Warm-upWarm-upWhat are some things that happen to the What are some things that happen to the

body when it is injured?body when it is injured? Is swelling a good thing?Is swelling a good thing? Is scar tissue a good thing?Is scar tissue a good thing?Do you have any scars?Do you have any scars? Is pain physiological or psychological?Is pain physiological or psychological?

TISSUE RESPONSE TO TISSUE RESPONSE TO INJURYINJURY

SPORTS MEDICINESPORTS MEDICINE

PRINCIPLES OF ATHLETIC PRINCIPLES OF ATHLETIC TRAININGTRAINING

THE INFLAMMATORY THE INFLAMMATORY RESPONSERESPONSE

ACUTE OR ACUTE OR CHRONICCHRONIC

ACUTE HAS A ACUTE HAS A SHORT ONSETSHORT ONSET

CHRONIC HAS A CHRONIC HAS A LONG ONSET AND LONG ONSET AND LONG DURATIONLONG DURATION

ACUTE INFLAMMATIONACUTE INFLAMMATION THREE PHASESTHREE PHASES ACUTE, REPAIR, AND REMODELINGACUTE, REPAIR, AND REMODELING PHASE 1: ACUTEPHASE 1: ACUTE1.1. INITIAL BODY RESPONSEINITIAL BODY RESPONSE2.2. 3 TO 4 DAYS3 TO 4 DAYS3.3. REACTION DESIGNED TO:REACTION DESIGNED TO:

a. Protecta. Protectb. Localizeb. Localizec. Rid the body of some injurious agent in c. Rid the body of some injurious agent in preparation for healing and repairpreparation for healing and repair

ACUTE INFLAMMATIONACUTE INFLAMMATION MAIN CAUSES OF INFLAMMATION ARE :MAIN CAUSES OF INFLAMMATION ARE :a)a) TRAUMATRAUMAb)b) CHEMICAL AGENTSCHEMICAL AGENTSc)c) THERMAL EXTREMESTHERMAL EXTREMESd)d) PATHOGENIC ORGANISMSPATHOGENIC ORGANISMS CELLULAR DEATH OCCURS FROM THE CELLULAR DEATH OCCURS FROM THE

TRAUMATRAUMA DEATH OF TISSUE MAY BE CAUSED BY DEATH OF TISSUE MAY BE CAUSED BY

LACK OF OXYGENLACK OF OXYGEN

ACUTE INFLAMMATIONACUTE INFLAMMATION R.I.C.ER.I.C.E PRINCIPLE SHOULD BE USED TO PRINCIPLE SHOULD BE USED TO

DETER TISSUE DEATHDETER TISSUE DEATHR.R.est- stay of injured areaest- stay of injured areaI.I.ce- apply ice immediately for 15-20 minutesce- apply ice immediately for 15-20 minutesC.C. ompression- depending on the area injured a ompression- depending on the area injured a

compression wrap should be applied (never compression wrap should be applied (never on the lower leg)on the lower leg)

E.E.levation- elevate the injured area above the levation- elevate the injured area above the heartheart

ACUTE INFLAMMATIONACUTE INFLAMMATIONVASCULAR RESPONSEVASCULAR RESPONSE

VASOCONSTRICTION:VASOCONSTRICTION: IN THE FIRST HOUR IN THE FIRST HOUR BEFORE INFLAMMATION OCCURSBEFORE INFLAMMATION OCCURS

DECREASE IN THE DIAMETER OF THE BLOOD DECREASE IN THE DIAMETER OF THE BLOOD VESSELVESSEL

COAGULATION BEGINS TO SEAL BROKEN COAGULATION BEGINS TO SEAL BROKEN VESSELS AND IS FOLLOWED BY ACTIVATION OF VESSELS AND IS FOLLOWED BY ACTIVATION OF CHEMICAL INFLUENCESCHEMICAL INFLUENCES

