What are the main symptoms of an ACL injury. How is an ACL tear diagnosed. What are the treatment options for ACL damage. Can you live with a torn ACL. How can ACL injuries be prevented.

Understanding the Anatomy of the Knee and ACL

The knee joint is a complex structure where the femur (thigh bone) meets the tibia (shin bone). Four primary ligaments connect these bones, each serving a crucial function in knee stability and movement:

• Medial collateral ligament (MCL): Runs along the inside of the knee, preventing inward bending
• Lateral collateral ligament (LCL): Runs along the outside of the knee, preventing outward bending
• Anterior cruciate ligament (ACL): Located in the middle of the knee, preventing forward sliding of the tibia
• Posterior cruciate ligament (PCL): Works in tandem with the ACL, preventing backward sliding of the tibia

The ACL plays a pivotal role in knee stability, particularly during dynamic movements. Its primary function is to prevent excessive forward movement of the tibia in relation to the femur and to limit rotational movements of the knee.

Why is the ACL Prone to Injury?

The ACL is particularly vulnerable to injury due to its position and the forces it encounters during athletic activities. It’s often subjected to sudden changes in direction, rapid deceleration, and pivoting movements, which can place tremendous stress on the ligament.

Common Causes and Risk Factors of ACL Injuries

ACL injuries can occur through various mechanisms, often during sports or high-impact activities. Some common causes include:

• Sudden stops or changes in direction while running
• Landing incorrectly from a jump
• Direct contact or collision to the knee, such as during a football tackle
• Overextension of the knee joint

Certain sports are more commonly associated with ACL injuries, including basketball, football, soccer, and skiing. These activities often involve rapid direction changes, jumping, and potential for collision.

Are Women More at Risk for ACL Injuries?

Research has shown that women are indeed more likely to experience ACL tears compared to men. This increased risk is attributed to several factors:

1. Anatomical differences: Women typically have a narrower notch in the knee where the ACL passes through
2. Hormonal influences: Estrogen may affect ligament laxity and strength
3. Neuromuscular factors: Differences in muscle activation patterns and lower body mechanics
4. Biomechanical considerations: Women often have a wider pelvis, which can affect knee alignment during movements

Recognizing the Symptoms of an ACL Injury

Identifying an ACL injury promptly is crucial for proper management and treatment. The symptoms of an ACL tear can vary in severity but often include:

• A distinctive “popping” sound at the moment of injury
• Rapid swelling of the knee, typically within 6 hours of the injury
• Severe pain, especially when attempting to bear weight on the affected leg
• Difficulty continuing physical activity or sport
• A feeling of instability or the knee “giving way”

In cases of partial tears or milder injuries, individuals may experience a sense of knee instability during certain movements or activities.

When Should You Seek Medical Attention for a Suspected ACL Injury?

It’s essential to consult a healthcare provider if you suspect an ACL injury. Immediate medical attention is necessary if:

• You hear a popping sound accompanied by immediate pain and swelling
• Your knee feels unstable or gives way during normal activities
• You’re unable to bear weight on the affected leg
• The foot appears cool and blue after a knee injury (a sign of potential knee dislocation and vascular compromise)

Diagnosing ACL Injuries: What to Expect

Accurate diagnosis of an ACL injury involves a combination of clinical examination and imaging studies. The diagnostic process typically includes:

1. Physical examination: Your doctor will assess knee stability, range of motion, and perform specific tests to evaluate ligament integrity
2. Patient history: Discussing the mechanism of injury and symptoms experienced
3. Imaging studies:
   • X-rays: To rule out fractures or other bone abnormalities
   • MRI (Magnetic Resonance Imaging): The gold standard for diagnosing ACL tears, as it provides detailed images of soft tissues

An MRI can confirm the diagnosis of an ACL tear and reveal other potential knee injuries, such as meniscus tears or damage to other ligaments.

How Accurate is MRI in Diagnosing ACL Tears?

MRI is highly accurate in diagnosing ACL tears, with a sensitivity and specificity of over 90%. However, interpretation by an experienced radiologist is crucial for accurate diagnosis.

Treatment Options for ACL Injuries

The treatment approach for ACL injuries depends on various factors, including the severity of the tear, the patient’s age, activity level, and overall health. Treatment options typically fall into two categories: non-surgical and surgical.

