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Injury Prevention & Management of Injuries Presented by: Karen Craven BSc(PT),Dip Sport (PT), CSCS Prevention Through – Training Program Design Physical Conditioning Nutrition/Hydration Warm-up and Cool-down Stretching Monitoring 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) water During 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 100 90 80 Effect of hydration status on performance 70 60 50 40 1 2 3 4 5 6 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. Level of Physi cal prepa redne ss/fu els Training load Next workout? Too soon Perfect Supercompensation Fatigue, decrease in normal functioning level Too late Normal functioning level of the body Recovery of tissues and fuels after training session Adapted from NCCP Task #6 readings Ref. Page 30 Workout during supercompensation phase Fitness gain! Baseline fitness Sufficient recovery = performance gains! Workout before supercompensation phase Baseline fitness Fitness loss! Insufficient recovery = performance decrements! Staging of Tendinitis/Overuse Syndrome/Under-recovery SYMPTOMS 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-recovery SYMPTOMS 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-recovery SYMPTOMS 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 Joint Damage Muscle Weakness Reflex Inhibition Muscle Wasting 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 - STAGES OF REHAB RUNNING PROGRESSION 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 The End THANK YOU! 306-934-2011 [email protected]