Professional Documents
Culture Documents
Meet The Expert Edit Gabung
Meet The Expert Edit Gabung
Injury
Tirza Z. Tamin1
1
Department of Physical Medicine and Rehabilitation, Cipto Mangunkusumo
Hospital; Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
Email: tirzaediva.tamin@gmail.com
Abstract: The main focus of physiatrist is to evaluate and treat injuries, physical
illness, and disability through comprehensive, patient centered
treatment plans, utilizing cutting-edge as well as time-tested
methodologies to maximize function, reduce pain, and enhance the
quality of life. Injury specific rehabilitation protocols are being
practiced worldwide but need to be introduced according to the nature
of the sport.
1. Introduction
Sports injury is the process in which tissues or organs are damaged when playing a
game, causing loss of bodily function or structure Timpka.bin After a sports injury, the first
question asked is: ‘When will I (the athlete) be able to compete again?’ ardern Sports
injuries are a problem that almost every athlete will face, and even bring a lifetime of
pain. Many excellent athletes have left their careers because of sports injuries. The
players continue to increase their intensity, difficulty, and in the process of constantly
beyond, it also bring more sports injuries to athletes.bin
Approximately, there were 2.9 million sport related injuries a year. The most
number of injury is due to sprains and strains (41.4 per 1000). Following it are
fractures, 20 per 1,000, then contusions (19), open cuts (10), traumatic brain injury
(4.5), and dislocations (2.9)American Physical Therapy Association
Sports injuries have received more widespread attention in recent years due in part
to interest in injury monitoring and prevention and rising rates of traumatic brain
injury (TBI)-related emergency department (ED) visits. CDC2019 Concussions related to
sport have contributed to more than 200,000 hospital visits a year Marshall. Sports
injuries are a common type of injury presenting to hospital EDs and are most
common among older children and young adults.ruipinyau
Athletic injury recovery can be a long, challenging process Kraemer. The high risk of
injury reoccurrence caused by an insufficient rehabilitation program nor an ill timed
return to competition, showing important role of physiatrist and rehabilitation in sport
injury recoveryErickson.
We need an understanding of the sport and what biomechanical and physiological
demands this has on the athlete. Therefore, reviewing the literature on sports will help
in providing doctors with an understanding of the types of general injuries, the
mechanism behind them, and the management protocols currently used globally.himmat
2. Injury
As with any injury to biologic tissue, acute inflammation lasts 48 to 72 hours after
the injury and then gradually resolves as repair progresses. Some of the events that
occur during inflammation, including the release of cytokines or growth factors, may
help to stimulate tissue repair. These mediators promote vascular dilation and
increase vascular permeability, leading to exudation of fluid from vessels in the
injured region, which causes tissue edema. Blood escaping from the damaged vessels
forms a hematoma that temporarily fills the injured site. Fibrin accumulates within
the hematoma, and platelets bind to fibrillar collagen, thereby achieving hemostasis
and forming a clot consisting of fibrin, platelets, red cells, and cell and matrix debris.
The clot provides a framework for vascular and fibroblast cell invasion. As they
participate in clot formation, platelets release vasoactive mediators and various
cytokines or growth factors (e.g., transforming growth factor-β [TGF-β] and platelet-
derived growth factor). Polymorphonuclear leukocytes appear in the damaged tissue
and the clot. Shortly thereafter, monocytes arrive and increase in number until they
become the predominant cell type. Enzymes released from the inflammatory cells
help to digest necrotic tissue, and monocytes phagocytose small particles of necrotic
tissue and cell debris. Endothelial cells near the injury site begin to proliferate,
creating new capillaries that grow toward the region of tissue damage. Release of
chemotactic factors and cytokines from endothelial cells, monocytes, and other
inflammatory cells helps to stimulate migration and proliferation of the fibroblasts
that begin the repair process.sportinjury vol2
3. Repair
Tendons and ligaments may possess both intrinsic and extrinsic capabilities for
healing, and the contribution of each of these two mechanisms probably depends on
the location, extent, and mechanism of injury and the rehabilitation program used
after the injury. As in other areas in the body, tendon healing proceeds in three
phases: (1) an inflammatory stage, (2) a reparative or
collagen-producing stage, and (3) a remodeling phase.
3.1 Inflammatory Phase
Tendon and ligament healing begins with hematoma formation and an
inflammatory reaction that includes an accumulation of fibrin and inflammatory cells.
