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KIN 337

by: Ixchel Buelna
Ixchel Buelna
California State University, Northridge
GPA 3.16

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About this Document

They cover athletic injuries from upper to lower extremity.
Prevention and Care of Athletic Injuries
Dr. Sean Flanagan
Kinesiology, Athletic injury prevention
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This 45 page Bundle was uploaded by Ixchel Buelna on Monday September 12, 2016. The Bundle belongs to KIN 337 at California State University, Northridge taught by Dr. Sean Flanagan in Fall 2016. Since its upload, it has received 4 views. For similar materials see Prevention and Care of Athletic Injuries in Kinesiology at California State University, Northridge.

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Date Created: 09/12/16
Athletic Training (AT)  allied health   Narrow focus  Sees patients right away  Athletics  Industrial setting  Performing arts  ..  sees "athlete" from pre-injury to return-to-pay  Pre-participation exam (PPE)  Perform rehabilitation **neopathic - unknown cause**  Not going to deal with o People with strokes, MS, cerebral palsy Physical Therapy (PT)  Overlap with AT  Broad focus ________________________________________________________ -itis (inflammation) -otis (abnormal condition) Chondro- (cartilage) Hyper- (more than) Hypo- (less than) ________________________________________________________ Systems  -injury is a caused by mechanical event  Physiological event o Governed by feedback (feedback loop) - proprioception   All our systems are on different feedback loops Movement system  Structural system <--> environment (leads to movement) o Bones o Muscles o Fats  Fuel system o ATP-PC o Glycolytic o Aerobic  Force system o Muscles o Tendons  Control system o Brain o PNS o CNS  Cooling system _________________________________________________________ Mechanical principles  o Time o o Displacement (change in position) o Velocity (speed and direction) o  Momentum and Inertia (linear movement) o Mass (how much stuffs composed of) o Momentum (mass X velocity)  o Moment of Inertia (angular movement)  How mass is distributed o Angular momentum  Moment of inertia and angular velocity Kinetics (forces involved)   2nd law - (F=ma) -> a = change in velocity/change in time  3rd law - action/reaction  Torque (turning effect of a force) o Further from axis o Force perpendicular causing more torque Work and Energy  Energy o Ability/potential to change  Kinetic  Potential (stored energy)   Strain potential energy (elastic energy)  Work = Fd o Moving energy into/out of a system o Positive  Increasing energy (creating) o Negative  Decreasing energy (absorbing)  Thermodynamics o Conservation of energy - energy is neither created nor destroyed  Power o o Work/time Force  Push/pull by one body or another  Load (stresses)  Pressure (stress) o Force/area o Decrease stress by decreasing force or increasing area **increase tolerance, or decrease stress** Models of injury (blue - tolerance ; red - margin of safety ; green - stress) Strain  Change in dimension/original dimension  Usually in percentages Red dot - yield point Elastic region  First degree injuries - mild o Occur if there is pain, but no structural damage Plastic region  Second degree injury - moderate (highly variable) o Involve tearing of fibers within tissue Third degree injury - severe  Complete rupture *supposed to be under force*  Load (stresses) o Compression (bring two ends of material closer together  Forces along same line and getting closer together o Tension  Forces along same line but going opposite ways o Shear  Forces not along the same line (sliding) o Torsion (twisting)  Cause shear force within material itself) o Bending  Convex - tensile loading  Concave - compression loading Body structures (deep to superficial)  Bones (constantly being remodeled) o Diaphysis (long shaft) o Epiphysis o Epiphyseal growth plate  Between dia&epi o Periosteum o Cortical (compact)  Doesn't change o Trabecular (spongy)  Changes  Joint (where two bones come together) o Hyaline (articular) cartilage o Joint capsule (surrounds entire joint) o Synovial membrane (inside of joint capsule) o Joint cavity (inside of capsule and membrane)  Synovial fluid o Ligaments  Can be inside (intra), outside (extra), or part of (inter) joint capsule o Fibrocartilage (not in all joints)  Make joint socket deeper  Shoulder  Wrist  Hip  Knee o Bursa (not in all joints)  Fluid filled sac  Protect structures due to high friction o Fat pads (not in all joints)  Pad of adipose tissue  Protect structures due to high friction  Muscle Tendon Complex (MTC) o muscle forces transmitted through the tendon to the joint; o elastic energy recoil of the tendon. o Osteotendinous junction o Body of tendon o Myotendinous junction o Muscle  Sarcomere  Muscle fibers  Fascicles  Muscle cell  Nerves o CNS  Brain & spinal cord o PNS  Vascular o Oxygen keeps living tissue alive o Helps remove metabolic waste  Lymphatic o How this system responds to injury  Skin  Internal organs ___________________________________________________________________________ Bone  Injury = fracture o Don't do well with bending loads (tensile