Non-Surgical Management

Non-surgical treatment may be appropriate for individuals with partial ACL tears or those with less demanding physical activity requirements. This approach typically includes:

• RICE protocol (Rest, Ice, Compression, Elevation) in the acute phase
• Physical therapy to improve knee stability, strength, and range of motion
• Bracing to provide additional knee support
• Activity modification to avoid high-risk movements

Surgical Intervention: ACL Reconstruction

For complete ACL tears or cases where non-surgical management is insufficient, ACL reconstruction surgery may be recommended. This procedure involves:

1. Removing the torn ACL
2. Harvesting a graft (either from the patient’s own tissue or from a donor)
3. Placing the graft in the knee to create a new ACL
4. Securing the graft with screws or other fixation devices

Recovery from ACL reconstruction typically takes 6-9 months and involves extensive rehabilitation to restore knee function and strength.

Living with a Torn ACL: Is It Possible?

While some individuals can function with a torn ACL, it’s important to understand the potential consequences. Living with an untreated ACL tear may lead to:

• Chronic knee instability
• Increased risk of further knee damage, including meniscus tears
• Development of osteoarthritis in the long term
• Limitations in high-demand physical activities and sports

The decision to pursue surgical or non-surgical management should be made in consultation with an orthopedic specialist, considering the individual’s lifestyle, activity goals, and overall health.

Can You Return to Sports After an ACL Injury?

Returning to sports after an ACL injury is possible, but it requires dedication to rehabilitation and careful progression. Factors influencing return to sport include:

1. The type of treatment received (surgical vs. non-surgical)
2. The quality and duration of rehabilitation
3. The individual’s commitment to strengthening and retraining
4. The specific demands of the sport

With proper treatment and rehabilitation, many athletes can return to their pre-injury level of performance, though this process often takes 9-12 months or longer.

Preventing ACL Injuries: Strategies for Reducing Risk

While not all ACL injuries can be prevented, several strategies can help reduce the risk:

• Neuromuscular training programs: Focusing on proper landing techniques, balance, and core stability
• Strength training: Emphasizing quadriceps, hamstrings, and hip muscles
• Flexibility exercises: Maintaining good range of motion in the lower extremities
• Proper warm-up routines: Including dynamic stretching and sport-specific movements
• Appropriate footwear and playing surfaces: Ensuring good traction and stability

Are Knee Braces Effective in Preventing ACL Injuries?

The use of prophylactic knee braces to prevent ACL injuries remains controversial. While some studies suggest a potential benefit, particularly in contact sports, conclusive evidence is lacking. Current research indicates that neuromuscular training programs may be more effective in reducing ACL injury risk than bracing alone.

Long-Term Outlook and Management of ACL Injuries

The long-term prognosis for individuals with ACL injuries depends on various factors, including:

• The severity of the initial injury
• The chosen treatment approach
• Adherence to rehabilitation protocols
• Ongoing commitment to knee health and strength

Proper management of ACL injuries can lead to excellent outcomes, but it’s important to recognize that these injuries may have long-term implications:

1. Increased risk of early-onset osteoarthritis
2. Potential for re-injury, especially in high-risk sports
3. Need for ongoing maintenance exercises and activity modifications

Regular follow-up with healthcare providers and maintaining a proactive approach to knee health can help mitigate these long-term risks and maintain optimal function.

How Does ACL Injury Impact Future Athletic Performance?

The impact of ACL injury on future athletic performance varies among individuals. While many athletes return to their pre-injury level of competition, others may experience:

• Decreased performance in high-demand activities
• Changes in playing style or technique to accommodate the reconstructed knee
• Psychological barriers, such as fear of re-injury

Comprehensive rehabilitation programs that address both physical and psychological aspects of recovery are crucial for optimizing athletic performance post-ACL injury.

Anterior cruciate ligament (ACL) injury: MedlinePlus Medical Encyclopedia

An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) in the knee. A tear may be partial or complete.

The knee joint is located where the end of the thigh bone (femur) meets the top of the shin bone (tibia).

Four main ligaments connect these two bones:

• Medial collateral ligament (MCL) runs along the inside of the knee. It prevents the knee from bending inward.
• Lateral collateral ligament (LCL) runs along the outside of the knee. It prevents the knee from bending outward.
• Anterior cruciate ligament (ACL) is in the middle of the knee. It prevents the shin bone from sliding out in front of the thigh bone.
• Posterior cruciate ligament (PCL) works with the ACL. It prevents the shin bone from sliding backward under the femur.

