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Intro to Athletic
| Question | Answer |
|---|---|
| Shortening or lengthening the muscle through its complete range of motion | Isotonic contraction |
| Allows athlete to overcome a given resistance | Muscle strength |
| Ability to sustain muscle contraction at a sub maximal effort over time | Muscle endurance |
| Wasting away of a tissue | Atrophy |
| Motion occurring between two articulating surfaces of a joint throughout a physiologic range | Arthrokinematics |
| Contraction with no change in length of muscle or the angle of the joint | Isometric contraction |
| Exercises are concerned with restoring normal body function after injury | Therapeutic exercise |
| Contraction of muscle against an accommodating resistance throughout the range of motion | Isokinetic contraction |
| A manual therapy technique that can be used for strengthening muscle or increasing range of motion | Proprioceptive neuromuscular facilitation |
| Mind's attempt to teach the body conscious control of a specific movement | Neuromuscular control |
| What are two types of kinetic chain activities and their definitions? | Open and Closed |
| Open | Foot or hand is off the ground |
| closed | foot or hand is on the ground |
| How can we retard the loss of articular cartilage and degeneration of the joint after immobilization? | Continuous passive motion |
| Reasons to use isokinetics in a rehab program? | Accommodating resistance |
| Why should exercise begin 24 hours after surgery? | Prevent atrophy |
| In establishing a conditioning program emphasis should be put on: | 1. Coordination of the entire body 2. Endurance 3. Flexibility 4. Strengthening |
| rehab begin....after injury | immediately |
| Initial care is | crucial |
| One of an ATC’s primary responsibilities is | to design, implement, supervise rehab plans |
| Easy part is designing the program based on | short and long term goals |
| Difficult part is knowing | when and how to progress athlete |
| Progress should be based on | specific criteria |
| Return to play must be based on | functional outcomes |
| Optimal healing environment | is key |
| Rehab must be Must return to competition | aggressive quickly and safely |
| Rehab should be based on framework | of healing process |
| Understand time and sequence | of healing and physiological principals |
| No | cookbook approach |
| Systematic approach for less experienced clinicians | RAMP |
| R | Rehabilitation goals |
| A | management of the Acute responses to injury |
| M | restoration of Mobility |
| P | successful completion of Performance goals |
| When Injury Occurs | -Loss of physical fitness due to loss of activity -Specific immobilization of injured body part |
| Effects of General Inactivity | -Highly conditioned athlete will experience rapid generalized loss of fitness -Loss of muscle strength, endurance and coordination -Athlete must continue to work entire body w/out aggravating the injury |
| Immobilization causes a number of disuse problems that impact | muscle, joints, ligaments, bones, neuromuscular efficiency and cardiorespiratory system |
| Components of a Rehab Program | 1.Minimize initial swelling 2.Controlling pain 3.Restoring range of motion |
| Rehab Program Cont. | 4.Restoring Muscular endurance, strength & power 5.Isometric, Progressive resistive (concentric/eccentric), Isokinetic 6.Reestablish Neuromuscular control, Proprioception, Kinesthesia |
| Rehab Program Cont. | 7.Regaining postural stability & balance 8.Maintaining Cardiorespiratory fitness 9.Incorporate functional progression |
| the ability to determine the position of a joint in space. | Proprioception |
| shortens and lengthens the muscle through complete ROM | Isotonic |
| Contracts the muscle statically w/o changing length | Isometric |
| controlled speed and resistance | Isokinetic |
| lengthening of muscle | Eccentric |
| shortening of muscle | Concentric |
| ability to generate force against resistance | Muscular Strength |
| Rehab Plan | Carefully designed |
| Must have complete understanding of the injury: | 1. how it was sustained 2. major anatomical structures involved 3. the grade of trauma 4. stage or phase of healing |
| Acute Inflammatory Phase may last up to | 4 days |
| Rehab should be initiated....after the injury takes place | 24hrs |
| Immobility for the first......is necessary to control inflammation | 2 days |
| Primary focus is to control swelling and modulate pain w/ | RICE |
| Being ..... in this phase can be detrimental | overly aggressive |
| Begin pain free ROM as | swelling subsides |
| Phase I : Acute Inflammatory Response | 1.May last up to 4 days Should be initiated 24hrs after the injury takes place 2.Immobility for the first 2 days is necessary to control inflammation |