VASODILATION:VASODILATION: INCREASE THE DIAMETER OF THE INCREASE THE DIAMETER OF THE BLOOD VESSELBLOOD VESSEL

a)a) LEADS TO SWELLING (EDEMA)LEADS TO SWELLING (EDEMA)b)b) EXUDATES OF PLASMA AND CONCENTRATION OF EXUDATES OF PLASMA AND CONCENTRATION OF

RED BLOOD CELLSRED BLOOD CELLSc)c) THE CELL WALL BECOMES MERE PERMEABLETHE CELL WALL BECOMES MERE PERMEABLE

ACUTE INFLAMMATIONACUTE INFLAMMATIONBLEEDING AND EXUDATESBLEEDING AND EXUDATES

THE EXTENT OF FLUID THE EXTENT OF FLUID IN THE INJURED AREA IN THE INJURED AREA IS HIGHLY DEPENDENT IS HIGHLY DEPENDENT ON THE EXTENT OF ON THE EXTENT OF DAMAGED VESSELS DAMAGED VESSELS AND THE AND THE PERMEABILITY OF THE PERMEABILITY OF THE INTACT VESSELINTACT VESSEL

WARM-UPWARM-UP AN INJURY THAT JUST HAPPENED IS AN INJURY THAT JUST HAPPENED IS

CONSIDERED AN __________ INJURY?CONSIDERED AN __________ INJURY? WHAT IS EDEMA?WHAT IS EDEMA? WHAT IS ECCYMOSIS?WHAT IS ECCYMOSIS? WHAT DOES R.I.C.E. STAND FOR?WHAT DOES R.I.C.E. STAND FOR? THE INITIAL BODIES RESPONSE TO INJURY THE INITIAL BODIES RESPONSE TO INJURY

IS DESIGNED TO DO WHAT?IS DESIGNED TO DO WHAT? WHAT IS VASODIALATION?WHAT IS VASODIALATION? IT HAS BEEN DETERMINED THAT THE IT HAS BEEN DETERMINED THAT THE

IMMEDIATE APPLICATION OF ICE REDUCES IMMEDIATE APPLICATION OF ICE REDUCES THE HEALING TIME BY?THE HEALING TIME BY?

PHASE II: REPAIR PHASEPHASE II: REPAIR PHASE(HEALING)(HEALING)

FOLLOWS INFLAMMATORY PHASEFOLLOWS INFLAMMATORY PHASE 48-72 HOURS TO APPROXIMATELY 6 48-72 HOURS TO APPROXIMATELY 6

WEEKSWEEKS THIS PHASE OCCURS WHEN THE AREA HAS THIS PHASE OCCURS WHEN THE AREA HAS

BECOME CLEAN THROUGH THE REMOVAL BECOME CLEAN THROUGH THE REMOVAL OF CELLULAR DEBRIS, ERYTHROCYTES OF CELLULAR DEBRIS, ERYTHROCYTES AND THE CLOTAND THE CLOT

THIS PHASE DEPENDS ON HOW WELL WE THIS PHASE DEPENDS ON HOW WELL WE TREAT THE PATIENT DURING THE ACUTE TREAT THE PATIENT DURING THE ACUTE PHASE!PHASE!

TYPES OF HEALINGTYPES OF HEALING TISSUE REPAIR IS ACCOMPLISHED TISSUE REPAIR IS ACCOMPLISHED

THROUGH THREE PROCESSESTHROUGH THREE PROCESSES1.1. RESOLUTION:RESOLUTION: THERE IS LITTLE THERE IS LITTLE

TISSUE DAMAGE AND NORMAL TISSUE DAMAGE AND NORMAL RESTORATIONRESTORATION

2.2. GRANULAR TISSUE:GRANULAR TISSUE: OCCURS IF OCCURS IF RESOLUTION IS DELAYEDRESOLUTION IS DELAYED

3.3. REGENERATION:REGENERATION: REPLACEMENT OF REPLACEMENT OF TISSUE BY THE SAME TISSUETISSUE BY THE SAME TISSUE

HEALING cont.HEALING cont. GRANULATION TISSUE IS GRANULATION TISSUE IS

SCAR TISSUESCAR TISSUE THE PROXIMITY OF THE THE PROXIMITY OF THE

INJURY DETERMINES THE INJURY DETERMINES THE AMOUNT OF SCAR AMOUNT OF SCAR TISSUETISSUE

GRANULATION HEALING GRANULATION HEALING HAS 2 TYPES:HAS 2 TYPES:

