanics

Thermoregulation

The body tries to regulate the heat loss with heat gain in a process called thermoregulation. Children and young athletes find it more difficult to regulate their body temperature, which means they are at greater risk of hypothermia (cold) and hyperthermia (hot). Because children and young adults have underdeveloped sweat glands they are less responsive to temperature changes. Less sweat being produced, meaning less ability to cool the body down. Instead, children must rely on radiation and convection to cool them down which is not as effective as sweat evaporation.

Children also possess slower rates of acclimatisation, which means that dehydration is more likely to occur due to their shorter tolerance for extreme heat or cold conditions.

To lower the risk, it is important that appropriate clothing is worn, there is sufficient hydration and shade available on hot days and intense activities are avoided when the air temperature is over 34 degrees.

Appropriateness of Resistance Training

When designing a resistance training program for children or young athletes, it is important to remember that each individual is different. Professional sports trainers should check and evaluate the prior experience, goals and their mental capacity of each child before developing a program.

Resistance training can be beneficial for young athletes, reducing body fat percentage and increasing lean muscle mass. However, precautions should be put in place. Young athletes must be fully supervised at all times by qualified instructors and heavy lifting should be avoided until the athlete has finished growing. It is important to perfect technique first, rather than lifting for absolute strength, as the growth plates can be easily damaged.

Some young athletes mature at quicker rates and can engage in more advanced resistance training programs. Other adolescent athletes, who haven’t physically matured at the same rate, may need to focus on technique and beginner workouts.

Adult and Aged Athletes

It is important that people continue to exercise, as they get older. As people age onset of lifestyle diseases becomes more likely. Exercising regularly, maintaining aerobic health, flexibility, muscular endurance and strength, can decrease the likelihood of illnesses such as Type 2 diabetes and CVD developing.

Exercise is not just essential for physical health; it also has a positive impact on social and mental health as well.

Pre-existing health conditions can impact the performance capability of adults and aged athletes. Before exercise is undertaken, athletes should undergo medical health checks and screening ensure they are able to the participate in the planned activity or exercise, without risking their health or safety.

All exercise programs should start off at a level that is comfortable for the athlete and progress slowly to a moderate level. Activities such as yoga, walking groups or aqua aerobics are generally recommended for beginners. More serious athletes should work under the guidance of a trained coach.

Heart Conditions

Common heart conditions include heart attacks, high blood pressure and other cardiovascular problems. It is important that people continue to exercise, even after they have been diagnosed with a heart condition, to improve their overall cardiovascular health. People with a family history of cardiovascular illness should undergo regular health checks and pre-screening. They can also decrease the risk of developing a heart condition by following a program of regular exercise and consuming a healthy diet free of fat and excess salt.

People who have been diagnosed with a heart condition should seek medical clearance before exercising. They should also work with a professional to design a program that is tailored to suit their needs. It should incorporate aerobic activities, such as walking, swimming, jogging, and be no longer than 30-45 minutes in duration, with 3-4 sessions planned per week.

A moderate intensity is sufficient for this age group. Strength training programs may also be beneficial, however, they should only be completed with light training loads as heavier loads can raise an athlete’s blood pressure to an unsafe level.

Athletes and aged individuals need to carefully monitor feelings of dizziness, nausea, shortness of breath and chest pain. If these occur, they should cease exercise immediately.

Fractures and Bone Density

As people age, their bones become fragile and less dense. Exercise can help combat this degeneration by building bone strength and reducing the risk of conditions like osteoporosis, a degenerative disease where bones become brittle and are more likely to fracture.

Exercise is particularly important for athletes who are post-menopausal, as this process results in a significant loss of bone density. Hard tissue injuries are particular hard to recovr from for older athletes and can lead to a loss of independence.

Sport and exercise are positive activities which encourage older people socialise, whilst also improving their physical health. Older athletes should participate in safe exercises, which focus on balance, strength and coordination to reduce the risk of injury. All new activities should be approved by a doctor and actively supervised to ensure that there is a low risk of injury.

