Injury Prevention

Advanced Physiotherapy and Injury Prevention
Part 1. Overview of 8 point plan - tonight Part 2. Strapping Part 3. Periodisation - The Science of Training Part 4. Warmup
Prevention/Performance Rest Ice Compression Elevation Diagnosis
60 50 40 30 20 10 0 Preinjury Postinjury
games/season
8 7 6 5 4 3 2 1 0 Pre-injury 1 Year Post injury

Up to 2 years may be needed to regain normal quadriceps muscle performance following ACL reconstruction. Frequent non-return to peak performance (20 50%)
18 16 14 12 10 8 6 4 2 0 pre injury post injury

Advanced Physiotherapy and Injury Prevention (c)
Previous Hamstring Injury 30 % will re-injure within the season
Screening Warm-up, cool-down

Physical conditioning Fair play Protective equipment Hydration and nutrition Injury analysis Environment
Who is at risk? Why are they at risk? What can be done about it?
4 Steps to developing a successful screening program

Health questionnaire Lifestyle assessment questionnaire Physical assessment Follow-up screening
General health Medical history Medical conditions, allergies Previous injuries Drug use
Health Questionaire
General History Medical conditions Previous injuries Drug use
Social Environmental Alcohol/cigarettes Living arrangements Diet
Health Questionaire
Lifestyle Questionaire
Health Questionaire
Physical Assessment
Medical Fitness Musculoskeletal
Health Questionaire
Physical Assessment
Musculoskeletal Fitness Medical
Followup
Mid-year After injury
Health
Lifestyle
Physical
Musculoskeletal
Fitness Medical
Followup
Mid-year After injury
For example ACL injuries are more prevalent in those with poor strength of their hip external rotators ACL injuries are more prevalent in those with poor balance Patellofemoral pain is more prevalent in those with weak hip external rotators, flat feet, weak quadriceps (VMO) Shoulder impingement syndrome is more common in those with poor thoracic extension
Ligaments/joints/muscles Biomechanics technique and movement patterns Balance and Proprioception
Weaker connective tissue Greater injury risk.
Biomechanics/Technique
Efficiency Injuries Performance.
Throwing and kicking Catching Hitting Swimming.
Running Changing direction Jumping and landing
Observation Physical Assessment Video Analysis Force Plate Analysis.
It is really hard to see things without slow motion but If something looks odd it probably is And needs professional assessment.
1.4 1.2 1 0.8 0.6 0.4 0.2 0 Before Program After Program
Pre Activity Warm-up. Aerobic exercise. Stretching. Sport-specific exercises.
Post Activity Cool-down Aerobic exercise. Stretching. Recovery
ACTIVITY
PHYSIOLOGICAL EFFECT
EFFECT ON PERFORMANCE
EFFECT ON INJURY PREVENTION
Issues
ACTIVITY
Increases heart rate, core temperature, nerve conduction
Can increase or impair performance depending on the amount done, rest intervals following

Reduces muscle soreness
Issues
Optimal not established, variable for different levels of fitness, different sports
- Aerobic Activity
ACTIVITY
Can increase or impair performance depending on the amount done, rest intervals following Reduces Performance unless followed by other activity

Issues
- Aerobic Activity
- Static Stretching
Increases compliance of muscle tendon unit
Nil
ACTIVITY
- Aerobic Activity
Can increase or impair performance depending on the amount done, rest intervals following Reduces Performance unless followed by other activity Likely increase
EFFECT ON INJURY Issues PREVENTION

Reduces muscle soreness Optimal not established, variable for different levels of fitness, different sports
- Static Stretching
Increases compliance of muscle tendon unit Neuromuscular activation, concentration
nil
- Sport Specific Exercises
Certain targeted programs very effective
Needs to be specifically targeted at sport/level
ACTIVITY

Issues
- Aerobic Activity
- Static Stretching
nil
- Sport Specific Exercises COOL-DOWN AND RECOVERY
ACTIVITY

Issues
- Aerobic Activity
- Static Stretching
nil
- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise
Nil
No proven effect
ACTIVITY

Issues
- Aerobic Activity
- Static Stretching
nil
- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching
Nil Increases compliance of muscle tendon unit Nil
No proven effect No proven effect
ACTIVITY

Issues
- Aerobic Activity
- Static Stretching
nil
- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching Massage
Nil Increases compliance of muscle tendon unit Reduced inflammation Nil Nil
No proven effect No proven effect Reduced muscle soreness Not strong evidence, expensive
ACTIVITY

Issues
- Aerobic Activity
- Static Stretching
nil
- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching Massage Cold water immersion
Sustains heart rate, core temperature, Increases compliance of muscle tendon unit Reduced inflammation Reduced inflammation
Nil Nil Nil Some evidence
No proven effect No proven effect Reduced muscle soreness May reduce muscle soreness Not strong evidence, expensive What temperature for how long,
Dynamic Stretching
Dynamic stretching consists of functional exercises which use sports specific movement patterns to prepare the body for activity
Static vs Dynamic Stretching

