Fit for play.Fit for play.Injury prevention and ManagementInjury prevention and Management

Chris McNicholl.Chartered Physiotherapist.Chris McNicholl.Chartered Physiotherapist.Mid Ulster Physiotherapy Clinic.Mid Ulster Physiotherapy Clinic.

Fit for play.Fit for play.

Set the scene re injury.Set the scene re injury.

Injury occurrence.Injury occurrence.

Injury management.Injury management.

Injury prevention.Injury prevention.

Dynamic, multifactorial model of sports Dynamic, multifactorial model of sports injury etiologyinjury etiology

Meeuwisse, ‘94Meeuwisse, ‘94

Internal Risk FactorsInternal Risk Factors•Age•Gender•Body composition•Health•Physical fitness•Anatomy•Skill level•Previous injury Previous injury •Motor AbilitiesMotor Abilities•Psychological profilePsychological profile

- MotivationMotivation- Risk takingRisk taking- Stress copingStress coping

Exposure to externalExposure to externalrisk factors:risk factors:•Human factors (teamMates, opponents, ref)•Training•Exposure•Protective equipment•Sports Equipment•Environment

Inciting event:Inciting event:

•Joint motion(Kinematics, jt forcesand moments)•Playing situation(Skill performed)•Training programme•Match schedule

Predisposed Athlete

Susceptible Athlete INJURY

BASEM Congress 2004BASEM Congress 2004

ExtrinsicFactors

Intrinsic Factors

ModificationsFrom

initial strain

QuestionableOptions intreatment

First Injury Recurrent Injuries

Croisier, 2004

BASEM Congress 2004BASEM Congress 2004

AgeAgeAgeAge

ActivitActivityy

AgeAge

TimeTime

Other Other

LocatioLocationn

NatureNature

CauseCause

SeveritySeverity

ResultsResults

Training41%

Game59%

Occurrence of InjuryOccurrence of Injury

0

10

20

30

40

50

60

1st 2nd 3rd 4th

% o

f In

jury

Training

Game

Location of InjuryLocation of Injury

0

5

10

15

20

25

30

AB

DO

MIN

AL

AC

HIL

LES

AN

KLE

AR

M

BA

CK

CA

LF

FA

CIA

L

FIN

GE

R

FO

OT

GR

OIN

HA

MS

TR

ING

HIP

KN

EE

LOW

ER

LE

G

OT

HE

R

QU

AD

S

RIB

SH

OU

LDE

R

TO

E

TH

IGH

% o

f In

jury

Training Game

Location of InjuryLocation of InjuryShoulder 7%

Hamstrings 22%

Quads 8% Knee 14%

Ankle 13%

Groin 9%

Hurling InjuriesHurling Injuries

Muscle injuries 24% (hamstrings Muscle injuries 24% (hamstrings 12%)12%)

Contusions 16.3%Contusions 16.3%

sprains 15.6%sprains 15.6%

41% were attributed to foul play!41% were attributed to foul play!

Watson 1996 Watson 1996 Am.J.Sp.MedAm.J.Sp.Med

Location of injuryLocation of injury

Fingers 13%

Hamstring 12%Head 9%

Knee and ankle 9%

Watson. A 1996 Am. J.Sp.Med

Copyright ©2007 BMJ Publishing Group Ltd.

Wilson, F et al. Br J Sports Med 2007;41:317-321

Figure 1 Site of injury, with 95% CI.

Copyright ©2007 BMJ Publishing Group Ltd.

Wilson, F et al. Br J Sports Med 2007;41:317-321

Figure 2 Type of injury, with 95% CI.

Copyright ©2007 BMJ Publishing Group Ltd.

Wilson, F et al. Br J Sports Med 2007;41:317-321

Figure 3 Mechanism of injury, with 95% CI.

Copyright ©2007 BMJ Publishing Group Ltd.

Wilson, F et al. Br J Sports Med 2007;41:317-321

Figure 4 Injury rate by position, with 95% CI.

