What To Do In Case Of Emergency | Injury Management For Coaches

When muscles, tendons, or ligaments are damaged, blood vessels in the area are also torn, and bleeding spreads rapidly into adjacent tissues. The bleeding causes swelling, placing increased pressure on surrounding tissues, which become tense and tender. The increased pressure causes pain in sensitive tissues, and the combination of bleeding, swelling, and increased pressure can adversely affect and delay the healing process.

Once bleeding has been controlled, some blood remains in the tissues and has to be resorbed. This function is performed mainly by the lymphatic system. A variable amount of scar tissue forms in the area and constitutes a weak spot in the injured muscle, tendon, or ligament. If too early or too heavy a load is applied to this scar tissue, injury is liable to recur.

Sports injuries may take so many different forms that it is impossible to create a standard protocol for their management. Certain guidelines for immediate treatment can, however, be drawn up.

– Listen to the injured athlete’s description of how the injury occurred and what symptoms are present.

– The injury should be examined in the light of the history. Is there any bleeding, swelling, an open wound, or any other abnormal sign?

– A simple functional assessment of the injured part should be made. Can the injured athlete carry out normal movements of the part (with or without a load) without pain?

– The area around the injury should be examined. Is there tenderness in soft tissues or bone? Can a defect be felt in any soft tissue?

If there is swelling and tenderness together with pain when movements are made or a load is applied, treatment should be started as follows.

Compression

A compression bandage is intended to provide counter-pressure to the bleeding developing within the injured area, so that the body’s own functions can take effect more easily. A compression bandage is an elastic bandage applied with careful tension. It should be applied as soon as possible. It is convenient to position an ice pack with the aid of an elastic bandage so that cooling and compression effects are achieved simultaneously. The compression bandage should be kept in position usually for another 2 days after cooling has ceased, provided the location and extent of the injury allow it.

Ice

When soft tissue injuries occur, the first priority is to attempt to stop the bleeding, since this results in swelling, pain, and tenderness. Therefore, in soft tissue injuries, reduce the extent of the bleeding by compression bandaging, rapid cooling, an elevated position of the injured limb, and rest. This enables the body's self healing mechanisms to take effect more easily. The use of ice on the injured body tissues brings about:

– a local pain-relieving effect which makes the injured athlete feel better and may encourage a return to sporting activity. Here trainers and coaches have a great responsibility: if an injury needs cooling it is probably of such severity that further exertion will only delay healing. Common sense should prevail;

– contraction of the blood vessels so that the blood flow is reduced in the injured area. The effect of the treatment is limited and does not really start for 15 minutes. Less swelling may occur and healing proceed more rapidly.

***Heat treatment should not be started until at least 48 hours after the injury has occurred. 

The same applies to massage.***

Ice is usually applied for 15–20 minutes per treatment and may be applied hourly for the first 24–72 hours after the injury. During each application of cold therapy, four progressive sensations will be experienced: cold, burning, aching, and numbness.

***Ice therapy has mainly a pain-inhibiting effect. Icing will therefore mask the real extent of the injury. There

is a great risk that an injury will get worse if the athlete resumes activity after cooling.***

Rest

It is generally true to say that an injured athlete should rest the injured part for 24–48 hours and that it should not be subjected to loading. It follows, therefore, that the athlete should be assisted from the scene of the injury and taken home or to a doctor, as soon as possible. Crutches are usually very helpful.

Elevation

When an injured part is elevated, its blood flow is reduced, and expelled blood is transported away from the site of injury more easily, thus reducing swelling. An injured leg that is elevated should be supported at an angle of more than 45° when the patient is lying supine. Four or five cushions or a stool placed under the leg will achieve this effect. In cases of extensive bleeding and swelling the injured part should be kept elevated for 24–48 hours if possible. Subsequently, it should be elevated whenever the opportunity arises.

Pain relief

Cooling, compression, and rest usually provide relief from pain in soft tissue injuries. Pain-relieving medication may be given if the examination is complete but should be avoided in the early stages as it can complicate further treatment if continued analysis and medical examination are required.

Injured athletes should seek a medical opinion within 24–48 hours in cases of:

– persistent symptoms arising from injuries to muscle, tendon, joint, or ligament;

– severe pain.

It is generally true to say that a doctor should be consulted if there is any uncertainty about the diagnosis, and thus the treatment, of any sports injury.

A medical opinion should be sought urgently in any of the following circumstances:

– unconsciousness or persistent headache, nausea, vomiting, or dizziness after a head injury;

– breathing difficulties after blows to the head, neck or chest;

– pains in the neck after impact, whether or not they extend to the arms;

– abdominal pain;

– blood in the urine;

– fracture or suspected fracture;

– severe joint or ligament injury;

– severe muscle or tendon injury;

– dislocation;

– severe eye injury;

– deep wound with bleeding;

– injuries with intense pain;

– any injury in which there is doubt about its severity, diagnosis or treatment.