| Phase I cont. | 3.Primary focus is to control swelling and modulate pain w/ RICE 4.Being overly aggressive in this phase can be detrimental |
| Phase I cont. | 5.Begin pain free ROM as swelling subsides |
| Repair is pain free | Range of motion |
| Pain control is still | critical |
| The addition of cardio, strengthening, flexibility and neuromuscular activities | should be gradually added |
| Phase 2: Repair Phase | 1.Repair is pain free Range of motion 2.Pain control is still critical 3.The addition of cardio, strengthening, flexibility and neuromuscular activities should be gradually added |
| Phase 3: Maturation/Remodeling | 1.Longest of 3 phases 2.Pain is minimal (none to the touch) and collagen adapts to forces placed upon it 3.Focus is on regaining strength |
| Phase 3 cont. | Strengthening exercises should be used to place athlete under stresses and strains normally associated w/ athletic participation |
| Phase 3 cont. | Increases in swelling, pain, a loss or plateau in strength/ROM, an increase in laxity or exacerbation of other symptoms indicates too great a load Exercise that is too long or prolonged can be detrimental to progress |
| Athlete compliance is critical | for success |
| To enhance adherence | 1.Provide encouragement 2.Be creative 3.Support from peers and coaches 4.Provide a positive attitude |
| To enhance adherence cont. | 5.Design clear plan and instructions 6.Coach must support the rehabilitation process 7.Make an effort to fit the program to the athlete’s schedule 8.Rehabilitation should be pain free |
| Rehab plan must determine | what is meant by complete recovery |
| The decision to return to play | should be a group decision. |
| Patient is | -fully reconditioned, -achieved full ROM, -strength, -neuromuscular control, -cardiovascular fitness and -sports specific functional skills |
| Patient is also | mentally prepared |
| RTP Decision should address the following concerns | -Physiological healing constraints -Pain status -Swelling -ROM, strength, neuromuscular control, proprioception, kinesthesia, cardiovascular fitness -Sports-specific demands -Functional testing |
| RTP cont. | -Prophylactic strapping, bracing, padding -Responsibility of the athlete -Predisposition of the athlete -Psychological factors -Athlete education and preventative maintenance program |
| Healing by direct contact | Conduction |
| General relaxation and reduction of pain- spasm-pain cycle | Moist heat packs |
| Heating by other forms of energy | Conversion |
| Lack of blood supply to the area | Ischemia |
| Local circulation is increased by water agitation and heat transmission | Whirlpool bath |
| Healing indirectly through water or air | Convection |
| High melting point provides a means of bringing sustained heat to angular body parts | Paraffin bath |
| Mild heating qualities with a general relaxation of spasmed muscles | Moist heat |
| Increased circulation and buoyancy of water allows mild exercise | Hot water soaks |
| Feeling of warmth results from skin capillary dilation and increase in local circulation | Analgesic balm |
| The body's effort to prevent tissue damage when exposed to prolonged cold is called the? | Hunting response |
| What are the major physiological effects of the cold? | Decreased muscle guarding, decreased pain reception, Increased joint stiffness |
| Adjunct to therapeutic exercise | Therapeutic Modalities |
| Must understand the healing process | Creating an optimal environment, not speeding it up. |
| Various types of modalities | Cryotherapy, electrical stimulation, ultrasound, massage, traction, diathermy, lasers and magnets |
| Select a modality based on | a thorough evaluation and desired results |
| Heat is transferred from a warmer object to a cooler one | Conduction |
| Temps greater than....will cause tissue damage | 116º |
| Types: | Hot packs, paraffin, ice pack, cold pack |
| Transfer of heat through movement of fluids or gases | Convection |
| Type: | Whirlpools |
| Heat is transferred through space. | Radiation |
| Types: | Shortwave diathermy, infrared heating, and UV therapy |
| Generation of heat from another object | Conversion |
| Type: | Ultrasound |
| Modality of choice for acute injury | Cryotherapy |
| Combined .................. for best results | w/ rest, compression and elevation |
| Tissue w/ ....... is better conductor | high water content |
| More penetrating then | heat |
| Too much ice can be | detrimental |
| Icing through a towel or bandage could | limit effectiveness |
| Physiological Principles of Cryotherapy | -Vasoconstriction -Increased blood viscosity -Decreases hypoxic injury to cell -Decreased metabolic rate -Decreased muscle spasm -Decreased nerve ending and peripheral nerve excitability |
