Sport Injury Prevention Research Centre Janteet kovilla kasvuiassa - Kuormituksen seuranta nuorten palloilulajeissa Kati Pasanen PT PhD Assistant Professor Sport Injury Prevention Research Centre Faculty of Kinesiology, University of Calgary
http://www.ucalgary.ca/knes/
Kinesiology - Areas of Study Injury Prevention, Rehabilitation & Sport Medicine Exercise Physiology Biomechanics Nutrition, Metabolism & Genetics Dance Science Sociocultural Aspects of Sport & Physical Activity Innovation in Pedagogy & Sport Performance Health, Exercise & Sport Psychology Leadership in Coaching & Pedagogy Motor Behaviour & Neural Control of Movement
https://www.ucalgary.ca/siprc/
Surveillance in High Schools to REDuce Injuries
Four Step Sequence of Sport Injury Prevention Research 1. Surveillance (extent of injury problem) 4. Evaluate the effectiveness of intervention 2. Find the risk factors and mechanisms (cause) 3. Develop an intervention (validation) Van Mechelen et al. 1992
Why is Sport Injury Prevention Important?
Injuries in Canada: Insights from the Canadian Community Health Survey 2009-2010 An estimated 4.27 million Canadians aged 12 or older suffered an injury severe enough to limit their usual activities Young people aged 12 to 19 had the highest likelihood of injury (27%) twice as high as all other age groups (13%) 35% of injuries occurred during participation in sport and exercise 66% of injuries among young people (aged 12 to 19), 29% of injuries among working-age adults, and 9% of injuries among seniors were related to sports
Injuries in Youth Sport and Recreation S&R participation is the leading cause of injury in youth 1 in every 3 youth (aged 11-18) in Canada seek medical attention for a sport-related injury every year Lower extremity injuries are the most prevalent across all sport (60%) 60% knee and ankle joint injuries Highest burden hockey (10%), basketball (10%), soccer (10%) Emery et al. 2006; Emery et al. 2009
Consequences of Youth Sport Injuries Participation in S&R School attendance Physical activity Overweight/obesity Osteoarthritis (ankle&knee joint injuries) Psychosocial consequences Health care and indirect costs are high Whittaker et al. 2015; Toomey et al. 2017; Clement et al. 2015
Levels of Prevention Primary Prevention Secondary Prevention Tertiary Prevention Primary prevention is concerned with preventing the onset of injury/disease it aims to reduce the incidence of injury/disease. It involves interventions that are applied before there is any evidence of injury/disease. Reduce occurrence Secondary prevention is concerned with detecting injury/disease in its earliest stages, and interventing to slow or stop its progression. Early diagnosis Tertiary prevention refers to interventions designed to arrest the progress of an established injury/disease and to control its negative consequences. Minimize consequences
Why are so Many of Our Young Athletes Getting Injured?
Peak Height Velocity http://athleticperformanceacademy.co.uk/2017/04/peak-height-velocity-maturity-estimation-calculation/
Training Load Training load is an important modifiable risk factor for both acute and overuse injuries Insufficient training load / spikes in training load / high training load / insufficient recovery may lead to a training imbalance therefore increasing injury risk Structure-specific training load (Windt J & Gabbet 2016; Oestergaard et al. 2017)
Gabbett Br J Sports Med 2016;50:273-280 Relationship between training load and injury rate in team sport athletes.
