Sports Medicine: First Aid kit for Coaches & Non-Medical Personnel
Every team or individual participating in an athletic event or competition should have access to a first aid kit. In general, commercial kits do not cover the specific needs of athletes and are relatively expensive compared to custom-made kits.
A regular medical bag can be used, but a backpack with dividers or a small soft-sided case with a zip open top might be better alternatives. These latter two are more easily carried and washable when they become dirty.
The following items make up a basic first aid kit for almost any sport. Quantities are not given because of variations of team sizes and needs.
Arm sling (triangular bandage is fine)
Band-Aids, assorted sizes and shapes
Betadine or Hibiclens scrub
Elastic tape, 2”
Elastic wraps, 2”, 4”, 6”
Foam padding, assorted thickness
Non-stick wound dressing (telfa) pads, 3X4
Plastic bags for ice/instant ice packs
Several quarters for emergency phone calls
Sterile gauze pads, 3X3 or 4X4
Steri-strips, 1/8” to 3”
Vaseline or skin lube
White tape, 1”, 1 ½ “
It is preferable to use regular ice instead of instant ice packs for injuries. While the instant ice packs are certainly more convenient, they can be troublesome if they break. The chemicals in the ice packs burn if they come in contact with the skin.
Every kit should have a card with emergency telephone numbers listed. If the team has some athletes who are minors, this card should include the phone numbers where parents or guardians can be reached. If there is no phone near the practice or competition site, you may consider getting a cellular phone.
For basic medications, the following are legal USOC drug testing standards when used with only the listed ingredients:
Antacids Acetaminophen Aspirin Ibuprofen
Minors should not be given medications without parental consent. Therefore kits for youth sports should not contain any medications.
Cryotherapy is the use of cold for therapeutic treatment of injuries. It is the appropriate initial treatment for virtually all musculoskeletal injuries. Cryotherapy helps decrease pain and muscle spasm, produces numbness, and decreases inflammation.
WHAT HAPPENS WHEN THE BODY IS INJURED?
When there is an injury to the musculoskeletal system, the inflammatory process is initiated. Inflammation is the body’s method of protecting and localizing the damaged area. It has primary and secondary phases.
With trauma, damage occurs to cells in the injured area. The primary phase of inflammation involves cell death, hemorrhage (bleeding), and hematoma (pooling of blood). The secondary phase begins as damaged cells die and release enzymes called histamines. Histamines increase capillary permeability, which allows fluids to leak through capillary walls. So, not only are damaged blood vessels leaking blood, but also non-injured vessels leak plasma, proteins, colloids, and water into the injured area. Both processes produce swelling or edema.
Different methods of applying cryotherapy include ice packs, ice massage, cold baths and cold pressure wraps. The preferred method depends upon the body area and type of injury. A standard guide for treatment length for ice packs, cold baths, and cold pressure wraps is fifteen to twenty minutes, three to four times daily. (Artificial chemical ice packs can cause frostbite if left in place too long or if they are wrapped on the injury.) Ice massage is generally performed for five to ten minutes, three to four times per day.
Cryotherapy is the appropriate initial treatment for any musculoskeletal injury. For acute injuries, use ice packs, cold baths, or cold pressure wraps for a minimum of fifteen to twenty minutes. The procedure should be repeated several times daily during the first 48-72 hours following an injury. After this time, cryotherapy can be continued, especially if the athlete is getting better. Treatment can change to heat after the first 48-72 hours following an injury or when the athlete stops making progress with cryotherapy.
When cryotherapy is first applied, the athlete will feel intense cold, which should diminish in intensity during the first five minutes of treatment. It should be replaced by a feeling of numbness.
An athlete may develop a local allergic reaction to cold. An allergic reaction appears in the area where the cryotherapy was applied and is identified by raised, red, and warm areas similar to hives. If an allergic reaction results, cryotherapy should be discontinued immediately. Any further cold applications should be insulated from the skin by moist towels.
