Sports Medicine 1 Editing By A.K.A teamdoc, B. Sc., P.T. [Sports injury]. muscle joint.,,,,,,.,,. muscle joint tendinitis, arthritis, fracture. Primary prevention: [prevent occurrence] Secondary prevention: [prevent recurrence] I. [Warm up] General exercise: jogging, [calisthenics], general stretching, resistance Ex Specific Ex Intensity: some mild sweating without fatigue Duration: 15-30min 30-45 A. [Possible benefit effects of warm up] 1. Blood flow 2. Oxyhemoglobin breakdown muscle O2 3. Vascular resistance circulation 4. Myoglobin O 2 5. Cellular metabolic chemical reactions 6. Smoother muscle contraction muscle viscosity mechanical efficiency
Sports Medicine 2 7. Nerve impulse 8. Nerve receptors sensitivity 9. -fibers activity & stretched muscle sensitivity 10. tear force stretch length CT stiffness ROM injuries 11. Ex cardiovascular response 12. relaxation, concentration II. [Stretching] flexibility : musculotendonous injuries, muscle soreness, athletic performance Two type of flexibility Static: passively moved to ROM important to prevent injury Dynamic: moved as a result of muscle contraction important for athletic performance Three type of stretching Ex 1. Static: 30-60, tension myotatic stretch reflex. stretch 30,. 2. Ballistic: stretch bouncing movement stretch. bouncing reflex contraction. static stretching gymnastics ballet, dance maximal ROM. 3. Propriceptive neuromuscular facilitation: alternating contraction and relaxation of both agonist and antagonist muscles is increased by contraction of the antagonist muscles greater flexibility than others overstretch. Principles of stretching 1. Warm up prior to stretching 2. Stretch before and after Ex 3.Stretchtothepointoftensionbutneverpain
Sports Medicine 3 Overstretching(stretching to pain) Microscopic tear scar elasticity III. [Taping and Bracing] Restrict undesired harmful motion Indication 1. Prevention: in high risk activities, For Example, basketballer's ankles 2. Rehabilitation: protective mechanism Taping A. 1. a. b. 2. 3. B. Taping 1. taping Jt, Jt. taping Jt. 2. injury. taping. 3. Taping. C. Taping 1. 2. 3. 4. 5. 6. To restrict undesired motion: adhensive, strong, non-irritant, non-stretching (rigid), easily torn, elastic. Wrist, ankle, finger, acromioclavicular Jt. 1st MP Jt.
Sports Medicine 4 Bracing A. Brace 2 1. Hinges posts and straps 2. Hinges posts and shells 2 hinges monocentric, bicentric, polycentric B. :, more convenient, cost effective C. : Slipping of brace, weight, wearing out IV. [Protective Equipment, IX ] Helmet, mouth quards, shoulder pad, chest, forearm, groin protectors, shin pad V. [Correct Biomechanics] Static abnormality Functional abnormality: sprain, muscle imbalance, poor technique Cf. Running with excessive ant. pelvic tilt, lumbar lordosis: hamstring strain VI. Abnormal Biomechanics A. Excessive pronation Cause excessive 1. Int. rotation load on the medial 1st MP Jt pathology, exostosis, hallux valgus, sasamoid pain, strain on the plantar fascia and muscle 2. tibia rotation lat. subluxation of patellar, patellofemoral Jt dysfunction 3. Stress Fx metatarsal, sesamoid, navicular, tibia, fibular Bones, tendons, muscles of foot B. Excessive supination 1. Result of spasm or thighness of GCM - Soleus
Sports Medicine 5 2. Stress Fx tibia, fibular, calcaneus, 5th metartarsal 3. Lat. instability 4. Lat stress IT band, femoral epicondyle bursitis C. Abnormal pelvic mechanics 1. Exessive ant. tilt lumbar lordosis, knee flexion eccentric load across the extensor mechanism of the knee patellar tendon injury 2. Exessive lat. tilt hip abductors and adductors 3. Assymetrical pelvic movement VII. [Common structural abnormality] A. Forefoot varus B. Forefoot valgus C. Plantar flexed first ray D. Rear foot varus, valgus E. Ankle equinus F. Tibia abnormality G. Genu valgus, varus H. Leg length discrepancy Right leg : looking at back of heel VIII. [Correction of Abnormal Biomechanics] A. Orthosis Shoe modification 1. Non-casted orthosis Arch support, cork, rubber, plasterzote 2. Casted orthosis Polyethylene, polypropylene IX. [Suitable Equipment] injury. A. Protective helmets(for head injuries),,,,,, head,,,..