Women are more likely to have an ACL tear than men.

An ACL injury can occur if you:

• Get hit very hard on the side of your knee, such as during a football tackle
• Overextending your knee joint
• Quickly stop moving and change direction while running, landing from a jump, or turning

Basketball, football, soccer, and skiing are common sports linked to ACL tears.

ACL injuries often occur with other injuries. For example, an ACL tear often occurs along with tears to the MCL and the shock-absorbing cartilage in the knee (meniscus).

Most ACL tears occur in the middle of the ligament, or the ligament is pulled off the thigh bone. These injuries form a gap between the torn edges, and do not heal on their own.

Early symptoms:

• A “popping” sound at the time of injury
• 
  Obvious knee swelling within 6 hours of injury
• Pain, especially when you try to put weight on the injured leg
• Difficulty in continuing with your sport
• Feeling of instability

Those who have only a mild injury may notice that the knee feels unstable or seems to “give way” when using it.

See your health care provider if you think you have an ACL injury. Do not play sports or other activities until you have seen a provider and have been treated.

Your provider may send you for an MRI of the knee. This can confirm the diagnosis. It may also show other knee injuries.

First aid for an ACL injury may include:

• Raising your leg above the level of the heart
• Putting ice on the knee
• Pain relievers, such as nonsteroidal anti-inflammatory drugs (such as ibuprofen)

You also may need:

• Crutches to walk until the swelling and pain get better
• Brace to give your knee some stability
• Physical therapy to help improve joint motion and leg strength
• Surgery to reconstruct the ACL

Some people can live and function normally with a torn ACL. However, most people complain that their knee is unstable and may “give out” with physical activity. Unstable knee after ACL tears can lead to further knee damage. You are also less likely to return to the same level of sports without the ACL.

• Do NOT move your knee if you have had a serious injury.
• Use a splint to keep the knee straight until you see a doctor.
• Do NOT return to play or other activities until you have been treated.

Contact your provider right away if you have a serious knee injury.

Get immediate medical attention if the foot is cool and blue after a knee injury. This means that the knee joint may be dislocated, and blood vessels to the foot may be injured. This is a medical emergency.

Use proper techniques when playing sports or exercising. Some college sports programs teach athletes how to reduce stress placed on the ACL. This involves a series of warm up exercises and jumping drills. There are jumping and landing exercises that have been shown to reduce ACL injuries.

The use of knee braces during vigorous athletic activity (such as football) is controversial. It has not been shown to reduce the number of knee injuries, but not specifically ACL injuries.

Cruciate ligament injury – anterior; ACL tear; Knee injury – anterior cruciate ligament (ACL)

• ACL reconstruction – discharge

• Knee arthroscopy
• ACL degrees
• ACL injury
• Normal knee anatomy
• Anterior cruciate ligament (ACL) injury
• Anterior cruciate ligament repair – Series

Bolgla LA. Gender issues in ACL injury. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 49.

Brotzman SB. Anterior cruciate ligament injuries. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 47.

Cheung EC, McAllister DR, Petrigliano FA. Anterior cruciate ligament injuries. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 98.

Kalawadia JV, Guenther D, Irarrazaval S, Fu FH. Anatomy and biomechanics of the anterior cruciate ligament. In: Prodomos CC. The Anterior Cruciate Ligament: Reconstruction and Basic Science. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 1.

Miller RH, Azar FM. Knee injuries. In: Azar FM, Beaty JH, eds. Campbell’s Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 45.

Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21-32. PMID: 26955296 pubmed.ncbi.nlm.nih.gov/26955296/.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Anterior Cruciate Ligament (ACL) Injury or Tear

What You Need to Know

• ACL injuries are more common among girls than boys.
• Treatment for ACL injuries in children requires special consideration because of the location of growth plates.
• ACL injuries are classified by grades 1, 2, and 3.
• Depending on the grade of ACL injury, the patient’s age, and level of athleticism, non-operative or surgical treatments may be recommended.

What is the anterior cruciate ligament?

