SPRAINS
Sprains are injuries in and around joints that involve ligaments. Sprains
are defined as a tearing of ligaments; tears may be mild (a few fibers),
moderate, or severe (complete tear). Severe sprains generally require
surgery and/or casting to correct and connect the ligaments.
Sprains are quite common in sports. Ankle sprains are common in basketball,
football, soccer and soft/baseball. Finger sprains are common in volleyball
and basketball. Shoulder sprains are frequent in wrestling and football. Knee
sprains can occur in a variety on sports, particularly ones which use a
cleated shoe. When the cleats become entangled in the grass, the ankle locks
and the knee is forced to absorb the majority of the twisting.
STRAINS
Strains are injuries to muscles and the tendons that connect muscles to
bones. Strains are also called “pulled” muscles. Strains most often occur
when the range of motion (flexibility) is exceeded. Regular flexibility
exercise should be a part of every athlete’s daily routine. Stretching before
participation must be coupled with stretching after as well as several times
during the day as well.
When the athlete sustains a strain it may be classified in the same three
degrees of severity as sprains; tears may be mild (a few fibers), moderate,
or severe (complete tear). Since muscles have a good blood supply there may
be some black-and-blue appearing after they “pull”. Strains often occur in
the low back, hamstrings and shoulder areas.
Remember sprains involve joints and ligaments; strains involve muscles and
tendons. Both injuries should be handled initially with RICE.
------------R I C E for Athletic Injuries---------
The standard initial procedure for dealing with the majority of injuries seen
in athletics is to follow the acronym R I C E. The procedures of RICE are
designed to control and reduce inflammation and the resultant swelling.
Controlling swelling promotes healing by eliminating the body’s production of
histamine which triggers inflammation.
The “R” stands for resting an injury by eliminating movements which use or
stress the injured area. This will decrease hemorrhaging, swelling and
further stress on delicate structures. The length of rest is dependent upon
the severity of the injury as determined by the physician. An athlete who
continues to participate with an injury may cause further damage.
The “I” stands for ice. Ice applications should be done as soon as possible
and repeated 3-4 times each day. This rule generally applies for the first 2-
3 days after the injury occurred and certainly until the acute symptoms
subside which may be more than two days. The application of heat too soon
may cause unwanted swelling.
What cannot be forgotten is that the skin also needs time to respond and
react to the cold; therefore, after applying ice for 20-30 minutes the cells
need 40-60 minutes to recover. If ice is applied directly onto the skin, the
effects occur quicker, therefore the time is reduced. Ice cubes or crushed
ice in a plastic bag may be held in place with an elastic wrap. Chemical ice
packs were designed for the convenience and work for 8-10 minutes. If you
use chemical packs make certain that you “activate” the chemicals correctly
so as to avoid breaking the bag. It is recommended to avoid placing chemical
ice packs directly onto the eyes, ears and mouth due to the possibility of
leakage.
The “C” stands for compression. When applied correctly elastic wraps squeeze
and reduce the body’s ability to swell. Elastic wraps should be applied below
the injury and wrapped up toward the heart. The wraps should be applied snug
but not too tight. When elastic wraps are applied too tight they cause
tingling, numbness and loss of feeling. Their purpose is to control swelling,
not impair circulation.
The “E” stands for elevation. Since the purpose of RICE is to control
swelling and reduce inflammation, the addition of elevation controls swelling
since blood does not flow uphill well. When a forearm is injured, the
athlete should hold the area at an upward angle and an upper arm injury
should be rested on a shoulder height surface. Leg injuries are easily
elevated to hip height when seated.
WOUND CARE
Bleeding can be from an artery, vein or capillary. Arterial bleeding is life
threatening since the blood is lost with each powerful heart beat and is
characterized by bright red, spurting blood. Venous bleeding can be
dangerous as well depending upon the size of the vein. Venous bleeding is
slower and the blood is darker. Capillary bleeding is the most common type in
athletics. The blood “oozes” from the wound and can usually be controlled
with direct pressure. Always follow standard Universal Precautions when
dealing with any body fluid. In the case of wound care, wear gloves and use
direct pressure with sterile gauze pads to control bleeding. If the initial
pad becomes saturated, do no remove it; rather place additional ones directly
onto the initial ones. In the case of limbs, elevation will assist reduce
the flow of blood
There are basically four types of open wounds that occur most often in
athletics. The acronym PAIL will assist in remembering these wounds.
A Puncture wound may be received from the athlete stepping on a nail,
thumbtack or by being stepped on by something such as a cleat or spiked
shoe. The chance of tetanus is greatest with a puncture wound due to the
difficulty of cleaning the wound since it often closes when the implement is
withdrawn. If the wound bleeds freely, the blood will often serve to dislodge
any trapped dirt. Puncture wounds should prompt the question “when did the
athlete have his/her last tetanus shot”? Avoid attempting to clean puncture
wounds since the disinfectant often becomes lodged deep in the wound. Follow
RICE guidelines.
An Abrasion is caused by scrapes and sliding. They are common in sports such
as baseball, track, soccer, field hockey, lacrosse and football. Due to the
large surface area involved, there is a high chance of infection with this
type of injury. Recent studies have shown that water is the best agent for
cleaning wounds. A good technique is to flush the area with water. Cleansing
solutions such as hydrogen peroxide and betadine have been shown to delay
wound healing.