Blisters occur when motion causes layers of skin to separate and accumulate fluid. Fluid may be clear (serous) or dark (blood) depending upon the depth of the blister. Deep blisters tend to be filled with bloody fluid because they are closer to blood vessels.
Soft skin, whether from non-use or sweat, is more prone to blisters than tough skin. Blisters are usually more of a problem early in the season when the athletes are unaccustomed to heavy work. Obviously, prevention is the key.
If you get a blister, proper treatment will keep the blister from becoming infected and permit you to return to activity without discomfort.
IF THE BLISTER HAS NOT BROKEN
1. Clean the area with surgical soap and put pressure on the blister with a bandage or non-sticking dressing. This helps the body re-absorb the fluid in the blister.
2. Use a donut pad to take the pressure off the blister. Try to keep the skin over the blister from tearing.
3. If the blister is large, it may need to be drained. Clean the skin again with surgical soap and use a sterile needle or scalpel to make a small hole for the liquid to drain out.
4. Clean the area again with surgical soap.
5. Use a donut pad with antibiotic ointment. (Neosporin®, Bacitracin®, Polysporin®)
6. Monitor the blister for any signs of infection: redness, increased tenderness, increased pain, and increased temperature.
7. If there are any signs of infection, contact an athletic trainer or physician immediately.
IF THE BLISTER HAS BROKEN
1. Clean the area with surgical soap. If you are working on another person, wear latex gloves since you will be in contact with broken skin and body fluids.
2. Apply an antibiotic ointment. (Neosporin®, Bacitracin® Polysporin®)
3. Use a donut pad to reduce pressure and cover with a dressing.
4. Monitor the blister daily for any signs of infection: redness, increased tenderness, increased pain, and increased temperature.
5. If there are any signs of infection, contact an athletic trainer or physician immediately.
Calluses result from constant, gradual pressure or friction to the skin. The skin responds by becoming thicker. Calluses serve as a protective mechanism and need only be addressed if they become excessively large, uncomfortable, cracked, ripped, or blistered underneath.
Calluses may appear anywhere on the body. They are more common on the hands and feet because these body parts are exposed to the most stress. However, sport-specific equipment may cause calluses elsewhere. For example, figure skaters and skiers often develop calluses on their ankles.
Calluses also develop from equipment that doesn’t fit properly. To assure a proper fit, a complete change of equipment may be necessary. In many instances, auxiliary pads, wedges, or donuts can be used to reduce friction from equipment.
Not all athletes will develop calluses. Those who do should be aware of how to take care of them. Following is a list of suggestions on callus care:
1. Keep calluses filed down and smooth with a callus file. Some athletes prefer to do this after a shower when calluses are soft. This should be a daily or every-other-day ritual.
2. Keep calluses soft with hand lotion during the day and petroleum jelly at night. Other products that may be helpful include Bag Balm® and Corona Ointment®.
3. If calluses are large or cracking, try an intensive program of sanding and softening. If this does not help, consult an athletic trainer or physician.
4. If a blister develops underneath a callus, sand the callus and protect the callus/blister with a donut pad to reduce pressure. DO NOT ATTEMPT TO DRAIN THE BLISTER. The blister can become infected very easily. If you notice redness, increased temperature, or increased pain around the blister, consult an athletic trainer or physician.
First Aid – Sprains and Strains
The terms sprain and strain are often mis-used when describing injuries to the musculoskeletal system – the system of muscles and bones of the human body.
A SPRAIN is an injury to a ligament tissue connecting one bone to the same or another bone. Ligaments generally cross a joint, the intersection of two different bones. Therefore, a joint dislocation is a type of sprain.
A STRAIN is an injury to muscle or tendon that connects muscle to bone. Common strains include those to the quadriceps, muscles on the front of the thigh, or hamstrings, muscles on the back of the thigh.
The terms sprain and strain are not synonymous. A muscle cannot be sprained and, conversely, a ligament cannot be strained.
Both types of injuries are ranked by degree.
A first-degree injury means a structure was stretched but no fibers torn. The injured tissue is painful but functional and stable.
