active norfolk
TRANSCRIPT
Injury prevention
How to make every session count
www.nwconditioning.com
Neil Welch MSc ASCC• BSc Sports science and physiology
• MSc Strength and conditioning
• S&C coach for the the England alpine ski team
• Work with athletes from multiple sports including rugby, cricket, rowing and triathlon
• Founder of nw conditioning strength and conditioning consultancy
• Run biomechanist at Profeet
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Session overview
• Common injuries and their mechanisms
• Practical - how to screen for these injuries
• Practical - injury prevention strategies
• Using the whole training session
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Learning outcomes
• Learn to identify potential mechanisms of injury in athletes
• Learn what to do to help prevent injury occurrence
• Learn how to implement those strategies into your training sessions
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Common injury types
• Acute impact trauma - not much we can do about impacts, nature of the sport, although better strength and conditioning will mean better ability to concentrate
• Pulled muscles are definitely preventable, need; – Appropriate strength through full range of motion– No bilateral imbalances– Limit agonist antagonist imbalances
• Connective tissue injuries such as tendon/ligament ruptures we can have some say in reduction
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Common injury areas
• Lower leg - achilles
• Shoulder injuries
• Hamstring
• Knee
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Injury prevention or improved performance
• Injury prevention is a conservative approach
• As coaches we are looking to improve our athlete’s performance
• Improved performance goes hand in hand with injury prevention
• Developing strong, mobile and balanced athletes will reduce injuries
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Achilles tendon
• The connective tissue link between the calf muscles and the heel (calcaneous)
• It is the strongest tendon in the human body
• Stores elastic energy while running improving efficiency
• Has been suggested that the limiting factor in human sprinting speed is achilles tendon strength
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Achilles injury mechanisms
• High impact forces force the tendon to dissipate force
• Lack of range of motion about the ankle
• Lack of strength in the muscles of the calf
• Growth spurts can cause a time lag in the change of length of muscles overloading the tendon (known as Sever’s disease)
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Achilles injury prevention
• Increase the strength of the calf muscles
• Ensure appropriate range of motion about the ankle
• Improve shock absorption of the whole system (landing mechanics)
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Shoulder injury mechanisms
• The shoulder girdle is made up of 3 joints and is inherently instable
• This makes it particularly vulnerable in an overhead position
• Common injuries therefore in overhead sports e.g. tennis, cricket, javelin
• Due to imbalance between internal concentric movement and external eccentric movement
• Poor scapula function
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Shoulder injury prevention
• Need to be aware of whole body biomechanics and how they effect range of motion
• Opening the hips improves range of motion and reduces load on the shoulder
• Work on the brakes, ability to slow down the movement is important
• Correct patterning of the scapula is very important
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Hamstring injury
• Most prevalent muscle strain 6-29% of all injuries
• High re-injury risk of 12-31%• Recent research showing injury rates not
improving– Ekstrand et al 2011 looked at injury rates for 7
consecutive seasons– 23 professional European football clubs– Unchanged competitive and training injury rates
• Whatever strategies have been in place haven’t been working
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Hamstring injury links
• Lack of flexibility in hamstrings and hip flexors• Lack of gluteal activation in extending the hip• Weakness of core musculature• Weakness in the hamstrings themselves – 2.5 x bodyweight
per running stride• Chronic fatigue• Previous injury• Research is mixed on the exact causes, mainly because of
isolationist approaches, likely to be a mix of all these
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The knee - ligaments
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• 4 ligaments in the knee
• Collateral ligaments prevent lateral movement
• Cruciate ligaments prevent anterior posterior movement
The knee - musculature
• Significant musculature surrounding the joint
• Imbalance can put altered load on the ligaments
• Lack of strength can increase load on the ligaments
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Causes of ACL injury
• Weakness in musculature about the hips and core
• Particularly vulnerable in a position of knee valgus
• Knee valgus can lead to MCL strain and increase risk of ACL injury
• Usually involves a rapid deceleration of the joint, therefore increased strength is a requirement
• More susceptibility with females
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Female athletes and ACL injury
• More occurrence of ACL injury than males• Due to hormonal, anatomical and neuromuscular
differences• Neuromuscular control deficits: strength, power or activation
patterns• Ligament dominance: imbalance between ligament and
neuromuscular control of knee stability• Quadriceps dominance: imbalance between quads and
