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

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

60 50 40 30 20 10 0 Preinjury Postinjury
Advanced Physiotherapy and Injury Prevention

games/season

8 7 6 5 4 3 2 1 0 Pre-injury 1 Year Post injury
Advanced Physiotherapy and Injury Prevention

• Up to 2 years may be needed to regain normal quadriceps muscle performance following ACL reconstruction. • Frequent non-return to peak performance (20 – 50%)

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

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
• • • • • • Physical conditioning Fair play Protective equipment Hydration and nutrition Injury analysis Environment
Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

• Who is at risk? • Why are they at risk? • What can be done about it?

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

• 4 Steps to developing a successful screening program
– Health questionnaire – Lifestyle assessment questionnaire – Physical assessment – Follow-up screening

Advanced Physiotherapy and Injury Prevention

•General health •Medical history •Medical conditions, allergies •Previous injuries •Drug use

Health Questionaire

Advanced Physiotherapy and Injury Prevention

•General •History •Medical conditions •Previous injuries •Drug use

•Social •Environmental •Alcohol/cigarettes •Living arrangements •Diet

Health Questionaire

Lifestyle Questionaire

Advanced Physiotherapy and Injury Prevention

•General •History •Medical conditions •Previous injuries •Drug use

•Social •Environmental •Alcohol/cigarettes •Living arrangements •Diet

Health Questionaire

Lifestyle Questionaire

Physical Assessment
•Medical •Fitness •Musculoskeletal

Advanced Physiotherapy and Injury Prevention

•General •History •Medical conditions •Previous injuries •Drug use

•Social •Environmental •Alcohol/cigarettes •Living arrangements •Diet

Health Questionaire

Lifestyle Questionaire

Physical Assessment
•Musculoskeletal •Fitness •Medical

Followup
•Mid-year •After injury

Advanced Physiotherapy and Injury Prevention

•General •History •Medical conditions •Previous injuries •Drug use

•Social •Environmental •Alcohol/cigarettes •Living arrangements •Diet

Health

Lifestyle

Physical
• Musculoskeletal
•Fitness •Medical

Followup
•Mid-year •After injury

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

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
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

• Biomechanics/Technique

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

• It is really hard to see things without slow motion but • If something looks odd it probably is • And needs professional assessment.

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

1.4 1.2 1 0.8 0.6 0.4 0.2 0 Before Program After Program
Advanced Physiotherapy and Injury Prevention

Pre Activity Warm-up. • Aerobic exercise. • Stretching. • Sport-specific exercises.

Post Activity Cool-down • Aerobic exercise. • Stretching. • Recovery

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT

EFFECT ON PERFORMANCE

EFFECT ON INJURY PREVENTION

Issues

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
Can increase or impair performance depending on the amount done, rest intervals following

EFFECT ON INJURY PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
Can increase or impair performance depending on the amount done, rest intervals following Reduces Performance unless followed by other activity

EFFECT ON INJURY PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit

Nil

Advanced Physiotherapy and Injury Prevention

ACTIVITY
- Aerobic Activity

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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 PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit Neuromuscular activation, concentration

nil

- Sport Specific Exercises COOL-DOWN AND RECOVERY

Certain targeted programs very effective

Needs to be specifically targeted at sport/level

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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 PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit Neuromuscular activation, concentration

nil

- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise

Certain targeted programs very effective

Needs to be specifically targeted at sport/level

Nil

No proven effect

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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 PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit Neuromuscular activation, concentration

nil

- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching

Certain targeted programs very effective

Needs to be specifically targeted at sport/level

Nil Increases compliance of muscle tendon unit Nil

No proven effect No proven effect

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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 PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit Neuromuscular activation, concentration

nil

- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching Massage

Certain targeted programs very effective

Needs to be specifically targeted at sport/level

Nil Increases compliance of muscle tendon unit Reduced inflammation Nil Nil

No proven effect No proven effect Reduced muscle soreness Not strong evidence, expensive

