Great Challenges

Towards Sports Injury

Prevention & Rehabilitation
Angela B.M. Tulaar; Damayanti Tinduh
Conceptual framework
• Rehabilitation is, by definition, the restoration of optimal form (anatomy) and function
(physiology).
• It is a process designed to minimize the loss associated with acute injury or chronic
disease, to promote recovery, and to maximize functional capacity, fitness and
performance.
• The process of rehabilitation should start as early as possible after an injury and form a
continuum with other therapeutic interventions such as the use of pharmacological
agents. It can also start before or immediately after surgery when an injury requires a
surgical intervention.
• The rehabilitation of the injured athlete is managed by a multidisciplinary team with a
physician functioning as the leader and coordinator of care. The team includes, but is not
limited to, athletic trainers, physiotherapists, psychologists, and nutritionists.The
rehabilitation team works closely with the athlete and the coach to establish the
rehabilitation goals, to discuss the progress resulting from the various interventions, and
to establish the time frame for the return of the athletes to training and competition.
 Sports Injury
• How to monitor sports injury?
• What are the risk factors?
• How these factors interact?
• What is the healing process of injured tissues?
• How can we optimize the process of healing, functional recovery
& safe return to sports?

Edouard P and Ford KR (2020) Great Challenges Toward Sports Injury Prevention and
Rehabilitation. Front. Sports Act. Living 2:80. doi: 10.3389/fspor.2020.00080
The sequence of events resulting from a sportsrelated injury that
may lead to a reduction or inability to perform in sports can be
framed using a disability model

Pathology Impairment Functional loss Disability

(injury)
Strain Contracture Inability to Inability to
Sprain Muscle atrophy run, jump Compete
Fracture and weakness in sports
 Strategies to reduce the occurrence &
recurrence of sport injuries
• How can we play on/modify sports injury factors?
• Which efficient strategy or combination of strategies
(scientifically & clinically based)?
• How we can implement these strategies?
• How can athletes be compliant with these strategies?

Edouard P and Ford KR (2020) Great Challenges Toward Sports Injury Prevention and
Rehabilitation. Front. Sports Act. Living 2:80. doi: 10.3389/fspor.2020.00080
Conceptual Frameworks of Sports Injury Monitoring
• Classic 4-step sequence (Mechelen et al, 1992)
• Monitor the progress & effectiveness of sports injury incidence reduction
• Revised by Bolling et al (2018) on the 1st step, which extended to exploration
of the context of the sports injury
• Etiology of Sport Injury (Meeuwisse, 1994)
• Understanding Injury Mechanisms (Bahr and Krosshaug, 2005)

• Sequence of Prevention (Finch 2006)

• Implementation of preventive measures & evaluation of real-world-impact
• Concept of sports injury (Timpka et al., 2014)
• Risk factors based categorization of prevention (Jacobsson and Timpka,
2015)
• Complex system approach (Bittencourt et al., 2016; Pol et al., 2019)
• Individual approach (Roe et al., 2017)
• A Biomechanics-focused model (Hewett and Bates, 2017)
• Prevention measure implementation (Tee et al., 2020)

Frontera WR (Ed), 2003.

Rehabilitation of Sports Injuries:
Scientific Basis
Wiese-Bjornstal D, 2009. Sport Injury and College Athlete Health Across the Lifespan.
Journal of Intercollegiate Sport 2(1):64-80 Ruddy JD, Cormack SJ, Whiteley R, Williams MD, Timmins RG and Opar DA,
2019. Modeling the Risk of Team Sport Injuries: A Narrative Review of Different
Statistical Approaches
 Primary vs Secondary Prevention
Primary Prevention Secondary Prevention = Rehabilitation
Goal Reduce/control occurrence Reduce/control recurrence of sport injuries
of 1st Sport Injury - Orient/guide the injured tissue healing
process
- Restore the function
- Help the patient/athlete return to sporting
activities while minimizing the reinjury
risk
Dominance area Sports Scientist Health professionals
Coach

This knowledge should be directly translated

applied & clinical to all stakeholders
(Hewett and Bates, 2017; Cools et al., 2020)
 Types of Sport Injury

70.2%

45-60%

Muscle weakness
Muscle strength imbalance
Frontera WR (Ed), 2003. Rehabilitation
Anatomical misalignment of Sports Injuries: Scientific Basis
Sport Injury Healing Process

