Gungahlin Jets Junior AFC - When Injuries Occur

	Gungahlin Junior AFC

	When Injuries Occur

About Injuries	Unconscious Player - DRABC	Conscious Player - STOP	Soft Tissue Injuries
RICER	HARM	Classic Injuries	Severe Injuries

The Inevitable Paperwork

While the immediate attention to minimising the injury is paramount, there needs to be some administrative recording of what happened so club records and potential insurance requirements can be maintained. It is a club policy that for every injury that occurs whether at training, during a Junior League endorsed game (including practice games*) or club sponsored function that a record of events is captured.

(* The Junior League's position on practice matches is still to be ratified, however at this stage if the game is between two Junior League teams and the game is conducted under Junior League rules and by-laws then it is likely to be within the boundary for insurance purposes)

To all Junior Jets coaches and managers, the following should be applied as a process when an injury occurs:

Note the circumstances surrounding the lead-up and action after the injury.

Note the condition of the ground (if on a game-day this should already be captured)

Fill in the Injury Report Sheet as early as possible after the injury occurs.

Keep one copy for your (coaching) records.

Forward a copy to the Injury Management Officer.

If the injury requires hospitalisation, surgery or Doctor visitation and a claim is to be sought by parents/guardians then the Junior League's insurance covers all players. To make a claim you will need to do the following:

log on to the website of Jardine Lloyd Thompson who are the Junior League's insurer.

go to the Australian Football League Program.

to see information about the cover then use the navigation options. The cover is in the Non-Medicare section.

follow the instructions for making a claim - located in the left hand navigation area.

download the claim form; or

contact JLT via the contact information provided.

If still unsure regarding the Junior League's administrative requirements then please contact Judy Mustard (judy.mustard@aflact.com.au) of the Junior League.

About Injuries

Injuries are an inevitable occurrence in footy.

Coaches have a duty of care to ensure that injury prevention and management are a fundamental component of their planning. Managing injuries is also about ensuring no further damage can occur to the player. Therefore one of the most important decisions a coach must make is whether to allow a player to continue playing. It is better to rest the player if unsure so as not to increase any damage.

Parents also need to be aware of how they can help (as not all injuries occur on the footy field). For the junior football player you can't always rest on the old belief that kids are durable and will bounce back with little effort.

Let's also agree on something important too, that carrying a significant injury untreated is just plain stupid!! Years ago it might have been "manly" to carry injuries called "niggling injuries" such as strained hamstrings, sore shoulders, corkies and wrenched knees, but our attitude at the Jets is to encourage kids through their coaches, to discipline themselves to take injuries - no matter how minor, seriously.

Simply put, by not addressing injuries properly at any stage may aid future recurrence which might lead to irreparable damage. So don't mess around with kids getting hurt!

The following represents some assistance in considering current views and methods endorsed by various medical and league bodies. We recommend the SMARTPLAY website to all coaches and parents as a resource for some in-depth material. Try and have a look at the South Australian version of Smartplay as it contains a heap of stuff not just about injuries.

The main things to cover with injuries are:

Preventing injuries - simply trying to reduce the opportunity

Dealing with injuries on occurrence - minimising the effect of injuries from the early moments they happen

Overcoming injuries - supporting the player through the rehabilitation period and getting the player back on the track as quickly as possible.

So good luck, have few injuries with your kids and remember the cardinal rule that "To play safe with any injuries, if the player has not moved after copping a bump or taking a spill then immediately stop the play and get medical assistance to the player fast".

D.R.A.B.C.
An unconscious player represents a life threatening situation - especially in the initial moments. The DRABC of first-aid is necessary to perform as soon as the player is injured this way to determine next steps. Danger Check for danger to the player Response Seek some response from the player Ask them to open their eyes - hold up a couple of fingers and ask them how many they see Ask them a question i.e. "What is your name?" Airway Make sure the airway is clear Breathing Check the player is breathing by observing the chest for movement or whether air is moving through the mouth or nostrils No breathing means an accredited trainer must begin Expired Air Resuscitation (EAR) Circulation Check for a pulse - if no pulse is evident then an accredited trainer must perform Cardio Pulmonary Resuscitation (CPR) EAR and/or CPR must continue until respiration and/or circulation are at a normal or acceptable stage and/or professional assistance is obtained If any bleeding is occurring then try and stem the flow by applying firm pressure over the wound site.

S.T.O.P.

This procedure is recommended as a set procedure for coaches to use to determine the severity of an injury and whether the player should continue or have an early shower.

Stop

Stop the player from further movement and/or participation. If necessary, STOP the game.

