Injury Info

What is a Concussion?

A concussion is a brain injury that results in a temporary disruption of neurological function. Any blow to the head, face, or body that jolts the brain can result in a concussion, which can be dangerous if not handled properly. ONE DOES NOT NEED TO LOSE CONSCIOUSNESS TO SUFFER A CONCUSSION (in fact, less than 10% of sport-related concussions actually involved LOC). Because the brain floats freely within the cerebrospinal fluid, it moves at a rate that cannot be stopped by protective barriers, such as a helmet or a protective headband. The result is that the brain may “bounce” or “twist” inside of the skull (think of an egg yolk moving around a shaken eggshell). While helmets may lessen the blow, they are intended to prevent skull fractures and have not been proven to decrease concussive forces.

Signs and Symptoms (It only takes 1 sign/symptom to suspect a potential concussion)

• Symptoms:
  • Headache
  • Nausea
  • Fatigue
  • Balance Problems
  • Sleep Disturbances
  • Dizziness
  • Visual Disturbances
  • Feeling Sluggish
  • Difficulty Concentrating
  • Difficulty Remembering
  • Fogginess
  • Confusion
  • Light Sensitivity
  • Noise Sensitivity
  • Pressure in Head
  • Ringing in Ears
• Signs
  • Appears Dazed
  • Confusion
  • Forgets plays.
  • Unsure of game situations (score, opponent, etc.)
  • Clumsy Movements
  • Slow Answers
  • Loss of Consciousness
  • Behavioral Changes
  • Amnesia
  • Vomiting

Where can I get more information?

• General Info- CDC Heads Up Website
• A Nurse's Guide to Sports Concussions 
• National Athletic Trainers Association Position Statement: Management of Sport Concussion (nata.org)
• NATA Concussion Explainer (youtube.com)

General Information

Ankle sprains are one of the most common injuries seen in sports. They are injuries to the ligaments that stabilize the ankle joint. Most of the time sprains occur by 'rolling' or 'twisting' the ankle while running or jumping. Ankle Sprains can be categorized into three main categories.

• Lateral Ankle Sprain- Most Common- Involves 'rolling' ankle inwards resulting in damage to the lateral (outside) ligaments.
• Medial Ankle Sprain- Less Common- Involves 'rolling' ankle outwards resulting in damage to the medial (inside) ligaments.
• High Ankle Sprain- Involves 'twisting' the ankle outwards while it is being forced into dorsiflexion (upwards) damaging the syndesmosis joint which stabilizes the two shin bones (fibula & tibia). High Ankle Sprains traditionally take longer to heal than lateral or medial ankle sprains.

Initial Care

Follow up with the CRHS - South athletic trainer as soon as possible to start a treatment plan which generally consists of:

• Protection- You may be given an air cast, Cam walker (walking boot), brace, or crutches to protect the injury while walking around in an uncontrolled environment.
• Rest- Avoid painful and strenuous activities.
• Ice- Apply for 15-20 minutes every 1.5-2 hours as needed.
• Compression- Wear an elastic bandage (ACE wrap) snuggly (not overly tight) from distal (closest to toes) to proximal (closest to hip). You may also be given a horseshoe pad to wear under the wrap to assist with reducing swelling.
• Elevation- Elevate the injured ankle above the heart whenever possible.
• Mobilization- As long as a fracture is not suspected, light ankle ROM initially can help to increase blood flow and decrease swelling. Acute rehab exercises are found under the Rehab Programs Tab.

Prevention

Repeated ankle sprains can lead to CAI (chronic ankle instability) in which the ankle repeatedly rolls and feels unstable. As a result, prevention of ankle sprains is very important. Prevention Options include:

• Ankle Specific Exercise Programs focusing on balance, ankle strengthening, calf flexibility, hip stabilization, and intrinsic foot musculature development.
• Preventative/Prophylactic Bracing

Types of Injuries:

Shin Pain can be broken down into three major categories:

1. Shin Splints (Medial Tibial Stress Syndrome)
   • MTSS is a general term used to define overuse lower leg pains. It commonly presents as diffuse tenderness over the medial (inner) aspect of your tibia (shin bone). This pain is common during activity and as it worsens may hurt after activity.
2. Stress Reactions/Stress Fractures
   • Untreated shin pain may develop into a stress reaction or fracture, which is defined as a small crack (fracture) in the bone. The pain is often focalized to a specific location and the stress fx may not be present on x-ray.
3. Chronic Compartment Syndromes
   • The muscles of your lower leg are grouped together in bundles called compartments. Compartment syndrome is defined as an increased pressure within one or more compartments. This pressure often results in pain during activity that decreases after you stop. Chronic compartment syndrome is caused by overuse and can be treated with a conservative approach. However, compartment syndrome can also happen acutely after a significant blow to the lower leg, in which case it is a medical emergency.

