1. Injury Prevention & Management of Injuries Presented by: Karen Craven BSc(PT),Dip Sport (PT), CSCS

2. Prevention Through – Through – Training Program Design Training Program Design Physical Conditioning Physical Conditioning Nutrition/Hydration Nutrition/Hydration Warm-up and Cool-down Warm-up and Cool-down Stretching Stretching Monitoring of over-use signs and symptoms Monitoring of over-use signs and symptoms

3. Training Program Design Appropriate type of training stimulus Appropriate type of training stimulus Ample rest and recovery time Ample rest and recovery time Specific to your sport Specific to your sport Specific to improve your weaknesses and maximize your strengths. Specific to improve your weaknesses and maximize your strengths.

4. REST… is the most important part of your workout. Between workouts there must be ample time for recovery

5. Complete recovery time required following various types of training inducing HIGH fatigue Type of training Type of training Speed Speed Strength Strength Anaerobic lactate Anaerobic lactate Aerobic Power Aerobic Power Aerobic endurance 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

6. Physical Conditioning Strength – gluts, hamstring/quadricep ratio, ankle and calf, upper body Strength – gluts, hamstring/quadricep ratio, ankle and calf, upper body Neuromuscular coordination drills (ie SAQ drills) Neuromuscular coordination drills (ie SAQ drills) Good technique and execution Good technique and execution Balance and proprioception exercises Balance and proprioception exercises Plyometrics Plyometrics Flexibility – ankle, thoracic spine Flexibility – ankle, thoracic spine Aerobic/anaerobic conditioning Aerobic/anaerobic conditioning

7. 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. Think of the Means of skill performance, not the end product.

9. 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

10. Hydration Status

11. Warm-up & Cool-down Increase body temperature Increase body temperature Increased readiness to participate Increased readiness to participate Increased efficiency of movement Increased efficiency of movement Decrease in metabolic processes Decrease in metabolic processes Removal of Lactic Acid Removal of Lactic Acid Replenish Energy Replenish Energy

12. Warm-up/Cool-Down Warm-up Warm-up Should be Dynamic! Should be Dynamic! Cool-Down Cool-Down Means slowing down (not stopping completely), after exercise 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 Continue to move around at a very low intensity for 5 to 10 minutes after a workout Finish with some stretching Finish with some stretching

13. Stretching Muscles surrounding the hip, knee and ankle, back Muscles surrounding the hip, knee and ankle, back Daily stretching Daily stretching Passive and active Passive and active Hold static stretches 30 sec. Repeat 3-5x. Hold static stretches 30 sec. Repeat 3-5x.

14. 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

15. All physiological training is intimately dependent on the concept of progressive overload.

16. 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. 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.

17. Training load SupercompensationNormal functioning level of the body Recovery of tissues and fuels after training session Fatigue, decrease in normal functioning level Adapted from NCCP Task #6 readings Perfect Too soon Too late Next workout? Level of Physi cal prepa redne ss/fu els Ref. Page 30

18. Baseline fitness Fitness gain! Workout during supercompensation phase Sufficient recovery = performance gains! Baseline fitness Fitness loss! Workout before supercompensation phase Insufficient recovery = performance decrements!

19. Staging of Tendinitis/Overuse Syndrome/Under-recovery SYMPTOMS n Stage I: n Pain only after activity. n Does not interfere with performance. n Often generalized tenderness. n Disappears before next exercise session. n Stage II: n Minimal pain with activity. n Does not interfere with intensity or distance. n Usually localized tenderness. TREATMENT n Modification of activity. Assessment of training pattern. Possibly NSAIDs Modification of activity. Physical therapy; NSAIDs; consider orthotics. Reid, 1992

20. Staging of Tendinitis/Overuse Syndrome/Under-recovery SYMPTOMS n Stage III: n Pain interferes with activity. n Usually disappears between sessions. n Definite local tenderness. n Stage IV: n Pain does not disappear between activity sessions. n Seriously interferes with intensity of training. n Significant local signs of pain, tenderness, creptitus, swelling. TREATMENT n 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

