SAINS SUKAN

TOPIK 10
SPORT MEDICINE

OBJECTIVES:
To understand the important components and
stages of rehabilitation
To understand the criteria for return to play
To be aware of medical conditions affecting
athletes
To plan and institute measures for medical
preparedness during competition and travel

SPORTS MEDICINE LEVEL III

1. Rehabilitation of sports injury
2. Medical conditions in athletes
3. Medical preparedness for competition and
travel

 Definition
Components of Rehabilitation
Stages of rehabilitation

REHABILITATION OF SPORTS
INJURY
Rehabilitation is defined as the process of
restoration of the injured athlete to full
function as required by the sport.

Components of Rehabilitation

a) Muscle Conditioning
b) Flexibility
c) Neuromuscular Control
d) Functional Exercises
e) Sports Skills
f) Correction of Abnormal Biomechanics
g) Maintenance of Cardiovascular Fitness
h) Psychology

 *Integration of Individual Components into a

progressive rehabilitation program

Stages of rehabilitation
a) Initial Stage
b) Intermediate Stage
c) Advance Stage
d) Return to play

Initial Stage
RICE Treatment & Electrotherapy for pain
relief and minimising swelling
Isometric Exercises, followed by AROM & PROM
exercises to improve ROM, activate &
strengthen muscles;
* Type of activity, duration, Frequency, Intensity
and complexity depends on pain-free ROM.

INITIAL STAGE (CONTINUED)

Start with non-weight bearing (NWB) exercises
& progress to partial WB & full WB (FWB) for
stability & improves strength
Resistance exercises with theraband / light
weights helpful in strengthening & endurance
training

INTERMEDIATE STAGE
Prerequisites: Able to resume activities of daily
living, improved ROM & strength.
frequency of AROM & PROM,
Start stretching exercises & joint mobilisation to
promote flexibility (realignment of scar tissue)
the load & repetitions using free-weights, pulleys,
theraband, tubing, exercise devices - to strength,
power & endurance;
functional, closed kinetic chain exercises to
promote WB exercises

INTERMEDIATE STAGE
(CONTINUED)
Introduce more difficult proprioceptive & balance
exercises progressively;
Start sports specific activities without using affected
limb: e.g. stationary shooting (basketballer with
lower limb injury), footwork for badminton athlete
with shoulder injury.

INTERMEDIATE STAGE
(CONTINUED)
Lower limb exercises: supervised walking,
jogging, striding and agility
Upper limb exercises: supervised wiping
exercises, ball balance exercises, wobble board
exercises;
* Other treatment modalities e.g. joint mobilisation,
RICE, electrotherapy & massage therapy may
be utilised to promote progress.

ADVANCE STAGE
Prerequisite: Good strength & endurance with full
flexibility & ROM; improved proprioceptive, agility &
functional exercises without adverse effects;
Muscle conditioning specific to activity of sports:
power for sprinters & weight lifters (high load, low
repetitions); endurance for distance runners or
swimmers (low load, high repetitions);

ADVANCE STAGE
(CONTINUED)
Fast-speed isotonic exercises & functional
plyometric exercises; Progressive through a
sequence of functional activities required for the
sport: jogging, striding, bounding, agility skills of
increasing complexity intensity & volume. Ball &
racquet skills: stroke, lob, jab, smash;
Identify biomechanical abnormality & technique
faults (video analysis).
Participate in between 70-90% normal training load.
Introduce more sports specific skills progressively

RETURN TO PLAY
If an injured athlete returns to play (RTP)
prematurely
injury may be recurrent or chronic
injury may worsen
May predispose to other injuries

RETURN TO PLAY
An injured athlete may RTP if he fulfills these
criteria
a)completed specified duration of healing &
supervised rehabilitation program;
b)no persistent swelling and pain-free ROM;
c)adequate strength & endurance, good flexibility,
proprioception
&
balance;
adequate
cardiovascular
fitness;
regained
skills,
psychological mindset & training form for sports,
corrected biomechanical anomaly (if any).

