PE REVIEWER MAY
existing medical conditions.
CHAPTER 8 – SPORTS INJURY MANAGEMENT
Concussions are common in combat sports such as
boxing. In 2009, Filipino boxer Z “The Dream” Gorres
suffered a concussion in a boxing match against Luis
Melendez in Las Vegas. Gorres was knocked down in the
10th round but he was able to recover and eventually
won the title. He collapsed inside the ring after the
announcement of winner. Rushed to the hospital for an
emergency surgery to repair the internal bleeding.
Injury evaluation is not the same as diagnosis. The
doctor is the only person allowed to diagnose the
condition of a patient. Evaluation happens in the field
while the diagnostic process accounts all the information
needed to see a holistic picture of the cause and severity
of the injury such as patient’s history, comprehensive
physical examination, special tests, and diagnostic tests
(e.g., MRI, x-ray) among others. On the other hand, the
goal of the injury evaluation process is to rule out the
presence of a severe injury or a life-threatening
condition, how to transport the patient and the
appropriate first aid while transporting the patient.
The coach or athletic trainer should have a background
on injury evaluation and management to bridge the gap
between the playing field and the hospital
Primary survey – first part of the evaluation. Quick
evaluation if there are life-threatening injuries present.
The evaluation needs to consider if the patient should be
moved or transported immediately to a medical facility.
Concussion or traumatic brain injury – one of the
life-threatening sports injury. Common to contact and
combat sports(i.e., boxing) and is caused by a strong
blow to the head that temporarily impairs brain function.
Unconscious, amnesia, loss of balance, poor motor
coordination and slurred balance.
Classification of concussion
Category Description Characteristics
No loss of consciousness,
Grade I Mild condition normalizes in less than
15 mins
No loss of conscious, condition
Grade II Moderate
normalizes beyond 15 mins
Grade III Severe Loss of consciousness
According to the American Academy of Neurology, there
are three types of concussion based on severity.
Other conditions that can lead to life-threatening
condition are cardiac arrest and shock. Some individuals
are susceptible to developing cardiac arrests because of
some pre-existing medical conditions such as
hypertrophic cardiomyopathy and Marfan’s syndrome. It
is important that individuals consult a doctor prior to
engaging in strenuous physical activity to screen pre-
The coach or trainer has to perform a primary survey to
determine if the injured athlete is in a life-threatening
condition. There are two tell-tale: unconsciousness and
not breathing. If the injured athlete is breathing but
unconscious, do not move the body unless the neck and
back is stabilized to prevent complications.
CPR technique incorporates chest compressions and
rescue breathes to facilitate blood flow to the brain and
prolong the life of the person. The American Heart
Association (AHA) recommends the first responder to
administer COR as soon as possible to increase the
survival rate. CPR is performed by placing the heel of
one hand on top of the breast bone at the level of the
nipple while the other hand is on top with fingers
interlocking with the fingers of the hand that is on the
chest.
The breastbone has to be compressed to a depth of one
and a half inch to two inches. Chest at a rate of 100
times a minute. Give rescue breaths, every after 30
compressions.
A more thorough evaluation procedure or a secondary
survey is performed if the patient is stable. The goal of
the secondary survey is to determine the primary injury,
severity, muscle function, and joint stability, as well as
the location and mechanism of injury or the movement
or force that caused the injury.
The inspection or observation process is a passive
component of secondary survey which is usually
performed visually and manually.
Another aspect of the survey is identifying the location
of the injury. The location of the injury helps the coach
and trainer understand the possible structures that could
be damaged. The most painful area is usually the injury
site.
Identifying the type of pain (i.e., dull, sharp and
radiating) also helps in identifying the damaged tissues.
It should be noted that this method is subjective and
depends on the pain threshold of the person.
Nevertheless, the coach should be concerned if the
athlete reports pain scored higher than six.
0 no hurt
2 hurts little bit
4 hurts little more
6 hurts even more
8 hurts whole lot
10 hurts worst
It is important that the coach or trainer understands
how the movement or force could have injured the body
part. It will help in determining the appropriate first aid
and how to immobilize the injured part. Lastly, ross
motor movement is the active component of the
secondary survey and it checks muscle weakness and
joint stability. It helps the coach or trainer determine the
severity of the injury.
The passive component of the secondary survey will be
able to rule out if there are injuries to the hard tissues
(i.e., bones, joints) while the active component will be
able to identify if there are injuries to the soft tissues
(i.e., muscle, tendon, ligaments)
The first responder has to make a decision whether the
injury needs immobilization, a process of restricting
movement of an injured limb to prevent further
aggravation.
Rigid splint usually made of tough materials such as
wood, plastic and plaster of paris
Soft splints newspapers, pillows, and air splints
Anatomical splint an immobilization technique wherein
the object that restricts movement is another body part
of the injured athlete.
Principles of Immobilization
1. Immobilize the limb in the position that is the
least painful or in the position it was found
2. Take note of any changes in skin color,
temperature, sensation
3. Include the joint above and below the fractured
bone in the splint
4. Leave fingers and toes uncovered
5. Apply it firmly without discomfort
6. When using an elastic bandage, apply consistent
tension
An effective immobilization technique for injuries
involving the upper extremities is the cervical arm sling
using a triangular bandage. The elbow is usually bent 90
degrees and the palm is facing the chest.
Inflammation is the first step of the healing process,
which increases blood flow to the injured area. The
downside of increased blood flow is swelling.
PRICE PRINCIPLE
Swelling and other symptoms of inflammation (i.e., pain)
can be controlled using the PRICE. PRICE stands for
Protect, Rest, Ice, Compression and Elevation.
Rest is recommended to give the body part enough time
to heal.
Ice or cryotherapy is commonly used in injuries because
it has analgesic or pain-relieving effect. Cryotherapy
constructs the blood vessels, which can reduce blood
flow and swelling to the injured area. It is commonly
applied during the first 24 to 48 hours of injury for about
15 to 20 minutes with a two-hour interval.
There are different cryotherapy methods such as ice
massage, immersion, cold gel pack and crushed ice.
Crushed ice application is the most convenient and
practical method.
Another effective method to reduce swelling is to
compress the injured area using an elastic bandage. A
common technique for elastic bandage application is the
spiral and the spica or figure of eight. These techniques
are commonly used in ankle sprains but is also effective
in other soft tissue injuries.
Swelling can be reduced by elevating the injured limb
higher than the level of the heart. The fluid slowly
moves away from the injured area as gravity pulls it
down. Elevation is usually done while the person is
sleeping.
MANAGEMENT OF CHRONIC INJURIES
Management of chronic injuries differs from acute
injuries because the onset of swelling and pain is
different. Acute injuries have a sudden onset of pain
while overuse injuries have gradual onset of pain. The
prolonged inflammation that occurs in chronic or overuse
injuries cannot be managed by the PRICE principle.
Stage I (i.e., mild) overuse injuries are managed by
reducing the workload and performing corrective
exercises.
Athletes with Stage II (i.e., moderate) overuse injuries
usually complain when pain becomes intolerable and
worsens during the activity. The recommended
management is rest and non-steroidal anti-inflammatory
medications to relieve pain and reduce swelling
The priority care for wounds is to control bleeding. The
second aspect of wound care is infection prevention.
Bleeding is controlled by applying direct pressure over
the wound. it is recommended that a clean piece of cloth
or dressing is placed over the wound to minimize
infection.
Wound cleaning is important to prevent infection. The - movement becomes reduced
process should remove foreign contaminants and dead
- pain continues and worsens at times, lasts a week or
tissues. The best way to clean the wound is with running
more
water because the pressure pushes the first and other
materials out of the wound.