1.1. PRIMARY HEALING: LOW PRIMARY HEALING: LOW SCAR TISSUESCAR TISSUE

2.2. SECONDARY HEALING: SECONDARY HEALING: GAP IN INJURYGAP IN INJURY

PHASE III: REMODELINGPHASE III: REMODELING(REHABILITATION)(REHABILITATION)

OVERLAPS THAT OF REPAIROVERLAPS THAT OF REPAIR FIRST 3 TO 6 WEEKS ARE CHARACTERIZED FIRST 3 TO 6 WEEKS ARE CHARACTERIZED

BY INCREASE PRODUCTION OF SCAR BY INCREASE PRODUCTION OF SCAR TISSUE AND INCREASED STRENGTH OF TISSUE AND INCREASED STRENGTH OF THEIR FIBERSTHEIR FIBERS

STRENGTH OF SCAR TISSUE CONTINUES STRENGTH OF SCAR TISSUE CONTINUES TO INCREASE FROM THREE MONTHS TO TO INCREASE FROM THREE MONTHS TO YEARSYEARS

THE SCAR TISSUE IS ONLY AS STRONG AS THE SCAR TISSUE IS ONLY AS STRONG AS THE DEMANDS THAT YOU PLACE ON ITTHE DEMANDS THAT YOU PLACE ON IT

CHRONIC INFLAMMATIONCHRONIC INFLAMMATION SWELLING THAT SWELLING THAT

LAST FOR MONTHS LAST FOR MONTHS TO YEARSTO YEARS

RESULT OF RESULT OF REPEATED MICRO REPEATED MICRO TRAUMA AND TRAUMA AND OVERUSEOVERUSE

SOFT TISSUE HEALINGSOFT TISSUE HEALING ALL TISSUES OF THE BODY EXCEPT FOR ALL TISSUES OF THE BODY EXCEPT FOR

BONEBONE THE BODY AS 4 TYPES OF SOFT TISSUE:THE BODY AS 4 TYPES OF SOFT TISSUE:1.1. EPITHELIAL TISSUE:EPITHELIAL TISSUE: SKIN SKIN2.2. CONNECTIVE TISSUE:CONNECTIVE TISSUE: TENDONS, TENDONS,

LIGAMENTS, CARTILAGE, FAT, BLOOD LIGAMENTS, CARTILAGE, FAT, BLOOD VESSELSVESSELS

3.3. MUSCLESMUSCLES4.4. NERVOUS TISSUE:NERVOUS TISSUE: BRAIN, SPINAL CORD, BRAIN, SPINAL CORD,

& NERVES& NERVES

CARTILAGE HEALINGCARTILAGE HEALING ARTICULAR ARTICULAR

CARTILAGE HAS CARTILAGE HAS LIMITED CAPACITY TO LIMITED CAPACITY TO HEALHEAL

CARTILAGE HAS CARTILAGE HAS LITTLE TO NO DIRECT LITTLE TO NO DIRECT BLOOD SUPPLYBLOOD SUPPLY

THE CLOSER THE THE CLOSER THE CARTILAGE IS TO A CARTILAGE IS TO A BLOOD SUPPLY THE BLOOD SUPPLY THE MORE LIKELY IT WILL MORE LIKELY IT WILL HEAL (BUT IT WILL HEAL (BUT IT WILL TAKE TIME)TAKE TIME)

