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Preventing Athletic Preventing Athletic InjuriesInjuries
Preventing Athletic Preventing Athletic InjuriesInjuries
Tony Milian, ATC, LATTony Milian, ATC, LATManager, Sports MedicineManager, Sports Medicine
[U18] Sports Medicine[U18] Sports MedicineCooper City Optimist LectureCooper City Optimist Lecture
February 16th, 2010February 16th, 2010
Tony Milian, ATC, LATTony Milian, ATC, LATManager, Sports MedicineManager, Sports Medicine
[U18] Sports Medicine[U18] Sports MedicineCooper City Optimist LectureCooper City Optimist Lecture
February 16th, 2010February 16th, 2010
Parents’, Coaches’, Trainers’, Physicians’Parents’, Coaches’, Trainers’, Physicians’ Everybody’sEverybody’s Goals Goals
Parents’, Coaches’, Trainers’, Physicians’Parents’, Coaches’, Trainers’, Physicians’ Everybody’sEverybody’s Goals Goals
Make the game as safe as possible for the players
Protect the athlete from further injury
Accurate evaluation
Early recognition and treatment
Definitive injury care
Return to play
Make the game as safe as possible for the players
Protect the athlete from further injury
Accurate evaluation
Early recognition and treatment
Definitive injury care
Return to play
PreventionPreventionPreventionPrevention
Representative Areas For Today:
Head Injury
Heat Injury
Supplement Injury
Lightning Injury
Stretching Dynamic / Static
Representative Areas For Today:
Head Injury
Heat Injury
Supplement Injury
Lightning Injury
Stretching Dynamic / Static
Head Injury: ConcussionHead Injury: ConcussionHead Injury: ConcussionHead Injury: Concussion
Definition - Immediate and transient impairment of neurologic function due to traumatic injury to the head
May or may not involve loss of consciousness (LOC)
Definition - Immediate and transient impairment of neurologic function due to traumatic injury to the head
May or may not involve loss of consciousness (LOC)
Early Signs of ConcussionEarly Signs of ConcussionEarly Signs of ConcussionEarly Signs of Concussion
Impaired attention
Slurred, incoherent speech
Disorientation
Impaired Coordination
Emotional reaction out of proportion
Memory deficits
Any loss of consciousness
Impaired attention
Slurred, incoherent speech
Disorientation
Impaired Coordination
Emotional reaction out of proportion
Memory deficits
Any loss of consciousness
Late Signs of ConcussionLate Signs of ConcussionLate Signs of ConcussionLate Signs of Concussion
Persistent headache
Dizziness
Poor Attention
Memory Dysfunction
Nausea or Vomiting
Irritability
Photophobia
Persistent headache
Dizziness
Poor Attention
Memory Dysfunction
Nausea or Vomiting
Irritability
Photophobia
AAN Concussion Grading AAN Concussion Grading ScaleScale
AAN Concussion Grading AAN Concussion Grading ScaleScale
Grade I
Abnormal symptoms resolve in less than 15 minutes
Grade II
Abnormal symptoms resolve in greater than 15 minutes
Grade III
A: Brief LOC (seconds)
B: Prolonged LOC (minutes)
Grade I
Abnormal symptoms resolve in less than 15 minutes
Grade II
Abnormal symptoms resolve in greater than 15 minutes
Grade III
A: Brief LOC (seconds)
B: Prolonged LOC (minutes)
AssessmentAssessmentAssessmentAssessment
Cervical Spine (LOC)
Facial Expression
Pupil size and reactivity
Upper and Lower extremity
Orientation
Immediate Memory
Delayed Recall
Cervical Spine (LOC)
Facial Expression
Pupil size and reactivity
Upper and Lower extremity
Orientation
Immediate Memory
Delayed Recall
AAN Concussion AAN Concussion ManagementManagement
AAN Concussion AAN Concussion ManagementManagement
Grade I (<15 minutes, no LOC)
Remove from contest
Immediate exam and at 5 minute intervals
Out for Remainder of Game
Grade I (<15 minutes, no LOC)
Remove from contest
Immediate exam and at 5 minute intervals
Out for Remainder of Game
AAN Concussion AAN Concussion ManagementManagement
AAN Concussion AAN Concussion ManagementManagement
Grade II (>15 minutes, no LOC)
Remove from contest; no return
Immediate exam and at 5 minute intervals
Re-exam the next day
MD exam and clearance after 1 asymptomatic week
Grade II (>15 minutes, no LOC)
Remove from contest; no return
Immediate exam and at 5 minute intervals
Re-exam the next day
MD exam and clearance after 1 asymptomatic week
AAN Concussion AAN Concussion ManagementManagement
AAN Concussion AAN Concussion ManagementManagement
