Fitness and Injury Management

Pre Season Fitness	Fluid Replacement	Hamstrings	Soft Tissue Injuries
Lacerations	Blisters	Head Injuries	Facial Injuries
Neck and Spinal Injuries	Abdominal Injuries	Knee and Ankle Injuries	Fractures of the limbs
Transport

Pre Season Fitness

We've all been through it. Last night was the first Broomball practice of the new season. Today you awaken from your slumber, stiff and sore. The idea arrives that you have been through this many times before. The idea also arrives that there must be something you can do to keep this from happening.

Good news - there is. That 'something' is exercise, or preparation of your body.

The biggest situation to avoid, however, is the 'too-much too-soon' phenomenon. In our enthusiasm to turn our bodies into a lean mean machine, we have a tendency to go too hard, and the result is sore or injured muscles.

The trick then, is to improve gradually. You will want to start preparing your body at least eight weeks before the first expected day of broomball. In reality, the sooner the better.

If you do nothing else over the summer, the most important overall fitness aspect to improve upon is the aerobic or cardiovascular system. It's also the easiest to do. Any rhythmic continuous activity that can raise and maintain an elevated heart rate for 20-30 minutes is a good choice. Cycling, jogging, swimming, and rowing are excellent examples.

To get the most for your efforts though, you have to choose the proper pace. Moderate exertion is ideal for the best aerobic training effect. How moderate is moderate ? Well there are two ways to find the answer.

The first is to check your heart rate during your activity. For most people in this sport, the training heart rate should be between 138 and 162 beats per minute. During your activity, you only need to find your pulse in the wrist or neck and count for 10 seconds. You should feel 23 - 27 pulses in this time. If you feel less than this, then you should pick up the pace just a little. If your count is faster than this, and you'll have to really push yourself to get 20-30 minutes in, then back off the pace a little.

The second way is much less scientific, but works well if you trust your own diligence. The idea is to establish a pace whereby you can maintain a conversation without gasping for air - but that if you went just a little harder you couldn't. This "seat of the pants" method relies a lot on how you feel from day to day and is therefore, in some ways better. The biggest drawback to this method is that there is a tendency to spend a lot of ineffective time finding the right place.

Probably the best strategy is to try the first method first, until you know what it's supposed to feel like, and then move over to method number two.

Don't forget your walkman. Have a good summer.

Reprinted from an Article by Stephen Hartley

Fluid Replacement

Your body needs water, not just when you are thirsty, but before, during and after exercise.

Before Activity - Drink 200 -300ml (2-3 cups) 45 minutes before.

During Activity - Drink 100 - 200ml (1 -2 cups) every 15 - 20minutes.

After Activity - Drink more than you are thirsty for.

Hamstrings

The hamstring muscles are subjected to great forces, especially with sprinting, that make them vulnerable to injury. The low back, sciatic nerve and hip joints can also cause pain in the back of the thigh, particularly in distance runners. Hamstring injuries and pain are a common problem in runners and can severely limit a season of athletics.
The hamstrings actually consist of 3 large muscles that attach to the base of the pelvis on your 'sitting bone' and then insert into the tibia and fibula just below the back of the knee. The two occasions they come in strongly during running are:-
- At the end of the swing through of the leg, the hamstrings again contract strongly to slow down the forward swing of the lower leg and bring it to the ground.

- When the foot hits the ground, the hamstrings again contract strongly, along the gluteal or buttock muscles, to prevent the buttock sagging to the ground.

At both these times the hamstrings are lengthening while they are contracting. This type of contraction is called eccentric contraction and is when the muscle structure is most vulnerable to tearing. Hence the dramatic pulling up of sprinters as the muscle tears during one of these phases.

Researchers have developed a programme of eccentric exercises that works extremely well in rehabilitating hamstrings. It is also used to improve the speed of hamstring contraction in sprinters and can be incorporated into a gym programme. It is important to warm up and stretch before attempting these exercises.

Start with the knee bent, kick out and catch leg, and pull back rapidly again. Repeat 3 x 10-15

Squat jumps - bend hips and knees, spring up and land bending into squat again. Repeat 3 x 10-15.

Lack of flexibility - To isolate the hamstrings when stretching, the low back must be kept straight. The easiest way to do this is to stretch lying on your back, extending the leg up and back, supporting the leg behind the knee. Hold for 10 -20 seconds and repeat 1-3 times.

Poor technique - running with hips low and 'pulling' with the hamstrings. Run with hips carried high and 'push' with full extension of the leg. Consult closely with your coach.

Back and hip problems - these are complex and can be present in many ways. Professional assessment and treatment is required.