STATIC STRETCHING EFFECT ON PERFORMANCE EFFECT ON INJURY RATES NEGATIVE UNCLEAR MAY INCREASE OR DECREASE DYNAMIC STRETCHING POSITIVE UNCLEAR MAY DECREASE
Static stretching will probably reduce performance unless it is followed by dynamic activity Any form of stretching has very little relevance to sport where 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 a sports specific way as many sports still require extreme ranges of motion Dynamic stretching has potential to increase performance and to reduce injury rates however must be done when the athlete is warm and needs to be sports specific
Performing a properly structured professionally designed warmup and competing will do the following
Performance Reduce injury rate
Is the sports specific part Which, if done correctly Is the only part you have to do
Several Programs exist that have been shown to reduce the incidence of ACL injuries from 60 -89% Focus on
Proper landing technique Engaging knee and hip flexion in landing and lateral manoeuvres Avoiding excessive dynamic valgus at the knee on landing and squatting Increasing hamstring, gluteus medius, hip abductor strength
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 Medicine Research 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 times per week during the season
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
A world class sports warm-up routine for sports requiring speed, agility and quickness designed to improve performance and reduce injury, that INTEGRATES INTO YOUR CURRENT TRAINING PROGRAM
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)
Fatigue causes changes in technique (most muscle tears occur when the athlete is fatigued in AFL) The muscular contractile unit loses up to 20+ percent of its ability to withstand load when fatigued High BMI
Increases forces Effects tendon health
BMI= kg/m2 Normal 18-25 Above or below doubles the injury risk
Periodisation Genetics Injury Correct technique Exercise selection Rest Psychological

Periodisation is the process of separating the annual or long-term training plan into smaller more manageable periods or cycles and phases.
This allows for a more effective manipulation of training variables, with the goal of optimizing the athletes physiological and psychological state of preparedness for the main competitions of the year while avoiding injury or the over-trained state. (Dolcetti 2000, adopted
from Bompa, 1983)
Fair play means respecting the opposition, the officials and 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 players arent allowed to raise their sticks above shoulder level, spear tackling in rugby is illegal, and physical contact in non-contact sports is penalised. This is the responsibility of coaches, player and officials
Bracing and taping. Bracing and taping can provide some protection against injury to joints. Bracing vs Taping.
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
Should contain four to eight percent carbohydrate and 0.5-0.7g/litre sodium (ACC website).
Needed for sports > 1 hour
Helps us to indentify injury trends Helps us to identify causes Allows us to provide solutions
Allows us to identify problem areas Leads to better solutions
Facilities
Perimeter fencing Vehicles and spectators Clean and hygenic
Surfaces
Level ground Hardness No holes, sprinkler Water spills on floor Adequate lighting Well maintained Appropriate size Padded posts Nets secured
Equipment

Make sure you have a system of monitoring and reporting both potential and current hazards. Make individuals responsible for checking 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 the directions 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 at your venue.
Symptoms of heat stress Heavy sweating Skin flushed, or cool and pale Headache Dizziness Muscle cramps Weakness Rapid pulse Loss of consciousness (seek immediate help)
Symptoms of hypothermia Weakness Shivering (mild to intense) Pale, waxy skin Uncoordinated movements Confusion or agitation Slow, slurred speech Strange behaviour Refusal of help Slow, shallow breathing
REST ICE COMPRESSION ELEVATION D
Diagnose as quickly as possible Dont figure it out for yourself Dont expect google to help Dont ignore small niggles
All the above applies to children but Children are not just small adults
Growth Plate Injuries

Severs Syndrome Osgood Schlatters Syndrome
Have now
Explanations of common injury
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Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Prevention/Performance Rest Ice Compression Elevation Diagnosis

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

8 7 6 5 4 3 2 1 0 Pre-injury 1 Year Post injury

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

18 16 14 12 10 8 6 4 2 0 pre injury post injury

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention (c)

Previous Hamstring Injury 30 % will re-injure within the season

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Screening Warm-up, cool-down

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

4 Steps to developing a successful screening program

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

General History Medical conditions Previous injuries Drug use

Social Environmental Alcohol/cigarettes Living arrangements Diet

Advanced Physiotherapy and Injury Prevention

General History Medical conditions Previous injuries Drug use

Social Environmental Alcohol/cigarettes Living arrangements Diet

Advanced Physiotherapy and Injury Prevention

General History Medical conditions Previous injuries Drug use

Social Environmental Alcohol/cigarettes Living arrangements Diet

Advanced Physiotherapy and Injury Prevention

General History Medical conditions Previous injuries Drug use

Social Environmental Alcohol/cigarettes Living arrangements Diet

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Ligaments/joints/muscles Biomechanics technique and movement patterns Balance and Proprioception

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Weaker connective tissue Greater injury risk.

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Efficiency Injuries Performance.

Advanced Physiotherapy and Injury Prevention

Throwing and kicking Catching Hitting Swimming.

Advanced Physiotherapy and Injury Prevention

Running Changing direction Jumping and landing

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Observation Physical Assessment Video Analysis Force Plate Analysis.

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention