current trends in sports injury along with its assessment and prevention and management in physiotherapy point of view along with its evidences

1. CURRENT TRENDS IN SPORTS
INJURIES.
1
Radhika Chintamani

2. This is a pic of Ashish Nehra , where he had
an injury in his hamstring muscle in IPL
season.
2
Study done was done by Urho M Kujala et al (Finland)
showed that there was about 8.7 % of sports injuries.
• Sports injuries.

3. Definition of sports injuries
• Sports injury denotes the injury to any bodily function or
structure during any gaming activity.
• Sports injuries result from acute trauma or repetitive
stress associated with sports activities.
• Sports injuries can affect bones or soft tissues.
(ligaments, muscles, tendons).
• There can be micro trauma or macro trauma.
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4. Sports injuries can be classified according to either the
cause of the injury or the type of body tissue damaged.
according to cause
• direct injury
a. collision
• indirect injury
a. Site of impact is
somewhere else
• overuse injury.
a. Repetitive stress
according to the type of
body tissue damaged
• soft-tissue injury
a. tears,
b. sprains and
c. contusions
• hard-tissue injury.
a. fractures and
b. dislocations.
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Classification

5. Epidemiology and pathophysiology of sports injuries
• Epidemiology:
• A study was done by Jennifer m Hootman,Randall
dick,julie agel on 15 sports. ( Result: 13.8 injuries per
1000).
• More than 50% of all injuries were to the lower
extremity.
• Ankle ligament sprains were the most common injury
over all sports.
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9. Pathophysiology
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10. Importance of sports physiotherapist
• The Physiotherapist in Sport,
focuses his objectives in the field of
sport and physical activity.
• Application of treatment by
physical means: electrical, thermal,
mechanical and manual therapeutic
exercises.
• Role of a physio:
– Prevention
– Recovery
– Rehab
– Teaching
– research
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11. Assessment
• When attending
an injured
athlete who is
unconscious,
DRS ABCD
action plan
must be
followed.
• DRS ABCD –
– danger,
– response,
– send for help,
– airway,
– breathing,
– compressions
– defibrillation.
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12. • If the athlete is conscious, the TOTAPS method of injury
assessment can be used.
• T - Talk
• O - Observe
• T - Touch
• A - Active movement
• P - Passive movement
• S - Skills Test.
• It is important to note that the control of bleeding takes
priority over TOTAPS.
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13. Principles of rehabilitation
• The cardinal rule of rehabilitation is to avoid
worsening the athlete’s present condition.
• ATC IS IT
1. Avoid aggravation
2. Timing
3. Compliance
4. Individualization
5. Specific sequencing
6. Intensity
7. Total patient should be considered.
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14. Rehabilitation concepts.
Initial treatment.
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Acute stage

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Functional training stage

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18. Different techniques used.
1. Aquatic therapy
2. High intensity interval training(HITT)
3. Vibrotactile feedback system
4. Deep transverse friction massage
5. Eccentric loading
6. Mc connells multimodal approach and
Kinesio taping
7. Plyometrics training and drills
8. Isokinetics 18

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20. Aquatic therapy.
• Benefits of aquatic therapy:
• Improves Rehab Efficiency
• Increases Range of Motion
• Increases Functional
Strength and Endurance
• Decreases Pain and Muscle
Spasm
• Improves Trunk Stabilization
• Improves Body Alignment
• Decreases Edema
• Decreases rehabilitation
time
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21. • “If I see somebody’s shoulder not progressing, their
getting that stiffness, pain, really can’t move, the pool
is a perfect solution for that” -Olmer Cruz
• Warm water - relaxing and soothing
• viscosity or resistance can be used for muscle
strengthening and increasing rehabilitation progressions.
• Buoyancy allows for flotation and reduces the effects of
gravity on injured or aching joints and muscles.
• Hydrostatic pressure supports and stabilizes the
patient, allowing people with balance deficits to perform
exercises without a fear of falling, decreasing pain and
improving cardiovascular return.
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22. • Turbulence and wave propagation let the
therapist gently manipulate the patient
through the desired exercises.
• The respiratory muscles are forced to
work harder in the water, allowing for a
natural strengthening that benefits the
patient long after the therapy session has
ended.
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23. • There was a study done by Eunkuk Kim and Hokyung
Choi in Korea on aquatic therapy to rehabilitate athletes.
• It showed that athletes and/or individuals who
underwent aquatic physical therapy for rehabilitation of
sports injuries showed improvement in pain, range of
motion, muscle strength, balance ability, and
performance.
• Aquatic Physical Therapy in the Rehabilitation of
Athletic Injuries: A Systematic Review of the Literatures
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24. • Eg: ACL recovery after surgery:
• Week 1 – 2: Diminish the pain, decrease swelling and
restore mobility.
• Week 3: Begin walking on the underwater treadmill in the
pool with minimal weight bearing.
• Week 6: Begin light jogging in the pool while beginning to
restore full range of motion.
• Week 8: Begin sprinting in the pool to start the transition
to land.
• Week 10+: Continue using the pool for conditioning, gait
refinement and strengthening as well as any skills that
need to be mastered before moving to land.
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25. • Shoulder rehabilitation:
• Horizontal abduction and adduction
• Shoulder flexion and extensions
• Push-pull alternating
• Sideways arm raises
• Forward arm raises
• Push-pull with hydro-tone bells
• Figure eight arm rotations
• Diagonal arm movements
• Palm up and palm down- front and side
• Flexion and extension, lying face down with a snorkel
• Barbell push-downs
• Swimming motions 25