forces) o Stress  Osteoblasts  Osteoclasts o Avulsion  Tearing of the tendon or ligament o Fracture  Location  Epiphyseal  Diaphyseal  Severity  Incomplete  Undisplaced - normal alignment  Displaced - move away from each other  More severe due to potential damage to other organs/arteries/nerves  Open (compound) - break through skin  Infection  Shape  Depressed (flat bone divot)  Greenstick  Bone splinters (in kids)  Type of incomplete injury  Transverse (perp to long axes of bone)  Longitudinal (along the long axes)  Oblique (angle of long axes)  Spiral (twisting of bone) - torsion  Compact (crushed/shortened)  Comminuted (shattering)  Apophysitis (inflammation of apophyseal growth plate) o Osgood-schlatter  Exostosis o Abnormal bone growth  Heel spur  Bunion _____________________________________________________________________________ Joints  Cartilage o Arthritis  Rheumatoid - systematic disease  Osteo - abnormal wearing o Osteochondral defects  Joint cavity o Osteochondritis dissecans (joint mice)  Piece of bone/cartilage that gets dislodged and is floating around  Synovial membrane o Synovitis  Ligaments (damaged when subject to tensile forces) - SPRAIN o First degree injuries - mild  Occur if there is pain, but no structural damage o Second degree injury - moderate (highly variable)  Involve tearing of fibers within tissue o Third degree injury - severe  Complete rupture o Dislocation o Subluxation (dislocation that popped out, but popped back in) o Fibrocartilage o Tear ____________________________________________________________________________ MTC  Muscle o Stiffness - excess fluid o Soreness (over exertion) - delayed onset muscle soreness (DOMS) o Muscle cramps (involuntary contractions) o Electronic imbalance o Muscle guarding (involuntary contraction due to pain) o Contusion (bruise) - crushing/compressing of tissue o Myositis ossificans - bone growing within a large muscle o Heterotropic calcification  Crushing of tissue, and blood calcifies in that area due to improper management o STRAINS (stretch and load) o First o Second o Third  Tendon **Can absorb 6-8x more energy than the muscle** o Tendinopathy (any type of painful tendon) o Tendinitis (inflammation involved) o Tendinosis (no inflammation, but still painful) o Tenosynovitis o Inflammation of tendon sheath ___________________________________________________________________________ Nerve & Vascular  Pinched (entrapped) o Carpal Tunnel o Sciatica o Stenosis  Stretched o First OR neuropraxia o Shoulder burner/stinger o Second OR axanotinesis o Sheath can get torn, but nerve intact o Third OR neurotinesis o Rupture of nerve **the further you are from CNS, the more likely you are to repair the nerve** **nerve has the least amount of healing potential** ____________________________________________________________________________ Skin  Incision (sharp cut)  Laceration (jagged tear)  Avulsion (tearing away)  Puncture (penetration)  Abrasion (scrapping away dermis and epidermis)  Blisters  Contusions (bruise)  Calluses (roughening of surfaces on weight bearing areas)  Corns (roughening of surfaces not on weight bearing areas) _____________________________________________________________________________ Response to injury  Evaluation o Clinical o Normally do not involve life threatening situations **Usual PT setting** o On field **Usual AT setting** o Ambulatory  Generally not as critical o Athlete down  Unconscious  Conscious  Athlete down o Primary survey o Responsiveness  Conscious & breathing o Airway o Breathing o Circulation o Signs of bleeding o Signs of shock  Pale  Rapid/shallow breathing  Clammy  Weak/quick pulse  Decrease in blood pressure o Secondary survey o Monitor vital signs o Musculoskeletal evaluation  Emergency response o Conscious? - YES o Talking? - NO  Heimlich maneuver o Conscious? - NO o Look - NO o Listen - NO o Feel - NO  Airway open? - YES  Rescue breathing o Circulation o Pulse? - NO  CPR o Bleeding? - YES o Direct pressure & cover wound o Elevate above heart o Pressure points o Turnicate o Shock? - YES o Elevate legs o Maintain body temperature  Vital signs o Temperature - 98.6 degrees o Pain o Blood pressure - 120/80 (syst increase/dia decrease or stays the same) o Beats per minute - 60-80 bpm o Respiration rate - 12-20 o Oxygen saturation o Skin color o Red - heat stroke, high bp o White - signs of shock o Blue - insufficient oxygen o Pupils (PEARL) - pupils are equal and reactive to light o Dilated and unresponsive = head injury Emergency action plan 1 Separate plan for each area 2 Proper equipment for each sport 3 Set of policies and procedures 4 Checking phones 5 Make sure there are keys for gates/padlocks/doors 6 Handoff procedures 7 Accompany athlete to hospital 8 Everyone needs to know it 9 Practice, practice, practice Immediate Treatment (Tx) for…  Bone o Fractures need ER  Joint  MTS  Nerve **first degree or slight second degree will not need a Physician** **second degree might need a Physician, but might not need the ER** RICE(S) - try in combination  Rest  Ice (as often as possible) o 20 min on  Vasoconstriction o 1-2 hrs off  Vasodilate  Compression (swelling - edema) o Limit effects of edema  Elevation  Splinting (if necessary) **analgesic effect - decrease