| Cryotherapy Techniques | -Ice massage -Ice packs -Cold / Ice immersion -Vasocoolant spray -Cryokinetics (Movement) |
| Thermotherapy Physiological effects | -Increased extensibility of collagen -Pain relief -Assistance w/ inflammation (NOT acute) -Assist with healing process -Reduce muscle spasm -Increase blood flow |
| Response depends on type of | modality used |
| Superficial Heat | Increases subcutaneous tissue Then indirectly spreads to deeper tissue |
| Types of superficial heat | -Moist heat pack -Whirlpool bath -Paraffin bath -Contrast bath -Fluidotherapy |
| Special considerations | Never: loss of sensation, acute, heart problems, eyes, genitals, abdomen, during pregnancy, acute inflammation |
| Stimulates repair of soft tissue and helps w/ pain relief | Ultrasound |
| Frequency | Most often 1 MHz (megahertz) or 3 MHz 1 allows for deeper penetration 3 is more superficial |
| Intensity – amount of energy delivered to the head | Measured in w/cm2 |
| Thermal and nonthermal effects | Continuous and pulsed |
| Various types of application | Direct skin, underwater (distance plays a factor), bladder |
| Rate of 4 cm/second Must maintain contact Circular or stroking patterns Area no bigger than 3 times the size of the sound head | Moving the transducer |
| US Time | Typically 5-10 minutes |
| US dosage, Intensity | Low - .1 to .3 w/cm2 Medium - .4 to 1.5 w/cm2 High – 1.5 to 3.0 w/cm2 |
| Driving molecules through skin via the sound waves | Phonophoresis |
| Typically administer medicine | anti-inflammatory, hydrocortisone, anesthetics |
| ....Pads also used | Chem |
| Electrotherapy Indications | -Pain modulation -Muscle contraction -Muscle pump -Muscle strengthening -Active contractions -Retardation of atrophy -Muscle re-education |
| Transporting chemical ions through skin via electrical current. | Iontophoresis |
| Typically anti-inflammatory medication Used for inflammation, wound healing, analgesic effects, scar modification, calcium deposits, hyperhydrosis | Iontophoresis use |
| Intermittent Compression Units Equipment | -Utilizes nylon inflatable sleeve -Sleeve is inflated to specific pressure using either water or air -Utilized to facilitate movement of lymphatic fluids -Good for acute injury, pitting edema -Elevation important |
| Able to adjust on/off time, pressure and treatment time | Parameters |
| On/Off Time | Will often vary (1:2, 2:1, or 4:1) |
| Must be mindful of blood pressure | Pressures |
| Upper extremity Lower extremity | 30-50 mm Hg 30-60 mm Hg |
| Some units allow for | combining cold along with compression |
| ......can also be combined during some treatments | Electric stim |
| Examples: | Game Ready / Cryo-Cuff |
| Heats tissue by deep penetration | Shortwave Diathermy |
| electrostatic field heating or electromagnetic/induction field heating | Performs through |
| Pulsed diathermy is relatively new | -Not continuous – reduces likelihood of significant tissue temperature increase -Utilizes drum electrode -Produces both thermal and non-thermal effects |
| -Effective for bursitis, capsulitis, osteoarthritis, deep muscle spasm and strains -Penetrates up to 2 inches | Shortwave Diathermy Indications |
| Special Considerations | -Difficult to treat local areas -Toweling is critical -Avoid use with loss of sensation -Do not use if patient has metal implants -Avoid use if patient is pregnant or has open wounds |
| Psychological need for a drug | Addiction |
| Drug that inhibits pain | Analgesic |
| Administering a drug directly into a vein drop by drop | Antidote |
| Drug that increases urine output | Diuretic |
| Substance in which a drug is transported | Drug vehicle |
| Agents that cause vomiting | Emetics |
| Physiological need for a drug | Habituation |
| Administering a drug through the skin | Intradermal |
| Alcohol or oil-containing medicated fluid used for external massage | Liniment |
| Fake drug with no active ingredient | Placebo |
| How completely a particular drug is absorbed by the system | Bioavailability |
| Effect that is other than what is desired | Side effect |
| Desired effect of drug | Specific effect |
| Effect of two or more drugs is greater than when either is used alone. | Synergistic effect |
| Increasing amount of drug needed to achieve the same effectiveness | Tolerance |
| Chemical agent used in prevention, treatment, diagnosis | what is a drug? |
| Many are derived from | natural sources |
| Drugs which have, in the past, come from nature are now produced | synthetically |
| Method by which drugs are absorbed, distributed, metabolized, and eliminated | Pharmacokinetics |
| is the actions or effects of drugs | Pharmacodynamics |
