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Burnout- Facts and Figures. Dr. Philip Glasgow PhD, MRes, BSc(hons), MCSP, SRP Chartered Physiotherapist Sports Institute Northern Ireland GAA Conference- Bundoran 13 th November 2004. Is There A Problem?. How Can We Address It? Injury Prevention- Theory Musculoskeletal Screening Results

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burnout facts and figures

Burnout- Facts and Figures

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

Chartered 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
slide3

What can we do

to prevent injuries?

What can we do

to prevent injuries?

3

What is the magnitude

of the problem?

What are the

causes of injury?

slide4

Risk factors for injury

(distant from outcome)

Injury mechanisms

(proximal to outcome)

Susceptible

athlete

INJURY

Inciting event:

Exposure to external

risk factors:

  • Joint motion (e.g. kinematics, joint forces & moments)
  • Playing situation (e.g. skill performed)
  • Training program
  • Match schedule
  • 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)
  • 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)

Predisposed

athlete

Internal risk factors:

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

slide5

What is the magnitude

of the problem?

What are the

causes of injury?

What can we do

to prevent injuries?

CAUSES???

slide7

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
Screening Results
  • Postural Alignment
  • Joint Range of Motion
  • Flexibility
  • Stability/Movement Control
  • Previous/Current Injury
joint range of motion
Reduced ROM hip joints

Increase laxity shoulder joints

Reduced ROM spinal joints especially thoracic spine

Joint Range of Motion
flexibility
Generally poor flexibility

Reduced hamstring range (45-600 SLR)

Standard- 90-1200

Tight hip flexors

Tight chest muscles

Flexibility
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

Stability/Movement Control
current previous injury
High incidence of ankle and knee injuries

High incidence hamstring injuries

High recurrence rate

Lack of adequate treatment and rehabilitation

Current/Previous Injury
summary of findings
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
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
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
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
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
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
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
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
training program
Training program
  • Three types of exercises with progression:
    • Floor
    • Airex balance mat
    • Wobble board
  • 5 weeks 2-4 x each week
  • Maintenance 1 x weekly during the season

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

slide42

Week 1

Week 4

Week 2

Week 5

slide43

00-01

98-99

99-00

P=0.15 vs. 98-99

P=0.06 vs. 98-99

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

recommendations
Recommendations
  • Change training practices:
    • Volume*
    • Content
    • Periodisation
    • Recovery
  • Emphasis on:
    • Technique
    • Postural alignment
    • Flexibility
    • Stability
    • Adequate treatment and rehabilitation of injuries
    • Prehabilitation
ad