connecting rehab from the training room
Post on 05-Jul-2015
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Connecting Rehab from the Training Room/ Clinic to the
Weight Room
Todd Burkey AT,CSCS
Youngstown State University
The Injury Epidemic• 30 million high school or younger participate in sports each
year.
• 3.5 million receive treatment for sports injuries each year. (CDC)
• High school athletes sustain an estimated 2 million injuries per year.
• Overuse injuries responsible for nearly half of all sport injuries.
• Surgeons seeing 4X as many injuries vs. 5 years ago ( Dr. James Andrews ).
• 1 of every 4 injuries are considered serious.
• 62% of injuries occur during practice.
• Sports related injuries increase severity with age.
Higher Level?
• Have noted more athletes entering their freshman year of college with some injury or restriction.
• 1 of every 3 have a pre existing condition due to sports injury.
• 1 of every 4 do not finish their college career due to injury.
• Injury rates seem excessive.
• 67% of college football players reported injuries at some point during their career.
• 36% of these injuries were to the knee.
• 80% of knee injuries required surgery.
The Athlete’s Knee
• ACL injuries have become commonplace (especially in females)
• ACL Injuries as a % of all injuries:
• 1) Women’s Basketball ( 4.9% )
• 2) Women’s Gymnastics ( 4.9% )
• 3) Women’s Lacrosse ( 4.3% )
• 4) Women’s Soccer ( 3.7% )
• 5) Men’s Spring Football ( 3.5% )
• ACL Injury Rate per 1000 contacts:
• 1) Men’s Spring Football ( 0.33 )
• 2) Women’s Gymnastics ( 0.33 )
• 3) Women’s Soccer ( 0.28 )
• 4) Women’s Basketball ( 0.23 )
• 5) Men’s Football ( 0.18 )
Scary Statistics… ( 2006 )
•1,042,511 injuries per YEAR
•86,875 injuries per MONTH
•20,048 injuries per WEEK
•2,856 injuries per DAY
•119 injuries per HOUR
•> 1 injury per MINUTE
Any good news?
• A careful, balanced and consistent training plan can affect risk of injury.
• Evidence suggests that training can drastically reduce incidence of ACL injury.
• According to ( ACSM ) 50% of overuse injuries in children are preventable.
• Training can not only reduce risk of injury, but can also increase performance.
•So why all the injuries?????
The Problem
• The American Sport Culture is not consistent.
• Medical care for athletes does not always cooperate with the training plan.
• Differing opinions ( although diverse ) do not help the process of preparing an athlete or safely returning them to activity.
• There needs to be a transition of care from rehabilitation in the training room/ clinic back to the weight room.
• Try to look at it as two points in the same program.
• Consistently educate each other and the athletes you are working with.
• Sport coaches ( especially youth ) need to be conscious of developing proper body mechanics before sport play.
What to Do?
• Establish stability.
•Develop mobility.
•Develop control.
•Work on stopping before starting.
•Progress training.
•Continually revisit basic mechanics.
Establish Stability
• Isometric exercises.
•Posture ( Core Strength and Endurance )
• Joint Position.
• Should probably be 1st aspect of training or rehab.
Develop Mobility
• Hip mobility is lacking in most athletes.
• Thoracic mobility is also a major issue in athletes.
• Major cause of LBP is lumbar mobility combined with hip and upper back stiffness ( McGill ).
• Hip flexor stiffness associated with hamstring injury/ re injury ( New Zealand ).
• Most mechanical shoulder pain ( impingement ) due to poor posture and scapular control.
• Mobility is not necessarily an issue of flexibility ( Mike Boyle ).
Develop Control
• Eccentric emphasis through a range of motion.
• Should precede speed work and emphasis on concentric muscle action.
• Has shown effective in treating tendonitis ( Journal of Physical Therapy ).
• Most effective at submaximal load in low volume.
Work on Stopping
• Deceleration emphasis.
• Focus on landing position in jumps.
• Focus on foot position, knee position, hip position when stopping ( front and side ).
• “ Jump Training “
• Evidence suggests deceleration training has a direct impact on risk of injury ( especially females ).
• Too often the focus is on acceleration and high speed agilities ( contributes to bad movement mechanics )
Progress Training
• Continue to develop athletes in each phase.
• Stability, Mobility, and Control should be present in nearly every phase ( prehab, training, rehab ).
• Too often these are left aside or dropped as rehab and training advances ( detraining effect ).
• Most current model is Triphasic training ( Cal Dietz ).
Example training plan
• Initial 6 weeks
• Monday ( Isometric Focus ) Pause Squat, Pause Bench, Submaximal Load
• Wednesday ( Eccentric Focus ) 5 count Back Squat, 5 count Bench Press ( Submaximal Load )
• Friday ( Concentric Focus ) Box Squat with Bands, Bench Press with Bands
• Daily deceleration drills as part of warm up.
Example rehab plan ( ankle )
• Day One ( Isometric focus ) Isometric resisted inversion, eversion, plantar flexion, dorsiflexion
• Day Two ( Eccentric focus ) 5 count heel raises, 5 count band resisted dorsiflexion
• Day Three ( Concentric focus ) band resisted inversion, eversion, plantar flexion, dorsiflexion for reps
• After acute inflamatory response has ended initiate deceleration drills on a daily basis.
Summary
• Injury rates have been on the rise, especially in youth sports.
• Training is often too advanced for skill level.
• Training/ practice/ game volume is way too high.
• You can reduce the risk of injury by developing stability, mobility and control.
• A training plan and rehab plan work best when in sync.
• Sport coaches ( especially youth ) should consider proper instruction and movement should precede gameplay.
• Thanks to Doug Smith and Juniata College for the opportunity to share and learn from this conference.
• Special thanks to Dan Wathen for the opportunity to work in this field.
• If you have any questions please feel free to email: teburkey@ysu.edu
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