ComparisonsComparisonsGaelic football 13.5/1000 hrs Wilson et al Gaelic football 13.5/1000 hrs Wilson et al 20062006

Soccer 8.5/1000 hrs Hawkins.Soccer 8.5/1000 hrs Hawkins.

Aus Rules 62/1000 hrs Seral et alAus Rules 62/1000 hrs Seral et al

Rugby League 139/1000 hrs Seral et alRugby League 139/1000 hrs Seral et al

Rugby Union 72/1000 hrs Bird et alRugby Union 72/1000 hrs Bird et al

My practice.My practice.

296 attendances in 2004.296 attendances in 2004.

33% Muscular33% Muscular

22.6% Ligament 22.6% Ligament

23.9% Overuse23.9% Overuse

9.5% Tendon9.5% Tendon

6.5% Contusion6.5% Contusion

4.5% Fracture,Dislocation, 4.5% Fracture,Dislocation, derangement.derangement.

hand 4neck 8shoulder 15

back 53

hip 18

groin

hamstring 48

quad 20

knee 57

calf 14shin 4

ankle 47

foot 8

Audit of Gaelic footballers and hurlers attending from clubs in Tyrone, Derry and Antrim over 2004.

Injury management.Injury management.

Acute Stage (Hours and days)Acute Stage (Hours and days)

Bleeding and onset of inflammation. Bleeding and onset of inflammation.

Protection.Protection.

Rest.Rest.

Ice.Ice.

Compression.Compression.

Elevation. Elevation.

Regeneration.Regeneration.Involves the production Involves the production of scar (collagen) of scar (collagen) material. Begins 24-material. Begins 24-48hrs post injury and 48hrs post injury and can peak up to 2-3 can peak up to 2-3 weeks post injury.weeks post injury.

Therapeutic modalities.Therapeutic modalities.

Soft tissue mobilisation.Soft tissue mobilisation.

Return to non- Return to non- “harmful” activities. “harmful” activities.

Repair and remodelling.Repair and remodelling.

The production of a high quality The production of a high quality functional scar. 4 weeks to 6 months.functional scar. 4 weeks to 6 months.

Graduated exposure to stress.Graduated exposure to stress.

Return to full range of movement Return to full range of movement and strength.and strength.

Full sport specific rehabilitation.Full sport specific rehabilitation.

Address any biomechanical Address any biomechanical weaknesses.weaknesses.

Inadequate rehab.Inadequate rehab.Watson demonstrated in Irish Soccer/Gaelic/hurling that Watson demonstrated in Irish Soccer/Gaelic/hurling that time lost through injury in the previous year was largest time lost through injury in the previous year was largest predictor of new injury.predictor of new injury.82% of County players in one study had been injured in 82% of County players in one study had been injured in previous 6 months.previous 6 months.35% of these injuries were recurring.35% of these injuries were recurring.46% Continued to play, 93% of whom believed their 46% Continued to play, 93% of whom believed their performance had been affected. Cromwell et al 2000. Br performance had been affected. Cromwell et al 2000. Br J.Sp Med.J.Sp Med.

Injured muscle retains sufficient muscle strength to allow Injured muscle retains sufficient muscle strength to allow early limited functional rehabearly limited functional rehabInjured muscle at risk for complete rupture if muscle Injured muscle at risk for complete rupture if muscle subjected to high tensile forcessubjected to high tensile forcesUse of techniques designed to rapidly return the athlete to Use of techniques designed to rapidly return the athlete to competition may magnify this risk for rupturecompetition may magnify this risk for rupture

Taylor et al, ’93Taylor et al, ’93

Injury preventionInjury prevention

Injury prevention.Injury prevention.Ensure previous injuries Ensure previous injuries are fully healed and are fully healed and player fully player fully rehabilitated.rehabilitated.Use professionals.Use professionals.Set yourself /team a rule Set yourself /team a rule that going into league that going into league players returning from players returning from injury must be back in injury must be back in training for 2 weeks training for 2 weeks before game.before game.