Grade III (Any LOC)
EMS transport to nearest ER
MD evaluation and +/- brain imaging
Possible Admit
Grade III (Any LOC)
EMS transport to nearest ER
MD evaluation and +/- brain imaging
Possible Admit
AAN Concussion AAN Concussion ManagementManagement
AAN Concussion AAN Concussion ManagementManagement
Grade III - Return to play
Brief LOC : 1 week
Prolonged LOC : 2 weeks
2nd Injury: 1 month
Abnormal Brain Scan : season terminated
Grade III - Return to play
Brief LOC : 1 week
Prolonged LOC : 2 weeks
2nd Injury: 1 month
Abnormal Brain Scan : season terminated
Heat InjuryHeat InjuryHeat InjuryHeat Injury
When “walk it off” is not the right thing to say
What three types exist
What are the risk factors
Prevention strategies
Treatment strategies
Heat cramps
Heat exhaustion
Heat stroke
When “walk it off” is not the right thing to say
What three types exist
What are the risk factors
Prevention strategies
Treatment strategies
Heat cramps
Heat exhaustion
Heat stroke
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
Heat production increases 15X with exercise
Two mechanisms to dissipate head
Radiation (65%) – Clothing
Evaporation (30%) – Humidity
Heat production increases 15X with exercise
Two mechanisms to dissipate head
Radiation (65%) – Clothing
Evaporation (30%) – Humidity
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
Heat Cramps
Painful muscle spasms that most commonly occur in the calf and abdomen but can occur anywhere.
Treatment involves drinking water, mild stretching and ice massage of the affected area.
Heat Cramps
Painful muscle spasms that most commonly occur in the calf and abdomen but can occur anywhere.
Treatment involves drinking water, mild stretching and ice massage of the affected area.
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
Heat Exhaustion
Headache
Dizziness
Weakness
Fatigue
Muscle cramps
Vomiting
Excessive thirst dry tongue and mouth
In-coordination, mental dullness,
Elevated body temperature & reduced sweating.
Heat Exhaustion
Headache
Dizziness
Weakness
Fatigue
Muscle cramps
Vomiting
Excessive thirst dry tongue and mouth
In-coordination, mental dullness,
Elevated body temperature & reduced sweating.
Looks Like a
Viral Illness
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
Heat Exhaustion
Treatment
Rest
Remove from hot environment
Fluid replacement over several hours
Likely requiring IV fluid
Ice packs to neck, groin, armpits
Heat Exhaustion
Treatment
Rest
Remove from hot environment
Fluid replacement over several hours
Likely requiring IV fluid
Ice packs to neck, groin, armpits
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related InjuryHeat Stroke
Sudden collapse usually with a loss of consciousness
Flushed, hot skin; Rapid, strong pulse
Sweating is often absent
Body has lost the ability to cool itself
Treatment - Immediate call to 911 and
Cool the body
Strip all the clothing off the athlete
Sponge with cool water, and fan with a towel
Ice water immersion is controversial
No alcohol sponge baths
Heat Stroke
Sudden collapse usually with a loss of consciousness
Flushed, hot skin; Rapid, strong pulse
Sweating is often absent
Body has lost the ability to cool itself
Treatment - Immediate call to 911 and
Cool the body
Strip all the clothing off the athlete
Sponge with cool water, and fan with a towel
Ice water immersion is controversial
No alcohol sponge baths
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related InjuryPrevention Strategies
Education
Hydration
Prior to activity (1/2 liter starting 2 hours prior to activity)
Every 15-20 minutes during activity
If Child = 5oz
If Adolescent = 9oz
Rest
More frequently during hot and humid days
Schedule adjustment
Equipment removal
Prevention Strategies
Education
Hydration
Prior to activity (1/2 liter starting 2 hours prior to activity)
Every 15-20 minutes during activity
If Child = 5oz
If Adolescent = 9oz
Rest
More frequently during hot and humid days
Schedule adjustment
Equipment removal
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
Hydration
Sports Beverages Recommended
Carbohydrate (glucose and sucrose)
Sodium
Potassium
Hydration
Sports Beverages Recommended
Carbohydrate (glucose and sucrose)
Sodium
Potassium
Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury
WARNING!!!WARNING!!!