26. High intensity interval training (HITT)
• Helps to burn more calories, increase speed, strength,
endurance, motivation and overall performance.
• Originally it was called Fartlek.
– It combined alternating exercise with slower and easier activity of
continuous workout.
• Types:
– The fitness interval: beginners and intermediate exercisers. 2-5 minutes.
should not exceed the anaerobic threshold of below 85% heart rate reserve.
– The performance interval: more advanced and is recommended for
conditioned athletes. 85% – 100% heart rate reserve. 2-15 min.
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27. • intense work periods: may range from 5 seconds to 8
minutes long. [usually 3,4 or 5 min.]
• Intensity : 80 to 95 % of the estimated maximal heart rate.
• Ratio: 1:1 (intense workout : recovery period)
• Recovery period: 40% to 50% of a person’s estimated
maximal heart rate
• Total workout time: 20 to 60 min.
• Another popular HIIT training protocol is called the
“spring interval training method”. With this type of
program the exerciser does about 30 seconds of ‘sprint or
near full-out effort’, which is followed by 4 to 4.5 minutes
of recovery. This combination of exercise can be repeated 3
to 5 times.
• How many times a week ?
– Start with once a week. Progress to 7 days a week.
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30. Vibrotactile feedback system
• The sense of touch is one of the most informative senses
humans possess, and tactation is the sensation
perceived by the sense of touch.
• Tactation is resulted by the skin's receptors that are
stimulated by modalities such as vibration, pressure, etc.
• The concept of tactile technologies is based on the skin's
ability to communicate information through these
modalities. Current advances include electrical
stimulation, Vibrotactile stimulation, thermal
stimulation, etc.
• Domains:
» motion improvement
» Motor learning
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31. • The main components of this system
include motion tracking, visual feedback,
and vibration feedback.
• Motion tracking: Sleeve tactile motion
guidance system, to track the user’s
motions.
• Visual feedback: a computer screen
provides visuals of the measured and
desired motions.
• Vibration feedback: A pair of
vibrotactile arm bands to indicate motion
errors.
• Indications: ACL rehab, Ankle rehab,
balance retraining, proprioception and
co ordination training.
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33. • A study was done by A. U. Alahakone , S. M. N. A. Senanayake.
(Malaysia).
• Human Motion analysis has become an essential tool for motion
diagnostics in sports and medical domain.
• The ultimate goal of motion analysis in sports is to improve
technique and prevent or reduce the risk of sports injuries.
• There is a high risk of Anterior Cruciate Ligament (ACL) injury that
can occur due to poor landing postures followed by athletes .
• Identifying and understanding biomechanical risk factors associated
with jump landing , can aid in preventive measures to be followed
during sports training .
• Therefore ACL injuries can be minimized by training athletes to
increase knee flexion and reduce knee abduction/adduction
during landing .
• This is done by vibration cues given by the device.
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34. Deep transverse friction massage
• Deep transverse friction has three main effects :
1. Traumatic hyperaemia, which helps to
evacuate pain triggering metabolites.
2. Movement of the affected structure, which
prevents or destroys adhesions and helps
optimize the quality of the scar tissue.
3. Stimulation of mechanoreceptors, which
produces a quantity of afferent impulses that
stimulate a temporary analgesia. This also helps
the patient to perform movement exercise.
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35. • Technique:
• For larger muscles use elbow.
• Muscle should be in relaxed
position
• Sufficient pressure should be
applied to reach the deep
structures
• Acute injury- contra indicated
• Usually painful
• can be followed by stretching
to improve ROM.
• If transverse , thumbs should
stroke from opposite direction.
• Treating ligament or tendon :
across fiber
• Scar: circular pattern.
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36. • Indications : muscular, tendinous and
ligamentous lesions.
• Contra-indications :
– Calcification
– Rheumatoid tendinous lesions
– Local sepsis
– Skin diseases
• 3 times/week
• 10 to 15' per session
• The treatment can be ended when the
patient is symptom free and the functional
examination has become negative.
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37. Eccentric loading
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38. • indication
• tendinopathies, muscle strains, anterior
cruciate ligament rehabilitation etc.
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39. • Regardless of the involved tendon, load and volume of
exercise should be progressed gradually and should be
dictated by the amount of pain experienced by the athlete.
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40. • Shalabi et al evaluated 25 patients with chronic
achilles tendinopathy before and after an eccentric
program using the Alfredson et al protocol.
• Subjects tendon volume and intratendinous signal
were measured via magnetic resonance imaging.
• Eccentric training resulted in decreased tendon
volume and decreased intratendinous signal,
which correlated to improved pain and
subjective performance.
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41. KINESIO AND MCCONNELL TAPING
• Kenzo Kase, a Japanese chiropractor and acupuncturist,
designed the tape and taping method back in 1979. Kase
believed a flexible tape would stimulate better circulation to an
injured muscle due to its tug on the skin.
• Principle: When the tape is applied correctly, it achieves the
effects by lifting the skin to create a small space between the
muscle and dermis layers. That space takes the pressure off
swelling or injured muscles, allows smooth muscle movement
and makes space for drainage and blood flow.
• It changes muscle tone, move lymphatic fluids corrects
movement patterns, improves posture, reduce pain and
inflammation, relaxes over used muscles, and supports muscles,
corrects the joint mal alignment and helps the muscles to work
better by stabilizing and supporting the affected part.
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42. KINESIO
• The elastic tape is unique
in that it can stretch to 130‐
140% of its static length
(theoretically allowing full
range of motion while the
muscle is placed on gentle
functional stretch during
the application)
• tape can be worn for 3 5‐
days.
• hypoallergic
MCCONNELL
• The MT is structurally
supportive and uses a tape
that is rigid, highly
adhesive.
• Restricts ROM
• can be worn up to 18 hours.
• allergic
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43. KINESIO TAPING MC CONNELL’S TAPING
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44. Plyometrics
• Plyometric exercise was initially utilized to enhance sport
performance and is more recently being used in the
rehabilitation of injured athletes to help in the preparation for a
return to sport participation.
• The identifying feature: lengthening of the muscle-tendon unit
followed directly by shortening (stretch-shortening cycle).
• Initiated at a lower intensity and progressed to more difficult ,
higher intensity levels.
• The progression to higher-intensity plyometric exercises
resolves post injury neuromuscular impairments and prepares
the musculoskeletal system for rapid movements and high forces
that may be similar to the demands imposed during sport
participation, thus assisting the athlete with a return to full
function. 44