“Recovery that’s the name of the game… Whoever recovers the fastest does the best”.

Principles of trainingPrinciples of trainingAdaptation.Adaptation.

Adaptation only happens if the body is worked Adaptation only happens if the body is worked harder than normal. This is called OVERLOAD.harder than normal. This is called OVERLOAD.

If the body is overloaded regularly it will adapt If the body is overloaded regularly it will adapt to try and tolerate the stress. This is the point of to try and tolerate the stress. This is the point of training.training.

If the overload is too great the body may If the overload is too great the body may breakdown and cause an injury.breakdown and cause an injury.

Therefore the overload needs to be Therefore the overload needs to be PROGRESSIVEPROGRESSIVE

Consequences of exerciseConsequences of exercise

Training and competition create an Training and competition create an overload to stress the body, which overload to stress the body, which in turn produces fatigue –followed in turn produces fatigue –followed by improved performance.by improved performance.

The Principle of Recovery

MuscleMuscleDOMS.DOMS.

Increase in muscle Increase in muscle stiffness.stiffness.

Lactic.Lactic.

Calcium and Calcium and fatigue.fatigue.

NeurologicalNeurologicalSympathetic nervous system.Sympathetic nervous system. Aerobic metabolism.Aerobic metabolism.Fast and slow components.Fast and slow components.

With adequate recovery this With adequate recovery this returns to normal levels.returns to normal levels.However if a high training volume or However if a high training volume or intensity is repeatedly performed intensity is repeatedly performed without necessary rest sympathetic without necessary rest sympathetic nervous system activity will become nervous system activity will become increasingly high. increasingly high. This leads to an increase in This leads to an increase in resting heart rate and is a sign of resting heart rate and is a sign of overreaching and overtraining overreaching and overtraining when symptoms are not when symptoms are not detected.detected.Hahn 1994Hahn 1994

Key Aspects to FatigueKey Aspects to Fatigue

RecoveryRecoveryRecovery is one of the basic principles of training Recovery is one of the basic principles of training methodology.methodology.Rushall and Pyke 1990.Rushall and Pyke 1990. It refers to the period of time after training when the It refers to the period of time after training when the body recovers from the demands placed upon it body recovers from the demands placed upon it during intense exercise.during intense exercise.Many athletes train extremely hard without giving their Many athletes train extremely hard without giving their body time to recover.body time to recover.This can lead to over reaching, burn out, or poor This can lead to over reaching, burn out, or poor performance.performance.Mackinnon and Hooper 1991Mackinnon and Hooper 1991

““The team” (athlete, coach, trainer, Physio, Doctor The team” (athlete, coach, trainer, Physio, Doctor Masseur) need to continually monitor for signs and Masseur) need to continually monitor for signs and symptoms of poor adaptation to training and stress.symptoms of poor adaptation to training and stress.Need to implement strategies to minimize residual Need to implement strategies to minimize residual fatigue.fatigue.

Adequate RecoveryAdequate Recovery

Fitn

ess

Leve

l

Days

Session 1 Session 2 Session 3

Inadequate RecoveryInadequate Recovery

Fitn

ess

Leve

l

Days

Session 1 Session 4Session 2 Session 3

OvertrainingOvertraining

Fitn

ess

Leve

l

Days

Session 1 Session 2

Session 3 Session 4 Session 5

Signs and symptoms of incomplete recoverySigns and symptoms of incomplete recovery (Adapted from Angela Calder: (Adapted from Angela Calder:

Recovery Strategies for Sports Performance)Recovery Strategies for Sports Performance)

Athlete says he has:Athlete says he has:

Heavy legsHeavy legs

Doesn’t feel goodDoesn’t feel good

Legs are soreLegs are sore

Feels tiredFeels tired

Facial Expression

Facial Colour

Posture

Signs of frustration

Signs and symptoms of incomplete recoverySigns and symptoms of incomplete recovery (Adapted from Angela Calder Recovery Strategies for Sports Performance)(Adapted from Angela Calder Recovery Strategies for Sports Performance)

