Sideline Management

Sideline SafetyWorkbook
Tutor: Hamish Ashton MHSc

NZAS Approved Physiotherapist
Sports Physiotherapy New Zealand
Side Line Safety
Sideline Safety
Unit Objectives:
* To enable the student to identify commonly encountered sports related injuries.
* To equip the student with basic knowledge of injury management, prevention and
rehabilitation.
The Objectives will be achieved by:-
* Basic understanding of Physiology associated with injury.
* Sports Medicine:-
- Identification of commonly injured musculo-skeletal structures TOTAPS

- Pathology relating to sports injury sites
- Treatments - RICE, Taping.
- Rehabilitation, Stretching, Warm-up, Prevention.
On completion the student will have an understanding of:
- the principles of first aid and their relevance to sports injury;

- the practical applciation of appropriate first aid techniqes;
- the practical application of iniitial treatment of common sports injuries;
- the requirements of pre-event planning and preparation.
Sideline management2 Page - 2

Side Line Safety
Sports Trainer / Medic

Side Line Safety
General Roles and Responsibilities of the Sports Trainer
1. Immediate and Total Care of the Athlete:

The trainer should attend all training sessions, games and performances and assist in pre-
participation checks on athletes, in particular those with injuries. The condition of the
athletes should be reported to the coach before their on-field participation.
A team approach is needed for on-field care, with the sports trainer working in conjunction
with other team officials. After competition, the trainer is concerned with dressing room
care and liaison with other health professionals to ensure the optimum treatment for injured
athletes. A careful check should be made on all injuries, some of which may not have been
obvious during competition.
2. First Aid:
The role of the sports trainer is to recognise the occurrence of an injury and administer
immediate first aid care. Further treatment should be determined by liaison with an
appropriate health professional.
3. Injury Prevention:
In association with a physiotherapist, the sports trainer uses strapping techniques to minimise
the recurrence of injuries. It is the duty of the sports trainer to ensure that all athletes make
use of suitable, well-fitted protective equipment, such as mouth guards, shin guards and,
where appropriate, headgear.
4. Rehabilitation:
After the occurrence of an injury, the sports trainer should ensure that the rehabilitation
program prescribed by a team doctor or physiotherapist is completed. Various physical
techniques and rehabilitation procedures may be used by the sports trainer under the
direction of a team doctor or physiotherapist, to restore injured athletes to competition as
soon as possible. The trainer should ensure that an athlete does not return to activity
without the consent of the supervising clinician.
5. Health Training:
A further responsibility of the health team is the education of athletes for the development of
sound general health and fitness practices.

Side Line Safety
6. Facility Management:
The Venue - The sports trainer should ensure that the playing area and surrounding grounds
are free from hazards, and that the training facility is maintained in an orderly and sanitary
state.
Dressing and Club-room Facilities - A specific treatment area should be set up, which has
an appropriate treatment table, a chair, adequate light and running water close at hand.
Good hygiene and health practices should be maintained in club facilities - dressing and club
rooms, showers and toilets - and such facilities must be adequate for the number of people
using them. The sports trainer should encourage team members to practise good personal
hygiene and where possible provide posters on basic first aid and health practices in the club
rooms.
On-site Equipment - Appropriate first aid equipment should be available at both training
and competition venues.
Access to the Venue - The sports trainer must be familiar with the location of the entrances
and exits at all venues, and in the case of an emergency, ensure adequate access for an
ambulance.
Communications - There should be a telephone or alternative means of communication in

case of an emergency. The sports trainer should know the location of telephones at both
home and away venues, and ensure that emergency numbers such as ambulance and
hospital service numbers are clearly displayed in the club room telephone area.
Appropriate hand signals should be familiarised for emergency communications for on-field
assistance.
Medical back-up - Immediate medical help should be available to the athlete when injury
occurs. However, if this is not possible, the athlete should be referred to the appropriate
medical help as soon as possible after the injury.
Notification for Visiting Teams - The sports trainer should notify visiting team officials
about the standing orders for emergencies. These would include equipment, facilities, access
and communications.
7. Records:
It is the role of the sports trainer to instigate an accurate and up-to-date record system. For
each team member, the following information should be recorded:-
a) Past medical history - All relevant matters concerned with physical health of the
athlete such as a relevant medical history, treatment given, and past fitness tests.
b) Current medical history - The present injury and how it is being treated.

Side Line Safety
Code of Ethics:
The sports trainer's skills and knowledge are used to aid both the health and performance of an
athlete.
It is essential for trainers to recognise their limitations and not exceed their role and responsibilities
as this can be detrimental to the health and performance of athletes. A sports trainer therefore,
assumes a definite role and certain responsibilities which are developed in conjunction with other
team officials.

Side Line Safety

Side Line Safety

Side Line Safety

Side Line Safety

Side Line Safety
Injury Prevention
1. Introduction:
Many injuries in sport are preventable. Coaches are often in the best position to educate
athletes on injury prevention and this area should be given priority. Prevention is better than
cure. The prevention of any health problem is far more cost effective than treating the
problem after it arises. Too often, lapses in common sense result in serious injury while
other injuries result from a clear lack of knowledge of the human body and its capabilities.
An important element that may assist in the prevention of injury is the development of the
appropriate skill and fitness level for the sports performance required. There are many other
factors which may cause injury in sport. The player has direct control over many of these
and should therefore recognise them as personal responsibilities.
Other contributing factors include:
i) not wearing protective equipment

ii) breaking the rules of the game
iii) playing on substandard facilities.
2. Injury Prevention:
The coach is in an excellent position to assist the player in understanding the possibilities for
injury prevention. It is important to recognise that factors such as conditioning, warm-up
and flexibility are a crucial aspect of an injury prevention programme. These areas are
covered in more detail in other chapters.
3. Protective Equipment:
Equipment should be designed to protect against injury, to be light and comfortable and not
to interfere with function.
Helmets - should be worn in activities where there is a risk of injury to the head from falls,
balls, collision or other external force. They are essential for sports such as motor racing,
motor cycling, bicycling, ice hockey, horse riding, cricket. They should be made of material
which can withstand considerable force. They should protect the head, jaw and face without
restricting vision. They should also be light and cool.
Mouthguards - any mouthguard to be worn in a contact sport should be fitted by a dentist

to ensure comfort and uninterrupted breathing, while still allowing the athlete the luxury of
talking properly. Mouthguards are designed to protect teeth and jaws against trauma and
injury.
Side Line Safety
Shoulder Pads - worn in rugby do not reduce the incidence of severe injuries such as dislocated
shoulder, fractured collar-bones or subluxation of the acromioclavicular joint (the knobs of the tops
of the shoulders). They do protect against bruising of soft tissue around the shoulder. Some sports
medicine practitioners believe that shoulder pads should not be allowed. They suggest that by giving
the sportsman a false sense of security the shoulder pads may contribute to injuries.
Hip Pads - are not often used, as they have been found to be more cumbersome than protective,
although they are sometimes used in cricket.
Knee Pads - do not protect the knee against internal injury. They are used in protecting against
superficial injury such as that caused by gravel on hard surfaces, as in netball or skateboarding or by
an artificial surface such as that used for field hockey.
Shin Pads - are worn in many sports, but most commonly in soccer and field hockey. It is
important to make sure that they are made from material which is easily moulded to the shin so they
should be properly fitted.
Taping - is often used to protect such joints as the ankle, knee or thumb against injury. A non-
stretch tape should be applied by someone who has had some formal instruction.
Inner Soles - shock-absorbent inner-soles are a proven method of dissipating the forces that are
transmitted from the road surface to the athlete during running. They should be the correct size and
shape for the individual's feet.
Wet Suits - used for water skiing are designed to protect the abdominal and pelvic areas of the body
and should be worn, particularly when travelling at high speeds. They are also used in sports like
yachting, sail-boarding and surfing to minimise heat loss and reduce the risk of hypothermia.

Side Line Safety
Other Prevention Factors
In addition to the major preventative measures already detailed, several other factors should be
considered.
Footwear:
* Correctly fitting
* Structurally sound
* Appropriate to the activity and playing surface
* Laced adequately for support
* Hi-top boots add to ankle support.
Equipment:
* Complete and undamaged

* Not excessively worn
* Suitable to user's size, skill and fitness
* Wear appropriate protection
* Protective devices undamaged, and correctly fitted.
Environment:
* Surface condition checked for safety eg: holes, unevenness, debris, floor nails,
fixtures etc.
* Goal uprights padded, lines marked, corner posts safe
* Extremes of weather:-
- heat - humidity - cold

- wind - rain - sun exposure.
Note: Moderate heat coupled with humidity can produce heat stress as great as very hot
conditions. Allow removal of hot clothing and drink plenty of water in hot
conditions.
Cool but windy conditions can be more 'chilling' than cold alone. Keep warm and
dry and block-out the wind to avoid "hypothermia".

