Basketball: Re-Conditioning After Injury

Basketball:
Re-Conditioning After Injury
Adriano Vretaros
Strength and Conditioning Coach
2021
Basketball: Re-Conditioning After Injury
The Problem – I
BASKETBALL
PLAYERS
Training Matches
** INJURIES **
The Problem – II
Multilevel Nonlinear Complex Dynamic System
q x
y
a
w k
u
h
b o z
(Adapted from Bittencourt et al, 2016)

The Problem – III
INTRINSIC Risk ** INJURIES **

Factors (Yes \ No)
EXTRINSIC Risk
Factors
SUSCEPTIBLE
PREDISPOSED PLAYER
PLAYER
Training + Competitions +
Preventive Strategies
(Adapted from Bahr & Krosshaug, 2005)

The Problem – IV
Contact
ACUTE
Injuries
Non-Contact
Basketball
Injuries
CHRONIC
Injuries Non-Contact
(Adapted from Cumps et al, 2007; Siegmund et al, 2008; Dalton et al, 2015)
The Problem – V
Basketball Injuries
Load-Injury Fatigue-Injury
(Adapted from Lewis, 2018)

The Problem – VI
FEMALE Players % MALE Players %
Head, Face, and Neck 14,2 Head, Face, and Neck 12,8
Upper Limbs and 2,5 Upper Limbs and 2,8

Shoulder Shoulder
Hand, Wrist and Fingers 9,5 Hand, Wrist and Fingers 9,4
Trunk 4 Trunk 7,1
Hip and Thigh 8,7 Hip and Thigh 8,2
Knee 18,2 Knee 10,6
Lower Limbs 4,9 Lower Limbs 3,4
Ankle and Foot 35,9 * Ankle and Foot 43,2 *
Other 2,2 Other 2,4
(Adapted from Borowski et al, 2008)

The Problem – VII
Tissues Affected by Injuries
Muscle Tendon Ligament
Cartilage Fascia Bone
Joint
The Problem – VIII
Financial Cost of Injuries - I
Direct Indirect
● Mean Medical Cost per Injury;

● Mean Human Capital Cost per Injury;
● Mean Comprehensive Cost per Injury
(Adapted from Knowles et al, 2007)

The Problem – IX
Financial Cost of Injuries - II

NBA Teams Regular Season Games Salary Cost of Games Lost
2014-2015 Season Lost to Injury to Injury ($)
Minnesota Timberwolves 340 22,604,770
Los Angeles Lakers 338 28,009,937
Philadelphia 76ers 281 12,134,306
New York Knicks 262 28,120,176
Milwaukee Bucks 260 9,893,61
OKC Thunder 224 21,288,979
Miami Heat 220 21,026,069
Indiana Pacers 219 24,548,630
Houston Rockets 182 13,425,804
(Adapted from Stotts, 2015)

The Problem – X
BASKETBALL
PLAYER Re-Conditioning
Process
Injury
Rehabilitation
The Problem - XI
● What kind of injury was the player affected?

● How long (time loss) will be the period of absence from training
and competitions?
● What is the moment you can start the physical re-conditioning?
● How long does the physical re-conditioning process take?
● What activities and criteria should be used in the physical re-
conditioning process?
● When effectively ends the physical re-conditioning?
Scientific Team - I
● How Does Your Scientific Team Work?
MULTI INTER TRANS

disciplinary disciplinary disciplinary
(Adapted from Buekers et al, 2017)

Scientific Team - II
Internal Communication Between

Members of the Scientific Staff
(Adapted from Ekstrand et al, 2018)

Scientific Team - III
Intra-Team Communications and Injuries
“In elite sports, players are commonly pressured to return to

play after an injury”
● Clear Communication Between Staff Members

● Continuous Management of Expectations
● Avoid the Probability of Premature Return
(Adapted from Ekstrand et al, 2018)