A clot forms between the two ends and is invaded by cells resembling fibroblasts and
migratory capillary buds. Within 2 to 3 days of the injury, fibroblasts within the
wound begin to proliferate rapidly and synthesize new matrix. They replace the clot
and the necrotic tissue with a soft, loose fibrous matrix containing high
concentrations of water, glycosaminoglycans, and type III collagen. Inflammatory
cells and fibroblasts fill this initial repair tissue. Within 3 to 4 days, vascular buds
from the surrounding tissue grow into the repair tissue and then canalize to allow
blood flow to the injured tissue and across small tissue defects. This vascular
granulation tissue fills the tissue defect and extends for a short distance into the
surrounding tissue but has little tensile strength. The inflammatory phase is evident
until the 8th to 10th day after injury.sport medicine vol2
5. Epidemiology
Total number of sport injuries incidents aged 5 years and older was 8.6 million, or
34,1 episodes per 1,000 people. Most of them were people aged 5–24 years with 61%
of men. Half of the injury incidents associated with sport and exercise (or 4.3 million
annually) resulted in therapy in a doctor's office without going into ED, and 36.6%
(or 3.2 million) resulted in a non-hospitalized ED stay.CDC.
For 2010–2016, the top five most frequent activities that caused ED visits for
sports injuries by patients aged 5–24 years were football (14.1%), basketball (12.5%),
pedal cycling (9.9%), soccer (7.1%), and ice or roller skating or skateboarding
(6.9%). Variation was observed by age and sex in the types of activities causing ED
visits for sports injuries (Table 1).ruipinyau
ruipinyau
The top five most frequent activities causing ED visits for sports injuries among
male patients aged 5–24 were football (20.2%), basketball (14.3%), pedal cycling
(10.3%), soccer (6.8%), and ice or roller skating or skateboarding (6.7%). Among
female patients, the top five most frequent activities causing ED visits for sports
injuries were gymnastics or cheerleading (11.8%), playground (9.2%), pedal cycling
(9.1%), basketball (8.9%), and other or unspecified activities (8.8%). ruipinyau
Sprains and strains or dislocations (28.1%) accounted for the largest percentage of
ED visits by patients aged 5–24 years for sports injuries, followed by other or
unspecified injuries (22.6%), fractures (18.0%), contusions and superficial injuries
(16.1%), open wounds (10.5%), and internal injuries (4.7%) (Table 2).rupinyau
Two body regions (upper and lower extremities) accounted for a majority of all
ED visits for sports injuries by patients aged 5–24 years (62.6%), followed by injuries
affecting the head and neck (23.0%) (Table 2).rupinyau
ruipinyau
4. Pain management
Treat injury pain with ice, compression, elevation and rest. But stretching injury site
is forbidden during period of pain. When a tendon or muscle is pulsing with injury
pain, resist the temptation to stretch it outMurphy.
The WHO Ladder was first published over twenty years ago (1986) in a
handbook called Cancer Pain Relief. Since then, the Ladder has guided clinicians all
over the world in treating cancer as well as non-cancer pain.Heatlh Care Association of New Jersey
9.3 Return to sport (RTS)
9.3.1 Defining RTS
Once the rehabilitation criteria for the reconditioning phase have been fulfilled, a
decision to RTS needs to be taken.himmat Success means different things to different
people and is context-dependent and outcome-dependent. To the athlete, success
might be defined by return to sustained participation in sport in the shortest possible
time (goal focus). To the coach (and many athletes), success might be defined relative
to the athlete’s performance on RTS (performance focus). To the clinician, success
might be defined by the prevention of new (or recurring) associated injuries (outcome
focus). The decision-making team must collaboratively decide on how success will be
defined, as soon as possible after the injury.ardemm
In a RTS continuum we define three elements (figure 1), emphasising a graded,
criterion-based progression, that is applicable for any sport and aligned with RTS
goals.ardem
ardem
hammet
11. Conclusion
Sports make a vital contribution to the development of healthy and active
communities. If the objective of increased and sustainable participation in sport is to
be achieved, injury prevention and management will need to be supported and
promoted as an indispensable component of sports participation programs and
strategies. The use of facility design and the role of standards to reduce injury risks
were noted carefully. Improvements in the design, quality and maintenance of
facilities, including playing surfaces, would benefit injury prevention. Future
opportunities to identify and cost-effectively improve facility safety, as part of the
government’s ongoing investment in all types of sports infrastructure, should be
considered. The practical limitations on improving facility safety highlight the
imperative of improving the use of injury risk management strategies and medical
emergency planning in sport. Satish Bhardwaj
The main focus of physiatrist is to evaluate and treat injuries, physical illness, and
disability through comprehensive, patient centered treatment plans, utilizing cutting-
edge as well as time-tested methodologies to maximize function, reduce pain, and
enhance the quality of life.