Side Line Safety
Skill:
* Assessed and developed

* Appropriate to game or competition level
* Adequate in all areas.
Rehabilitation:
* Guided by a qualified, sports medicine professional

* Reported by a sports medicine practitioner and recorded by coach or trainer
* Complete for any injury
* Assessed performance prior to return (fully fit).
Rules:
* Keep to them, for safety sake

* Encourage fair play.
Age:
* Children (and teenagers) grow at different rates - don't match on age alone
* Physique may belie physical capacity - big is not always strong!
* Age and physique are often "older" than maturity of thought and emotions
* Fun is still fundamental for non-adults
* Consider the future careers of young players - employ ALL injury prevention
measures
* Adult athletes still need care and guidance in prevention, treatment and rehabilitation
of injuries.
Take a long-term view and,

Prevent
a long-term injury

Side Line Safety

Side Line Safety
Physical Preparation
Introduction:
When sports injuries occur, inevitably costs are involved. For the athlete the costs are in terms of
playing and training time, loss of physical condition (fitness) through reduced activity and,
monetary ($) and time costs for necessary medical treatment and rehabilitation. The player's team
and coach have the cost of compensating for the injured member. This section describes important
factors which can reduce the risk and so the costs of sports injuries. In particular, warm-up,
stretching, physical conditioning and taping are detailed as injury prevention (prophylactic)
measures. Many of these activities are also essential for quality performance in most vigorous
sports.
The trainer has an important role to play in encouraging players and coaches to adopt a
preventative attitude to sports injuries. Planning time for physical conditioning during the off-
season and pre-season, and, taping and maintenance of physical condition in the competitive season
should more than offset the costs of injury (which increase as the competitive season develops).
*Indeed prevention is better, and costs less than cure!!

Side Line Safety
Pre-Activity Preparation (Warm-Up)
General Warm-Up:
Warm-up basically is just that!! Before beginning vigorous physical activity, bodies need to prepare
for the extra stress of exercise. The "warm-up" includes controlled movement, using large muscle
groups, working from easy to moderate effort. Examples of such activities include easy jogging,
cycling or swimming, low jumps, arm swings, large trunk movements, ball work and basic game
skills.
The body responds by increasing heart rate and circulation, increasing use of oxygen and producing
Heat. As a result of these responses, light sweating commences.
Warm-up activities should:
* use all large muscle groups

* be easy effort to begin
* build-up gradually to moderate effort
* continue (approx 10 minutes) until each player feels warm as indicated by
perspiration and verbal report
* be followed immediately by muscle stretching activities (refer section on stretching)
* also be performed in longer stretch sessions to maintain warmth.
* be interesting by use of game related, group activities.
Warm-up, when performed correctly and directly followed by muscle stretching, prepares the body
for efficient, vigorous activity and reduces the risk of soft tissue injury.
Specific Warm-Up:
Sports activities which involve speed, power, agility, or very specific movements require further
physical preparation prior to full effort in training or competition. The nature of the sport or
training activities will determine what is done in this second phase of warm-up.
However the following guide-lines should apply:
* Be specific - warm-up and stretch muscles involved in the actual game or training
session.
* Perform - the movements to be used in the game or training session.
* Grade effort - start moderately and build to the intensity of the training or
competition to follow.
* Avoid fatigue - through warm-up, especially for children.

Side Line Safety
Dynamic stretching
http://www.acc.co.nz/preventing-injuries/playing-sport/sportsmart-10-point-plan/warm-up-cool-down-and-
stretch/pi00114
Dynamic stretching is good for waking up muscles, to get them ready to work hard. This involves
moving your limbs through the full range of motion that they will be used in during activity.
Effective dynamic stretching

 Always do 5-10 minutes of aerobic exercise before starting dynamic stretching.
 Maintain tension in the lower abdominals to protect your lower back and to control movement of your trunk.
 Keep your knees in line with your toes to protect your knees.
 Do not force the movement or lose control of the movement.
 Gradually increase the range of the movement over a series of repetitions as you loosen up.
 Repeat the movements up to 12 times. You may need to do more or less than this number depending on how
tight your muscles feel.
 Spend about five minutes in total on your dynamic stretches during warm-up.
Note:
If you have been given static stretches by your trainer or physiotherapist for tight muscles, do the
stretches after your aerobic exercise. Static stretches relax muscles, therefore only stretch the
muscles that are tight. Make sure that you stay warm when doing static stretches. Repeat the
stretches after training and games.
If you require specific dynamic stretches for your sport, see Smart tips (external link).
Leg swings forward and back

Buttocks, front and back of thigh
1. Hold on to a solid object and balance on one leg.
2. Swing the other leg forwards to a comfortable height, ensuring that your trunk and lower back stay rigid and
do not bend.
3. Swing the leg backwards, ensuring that there is little movement in your back.
4. Change legs and repeat.
Notes:
 Keep your hips facing forward.
 Keep the knee of your swinging leg straight when swinging forward.
 Keep the knee of your swinging leg slightly bent when swinging back.
 Swing to a height that suits your flexibility. Forcing the leg high by swinging too hard may result in injury.

Side Line Safety
Leg swings side to side
Back and inner thigh
1. Hold on to a solid object and balance on one leg.
2. Turn your foot (on the leg you are balancing on) outwards.
3. Swing the other leg away from your body, turning the foot so your toes point at the sky.
4. Swing the leg back across your body, pointing the toes in the direction your leg is moving.
Note:
Keep checking that you are minimising trunk movement.
Hurdle step overs

Buttocks and inner thigh
1. Hold on to a solid object and stand with one leg behind the other.
2. Lift the knee (of the back leg) high to the front.
3. Rotate the leg outwards.
4. Returning to the start position.
Note:
Keep checking that you are minimising trunk movement.
Lower leg calf raises

Calf muscles
1. Position your body as if you were on the starting blocks of a sprinting race, feet side by side.
2. Support your weight on your hands and feet.
3. Start stretching your calves by pushing one heel towards the ground then onto the ball of the foot and then
back again.
4. Alternate between legs.

Side Line Safety
Upper body trunk rotation
Trunk muscles and chest
1. Position your feet shoulder or hip-distance apart.
2. Stand with your back straight and knees slightly bent.
3. Swing your arms across your body at waist height. (You should feel this mostly in your lower back.)
4. Move your arms higher to around shoulder height and swing them across your body. (You should feel a
stretch through the middle of your back.)
5. Raise your arms above your head and swing them. (You should feel the stretch higher in your back.)
Note:
If you find a tight area, do extra repetitions to loosen it up without forcing the movement.
Bent over upper body rotation

Trunk muscles, chest, inner and back thigh
1. Position your feet apart, twice the distance of your shoulder or hip-width.
2. Bend at the hips, ensuring that your spine stays long and your back doesn’t round out.
3. Bend your knees a little.
4. Extend both arms out to your side, at shoulder height.
5. Rotate your trunk and arms to reach towards the opposite toe while bending that leg.
6. Alternate sides.
Note:
Reach as low as your flexibility comfortably allows - aim for tension, not pain. It is not necessary to
touch your toes if you can’t reach that low.
Arm circles
Side Line Safety
Muscles around the shoulder
1. Stand with your back straight and knees slightly bent.
2. Swing both your arms around in circles while keeping your back still.
3. Change direction and repeat.
Note:
If you find tightness in an area, spend more time in the area to loosen it up.
Lunges / lunge walks

Side trunk, back, hip and leg muscles
1. Stand with your trunk upright at all times.
2. Take a large step forward and drop your body down between your legs.
Note:
The front knee should be pointing in the same direction as the toes and shouldn’t be too far forward over the
toes.
3. Check the front and back knees are at right angles at the bottom of the step.
4. Alternate between legs.
Progression
Reach the arm on the side of the leg that is back, up and over to the other side. You should feel this
stretch down the sides of your trunk. For an extra challenge, try doing the walk forwards and
backwards.

