This chapter provides a comprehensive overview of the most common soft-tissue injuries seen in sport, including both closed and open wounds.

Sprains and strains are among the most common orthopedic injuries seen in athletes, both inside of the clinic and on the sidelines. This chapter will review the soft tissue’s response to injury as well as healing timelines for common sprains and strains.

The sports physical therapist has an obligation to respond quickly to soft-tissue and bleeding injuries in order to avoid further damage or significant loss of blood that could result in death. In this lab-based chapter, the sports medicine team of Katie Whetstone and Todd Arnold will show viewers how to respond appropriately in the case of significant soft-tissue injury, including the use of a tourniquet to stop severe bleeding.

In this chapter, Katie Whetstone delves into a life-threatening condition: shock. This chapter covers the types and causes of shock and relates each type of shock to athletic conditions. Different signs and symptoms of shock are discussed, and the important steps for treatment of shock are detailed.

Todd and Katie share their experiences with open and closed soft-tissue injuries in this question and answer session on emergency management of soft-tissue injuries.

This chapter will provide an introduction to heat-related injuries and the importance of quick and effective decision-making in the presence of harsh environmental conditions. In hot conditions, the body can often lose control of its thermoregulation, resulting in heat-related illnesses such as heat exhaustion, heat stroke, or death. This chapter discusses the importance of maintaining equilibrium in hot and/or humid conditions. We will also provide a basic review of the body’s mechanisms, such as sweating and shivering, that maintain normal body temperature in both hot and cold conditions.

The most common cold-related conditions athletes experience are hypothermia and frostbite. Hypothermia is described as a general cooling of the body, while frostbite is the freezing of body tissues. This chapter will describe the different stages of each of the injuries, as well as treatment and prevention options.

Outdoor sporting events pose a unique risk to the athletes, coaches, officials, and spectators due to the chance of lightning-related injury. This chapter will discuss the protocol for treating lightning injuries, including a safety assessment of the area, evaluation and treatment options, and prevention guidelines, including the flash-to-bang ratio.

Dehydration can affect the physical and mental performance of athletes and often is not recognized until after the athlete is dehydrated. This chapter will discuss signs, symptoms, and treatment strategies for dehydration, as well as tactics to get the athlete to remain hydrated throughout training and competition without becoming overhydrated.

Regardless of location, the illness and fatigue that often comes with travel can become very limiting to athletes at all ages and competition levels. For athletes who travel to areas of high elevation for sport and competition, altitude-related illnesses are likely and can lead to very serious conditions. This chapter discusses the signs, symptoms, prevention, and treatment of travel-related conditions such as altitude sickness and jet lag.

This chapter will introduce common conditions that are associated with sudden cardiac death and address athletic participation for those with known cardiovascular conditions. The use of preparticipation exams to screen for cardiovascular disorders will be discussed.

This chapter discusses the unusual situation of sickle cell trait in an athlete. Katie Whetstone covers exertional sickling, situations that affect sickling, and death as a result of sickle cell trait. Finally, this chapter covers the signs and symptoms of sickling, and precautions and treatment for athletes with sickle cell trait.

This chapter provides an overview of sudden cardiac death in athletes and discusses the role of the sports physical therapist in the emergency response to a cardiovascular-compromised athlete.

In this lab simulation chapter, Todd Arnold and Katie Whetstone will review the use of the most important tool available in cardiovascular emergencies: the automated external defibrillator.

It is inevitable that at some point, the sports physical therapist will be involved in the decision-making process of sending an athlete to the hospital through Emergency Medical Services. These are the scariest and most heart-pounding moments of performing sideline coverage at sporting events. Every move the sports physical therapist makes in these situations is crucial to the overall outcome for the athlete. When in a life-and-death emergency, the sports physical therapist’s decision-making needs to be conservative and second nature. This chapter will introduce the possible life-changing spinal and visceral injuries that can occur in sports. In addition, this chapter emphasizes the importance of an emergency action plan, informs the viewer of the essential components of an emergency action plan, and provides rules of evaluation for an injury on the sidelines and on the field.

When an athlete goes down and is not moving, the sports physical therapist must know how to perform an initial assessment and thorough but quick evaluation of the athlete to determine the nature of the injury. When considering potential spinal injuries, quick thinking and differential diagnosis are key. In this chapter, Katie Whetstone covers spinal anatomy and symptoms of various conditions involving the spine. In addition, a step-by-step approach to evaluation of the potential spinal injury is given.

In this lab demonstration, the sports medicine team runs to the side of an athlete who is down and is not moving. Viewers can follow along with the step-by-step initial assessment and evaluation of the athlete, which eventually leads to spine boarding and emergency transportation of the athlete.

This chapter covers a variety of visceral injuries and focuses especially on chest and abdominal injuries and their common referral patterns. Katie Whetstone emphasizes typical mechanisms of injury, signs and symptoms, and acute management for a variety of visceral injuries.

In this interview-style chapter, the sports medicine team of Todd Arnold and Katie Whetstone share their experiences in the acute management of spinal and visceral injuries prior to hospital transport.