Talk

Talk to the injured player. Ask various questions to get an idea of the players lucidity and mental state. "What happened?", "How did it happen?", "What did it feel like?", "Does it hurt?", "Why does everyone hate Collingwood?" (if the player can't answer that then they are not only injured but should be playing something else altogether!)

The main thing with talking to the player is in encouraging the player.

Observe

Whilst talking with the player, observe some general things such as if the player is distressed or favouring a position of comfort that seems unusual. Keep an eye on the injury area for evidence of significant damage such as swelling, discolour, tenderness if touched or pain if movement occurs. If any of these are evident then the prevention part kicks in.

Prevent

Prevent any further injury. Seek qualified/professional assistance. Adhere to that guidance and/or direction. Generally, the injuries will fall into three categories of Severe, Less Severe (Classic) and Minor. Minor injuries, such as bumps and bruises will require some monitoring but for the duration of the game should not unduly impair the player. At the end of the game, R.I.C.E.R. should be applied.

Soft Tissue Injuries

No kid wants to be on the sidelines as a result of injury. As a coach/manager or parent, the best approach to getting the kids back on the track as quick as possible from any soft tissue injury is by using the RICER and NO HARM injury management approach. So you are aware, a list of Classic Injuries is also displayed, with advice on initial treatment. Severe injuries require more caution and professional assistance.

A Soft Tissue injury refers to all ligament sprains, muscle strains and muscle bruises (corks etc) and most bumps and bruises which occur in sport. They are generally the most prevalent.

These techniques for the soft tissue injuries are designed to help prevent further damage and will mean less time away from footy and most importantly it gets the little buggers out from under your hair.

The first 48–72 hours are vital in the effective management of any soft tissue injury.

The immediate treatment is RICER.

RICER should be initiated immediately after injury and continued for 48–72 hours. To ensure a successful recovery.

NO HARM factors should also be followed in conjunction with RICER.

Click <here> to download a Smartplay brochure (pdf) on RICER and HARM.

R.I.C.E.R.

	Place athlete in a comfortable position, preferably lying down, supported and immobilized. This will reduce internal bleeding and help limit further damage around the injury site.
	Apply Leuko Cold-Hot Pack to injury for 20 minutes every 2 hours. Continue this treatment for the first 48 to 72 hours after the injury has occurred. Cold reduces swelling, pain, muscle spasm and secondary damage. Caution: Don't apply cold pack directly to skin. Be wary of people sensitive to cold (eg: children) or with circulatory problems.
	Apply a firm wide elastic bandage such as Eloflex, generously covering the injured area, as well as above and below the injured area. This compression reduces internal bleeding and swelling. Caution: Check the bandage is not too tight.
	Raise injured area above the level of the heart. This reduces bleeding, swelling and pain, as gravity helps drain excess fluid away.
	Refer the injured person to a qualified professional such as a Doctor or Physiotherapist for precise diagnosis, ongoing care and treatment. A full recovery is then more likely with less scarring.

What if you don't apply R.I.C.E.R?

Regardless of the extent of a soft-tissue injury or for that matter, a minor ligament strain or jarring, the application of RICER is worth doing as a simple precaution.

H.A.R.M.

No Heat

No Alcohol

No Running

No Massage

As you can see, making sure the kids stay off the booze will really help their recovery.

Classic Injuries

The following represent some "classic injuries" or are seen as fairly common. We've also included a bit on the blood injuries and the "Blood Rule". There is a document that is available for download called Foot Injuries that has more information about some foot related injuries.

Type	Concussion
Assessment	While here as a "Classic" injury, concussion should also be viewed as a Severe Injury type regardless of type. Concussion is seen as an alteration of consciousness, visual disturbance, dizziness, headache, confusion, nausea and loss of memory before or after the event. There are three types of concussion, mild, moderate and severe.
Management On Occurrence	If any signs as above are present then refer to doctor immediately. If no signs present straight after incident monitor for 24 hours. If there are no symptoms, return after 30 minutes.

Type	Knee Injury
Assessment	Knee injuries are costly to AFL clubs and players alike. In fact, they cause more missed games than injury to any other area. After hamstring strains they are the second most commonly occurring injury type. Symptoms include the player who can't walk, can't twist, can't extend the leg. Types of knee injuries are Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Ligament, Meniscal (cartilage damage) and Acute Patella (kneecap). The knee may require complete reconstruction.
Management On Occurrence	Immobilise, RICER and seek immediate medical treatment.