The knee is a hinge joint held together by four ligaments. A ligament is a structure in the knee that holds the bones together and helps to control joint movement or motion. There is a ligament on each side of the knee (the collateral ligaments) and two ligaments deep inside the knee. The two ligaments inside the knee that “cross” each other are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Both ligaments attach on one side to the end of the thighbone (femur) and on the other to the top of the shinbone (tibia). [Figure 1].

During activity, the ACL controls how far forward the tibia can “slide” relative to the femur: it essentially acts to prevent too much forward movement. While some degree of motion or sliding is normal and is required for knee function, too much motion may damage other structures in the knee which can lead to long term problems in some patients.

How is the ACL injured? What are the symptoms?

The ACL can be injured or torn in a number of different ways. The most common mechanism is that of a sudden pivoting or cutting maneuver during sporting activity, which is commonly seen in football, basketball and soccer. The ligament can also tear due to work injuries or automobile accidents.

At the time of the injury, a “pop” or “snap” can sometimes be felt or heard. The amount of pain experienced at the time of the injury is somewhat variable but can be quite severe. Typically, the person is unable to continue play or activity, and has the impression that a significant injury has occurred. Immediate swelling of the knee develops at the time of injury—within the first several hours—but the extent of swelling can be limited if the knee is immediately iced or splinted.

What are the symptoms of an ACL injury or tear?

• A “pop” in the knee at the time of injury
• Swelling of the knee
• Inability to bear weight on leg (though some have little or no pain)
• Instability of the knee

ACL Surgery | Michelle’s Story

After an ACL tear, Michelle was determined to get back to her active lifestyle. She traveled to Johns Hopkins for ACL reconstruction under the care of sports medicine orthopaedic surgeon Andrew Cosgarea, M.D.

How is an ACL injury diagnosed?

An ACL tear can be diagnosed by a physician through a history and physical examination. On physical examination, the physician can specifically assess the amount of motion present and determine if the ACL is torn. Additionally, evaluation of other structures within the knee is done also, as ACL tears are often found in association with injury to other structures within the knee, such as the cartilage and collateral ligaments.

X-rays are taken to evaluate for the presence of any fractures. In many patients, an MRI scan of the knee may be ordered. The scan can clarify the question of an ACL tear if the history and examination are inconclusive. The scan is also useful for evaluating the cartilage or meniscus tissue in the knee if this information is necessary to make decisions regarding the best treatment for a specific patient.

What are the different types of ACL injury or tears?

ACL injuries are commonly classified in grades of 1, 2 or 3.

Grade 1

Grade 1 injuries include ACLs that have suffered mild damage, e.g., the ACL is mildly stretched but still provides adequate stability to the knee joint.

Grade 2

Grade 2 ACL injuries are rare and describe an ACL that is stretched and partially torn.

Grade 3

Grade 3 ACL tears happen when the ACL is torn completely in half and is no longer providing any stability to the knee joint.

Tibial Spine Avulsion ACL Injury

Adolescents may also commonly have what is called a tibial spine avulsion ACL injury. With this type of injury, the ACL itself is not torn, but the bony attachment of the ligament to the tibia (lower legbone) is pulled off. Depending on how far the bony attachment of the ligament is pulled off, the injury can result in weakness or instability of the knee if it is not fixed.

ACL Tears in Female Athletes: Q&A with a Sports Medicine Expert

Sports injury prevention isn’t a one-stop shop, especially for injuries like ACL tears, which are four to eight times more common among women than men. Discover ways for women to help prevent this common injury.

Read more

What is the treatment for an ACL injury or tear?

Treatment options are based on the patient’s symptoms, examination, the growth remaining in his or her growth plates, type of injury to the ligament, and the type of sports and activity goals.

Nonsurgical

Nonsurgical treatment is most appropriate for grade 1 injuries. This would include immobilization or bracing, physical therapy, and a gradual progression back to regular activities and sports.

Surgical

Surgical treatment is recommended for individuals with a grade 3 or complete ACL tear. Surgical options may vary based on the type of ACL injury, whether the patient has open or closed growth plates, and the type.

Seminar

Common Sports and Activity Related Injuries: What to Consider from Pain to Breaks

Learn more about common sports injuries and treatments to consider from our sports medicine expert Alex Johnson, M.D., and our foot and ankle expert John Thompson, M.D., in this webinar-based video.

Watch the webinar

What are the special considerations for a pediatric ACL injury or tear?

Children and adolescents may have open growth plates and a significant amount of growing left to do. This is an important factor and part of the discussion when weighing the options for ACL treatment.

