Sports Injury Prevention Part 1
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Advanced Physiotherapy and InjuryPrevention
Part 1. Overview of 8 point plan - tonight
Part 2. Strapping
Part 3. Periodisation - The Science of Training Part 4. Warmup
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Advanced Physiotherapy and InjuryPrevention
Prevention/Performance
Rest
Ice Compression
Elevation
Diagnosis
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Advanced Physiotherapy and InjuryPrevention
0
10
20
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60
Preinjury Postinjury
games/season
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8
Pre-injury 1 Year Post injury
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Up to 2 years may be needed to regain normal
quadriceps muscle performance following ACL
reconstruction.
Frequent non-return to peak performance (20
50%)
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pre injury post injury
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Advanced Physiotherapy and InjuryPrevention (c)
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Previous Hamstring Injury 30 % will re-injure within the season
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General health
Medical history
Medical conditions,allergies
Previous injuries
Drug use
Health
Questionaire
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Social
Environmental
Alcohol/cigarettes
Living arrangements
Diet
General
History
Medical conditions
Previous injuries
Drug use
Health
Questionaire
Lifestyle
Questionaire
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Medical
Fitness
Musculoskeletal
Social
Environmental
Alcohol/cigarettes
Living arrangements
Diet
General
History
Medical conditions
Previous injuries
Drug use
Health
Questionaire
Lifestyle
Questionaire
Physical
Assessment
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Mid-year
After injury
Musculoskeletal
Fitness
Medical
Social
Environmental
Alcohol/cigarettes
Living arrangements
Diet
General
History
Medical conditions
Previous injuries
Drug use
Health
Questionaire
Lifestyle
Questionaire
FollowupPhysical
Assessment
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For example
ACL injuries are more prevalent in those withpoor strength of their hip external rotators
ACL injuries are more prevalent in those withpoor balance
Patellofemoral pain is more prevalent in thosewith weak hip external rotators, flat feet, weakquadriceps (VMO)
Shoulder impingement syndrome is morecommon in those with poor thoracic extension
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Ligaments/joints/muscles
Biomechanics technique and movement
patterns
Balance and Proprioception
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Weaker connective tissue
Greater injury risk.
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Biomechanics/Technique
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Efficiency
Injuries
Performance.
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Throwing and kicking
Catching
Hitting
Swimming.
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Observation
Physical Assessment
Video Analysis
Force Plate Analysis.
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It is really hard to see things without slow
motion but
If something looks odd it probably is
And needs professional assessment.
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0
0.2
0.4
0.6
0.8
1
1.2
1.4
Before Program After Program
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Pre Activity Warm-up.
Aerobic exercise.
Stretching.
Sport-specific
exercises.
Post Activity Cool-down
Aerobic exercise.
Stretching.
Recovery
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on theamount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels offitness, different
sports
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on theamount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels offitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
Nil
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON INJURY
PREVENTIONIssues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on the
amount done, restintervals following
Reduces muscle
soreness
Optimal not established,
variable for different
levels of fitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
nil
- Sport Specific
Exercises
Neuromuscular
activation,
concentration
Likely increase Certain targeted
programs very effective
Needs to be specifically
targeted at sport/level
ACTIVITY PHYSIOLOGICAL EFFECT ON EFFECT ON
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on theamount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels offitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
nil
- Sport Specific
Exercises
Neuromuscular
activation,
concentration
Likely increase Certain targeted
programs very
effective
Needs to be
specifically targeted at
sport/level
COOL-DOWN AND
RECOVERY
ACTIVITY PHYSIOLOGICAL EFFECT ON EFFECT ON I
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on theamount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels offitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
nil
- Sport Specific
Exercises
Neuromuscular
activation,
concentration
Likely increase Certain targeted
programs very
effective
Needs to be
specifically targeted at
sport/level
COOL-DOWN AND
RECOVERY
Aerobic Exercise Nil No proven effect
ACTIVITY PHYSIOLOGICAL EFFECT ON EFFECT ON I
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ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on theamount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels offitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
nil
- Sport Specific
Exercises
Neuromuscular
activation,
concentration
Likely increase Certain targeted
programs very
effective
Needs to be
specifically targeted at
sport/level
COOL-DOWN AND
RECOVERY
Aerobic Exercise Nil No proven effect
Stretching Increases compliance
of muscle tendon unit
Nil No proven effect
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ACTIVITY PHYSIOLOGICAL EFFECT ON EFFECT ON I
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Advanced Physiotherapy and Injury
Prevention
ACTIVITY PHYSIOLOGICAL
EFFECT
EFFECT ON
PERFORMANCE
EFFECT ON
INJURY
PREVENTION
Issues
- Aerobic Activity Increases heart rate,
core temperature,
nerve conduction
Can increase or impair
performance
depending on the
amount done, rest
intervals following
Reduces muscle
soreness
Optimal not
established, variable
for different levels of
fitness, different
sports
- Static Stretching Increases compliance
of muscle tendon unit
