Sports Medicine

Pottsgrove Guidelines for Concussion Management

Q: What should you do for a new injury (strain or sprain?)

A: You should immediately see the Athletic Trainer. However, if you are away from school, here are some easy steps to remember. The best way to remember it is to think PRICE

P - Protection - Splint if need be. Crutches can help to take pressure off a new injury.
R - Rest - Give the injury the proper rest to heal correctly.
I - Ice - Ice should be used for the first 24 to 72 hours to help reduce inflammation/swelling and help with pain. Ice should be applied for 20 minutes and taken off for twenty minutes. One should never use heat for the first 72 hours.
C - Compression - An ace bandage or any compression dressing is very effective in reducing and preventing any swelling from occurring. Reducing the amount of swelling will help speed up the healing process.
E - Elevation - By keeping the injured body part above the level of the heart, you use gravity to your advantage help prevent/decrease swelling.

Q: Is time and rest enough for an injury to heal properly?

A: No. It is important that a comprehensive rehabilitation plan be developed that will ensure the athlete is at the same if not better level than before injury. It is also important to consider the cause of the injury to prevent a reoccurrence. An example would include a typical lateral ankle sprain. In an ankle sprain, ligaments are torn. However, the muscles of the ankle can become weak, even though they were not injured at the time of the injury. If an athlete provides only rest for this injury, the athlete will return with a weaker ankle and could predispose themselves to another. Undergoing a lower leg strengthening program as well as exercises to maintain their balance skills would ensure a safe return to sport. Another example would include non-stress fracture type "shin splint" injuries. This type of injury is usually a result of overuse and over-training. Typically, the athlete is training at a level that is too much for the body to tolerate and a syndrome of irritation and inflammation occurs. Rest is an important part of the process, but the athlete must strengthen the lower leg muscles so it can handle the stress of the sport. A logical gradual return to sport is also warranted. Several modalities can also be utilized to help accelerate the healing process. I highly recommend an appropriate rehabilitation program for all injuries.

Q: What is better, Heat or Cold?

A: It is very important to understand that if an injury is new or an old injury is aggravated, ONLY use cold. When an injury occurs, there is damage to one's tissues. The result is swelling to the injury site. Although the body’s response is meant to help heal the injury, in most cases there is too much swelling which actually slows down the recovery process. Ice is a very effective tool to help control the swelling. If one applies heat to the area, then the amount of swelling will be increased which could produce disastrous effects. An example would be applying heat to a thigh contusion/bruise. The increase in swelling could develop into a condition called myositis ossificans, in which the body actually develops a bony mass in the muscle. This condition will result in a significant time loss for the athlete. Ice also helps break the PAIN SPASM cycle. When the body is injured, the muscles go into a protective spasm. This spasm will result in pain. The pain in turn will increase the body’s spasm response. Ice is very effective in reducing the pain of the injury and also the muscle spasm. This in turn will accelerate the recovery of the injury. Ice is also very effective after practices/games when an athlete returns to sport but is still not completely recovered from an injury.

Heat is very effective part of recovery a couple of days after a new or aggravated injury. Heat is also helpful as a warm up tool for tight muscles before activity. Heat helps bring nutrition to an injury and helps improve tissue extensibility. As part of a rehab program, it is common to heat the body part before rehab/exercises and ice down after, as long as the acute phase is over. If you are not sure, always remember that you can't go wrong with ice and always check with the Certified Athletic Trainer.

Q: How effective are those topical heat / cold creams in healing an injury?

A: They don't do anything and could potentially make an injury worse. It is important to understand that these creams contain chemical irritants that irritate the nerves in your skin, and in turn produce either a warm or cold "sensation". The cream actually never gets to the muscles and there is no real heating or cooling effect. This could be dangerous with a new injury. If one uses this cream with a hamstring strain in hopes to loosen the muscle, all that will happen is a masking of the pain. An athlete could easily increase the severity of injury if they were to compete. These creams are best left for mild soreness relief due to workouts, not injuries.

