AAYFL Coaches Clinic 2014 Houston Methodist Orthopedics and
Sports Medicine July 23rd, 2014
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Who we are The only facility in Northwest Houston with the
expertise to care for all the needs of the athlete of any age
Primary Care Sports Medicine Sports Orthopedic Surgery On site
x-ray Physical therapy Outpatient Surgery All in one place
8/30/14Houston Methodist Orthopedics & Sports Medicine
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Agenda Emergency Action Plans and First aid kit Common injury
principles in young athletes Common injuries in collision sports
Concussion recognition and management and neck injuries Heat,
hydration and Nutrition Pearls for coaches from our coach for
keeping kids safe and motivated. 8/30/14Houston Methodist
Orthopedics & Sports Medicine
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Emergency Action Plans A written document that details what
actions are done by whom in the case of an emergency Applies to
medical emergencies, environmental emergencies and anything else
you want Lets everyone know who does what Common in many
organizations Schools, large companies and any other organization
where groups of people gather 8/30/14Houston Methodist Orthopedics
& Sports Medicine
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8/30/14Houston Methodist Orthopedics & Sports Medicine
Activating Emergency Action Plan Know who is going to call the
ambulance What do they need to say Who is bringing the first aid
kit Who will direct the ambulance to the field Who is going to take
care of the other athletes
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Calling the ambulance Identify yourself Know your exact location
Know the age of the athlete and the type of injury Know the status
of the athlete Conscious Breathing Bleeding
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Calling the ambulance Know the best approach to the field Answer
all the questions from the dispatcher Dont hang up until the
dispatcher does Have someone designated to meet the ambulance
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Caring for the downed athlete Remain calm If there is any concern
for a spine injury, leave the athlete on the ground with the helmet
on Support the head Apply direct pressure to any bleeding areas If
the athlete is unresponsive, assess need for CPR and attach
AED
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Practice Emergency Drills Schedule a drill prior to the season
Plan a scenario for the drill Critique the staffs response, duties
& actions Obtain support and guidance from your local EMS
8/30/14Houston Methodist Orthopedics & Sports Medicine
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Summary Emergency Action Plans Save Lives Use common sense and
remain calm Dont do more than you should Practice your plan!
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First aid Equipment and Supplies
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Equipment and Supplies Available at Practices and Games for trainer
or Paramedic Splints Crutches Bandages Automated Defibrillator
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First Aid Kit Supplies Think about what you need to treat common
injuries Remember personal protection Latex or nitrile gloves
Antiseptic towels Hand sanitizer Breathing barrier See the list in
your handout.
Injury recognition in youth sports overview Bruce Moseley,
M.D.
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Objectives Discuss how kids are different Describe some common
injuries Discuss Treatment principles Return to play criteria for
common injuries
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8/30/14Houston Methodist Orthopedics & Sports Medicine Kids
are different!!! Bones are pliable Every bone has a growth plate
Growing bones are susceptible to injuries. Ligaments commonly
stronger than bones Immature brains heal slower than mature brains
Kids dissipate heat more slowly
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Bones Grow from the Ends Growth plates at the wrist and ankles are
most commonly injured Every bone has a growth plate Point
tenderness near the end of the bone raises concern for bone
injury
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Injury Treatment Principles Rest Immobilize anything that hurts at
the end of a bone Ice First 2 days for most any injury Compression
Ace wrap Elevation Higher than the heart.
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Definitions Fracture = break Open fracture = break in the skin
Closed fracture = no break in the skin Strain Small muscle tear or
tear where muscle turns to tendon Sprain Ligament (holds joints
together) stretched or torn
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Injury Evaluation History Be able to describe what happened Simple
descriptions Hit in knee, heard a pop Tackled and hit back of head
on ground How bad was the injury initially? Able to walk off the
field Pain with bearing weight Any previous injury like this
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Injury Evaluation Inspection Begins immediately after an injury
Limping Holding injured body part Bleeding Deformed arm / leg
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Injury Evaluation Palpation Gently Tender over a bone or joint Is
there any deformity Blood flow Capillary refill Run back the
Kickoff Numb or tingling
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Injury Evaluation Functional testing Pain is a defense that
protects the body DO NOT disregard a players complaint of pain.