Aged athletes can, and should, participate in a range of activities, including:

– Walking

– Swimming

– Low impact activities like water aerobics, which build joint strength and mobility

– Low resistance strengthening exercises, which focus on the core muscle groups

Flexibility and Joint Mobility

The level of flexibility and joint mobility decrease as people age. This can make it harder to complete everyday tasks such as housework and gardening without feeling some level of discomfort. It is important that older people and aged athletes continue to stretch before and after any physical activity. Regular exercise and physical activity can help relieve the symptoms of common conditions older people suffer from, like arthritis and muscle aches.

Training programs should incorporate low impact exercises, which take into account any medical conditions which may limit mobility. Activities such as walking, yoga, pilates and swimming are designed to increase flexibility, strength, and balance. Gentle, low impact exercises like these can help older athletes improve the quality of their lives.

Female Athletes

There are a variety of medical issues that may impact the performance levels and health of female athletes.

Eating Disorders

There are a number of sports, including gymnastics, dancing and synchronised swimming, which place additional pressure on women. Athletes who compete in these sports face additional expectation relating to their weight, shape and general appearance. Female athletes who participate in these sports are not only expected to perform at an elite level, they are told they must look a certain way as well.

Due to this focus on physical appearance, female athletes are more likely to develop eating disorders than their male counterparts, especially if they compete in gymnastics, body-building, ice skating or dancing.

An eating disorder is a psychologically driven disorder, which manifests in the adoption of certain behaviours including vomiting, starvation or binge eating. Anorexia nervosa (insufficient eating or starvation) and bulimia nervosa (binge eating, followed by vomiting) are the two most common types of eating disorder.

Eating disorders are a serious health concern and can have severe consequences. Athletes who suffer from these conditions often lack essential nutrients in their diet and are frequently dehydrated; factors which have a significant impact on their performance.

To stop these kinds of disorders from occurring, it is important that parents, friends and coaches encourage female athletes to develop positive, realistic and healthy habits and attitudes towards their self-worth and image.

Awareness of warning signs, such as changes in mood, increased training or exercise and a rapid change in their body shape, can also help prevent the development of disorders. Parents and coaches who are concerned about the health of their athletes should carefully observe training routines and monitor eating habits.

Iron Deficiency

Iron is the active component of haemoglobin, which is found red blood cells, and is very important for the body as it aids in the delivery of oxygen to working muscles. A lack of iron in the system causes anaemia, a condition which develops when there are abnormally low levels of haemoglobin in the body.

A lack of iron indicates that there is a reduction in the quantity of red blood cells in the body, limiting the oxygen carrying capability of the blood. This means less oxygen is delivered to parts of the body that need it, leading to fatigue and energy loss.

Female athletes are more likely to suffer from iron deficiency as they generally consume less red meat (which is high in iron) and lose red blood cells during menstruation. Low levels of iron can also affect athletes who undergo higher levels of endurance training because their body requires the delivery of more oxygen to working muscles, for longer periods of time.

Female athletes who suffer from iron deficiency will experience feelings of fatigue and low levels of energy during and after exercise. As a result, they may find it difficult to train at a high intensity.

Working with a nutritionist or dietician can help athletes monitor their iron levels and ensure their diet is high in lean red meat, leafy green salads, vegetables and other foods which are rich in nutrients like iron. Athletes may also take supplements to treat iron deficiency, although these should only be taken under the guidance and supervision of a doctor or dietician.

Bone Density

Bone density is impacted by the amount of calcium in the bones. If athletes have poor bone density, they are more likely to suffer from fractures and diseases like osteoporosis. They may also experience decreased mobility and pain.

It is important that, from a young age, female athletes consume adequate levels of calcium by incorporating foods like milk, cheese and salmon in their diet. Undertaking weight bearing exercise activities can also help athletes to strengthen their bones. This is particularly important for female athletes because after menopause they lose calcium at a quicker rate, increasing the risk of developing bone diseases like osteoporosis.

Pregnancy

Pregnant women are encouraged to exercise and participate in regular physical activity to maintain their health. It is important that this exercise remains at a moderate level to ensure cardiovascular fitness. The intensity of the exercise must decrease in the 3^rd trimester, as only gentle activities are recommended.

