Common Youth Sports Injuries & Prevention. Mark Looper MS, PT, COMT, FAAOMPT Olympic Physical Therapy of Kirkland

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1 Common Youth Sports Injuries & Prevention Mark Looper MS, PT, COMT, FAAOMPT Olympic Physical Therapy of Kirkland 1

2 Olympic Physical Therapy of Kirkland History of Excellence since 1983 now 9 clinics strong Consulting PT for the Seattle Seahawks for 7 years Medical Support for Seattle Storm Professional Basketball Team Medical Support for Seattle Reign Professional Women's Soccer Team Traveling Medical Support for US Ski & Snowboard Team 425 Magazine- Best Physical Therapy Practice Winner of Best Eastside Small Business Award Winner of Best Places to Work in Washington Puget Sound Business Journal National Instructor for McConnell Institute National Instructor for NAIOMT 2

3 3

4 Why is Injury Prevention Important? BIG # s Over 1.2 Million Injuries in

5 Trends & Characteristics of Severe High School Sports Injuries? : 4% of injuries severe in nature Differs per sport, age and gender In general as athletes get older they are injured more -For soccer, basketball, baseball/ softball comparison girls at 29% were injured more than boys at 23% -Most common injured areas: Knee 29%, Ankle 12.3%, Shoulder 10.9% Most common diagnoses: Fractures 36%, complete ligament tears 15.3%, ligament sprains 14.3% Severe injuries: Only 0.3% career ending, 56.8% season ending, nearly 28% required surgery [of those 28%, 54% were knee surgeries] 5

6 More On Injuries Contact sports such as football, soccer, basketball and baseball highest prevalence of injury More severe injuries happen during competition 7.9% [practice 2.4%] 6

7 How Can We Prevent Injuries In Sport? 7

8 PREVENTATIVE PROGRAMS RESEARCH How effective are ACL prevention training programs? Sadoghi et al, J Bone Joint Surg Am., 2012 systematic review found a reduction in ACL tears with prevention programs of 52% for females and 85% for males an ounce of prevention beats a pound of reconstruction Voskanian, Curr Rev Musc Med, % of ACL tears are non-contact Ankle sprain prevention programs? McGuine, Am J Sports Med, A comprehensive balance program reduced ankle sprain occurrence by a significant 3.8% Athletes with previous ankle sprain had 2 fold increased risk of resprain McHugh et al, Am J Sports Med, minutes of single leg balance training on foam pad 5 days/ week X 4 weeks, 2x s/wk in season reduced risk of ankle sprain 77% in athletes with hx of previous ankle sprain or high body mass index 8

9 Olympic Physical Therapy s Unique Perspective on Injury Prevention 9

10 Sports Illustrated July 28, 2014 Drew Brees 10

11 Drew Brees was Right! You ( ) with your core! -Throw -Catch -Kick - Header -Pitch -Shoot -Run -Lift etc 11

12 What Most People don t Know- -Is that there is an Inner & Outer This guy could have a weak Inner Core Core 12

13 The Missing Link Developed a unique Spine Course for Physical Therapist taught on a national basis The Missing Link- Evaluate & measure an Inner Core deficit Allows us to see an injury before it happens (Huge implications in injury prevention!) Facilitate the Inner Core for "Full Core Balance" 13

14 What are the Inner Core Muscles? Segmental Stabilizers or Inner Core Muscles Transverse Abdominis, posterior fibers of Psoas, ms of the Pelvic Floor, and Multifidus 14

15 How do you lose CORE Balance? Studies have shown that within min/hrs of a back/neck injury.the Multifidus at that level SHUTS DOWN (leads to a Neurogenic Dysfunction). Furthermore the Multifidus does not automatically return to it s pre-inhibited state...but it can be trained! Hides et al- Spine 1994 Hides, et al

16 The Lumbar Multifidi Inner Core Muscle 16

17 The Multifidus is not the stabilization system - -But it is the best indicator of how well the Inner Core System is responding. 17

18 Significant Back Injury Similar studies have found inhibition of the Transversus Abdominus the body is less coordinated and is more vulnerable to injury The trunk s Inner Core become neurally inhibited W/O optimal Inner Core Activation the body is less coordinated and is more vulnerable to injury Hodges & Richardson,

