West Seattle SWAC Junior Football & Cheer Safety

Caring for Bruises and Abrasions

Russell L. Ellis, M.D., Lawrence J. Lemak, M.D.

Abrasion and bruises are common and simple to treat.

Bruises

A bruise can be caused by blunt trauma that in turn causes bleeding under the skin.

Some bruises may overlie injuries to muscles, ligaments, or even a broken bone.

Bruises should be treated initially with cold compresses or ice along with elevation of the affected area above the level of the heart.

Always use a barrier, such as latex or vinyl gloves, when there is a chance of coming into contact with blood or other bodily fluids.

Abrasions

Abrasions should be cleaned, kept moist with antibiotic ointment, covered by a sterile bandage, and watched for signs of infection.

Abrasions can lead to infection. Signals of infection include:

Redness, swelling, and warmth around the abrasion

Red streaks extending away from the abrasion toward the heart

Increased or throbbing pain

Fever

Though they are less serious injuries, bruises and abrasions are two of the most common injuries in sports. Most are not reported to the coach or athletic trainer unless they interfere with participation. They usually can be managed with simple measures, and the athlete may miss little if any time from the sport. Coaches can treat and protect their players from further injury.

Bruises are simply areas of bleeding trapped under the skin. When an area of bruising is caused by blunt force to the injured area, it is called a contusion. Bruises are often associated with falls or being struck by another object such as a helmet or football. This force causes the small blood vessels in the skin to burst and bleed into the soft tissue. The blood then gives the area its characteristic color that changes as the blood is reabsorbed.

Sometimes bruising is caused when a muscle or ligament is torn or a bone is fractured. In these cases, the bleeding is not caused by blunt force, but the appearance of the skin is basically the same. The bruised area is referred to as an ecchymosis. An area of ecchymosis can also happen for no apparent reason in people with bleeding disorders. Any player that has an area of ecchymosis or bruising should undergo prompt medical evaluation when it occurs for no reason or when a broken bone or muscle or ligament tear is suspected.

Bruises should be treated initially by applying cold compresses or ice along with elevation of the affected area above the level of the heart. This will decrease local bleeding and swelling. The affected body area should also be checked for a fracture, or a muscle or ligament tear. If swelling and pain are severe, a fracture should be suspected and the injury should be evaluated immediately by a physician.

With abrasions, there may be external bleeding and the skin may be scraped away. Abrasions are typically caused by friction between the skin and a rough surface. Players and coaches often refer to superficial abrasions as "strawberries." The athletic trainer and/or the team physician should evaluate very large or deep abrasions.

A coach or responder should always use a barrier, such as latex or vinyl gloves, when there is a chance of coming into contact with blood or other body fluids. Clean an abrasion with warm soapy water immediately even if the incident occurs on artificial turf. If the injury is particularly dirty, a soft brush should be used to dislodge any imbedded particles. Keeping the injury moist with antibiotic ointment and covering with a sterile bandage helps it heal faster.

An abrasion should be observed over several days after the incident for signs of infection. The signs of infection include:

Redness, swelling, and warmth around the abrasion

Red streaks extending away from the abrasion toward the heart

Increased or throbbing pain

Fever

If any of these signals appear, consult a physician immediately.

Most bruises and abrasions are benign and do not require a visit to the physician, but coaches should be able to recognize them and know how to care for an injured player. They should also be able to recognize more serious associated injuries and seek prompt medical attention.

Go Cougars!

SWAC Jr. Football and Cheer

Caring for Strains, Sprains, Dislocations, and Fractures

Football coaches must recognize the signals of strains, sprains, dislocations, and fractures and know how to provide immediate care.

Usually, only a trained medical professional can tell the difference between a strain, sprain, dislocation, or fracture. It is not important to know what kind of injury it is to provide immediate care.
Activate the Emergency Action Plan and follow the emergency action steps, Check-Call-Care.
Provide immediate care in the following manner:
- Avoid any movement or activity that causes pain.
- Apply ice or a cold pack to the injured body part for about 20 minutes to control swelling and reduce pain. To prevent cold injury, place a towel or cloth between the source of the cold and skin.
- Splint the arm or leg only if the athlete must be moved or transported and if you can do so without causing more pain and discomfort to the athlete.
- To minimize shock, keep the athlete from getting chilled or overheated.

BRIEF INJURY DEFINITIONS

Strain: The excessive stretching and tearing of a muscle, or of tendon fibers.

Sprain: When the bones that form a joint are forced beyond their normal range of motion as a result of tearing of ligaments.

Dislocation: A displacement or separation of a bone from its normal position at a joint.

