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Injury Prevention & Management of Injuries
Presented by:Karen Craven
BSc(PT),Dip Sport (PT), CSCS
Prevention Through –
Training Program DesignPhysical ConditioningNutrition/HydrationWarm-up and Cool-downStretchingMonitoring of over-use signs and symptoms
Training Program Design
Appropriate type of training stimulus Ample rest and recovery time Specific to your sport Specific to improve your weaknesses
and maximize your strengths.
REST… is the most important part of your workout.
Between workouts there must be ample
time for recovery
Complete recovery time required following various types of training
inducing HIGH fatigue
Type of training Speed Strength Anaerobic
lactate Aerobic Power Aerobic
endurance
Recovery time 24 hrs 48-72 hrs 48 hrs 48-56 hrs 56-72 hrs
N.B. Obviously, less recovery required when fatigue is not ‘high’Discussion required of these points!
Modified from Platonov, 1988, via Marion (1995) & Balyi, NCI-Victoria
Physical Conditioning
Strength – gluts, hamstring/quadricep ratio, ankle and calf, upper body
Neuromuscular coordination drills (ie SAQ drills)
Good technique and execution Balance and proprioception
exercises Plyometrics Flexibility – ankle, thoracic spine Aerobic/anaerobic conditioning
Golden Rules...
During any given training session, quality of exercise performance
is the cornerstone of the training program.
Think of the Means of skill performance, not the end
product.
Your body needs 8 to 10 cups of fluid during the day to stay hydrated
Fluid Intake Guidelines
Before event- drink 500 ml (2 cups) waterDuring the event- drink 150 to 300 ml
every 15-20 minutes for events < 1 hour WATER is good
for events > 1 hour a source of carbohydrates helps to delay fatigue.
Choose a beverage with 4 - 8% carbohydrates
(i.e. 4-8g carbohydrates/100 ml)After the event - consume enough fluid to
replace all losses. 1500 ml per kg of body weight lost
Hydration Status
40
50
60
70
80
90
100
1 2 3 4 5 6
Effect ofhydration statuson performance
Warm-up & Cool-down
Increase body temperature Increased readiness to participate Increased efficiency of movement
Decrease in metabolic processes Removal of Lactic Acid Replenish Energy
Warm-up/Cool-Down
Warm-up Should be Dynamic!
Cool-Down Means slowing down (not stopping
completely), after exercise Continue to move around at a very low
intensity for 5 to 10 minutes after a workout
Finish with some stretching
Stretching
Muscles surrounding the hip, knee and ankle, back
Daily stretching Passive and active Hold static stretches 30 sec. Repeat
3-5x.
Physical Activity
Muscle Fatigue
Altered Movement Patterns
Altered Recruitment Patterns
Altered Proprioception
Abnormal Loading
Altered Stress Distribution
Increase in Compressive Forces
Increase in Tensile Forces
Tissue Stress/Strain
All physiological training is intimately dependent on
the concept of progressive overload.
Overtraining and Overreaching
Is an advanced expression of athletic fatigue. It is characterized by a decline/stagnation in performance, and is accompanied by a set of physiological, psychological and biochemical signs and symptoms.
Training load
Supercompensation Normal functioning level of the body
Recovery of tissues and fuels after training sessionFatigue, decrease in normal
functioning level
Adapted from NCCP Task #6 readings
PerfectToo soon Too late
Next workout?
Level of Physical preparedness/fuels
Ref. Page 30
Baseline fitness
Fitness gain!
Workout during supercompensation phase
Sufficient recovery = performance gains!
Baseline fitness
Fitness loss!
Workout before supercompensation phase
Insufficient recovery = performance decrements!
Staging of Tendinitis/Overuse
Syndrome/Under-recoverySYMPTOMS Stage I:
Pain only after activity. Does not interfere with
performance. Often generalized
tenderness. Disappears before next
exercise session.
Stage II: Minimal pain with
activity. Does not interfere with
intensity or distance. Usually localized
tenderness.
TREATMENT
Modification of activity.Assessment of training pattern.Possibly NSAIDs
Modification of activity.Physical therapy; NSAIDs; consider orthotics.
Reid, 1992
Staging of Tendinitis/Overuse
Syndrome/Under-recoverySYMPTOMS Stage III:
Pain interferes with activity. Usually disappears between sessions. Definite local tenderness.
Stage IV: Pain does not disappear between activity sessions. Seriously interferes with intensity of training. Significant local signs of pain, tenderness, creptitus,
swelling.
TREATMENT Significant modification of activity.
Assess training schedule.Physical therapy; NSAIDs; consider orthotics.
Usually need to temporarily discontinue aggravating motion.Design alternate program.May require splinting.Physical therapy and NSAIDs.
Reid, 1992
Staging of Tendinitis/Overuse
Syndrome/Under-recoverySYMPTOMS Stage V:
Pain interferes with sport and activities of daily living.
Symptoms often chronic or recurrent. Signs of tissue changes and altered
associated muscle function.
TREATMENT
Prolonged rest from activity.NSAIDs plus other medical therapies.Consider splint or cast.Physical therapy.May require surgery.
Reid, 1992
Symptoms of Overtraining
Apathy (no emotion) Lethargy (tired all the time) Depression Decreased self-esteem Emotional instability Impaired performance Restlessness Irritability Disturbed sleep Weight loss Loss of appetite Increased resting heart rate Increased vulnerability to injuries Muscle pain/soreness
Preventing Over-training Set realistic and flexible
training/game goals Physical conditioning Practice quality not quantity Keep program flexible Allow for rest and recovery Relieve Stress Nutrition and hydration Recovery techniques (Active Rest,
Relaxation, Massage, Hot/Cold etc)
Preventing Over-training
What to Monitor: Morning heart rate Sleep Mood Appetite Weight Hydration Status
Injury Care
Vicious Circle
JointDamage
ReflexInhibition
MuscleWasting
MuscleWeakness
Immobilization
Common Signs of An Injury
Painful to move or use Swelling Discoloration Warm to touch
Basic Treatment of Injuries
R.I.C.E.R REST AND RESTRICTED
ACTIVITY ICE COMPRESSION ELEVATION REFER TO MEDICAL
PROFESSIONAL
Rest Immobilization in
anatomical position NWB Crutch walking PWB Crutch walking with
pain-free heel-toe gait as tolerated
FWB with pain-free gait without limp
Ice
15-20 minutes per time, 5-7 times a day (every couple of hours)
First 48 hours most important time
DON’T FREEZE! After activity (NOT before
or during activity) Place wet towel between
skin and ice
Compression
Minimize swelling with a tensor Don’t wear at night
Elevate
Keep the ankle at or above waist level at all times when the patient is not active
Should be continued until the swelling has resolved
Refer
Refer for medical advice for injuries requiring additional treatment
Receive permission to return to sport from a medical advisor
Ensure joint is well supported on return to sport (ie. Brace or tape)
Seek Treatment:“The earlier the better!!”
Sport Physiotherapy: - Movement patterns- Alignment- Asymmetries/imbalances- Resting and active muscle tone- Flexibility and joint range of motion
STAGESOFREHAB
RUNNINGPROGRESSION
RULE OF THIRDS
Magee
Therapeutic Exercise Program
Control Inflammation (RICER) Modify training Rehabilitative exercises from
physiotherapist Gradual introduction of muscular
strength, endurance and power Progressive and gradual return to sport
activity Maintain strength of opposite limb Core stability and flexibility Maintain cardiovascular fitness through
alternative exercise (ie swimming)
Success is...not an accident, but rather the product of a
thoughtful and well executed plan
