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Acute = An injury that occurs instantaneously - Concussion - injury to the brain. Athlete may or may not lose consciousness.
- Contusion - bruising of soft tissue due to direct contact.
- Dislocation - stretching of ligaments resulting in total displacement of joint.
- Fracture - broken bone, may or may not have obvious deformity.
- Sprain - excessive twisting of a joint causing damage to the ligaments (ex. Ankle or knee sprain).
- Strain - pulling or tearing of muscles (ex. quadriceps or hamstring strain).
- Subluxation - stretching of ligaments resulting in partial displacement of joint.
Chronic = An injury occurring over time - Apophysitis - inflammation of the growth plate in young athletes (ex. Osgood- Schlatter’s in the knee).
- Impingement - pain at or around the shoulder related to overhead activities.
- Tendonitis - inflammation of a muscle tendon (ex. “jumper’s knee).
- Patellofemoral Pain - pain around or underneath the kneecap due tightness and/or weakness around the knee. May also be related to faulty biomechanics.
Note: For treatment, see the Initial Management of Injuries information. Heat Illness
| Characteristics | Heat Cramps | Heat Exhaustion | Heat Stroke | Cramping | Present | May be present | Absent | Mental State | Normal | Possible disorientation, weak, dizzy, faint | Stupor or coma | Pupils | Normal | Dilated | Constricted | Skin | Cool, Moist | Cool, pale, moist | Hot, flushed, dry | Temperature | Normal | Normal or low | High | Pulse | Rapid | Rapid or weak | Rapid, strong | Blood Pressure | May be low | May be low | May be high | Emergency Care | Oral Hydration with salt and water if tolerated | Oral or IV hydration salt and water, cooling with cold/wet towels, ets. | Rapid cooling, IV hydration |
Hydration
Signs of Dehydration - Thirst
- Cramps
- Weakness
- Dizziness
- Headache
- Decreased Performance
- Irritability
- Nausea
Drink Before, During, & After Exercise - Drink 20 oz of water or sports drink with less than 8% carbohydrate 2-3 hours before exercise.
- A sports drink is needed if exercising more than 45 minutes.
- During activity, drink 7 oz every 10-20 minutes.
- Avoid fruit juices, sodas, & sports drinks with carbohydrates greater than 8%.
- For every pound of weight loss, drink 20-24 oz of sports drink diluted with water.
- If greater than 3% of body weight is lost, there is an increased risk of heat illness, such as: heat cramps, heat exhaustion, and heat stroke.
REMEMBER: IF YOU’RE THIRSTY YOU ARE ALREADY DEHYDRATED
Initial Management of Injuries
Call 911 - If the athlete is unconscious or not moving.
- If the athlete is having a seizure.
- If deformity is noted, do not move the athlete.
- If there is a suspected neck or spine injury, DO NOT move the athlete.
If your injury has not improved within 3-5 days, contact your physician. In the meantime, remember to ICE. - Rest - Decrease motion of area hurt. Splint and use crutches, if necessary.
- Ice - No more than 20 minutes at a time. Reapply when area has warmed up.
- Compression - Use an ace wrap and apply from below to above the injury. If numbness or tingling occurs reapply, but loosen mildly.
- Elevate - Raise the injured area above the heart.
Wound Care - Apply direct pressure to stop bleeding.
- Apply bandage after cleaning wound.
- Add more bandage if blood soaks through original. Do not remove the original bandage, add to it.
- Stitches - if wound is greater than 3 mm deep and need to be applied within 3 hours of injury.
Blister Care - Do not remove top layer of skin if you drain it. Use it as a layer of protection.
Nutrition
Bread, Cereal, Rice, & Pasta: 6-11 Servings/day - Choose whole grains.
- Choose foods with little fat or sugars, like bread, English muffins, rice, & pasta.
- 1 slice of bread, 1 cup ready to eat cereal, & ½ cup cooked cereal or pasta count as a serving.
Vegetable Group: 3-5 Servings/day - Eat a variety, include dark-green leafy vegetables & legumes several times a week.
- ½ cup equals one serving.
Fruit Group: 2-4 Servings/day - Choose fresh fruits, frozen, or dried fruit.
- Count only 100% fruit juice as fruit. Punches, ades, and fruit “drinks” contain only a little juice & lots of added sugars.
- One serving is equal to ½ cup berries or one medium sized fruit.
Milk, Yogurt, & Cheese: 2-3 Servings/day - Choose 1-2% milk & low fat yogurt often.
- 1 1/2 to 2 oz of cheese & 8 oz of yogurt count as a serving.
- Choose part skim or low fat cheeses when available.
Meat, Poultry, & Fish: 2-3 Servings/day - Choose lean meat, skinless poultry, fish, & dry beans & peas often.
- Broil, roast, or boil these foods instead of frying them.