Lesional Context
Injured
Basketball Player
BIOPSYCHOSOCIAL
Physical Emotional Social
(Adapted from De Rose et al, 2008; Arden et al, 2016)

Definition
● What is Physical Re-Conditioning?
It is a gradual process of returning to sports activities after

the athlete has suffered an injury and has met the minimum
acceptable clinical criteria.
Professionals Involved in Re-Conditioning - I
1)- Physician
2)- Physiotherapist
Sport Exercise
Scientist Physiologist
3)- S&C Coach
(Adapted from Vretaros, 2002)

Professionals Involved in Re-Conditioning - II
(2)- PHYSIOTHERAPIST
(1)- PHYSICIAN Diagnostics
(3)- S&C COACH
Re-Conditioning
Process
The Process - I
BASKETBALL
RE-CONDITIONING
PROCESS
(1)- Return to
TRAINING (3)- Return to
(2)- Return to PERFORMANCE
SPORT
(Adapted from Arden et al, 2016)

The Process - II
(1)- Return to (2)- Return to

TRAINING SPORT
“Athlete-Centred”
Injury Type
(3)- Return to
PERFORMANCE
(Adapted from Arden et al, 2016; Taberner et al, 2019)

The Process - III
Re-Conditioning Process
CONTROLLED CHAOTIC
Activities Activities
PROGRESSION
Properly controlled Movement based on

movements the reality of matches
(Adapted from Taberner et al, 2019)

The Process - IV
- Apply Progressive Mechanical Loading
- Gradually Restore Mechanical Rigidity
- Use Metrics Based on Training Loads
- Return to Physical Fitness Pre-Injury Values
(Adapted from Taberner et al, 2019a)

Return to Training - I
CHARACTERISTICS
●
Final Rehabilitation Stage
● Pain Monitoring
●
Player Psychological Security
●
Adapted Training
●
Adequacy of Loads

Return to Training - II
ACTIVITIES:
Intensive and Extensive
●
Return to running (linear)
● Front running, lateral running, backpedal
●
Low impact forces
ENDURANCE: aerobic
STRENGTH: (Adapted
isometricfrom
training and anatomical
Taberner et al, 2019)adaptation
Return to Sport - I
CHARACTERISTICS
●
Integral Training
● Increase Specific Skills
●
Gradual Load Increase
●
Monitor Injury Symptoms (Y\N)

Return to Sport - II
ACTIVITIES:
● Introduce changes of direction (with ball and without ball)
● Introduce short accelerations \ decelerations
● Introduce medium accelerations \ decelerations
● Introduce elements of technical skills
ENDURANCE: aerobic and anaerobic
STRENGTH: hipertrophy and maximal strength

Return to Performance - I
CHARACTERISTICS
●
Final Phase of Re-Conditioning
● Game Pace Acquisition
●
Gradual Return to Matches
●
Control of Minutes on the Court
●
Player Efficiency Ratings (PER)
(Adapted from Arden et al, 2016; Siu et al, 2020)

Return to Performance - II
ACTIVITIES:
● Introduce long accelerations \ decelerations
● Running speeds
● Acc\Dec demands (playing positions)
● Jumps \ Landings + SSCG
ENDURANCE: aerobic and anaerobic
STRENGTH: power and power endurance

Gradual Performance
Activities Overview
Metabolic Training Strength Training

Linear Running Isometric Training
Short Accelerations \ Decelerations Anatomical Adaptation
Medium Accelerations \ Decelerations Hypertrophy + Maximal Strength
Changes of Direction Jumping + Landing Preparation
Long Accelerations \ Decelerations Power + Power Endurance
Running Speeds
1)- Aerobic and 2)-Anaerobic
Small-Sided Conditioning Games
(Adapted from Taberner et al, 2019; Taberner et al, 2019a)

Periodization - I
Periodization in the
Linear Model Non-Linear Model
(Adapted from Lorenz & Morrinson, 2015; Kakavas et al, 2020)