| Internal Administration | Inhalation, Intradermal, Intramuscular, Intranasal, Intraspinal, Intravenous, Oral, Rectal, Sublingual/buccal |
| medication through respiratory tract | Inhalation |
| into the skin | Intradermal |
| medication directly into muscle | Intramuscular |
| Through the nose | Intranasal |
| medication injected into the spine | Intraspinal |
| into a vein | Intravenous |
| most common | Oral |
| limited due to dosage regulation | Rectal |
| dissolvable agents placed under tongue | Sublingual/buccal |
| External Administration | Inunctions, Ointments, Pastes, Plasters, Transdermal patches |
| oil based medication rubbed into skin | Inunctions |
| long lasting topical medication | Ointments |
| ointments with nonfat base | Pastes |
| thick ointment, counterirritant for pain & inflammation relief, increasing circulation | Plasters |
| patch with slow release mechanism | Transdermal patches |
| ADME | Absorption, Distribution, Metabolism, Excretion |
| -Drug must be dissolved. -Rate and extent determined by chemical characteristics of drug, dosage, and gastric emptying | Absorption |
| Once absorbed, transported through the blood | Distribution |
| Biotransformation of drug to water to be excreted (liver, blood, kidneys) | Metabolism |
| Excretion of drug or its metabolites is controlled by kidneys (sweat, saliva, feces) | Excretion |
| the absorption after oral administration | Exercise decreases |
| absorption after intermuscular or subcutaneous administration. Due to increase rate of blood flow | Exercise increases |
| the amount of a drug that reaches the receptor site | Exercise has an influence on |
| Defined as a single dose of medication to be used by a patient | Administering |
| providing a sufficient quantity to be used for multiple doses | Dispensing constitutes |
| By law, only......may prescribe or dispense prescription drugs for an athlete | licensed persons |
| ATC’s are not allowed to dispense medication unless allowed by | state licensure |
| ATC may be allowed to administer a.......of non prescription drugs | single dose |
| For College and professional athletes most are of legal age and are allowed | to use whatever nonprescription drugs they choose |
| ATC must still use........ about types of medication provided | reasonable care and be prudent |
| actions should be performed under the supervision of a physician | In all cases |
| Must maintain accurate and up to date medical records | Record Keeping |
| Should include the following in log | 1. Quantity of med given 2. Method of administration |
| Should be aware of state regulations relative to | ordering, prescribing, distributing, storing and dispensing of the medications |
| ATC’s must maintain accurate and up to date medical records | -Name -Complaint -Current medications -Any known drug allergies |
| Medical records cont. | -Name of medication -Lot number -Expiration Date |
| Medical records cont. | -Quantity of medication given -Method of administration -Date and time of administration |
| Nonprescription drugs should not be | repackaged |
| All drugs dispensed from the athletic training room must be | properly labeled |
| Legal liability if drugs removed | from original packaging and dispensed |
| Unable to review......(information needed for safe use) | contents, dosage, directions and precautions |
| Same liability associated with | providing prescription medication |
| No drug is completely | safe and harmless |
| Any drug under the correct conditions can be | potent and dangerous, w/ every individual reacting differently |
| Athlete must be instructed on specifics of medications | when to, how to and w/ what medication should be taken with |
| When traveling with a team or individually the athlete should be advised to do the following relative to medications: | -Medication should not be stored in a bag/luggage but carried by the athlete taking it -Sufficient supply should be packaged in case of emergency |
| Traveling cont. | -Make sure there is a source of medication while traveling -Take copies of written prescriptions -Keep medication in original container |
| substances that can be placed on living tissue for killing bacteria or inhibiting growth | Antiseptics |
| used to combat microorganisms | Disinfectants |
| Most widely used skin disinfectant | Alcohol |
| .....alcohol (70% by weight) and....alcohol (70% by weight) are equally effective | Ethyl isopropyl |
| -Hydrogen peroxide is commonly used in the athletic training room -Dilute solution can be used to treat inflammatory mouth and throat conditions | Oxidizing agent |
| -Medicine used to treat fungi (epidermophyton, trichophyton, and candida albicans) -Most administered topically | Antifungal Agents |
| Chemical agents that are produced by microorganisms | Antibiotics |
