Sports Injury Management- The first 72 hours- What to do

Sports Injury Management- The first 72 hours- What to do

RICE protocol.

Risk factors for groin/hip injuries in field-based sports

Groin/hip injuries occur frequently in the athletic population, particularly in sports requiring kicking, twisting, turning and rapid acceleration and deceleration. Chronic hip, buttock and groin pain make up 10% of all attendances to sports medicine centres. Understanding risk factors for field-based sports (FBS) players is important in developing preventive measures for injury. The objective of this systematic review was to identify and examine the evidence for groin/hip injury risk factors in FBS. 14 electronic databases were searched using keywords. Studies were included if they met the inclusion criteria and investigated one or more risk factors with relation to the incidence of groin/hip injuries in FBS. Studies were accumulated and independently analysed by two reviewers under a 12-point quality assessment scale (modified CASP (for cohort study design) assessment scale). Because of the heterogeneity of studies and measures used, a meta-analysis could not be conducted. As a result risk factors were pooled for analysis and discussion. Of the 5842 potentially relevant studies, 7 high-quality studies were included in this review. Results demonstrated that previous groin/hip injury was the most prominent risk factor, identified across four studies (OR range from 2.6 (95% CI 1.1 to 6.11) to 7.3, (p=0.001)), followed by older age (OR 0.9, p=0.05) and weak adductor muscles (OR 4.28, 95% CI 1.31 to 14.0, p=0.02) each identified in two studies. Eight other significant risk factors were identified once across the included studies.

This study identified 11 significant risk factors for groin/hip injury for FBS players. The most prominent risk factor observed was previous groin/hip injury. Future research should include a prospective study of a group of FBS players to confirm a connection between the risk factors identified and development of groin/hip injuries.


For detailed study, kindly visit-
http://www.ncbi.nlm.nih.gov/pubmed/24795341

Importance of "pre-habilitation" to avoid knee injuries in young athletes

A 2014 article in the medical journal Pediatrics summarized the current research and has concluded that a specific exercise routine, known as neuromuscular training, greatly reduces the risk of knee injuries in young female athletes.

This neuromuscular training routine has been coined "Pre-habilitation" because it is performed before and throughout the sporting season. The comprehensive research results have shown a reduction in Anterior Cruciate Ligament (ACL) tears by 72 per cent, thereby avoiding surgery and/or a prolonged rehabilitation. The ACL is one of four major ligaments that stabilize the knee. There has been an increase in the number of ACL injuries over the past 20 years, with the rate being higher for females compared to males within similar sports. Interestingly, the majority of ACL injuries occur without any external contact by another player.

The risk of ACL injury in athletes sharply increases at adolescence (12-13 years old for girls; 14-15 years old for boys), with girls having a significantly higher risk until adulthood. This occurs because of what is called a 'motor-machine mismatch', where the body is growing faster then what the neuromuscular system can control it. Anatomical differences also contribute to increased risk for girls, and boys appear to be partially protected because of increased testosterone at puberty which accelerates muscle growth and strength.

An ACL injury, with or without surgery, will require many months of rehabilitation, and can be very disruptive to a young person due to time lost from school and sports. According to local Orthopaedic Surgeon, Dr. Stephen Sohmer, a young athlete with a complete ACL tear will almost certainly require surgery in order to return to sporting activity. An untreated ACL tear increases the risk of irreversible damage to other knee structures, and premature arthritis later in life. He supports pre-activity training programs for all young athletes in order to prevent an ACL tear in the first place.

Neuromuscular training works by preparing the body to perform sport specific movements in a way that reduces risk of injury during pivoting, landing, or unexpected loading of the knee. This is particularly relevant to any athlete that plays a sport requiring sprinting, pivoting, cutting, jumping, or landing (such as soccer, volleyball, lacrosse, football, baseball, or basketball).



via-http://www.courierislander.com/sports/local-sports/research-supports-pre-habilitation-to-avoid-knee-injuries-in-young-athletes-1.1202129

The effectiveness of exercise interventions to prevent sports injuries

Physical activity is important in both prevention and treatment of many common diseases, but sports injuries can pose serious problems.

To determine whether physical activity exercises can reduce sports injuries and perform stratified analyses of strength training, stretching, proprioception and combinations of these, and provide separate acute and overuse injury estimates, a research was done.

You can have full access to the study here-

http://bjsm.bmj.com/content/48/11/871.short

Primary Patellar Dislocation: Management

Patellar dislocation accounts for 2 – 3% of all knee injuries, however, is the second most common cause of knee haemarthrosis (Aglietti et al., 2001). Patellar dislocation is most commonly associated with sports injuries, and therefore, is encountered commonly by the sports physiotherapist. In recent times there has been controversy on the most appropriate forms of management following primary (or first time) patellar dislocation.

Management-

A CASE FOR PRIMARY SURGERY:-

Stefancin and Parker (2007), suggest that surgery is indicated in the following cases:
*.Significant chondral injury
*.Osteochondral fractures
*.Large medial patellar stabilizer defects (i.e. MPFL, medial retinaculum, VMO)
*.Subsequent dislocation
*.Failure to improve with conservative management

CONSERVATIVE MANAGEMENT:-

The physiotherapy management of patellar dislocation should include the following:

A period immobilisation/bracing in extension (at least 3 weeks). This follows the results of Maenpaa and Lehto (1997) who found a 3-fold higher risk of redislocation in those treated with immediate mobilization, rather than a period of immobilisation.This should be followed by functional rehabilitation, with the aims of:
*.Quadriceps strengthening
*.VMO Biofeedback – aimed at reducing inhibition*.Restoration of ROM
*.Stretching of lateral structure tightness
*.Mobilisation for cartilage nutrition

The outcomes of conservative management are quite favourable. The systematic review (Stefancin and Parker, 2007) showed an excellent to good results in 76% of patients, with an average re-dislocation rate of about 48%.

ASPIRATION:-

In patients who present with significant effusion, aspiration may aid both therapy and diagnosis (Stefancin and Parker, 2007). This is because:
*.It can decrease pain and local anaesthetic injection can improve both clinical and radiographic assessment
*.It will achieve joint depression
*.Larger haemarthrosis volume will be related to a larger injury to the medial patellar stabilizers and/oran osteochondral injury
*.Analysis of the aspirate may identify the presence of fatty globules, which is indicative of an osteochondral fracture.

SURGICAL MANAGEMENT:-

As stated above, there are a number of cases in which surgical management is indicated. If the osteochondral fracture is greater than 10% of the patella articular surface, or if it is a part of the weight-bearing portion of the lateral femoral condyle, open repair is indicated (given that the fragment is amendable to fixation). Any large defects in the medial patellar stabilisers should under repair/reconstruction. A lateral release can also be performed to release tight lateral structures.The results of surgical management are positive. Subjectively there has been excellent to good results in 69% of patients, with a lower re-dislocation rate of 12%.