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Mark A. Merrick and Nicole M. McBrier


Acute musculoskeletal-injury management largely focuses on inhibiting secondary injury, although the data describing secondary injury and the timeline for its progression are sparse.


To describe the timeline and early progression of secondary injury in skeletal muscle over the first 5 h after blunt trauma.


A controlled laboratory study with 2 independent variables (injury status and postinjury time point) in a 2 × 21 factorial.


University research laboratory.


168 male Sprague Dawley rats (250 to 275 g).


Uniform blunt-contusion injury was caused to the right triceps surae using a drop-weight method; the contralateral limb served as an uninjured control. Both triceps surae were excised and flash frozen at 21 intervals across 5 h postinjury (8 animals, each 15 min).

Main Outcome Measures:

Cytochrome-c oxidase activity via reduction of triphenyltetrazolium chloride (TTC) to triphenyl-formazan.


There was an interaction effect (P = .041) between and main effects for both injury status (P < .0005) and postinjury time point (P = .038). In the first 30 min after injury, uninjured tissues did not differ from injured tissues, and both displayed TTC reduction rates in the vicinity of 7.1 ± 0.94 μg · mg−1 · h−1. Statistical differences between uninjured and injured tissues became evident starting at 30 min. TTC reduction for uninjured tissues did not change, but injured tissues declined in a roughly linear fashion across the entire 5-h period to 4.8 ± 1.04 μg · mg−1 · h−1.


Cytochrome-c oxidase activity, an indicator of oxidative phosphorylation and mitochondrial viability, is diminished by events that follow muscle trauma. Loss of this enzymatic activity becomes statistically evident at 30 min postinjury and continues linearly for at least 5 h. This suggests that secondary injury is a slowly developing problem of more than 5 h duration. A window of opportunity for intervention may lie somewhere within the first 30 min after injury.

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Neil Maguire, Paul Chesterton and Cormac Ryan

Context: Pain education is a fundamental part of a holistic approach to athlete injury management. Objective: To investigate the effect of pain neuroscience education (PNE) on sports therapy and rehabilitation students (1) knowledge of persistent pain, (2) attitudes toward athletes with persistent pain, and (3) clinical recommendations for athletes with persistent pain. Design: Parallel groups, single-blind randomized control trial. Setting: A university in the United Kingdom. Participants: Sixty-one undergraduate and postgraduate sports therapy and rehabilitation students. Interventions: The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. Outcome measures: (1) Knowledge—the Revised Pain Neurophysiology Questionnaire; (2) Attitudes—the Health Care Pain Attitudes and Impairment Relationship Scale; and (3) Clinical recommendations—an athlete case vignette. Results: Posteducation, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2; 95% confidence interval [95% CI], 2.1 to 4.3; P < .01) and improved attitudes (mean difference −10.1; 95% CI, −16.6 to −3.6; P < .01). In addition, students in the PNE group were more likely to make appropriate clinical recommendations (odds ratio [OR]; 95% CI) regarding return-to-work (OR = 6.1; 95% CI, 1.1 to 32.3; P = .03), exercise (OR = 10.7; 95% CI, 2.6 to 43.7; P ≤ 01), and bed rest (OR = 4.3; 95% CI, 1.5 to 12.8; P = 01). Conclusion: A brief PNE session can, in the immediate term, increase sports therapy and rehabilitation students’ knowledge of pain neuroscience, improve attitudes toward athletes with pain, and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.

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Cordial M. Gillette and Mark A. Merrick

as well as structural components of the cell, eventually leading to cellular necrosis. 7 , 18 The use of cryotherapy suppresses the cell’s metabolic demand, allowing it to better survive the hypoxic period. 1 , 13 , 19 Typical acute injury management with cold has 3 components—ice, compression, and

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Leanne Sawle, Jennifer Freeman and Jonathan Marsden

. 10 The use of compression garments as a postexercise adjunct to recovery has been reported as beneficial for performance recovery and delayed-onset muscle soreness. 11 , 12 However, there is a paucity of research in the field of compression and injury management. Of the work undertaken in this

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Nicole J. Chimera, Monica R. Lininger and Meghan Warren

sports trainer, who logged this data into Sports Injury Tracker (GippSport, Victoria, Australia). Sports trainers (provide on-site first aid and acute injury management; mandated to attend courses on first aid, taping, and injury management through regulatory bodies such as Sports Medicine Australia

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Megan Elizabeth Evelyn Mormile, Jody L. Langdon and Tamerah Nicole Hunt

statement highlights pediatric and adolescent concussion as an injury that may require a longer recovery and return to play progression than that of adults. 11 With regards to injury management and return to play, the NATA position statement specifies the collaboration of athletic trainers, school

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Jill Alexander and David Rhodes

skin surface initially to achieve physiological responses. 10 A therapeutic skin surface temperature ( T sk ) target range of between 10°C and 15°C is essential to initiate those essential responses to aid acute injury management. 11 Modalities of cooling differ in thermodynamic properties and

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Richard J. Boergers, Thomas G. Bowman, Nicole Sgherza, Marguerite Montjoy, Melanie Lu and Christopher W. O’Brien

neutral sagittal cervical alignment after football helmet removal during emergency spine injury management . Spine J . 2012 ; 37 ( 8 ): 654 – 659 . doi:10.1097/BRS.0b013e31822da067 10.1097/BRS.0b013e31822da067 9. Horodyski M . Care of the spine-injured athlete- recent changes in emergency protocols

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Tomomasa Nakamura, Yuriko Yoshida, Hiroshi Churei, Junya Aizawa, Kenji Hirohata, Takehiro Ohmi, Shunsuke Ohji, Toshiyuki Takahashi, Mitsuhiro Enomoto, Toshiaki Ueno and Kazuyoshi Yagishita

hand, jump-landing is a common cause of lower limb injury. Management of body balance during jump-landing will contribute to enhancing not only sport performance 19 , 20 but also injury prevention. 21 There are few reports investigating the relationship between teeth clenching and sport performance

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Tywan G. Martin, Jessica Wallace, Young Ik Suh, Kysha Harriell and Justin Tatman

Sport-media outlets portray sports-injury management accurately. H (2) = 5.45, p  = .07 H (2) = 1.80, p  = .41 H (2) = 1.68, p  = .43 Sport-media outlets use accurate terminology when reporting on concussions. H (2) = 4.39, p  = .11 H (2) = 7.34, p  = .03 H (2) = 2.29, p  = .32 Sport-media outlets