Sports Injuries
Task 2
Access to Sports Science
Patrick Leslie
This case study will discuss the injury suffered by David Beckham at his series A game for AC Milan in march the 14th 2010, during which Beckham completely ruptured his left achilles tendon.
The nature of the Injury, chronological treatment and rehabilitation, and chronological physiological responses will be discussed separately.
Injury:
The Achilles tendon, referred to anatomically as calcaneal tendon, attaches the plantaris, grastrocnemius and soleus muscles to the calcaneus bone (webMD, 2017). This injury would be classed as a third-degree injury, due to the severe pain, full rupturing of tissue, the high amounts of joint instability it would produce and the severe limitation to the range of motion.
The incident in which Beckham ruptured his Achilles tendon was during a game, where he put his left foot back loading weight on to it whilst his knee was bent, creating an excessive amount of muscle lengthening, which lead to the muscle rupture, immediately followed by him limping unable to bend his knee or utilise plantar flexion or extension to move correctly.
This injury can occur commonly amongst elite athletes who participate in disciplines that involve a consistent element of running over an extended period of time, a study in over one thousand two hundred former elite athletes concluded that participated in these disciplines are at high risk of suffering a achilles tendon rupture (Kujala et al., 2005)
Physiological responses
1)Acute phase
The physiological responses displayed immediately in this phase are inflammation, local heat and swelling, the athlete will experience pain and loss of function/mobility in the affected area.
Vasoconstriction will occur during this phase, the narrowing of blood vessels will curtail the loss of blood, enabling the initiation of clotting and leading to hypoxia and necrosis (death of tissue) due to the lack of blood and oxygen.
Finally, vasodilation will also occur in this phase, after vasoconstriction and as a consequence of the chemicals released by the body, it will increase blood flow causing swelling to the area affected stimulation nerve endings causing pain in the area, the broken blood vessels will also
create hematoma in that region. This physiological reaction will also accelerate the arrival of cells that will remove dead cells and infectious agents.
2)Repair and Regeneration Phase
This will take place in the two days following injury and through the next six to eight weeks.
It will begin when the hematoma has diminished in size allowing growth of new tissue, except for skin tissue, all other soft tissue will replace damaged cells with scar tissue.
Fibroblasts will accumulate producing scar tissue and beginning the healing process, with these producing immature collagen. The tissue formed (scar tissue) will be less strong and functional than its parent tissue.
3)Remodelling phase
This phase will begin about three weeks after the injury, overlapping the previously discussed phase and will continue for up to a year or more. During this phase the newly formed tissue that was previously weaker and less functional will mature, taking full capacity of its parent tissue.
There will also be a decrease in fibroblast activity, organisation of tissues will increase and normal chemical activity of the body and parent tissue will resume.
Treatment and Rehabilitation
1)Immediate post-injury stage
Following the trauma, immediate intervention takes place, the initial process having seen the injury occur would be to make an accurate assessment of the damage taken, for this process SALTAPS (Barker et al.,2014) is used:
See the injury take place.
Ask questions about the injury, where it hurts.
Look for specific signs or symptoms: swelling, bruising, in some cases foreign objects.
Touch, feel the injured area to identify pain sources and swelling.
Active movement, ask the injured if they can move the injured part without assistance.
Passive movement, if they can, take the part through full range of movement carefully.
Strength testing, can the athlete stand or put pressure on the injury?
Immobilisation is a must following SALTAPS, specifically for the athlete to travel ensuring the injury does not suffer further damage.
2) Acute phase (Surgery to 2 weeks after surgery)
In this particular scenario, the injury was assessed and required immediate surgical intervention, taking place the next day (sportmedbc.com., 2010).
It is widely recommended to follow the application of RICE protocol during the acute phase of an injury in order to begin the healing process:
Rest: Proven by studies on the effects of immobilization on tissue healing, however immobilisation should be limited to the first few days, allowing scar tissue to connect injured muscle stumps to tolerate contraction generated forces without damaging again (Jarvinen, 2005).
Ice: The exact physiological responses have not been fully proven, as such effective evidence based treatments are yet to be established, some evidence has been shown that the early use of cryotherapy results in smaller hematoma, decreased inflammation, and accelerated early regeneration within tissue cells (Järvinen et al., 2007).
Compression: It is recommended compression and ice are applied in twenty minute rotations, resulting in a decrease of intramuscular temperature and a fifty percent reduction of intramuscular blood flow (Järvinen et al., 2007), however it is open to debate if compression applied immediately after trauma accelerates the healing process (Thorsson et al., 2007).
Elevation: Physiology and traumatology principles state the elevation of an injured extremity higher than the heart diminishes the accumulation of interstitial fluid (Jarvinen, 2005).
Whilst RICE (Rest Ice Compression Elevation) is referred to as an essential factor in treating injuries in the early stages of injury to control muscle swelling and inflammation, research has found little evidence in its capacity to be beneficial during this process (Van den Bekerom et al., 2012).
3) Sub-acute phase (2 to 4 weeks post-surgery)
During this phase whilst the priority is to avoid excessive stress on the injured area to avoid inducing chronic injuries by reinjuring the affected area, some mobility work will be done under the monitoring of a sports therapists.
Going through range of movement patterns without load bearing or the response of ground force reaction and progressing slowly to small isolation patterns to start strengthen scar tissue slowly.
Ultimately the objective in order to accelerate healing process is to progress into full weight bearing exercises, as concluded in a study that compared twelve randomized trials, five comparing full to no weight bearing, three compared full weight bearing and early mobilization to cast immobilization and the other four compared non weight bearing mobilization to immobilization, results conclude that the best combination in order to achieve accelerated healing of a Achilles rupture without risk of rerupture was a pairing of bot full weight bearing and early mobilization progressive patterns after the first two weeks post-surgery (Brumann et al., 2014).
In cross study with over twelve different research projects involved the results conclude the benefits of operational rehabilitation from an early stage of achilles tendon rupture far exceed those of non-operational rehabilitation. furthermore, those subjects that utilised a functional brace post-surgical intervention had a faster recovery of completely functionality of the joint as well as a far lower risk of recurrent injuries in this area (Khan et al., 2005)
Injury prevention
A key element to discuss regarding achilles tendon rupture prevention is stretching and warming up prior to performing the specific activity, in this case football. A study conducted on fifty males split into three groups being no warm up, static stretching relevant to the achilles tendon and a third group warming up with a ten-minute run.
The results display the groups performing static stretching displayed increased muscular compliance, which could be relevant to injury prevention, on the other hand the warm up run group proved to elicit more force suggesting this could lead to further performance enhancement (Rosenbaum and Hennig, 1995), however further research should be conducted to proof If a combination of both could increase performance and reduce injury risk simultaneously.
Bibliography
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Brumann, M., Baumbach, S., Mutschler, W. and Polzer, H. (2014). Accelerated rehabilitation following Achilles tendon repair after acute rupture – Development of an evidence-based treatment protocol. Injury, 45(11), pp.1782-1790.
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Thorsson, O., Lilja, B., Nilsson, P. and Westlin, N. (2007). Immediate external compression in the management of an acute muscle injury. Scandinavian Journal of Medicine & Science in Sports, 7(3), pp.182-190.
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