Assessment and Evaluation of Athletic Injuries

How to assess an athletic injury.
Assessment and Evaluation of
Athletic Injuries
These are important proficiencies that
everyone on the athletic heath care team
must possess
 The knowledge and expertise of the
certified athletic trainer, which are
applied to evaluate injuries immediately
after they occur, helps in getting the
proper aid to the athlete as quickly as
Certified athletic trainers can assess and
evaluate, but cannot diagnose
 Diagnosis is the domain of the licensed
health care provider, typically a
physician, although sometimes limited by
his or her specialty
 The physician uses all the information
obtained in the evaluation to arrive at a
diagnosis of the injury
 The certified athletic trainer uses
information from the physician to set
short-term and long-term goals for
Factors Influencing Athletic
Many factors influence the type and severity of
athletic injuries
 Some but not all can be controlled by the
Anthropomorphic data
 includes the size, weight, structure, gender,
strength, and maturity level of the athletes
 compare high school and college athletes
○ JV athletes are much smaller than Varsity
○ college athletes are stronger, faster, and have
mature body structure
Mechanism of force
 comprises all forces involved at the time
of an impact, including:
○ the direction of the force
○ its intensity and duration
○ the activity being undertaken
○ the position of the body part at the time of
 influences the type and severity of athletic injuries
because a greater speed of collision causes a
greater chance of injury
 If athletes of greatly differing skill levels practice
together, the lesser skilled athlete typically has the
greater chance of being injured
Protective equipment
 Greatly reduce the risk of injury by absorbing and
distributing force that would be otherwise absorbed
by the body
 New materials and better equipment design have
helped to reduce injuries even though athletes are
getting bigger, faster, and stronger
The skill level of the athlete
 influences the rate and severity of athletic
injuries because the more skilled athlete
has a greater knowledge of what to do to
minimize risk of injury
 Playing within one’s ability, and being in
control, is an important factor in
minimizing the risk of injury
Recognition and Evaluation
Certified Athletic Trainers are trained to:
 Recognize when an injury has occurred
 Determine its severity
 Apply proper evaluation procedures and
treatment protocols
Recognition of injuries is the process in
which the certified athletic trainer
determines the probable cause and
mechanism of injury, based on direct
observation or second hand accounts
Primary Injury Survey
 Involves controlling life-threatening conditions first
and activating the emergency medical services
(EMS) when needed.
 Evaluators look for the basic ABCs
 Open the victim’s airway by tilting the head
back and lifting the chin, unless spinal injury
is suspected, the jaw-thrust technique is
 Listen, look, feel for breathing
 If victim is not breathing, give two breaths
and check for circulation
 Check for signs of circulation such as
breathing, coughing, or movement in
response to the breaths. If there are no
signs, start chest compressions
Cardiopulmonary resuscitation
Only individuals properly trained and
certified in CPR should practice this
 The Good Samaritan law protects
most helpers from legal actions
brought against them, but not if the
helper performs procedures for which
he or she is not properly trained
For those trained in CPR, the American
Heart Associate provides guidelines,
recommending that rescuers phone 9-1-1
for unresponsive adults before giving CPR
 provide one minute of CPR for infants and
children to the age of eight before calling 9-1-1
 Begin chest compressions in the absence of
circulation signs, giving about 100
compressions per minute for a person over 8
years old, at a ratio of 30 compressions to 2
 Chest-compression-only CPR is recommended
only when the rescuer is unwilling or unable to
perform mouth-to-mouth rescue breathing
 The Secondary Survey involves the management
of nonlife-threatening injuries, entailing a
thorough, methodical evaluation of an athlete’s
overall health. The H.O.P.S (history, observation,
palpation, special tests) evaluation if often used
○ Take their time and be thorough, ruling out the
most serious injuries first
○ Athletic Trainers run the risk of overlooking
additional injuries if they are pressed to return
an athlete to competition
○ The well-being of the athlete always comes
Gather history before touching the
athlete. Question others who witnessed
the incident
 What happened? Body part injured;
description of injury.
 When did the injury occur?
 What factors influenced the injury? Some
factors include position of the body and
injured area; activity (collision or contact);
speed; direction of force; the force’s intensity,
duration, and results (twisting,
hyperextension, hyperflexion).
