Injury Prevention

A Workshop to Explore Injury Prevention in Talented Athletes

CTC

Introduction• Mathew Hawkes• Senior Physiotherapist• CTC Physiotherapy• Graduated from The University of Salford in 2004• Worked at Leighton, North staffs city general and RI

and Haywood hospital• Specialism in Applied Lower Limb Biomechanics

Project Aims• To gain a better understanding of injury

and the structures involved• To understand postural and

biomechanical importance on injury• To understand the importance of

screening in sport• To understand and implement injury

prevention strategies relevant to individual sports

Applied Anatomy

• Muscles

• Tendons

• Ligaments

• Joints

• Nerves

Muscle

• Skeletal Muscle• Smooth Muscle• Cardiac Muscle

639 documented Skeletal Muscles

Muscle• To initiate movement• To provide power• To maintain posture• To protect underlying

structures• To enable activity

Tendons• To provide anchorage

for muscle to bone

• To allow adequate force generation

• To transmit the force of a muscle contraction

Ligaments

• Short, tough fibrous bands of collagen

• Connect bone to bone

• Very little Elasticity – Gradually lengthen under continued tension

• Provide mechanical reinforcement of joints helping stability

• May limit or stop movement

JointsTypesTypes• Hinge Hinge • Ball and socketBall and socket• PivotPivot• SaddleSaddle• GlidingGliding

Other StructuresOther Structures•CapsuleCapsule•CartilageCartilage•BursaBursa•Fat padFat pad

Nerves• Sends information to and from Sends information to and from the brain the brain • Connect to the brain via the Connect to the brain via the spinal cordspinal cord• Good blood supplyGood blood supply• Injury may cause altered Injury may cause altered sensation, pain and weakness or sensation, pain and weakness or paralysisparalysis• May present as referred painMay present as referred pain

Mechanism of InjuryAcute Injury• Direct• Indirect

Chronic Injury• Repetitive Strain• Cumulative Strain• Static Strain• Postural Strain• Abnormal Pathology

Acute InjuryThree Phases of Healing:

1. Inflammation

2. Repair

3. Remodelling

Inflammatory PhaseUsually from injury lasting 2-5 days

• Heat• Redness• Swelling• Pain• Bleeding/Bruising• Disturbance of Function

Repair PhaseUsually from day 2 lasting 2-3 weeks

• Increased cellular activity• Removal of damaged tissue• Increased blood supply• Granulation Tissue produced• Collagen laid down

Remodelling PhaseFrom 2-3 weeks lasting up to a year

• Reduction of wound size

• Increased scar strength

• Contraction of granulation tissue

• Collagen strength increases

Management - Inflammatory Phase

Protection

Rest

Ice

Compression

Elevation

Movement

Management - Repair Phase

• Symptom Management

• Stretching

• Movement

• Progressive loading

• Education

• Advice

Management - Remodelling Phase

• Progressive Stretching

• Progressive Loading

• Post-Injury Rehabilitation

• Functional Rehabilitation

Chronic Injury

• Non specific pain• Variable symptoms• Gradual onset• Complex• Many factors• Acute flare up

Management of Chronic Injury

• Symptom treatment• Improve flexibility• Improve strength• Improve stability• Improve posture• Restore function• Educate

SpinalNeck and Lower Back

Symptoms• Dull or sharp pain• Muscle spasm• Neurological symptoms

Cause• Posture• Degenerative changes

Neural Tension•Nerves like muscles can lose length and become tight•It can be apparent in the upper and lower limb•It can be caused by trauma to the nerve, a disc bulge trapping the nerve, muscle tension, scar tissue and spinal changes•Treatment often consists of stretches which can be done independently to stretch and mobilise the nerveStretches•Sciatic nerve•Femoral nerve•Radial nerve•Ulna nerve•Median nerve

Factors Affecting Recovery

• Extent of injury• Nature of injury• Previous Injury• Age• Fitness

• General Health• Underlying Pathology• Psychological Factors• Sociological Factors

Common Conditions and Injury• Shin Splints• Tibialis posterior tendonitis• Patella tendonitis • ITB syndrome• Muscle strains• Plantar fasciitis

Prevention of Injury• Rest/ Recovery• Warm up• Correct equipment• Posture• Technique• Stretching

• Core stability• Sport specific training

• Screening• Biomechanics

• Diet

Rest/ Recovery• Training is the stimulus for your

body to adapt but rest is when the changes are done

• If you train too much it will stunt your gains

• Every time you train you create microscopic damage to the structures of your body, which need to heal before you train again

• If not healed they will build up into an injury• Sleep: very important!! 8 hours (healing- growth hormone

release)

Warm-up• Specific to sport• No static stretches (stretch

weakness)• Include dynamic stretching • Increase respiratory and

heart rate slowly• At least 10 minutes (first 3

steady to avoid lactate build up)

Correct equipment

• Clothing• Footwear• Orthotics?• Training equipment

Postural Advances ?