Poor skill executionPoor skill execution

Slow acceleration Slow acceleration off the markoff the mark

Heavy feetHeavy feet

Poor decision Poor decision making making

Slow response timeSlow response time

Low motivationLow motivation

Low concentrationLow concentration

AggressivenessAggressiveness

No self confidenceNo self confidence

Poor eating/dietPoor eating/diet

Poor sleep patternPoor sleep pattern

Case StudyCase Study20yr old footballer20yr old footballerPoor kyphotic posturePoor kyphotic postureHistory of right ankle sprainsHistory of right ankle sprainsHistory of right hip pathologyHistory of right hip pathologyHistory of right shoulder painHistory of right shoulder painCurrently complaining of left thigh painCurrently complaining of left thigh painPoor balance and proprioceptionPoor balance and proprioceptionSignificantly reduced hamstring lengthSignificantly reduced hamstring lengthUnstable right shoulderUnstable right shoulderContinued to play throughout injury- still feels sore (2 Continued to play throughout injury- still feels sore (2 years later)years later)Constantly feels stiff and soreConstantly feels stiff and soreTrains 5 times per weekTrains 5 times per weekRegularly plays 3 games per weekRegularly plays 3 games per week

Advantages of good recovery.Advantages of good recovery.Minimise the effects of residual training Minimise the effects of residual training

fatigue.fatigue.

Help prevent overtraining- injury- illnessHelp prevent overtraining- injury- illness..

Allow you to get the most out of your Allow you to get the most out of your trainingstrainings

Overall improve performancesOverall improve performances

Hydration and NutritionHydration and Nutrition Restore fluid balance as quickly as Restore fluid balance as quickly as

possiblepossible 1.5 litres fluid for every 1 kg weight loss1.5 litres fluid for every 1 kg weight loss Rehydration solutions helps retain fluid and Rehydration solutions helps retain fluid and

prevents big lossesprevents big losses

Consume CHO immediately to promote Consume CHO immediately to promote refuellingrefuelling

1 g / kg body weight immediately1 g / kg body weight immediately

Eat / Drink protein Eat / Drink protein Follow with a high CHO meal within 2-3 Follow with a high CHO meal within 2-3

hourshours Sodium replacement will help to maximise Sodium replacement will help to maximise

retention of ingested fluidretention of ingested fluid

Passive Recovery (Rest is Best!)Passive Recovery (Rest is Best!)

A good 7-9 hrs provides invaluable time for an adult to adapt to the Physical - Immunological - Emotional – Stressors experienced During that day

Napping helps recovery ? ½ hr during day

HydrotherapyHydrotherapyThe TheoryThe Theory

Accelerates recovery Accelerates recovery by increasing by increasing peripheral circulation, peripheral circulation, removing metabolic removing metabolic wastes and stimulating wastes and stimulating the central nervous the central nervous systemsystem..Calder 2001.Calder 2001.

Hot and cold baths Hot and cold baths accelerated lactate accelerated lactate recovery in elite female recovery in elite female hockey players.hockey players. Sanders 1996 Sanders 1996

Jet pressurised water spa Jet pressurised water spa immersion in Judo fighters immersion in Judo fighters demonstrated an demonstrated an improvement in recovery. improvement in recovery. Gieremek 1990.Gieremek 1990.

Contrast baths (hot and cold)

Spas

Showers

Ice baths

? Cryotherapy chambers

HydrotherapyHydrotherapy““Despite the popularity..little research has been Despite the popularity..little research has been

conducted….they all need to be thoroughly conducted….they all need to be thoroughly investigated before it can be claimed as an investigated before it can be claimed as an accelerant for aiding recovery” accelerant for aiding recovery” Cochrane J 2004 .Alternating hot and cold water immersion for Cochrane J 2004 .Alternating hot and cold water immersion for

athlete recovery:a review. Physical Therapy in Sport.athlete recovery:a review. Physical Therapy in Sport.