Compare strength and range of motion with the uninjured side. IF
the 2 sides are different, err on the side of caution and dont
return to play until seen by physician or symptoms clear
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Injury Evaluation Lower extremity injuries To return to play Bear
weight without pain Walk without a limp Duck walk without pain Jog
then run without pain Do position specific drills If they cant do
the things necessary for a position, dont return to play
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Injury Reporting Most clubs have specific protocols If your club
does not --- develop one Protects the athlete Protects the
organization Improves communication between coach, parent and
physician
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Reporting Protocol Should include Athlete name Date of injury Type
of injury Cause or mechanism of injury First aid applied Parents
notified Documentation of others who witnessed the event Identify
the person filling out the form
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Injury Log Helps track type of injury Tracks the athlete who gets
recurrently injured Shows length of time lost by injury type If
used well, can show change in injury rate if you institute a
prevention strategy.
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Common Injuries in Collision Sports John Seaberg, M.D.
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8/30/14Houston Methodist Orthopedics & Sports Medicine
Common Injuries in Collision Sports Collar Bone fracture Buckle
fracture Mallet finger Jersey finger Muscle strain Ankle sprain
Muscle contusions Joint dislocation Long bone fractures Abdominal
injuries Abrasions and lacerations Knee ligament injuries
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Collar Bone Fracture Fall on shoulder or outstretched hand Usually
breaks in the middle Treated with a sling or figure of 8 splint
Usually out at least 8 weeks Younger and not throwing may return
earlier
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Buckle Fracture Fall on an outstretched hand Point tenderness
usually on the thumb side of of the end of the forearm Sometimes
swollen Collapse of one side of the bone Usually casted for 3-6
weeks
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8/30/14Houston Methodist Orthopedics & Sports Medicine
Mallet Finger Struck on the end of the finger by ball or helmet
Tendon pulls a bone fragment off If not treated right, permanent
deformity Extension splint for at least 6 weeks
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Jersey Finger Tendon pulls away from the palm side of the end of
the finger Severe pain Often needs surgery Season ending
injury
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Muscle Strain Pull or tear Stretch beyond its limit Treatment is
ice, rest, compression Return when pain free and muscle strength is
normal Few days to few weeks
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Ankle Sprain Usually the outside of the ankle Ice, Compression,
elevation If unable to walk 4 steps or tender over the ankle bumps,
needs an x-ray Need to do position specific drills without pain
before return
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Muscle Contusion Most common in the thigh and upper arm Treat with
ice, compression and stretch May heal with a calcium deposit in the
muscle
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Joint Dislocation Fall on outstretched hand or forced pulling back
on the arm Severe pain Do not try to relocate on your own Splint
and transport to an ER for reduction Finger may return in a week,
all others, usually season ending
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8/30/14Houston Methodist Orthopedics & Sports Medicine Long
Bone Fractures Forearm, upper arm, leg or thigh Usually grossly
deformed May have nerve and blood vessel damage Splint for support
and send to ER.
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Abdominal Injuries Spleen is the organ we worry about the most Left
upper part of abdomen Will cause shoulder pain of damaged Kidneys
also easy to damage Severe stomach pain after a blow Needs to be
evaluated in an emergency room
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Abrasions and Lacerations All bleeding stops It stops faster with
direct pressure Remember to wear gloves. If the edges of the wound
are apart without being touched, it needs stitches If bleeding is
controlled, in general the athlete can continue to play if the
wound is covered. Dont expose other athletes to patients blood
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8/30/14Houston Methodist Orthopedics & Sports Medicine Knee
Ligament Injuries ACL and meniscus tears can happen in young kids
Most commonly plant and twist or blow to a knee with the foot
planted Often feel a pop Almost always requires surgery to be a
competitive athlete
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Tendon Attachments Achilles tendon Severs disease Patellar tendon
Osgood Schlatter disease Pain that is worse with activity.
