1. Burnout- Facts and Figures Dr. Philip Glasgow PhD, MRes, BSc(hons), MCSP, SRP Chartered Physiotherapist Sports Institute Northern Ireland GAA Conference- Bundoran 13 th November 2004

2. Is There A Problem? How Can We Address It? Injury Prevention- Theory Musculoskeletal Screening Results Response Example of best practice Recommendations

3. What is the magnitude of the problem? What is the magnitude of the problem? What are the causes of injury? What are the causes of injury? What can we do to prevent injuries? What can we do to prevent injuries? What can we do to prevent injuries? What can we do to prevent injuries?

4. Meeuwisse WH: Clin J Sports Med 4: 166-170, 1994 Internal risk factors: Age (maturation, aging) Gender Body composition (e.g. body weight, fat mass, BMD, anthropometry) Health (e.g. history of previous injury, joint instability) Physical fitness (e.g. muscle strength/power, maximal O 2 uptake, joint ROM) Anatomy (e.g. alignment, intercondylar notch width) Skill level (e.g. sport- specific technique, postural stability) Predisposed athlete Risk factors for injury (distant from outcome) Injury mechanisms (proximal to outcome) Susceptible athlete Exposure to external risk factors: Human factors (e.g. team mates, opponents, referee) Protective equipment (e.g. helmet, shin guards) Sports equipment (e.g. skis) Environment (e.g. weather, snow & ice conditions, floor & turf type, maintenance) INJURY Inciting event: Joint motion (e.g. kinematics, joint forces & moments) Playing situation (e.g. skill performed) Training program Match schedule

5. What is the magnitude of the problem? What is the magnitude of the problem? What are the causes of injury? What are the causes of injury? What can we do to prevent injuries? What can we do to prevent injuries? CAUSES???

6. Cause?

7. Musculoskeletal Screening Identify predisposing factors to injury Detect musculoskeletal impairments that may affect performance Identify ongoing injuries, which may or may not be receiving treatment Provide information to coaches on management of ongoing injuries Identify problems not responding to treatment Follow up to previous screening Put in place appropriate measures to prevent injury and enhance performance

8. Screening Results Postural Alignment Joint Range of Motion Flexibility Stability/Movement Control Previous/Current Injury

9. Postural Alignment High incidence poor kyphotic posture Rounded shoulders Poor alignment

12. Joint Range of Motion Reduced ROM hip joints Increase laxity shoulder joints Reduced ROM spinal joints especially thoracic spine

15. Flexibility Generally poor flexibility Reduced hamstring range (45-60 0 SLR) Standard- 90-120 0 Tight hip flexors Tight chest muscles

21. Stability/Movement Control Provides picture of how athlete moves Demonstrates effects of static findings High incidence poor single leg movement control tests Poor gluteal activation Poor shoulder stability Poor core

26. Examples of Functional Tests (Video)

27. Current/Previous Injury High incidence of ankle and knee injuries High incidence hamstring injuries High recurrence rate Lack of adequate treatment and rehabilitation

32. Summary of Findings Poor Posture Decreased Thoracic Extension Increased Laxity Shoulder Joints Poor Flexibility: –Hamstrings –Hip Flexors –Calves –Lumbar Spine Reduced Movement Control High Incidence of Previous Injury: – Associated With Ongoing Problems

33. Case Study 1 20yr old footballer Poor kyphotic posture History of right ankle sprains History of right hip pathology History of right shoulder pain Currently complaining of left thigh pain Poor balance and proprioception Significantly reduced hamstring length Unstable right shoulder Continued to play throughout injury- still feels sore (2 years later) Constantly feels stiff and sore Trains 5 times per week Regularly plays 3 games per week

34. Case Study 2 Screening Results: –Dislocated right shoulder –History of ankle sprains –Poor flexibility –Reduced spinal movements –Very poor posture –Leg length discrepancy –Very left side dominant –Poor single leg control

35. Case Study 2 cont. Management: –4 Months out of playing to rehab dislocated shoulder –Concurrently worked on flexibility, control, stability and spinal movements Outcome: –Returned to full training and competition –No recurrence of shoulder problems –Maintained flexibility and spinal movement –Reports that movement control has contributed significantly to his game.

36. Case Study 3 Screening Results: –Very poor kyphosed posture –Reduced flexibility –Longstanding quadriceps injury for 6 months that has not improved despite treatment –Continuing to play

37. Case Study 3 cont. Management: –Cessation of playing –Treatment of injury –Advanced rehabilitation programme –Work on flexibility and control Outcome: –Return to playing –No further problems with quad –Improved flexibility and power generation

38. Conclusion In light of the theory of injury prevention, the significant incidence of intrinsic risk factors in conjunction with numerous extrinsic factors (such as training volume and practices), the GAA squad presents as a High Risk Population

39. How Do We Respond? Strategies to reduce injury risk. Assessment of training practices: –Content –Periodisation –Recovery Emphasis on: –Technique –Postural alignment –Flexibility –Stability –Adequate treatment and rehabilitation of injuries –Prehabilitation

40. Technical training Balance training Special drills Volleyball intervention study

41. Myklebust et al. Clin J Sport Med 13: 71-78, 2003 Training program Three types of exercises with progression: 1. Floor 2. Airex balance mat 3. Wobble board 5 weeks 2-4 x each week Maintenance 1 x weekly during the season

42. Week 1 Week 2 Week 4 Week 5

43. Myklebust et al. Clin J Sport Med 13: 71-78, 2003 P=0.15 vs. 98-99 00-01 99-00 98-99 P=0.06 vs. 98-99

47. Recommendations Change training practices: –Volume* –Content –Periodisation –Recovery Emphasis on: –Technique –Postural alignment –Flexibility –Stability –Adequate treatment and rehabilitation of injuries –Prehabilitation

48. Questions