Reduces Performance
unless followed by
other activity
nil
- Sport Specific
Exercises
Neuromuscular
activation,
concentration
Likely increase Certain targeted
programs very
effective
Needs to be
specifically targeted at
sport/level
COOL-DOWN AND
RECOVERY
Aerobic Exercise Sustains heart rate,
core temperature,
Nil No proven effect
Stretching Increases compliance
of muscle tendon unit
Nil No proven effect
Massage Reduced inflammation Nil Reduced musclesoreness
Not strong evidence,expensive
Cold water immersion Reduced inflammation Some evidence May reduce muscle
soreness
What temperature for
how long,
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Dynamic Stretching
Dynamic stretching consists of functional
exercises which use sports specific movement
patterns to prepare the body for activity
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Static vs Dynamic Stretching
STATIC STRETCHING DYNAMIC STRETCHING
EFFECT ON PERFORMANCE NEGATIVE POSITIVE
EFFECT ON INJURY RATES UNCLEAR MAY INCREASE
OR DECREASE
UNCLEAR MAY DECREASE
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Advanced Physiotherapy and Injury
Prevention
Static stretching will probably reduce performance unless itis followed by dynamic activity
Any form of stretching has very little relevance to sportwhere excessive muscle length is not required
Static stretching will probably not prevent a muscle strain
Static stretching is still valuable at other times if done in asports specific way as many sports still require extremeranges of motion
Dynamic stretching has potential to increase performance
and to reduce injury rates however must be done when theathlete is warm and needs to be sports specific
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Advanced Physiotherapy and Injury
Prevention
Performing a properly structured
professionally designed warmup and
competing will do the following
Reduce injury ratePerformance
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PEP PROGRAM (74 81% reduction in ACL Injury Rates) Developed due to incidence of female ACL injuries (2-8x
men)
Developed by Santa Monica Orthopaedic and Sport MedicineResearch Foundation.
Designed to replace the traditional 20 minute soccer warmup
Emphasis on soft landing and deep knee and hip flexion
Optimally the program should be performed at least 2-3 timesper week during the season
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These programs are excellent but only cover
knee injuries
We know how to prevent many other running
injuries
So ..... Integrating what we know from these
programs with what we know from running
biomechanics will result in
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Prevention
A world class sports warm-up routine for
sports requiring speed, agility and quickness
designed to improve performance and reduce
injury, that INTEGRATES INTOYOUR CURRENT TRAINING
PROGRAM
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Reduced fitness increases injury risk
irrespective of experience in the sport
Least fit are 14X more likely to get injured
than most fit (Pope et al 2000)
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BMI= kg/m2
Normal 18-25
Above or below
doubles the injury risk
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Advanced Physiotherapy and Injury
Prevention
Periodisation
Genetics
Injury
Correct technique
Exercise selection
Rest
Psychological
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This allows for a more effective manipulation
of training variables, with the goal of
optimizing the athletes physiological and
psychological state of preparedness for themain competitions of the year while avoiding
injury or the over-trained state. (Dolcetti 2000, adoptedfrom Bompa, 1983)
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Fair play means respecting the opposition, the officialsand the rules, staying calm no matter what happens,and maintaining your dignity whether or not you are
winning. Some rules are designed and enforced to reduce or
remove the risk of injury. For example, hockey playersarent allowed to raise their sticks above shoulder
level, spear tackling in rugby is illegal, and physicalcontact in non-contact sports is penalised.
This is the responsibility of coaches, player and officials
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Bracing and taping. Bracing and taping can
provide some protection against injury to
joints.
Bracing vs Taping.
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Footware. Players wearing shoes with air cells
in the heel were 4.3 times more likely to injure
an ankle than those wearing shoes without air
cells Br J Sports Med 2001;35:103-108
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Prevention
Should contain four to eight percent
carbohydrate and 0.5-0.7g/litre sodium (ACC
website).
Needed for sports > 1 hour
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Advanced Physiotherapy and Injury
Prevention
Helps us to indentify injury trends
Helps us to identify causes
Allows us to provide solutions
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Allows us to identify problem areas
Leads to better solutions
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Facilities Perimeter fencing
Vehicles and spectators
Clean and hygenic
Surfaces
Level ground
Hardness No holes, sprinkler
Water spills on floor
Adequate lighting
Equipment
Well maintained
Appropriate size
Padded posts
Nets secured
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Make sure you have a system of monitoring and reporting bothpotential and current hazards. Make individuals responsible forchecking areas or equipment regularly.
Emergency procedures
Ensure:
a qualified first-aider is always at training and competition a first aid kit is always available and is well sign-posted
emergency access is always clear, and that coaches know thedirections to the nearest Accident and Emergency (A&E) clinic
a phone is always available, to contact emergency services.
Note:Ensure that any visiting teams know the emergency procedures atyour venue.
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REST
ICE
COMPRESSION
ELEVATION
D
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Diagnose as quickly as possible
Dont figure it out for yourself
Dont expect google to help
Dont ignore small niggles
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All the above applies to children but
Children are not just small adults
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Growth Plate Injuries
Severs Syndrome
Osgood Schlatters Syndrome
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