Many doctors do not advise the use of alcohol because it

kills both the microorganism and the healthy cells in the
skin. Good alternative is iodine povidone, which is a
good antiseptic that does not stimulate pain.

The average blood volume of a person is five liters. A

person who loses more than 20% of his/her blood
volume would be weak and has a high risk of infection.
30% of the total blood volume is at risk of developing
shock.

Shock is a condition wherein the heart continuously

pump but blood does not flow properly due to a low
blood pressure.

It is important to act fast and recognize the signs and

symptoms of shock such as rapid but weak pulse rate,
cool and clammy skin, pale or bluish lips and rapid and
shallow breathing.

Illness Signs Symptoms

Cramps Exhaustion Stroke
Fever above
Muscle spasm Dizziness
40C
Fatigue Weakness Weak pulse
Thirst Cool skin Dry, hot skin
Profuse
Dark urine Rapid breathing
sweating

Heat stroke is the most severe form of heat illness. It

is usually caused by strenuous activity under a very hot
and humid weather.

As the condition worsens, the blood pools in the lower

extremities, which affects the pumping ability of the
heart. The excessive dehydration makes the blood more
viscous which means that the heart has to generate
more force just to circulate the blood to the rest of the
body. When the blood pressure drops, the individual will
experience shock

Early recognition is the key to increasing the survival

rate of an athlete

Call a doctor when

- injury is painfully awful

- more painful when active

- injury is swollen

- you are limping