Injury Prevention and Management for Athletes with

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BlazeSports Institute
for Applied Science
CDSS Level I Curriculum
1
Injury Prevention for
Athletes with Physical
Disabilities
2
We would like to thank the following people for their
contributions to the content of this presentation:
Ben Johnson, EdD, CDSS
Professor and Chair
Dept. of Physical Education and Exercise Science
Brooklyn College
City University of New York
Jackie McParlane, DO, FACOEP
Director - Emergency Medicine Residency Program
Botsford Hospital
Farmington Hills, MI
3
OBJECTIVES
This session will provide basic sport science
insights into how injuries occur in sport and
physical activity and their prevention through
proper planning and training and conditioning
programs.
The goal is to provide the participant with an
understanding of how acute and chronic injuries
occur and ultimately can be reduced or even
eliminated through sound planning and training.
4
OBJECTIVES
1. The session participant will identify the areas of specialization
under the sports medicine umbrella and learn the important
components of the coach’s role in the absence of a Certified
Athletic Trainer (ATC).
2. The session participant will learn about the relationship of stress
and strain on musculoskeletal tissues and how each relates to
both acute and chronic injuries.
3. The session participant will learn about the components of
fitness and the principles of training and conditioning.
4. The session participant will learn to identify specific aspects of
disability sport and physical activities that may contribute to
injury.
5
SPORTS MEDICINE
The American College of Sports Medicine (ACSM)
defines sports medicine as multidisciplinary,
including the physiological, biomechanical,
psychological, and pathological phenomena
associated with exercise and sport.
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WHAT IS YOUR ROLE?
Performance
Enhancement
Coaching
Physical Education
Sport Psychology
Personal Fitness Training
Strength & Conditioning
Sports Nutrition
Exercise Physiology
Biomechanics
Injury Care &
Management
Athletic Training
Sports Physical Therapy
Physician
Physicians Assistant
Sports Massage Therapy
Sports Dentistry
Osteopathic Medicine
Orthotists/Prosthetists
Sports Chiropractic
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THE COACH
• Understand the role and responsibility of each person on
the sports medicine team
• Know the state laws surrounding the ability to function as
a health care provider
• Certified in CPR and First Aid
• Directly responsible for injury prevention by ensuring
athletes have the proper level of fitness to participate
• Must engage in professional development
8
THE COACH
When there is no Certified Athletic Trainer
• Ensure the competitive environment (field of play) is as
safe as possible
• Educate parents and athletes about inherent risks related
to participation
• Ensure proper training and conditioning of athlete
• Monitor environmental conditions to ensure safe
participation
• Selecting, properly fitting and maintaining equipment
including protective equipment
• Explain importance of proper nutrition and hydration
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TRAINING AND CONDITIONING
Improper conditioning is one of the
major causes of sports injuries!!
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TRAINING AND CONDITIONING
A FATIGUED athlete is more prone to injury!!
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TRAINING AND CONDITIONING
SAID Principle
•
•
•
•
S
A
I
D
pecific
daptations to
mposed
emands
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Cardiorespiratory Fitness
• Flexibility
• Muscular Fitness
13
TRAINING AND CONDITIONING
Components of Physical Fitness
• Cardiorespiratory (Energy) Fitness
• Aerobic
• Anaerobic
14
TRAINING AND CONDITIONING
Components of Physical Fitness
• Cardiorespiratory Fitness
• Interval Training
15
TRAINING AND CONDITIONING
Components of Physical Fitness
• Flexibility
• Static (passive)
• Dynamic (active)
16
TRAINING AND CONDITIONING
Components of Physical Fitness
• Factors that Affect Flexibility
• Anatomical
• Joint structure, age, gender
• Limited training affect
• Training
• Activity level, resistance training, stretching
exercises
17
TRAINING AND CONDITIONING
Components of Physical Fitness
Stress and Strain on Tissue
Loading or Force
Tension
Compression
Shear
Bending
Torsion
Deformation
Change in shape/length
Elastic limits of bone, tendons,
ligaments and cartilage