Fracture: A cracked or broken bone.

Strains, sprains, dislocations, and fractures are common football injuries. Usually, only a trained medical professional can tell the difference between them. It is not important to know which kind of injury it is to provide immediate care.

Strains
A strain is the excessive stretching and tearing of a muscle, or of tendon fibers. It is sometimes called a "muscle pull" or "tear." Because tendons are tougher and stronger than muscles, tears usually occur in the muscle or where the muscle attaches to the tendon. In athletes who have not physically matured, which pertains to most high school athletes and younger players, a piece of bone may be pulled from the muscle attachment.

Generally, muscle strains occur when a player has not properly stretched before practice or a game. Muscles are also more susceptible to injury in a setting of prolonged intense activity. Good conditioning and common sense can help avoid muscle strain injuries. Most muscle strains are not severe, and a player can return to the same level of play after recovery. Though there are not any long-term effects, muscle strains must completely heal and be rehabilitated or they are likely to recur.

Stretching regimens and slow warm-up exercises have been shown to reduce the occurrence of muscle strain injuries. This allows the muscles, tendons, and ligaments to adjust to increased intensity in activity levels. Muscles most commonly involved in strains are the hamstrings and quadriceps (thigh muscles) and gastrocnemius (calf muscle). If a severe strain is suspected, activate the Emergency Action Plan and contact EMS for the transport of the athlete to a medical facility.

Sprains
A sprain usually results when the ligaments that hold the bones forming a joint are stretched too far or torn. The bones can then be forced beyond their normal range of motion. The more ligaments that are torn, and the more complete the tear, the more severe the injury. The sudden violent forcing of a joint beyond its limit can completely rupture ligaments and dislocate bones. Severe sprains may also involve a fracture of the bones that form the joint.

When dealing with young athletes, particularly between the ages of 8 and 15, coaches should be aware that severe sprains can result in avulsion fractures that involve the growth plate. This type of injury can have long-term effects.

The sprain must be allowed to heal and the area rehabilitated. Severe sprains or sprains that involve a fracture usually cause pain when the joint is moved or used, and are recognized as serious.

Often, a sprain is more disabling than a fracture. When the fractures heal, they usually leave the bone as strong as it was before. It is unlikely that a repeat break would occur at the same spot. On the other hand, once ligaments become stretched or torn, the joint may become less stable. A less stable joint makes the injured area more susceptible to reinjury.

The most common sprains in football occur at the ankle, knee, and shoulder joints. Coaches should be able to recognize signals of a sprain and provide the immediate care until a physician can examine the athlete. X-rays may be required to rule out a fracture or widening of the joint.

A physician should be consulted if the athlete:

Has pain or significant bone tenderness at the site of the injury
Is unable to bear weight
Has diminished or increased range of motion
Is unable to perform at a preinjury level.

If a severe sprain is suspected, activate the Emergency Action Plan and contact EMS for removal of the athlete to a hospital.

Dislocations
A dislocation is a displacement or separation of a bone from its normal position at a joint. The injury requires immediate care, and if it goes unnoticed such as by slipping back into place, it may be incorrectly treated. Such a misdiagnosis can lead to longterm problems for the athlete. Therefore, it is important for a coach to be able to recognize the signals of this type of injury and get the athlete the appropriate treatment.

Dislocations are generally obvious because the joint appears deformed. The displaced bone end often causes an abnormal lump, ridge, or depression. Also, an injured person is unable to move a joint freely that is out of place.

Some dislocations tear the skin and become an open dislocation. If the skin is broken, a responder should place a clean bandage over the wound to keep it from becoming more contaminated. Open dislocations require immediate medical care. If any dislocation is suspected, activate the Emergency Action Plan and contact EMS for removal of the athlete to a medical facility.

Fractures
Fractures are among the more serious injuries sustained in sports. The signals of a bone fracture can be easy to detect. Athletes often complain of hearing or feeling a "snap." The most consistent complaint is tenderness or pain, usually localized to a specific area of the body. It is usually difficult for the person to move the injured part and not further damage the fracture. There may be bruising and swelling, although this may not occur immediately. In completely displaced fractures, there may be an obvious deformity.

Call 9-1-1 or the local emergency number for the following situations:

Limb deformity.
Moderate or severe swelling and discoloration.
Feels or sounds like bones are rubbing together.
"Snap" or "pop" was heard or felt at the time of injury.
A fracture with an open wound on or around the injury site (bone ends may or may not be visible).
Inability to move or use the affected part normally.
The injured area is cold and numb.
The injury involves the head, neck, or back.
The injured athlete has trouble breathing.
The cause of the injury suggests that the injury may be severe.
It is not possible to move the athlete safely or comfortably to a vehicle for transport to a hospital.