If the patient has significant growth remaining, the treatment recommended will avoid disrupting the growth plates so that future growth isn’t hindered.  

Damage and armor penetration: how it works | News

August 9, 2021

Damage and Penetration: How It Works

This is the first article in a series about the damage mechanics of Caliber. In this article, we will talk about damage and armor penetration in the torso and limbs.

Each weapon in the game has its own base damage, which is listed as “damage” in the weapon’s stats in the game. However, you may find that in combat, the damage dealt by a weapon differs from that indicated in the operative’s personnel file. The reason for this is the different conditions under which it was applied.

– Weapon damage depends on where the shot hits.

– There are three types of damage in Caliber: to the head, to the body and to the limb.

– Damage to limb equals 80% damage to torso.

– A weapon’s “armor penetration” parameter is how much damage this weapon will inflict on an armored opponent.

– An Operator with full armor but low health is more vulnerable than an Operator with full health but low armor.

– Shooting at the legs of an armored operative deals the least damage.

In-game damage can be seen by hovering over the operator’s weapon icon.

Damage is the amount of health points that one hit removes.

Armor Penetration is the percentage of damage that will be dealt to the enemy’s health if he has armor.

For this article about damage, just remember that the weapon has base damage, armor penetration, and a damage modifier when it hits a limb. There are other modifiers: headshot damage, ranged damage, or ability modifiers; we will devote the following materials to their features. In this article, we talk about the damage of a weapon, provided that it is fired at an effective distance.

Limb hit modifier for all operatives equals 80% base damage. Damage to a limb is registered under the condition that the limb does not cover the body, that is, most often 80% of the base damage is received by the operator who is shot at the legs or arms (forearm) when attacking from the flank.

Raid support, medic and sniper have a special trait that reduces damage to limbs by 20%. When wounded in a limb, they will take 60% of the damage.

To show the types of damage, let’s take Nightmare and shoot at Grandfather, who has no armor.

Nightmare main weapon damage to Grandfather will be 22 health points, head damage 39 points, which is equal to the declared base damage and head damage of the main Nightmare weapon HK416 A5. And if Grandfather hits the leg, the Nightmare will deal damage equal to 80% of the base damage or 17.6 health points.

If an operative has armor, damage to him is calculated using two formulas: one calculates how much a shot removes health points, the second – how much the same shot removes armor. Let’s call these formulas Damage to Health and Damage to Armor.

Health Damage = Weapon Damage * Weapon Penetration

Armor Damage = Weapon Damage – Health Damage

9002 5 And again Nightmare shoots Grandfather in the body. But this time, Grandfather is prepared – he has the maximum amount of armor, 40 units.

Nightmare weapon damage – 22 points.

Armor penetration – 60%, which is equal to a coefficient of 0.6.

It turns out that the health damage from the main weapon of the Nightmare is [22 * 0.6 = 13.2] – this is the number of points that the target’s health will decrease if the Nightmare hits the body.

Nightmare’s main weapon armor damage is [ 22 − 13.2 = 9 ] – this is the amount the target’s armor will be reduced if the Nightmare hits the body.

“Under the hood” the game counts damage to the sixth decimal place, but counts it with some peculiarities. So, “health damage” is counted as fractional numbers. For example, Nightmare deals 13.2 health damage to the body of an operative with armor. A player who has damage display enabled will see that they dealt 13 damage. However, in total for five shots, it turns out that the Nightmare will shoot 66 damage, and not 65. And the game will count exactly 66 damage.

Unlike health, armor damage in Caliber is rounded to the nearest integer. Thus Nightmare deals not 8.8 damage to armor, as follows from the calculations, but 9- according to the rules in force in Caliber.

Following this logic, it is possible to calculate the damage to an armored operator when shooting at limbs.

Damage to health when shooting at the limbs of an operative in armor = (weapon damage * 0.8) * armor penetration of the weapon 10.56].

Armor damage when shooting at limbs = (weapon damage * 0.8) – damage to health when shooting at the limbs of an operator in armor

That is, Nightmare, shooting Grandfather in the legs, will deal 7 damage to armor: [ (22 * 0. 8) – 10.56 = 7.44]. In this case, the game will count the fractional number as the nearest integer, that is, the damage to the armor will be 7 units.