Failure point of tissue
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Force / Load
Serious injury of tissue begins
Micro-injury of tissue
begins with frequent
repetition in this range
Complete
Failure of
Tissue
Plastic Region
Elastic Region
Normal range for most people
Length/Deformation of Tissue
19
TRAINING AND CONDITIONING
Components of Physical Fitness
• Stretching Techniques
• Passive
• Static
• Active
• Ballistic
• Dynamic
• Combined
• Proprioceptive Neuromuscular Facilitation (PNF)
20
TRAINING AND CONDITIONING
Components of Physical Fitness
• Static Stretching
•
•
•
•
Most common method
Excellent for increasing ROM
Appropriate for all athletes
Safest method of stretching due to slow, controlled
movements
• 30 second hold
• 3-4 repetitions
21
TRAINING AND CONDITIONING
Components of Physical Fitness
• Ballistic Stretching
•
•
•
•
•
•
Bouncing movements
Stretch not held
Invokes stretch reflex
Higher potential for injury
NOT recommended for increasing flexibility
Different from plyometric training
• Performed within existing ROM
22
TRAINING AND CONDITIONING
Components of Physical Fitness
• Dynamic Stretching
• Functional, sport-specific movements
• NO bouncing
• Ideal during warm-up
• Incorporate multiple joints
• Maintain body temp
• Time efficient
• Not as effective for ROM increase as static or PNF
stretching
23
TRAINING AND CONDITIONING
Components of Physical Fitness
• PNF Stretching
• First used in neuromuscular rehabilitation
• Relax muscle with increased tone or activity
• Can be ore effective than static stretching
• Usually requires a partner
• Three Types
• Hold-Relax
• Contract-Relax
• Hold-Relax with Agonist Contraction
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Muscular Fitness
•
•
•
•
Flexibility
Strength
Power
Endurance
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TRAINING AND CONDITIONING
Components of Physical Fitness
Force
Motion
Energy
Motion
Energy
Injury
Potential
26
TRAINING AND CONDITIONING
Components of Physical Fitness
• Strength
• The maximal force a muscle group can generate at
a specified velocity
Velocity (v) = change in position
change in time
v = displacement
time
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Strength
• The maximal force a muscle group can generate at
a specified velocity
Force (F) = mass x acceleration
acceleration (a) = change in velocity
change in time
28
TRAINING AND CONDITIONING
Components of Physical Fitness
F = m (v / t)
Maximize or Minimize Force???
Force =

Mass =
 
Change in Velocity =
 
Time =
 
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Power
• The ability to generate force rapidly
Power = Work / time
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Endurance
• The ability to perform repetitive muscular
contractions against some resistance
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Muscle Balance
• Train anterior and posterior muscles uniformly
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TRAINING AND CONDITIONING
Components of Physical Fitness
• Muscle Balance
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TRAINING AND CONDITIONING
Principles of Conditioning
•
•
•
•
•
Warm-up/cooldown
Motivation
Overload
Consistency
Progression
•
•
•
•
•
Intensity
Specificity
Individuality
Stress
Safety
34
TRAINING AND CONDITIONING
Principles of Conditioning
• Warm-up 15-20 min.
• General
• Increase heart rate, blood flow, body temp.,
respiration rate, perspiration and decrease joint
viscosity
• Stretching
• Static Vs Dynamic
• Specific (technical skill)
35
TRAINING AND CONDITIONING
Principles of Conditioning
• Cooldown 5-15 min.
• Brings heart rate back to baseline
• Prevents blood from pooling in lower extremities
• Stretching helps relax muscles, maintain ROM
36
TRAINING AND CONDITIONING
Principles of Conditioning
• Motivation
• Vary the training program to keep it fresh
• Utilize proper goal setting to maintain motivation
• Overload
• Gradually increase the imposed demands to realize
continual results
• Maintain muscle balance
37
TRAINING AND CONDITIONING
Principles of Conditioning
• Consistency
• Training and conditioning must take place 2-3 times
per week to realize change
• Progression
• Gradually increase the intensity of the program
• Intensity
• Increase intensity rather than quantity/duration
38
TRAINING AND CONDITIONING
Principles of Conditioning
• Specificity
• Develop the program to address specific fitness
goals
• Begin with general fitness, then move to sport-specific
• Aerobic, anaerobic, power, speed, endurance,
flexibility, etc.
