Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
http://muscletechnetwork.org/proyectos-id/publicaciones/
Clinical Practice Guidelines for Muscle Injury
FC Barcelona and A...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
1. Muscle injuries classification
2. Diagnosis and management of ...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
1. Muscle injuries classification
2. Diagnosis and management of ...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
Take home messages
1. Clinical expertise in muscle injuries.
2. U...
http://muscletechnetwork.org/proyectos-id/publicaciones/
1. Muscle injuries classification
2. Diagnosis and management of ...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
Criteria-based progression
Development of an approach
XXIV International Conference on Sports Rehabilitation and Traumatol...
Physio
On-field
100%
0%
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelin...
Physio On-field
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
Painless single leg squat
Painless bike 150W, 5 mins
Full ...
Passive
movement
Massage – no
pain
Massage -
discomfort
Active range of
motion
Eccentric outer
range
Slow run
Concentric
t...
Gait
• Walk
• Jog
• Run
• Triple extension
• Late swing (“A drill”)
• Direction change
4 laps =8 ‘sprints’ X 3 sets
~ 700m...
Physio On-field
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
Painless single leg squat
Painless bike 150W, 5 mins
Full ...
0
20
40
60
80
100
120
140Percentofuninjuredside Inner range
Mid range
Outer range
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
Take home messages
1. Sequential and progressive.
2. Dynamic and ...
http://muscletechnetwork.org/proyectos-id/publicaciones/
1. Muscle injuries classification
2. Diagnosis and management of ...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
Take home messages
1. Personalized.
2. Technology and experience....
http://muscletechnetwork.org/proyectos-id/publicaciones/
1. Muscle injuries classification
2. Diagnosis and management of ...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
http://muscletechnetwork.org/proyectos-id/publicaciones/
Take home messages
1. Evolving knowledge.
2. Primary prevention l...
http://muscletechnetwork.org/proyectos-id/publicaciones/
XXIV International Conference on Sports Rehabilitation and Traumatology
Clinical Practice Guidelines for Muscle Injury, FC...
Upcoming SlideShare
Loading in …5
×

Isokitenic 2015: Clinical Practice Guidelines for Muscle Injury FC Barcelona and Aspetar Experience

4,378 views

Published on

Presentation at: 'Football Medicine Strategies for Player Care', XXIV International Conference on Sports Rehabilitation and Traumatology, 11th- 12th April, 2015- London

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating for everyone is here: ♥♥♥ http://bit.ly/39sFWPG ♥♥♥
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating direct: ♥♥♥ http://bit.ly/39sFWPG ♥♥♥
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Here's How YOU Can Stake Out Your Personal Claim In Our EIGHT MILLION DOLLAR GOLDMINE... ♥♥♥ http://t.cn/AieX2Loq
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • You're Going to Want to Read This Before Tonight ◆◆◆ http://t.cn/Airfq84N
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Isokitenic 2015: Clinical Practice Guidelines for Muscle Injury FC Barcelona and Aspetar Experience

  1. 1. http://muscletechnetwork.org/proyectos-id/publicaciones/ Clinical Practice Guidelines for Muscle Injury FC Barcelona and Aspetar Experience
  2. 2. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Clinical Practice Guidelines for Muscle Injury (2015) Clinical Practice Guidelines for Muscle Injury (2009) Clinical Practice Guidelines for Muscle Injury (2018) Previous consensus (2017)
  3. 3. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London (UCL Elite Club Injury Study. 2013/2014 Season Report)
  4. 4. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 11% 28% 61% 43% 25% 32% 0% 10% 20% 30% 40% 50% 60% 70% Quadriceps Adductor Hamstrings FCB 1st Team FCB Academy
  5. 5. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention CONTENTS
  6. 6. http://muscletechnetwork.org/proyectos-id/publicaciones/ 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention
  7. 7. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Introduction Several grading and classification systems for muscle injuries have been published; indeed, no validated classification system exists. To classify is necessary to have good epidemiological data, which are basic to find the best therapeutic option for an injury/disease.