Sometimes has swelling Treat with rest and stretching activities.
Ice after games
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Concussion recognition and management Greg Seelhoefer, MD
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8/30/14Houston Methodist Orthopedics & Sports Medicine
Concussions A brief alteration in brain functioning caused by
trauma. Does not have to be a blow to the head Does not require a
loss of consciousness. Imaging tests (CT scan, MRI) are normal
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Concussions Grading concussions does not help and can make a
serious injury seem mild Returning to play before symptoms have
cleared increases chances for recurrent concussion and second
impact syndrome No evidence protective gear (headgear, mothgaurds)
prevents concussions
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Concussions How do you know if someone has had a concussion? All
based on symptoms Dazed Confused Slow to respond Dizzy Headache
Nausea Vomiting Unable to remember new things Unable to remember
the hit or recent parts of the game Blurred vision, Ringing in the
ears 8/30/14Texas Sports Medicine Center
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Initial evaluation ABC Just say hi Consider C-spine injury in any
athlete with a head injury and altered level of consciousness or
any neck pain Ask them what happened IF they dont remember, ask
someone else Memory for the event may never return
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Assess Brain Function Orientation Who they are Where they are When
they are Responsiveness Alert Groggy Pupils equal?
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8/30/14Houston Methodist Orthopedics & Sports Medicine On
the Field Ask if they have any neck pain Immobilize first, then ask
Just use hands initially Ask them to move arms and leg Dont move
any extremity or body part for them. IF no neck pain, able to move
all extremities and answers questions well, allow them to stand
slowly and walk off the field with assistance
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the Sideline Continually reassess Repeat the questions you asked on
the field. Take away his helmet If symptoms are worsening, send to
the emergency room
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8/30/14Houston Methodist Orthopedics & Sports Medicine When
to Return No child who gets a concussion should return to play the
same day. Nope not ever Very little research is done on children
younger than 12 with concussions We know high school age kids are
more susceptible and take longer to recover than college or pro
athletes
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can the Athlete Return No symptoms at rest and with exertion Return
to play slowly Jogging Running Non contact drills Contact drills
Full activity Drop back if symptoms recur at any level
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in Doubt Hold them out
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The unconscious athlete
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Unconscious Athlete An unconscious athlete has an unstable neck
fracture until proven otherwise Assess ABCs IF breathing and has a
pulse Stabilize the neck and do not move the patient. Wait for EMS
arrival If not breathing or no pulse Log roll while stabilizing the
neck Begin CPR until help arrives.
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Cervical Spine Injuries Contact sports place the cervical spine at
risk Incidence has decreased since rules outlawed spearing Most
injuries are still due to axial load Fracture of the neck can cause
paralysis, death
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8/30/14Houston Methodist Orthopedics & Sports Medicine Neck
Injury Symptoms Pain in neck Decreased range of motion Pain,
numbness or weakness in the arms Spasm of neck muscles Bowel or
bladder problems Unequal grip strength
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8/30/14Houston Methodist Orthopedics & Sports Medicine Neck
Injury Treatment If concerned about a fracture, immobilize and
transport for evaluation Whiplash Strain of the ligament going down
the back of the neck Stinger Stretch of the nerves supplying the
arm Shooting pain or arm may feel dead for a few seconds May return
if symptoms completely clear Needs eval if recurrent
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Heat Injuries Christian Schupp, MD 8/30/14Houston Methodist
Orthopedics & Sports Medicine
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8/30/14 Heat Injuries A completely preventable injury A very
common injury Usually bothersome, but can be deadly 3 different
phases: Heat cramps Heat exhaustion Heat stroke Houston Methodist
Orthopedics & Sports Medicine
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Cramps Dehydration causes localized electrolyte problems Adequate
hydration is usually preventative Can occur in any muscle, but most