Pregnant women should exercise during cooler periods of the day and stay hydrated. Women find it hard to regulate their temperature when they are pregnant and it is important to avoid placing stress on the developing foetus.

Although female athlete can continue to participate in competitive sport, they should avoid contact sports, like basketball and rugby, after the first trimester. Activities such as walking, swimming, yoga are all safe exercises for pregnant women.

Physical Preparation

Preparation is integral to the development of a healthy training regime and athletic success. Athletes are encouraged to physically ready themselves during training and before an event to reduce the likelihood of injury occurring. The body must be prepared to endure the physical demands and stress of the activity being undertaken.

Pre-screening

Pre-screening involves the assessment of an athlete’s level of health before they become instigate a new training program. Not only does the athlete provide information about their medical history, but they also discuss their physical capabilities as well as their training expectations and objectives.

Pre-screening programs are conducted to:

– Identify any previous, ongoing or recurring health issues

– Aid in the design of a suitable training program for the individual

– Check the motivation of the athlete and identify the goals that they have

– Collect information about the age, weight, exercise history and previous experience of the athlete

These criteria are helpful and can help a trainer isolate areas of need in terms of health. This information will also guide and dictate the types of activities which are suitable and well suited to the athlete.

Pre-screening is particularly important if you:

– Are male and over 40

– Have asthma

– Suffer or have a family history of heart problems

– Are pregnant

Pre-screening prevents injuries, reduces the occurrence muscle soreness and promotes high levels of motivation by ensuring that programs are tailored to the unique needs of the individual athlete. Every athlete can benefit from understanding their limitations and utilising programs which have been designed with the FITT principle (frequency, intensity, type, time) in mind.

Skill and Technique

To prevent injury, it is important that athletes conduct as much training as possible to properly develop and improve the skills and techniques relevant to their sport. A common cause of injury is the repetition of incorrect or poorly executed movements. It is essential that coaches understand the needs of the athlete and possess knowledge of how the body works and the correct processes for technical skills.

For example, a rugby league player needs to learn to correctly and safely execute a tackle, ensuring that they place their head in the right position to avoid injury. Another example involves learning how to correctly swing a golf club. Poor body position can place excess stress on different areas of the back, causing pain.

Correctly developing skills and techniques can help the athlete to reduce the occurrence and severity of injuries.

Physical Fitness

To effectively participate in their chosen sport or activity athletes need to develop the fitness levels required to complete a whole game or session without fatigue. Working on overall physical health also reduces the likelihood of injury. Athletes must to ensure that their body has sufficient energy supplies and levels so that they can reach peak performance. This involves a balance of both health and skill related components of fitness training.

Athletes will need to focus on specific aspects trailing so that their physical fitness suits the sport or activity they want to participate in. For example, a cross country runner would embark on a cardiovascular endurance training program to increase their physical fitness level. Conversely, a gymnast would need to focus more on their flexibility, muscular strength and general endurance training to develop and improve their levels of physical fitness.

Health Related Components of Fitness

Health Related Components of Fitness

Skill Related Components of Fitness

Cardio-respiratory endurance

Speed

Muscular strength

Agility

Muscular Endurance

Reaction time

Flexibility

Balance

Body Composition

Coordination

Power

Warm up, Stretching and Cool Down

Warm ups, stretching and cool downs are important aspects of an athlete’s routine.

Warm ups are specific to the nature of the sport or activity that the athlete is participating in and are designed to gradually prepare an athlete for the physical and mental components of competition. It is uncommon to see an athlete not conduct any warm up before they play. These exercises improve the flexibility and strength of the muscles, while also increasing blood flow, ensuring that oxygen delivery is at maximum efficiency.

Warm up sessions vary in length, depending on sport or activity. Generally, a 20 – 25 minute warm up is considered adequate for a sport, which involves moderate to high levels of intensity over an extended period, such as soccer or rugby union. Athletes competing in sport which require more explosive movements, such as a sprinting, may require a longer warm up session.

A good warm up will include aerobic activity, sport specific movements and a variety of stretching exercises, including static (not moving) , PNF (partner stretches; a static stretch followed by isometric contraction with a partner) and dynamic (leg swings).