Upon reaching account level 20, all operatives, except for snipers, will be able to increase armor penetration by another 10%. This is done using the Armor Piercing Ammo skill, with which the same Nightmare will already have 70% armor penetration, which will make it an even more formidable opponent.

Finally, let’s clearly illustrate the fact that health points and armor points in Caliber are independent values ​​that receive damage in parallel.

Consider Archer, who fires at Grandfather with full armor for the last time in this article.

The base damage of Archer’s primary weapon, the M95 sniper rifle, is 115.

Archer’s armor penetration is 80%, which is equal to a factor of 0.8.

And Grandfather, until he reaches the 15th level of the operative, has only 90 health points.

It turns out that damage to health from Archer’s main weapon = [ 115 * 0. 8 = 92 ] – this is the number of health points that Archer’s shot will take when it hits an operative.

This is all you need to know for a basic understanding of the mechanics of dealing damage in Caliber. The next article will be devoted to the mechanics of dealing damage at a distance.

See you in battle!

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Damage and Healing – Combat | SRD 5.1 – D&D 5e

Wounds and the threat of death are a constant companion when exploring fantasy game worlds. Sword lunge, well-aimed arrow, flame from spell fireball – all this can cause damage and even kill the most resistant creatures.

Hit Points

Hit Points reflect a combination of physical and mental toughness, sustenance, and luck. Creatures with high hit points are hard to kill. Those with low hit points are less viable.

A creature’s current hit points (commonly called just hit points) can be any number between 0 and its hit point maximum. This number often changes as the creature takes damage and is healed.

Each time a creature takes damage, that damage is subtracted from its hit points. Losing hit points has no effect on the creature’s abilities until it drops to 0 hit points.

Damage Roll

Weapons, spells, and combat skills of monsters have their damage listed. You roll the indicated die or dice, add modifiers, and deal the resulting damage to the target. Damage bonuses are provided by magical weapons, special skills and other factors. With a penalty, you can deal 0 damage, but never negative damage.

When attacking with a weapon, you add an attribute modifier to damage, the same attribute that was used on the attack roll. In spell , spell says which dice to roll to determine damage and which modifiers apply.

If a spell or effect deals damage to multiple targets at once, the damage roll is made one at a time. For example, when a wizard throws fireball or a cleric throws heavenly fire , spell damage rolls once for all creatures caught in the explosion.

Critical Hits

When you make a critical hit, you roll damage dice at the target twice. Roll the damage dice two times and add up the total. Then add any relevant modifiers. To speed up, you can roll all the dice at the same time.

For example, if you make a critical hit with a dagger, roll 2d4 for damage instead of 1d4, then add the ability modifier. If the attack includes other damage dice, such as from the rogue’s Sneak Attack skill, you roll those dice twice as well.

Types of damage

Different attacks, spells and other effects cause different types of damage. Damage types themselves do not have special rules, but other elements of the game depend on them, such as damage resistance.

Damage types come with examples to help the DM determine the damage type for a new effect.

Acid. Black Dragon’s Acrid Breath and Black Pudding’s Dissolving Slime deal acid damage.

Crusher. Heavy power attacks – hammer, fall, crush, etc. – deal bludgeoning damage.

Refrig. Frost Devil Spear and White Dragon’s Frost Breath inflict cold damage.

Fire. A red dragon that breathes fire and many spells that create heat deal fire damage.

Power. Strength is pure magic focused into destructive power. Most commonly, force damage is dealt by spells such as magic arrow and spirit weapon .

Lightning. The *lightning* spell and the blue dragon’s breath deal lightning damage.

Necrotic . The necrotic energy emitted by some undead and spells such as chill touch sear the flesh and even the soul.

Stab. Stab and pierce attacks, including spear strikes and monster bites, cause piercing damage.

Poison. The green dragon’s poisonous bites and toxic breath deal poison damage.

Mental. Mind attacks, such as mind flayers, deal psychic damage.

Radiant. The damage dealt by the priest’s spell Heavenly Fire and the angel’s vengeance weapon sear flesh like fire and overwhelm the spirit with power.

Chopping. Monster swords, axes, and claws deal slashing damage.

Thunder. Deafening sound waves, such as those from thunder wave , cause thunder damage.

Damage Resistance and Vulnerability

Some creatures and objects are extremely difficult or vice versa, easy to harm with certain types of damage.