Periodization - II
LINEAR
Model
● a
Periodization - III
NON-LINEAR
Model
● a
Training Load - I
Monitoring Training Loads During Re-Conditioning Process
● EXTERNAL
EXTERNAL LOAD:
LOAD:
1)- Volume, intensity, density, frequency and complexity;
2)- Distance traveled, number of accelerations, number of
decelerations, number of changes of direction, number of
jumps, average speed, playerload, etc.
(Adapted from Gabbett, 2020; Petway et al, 2020)

Training Load - II
● INTERNAL
INTERNAL LOAD:
LOAD:
1)- OBJECTIVE: Heart rate, lactate, creatine phosphokinase,
testosterone\cortisol ratio, VO2max, etc
2)- SUBJECTIVE: RPE, monotony index, strain index, wellness
questionnaire, TQR questionnaire, etc
(Adapted from Fitrianto et al, 2018; Paulauskas et al, 2019; Gabbett, 2020; Petway et
al, 2020; Brini et al, 2020)
Training Load - III
● ACWR
ACWR (acute:chronic
(acute:chronic worloadratio):
workload ratio):
1)- Acute Training Loads (weekly basis) - FATIGUE
2)- Chronic Training Loads (3-6 weeks) - FITNESS
SAFETY Zone RISK Zone
~0.8-1.3 ≥1.5
The 10% rule

(≤10-25%) - ?
(Adapted from Gabbett et al, 2016; Gabbett, 2020a; Gabbett, 2020b)

Training Load - IV
● Errors and\or Spikes in Loads:
~1-2 weeks
Muscle injuries
Tendon injuries ~3 weeks
~3-4 weeks
Bone injuries
(Adapted from Tibana et al, 2017)
Training Load - V
Load DISTRIBUTION
Plan the Program
Load CONTROL
Monitor Responses
(Adapted from Meneses, 2020)

Progression Criteria - I
Pain Tolerance ●
Load Tolerance
●
Strength + Neuromuscular Control
Aerobic and Anaerobic Capacity ●
Range of Motion ●
Joint Stability "Injury Type-Dependent"

●
Tenderness
Inflammation or Swelling ●
Effusion ●
Girth
●
Other
(Adapted from Creighton et al, 2010; Bahr et al, 2012)

Progression Criteria - II
(1)- Health (2)- Participation (3)- Decision-
Status Risk Making
- Athlete Demographics;
- Symptoms; - Season Period;
- Demands of Sport;
- Medical History; - Pressure from Player;
- Position Played;
- Physical Exam; - External Pressure;
- Limb Dominance;
- Lab Tests; - Masking the Injury;
- Competitive Level;
- Functional Tests; - Conflict of Interest;
-Ability to Protect
- Psychological State; - Fear of Litigation
- Potential Seriousness
(Adapted from Creighton et al, 2010)

Relationship Between Physical Fitness and
Injury Symptoms
Hypothetical Model of the Relationship Between Physical
Fitness (yellow line) and Injury Symptoms (red line) in the
Three Phases of Re-Conditioning
Return to Return to Return to

Training Sport Performance
Return to Performance Duration
Injury Type RTP Duration
● a(weeks) Authors
Achilles tendon rupture ~40-80 Lemme et al, 2019; Carmont et
al, 2020; Siu et al, 2020
Soleus muscle strains ~5 Pedret et al, 2015
Ankle sprains >4 McKeon et al, 2014
ACL rupture ~24-60 Lohmander et al,
2007; Nagano et 2011; Brophy et
al, 2012; Oiestad et al, 2018;
Wellsandt et al, 2018
Repair of the rectus abdominis ~5 Short et al, 2016
and adductor longus
Hamstring strain ~1->5 Cohen et al, 2011; Reurink et al,
2014
Adductor strain\tear ~4-9 Patel et al, 2020
Shoulder ~3-8 Lu et al, 2020
subluxations\dislocations
Cervical, thoracic, and lumbar ~12-48 Huang et al, 2015
spine injuries
Hand and finger fracture ~4-17 Morse et al, 2017
Concussions ~1-3 Patel et al, 2019
Risk of Injury After Return
RECURRENCE RISK
(muscle strains)
↑ 15 weeks after return