pain** **initial stage of injury, do not want to use heat** _________________________________________________________________ Equipment removal  Head and neck injury with suspected cervical-spinal injury o Need for C-collar and spine board o Need to take off shoulder pads and face masks  Unscrew the tabs of face mask  Use cutting tool to cut through plastic of face mask o AT should ALWAYS remove mask and pads at all times _________________________________________________________________ Skin bleeding  Blood borne pathogens o Microorganism has the potential to cause disease  Blood  Semen  CSF  Vaginal secretion  Synovial fluid o Hep B  Transmitted through poor sanitary environments  Children susceptible  Vaccine  Stronger and more durable, and can last up to a week on surfaces o Hep C  Transmission through needle use  Tattoos, piercings, drug needles  No vaccine  There are drugs to combat disease o HIV  Transmitted through sexual contact  No vaccine  Universal precautions o Vaccination from HBV (Hep B) o PPE o Proper disposal for PPE o Control and cover bleeding o Deal with bloody uniforms o Cleaning surfaces with 1:10, bleach:water o Sharp objects container Treat the wound  Clean area with soap and water o Clean away dirt and debris from wound  Use hydrogen peroxide  Cover with sterile bandage  Cover with antibiotic (if not going to doctor)  Tetanus shot (puncture wound) Follow-up care  Changing dressing (antibiotic)  Signs of infection - referral to physician o Redness (streaks  Discharge - pus o Foul odor o Swelling o High levels of pain o Loss of function o Heat at the site o Fever o Swollen lymph nodes **WHAT IS ENERGY**  Part of a state of a system, which describes the ability/capacity to change o Sound o Heat  Conservation of E o Neither created no destroyed First Law of Thermodynamics  Efficiency o Nothing is 100% efficient o Mechanical output/input (high output, low cost)  Body force/(metabolic)  Car (gas) Second Law of Thermodynamics  Heat goes from cold to hot/cold to hot place Heat exchange  Conduction - on surface  Convection - circulating medium  Radiation - radiant energy  Evaporation - change of state/form o Require greatest amount of energy o Most effective way of exchanging heat  Within Environment o Temperature o Humidity Heat illnesses  Heat rash (hot/wet material around skin) o Keep area dry (baby powder)  Heat syncope (fainting) o Blood pooling to one area o Put into cool environment o Lay down o Replenish fluids  Heat cramps (painful spasms from electrolyte imbalances) o Ingest fluids o Mild stretching o Ice massage o Eat bananas  Heat exhaustion (core temp less than 104 degrees) o Collapse o Dizzy o Sweating profusely o Pale/moist skin o Hyperventilating  Bed rest in a cool room  Ingest fluids  Heat stroke o Skin = HOT (CORE temp. of 104) o Stops sweating = medical emergency  Rapid cooling by any means necessary  Hyponatremia (low sodium - loss of sodium in blood ) o Headache o Vomiting o Swelling in hands and feet o Too much water Prevention of heat illnesses  Monitor temp and humidity o Wet bulb globe tamp  Above 82 degrees, need for modified activity  Fluid and carbohydrate replacement o 1.5 L/hr o 1.4 g carb/8 oz of water  Acclimatization o 14 day period to get athletes ready again for heat o Gradual progression of intensity  Equipment modification oModify how much equipment used/on  ID susceptible individuals o People who have had a previous heat illness o Sickle cell trait/disease  Test for it  Modify activities  Training year-round  Longer rest periods o Rhabdomyolysis  Breakdown of muscle tissue that releases a damaging protein (myoglobin) into the blood o Monitor weight o Keep records o Look at safe weight loss o Performance dec. if you lose 1% of body weight Cold injuries  Hypothermia o Body temp below 98.6 degrees o Apply heat packs along trunk, axilla, groin  Do not apply to extremities o Mild  95-98.6 degrees o Moderate  90-95 o Severe  Below 90 degrees  Frost bite (frost nip) o Tissue freezes o Precursor = frost nip  OR superficial frost bite, and place area against someone else's body o Gradually re-heat tissue  Immerse in warm bath Lightning  Safest places o Classroom o Vehicle  Least safe places o Locker room o Under a tree o Pool  Flash-to-bang o 6 sec, you are within 5 mile radius o Stay inside for 30 minutes, at the least CH. 4-6, 10-12 **to lower stress, decrease force or increase area** **decrease Force by increasing time** OVERALL GOAL IS TO DECREASE STRESS Protective devices  Purpose o Alter impact force  Move impact force  Hit different area of the body instead (eye goggles)  Distribute impact force  Helmets and shoulder padding (has to be tight against body) - proper fitting  Decrease impact force  Cushioning  Shoes o Provide a barrier  Mouth guard  Shoes  From injury o Limit motion (sagittal, frontal, transverse planes of movement)  Soft tissue  Sports bras (coopers ligament)  Supporters  Joints  Ankle brace  Limit inversion/eversion  Braces  Taping  Orthotics  Only use approved equipment  Has to be inspected regularly  Has proper fit (check lab manual)  Do not modify it _____________________________________________________________________________ Strength & Conditioning Biomotor abilities *Underlying attributes