Advanced Physiotherapy and Injury Prevention

ACTIVITY

PHYSIOLOGICAL EFFECT
Increases heart rate, core temperature, nerve conduction

EFFECT ON PERFORMANCE
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 PREVENTION
Reduces muscle soreness

Issues
Optimal not established, variable for different levels of fitness, different sports

- Aerobic Activity

- Static Stretching

Increases compliance of muscle tendon unit Neuromuscular activation, concentration

nil

- Sport Specific Exercises COOL-DOWN AND RECOVERY Aerobic Exercise Stretching Massage Cold water immersion

Certain targeted programs very effective

Needs to be specifically targeted at sport/level

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,

Advanced Physiotherapy and Injury Prevention

Dynamic Stretching
• Dynamic stretching consists of functional exercises which use sports specific movement patterns to prepare the body for activity

Advanced Physiotherapy and Injury Prevention

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

Advanced Physiotherapy and Injury Prevention

• 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

Advanced Physiotherapy and Injury Prevention

• Performing a properly structured professionally designed warmup and competing will do the following
Performance Reduce injury rate

Advanced Physiotherapy and Injury Prevention

• Is the sports specific part • Which, if done correctly • Is the only part you have to do

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

• 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
Advanced Physiotherapy and Injury Prevention

• 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

Advanced Physiotherapy and Injury Prevention

• 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

Advanced Physiotherapy and Injury Prevention

• 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

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

• 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)

Advanced Physiotherapy and Injury Prevention

• 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
Advanced Physiotherapy and Injury Prevention

• BMI= kg/m2 • Normal 18-25 • Above or below doubles the injury risk

Advanced Physiotherapy and Injury Prevention

• • • • • • •

Periodisation Genetics Injury Correct technique Exercise selection Rest Psychological
Advanced Physiotherapy and Injury Prevention

• “Periodisation is the process of separating the annual or long-term training plan into smaller more manageable periods or ‘cycles’ and ‘phases’.

Advanced Physiotherapy and Injury Prevention

• This allows for a more effective manipulation of training variables, with the goal of optimizing the athlete’s 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)

Advanced Physiotherapy and Injury Prevention

Advanced Physiotherapy and Injury Prevention

• 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 aren’t 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
Advanced Physiotherapy and Injury Prevention

Bracing and taping. Bracing and taping can provide some protection against injury to joints. Bracing vs Taping.

Advanced Physiotherapy and Injury Prevention

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

Advanced Physiotherapy and Injury Prevention

Should contain four to eight percent carbohydrate and 0.5-0.7g/litre sodium (ACC website).

Needed for sports > 1 hour

Advanced Physiotherapy and Injury Prevention

• Helps us to indentify injury trends • Helps us to identify causes • Allows us to provide solutions

Advanced Physiotherapy and Injury Prevention

• Allows us to identify problem areas • Leads to better solutions

Advanced Physiotherapy and Injury Prevention

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
– – – –

Advanced Physiotherapy and Injury Prevention

• 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.
Advanced Physiotherapy and Injury Prevention

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

Advanced Physiotherapy and Injury Prevention

• • • • •

REST ICE COMPRESSION ELEVATION D

Advanced Physiotherapy and Injury Prevention

Diagnose as quickly as possible Don’t figure it out for yourself Don’t expect google to help Don’t ignore small niggles

Advanced Physiotherapy and Injury Prevention

• All the above applies to children but • Children are not just small adults

Advanced Physiotherapy and Injury Prevention

• Growth Plate Injuries
– Severs Syndrome – Osgood Schlatters Syndrome

Advanced Physiotherapy and Injury Prevention

• Have now
– Explanations of common injury

• Are producing or uploading
– Performance enhancement and injury prevention blog – Screening questionaires – Sports trainer’s kit – Uploaded screening information – Video of Advanced Warmup
Advanced Physiotherapy and Injury Prevention

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