  8. 8. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London The Proposal In our opinion the evaluation of the amount of extracellular matrix (ECM) damaged and its impact in force generation and transmission is a key factor in muscle injuries clinics and prognosis; therefore the classification is based on this concept. We reviewed the literature to select and organize the knowledge about muscle injuries: • Mechanism. • Clinic and imaging prognosis factors. • Injury relation with MTJ and amount of connective tissue damage (indeed of function). • Evolution in time. We organize and resume this concept in a 4 letters acronym structure.
  9. 9. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Muscle Injury Mechanism 1. Direct injuries: • Located in the place of the trauma. • Size is not well correlated with the functional impairment. • Different clinical evolution than indirect injuries (shorter time loss). 2. Indirect muscle injuries are located close to a myotendinous junction (MTJ). Lee J, Mitchell A, and Healy J. Imaging of muscle injury in the elite athlete. British Journal of Radiology 85: 1173-1185, 2012. Thorsson O, Lilja B, Nilsson P, and Westlin N. Immediate external compression in the management of an acute muscle injury. Scandinavian journal of medicine & science in sports 7: 182-190, 1997. Garrett WE, Nikolaou PK, Ribbeck BM, Glisson RR, and Seaber AV. The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. The American journal of sports medicine 16: 7-12, 1988.
  10. 10. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Extracellular matrix (ECM) damage The evaluation of the amount/severity of ECM damaged is done trough: • Muscle injury relation with the MTJ (proximal or distal). • % CSA as reflection of the amount of ECM damaged. • If there is tendon gap/retraction/loss of tension. Structure and function of the skeletal muscle extracellular matrix Gillies 2011
  11. 11. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Mechanism Location Grade Re-injury
  12. 12. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Mechanism It describes the mechanism of injury, which could be a direct blow or an indirect strain: • Direct injuries D • Indirect injuries I
  13. 13. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Location for direct injuries Is a lowercase regarding the anatomical location: • p injuries located at the proximal third. • m injuries located at the middle third. • d injuries located at the distal third.
  14. 14. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Is a capital letter followed or not by a lowercase regarding the Location. It describes the connective tissue damage location, tendon or MTJ. • J for the injuries at the MTJ. • T for injuries affecting the tendon: gap/retraction/loss of tension. • After the T and J, as a sub-index, the proximal and distal location must be specified (p for proximal and d for the distal). Location for indirect injuries
  15. 15. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Grade Is a number from 0 to 4 regarding the Grade. MRI based, is referred to the percentage of the cross sectional area (% CSA) of the affected muscle to total muscle belly, in the axial plane where the injury is greater. The affected area is considered where there is a hyper-signal change on fat suppressed/STIR images. If more than one muscle is injured, the muscle with the greater area of signal abnormality or architectural distortion will be considered the primary site of injury and the grading criteria will be taken for that particular muscle.
  16. 16. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 0 Grade 0: clinical suspicion of muscle injury with negative MRI. 1 Grade 1: ≤10% of CSA. 2 Grade 2: 11-25% of CSA. 3 Grade 3: 26-49% of CSA. 4 Grade 4: ≥50% of CSA. In the future, the architectural distortion, more than the oedema, should be the key in the imaging evaluation to grade the muscle injuries. Grade
  17. 17. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Re-injury Describes the injury chronology (first episode or a re-injury): R0: First episode, R1: First re-injury, R2: Second re-injury… and so on. A re-injury is defined as “injury of the same type and at the same site as an index injury occurring no more than 2 months after a player’s return to full participation from the index injury” (Ekstrand 2011). If during the two months period after the RTP a new injury occur in the same muscle but in a different location, it will also considered a re-injury.