Side Line Safety
Maintenance of Warm-Up:
The pre-activity preparation or "warm-up", as outlined, should be standard practice for all
exercise situations. Sometimes the benefits of warm-up and stretch are reduced or lost before
competition or heavy training commences. This may also occur whilst waiting between events or
during time outs.
Loss of the warm-up effect should be avoided or minimized and the following guide-lines may
help:
Planning: - reduce time between the end of warm-up and intense exercise
Clothing: - make accessible for wear after warm-up, including head and
neck covering
- allow wear during training if practical
Activity: - use intervals of activity to offset cooling
Environment: - provide shelter from wind, rain or cold, eg: room, tent.
Cooling Down:
After the intense activity of physical conditioning, or skill training, or competition, activity level
should be gradually reduced, not suddenly stopped. This allows the body to recover from effort and
reduces the effects of fatigue, including muscle soreness.
Firstly, exercise intensity should be graded down to jogging/walking pace, or to some simple
activity requiring moderate effort only.
Secondly, muscles and joints are hot following intense work of contracting. This is an ideal time to
stretch them out again. Tracksuits or similar should be available for wear at this point.
This end phase of training may also be used to reflect on the training session, and for coaches to
motivate players for the next game or training session.
Cool down summary: - down grade intensity

- replace clothing (track-wear)
- stretch muscles
- coach communication

Side Line Safety
Anatomy

Side Line Safety
Terms of Movement
Movements take place at joints where two or more bones meet or articulate with one another.
Table 2: Commonly used terms of movement.
Flexion: Bending or decreasing the angle between the body parts eg:
flexing the elbow joint.
Extension: Straightening or increasing the angle between the body parts eg:
extending the knee joint.
Abduction: Moving away from the midline eg: abducting the upper arm.
Adduction: Moving towards the midline eg: adducting the lower leg.
Rotation: Moving around the long axis eg: medial or lateral rotation of
the upper arm.
Circumduction: Circular movement combining flexion, extension, abduction and

adduction eg: in circumduction of the upper arm.
Eversion: Moving the side of your foot away from the midline eg: when the
outer/later surface of the foot is raised.
Inversion: Moving the side of your foot towards the midline eg: when you
examine your foot for a splinter.
Supination: Rotating forearm and hand laterally - so palm faces anteriorly.
Pronation: Rotating forearm and hand medially - so palm faces posteriorly.

Side Line Safety
Basic Anatomy
Bone:
Bone is rigid material. It is hard, rigid, strong and does not bend. Bones are made up of a firm
outer casing called the cortex and a softer centre called the medulla.
There are special cells called osteoclasts and osteoblasts which are responsible for bone growth and
repair. They are situated in the periosteum (special connective tissue). A joint is where two or
more bones meet. There are many types of joints
Muscles:
Muscles are made up of bundles of muscle fibres arranged in direction to assist their action. They
are well supplied with blood vessels, connective tissue and nerves.
Their role is to assist the body to move. Some muscles are only for specific functions eg:
respiratory muscles - diaphragm and intercostals, others perform complex and integrated activities
during everyday life or sporting activities.
Ligaments:
Ligaments are made up of orderly bundles of collagen fibres and are attached to bone around joints
to provide stability during movement. They are non-elastic and their direction and length is directly
related to their function and site within the body. They can also control the extent and direction of
movement at the joint.
Tendons:
Tendons are parallel bundles of collagen fibres designed to transmit the contractile force of muscle
to the bone. They are all attached to major propulsive muscles eg: the quadriceps, hamstrings,
gastrocnemius and then insert into bone thus crossing a joint. They enable the muscle to flex or
extend the joint.
Tendons are served by special nerves to inhibit over-contraction but injuries occur if poor co-
ordination, fatigue or lack of skill exists.
Nerves:
These are the work-mates of muscle for without them muscles are useless. Motor nerves must fire
electrical impulses for a muscle to contract and work.
Where a nerve crosses a joint, the nerve may get damaged. If this happens the muscle-nerve
partnership suffers and muscles become weak.
Other (sensory) nerves are like news reporters, finding out what is happening in muscles, joints, and
on the skin. One message of these sensory nerves in Pain.
Side Line Safety
Skin:
The skin is a vital organ and provides a waterproof covering, acts as a barrier which protects the
body against injury and disease. Its pigmentation can guard against the harmful rays of the sun. It
has skin receptors to enable the body to respond to pressure or touch, temperature and pain.
It has a good blood supply which enables heat to be retained or dissipated (lost) and to facilitate
quick healing if injury has occurred.

Side Line Safety
Sports Injuries

Side Line Safety
Principles of Injury Management
The management of sports injuries is one of the most significant functions of a sports para
medic/trainer. A number of musculo skeletal injuries to common sports are discussed.
Injuries may be classified according to their cause or in relation to the specific tissue damage.
This module goes through in detail the classification of soft tissue injury types, revision of pathology
of injury and repair, and initial management using R.I.C.E. rule. Examples will be given of common
injuries to muscles, tendons, ligaments and skin.
First aid treatments for specific soft tissue injuries will be covered.
Type of Injury:
Sports injuries may be classified by their particular cause or by definition of the type of tissue
injured, for example soft tissue (muscle skin) or hard tissues such as bone.
When classified according to cause or mechanism the following groupings are generally used.
Primary Injury:
This is the most common type of sports injury. The injury results directly from a sporting activity.
Three types of primary injury may be mentioned.
Indirect or Intrinsic Injury:
Indirect injuries are caused by the individual sports person. For example, an individual may over-
stretch, or may not execute a particular movement correctly, perhaps as a result of trying too hard,
fatigue, lack of fitness or previous injury. Therefore, one might say that the resultant injury may
have been avoided had the individual been fitter or the technique better.
The result of indirect/intrinsic injury usually involves mainly muscle, tendon and ligament tears, that
is soft tissue damage. Such injuries are often less severe than direct injury but exceptions do occur.

Side Line Safety
Direct or extrinsic injury:
Such an injury results from an outside cause such as an external blow or external force applied to the
body. For example, colliding or being hit by another person or object (eg: ball, stick, racquet) or
falling from an elevated position. Such injuries tend to occur instantaneously, in one accident.
Often this type of injury is more severe than other sporting injuries, since the forces involved can be
much greater. Fractures, dislocations, severe ligament and tendon injuries and/or muscle damage
may be the result.
Types of Injuries:
* Intrinsic - internal force (non contact)

* Extrinsic - external force eg: foreign object
(contact/collision)
Overuse Injury:
Overuse injuries place excessive stress on particular tissues such as bones, ligaments, or other soft
tissue structures. Mechanical stresses which are commonly repetitive in nature cause micro damage
to tissues which under normal circumstances are able to repair damage quite naturally. When the
stresses become excessive the damage accumulates until it exceeds the normal repair capability of
the tissue. At this point symptoms such as pain or inflammation generally arise and the structure is
more susceptible to injury overuse symptoms generally arise when there is a sudden change in the
frequency or intensity of an activity for which the tissue is unprepared.
Secondary Injury:
This type of injury occurs as a result of an earlier, often inadequately treated sports injury. It occurs
when a player does not allow a damaged structure to heal sufficiently and then puts too much force
on it, causing the injury to occur again.
Structural Classification of Injury:
Classified according to structure - hard tissues, soft tissues, special organs, skeletal damage and joint
injury are relatively common in contact sports and in sports where speed and/or height play a part.
Fractures and dislocations are usually the result of direct or indirect trauma. The injuries usually are
treated at the hospital. Occasionally some are undetected eg: finger fractures and may seek advice
from a pharmacy.

Side Line Safety
Soft tissue injuries are damage to muscles, tendons, joint capsules, ligaments, skin:-
* Sprains - (ligament injury)

* Strains - (muscle injury)
* Haematomas/Bruises - (skin or muscle injury)
The basic processes of soft tissue healing underlie all treatment techniques for sports injury. There
are three stages - acute, subacute and chronic.
Commences with trauma

|
Capillary damage + Tissue destruction + Cellular damage
|
Five Cardinal signs of injury
Redness, Heat, Swelling, Pain, Loss of Function
Soft Tissue Injury:
The soft tissues most commonly injured in sport include the skin, muscles, tendons and ligaments.
Although less frequently, other soft tissues such as contained within the abdomen, brain, lungs,
genitals etc may be vulnerable in certain activities.
Pathology of Injury and Basis for Treatment:
The timing of any treatment or rehabilitation programme closely follows the micro structural repair
processes that are occurring in the damaged tissue. Therefore it is important to understand these
processes which provide the foundation for a sound rationale for treatment.
In general terms muscles, tendons, and ligaments pass through three phases of repair. These are:-
Acute Inflammatory phase:

Which may last up to 72 hours after the injury. Immediately following injury there is an increased
blood flow to the area. If the blood vessels are damaged blood will also escape into the would or
directly into the surrounding tissues. Other cells also move into the damages area and various
secretions of these cells increase the permeability of the blood vessel walls causing leakage of fluid.
The accumulation of fluid may give rise to a form of swelling (oedema). During this phase clot
formation begins and the preliminary scaffolding or repair is established.
Repair phase:
Which may last from 72 hours to four or six weeks. During this period specialised cells remove the
debris from the damaged tissue and new fibres are formed. By comparison with normal tissues these
fibres are not fully orientated in the direction of forces to which they are normally subjected. Such
orientation occurs during the next phase as the tissue is gradually reintroduced to its normal function
during a carefully graduated exercise programme.

