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1 Where Regional Athletes Succeed Western Region Academy of Sport Regional Athlete Coach Education 2015 Preventing Rehab with Prehab: Injury prevention with the FIFA+11 Rehab or Prehab? What s the difference between rehabilitation and prehabilitation? Common injuries What are common injuries in youth athletes? FIFA 11+ The FIFA 11+ approach Marshall McGee, WRAS S&C Intern Jess Sewastenko, WRAS S&C Intern Nyrie Atkin, WRAS Assistant S&C Coach Dr Stephen Bird PhD, BHMvt(Hons), CSCS, AEP, RNutr Director of Strength and Conditioning, WRAS School of Human Movement, Studies, Charles Sturt University Sponsors of the Western Region Academy of Sport Take home points Movement prep FIFA 11+ WRAS leading the way Image from Rehabilitation vs. Prehabilitation What s the difference? Four phases Rehabilitation Strength, Flexibility, ROM Can be lengthy process Time away from sport Prehabilitation Sport-specific Reduce risk of injuries Strengthen injury prone areas Movement preparation Prehabilitation: systematic approach that identifies common sports-specific injuries followed by implementation of exercises that minimise injury risk Meir, R., Diesel, W., & Archer, E. (2007). Developing a prehabilitation program in a collision sport: A model developed within English premiership rugby union football. Strength and Conditioning Journal, 29(3), Sport-specific coordination and stabilisation Adjunct to normal S&C program improving muscle length/balance, joint stability, body awareness (proprioception) more advanced athlete = greater need for prehab program Mobility Brumitt & Meira (2006). Strength Cond J. 28(3), After injury Prehabilitation: proactive approach that identifies common sportsspecific injuries followed by implementation of exercises that minimise injury risk Proactive approach Core (pelvis and hips) Akuthota et al. (2008 ). Curr Sports Med Rep 7: Shoulder (scapula) Brumitt & Meira. (2008) Strength Cond J. 28(3), Glute activation Presswood et al. (2008). Strength Cond J. 30(5), Jump training (ankle, knee, hips) Myer et al. (2011). Curr Sports Med Rep, 10(3), Balance and postural stability Bird & Stuart. (2012). Strength Cond J. 4(3), Meir, R., Diesel, W., & Archer, E. (2007). Developing a prehabilitation program in a collision sport: A model developed within English premiership rugby union football. Strength and Conditioning Journal, 29(3), Hartwich, K. (2009). 'Bowling prehab': An innovative approach to injury prevention and rehabilitation for fast bowlers. Sport Health, 27(4),

2 Prehabilitation Program Ankle/Calf Prehab Group Green band 45deg SL calf raise Hop onto min-tramp from floor with ¼ rotation + stick landing SL springboard balance + MB passes across body OH plate (15kg) walk 3 rd high knee pelvic alignment Physo ExRx x1 Foam roller Gastroc/soleus Peroneal ITB Quad Adductor Feb x leg 2x 6@ leg 2x 10@ leg 2x 15m 2x leg Injury Rates and Common Injuries Basketball example. Common basketball injuries combined across levels (high school, collegiate, semi-professional and professional) of play and gender Injury classification Occurrence (%) Sprains 28-52% Overuse 22-39% Strains 15-18% Contusions 8-25% Fractures 4-8% Data from [1, 6, 15-18, 47, 48] 54.1% 53.8% Injury prevention: Injury rates (per 1000 athlete exposures). Gender comparisons between NBA/WNBA, NCAA and high school basketball players. Bird, S.P., et al. (2015). Basketball-specific performance testing: Current practice and recommendations for youth athletes. Strength and Conditioning Journal, in progress. Borowski, L. A., Yard, E. E., Fields, S. K., & Comstock, R. D. (2008). The epidemiology of US High School basketball injuries, American Journal of Sports Medicine, 36(12),

3 What are the indicators of injury risk? Movement efficiency 1. Posture alignment Back pain Modifying risk factors Non-Modifiable & Modifiable Non-Modifiable Modifiable 2. Muscle imbalances Hamstring tightness Groin soreness Calf tightness 3. Knee pain Poor limb control Patellar tendinopathy ACL injuries Anatomy (structure) Hormones (testosterone) (estrogen) Movement efficiency Neuromuscular Control (body awareness) Do you suffer from any of these? Mann, K., Edwards, S., Drinkwater, E. J., & Bird, S.P. (2013). A lower limb assessment tool for athletes at risk of developing patellar tendinopathy. Medicine and Science in Sports and Exercise, 45(3), Implementing BAPS: A movement preparation strategy What we know: Challenging an athletes centre of gravity within their base of support may enhance ability to regain stability in athletic context: 1. Promotes increases awareness of lumbo-pelvic position (control) during movement 2. Enhances movement preparation and sportspecific strength characteristics 3. Effective strategy for reducing sports related injuries in young athletes Bird, S.P., & Stuart, W. (2012). Integrating balance and postural stability exercises into the functional warm up for youth athletes. Strength and Conditioning Journal, 34(3),

4 BAPS Integrated Training: Improvements in performance and biomechanics Training decreased medial knee collapse (28%) forces acting on the knee (38%) Early results are indeed promising; Predicted 1RM Squat 92% Single-leg hop dist. (L) 6% / (R) 5% Vertical jump 8% Knee flex-ext ROM during landing (L) 8% / (R) 7% Myer, G. D., Ford, K. R., Palumbo, J. P., & Hewett, T. E. (2005). Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research, 19(1), BAPS Integrated Neuromuscular Training Female high school athletes (n = 53); 13-17yrs 6-week protocol; 3 x wk; 90 min Day 2: 30min plyo s 30 min strength 30 min core/baps Day 4: 30min plyo s 30 min speed 30 min strength/baps Day 6: 45min speed 45 min strength BAPS Integrated Neuromuscular Training Increased performance levels in youth female athletes combining improved; power-strength-speed lumbopelvic stability knee control, thereby reducing injury risk 4

5 All injuries: 135 v 166 Match injuries: 96 v 114 Lower ext injuries: 121 v 143 Knee injuries: 33 v 47 Acute injuries: 112 v % 19% 18% 42% 16% BAPS-based Injury Prevention Program (FIFA 11+ / )PEP Core stability/balance NM control focus during sport-related movement 1. Hip control 2. Knee alignment Avoiding excessive knee collapse Image from Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., et al. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ, 337. Olawale, et al. (2014). Efficacy of the FIFA 11+ warm-up programme in male youth football: A cluster randomised controlled trial. Journal of Sports Science and Medicine, 13(1),

6 FIFA 11+ program is effective in reducing the incidence of injury in male youth football players 1 Poor posture and muscle imbalances increase injury risk by reducing movement efficacy 2 Prehabilitation: proactive approach to minimise injury risk 3 Movement preparation activities, such as BAPS / FIFA 11+ are effective prehabilitation strategies for youth athletes 6

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