Pdhpe_Sports_Med

Year 12 PDHPE Assessment task- Sports Medicine: First aid scenario As the doctor of the Liverpool Football Club, you are required to provide a report for the club on how Djibril Cisse’s injury should be managed a) Outline of the immediate on-field assessment protocol utilised Once I am on the field and the game has been stopped I would undertake the TOTAPS regime as my protocol for the assessment of Cisse’s injury. TOTAPS is an acronym standing for Talk, Observe, Touch, Active movement, Passive movement, Skills test. This allows the assessor to determine whether the athlete may return to play. At anytime the assessor feels the player is in too much discomfort the regime may be stopped. T- How I would approach this is to talk to Cisse, asking for a description on how the injury occurred and rate the pain out of 10 (10 being the most pain), as a rough indication of his perspective towards the pain. (I would stop the assessment here if pain was too high for Cisse to endure: as clip illustrates) O-After talking to the athlete, observe the injury. Body language is a key sign of whether the athlete may continue or not, as well as comparisons with the same other body parts. In this case an appropriate comparison would be against the two legs. Cisse’s leg appears to be deformed will prevent Cisse from further participation in this match. T-Next phase is to touch the injured body part. This allows the assessor to gain physical evidence on the severity of the injury. While touching the body part the assessor may ask to gauge the pain using a rating out of 10. In this phase both legs may be touched to outline the state of the injury. Djibril Cisse would experience vast soreness if I touched his leg. A-The next step of this procedure is active movement. The assessor will ask the player to attempt to move the injured body part to visualize the pain and agony expressed by the athlete when pressure is placed on the area. Cisse would be in immense pain if asked to rotate his leg for example. P-After the active movement stage, passive movement is initiated. The assessor is required to rotate, flex or extend the injured body part to see how mobile and flexible the injured body part is. Cisse would experience extreme aching if he was put in that decision. S-Finally, a skills test is undertaken to assess the athlete on a game like skill in order to observe whether he may re-enter the game. In Cisse’s case a passing drill may be in affect to evaluate his progress in accordance with the game’s standard. He would feel tenderness to the leg and would be unable to re-enter the game. If all areas are passed then the competitor may return to play however in Cisse’s situation he is unable to return to play as he is unable to compete at his full potential. (b) Identify the classification of Cisse’s injury Djibril Cisse has sustained a comminuted fracture of the tibia and fibula. It is a simple fracture as the bone as not protruded outside the body (clip shows shin pad and sock are still on).This injury is a direct hard tissue injury. (C) Describe how you would manage Cisse’s injury at the acute stage After Cisse’s failure of the TOTAPS assessment, our team would undertake the DRABCD protocol If Cisse was unconscious. If Cisse was unconscious we would have to get him into the recovery position and clear out his airways, if they were blocked or wasn’t breathing or breathing comprised we would commence CPR until paramedics were on the scene Our team would then check for any bleeding the athlete has sustained. Cisse has not so, while Cisse is still on the field my team would then treat him for shock and begin to reassure the casualty by placing them into a position of comfort (seated up-right) and, attempt to calm the athlete down. I would then remove Cisse from the field via a stretcher. This measure would allow Cisse to leave the field without any pressure being applied to the injury. My team would then splint use cardboard splint or bandage his leg to immobilise the area to prevent further injury occurring and limit further damage being done to the casualty. One off the field we will call 000 and get a ambulance come to the venue where they would then hospitalise the casualty, to get x-rays etc. and a further medical analysis would be provided by a specialist. Once the doctor has put the bone back together. The focus must go to the muscles, joints etc which were injured so Cisse must follow the RICER method: rest the injury, ice the injury to prevent inflammation, compress the area to reduce swelling and elevate the injury to further decrease swelling and throbbing. (D) Examine and justify what injury rehabilitation procedures should be implemented for Cisse’s injury The aim of rehabilitation is to return the injured athlete to the field of play, restore peak performance and prevent re-injury of the same site. The process involves: progressive mobilisation, Graduated exercise (stretching, conditioning), strengthening, training and the use of hot and cold. Progressive mobilisation- This area of rehabilitation attempts to steadily extend the range of movements in the injured area. For Djibril Cisse his rehabilitation has to start quickly as there is pressure to return to the field faster. In this area he may do very minimal leg movements, just to restore function back into the leg. While waiting for the bone to heal. This is because if the leg is rushed into mobilisation and not gradually mobilised then re-injury may occur and further injury to the area may be done. Graduated exercise - Stretching: the focus of stretching is to ensure the injury heals without scar tissue as scarring shortens the muscle making it more prone to injury. Proprioceptive neuromuscular facilitation stretching is the most effective form of stretching for rehabilitation as it adds an element of resistance training to the body, strengthening muscles under tension. In regards to Cisse an effective solution for a stretch would be Stretching the calf muscles can help to prevent a whole range of lower limb injuries. By stretching it allows more elasticity and flexibility to the joints around the tibia and fibula bones a highly range of movement can be applied in the leg. This is of advantage to Cisse as a wider range of movement contributes to improved function in the skills of passing, kicking and shooting. PNF stretching is beneficial to the athlete as it is the most effective stretch in rehabilitation as it provides athlete with a form of resistance to also strengthen the muscle. The muscle will then become more elastic from this form of stretching unlike if stretching was not used the leg would be very ‘tight’ and more prone to injury. Strengthening Strengthening