LIGAMENT & MUSCLE HEALINGLIGAMENT & MUSCLE HEALING

UNDERGOES THE THREE PHASES OF UNDERGOES THE THREE PHASES OF ACUTE, REPAIR AND REMODELINGACUTE, REPAIR AND REMODELING

FULL LIGAMENT HEALING WITH SCAR FULL LIGAMENT HEALING WITH SCAR MATURATION MAY TAKE AS LONG AS MATURATION MAY TAKE AS LONG AS TWELVE MONTHSTWELVE MONTHS

MUSCLE MUST HAVE REHABILITATION MUSCLE MUST HAVE REHABILITATION STRENGTHENING EXERCISES IN A STRENGTHENING EXERCISES IN A PROGRESSIVE MANNER TO HEAL PROGRESSIVE MANNER TO HEAL COMPLETELYCOMPLETELY

NERVE HEALINGNERVE HEALING NERVE CELLS DO NERVE CELLS DO

NOT REGENERATENOT REGENERATE REGENERATION CAN REGENERATION CAN

TAKE PLACE WITHIN A TAKE PLACE WITHIN A NERVE FIBERNERVE FIBER

THE CLOSER THE THE CLOSER THE INJURY IS TO THE INJURY IS TO THE NERVE CELL THE NERVE CELL THE MORE DIFFICULT MORE DIFFICULT REGENERATION REGENERATION BECOMESBECOMES

MODIFYING SOFT-TISSUE MODIFYING SOFT-TISSUE HEALINGHEALING

HEALING PROCESS IS UNIQUE IN EACH ATHLETE. HEALING PROCESS IS UNIQUE IN EACH ATHLETE. DIFFERENT TISSUE VARY IN THEIR ABILITY TO DIFFERENT TISSUE VARY IN THEIR ABILITY TO

HEAL (CARTILAGE)HEAL (CARTILAGE) AGE AND NUTRITION MAY ALSO AFFECT HEALINGAGE AND NUTRITION MAY ALSO AFFECT HEALING MANAGEMENT CONCEPTS:MANAGEMENT CONCEPTS:1.1. ANTI-INFLAMMATORY DRUGS- DECREASE ANTI-INFLAMMATORY DRUGS- DECREASE

VASODILATIONVASODILATION2.2. THERAPEUTIC MODALITIES: COLD, HEAT, THERAPEUTIC MODALITIES: COLD, HEAT,

ULTRASOUND, ELECTRIC STIMULTRASOUND, ELECTRIC STIM3.3. THERAPEUTIC EXERCISE: STRENGTH AND RANGE THERAPEUTIC EXERCISE: STRENGTH AND RANGE

OF MOTION ARE THE KEYOF MOTION ARE THE KEYa. IMMOBILIZATION IS NOT ALWAYS GOOD FOR a. IMMOBILIZATION IS NOT ALWAYS GOOD FOR INJURIESINJURIES

FRACTURE HEALINGFRACTURE HEALING FX HEALING TAKES FX HEALING TAKES

TIME, COACHES, TIME, COACHES, TRAINER, & TRAINER, & ATHLETES MUST BE ATHLETES MUST BE PATIENTPATIENT

FX HEALING FX HEALING FOLLOWS THE SAME FOLLOWS THE SAME THREE PHASES OF THREE PHASES OF HEALING BUT IS HEALING BUT IS MORE COMPLEXMORE COMPLEX

ACUTE PHASE:ACUTE PHASE: TRAUMATRAUMA HEMORRHAGEHEMORRHAGE BONE DEATHBONE DEATH REPAIR PHASE:REPAIR PHASE: GRANULATIONGRANULATION WOVEN BONEWOVEN BONE CALLUS FORMATIONCALLUS FORMATION REMODELING PHASE:REMODELING PHASE: RESORPTION OF RESORPTION OF

