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HMS, TIP EQ-Bank 113 MC

A netball player lands awkwardly from a jump, without contact with another player, and tears a ligament in her ankle.

How should this injury be classified?

  1. Direct, soft tissue
  2. Indirect, soft tissue
  3. Indirect, hard tissue
  4. Overuse, soft tissue
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\(B\)

Show Worked Solution
  • B is correct: The injury is indirect because it was caused by internal forces when the player landed, not by an external impact. It is soft tissue because ligaments are connective tissue, not bone.

Other options:

  • A is incorrect: A direct injury results from an external force, such as a collision or being struck. No contact occurred here.
  • C is incorrect: The classification as indirect is correct, but ligaments are soft tissue. Hard tissue injuries involve bone.
  • D is incorrect: Overuse injuries develop gradually from repeated stress. This injury occurred suddenly in a single event.

HMS, TIP EQ-Bank 112 MC

A soccer player is kicked in the lower leg during a tackle. During assessment, the player reports hearing a crack. There is swelling but no obvious deformity, and touching the shin causes sharp pain at one point on the bone.

What should the sports trainer do next?

  1. Proceed to active movement to see whether the player can bear weight
  2. Stop the assessment, immobilise the leg and refer the player for medical attention
  3. Proceed to passive movement, as it places less stress on the injury than active movement
  4. Apply ice and complete a skill test once the pain settles
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\(B\)

Show Worked Solution
  • B is correct: The crack and sharp pain at one point on the bone suggest a possible fracture. TOTAPS should stop once a serious injury is suspected, because further movement could worsen the damage.

Other options:

  • A is incorrect: The absence of deformity does not rule out a fracture. Bearing weight could displace the broken bone.
  • C is incorrect: Passive movement still moves the injured area. It should not be attempted when a fracture is suspected.
  • D is incorrect: The skill test is the final step and is only completed if earlier steps show no serious injury. Ice reduces pain but does not make the injury safe to test.

HMS, TIP EQ-Bank 118

A 16-year-old fast bowler develops lower back pain that gradually worsens over the cricket season. Scans reveal a stress fracture in a vertebra of the lower spine.

Classify this injury and explain your classification.   (4 marks)

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Classification: an overuse, hard tissue injury.

  • It is classified as an overuse injury because it developed gradually from repeated stress rather than from a single event. Each delivery places bending and twisting forces through the lower spine.
  • Over a season of bowling, this repeated loading causes the bone to break down faster than it can repair. As a result, a stress fracture develops. This is supported by the pain gradually worsening over the season rather than starting suddenly.
  • It is classified as a hard tissue injury because the damage is to bone (a vertebra), rather than to muscles, tendons or ligaments.
  • Young bowlers are particularly at risk because their bones are still developing. Consequently, high bowling workloads without enough recovery increase the likelihood of this injury.
Show Worked Solution

Classification: an overuse, hard tissue injury.

  • It is classified as an overuse injury because it developed gradually from repeated stress rather than from a single event. Each delivery places bending and twisting forces through the lower spine.
  • Over a season of bowling, this repeated loading causes the bone to break down faster than it can repair. As a result, a stress fracture develops. This is supported by the pain gradually worsening over the season rather than starting suddenly.
  • It is classified as a hard tissue injury because the damage is to bone (a vertebra), rather than to muscles, tendons or ligaments.
  • Young bowlers are particularly at risk because their bones are still developing. Consequently, high bowling workloads without enough recovery increase the likelihood of this injury.

HMS, TIP 2018 HSC 30a

An athlete running a 400-metre race experiences a hamstring strain in the sprint towards the finish line.

Explain the classification and management of the athlete’s injury.   (8 marks)

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  • The hamstring strain is classified as an indirect, soft tissue, acute injury because the damage occurs from internal forces within the athlete’s body. This occurs because the hamstring muscle experiences excessive tension during the high-intensity sprint phase. The reason for this is the muscle cannot cope with the explosive demands, resulting in muscle fibres tearing. This demonstrates an indirect injury pattern where no external contact causes the damage.
  • Immediate management follows the RICER protocol because this approach minimises secondary tissue damage and inflammation. For example, rest involves immediately stopping activity to prevent further muscle tearing. Ice application for 15-20 minutes every hour helps to reduce pain, swelling and metabolic demands of damaged tissues.
  • This leads to vasoconstriction that limits bleeding within the muscle. Compression using elastic bandaging creates external pressure that supports damaged tissues and reduces swelling.
  • Finally, elevation of the injured leg above heart level facilitates venous return and reduces fluid accumulation.
  • Referral to medical professionals is essential because accurate diagnosis determines appropriate treatment progression. This process ensures that the severity of the strain is properly assessed using clinical tests or imaging.
  • For instance, a physiotherapist can determine if the injury is Grade 1 (mild), Grade 2 (moderate) or Grade 3 (severe) which then guides rehabilitation timeframes and return-to-play decisions. Therefore, proper medical assessment prevents complications and ensures safe recovery.