In this introductory chapter, Katie Whetstone will provide a description of commonly seen skeletal injuries as well as key components of an acute assessment of the potential skeletally injured athlete.

Whether big bones or small, fractures are one of the more common injuries that the sports physical therapist will need to address acutely. Sometimes fractures can be relatively minor and easy to address, such as a fracture of a toe or finger; however, many times fractures are emergencies that can be associated with life-threatening conditions like shock and distress. In this chapter, Katie Whetstone will address the common types of fractures seen in the athletic population, as well as considerations for acute management of fractures when attempting to immobilize in the field.

Second to fractures, dislocations are among the most frequently occurring injuries seen during sporting events, especially during contact sports; however, sports physical therapists are limited in the acute management of dislocations. During this chapter on dislocations, Katie Whetstone will review the common joint dislocations that occur in sport, as well as the typical athlete presentation associated with dislocation. In addition, Katie will review the role of the sports physical therapist as it relates to treatment of acute joint dislocation.

Immobilization is the standard of care in the acute management of fractures and dislocations in the field. In this chapter, the sports medicine team will demonstrate the various types of splinting immobilization techniques.

Return-to-play decision-making after fractures can be complicated as it is multifactorial. In this chapter, Katie Whetstone will discuss typical bone healing times, weight-bearing precautions and restrictions, and general return-to-play criteria following a fracture or dislocation.

Protective equipment is our first line of defense against injury in sport, but in order to be protective, equipment must be utilized and worn correctly. In this chapter, Katie Whetstone will introduce the history of protective equipment in sports as well as the legal obligations of the sports physical therapist to utilize the protective equipment correctly.

This chapter will emphasize the types of head and face protection that are on the market by demonstrating helmets, face masks, jaw pads, mouth guards, eye protection, and more. Katie Whetstone and Todd Arnold will walk viewers through the steps of proper helmet fitting.

In this chapter, Katie Whetstone and Todd Arnold will show multiple options for neck, trunk, and thorax protection, including shoulder pads, cowboy collars, chest and rib protectors, protective cups, and more. The chapter also provides a demonstration of proper shoulder pad fitting.

Protection and braces for upper- and lower-extremity injuries are easy to purchase over the counter, but how does one know the correct equipment to buy and when medical grade or custom equipment is preferable to over-the-counter equipment? In this chapter, Todd Arnold and Katie Whetstone will discuss types of shoe wear, muscle protection, orthotics, guards, and braces for the upper and lower extremities.

In this chapter, the instructor reviews the most commonly cited theories of EAMC etiology in research. Research that supports each theory is provided. Understanding possible etiologies of EAMC provides the support to using traditional and nontraditional (emerging) treatment strategies.

Research from athlete and military populations that relates to each etiologic theory is presented. Risk factors that can be identified from the results will be selected, and the most likely clinical scenario for EAMC will be discussed.

In this chapter, the instructor reviews typical signs and symptoms of EAMC, and important signs that differentiate EAMC from similar conditions (e.g., exertional sickling).

Traditional treatments (e.g., stretching) and prevention strategies recommended in a consensus statement for EAMC are reviewed, with research support. Determination of when advanced medical care may be needed for EAMC is presented. Intravenous and oral hydration in the treatment of EAMC are compared.

Nontraditional, or emerging, treatments and prevention strategies for EAMC will be introduced, with research support if it exists. The foundation of how to develop an individualized plan of care for individuals with a history of EAMC using traditional and nontraditional treatments and prevention strategies is provided.

The etiologies of exertional heat exhaustion and exertional heat stroke in active populations are described. In this chapter, the instructor provides an explanation of why a continuum of the two conditions is a myth and reviews epidemiologic research into the prevalence of each condition.

Particular focus on the recognition of exertional heat exhaustion is provided in this chapter. The basic signs and symptoms of exertional heat stroke are also provided, but emphasis on key signs and symptoms of exertional heat stroke, exertional heat exhaustion, and other conditions (e.g., exertional sickling) is presented to improve differential diagnosis.

The instructor reviews on-site treatment of exertional heat illness along with the equipment needed. She also compares and contrasts intravenous versus oral hydration for the treatment of exertional heat exhaustion. You will also learn how to recognize when misdiagnosis of heat exhaustion may occur.

Research support of ice water immersion as the gold standard for EHS treatment is provided. Research regarding alternatives to cold water immersion are also discussed, along with the advantages and disadvantages of each treatment method.

The instructor describes and demonstrates each step of the treatment process (initial, during, and post) for exertional heat stroke. Equipment needed and logistics of each step are stipulated. You will also learn how to determine when it is safe for EMS to transport an EHS patient. Myths that commonly surround ice water immersion are also debunked.

In this chapter, the difference between extrinsic and intrinsic risk factors is clarified, and types of prevention strategies are defined. Research examining overall prevalence of exertional heat illnesses is also provided.

A description of the heat balance equation is reviewed, explaining why inappropriate work-to-rest ratios are a predisposing factor for EHI. Discussion of how to use the research results for the practical application of prevention strategies is presented. Examples of policy statements that can be used for different active populations are given.