Heat IllnessHeat IllnessHeat IllnessHeat Illness
Heat illness may be hard to detect
Fluids before / during / after
EMS activation
Treatment on scene
Prevention is key
Heat illness may be hard to detect
Fluids before / during / after
EMS activation
Treatment on scene
Prevention is key
Supplement IllnessSupplement IllnessSupplement IllnessSupplement Illness
Caffeine
Steroids
GNC
Amphetamines
Red Bull
Caffeine
Steroids
GNC
Amphetamines
Red Bull
Caffeine ContentStandard 4 ounce cup = 50 mg caffeine
8 oz Red Bull
16 oz Rockstar
16 oz Arizona
8 oz Cocaine Energy Drink
2 oz Extreme Energy
OR
Lightning InjuryLightning InjuryLightning InjuryLightning Injury
Florida ranks as # 1 in the US for lightning related injury and death
One out of every 9 lightning strikes end in a fatality
Common misconceptions
Florida ranks as # 1 in the US for lightning related injury and death
One out of every 9 lightning strikes end in a fatality
Common misconceptions
Lightning IllnessLightning IllnessLightning IllnessLightning Illness
Lightning strikes up to 25 miles away
Be Proactive!
Plan Ahead
Monitor the weather
Postpone the activity
Get to a safe place
Lightning strikes up to 25 miles away
Be Proactive!
Plan Ahead
Monitor the weather
Postpone the activity
Get to a safe place
LightningLightningLightningLightning
LightningLightningLightningLightning
Use the 30/30 rule…
If time between lightning and thunder is LESS than 30 seconds…get to a safe place!!!
WAIT 30 seconds after hearing last thunder before leaving safe location
Retreat to an enclosed building
Vehicle with closed window adequate
OK to touch victim
AVOID…
Dugout
Picnic pavilion
Rain shelter
Use the 30/30 rule…
If time between lightning and thunder is LESS than 30 seconds…get to a safe place!!!
WAIT 30 seconds after hearing last thunder before leaving safe location
Retreat to an enclosed building
Vehicle with closed window adequate
OK to touch victim
AVOID…
Dugout
Picnic pavilion
Rain shelter
LightningLightningLightningLightning
Move victim ONLY if necessary, with particular attention to any possible brain or spinal cord injury
Examine for burns, broken bones, cuts, loss of hearing or eyesight
Emergency Plan Activation
Activate your plan
Notify EMS
AED if available
Log roll
Initiate effective CPR
Move victim ONLY if necessary, with particular attention to any possible brain or spinal cord injury
Examine for burns, broken bones, cuts, loss of hearing or eyesight
Emergency Plan Activation
Activate your plan
Notify EMS
AED if available
Log roll
Initiate effective CPR
Some Emergencies on the field Obviously need 911
Dislocations
Open Fractures
Gross Deformities
LOC
3333
Injury PreventionInjury Prevention
3.5 million injuries each 3.5 million injuries each yearyear– Most common are Most common are
strains and sprainsstrains and sprains
PreventionPrevention– Dynamic warm upDynamic warm up
– Static stretchingStatic stretching
– Proper biomechanical Proper biomechanical trainingtraining
3344
StretchingStretching
Stretching:Stretching: the act of performing a particular the act of performing a particular exercise to improve joint range of motion. exercise to improve joint range of motion. European European College of Sports Sciences 2006.College of Sports Sciences 2006.
Static StretchingStatic Stretching: when a body part is taken to a : when a body part is taken to a point of mild discomfort and held for an amount of point of mild discomfort and held for an amount of time.time.
Dynamic Stretching/MovementsDynamic Stretching/Movements: movements that : movements that maximize active range of motion and elevate core maximize active range of motion and elevate core body temperature.body temperature.
