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Care and Prevention of Activity and Sports Injuries

This is an excerpt from Adapted Physical Education and Sport 7th Edition With HKPropel Access by Joseph Winnick & David L. Porretta.

By G. Monique Mokha

Students might sustain activity or sport injuries in various settings. Although some injuries might originate in a physical education class, more occur during free time or recreational pursuits. Injuries may be caused by acute (sudden specific) or overuse (prolonged repetitive) trauma and be mild, moderate, or severe in nature.

If an injury occurs in physical education or sport, immediate care should be provided in the POLICE sequence: protection, optimal loading, ice, compression, and elevation (table 18.1). This replaces the older RICE (rest, ice, compression, elevation) model (Bleakley, 2012). The focus of these initial management techniques is to limit swelling and minimize pain.

Table 18.1 Administering POLICE Sequence

Although physical educators cannot act in the capacity of athletic trainers, they might be able to provide valuable first aid assistance. The physical educator also might recommend that the student see a medical professional if the injury is lingering or worsening. Many hospitals provide sports medicine services; these clinics or departments are staffed by sport physical therapists or athletic trainers.

If the injured student is progressing normally toward recovery, the physical education teacher, in consultation with the student’s physician, might provide activities and exercises that ameliorate the condition. Following recovery from activity or sport injury, the Brockport Physical Fitness Test (BPFT) (Winnick and Short, 2014) may be used to assess aerobic functioning, body composition, and musculoskeletal functioning.

Prevention

Physical educators and coaches can help prevent activity- and sports-related injuries in students with and without disabilities. Management tactics such as defining perimeters with cones or tape and getting students accustomed to starting an activity session with a dynamic warm-up aid in preventing acute injuries (Merrie et al., 2016). Physical educators and coaches should be certified in cardiopulmonary resuscitation and first aid, know how to use an automated external defibrillator (AED), and have an emergency action plan (EAP) for their facilities. An EAP is a blueprint for handling emergencies that identifies specific components such as personnel involved, equipment needed to respond to the emergency, and a communication system to summon care. For more on planning for emergencies in sports and physical activity, consult the position statement from the National Athletic Trainers’ Association (Anderson et al., 2002).

The following best practices may be used in most physical education and sports settings to prevent activity injuries:

  • Ensure all facilities and equipment are safe and in good condition by routinely inspecting them.
  • Fit personal equipment (e.g., helmets, rackets, sport wheelchairs) to students using appropriate guidelines.
  • Supervise all activity.
  • Understand and teach proper skill techniques (e.g., standing and seated throwing biomechanics).
  • Monitor environmental factors (e.g., heat and humidity) and adapt physical activity accordingly.
  • Identify common risks for the specific sport, group, or activity and take appropriate action to reduce risk.

The latter of these important actions will be presented in more detail. Additionally, in a sports setting, the coach must ensure that athletes have been medically cleared to participate by a physician.

Injuries such as strains, sprains, and contusions to the lower limb are common in youth. In fact, children and adolescents have higher rates of ankle sprains than adults (Doherty et al., 2014). These sprains tend to recur and lead to chronic instability when not addressed (Donovan et al., 2020). Sprains to the knee’s anterior cruciate ligament (ACL) are concerning in youth activity and sports, especially for girls (Bonazza et al., 2019). Lower limb injuries are also common in ambulatory athletes with disabilities (Fagher and Lexell, 2014), especially track and field athletes with visual impairments (Athanasopoulos et al., 2009; Magno e Silva, Winckler, et al., 2013), amputations, and cerebral palsy (Ferrara and Peterson, 2000). Therefore, physical educators and coaches play vital roles in injury prevention.

Upper limb injuries are more common in sports and activities that include repetitive throwing motions (e.g., baseball, softball, swimming, tennis). Overuse injuries are common to the shoulder (rotator cuff impingement, tendinitis, bursitis), elbow (epicondylitis, sprains), and wrist and fingers (strains, sprains, and dislocations). Researchers found that although these overuse injuries are prevalent in adolescents and children, they often don’t reach a pain threshold that causes them to seek medical attention (Fuglkjær et al., 2017) and therefore may linger, making injury prevention in physical education and youth sports even more important. It is especially important to identify and correct errors in technique.

