Manage Sports Injuries

How to Manage Sports Injuries?How to Manage Sports Injuries?
Adriano VretarosAdriano Vretaros
Strength and Conditioning CoachStrength and Conditioning Coach
20182018
São Paulo – BRAZILSão Paulo – BRAZIL
avretaros@gmail.comavretaros@gmail.com

What are Sports Injuries?What are Sports Injuries?
““ A ‘sports injury’ can be deﬁned as an injuryA ‘sports injury’ can be deﬁned as an injury
that occurs during sporting activi-ties orthat occurs during sporting activi-ties or
exercise.”exercise.”
(Rolf, 2007)(Rolf, 2007)

Types of Sports Injuries - ITypes of Sports Injuries - I
- Contact and Non-Contact- Contact and Non-Contact
- Acute and Chronic- Acute and Chronic
- Intrinsic- Intrinsic
- Extrinsic- Extrinsic
- Fatigue, muscle- Fatigue, muscle
imbalances, etc.imbalances, etc.
- Equipment, playing field,- Equipment, playing field,
environment, etc.environment, etc.
Adapted from Marujo, 2014Adapted from Marujo, 2014

Types of Sports Injuries - IITypes of Sports Injuries - II
IMPORTANT ASPECTS:IMPORTANT ASPECTS:
- Athlete Level- Athlete Level
- Type of Sport- Type of Sport
- Location- Location
- Biomechanical Mechanism- Biomechanical Mechanism
- Symptoms- Symptoms
- Clinical Tests and Exams- Clinical Tests and Exams
- Diagnosis- Diagnosis
- Relevant Research- Relevant Research
- Treatment- Treatment
- Evaluation of Treatment- Evaluation of Treatment
- Return to Training- Return to Training
- Return to Play- Return to Play

Professionals Involved in ManagementProfessionals Involved in Management
Sports PhysicianSports Physician
- Assessment- Assessment
- Indication of- Indication of
TreatmentTreatment
SportsSports
PhysiotherapistPhysiotherapist
- Rehabilitation- Rehabilitation
Strength andStrength and
ConditioningConditioning
CoachCoach
- Specific Training- Specific Training
- Prevention of- Prevention of
InjuriesInjuries
- End Stage of- End Stage of
RehabilitationRehabilitation
- Return to Play- Return to Play
HealthHealth
ProfessionalsProfessionals
- Physiologist- Physiologist
- Masseur- Masseur
- Chiropractic- Chiropractic
- Podiatrist- Podiatrist
- Nutritionist- Nutritionist
- And Other- And Other

The Scientific Staff WorkThe Scientific Staff Work
InterdisciplinaryInterdisciplinary
TeamTeam
MultidisciplinaryMultidisciplinary
TeamTeam
TransdisciplinaryTransdisciplinary
TeamTeam

Injury Management PlatformsInjury Management Platforms
CORRECTIVECORRECTIVE
PlataformPlataform
PREVENTIVEPREVENTIVE
PlatformPlatform
PREDICTIVEPREDICTIVE
PlatformPlatform

Corrective Platform - ICorrective Platform - I
**** CYCLE INJURY-CORRECTIONCYCLE INJURY-CORRECTION ****

Corrective Platform - IICorrective Platform - II
1)1) URGENTURGENT
PLATFORM:PLATFORM:
2)2) PROGRAMMEDPROGRAMMED
PLATFORM:PLATFORM:
When the severity of theWhen the severity of the
injury involves the athleteinjury involves the athlete
IMMEDIATE clearance toIMMEDIATE clearance to
reach a DEFINITIVEreach a DEFINITIVE
SOLUTION.SOLUTION.
When the injury to theWhen the injury to the
athlete undergoesathlete undergoes
PERIODIC treatment and/orPERIODIC treatment and/or
a surgical intervention isa surgical intervention is
decided in the MEDIUM ordecided in the MEDIUM or
LONG TERM.LONG TERM.

Preventive Platform - IPreventive Platform - I
SMARTSMART
TRAININGTRAINING
(Boyle, 2015)(Boyle, 2015)
SPORTSSPORTS
PERFORMANCEPERFORMANCE
PREVENTPREVENT
INJURIESINJURIES

Preventive Platform - IIPreventive Platform - II
EVALUATION TOOLS for InjuryEVALUATION TOOLS for Injury
Prevention:Prevention:
- Functional Movement Screen- Functional Movement Screen
- Y-Balance Test- Y-Balance Test
- Star Excursion Balance Test- Star Excursion Balance Test
- Isokinetic Evaluation- Isokinetic Evaluation
- Global Postural Assessment- Global Postural Assessment
- Unilateral Vertical Jump Test- Unilateral Vertical Jump Test
- Unilateral Horizontal Jump Test- Unilateral Horizontal Jump Test
- And Other- And Other