• Individuality
• Adjust the training program to meet the needs and
progression of the individual athlete
39
TRAINING AND CONDITIONING
Principles of Conditioning
• Stress
• If you are engaged in a program that meets multiple
times per week, understand that the athlete has
other stressful aspects to their life and may need
time away from training
• Safety
• Environment
• Education
40
PERIODIZATION
Principles of Conditioning
•
•
•
•
•
Individualized
Organizes training and conditioning into cycles
Timely peak performance
Helps reduce injury
Helps avoid overtraining
41
PERIODIZATION
Principles of Conditioning
Season
Off-season
Period/Phase
Type of Training
Transition Period
(postseason)
Unstructured, recreational
Preparatory Period
Cross training
Hypertrophy/
endurance phase
Low intensity, high volume, general
Strength Phase
Moderate intensity, moderate volume,
begin sport-specific
Preseason
Power Phase
High intensity, decrease volume,
highly sport-specific
In-Season
Competition Period
High intensity, low volume, skill
training, strategy, maintain strength
and power
42
AGE CONSIDERATIONS
Principles of Conditioning
• Youth
• Ensure emotional and cognitive maturity to follow
directions
• Focus on muscular strength and endurance,
flexibility, and cardiorespiratory endurance
• Limit heavy loads and moderate progression
43
AGE CONSIDERATIONS
Principles of Conditioning
• Older Adults
• Consider pre-existing health conditions
• Aerobic and resistance training beneficial
• Begin with low-intensity and low-volume in
untrained participants
• Moderate progression
44
INJURY CONCERNS BY
IMPAIRMENT/DISABILITY
Athletes who use Sport Chairs
Athletes with Amputations
Athletes with Cerebral Palsy
Athletes with Visual Impairment
45
ATHLETES WHO USE SPORT
CHAIRS
1. Most common injuries are strains & muscular injuries
of upper extremities
2. Overuse Injuries
3. Fractures of hands from falls & collisions
4. Overdevelopment of anterior muscles, weakness of
posterior muscles
46
AUTONOMIC DISREFLEXIA
Can be life threatening!
• Conditions, below the level of injury, that
may lead to autonomic hyperreflexia
include:
•
•
•
•
•
•
•
Full Bladder
Constipation or a full bowel
Pain
Infection
Skin breakdown
Ingrown toenail
Sudden temperature changes in the
surrounding environment
• Symptoms may include:
•
•
•
•
•
•
High blood pressure
Low heart rate
Anxiety or agitation
Severe pounding headache
Sweating above the level of the injury
Nasal stuffiness
47
AUTONOMIC DISREFLEXIA
Can be life threatening!
• Treatment
•
•
•
•
•
Sit athlete up/dangle legs down
Removal of Stimuli
Catheterization
Loosen tight clothes
Anti-hypertensive medication
• Complications
•
•
•
•
Seizures
pulmonary edema
myocardial infarction
cerebral hemorrhage
48
ATHLETES WITH AMPUTATION
1. Risk for skin irritation or breakdown.
2. Use appropriate padding and friction
eliminating material
49
ATHLETES WITH
CEREBRAL PALSY
• Seizures relatively common in
this population
• Increase in lactic acid
production => muscle fatigue
• Wheelchair users have higher
upper extremity strains, sprains,
overuse
• Ambulatory athletes have more
knee injuries
• Be aware of the role spasticity
plays
• Crashes
50
ATHLETES WITH
VISUAL IMPAIRMENT
• No visual cues
• May have different biomechanics
• May expend more energy because of lack of visual
cues.