Coaches' Response
For strains, sprains, dislocations, and fractures, activate the Emergency Action Plan and follow the emergency action steps, Check-Call-Care. Check the scene for safety and check the athlete, Call 9-1-1 or the local emergency number when needed, and Care for the player until EMS personnel arrive. Immediate care should be provided in the following manner:

Avoid any movement or activity that causes pain.
Apply ice or a cold pack to the injured area for about 20 minutes to control swelling and reduce pain. To prevent cold injury, place a towel or cloth between the source of the cold and the skin.
Splint the arm or leg only if the athlete must be moved or transported and if you can do so without causing more pain and discomfort to the athlete.
To minimize shock, keep the athlete from getting chilled or overheated.

Splinting is a method of immobilizing an injured body part to keep it from moving. It may also help reduce pain, making the injured athlete more comfortable. Splint only if the athlete must be moved or transported and if you can do so without causing more pain and discomfort to the athlete.

The following guidelines should be followed when applying a splint or sling for immobilization:

Immobilize an injury in the position you find it.
Immobilize the joints above and below an injured bone.
Immobilize the bones above and below an injured joint.

Check for warmth and color of the skin below the site of the injury before and after splinting. Make sure that circulation has not been restricted by applying the splint too tightly. Loosen the splint if the athlete complains of numbness or if the limb turns blue or cold.

Because in most cases only a trained medical professional can tell the difference between a strain, sprain, dislocation, or fracture, the injured athlete should consult a physician. If an injury appears severe, do not move the player; activate the Emergency Action Plan and transport the athlete to a hospital immediately. X-rays may be needed to determine the extent of the injury. Immediately consulting a medical professional is important to establish the correct method of treatment, rehabilitation, and return to play guidance.

For less severe injuries, a prompt visit to a physician may result in advice for the athlete to:

Rest the injury and bear weight only when tolerated
Apply ice wrapped in a towel or cloth several times throughout the day
Apply light compression with a loosely fitted elastic wrap or bandage
Elevate the injured extremity to the level of the heart.

The prescribed rehabilitation program may be started a few days after the injury when the swelling is reduced. Early range of motion and strengthening exercises may be prescribed to promote recovery and protect from recurrent injury. Taping and bracing for support may help prevent re-injury.

Some injuries such as fractures, dislocations, and sprains or strains may require further medical treatment as well as an extended rehabilitation and recovery period. Following a strain, sprain, dislocation, or fracture, return to play should be guided by a physician's recommendation.

Preventing Heat-Related Illness

As the season approaches and the weather becomes more intense in many parts of the country, it is wise to keep these tips in mind when running a football practice this summer.

WHAT COACHES SHOULD KNOW

Heat-related illnesses are caused when an individual is subjected to extreme temperature and humidity and is unable to cool down.
Schedule and enforce frequent water breaks.
Coaches should take steps to prevent heat-related illnesses. When athletes are practicing or competing, coaches should do the following:

Allow days for adjusting to warmer climates
Schedule practice during cooler times of the day

Heat Precautions

When necessary, coaches should instruct athletes to do the following:

Wear net-type jerseys
Wear T-shirts and shorts, not pads
Remove helmets when not playing or scrimmaging
Avoid wearing sweatshirts
Change sweat-soaked clothing

Appropriate Fluid Intake

Players should be weighed before and after a competition or workout.
Drink 16 ounces of appropriate fluid for every pound of weight lost after activity.
Players should not take salt tablets, but rather salt their food liberally when playing in hot, humid weather.
Before a competition or practice, players should consume appropriate fluids as follows:
Two to three hours before a competition or workout, drink 4-5 ounces of appropriate fluid every 10-20 minutes
One hour before a competition or workout, drink 8 ounces of appropriate fluid
Fifteen minutes before a competition or workout, drink 4-5 ounces of appropriate fluid
During a competition or workout, drink 4 ounces of appropriate fluid every 10 to 20 minutes.

Treatment Of Heat-related Illnesses

Heat-related illness may progress into heat exhaustion. Signals of heat exhaustion include headache, nausea, or dizziness and weakness. If this happens, the player needs to lie in a cool place, apply cool, wet towels to the body, drink cool water, and monitor his vital signs. In this stage, heat related-illness can usually be reversed with prompt care. Often an injured player feels better when he rests in a cool place and drinks cool water.
If signals are present that the illness is progressing, activate the emergency action plan and follow the emergency action steps, Check-Call-Care. Call 9-1-1 or the local emergency number immediately.
As the illness progresses into heat stroke, a player may have a high body temperature, have red, hot, dry, or moist skin, vomit, lose consciousness, have shallow breathing and/or a weak pulse. A player experiencing respiratory or cardiac arrest needs to receive rescue breathing or CPR.