MEDICAL CONDITIONS IN
ATHLETES

Asthma & Exercise Induced Asthma (EIA)

Gastrointestinal Problems
Athletes Hematuria
Menstrual Problems
Skin Infections
Contraindications to sports
Prevention of Infectious Diseases

ASTHMA & EIA

Bronchial Asthma: An attack of shortness of
breath, persistent cough, wheezing (high pitched
breathing), chest tightness; may worsen with
physical exercise;
Athletes with Exercise induced asthma has an
asthma attack during or after physical exercise.
May be triggered especially in the cold; during
URTI (Colds or flu), exposure to allergens and
irritants

ASTHMA & EIA (CONTINUED)

Require physical assessment & spirometry to
determine severity & treatment options for good
control.
Rx with Inhalers (require TUE Exemption), but
oral corticosteroids & bronchodilators are not
allowed.
Oral Leukotriene Antagonists (Singulair) does
not require TUE.
Rx of upper airway disease (e.g. Allergic Rhinitis
and Chronic Sinusitis) is beneficial.
Return to play: when athlete is asymptomatic

GASTROINTESTINAL PROBLEMS
Endurance runners often suffer from abdominal
cramps & diarrhoea during prolonged moderate
intensity exercise.
May be due to delayed gastric emptying time,
diminished blood flow to the large intestine,
reduced absorption of fluid during exercise.
Other symptoms are heartburn, nausea, bloating,
flatulence, rectal bleeding.
Treatment: Reduce training load & anti-diarrhoeal
medication.

ATHLETES HEMATURIA
Prolonged running may also predispose to
hematuria due to reduced blood supply to the
kidneys and increased renal parenchymal
permeation.
Symptoms usually resolves itself with reduced
training load or rest. However, the athlete will
need to be examined by a doctor to rule out
other medical conditions.

MENSTRUAL PROBLEMS
Female
athletes
who
suffer
from
dysmenorrhoea (period pain) may be offered
options of timing of menses before or after a
competition event. The athlete should consult a
doctor at least 1 month before the event to
ensure that intervention with oral contraceptive
pills could be attempted.

MENSTRUAL PROBLEMS
(CONTINUED)
Endurance athletes may occasionally suffer
from amenorrhoea (delayed period) due to
hormonal changes associated with increased
mileage (duration of training).
Prolonged periods of amenorrhoea (>6 months)
should be treated to prevent osteoporosis.
Refer to the doctor & nutritionist if Female
Athletes
Triad
(amenorrhoea,
anorexia,
osteoporosis) is suspected.

SKIN INFECTIONS
Skin infections (e.g. tinea infection, impetigo,
viral warts, herpes simplex) are common
amongst athletes in contact sports (e.g. rugby,
soccer, wrestling).
Athletes with such conditions should be
adequately treated and symptom free before
return to play.

SUDDEN CARDIAC DEATH

Sudden cardiac death is an uncommon
occurrence causing an athlete to collapse &
die during exercise .
Athletes who are < 35 yrs old may have
structural
congenital
heart
lesion
(hypertrophic cardiomyopathy).
Athletes > 35 yrs old may collapse due to
Coronary Arterial Disease.
Other causes are heart valve structural
problems or disease or arrhythmia.

CONTRAINDICATIONS TO
SPORTS
In certain medical conditions, participation in
sports may predispose the athlete to further
harm and danger. It is the responsibility of the
coach to identify situations that may put the
athlete at risk and act accordingly. The coach
must consult the Medical Officer if the athlete
has the following contraindications:

CONTRAINDICATIONS TO
SPORTS (CONTINUED)
Absolute Contraindications
Sensory: Detached Retina, Severe hearing
loss (tympanic perforation), severe myopia,
Seizure disorder (depends on sport),
Concussion; Brachial Plexus Injury;
Spine: Spondylosis, Spondylolisthesis,
Cervical Spine Instability, Cervical Stenosis,
Herniated Disc with Cord Compression;
Abdominal: Enlarged liver or spleen, Active
hepatitis, Inguinal hernia;
General Illnesses: Acute Febrile Illness,
Uncontrolled Diabetes, Severe and Moderate
Hypertension,
Cardiovascular: Coronary Arterial Disease,
Valvular Heart Disorders, Cardiac
Arrhythmias;
Pulmonary: Pneumothorax, Hemothorax,
Tuberculosis,
Blood disorder: Hemophilia & bleeding
tendencies; severe anaemia;
Skin: Herpes Simplex, Measles, Chicken Pox,
viral warts, tinea infection (fungal);
Single Organ: Eye, Ear, Kidney, testicle (for
contact sports)