that make skills effective*  Strength o Max strength can produce max force o Muscle actions (motor, brake, strut, spring)  Concentric (motor) - two ends of muscle come closer together  Increase energy through muscle generation  Eccentric (brake) - muscle elongates  Absorb energy through muscle  Isometric (strut) - no movement occurs  Transfer of energy  SPRING - Stretch-shorten cycle (SSC) - combination of concentric and eccentric  We can store elastic energy within tendon o Hypertrophy - increase muscle fiber cross sectional size o Neurologic - recruitment; increasing motor units or firing rate/frequency  Mobility o Be able to go through a certain ROM o If we have a limitation it in one joint, we can compensate for it another part o Know normal ROMs  Improve mobility through STRETCHING (involved MTC)  Static - hold stretch until reaching discomfort level (effective - hold for 30 sec and repeat multiple times)  Decrease force and power outputs for up to an hour after stretching  Don't need to stretch to prevent injury, but need to WARMUP  Do it at the end, before cooldown  Ballistic - go to an end range, and bounce (NOT GOOD)  Dynamic - going through a movement  PNF - *lab manual* *no one type of stretching is better than another* *need to train multiple plains*  Neuromuscular control o Coordination (proper technique) o Stability (need for proprioception - feedback that goes to CNS, then to muscular system to provide movement/position -> muscle spindle, GTO, mechanoreceptors, cutaneous receptors, semicircular canals, vision)  Static (ability to maintain a desired position)  Dynamic (ability to maintain a trajectory)  Perturbations (disturbance)  Internal  External  Energy systems - ATP must be present for a muscle contraction to occur o ATP-PC  Intense and short (high power/short duration)  Functions without oxygen  12 sec max effort o Glycolytic  Moderate power/short duration o Aerobic  Long and less intense (low power/long duration)  Mental/psychological  Power o Velocity specific strength o Inverse relationship between force and velocity  Slowly is where we express our max amount of strength o Need to find optimal range o Most injuries occur during rapid movement _________________________________________________________________________________ Acute program variables  Choice of exercise o 1-6 - neurologic change o 6-12 - hypertrophic change o Power  Decelerate as much as you accelerate, if stopping at 0  Create a projectile o Neuromuscular control  Create perturbations  Not building strength  Pick load o Really heavy weight, less reps  Pick volume o Reps and sets will increase/decrease  Rest periods o Work:rest ratio o Incomplete or complete recovery  Order o Least taxing, more neuromuscular control to most taxing,  Frequency o How often?  Cumulative effects (periodization) o Long term planning **need optimal amount, not maximal or more, of each ability** **approx. 244 degrees of freedom in our body** _____________________  Endurance o Strength o Power *as we fatigue, our technique can change* _____________________________________________________________________________ Principles of training (our body is good at maintaining homeostasis)  Adaptation (expect change)  Reversibility (if you don't use it, you lose it)  Specificity (body adapts in specific ways for particular demands being placed on it)  Individuality (everyone has different/unique responses)  Overload/Minimum intensity (to evoke a change)/Dose response (too little, not effective, too high, overdose)  Window of adaptation (genetic potential) o Farther from genetic potential, the easier for gains  Progression (make a change based on overload, adapt, and raise threshold)  Recovery o Get stronger during this period o Fatigue effects occur more rapidly than fitness effects, but subside faster  Variation  Transfer/Interference _________________________________________________________________________________ Workout  Warm-up o Prepare body for intensity and ROM (that you already have) about to go through  Exercise session o Greater control & least fatiguing --> less control & more fatiguing  Cool down o Go back to baseline Rules  Make words tender and sweat, for one day I may have to eat them  Do no harm  Stimulate, don't annihilate  You can't fire a cannon from a canoe  Fatigue makes cowards of us all  We are what we train to be  Sweat the small stuff, in the details  Concentrate on the breaks, not the accelerator  Muscle is quicker to adapt  Find the weakest link and strengthen  Think about optimal not maximal ________________________________________________________________________________ Nutrients  Macro (need a lot of) - all energy sources o Carbs  Simple  Sugar  Fruits  Complex - take longer to metabolize  Bread  Pasta  Milk  Fiber o Fats  Saturated (solid @ room temp., come from animal products)  Unsaturated (liquid @ room temp., come from plants)  Monounsaturated  Polyunsaturated  Omega-3 fatty acids (fish)  Transfat (solid @ room temp., come from animal products) o Proteins  Complete (contain all essential amino acids)  Incomplete o Water  Micro (need a little of) o Vitamins - not used for sources of energy  Fat soluble  ADEK  Water soluble  B  Rebound effect - body acts like it doesn't have enough of that vitamin  Mega dosing o Minerals - not used for sources of energy _________________________________________________________________________________ Principles  Balance  Variety  Moderation  Exercise __________________________________________________________________________________ Dietary recommendation  2.5 L/day of water  Calories o Female: 1000-1200/day min o Male: 1200-1400/day min o Overall: 2000-5000/day  Carbs: 60-70% of overall cals  Protein: 10-15% of overall cals  Fats: < 25% of overall cals  Have to make sure our diet is composed of what we need it to be composed of  Expensive pee  Cannot escape conservation of energy  Cant outrun your fork  You can't outsmart your body (or can you?)  