CALLUSCALLUS TRABECULAR BONETRABECULAR BONE BONEBONE

ACUTE FX HEALINGACUTE FX HEALING IN GENERAL ACUTE FX IN GENERAL ACUTE FX

HEALING HAS 5 HEALING HAS 5 STAGESSTAGES

1.1. HEMATOMA HEMATOMA FORMATIONFORMATION

2.2. CELLULAR CELLULAR PROLIFERATIONPROLIFERATION

3.3. CALLUS FORMATIONCALLUS FORMATION4.4. OSSIFICATIONOSSIFICATION5.5. REMODELINGREMODELING

HEMATOMA HEMATOMA FORMATION:FORMATION:

ACUTE INFLAMMATION ACUTE INFLAMMATION USUALLY LAST ABOUT USUALLY LAST ABOUT 4 DAYS4 DAYS

HEMATOMA FORMS HEMATOMA FORMS AROUND THE ENDS OF AROUND THE ENDS OF THE BONE AND A THE BONE AND A CLOT FORMSCLOT FORMS

FX HEALINGFX HEALING CELLULAR FORMATIONCELLULAR FORMATION1.1. HEMATOMA BEGINS ORGANIZATION OF HEMATOMA BEGINS ORGANIZATION OF

GRANULAR TISSUE AND GRADUALLY GRANULAR TISSUE AND GRADUALLY BUILDS A FIBROUS JUNCTION BETWEEN BUILDS A FIBROUS JUNCTION BETWEEN THE FRACTURED ENDSTHE FRACTURED ENDS

2.2. THESE CELLS INITIALLY PRODUCE A THESE CELLS INITIALLY PRODUCE A FIBROUS CALLUS, THEN CARTILAGE, FIBROUS CALLUS, THEN CARTILAGE, AND FINALLY WOVEN BONEAND FINALLY WOVEN BONE

FX HEALINGFX HEALING CALLUS FORMATIONCALLUS FORMATION SOFT CALLUS: FORMED WITHIN 1-2 WEEKS SOFT CALLUS: FORMED WITHIN 1-2 WEEKS UNORGANIZED NETWORK OF WOVEN BONE UNORGANIZED NETWORK OF WOVEN BONE

AT THE ENDS OF THE FRACTUREAT THE ENDS OF THE FRACTURE LATER ABSORBED AND REPLACED BY BONELATER ABSORBED AND REPLACED BY BONE SOFT CALLUS STAGE THE INTERNAL AND SOFT CALLUS STAGE THE INTERNAL AND

EXTERNAL CALLUS ARE PRODUCEDEXTERNAL CALLUS ARE PRODUCED THESE CALLUS START TO IMMOBILIZE THE THESE CALLUS START TO IMMOBILIZE THE

FXFX

FX HEALINGFX HEALING HARD CALLUSHARD CALLUS1.1. IN 3-4 WEEKS THE HARD CALLUS STARTS IN 3-4 WEEKS THE HARD CALLUS STARTS

TO FORM INTERNALLY FIRST FOLLOWED TO FORM INTERNALLY FIRST FOLLOWED BY THE EXTERNAL CALLUSBY THE EXTERNAL CALLUS

2.2. THE HARD CALLUS CONTINUES TO GROW THE HARD CALLUS CONTINUES TO GROW UP TO 3-4 MONTHSUP TO 3-4 MONTHS

3.3. THE HARD CALLUS IS A GRADUAL THE HARD CALLUS IS A GRADUAL CONNECTION OF BONE FILAMENT TO THE CONNECTION OF BONE FILAMENT TO THE WOVEN BONE AT THE FRACTURE ENDSWOVEN BONE AT THE FRACTURE ENDS

FX HEALINGFX HEALING OSSIFICATION:OSSIFICATION:1.1. OCCURS WHEN THE BONE HAS BEEN OCCURS WHEN THE BONE HAS BEEN

PROPERLY IMMOBILIZED AND THE BONE PROPERLY IMMOBILIZED AND THE BONE ENDS BECOME CROSSED WITH THE ENDS BECOME CROSSED WITH THE LAYING DOWN OF PRIMARY BONELAYING DOWN OF PRIMARY BONE