Relative
Contraindications
Hypertension,
Diabetes Mellitus,
hyperthyroidism,
anaemia;
Delayed Onset Muscle
Soreness, Cramps,
Overuse injuries:
tendinopathy, mild
osteoarthritis;

PREVENTION OF INFECTIOUS
DISEASES
Infectious diseases can be transmitted during
sporting activity. Modes of transmission in
athletic settings include
a.Person-to-person contact,
b.Food & Water Borne
c. Airborne/droplet spread
d.Vector Bourne

PERSON-TO-PERSON CONTACT:
HIV, Hepatitis B, Herpes Simplex, Gonorrhoea,
Syphilis, Candidal infection may be transmitted
sexually
Preventive measures:
a. Vaccination (Hepatitis B)
b. Safe sex: single partner, barrier methods
(condom), avoid unnatural practices
c. precautions of contamination from wounds (gloves,
wound dressing)
d. personal hygiene

PERSON-TO-PERSON
CONTACT (CONTINUED)
Viral warts; Taenia Infection; Onychomycosis;
Impetigo; may be transmitted by skin contact
Preventive measures:
a.Isolation and treatment of infective athlete
b.Closing affected area of skin
c. Hand washing
d.Personal Hygiene

FOOD & WATER BORNE:

Acute Gastroenteritis; Typhoid, Hepatitis A,
Cholera;
Preventive measures:
a)Hand washing
b)Drinking boiled water
c)Hygienic food preparation & food handling
d)Vaccination (Typhoid, Hepatitis A)

AIRBORNE / DROPLET
SPREAD:
Haemophilus Influenza A and B (flu), Coxsackie
Virus;
Preventive measures:
a)Vaccination (if available)
b)Avoid contact with ill athlete
c)Hand washing
d)Personal Hygiene

VECTOR BOURNE:
Dengue fever, Chikungunya, Malaria, Yellow
Fever;
Preventive measures:
a)Insect repellent and larvicide (e.g. Abate)
b)Long-sleeve attire and mosquito netting
c)Malaria prophylaxis: Malarone or Mephaquin
tablets
d)Vaccination: Yellow fever

MEDICAL PREPAREDNESS:
COMPETITION & TRAVEL
Pre-event preparation
Event Coverage
Preparation for travel

PRE-EVENT PREPARATION
Sports injuries & medical emergencies can
be prevented with adequate preparation
before the sporting event.
The role of a coach is essential in ensuring
that the risk of such injuries & emergencies
are minimised.

ROLE OF COACH:
Ensure athlete undergoes pre-participation medical
examination
Identify athletes medical conditions & injury
Identify nutritional supplements & medication used by
athletes. Inform Medical Officer & notify Anti-Doping
Agency (MASDOC)
Appoint Medical Personnel responsible for the team
Inform injury risk & medical conditions
Prepare first-aid box, taping kit & coolman (Ice box)
Identify medical facilities & support (include referral)
available at the event
Identify time for food intake, warm-up, cool-down &
rest

EVENT COVERAGE
a) Identify medical facility & person-in-charge at the
venue
b) Ensure that Medical Personnel is present during
warm-up & cool-down
c) Ensure that athletes are well-hydrated
d) Ensure that open wounds are covered with wound
dressing
e) Tape injured parts before warm up and ensure
tape is removed after cool-down
f) Ensure that protective devices are properly applied
by athletes
g) Accompany injured athlete to hospital (if medical
personnel is not available)

PREPARATION FOR TRAVEL

a) Pre-participation medical examination to certify fitness
of participation & to identify risk of injury & medical
conditions
b) Vaccination of team members (at least 2 weeks prior to
travel)
c) Briefing of team members
d) Planning of duration of stay before competition to
prevent jet-lag
e) Sleep hygiene during travel: adjust to time of
destination, avoid alcohol intake, carbonated drinks &
fatty foods
f) Prepare medical first-aid kit, taping kit & coolman (ice box)
g) Arrange for Insurance Coverage during travel & competition
*NB: Some insurance policies do not cover for participation in
competitive sports