Getting Fit for Football 4 th January 2009

Transcription

1 Getting Fit for Football 4 th January 2009 Dr John A. MacLean Medical Director The National Stadium Sports Medicine Centre Hampden Park, Glasgow International Team Doctor, SFA

2 Benefits of Exercise in Health and Disease

3 Risks & Nature of Injury in Sport. Management of Sports Injuries. Preparation for Sport Prevention of Injury.

4 But what are the risks? Risk of death due to the nature of the sport. Sudden death during exercise Risk of Injury

5 Recorded accidental deaths in GB Accidental deaths by activity ROAD HOME WORK SPORT OTHER

6 Risk of death due to the nature of the sport. Sports participation carries certain risk. 160 fatalities/year in sport. 1.3% of all accidental deaths High risk sports: Height, Water and Speed.

7 Fatal accident Rates Fatal accident rate/100m hrs exposure Air sports Mountaineering Motor Sports Water sports Horse Riding Football Gymnastics Running

8 Specific Issues: Sudden Death in Sport

9 Sudden Cardiac Death Up to 8 young people each week in the UK. Scotland 75/yr % of all non-traumatic sudden deaths in young competitive athletes result of congenital cardiac abnormalities HOCM accounts for 40-50% of these. Those with symptoms should be considered to be the lucky ones!

10 How do we diagnose? 1.Family History 2.Symptoms 3.Clinical Examination

11 How do we diagnose? 4. ECG

12 5. Echocardiography

13 Sport for all Means Injury for all

14 Risk of Injury 20 million Sports injuries/yr. in GB 50% football related. 1 billion cost of treatment/lost production. Majority do not seek medical attention Sports injury clinics can provide appropriate advice/facilities and Medical/Rehabilitation services.

15 Injury Rates Injury rate/100 hrs exposure Football Hockey Ski-ing Athletics Horse riding Running Swimming

16 Nature of Sports Injury Increasing activity due to increasing public interest in health. Increased leisure time and availability of sporting activity A&E attendance's % % Macrotrauma v Microtrauma (overuse)

17 What parts of the body can be injured? Areas of the body Legs Head Neck Hands Chest Back Feet and ankles Shoulder Abdomen Types of injury Ligament Muscles Tendons Bones Fractures dislocations

18 Anatomical Sites of Injury Head/Neck 17.7% Upper Limb 30.7% Chest/Abdo 6.4% Upper Leg 2.2% Knee 10.4% Lower Leg 32.6%

19 Traumatic Sports Injuries Fractures and Dislocations Major Muscle/Ligament/Tendon injuries Head and Spinal injuries Chest and Abdominal injuries

20 Overuse Injuries EXTRINSIC External factors outwith the body INTRINSIC Within the athletes themselves

21 Extrinsic Factors Surface: Higher force on hard surfaces Footwear: Inadequate / Non sports specific / Worn shoes. Environment : Cold/Heat affect metabolic rates and blood supply. Rules : Esp in young athletes Limitation of number / duration of games. Running produces 250% body weight at ground contact.

22 Intrinsic Factors Intrinsic factors present in 40% but only in 10% are they the only demonstrable factor Malalignments most common and most important, mostly minor and subtle.

23 Risks & Nature of Injury in Sport. Management of Sports Injuries. Prevention of Injury.

24 Emergency Evaluation and Treatment On the spot will indicate injury mechanism. Look for Head, Neck and Chest injuries. Adequate exposure of injury & surrounding. Listen to the sportsman Utilise the ABC AIRWAY BREATHING COMPRESSIONS

25 Initial Management P=PROTECTION of the injured area from further damage and surrounding structures. R=REST of the injured part to avoid prolonged irritation. Absolute v relative rest. I=ICE for controlling pain, bleeding & swelling. C=COMPRESSION for support and controlling swelling. E=ELEVATION for decreasing bleeding and swelling. S=SUPPORT for stabilisation of the injured part.

26 Management of Acute Sports Injuries Injury Tissue Damage Bleeding Pain Tenderness Swelling Increased tissue pressure Impaired Healing Aim is to inhibit and control bleeding early.

27 Injury due to overuse Intrinsic factors Increased Participation Increased intensity and duration of training Extrinsic factors Anatomical Muscle imbalance Inflammation Overload Tissue Injury Pain Training errors Poor technique Incorrect equipment Poor conditions Continued activity Rest Healing Rehabilitation Correction of cause

28 Initial Management Adequate Pain Relief - Remember Doping!! Return to Play: Will not worsen existing injury Will not increase risk of other injuries Will be able to protect himself AND not place others at risk. If in doubt say NO or reassess. Continue to observe as long as required.

29 Follow-on Care Initial REST followed by ACTIVE REST. Continue active muscle conditioning e.g.. Hydrotherapy. CRYOTHERAPY continues during initial inflammatory phase. ELECTROTHERAPY - e.g. ultrasound. SUPPORT/TAPING

30 Follow-on Care Further Investigations: X-ray MRI/CT Scan Ultrasound Bone scan Arthroscopy

31 Follow-on Care Other treatment modalities: Massage Manipulation Mobilisation Acupuncture Nerve stimulation Surgery as indicated. Medicines Non-steroidal Drugs Oral v topical Cortisone and/or Local Anaesthetic injections

32 Follow-on Care Rehabilitation and Training Programme Strength Flexibility Proprioception Functional and Sports-specific training A structured rehab programme is the key When can I play again????