A second-degree injury indicates structural damage including some fiber tearing. The injured structure is partially intact. An evaluation of the number of damaged fibers may vary from 1-2% up to 99%. The injured structure is not totally functional or stable due to this tearing.
A third degree injury indicates the tissue is torn in half. This is obviously a very serious injury with accompanying instability and loss of function.
Initial treatment for all strains and sprains of any degree is R-I-C-E: Rest, Ice, Compression and Elevation. This first aid helps reduce swelling and pain associated with the injury. It also helps prevent additional damage to nearby cells from the pressure of swelling. If a lower extremity sprain or strain is painful when weighted, the athlete should not walk until the injury is evaluated by a medical professional. If an upper extremity sprain or strain is painful during movement, the arm should be immobilized in a sling until evaluated by a medial professional.
RICE should be continued for an absolute minimum of 48-72 hours following any acute injury. Ice should be kept in place for 15-20 minutes and repeated every 2-3 hours. Ice should not be wrapped on the injured area too tightly due to the possibility of frostbite. Do not ever wrap a chemical cold pack, either instant or reusable, on an injury. The pack is too cold and will cause frostbite. If the athlete is feeling better with the RICE treatments, they can certainly be continued past the 72-hour phase of injury.
If icing results in extreme numbness or any tingling, it should be removed immediately. Never use heat for initial treatment or an acute injury as it may produce additional swelling and damage that will complicate the healing process.
Many sprains and strains are preventable. Warm-up thoroughly before any activity. Include stretching, but remember stretching by itself is not a sufficient warm-up. An adequate warm-up combines stretching with large muscle activity such as running, cycling, drills, etc., intense enough to cause sweating. Sweating indicates your internal body temperature is above resting levels, and the body is ready for activity.
Get in shape to play your sport; do not use your sport to get in shape. Many injuries occur in early season practices and games because athletes are not in condition, aerobically or anaerobically. Consequently, they become fatigued, cannot react as quickly to situations, and may be injured more easily.
In addition, lack of strength or flexibility contributes to possible injury. Strength permits athletes to control their bodies. Flexibility permits extra motion around a joint allowing it to absorb additional energy before being injured.
Inspect your personal equipment. Shoes wear out reducing their support. Protective equipment wears reducing its protective ability. Loose clothing may be comfortable for you but a hazard to another athlete’s hands and fingers.
Inspect the area where you are practicing or competing. Are there any obstacles such as holes, bushes or trees in the immediate area? Are there any slippery spots due to water or mud?
Athletes with prior injuries should not practice or compete until fully rehabilitated and released by their physician. Lack of strength, flexibility, or conditioning, either aerobic or anaerobic, will predispose an athlete to injury. Coaches should not permit any athlete returning from an injury to jump into a full practice the first day back. Individual and team sport skills must be gradually re-introduced until the athlete can perform at a level with the rest of the team. When in doubt, keep athletes out!
First Aid – Contusions
A contusion, or bruise, is caused by an object striking the body with enough force to crush the tissues beneath the skin. The greater the force of the blow, the greater the tissue damage. If the blow is over a bony area, the bone also may be contused.
A contusion results in varying amounts of swelling and disability, directly related to the force of the blow and its location. A contusion damages tissue cells and capillaries. This results in blood and waste products leaking into the area around the cells. These blood and waste products gradually travel to the skin, producing the characteristic black and blue mark of a contusion. Because of gravity, the “black and blue mark” may appear below the actual contusion.
When there is a lot of damage, large amounts of blood and waste products are produced. They may collect in a pool instead of dispersing throughout the tissue. This is a hematoma. Hematomas commonly form following a severe contusion to the thigh. Blood loss can be severe and may result in shock. If you suspect a hemoatoma, remove the athlete from al activity immediately.
As mentioned above, bone can also be contused. When this happens, swelling occurs between the covering of the bone, the periosteum, and the bone itself. Due to limited circulation, swelling reduces very slowly, and the contusion remains very tender for an extended period of time.