Side Line Safety
Remodelling phase (three to six weeks up to three to six months):

It is impossible to separate this phase precisely from the repair phase as there is obviously some
overlap.
During this period the replacement tissue remodels or re-orientates according to the stresses to
which it is subjected. Research has shown that controlled exercise programmes will stimulate new
fibre growth together with increases in strength of the replacement tissue.
Knowledge of these repair processes provides a basis for selection of treatment procedures which
serve to increase the rate of healing without causing further damage.
Healing Process:
Time Post
Injury Sign Changes in Tissues
0 - 15 minutes Pain Cell damage, blood vessels disrupted
reduction in blood flow and 02 to area increase
inflammatory exudate
loss of plasma proteins to tissues
Cell death, enzyme released.
15 mins - Heat and Redness Continued bleeding if highly vascularized eg: in

4 hours muscles
monocytes, macrophages (phagocytic) polymorpho
leucocytes
exudate + fibrinogen
Opening up of local blood capillaries
Up to 12 hours Swelling, Fibro blasts + endothelial cells

Redness Protein concentration in tissues
Heat Vascular collagen
Pain Loss of muscle pump
Loss of Function
3 days Swelling Cell proliferation

Heat Granular tissue formation
Pain 02 nearer to injury site
Loss of Function fibroblast/myofibril
Contraction of scar
3 weeks - Variable Remodelling

6 months according to area Scar (a vascular)
and extent of damage Stress needed eg: movement

Side Line Safety
Treatment
General Principles:
The sports physiotherapist/podiatrist/coach's importance lies in the immediate management of a soft

tissue injury. After that, other professional medical advice can be sought in order to fulfil all three
stages of repair, making it possible for the player to return to sport as quickly and as safely as
possible.
Aims:
* To prevent further tissue damage
* Initially to reduce swelling and later assist in removal of swelling
* To ease pain
* To prevent loss of range of joint motion
* To prevent muscle wasting
* To maintain player's fitness while the injured region is healing
* To regain power and function
* To restore confidence in the affected part or limb
* To return player to sport as soon as possible
* To prevent recurrence by education and training.
Management During Repair Phases
Acute Phase (first two to three days):
The aim of immediate treatment is to reduce the bleeding and formation of oedema or fluid released
as a normal response to the tissue damage.
The aim is achieved by the following procedures which are commonly referred to as the R.I.C.E.
rule.
* REST Stops further damage Stop exercise 48 hours
* ICE Reduces bleeding Ice pack
* COMPRESSION Stops swelling and bruising Compression bandage
* ELEVATION Prevents excessive swelling Elevate injured limb.

Side Line Safety
Avoid
 Heat Heat will increase blood flow to the region and increase bleeding
 Alcohol Alcohol is a vasodilator. This will increase blood flow to the region
increasing bleeding and swelling
 Running Running or continuing activity can lead to further trauma
 M assage Massage techniques obviously disturb the formation of the repair tissue and
heat will increase bleeding to the area and increase oedema formation.
Repair and Remodelling Phase:
Management of the soft tissue injury during the repair and remodelling phases often creates a
conflict between what the physiotherapist/podiatrist may consider optimum timing and duration of
treatment and the sports person/coach's desire to return to sport.
The ultimate aims following muscle injury is to regain full extensibility of the muscle and
demonstrate full strength and power under competitive conditions.
The goal following a ligament injury is to achieve a pain-free ligament and return to pre-injury
ligament strength sufficient to perform its stabilising role at the joint concerned.
Until recently, most athletes who sustained injury were advised to rest from all sport and physical
activity. This advice was given, thinking that the most appropriate and safest treatment involved
complete rest. However, it is now accepted that the rate of recovery of injury to soft tissue can be
increased by application of the concept of early mobilisation with careful supervision.
The nature of the injury determines the time after which mobilisation may begin and the extent of the
exercise must be within the limits of pain.
Rest allows for the injury to heal and for the individual to be relieved of pain and discomfort. But
this time period allows for scarring to occur, joints to stiffen, muscles to waste, and cardio
respiratory fitness to decline.
In the remodelling - gentle training and fitness programmes can begin exercising non-injured areas
eg: knee injury - arm, stomach and non-injured leg workouts can be used.
As injury repairs and strength/stability improves selected skill work can be used by the therapist,
athlete, coach/trainer.

Side Line Safety
Classification of Sporting Injuries
Site Acute Overuse Injuries
Bone Fracture Stress Fracture

Periosteal Contusion "Bone strain/stress reaction"
Osteitis/periostitis
Joint Dislocation Synovitis

Subluxation Osteo-arthritis
Ligament Sprain/tear (grades I - III) Inflammation
Muscle Strain/tear (grades I - III) Chronic Compartment syndrome

Contusion Delayed onset
Cramp Muscle soreness
Acute Compartment Syndrome Focal tissue thickening
Tendon Tear (complete or partial) Tendonitis

Para tendonitis
Tenosynovitis
Bursa Traumatic bursitis Bursitis
Nerve Neuropraxia Entrapment

Minor nerve injury Increased neural tension
Skin Bruise (Haematoma) Blister

Laceration Friction Burn
Puncture
Burn

Side Line Safety
Specific Soft Tissue Injuries
Muscles:
Muscle injuries occur as a result of a direct blow or from forces generated within the muscle itself.
Irrespective of the manner in which the injury occurs, damage within the muscle is typified by tearing
of muscle fibres, connective tissue and blood vessels.
The severity of the muscle damage may vary from disruption of a few fibres (strain) to a complete
rupture of the muscle.
Strains are more common and the prognosis depends on whether the torn muscle fibres and blood
vessels are in the belly or at the edge of the muscle bundle.
The former injury, bleeding takes place between the muscle fibres and is effectively trapped by the
connective tissue that surrounds the bundle of fibres.
The resultant accumulation of blood is termed an intra muscular haematoma.
Damage to the periphery of the muscle bundle produces muscle fibres bleeding between the
connective tissue fascia surrounding the muscle bundles and this is termed an inter muscular
haematoma. This latter type of tear tends to drain quickly, produce marked bruising and lead to
earlier return to normal range of motion.
In contrast the intra muscular haematoma produces early disability and tenderness possibly with a
lump and persistent loss of function.
Immediate treatment of these injuries consists of ice, compression and elevation. Within 48 hours
the inter muscular haematoma will be considerably improved with an increased range of motion.
The intra muscular haematoma will feel the same or worse and with no increase in the range of
motion.
Heat and massage should not be used because of the danger of increasing blood loss.
Although less frequent, complete muscle tears may be heralded by a painful snapping sensation and
on examination retraction of the muscle ends which is recognised as two bumps separated by a gap.
Within a short time this gap will fill with blood and extra tissue fluid, making the condition harder to
recognise.
Surgery is the only effective treatment for this injury.