A cool down is often neglected by athletes but can help the body return to its pre-game state. The cool down is designed to ease the body into recovery mode, reduce the severity of aches and decrease the likelihood of blood pooling in the body’s extremities. It also aids in the removal of lactic acid and can reduce the likelihood of delayed muscle soreness from occurring (DOMS). Static stretching is the best type of exercise for a cool down.

Sports Policy and the Sports Environment

Rules of sports and activities

Rules are designed to protect the athlete from injury and are usually enforced by referee’s or umpires on the field. In high impact sports such as rugby league or AFL, there is a greater potential for injury. The sport protects its’ athletes by having game laws and processes to deal with athletes who abuse or break them. For example, in rugby there are a number of ‘illegal tactics’, such as high tackles, and players who use these stragies may be dismissed from the field of play or suspended from several games.

Other types of regulations include the use of protective equipment like shin pads in soccer or helmets in cricket. These rules are created and enforced to increase and promote safety in sport.

Modified rules for Children

Recent modifications have taken place in junior sports to create an environment that lowers the risk of injury and focuses more on participation and enjoyment, rather than results. The modified games still encourage skill and tactical development, however, they are primarily designed to ensure safety for young athletes.

Some examples of modified sports include:

• Kanga or milo cricket – plastic bats, rubber ball, everyone has a bowl and a bat

• Basketball – lowering the ring to enhance the ability to score

• Little athletics – lighter equipment and reduced distances to encourage participation and increase success

• Rooball (soccer) – smaller fields, smaller goals, fewer players

• Mod league –two passes from dummy half before defence can move

These modifications are designed to meet the specific needs of young people and help develop a love of sport and exercise. Depending on the sport, changes may include field size, length of the game, rules and equipment.

Matching of Opponents

In most sports it is common for athletes to be matched up according to their age, weight or gender. This is fine for sports such as athletics, however for contact sports such as rugby league or rugby union, players of the same age may have a 10-20kgs weight difference, which can be an issue due to the amount of tackling in the game. Players with extra weight are harder to tackle and possess a power advantage over smaller athletes.

Accordingly, some sports have discussed changing the rules to match players based on weight and size. Unfortunately, this could mean that a larger unskilled child may end up playing against an older, more mature player at the same size. While they are even physically, the psychological difference is still a concern.

Many sports, like boxing and judo, have weight divisions, which are designed to protect the health of the athletes.

Junior sports competitions need to be even to help aid in the development of skill. When there is a close, even competition, it makes the game more interesting for the players.

Use of Protective Equipment

Wearing protective equipment is a requirement of most sports. Whether it is a mouth guard in league or a shin pad in soccer, most sporting competitions will make wearing protective gear compulsory, by making it part of a mandatory guideline.

Protective equipment must be comfortable and fit properly. For example, a cricket helmet must be the correct size for the player as gear that is too loose or tight will fail to prevent or protect the athlete from injury. If the helmet doesn’t have a metal grill the player faces the risk of facial injuries.

Athletes are encouraged to purchase high quality equipment to protect themselves. Some other examples of protective gear include:

– Wetsuits

– Goggles

– Mouth guards

– Helmets

– Padded pole posts

– Good quality shoes

Safe Grounds, Equipment and Facilities

Athlete safety is important. All grounds, equipment and facilities must be maintained to provide a safe environment, with minimal potential for injury, for all athletes to compete in. Councils, clubs and associations are all responsible for the maintenance of playing fields.

Playing surfaces should be flat and free from rubbish, like bottles, and other obstructions, such as sprinkler heads. It is also essential that the lighting is adequate and that there is access for emergency vehicles. Local councils and associations must determine if fields and grounds are suitable for play during wet weather and other conditions.

Clubs are responsible for setting out guidelines for coaches, managers and spectators. This may include enforcing a minimum distance between fans and the playing field as well as the provision of first aid staff and facilities. Due to a number of recent deaths, there has been a recent push for all local clubs to have access to a defibrillator, in case of emergency.

All equipment must be checked regularly and before each use to ensure it is the correct size, maintained correctly and used properly.