  18. 18. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Proposal Mechanism Location Grade Reinjury D (direct) D p proximal third direct injury 0 negative MRI 1 < 10 % CSA 2 11 – 25 % CSA 3 26 – 49 % CSA 4 >50 % CSA R0 1st episode R1 1st reinjury R2 2nd reinjury ..and so on. D m medial third direct injury D d distal third direct injury I (indirect) I T p proximal tendon injury I T d distal tendon injury I J p proximal MTJ injury I J d distal MTJ injury
  19. 19. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London • Direct injury located in A: – D-p-G-R0 • Direct injury located in B: – D-m-G-R0 • Direct injury located in C: – D-d-G-R0 A B C Direct Injuries Codification
  20. 20. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Indirect Injuries Codification • Indirect injury located in A: – I-Jp-G-R • Indirect injury located in B: – I-Jd-G-R A B
  21. 21. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Indirect Injuries Codification • I-Tp-G-R
  22. 22. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Take home messages 1. With an acronym we can describe the injury. 2. Allows communication among medical staff. 3. Flexible structure allowing to incorporate knowledge in the future. 4. Easy to use.
  23. 23. http://muscletechnetwork.org/proyectos-id/publicaciones/ 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention
  24. 24. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Background • Most of them are treated non-surgically. • The clinical appearance is not always clear. • Determining the optimal treatment for any injury can be difficult. NEEDS • Detailed history of the patient and about the injury mechanism. • Careful examination. • Imaging diagnosis: – Magnetic Resonance Imaging (MRI) – Ultrasound (US) Critical goal is to differentiate between those patients with injuries possibly requiring surgical treatment from patients with non-surgical injuries
  25. 25. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 1. Appropriate history  About the player: • Similar injuries before? • Medications? • Susceptibility…  About the mechanism of injury: • Direct blow or indirect strain? • During training or competition? • When and how did it start?  About the initial progress: • Stop or continue playing? • Normal walk without pain?
  26. 26. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 2. Physical exam • Looking for asymmetries. • Pain. • Colour. • Muscle belly shape. • Strength. • ROM without pain. • The athlete is unable to walk at a normal pain-free pace. BF injury is more painful during stretching than contraction while a injury in SM or ST will have more pain during contraction than during stretching.
  27. 27. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 3. Imaging of muscle injury  RX: limited value unless an avulsion fracture with bony fragment or apophyseal fracture in a skeletally immature individual.  US and MRI: • Describe the location (which muscle and tissue). • The lesion size. • The lesion nature (oedema/haemorrhage) by echotexture (US) and signal intensity (MRI)
  28. 28. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 3.1 Ultrasound • Cost effective. • Radiologist experience dependent. • Dynamic and interactive process allowing “echopalpation” of painful areas. • It enables progress monitoring. • Guide the evacuation of fluid collections. • Useful in distal hamstring injuries (superficial anatomy).
  29. 29. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 3.2 Magnetic resonance imaging To evaluate the involvement of tendons, fascia and contractile tissue. Routine MRI protocol: • At least two orthogonal planes (axial, coronal or sagital) and one of two pulse sequences (STIR or T2 fat sat). Restricted in routine assessment of injuries (limited availability and high costs). Its utilization in prognosis of return to play is controversial.
  30. 30. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London MRI advantages • To measure the size of injury (length and cross-sectional area). • Proximal hamstring injuries. • Groin area injuries. • In assessing the tendon retraction (preoperative planning). • In highlighting subtle edema. • In evaluating injuries to deep injuries of muscles. • In evaluating injuries when a previous injury is present (residual scarring). • Discovering concomitant image.
