Sports Rehabilitation
Key to Olympic success
Bruce Paton
Musculoskeletal Extended Scope
Physiotherapist – UCLH
Outline
• Introduction
– Case study to show why rehab is important
• Principles of rehabilitation
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Tissues and healing
Optimally loading tissues and adaptation
Aims of rehabilitation
Specificity of training per olympic sports
• UCLH
– Musculoskeletal pathways now and in past
Introduction
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Alistair Brownlee 22 yo triathlete
Winner of ITU WC series 2009
Feb 2010 – Femoral Stress Fracture
Physiotherapist- Emma Deakin
Return to competition June – madrid
Winner final race ITU WC series
– Budapest sat 11 th sept 2010
– Times overall time 01:42:26
» Swim (1500m) 00:17:12
» Bike (40km) 00:53:54
» Run (10km) 00:30:00
• How does and athlete get to this level training ?
• What does the athlete do if they get injured ?
Rehabilitation principles
• Rehabilitation Follows many of the same principles
of training
• training dealing with strengthening normal tissues
( Nb holds true for athletes & normal population)
• Rehabilitation involves strengthening injured
tissue
Tissues and
Healing
• After injury – stages of healing
• Body does a lot of our work !!
• Thankfully it works to heal itself !
• Tissues have capacity for
strengthening with training
(Adaptation)
– They adapt to the loads placed on
them
– Science expanding knowledge
Increase intensity
session Longer
recovery required
Increase
Frequency
Reduced rest
tissue weakening
TISSUE
STRENGTH
Adaptation
progressive
overload = tissue
strengthens
T IME
Tissues and Loading
• Different tissues ADAPT and
HEAL differently
– Time scales
– Recovery times
• What is OPTIMAL loading for
strengthening tissues ?
• Ie how do you pitch the athlete’s
loading correctly
• Secret to good rehabilitation
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Correct PACING OF LOADS/TRAINING
Frequency
Intensity
Duration of loading
RECOVERY TIME !!
» Often a difficult factor for olympic
athletes
» make me better Yesterday!!
Increase intensity
session Longer
recovery required
Increase
Frequency
Reduced rest
tissue weakening
TISSUE
STRENGTH
Adaptation
progressive
overload = tissue
strengthens
T IME
Aims of Rehab – Early
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•
•
•
•
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Manage Pain
Manage inflammation
Protection - Brace / tape
Normalise movement
Muscle Control/ Recruitment
Maintain fitness
• PSYCHOLOGY
Aims of Rehabilitation
middle stage
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Address Biomechanics
Muscle flexibility
Restore joint movement
Muscle Strength
Neurodynamics
Proprioception/ Balance
Cardiovascular fitness
• PSYCHOLOGY
Aims of Rehabilitation
late stage
• M strength Endurance
• Speed and power
• Impact tolerance / Tissue
hardening
• Direction change / Pivoting/
Agility
• Coordination/ Technique
• Control / core stability
• Sports Specific work
– Return to training / sport
• Future jt protection and
prevention of re injury
– clear all Contributing Factors
• PSYCHOLOGY
Specificity
• Olympic sports
• Paralympic sports
• Each has very
specific demands
• Rehab needs to take
into account the
demands of the sport
• TRx and Tq
knowledge
Olympic sports
Aquatics
Handball
Archery
Hockey
Athletics
Judo
Modern Pentathlon
Badminton
Rowing
Basketball
Boxing
Canoeing
Cycling
Equestrian
Fencing
Football
Gymnastics
Sailing
Shooting
Table Tennis
Taekwondo
Tennis
Triathlon
Volleyball
Weightlifting
Wrestling
Paralympic sports
Archery
Rowing
Athletics
Sailing
Boccia
Shooting
Cycling
Equestrian
Sitting volleyball
Swimming
Football 5-a-side
Table tennis
Football 7-a-side
Wheelchair basketball
Goalball
Wheelchair fencing
Judo
Powerlifting
Wheelchair rugby
Wheelchair tennis
Contributing factors
Extrinsic
• Equipment
• Surfaces
• Footwear
• Training schedules
– Science
Intrinsic
• Skill Technique / movt
pattern
• Strength / flexibility
• Biomechanics
Prevention
• Long term thinking
• Science contribution
MSk Rehabilitation pathways at UCLH
•
NHS experience Rehabilitation
– Many units lack facilities and expertise to
allow
» High level strengthening
» Paced return to sport
– Discharge before full return
UCLH Strengths
• Consultants with sports background
– Incl SEM consultant
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Strong multidisciplinary
communication
Gym based pathway
– Facilities
– Expertise
Diagnosis / Screening

Prehabilitation

+/- Surgery

Rehabilitation
– Early stage 1:1
– Middle stage 1:1 / Gym

Late stage Gym
– Return to training
– Return to sport
Rehabilitation at UCLH
• Facilities
– Dept
– Gyms
– Hydrotherapy
• Systems
– Gym based rehab systems
» Advanced Gps
• 1300 pts since dec05
» Early stage
• 700 pts since feb 07 )
» Upper / Lower Limb
» Spinal
Rehabilitation at UCLH
Expertise
– Long Hx of rehab for high level
athletes
– Physios working with professional
sports teams background
– University teaching links
– Research studies
– Inter trust Inservice training
Links
– UCL
» ISEH
» Sports MSc
– Pct
– BOA / EIS and External
sports groups
Rehabilitation Opportunities
• Opportunities
• Systems
• Expertise
– Volunteering
– Further training / teaching
– Research strategy
• Links
– BOA
– UCL ISEH and sports MSc
– LOCOG
Conclusion
• Successful rehabilitation
– expertise in knowing
» demands of sport
» Behaviour of healing tissues
– Skills in
» Optimal pacing of rehabilitation and training
» Effective management of contributing factors
• Excitement of Games in London
– Logistics
– Volunteers ( 70,000 reqd / 40,000 paralympics)
• Opportunities for UCLH
– Strong capabilities
– Strong links
“To contribute to building a peaceful and
better world by educating youth through
sport practiced without discrimination of
any kind and in the Olympic spirit, which
requires mutual understanding with a
spirit of friendship, solidarity and fair
play.”
International Olympic Committee, ‘Fundamental Principles’,
Olympic Charter
"To Enable Paralympic Athletes to Achieve
Sporting Excellence and Inspire and Excite
the World".
International paralympic movement - Vision and Mission statement
Thank you for
listening
Questions ?