Environmental Considerations

Environment factors, such as temperature, humidity and wind, can present a number of hazards for athletes. Planning can minimise the risk, however a climatic change can catch an athlete off guard if they are participating in outdoor events.

Temperature Regulation

A person’s normal core body temperature is between 36° and 37° Celsius. If this drops below 36°, the body begins to shiver; anything over 38° is classified as a fever. These responses are triggered by the hypothalamus, the body’s thermostat. The body has different processes to deal with heat loss or gain: convection, conduction, radiation and evaporation.

Convection occurs when fluid, in the water or air, draws heat away from the skin as it passes over. For example, when an athlete is running, the air that they move through draws heat away from the skin and cools the body. On cold days, athletes will wear tighter clothing to trap heat in. For example, cold players will wear a long sleeve jersey in soccer or AFL.

Conduction describes the process when heat from an athlete’s skin or body is transferred onto another object. A cyclist transfers heat onto the seat of their bicycle, while a baseball player will transfer heat from their hand to the catching mit.

Radiation occurs naturally when the body becomes warm and radiates heat into the atmosphere. For example, if you stand near a person who has been working hard, it is possible feel the heat coming off them.

Evaporation occurs when the body sweats; when water evaporates on the skin it cools the body. This is the most effective way for an athlete to cool down, particularly in hot temperatures. During this process it is important to keep up hydration to counteract the fluid being lost. Athletes should also wear clothing that ‘breathes’ to help with the process, drawing sweat away from the body, as this can help prevent dehydration

Climatic Conditions

Climatic conditions, including temperature, wind, rain, humidity, altitude and pollution, can have an impact on the performance and health of an athlete. Changing conditions can have a negative and harmful effect on an athlete. It is important that athletes are fully prepared when training to compete in different climatic conditions.

Temperature

When an athlete competes or performs in the 15-25 degree Celsius temperature range, there is little risk to the body. However, when the competition occurs in conditions which are warmer or cooler than these temperatures, there is need for concern.

It is important that when the temperature rises above this range that there are adequate rest and fluid breaks for athletes. Athletes risk dehydration, as a result sweating and insufficient fluid intake, along with heat stroke when exercising in hot or humid conditions. Wearing light, loose clothing can help players regulate their temperature.

Hypothermia occurs when the players rapidly lose body heat. To avoid the onset of conditions like this, athletes should prepare and wear appropriate clothing when exercising in extreme, cold environments.

Humidity

When the level of humidity is high, exercising becomes more dangerous. Humid conditions make it difficult for the body to rid itself of heat through the natural process of evaporation. When the temperature is high, above 25 degrees, and the humidity level is also high, 75 percent or higher, athletes should exercise with extreme caution.

Wind

When athletes exercise or compete in windy conditions, it can increase the convection. This can be quite dangerous in cold conditions, as the body cools quite quickly. Athletes will often refer to this as wind chill. Strong winds can cause burning sensations against the skin. Protective wear, like wetsuits, can help athletes to mitigate the effects of wind chill.

Rain

Rain can make playing surfaces slippery and dangerous, negatively impacting of the safety of athletes. Examples of high risk situations include an athlete playing soccer on a wet field without the right studs on their shoes, or a cyclist in the Tour de France having their vision limited by the rain. When rain is coupled with wind, it can increase the likelihood of hypothermia occurring.

Altitude

Athletes who compete at a higher altitude (above 1500m) will experience lower oxygen levels, which can have an impact on their health and ability to perform aerobic activities. The body can adapt to this scenario, but this takes time. Physiological adaptations, for example increased red blood cells and lung capacity, are possible, however, the athlete will need to acclimatise to this condition before competing.

Pollution

Pollution is a safety hazard. It can be dangerous to train around city areas as polluted air contains irritants, which can effect breathing. Carbon monoxide, which is a common element of polluted air, is particularly dangerous. This pollutant can bind to haemoglobin in the blood, which negatively effects the body’s ability to deliver sufficient oxygen to working muscles.

Guidelines for Fluid Intake

The body can lose a great deal of fluid through sweat (evaporation), which needs to be replaced. Water in the body is needed for thermoregulation (temperature regulation). Water is also required for blood plasma. Any reduction in the water level can cause blood pressure to decrease, meaning that there is less blood being made available to the working muscles.