Recurren ce risk
to performance
Week since return to performance

(Adapted from Orchard et al, 2020)
Final Considerations - I
● Re-conditioning is a gradual process of returning to
competitive activity after an injury;
● There are three phases in the re-conditioning process: 1)-
return to training, 2)- return to sport and 3)- return to
performance;
●
The process involves being athlete-centered and
dependent on the type of injury;
●
It is important to prescribe appropriate activities for each
phase and monitor training loads;
●
Observing the progression criteria would minimize errors
in decision making.
Final Considerations - II
● THANKS!!!
● FACEBOOK: adrianovretaros01
● TWITTER: @adrianovretaros
● INSTAGRAM: @adrianovretaros
● E-Mail: avretaros@gmail.com

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Basketball:

Re-Conditioning After Injury

Multilevel Nonlinear Complex Dynamic System

(Adapted from Bittencourt et al, 2016)

INTRINSIC Risk ** INJURIES **

(Adapted from Bahr & Krosshaug, 2005)

(Adapted from Lewis, 2018)

FEMALE Players % MALE Players %

Upper Limbs and 2,5 Upper Limbs and 2,8

Trunk 4 Trunk 7,1

Hip and Thigh 8,7 Hip and Thigh 8,2

Knee 18,2 Knee 10,6

Lower Limbs 4,9 Lower Limbs 3,4

Ankle and Foot 35,9 * Ankle and Foot 43,2 *

Other 2,2 Other 2,4

(Adapted from Borowski et al, 2008)

Tissues Affected by Injuries

Muscle Tendon Ligament

Cartilage Fascia Bone

Financial Cost of Injuries - I

● Mean Medical Cost per Injury;

(Adapted from Knowles et al, 2007)

Financial Cost of Injuries - II

(Adapted from Stotts, 2015)

● What kind of injury was the player affected?

● How Does Your Scientific Team Work?

MULTI INTER TRANS

(Adapted from Buekers et al, 2017)

Internal Communication Between

(Adapted from Ekstrand et al, 2018)

Intra-Team Communications and Injuries

“In elite sports, players are commonly pressured to return to

● Clear Communication Between Staff Members

(Adapted from Ekstrand et al, 2018)

Physical Emotional Social

(Adapted from De Rose et al, 2008; Arden et al, 2016)

● What is Physical Re-Conditioning?

It is a gradual process of returning to sports activities after

(Adapted from Vretaros, 2002)

(1)- PHYSICIAN Diagnostics

(3)- S&C COACH

(Adapted from Arden et al, 2016)

(1)- Return to (2)- Return to

(Adapted from Arden et al, 2016; Taberner et al, 2019)

Properly controlled Movement based on

(Adapted from Taberner et al, 2019)

- Apply Progressive Mechanical Loading

- Gradually Restore Mechanical Rigidity

- Use Metrics Based on Training Loads

- Return to Physical Fitness Pre-Injury Values

(Adapted from Taberner et al, 2019a)

(Adapted from Arden et al, 2016)

(Adapted from Arden et al, 2016)

STRENGTH: hipertrophy and maximal strength

(Adapted from Taberner et al, 2019)

(Adapted from Arden et al, 2016; Siu et al, 2020)

ENDURANCE: aerobic and anaerobic

STRENGTH: power and power endurance

(Adapted from Taberner et al, 2019)

Metabolic Training Strength Training

(Adapted from Taberner et al, 2019; Taberner et al, 2019a)

Linear Model Non-Linear Model

(Adapted from Lorenz & Morrinson, 2015; Kakavas et al, 2020)

Monitoring Training Loads During Re-Conditioning Process

INTRINSIC Risk INJURIES