Many wheelchair athletes are particularly prone to shoulder pain. The root of this pain is likely multifactorial, with training, activities of daily living, muscle imbalances, age, posture, and strength all playing a role. The nature of wheelchair propulsion combined with sport maneuvers tend to overdevelop the anterior musculature and cause the posterior musculature to be relatively weak; therefore, coaches should stretch the anterior musculature and strengthen the posterior musculature, especially the external rotators and scapula retractors. The rowing ergometer may be beneficial for this exercise. In a small training study of quad rugby players, researchers were able to improve muscle imbalances by increasing shoulder external rotation motion and scapula retraction strength over six weeks (Wilroy and Hibberd, 2018). Coaches should address dynamic stretching and strengthening exercises for the shoulders and scapulae by incorporating them into formal strength and conditioning sessions, warm-ups, or home programs.

Research shows neuromuscular training (NMT) is effective in preventing injuries (Barber Foss et al., 2018). NMT focuses on training the nerves and muscles to react and communicate—in other words, to create “readiness” in the muscles (Risberg et al., 2001)—so there is better dynamic joint stability, muscle firing, and body control. NMT also develops proprioception (e.g., the body’s sense of motion and position in space); protocols often include proprioceptive neuromuscular facilitation (PNF) stretching (Prentice, 2017), as well as exercises such as moving the arm into functional positions without the benefit of sight. Deficits in proprioception are common after injury. For more information on PNF, consult Stopka (2008) and Surburg (1999). PNF stretching can be carried out in both physical education classes and sport settings as warm-ups to stretch any muscle group (Stopka, 2010). Most commonly, stretches include the hamstrings and gluteal muscles, calves, hip flexors, quadriceps, hip adductors, pectorals, and especially the triceps and deltoids.

NMT usually involves both open and closed kinetic chain exercises. Open kinetic chain exercises are non–weight-bearing exercises in which the distal end (foot or hand) is free to move; they generally involve motion in one joint. Seated knee extensions and dumbbell front raises are good examples of open kinetic chain exercises. Closed kinetic chain exercises are weight bearing, with the distal segment in contact with a supporting surface and several joints involved in the execution of movement. Squats and push-ups are good examples of closed kinetic chain exercises. Both open and closed kinetic chain exercises should be part of an injury prevention program (Jewiss et al., 2017). If one thinks of a basic movement, such as walking, there are both open (swing phase) and closed (stance phase) components to this motor skill.

Table 18.2 provides an NMT exercise protocol to prevent injuries that might occur from a variety of movement patterns, rather than from a single activity or sport. Many sports and physical activities have similar movement patterns that predispose students to injury (e.g., changing direction, acceleration/deceleration, jumping/landing, pushing/pulling, throwing/catching), making it easier for the physical educator to apply these injury prevention exercises. NMT could prevent acute injuries like inversion (rolling the foot inward) and eversion (rolling the foot outward) ankle sprains, anterior cruciate ligament sprains, calf muscle strains, thigh muscle strains (hamstrings, quadriceps, groin), and even upper limb fractures and dislocations resulting from falls (see figure 18.2a-f). These may be adapted given a student’s abilities.

Table 18.2 Neuromuscular Training Exercises for Injury Prevention

The reader is also invited to explore the Fédération Internationale de Football Association’s (FIFA) 11+ injury prevention program when working specifically with soccer athletes (FIFA, 2019). The FIFA 11+ is for participants age 14 and older and consists of 15 exercises divided into three components: (1) running, including change of direction, cutting, and landing; (2) strength, plyometric, and balance exercises; and (3) high-speed running, including change of direction. There is also a FIFA 11+ Kids program for soccer players younger than 14 that incorporates exercises for spatial orientation and attention, body stability and movement coordination, and learning appropriate fall techniques. Interestingly, the FIFA 11+ program has also been shown to be effective in preventing injuries in adolescent basketball players (Longo et al., 2012).

Acute injuries like growth plate (physeal) fractures are common in the elbow and wrist because they are caused by falling on an outstretched hand (FOOSH). A FOOSH mechanism may also cause elbow and shoulder dislocations (separation of the bones at a joint) as well as clavicle fractures. The NMT exercises in table 18.2 may help prevent these acute injuries by improving balance, coordination and motor control. Physical educators and coaches must recognize that previous injury, growth, activity biomechanics, early sport specialization, and sleep can all affect the student’s risk of injury (Stracciolini et al., 2017).

More Excerpts From Adapted Physical Education and Sport 7th Edition With HKPropel Access