Side Line Safety
Tendon injuries:
Tendons consist of parallel bundles of fibres designed to transmit force of the muscle to the bone.
A variety of conditions may affect tendons. The most common in sport being tenosynovitis,
tendonitis and tenovaginitis. Tendons may experience partial or complete tears eg: Achilles tendon
rupture.
Tenosynovitis is a lesion to the gliding surfaces of the outside of the tendon and the inside of its
sheath, but not the sheath itself. The lesion usually occurs as a result of overuse or compression.
Tenovaginitis occurs when the tendon sheath is chronically inflamed and thickens. It is the fibrous
wall of the tendon sheath rather than the synovial lining which is affected. Common sites include the
flexor sheaths of the thumb or fingers.
Tendonitis or inflammation of the tendon itself. This occurs as a result of over use, training error,
friction from footwear, change of exercise modality.
Treatments - many and varied. Usually rest, ice, pain relief.
Ligament Injuries (Sprain/Tear):
Injuries to ligaments occur when the joint is stressed beyond its normal movement range, causing the
ligament to be abnormally extended. If the extension is excessive, tearing of some of the fibres may
take place and irreversible damage may occur.
Such damage is termed a sprain and depending on its severity may eventually lead to some joint
instability.
Clinically three grades of ligament injuries are recognised. Grade I sprains involve minimal tissue
damage with some local tenderness. Swelling is only slight, and function almost normal.
With a Grade II sprain, more ligament fibres are injured or the ligament becomes partially detached
from its bony attachment. Local pain is more intense and movement more limited.
Grade III injuries constitute a complete rupture. There is rapid onset of effusion (swelling) with
considerable pain. The joint is unstable and loss of function is complete.
Where possible Grade II and III ligament injuries should be protected against further injury/external
forces, swelling reduced (RICE regime) and early movement within pain-free range encouraged.
This will prevent loss of joint movement in adjacent areas.

Side Line Safety
Skin Injuries:
Skin wounds can be divided into two categories - open or closed. Closed wounds occur when there
is no penetration of the epidermis, and open wounds are those in which the epidermis has been
pierced.
Closed wound examples are contusions, abrasions and friction burns, such as caused by gravel.
Open wounds in sport include lacerations (full skin thickness) and puncture wounds.
A contusion or bruise involves a direct blow to the skin. An abrasion or graze occurs through a
glancing injury or repeated microtrauma to the skin surface. Blisters are produced by friction eg:
when wearing ill-fitting shoes. This causes a separation of the layers of skin with the gap between
them being filled by a watery fluid.
Treatment for:
A CONTUSION:- - Firmly apply an ice pack to the area and

- secure with a compression bandage. 15 - 20 minutes.
- Gentle stretches after 24 hours.
- Ice compression and stretches for up to 72 hours.
AN ABRASION:- - Clean the area immediately

eg: with running water if minor
ie: with no dirt embedded.
- A light scrub with soap and water with sterile gauze
to prevent infection.
- Apply non-stick sterile dressing.
- If abrasions persists in bleeding, ice and elevate and
compress the part.
- Change dressing daily until healed.
- Any infection refer to General Hospital/Practitioner.
A BLISTER:- - Prevention is the best treatment.

- Correct the cause.
- Clean the area with soap and water.
- Ice the area to reduce swelling and pain.
- Apply a protective "doughnut".
LACERATIONS: - As for abrasion

- Bleeding controlled by compression and elevation.
- Some may need suturing - Hospital
- Antibiotics
A laceration refers to a wound which penetrates full thickness of the skin, exposing the underlying
subcutaneous tissues. Lacerations may be clean-cut, jagged or puncture wounds depending upon
the cause of injury.
Side Line Safety
Hard Tissue Injuries:
Injuries to the bones of the skeleton may be referred to as hard tissue injuries. They range from
bruising of the bone to various types of breaks or fractures.
Bruising of the bone commonly occurs where there is a lack of padding, as for example at the shin.
The injury produces an accumulation of blood between the outer lining of the bone (the periosteum)
and the underlying compact bone (cortex).
How Bones Break:
If a broken bone remains beneath the skin, the fracture is described as closed (simple); if the ends of
the fractured bones project outside the skin, the injury is described as open (also called compound).
A displaced fracture occurs when the bones are forced from their normal anatomical position.
A bone may be fractured by a direct force which exceeds the strength of the bone. Such forces are
frequently produced on contact sports wither by direct impact or by a twisting force when one end
of the limb, for example the foot, is fixed. In non-contact sports, although impact fractures are less
common, stress or overuse fractures often occur as a result of repetitive loadings. These cause an
accumulation of micro damage which exceeds the capacity of the normal repair processes of the
tissues. This eventually produces a fracture similar to a fatigue fracture in metal.
Types of Fracture:
Bones break in different ways depending on the angle and degreee of force to which they are
subjected, and on the part affected. From these patterns, a surgeon can usually gauge the probable
stability of the bone fragments, and the easiest way in which to reposition the injury.
Treatment:
The obvious fracture may present a number of easily recognised signs and symptoms. These
include pain, loss of function, abnormal mobility, tenderness, grating, deformity of the bone when
compared with the non-injured limb.
Medical care should be sought immediately. This will enable diagnostic x-raysto be taken to
determine the severity and extent of the bone injury.

Side Line Safety
Stress Fractures:
The recognition of this type of fracture is less obvious because the onset if often protracted over a
matter of weeks. The main symptom is pain which is often worse at night and during/after exercise.
Pain is usually localised to the affected bone and local tenderness may be shown. Loss of function
may be mind, but annoying to the athlete.
NB It takes six to eight weeks for a stress fracture to show on an x-ray.
Since the injury is initiated and exacerbated by excessive loads created by the weight of the body or
repetitive muscle pulls, the immediate treatment plan is rest, ice and some form of external support
for the injured part.
Management is essentially rest and avoidance of any activity that may irritate the condition. In
return to sport, the training intensity is carefully controlled for many months.
Joint Injuries:
Joint injuries are very common in sports activities with the knee, ankle and shoulder joints being
frequently involved. Damage can occur to any one structure or combinations of structures which
characterise synovial joints. Injury may vary in severity from complete displacement of one bone out
of its normal place to tearing of a few fibres of a reinforcing ligament.
Joint injury most frequently occurs when the normal range of movement is exceeded. This initially
involves tearing of the supporting structures (the joint capsule and ligaments) and if the stress is
continued, distortion of the alignment of the articular surfaces. This distortion - termed a
subluxation, may return to normal spontaneously after removal of stress, or in some cases a
deformity may persist requiring medical attention.
A dislocation occurs when one bone is completely displaced from another, and this injury is more
serious as it usually involves considerable damage to surrounding tissues.
Occurs when the normal range of movement is exceeded

Side Line Safety
Head Injuries
Concussion, Brain Damage, Fractures, Scalp and Face Lacerations:
Concussion: - Loss of consciousness, loss of awareness
Brain damage: - Injury to brain cells, blood clots

- There is rapid deterioration of health
- Loss of consciousness/coma
Fractures: - Blood stains or clear fluid from the nose or ear

- Clear fluid - CSF.
Scalp and face lacerations: - Bleeding  First Aid
Signs and symptoms of - Temporary loss/clouding of vision

Concussion: - Consciousness/vagueness/disorientation
- Headache
- Memory loss
- Nausea
- Vomiting
- Tingling/numbness
- Blurred vision
Treatment: - Medical advice

- NO ALCOHOL
Fits in Head Injuries: Strong jerky movements, breathing may be halted.
Treatment: - Stop self-inflicted damage

- Support
- Safe place
- Lie on side
- DO NOT force mouth open
- DO NOT resuscitate
- Remove foreign material eg: vomit, mouth guard, false teeth
- Observe - confusion after the fit
- Consult doctor
Time off: - For any concussion or head injury minimum three weeks
off from sport (including training if contact sport).
Medical clearance to return.

Side Line Safety
Spinal Injury
Send for medical help:
Signs and Symptoms: - Pain

- Inability or difficulty in moving limbs
Limbs: - Loss of feeling

- Pins and needles
- Difficulty with breathing
i) Unconscious player: - Breathing - medical help

- Not breathing - CPR + Medical help
ii) Conscious player: - DO NOT MOVE

- Medical help
- Lie on back
- Act quickly
- Support
- No food/drink
Referral to Professionals:
* Unconscious player
* Life-threatening
* Head injury
* Fracture
* Dislocation
* Hand injury with loss of function
* Neurological signs and symptoms
* Player unable to get up unassisted

Side Line Safety
Injury Assessment

Side Line Safety
First Aid - General Aims
1. To prevent further injury
2. Maintain an open airway, respiration and circulation
3. Control Bleeding
4. Prevent Infection
5. Minimise Swelling
6. Minimise Pain
7. Minimise Shock
8. Seek Medical Aid

Side Line Safety
Injury Assessment
A predetermined approach to management is critical. The injury can be assessed and management
can be started immediately.
Consider:
- Specific injury
- Reaction to the body
- Player's total reaction - emotional and attitudinal
- Immediate environment
Process:
- Assess the situation
- Plan for management
- Carry out the treatment
- Re-assess the situation
Ensure safety first, then complete the examination.
1. Unconscious patient:
- Check breathing, pulse
- If neither start CPR
Airway
Breathing
Circulation
2.
Once there is circulation and breathing, check for further first aid
eg: hemorrhaging.
3.
Determine the injury, the extent and severity. Check all
injuries.