Sports Medicine 6 Protective helmets B. Face guards(for facial injuries),,, bone, eye injury. Face guards C. Gum shields(for dental injuries),, maxillary bone Gum Shields D. Shoulder padding(for shoulder injuries) shoulder (,, ) Ball-socket Jt Shoulder padding E. Elbow guards(for elbow injuries) fall elbow (,,, )
Sports Medicine 7, elbow bursa injury, elbow Jt cartilage injury Elbow guards F. Genital protectors(for injuries to the lower abdomen) penis testicle (,, ), genital acute pain, genital blood supply bleeding Genital protectors G. Hip or thigh guards(for hip injuries) hip thigh guards femur, hip Jt (,, ), fall pain, bleeding Hip or thigh guards H. Knee pads(knee injuries) knee pad knee Jt meniscus lig injury, (, ) Jt surface cartilage patello-femotal Jt injury Knee pads
Sports Medicine 8 I. Shin pad(for leg injuries) pain shin ( ) bone soft tissue injury Shin pad J. Ankle and foot protection(for ankle injuries) Overuse injury sprain, foot ankle liga bone Ankle and Foot protections K. Gloves(For wrist and hand injuries) hand bone Fx,, thumb wrist lig injury (,,, ) Glove X. [Appropriate Training] Training errors are among the most common predisposing factors A. Principle of training 1. sports injury a. Muscular imbalance b. neuromuscular coordination c. lig. and tendon strength d. muscle cardiovascular endurance
Sports Medicine 9 e. muscle bulk f. flexibility 2. Conditioning Seasons a. Post season: sport seasons : physical restoration b. Off season: strength, endurance, flexibility c. Preseason: training d. In season 3. Periodization: conditioning(preparation), precompetition, competition Adequate time between the end of one season and the commencement to allow complete recovery from the physical and mental stress of competition 4-6 week Easy week, every third or 4th week Short term schedule 4. Overload Increase in stress adaquate adaptation time increased work capacity supercompensation Changing volume(quality or duration), intensity(quality) Specificity Individuality XI. [Training method] A. Aerobic training [aerobic metabolism].( ) 1/5 L + O 2 CO 2 +H 2 0 Increased aerobic capacity or fitness via aerobic metabolic pathway Max O2 consumption, HR, Target HR(70-85% of max-hr) Effect on muscle Skeletal muscle cells mitocondria Muscle glycogen Free fatty acids availability
Sports Medicine 10 Muscle vascularity Cardiovascular Response 1. [cardiac output: Q] [stroke volume],, V O2. 2. [stroke volume: SV] 70-80 ml,,. 25-30%, 120ml., muscle thoracic & abdomen cavity pumping- mechanism [venous return] stroke volume. 3. [Heart rate: HR], sympathetic system parasympathetic system, HR sympathetic N epinephrine norepinephrine, HR parasympathetic N acetycholine. Group Rest Medium Ex Maximal Ex HR SV Q HR SV Q HR SV Q Sedentary adults 75 80 6,000 120 100 12,000 190 120 22,000 Active adults 60 100 6,000 120 130 15,600 190 150 28,000 highly trained adults 50 120 6,000 120 150 18,000 190 200 38,000 (HR), 1 (SV), ( Q) 4. [Blood Pressure: BP] a. [systolic pressure: SP] V O2 0.5l 8mmHg. 4-5. Q. SP 120mmHg. 200 mmhg, 180mmHg. Q. b. [diastolic pressure: DP],,. DP peripheral resistance, pressure 5. [Blood flow distribution: BFD]