An explanation of how organizational pressure can be a predisposing factor for EHI is provided. Wrong diagnosis, improper treatment, and lack of education are identified as risk factors for heat stroke deaths. Discussion of how to use the research results for the practical application of prevention strategies is presented. Examples of policy statements that can be used for different active populations are given.

In this chapter, the instructor describes why high environmental temperatures are a primary risk factor for EHI, as well as components of WBGT as a measure of environmental temperature. Various WBGT activity modification tables are presented, along with the advantages and disadvantages of each. How to measure WBGT is demonstrated and explained. Discussion of how to use the research results for the practical application of prevention strategies is presented. Examples of policy statements that can be used for different active populations are given.

Thermal stress demands that result from wearing uniforms are described with supporting research. Different uniform configurations (American football, baseball, military) are discussed. The instructor presents how to use the research results for the practical application of prevention strategies. Examples of policy statements that can be used for different active populations are given.

The difference between extrinsic and intrinsic risk factors is clarified. Types of prevention strategies are defined.

In this chapter, the instructor provides examples of which comorbidities may be predisposing factors for EHI and why. This chapter also discusses which medications affect hydration status and body temperature and therefore are predisposing factors. Examples of policy statements are given that can be used for different active populations.

The instructor will explain why being overweight is a predisposing factor for EHI, while debunking a common myth about this body type. This chapter will also present research as to the prevalence of overweight and obese individuals in active populations. This chapter will include a description of how an overzealous attitude can be a predisposing factor for EHI. Discussion of how to use the research results for the practical application of prevention strategies will be presented. Examples of policy statements are given that can be used for different active populations.

In this chapter, the instructor explains why febrile and gastrointestinal illnesses are predisposing factors for EHI. Research is discussed, as well as possible explanations for sleep deficits as risk factors. The chapter also reviews how an individual’s physical conditioning level can be a risk factor in certain exercise. There is a discussion of how to use the research results for the practical application of prevention strategies. Examples of policy statements are given that can be used for different active populations.

This chapter starts off with why hypohydration is a primary etiology for EHI. There’s also a discussion of the benefits of heat acclimatization. The instructor provides research supporting why inadequate heat acclimatization is a predisposing factor and discusses how to use the research results for the practical application of prevention strategies. Examples of policy statements are given that can be used for different active populations.

The definitions for sickle cell trait (SCT) and sickle cell disease (SCD) are provided with clear differentiation between the two. The origins of sickle cell hemoglobinopathies are clarified in historical context as well as global prevalance. An explanation of how SCT and SCD are genetically passed down is provided for clinicians to use when educating their patients.

The two most common ways to test for sickle cell trait are described. Advantages and disadvantages of both tests are discussed for clinicians to determine which is the best option for their institution. False positive rates of each test are also provided.

The typical hemoglobin profiles given on lab reports are broken down into types and ranges. Atypical profiles are presented to explain their significance in relation to SCT and SCD as well as other possible hemoglobinopathies.

The United States’ national newborn screening mandate for sickle cell hemoglobinopathies is reviewed along with basic information for how to obtain a copy of these records. Organization mandates for SCT screening are discussed in terms of testing and education. Examples of how to integrate SCT screening into institutional policy are provided.

The etiology and most common circumstances for exertional sickling are examined. The pathophysiology of how an exertional sickling event begins and how it can become a life-threatening emergency is demonstrated. Clinical ramifications of an untreated exertional sickling event are outlined.

Research pertaining to the prevalence of SCT in active populations is presented along with evidence supporting successful training and competition. Risk of death during exercise in individuals with SCT is reported in different clinical settings.

The definitions of exertional sickling events are described. Signs, symptoms, and vitals to be monitored during a sickling event are reviewed. Exertional sickling symptoms are compared to and differentiated from symptoms of other conditions that are similar.

When an exertional sickling episode is recognized early, treatment can improve the likelihood of quick return to activity. This chapter will outline each step that clinicians should take when intervening early and providing treatment to an athlete with known SCT status.

Similarities and differences in the treatment of more severe cases of exertional sickling are covered. Additionally, transport and hospital decisions are discussed to ensure that best possible care is provided when care transitions from the on-site responder. Information that should be conveyed to EMS and the receiving emergency department is provided.

The basic elements needed for return to activity in mild to severe cases are provided as well as how additional considerations may be needed in more severe cases. General guidelines for developing an institutional-graded return-to-activity protocol are given. Examples of when medical disqualification may need to be considered are provided.

Factors with external causes that increase the risk of exertional sickling are provided in addition to the physiological reasoning behind each factor. Physiological reasons include altitude, hyperthermia, acidosis, and pressure. After each factor is explained, one or more paired prevention strategies are recommended to reduce risk.

Factors with internal causes that increase the risk of exertional sickling are provided in addition to the physiological reasoning behind each factor. Physiological reasons include respiratory conditions, illnesses, poor sleep, inadequate nutrition, and hypohydration. After each factor is explained, one or more paired prevention strategies are recommended to reduce risk.