  31. 31. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Management of a muscle injury Clinical history Physical exam US MRI Treatment Immediate X X Could be made anytime Rest Ice Compression Elevation Analgesia 12 hours X X 24 hours X X 48 hours X X Functional tests 1st week Monitorize players feelings X x To evaluate how the progression of loads are assumed Rehabilitatio n progressive protocol Weekly X X Return to play X X For follow-up the functional recovery and sometimes to help to decide return to play: • Muscle: Tensiomyography, electromyography and strength tests. • Player: GPS, HR and self administered scales during and after the rehabilitation sessions on field. Initial acute phase Subacute and functional phase
  32. 32. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London  Muscle injuries heal conservatively.  Indications of surgical treatment: • Total or subtotal (>50%) rupture with few or no agonist muscles. • Large intramuscular hematoma. • Complains of chronic pain (>4-6 months) in a previously injured muscle, specially with ROM deficit. Surgical procedure: • Anatomic restoration when is possible. • Surgical release of adhesions from the nerve and scar debridement in chronic cases. Surgical treatment
  33. 33. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Bony avulsions Muscle Part of muscle Tendon Treatment Quadriceps Proximal ASIS AIIS Conservative; unless > 2cm Distal Patellar avulsion Surgical; (except non displaced) Hamstrings Proximal Ischial tuberosity Gap < 2cm conservative Bigger gaps: surgical Distal All (rare) ( BF – SM ) Surgical reattachment must be considered
  34. 34. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Proximal Distal Rectus femoris
  35. 35. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Tendon-bone disinsertions Muscle Localization Tendon Treatment Quadriceps Rectus Femoris Proximal Direct head Surgical reattachment Indirect head Little gap: Conservative Big gap: Surgical Direct + Indirect head Surgical Hamstrings Proximal Biceps Femoris Long Head and/or Semitendinosus Surgical Semimembranosus Conservative. If there were symptoms after 4 months: surgical reattachment must be considered Distal All (rare) Surgical reattachment must be considered
  36. 36. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Ischion Central Tendon
  37. 37. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Reattached
  38. 38. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Comin J, Malliaras P, Baquie P, Barbour T, Connell D. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med. 2013;41(1):111-115. • Long recovery times. • Worse results. • Biceps femoris 45% • Recurrent injury. New surgical indication for hamstring?
  39. 39. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London DISTAL PROXIMAL Proximal end of Central Tendon Distal end of Central Tendon
  40. 40. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Central Tendon injuries MTJ injuries, when the Central Rectus Femoris Tendon or Common Hamstring Tendon is involved with loss of tension Muscle Part of muscle-tendon Treatment Quadriceps and Hamstrings < 2 cm from bone insertion Reattachment to the bone and reduce tension at MTJ More than 2 cm to bone insertion Surgical treatment: Anatomical repair with minimally invasive approach
  41. 41. http://muscletechnetwork.org/proyectos-id/publicaciones/ Take home messages 1. Clinical expertise in muscle injuries. 2. US and MRI to confirm diagnosis. 3. Surgical treatment when tendon is affected.
  42. 42. http://muscletechnetwork.org/proyectos-id/publicaciones/ 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention
  43. 43. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Rehabilitation Program LITERATURE SEARCH SCIENTIFIC EVIDENCE EXPERIENCE CONSENSUS THERAPEUTIC
  44. 44. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Proposal of Algorithm ALL PARAMETERS DIAGNOSTIC PHASE ACUTE PHASE SUBACUTE PHASE FUNCTIONAL PHASE PHASE TO RTP AND CONTROL TEST DESTRUCTION REPAIR REMODELLING PHISICAL THERAPY X X X MANUAL THERAPY X X X FLEXIBILITY AND ROM X X X PROPIOCEPTION X X X CORE X X X NEUROM-CONTROL X X X X STRENGTH X X X POWER X X FITNESS X X PAIN/FATIGUE X X X X X BIOMECANICHS X X X X X IMAGE X X X X X
  45. 45. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Progression of exercises
  46. 46. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Algorithm of Rhb INJURY DIAGNOSTIC PHASE Goals Criteria Validation Test Goals Criteria Validation Test Goals Criteria Validation Test RTP
  47. 47. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Diagnostic Phase Kerkhoffs, G., et al. "Diagnosis and prognosis of acute hamstring injuries in athletes”, 2013 INJURY !!! • PRESSION (together with Cryotherapy 3 times/day, every 3h, 20’-30’) • REST (sporting, not total) • ICE (Cryotherapy 3 times/day, every 3h., 20’-30’) • IMMOBILISATION (3-4 days, every 3-4h, between 15-20’) • ELEVATION (upper the heart level and different positions) • ANAMNESIS (Injury analysis, antecedents,...) • COMPLEMENTARY PROOFS (RN, ECO, ...) • GENERAL TESTS (Assessment muscular, articular,...) • SPECIFIC TESTS (types of pain, localisation, function) • PSICOLOGIC SUPPORT OF PLAYER • DIFFERENTIAL DIAGNOSTIC • FINAL DIAGNOSTIC
  48. 48. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Algorithm of Rhb INJURY DIAGNOSTIC PHASE Goals Criteria Validation Test Goals Criteria Validation Test Goals Criteria Validation Test RTP