21. Staging of Tendinitis/Overuse Syndrome/Under-recovery SYMPTOMS n Stage V: n Pain interferes with sport and activities of daily living. n Symptoms often chronic or recurrent. n Signs of tissue changes and altered associated muscle function. TREATMENT n Prolonged rest from activity. NSAIDs plus other medical therapies. Consider splint or cast. Physical therapy. May require surgery. Reid, 1992

22. Symptoms of Overtraining Apathy (no emotion) Apathy (no emotion) Lethargy (tired all the time) Lethargy (tired all the time) Depression Depression Decreased self-esteem Decreased self-esteem Emotional instability Emotional instability Impaired performance Impaired performance Restlessness Restlessness Irritability Irritability Disturbed sleep Disturbed sleep Weight loss Weight loss Loss of appetite Loss of appetite Increased resting heart rate Increased resting heart rate Increased vulnerability to injuries Increased vulnerability to injuries Muscle pain/soreness Muscle pain/soreness

23. Preventing Over-training Set realistic and flexible training/game goals Set realistic and flexible training/game goals Physical conditioning Physical conditioning Practice quality not quantity Practice quality not quantity Keep program flexible Keep program flexible Allow for rest and recovery Allow for rest and recovery Relieve Stress Relieve Stress Nutrition and hydration Nutrition and hydration Recovery techniques (Active Rest, Relaxation, Massage, Hot/Cold etc) Recovery techniques (Active Rest, Relaxation, Massage, Hot/Cold etc)

24. Preventing Over-training What to Monitor: What to Monitor: Morning heart rate Morning heart rate Sleep Sleep Mood Mood Appetite Appetite Weight Weight Hydration Status Hydration Status

25. Injury Care

26. Vicious Circle Joint Damage Reflex Inhibition Muscle Wasting Muscle Weakness Immobilization

27. Common Signs of An Injury Painful to move or use Swelling Discoloration Warm to touch

28. Basic Treatment of Injuries R.I.C.E.R REST AND RESTRICTED ACTIVITY REST AND RESTRICTED ACTIVITY ICE ICE COMPRESSION COMPRESSION ELEVATION ELEVATION REFER TO MEDICAL PROFESSIONAL REFER TO MEDICAL PROFESSIONAL

29. Rest Immobilization in anatomical position Immobilization in anatomical position NWB Crutch walking NWB Crutch walking PWB Crutch walking with pain-free heel-toe gait as tolerated PWB Crutch walking with pain-free heel-toe gait as tolerated FWB with pain-free gait without limp FWB with pain-free gait without limp

30. Ice 15-20 minutes per time, 5-7 times a day (every couple of hours) 15-20 minutes per time, 5-7 times a day (every couple of hours) First 48 hours most important time First 48 hours most important time DONT FREEZE! DONT FREEZE! After activity (NOT before or during activity) After activity (NOT before or during activity) Place wet towel between skin and ice Place wet towel between skin and ice

31. Compression Minimize swelling with a tensor Minimize swelling with a tensor Dont wear at night Dont wear at night

32. Elevate Keep the ankle at or above waist level at all times when the patient is not active 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 Should be continued until the swelling has resolved

33. 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)

34. Seek Treatment: The earlier the better !! Sport Physiotherapy: Sport Physiotherapy: - Movement patterns - Alignment - Asymmetries/imbalances - Resting and active muscle tone - Flexibility and joint range of motion

35. STAGES OF REHAB

36. RUNNING PROGRESSION RULE OF THIRDS Magee

37. Therapeutic Exercise Program Control Inflammation (RICER) Control Inflammation (RICER) Modify training Modify training Rehabilitative exercises from physiotherapist Rehabilitative exercises from physiotherapist Gradual introduction of muscular strength, endurance and power Gradual introduction of muscular strength, endurance and power Progressive and gradual return to sport activity Progressive and gradual return to sport activity Maintain strength of opposite limb Maintain strength of opposite limb Core stability and flexibility Core stability and flexibility Maintain cardiovascular fitness through alternative exercise (ie swimming) Maintain cardiovascular fitness through alternative exercise (ie swimming)

38. Success is... not an accident, but rather the product of a thoughtful and well executed plan

39. The End THANK YOU! 306-934-2011 craven.sports@sasktel.net