• Journal of Strength and Conditioning 2005Journal of Strength and Conditioning 2005
3355
Static vs. DynamicStatic vs. Dynamic
Does static stretching prior to activity Does static stretching prior to activity achieve the goals of injury prevention and achieve the goals of injury prevention and performance enhancement?performance enhancement?
NONOResearch has shown that static stretching Research has shown that static stretching can be detrimental to performance and does can be detrimental to performance and does not lead to a decrease in injurynot lead to a decrease in injury
3366
Static vs. DynamicStatic vs. Dynamic• Study from the Journal of Strength and Conditioning, 2008Study from the Journal of Strength and Conditioning, 2008
24 Division I wrestlers were randomly assigned to 24 Division I wrestlers were randomly assigned to complete a 4 week Dynamic or Static warm up complete a 4 week Dynamic or Static warm up routine prior to their preseason practicesroutine prior to their preseason practices
11 performed the static warm up 11 performed the static warm up
13 performed the dynamic warm up13 performed the dynamic warm up
They were tested on med ball underhand throw, They were tested on med ball underhand throw, 300 yard shuttle, pull ups, push ups, sit ups, broad 300 yard shuttle, pull ups, push ups, sit ups, broad jump, 600 m run, sit to stand reach, trunk jump, 600 m run, sit to stand reach, trunk extension, quad and hamstring peak torque tests.extension, quad and hamstring peak torque tests.
3377
Static vs. DynamicStatic vs. Dynamic
• Results Dynamic GroupResults Dynamic GroupIncrease in quadriceps peak torque by 11%Increase in quadriceps peak torque by 11%
Increase in broad jump by 4%Increase in broad jump by 4%
Increase in underhand med ball throw by 4%Increase in underhand med ball throw by 4%
Increase in sit ups by 11%Increase in sit ups by 11%
Increase in push ups by 3%Increase in push ups by 3%
Static group posted no improvements to tests Static group posted no improvements to tests performed.performed.
3388
Static vs. DynamicStatic vs. Dynamic• Study from the Journal of Strength and Conditioning, 2006Study from the Journal of Strength and Conditioning, 2006
United States military academy took 30 cadets to do a United States military academy took 30 cadets to do a study on static vs. dynamic warm up routines to see study on static vs. dynamic warm up routines to see which one would better prepare their cadets for power which one would better prepare their cadets for power and agility activitiesand agility activities
Tested on the 5 step jump to determine functional leg Tested on the 5 step jump to determine functional leg powerpower
Medicine ball throw was chosen to measure total Medicine ball throw was chosen to measure total body powerbody power
T-drill was chosen to measure agilityT-drill was chosen to measure agility
3399
Static vs. DynamicStatic vs. Dynamic
For 3 days one group of cadets performed For 3 days one group of cadets performed static stretches for 10 minutes prior to data static stretches for 10 minutes prior to data collectioncollectionOther group performed dynamic stretches Other group performed dynamic stretches for 10 minutesfor 10 minutesAll routines were done at 6AM each dayAll routines were done at 6AM each dayThere was a 2 minute period between There was a 2 minute period between finishing the warm up and beginning the finishing the warm up and beginning the performance testperformance test
4400
Static vs. DynamicStatic vs. Dynamic
• ResultsResultsT –drill static warm up = 9.69 sec vs. dynamic’s T –drill static warm up = 9.69 sec vs. dynamic’s 9.56 sec9.56 sec
Medicine ball throw = 9.34 meters with static vs. Medicine ball throw = 9.34 meters with static vs. 9.79 meters with dynamic9.79 meters with dynamic
5 step jump = 9.78 meters with static vs. 10.06 5 step jump = 9.78 meters with static vs. 10.06 meters with dynamicmeters with dynamic
For task requiring power and agility, the results For task requiring power and agility, the results suggest that dynamic warm up will offer suggest that dynamic warm up will offer performance benefits not found with static warm performance benefits not found with static warm ups.ups.
4411
Times have changed!Times have changed!
Thank YouTony Milian, ATC, LATManager, [U18] Sports Center
954-538-5501amilian@mhs.netwww.u18sportsmedicine.com
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