  49. 49. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Acute Phase
  50. 50. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Goals and Criteria Acute Phase - NO PAIN or discomfort during exercises - During exercises to maintain neutral spine in static position to Bosu or Board - To work from Low to Moderate Intensity - Isometric knee flexion 15º, decubitus prono (ISOM)/(CONC)/(ECC) - Work with flexion knee to 45° and hip 0°>50% (CKC) / (OKC) - Uninjured leg (dynamometer or similar 50%.) - (SBET) with 30º Flexion Knee +(SLS) +(ESH) <70 avoiding pain - Walk/Run to treadmill until 70% -3% (ESH) decrease CKC: Close Kinetic Chain, OKC: Open Kinetic Chain, ISOM: Isometric, CONC: Concentric, ECC: Eccentric, ROM: Range of Motion; ESH (Elongation Stresson Hamstrings.). DST: (Deep squat test). SLS: Single leg squat. RPT: Runner post test. AKET: Active Knee Ext Test:
  51. 51. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Algorithm of Rhb INJURY DIAGNOSTIC PHASE Goals Criteria Validation Test Goals Criteria Validation Test Goals Criteria Validation Test RTP
  52. 52. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Subacute Phase
  53. 53. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Goals and Criteria Subacute Phase - NO PAIN or discomfort during exercises. - Not tilting the pelvis or flattening the spine during dynamic exercises - To work from Moderate to High Intensity - Isometric knee flexion strength decubitus supine knee flexion 25° - hip flexion 45°, less than 10% asymmetry (OKC)/(CKC) - Work uninjured leg (dynamometer or similar 70%.) - Isometric hip extension strength, knee 0º, Hip 70º less than 10% - (ESH) Stretch < 70 +(SLS) +(DST) painless - Start Walking on the treadmill to <8 km/h 5% (ESH) CKC: Close Kinetic Chain, OKC: Open Kinetic Chain, ISOM: Isometric, CONC: Concentric, ECC: Eccentric, ROM: Range of Motion; ESH (Elongation Stresson Hamstrings.). DST: (Deep squat test). SLS: Single leg squat. RPT: Runner post test. AKET: Active Knee Ext Test:
  54. 54. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Algorithm of Rhb INJURY DIAGNOSTIC PHASE Goals Criteria Validation Test Goals Criteria Validation Test Goals Criteria Validation Test RTP
  55. 55. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Functional Phase
  56. 56. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Goals and Criteria Functional Phase - No PAIN or discomfort during exercises. - Correct spine control and strength transfer during exercises - To work from High to Explosive Intensity - Integrate strength, neuromuscular and proprioceptive work - Achieved in contralateral leg no asymmetry (dynamometer/encoder 100%) - Uninjured leg (Encoder or isokinetic 100%.) - Isokinetic criteria: We should avoid differences higher than 20% - (RPT)+(AHFT)+(AKET) No asymmetry - Test of the feed and games CKC: Close Kinetic Chain, OKC: Open Kinetic Chain, ISOM: Isometric, CONC: Concentric, ECC: Eccentric, ROM: Range of Motion; ESH (Elongation Stresson Hamstrings.). DST: (Deep squat test). SLS: Single leg squat. RPT: Runner post test. AKET: Active Knee Ext Test:
  57. 57. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Algorithm of Rhb INJURY DIAGNOSTIC PHASE Goals Criteria Validation Test Goals Criteria Validation Test Goals Criteria Validation Test RTP
  58. 58. Criteria-based progression Development of an approach XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  59. 59. Physio On-field 100% 0% XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  60. 60. Physio On-field Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Painless single leg squat Painless bike 150W, 5 mins Full knee Ext supine Run > 70% ROM SLR & HS Θ > 75% 100% running Painless direction change Light Football Training Session In-between Football Training Session Heavy Football Training Session XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  61. 61. Passive movement Massage – no pain Massage - discomfort Active range of motion Eccentric outer range Slow run Concentric through range Fast run Direction change Isometric – inner range Eccentric inner range Outer range ballistic Stretching Trunk control Cardio (bike) Isometric outer range Painless single leg squat Painless bike 1.5*BW, 5 mins Full knee Ext supine Run > 70% ROM SLR & HS Θ > 75% 100% running Painless direction change XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  62. 62. Gait • Walk • Jog • Run • Triple extension • Late swing (“A drill”) • Direction change 4 laps =8 ‘sprints’ X 3 sets ~ 700m 11s → 3.1 s 10% → 100% 3 reps 12s → 9s 60% → 100% XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  63. 63. Physio On-field Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Painless single leg squat Painless bike 150W, 5 mins Full knee Ext supine Run > 70% ROM SLR & HS Θ > 75% 100% running Painless direction change Light Football Training Session In-between Football Training Session Heavy Football Training Session XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  64. 64. 0 20 40 60 80 100 120 140Percentofuninjuredside Inner range Mid range Outer range
  65. 65. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  66. 66. http://muscletechnetwork.org/proyectos-id/publicaciones/ Take home messages 1. Sequential and progressive. 2. Dynamic and open. 3. Adaptable to each player. 4. Criteria-based progression 5. Based on knowledge and experience.