Ice bathsIce baths

““Its absolute agony, and I dread it, but it allows my Its absolute agony, and I dread it, but it allows my body to recover so much more quickly” body to recover so much more quickly”

Paula RadcliffePaula Radcliffe

Reduces inflammation but is this always desirable?Reduces inflammation but is this always desirable?

MassageMassage Improved recovery and Improved recovery and

maintenance of maintenance of performance during pre performance during pre season female volley season female volley ball. ball. Mancellini et al 2006Mancellini et al 2006

It does promote It does promote relaxation in the musclesrelaxation in the muscles Calder Calder

Improved mood states Improved mood states and feelings of well being and feelings of well being have been shown in have been shown in several studiesseveral studies. Hamer 1999. Hamer 1999

Psychological RecoveryPsychological Recovery

DebriefingDebriefingEmotional Recovery/Contingency plansEmotional Recovery/Contingency plansMental Toughness Skills e.g. positive self Mental Toughness Skills e.g. positive self talk, positive body languagetalk, positive body languageRelaxation techniques egg meditation, Relaxation techniques egg meditation, music, breathingmusic, breathing

Healing rates are slower when in a state of stress.Marucha et al 1998

Higher levels of depression and anxiety had a statistically significant association with slower healing.Cole-King 2001

Compression Compression Garments Garments

•Garments-leggings,short pants or tops

•Apply a graded compression to the body.

N.Gill investigated 4 different recovery strategies following N.Gill investigated 4 different recovery strategies following competitive rugby matches by measuring Creatine Kinase competitive rugby matches by measuring Creatine Kinase concentration.concentration.

Players were measured post match and at 24 hrs and 72 hrs.Players were measured post match and at 24 hrs and 72 hrs.

11 active recoveryactive recovery

22 hot and cold bathshot and cold baths

33 passive recoverypassive recovery

4 skins4 skins

0

500

1000

1500

2000

2500

Post game 24 hrs 72 hrs

Active RecoverySkinsHot and coldPassive

PeriodisationPeriodisation

•This is the term used for planning and organising training , competition and rest over a given period of time e.g. 1 season with the aim of “peaking” at various times.

•Period should be divided into blocks or cycles of training.

•There should always be several consistent phases to the training plan.

Planning your season.Planning your season.

DeDecc

JanJan FebFeb MarMar AprApr MaMayy

JunJun JulyJuly AuAugg

SepSep OctOct NoNovv

Off season. Rest, recovery, holiday, turkey. Injuries sorted. Screening.

Pre-season. Set a base.

Developmental phase. Advance and develop key components of fitness

Power phase. Power, speed and explosive fitness.

Competition Phase. Maintain strength etc.

Example 2 months training consisting of 2x 4week cycles

FF CC FF FF CC FF CC PP FF CC FF CC PP FF CC PP

LL MM MM MM HH HH LL

CC FF CC FF FF CC FF CC FF PP FF CC FF CC FF PP

HH HH MM HH MM HH HH LL

F= Field, C=Circuit, P=PoolF= Field, C=Circuit, P=Pool

Intensity: L= Low, M=Medium, H=High

Planning your session.Planning your session.

Ensure players are punctual and Ensure players are punctual and hydrated.hydrated.

Warm up 15mins- 20minsWarm up 15mins- 20mins

Match /Training 60 mins+/- Match /Training 60 mins+/-

Warm down.10-15maxWarm down.10-15max

Recovery strategies.Recovery strategies.

Warm upWarm upGradual increase in intensity jog- ½ ¾ pace.Gradual increase in intensity jog- ½ ¾ pace.

Increase blood flow, get the nervous system Increase blood flow, get the nervous system “tuned in” and decrease muscle stiffness “tuned in” and decrease muscle stiffness (passive). (passive).