Thirst is not a good indicator of when you should take on fluid because the body will need water before you feel a desire for fluid. As you dehydrate you will continue to fatigue, which can lead to heat stress on your body, heat stroke or, in severe circumstances, death.

It is important to consciously and regularly drink water throughout exercise before thirst kicks in to maintain safe hydration levels. A simple way to assess hydration is to monitor urine. If it is clear or pale, hydration levels are sufficient. Yellow or darker urine indicates dehydration and the need for more fluids.

Acclimatisation

It is important that athletes identify the different environmental conditions that they will be competing in as they will need to prepare and adapt their bodies so that they are able perform in unfamiliar climates.

The term acclimatisation describes this process of adapting to new climate conditions and may involve training in extreme temperatures (hot and cold), high levels of humidity, wind chill and high altitudes. As a result of this training, the athlete will experience physiological changes to help them cope with the new conditions. This process can take up to 3 weeks.

Long distance athletes will often train in places of high altitude before competition to develop the body’s ability to produce red blood cells so that when they compete, their body has already adapted to this. However, there are now machines used in sport laboratories, like hyperbaric chambers, which can simulate different altitudes so that athletes no longer have to travel overseas to prepare themselves for competition.

Taping and Bandaging

Taping and bandaging can be used to prevent injury from occurring or to aid in recovery or rehabilitation after injury.

Preventative Taping

Preventative taping is most commonly applied to joint areas to strengthen, support or prevent the joint from exceeding its normal range of motion during movement. It is also beneficial for an athlete who may have had a previous injury or weakness. Any sport that requires explosive movements or change in direction, like basketball, tennis or soccer, places stress on joints, meaning that players can benefit from this form of taping. The main areas that athletes apply preventative taping to are the ankle, knee, shoulders and fingers (particularly thumbs).

It is important that athletes not rely on taping in the long term as they may become psychologically dependent on it, rather than simply using it to strengthen a weakened site or for rehabilitation. Taping can also be used on muscles, provideing compression and or support.

Taping for Isolation of Injury

Early in rehabilitation, taping is used to provide support and prevent any further damage by immobilising or isolating the site of injury. Immobilisation can help athletes get through training and allow work on their conditioning while they are in rehab mode.

This type of taping can also be useful for an athlete returning from injury back to training by preventing them from moving their body incorrectly. Isolation or immobilisation can increase an athlete’s sense of proprioceptive awareness, which is their ability to correct and avoid potentially dangerous positions. An ability which may have been lost during the recovery process.

Bandaging for the Immediate Treatment of Injury

Bandaging immediately after first aid has been applied to an injury or to secure an injury for ongoing treatment. The RICER principles support the use of a compression bandage to reduce swelling and blood flow to the injured area. Bandaging can also be used to immobilise an injured site.

REHABILITATION PROCEDURES

-­‐ Rehabilitation àprocess of restoring athlete to the pre-­‐injury level of physical fitness

-­‐ Involves mobilisation, stretching, conditioning, taping, training & testing

Po-­‐po May GET CHU

Progressive Mobilisation Graduated Exercise Training Cold + Heat Use

PROGRESSIVE MOBILISATION

àGradually extending the ROM through which the injured part can be manipulated

-­‐ Joint mobilisation is achieved through active exercises (performed by athlete) + passive methods (manipulation by another person)

-­‐ Very important to ensure scar tissue development doesn’t ↓ mobility

-­‐ Mobilisation shouldn’t be commenced during acute inflammatory phase

-­‐ M’ment should be slow/progressive rather than sharp/rapid

GRADUATED EXERCISE

(STRETCHING, CONDITIONING, TOTAL BODY FITNESS)

Stretching

-­‐ Important to ensure injured area heals without scarring, which shortens muscle & makes it prone to further injury

-­‐ Loss of flexibility occurs as result of injury to muscle. Stretching during rehab is important as it ↓s muscle tension which ↑s circulation, ↑ing muscle + tendon length & ROM

-­‐ PNF = most effective type as it stretches, strengthens & also stimulates proprioceptors in the muscle + connection tissue