is an important part of the recuperation process as it makes the injured area stronger against obstacles and prevents re-injury to that area. There are two parts to this stage: isometric exercise and weights. Isometric exercise would be beneficial to Djibril Cisse because his gastrognemius and soleus muscles are protecting his tibia and fibula bones which were severely fractured. By the two muscles being under tension , the area strengthens as its form of resistance increases against the external environment/forces and the bone becomes stronger, enabling force to be applied in that area. For example: jostling for the ball in a contest when in or out of possession. Weights are the other component for this area of rehabilitation. They strengthen the area leading to muscle hypertrophy and a larger protection base to the tibia and fibula bones which are rehabilitating from fractures. Progressive overload is a principle of training which needs to be established as in leads to an increase in hypertrophy to the muscles as the body adapts to the increase in resistance. In Cisse’s case the leg muscles will be targeted in the rehabilitation as he is a professional soccer athlete. This requires the principle of specificity to be applied when rehabilitating this injury. As the skills of passing, kicking and shooting are key in soccer. Without weights his muscles will succumb to reversibility and atrophy will occur. This is bad as his legs need to have a lot of muscle as they are required to generate maximal power while in full intensity competition. Conditioning: This area is a build up of fitness as a result of adaptations to progressive overload. Specificity is a key principle in this area as the region of the body is targeted to heal efficiently and quickly. In this area basic skills and game skills are undertaken at low to moderate intensity to ease the athlete lack into their training regime and becoming comfortable with the injury’s post rehabilitation. The basic movements require a range of pain free movement, to do necessities of their sport. In Djibril Cisse’s case kicking, shooting and running are essential. In game skills a higher range of movement is required for example: Cisse may practice step-overs, as rotation of the leg expands the range of movements compared to the basic skills. By the use of conditioning, it allows the athlete (Djibril Cisse) to return to play and be in better shape when returning to competition. Training- After conditioning comes training. In this procedure the athlete is expected to return to training at a moderate to moderate intensity and build up. This involves participating in a warm-up, conditioning, drills, skill development, exercise and a cool-down. In training game like situations can be tested or the athlete can return to full training. In game- like situations no direct opponent is advised so I’d implement a one on one, penalty session with the keeper, just to improve accuracy as well as assess how much power Cisse is generating from the shot in comparison to when he was playing before the injury. After when Cisse advances to full training the intensity is increased and preventative taping may be applied for pre cautionary reasons. This is because if there is no taping the muscles and joints in that area are not stabilised which increases the chance of an irregular movement and could result in re-injury and sets the rehabilitation process back several weeks. In Cisse’s case I would play him at striker if a match between attack and defence is played. This is because strikers don’t do a lot of tackling. I would also not play him the whole game as he would ease into the match as it is his first game in such a high intensity for quite some time. This is because if exposed to long periods of the game, his body is unable to cope with the high amount of intensity required, also if the entire match is played more running is done and more pressure is put on the leg making it more susceptible to re-injury. Total body fitness- coaching staff would also continually ask Cisse questions trying to gauge his physiological readiness to compete in regards to his injury as well as how he is feeling about it physically. My team would then assess his mentality towards his injury and how he feels in different stages of training: e.g. : look at his body language when going in for a tackle or getting tackled, so we could see if our star was 100% comfortable with his rehabilitation towards his leg injury. This is because if Cisse is tentative towards physical competition he would not compete at his full potential and be more likely to commit further injury, which would see rehabilitation restart again. Use of Heat and Cold Cold is used for the immediate treatment of injury as it prevents swelling due to internal bleeding. It can be applied by using ice packs, ice contained in plastic and wrapped in a towel or cool water/ice baths and immersion for short periods. In Cisse’s case it would be used after surgery. Cryotherapy assists with reduction of pain, blood flow and swelling to the area. If use of cold was not performed to soft tissue areas contusions would form and function of area as well as performance would be impaired. This is because if cryotherapy was not used increased blood flow would enter the area and more pain would be felt by Cisse, which would cause further injury. Heat should not be used in the early stages of injury while bleeding at the injured site is still occurring. So once the cryotherapy has reduced the blood flow to the area, thermotherapy is used. It may help in promoting movement and blood flow and relaxing the muscles through rehabilitation. In Cisse’s case ultrasound therapy is advised as it is more effective on denser/ deeper tissue, such as bone and surrounding tissue, as thermotherapy increases flexibility and elasticity allowing a wider range of movement to occur and will also assist in fully healing the fracture. Without the use of heat the muscles will continually be under tension making the muscles more prone to tears, increase the amount of rehabilitation and lengthen the stint off the field. After Djibril Cisse has successfully completed the injury rehabilitation procedures he will be allowed to play. This is provided if he obtains a medical clearance by his physiotherapist and other specialists in the field. The medical personal would be monitoring the indicators of readiness to play. These include: elasticity, strength, mobility, balance and pain free. If all these indicators are 100 percent Cisse and the doctors are comfortable if the injury will not reoccur in a short period of time, then Djibril Cisse will be allowed to return to play. By: Tony Salerno 1/12/10