Sports Medicine

1. Explain how modifying rules and matching of opponents by growth and development or skill level can promote safe participation for children. (8 Marks)

A modification can be described as a small alteration, adjustment, or limitation towards a specific action, concept or sport. The matching of opponents is the equalising of children of comparable sizes within their sport, to ensure safe and fair play. By modifying the rules and the matching of opponents by growth and development or skill level can beneficially promote safe participation and fair play for children.

Many major modifications have been made particularly to children’s sports, to accommodate to their specific needs, including skill level and equipment used. It is easily recognisable that children will not automatically have the ability to participate in sport activities at the same standard to that of an older athlete, merely due to their stature and limited capabilities. Due to this, modifications of equipment size, court dimensions, rules and playing environment are put into place to enhance the children’s willingness and enjoyment towards participating in the sport.

Rugby League is an example of a sport that has actively modified the rules of the game to accommodate to the needs of children involved in the sport. The development of “Mini Footy” (for children from under 6’s to under 8’s) has numerous modified rules including decreasing the size of the ball – “Mini Ball”, smaller goal posts and smaller fields (the field measures 68 metres x 30 metres) which are used to help provide a safe environment for the participants.

Other modifications of the rules are included in scrums, tackling and playing of the ball. Tackling is not allowed in majority of Mini Footy however in the older divisions of Mini Footy ‘gentle’ below the shoulder tackling is allowed, with exclusions of tripping and shoulder barging.

If a scrum is to occur only 3 players from each side are to be correctly bound in the accepted fashion, no pushing, pulling or rotating of the scrum is allowed and on other occasions when a scrum would have been set the ball simply “changes hands” and the non-offending side plays the ball. When playing the ball the regular rules apply, however, there are no markers allowed. It is due to these modifications of rules that children’s participation in Rugby League or “Mini Footy” help them learn more readily by playing in an environment suitable for them where greater involvement is allowed and where less pressure is present. This therefore allows children to acquire the fundamentals of the game and successfully promotes safe participation.

The matching of opponents by growth and development or skill level is an important factor in promoting safe participation in sports for children. To promote safety, it is very desirable to match children with others of comparable size. However this problem can be relatively difficult to address because most schools and junior sport controlling bodies match teams on age. This is convenient because birth certificates are readily available, although there can be vast differences in physical maturity between individuals of the same age. For many years, there has been widespread discussion about differences in the growth and development of young athletes.

Rugby League provides a good example to the promotion of safety through the matching of opponents by both growth and development characteristics. It has been more recently that the matching of opponents is again allowed within this sport (mostly at a lower level). This can be seen through the permits to go down an age group if you are under a specific weight, or go up if you are over a specific weight and have acquired the skills needed, for example in the under 17’s if a player is under the weight or on the weight of 60 Kilograms then they have the choice to go down an age division.

This predominately creates a safer playing environment, as the force applied from a defender who is much heavier in mass and is taller, in contrast to an attacker who is of a relatively small build and weight, can potentially cause serious harm and puts the players at higher risk of injury during both training and playing. Without the matching of opponents, particularly in Rugby League amongst other sports, creates the pressure to reach a certain standard of weight or muscle strength to perform at the same level as your peers, this detrimentally can result in participants taking Anabolic Steroids to promote tissue growth and enhance muscle growth. It is due to Rugby League associations allowing the matching of opponents that a safer environment is created and the promotion of fair play is acknowledged.

2. Justify rehabilitation procedures that are used for either a hamstring tear or a shoulder dislocation. In your answer ensure all relevant examples are used and all syllabus points covered. (8 marks)

Rehabilitation is the process of restoring the athlete to the pre-injury level of physical fitness. It involves mobilisation, stretching, conditioning, taping training and testing as part of the assessment process. In order to reach the stage of being completely healed and returning to play, it is vital that a proper rehabilitation plan is followed throughout different stages. The time that it takes to reach this state of being completely healed varies for every injury and is dependent of the severity and the person. There are four main aspects of rehabilitation procedures, this includes- Progressive mobilisation, graduated exercise (stretching, conditioning, totally body fitness), training and the use of heat and cold.