 Was a sound heart? Was it a pop, snap, rip?
Where is the pain located now? Where was
the pain at the time of injury?
Describe the pain: sharp or dull/achy,
stabbing, throbbing, constant, cramping,
and intermittent. Is the pain present at rest
or with use of the injured body part? What
is its intensity (rate on a scale of 1-10)?
Are neurological functions intact? Is there
numbness, pins-and-needles prickling,
muscle weakness, paralysis, burning
Is there instability? A sense that something
not working right (do not have the person
actually use the part in question)
Is there a prior history associated with the
injured body part?
Expose the injury to observe the
extent of damage.
 It is important to recognize the privacy of
the athlete, exposing the injury in a locker
room or private area if at all possible
 It is good practice to have a member of
the training staff who is the same sex as
the inured athlete in attendance for all
Perform a Physical Exam
 Compare the injured side to the uninjured side
 Always look above and below injury site
 look especially for deformity, swelling,
bleeding, and skin color changes
Palpation is the touching of the injured
 should be firm enough to cause pain
 palpating too lightly may result in missing a
significant injury
 observe facial expressions
Active motion is movement done by the
athlete, asking him or her to move the
injured body part through its full range of
Passive motion is movement done by the
examiner, with the athlete relaxing all
Resistive motions is when a force is applied
to the athlete’s movement
Test for strength
 Ask athlete to contract muscles around the
injury without moving bones (isometric
 Note any visible defects and palpate for knots
or lumps in the injured muscle
Stability tests investigate ligamentous
laxity, a stress test for ligaments. A
sprain can then be graded 1, 2, 3
 A grade 3 sprain or complete tear will require
prompt referral to an orthopedic surgeon for
Special tests and examinations may be
necessary to establish the degree of
Functional activity tests determine the
level of activity the athlete may resume.
Allow the injured athlete to stand, walk,
hop, jog, sprint, cut, and twist.
Test the uninjured side first for
comparison purposes.
Sports-specific activity tests determine if
the athlete can safely resume the
activities of a particular sport.
Injured athletes are asked to
demonstrate specific maneuvers and
actions of their sports, with appropriate
supporting devices such as taping.
Return to play criteria
 Full strength refers to muscles, ligaments,
and tendons being at 100% of pre-injury
 An athlete must be free from pain during
return-to-play performance tests.
 Skills required for the sports are tested,
starting at a low level of intensity and
gradually increasing until the athlete is
performing at game speed. If at any time
the athlete is not able to perform one of the
tests, the athlete is not ready to return to
the sport
Emotional recovery is just as important as
physical recovery/ counseling by the certified
athletic trainer or sports psychologist helps
the athlete work through any hesitation of
returning to play
Documentation of Injuries
Advantages of complete documentation
 One of the biggest reasons for complete
documentation is for the follow-up care
 Athletes are more likely to get the treatment they
need with proper documentation
 A profile of injuries in a sport can allow the
program director to recognize trends, which can be
shared with coaches who can then develop
strengthening and stretching programs that may
lower injury rates
 If a lawsuit is filed for negligence or malpractice,
good recordkeeping will help keep the facts
notes refer to a particular format
of recording information regarding
treatment procedures (subjective,
objective, assessment, plan)
 Subjective
○ The component that incorporates subjective
statements made by the injured athlete, often
obtained through history taking
 Objective Finding
○ include the certified athletic trainers’ visual
inspection, palpation, and assessment
Assessment of the injury
 certified athletic trainer’s professional
judgment and impression as to the nature and
extent of the injury
 First aid treatment rendered to the athlete and
the sports therapist’s intentions as to
disposition, which could include referral for
more definitive evaluation or simply application
of a splint, wrap, or crutches and a request for
reevaluation the next day
 The
daily sideline injury report is a way
to track every athlete who participates
in a sport.
 Data can later be analyzed by computer to
reveal injury patterns
 The
training room treatment log is filled
out by certified athletic trainers as they
treat athletes
 Everyone taped, wrapped, iced, and so on
should be documented
 Daily red cross list
 Used to inform coaches of the status of their
athletes from one practice to another
 After athlete returns to full practice and
competition, his or her name is removed from
the list
 An athlete medical referral form
 From the certified athletic trainer taken to the
doctor allows accurate communication
between the training staff and the physician’s

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