Dr Aparajitha Krishnan

Sports Physician
Hospital Sungai Buloh

kinds of injuries that occur during sports

or exercise.
Due to :
1) accidents
2) poor training practices
3) improper equipment,
4) lack of conditioning,
5) insufficient warm up/down

the term is viz.ly reserved for injuries that

involve the MSK system i.e. :
Muscles
Bones
Cartilage
Ligaments
Tendons

H = history
O= observation
P = palpation
S = special test
I = investigation
T =treatment

History: Attitude, mental condition, and

perceived physical state.
Stated

by the athlete.
Primary Complaint
Mechanism of Injury
Characteristics of the Symptoms
Limitations
Past History

Observation:
General

Appearance

Consciousness
Posture

and Gait

Deformity,

swelling, discoloration, scars, and

general skin condition

Rule out #
Skin temperature/ wettedness
Swelling
Tenderness
Deformity
Muscle spasm

Caused by an interaction between an

outside force and the body
Causing :1.An abrasion/laceration/blister
2.A sprain/strain
3.A subluxation/dislocation
4.A fracture

 Enviromental factors causing

1)Heat injuries
exercise induced collapse
heat cramps
heat stroke
2) Cold injuries
hypothermia

Mechanism of onset= application of force, such as

scraping or friction to the outer layer of skin
Eg tackle on a dry, hard surface which causes the skin
to be scraped off.
Treatment :
gentle cleansing with flavin to prevent infection.
If laceration is >1cm wide or with active bleedingrefer
to dr
If laceration is over lip or eyelid refer dr

An injury to a ligament results from

overstretching

Severity =from tissue microtrauma to total

disruption of the tissues.

Areas of the body most vulnerable to sprains are

ankles, knees, and wrists.

Signs of a sprain include :

a) tenderness
b) bruising
c) inflammation
d) swelling;
e) inability to move a limb or joint
f) joint laxity or instability.

when the ligaments have been stretched but

not torn.
Symptoms include:
Mild pain
Some swelling
Mild joint stiffness
Slight pain with functioning

is a partial tearing of the ligament.

Symptoms include:
Significant swelling
Bruising
Moderate pain
Some loss of motion

Stressing the joint is painful,

The ligament has been torn completely.

Symptoms include:
Severe swelling
Severe pain
Instability of the joint
Complete loss of function
Stressing the joint is less painful because the ligament is
completely torn and is not being stretched,

Phase 1
immobilize the area
PRICEM for 24-72
hours.

move patient to a safe area

immobilize
bandage
tape

1st 24-72hrs maintain area w/o

unnessary activity
2 types
a)active restspecifically do not do
activity aka absolute rest

b)Passive restdoing activities of

daily living

The 1st 24 72 hrs

o Method**
o For 15-20min
o With 1-2 hr betw applications
o Aim minimise swelling n pain
o

The way which ice is applied will vary

according to the required effects.
It may be applied in the following ways:
Ice

towels
Ice packs
Immersion
Ice cube massage
Ice spray
Cold gel

oDecrease metabolism of cell

oVasoconstrictionreduce heamatoma
p substance entry is
reduced
oDelays inflammation
oincreases action potential of mast
cells
oreduces firing of nerves
oDecrease muscle spasm by inhibiting

oRaynauds phenomena
oSLE
oVasculitis
oMultiple myeloma
oCold urticaria

Compression
limits space of swelling
Distribute localised edema ie
available for reabsorption into
circulation
Elevation
increases venous flow

NSAIDs
Cox-2 inhibitors
Opioids
Paracetamol

Heat
Heat increases the bleeding at the injured
site.
Avoid hot baths and showers, saunas, hot
water bottles, heat packs and liniments.

Alcohol increases bleeding and swelling at

the injury site, and delays healing.
It can also mask the pain of the injury

Underestimate severity so player wont seek

treatment as early as they should.

as it cause further damage.

should not resume exercise within 72 hours
of an injury

Massage
Increase in bleeding and swelling
should be avoided in 1st 72 hours

Heat injury is 48-72 hours old

Earlier =worsens the bleeding and inflammation.
Heat can be applied in the form of:
Deep heat creams
Heat pads
Hot water bottles
Heat lamps
Heat dilates the blood vessels so more blood to the area
It eases pain and muscle spasms.
Heat can burn the skin.

Fracture

A fracture is a loss of
continuity in the bones
surface.

What is a Fracture?

A fracture is a break, crack, or chip in the bone.

Signs &Symptoms of a Fracture

The player or others may have heard a crack.

There will be localised pain
Sometimes there can be a visible deformity
Localised swelling & bruising.
The player may be unwilling or unable to move or put weight
on the limb.
Sometimes there can be numbness or tingling
(pins & needles).

Treatment of a Fracture
Do not move the player.
Immobilise the injured
limb.
Call an ambulance.
Keep player warm.
Monitor
pr/bp/consciousness

If athlete is experiencing any symptoms of heat illness, initiate action plan:

Heat Stress (Mild):
S/S:

Cramping

Txm:Remove from sun

Dizziness / Light headed

Nausea/Vomiting

Remove clothing and

equipment

Rapid Breathing

Encourage athlete to
drink fluids
Apply ice towels to
axilla/groin/head/neck

Monitor and record vitals every 3-5 minutes.

Heat Exhaustion (Moderate):

S/S:

Cramping

Txm:

Extreme Exhaustion

Treatment same as Heat Stress +

Dizziness/ light headed

Moist / Pale / Cool skin

Visual Disturbances

Altered mental state

Increased body temp (>102)

Cool with fans if available

Elevate legs

sponging w cold water

Monitor and record vitals every 3-5 minutes

Heat Stroke (Severe):

S/S:

Staggering

Txm:

Hot / Dry skin

same as heat exhaution + ice bath

Altered mental state

Severe headache

Increased body temp (>104)

Weak pulse

Decreased blood pressure

Monitor and record vitals every 3-5 minutes

Causes: Improper clothing

Unfavourable weather
Aged/infant
1) Cold

induced bronchospasm
S1 n S2
TxmMDI
Sob
warm drink
Chest tightness
wheeze

Area is cold/numb
Skin=red and swollen

Txm remove clothing

immerse area in water heated up to 39-42C
Wrap area to prevent recooling

Dehydration occurs when more fluid is lost

from the body than is taken in.

This causes an imbalance of minerals,

sodium, and potassium, which are all needed
for muscle and nerve function.

There are many things that cause

dehydration including: vomiting, diarrhea,
blood loss, and failure to drink .

dry mouth,
fatigue,
chills,
dry skin,
dark colored urine,
thirst.

racing pulse,
difficulty breathing,
muscle spasms,
dim vision,
confusion,
unconsciousness
death

Water

hydrates better
inexpensive,
taste not appealing
Sports drinks
taste better.
additional electrolytes
Juice
nutritious,
not a good thirst quencher (fruit sugar).
Caffeinated soft drinks
quick energy boost
do not rehydrate
coffee, tea, and alcohol
diuretic

HOPSIT

rememberPRICEM

Hydration