• Watch for earlier fatigue & overuse injuries
• Crashes
51
MEDICAL ISSUES OF CONCERN
Across the Spectrum
Overuse Injuries
Dehydration
Heat Illness
Cold Injury
Acclimatization
Seizures
Pressure Ulcers
Prosthetics & Orthotics
Multiple Sclerosis
Brittle Bones
Concussions
OVERUSE/CHRONIC INJURIES
REPETITIVE MOTION INJURIES
Bursitis / Tendinitis
Plantar fasciitis
Patellofemoral syndrome
Sprains and strains
Stress fractures
Lower back injuries
DEHYDRATION
54
DEHYDRATION
• Drink water before, during
& after event
• DO NOT rely on thirst as
indicator of when to drink
• Drink COOL beverages
• Drink 480ml for every .45kg lost
• Begin fluid replacement immediately
• Sports beverages should have
carb concentration of 4-8%
55
DEHYDRATION
• NEVER
• consume energy drinks prior to competition
56
HEAT ILLNESS
Signs and Symptoms
• Heat Cramps
•
•
•
•
Dehydration
Thirst
Fatigue
Transient muscle cramps
57
HEAT ILLNESS
Signs and Symptoms
• Heat Exhaustion
•
•
•
•
•
Profuse sweating
Cool, clammy skin
Chills
Dizzy/lightheaded
Persistent muscle
cramps
58
HEAT ILLNESS
Signs and Symptoms
• Heat Stroke
•
•
•
•
•
•
Body temp ≥ 104°
ACTIVATE
Hot, dry skin
EMERGENCY
Staggering
Disorientation
ACTION PLAN
Loss of consciousness
Tachycardia (100-120 bpm)
59
COLD INJURY
Athletes with SCI
• Less sensitive to the sensation
of cold on the skin surface
• Diminished perception of skin
temperature change
• Diminished capability to stabilize
core temperature
• Unable to induce shiver
response
60
COLD INJURY
Prevention Strategies
• Educate athletes and coaches on prevention,
recognition and treatment
• Maintain proper hydration and food intake
• Develop event and practice guidelines to make
participation decisions
• Proper clothing
• Rewarming opportunities
61
ACCLIMATIZATION
62
SEIZURES
• Hypersynchronous
discharge of the
cerebral neurons
• Range of types
• Factors Increasing
Incidence of Seizures:
–
–
–
–
–
–
Dehydration
Stress
Hypoglycemia
Hyperventilation
Electrolyte Imbalance
Head Trauma
63
PROSTHETICS & ORTHOTICS
64
PRESSURE ULCERS
• Most common in athletes with paralysis or athletes
unable to move themselves
• Can occur with orthotics & prosthetics
• Check for ulcers/skin breakdown regularly
• Begin treatment as soon as noted
65
MULTIPLE SCLEROSIS
• Concerns in Sport
– Heat
– Over Exertion
66
OSTEOGENESIS IMPERFECTA
• Concerns in Sport
– Fractures
– Breaks
• Low Impact Exercise
– Improves bone density
67
CONCUSSIONS
• Traumatic Brain Injury (TBI)
– Wear proper protective equipment
– Ensure all equipment is maintained and safe
• Wheelchairs and anti-tip bars
68
CONCUSSIONS
• Maddocks questions combine scientific validity
with a quick simple and practical tool which can
be administered either on-field or on the
sidelines. Any incorrect response indicates
concussion and requires removal from the
playing field for further medical evaluation
69
CONCUSSIONS
• Which field are we at?
• Which team are we playing today?
• Who is your opponent at present?
• Which half/period is it?
• How far into the half is it?
• Which side scored the last
touchdown/goal/point?
70
CONCUSSIONS
www.cdc.gov/concussion
71
INJURY PREVENTION
STRATEGIES
Safe environment
Appropriate, well maintained equipment
Individualization of training
Warning signs of impending injury
Warm-up, stretching, and cool-down
Appropriate training prescription
(mode, duration, frequency, intensity, progression)
72
INJURY PREVENTION
STRATEGIES
Rest and Recovery
FATIGUE FATIGUE FATIGUE
The chance of musculoskeletal injury
increases significantly when fatigued
73
TAKEAWAYS FROM THIS
PRESENTATION
Use basic common sense and logical thinking to prevent or reduce
injuries!
Remember that FORCE leads to MOTION that leads to ENERGY that
leads to INJURY
The body’s tissues have physiological/biomechanical limitations that, if
exceeded, will lead to injury
One must limit or reduce force applied to and by the body while also
avoiding extreme deformation of body tissues in unnatural positions.
Chronic fatigue and overtraining is the enemy of the athlete with or
without a disability
74
ADDITIONAL RESOURCES
Baechle, T. R., & Earle, R. W. (Eds.). (2008). Essentials of Strength
Training and Conditioning - National Strength and Conditioning
Association (3rd ed.). Champaign, IL, USA: Human Kinetics.
Martens, R. (2004). Successful Coaching - American Sport Education
Program (3rd ed.). Champaign, IL, USA: Human Kinetics.
Prentice, W. E. (2008). Essentials of Athletic Injury and Management
(7th ed.). New York, NY, USA: McGraw-Hill.
Spengler, J. O., Connaughton, D. P., & Pittman, A. T. (2006). Risk
Management in Sport and Recreation. Champaign, IL, USA: Human
Kinetics.
75
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