2.2. THE CALLUSES ARE ABSORBED BY THE THE CALLUSES ARE ABSORBED BY THE OSTEOCYTES (BONE CELLS)OSTEOCYTES (BONE CELLS)

3.3. THE FRACTURE HAS BEEN BRIDGED AND THE FRACTURE HAS BEEN BRIDGED AND FIRMLY UNITEDFIRMLY UNITED

FX HEALINGFX HEALING REMODELINGREMODELING1.1. OCCURS AFTER THE CALLUS HAS BEEN OCCURS AFTER THE CALLUS HAS BEEN

ABSORBED AND THE NEW BONE HAS ABSORBED AND THE NEW BONE HAS BEEN LAID DOWNBEEN LAID DOWN

2.2. THIS CAN LAST UP TO YEARSTHIS CAN LAST UP TO YEARS3.3. THE REMODELING PHASE IS CONSIDERED THE REMODELING PHASE IS CONSIDERED

COMPLETE WHEN THE FX HAS BEEN COMPLETE WHEN THE FX HAS BEEN RESTORED TO ITS FORMER SHAPE OR RESTORED TO ITS FORMER SHAPE OR HAS DEVELOPED A SHAPED THAT CAN HAS DEVELOPED A SHAPED THAT CAN WITHSTAND IMPOSED STRESSESWITHSTAND IMPOSED STRESSES

MANAGEMENT OF ACUTE FXMANAGEMENT OF ACUTE FX BONES MUST BE IMMOBILIZED UNTIL X-BONES MUST BE IMMOBILIZED UNTIL X-

RAYS REVEAL THE HARD CALLUS HAS RAYS REVEAL THE HARD CALLUS HAS FORMEDFORMED

SOME DOCTORS ALLOW THE ATHLETE TO SOME DOCTORS ALLOW THE ATHLETE TO RETURN TO ACTIVITY AT THIS STAGE AS RETURN TO ACTIVITY AT THIS STAGE AS LONG AS THE FX IS NON-WEIGHT LONG AS THE FX IS NON-WEIGHT BEARING AND IMMOBILIZEDBEARING AND IMMOBILIZED

ITEMS THAT MAY AFFECT THE HEALING ITEMS THAT MAY AFFECT THE HEALING PROCESSPROCESS

1.1. POOR BLOOD SUPPLYPOOR BLOOD SUPPLY2.2. POOR IMMOBILIZATIONPOOR IMMOBILIZATION3.3. INFECTIONINFECTION

PAINPAIN

PAINPAINMAJOR INDICATOR OF INJURY!MAJOR INDICATOR OF INJURY!PAIN RECEPTORS PAIN RECEPTORS (NOCICEPTION)(NOCICEPTION)TYPE C FIBERS TYPE C FIBERS (SLOW)(SLOW)TYPE A FIBERS TYPE A FIBERS (FAST)(FAST)TYPE C RATE OF .5 TO 2 METERS PER TYPE C RATE OF .5 TO 2 METERS PER

SECONDSECONDTYPE A RATE OF 5 TO 30 METERS PER TYPE A RATE OF 5 TO 30 METERS PER

SECONDSECOND

PAINPAIN TYPE CTYPE C ARE THE SLOW ARE THE SLOW

TRAINS TO THE BRAIN TRAINS TO THE BRAIN AND CARRY THE DULL AND CARRY THE DULL ACHING TYPE PAINACHING TYPE PAIN

TYPE ATYPE A ARE THE FAST ARE THE FAST TRAINS TO THE BRAIN TRAINS TO THE BRAIN AND CARRY THE AND CARRY THE SHARP STABBING SHARP STABBING TYPE PAINTYPE PAIN

BOTH THESE TRAINS BOTH THESE TRAINS TELL THE BODY TO TELL THE BODY TO RELEASE ITS OWN RELEASE ITS OWN PAIN KILLERSPAIN KILLERS