- 3 oz of meat, about the size of a deck of cards counts as a serving.
Never skip breakfast! It is the most important meal of the day and should contain a large amount of carbohydrates, moderate protein and lower fat. Try a bowl of cereal with milk and fruit or peanut butter toast with a glass of milk.
Return to Participation Guidelines After a Leg Injury
The following guidelines are used to return to play after a low-grade injury to your leg. Begin at the first level. Once you succeed at the category pain free, progress to the next category. If pain hinders walking for greater than 3-4 days, see your physician or consult your athletic trainer. - Walking forward and backward
- Jogging forward and backward at 50% à 75% à 100% effort
- Shuffles side to side at 50% à 75% à 100% effort
- Grapevine at 50% à 75% à 100% effort
- Figure of Eight Pattern at 50% à 75% à 100% effort
- Zig Zag patterns at 50% à 75% à 100% effort
When to Use Heat Vs. Ice
Heat - Use to treat chronic injuries, such as tendonitis, or prior to activity.
- May be used on acute injuries, once swelling subsides.
- Apply for 15-20 minutes.
- Consult your physician if you have an adverse reaction to heat treatment.
Ice - Use to treat acute injuries, such as strains and sprains immediately after injury.
- Can be 1-3 days depending on if swelling/heat to the touch persists.
- Treat soreness following activity to reduce pain and inflammation.
- Apply 15-20 minutes every 1-2 hours.
- Do not apply for longer than 20 minutes.
- Do not sleep with ice packs.
Consult your physician if you have circulatory disorders or develop an adverse reaction to ice treatment. Endurance Training Tips
Training Intensity - Most of your workouts should be of relatively easy to moderate intensity.
- Physiology testing can help you determine your own training zones.
- High intensity training should only be performed one to three days each week.
- Using heart rate monitors, power meters, GPS units in addition to perceived effort is recommended.
Training Volume - Begin training with shorter sessions, possibly as little as 15 minutes.
- Increase training distance and/or time by only 10-20% each week.
- Do not perform back to back long distance training sessions.
- Incorporate a recovery week with reduced training every 3rd or 4th week.
Concussions The Management of Concussions Grade 1 - Remove from play.
Examine immediately and at 5 minute intervals. Test at rest and with exertion to see if status changes. Return to play if symptoms clear in less then 15 minutes.
Grade 2 - Remove from play.
- NO return that day.
- Examine frequently for signs of getting worse or not returning to previous pre-concussion status
- Refer to M.D. for neurologic exam. M.D. must clear athlete to return to play after 1 full week asymptomatic at rest and with exertion.
Grade 3 - Call 911 to transport to emergency room.Neurological exam by M.D.
- M.D. returns athlete to play.
Grading Severity of Concussions Grade 1 Transient confusion (inattention, inability To maintain a coherent stream of thought and carry out goal-directed movements). No loss of consciousness. Upon exam, symptoms resolve in less than 15 minutes.
Symptoms Frequently Observed with Grade 1 Concussions Headaches Dizziness Nausea Unsteadiness Light sensitive Blurred or double vision Mental status changes
Grade 2 Transient confusion (inattention, inability to maintain a coherent stream of thought and
carry out goal-directed movements). No loss of consciousness. Symptoms last longer than 15 minutes.
Grade 3 - Any loss of consciousness.
- Brief (seconds) or prolonged (minutes).
Symptoms Frequently Observed with Grade 2 & 3 Concussions Vacant stare or disoriented Slow to answer questions or follow instructions Confusion and inability to focus attention Slurred or incoherent speech Stumbling, inability to walk a straight line Distraught or crying for no reason Memory deficits Loss of consciousness
Note: Any of these symptoms can occur together at any time. Sideline Evaluation for Concussions For Grade I concussions, the athlete can return to play if he/she can do a minimum of all of the below WITH NO SYMPTOMS after 5-10 minutes post concussion. Athlete is at risk for further injury if he/she returns to play with symptoms. If symptoms persist or worsen, see a physician IMMEDIATELY!! Mental status testing: Orientation: Time, place, person and situation. Concentration: Repeating words or numbers backwards (ie., 10,8,6,4, etc or months of the year in reverse order). Memory: Names of teams in contest, recall of 3 words and 3 objects at 0 and 5 minutes, recent newsworthy events, details of the contest (score, etc).
Exertional Provocative Tests: 40 yard sprint 5 push-ups 5 sit-ups
Post Concussion Syndrome Consists of lingering symptoms and continuing cognitive deficit following a
concussion injury. Second Impact Syndrome Second concussion occurs while still symptomatic and healing from previous injury days or weeks earlier. Loss of consciousness not required. Second impact more likely to cause brain swelling and other widespread damage. Higher risk of long-term cognitive dysfunction. Can be fatal—50% mortality rate in the most severe case.
Visit BCH Neurotrauma for more information
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