Kildare Catholic College

Sports Medicine
Case Study
Matthew Cerato

09

Sports Medicine Case Study Outline the procedures that you would have followed when Glenn collapsed on the
field in severe pain

In all first aid situations a primary survey should be used to make a quick assessment of the overall scene prior to becoming involved with the situation. The acronym DRABCD should be used but firstly the people involved with the scene should immediately call emergency services (000). Danger dangers such as fire, traffic and chemicals immediately surrounding the patient should be assessed then removed because first aid will not be able to be done. Eg In Glenn McGraths (GM) case rubber gloves may be used to reduce the risk of infection to the assessor. Response assessment of the victims response by Squeeze and Shout; speaking to the patient loudly if they are unconscious then squeeze the victim by the shoulders if there is no response. Eg. Ask GM questions such as what is your name and where are you? Due to the low intensity of this case GM would have been conscious and been able to be responsive to the practitioner, this would be the end of the DRABCD primary survey for GMs situation due to his responsiveness and the dismissal of danger. Airway open the airway and look for signs of life Breath look, listen and feel for signs of normal breathing Compression two breaths, thirty compressions (Repeat C until signs of life appear or the ambulance comes) Defibrillation This is used after CPR to get the patients heart beat to start pumping again. Figure 1.1 shows a resuscitation chart that should be used as a guideline when doing a primary survey.

Figure 1.1 2 Sports Medicine Case Study Matthew Cerato

When injuries occur an assessment of the injury needs to take place which will result in whether the individual is able to return to the field. TOTAPS is a nationally recognised regime for assessing sports injuries. The following steps should be taken: Talk talk to the injured player and ask them what exactly happened. In GMs case he should have been asked specific questions including: - How did you sustain this injury? - How painful is the injury? - What area is the injury in? These questions will allow the qualified practitioner to find out important information about the nature of the injury; this will enable a direct assessment of the injured area for further assessment. Observe involves looking at the injured area to see if there are any obvious signs of deformity or swelling. In GMs case his ankle should have been compared his other one. This is done to show the differentiation of the ankles and the substantiation of the injury. Touch Further from observing the area the practitioner should gently touch the injury to feel for deformities and swelling. In GMs case this would be done by feeling the ankle region and comparing the ankle with his other ankle and also if obvious signs of pain inhabit Glenn. This act is done to try and pinpoint the main area of pain which will allow effective management of the area.

Active Movement The patient should then be asked to perform joint movements such as flexion, extension and rotation. GM would be asked to perform these actions with his ankle to establish the immediate severity of the injury; rotating, bending and extending his ankle. GM probably would feel pain during the performance of these movements and therefore the assessment of his injury wouldnt have proceeded under the TOTAPS regime because it might have increased injury. If these movements can be done pain free, then the final stages of TOTAPS should be attended to. Passive Movement The assessor would then physically mobilise the joint using a range of movements previously stated. If GMs examination preceded this would involve the assessor physically handling the ankle and moving it through movements such as flexion, extension and rotation. This is done to identify painful areas and the instability in the joint which would allow better management of the painful areas.

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 Skills Test This phase involves the patient performing a skill directly relating to the game. In GMs case this wouldnt have been done because Glenn was involved in an enjoyable game of touch-rugby, but if it was sustained during a cricket match he would be asked to perform things such as running, bowling and appropriate left and right movements to show that he was able to return to the field with adequate movement and no further major risks; if it was a minor injury then GM could possibly return to the field. Stop assessment if damage is apparent and pain is felt. After the TOTAPS assessment has taken place injuries should be classified according to their cause; injuries frequently occur in sports such as football and cricket by common movements including jogging and jumping. These injuries are classified directly relating to their cause; common classifications to identify and manage them successfully include: Direct caused by an external force applied to the body (Ron Ruskin, 2007). Common injuries include fractures, dislocations, sprains and bruises which can stem from collisions which other individuals or a force driven tackle. Eg. A sprain caused by a collision of two soccer players. Indirect caused by an intrinsic force that is, a force within the body (Ron Ruskin, 2007). Inadequate warm-ups, ballistic movements, excessive movement and execution faults are all common causes for indirect injuries due to the excessive stress on the muscles and joints. Common injuries include tearing muscles or placing stress on tendons and ligaments which will lead to possible damage and irritation. Eg. A hurdler tearing a calf muscle during an event. Overuse caused by overuse of specific body regions over long periods of time (Ron Ruskin, 2007). Common exercises such as jogging and stepping can cause overuse injuries if they are repetitive and low-impact. The repetition of these exercises can cause shin splits and tendinitis which can be become inflamed and painful. Eg. Getting stress fractures due to excessive running.