Type	Lower Limb
Assessment	Fracture/Break of the lower leg or ankle.
Management On Occurrence	Immobilise, RICER and seek immediate medical treatment. For breaks or fractures the best course is to maintain the player in the area (on the ground) the break occurred and seek immediate first-aid or ambulance assistance. Moving the player could cause further discomfort.

Type	Shin Splints
Assessment	Shin splints are a condition where an individual complains of pain along the inside border of the larger lower leg bone - the tibia. The main cause is the tractioning effect of the muscles that attach to the bone.
Management On Occurrence	Shin Splints can be due to a sudden increase in training loads, poor supporting shoes or pronated (flat) feet. You can often feel a very tender and painful lump in the area which makes running very difficult. For this type of injury then medical advice (doctor or physio) is recommended.

Type	Ankle Injury
Assessment	Strained lateral ligament or Achilles.
Management On Occurrence	Immobilise, Rather than the common R.I.C.E.R principles, consider C.R.I.E: Compression is the most important feature of your immediate management of the sprain, speeding up your recovery by preventing secondary swelling, Rest by restricting loading on the joint (+/- crutches), Ice application to decrease pain and; Elevation to assist in swelling reduction.

Type	Hamstring Injury
Assessment	Hamstring Strain/Tear.
Management On Occurrence	RICER. Assist the player from the field as walking may continue the tear.

Type	Nose bleed
Assessment	Bleeding from the nose.
Management On Occurrence	Sit the athlete down with the head forward. Instruct the athlete to breathe through their mouth. Get the athlete to apply direct pressure by pinching the lower half of the nose (the soft part) using the thumb and forefinger. Maintain the pressure for at least 10 minutes, 20 minutes may be needed if the athlete has been strenuously exercising or it is a hot climate. If the bleeding is not controlled after the initial 1O minutes, continue the direct pressure for another 10-20 minutes. lf bleeding cannot be controlled or recommences when the pressure is released, refer the athlete to a doctor or hospital. An ice pack may be applied to the bridge of the nose to help control the bleeding and reduce the soft tissue damage. Time Out 10 to 20 minutes.

Type	Bleeding
Assessment	Open wounds, gashes, scrapes and scratches.
Management On Occurrence	The Blood Rule What is it? A player who is bleeding or has blood on their playing uniform must leave the ground for immediate medical attention. They must ensure that the bleeding is stopped, the wound dressed and that there is no blood on their uniform before they return to the playing arena. Why does it exist? The "blood rule" exists in many sports. A number of blood borne infectious diseases can be transmitted during body contact and collision sports. The most serious of these includes HEPATITIS and HIV (AIDS). It has been put in place to protect: the injured player, their teammates, the opposition and all sporting officials. What if I am bleeding? The best method to stop the bleeding quickly is compression and elevation. As quickly as possible apply pressure to the wound. This means that before you get to the sidelines you may hold the area that is bleeding very tightly. If you have a trainer or coach present they should put on disposable rubber gloves before they treat your injury. A pressure bandage will be applied, and your injury will be elevated. If the bleeding can be controlled and dressed correctly you may be back on the ground quickly. In matches where a doctor is present stitches may be given. Sometimes you may need to go to a doctor or hospital for further treatment. Remember... You have an open wound so you are at risk of getting an infection. Can I prevent catching these diseases? Both Hepatitis and HIV may be spread by contact between broken skin or mucous membranes and infected: Blood Saliva (not HIV) Semen and Vaginal fluids Sports Medicine Australia recommends: That maintaining strict personal hygiene is the best method of controlling these diseases. That includes NOT sharing water bottles with team mates. That all participants involved in contact / collision sports and playing under adult rules, be vaccinated against HEPATITIS B How do I get more information for my coach and my parents? Sports Medicine Australia has an infectious diseases policy that is updated regularly.

Severe Injuries

The following represent severer injury types. In all cases they will require more professional assistance at the initial stage. They are not meant to detract from the "classic injuries", the soft-tissue types or head injuries in particular. With severe injuries, get professional help as quickly as possible, do not immediately move the player until an informed assessment is made by a medical professional or sports trainer, keep people away and try and comfort the player.

Type	Ribs
Management	Be careful when players get winded or cop a whack in the guts or get a knee in the back. Rib damage, unless obvious, may not be that evident until the player has cooled down. For winded players, do not put them on their back and draw their legs to their chest (an old approach). Try to get them to stand or kneel and let them suck the breath back. If pain is evident after getting the breath back (the rib area will be quite painful) then withdraw the player immediately. Seek medical advice ASAP.