Side Line Safety
Examination
TOTAPS DO NOT RUSH
- find out about the pain - sharp, dull, aching, throbbing

T Talk to the athlete: - how the injury occurred - cause and mechanism
- site of injury
- deformity
- abnormal sounds - grating, snap, pop, compare with other
injuries
O Observe: - mental state

- consciousness
- position of the body
- size
- position
- shape
- colour
- athlete's pupils and facial expression
T Touch: - feel - lumps, depression, swelling, heat, points of tenderness

- skin
- soft tissues
- bones
A Active Movement: - Functional tests - for muscles and joints
P Passive Movement: - put the joint or part through a normal range of movement
- check for instability
S Skill Test: - If none of these produce pain, then test the athlete to ensure
he/she may return to play.

Side Line Safety
If at any stage injury is detected, commence treatment
At this point consider:

- Transport
- Medical advice
- Physical comfort, safety
- Reduce shock
- Psychologically support the athlete
DO NOT RUSH - examine and assess each injury separately
When to refer to a doctor:

- Doubt
- Loss of consciousness
- Head injury
- Chest/abdominal
- Fracture or dislocation
- Neck or back pain
- Laceration
Diagnosis: - For the doctor, however the trainer may need to converse
with the doctor to discuss:-
- history
- signs
- symptoms
- Notification

Side Line Safety
Concussion
Concussion is a injury caused primarily by trauma to the head and jaw region. Due the physical
nature of some sports such as ice hockey, rugby union, rugby league and American football knocks
to the head are likely to occur at some time. Some of these knocks will be sufficient to cause a
concussion. Concussion has be defined by Powell (2001) as
..a clinical syndrome characterised by immediate and transient post traumatic impairment of
neural function, ……
This impairment may include loss of consciousness, or just disturbance to balance or vision, and
other brain stem involvement.
If, as the definition defines, this is a transient problem, is there any concern? With short term effects
are said to include headaches, confusion, and an inability to take in new information (Willer, 2001),
this would not only affect performance on the sports field but may lead to other injuries through a
decreased ability to perform. Longer term problems may include changes to mood and temper,
memory problems and a decrease in judgement and concentration. There may also be longer term
changes leading to a decreased ability with learning especially music and maths (Willer, 2001).
The incidence of concussion in thought to be increasing. This could be due to players being bigger
and faster. It has been estimated that 14000 New Zealanders are concussed each year (Willer, 2001),
20% of these occurring in organised sport. The incidence in Rugby League is harder to define.
Figures from the AFL for the seasons 1997 – 2000 show an average incidence of only 0.6 players
per club per season (Orchard & Seward, ). In a study of high school rugby union over a two year
period concussions accounted for 25% of all reported injuries (Marshall & Spencer, 2001), or 3.8
players per club per season. This is higher than any other reported studies. These later figures would
equate to what the author has experienced while working with club league over the last 3 years. The
discrepancy may reflect differences in level of athlete, under-reporting, or some other unknown
factor.
There are many grading systems for concussion. Below is one example used. From the point of view
of being a sports medic the grading is not as important as recognising the presence of one.

Side Line Safety
Grading of Concussions
See more at http://www.bch.org/sportsmedicine/tips.aspx#Section2
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.
One system of assessment is using Maddocks questions

These questions are a system by which a clinician can make a rapid diagnosis of concussion. They
combine scientific validity with a quick simple and practical tool which can be administered either
on-field or on the sidelines. These are however not considered by some to be sufficiently
challenging, and the examineer also must know the answers.
Which ground are we at?

Which team are we playing today?
Who is your opponent at present?
Which quarter is it?
How far into the quarter is it?
Which side scored the last goal?
Which team did we play last week?
Did we win last week?

Side Line Safety
Sport Concussion Assessment Tool (SCAT)
This tool represents a standardized method of
evaluating people after concussion in sport. This Tool
has been produced as part of the Summary and
Agreement Statement of the Second International
Symposium on Concussion in Sport, Prague 2004 The SCAT Card
(Sport Concussion Assessment Tool)
Athlete Information
Sports concussion is defined as a complex
pathophysiological process affecting the brain, induced What is a concussion? A concussion is a disturbance in the function
by traumatic biomechanical forces. Several common of the brain caused by a direct or indirect force to the head. It results in
features that incorporate clinical, pathological and a variety of symptoms (like those listed below) and may, or may not,
biomechanical injury constructs that may be utilized in involve memory problems or loss of consciousness.
defining the nature of a concussive head injury include:
1. Concussion may be caused either by a direct blow to How do you feel?Post
YouConcussion
should scoreSymptom Scale
yourself on the following
the head, face, neck or elsewhere on the body with symptoms, based on how you feel
Nonenow. Moderate Severe
an 'impulsive' force transmitted to the head. Headache 0 1 2 3 4 5 6
2. Concussion typically results in the rapid onset of “Pressure in head” 0 1 2 3 4 5 6
short-lived impairment of neurological function that Neck Pain 0 1 2 3 4 5 6
resolves spontaneously. Balance problems or dizzy 0 1 2 3 4 5 6
3. Concussion may result in neuropathological changes Nausea or vomiting 0 1 2 3 4 5 6
but the acute clinical symptoms largely reflect a Vision problems 0 1 2 3 4 5 6
functional disturbance rather than structural injury. Hearing problems / ringing 0 1 2 3 4 5 6
4. Concussion results in a graded set of clinical “Don’t feel right” 0 1 2 3 4 5 6
syndromes that may or may not involve loss of Feeling “dinged” or “dazed” 0 1 2 3 4 5 6
consciousness. Resolution of the clinical and Confusion 0 1 2 3 4 5 6
cognitive symptoms typically follows a sequential Feeling slowed down 0 1 2 3 4 5 6
course. Feeling like "in a fog" 0 1 2 3 4 5 6
5. Concussion is typically associated with grossly Drowsiness 0 1 2 3 4 5 6
normal structural neuroimaging studies. Fatigue or low energy 0 1 2 3 4 5 6
More emotional than usual 0 1 2 3 4 5 6
Irritability 0 1 2 3 4 5 6
Post Concussion Symptoms Difficulty concentrating 0 1 2 3 4 5 6
Ask the athlete to score themselves based on how they Difficulty remembering 0 1 2 3 4 5 6
feel now. It is recognized that a low score may be
normal for some athletes, but clinical judgment should (follow up symptoms only)
be exercised to determine if a change in symptoms has
occurred following the suspected concussion event. Sadness 0 1 2 3 4 5 6
Nervous or Anxious 0 1 2 3 4 5 6
It should be recognized that the reporting of symptoms Trouble falling asleep 0 1 2 3 4 5 6
may not be entirely reliable. This may be due to the Sleeping more than usual 0 1 2 3 4 5 6
effects of a concussion or because the athlete’s Sensitivity to light 0 1 2 3 4 5 6
passionate desire to return to competition outweighs Sensitivity to noise 0 1 2 3 4 5 6
their natural inclination to give an honest response. Other: _______________ 0 1 2 3 4 5 6
If possible, ask someone who knows the athlete well

about changes in affect, personality, behavior, etc.
What should I do?

Remember, concussion should be suspected in the
Any athlete suspected of having a concussion should be
presence of ANY ONE or more of the following:
removed from play, and then seek medical evaluation.
 Symptoms (such as headache), or
 Signs (such as loss of consciousness), or
Signs to watch for:
 Memory problems
Problems could arise over the first 24-48 hours. You should not be left
Any athlete with a suspected concussion should
alone and must go to a hospital at once if you:
be monitored for deterioration (i.e., should not be
 Have a headache that gets worse
left alone) and should not drive a motor vehicle.
 Are very drowsy or can’t be awakened (woken up)
For more information see the “Summary and  Can’t recognize people or places
Agreement Statement of the Second International  Have repeated vomiting
Symposium on Concussion in Sport” in the April, 2005  Behave unusually or seem confused; are very irritable
edition of the Clinical Journal of Sport Medicine (vol 15),  Have seizures (arms and legs jerk uncontrollably)
British Journal of Sports Medicine (vol 39),  Have weak or numb arms or legs
Neurosurgery (vol 59) and the Physician and  Are unsteady on your feet; have slurred speech
Sportsmedicine (vol 33). This tool may be copied for Remember, it is better to be safe. Consult your doctor after a
distribution to teams, groups and organizations. suspected concussion.
©2005 Concussion in Sport Group
What can I expect?
Concussion typically results in the rapid onset of short-lived impairment
that resolves spontaneously over time. You can expect that you will be
told to rest until you are fully recovered (that means resting your body
and your mind). Then, your doctor will likely advise that you go through
a gradual increase in exercise over several days (or longer) before
returning to sport.