To help prevent heat-related illnesses, keep players cool and hydrated.

Appropriate Fluids
Include water or a correctly proportioned sports drink. Water is an appropriate hydrating solution when practices are not intense and do not exceed 60-90 minutes. Though water can be used in situations of more intense and extended practices, correctly proportioned sports drinks may offer an advantage-particularly in hot weather.

A correctly proportioned sports drink (per eight ounces) contains approximately 6% carbohydrates (14 grams sucrose, glucose, fructose, or glucose polymer), approximately 50 calories, approximately 28 milligrams of potassium, and approximately 100 milligrams of sodium with no carbonation, no caffeine, and no stimulants. This combination permits a quicker replacement of lost body fluids and helps maintain the availability of the glucose fuel for energy production. Potassium losses are also replaced. The sports drinks, which are usually flavored, should be ingested cold.

Sunny weather is ideal for practicing football and competing. However, overexposure to high temperature and humidity can cause heat-related illnesses. Conditions contributing to heat-related emergencies include:

Heat
High humidity
Extreme physical exertion
Inappropriately layered or rubberized clothing
Inadequate fluid intake.

Heat-related illnesses, such as heat cramps, heat exhaustion, and heat stroke are caused when an individual is subjected to extreme temperature and humidity and is unable to cool down. The National Weather Service issues heat alerts when the daytime heat index (a combination of temperature and humidity) is 105 degrees F or more, which can cause the most serious heat-related illnesses. At 80-105 degrees F, fatigue and sunstroke are possible with prolonged exposure. Athletes playing in the sun for long periods of time wearing protective padding are especially at risk. The illnesses are treatable, but become life threatening without immediate attention.

Coaches need to know how to prevent heat-related illnesses. When weather is excessively hot and humid, coaches need to adjust the intensity of workouts, building in intensity over a period of time to allow players to adjust to the weather conditions. Coaches also should consider canceling practice or scheduling practice during cooler times of the day.

Players should have unrestricted access to appropriate fluids. Players should weigh themselves before and after activity to check for dehydration. To prevent dehydration, players should begin hydrating, at least two to three hours prior to working out or competing, by drinking at least 16 ounces of fluid. One hour before a competition or workout, athletes should drink 8 ounces of fluid followed by 4 ounces of fluid 15 minutes before the activity. During a competition or workout, athletes should drink 4 ounces of appropriate fluid every 10 to 20 minutes. Following a competition or workout, the coach should have the players drink 16 ounces of fluid for every pound of weight lost to replace the water loss and consume foods that contain a liberal amount of salt. Sports drinks may provide some benefit over water.

Without taking precautionary measures, a player may experience a heat-related illness. In some cases, a player may be unaware he is experiencing this condition and continue practicing. Early signals of a heat-related illness are heat cramps. For heat cramps, the athlete should stop the activity, gently stretch and massage the muscle, and drink appropriate fluids.

A heat-related illness may progress into heat exhaustion. Therefore, coaches should periodically check players during practice or workouts for symptoms related to heat exhaustion, which include headache, nausea, dizziness, weakness, or muscular spasms. The player experiencing these symptoms needs to lie in a cool place; apply cool, wet towels to the body; drink cool water; and have his vital signs monitored. In this stage, heat-related illness can usually be reversed with prompt care. Often the injured player feels better when he or she rests in a cool place and drinks cool water. If the player's condition does not improve, activate the Emergency Action Plan and follow the emergency action steps, Check-Call-Care. Call 9-1-1 or the local emergency number immediately.

If the illness progresses into heat stroke, a player may vomit; have a high body temperature; have red, hot, dry, or moist skin; lose consciousness; or have shallow breathing and/or a weak pulse. Sweating may stop, which prevents the body from cooling. This increases body temperature and causes vital organs, such as the heart, to fail.

When the circulatory system is affected, the player may experience mild shock, convulsions, or a coma. If a player experiences respiratory or cardiac arrest, begin rescue breathing or CPR, as appropriate. If possible, cold towels should be placed on the body of the player while awaiting EMS.

Playing in the sun can be fun, but the best thing to do is play it safe. Heat-related illnesses are preventable if coaches and players know their signs and stay cool and hydrated.