HIGH PERFORMANCE CENTRE FOR SPORTS RECOVERY

HIGH PERFORMANCE CENTRE FOR SPORTS RECOVERY

EDMONTON BREWERY DISTRICT DOWNTOWN Edmonton s First Boutique Physiotherapy Clinic

WHAT SETS US APART? NO ATHLETE IS TRULY TESTED UNTIL THEY VE STARED INJURY IN THE FACE AND COME OUT ON THE OTHER SIDE STRONGER THAN EVER - ANON

HIGH PERFORMANCE PHYSIOTHERAPY SERVICES STRENGTH AND CONDITIONING RECOVERY SESSIONS COURTSIDE/FIELDSIDE PHYSIO MOVEMENT SCREENING BASELINE PERFORMANCE TESTS SPORT SPECIFIC REHAB

Physiotherapy and the Workplace What is an Injury? How Long Does it take to heal? How do you heal?

Common Injuries in MSK Tissues Soft tissue (ligament, muscle, tendon) Joint Contusion- bruise Dislocation Muscle Strain Subluxation Ligament Sprain Internal Derangement Tendonopathy all encompassing for tendon problems Meniscus Itis- acute Loose body Osis- chronic Labral lesion Bursitis

Bone Fractures Open- breaks the skin Closed does not break skin Comminuted- multiple fractures Avulsion Stress- crack in the bone Pathological underlying disease causing bone to break

The healing response has 3 main phases Inflammatory 1-10 days Proliferative 7-21 days Remodelling 14 days to 1 year 10 days 21 days Months

Inflammatory: Management PRICEMM Protection Rest Ice Compression Elevation Modalities Medication

Proliferative: Management Exercise Low load mobilization and controlled movement Stress on injury to allow for realignment of tissue Goal: smaller scar, better structural organization and capillary growth Nutrition-> balanced diet Pharmacology &/or Modalities Goal: decrease residual oedema and pain General goal: Decrease loss of function Or at least maintain level of function there is a fine line between too much and too little

Remodeling: Management Management: Exercise SAID: Specific Adaptation to Imposed Demand (Wolff s law) Avoid overload Ensure progress Goal: Decrease adhesions Optimize tissue strength by improving quality (composition) and organization

Key injury management principles PRICEMM Nutrition (all stages of healing) Pain control Exercise: controlled, pain free, (a little discomfort is ok) SAID Surgical referral Pharmacology Proteins Fats Glucose Minerals Vitamins Overall importance of a well balanced diet

Healing of Specific Tissues

Healing of Muscle Injury: Fiber disruption usually occurs before connective tissue damage Similar healing process: exception activation of satellite cells (proliferative phase). Satellite cells align along the basal lamina Cells proliferate then differentiate into myoblasts and ultimately fuse into myotubes. Occurs from both sides of injury. Reinforce laterally by adhesions of the myofibers to the extracellular matrix Healing dependent upon the degree of damage (incomplete more common), the vascular and nerve supply to the area, the location (muscle belly vs myotendinous junction).

Management of Muscle Day 1-3 Ice and compression, limit WB for LE Too much too soon may result in excessive scar formation or re-rupture but immobilization will cause an increase in intramuscular connective tissue (adhesions) Controlled mobility (gentle stretching) and activity within pain free range Day 4-10 Flexibility, pain free resisted ex s Modalities may be used prior to mobilizing tissues (e.g. heat, ultrasound) to help with pain, and minimize inflammation Day10+ Strengthening emphasizing endurance then progressing to strength Avoid eccentric contractions until end stage rehabilitation Key principles: SAID, pain as guiding factor

Healing of ligaments Ligaments are less vascular than other tissues (such as muscles) thus take longer to heal Initially type III collagen is present in higher levels but provides stability by forming cross-links Replacement by type I collagen and alignment of fibers can take up to a year. Surgical intervention is often essential if the ends are no longer in contact Extra-articular ligaments (MCL) heal better than intra-articular ligaments (ACL) Isolated ligament injuries are rare, usually presence of secondary less injured ligaments

Management of ligaments Inflammatory (longer if higher grade) PRICEMM Proliferative Immobilization causes rapid deterioration in ligament properties due to atrophy, also causes resorbtion at bony insertion Exercise: Low load cyclic movements Need some stress to promote healthy healing Longitudinal sress Remodeling Strengthening of joint controlling muscles SAID load cyclic movements

Healing of tendons Similar to ligament, also less vascularized Attach to contractile tissue Dependent on site of injury muscle-tendon junction, bone-tendon junction, midsubstance (junction heals more slowly)

Management of tendons Depends on mechanism of injury (overuse vs acute) Acute: PRICEMM, cyclic low threshold loading Chronic/overuse: Inflammation is not the focus, may become acute Exercise Similar exercise principles as muscle although slower progression Eccentric exercises (chronic phase) Address external factors, whole kinetic chain Several modalities have been developed to treat tendinopathy (ultrasound, electrical stimulation, ice) although there is limited/mixed evidence to support them.

Healing of bones

Management of Bones Immobilization (4-6wks) until a stable callus has formed Depends on type and site of fracture and type of immobilization (ORIF vs cast) Unstable fractures can lead to complications Immobilization will affect all types of tissues Gentle ROM exercises can be performed at the proximal and distal joints Progressive ROM and strengthening exercises Progressive WB and loading of the bone will stimulate remodeling

Classification of injuries based on duration Acute (0-7 days) Subacute (7-21 days) Chronic (3 months or greater) Recurrent Eg. Back pain goes away and comes back

Back Injury Prevention

Today at a Glance Facts on the Back Assess your Risk Tips to Prevent Injury Warm Up Program

Facts on the Back

How Common are Back Injuries The Alberta Worker s Compensation Board reported that 20.4% of workplace injuries were back injuries WorkSafeBC reported 25% of workplace injuries were back injuries. Back Injuries All other workplace injuries

Assess your Risk General tips for all workers

What will put you at risk to injury?

Tips to Prevent Injury How to carry your body for prevention

Tips to Prevent Injury Lift properly Stand with good posture Sit with good posture Squat or crouch when working at ground level Shift not twist Take only as much as you can handle Keep workstation at waist height Push loads

Warm Up Program A daily prevention program

Warm Up Program: A Daily Commitment Please see handout provided

Adequate and appropriate recovery can enhance performance Recover Today, Ready Tomorrow HIGH PERFORMANCE AND RECOVERY Why is Recovery PIVOTAL for high performance? Appropriate recovery accelerates the regeneration rate between training and competitions It increases the quality and quantity of training Reduces the risk of developing over training Reduces the risk of injury

PIVOTAL RECOVERY

References 1. www.surehire/ca/statistics 2. www2.workplacebc.com/pdfs/ergonomics/back_brochure_1.pdf 3. https://www.osha.gov/dte/grant_materials/fy06/46g6- ht22/back_injury_prevention.pdf Tissue Healing PTHER 528, Sept 4 2014

QUESTIONS? www.pivotalphysio.com High Performance Centre 201, 11936-104 Ave Edmonton, AB 1.855.5PIVOTAL 1.855.574.8682