  67. 67. http://muscletechnetwork.org/proyectos-id/publicaciones/ 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention
  68. 68. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London The decision-making process of returning an injured or ill player to competition
  69. 69. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London All clear to play Huge reinjury risk (14-16%) Criteria 1. Clinical/ Anatomical 2. Imaging (US) 3. Functional Specific Physical Test High workloads Highest competition level No reinjury HEALTHY INDIVIDUALS WHEN?
  70. 70. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Return to play Anatomical, imaging and functional CRITERIA have to be taken into consideration in order to provide: Personalized return to play: 1. Injury location/connective tissue involved 2. Anatomical variability 3. Imaging 4. Player position/GPS
  71. 71. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 1. Injury location/connective tissue
  72. 72. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Return to play Anatomical, imaging and functional CRITERIA have to be taken into consideration in order to provide: Personalized return to play: 1. Injury location/connective tissue involved 2. Anatomical variability 3. Imaging 4. Player position/GPS
  73. 73. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 2. Anatomical variability
  74. 74. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London A B C Semimembranosus injuries
  75. 75. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Return to play Anatomical, imaging and functional CRITERIA have to be taken into consideration in order to provide: Personalized return to play: 1. Injury location/connective tissue involved 2. Anatomical variability 3. Imaging 4. Player position/GPS
  76. 76. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 3. Imaging
  77. 77. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London
  78. 78. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Return to play Anatomical, imaging and functional CRITERIA have to be taken into consideration in order to provide: Personalized return to play: 1. Injury location/connective tissue involved 2. Anatomical variability 3. Imaging 4. Player position/GPS
  79. 79. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London 4. Player position / GPS
  80. 80. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London COMPARISON THE PLAYERS SAME POSITION WITH THE PLAYER INJURED 0 50 100 150 200 250 300 AVE HSR SET 5 PLAYER INJURY AVE HSR SET 6 PLAYER INJURY AVE SPRINT SET 5 PLAYER INJURY AVE SPRINTS SET 6 PLAYER INJURY AVE ACEL SET 5 PLAYER INJURY AVE ACEL SET 6 PLAYER INJURY AVE DEC SET5 PLAYER INJURY AVE DEC SET 6 PLAYER INJURY AVE VEL.MAX SET5 PLAYER INJURY AVE VEL.MAX SET6 PLAYER INJURY SUMMARY DATAWEEKS5/6 Comparision with the same players injured player position return to train with the group
  81. 81. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London COMPARED TO OTHER DEFENDER SAME POSITION DURING 60’ MINUTS THE FRIENDLY MATCH 43 51 32 37 38 55 49 45 45 44 42 59 0 20 40 60 80 100 120 HIGH ACEL/DESA <3mts/s DESA.MAXIMES ACEL.MAXIMES 202,91 211,5 290,59 303,53 292,24 542,61 0 100 200 300 400 500 600 DEFENDER 1DEFENDER 2DEFENDER 3DEFENDER 4DEFENDER 5 PLAYER INJURED HSR DISTANCE <21K/h 15 20 21 15 19 25 0 5 10 15 20 25 30 DEFENDER 1DEFENDER 2DEFENDER 3DEFENDER 4DEFENDER 5 PLAYER INJURED TOTAL SPRINTS 29,88 30,38 29,12 34,31 31,68 32,73 26 28 30 32 34 36 DEFENDER 1 DEFENDER 2 DEFENDER 3 DEFENDER 4 DEFENDER 5 PLAYER INJURED PEAK SPEED MAX
  82. 82. http://muscletechnetwork.org/proyectos-id/publicaciones/ Take home messages 1. Personalized. 2. Technology and experience. 3. Six training sessions. 4. Friendly matches.