Side Line Safety
Sport Concussion Assessment Tool (SCAT)
Instructions:
This side of the card is for the use of medical doctors,
physiotherapists or athletic therapists. In order to
maximize the information gathered from the card, it is
The SCAT Card strongly suggested that all athletes participating in
(Sport Concussion Assessment Tool)
contact sports complete a baseline evaluation prior to
Medical Evaluation the beginning of their competitive season. This card is
a suggested guide only for sports concussion and is not
Name: ___________________________ Date __________ meant to assess more severe forms of brain injury.
Please give a COPY of this card to the athlete for
Sport/Team: _______________________ Mouth guard? Y N their information and to guide follow-up
assessment.
1) SIGNS Signs:
Was there loss of consciousness or unresponsiveness? Y N Assess for each of these items and circle
Was there seizure or convulsive activity? Y N Y (yes) or N (no).
Was there a balance problem / unsteadiness? Y N
Memory: If needed, questions can be modified to
2) MEMORY make them specific to the sport (e.g. “period” versus “half”)
Modified Maddocks questions (check correct)
Cognitive Assessment:
Select any 5 words (an example is given). Avoid
At what venue are we? __; Which half is it? __; Who scored last?__
choosing related words such as "dark" and "moon"
which can be recalled by means of word association.
What team did we play last? __; Did we win last game? __?
Read each word at a rate of one word per second. The
athlete should not be informed of the delayed testing of
3) SYMPTOM SCORE
memory (to be done after the reverse months and/or
Total number of positive symptoms (from reverse side of the card) = ______
digits). Choose a different set of words each time you
perform a follow-up exam with the same candidate.
4) COGNITIVE ASSESSMENT
Ask the athlete to recite the months of the year in
reverse order, starting with a random month. Do not
5 word recall Immediate Delayed
(Examples) (after concentration tasks) start with December or January. Circle any months not
Word 1 _____________ cat ___ ___ recited in the correct sequence.
Word 2_____________ pen ___ ___ For digits backwards, if correct, go to the next
Word 3 _____________ shoe ___ ___ string length. If incorrect, read trial 2. Stop after
Word 4 _____________ book ___ ___ incorrect on both trials.
Word 5 _____________ car ___ ___
Months in reverse order: Neurologic Screening:

Jun-May-Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sep-Aug-Jul (circle incorrect)
Trained medical personnel must administer this
or examination. These individuals might include medical
Digits backwards (check correct) doctors, physiotherapists or athletic therapists. Speech
5-2-8 3-9-1 ______ should be assessed for fluency and lack of slurring.
6-2-9-4 4-3-7-1 ______ Eye motion should reveal no diplopia in any of the 4
8-3-2-7-9 1-4-9-3-6 ______ planes of movement (vertical, horizontal and both
7-3-9-1-4-2 5-1-8-4-6-8 ______ diagonal planes). The pronator drift is performed by
asking the patient to hold both arms in front of them,
Ask delayed 5-word recall now palms up, with eyes closed. A positive test is pronating
the forearm, dropping the arm, or drift away from
5) NEUROLOGIC SCREENING midline. For gait assessment, ask the patient to walk
Pass Fail away from you, turn and walk back.
Speech ___ ___ Return to Play:

Eye Motion and Pupils ___ ___ A structured, graded exertion protocol should be
Pronator Drift ___ ___ developed; individualized on the basis of sport, age and
Gait Assessment ___ ___ the concussion history of the athlete. Exercise or
training should be commenced only after the athlete is
Any neurologic screening abnormality necessitates formal neurologic clearly asymptomatic with physical and cognitive rest.
or hospital assessment Final decision for clearance to return to competition
should ideally be made by a medical doctor.
6) RETURN TO PLAY
Athletes should not be returned to play the same day of injury. For more information see the “Summary and
When returning athletes to play, they should follow a stepwise Agreement Statement of the Second International
symptom-limited program, with stages of progression. For example: Symposium on Concussion in Sport” in the April, 2005
1. rest until asymptomatic (physical and mental rest) Clinical Journal of Sport Medicine (vol 15), British
2. light aerobic exercise (e.g. stationary cycle) Journal of Sports Medicine (vol 39), Neurosurgery (vol
3. sport-specific exercise 59) and the Physician and Sportsmedicine (vol 33).
4. non-contact training drills (start light resistance training) ©2005 Concussion in Sport Group
5. full contact training after medical clearance
6. return to competition (game play)
There should be approximately 24 hours (or longer) for each stage and
the athlete should return to stage 1 if symptoms recur. Resistance
training should only be added in the later stages. Medical clearance
should be given before return to play.

Side Line Safety
Concussion Management
If the palyer is unconscious or suspected to have a spinal injury immediate emergency first aid is
undertaken and an ambulance rung.
All players suspected of concussion should be removed from the field of play to be assessed.
Players are best assessed in a quite environment away from the distraction of the game or other
players.
An assessment is undertaken
Should the assessmenet showed the player is concussed or suspected of being consussed they should
not be allowed to return to the field of play.
If not an emergency situation the player can be given written instruction such as that on the scat
card.
They should go to the doctor to be fully assessed. Note due to the fact they have a concussion they
should be taken to the doctor by a responsible person.
Note many sports have minimum stand down times before the athlete can return to play. However
this is the minimum time frame and the player must be fully symptom free before playing.
Return to play protocol
The return to play following a concussion follows a stepwise process:

1. No activity, complete rest. Once asymptomatic, proceed to level (2).
2. Light aerobic exercise such as walking or stationary cycling.
3. Sport specific training (eg. running drills, ball handling skills)
6. Non-contact training drills.
7. Full contact training after medical clearance.
8. Game play.

Side Line Safety
Taping

Side Line Safety
Reading
1. Modern Sports Strapping and Bandaging Techniques. BDF Australia Ltd.

2. Elastoplast Sport Strapping Techniques - Chapter - Taping for Prevention and Care of Injuries
- pages 30-41.
3. Basic Sports Strapping and Bandaging - Stuart Gray.
Objectives
* To have ability to recognize the main purposes for taping.

* To understand the terms strapping/taping and bandaging.
* To be able to demonstrate the application of appropriate techniques for taping of an ankle,
thumb and finger.
Introduction:
A sound knowledge of basic anatomy coupled with thoughtful use of strapping materials makes
taping a highly effective measure for preventing and protecting many sports injuries.
Definition:
Application of adhesive tape to support, protect and provide proprioception.
Strapping/Taping:
Uses Elastic (stretch) or non-elastic (rigid zinc oxide) adhesive tape to support injured structures
and joints with minimal limitation of function.
A. Taping:
Uses in acute injury non-adhesive stretch.
1. Reduce swelling - be careful not to stop circulation.
2. Restrict movement.
3. Support injured area.
Apply firmly, use felt/foam or cotton pads for pressure.

B. Prophylactic Use:
1. Prevention of Injury by restricting movement.
2. Prevents friction.
3. Provides psychological support.
Use:-
non stretch, adhesive tape with pads. Care must be taken that strengthening exercises are not
forgotten.
C. Therapeutic (during the Treatment Phase):
1. Infection, swelling and bleeding use - Dressings, elastic, non adhesive bandages.
2. Immobilisation of bones and joins use - Slings, non-elastic and elastic tape. This allows
early mobilisation.

Side Line Safety
Strapping and Bandaging
Questions to ask before start strapping

What are you going to strap?
Where are the structures you wish to support?
Why do you want to strap the region?
What do you need?
What to strap and where?

Ankles, Knees, Shoulders Thumbs and Fingers are the most common regions strapped. In
most cases it is the ligament that is the structure the strapping is aimed at. Occasionally strapping is
applied to muscles. Therefore to strap effectively you need a good knowledge of where the
ligaments are and what their function is.
Why strap?
Strapping can aid in supporting the region, can help to provide protection and can improve
proprioception. Before strapping you must ask “why am I doing this?” Is it to give support to an
acute injury (as part of your RICE management) to stop them causing further damage? Is it to
improve proprioception and provide some support so they can increase their activity level as a
progression of their rehabilitation, or as they return to sport? Is it as a prophylactic - i.e. helping limit
movement, to prevent an injury? Or is it to allow a person to keep going despite them being
injured?
Once you have your answer ask “Should I be strapping this?”