Treatment Options

• Decrease in Mileage/Crosstrain on Stationary Bike
• Ice Massage/Ice Immersion
• Lower Leg Stretching
• Lower Leg Strengthening
• Finding a Proper Fitting Shoe/Orthotic
• Correcting Foot Abnormalities (i.e high or low arch)
• Gait Analysis and Form Correction
• Nutritional Counseling (for repeated stress fxs)

Prevention

• Listen to your coaches and athletic trainers on proper running progression.
• Progress your training slowly and take necessary time off
• Wear proper footwear for your specific foot. Replace shoes as needed (about every 300 miles)
• Be aware of changing running surfaces/intensities when transitioning between sports.

Skin Infections common in athletes can be broken down into 3 major categories:

1. Bacterial Infections
   • Impetigo
   • MRSA
   • Folliculitis
   • "Staph Infections"
2. Fungal Infections
   • Ringworm (Tinea)
   • Athlete's Foot
   • Jock Itch
3. Viral Infections
   • Herpes Gladitorium (Mat Herpes)
   • Herpes Zoster (Shingles)
   • Herpes Simplex 1 & 2
   • Molluscum Contagiousum

If you notice a skin infection, please consult with an athletic trainer immediately to avoid spreading the infection to your teammates. If you do not have access to an athletic trainer (i.e. weekends) please see a physician or go to urgent care as soon as possible. The quicker you start proper treatment, the quicker the lesion will resolve (and not spread to other body parts), and the quicker you can return to your sport.

*Please note that skin infections must follow the NFHS guidelines which can be found on the NFHS Skin Lesion Form. If returning to wrestling, this form must be completed by the physician or other appropriate health care provider.

SKIN LESION FORM FOR DOCTOR:

• NFHS Skin Lesion Form

A tendon is a structure that serves as an anchor point when attaching a muscle to an adjacent bone. Tendon injuries are typically broken down into two types of injuries, tendinitis where there is an inflammation of the tendon and tendinopathy where there is a breakdown of the tendon. Both are treated about the same way and are commonly (but incorrectly) used interchangeably. Common sites of tendon injuries include the Quadriceps Tendon, Patellar Tendon, Achilles Tendon, and Biceps Tendon. In skeletally immaturely individuals, growth plate and avulsion fracture injuries are often confused for tendon, ligament, or muscle injuries, so it is important to get them evaluated by an athletic trainer or other professional.

A muscle strain is a mild tearing/stretching of a muscle. They can occur in all muscles but they seem to be most common in the hamstrings, hip flexors, quads, and abdominal muscles. Initial treatment should consist of limiting movement and treating for pain with rest and ice. As the pain decreases and strength begins to return, rehabilitation consists of light stretching and strengthening as directed by a health care provider. You may be able to crosstrain or return to limited activity relatively soon but muscle strains tend to linger or worsen when returned to full activity before fully healed. In skeletally immaturely individuals, growth plate and avulsion fracture injuries are often confused for tendon, ligament, or muscle injuries, so it is important to get them evaluated by an athletic trainer or other professional.

A ligament is a structure that links two bones together. Sprains often happen when a ligament is 'stretched' beyond its capability. Common ligaments that are sprained include the ATF- anterior talofibular (ankle), Deltoid (ankle), MCL- medial collateral ligament (knee), ACL- anterior cruciate ligament (knee), AC- acromioclavicular (shoulder), UCL- ulnar collateral ligament (elbow). A severe sprain is considered a rupture (i.e. a Grade 3 ACL Sprain is the same as a torn ACL). In skeletally immaturely individuals, growth plate and avulsion fracture injuries are often confused for tendon, ligament, or muscle injuries, so it is important to get them evaluated by an athletic trainer or other professional.

A Salter Harris Fracture is a fracture of the growth plate of the bone. This type of fracture is usually seen in younger people who are still growing and is one of the most common injuries seen. For more information: http://http://www.sports-injury-info.com/salter-harris-fracture.html

“Apophysitis” is the medical term used to indicate inflammation and stress injury where a muscle and its tendon attaches to the area on a bone where growth occurs in a child or adolescent, an area called the “growth plate.” Apophysitis is commonly seen in active, growing children and adolescents. It can occur in many different body parts, depending on the specific repetitive activities the young athlete is commonly doing. See this website for more information: http://www.sportsmedtoday.com/apophysitis-va-117.htm