Growth & maturation are

impaired by decreased
MECHANICAL LOAD on
regenerating tissue

Frontera WR (Ed), 2003. Rehabilitation

of Sports Injuries: Scientific Basis
Sport Injury Healing Process
Frontera WR (Ed), 2003.
Rehabilitation of Sports Injuries:
Scientific Basis
 Sport Injury Rehabilitation
Basic Rehabilitation Program Return to Sport Program
Goal Promote Healing Process
Action Physical Modality, Therapeutic Exercise
PM&R and Rehabilitation Team PM&R & Rehabilitation Team, Team Physician, Coach, Trainer

Trebinjac, S., Nair, M.K. (2020). Current Practices in Sports Injury Rehabilitation. In: Frontera WR (Ed), 2003. Rehabilitation
Regenerative Injections in Sports Medicine. Springer, Singapore. of Sports Injuries: Scientific Basis
Frontera WR (Ed), 2003.
Rehabilitation of Sports Injuries:
Scientific Basis
 Consequences of Training Cessation in Injured
Athletes : Detraining
• Reduced VO2max
• 2 weeks of inactivity will reduce 4-4.7% of VO2max in well-trained athletes (Houston et al., 1987 ;
Houmard et al., 1992, 1993)
• Reduced Blood Volume
• starts on 2nd day of inactivity (Thompson et al., 1984; Cullinane et al., 1986)
• 2 weeks of inactivity will reduce 5-5.1% of resting plasma volume (Thompson et al., 1984; Cullinane et al.,
1986; Houmard et al., 1992)
• Heart Rate
• Resting HR
• Increased after 3 days of bed rest (Smarowinski et al., 2001)
• Increased by 6.4% in 2-12 weeks inactivity (Banhegyi et al., 1999)
• Submaximal HR
• Increased by 11% after 2-4 weeks inactivity (Houmard et al., 1992)

• Stroke Volume
• Decreased by 10-14% after 12-84 days inactivity (Coyle et al., 1984)
• Cardiac Output
• Decreased 8% after 21 days inactivity (Coyle et al., 1984)
• Cardiac dimension & circulation
• Decreased LV End Diastolic dimension 11.8%, LV Wall Thickness 25%, LV mass reduction 19.5%, increased
Mean Blood Pressure after 3 weeks inactivity (Martin et al., 1986; Coyle et al., 1986)
• Higher total peripheral resistance 8% after 2-4 weeks inactivity (Coyle et al., 1986)
• Vantilation function
• Higher decline in max ventilation 21.3% after 3 days inactivity (Smorawinski et al., 2001)
• Lower max O2 pulse after 10 days of inactivity

Frontera WR (Ed), 2003. Rehabilitation

of Sports Injuries: Scientific Basis
 Consequences of Training Cessation in Injured
Athletes : Detraining

Frontera WR (Ed), 2003. Rehabilitation

of Sports Injuries: Scientific Basis
Table 1.1 The variety of sport medicine team members who work with
athletes
Medicals and surgeons Para-medicals Sport scientists Sport educators
GP Sport rehabilitator Biomechanist Coach
Chiropodist Physiotherapist Exercise Conditioning specialist
Sport dentist Osteopath physiologist Physical educator
Consultants: Chiropractor Sport psychologist Club manager
Orthopaedic surgeon Massage therapist Nutritionist
General surgeon Sport optometrist Kinesiologist
Neurosurgeon Acupuncturist
Cardiologist First responder
Radiologist Alternative therapy
Physiatrist practitioner
Neurologist

Sports Rehabilitation and Injury Prevention Edited by Paul Comfort and Earle
Abrahamson
 CURATIVE
Comprehensive,
Integrated, Continuously
4 Surgeon
Team Physician Early Diagnostic Physiatrist & Rehab Team
Trainer Prompt Treatment Clinical Physicians
Coach PEAK PERFORMANCE
Psycholog
Psycholog
3 Nutritionist
Nutritionist
Physiatrist & Rehab Team REHABILITATIV
SPECIALIZATION E
Specific Prevention PREVENTIVE
Recovery, Restoration,
Injury Prevention Program
1st, 2nd, 3rd Prevention 2 Compensation,
Basic Rehabilitation Program
Substitution of function Return to Sport Program
Environment Assessment
FORMATION

1 Physiatrist & Rehab Team

Coach Coach
Trainer Trainer
Psycholog BEGINNER
Psycholog
Nutritionist Nutritionist
Team Physician PROMOTIVE
Modified life style Team Physician
Physiatrist & Rehab Team

Risk Factor Assessment Sport Clinic Service Development Center Dr. Soetomo
Potency Assessment General Academic Hospital, 2022
TERIMA
KASIH