In the USA, the Certified Athletic Trainer (ATC) is an allied health care professional that is certified by the Board of Certification, Inc. (BOC). Certified Athletic Trainers are also sometimes referred to as sports medicine practitioners or athletic therapists, and are the centerpiece of the sports medicine team. They serve as a liaison to the athlete, coach, physician and other supplemental personnel providing care to people sustaining physical or emotional trauma. Specifically, the Certified Athletic Trainer's role delineation encompasses six domains:
 

1. Athletic Injury Prevention and Risk Management
2. Recognition, Evaluation and Assessment of Injuries and Illnesses
3. Immediate Care of Injuries
4. Treatment, Rehabilitation and Reconditioning
5. Health Care Organization and Administration
6. Professional Development and Responsibility

As a part of the complete sports medicine team, the Certified Athletic Trainer works under the direction of a licensed physician and in cooperation with other health care professionals, athletics administrators, coaches and parents.
 

A day in the life of a certified athletic trainer...
Certified Athletic Trainers work in a wide range of areas. They work in athletics as well as in clinic settings. In clinic settings, they work with people of all ages and all activity levels specializing in injury and illness prevention, assessment, treatment and rehabilitation for all people. Certified Athletic Trainers are also highly involved in the day to day processes of professional, intercollegiate, or high school athletics. They are responsible for the preparation and maintenance of athletes that are poised for competition. Some duties of a Certified Athletic Trainer will include:
 

• Prepping athletes for practice or competition including taping, bandaging, bracing or applying other forms of risk management
• Evaluating injuries to determine the best course of action in regard to the health and welfare of the athlete
• Developing and implementing conditioning programs
• Implementing treatment and rehabilitation programs

Certified Athletic Trainers that are not integrated in the athletics community may function as a sports rehabilitation specialist. The rehabilitation specialist spends their days in a private, corporate or hospital based rehabilitation clinic constructing rehabilation protocols, monitoring therapeutic exercise regimens and performing treatments with the various therapeutic modalities that may be offered for patient care. A Certified Athletic Trainer must have a strong knowledge of the human anatomy and health and human performance, and strong decision making skills through education and training.
 

Places of Employment
Certified Athletic Trainers can be found almost anywhere. Whether it's on the playing field or in the industrial setting, Certified Athletic Trainers are in place to help people avoid injuries, embrace health and wellness, and perform to the best of their abilities. Certified Athletic Trainers are employed in secondary schools, intercollegiate athletics, professional athletics, sports medicine clinics, the military, the sets of the movie industry, professional dance settings, or industrial and commercial settings. Hospitals and health clubs are also venues that create job opportunities for Certified Athletic Trainers.
 

Athletic Training Education
Athletic Training Education Programs are accredited by the [Commission on Accreditation of Athletic Training Education] (CAATE). Entry level athletic training education uses a competency-based approach in both the classroom and clinical settings. Using a medical based education model, athletic training students are educated to serve in the role of physician extenders, with an emphasis on clinical reasoning skills. Educational competencies are bases on cognitive (knowledge), psychomotor (skill), affective competencies (professional behavior), and clinical proficiencies (practice oriented outcomes). Students must receive instruction in the foundational courses of human physiology, human anatomy, exercise physiology, kinesiology/biomechanics, nutrition, acute care of injury and illness, statistics and research design, and strength training and reconditioning. The student must be introduced to professional coursework that encompasses the following domains:
 

• Risk management
• Pathology of injury/illness
• Prevention and assessment of injuries/illness
• General medical conditions and disabilities
• Therapeutic modalities
• Strength and Conditioning
• Therapeutic massage
• Emergency medicine
• Weight management and body composition
• Psychosocial intervention and referral
• Medical ethics and legal issues
• Pharmacology
• Professional development and responsibilities

Emergency Action Plan

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