Type	Abdominal/Internal organs (Kidneys)
Management	Causes of this may be due to hands/knees or whacks in the stomach and will be accompanied by immediate and then enduring pain. Kidney damage may occur from knees in the back or a severe tackle/whack in the area. Pain may not be overly noticeable until later or damage not suspected until blood occurs in urine. If in doubt, get the player to the hospital ASAP.

Type	Shoulder -Collarbone
Management	Most shoulder injuries that occur are for collarbone damage. Either fractured, broken or dislocated. Other types of shoulder injuries occur due to poor muscle development. On occurrence it is basically a matter of immobilising the arm and shoulder and getting the player to the hospital as quickly as possible.

Type	Neck
Management	If pain in the neck occurs or loss of feeling, then stop the game and do not move the player. As a regular precaution, any injury that has the player lying in a prone position should be considered as possibly neck associated. Get an ambulance to the ground ASAP. After medical diagnosis occurs and treatment given, the coach must not consider having the player resume training and playing until a medical all-clear is provided.

Type	Pelvis/Groin
Management	Common pelvic injuries occur from players copping a knee in the lower back from either tackles or opposition players taking marks. If damage occurs, get the player to the hospital - x-rays will determine if damage has occurred. Unraveling the mystery of the footballer's groin As the 'growth injury' of Australian Rules Football, osteitis pubis is receiving considerable interest from the football community. Unfortunately key AFL players, such as Wayne Carey and Josh Fraser, have been struck down with this debilitating condition. The major concern for players, coaches, parents and medical staff regarding osteitis pubis is the length of time to recover and return to full athletic performance. The disruption to the careers of players, such as Stephen Powell and Damien Adkins, highlight the implications of osteitis pubis. Although AFL injury statistics indicate no significant increase in the number of missed games due to hip/groin problems, there is a genuine level of concern among AFL clubs regarding the apparent increase in the number of players diagnosed with osteitis pubis. This may in part be due to improved diagnosis of the condition through more sensitive clinical tests and investigative procedures. However, we must keep in mind that osteitis pubis is only one of several possible diagnoses around the hip and groin. WHAT IS OSTEITIS PUBIS? Osteitis Pubis is an inflammatory and/or degenerative process in the bone around the pubic symphysis (ie. the central joint between the two pelvic bones). Current theories suggest that the inflammation occurs as a result of increased shearing forces at this central joint. This increased stress is generally thought to be a result of muscular imbalance around the pelvis. Reasons behind the apparent increase in the occurrence of osteitis pubis may include: Increased loads through the pelvis due to the faster nature of the game and the rapid changes of direction An increased expectation of training and playing loads in juniors The year round demands of kicking and running DIAGNOSIS AND INTERVENTION It is generally accepted that earlier recognition and intervention of the condition contributes to shorter recovery processes and therefore an earlier return to sport. However the condition still requires a significant recuperative process with substantial disruption to a player's training, development and performance. Accurate diagnosis of the actual problem is paramount to differentiate osteitis pubis from other causes of groin pain. Physiotherapy assessment for clinical signs of pain and/or weakness, and possible contributing factors (such as weak gluteals and stiff hip joints), is combined with investigations such as MRI, CT or bone scan. Treatment involves rest from the aggravating activities while imbalances around the hips and pelvis are addressed. This will involve massage of tight structures, strengthening of weak muscles, and increasing trunk and pelvic control.

Type	Arms/Wrist
Management	These could also be considered in the "Classic Injuries" due to the common occurrence. Players falling awkwardly or the ball hitting the hands before the player can adjust etc are normal causes for wrists being damaged. R.I.C.E.R. immediately the injury occurs. Do not let the player continue if a wrist injury occurs until establishing the severity. Damage to arms could be caused by landing awkwardly, accidental kicking in packs, an entangling of arms or poorly executed tackles. The pain should be acute and lingering enough to demonstrate that further (and quick) medical treatment is required. Isolate the arm area with compression tape and immobilise (sling). Have a graduated return for the player into training once the plaster is removed - however there is no reason that the player couldn't participate in the non-contact reduced ball work activities to keep them involved.

Type	Dislocations
Management	A dislocation will be accompanied by extreme pain and some obvious deformity. If the dislocation is a finger (and there is no broken skin) then it can be reset reasonably quickly by firmly grabbing the dislocated part and holding the main joint(s) and sliding the dislocated part back into place. Depending on the age and size of the player, it will be hard to move due to the ligaments but should be achievable. The player may find that the finger feels OK and after the game should have some precautionary ice treatment. Bruising may occur. Dislocations elsewhere will require immediate attention from medical professionals.