Facilitate motor unit recruitment before full out Facilitate motor unit recruitment before full out activity.activity.Introduce skills and change of direction.Introduce skills and change of direction.Introduce dynamic movements/stretches.Introduce dynamic movements/stretches.

Get our full active flexibility.Get our full active flexibility.Introduce full pace and end range body Introduce full pace and end range body movements necessary for that sport.movements necessary for that sport.

SpecificitySpecificityIt is advised that training should be sport It is advised that training should be sport specific.specific.Gaelic football and hurling are multisprint Gaelic football and hurling are multisprint sports.sports.Sprints are rarely any more than 40 Sprints are rarely any more than 40 metres, with the majority less than 20 metres, with the majority less than 20 metres.metres.They are rarely linear.They are rarely linear.Training should include lots of directional Training should include lots of directional change at pace to include decceleration as change at pace to include decceleration as well as acceleration.well as acceleration.

FatigueFatigueRemember alterations in calcium ion Remember alterations in calcium ion

content in muscle affects content in muscle affects contractibility.contractibility.Muscles less able to absorb high Muscles less able to absorb high forcesforcesDecreased viscoelasticity.Decreased viscoelasticity.

Avoid sprints when fatiqued.(ie end of Avoid sprints when fatiqued.(ie end of session).session).

Australian RulesAustralian RulesVerral et al 2005 British Journal of Sports Verral et al 2005 British Journal of Sports Medicine.Medicine.Pre season intervention to decrease. Pre season intervention to decrease. hamstring injuries.hamstring injuries.Changed focus from long endurance runs to Changed focus from long endurance runs to acceleration training and high intensity sports acceleration training and high intensity sports specific drills. Stretched when fatigued.specific drills. Stretched when fatigued.Strength training. Bodyweight only to first Strength training. Bodyweight only to first timers, weights to those with experience.timers, weights to those with experience.Hamstring injuries went from 4.7/1000 playing Hamstring injuries went from 4.7/1000 playing hours to 1.3/1000.hours to 1.3/1000.

Active Recovery (Cool Down)Active Recovery (Cool Down)The Theory:The Theory:

Light activity during the post exercise period has been Light activity during the post exercise period has been shown to increase lactate clearance rates. E.g. shown to increase lactate clearance rates. E.g. Walk/jog/cycle/swim Gupta et al 1996 Walk/jog/cycle/swim Gupta et al 1996 Needs to be at least 5 mins. Bonen A 1976Needs to be at least 5 mins. Bonen A 1976Dodds.s demonstrated greatest recovery at 35% VO2 max.Dodds.s demonstrated greatest recovery at 35% VO2 max.Advice is to work for approx 10-15 mins as any Advice is to work for approx 10-15 mins as any longer causes glycogen depletionlonger causes glycogen depletion..Improves psychological recovery. Suzuki 2001Improves psychological recovery. Suzuki 2001The following day 15-20 mins of light activity (eg low The following day 15-20 mins of light activity (eg low intensity pool session.) Reduces DOMs. intensity pool session.) Reduces DOMs. Hasson Hasson et al 1989et al 1989? stretch? stretch

Active Recovery (Cool Down)Active Recovery (Cool Down)In Practice:In Practice:

Desirable after training and gamesDesirable after training and gamesWhere possible use “off feet” strategies ie Where possible use “off feet” strategies ie bike/rower or pool : bike/rower or pool : eg easy spinning 5 mins /row eg easy spinning 5 mins /row 5 mins then walking and general limb 5 mins then walking and general limb movements in water.movements in water.Sports requiring repeated bouts of high Sports requiring repeated bouts of high intensity work will benefit from active recovery intensity work will benefit from active recovery in between efforts.in between efforts.Next day where possible short low intensity Next day where possible short low intensity session.session.