hamstrings• Leg dominance: imbalance from leg to leg• Trunk dominance: inability to activate core correctly
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Knee injury prevention
• Ensure adequate hamstring strength
• Work on posture and pelvic alignment
• Correct takeoff and landing mechanics – work on the brakes
• Develop movement and force reduction and production in all 3 planes of motion
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Screening
• Allows progression to be monitored
• Can show the athlete why they need to be doing the exercises/training they have been set
• It can highlight those most at risk and allow the coach to target specific work to those athletes
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Methods of screening: Hop and stop• Measures differences in force production and stability
relative to height
• Gives quantitative information to compare on an ongoing basis
• Is quick and easy to administer
• For details and reminder of protocol see athlete by design
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Methods of screening: Tuck jumps
• Again, quick and easy to administer
• Feet 35cm apart, slight knee bend and jump using an arm swing bringing the knees up to parallel with the floor
• On landing immediately go straight into the next jump continuing for 10 seconds
• The athlete should be encouraged to land softly using a toe to midfoot rocker and keep the same footprint on landing
• The athlete should be instructed to stop if they show a sharp decline in technique
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Methods of prevention
• Now we have an idea of the mechanisms of injury, we can target those areas to help prevent them
• You don’t have to train individual muscles unless to address a specific imbalance or rehab program
• By training the correct movement it makes prevention functional and will improve performance
• These movements will help long term physical preparation
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Get stronger!
• The stronger your athletes, the greater the ability to produce reduce and stabilise force
• Reduction in potential for injury, prevention is better than cure
• Focus on whole body strength not individual muscles
• First strength gains are neuromuscular, you get better at the movements.
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Jumping and landing
• Focus on technique– Maintain correct knee alignment– Landing on forefoot rocking back to mid-foot– Keep the noise down– Brace core
• Progressions:– Increase height– Change direction– Introduce rotation– Single leg
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Activating hip abductors
• To help maintain proper alignment at the knee
• Exercises working against a lateral resistance during uni or bi-lateral exercises– Band squats– Split squats/lunges– Monster walks– Side lying leg raises
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Addressing quad dominance: Hamstrings
• Looking to load the Hamstrings eccentrically
• Number of possible exercises to use– Good mornings– Stiff leg deadlift– Stiff leg deadlift variations
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Calf work
• Calf stretching – straight leg, bent leg and big toe raised
• Calf raises – – slow eccentrics and bounces– Whilst walking
• Plyometric work – ankle hops – Low load short sets of below 10 on each leg
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Addressing leg dominance
• Even out through correct bilateral technique
• Use of single leg exercises– Single leg squats– Split squats– Lunges
• Increase the load on the non-dominant leg
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Core
• Important to use and train core musculature in the correct way
• Pelvic tilt awareness• Use of the abdominal Brace• The big 4!
– Curl ups– Bird dogs– Glute bridges– Side bridges
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Shoulder
• Thoracic mobility
• External rotations
• Wall angels
• Scapula activation
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Athlete education
• Education plays an important role, create the all round athlete
• Help the athlete to understand why they’re doing what they’re doing
• Get the athletes to coach each other, will embed the technique
• Will give greater adherence• Encourage self awareness, the athlete should be able to
feel where they are going right and wrong
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Flexibility
• Calf• Hamstring• Hip flexor• Glute• Quads• 3D stretching
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Making every session count
• Your time with your athletes is valuable, we need to make sure none of it is wasted
• The warm up, it is a substantial percentage of training and contact time
• Need to plan this as much as the technical components of our sessions
• Include jumps, landings, lunges, squats, accelerations and decelerations
• We have to do better than a run around the pitch and some stretching
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Use your down time
• Your athletes will need to rest during a session, especially if it’s high intensity
• Technical sessions often lower in intensity • Possible to plan small exercise blocks into the session
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Get creative
• You can incorporate a lot of these movements into your technical drills
• A jump, a lunge, a hop. These are all useable and the beginning or mid way through a drill.
• Alter your start position• Alter your finish position• Alter the direction of the drill
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Any Questions?
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Thank you for your time
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