Carbs are king (fat burns in a carb flame)  Protein is not as big a deal as you think it is Energy in VS. Energy out  Energy in o Food  Carbs: 4 kcal/gm  Protein: 4  Fat: 9  Alcohol: 7  Energy out o Activity o BMR **Harris benedict equation** ___________________________________________________________________________________ Female athlete triad  Disordered eating (believe they have an unhealthy body image - body dysmorphia o Bulimia - binge and purge o Anorexia nervosa - don’t eat, or min calories o Anorexia athletica - exercise a ton to get the desired body image  Amenorrhea o Put hormones out of whack  Osteoporosis o Lose bone mineral density  Not enough calcium  Hormonal imbalance **if you have a larger ROM in joint, the less likely you are for injury AND VICE VERSA** **Sagittal has the most ROM** **Work:Rest ratio** **muscle burns fat 24-hours a day** **try not to consume more than 500 cals at one time** Change technique CH 14-17 Phases of Healing 1 Inflammatory response phase (2-4 days) - immediately after injury o Good o Bad if left unchecked, because later healing stages cannot occur o Most critical  Inflammation o Vascular (necessary for healing process)  Vasoconstriction - slow down flow of blood  Coagulation (temporary fix)  Vasodilation -  Clot formation - patching up  Fluid removal o Cellular (necessary for healing process)  Neutrophils  Cluster bomb (get rid of toxic waste)  Indiscriminate - can destroy healthy cells  Macrophages - clean up stuff  Drop into lymphatic system  Use RICE to therapeutize injured/inflamed area 1 Fibroblastic repair phase (4-6 weeks, depending on injury) o Reinforce  Primary intention  Resolution (first degree injury) - maintain full function  Structures are intact  Regeneration - most function remains  Like-replacing-like (muscle damaged tissue, muscle replaces)  Secondary intention  Repair - loss of function  Scar formation (replace muscle with scar)  Prefer not to happen/occur  Delicate balance between letting scar form and not letting it go too far unchecked  Improve ROM, then work on Biomotor abilities 1 Maturation remodeling phase (2-3+ years) - try to minimize damage of it o Minimize scar tissue overlap o Reestablish/realignment of scar tissue in a position of maximum efficiency, parallel to the lines of tension _____________________________________________________________________ Goal Setting S - specific M - measureable A - attainable R - relevant T - time based Education (underneath the skin)  Keep people informed to be able to deal with problem _____________________________________________________________________ Things go bad - when things go unchecked  Hemorrhage - vessel is disrupted and leakage occurs due to pressure inside being greater than the pressure outside o Pressure flow from high-low (2nd law of thermodynamics)  Pressure wrap to reverse these effects  Edema - swelling (plasma fluid accumulates) o Increase pressure through compression and/or elevation o Decreased lymphatic return and venous return o Decrease of oxygen to tissue - leads to secondary trauma  Result in decrease of oxygen  Leads to cell death  Ice  Decrease cellular metabolism (decreasing the need for oxygen) ____________________________________________________________________ Bone  Good to go  Better chance of healing o Subchondral bone  Fractures o Most common acute fracture is the 5th metatarsal fracture = jones fracture o March fractures (stress fracture of 2nd metatarsal due to running and jumping)  Stresses applied?  Stiff landing  Heavy foot strike  Frequency of stress applied? o Apophysitis of Achilles tendon  Sever's disease o Exostosis  Heel spur (excess plantar fascia)  Bunion (hallux valgus deformity)  Excessive pronation and external rotation of hips  Proximal drives the distal and vice versa Ligament  Not good at healing  Restrict or guide certain motions Cartilage  Red zone (received blood) o Better chance of healing  White zone (no blood supply) o Not good at healing Tendons  Not good at healing (mediocre) o Poor blood supply Muscle  Some ability to regenerate Nerve  NO ability to regenerate o Farther out, better chance of regeneration o Closer to CNS, little to no change of regeneration ____________________________________________________________________ Lower extremity  Leg stiffness (joint stiffness) o Lack of strength/endurance in tibialis anterior o Too stiff, more prone to injury o over-pronators - too much motion in transverse plane o supinator's - don't have enough motion in transverse plane o