Chapter 5 - Mechanisms of

Injury
Physical process responsible
for a given action, reaction or
result

Why is it necessary to
determine the mechanism of
injuries?
Important for the diagnosis,
rehabilitation and prevention
of injuries

Injury Mechanism

Depends persons
perspective
Mechanism often
acts in
combination
Establish cause
and effect
relationship

Sport medicine
classification

Contact or impact
dynamic overload
overuse
structural
vulnerability
inflexibility
muscle inbalance
rapid growth

Mechanical Loading

Loads greater
than physiological
lead to injuries
Chronic injuries
cumulative
trauma
repetitive stress

Acute injuries

Principles of Injuries

Catch-all terms

shinsplints
tennis elbow
jumpers knee

Level of dysfunction
catastrophic injuries

Progression
untreated or lack to time to heal lead to more
severe injuries

Assessment of Severity

Clinical classifications
help assign common
characteristics to
injuries
Severity linked to
amount of tissue
damage
Mild & moderate:
partial disruption,
tissue is able to accept
loads

Ligaments
grade 1 mild

negligible structural
minimal time loss

grade 2 moderate

partial rupture
swelling tenderness
up to 6 wk time

grade 3 severe

complete, gross
swelling, 8 wk min

Injury Principles

Micro vs macrotrauma
Primary: direct
consequence of trauma
Secondary
injury surface after
original trauma
accommodation to
primary injury
(adaptation of loads)
Tissue structure

Contributing factors

Age

acute injuries: young

chronic: older

Gender
Genetics
Fitness level
Nutrition
Psychological
Human interaction
Fatigue
physical & mental

Environment

Equipment
protective
contributes to injuries

Previous injury
Disease
Drugs
Rehabilitation
Anthropometrics
Skill level
Experience
Pain

Tissue Injury

Inflammation:
pathological process
vascular response
increase capillary
permeability
(swelling)

Pain: swelling related

pressure on nerve
endings (more in
confined spaces)

Tissue Injury

Vasodilatory phase
flow of fluid/plasma
proteins into tissue

Control of inflammation
Chemicals mediators

Plasma proteins
fibrinogen

Functions
dilutes & inactivates
toxins
nutrients to
inflammatory cells
antibodies, proteins

histamine, serotonin,
bradykin,
prostagladins, plasmin
etc.

Other Cells

Phagocytes (fungal and

bacterial infection)
Lymphocytes
(antigens)

Why inflammation?
Bodys first line of defense
against injuries

Bone

Any conditions that

affects osteocyte
performance
Osteonecrosis: cessation
of blood flow
vessel disruption
occlussion
injury or pressure to
arterial walls
matrix, bone strength
likelihood of fracture

Bone

Osteoporosis
Major public health
issue
Affect mostly
trabercular bone
Bone of axial
skeleton
Multifactor
Clinical conditions

Bone

Fracture (break):
applied loads exceeds
bones ability
Resistance

material properties
geometry
anisotropic effects
porosity

Type of loading
acute vs chronic

Fractures

Indirect or direct
Risk and type of bone
Diagnosis

site
extent of injury
configuration
fragments (displaced)
environmental (open
closed)
complications
etiological

Fractures

Healing phases:

inflammation
union of bony ends (3wk)
callus remodeling (6 wks)

Articular Cartilage

Excessive loading
loss of cartilage
matrix
chondral fractures
osteochondral
fracture

Inability to repair

Articular Cartilage

AO
non inflammatory
weight bearing
joints
deterioration of AC
osteophytes
formation
cartilage fibrillation

Artificial Joints
cemented or non

Fibrocartilage

Distributes forces
at joints
Shock absorber
Improve joint fit
menisci
intervertebral
disks

Tendon

Force transfer
Injuries
direct (cuts)
indirect (excessive loads
applied to unit)

Musculotendinous
injuries: Strain

Mild, moderate,
severe
severe: precede
by microdamage

Tendon

Repetitive overloading:
inflammatory response or
tendinitis
Also could affect tendon
sheath, peritenon etc.

Healing

Inflammation
Synthesis of collagen
and GAG (matrix)
Cyclic loading (2-3 wk)
Progressive stress

Peritenonitis
Tendinosis
(intratendinous
degeneration dut ot
atrophy)
Tendinitis (Symptomatic
degeneration vascular
disruption and
inflammation

Ligaments

Ligament injuries
sprain
partial tears
complete tears

Healing
bleeding & inflammation
(fibrin, fibroblas scar cells)
proliferation of building
material (scar tissue)
matrix remodeling
smaller fibers
lack organization

Muscle

Injuries
Acute muscular strain

overstreching or
overloading
force, rate, application
moderate:partial tear
severe: complete tear,
hemorrage, swelling

contusions

intramuscular bleeding
myositis ossificans

exercise induced injury

DOMS 24-72 hr after

exercise
eccentric

Skin

Abrasions
Contusions
Penetrating wounds
obscure deeper
damage

Lacerations
Infection
Excessive bleeding

Nervous tissue

Not musculoskeletal
Greatest potential for
dysfunction
Injuries

chemical
thermal
ischemic
mechanical
entrapment
trauma: compressive
or tensile

Temporary or complete
axonal discontinuity
Motor impairment can
lead to secondary
injuries

Nervous Tissue
Degree

Mechanism

Effect

First degree

Low compression or acute

high compression

Conduction block, no
axonal discontinuity

Second degree

Pinching or crunching
Prolonged pressure

Third degree

Any of the above

Axonal interruption,
wallerian degeneration,
nerve supporting structure
intact (recovery ok)
Loss of continuity, damage
to axons and sheath, loss
of sensory and motor.
Slow recovery
Loss of all tissue except
epineurial tissue, surgical
repair
Incomplete regeneration, if
occurs, needs surgical
repair

Fourth degree
Fifth degree

Severance of nerve trunk

Nervous Tissue

Compartment or
entrapments of nerves or
vessels
Increase pressure
transmitted
Enclosed spacing

Symptons
numbness, tingling &
pain
decreased vessel
perfusion

Inflammation: positive
feedback loop

Joint Injuries

Excessive loading
Dislocation (luxation)
Partial dislocation
(subluxation)
Synovitis
Arthritis

OA
RA
Gouty