Treatment for contusions is the same as for other injuries and can be remembered by the acronym RICE: rest, ice, compression and elevation. The athlete should be removed from activity, and the injured area cooled, compressed, and elevated as soon as possible to minimize damage to uninjured tissues. Do not permit the athlete to try to “run off” a contusion as the muscle activity may increase the bleeding in the contused area.
Athletes with minor contusions can often return to activity very quickly. Serious contusions may impair an athlete for months. An accurate assessment of the seriousness of a contusion is beyond the scope of a non-medical person. However, if the athlete can use the injured body part with full strength and can move it through a full range of motion with little or no discomfort, it is probably safe to return. When in doubt, do not permit an athlete to return to play. This type of judgement error may complicate a simple injury.
After a contusion, the injured area must be protected from further trauma. The use of additional pads or pads with a different design can provide this protection. For example, an athlete who repeatedly falls should wear kneepads. Football players may wear additional or larger pads. Sometimes, custom pads are made to protect a contused area, but this should be done by a medical professional. Not only do custom-made pads protect the injured athlete, but they are also designed to pose no threat to other athletes.
Obviously, the best treatment is prevention of the contusion in the first place. Sports-specific protective equipment should be approximately sized and fitted to every athlete. Protective equipment that is either too small or too large is not effective.
It is the responsibility of the coach to ensure all athletes wear required protective equipment that fits properly and is in good condition. Equipment left in the locker does not do any good. Also, the fit and condition of protective equipment should be checked regularly. Improperly sized or worn out equipment provides little or no protection and gives athletes a false sense of security.
First Aid – Abrasions and Lacerations
Common athletic injuries to the skin include abrasions (road rash, strawberries, floor burns) and lacerations (cuts). While usually not serious, both require prompt attention to prevent infection and reduce scarring.
An abrasion is the removal of the top layer or layers of skin by the friction of anything rubbing directly on the skin. Usually, an abrasion oozes blood or fluid from injured capillaries (small blood vessels). Because superficial nerve endings in the skin are exposed, abrasions tend to be very uncomfortable.
As soon as possible, clean the abrasion with clear water and soap, wearing latex gloves if you are treating anyone other than yourself. A surgical soap, Betadine® or Hibiclens®, is preferable, but any mild soap without fragrance, such as Ivory® dishwashing soap, can be used in a pinch. Try to remove all foreign material from the wound using a washcloth or sterile gauze pads. Do not use a scrub brush as it is too harsh. If you cannot remove all imbedded material, seek additional medical care. Remaining material may cause infection or tattooing of the skin.
Generally, abrasions should be covered with an anti-bacterial ointment such as Bacitracin®, Polysporin® or Neosporin® and any non-stick dressing. Change this dressing several times a day until healing is complete. When an abrasion is over a joint or a moving body part, keep the abrasion moist until healed. Otherwise, scabs may be torn loose during the movement and hinder the healing process
A laceration is a wound that penetrates all layers of the skin and may also continue below the skin into subcutaneous fat, muscle, blood vessels, and nerves. A laceration will display a gap in the skin that can be opened or closed when pressure is applied along the sides of the wound.
Lacerations may also damage blood vessels. If a laceration is bleeding profusely, apply direct pressure, remembering to wear latex gloves if treating someone other than yourself. Use whatever is available to control the bleeding but a sterile gauze pad is preferred. Apply additional gauze as needed. Do not remove the previous gauze pads as they become saturated with blood. If a laceration is spurting bright red blood, an artery may have been damaged. If so get immediate medical attention immediately. Do not apply a tourniquet.
Most lacerations need suturing (stitches) by a physician. This promotes healing and reduces scarring. Follow your physician’s instructions to care for a sutured laceration. The length of time stitches stay in depends upon the location of the laceration, its length and/or depth, and associated tissue damage. AGAIN, IF THERE ARE ANY SIGNS OF INFECTION, SEEK MEDICAL ATTENTION IMMEDIATELY.