Early Specialization and Training Volume Neeru Jayanthi et al. 2016
Definition of early sports specialization 1. Participation in intensive training/or competition in organized sports greater than 8 months per year 2. Participation in 1 sport to the exclusion of participation in other sports 3. Involving prepubertal (seventh grade or roughly age 12 years) children
Sport Specialization and LE Injuries Sport specialization scale three questions: Have you quit another sport to focus on your primary sport? Do you consider your primary sport more important than your other sports? Do you train more than 8 months a year in your primary sport? Athletes are classified as Low (score = 0-1) Moderate (score = 2), or High (score = 3) specialization. McGuine et al. 2017
Tendon Injuries in Young Athletes
Injuries in Young Athletes There are physical and physiological differences between the young athlete and the adult athlete that can cause children to be more vulnerable to injury, such as Children have larger heads compared to their bodies Children may be too small for protective equipment Children may not have complex motor skills needed for certain sports Children have open physes (growth plates) Adirim & Cheng 2003
Physeal Injuries The epiphysis is the end of a long bone the physis in a long bone is called the epiphyseal growth plate (ossification centre) These are weaker areas and therefore prone to injury Epiphysitis is a compression or shear injury Injury to the epiphyses and their associated growth plates may result in growth disturbance (e.g. length discrepancy, altered joint mechanisms) The apophysis is the growth cartilage site where a tendon inserts on the growing bone apophyseal growth plate (ossification centre) Tendon is stronger than apophyseal growth plate Apophysitis is a traction injury Injury to the apophyses is due to chronic traction of a tendon at its insertion -> resulting in microtraumas (microavulsions) Maffulli & Bruns 2000; Maffulli et al. 2010
Apophysitis Painful inflammation of the apophysis The growth plate is made up of cartilage, which is softer than bone Calcaneal Apophysis (Sever s Disease) Achilles tendon insertion Ages 7-13 5 th Metatarsal (Iselin s Disease) Peroneus Brevis tendon insertion Ages 9-14 Tibial Tubercle (Osgood Schlatter s Disease) Patellar Tendon Ages 10-14 Bottom of Patella (Sinding Larsen Johansson s Disease) Patellar Tendon Ages 10-16
Pelvic Apophyseal Growth Plates Moller 2003
Treatment of Apophysitis Causes and risk factors Apophysitis is caused by repetitive overuse activities (but can happen with an acute injury as well) Risk factors Traction load Rapid growth Inflexibility Single sport specialization Treatment Activity/load modification Icing Physiotherapy to improve flexibility, strength and lower limb alignment
Tendinopathy Tendon: dense and highly structured connective tissue Tendinopathy: umbrella term for tendon/paratendon injury or disorder Patellar Tendinopathy and Achilles Tendinopathy common disorders in sports
Tendinopathy Tendon: Very tough and strong but prone to injury when overloaded over time
Prevention of Patellar and Achilles Tendinopathies in Youth Basketball (2016 2018) Purpose To identify risk factors for patellar and Achilles tendinopathies in youth basketball players (12-18 years) Including basketball specialization and workload Daily jump load (wearable devices), session RPE, training and playing hours Develop and evaluate the implementation and effectiveness of a basketballspecific neuromuscular training (NMT) program on all injuries
Injuries in Youth Basketball Injury risk in youth basketball is high 30 injuries / 100 players / season 60-80 % of injuries affect the lower limb Ankle and knee ligament injuries Knee overuse injuries Meeuwisse et al, 2003; Emery et al, 2006, 2007, 2009; Owoeye et al, 2012; Visnes et al 2012; Pasanen et al. 2017
Overuse Knee Injury Extrinsic Risk Factors e Knee Injuries Known Risk Factors Playing level Sport Training volume and pattern Jump Frequency Intrinsic Risk Factors Sex Age Previous injury Flexibility Landing biomechanics Body Composition Dynamic balance Strength http://www.hightechphysio.com/knee-pain/ Meeuwisse et al, 2003; Emery et al, 2006, 2007, 2009; Owoeye et al, 2012; Clarsen et al, 2014; Gabbett 2016, Manzi et al 2012; Visnes et al 2012; Bhar et al 2014; Leppanen et al. 2017
Measures of Training Load External Training Load Internal Jump Load Distance Travelled Accelerations & decelerations # of Sessions (games/practices) Fatigue INJURY Heart Rate srpe Psychological Stressors
Data Collection Pre-season Testing Baseline Testing Leg Power (Vertical Jump Height) Joint biomechanics Dynamic Balance Aerobic capacity: Predicted VO 2max Baseline Questionnaire (risk factors) Previous injury Training history
Data Collection In-Season Monitoring Training Load (exposures) RPE (CR-10 modified Borg, Foster et al, 2001) Participation Training and jump loads: IMU devices & ipad Injury (outcomes) Oslo Sports Trauma Research Center Overuse injury questionnaire Injury Report forms: Time loss or medical attention
Absolute Cumulative Acute (7 days total) Chronic (4 weeks total) Relative % weekly change Acute:chronic workload ratio (ACWR) Acute (7 days) Chronic (4 weeks average) Estimating Workload 500 jumps 500 jumps ACWR = = 1. 0 Low risk VS 500 jumps Acute: Chronic Workload Ratio(ACWR) = 300 jumps Acute = 1. Workload 6 = Danger Chronic Workload Hulin et al, 2014, Gabbett, 2016
VERT 96.9% Sensitivity 100% Specificity Grewal et al, 2017
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SHRED Injuries 10 min Warm-up