Surface/environment o Frequency (training errors)  Pronation/Supination (breaking phase - pronation [absorbing energy] occurs; ) o Subtalar Joint (pronation - supple & supination - locks) i. Eversion (calcaneus slides laterally while foot in planted) ii. Abduction i. Dorsiflexion o Talus (supination)  Plantar flexes  Adduction  Inversion o Transverse Tarsal (supination and pronation)  Midfoot does opposite of rear foot, and vice versa o Plantar fascia  Superficial layer of sole of foot  Generate force from Achilles to metatarsal bones  Flexor digitorum brevis (intrinsic) - muscle right below  Locks foot in place when tight  Modulate health of plantar fascia  Runs in same direction of plantar fascia o Talocrural (plantar/dorsiflexion)  Anterior talofibular ligament (lateral) - restrict/constrain inversion & susceptible to injury  Weakest one  Calcaneofibular ligament (lateral) - ""  Posterior talofibular ligament (lateral) - ""  Excessive inversion = lateral sprain (more common)  Fibula extends further down than tibia  When we land, we go into pronation  Deltoid ligament more loaded = more thick  Occur from landing on someone's foot  Medial side  Deltoid ligament - restrict eversion  Excessive eversion = sprain of deltoid ligament  Can take longer to heal o Distal tibia/fibular joint  Syndesmotic joint/sprain - high sprain  Excessive dorsiflexion & external rotation of foot  Anterior  Posterior  Crural  Having the two bones makes the lower leg lighter (not as heavy to move around) - energy saving mechanism  Shape of talus is wider anteriorly than posteriorly, we need an adjustment o Shank (tibia and fibula)  Internal rotation  Tibia  Most commonly fractured long bone o Femur  Internal rotation o Hip  Internal rotation o Ankle  Dorsiflex o Knee  Flex o Hip  flex Joint Injuries  Dislocation occur anywhere, but less common than fractures  Turf toe o Hyperextension of metatarsal phalangeal joint (occurs on turf) + extra weight  Prevent injuries o Focus on eccentric strength o Wear braces o Taping (more effective) o Neuromuscular control on the trunk Foot  MTPJ (metatarsal phalangeal joint) Muscle/tendon  Tibialis anterior/extensor halluces longus o Prevent foot slap (need adequate endurance)  Tibialis posterior o Regulate arch  Posterior tibialis o Gastrocnemius and Soleus o Minimize/limit uphill running  Plantar fasciitis o Lack of strength & endurance of plantar fascia o Tight gastroc/soleus o Focus on intrinsic muscles of foot  Peroneal tendon subluxation (partial dislocation) o Forceful plantarflexion and inversion  Shin splints (strain of tibialis anterior) o Control heal strike to flat foot o Minimize/limit downhill running Nerve  Sciatic nerve = Tibial nerve + common peroneal nerve o Splits at the knee o Common peroneal nerve splits deep, to control extensors o Tibial stays superficial  Tarsal tunnel syndrome o Compression of Tibial nerve in tarsal tunnel o Excessive pronation o Strengthen supinator's, or use orthotics  Anterior compartment syndrome o Anterior & posterior Tibial artery o Tightly bound by fascia o Swelling in anterior compartment and can pinch off anterior Tibial artery (decreased blood flow) o Exertional anterior compartment syndrome i. Inflamed tibialis anterior o Acute/traumatic "" i. Some gets "smacked" ii. Medical emergency iii. Swelling doesn't go down right away Knee  Tibia, fibula, femur, patella  Joint o Tibiofemoral  Flexion  Extension  Internal rotation (not under voluntary control unless non-weight bearing)  External rotation (not under voluntary control unless non-weight bearing)  The menisci (medial "C" shape; and lateral "O" shape)  Deepen the surfaces of the joint  Load transmission  Shock absorption  Assist gliding movement  Catch and push (Newton's third law)  Attached to tibia  Move with, follow femur  Excessively stretched, usually with rotation = tear  Osteoarthritis - improper wearing/tearing of joint  Anterior cruciate ligament (ACL)  Does not like anterior translation  Internal rotation (ACL wraps around PCL)  Valgus (bringing knee in) or varus (knee out)  Prevent tibia from moving anteriorly from femur & vice versa  Valgus collapse (bowing in)  Transverse plane = slippage  Sagittal plane  Adduction and internal rotation of femur  Women more common  Rupture of PCL  Prevents femur from moving anterior to tibia  Medial collateral ligament  Prevent valgus movement  More common because more likely to get hit from the outside-in, than inside-out  Resist external Tibial rotation  Relaxed during flexion  Lateral collateral ligament  Prevent varus movement  Relaxed during flexion o Patellofemoral (common knee pain)  Trochlear depth (flexion)  Shallow superiorly (within 30 degrees)  Deeper inferiorly (60 degrees)  PFPS (patellar femoral pain syndrome) - (valgus collapse)  Excessive stress (Force/area)  Increase contact area = decrease stress  Increase strength of quads  IT Band friction syndrome  IT band doesn't have nerves  Fat pad being pinched, is signaling pain between femoral condyle and IT band (valgus collapse) Hip (cocsyfemoral joint)  Does not get injured as much o Deep sockets o Strong ligaments  Iliofemoral (Y ligament, big load)  Prevent hyperextension  Ischiofemoral  Prevent internal rotation  Pubofemoral  Prevent adduction  