Flexibility is the range of motion of a joint. It is somewhat genetically determined but can be increased and refined through proper stretching exercises. The terms flexibility and stretching are often used synonymously. However, an athlete can be flexible without stretching and conversely, an athlete can stretch without gaining flexibility.
Every sport has its own flexibility requirements. Some sports, such as gymnastics and figure skating, require extensive flexibility for successful participation. Other sports require joint specific flexibility. For example, swimmers need shoulder flexibility and track hurdlers need hip flexibility.
Some athletes are successful in spite of flexibility problems. However, adequate flexibility permits better technique – which should lead to better performance.
In the past, medical practitioners tested athletes and classified them as flexible or non-flexible. Theory followed that flexible athletes were more prone to ligament injuries since their joints were hypermobile or loose. Flexible athletes were given strengthening programs so muscles could protect loose joints. Non-flexible athletes were more prone to muscle injuries since their muscles absorbed forces not dissipated by joint range of motion. These athletes were given flexibility programs to increase joint range of motion.
Later studies did not support this theory. Additionally, more sensitive tests found athletes could have a flexible upper body and an inflexible lower body or vice versa. An athlete may be flexible in some joints but not in others.
STRUCTURES LIMITING FLEXIBILTY
Flexibility is determined by the bony construction of a joint and the soft tissues surrounding it. Soft tissues include ligaments, joint capsules, tendons and muscles crossing the joint, subcutaneous fat, and skin overlying the joint.
Certain joints permit more motion because of their construction. Ball and socket joints, like the shoulder and hip, permit the most motion. Hinge joints, such as the fingers, permit motion only in one direction. Some joints, like the radio-ulnar joint at the elbow, pivot one bone on another. The small joints between the spinal vertebrae permit small sliding-type motions individually, though several joints may combine to produce larger motions.
The joint capsule and ligaments support the joint and permit motion determined by a joint’s anatomical construction and oppose any abnormal motion. If the joint capsule or ligaments are injured, resulting scar tissue may limit motion. Conversely, a torn joint capsule or ligament may permit too much motion or motion in inappropriate directions.
Tendons and muscles crossing a joint also limit its range of motion. If the muscles and tendons are tight, joint motion is limited. This tightness is alleviated through aggressive stretching.
If the skin over a joint has been injured, it may lose its elastic properties and not stretch. For example, a scar from a burn may not stretch as the joint moves, limiting motion.
If a person is overweight (not usually a problem with athletes) motion may be limited by two body parts running into each other. For example, hip motion may be limited by a large abdomen hitting the thighs rather than hamstring muscle tightness.
TYPES OF STRETCHING
Three types of stretching are commonly used.
1. Ballistic stretching uses a bounding motion to increase joint range of motion. While an argument may be made that sports are ballistic in nature and stretching should be similar for specificity of training, ballistic stretching causes a protective muscular reflex, the stretch reflex, to fire and shorten the muscle while it is being stretched. Since the athlete is trying to lengthen the muscle while the stretch reflex is contracting it, there is an increased chance of injury while stretching ballistically.
2. Static stretching applies a slow, controlled lengthening force to the muscle. A muscle is gradually put under tension until a comfortable stretching sensation is felt in the muscle. This position is held for 30-60 seconds. As the stretching sensation diminishes, tension is increased to re-establish the original sensation. The stretch and hold pattern is repeated 1-3 times for maximum results.
3. Contract-relax stretching uses neuromuscular reflexes to stretch more effectively. A muscle is first contracted isometrically, without joint motion, for 3-5 seconds then stretched statically for 15-30 seconds. This contract-relax-stretch pattern is repeated 3-5 times to achieve maximum results. This stretching usually requires a partner to apply the resistance and then stretch.
These three types of stretching all increase joint range of motion. Some are easier to perform than others. Some take more time. Some have a lesser risk of injury. All must be done in a controlled manner. If a stretching sensation is felt anywhere other than in a muscle or tendon, the position is wrong and needs to be re-evaluated. Stretching should increase the length of muscles and tendons not stress joints or ligaments.