Show Worked Solution

  • The hamstring strain is classified as an indirect, soft tissue, acute injury because the damage occurs from internal forces within the athlete’s body. This occurs because the hamstring muscle experiences excessive tension during the high-intensity sprint phase. The reason for this is the muscle cannot cope with the explosive demands, resulting in muscle fibres tearing. This demonstrates an indirect injury pattern where no external contact causes the damage.
  • Immediate management follows the RICER protocol because this approach minimises secondary tissue damage and inflammation. For example, rest involves immediately stopping activity to prevent further muscle tearing. Ice application for 15-20 minutes every hour helps to reduce pain, swelling and metabolic demands of damaged tissues.
  • This leads to vasoconstriction that limits bleeding within the muscle. Compression using elastic bandaging creates external pressure that supports damaged tissues and reduces swelling.
  • Finally, elevation of the injured leg above heart level facilitates venous return and reduces fluid accumulation.
  • Referral to medical professionals is essential because accurate diagnosis determines appropriate treatment progression. This process ensures that the severity of the strain is properly assessed using clinical tests or imaging.
  • For instance, a physiotherapist can determine if the injury is Grade 1 (mild), Grade 2 (moderate) or Grade 3 (severe) which then guides rehabilitation timeframes and return-to-play decisions. Therefore, proper medical assessment prevents complications and ensures safe recovery.

♦♦ Mean mark 55%.

HMS, TIP 2019 HSC 30a

An athlete dives towards the ground in an attempt to score a try in a game of touch football. The athlete hears a loud crack and remains on the ground, clutching the injured shoulder.

  1. Explain the assessment procedures that should be used to determine the nature and extent of this injury.   (4 marks)

  2. Describe the management of fractures and dislocations.   (4 marks)

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i.    TOTAPS assessment

  • TOTAPS assessment provides systematic evaluation of the shoulder injury. Talk involves questioning the athlete about pain location, intensity, and mechanism of injury. This determines initial severity and helps identify potential fracture or dislocation.
  • Observe compares the injured shoulder to the uninjured side for deformity, swelling, or abnormal positioning. This reveals obvious structural damage or displacement indicating serious injury requiring immediate medical attention.
  • Touch assesses tenderness, heat, and structural abnormalities through gentle palpation. This identifies specific injury location and severity. However, if significant deformity or severe pain exists, assessment should stop immediately.
  • Active and passive movement testing would not proceed due to suspected hard tissue injury. This occurs because movement attempts could worsen fracture displacement or joint damage, requiring immediate medical intervention instead.

ii.   Management of fractures and dislocations

  • Fractures require immediate immobilisation to prevent further tissue damage and reduce pain.
  • Support the injured area using splints, slings or bandages without attempting realignment.
  • Monitor for shock symptoms including pale skin, rapid pulse and decreased consciousness.
  • Transport to medical facilities immediately for professional treatment including X-rays and surgical intervention if required.
  • Dislocations involve joint displacement requiring professional medical reduction.
  • Never attempt to relocate the joint as this may cause additional nerve or blood vessel damage.
  • Immobilise the joint in the position found using appropriate supports.
  • Apply ice to reduce swelling and pain while monitoring circulation below the injury site.
  • Arrange immediate medical evacuation for proper diagnosis and professional joint reduction procedures.