Anterior tilt o Hip flexion and lumbar extension  Posterior tilt o Hip extension and lumbar flexion  Hip abduction o Glute med o Tensor fascia latae  Injuries o Hip pointer (contusion to iliac crest)  Preventable by proper padding o Labral tears  Pinching between labrum and femur o Hamstring strain  Occur during eccentric phase  Stretching hamstring over both knee and hip joint simultaneously  Then follow-up with a heavy, eccentric load  Occurs during late swing phase o Heterotopic ossification (myositis ossificans)  Contusion Valgus  Subtalar joint o Excessive pronation & internal rotation  Restriction in supination or weakness of  Ankle joint o Limited dorsiflexion  Hip joint o Excessive internal rotation  Restriction in external rotation or weakness of Equipment consideration  Foot type o Normal o Pes planus (flat feet)  Over pronators = too much motion  Stability or motion control shoe o Pes cavus (high arch)  Supinator = Not enough motion  Cushioning shoe  Lasks o Straight need motion control o Semi-curved o Curved  1/2 to 3/4 in from the end of the longest toe  Break of shoe = metatarsal heads  Width - don’t want squished toes  Measure both feet  Use the longest measure **phalange + metatarsal = ray** **look at bone diagrams** _____________________________________________________________________ **undamaged areas are still functional** **all the above refer to injured area only** **mobility-strength-power-endurance** **always lookout for 1. pain 2. subjective measures (how patient feels) 3. objective measures (goal to reach) - guide therapeutic exercise throughout entire process** **rehabbing a person, and not just the injury** **can't measure/see myofascial adhesion** **plantar flexion/inversion are most important, and act eccentrically as we go into pronation for a loading response - act concentrically to produce supination** **absorbing E (eccentric - opposite motion) = pronation ; creating E (concentric - does the motion) = supination** Upper extremity Sternum + Clavicle = sternoclavicular joint (SC)  Elevation o In sagittal plane = flexion  Elevation + upward rotation + protraction of GH o Frontal plane = abduction  Upward rotation + elevation + retraction o In plane of scapula = scaption  Upward rotation + elevation of GH  depression  Protraction/retraction Clavicle + Scapula = acromioclavicular joint (AC)  Upward/downward rotation  + accessory movement o Winging  Raised medial border of scapula o Tipping  Raised superior scapula Humerus + Scapula = glenohumeral joint (GH) - shallow ball & socket  Flexion/extension  Ab/adduction  Horizontal ab/adduction  Internal/external rotation Scapula sitting on rib cage = scapulothoracic articulation (ST) - (not really a joint)  Movement at SC joint & AC joint ______________________________________________________________ Shoulder movement  Combination of GH joint movement & ST movement ST motion  SC + AC motion ______________________________________________________________ Scapula  Scapula plane - not in full sagittal or transverse plane **Need scapula to point GH where we want it to go** Shoulder - GH  More prone to injuries  Shallow socket  60-90 degrees = no scapula movement, all GH  Loose GH ligament complex o Not strong, and doesn't limit movement o Fairly unstable, but needed for mobility Clavicle ________________________________________________________________ SC joint (muscles that move scapula)  Elevate o Traps (upper) o Levator scapulae o Rhomboids  Depress o Pectoralis minor o Lower traps  Protract o Serratus anterior  Retract o Middle traps o Rhomboids AC joint (muscles that move scapula)  Upward rotation o Upper & lower traps o Serratus anterior  Downward rotation o Rhomboids o Pectoralis minor o Levator scapulae GH  Flexion o Anterior deltoid o Pectoralis major (clavicular)  Extension o Lats o Posterior deltoid o Teres major  Abduction o Middle deltoid o Anterior deltoid o Posterior deltoid o Supraspinatus  Adduction o Lats o Pectoralis major o Teres major  Internal rotation o Pectoralis major o Lats o Teres major o Subscapularis  External rotation o Infraspinatus o Teres minor  Horizontal abduction o Posterior deltoid  Horizontal adduction o Pectoralis major (sternal) Highlighted = rotator cuff __________________________________________________________________ 4 "P's"  GH protectors: rotator cuff + biceps brachii lateral head o Keep humeral head in glenoid fossa o Most important o Isolated work can be key  Scapular pivotors: SC + AC joint muscles o Point GH where the humerus needs to be o Traps and serratus anterior o Isolated work can be key o Most important  Humeral positioners: o Position humerus where it needs to be in space o Deltoids  Propellers: lats, pec major, teres major (internal rotators) o Generate torque/energy that is delivered to the arm **started recording** ____________________________________________________________________ Shoulder injuries  Mechanisms o Direct blow o FOOSH (falling on outstretched hand) o Faulty mechanics  Clavicular fracture o Most common in sports  Occur in middle 1/3 of clavicle o Direct blow OR foosh o Breaks where the clavicle bends o Medical emergency  Humeral fracture o Direct blow, dislocation, &/or foosh o Occasionally occur  SC joint dislocation/sprain