-­‐ Passive stretching (machine, partner, physio) common in sports rehab as it’s a safe & effective way to lengthen soft tissue beyond normal length

Conditioning -­‐ Implies a build-­‐up of fitness as a result of adaptations to gradual ↑s in physical stress -­‐ Need to be individualised

-­‐ Effective conditioning applies the SPECIFICITY + OVERLOAD principles

-­‐ The conditioning regime needs to target general cardio respiratory fitness together with

↑ing need for strength, power & local muscular endurance around injured area

-­‐ Isokinetic exercises are considered beneficial at this stage as they develop strength through full ROM – important to monitor ↑ing strength of both agonist + antagonist muscles

Total body fitness

-­‐ About REGAINING pre-­‐injury fitness both PHYSICALLY + MENTALLY -­‐ Rehab adaptations that need to be present in athlete include:

- Hypertrophy (↑ed size) of muscles

- Strengthening of tendons & ligaments

- ↑ed elasticity of fibred

- ↑ed joint mobility

- Absence of all pain

- Fully restored balance & coordination

i Full confidence in knowing that injured area can handle match stress

-­‐ Maintenance of flexibility, strength & endurance should be promoted during rehabilitation, and they should be activities specific to sport. All activities should NOT endanger recovery from injury

-­‐ Examples of activities that promote overall body fitness:

- Swimming/water resistance activities

- Light walking/jogging

- Rowing/cycling ergo meters

TRAINING

-­‐ When total body fitness is achieved, full training can resume. Specific games skills, confidence, timing, speed & coordination have all been adversely affected due to their time off. By returning to training, the athlete is able to work on the physical & psychological demands of competition -­‐ Before returning to comp, the athlete MUST be able to display skill proficiency, delay fatigue & perform skills under pressure

-­‐ To determine their readiness to return to comp, most athletes will undergo testing

USE OF HEAT AND COLD

-­‐ Heat & cold methods are used based on the TYPE of injury the athlete has sustained

Heat

-­‐ Heat methods are used to ↑ circulation -­‐ The use of heat methods aim to:

↓ pain

↑ ability to stretch

↑ relaxation

↑ blood flow

↓ joint stiffness & muscle spasm

↑ tissue healing

-­‐ Heat can be applied via:

- Heat packs

- Hydrotherapy

- Infrared lamps à Ultrasounds

-­‐ DO NOT apply heat to acute injuries, heat should only be applied after the internal bleeding has ceased (48hrs)

Cold

-­‐ Ice = most common cold method used

-­‐ Cold treatments treat acute phase of injury & after therapeutic exercise of injured area -­‐ Cold methods are used to:

↓ swelling

↓ circulation to injured site

↓ acute inflammation

↓ pain & discomfort

↓ muscle spasm

↓ tissue metabolism

-­‐ Cold treatment should be applied regularly during the first 24-­‐48hrs of injury

Return to Play

Athletes will generally want to return to their sport as soon as possible. Care must be taken, through rehabilitation procedures, to ensure that they only return when they are fit and ready to minimise the risk of re-injury. This process involves discussions between the player, coach, team doctor or team/individual physiotherapist to ensure that all parties are satisfied that the athlete is ready to return to play.

Indicators of readiness for return to play (pain free, degree of mobility)

Before an injured athlete can return to normal competition, they need to undergo testing to ensure that they are both psychologically and physically prepared. Active and effective rehabilitation will ensure the healing process has resulted in a marked improvement to the injured site. Testing should demonstrate that the athlete has a full range of movement at the injured site, so that the athlete can push the recovered part of the body to a high intensity in competition. The athlete should have also developed improved strength and flexibility, which will be evident after basic skill and fitness testing is conducted.

Confidence is important for the athlete as they need to be able to put their body in situations that may challenge the injured site. If they are not confident, they increase the chance of re-injury or poor performance.

Monitoring Progress (Pre-test and post-test)

It is important to monitor progress throughout the rehabilitation phase of an injury. Comparing results from pre-tests to those of test conducted after the injury was sustained will reveal whether any progress has been made. For example, comparing the results of pre-testing, determined Range of Motion (ROM) with those obtained after injury rehabilitation has taken place.