Wounds that are kept moist heal better and faster than wounds that are
allowed to dry, so rinse off any debris, apply antibacterial ointment or
first aid cream, cover and follow RICE guidelines.
Incised wounds may occur from buckles or edges of metal strips in any sport.
Incised wounds are knife-like and may be deep or shallow. The athlete with
an incised wound often may not experience pain. The cleaning of an incised
wound should be done thoroughly so that no foreign material is closed within
the wound site. Incised wounds should be cleaned lengthwise, not across the
wound, in order to avoid pushing debris under the edges of the wound.
Incisions and lacerations many times require sutures to draw the wound edges
close to each other to promote healing and prevent a wide scar. Follow RICE
guidelines and pad the area for further activity.
Lacerations involve the greatest amount of tissue damage. Lacerations are
characterized by rough edges with more apparent tissue damage than other
types of wounds. Controlling the bleeding is a primary concern. Cleaning
laceration wounds should be done lengthwise and is often made easier because
the bleeding itself often removes any foreign debris. Follow RICE and
anticipate shock.
SHOCK
Shock is a depressed condition of the body’s systems due to failure of the
circulatory system. Due to the slow down of circulating blood, vital organs
such as the brain and heart are deprived of blood. To combat this, attempts
are made to encourage blood flow back to the heart and brain. Shock is a
condition that is better prevented than treated. Shock is capable of
occurring with any injury; even ones that seem small to observers. Shock
should be prevented when it is in the earliest stages.
For an athlete who does not have an injury, which would prohibit movement,
the typical shock position is lying flat on the back with feet and legs
elevated about ten inches. This position should not increase leg or back
pain, it should not cause breathing difficulty, it should not produce
dizziness or nausea. If any of these or any change in the athlete’s
condition is observed, have the athlete assume the most comfortable position.
The athlete does not necessarily need to be covered with a blanket; the key
is to maintain body temperature. Hot days do not require a blanket; cold
days or a cold athlete do.
BLISTERS
Blisters are caused by friction and the heat that is built up. The body’s
method for dealing with excessive, localized heat is to fill the area with
extra body fluid.
Blisters should not be opened due to the chance of infection once the
protective layer of skin has been broken.
To prevent blisters, in the case of shoes, have the athlete lubricate areas
that are rubbing with petroleum jelly, wear two pairs of socks (thin
underneath, thicker outside) and ensure that the shoes fit properly. Blisters
on other body parts need to be protected by wearing proper equipment (gloves)
and/or taping and padding the area.
NOSEBLEEDS
Due to its prominent position on the face, the nose is highly subject to the
potential for many injuries. Equipment has been adopted in several sports to
protect the face; however, many sports still expose the body area.
Nosebleeds may be caused by a direct blow, dry air in the athlete’s house may
dry out the nasal capillaries making them susceptible to cracking and some
athletes simply have nasal capillaries nearer the surface than other athletes.
When an athlete presents with a bleeding nose, your immediate reaction must
be twofold: first aid and ask about the potential for a larger injury such as
a concussion or neck injury. First aid for nosebleeds is simply pinch the
mid-section of the nose (direct pressure), consider ice application (20/40 or
30/60), think about shock, and position the athlete so that he/she is sitting
upright with a slight forward head tilt to avoid swallowing blood. Once the
athlete is rested and the condition is subsiding, do not allow the athlete to
become active or blow the nose for 15-20 minutes to avoid disrupting the
clotting that has occurred
A nosebleed that bleeds freely and/or a long time should be suspected of
being broken.
DENTAL INJURIES
Dental injuries may be very frightening to the observer. As with any injury
that involves blood and a screaming athlete, cool heads must prevail.
Universal precautions for bloodborne pathogens should be followed.
If the tooth can be located, you must avoid the natural tendency to wipe any
dirt off the tooth. When you brush away dirt, you also brush away the body’s
natural protective enzymes. Instead, you should pick the tooth up making
certain to only touch the crown, not the roots. You should wash the tooth and
place it back into the socket (older, responsible youths only) or place the
tooth into a moist gauze pad.
90% of secondary teeth can be re-implanted if done so quickly. As with all
head and facial injures, do not forget to determine the possible presence of
other injuries. Remember to always anticipate shock.
EYE INJURIES
As frightening as dental injuries can be, eye injuries can be even scarier
for the athlete and any observers. Eye and visual injuries are difficult
since often only the injured athlete can see any difference. For that
reason, you must be good at asking questions. For example, don’t ask “who are
we playing today” or “what inning is it” when the other team and scoreboard
are plainly visible on the field.
Look at the athlete for obvious changes around the eye socket, control any
bleeding and apply ice for any swelling. Ask the athlete about the vision and
headache. Remember that facial injuries should make you think about head and
neck involvement as well.
When applying ice, remember do not press ice directly onto the eyeball (too
much pressure) and do not let ice in place n more than 5-10 minutes at a time
(the eye is very sensitive to cold).
While the athlete is treating the injury, do not let him/her blow his/her
nose (increases pressure within the eyeball).
Eyes are too valuable to turn any athlete into a hero. Don’t force the issue.
----------------------------------------------------------------