(fernando)
Sepu´lved, Luis Baerga, William Micheo. The Role of Physiatry in Regenerative
Medicine: The Past, The Present, and Future Challenges. PM R 7 (2015) S76-S80
Bin Lv, Sihua Li. Diagnosis study on sports injuries combined with medical imaging
technology. Biomed Res- India 2017
4. Dhillon MS, Garg B, Soni RK, Dhillon H, Prabhakar S. Nature and incidence of
upper limb injuries in professional cricket players a prospective observation. Sports
Med Arthrosc Rehabil Ther Technol. 2012;4:42–46. [PMC free
article] [PubMed] [Google Scholar]
5. Orchard JW, Kountouris A, Sims K. Incidence and prevalence of elite male cricket
injuries using updated consensus definitions. Open Access J Sports
Med. 2016;7:187–94. [PMC free article] [PubMed] [Google Scholar]
6. Tirabassi J, Brou L, Khodaee M, Lefort R, Fields SK, Comstock RD, et al.
Epidemiology of high school sports-related injuries resulting in medical
disqualification: 2005-2006 through 2013-2014 academic years. Am J Sports
Med. 2016;44:2925–32. [PubMed] [Google Scholar]
7. John R, Dhillon MS, Syam K, Prabhakar S, Behera P, Singh H, et al.
Epidemiological profile of sports-related knee injuries in Northern India: An
observational study at a tertiary care centre. J Clin Orthop Trauma. 2016;7:207–
11. [PMC free article] [PubMed] [Google Scholar]
30. Drew MK, Finch CF. The relationship between training load and injury, illness
and soreness: A systematic and literature review. Sports Med. 2016;46:861–
83. [PubMed] [Google Scholar]
31. Weiss KJ, Allen SV, McGuigan MR, Whatman CS. The relationship between
training load and injury in men's professional basketball players. Int J Sports Physiol
Perform. 2017;2:1–20. [PubMed] [Google Scholar]
32. Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The
acute: Chronic workload ratio permits clinicians to quantify a player's risk of
subsequent injury. Br J Sports Med. 2016;50:471–5. [PubMed] [Google Scholar]
33. Gabbett TJ. The training-injury prevention paradox: Should athletes be training
smarter and harder? Br J Sports Med. 2016;50:273–80. [PMC free
article] [PubMed] [Google Scholar]
34. Li RT, Kling SR, Salata MJ, Cupp SA, Sheehan J, Voos JE, et al. Wearable
performance devices in sports medicine. Sports Health. 2016;8:74–8. [PMC free
article] [PubMed] [Google Scholar]
Lai CC, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes
return to preinjury sport after anterior cruciate ligament reconstruction: A systematic
review with meta-analysis of return to sport rates, graft rupture rates and performance
outcomes. Br J Sports Med 2017 Feb 21. pii: bjsports-2016-096836. doi:
10.1136/bjsports-2016-096836. [Epub ahead of print].
Rui P, Ashman JJ, Akinseye A. Emergency department visits for injuries sustained
during sports and recreational activities by patients aged 5–24 years, 2010–2016.
National Health Statistics Reports; no 133. Hyattsville, MD: National Center for
Health Statistics. 2019.
Centers for Disease Control and Prevention. Surveillance report of traumatic brain
injury-related emergency department visits, hospitalizations, and deaths—United
States, 2014. Atlanta, GA. 2019
NETTER’S CLINICAL ANATOMY, FOURTH EDITION Copyright © 2019 by Elsevier Inc. John T. Hansen, PhD
Brukner & Khan's Clinical Sports Medicine, 4th ed. Peter Brukner, Karim Khan Sydney:
McGraw-Hill Australia; 2012
Miller, Mark D., and Stephen R. Thompson. DeLee, Drez & Miller's orthopaedic sports medicine Fifth edition..
Philadephia, PA: Elsevier, 2020.