Sports Medicine 11 6. BP, Q, V O2 BF. respiratory muscle skeletal muscle, heart skin BF, BF Circulatory redistribution muscle Area Rest Lgiht Ex Heavy Ex ml/min % ml/min % ml/min % Splanchnic 1,400 24.0 1,100 12.0 300 1.0 Renal 1,100 19.0 1,100 12.0 900 4.0 Brain 750 13.0 750 8.0 750 3.0 Coronary 250 4.0 350 4.0 1,000 4.0 Skeletal muscle 1,200 21.0 4,500 46.0 22,000 85.5 Skin 500 9.0 1,500 14.0 600 2.0 Other 600 10.0 400 4.0 100 0.5 Cardiac Output(Q) 5,800 100.0 9,600 100.0 25,650 100.0 (BFD) (Q) B. Anaerobic training [anaerobic metabolism] 10 (100m, ) 1. ATP : ATP ADP + P + E( ) 2.PC :PC P+C+E(ATP ) 3. G-L : G n(c6h 12 O 6 ) L + E(Pc ) ATP : [lactic acid] -, acidosis power ATP-PC, lactic acid aerobic system ATP Lactic acidosis: musle pain, extrem fatigue, nausea & vomiting ATP-PC system,
Sports Medicine 12 [glycogen] anaerobic lactic acid system ATP., 70g. System Maximal power Maximal capacity Maximal exercise (ATP mol/min) (ATP mol/ 70kg BW) (time) ATP-PC 3.6 0.7 10 Lactic acid 1.6 1.2 45 Aerobic 1.0 90.0 85 3, Trainging: lactic acidosis tolerance Most efficient anaerobic Ex: intermittent Ex intercal training(lactate ) Intensity, injury. 400m : bouts of Ex are shot & intense with long, full recovery period 5000m : repetition of longer distances at less intensity with shorter recovery period C. Strength & power training Muscular strength: muscle contraction Power: work 1. Isotonic training : more functional, full ROM, weight lifted :, supervision, lift. 2. Isokinetic 3. Isometric: ROM 4. Olympic type weight lifting Injury Back injury weight belt Excellent means 5. Polymetric training Polymetric = polymetric Ex muscle elastic recoil element &, muscle neurological stretch reflex eccentric muscle contraction resistance training forcefull
Sports Medicine 13 movement concentric contraction. [Hopping], bouncing drills,, [depth jumps] Explosive nature: injury Musclesoreness 1-2 6. Flexibility training Flexibility musculotendinous injury 7. Speed training Speed training muscle power & strength [Running drills]: high knees, heel to buttock, overspeed, downhill running, towing speed belts 8. [Agility training] [Inherited] Agility training: classic military stepping Ex, figure of 8 running 9. Specific skill training movement injury. 10. Cross training Jt, muscle, tendon W/B[weight bearing] stress aerobic fitness. Swimming, bicycling, water running Jt cartilage damage, overuse injury XII. [Adequate recovery] Inadequate recovery: impaired performance, tiredness, [lethargy]. overtraining SD Early morning PR : PR training training load 1-2. Training program A. Warm down Ex milder activity. Muscle soreness, stiffness. 5-10 min
Sports Medicine 14 Training muscle group stretching B. Whirlpools and spas Physiologic effect on muscle & other soft tissue relaxation Psychological effect C. Massage 1. [soft tissue] hard training Intense training: muscle tone band muscle tightness adaptation period. Abnormal muscle tone: O2 muscle tightness bone. elongation proprioceptive mechanism trigger mechanical nocicepter Repetitive microtrauma excessive cross linkage active trigger points. 2. Excessive post-ex muscle tone Muscle ROM circulation, symptomatic trigger point D. Rest & sleep 10-12 hrs XIII. [The role of psychology in aiding recovery] A. Effect of Ex on ANS[autonomic nervous system] Ex [SNS: sterile normal saline] -ReducedHR :glycogen