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48. • 1. Front Box Jump
• 2. Lateral Box Jump
• 3. Weighted Lateral Jumps
• 4. Broad Jumps
• 5. Skater Jumps
• 6. Scissor Jumps
• 7. Dot Drill
• 8. Lateral Box Shuffles
• 9. Barbell Squat Jumps
• 10. BOSU Ball Burpees
• Reps: 3sets * 10-15
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49. Front box jump
Weighted lateral jumps Broad jumps
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50. 50
Skater jump
Dot drill
Lateral box shuffle

51. Barbell squat jumps
BOSU ball burpees
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52. Isokinetic exercises
• Isokinetic exercise is a type of strength training in which
specialized machines, or dynamometers, maintain a constant
speed of movement.
• It blends the intense contractions of isometric exercises with
the range of motion achieved in isotonic exercises, and can
provide a maximal strength workout.
• It provides muscular overload at a constant preset speed.
• In this type of exercise, the angular velocity of the movement
remains constant.
• This type of exercise needs computer controlled equipment
which matches the resistance with patient’s effort.
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53. • Uses:
• Because the variable resistance in
these types of exercise
equipment is so controlled that
it helps to prevent a lot of
different kinds of injury for users.
• ( Isokinetic exercise also offers
more direct response and
customization of challenges to a
body's momentum.)*
• This kind of exercises are
especially helpful after injury,
where participants want to take
care not to strain muscles with
excessive resistance.
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54. References.
• http://bjsm.bmj.com/content/34/2/133.full
• https://www.hydroworx.com/research-education/additional-resources/aquatic-
therapy-injury-rehab-time.
• http://bmb.oxfordjournals.org/content/110/1/47.full
• /books.google.co.in/books?
id=_dq9BwAAQBAJ&pg=PA202&lpg=PA202&dq=isokinetic+rehabilitation+for+sport
s&source
• http://www.stack.com/a/best-plyometric-exercises-for-athletes
• www.ncbi.nlm.nih.gov/pmc/articles/PMC4623827/
• www.ncbi.nlm.nih.gov/pmc/articles/PMC3105370/
• http://www.fitday.com/fitness-articles/fitness/exercises/what-is-isokinetic-
exercise.html
• Initial Management of Acute Sports Injuries .-Martin Meyer
• http://ieeexplore.ieee.org/abstract/document/5370030/
• https://www.acsm.org/docs/brochures/high-intensity-interval-training.pdf
• https://www.google.co.in/webhp?sourceid=chrome-
instant&ion=1&espv=2&ie=UTF-8#q=common%20sports%20injuries
• https://www.acsm.org/docs/brochures/high-intensity-interval-training.pdf
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