Before returning to competition, athletes will usually need to test the injured site by completing a series of sports specific exercises. For example, a soccer player returning from a hamstring strain may be required to complete activities which focus on speed, change of direction, intense movements and striking. Athletes need to be able to complete these activities without pain and at 100% effort to match a game situation and demonstrate they are ready to return to play.

These tests are designed to assess the power, strength, flexibility and proprioception of the recovering athlete. If the activity cannot be completed in a similar fashion to how it was prior to injury, then the athlete should continue rehabilitation.

Psychological Readiness

In order to be considered fit for play and athlete must possess confidence in their abilities and positive outlook. Mental attitudes contribute significantly to recovery and the prevention of re-injury.

Many athletes want to return to their sport as soon as possible when they injure themselves. Others often feel externally pressured to play due to the expectations of media, sponsors or club directors, even though they don’t feel confident themselves. Both of these situations can often result in re-injury.

There needs to be open communication between the player, coach and sports psychologist to ensure that the athlete is mentally ready to compete again. Ideally an athlete must demonstrate a healthy balance of motivation, common-sense and a self-awareness before they can safely return to the game.

Specific Warm up Procedures

After injury elite athletes will develop specific warm up routines to minimise re-injury. It may need to focus on the injured site to ensure that there is adequate blood flow. They may also incorporate mental exercises to build confidence and reassurance. For example, an AFL player who is returning from a hamstring injury will spend more time warming up that area of his body, completing additional hamstring and quadriceps stretches. It is important that mentally, the athlete knows that they have warmed up in a safe environment and pushed that particular muscle group past what it may be expected to go through in the field. This will reassure the player that they have recovered and are ready to play.

Return to Play Policies and Procedures

The decision to return to play will be impacted by the severity of the injury. Individuals who do not play at an elite level are encouraged to make a decision based on discussion with their physiotherapist, trainer or doctor to ensure they are completely recovered. Parents will often make this decision for child athletes, in consultation with the medical professional.

At the professional level, there are different actions. which must be completed before an athlete is considered ready to play again. These types of protocols may include:

– consultation with appropriate medical professionals

– review of x-rays/ scans and medical reports

– rehabilitation discussions and preventative strapping advice

– a fitness assessment, which includes specific testing

– participation in a range of sport specific movements as part of an injury skills test

Depending on the sport and the level of competition, different coaches may draw on their own experiences to create specific criteria for individual athletes to determine whether they are fit for competition. They may have a system which allows the athlete to return via a less stressful environment, which will put less stress on the injured site, such as assigning them to a reserve grade game in soccer or rugby league. This type of strategy will often be impacted by the type of injury as well as the timing of the competition.

Each sport should have a return to play policy which addresses the different requirements of the athlete and coach, prior to return after an ijury. These include:

– Ensuring the athlete is safe and functional

– Identifying the potential risks to safety of others competing

– The requirements of the sport and whether the injury impacts this

At all levels, it is important that documents are kept and recorded to cover liability in case of re-injury.

Ethical Considerations (e.g. pressure to participate, use of painkillers)

Elite athletes often feel pressured to return to play as soon as possible. They may be trying to maintain a particular position on the team, fighting for a new contract or expected to play during a big game.

This pressure often comes from external sources like sponsors, fans and the team, which may force the athlete to return to the sport before they are ready. Athletes may also experience internal pressure caused by their own expectations about their success, motivation, ambition and self-worth. Unfortunately, these factor may lead athletes to use painkillers or other drugs in an effort to give them the temporary energy or relief they need to play their sport.

Younger athletes are frequently pressured by parents or coaches to perform, which can result in additional injury if they aren’t provided with an adequate recovery period following the initial injury.

Some injuries, like concussions, require the completion of compulsory documented procedures before an athlete can return to play. These kinds of regulations can protect athletes. The pressure to return to play, even a week early, can often result in further injury.

Athletes face a range of external and internal pressures, which may force them to return to play before they are ready. For example:

– Financial pressure

– Drive to win

– Sponsors

– Fans

– Friends and Family

However, the main priority of every athlete should be to maintain their health, safety and wellbeing.