o Foosh o Forced retraction o Direct blow to clavicle o Relatively uncommon  AC sprain "shoulder separations" o Direct blow to acromion  Down-back-in o Falling and landing on AC joint o Foosh o Easy to see because they pop out o Extremely vulnerable to sprains  GH dislocation (anteriorly [happen more frequently] & posteriorly) o Anterior dislocation  Abducted, externally rotated, extended  Hill-sachs lesion o Divot on humeral head cartilage o Occur on posterior aspect of humerus o Need subluxation for injury  Labrum tear (doesn't need to dislocate) o Surrounds glenoid fossa o SLAP lesion  Pull on superior portion of labrum  Avulsion o Bankart lesion  Inferior/anterior labral tear  Like meniscal tear  Anterior shear o Posterior  Flexion, adduction, internal rotation o Looks like foosh Chronic instabilities  Strengthen GH protectors and scapular pivotors Adhesive capsulitis (frozen shoulder)  Joint capsule becomes sticky by folding in on itself o Lose flexibility  Develop over time  Function of prolonged immobilization o Lack of ROM in older adults o People with shoulder injury  Hard to fix _________________________________________________________________________ Impingement  Something is getting pinched during repetitive overhead activities  Doing the pinching o Coracoacromial arch o Humeral head  Humeral head  Prevent upward rotation of scapula  Getting pinched under the coracoacromial arch o Biceps brachii tendon, long head o Supraspinatus tendon o Subacromial bursa Rotator cuff tear  Need eccentric muscle action through external rotators  Smaller arch = larger torque  Occur o Asking too much of external rotators - infraspinatus & teres minor o Not enough ROM in other areas that can absorb energy: hip & trunk o Scapula not working correctly o GH separates from glenoid fossa  Near insertion on the humerus o Supraspinatus muscle is the most common strain Biceps brachii/tendon ruptures  Can occur inferiorly or superiorly  Biceps tendon's roll as a GH protector  Distal rupture due to heavy eccentric load Biceps tendinopathy  .. Thoracic outlet syndrome  Brachial plexus nerve o Putting pressure on nerve by muscle GIRD (abnormal condition)  GH internal rotation deficit  Internal rotation less than 25 degrees  Side to side differences less than 25 degrees o Less time to hit breaks, the harder you need to hit the breaks Scapular dyskinesis (abnormal condition)  Abnormal movement/position of scap in the normal resting or active position Brachial Plexus  Stretching = burner or stinger o Shoulder in one direction, and head in another o Temporary disruption o Can't move arm  Direct blow o Same as stretching o Temporary disruption  Pinching o Same as stretching o Temporary disruption _________________________________________________________________________ Elbow  Slight angulation - carrying angle (normal - 5-15 degrees) o Women have larger carrying angle  Doesn't affect elbow function  Humerus o Rad i al collateral ligament - attached to humerus  Varus  Lateral side o Ulnar collateral ligament - attached to humerus  Valgus  Medial side  Radius (thinner)  Ulna (thicker) o Annular ligament - attaches radius and ulna  Surrounds radial head/holds it tight to ulna  Injuries o Dislocation is rare  Needs to occur posteriorly Forearm  Radius (thicker)  Ulna (thinner)  Supinators (stronger) o Supinator o Biceps brachii o Brachioradialis - brings to neutral position (thumbs up position)  Pronators o Pronators teres o Pronator quadratum o Brachioradialis - brings to neutral position (thumbs up position)  Injuries o Fractures  FOOSH o Little league elbow  Accelerated apophyseal growth region + delay in medial epicondyle growth plate o Soreness to fractures and ripped ligaments  Don't want kids throwing more than 75 pitches/game  Don't want kids pitching to no more than 1 batters/game o Dislocation  High incidence  FOOSH o Elbow in hyperextension OR severe twist while elbow is flexed o Ulnar collateral ligament  Valgus loading  Tommy john surgery  Strengthen wrist flexors o Nursemaids elbow  Yanking on arm  Radial head dislocation o Tennis elbow  Pain on lateral epicondyle - most common  Really a wrist injury - repeated wrist extension o Repeated strain of wrist extensors  Give smaller racket and looser strings (to prevent injury)  Get someone's feet to move faster o Golfer's elbow  Medial epicondylitis  Forceful flexion of wrist  Get better as golf  Not as common Wrist/Hand  Radial collateral ligament - attach to proximal carpal row  Ulnar collateral ligament - attach to proximal carpal row  Palmar o Flex wrist (originate on medial epicondyle of elbow)  No effect for elbow flexion/extension (no moment arm)  Flexor digitorum superficialis  Flexor digitorum profundus  Flexor carpi ulnaris  Flexor carpi radialis o Extend wrist (originate on lateral epicondyle of elbow)  Extensor digitorum  Extensor carpi radialis longus & brevis  Extensor carpi ulnaris o Proximal carpal bone (lateral to medial)  Scaphoid  Lunate  Triquetrum  Pisiform o Distal carpal bone  Trapezium  Trapezoid  Capitate  Hamate o Thumb  Flexion o In hand  Extend o Out of hand  Abduction  Adduction  Injuries o Colles fracture  Forearm fracture - most common


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