common in the calf Stretch, ice and hydration are the keys to
successful treatment Muscles that are cramping are more susceptible
to tears / strains
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Cramps: Hydration Daily weights (pre- and post- exercise) Fluid
replacement 20-24 fluid ounces of water or sports drink for every
pound lost >5% weight loss = serious dehydration Urine
color
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Exhaustion More serious, but not life threatening Usually caused by
volume loss from sweating that is not replaced Body cannot maintain
adequate blood flow to brain, heart, kidneys
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Exhaustion Symptoms Headache Nausea / vomiting Irritability Cool,
clammy or hot and sweaty skin Muscle cramps Thirst Low blood
pressure
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Exhaustion Treatment Cool place Loosen clothes Fans, wet towels,
Ice Elevate legs Encourage fluids Electrolyte solutions are better
absorbed. Acclimatize more slowly Return to play 1-2 days, but
should have a doctors note
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Stroke Rare Deadly Most common cause of death in the high school
and NCAA Bodys ability to regulate heat is gone Risk factors Temp
over 95 with 75% humidity Can occur at much cooler temps Out of
shape athlete, poorly acclimatized, prior problems Long periods of
strenuous exercise or short periods of intense exercise Dehydration
Korey Stringer (1974-2001)
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Symptoms of Heat Stroke Extreme body temperature Altered level of
consciousness is key! Irritability, incoherent, glassy stare, etc
Rapidly progresses to seizures and coma Definition = core
temperature >104 Rectal temp is the only reliable source Steve
Bechler (1979-2003)
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Treatment of Heat Stroke MUST COOL THEM DOWN IMMEDIATELY Shade or
air conditioning Remove clothes Ice to groin, arm pits Treat for
shock by elevating the legs Nothing to drink Get to the hospital as
soon as possible.
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Nutrition principles for adolescent athletes Christian Schupp,
MD
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Nutrition Basics Athletes need a balanced diet 55-60%
carbohydrates Starches like breads Fruits and vegetables Most
readily available fuel source No more than 30% fat Fats contain
more than twice as many calories per gram as protein or carbs
10-15% protein 8/30/14Houston Methodist Orthopedics & Sports
Medicine
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What about protein supplements? Not necessary and not helpful
Bodies can use no more than about gram per pound 100 lb boy can use
about 35-40 grams of protein per day Too much protein causes bowel
trouble and dehydration. 8/30/14Houston Methodist Orthopedics &
Sports Medicine
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Pre-Game Meals Pre-Game meals should be part of a sound nutritional
program and contain foods that are well tolerated by the athletes.
There is no particular food that will magically give an athlete
special energy, strength, or endurance
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Goals of a Pre-game Meal Provide adequate energy intake Allow for
an empty stomach & upper bowel at time of play Provide an
optimal state of hydration Cause minimal upset of G.I. tract
Provide familiar foods
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to Avoid? Fatty foods Roughage / high fiber Protein
Caffeine/Carbonation
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Click to edit the outline text format Second Outline Level
Third Outline Level Fourth Outline Level Fifth Outline Level Sixth
Outline Level Seventh Outline Level Eighth Outline Level Ninth
Outline LevelClick to edit Master text styles Second level Third
level Fourth level Fifth level Fat Fat delays empting of the
stomach 8/30/14Houston Methodist Orthopedics & Sports
Medicine
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Roughage / fiber Increase the need for defecation
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Protein Slower to digest Must be metabolized into fuel in the
liver Not an efficient fuel source Can lead to dehydration GI upset
8/30/14Houston Methodist Orthopedics & Sports Medicine
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Caffeine/Carbonation May increase urine output and upset the G.I.
tract
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Ideal Pre-game Meal 8/30/14Houston Methodist Orthopedics &
Sports Medicine Complex carbohydrates Pasta, breads and fruits
Small portion of veggies Small portion of lean meat
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Conclusion Encourage a balanced diet throughout the season
Focus on hydration Make the pregame meal at least 2-3 hours before
the game Do not encourage protein supplements Focus on hydration
Athletes plate TEAM USA (google) 8/30/14Houston Methodist
Orthopedics & Sports Medicine