Progressive mobilisation includes following the procedure of the RICER method (Rest Ice Compression Elevation Referral) and involves gradually extending the range of movement through which the injured part can be manipulated, this is continue until the part is fully functional. Graduated exercise includes stretching, which is import to ensure that it heals without scarring which shortens the muscle and makes it prone to further injury. It also includes conditioning, which acknowledges that a rehabilitation program needs to be individualised to the needs of the athlete, and implies a build-up in fitness as a result of adaptions to gradual increases in physical stress.

Lastly graduated exercise also includes total body fitness which is regaining the level of mental and physical fitness reached by the athlete before the injury occurred, this means the training program must progressively and gradually overload the muscle groups and energy systems so that the required adaptations are regained before competition is recommenced. Full Training can begin only once total body fitness is achieved, this involves participating in warm-up, conditioning, drills, skills development, exercises, tactics and cool-down, in a pain free environment. The use of heat and cold on injuries has always been controversial. Generally, cold can be applied for anything up to four days following injury and may be required at other times to reduce inflammation.

Cold is usually applied to an injury: during the initial phase of injury treatment, after therapeutic exercise of injured sites. 
Cold applied to an injury has the physiological effects of decreasing: swelling, circulation to the injured site, acute inflammation. Heat is not generally used for two or three days after injury, depending on the injury type and the extent of the damage inflicted. The shoulder joint for example, is the most frequently dislocated major joint of the body and all of these rehabilitation procedures apply to this injury from when it is sustained. Dislocations typically occur when an impact causes an abduction or extreme rotation and the head of the upper arm bone (the humerus) pops out of the socket. The shoulder can dislocate in any direction. Pain is intense and common. Swelling, numbness, and weakness soon follow.

The immediate treatment of a shoulder dislocation is to place the patient in a sling to allow the swelling and inflammation around the shoulder to subside the pain endured following the procedure of the RICER method (progressive mobilization). Following relocation of the shoulder, most patients heal well with appropriate physiotherapy treatment. The success rate of treatment is largely dictated by patient compliance. Treatment for a dislocated shoulder usually entails an initial period of approximately 3 weeks immobilization in a sling to allow the damaged connective tissue to heal and form a ‘scar’. During this period of immobilization, gentle pendular exercises are allowed as guided by a physiotherapist, this can be considered as graduate exercise. When the dislocation occurs, damage can lead to a tendency to have repeat dislocations.

Bracing is sometimes considered for patients, who sustain a shoulder dislocation, to help prevent another dislocation. A brace is most commonly used for an in-season athlete who sustains this injury and allows the athlete to train, which helps them regain total body fitness both mentally and physically this may be used when full training recommenced, the use of cold is commonly used through applications such as ice massage and ice water immersion. Cold is usually applied to an injury: during the initial phase of injury treatment, after therapeutic exercise of injured sites. 
Cold applied to an injury has the physiological effects of decreasing: swelling, circulation to the injured site, acute inflammation.

3. Critically examine policies and procedures that regulate the timing of return to play. Discuss why the same policies aren’t applied to each sport. (6 Marks)

The decision regarding when a player can return to play varies from one sport to another. In many amateur sports, individuals make a decision in consolation with their doctor, physiotherapist or sports trainer. At the professional level policies normally exist that suggest a set of procedures to be followed to prove that a player is free of injury. At this level, having players return to play only to suffer a recurrence of the injury can be expensive both monetarily and in term of team performance. Due to this being acknowledged, the policies and procedures that are put into place are to be followed and precautions are to be taken. In the case of head injuries for example a concussion, a medical clearance is essential. There are varies factors that contribute to regulating the timing of return to play which effect the policies and procedures put into place.

In the case of student-athlete sustaining an injury, a visit with the doctor for any medical condition, regardless if the Parent, Coach or Athletic Trainer initiated it, that student-athlete must provide clearance from the doctor. This clearance will clear the student-athlete back to the care of the Athletic Trainer who will provide return-to-play clearance to their sport. In many cases, if the athlete has been out of play because of an injury for several days, that student-athlete must go through the return-to-play protocol set by the schools athletic trainer. The athlete must be able to perform the functional duties of their sport and be mentally sound in performing their sport. In most cases, the athlete will need to complete one full practice before they are allowed to re-enter games or matches. This is a policy and protocol to be followed by Coaches and teachers of Primary and High School sporting teams and PE programs.