From these classifications they may also be categorised into: Inflammatory response Soft tissue injuries injuries to all tissue other than bones and teeth (Ron Ruskin, 2007). There are numerous soft tissue injuries and some common areas for these injuries to occur include damage to muscle, tendons, ligaments, cartilage, skin, blood vessels, organs and nerves. These injuries can be categorised two ways: - Acute sudden occurring injuries such as: - Sprains stretching or tearing a ligament (strong, rigid and inelastic tissue). When ligaments are stretched or torn there is an insurmountable pain and swelling of the injury area an there will be a tendency for the joint to not perform normal movements due to the role of the ligaments to connect bone to bone. When a sprain
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has be identified the injury can be classified according to the severity of the ligament damage and managed accordingly. SEXY? - Strains muscle or tendon is stretched or torn (connect muscle to bone). When this occurs, extensive pain with infiltrate the injured area through movement or pressure on the injury and discolouration will start to appear due to bleeding; strains may also be classified according to the severity of the injury. SEXY? - Contusions caused by a sudden blow to the body which interrupts blood flow to surrounding tissues which may cause internal bleeding. This injury may be superficial or deep, varying in intensity and severities. Eg. getting a bruise on your calf due to a sudden force. SEXY? - Abrasions a scraped area on the skin, resulting from injury or irritation which causes pain and bleeding; to prevent infection sterilisation should be used. Eg. a football player scraping their knee on a dry, hard surface during a game. - Lacerations - A jagged wound or cut to the flesh, which particularly occur to the scalp and mouth regions. This form of skin trauma should be attended to quickly and sterilely to reduce time for infection; lacerations longer than one centimetre should be referred to a doctor. Eg. the soft tissue has been forced against the teeth causing bleeding and a wound which should be rinsed with antiseptic and controlled by having ice. - Blisters - a thin vesicle on the skin, containing watery matter or serum, as from a burn or other injury. Blisters can occur due to new equipment being worn or used, equipment is used for a long time and sudden changes in direction during activity; the best treatment for blisters is rest for twenty-four hours. Eg. you purchase and play football in a new pair of boots and a blister forms after the game causing the player to rest his foot for twenty-four hours. - Calluses - a hardened or thickened part of the skin; a callosity. Calluses are caused by constant pressure from external sources and are commonly found on the hands and feet. This pressure causes a loss in elasticity and blood supply causing tears and cracks forming pain. Eg. Football boots that are too small for the players feet. Other common injuries include dislocations, subluxation and torn cartilage. Chronic prolonged injuries that are relatively the same as acute injuries but they have a greater impact creating a longer rehabilitation

Hard tissue injuries cause damage to bones and teeth (Ron Ruskin, 2007). They types of injuries are more serious than soft tissue injuries; common types include: - Fractures the breaking of a bone. The two type of fractures are simple (underneath the skin) and compound (protrudes the skin). Signs and symptoms may include intense pain, swelling, deformity and loss of bodily functions due to the bone breaking. If these symptoms occur the player should seek immediate medical
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attention and immobilise the injury. Different kinds of fractures can be seen in Figure 13.13. Eg. In a football match a player may land awkwardly resulting in a greenstick fracture (a) Dislocations the displacement of a bone at a joint which will cause pain and deformity of the dislocated area. This injury should be physically reinserted by a medical professional not by anyone else which may cause increased damage Eg. In a cricket match the cricket ball hits the players finger and it dislocates the finger joint. Subluxation is a form of dislocation with the joint quickly popping out then back in again; this may cause damage and make the joint vulnerable to further injuries or may not cause any further damage. Eg. A football players shoulder joints occurs subluxation through a hip and shoulder.

