Burnout- Facts and Figures

Dr. Philip Glasgow PhD, MRes, BSc(hons), MCSP, SRPChartered Physiotherapist

Sports Institute Northern Ireland

GAA Conference- Bundoran 13th November 2004

Is There A Problem?Is There A Problem?

• How Can We Address It?• Injury Prevention- Theory• Musculoskeletal Screening• Results• Response• Example of best practice• Recommendations

What is the magnitudeof the problem?

What is the magnitudeof the problem?

What are thecauses of injury?

What are thecauses of injury?

What can we doto prevent injuries?

What can we doto prevent injuries?

What can we doto prevent injuries?

What can we doto prevent injuries?

Meeuwisse WH: Clin J Sports Med 4: 166-170, 1994

Internal risk factors:

• Age (maturation, aging)

• Gender• Body composition (e.g.

body weight, fat mass, BMD, anthropometry)

• Health (e.g. history of previous injury, joint instability)

• Physical fitness (e.g. muscle strength/power, maximal O2 uptake, joint ROM)

• Anatomy (e.g. alignment, intercondylar notch width)

• Skill level (e.g. sport-specific technique, postural stability)

Predisposedathlete

Risk factors for injury(distant from outcome)

Injury mechanisms(proximal to outcome)

Susceptibleathlete

Exposure to externalrisk factors:

• Human factors (e.g. team mates, opponents, referee)

• Protective equipment (e.g. helmet, shin guards)

• Sports equipment (e.g. skis)

• Environment (e.g. weather, snow & ice conditions, floor & turf type, maintenance)

INJURY

Inciting event:

• Joint motion (e.g. kinematics, joint forces & moments)

• Playing situation (e.g. skill performed)

• Training program• Match schedule

What is the magnitudeof the problem?

What is the magnitudeof the problem?

What are thecauses of injury?

What are thecauses of injury?

What can we doto prevent injuries?

What can we doto prevent injuries?

CAUSES???CAUSES???

Cause?

Musculoskeletal Screening

• Identify predisposing factors to injury• Detect musculoskeletal impairments that may

affect performance• Identify ongoing injuries, which may or may

not be receiving treatment• Provide information to coaches on

management of ongoing injuries• Identify problems not responding to treatment • Follow up to previous screening• Put in place appropriate measures to prevent

injury and enhance performance

Screening Results

• Postural Alignment• Joint Range of Motion• Flexibility• Stability/Movement Control• Previous/Current Injury

Postural Alignment

• High incidence poor kyphotic posture

• Rounded shoulders

• Poor alignment

Joint Range of Motion

• Reduced ROM hip joints

• Increase laxity shoulder joints

• Reduced ROM spinal joints especially thoracic spine

Flexibility

• Generally poor flexibility

• Reduced hamstring range (45-600 SLR)

• Standard- 90-1200

• Tight hip flexors• Tight chest

muscles

Stability/Movement Control

• Provides picture of how athlete moves

• Demonstrates effects of static findings

• High incidence poor single leg movement control tests

• Poor gluteal activation• Poor shoulder stability• Poor core

Examples of Functional Tests

(Video)

Current/Previous Injury

• High incidence of ankle and knee injuries

• High incidence hamstring injuries

• High recurrence rate

• Lack of adequate treatment and rehabilitation

Summary of Findings

• Poor Posture• Decreased Thoracic Extension• Increased Laxity Shoulder Joints• Poor Flexibility:

– Hamstrings– Hip Flexors– Calves– Lumbar Spine

• Reduced Movement Control• High Incidence of Previous Injury:

– Associated With Ongoing Problems

Case Study 1• 20yr old footballer• Poor kyphotic posture• History of right ankle sprains• History of right hip pathology• History of right shoulder pain• Currently complaining of left thigh pain• Poor balance and proprioception• Significantly reduced hamstring length• Unstable right shoulder• Continued to play throughout injury- still feels sore (2

years later)• Constantly feels stiff and sore• Trains 5 times per week• Regularly plays 3 games per week

Case Study 2

• Screening Results:– Dislocated right shoulder– History of ankle sprains– Poor flexibility– Reduced spinal movements– Very poor posture– Leg length discrepancy– Very left side dominant– Poor single leg control

Case Study 2 cont.

• Management:– 4 Months out of playing to rehab dislocated

shoulder– Concurrently worked on flexibility, control,

stability and spinal movements

• Outcome:– Returned to full training and competition– No recurrence of shoulder problems– Maintained flexibility and spinal movement– Reports that movement control has contributed

significantly to his game.

Case Study 3

• Screening Results:– Very poor kyphosed posture– Reduced flexibility– Longstanding quadriceps injury for 6

months that has not improved despite treatment

– Continuing to play

Case Study 3 cont.

• Management:– Cessation of playing– Treatment of injury– Advanced rehabilitation programme– Work on flexibility and control

• Outcome:– Return to playing– No further problems with quad– Improved flexibility and power generation

Conclusion

• In light of the theory of injury prevention, the significant incidence of intrinsic risk factors in conjunction with numerous extrinsic factors (such as training volume and practices), the GAA squad presents as a High Risk Population

How Do We Respond?

• Strategies to reduce injury risk.• Assessment of training practices:

– Content– Periodisation– Recovery

• Emphasis on:– Technique – Postural alignment– Flexibility– Stability– Adequate treatment and rehabilitation of injuries– Prehabilitation

Technical training

Balancetraining

Specialdrills

Volleyball intervention study

Myklebust et al. Clin J Sport Med 13: 71-78, 2003

Training program

• Three types of exercises with progression:1. Floor2. Airex balance mat3. Wobble board

• 5 weeks 2-4 x each week• Maintenance 1 x weekly

during the season

Week

1W

eek

2

Week

4W

eek

5

Myklebust et al. Clin J Sport Med 13: 71-78, 2003

P=0.15 vs. 98-

99

00-0100-0199-0099-0098-9998-99

P=0.06 vs. 98-

99

Recommendations

• Change training practices:– Volume*– Content– Periodisation– Recovery

• Emphasis on:– Technique – Postural alignment– Flexibility– Stability– Adequate treatment and rehabilitation of injuries– Prehabilitation

Questions