Flexibility.Flexibility.Is described as a component of fitness.Is described as a component of fitness.Relationship with performance.Relationship with performance.Relationship with injury controversial.Relationship with injury controversial.No correlation between flexibility and injury in Irish No correlation between flexibility and injury in Irish

soccer/gaelic/hurlers. Watson 2001soccer/gaelic/hurlers. Watson 2001

Stretching: DefinitionsStretching: Definitions

We need to separate stretching from We need to separate stretching from flexibility /range of movement.flexibility /range of movement.

Static vs DynamicStatic vs Dynamic

BallisticBallistic

PNF.PNF.

Effects?Effects?

When..? Where...? How..?When..? Where...? How..?Sports involving bouncing and jumping activities with a high Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs) [e.g. hurling and intensity of stretch-shortening cycles (SSCs) [e.g. hurling and football] require a muscle-tendon unit that is compliant enough to football] require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits store and release the high amount of elastic energy that benefits performance in such sports.performance in such sports.

Sports involving SSC movements Sports involving SSC movements – Require a compliant muscle-tendon unitRequire a compliant muscle-tendon unit

Store/release high amounts of elastic energy Store/release high amounts of elastic energy

Stretching may be important as an injury prevention measureStretching may be important as an injury prevention measure

No, or low SSC movementsNo, or low SSC movements– Compliant muscle-tendon unit offers no advantageCompliant muscle-tendon unit offers no advantage– Additional stretching exercises to improve compliance may have no Additional stretching exercises to improve compliance may have no

beneficial effectbeneficial effectWitvrouw et al, ‘04Witvrouw et al, ‘04

Static StretchingStatic StretchingTherefore the advice Therefore the advice must be at present to must be at present to stretch throughout the stretch throughout the week as an week as an intervention to intervention to maintain compliance maintain compliance within the within the musculotendinous musculotendinous unit.unit.

ScreeningScreening

General health.General health.

Musculoskeletal profiling.Musculoskeletal profiling.

Functional testsFunctional tests

Pitch tests.Pitch tests.

Musculoskeletal profilingMusculoskeletal profilingIdentify predisposing factors to injury.Identify predisposing factors to injury.Detect potential “weak” links that affect Detect potential “weak” links that affect performance.performance.Identify injuriesIdentify injuriesPosturePostureRange of movementRange of movementMuscle StrengthMuscle StrengthStability.Stability.Balance.Balance.

Screening in Gaelic Football Screening in Gaelic Football Sports Institute for Northern IrelandSports Institute for Northern IrelandAs a group the Gaelic As a group the Gaelic

footballers hadfootballers had

Tight hip flexors and Tight hip flexors and poor core stability.poor core stability.

Poor posture Poor posture associated with associated with Thoracic and Lumbar Thoracic and Lumbar stiffness.stiffness.

Proprioceptive deficits.Proprioceptive deficits.

(Balance deficits)(Balance deficits)

8/18 “sway back” 8/18 “sway back” postureposture

14/18 had 14/18 had comments comments regarding postural regarding postural problemsproblems

8/18 Tight hip 8/18 Tight hip flexorsflexors

9/18 Poor pelvic 9/18 Poor pelvic stabilitystability

So what?So what?It is generally believed that poor control of It is generally believed that poor control of stability around the pelvis and CORE are stability around the pelvis and CORE are responsible for causing a lot of pain and injury.responsible for causing a lot of pain and injury.

L.Hennessy 1993 in a study looking at possible L.Hennessy 1993 in a study looking at possible causes of hamstring injuries in gaelic footballers causes of hamstring injuries in gaelic footballers found that poor lower back posture was an found that poor lower back posture was an increased risk factor.increased risk factor.Poor posture was the second best predictor of Poor posture was the second best predictor of injury in irish field sports after previous injury.injury in irish field sports after previous injury.In runners poor pelvic control was demonstrated In runners poor pelvic control was demonstrated as a risk factor.as a risk factor.

Core Stability????Core Stability????Where is your core?Where is your core?What does a stable core consist of?What does a stable core consist of?What is an unstable core like? What is an unstable core like? Demonstrate imbalance.Demonstrate imbalance.How do we improve core stability?How do we improve core stability?