  83. 83. http://muscletechnetwork.org/proyectos-id/publicaciones/ 1. Muscle injuries classification 2. Diagnosis and management of muscular injuries 3. Algorithm of rehabilitation 4. Return to play criteria 5. Primary and secondary prevention
  84. 84. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION Prevent the onset of muscle injury Addressing risk factors Enhancing resistance to exposure Part of the general football training (all players)
  85. 85. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Avoidance of a new muscle injury when the player has suffered a previous injury SECONDARY PREVENTION Individual, personalized, specific program
  86. 86. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PREVENTION “SNAPSHOT” PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) WARM UPS PREVENTION OBJECTIVES DAILY STRENGTH CIRCUITS FOOTBALL CIRCUITS GYM GYMPITCH SMALL GROUPS CIRCUITSPITCH
  87. 87. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) GYM strength training of the hamstrings Image Code Description weight Ser/Repet weight Ser/Repet frequency When Musculador belt STh1 Eccentric working withvariants indop: drop withrotation, different angles of flexion.. body weight or body weight with3kg 3x4 body weight or body weight with3kg 3x8 1x7 (1 competition)/10 days( 2 competitions) Before or afther 48 hours to match Splits withbody flexion STh2 Work hamstring body weight 4 repetitions body weight 8 repetitions once or twice a week Alternate days , never before or afther to match Angel STh3 Work hamstring body weight 4 repetitions body weight 8 repetitions once or twice a week Alternate days , never before or afther to match minimum stimulus maximum stimulus StrengthTraining Primary Prevention
  88. 88. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION DAY -4. ECCENTRIC STRENGHT. TIRANTE MUSCULADOR DAY -3. RUNNING TECHNIQUE & PROPIOCEPTION EXERCISES. DAY -2. AGILITY AND COORDINATION SKILLS. DAY -1. SPEED REACTION AND FEET WORK… PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) GYM WARM UPS PREVENTION OBJECTIVES DAILY PITCH
  89. 89. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION DAY -4. ECCENTRIC STRENGHT. TIRANTE MUSCULADOR
  90. 90. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION DAY -2. AGILITY AND COORDINATION SKILLS.
  91. 91. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION W/O BALL BOXES PASSING DRILLS POSSESSION GAMES HAMSTRINGS QUADRICEPS ADDUCTOR MUSCLES CORE STABILITY COORDINATION / AGILITY PROPIOCEPTION UPPER BODY PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) WARM UPS PREVENTION OBJECTIVES DAILY STRENGTH CIRCUITS GYMPITCH
  92. 92. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION MULTISTATIONS WITHOUT BALL MULTISTATIONS WITH BOXES MULTISTATIONS WITH PASSING DRILLS MULTISTATIONS WITH POSSESSION GAMES HAMSTRINGS QUADRICEPS ADDUCTOR MUSCLES CORE STABILITY COORDINATION / AGILITY PROPIOCEPTION UPPER BODY STRENGTH CIRCUITS ON THE FIELD
  93. 93. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION STRENGTH CIRCUITS ON THE FIELD MULTISTATIONS WITHOUT BALL MULTISTATIONS WITH BOXES MULTISTATIONS WITH PASSING DRILLS MULTISTATIONS WITH POSSESSION GAMES HAMSTRINGS QUADRICEPS ADDUCTOR MUSCLES CORE STABILITY COORDINATION / AGILITY PROPIOCEPTION UPPER BODY