If a creature or item has **resistance to ** a damage type, then that damage type’s damage is halved. If a creature or object has a **vulnerability** to a damage type, then that damage type’s damage is doubled against it.

Resistance and vulnerability are applied to damage after all other modifiers. For example, a creature with bludgeon resistance is hit by an attack that deals 25 bludgeoning damage. That creature is also in a magical aura that reduces all damage by 5. First, 5 is subtracted from the 25 damage and the result is halved, so the creature takes 10 damage.

Multiple resistances or vulnerabilities to the same type of damage do not stack. For example, if a creature has resistance to fire damage and resistance to nonmagical damage, then nonmagical fire damage is halved instead of quadrupled.

Heal

If the damage did not cause death, it is not permanent. And even death can be reversed with powerful magic. The creature’s hit points are restored by resting, and magic such as spell cure wounds or cure potion remove the damage instantly.

If a creature receives any healing, the restored hit points are added to its current hit points. The creature’s hit points cannot exceed its hit point maximum, so the extra hit points are lost. For example, a druid restores 8 8 hit points to a ranger. If the ranger is currently at 14 hit points and has a maximum of 20 hit points, the ranger regains 6 hit points instead of 8.

A dead creature cannot regain hit points until magic such as revive brings it back to life.

Hit Point Reduction to 0

If you drop to 0 hit points, you either die immediately or fall unconscious, as described below.

Instant Death

Huge damage can kill you instantly. If the damage drops your hit points to 0 and there is still a surplus left, you die if the surplus equals or exceeds your hit point maximum.

For example, a cleric with a maximum of 12 hit points now has 6 hit points. If she takes 18 damage from an attack, her hit points are reduced to 0, but 12 more damage remains. Since this damage is equal to the maximum hit points, the cleric dies.

Blackout

If the damage drops you to 0 hit points but doesn’t kill you, you fall unconscious (see appendix A). You regain consciousness if you regain hit points.

Death Saving Throws

If you start your turn at 0 hit points, you must make a special saving throw called a death saving throw to determine whether you are approaching death or clinging to life. Unlike other saving throws, this one is not tied to any ability score. Now you are in the hands of fate, and only spells and skills that improve the chances of successful saving throws can help you.

Roll a d20. If the result is “10” or higher, you have succeeded. Otherwise, the saving throw fails. Success and failure by themselves have no effect. On three successes, you become stabilized (see below). On three failures, you die. Successes and failures don’t have to be consistent; track the number of both until you accumulate three identical results. Both are reset to zero when you regain any hit points or become stabilized.

Rolled “1” or “20”. If you make a death saving throw and roll a 1, it counts as two failures. On a 20, you regain 1 hit point.

Damage at 0 hit points. If you take damage while you are at 0 hit points, you gain a failed death saving throw. If it’s critical hit damage, you get two failures. If the damage equals or exceeds your maximum hit point, you suffer instant death.

Stabilize a creature

The surest way to help a creature with 0 hit points is to heal it. If no healing is available, the creature can at least be stabilized so that it doesn’t die on a failed death saving throw.

You can use an action to administer first aid to an unconscious creature and attempt to stabilize it, which requires a DC 10 Wisdom (Medicine) check. but never regains consciousness. Upon taking damage, the creature is no longer stabilized and begins making saving throws against death again. A stabilized creature that has not received healing regains 1 hit point after 1d4 hours.

Monsters and death

Most monsters under the DM’s control die immediately when they drop to 0 hit points, without losing consciousness or saving throws against death.

Powerful villains and special NPCs may be exceptions; The GM can let them pass out and use the rules meant for the player characters.

Creature Knockout

Sometimes an attacker wants to disable an enemy rather than kill him. If the attacker reduces a creature to 0 hit points with a melee attack, it can claim to knock it out. The attacker can make this choice at the time of the damage. In this case, the target loses consciousness, but immediately becomes stabilized.

Temporary Hit Points

Some spells and special abilities give creatures temporary hit points. Temporary hits are not real hits; it is a barrier against damage, a buffer against wounds.

If you have temporary hit points and take damage, temporary hit points are removed first, and excess damage is transferred to regular hit points. For example, if you have 5 temporary hit points and take 7 damage, you lose all temporary hit points and take 2 damage. Thus, a character can have full hit points and still gain temporary hit points.