Reprinted from an Article by Jim Mack
M.App.Sc (Sports Physiotherapy)

Soft Tissue Injuries

This includes sprains, torn muscles, bruises, etc. The essence of early management is R.I.C.E.R. (rest, Ice, Compression, Elevation, Referral). This means that on the field or as early as possible, a firm bandage should be applied, especially to a sprain, and the athlete should be carried off to ensure that the injury is not aggravated.
Walking a couple of hundred metres on the damaged limb at this stage may add a couple of weeks to the length of the disability.
On reaching the dressing room the limb is elevated, and ice applied not directly to the skin, but over at least one layer of wet cloth. Ideally the pressure should be maintained, even during the the application of ice. The aim is to prevent swelling, bleeding and reduce pain.
Ice is applied for 10 - 20 minutes, being applied every 2 hours. Continue this for 48 hours, as far as possible maintaining a firm bandage and elevation both during and in between ice applications.
The only exception to the above routine is in the case of an injury which is obviously trivial, although it is wise to remember that some of these may turn out to be associated with a significant injury.
This routine will never do harm, even if it is later discovered that there is a fracture or other serious injury present.

Remember No H.A.R.M. - no Heat, no Alcohol, no Running, no Massage for the first 48 hours.

After 48 hours, treatment with heat may be commenced, and graduated activity allowed within the limits of pain.

Referral - For an accurate diagnosis and to optimize recovery, for all but trivial injuries, visit a sports doctor or physiotherapist.

Lacerations

Early repair (stitching) within 3-4 hours, is the best treatment. In the interim, firm direct compression with a pad and bandage, with elevation will control bleeding.

Blisters

Keep clean to avoid infection. Do not remove the covering layer of skin. Drain fluid by inserting a sterile needle near the edge. Cover with a clean dry dressing of friction free material if available eg. silicone padding.

Head Injuries

Concussion is associated with loss of consciousness and/or altered state of 'awareness following a head injury. Do not permit the player to continue the game or drive a car. He/she should be referred for medical assessment ie. see a doctor !

Deterioration during this period, especially headache, vomiting, or drowsiness, may indicate internal bleeding and an urgent operation may be required. The player should be send to hospital immediately. Any lapse into unconsciousness a second time is a serious sign.

Alcohol is unwise after a head injury. Match play should not be resumed until a doctor has cleared the casualty and he/she is completely fit and free of headache.

If the unconscious casualty it is essential to ensure that breathing is not obstructed: the tongue, a mouth guard or chewing gum may cause this. Place an unconscious casualty on his/her side in manner described for spinal injury.

Facial injuries

The Nose - A fracture is quickly masked by swelling. Early medical attention may permit straightening without an anaesthetic.

The Cheekbone - Fracture is indicated by flattening of the prominence of the cheek and swelling. Early operation may be required.

The Lower Jaw - This can be supported by the victims hands. Do not apply a bandage.

The Eyes - Do not insert drops or ointments. Cover the injured eye and seek medical attention. (additional, find out if the injured player wears contact lenses - soft or hard)

The Teeth - A broken tooth should be treated by a dentist within a few hours to prevent further damage. If a tooth is knocked out intact it should be firmly reinserted in it's socket as soon as possible so that it can survive. If it is soiled it should be rinsed in milk if available, or sucked clean by the player for a few seconds before reinsertion. If unable to replace the tooth, transport it to a dentist either in milk or wrapped in plastic cling film. eg. gladwrap.

Mouth guards prevent most dental injuries and are strongly recommended.

Neck and Spinal injuries

Spinal injuries may cause paralysis and loss of sensation below the level of injury. If this is suspected and the player is conscious, avoid all movement, provide support to each side of the neck and wait for ambulance assistance.

If unconscious and breathing normally, again assume neck injury, gently turn the player on his/her side keeping the head, neck and trunk straight by using assistants - apply gentle traction to the neck. Support the head and await ambulance assistance.

Any such injury causing difficulty with breathing, must be regarded as urgent.

Abdominal Injuries

Damage to an internal organ resulting in bleeding, may be caused by a knee, elbow, boot or crush. It is indicated by pain and perhaps fainting. Spleen, liver or kidney may be involved. In the case of the latter, blood may appear in the urine. Simple 'winding' should pass off in a few minutes. Damaged abdominal muscles will cause pain, but the victim will appear to be quite well. Any suspicion of damage within the abdomen requires prompt transport to hospital.

Knee and Ankle Injuries

These are often serious. If the player cannot readily get up, he/she should be carried off. Rapid swelling means bleeding, and usually indicates serious injury requiring urgent medical attention. Apply R.I.C.E.R. (as above)

Fractures of the Limbs

A fracture should be suspected if there is pain, swelling, and local tenderness and loss of strength or movement. For the upper limb, the most comfortable position is in a sling. The lower limb can be padded and bandaged to the opposite limb. When handling, be gentle but firm. When lifting the limb ensure that the fracture is fully supported.

Transport

Speed more often increases the injury and endangers other lives. If transport of any serious injury is required ring an ambulance on (Australia, 000 - North America, 911), and make sure a clear airway is maintained. In the case of less severe injury, transport in position of most comfort.

Reprinted from an Article by Australian Sports Medicine Federation