Side Line Safety
Strapping/Taping:
Type of Tape - Non-elastic tape, zinc oxide, adhesive rigid, tearable, variable widths.
Usage - Supports joints, ligaments and tissue to limit specific joint movements.
Bandaging:
Compression - Types:
1. Adhesive elastic.
2. Re-usable elastic - Tubigrip.
3. Non-adhesive crepe bandage
4. Rubber thread bandage.
5. Gauze elastic bandage.
Elastic Adhesive Bandage adhesive, stretch, compressive.
Usage:-
Assists in joint support especially in very mobile joints eg: shoulder. Local compression of soft
tissue injuries during activities.
Underwrap:
Thin foam material conforms to body, lightweight.
Uses:
Protects skin surface and hair from tape adhesive. (Skin allergy/hair pulling). Requires
adhesive spray.
Adhesive/Grip Spray:
Spray on adhesive. Sticks (adheres) underwrap to skin. Assists adhesion of sports tape to skin
eg: in wet conditions.
Heavy weight Crepe Bandage :

Non adhesive, stretch compressive, various widths.
Uses:
Apply compression to soft tissues; hold ice packs in position; provide some support to joints.
Objective:
To understand principles and guide-lines of taping.
Principles:
- Know anatomy involved.
- Know how injury occurred.
- Assess injury fully (T.O.T.A.P.S.).
- Knowledge of which structures need support or protection.
- Knowledge of taping technique.
- Have all materials for the procedure.

Side Line Safety
Guide-lines:
Situation:
- Choose a practical and convenient location.
- Practical and comfortable positioning for the strapper and athlete.
- Space should be available to position taping materials within easy reach.
Preparation:
* Skin:
- Hair on area to be taped should be removed several hours before taping
- Clean off sweat, dirt, oils
- Dry well
- Check for allergies
- Apply dressings over inflamed or broken skin
- Use underwrap and adhesive spray may be necessary.
Materials:
- Decide on the sizes, quantity of tapes and materials likely to be used.
- Position tape and materials close to work site and ready to use. Be organized and
methodical!
Objective:
To have knowledge and ability to demonstrate tape application and removal.
Materilas Commonly Used:-
Adhesive Spray:
- Spray area to be taped
- Let dry to "tackiness" before proceeding (20 seconds).
Position:
- Place joint to be taped in a supported position for easy tape application.
- The athlete must co-operate to maintain this position.
- The trainer must communicate this to athlete.
Rigid Tape:
- Choose a suitable width
- Size of athlete and particular joints will dertermine width of tape used. 5, 10, 18, 25mm tape.
- Application directly off the roll, or pre-cut lengths both have merits.
- Unwind tape off roll before laying on to skin (direct from roll method).
- Start tape from a position and direction that best allows it to follow the body contours, but still
go where the specific tape technique is required.

Side Line Safety
- Maintain moderate tape tension as it is laid onto the skin.

- Avoid continuous taping - use multiple strips.
- Overlap each piece by one half to two thirds over tape blow.
- Commence all taping with anchor pieces which will lie above or below the joint to be
supported.
- Complete all taping procedures with locking pieces.
Elastic Adhesive Bandage:
- Choose suitable width for job.

- Apply directly off the roll
- Unwind some EAB off roll before laying on skin and pre-stretch moderately before applying.
- Continuous application, using figure of eight or spiral pattern overlapping by half width (yellow
tracer).
- Use rigid tape to close (seal) the job, providing comfort, and additional support.
- Cut EAB with scissors.
Check:
- Circulation
- Support
Before Event - Movement and warm-up:
- Athlete should be able to stand and perform typical game - like movements of
injured/recovering
area with - boots, pads, etc to be worn.
- Check for any signs of skin irritation, pressure points, blisters, discomfort; ask athlete.
- Be prepared to re-tape if necessary.
After Event:
- Observe and ask if support was adequate or too tight etc.
- Note any changes that may be necessary next time.
Removal:
- Need not be painful
- Remove directly after training or playing ends.
- Use blunt nose scissors or specific tape removing tools to cut
the tape.
- Use tape adhesive removal lotion if necessary.
- Wash skin to remove tape adhesive residue; use soap and
water.
- Apply moisturiser to regularly taped skin to reduce dryness and
future irritation, or skin tears.

Side Line Safety
Taping Techniques
Practice makes perfect:

Learning to tear rigid tape with fingers and thumbs is an extremely useful skill, otherwise it is easier
to pre-cut lengths of tape rather than cutting when the application is in progress.
The figure-of-eight bandage is self-explanatory. Used on joints where the first turn encircles one
part of the limb, crosses the joint, and then encircles the part above the joint to complete a figure-of-
eight. The pattern formed by repeating the figure-of-eight manoeuvre is known as a spica because it
resembles an ear of wheat. The name if derived from the Latin word for 'ear of wheat'. The spica
is used to provide an even compression around joints.
Ascending/Descending Spica and Thumb Spica:

The ascending spica is a figure-of-eight bandage that begins with turns directly over the joint and
then steadily fanning away from the joint. The descending spica will start distant to the joint and will
finish with its last turn over the joint line.
Check Strap:
A check strap is a technique designed to protect an injured joint or muscle from movements that
would cause further harm, whilst allowing activity to continue in movements that are pain free. The
most common form of 'check strap' is a rigid tape spanning the gap between thumb and hand
thereby preventing the thumb from being pushed back.
Locking Tapes:
Locking tapes are the final turns of tape that will hold all others in position to prevent slipping and
loosening of the tape.
The simple spiral bandage is, as the name suggests, a simple winding of the bandage around a limb,
each turn covering a half to two-thirds of the previous turn. The simple spiral is used to hold
dressings in place, to apply compression, and sometimes to provide some impedance to movement
when applied over a joint.

Side Line Safety
Ankle Joint:
Finger & Thumb Joint

Side Line Safety
Knee Joint
Shoulder Joint
Remember:
* Determine why you are taping.
* Know the Anatomy involved.
* General guide-lines for taping.

Sideline Management

Uploaded by

Copyright:

Available Formats

You might also like

Sideline Management

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Sideline Management

Uploaded by

Copyright:

Available Formats

Sideline SafetyWorkbook

Tutor: Hamish Ashton MHSc

* To enable the student to identify commonly encountered sports related injuries.

The Objectives will be achieved by:-

* Basic understanding of Physiology associated with injury.

- Identification of commonly injured musculo-skeletal structures TOTAPS

On completion the student will have an understanding of:

- the principles of first aid and their relevance to sports injury;

Sideline management2 Page - 2

Sports Trainer / Medic

Sideline management2 Page - 3

General Roles and Responsibilities of the Sports Trainer

1. Immediate and Total Care of the Athlete:

Sideline management2 Page - 4

Communications - There should be a telephone or alternative means of communication in

Sideline management2 Page - 5

Sideline management2 Page - 6

Sideline management2 Page - 7

Sideline management2 Page - 8

Sideline management2 Page - 9

Sideline management2 Page - 10

Other contributing factors include:

i) not wearing protective equipment

Mouthguards - any mouthguard to be worn in a contact sport should be fitted by a dentist

Sideline management2 Page - 12

Other Prevention Factors

* Complete and undamaged

- heat - humidity - cold

Sideline management2 Page - 13

* Assessed and developed

* Guided by a qualified, sports medicine professional

* Keep to them, for safety sake

Take a long-term view and,

Sideline management2 Page - 14

Sideline management2 Page - 15

*Indeed prevention is better, and costs less than cure!!

Sideline management2 Page - 16

Pre-Activity Preparation (Warm-Up)

Warm-up activities should:

* use all large muscle groups

However the following guide-lines should apply:

Sideline management2 Page - 17

Effective dynamic stretching

 Do not force the movement or lose control of the movement.

Leg swings forward and back

4. Change legs and repeat.

Sideline management2 Page - 18

5. Change legs and repeat.

Hurdle step overs

3. Rotate the leg outwards.

4. Returning to the start position.

5. Change legs and repeat.

Lower leg calf raises

2. Support your weight on your hands and feet.

4. Alternate between legs.

Sideline management2 Page - 19

2. Stand with your back straight and knees slightly bent.

Bent over upper body rotation

3. Bend your knees a little.