  94. 94. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION STRENGTH CIRCUITS ON THE FIELD MULTISTATIONS WITHOUT BALL MULTISTATIONS WITH BOXES MULTISTATIONS WITH PASSING DRILLS MULTISTATIONS WITH POSSESSION GAMES HAMSTRINGS QUADRICEPS ADDUCTOR MUSCLES CORE STABILITY COORDINATION / AGILITY PROPIOCEPTION UPPER BODY
  95. 95. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PRIMARY PREVENTION STRENGTH CIRCUITS ON THE FIELD MULTISTATIONS WITHOUT BALL MULTISTATIONS WITH BOXES MULTISTATIONS WITH PASSING DRILLS MULTISTATIONS WITH POSSESSION GAMES HAMSTRINGS QUADRICEPS ADDUCTOR MUSCLES CORE STABILITY COORDINATION / AGILITY PROPIOCEPTION UPPER BODY
  96. 96. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) WARM UPS PREVENTION OBJECTIVES DAILY STRENGTH CIRCUITS FOOTBALL CIRCUITS GYMPITCH PRIMARY PREVENTION
  97. 97. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London RELATIONSHIP BETWEEN TECHNICAL, TACTICAL AND CONDITIONING CIRCUITS. CONDITIONING OR PREVENTION STATION PREVIOUS TO THE FOOTBALL ACTION. DECISSION MAKING + MULTIPLE OPTIONS CLOSER TO OUR STYLE OF PLAY/ GAME PLAN PRIMARY PREVENTION
  98. 98. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London LEVEL PROGRAMME FREQUENCY CATEGORIES OBJECTIVE EXERCISES 1. Indoor Prevention Squad Prevention Programme 1 p week Stretching STrength St 1 STq1, STq2Player Individual Strength Programme 2 p week 2. Daily Prevention Warm Ups Eccentric Training 1 p week Stretching STrength PRoprioception CoreStability AGility St2, St3, St4 STh1, STh3 PR2 CS1, CS2, CS3 AG 2 Proprioception 1 p week Agility & Coordination 1 p week Speed Reaction 1 p week 3. Multi Stations Prevention Circuits Multi Station Circuit Not Ball 1-2 p week Stretching STrength PRoprioception CoreStability AGility MultiInterv St2, STh1, STh2,ST q3 PR2, PR3 CS1,CS2,CS3 AG 1 MI 1, MI 2, MI 3 Multi Station Circuit with Boxes Multi Station Circuit with Passing Drills Multi Station Circuit with Pos Games 4. Football Circuit Drills Football Specific Strength Circuits 1-2 p week STrength PRoprioception AGility STh1, STq3 PR 3 AG 1 PRIMARY PREVENTION
  99. 99. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London SECONDARY PREVENTION PLAYER INDIVIDUAL STRENGTH PROGRAMME SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES) WARM UPS PREVENTION OBJECTIVES DAILY STRENGTH CIRCUITS FOOTBALL CIRCUITS GYM 2 PITCH 2 GYMPITCH
  100. 100. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Hamstrings injury prevention Seated eccentric knee flexor stretch (Seated Straight-Leg Raise)
  101. 101. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Hamstrings injury prevention Eccentric hip extensor stretch with inertial technology (VersaPulley)
  102. 102. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London Hamstrings injury prevention Eccentric knee flexor extension with inertial technology (Yo-Yo Knee Extension)
  103. 103. http://muscletechnetwork.org/proyectos-id/publicaciones/ Take home messages 1. Evolving knowledge. 2. Primary prevention linked with training. 3. Secondary prevention: personalized.
  104. 104. http://muscletechnetwork.org/proyectos-id/publicaciones/
  105. 105. XXIV International Conference on Sports Rehabilitation and Traumatology Clinical Practice Guidelines for Muscle Injury, FC Barcelona – Aspetar 11th-12th April, 2015 - London …It has been demonstrated that hamstring injuries typically occur at this musculotendinous junction: either at the proximal or distal ‘‘free’’ ends or, more commonly, at the central intramuscular tendon... Comin et al. Am J Sports Med. 2013;41(1):111-115

×