Show Worked Solution

i.    TOTAPS assessment

  • TOTAPS assessment provides systematic evaluation of the shoulder injury. Talk involves questioning the athlete about pain location, intensity, and mechanism of injury. This determines initial severity and helps identify potential fracture or dislocation.
  • Observe compares the injured shoulder to the uninjured side for deformity, swelling, or abnormal positioning. This reveals obvious structural damage or displacement indicating serious injury requiring immediate medical attention.
  • Touch assesses tenderness, heat, and structural abnormalities through gentle palpation. This identifies specific injury location and severity. However, if significant deformity or severe pain exists, assessment should stop immediately.
  • Active and passive movement testing would not proceed due to suspected hard tissue injury. This occurs because movement attempts could worsen fracture displacement or joint damage, requiring immediate medical intervention instead.

ii.   Management of fractures and dislocations

  • Fractures require immediate immobilisation to prevent further tissue damage and reduce pain.
  • Support the injured area using splints, slings or bandages without attempting realignment.
  • Monitor for shock symptoms including pale skin, rapid pulse and decreased consciousness.
  • Transport to medical facilities immediately for professional treatment including X-rays and surgical intervention if required.
  • Dislocations involve joint displacement requiring professional medical reduction.
  • Never attempt to relocate the joint as this may cause additional nerve or blood vessel damage.
  • Immobilise the joint in the position found using appropriate supports.
  • Apply ice to reduce swelling and pain while monitoring circulation below the injury site.
  • Arrange immediate medical evacuation for proper diagnosis and professional joint reduction procedures.

♦♦ Mean mark (ii) 48%.

HMS, TIP 2023 HSC 30a

Refer to the following scenario to answer BOTH Questions 30 (a) (i) and (ii).

An athlete tries to change direction quickly to evade an opponent during a basketball game. They hear a loud snap and feel their knee give way beneath them, sustaining knee ligament damage.

  1. Outline TWO classifications of this injury.   (3 marks)

  2. Explain the process for determining the nature and extent of this injury.   (5 marks)

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Sample answer

i.   Injury classifications

  • An indirect injury as it resulted from internal forces when the athlete tried to change direction, rather than from direct external impact.
  • A soft tissue injury since ligaments are connective tissue rather than bone, with damage occurring to the structural components that stabilize the knee joint.

ii. Assessment of nature and extent of the injury – TOTAPS

  • The TOTAPS assessment begins by talking with the athlete about injury mechanism and symptoms. This communication reveals critical information about the snap sound and knee instability because these details indicate potential ligament rupture severity. Questioning establishes pain location and movement limitations which helps identify specific structures involved.
  • Observation follows because visual indicators reveal injury extent through swelling, bruising, or deformity patterns. These signs demonstrate ligament damage severity and guide subsequent assessment steps. Touch assessment then occurs to pinpoint specific pain sites along knee ligament pathways. This palpation process identifies which structures like ACL or MCL are damaged because tenderness patterns correspond to anatomical locations.
  • Active movement testing enables the athlete to attempt limited knee flexion and extension. Range restrictions occur due to ligament injury and muscle guarding which indicates functional limitations. Passive movement assessment involves careful knee manipulation including anterior drawer tests. These specialised tests determine ligament stability because abnormal movement patterns reveal structural compromise. Skills testing becomes contraindicated because obvious instability creates risk for further damage to compromised ligaments.

Show Worked Solution

Sample answer

i.   Injury classifications

  • An indirect injury as it resulted from internal forces when the athlete tried to change direction, rather than from direct external impact.
  • A soft tissue injury since ligaments are connective tissue rather than bone, with damage occurring to the structural components that stabilize the knee joint.

ii. Assessment of nature and extent of the injury – TOTAPS

  • The TOTAPS assessment begins by talking with the athlete about injury mechanism and symptoms. This communication reveals critical information about the snap sound and knee instability because these details indicate potential ligament rupture severity. Questioning establishes pain location and movement limitations which helps identify specific structures involved.
  • Observation follows because visual indicators reveal injury extent through swelling, bruising, or deformity patterns. These signs demonstrate ligament damage severity and guide subsequent assessment steps. Touch assessment then occurs to pinpoint specific pain sites along knee ligament pathways. This palpation process identifies which structures like ACL or MCL are damaged because tenderness patterns correspond to anatomical locations.
  • Active movement testing enables the athlete to attempt limited knee flexion and extension. Range restrictions occur due to ligament injury and muscle guarding which indicates functional limitations. Passive movement assessment involves careful knee manipulation including anterior drawer tests. These specialised tests determine ligament stability because abnormal movement patterns reveal structural compromise. Skills testing becomes contraindicated because obvious instability creates risk for further damage to compromised ligaments.

♦ (ii) Mean mark 51%.