Sports Medicine 15 B. : physical work capacity :Depression Massage, spas, warm bath, shower, [floation tank], music visualization, relaxation tapes, breathing technique XIV. [The role of nutrition in aiding recovery] Muscle glycogen stores, protein dietary, rehydration A. Glycogen replacement muscular activity, 24-48 hrs CHO diet 24 hrs : simple complex CHO 24 hrs : complex( [starch], sugar) Glucose: muscle resynthesis, liver [fructose] Glycogen resynthesis : 2 hrs : 0.7-3.0 glucose/kg.bw B. Protein replacement Ex : 0.75 g/kg.bw/d Ex : 1.2-1.7 g/kg.bw/d,,, : 2.0 g/kg.bw/d Protein : protein dehydration, [renal complication]. C. Rehydration Chronic dehydration: fatigue,, [thermoregulatory control]
Sports Medicine 16 XV. & [Psychology & Injury prevention] Category Cause for Concern Feeling of inadequacy Getting tired Physical appearance Being afraid Inability to concentrate Feeling silly Lossofcontrol Behaviororspectators Bad luck Temperature Condition of playing surface Injuries Fear of Failure Performing up to ability level Losing Choking up Making foolish mistake Letting people down Guilt Making opponent look foolish Swearing too much Losing temper Sportsmanship Spectators disapproval Somatic complaints Upset stomach Urge to urinate Muscle tightness Sweating too much Awareness of heart beat Aspects of Competition that worry athletes : muscle tone injury, relaxation,synergy lossofrhythm". : - muscle group stress, "ready to play" Heart rate(hr) Breathing rate Blood Pressure(BP) Blood flow Sweating Muscle tension [RBC count] Adrenaline levels Brain wave activity Oxygen uptake and transfer Carbon dioxide production Blood sugar levels Pupil dilation [Cessation of digestion]. Psychological change experienced by athletes in a stress state
Sports Medicine 17 [Nail biting] [Eye blinking] [Foot tapping] [Knuckle cracking] [Muscle twitching] [Yawning] [Loud talking] [Excessive conversing] [Scowling] [Rapid gum chewing] [Repeated bathroom use] [Shivering]. Common Stress-Associated Behaviors XVI. & [Nutrition Injury prevention] [Eating before and during competitions] A. Carbohydrate loading muscle glycogen. carbohydrate loading. carbohydrate loading program,,,. B. Pre-competition Meal. muscle injury. high protein, high fat.. 1. high carbohydrate, low fat & protein 2. Solid food 3-4 3. Liquid meal 2-3. low fat, high carbohydrate vitamine mineral. 4..
Sports Medicine 18 Method A 1st day Depletion exercise 2nd day High carbohydrate diet; little or no exercise 3rd day High carbohydrate diet; little or no exercise 4th day High carbohydrate diet; little or no exercise 5th day Competition Method B 1st day Depletion exercise 2nd day High carbohydrate diet; regular exercise 3rd day High carbohydrate diet; regular exercise 4th day High carbohydrate diet; regular exercise 5th day High carbohydrate diet; little or no exercise 6th day High carbohydrate diet; little or no exercise 7th day High carbohydrate diet; little or no exercise 8th day Competition. Carbohydrate Loading Methods 5.. glycogen 6. hydration. 15-30. + + + + +. Sample Pre-competition Menus C. Competition. moderate high intensity glucose feeding hypoglycemia glycogen. 2-3% glucose solution. glycogen : protein, protein breakdown Soft tissue injury Ex injury.: training protein metabolism adaptation less injury hydration: working muscle blood [athletic amenorrhea]: Stress Fx