Preventive Platform - IIIPreventive Platform - III
Training LoadsTraining Loads
(internal and external)(internal and external)
(Adapted from Gabbett, 2016)(Adapted from Gabbett, 2016)
Dose-response of loadsDose-response of loads
Loading ThresholdsLoading Thresholds
Weekly loadWeekly load
increasesincreases
(up to 10%)(up to 10%)
Relationship BetweenRelationship Between
Acute-Chronic LoadAcute-Chronic Load
~ 0,6-1,3~ 0,6-1,3
High Risk Area would beHigh Risk Area would be
above or equal to 1.5above or equal to 1.5

Preventive Platform - IVPreventive Platform - IV
Training LoadsTraining Loads
(internal and external)(internal and external)
(Adapted from Gabbett, 2016)(Adapted from Gabbett, 2016)
Train "strong"Train "strong"
inappropriatelyinappropriately
INJURIESINJURIES
Train "strong"Train "strong"
appropriateappropriate
EFFECTEFFECT
NATURALNATURAL
PROTECTIVEPROTECTIVE

Preventive Platform - VPreventive Platform - V
ACTION PLANACTION PLAN
(Adapted from Parkkari, Kujala & Kannus, 2001)(Adapted from Parkkari, Kujala & Kannus, 2001)
VARIABLES:VARIABLES:
- Number- Number
- Incidence- Incidence
- Temporal Tendency- Temporal Tendency
- Consequences- Consequences
(deficiencies, disabilities and(deficiencies, disabilities and
costs)costs)
SET UP:SET UP:
a) Etiologya) Etiology
b) Risk factorsb) Risk factors
c) Injury Mechanismsc) Injury Mechanisms
Evaluate EFFECTIVENESS andEvaluate EFFECTIVENESS and
COST of Preventive ActionCOST of Preventive Action
PreventivePreventive
ProgramProgram

Preventive Platform - VIPreventive Platform - VI
RECOVERY RESOURCES:RECOVERY RESOURCES:
(Bompa & Haff, 2012)(Bompa & Haff, 2012)
- Cryotherapy- Cryotherapy
- Compressive Clothing- Compressive Clothing
- Massage- Massage
- Hydrotherapy- Hydrotherapy
- Hydration- Hydration
- Nutrition- Nutrition
- Sleep- Sleep
- Etc- Etc

Predictive Platform - IPredictive Platform - I
*** What is*** What is
PREDICTION? ***PREDICTION? ***
““ Affirm With CONVICTION WhatAffirm With CONVICTION What
May Happen in the FUTURE "May Happen in the FUTURE "

Predictive Platform - IIPredictive Platform - II
EmpiricistsEmpiricists
RationalistsRationalists

Predictive Platform - IIIPredictive Platform - III
EXPLICITEXPLICIT
KnowledgeKnowledge
TACITTACIT
KnowledgeKnowledge
- Perceptual Skills- Perceptual Skills
- Pattern Matching- Pattern Matching
- Workarounds- Workarounds
- Judging (?)- Judging (?)
- Mental Models- Mental Models
- Insights- Insights
- And (???)- And (???)
- Declarative Information- Declarative Information
- Routines- Routines
- Procedures- Procedures
- Protocols- Protocols
- Mathematical Expressions- Mathematical Expressions
-Others-Others

Predictive Platform - IVPredictive Platform - IV
MANIPULATEMANIPULATE
GREATGREAT
UNCERTAINTYUNCERTAINTY
RANDOMNESSRANDOMNESS

How to Manage Sports Injuries?
Predictive Platform - V
UNFORGETTABLEUNFORGETTABLE
CONTINGENCIESCONTINGENCIES
THINKTHINK
DIFFERENTDIFFERENT
MENTALITY “OUTSIDE THEMENTALITY “OUTSIDE THE
CURVE”CURVE”
HOW TO ACT?HOW TO ACT?

Predictive Platform - IV
THREE THEORIES:THREE THEORIES:
Predictive Platform - VIPredictive Platform - VI
1) Heuristic1) Heuristic
MethodologyMethodology
2) Black Swan2) Black Swan
LogicLogic
3) Logarithmic3) Logarithmic
EngineeringEngineering

Predictive Platform - VIIPredictive Platform - VII
HEURISTIC METHODOLOGYHEURISTIC METHODOLOGY
(Gingerenzer & Gaissmaier, 2011)(Gingerenzer & Gaissmaier, 2011)
You IGNORE Some ofYou IGNORE Some of
the Informationthe Information
FASTERFASTER
Decision MakingDecision Making
"Serve to Discover""Serve to Discover"
Discoveries WITHOUTDiscoveries WITHOUT
Statistical Calculations ofStatistical Calculations of
a Higher Level ofa Higher Level of
ComplexityComplexity
There Are NO RIGIDThere Are NO RIGID
RULES of Direction toRULES of Direction to
Seek SolutionsSeek Solutions
INTUITIVE FILTERINTUITIVE FILTER
for Analysisfor Analysis ECOLOGICALECOLOGICAL
RATIONALITYRATIONALITY