A) Low load postural exercisesA) Low load postural exercisesB) Low load Stability exercisesB) Low load Stability exercisesC) High load Stability exercisesC) High load Stability exercisesD) High load mobility exercises.D) High load mobility exercises.

InterventionsInterventionsPostural alignment and dynamic Postural alignment and dynamic balance are the foundation for all balance are the foundation for all training.training.Focus on perfect technique.Focus on perfect technique.Fundamental movement skills before Fundamental movement skills before sports specific skillssports specific skillsStop when technique fails.Stop when technique fails.Emphasis on powerful, safe and Emphasis on powerful, safe and efficient movement.efficient movement.

Train movements not muscles.Train movements not muscles.

CNS uses pre-programmed CNS uses pre-programmed motor/movement patterns.motor/movement patterns.

If form is correct muscles will adapt.If form is correct muscles will adapt.

If technique/form is incorrect then If technique/form is incorrect then faulty movement patterns will be faulty movement patterns will be rehearsed.rehearsed.

Some “core” strengthening with Some “core” strengthening with good technique.good technique.

Squat.Squat.

Lunge.Lunge.

Single leg squat.Single leg squat.

Plank.Plank.

Side bridge.Side bridge.

Press up.Press up.

BalanceBalanceBalance work using Balance work using wobble boards and wobble boards and other apparatus has other apparatus has been shown to been shown to reduce the risk of reduce the risk of knee and ankle knee and ankle injuries.injuries.

Include some of Include some of these ex`s in your these ex`s in your circuits or warm up/ circuits or warm up/ warm down.warm down.

Jumping and landing practice.Jumping and landing practice.Practice jumping Practice jumping and landing and landing technique.technique.

Reduces risk of Reduces risk of ACL injury.ACL injury.

Think of form and Think of form and landing softly.landing softly.

Strength and Conditioning.Strength and Conditioning.Increased fitness levels= increased Increased fitness levels= increased resistance to fatigue.resistance to fatigue.

Better strength improves ability to sprint Better strength improves ability to sprint and change direction.and change direction.

More muscle to absorb impact forces.More muscle to absorb impact forces.

Stronger bones, cartilage, tendons and Stronger bones, cartilage, tendons and ligaments.ligaments.

Load?Load?

McBride et al compared athletes jump McBride et al compared athletes jump squatting at 80% and 30% of 1RM max.squatting at 80% and 30% of 1RM max.

Measured sprint times, agility times Measured sprint times, agility times and agility runs, squat strength and and agility runs, squat strength and squat jumpsquat jump

80 % had decreased sprint times, 80 % had decreased sprint times, increased strength force and power.increased strength force and power.

30% had increases sprint, strength 30% had increases sprint, strength force and power.force and power.

Improving power.Improving power.We want to train muscle elastic We want to train muscle elastic components.components.During many functional movements the During many functional movements the muscles actually experience minimal muscles actually experience minimal lengthening due to joint movement and lengthening due to joint movement and tendon lengthening.tendon lengthening.Eccentric training, plyometrics and Eccentric training, plyometrics and flexibility can affect this positively.flexibility can affect this positively.Enhances ability for elastic energy Enhances ability for elastic energy storage.storage.Injury prevention.Injury prevention.

EquipmentEquipmentFootwear.Footwear.

Helmet.Helmet.

Hurling glove.Hurling glove.

Mouth guard.Mouth guard.

To sum up.To sum up.Injury surveillance a must to make Injury surveillance a must to make accurate interventions.accurate interventions.

Avoid high intensity work when fatiqued.Avoid high intensity work when fatiqued.

Allow for recovery.Allow for recovery.

Full functional rehab after injuryFull functional rehab after injury

Sports specific training.Sports specific training.

Strength and conditioning.Strength and conditioning.

Some balance training if time is available .Some balance training if time is available .