| Interferes w/ necessary metabolic processes of | pathogenic microorganisms |
| Types of Antibiotics | Penicillin, Bacitracin, Tetracycline |
| to prevent chronic and troublesome symptoms, maintain normal lung function, prevent exacerbation and provide adequate pharmacotherapy with minimal adverse effects | Goals of asthma therapy |
| are available | Portable hand-held inhalers |
| Often individuals become | dependent |
| Analgesics give relief by causing systemic and topical analgesia | Counterirritants and Local Anesthetics |
| Types: | Liniments, analgesic balm, spray coolants, cold, alcohol |
| Most derived from opium or are synthetic opiates | Narcotic Analgesics |
| Types: | Codeine, morphine, demerol |
| Designed to suppress all but most serious pain w/out losing consciousness | Non-narcotic Analgesics and Antipyretics |
| Types: | Acetaminophen (Tylenol) |
| Drugs to Reduce Inflammation | Acetylsalicylic Acid (Aspirin) |
| Helps reduce pain, fever and inflammation | Widely used analgesic, anti-inflammatory, antipyretic and abused drug |
| -Anti-inflammatory, antipyretic and analgesic properties -Fewer side effects and longer duration than aspirin | Nonsteroidal Anti-inflammatory Drugs (NSAIDS) |
| Types: | Ibuprofen (Advil); Naproxen Sodium (Alleve) |
| Prolonged use may cause rebound congestion and dependency | Nasal Decongestants |
| -Often added to decongestants -Beneficial in allergies | Antihistamines |
| Suppress cough (antitussives) or produce fluid in respiratory system (expectorant) | Cough Medications |
| Used to increase alertness, decrease fatigue, increase competitiveness and hostility | Stimulants |
| Cause mental stimulation and increased blood flow but can cause elevated blood pressure, headache, increased and irregular heart beat, anxiety and tremors | Sympathomimetic drugs |
| Sympathomimetic drugs are a difficult problem for the | USOC as they are often found in cold remedies |
| In moderation it will cause cerebral cortex and medular centers stimulation, causing wakefulness and mental alertness | Caffeine |
| -Used for management of moderate/severe pain -Risk physical and psychological dependency | Narcotic Analgesic Drugs |
| -Primarily used for hypertension and heart disease. -Used for sports requiring steadiness -Relax blood vessels, slows heart rate and decreases cardiac output and heart contractility | Beta Blockers |
| -Increase kidney excretion by decreasing kidney resorption of sodium -In sports, misused for weight loss and decreasing concentration in urine | Diuretics |
| Growth, development and maintenance of reproductive tissues, masculinization | Androgenic effects |
| increased muscle mass and weight, general growth and bone maturation | Anabolic effects |
| -Increases testosterone in men and particularly women -Banned by IOC, NFL, NCAA, and minor league baseball | Androstenedione |
| Human Growth Hormone (HGH) | -Amount released varies with age -Can be produced synthetically -Increases body length, weight and decreases body fat % |
| HGH cont. | -Difficult to detect so use is on the rise -No proof that increased HGH and weight training contributes to strength and muscle hypertrophy |
| Purpose is to identify individuals who have problems with drug abuse | Drug Testing in Athletics |
| -Began at the Olympics in 1968 and has since expanded nationally (USOC and NCAA) and internationally -Performed to ensure health of athletes and fair practices -Mandatory and random testing occurs at both levels | NCAA and USOC routinely test |
| Slight differences between NCAA and USOC, mostly in area of selection | The Drug Test |
| requires all athletes to sign consent form agreeing to participate in testing throughout the year | NCAA |
| tests randomly throughout the year and before USOC sanctioned events | USOC |
| During the test, athlete provides......under direct supervision | identification, and 2 samples |
| First time positive in NCAA | results in minimum one year suspension; will undergo random testing throughout the year |
| NCAA | Must test negative prior to reinstatement |
| However, additional positives can result in | lifetime disqualification from NCAA |
| Sanctions range from 3 months - 24 months depending on the drug for a first time offense | USOC |
| USOC | Lifetime ban for subsequent positive tests |
| Both NCAA and USOC | have a banned substance list for athletes |
| Includes | 4,600 different medications |
| USOC is more extensive than NCAA because | it is also subject to IOC rules |
| Athletic trainer working w/ athletes who may be tested for drugs by NCAA or world-class or Olympic athletes governed by USOC should be familiar | w/ the lists of banned drugs and substances |
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