33 PRINCIPLES OF TREATMENT TREAT THE SYMPTOMS Start with a correct diagnosis Treatment depends on the stage of the healing process Individualise treatment Start as soon as possible Teamwork vital TREAT THE CAUSE Training routines Malalignment Footwear Improve flexibility Braces and taping Surgical correction

34 Risks & Nature of Injury in Sport. Management of Sports Injuries. Preparation for Sport Prevention of Injury.

35 Preparation for Sport Training Speed and endurance Fitness Strength & conditioning Core stability Warm-up and Cool-Down

36 Why warm - up Main aims Increase core body temperature. Prepare cardiovascular system for activity. Injury prevention

37 Warm-up Musculoskeletal system Nervous system Cardiovascular system Metabolic system

38 Musculoskeletal system Muscle, tendons, ligaments & joint structures Increase temp of skeletal muscle and connective tissue. Decrease stiffness Increase extensibility Increased muscle efficiency, force generation contraction speed

39 Nervous system Brain, Spinal cord & Peripheral nerves. Increased nerve sensitivity. Nerve Conduction speed.

40 Cardiovascular system Heart, lungs and blood vesicles. Increased heart rate, output & pulse. Increased air to lung exchange Increased supply of O2 and fuel and removal of waste products from muscles.

41 Metabolic system Biochemical reactions Increased core body temp increases enzyme & chemical reaction. Increases O2 transfer at the lungs and transfer of O2 & fuel between blood & muscle. Aerobic & Anaerobic Energy systems, breakdown of food > fuel Hormone release e.g. adrenaline

42 Warm-up Large muscle group activity. Low Moderate Vigorous level. General Sport specific skill mins. Activity which mimics sports movement. Increased heart, respiratory rate and mild sweating.

43 Activities General Sport specific Jogging- forward, backward & to sides Speed, Agility drills Ladder drills Mini hurdles Cones Ball drills Passing Football movement

44 Stretching Muscle Tendon Connective tissue

45 Stretching Static Stretching Holding muscle lengthened position seconds 3-5 time each stretch.

46 Stretching Dynamic stretching Moving muscle through full range when active.

47 Cool Down WHY HOW Aid recovery from activity. Aid removal of waste products. (Lactic acid). Injury prevention mins. Low Mod, activity, large muscle groups. General movements patterns. (Jog) Stretching.

48 Exercise programme Warm-up Endurance training Flexibility training Resistance training Sports specific training Cool-down/ stretching

49 Warm-up and Cool-Down What are the benefits of a warm up? Increased speed of contraction and relaxation of warmed muscles Dynamic exercises reduce muscle stiffness Facilitated oxygen utilisation by warmed muscles because haemoglobin releases oxygen more readily at higher muscle temperatures Facilitated nerve transmission and muscle metabolism at higher temperatures. Increased blood flow through active tissues as local vascular beds dilate, increasing metabolism and muscle temperatures

50 Warm-up and Cool-Down What are the benefits of a cool down? An appropriate cool down will: aid in the dissipation of waste products including lactic acid reduce the potential for DOMS reduce the chances of dizziness or fainting caused by the pooling of venous blood at the extremities reduce the level of adrenaline in the blood

51 Countries

52 WHY DO ATHLETES TAKE DRUGS? Drug Reasons Speed Strength Stamina Skill Dependence Physical Effects Availability Accessibility Legality To feel good People Reasons Anxiety Appearance Lack of Confidence Will to win Beliefs-Attitudes-Values Dependence Environmental Reasons Family and media pressure National Identity Financial and prestige National Sports Policy

53

54 Risks & Nature of Injury in Sport. Management of Sports Injuries. Preparation for Sport Prevention of Injury.

55 Prevention of Injury Medical Screening in Sport Past/current health issues Family history Injury history Training history Medical & musculo-skeletal examination

56 Clinical Medical Examination Height & Weight Cardiovascular BP, pulse, heart sounds, apex Respiratory Auscultation and peak Flow General medical examination ENT Vision Urinalysis

57 Injury History Past or current injuries Time lost from sport training Recurrent injury Previous sports surgery Previous investigations scans, isokinetic or fitness tests

58 Training History Number of sessions Specific training type Recent change? Warm-up/cool-down Next major competition Short & Long-term goals

59 Musculo-skeletal Examination General posture Proprioception & stability Muscular development & muscle bulk Range of motion Flexibility Footwear and gait analysis Specific anatomical examination Impingement Swelling Crepitus Tenderness Function Alignment

60 Primary Prevention at Individual Level Medical Pre-season Screening. Warm up Protective Equipment. Flexibility,strength and proprioception Nutrition Biomechanics and use of orthotics Doping

61 Secondary Prevention at Group Level Rules e.g. helmets in boxing. Agreements e.g. to cancel an event. Information and Education for athletes, coaches and medical team.

62 Tertiary Prevention at Society Level Society planning e.g. bicycle routes Legislation e.g. banning hits to the head in boxing. Investment in Sport

63