Injuries are classified into these common areas because they allow the injury to be managed effectively according to each individual area. In Glenn McGraths (GM) case he trod on a stray cricket ball during a game of touch-rugby, causing pain and damage to his ankle. GMs injury would have been classified in the indirect category along with it being a soft tissue injury. Firstly he is classified as suffering an indirect injury due to the intrinsic force of his ankle. The excessive movement of the ankle rolling over the external stimulus of the ball on the ground created immense strain on muscles, tendons and ligaments causing damage to the ankles internal structures. Although the ball is external it cannot be classified as a direct injury because the ball doesnt have a force; the force is applied by GMs ankle and the movement of running. It also cannot be classified as being an overuse injury due to the sudden occurrence of the injury which wasnt caused through repetitive actions. Secondly he has sustained a soft tissue injury

Describe the management of Glenns injury during the initial stages

In the early stages of soft tissue injuries the RICER principle should be applied to injury. RICER allows the injury to recover quickly and ensures that it heals correctly and efficiently. Rest Ice Compression Elevation Referral -

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For the rehabilitation to be successful the individual needs to ensure that it is effective. It important to remember: Rest needs to be active Ice should be put on skin injuries Ice should be left on 20min To prevent futher damage to injuries specific techniques and substances need to be avoided. The HARM acronym should be used and remembered accordingly, it involves no heat, alcohol, running and massage. o Heat o Alcohol o Running o Massage Further reading

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 Describe the injury management procedures you would put in place, following
initial treatment and diagnosis, which would ensure his safe return to play (include examples of physical and skill related tests)

Rehab: Progressive mobalisation Stretching Conditioning Total Body fitness Taping Use of heat and cold Specific programs Return to competitive sport: Indicators Monitoring progress Taping Specific warm-ups Progressive involvement Figure 13.35

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 Provide a brief discussion regarding the ethics associated with pressure to return to
play that could be placed on Glenn by the Coach/match committee, sponsors and/or supporters. What role would you, as sports injury specialist, and Glenn play in deciding when he would be fit to return to play.

Ethics Playing with injury Pressure to participate Role of coach and sports medicine Use of drugs: For strength For aerobic performance To mask other drugs Drug testing
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Bibliography
(n.d.). Retrieved September Tuesday, 2009, from ESPN Cricinfo: http:ww.cricinfo.,com/engvaus/content/current/story/215050.html Ankle Sprains: Healing and Preventing Injury. (n.d.). Retrieved September 8, 2009, from Family Doctor: http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/010.html Ron Ruskin, K. P. (2007). Outcomes 2 HSC Course (Third ed.). Milton, QLD, Australia: John Wiley & Sons Australia, Ltd.

Appendix 1
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England v Australia, 2nd Test, Edgbaston, 1st day

McGrath ruled out with ankle injury

Cricinfo staff
August 4, 2005

Glenn McGrath was ruled out of the second Test shortly before the start of play on Thursday, after suffering a freak injury during Australia's pre-match warm-up. He is now a major doubt for next week's third Test at OId Trafford as well, having sustained a grade two tear to the lateral ligaments of his right ankle. McGrath, 35, trod on a stray cricket ball during a game of touch-rugby and had to be helped into a groundsman's buggy by his team-mates. His place in the side was taken by fellow seamer Michael Kasprowicz, who picked up five wickets in the drawn warm-up match against Worcestershire this week. "Glenn rolled his ankle during the early stages of training," Errol Alcott, the
Glenn McGrath goes down in pain during the warm-up Getty Images

team physiotherapist, told AFP. "There's nothing obvious in the X-rays regarding bone abnormalities but we are awaiting further expert reports from a radiologist this [Thursday] afternoon." McGrath returned to the dressing-room where his foot was elevated while the injury was iced. Australia's captain, Ricky Ponting, won the toss and chose to bowl first even though his spearhead was sidelined. "I guess the good thing about it is that Kasper took five wickets in the tour game during the week so he's in pretty good touch as well and I'm looking forward to seeing him bowl." This is the first Ashes Test McGrath has missed since Sydney in 2003 where England won by 225 runs. At Lord's, where Australia won the first Test by 239 runs, McGrath became only the fourth bowler to take 500 Test wickets, as Australia went 1-0 up in the five-Test series. http://www.cricinfo.com/engvaus/content/story/215050.html

Appendix 2

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Appendix 3

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