CCSP Sports Injury Treatment 4 — Questions and Answers
Question 1: A high school football player sustains a 'stinger' (burner). What is the mechanism and appropriate management?
- Cervical flexion causing disc herniation; MRI immediately
- Brachial plexus traction or cervical root compression; remove from play until symptoms fully resolve (Correct answer)
- Rotator cuff tear from impact; orthopedic referral
- Clavicle fracture; X-ray and splinting
Correct answer: Brachial plexus traction or cervical root compression; remove from play until symptoms fully resolve
Stingers result from brachial plexus stretch or cervical root compression; the athlete must be asymptomatic before returning to play.
Question 2: Which modality is most indicated for reducing acute post-surgical knee edema in the first 72 hours?
- Therapeutic ultrasound at 1 MHz
- Neuromuscular electrical stimulation (NMES)
- Cryotherapy with intermittent compression (Correct answer)
- Moist heat pack
Correct answer: Cryotherapy with intermittent compression
Cryotherapy with intermittent compression reduces post-surgical edema via vasoconstriction and mechanical lymphatic pumping.
Question 3: A triathlete with chronic Achilles tendinopathy is prescribed eccentric heel drops. At what position should the eccentric phase occur?
- Knee bent only, flat surface
- Both straight-knee and bent-knee positions on a decline board (Alfredson protocol) (Correct answer)
- Toes elevated, full plantar flexion only
- Dorsiflexion on flat ground only
Correct answer: Both straight-knee and bent-knee positions on a decline board (Alfredson protocol)
The Alfredson eccentric protocol uses both straight-knee (gastrocnemius focus) and bent-knee (soleus focus) drops on a decline board for Achilles tendinopathy.
Question 4: What is the most appropriate first-line treatment for an acute lateral epicondylalgia (tennis elbow) in a recreational athlete?
- Surgical debridement of the ECRB
- Corticosteroid injection series
- Activity modification, wrist extensor strengthening, and manual therapy (Correct answer)
- Complete immobilization in a long arm splint
Correct answer: Activity modification, wrist extensor strengthening, and manual therapy
Activity modification combined with eccentric/isometric wrist extensor strengthening and manual therapy has the best long-term outcomes for lateral epicondylalgia.
Question 5: A marathon runner presents with a femoral neck stress fracture. What is the critical management decision?
- Continue running with a compression brace
- Non-weight-bearing and urgent orthopedic referral due to fracture completion risk (Correct answer)
- Gradual return to running in 2 weeks
- NSAIDs and activity modification only
Correct answer: Non-weight-bearing and urgent orthopedic referral due to fracture completion risk
Femoral neck stress fractures carry high risk of complete fracture and avascular necrosis, requiring immediate non-weight-bearing and orthopedic consultation.
Question 6: In managing a sports-related posterior cruciate ligament (PCL) sprain Grade I–II, which approach is standard?
- Immediate PCL reconstruction surgery
- Conservative management with quadriceps strengthening and functional bracing (Correct answer)
- Hamstring-dominant rehabilitation only
- Long leg casting for 6 weeks
Correct answer: Conservative management with quadriceps strengthening and functional bracing
Grade I–II PCL sprains respond well to conservative care emphasizing quadriceps strengthening to compensate for posterior tibial sag.
Question 7: Which dry needling target is most evidence-based for treating myofascial trigger points in upper trapezius pain in overhead athletes?
- Needle insertion at the spinous process
- Intramuscular needling directly into the active trigger point until local twitch response (Correct answer)
- Superficial needling 5 cm proximal to the trigger point
- Periosteal pecking at the scapular spine
Correct answer: Intramuscular needling directly into the active trigger point until local twitch response
Needling directly into the trigger point to elicit a local twitch response is the most evidence-supported technique for immediate pain reduction.
CCSP Sports Injury Treatment 4
A high school football player sustains a 'stinger' (burner).
What is the mechanism and appropriate management?