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- 2. INJURY Injury refers todamage to the body produced by energy exchanges that have relatively sudden discernible effects
- 3. Types of Injury CauseBody tissue Duration Direct Indirect Overuse Soft-Tissue Hard-Tissue Acute Chronic
- 4. RTP Return-to-Play (RTP) isthe decision-making process of returning an injured or ill athlete to practice or competition. This ultimately leads to medical clearance of an athlete for full participation in sport.
- 5. Importance of RTP Recovery Risk Management Performance Optimization Legal and Ethical Considerations Psychological Readiness
- 6. RTS-Perspective Athlete -Return to sustained participation in sport in the shortest possible time (goal focus) Coach - Relative to the athlete’s performance on RTS (performance focus) Clinician - Prevention of new (or recurring) or associated injuries (outcome focus)
- 7. RTS- Continuum 1.Return toparticipation- • Participating in rehabilitation, training (modified or unrestricted), or in sport, but at a level lower than his or her RTS goal. • It is possible to train to perform, but this does not automatically mean RTS. 2. Return to sport (RTS)- • Has returned to his or her defined sport, but is not performing at his or her desired performance level. 3. Return to performance- • The athlete has gradually returned to his or her defined sport and is performing at or above his or her preinjury level.
- 8. RTS-Models Biopsychosocial model Strategic Assessment of Risk and Risk Tolerance (StARRT) Optimal loading—‘the Goldilocks approach’
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- 11. Assessment of HealthRisk Athlete Demographics Signs and Symptoms (pain, swelling) Medical History Special Test
- 12. Assessment of ActivityRisk Type of sport Position played Limb Dominance Competitive Level Ability to protect Functional test Psychological Readiness
- 13. Risk Tolerance Timingand Season Pressure of Athlete (desire to compete) External Pressure (Coach, Family) Masking of Injury (analgesics) Conflict of Interest (financial stability) Litigation ( if restricted or permited)
- 14. Goldilocks approach Monitoringthe training load during the current training week (acute) against the average of preceding four training weeks (chronic) provides an acute:chronic workload ratio. Helps in planning load progressions in RTS
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- 16. Hamstring • The hamstringmuscle complex occupies the posterior compartment of the thigh and is comprised of three individual muscles. • Biceps femoris • Semitendinosus • Semimembranosus Innervations- Common peroneal nerve Tibial nerve
- 17. Mechanism of injury 1.Stretch Type - Excessive Hip Flexion + Hyperextended Knee 2. Strength Related - High Eccentric Load (during late swing phase) Predisposed by - Lack of Eccentric Strength - Fatigue
- 19. Types • Grade 1: •Mild Strain, Only few fibres • Grade 2: • Half the fibres damaged/ruptured • Grade 3: • More than half fibres or Complete Rupture
- 20. Clinical Examination History-sudden onset of posterior thigh pain, sometimes accompanied by an audible or “sensory pop”,causing the immediate cessation of activity Pain - Can be rated by the athlete after injury (NAS/VAS) can be used as a reference point when monitoring symptoms throughout rehabilitation in rehabilitation Palpation - Grade of Tenderness, Discontinuity of muscle fibers Range of motion- Active/Passive movements Strength Testing Investigations-MRI
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- 23. Exercises-Which/WHY ? Isometrics- • Isometricsduring the early stages of HSI rehabilitation are introduced • Progression to the next phase after pain and strength between-limbs strength during isometric knee are resolved Eccentrics- • high-intensity loading appears to be a key component of interventions proven to increase hamstring strength, lengthen long head of the biceps femoris muscle fascicles, and reduce the HSI risk • Hamstring lengthening via the extender, diver, and glider exercises, the Askling L protocol reduced RTS time compared with conventional and multifactorial interventions Concentrics- • Proceed after Eccentrics. Continue to strengthen hip extensors from the initial stage right up to active participation
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- 25. Anterior cruciate Ligament Theanterior cruciate ligament (ACL) is one of the two cruciate ligaments which stabilizes the knee joint by preventing excessive forward movements of the tibia or limiting rotational knee movements. Primary functions Restraint to limit anterior displacement of the tibia Prevent hyperextension of knee Secondary functions Restraint to tibial rotation and varus /valgus angulation at full extension.
- 26. Mechanism of Injury Contactand high-energy traumatic injuries: Tackles , Collisions Are often associated with other ligamentous and meniscal injuries. Non contact: Cutting (Changing direction rapidly) Stopping suddenly while running Landing from a jump incorrectly
- 27. Clinical Features ACUTE INJURY •“Popping sound” heard by the patient • Pain with swelling. • Knee effusion (Haemarthrosis) • Loss of full range of motion • Tenderness CHRONIC INJURY (INSTABILITY/GIVING WAY) • Discomfort while walking
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- 29. Concussion A clinical syndromeof biomechanically induced alteration of brain function typically affecting memory and orientation, which may involve loss of consciousness
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- 32. Return to PlayGuidelines
- 33. Concussion Assessment SCAT-7 (SportsConcussion Assessment Test) Cobalt (Concussion balance test) VOMS (Vestibular oculomotor Motor Screening)
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