Predictive Platform - VIIIPredictive Platform - VIII
HEURISTIC Focused on theHEURISTIC Focused on the
Sporting EnvironmentSporting Environment
(Adapted from Jovanovic, 2017)(Adapted from Jovanovic, 2017)
ASSURANCEASSURANCE
KnowledgeKnowledge
RISKRISK
PredictablePredictable
ResultsResults
UNCERTAINTYUNCERTAINTY
UnpredictableUnpredictable
ResultsResults

Predictive Platform - IXPredictive Platform - IX
BLACK SWAN LOGICBLACK SWAN LOGIC
(Adapted from Taleb, 2015)(Adapted from Taleb, 2015)
ANTI-ANTI-
KNOWLEDGEKNOWLEDGE
CAUSALCAUSAL
CHAINSCHAINS
ForecastForecast
ERRORS ofERRORS of
Magnitude OftenMagnitude Often
NOT SCALEDNOT SCALED
RANDOMRANDOM
EVENTSEVENTS

Predictive Platform - XPredictive Platform - X
BLACK SWAN LOGICBLACK SWAN LOGIC
(Adapted from Taleb, 2015)(Adapted from Taleb, 2015)
DECREASE theDECREASE the
Probability of Surprises:Probability of Surprises:
1) Illusion of the1) Illusion of the
UnderstandingUnderstanding
2) Retrospective2) Retrospective
DistortionDistortion
3) Overvaluation3) Overvaluation
of Factualof Factual
InformationInformation

Predictive Platform - XI
THOUGHT:THOUGHT:
(Taleb, 2015)(Taleb, 2015)
Non-linearNon-linear
SPECULATIONSSPECULATIONS
ILLOGICALILLOGICAL
Real-lifeReal-life
ProblemsProblems

Predictive Platform - XII
LOGARITHMIC ENGINEERING:LOGARITHMIC ENGINEERING:
ARTIFICIALARTIFICIAL
INTELLIGENCEINTELLIGENCE
(Cruz, 2010)(Cruz, 2010)
PREDICTIONPREDICTION
MODELMODEL
(Douetteau, 2017)(Douetteau, 2017)
Linear RegressionLinear Regression
Logistic RegressionLogistic Regression
Decision TreeDecision Tree
Random ForestRandom Forest
Gradient BoostingGradient Boosting
Neural NetworksNeural Networks

Predictive Platform - XIIIPredictive Platform - XIII
LOGARITHMIC ENGINEERING:LOGARITHMIC ENGINEERING:
(R² = 0.53)(R² = 0.53)
POLYNOMIAL CURVESPOLYNOMIAL CURVES
TABLETABLE
(Blanch & Gabbett, 2016)(Blanch & Gabbett, 2016)
Create a SPECIFIC logarithmicCreate a SPECIFIC logarithmic
BY SPORTBY SPORT
RECURRENCE of the same injuryRECURRENCE of the same injury
NEW INJURY UNKNOWN RISKNEW INJURY UNKNOWN RISK

Predictive Platform - XIVPredictive Platform - XIV
LogarithmicLogarithmic
Black SwanBlack Swan
LogicLogic
JUNCTION OF THREE THEORIESJUNCTION OF THREE THEORIES
ComplexityComplexity
MULTIFACTORIALMULTIFACTORIAL
HeuristicHeuristic
MethodologyMethodology ++ ++

Predictive Platform - XVPredictive Platform - XV
1) Heuristic1) Heuristic
MethodologyMethodology
2) Logarithmic2) Logarithmic
3) Black Swan3) Black Swan
LogicLogic
FORMULATEFORMULATE
HypothesesHypotheses
andand
ProbabilitiesProbabilities
PREDICT SportsPREDICT Sports
InjuriesInjuries

Sports Injury Management
PlatformPlatform
PREVENTIVEPREVENTIVE
PlataformPlataform
PREDITIVEPREDITIVE
PlatformPlatform
SecondarySecondary
and/or Tertiaryand/or Tertiary
ResourceResource
Only employed inOnly employed in
typical emergencytypical emergency
situations or specificsituations or specific
cases such ascases such as
congenital injuries,congenital injuries,
etc.etc.
PRIMARYPRIMARY
ResourceResource
Try to solve possibleTry to solve possible
variables in a wayvariables in a way
that prevents thethat prevents the
onset andonset and
recurrence of therecurrence of the
injury.injury.
Speculate throughSpeculate through
conventional andconventional and
unconventionalunconventional
information and toinformation and to
anticipate situationsanticipate situations
randomly.randomly.
Primary ResourcePrimary Resource
COMPLEMENTARYCOMPLEMENTARY
to the preventiveto the preventive
platformplatform

Manage Sports Injuries

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