19 KEY POINTS To Be Truly Strong, Coordinated & Less Likely To Be Injured- -You Need a Balance Between The Inner & Outer CORE Injuries Create an Imbalance By Shutting Down The Inner Core W/O Inner Core Spinal Stabilization the body is less coordinated and is more vulnerable to injury 19

20 How Important is the Inner Core? How Important is the Rotator Cuff-to shoulder function? The Rotator Cuff is the Inner Core of the shoulder! Notice the Seahawk Colors 20

21 Low Back Injury Once your inner core is inhibited (injury) Your CNS (Brain) neurogenically inhibits muscles in the extremities This makes the body weak, less coordinated and is more vulnerable to injury 21

22 Spinal Neurogenic Dysfunction S.N.D.can mimic either a palsy (AKA: Pseudopalsy) or local peripheral dysfunction (ie Tendonitis) An inaccurate diagnosis can lead to incomplete treatment that yields unsatisfying results. Recognition of a S.N.D is thus critical. Pettman (2001)

23 80% of all shoulder problems are driven or perpetuated via neck dysfunction -Mark Looper s experience/opinion 23

24 Prove It! I will in a minute! 24

25 ACL Injuries Since 1998, I have had only one single ACL injury/reconstruction in my clinic that did not have weakness in their Gluteus Medius, Hams & Peroneals..or a L5 Myotomal weakness Not any longer! My Experience/Opinion 25

26 PREVENTATIVE PROGRAMS RESEARCH Hides et al, JOSPT, 2011 Aussie Rules Football players with pre-season hamstring, glute, thigh injuries had smaller deep core muscle size and poor activation The deep and outer core are crucial in force transfer from upper body to lower body" Gildea et al, JOSPT, 2013 An association found between low back and hip pain and smaller size of L/S multifidus muscles 26

27 Shin Splints/Recurrent Ankle Sprains Typically a result of a destabilized spine At L4 (Ant Tib) or L5 (Peroneals) Jumper s knee is also typically related to LB Problems 27

28 How Shin Splints Develop If the Multifidus is inhibited at L4 or L5 -the body (The Brain actually) will then protect itself by inhibiting the muscles in the Leg that are fed by L4 or L5.....[ Peroneals or Tibialis Anterior = Shin Splints]..Thus (Shin Splint) weakness in the leg is not really weakness. but is from inhibited muscles. 28

29 Sufficient Multifidi activation will stabilize the back at L5, remove the myotomal inhibition affecting the shins, and will then allow for successful training. I can make you strong immediately! OK Now I Will Prove it! but first I will make you weak 29

30 Inner Core Muscle System is only inhibited with a Spinal Injury No Injury No Problem! but injuries are more common in multi-year competitive sports! 30

31 Core Strengthening Typically we try to strengthen the Abdominals & Back Musculature Or try Balance/Green Ball Ex s Or try Yoga or Pilates Waisting Your Time! This will not activate the Multifidus or True Inner Core Muscles Most who perform Inner Core work do it wrong! We Do It Right! 31

32 Injury Prevention Implications It is through this unique perspective that we can.. see an injury before it happens 32

33 Thoughts On Recurrent LBP Think Spondylolysis Dr. Lyle Micheli:director of the Division of Sports Medicine at Children s Hospital of Boston Dr. Joseph Congeni; Medical director of Sports Medicine Center at Children s Hospital in Akron, OH LBP in adolescent ages cannot be dismissed as a strain or vague irritation of joint arthropathy. Micheli had 47/100 adolescents Dx with spondylolysis. Congeni reported that out of 40 children dx with spondylolysis, 47% had chronic nonhealing fractures and 40% had acute lumbar fractures at various stages of healing. 33

34 Further Thoughts & Recommendations? Coach Neutral Spine (typically this is well done) Tongue to Roof (when blocking, with headers ) Tall Neck Lift Pelvic Floor Don t play injured 34

35 SUMMARY There is a significant amount of information and research available to help reduce injuries Education and communication are key Establishing a network of medical and strength and conditioning specialists 35

36 Thank You! 36

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