PAIN CATEGORIESPAIN CATEGORIES ACUTE VERSUS CHRONIC:ACUTE VERSUS CHRONIC:a)a) ACUTE PAIN IS PAIN THAT IS LESS ACUTE PAIN IS PAIN THAT IS LESS

THAN SIX MONTHS IN DURATIONTHAN SIX MONTHS IN DURATIONb)b) ACUTE PAIN IS WHEN TISSUE ACUTE PAIN IS WHEN TISSUE

DAMAGE OCCURS AND SERVES AS A DAMAGE OCCURS AND SERVES AS A WARNING!WARNING!

c)c) CHRONIC PAIN HAS A DURATION CHRONIC PAIN HAS A DURATION LONGER THAN SIX MONTHSLONGER THAN SIX MONTHS

PAIN CATEGORIESPAIN CATEGORIES REFERRED PAIN:REFERRED PAIN: OCCURS AWAY FROM OCCURS AWAY FROM

THE INJURY SITETHE INJURY SITE 3 TYPES OF REFERRED PAIN3 TYPES OF REFERRED PAIN1.1. MYOFASCIAL PAIN:MYOFASCIAL PAIN: TRIGGER POINTS TRIGGER POINTS2.2. SLCEROTOMIC & SLCEROTOMIC & 3.3. DERMATOMIC: DERMATOMIC: BONE, BONE,

MUSCLE, FASCIA, OR SKIN AREAS MUSCLE, FASCIA, OR SKIN AREAS SUPPLIED BY A SINGLE NERVE ROOTSUPPLIED BY A SINGLE NERVE ROOT

THESE TYPES OF PAIN CAN CAUSE THESE TYPES OF PAIN CAN CAUSE DEPRESSION, ANXIETY, FEAR & ANGERDEPRESSION, ANXIETY, FEAR & ANGER

VARIATIONS IN PAIN VARIATIONS IN PAIN SENSITIVITYSENSITIVITY

PAIN MODULATION:PAIN MODULATION: PAIN PAIN IS A MIXTURE OF BOTH IS A MIXTURE OF BOTH PHYSIOLOGICAL AND PHYSIOLOGICAL AND PSYCHOLOGICAL PSYCHOLOGICAL

MANAGEMENT CAN BE A MANAGEMENT CAN BE A MAJOR CHALLENGEMAJOR CHALLENGE

PAIN ASSESSMENT:PAIN ASSESSMENT: VERY DIFFICULTVERY DIFFICULT

1.1. USE A SCALE OF 1 TO 10USE A SCALE OF 1 TO 102.2. USE WORDS LIKE: NONE, USE WORDS LIKE: NONE,

SLIGHT, MILD, SLIGHT, MILD, MODERATE, SEVEREMODERATE, SEVERE

TX OF PAINTX OF PAIN KEY IS TO STOPKEY IS TO STOP PAIN- PAIN-

SPASM-PAIN CYCLE!SPASM-PAIN CYCLE! HEAT AND COLDHEAT AND COLD ANALGESIAANALGESIA PAIN GATE THEORYPAIN GATE THEORY(HEAT, ICE, TENS, (HEAT, ICE, TENS,

ACUPUNCTURE, ACUPUNCTURE, COUNTERIRRITANT, COUNTERIRRITANT, ELECTRIC STIM)ELECTRIC STIM)

SPASM

SPASM PAIN

PAIN

INJURED ATHLETE

PSYCHOLOGICAL ASPECT OF PSYCHOLOGICAL ASPECT OF PAINPAIN

TOUGHEST PART OF TOUGHEST PART OF MY JOBMY JOB

PLAY WITH PAIN AND PLAY WITH PAIN AND NOT INJURY???NOT INJURY???

CRY WOLF SYNDROMECRY WOLF SYNDROME EASIER TO DETERMINE EASIER TO DETERMINE

WITH THE “TOUGH” WITH THE “TOUGH” ATHLETES?ATHLETES?