Posture• Biomechanics

• May need specific strengthening or

stretching or orthotics

• Part of screening

Good:

:

Technique

• Poor technique affects both performance and injury

• E.G.: a swimmer with too little body roll will risk Shoulder problems

Stretch

• To prevent injury?

• To improve function?

• To increase range?

• To reduce pain?

• Entertainment?

What type of stretching?

Static or dynamic?

Static stretching impairs sprint performance in collegiate athletes (Winchester et al 2008)

- Care re interpretation- Prior knowledge of athletes?

Dynamic stretching during warm-ups as opposed to static or no stretching is probably most effective for high speed performance sports such as football ( Little and Williams 2006)

Dynamic Stretching Ideas

• Lunge Walks• Walking High Steps• High Kicks• Deep Squats • Carioca• High skips• Trunk Rotations

The Evidence

‘Insufficient evidence that stretching exercises prevent lower limb injuries (Yeung and Yeung 2001)

Trials often drawn from the military- relevance to the sporting /general population?

Pope et al.(2000) . Military based trial. Stretching did not produce significant decrease in injury. General Fitness was an important risk factor ( shuttle run score)

Trials often involve warm up and cool down- ? reduced magnitude of stretching intervention

The Evidence

• Systematic review Thacker et al . (2004)

• 6 out of 361 studies eligible compared stretching to other prevention methods

• Not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes

The Evidence

• Does stretching induce lasting increases in joint ROM?

• Regular stretching increases joint ROM for more more than one day after cessation of stretching and possibly the effects of stretching are greater in muscle groupsd with limited extensibility ( Harvey et al. 2002)

• Stretching can produce a small but significant increase in ankle dorsiflexion range ( Radford et al. 2006)

The Evidence

• Does flexibility training increase muscle length?

No! Halbertsma and Goeken (1994) • 14 subject, 7 stretching, seven none stretching for 28

days. Small but significant increase in SLR

Yes! Halbertsma et al. (1996) • 16 subjects, 10 mins intermittent stretching produced

significant increases in stretch tolerance(hamstring) not the passive muscle stiffness curve

The Evidence

• Do subjects with stiffer Hamstrings have a greater propensity to injury?

• Malachy et al. (1999) investigate the effect of acute isokinetic training on subjects with varying muscle stiffness.

• Greater symptoms of muscle damage were found in subjects with greater stiffness.

• Research is ambiguous because if you are too stiff for your sporting requirements then Stretching is good

• If you are already flexible enough then stretching may not be of benefit

• What is always needed is control and strength of all the range you have got.

Core stability

NICE GuidelinesManagement of chronic LBP:

1. Mobilisation2. Acupuncture3. Exercise –

general and core stability

Published Feb, 2010

Definition•Core Stability is defined as the ability to control the position and motion of the trunk over the pelvis to allow optimum production, transfer and control of force and motion to the terminal segment in integrated athletic activities.( Kibler et al. 2006)

•Core muscle activity is best understood as the pre programmed integration of local, single-joint and multi-joint muscles to provide stability and produce motion.

• Poor core stability can lead to –– Postural deformities in the spine – Lower back pain– Weak/dysfunctional muscles leading to injury– Altered gait leading to biomechanical problems– Poor sports performance due to decreased power/strength

and ultimately injury

• Leetun DT et al. (2004) found that athletes with stronger hip abduction , external rotation, abdominal muscle function together better quadratus lumborum and erector spinae function had fewer injuries than their weaker counterparts

• Only Hip external rotation strength was a true predictor of injury

Sport specific training

Increasing the amount of anaerobic interval training, stretching whilst the muscle is fatigued, and implementing sport specific training drills resulted in a significant reduction in the number and consequences of hamstring muscle strain injuries. Verrall et al. (2005)

Baseball Pitch

Screening• Highlight any muscle or joint dysfunctions and

muscular imbalances which are major contributors to overuse injuries during

sporting performance (Forster et al., 2006). • Examination of the body’s mechanics

• Aiding the body’s efficiency during movements.

• Research based to help the prevention of injury and enhancing the young athlete’s

performance.• Needs to be specific (analysis with video of the movements produced and faults with them

Examples of screening tests:

• Dynamic lunge – look for knee and any foot drag etc.

• Crucifix against wall – pelvic tilt

• Single leg squat• Hypermobility tests• Hip rotations• Bridging• Superman

Biomechanics

Biomechanics is the science concerned with the internal and external forces acting on the human body and the effects produced by these forces (Hatze, 1974). In sports that involve walking, running or changing of direction, good technique is essential to enhance and improve performance. Basic walking and running patterns may be considered to be a foundation of good performance.

DIET AND EXERCISE

Healthy Weight =

INPUT (Calorie Intake) -OUTPUT (Calorie Burn)

Based on – BALANCED DIET– PORTION CONTROL

Diet

DIET AND EXERCISE

Basic ideas:• 5 colours on your plate

• At least 5 portions of different fruit and veg per day

• Plenty of water

Diet

Summary

PREVENTION

IS BETTER THAN CURE!

Thank-You For Your Attention

Mathew Hawkes – Senior Physiotherapist

CTC Physiotherapy