lluis til. sports medicine & orthopedics - fcbarcelona; olympic training center (car); consorci...

Lluís  Til    Sports  Medicine  &  Orthopedics  FCBarcelona  

Olympic  Training  Center  (CAR)  Consorci  Sanitari  de  Terrassa  (CST)  

Return  to  sport  aAer  hamstring  injury  

1.  Why  are  so  important  the  hamstrings  injuries?  

2.  What  can  we  do  for  them?  

3.  Special  cases      

1.  Why  are  so  important  the  hamstrings  injuries?  

Personal  cost  

Injury  rate  

Severity  of  injury  

Reinjury  risk  

CompeOOon    

1.  Why  are  so  important  the  hamstrings  injuries?  

1.  Why  are  so  important  the  hamstrings  injuries?  

Personal  cost  Injury  rate  Severity  of  injury  Reinjury  risk  CompeOOon        

1.  Why  are  so  important  the  hamstrings  injuries?  

Personal  cost  Injury  rate  Severity  of  injury  Reinjury  risk  CompeOOon        

1.  Why  are  so  important  the  hamstrings  injuries?  

Personal  cost  Injury  rate  Severity  of  injury  Reinjury  risk  CompeOOon    

0,18  

0,64  

0,17  0,13  

0,25  

Basquetball   Football   Football  cademy  FUTSAL  (indoor  Football)  

Handball  

Muscle  Injuries  Incidence  6  seasons  

2479  sport  injuries  

others  

muscle  

44975  days  9me  loss  

muscle  

others  

Ome  loss:  12,9  d/  injury  (1-­‐152)  

Ome  loss:  18,1  d/  injury  (1-­‐637)    

1.  Why  are  so  important  the  hamstrings  injuries?  

Days  Ome  loss  4683  Average  Ome  loss  17,5(SD  18,1)    Minim  days  1-­‐  Maxim  days  139  

Personal  cost  Injury  rate  Severity  of  injury  Reinjury  risk  CompeOOon    

1.  Why  are  so  important  the  hamstrings  injuries?  

Injury  rate  Severity  of  injury  Reinjury  risk  Personal  cost  CompeOOon         71  

84  

108  

4  

Adductor   Cuadriceps   Hamstring   Unspecified  

267  Muscle  Injuries  Thigh  Football  6seasons  

1.  Why  are  so  important  the  hamstrings  injuries?  

Injury  rate  Severity  of  injury  Reinjury  risk  Personal  cost  CompeOOon        

1.  Why  are  so  important  the  hamstrings  injuries?  

Injury  rate  Severity  of  injury  Reinjury  risk  Personal  cost  CompeOOon        

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

17:51   16  

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

17:51   17  

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

17:51   18  

2.  What  can  we  do  for  them?  

• Classical  approach  • Common  sense  

• 1st  FCB  muscle  injury  clinical  guide    

• Applying  limited  evidence    

17:51   19  

The   goal   of   preven9on   programs   should   be   to   prepare   athletes   to  support  the  stress  required  for  each  sport    •  As  faOgue  decreases  the  muscle's  ability  to  absorb  tension,  the  system  should  

improve  this  aspect  (increased  intensity  aerobic  interval  training)  •  Stretching  in  different    trunk  flexion  posiOons  •  Improve  mental  funcOon  and  pelvis  •  The   neuromuscular   control   of   the   movements   of   pelvic   Olt   and   lumbar  

improved  high-­‐speed  movements.    core  stability    •  Work  to  decrease    the  neural  tension  and  pain  in  the  posterior  thigh  •  Sport  specific  training    

3.  Special  cases    

• Case  1    

17:51   20  

• Long  jumper  

• Male  23  yo  

• Spanish  winter  championship  

• LeA  side  MTJ  distal  semimembranous  grade  2  

• PRP    

3.  Special  cases    

• Case  1  • Same  championship  

• Female  18  yo    triple  jumper  

• Same  injury  mechanism  

• Right  side  

17:51   21  

Extrinsic  factors  in  the  inciOng  event  

3.  Special  cases    

• Case  1    

17:51   22  

MTJ  proximal  biceps  LH  grade  3  ST  and  SM  are  also  affected  in  a  low  grade  

3.  Special  cases    

• Case  1    

17:51   23  

Proximal  tendon  is  agached  Medial  common  tendon  has  lost  tension  

Which  is  the  best  therapeuOc  opOon???  

3.  Special  cases    

• Case  1    

17:51   24  

2  PRP  aAer  haematoma  evacuaOon  RTP  4  month  

3.  Special  cases    

• Case  2  

17:51   25  

Footbal  player    Born  1994  

Pseudoarthrosi  2º  MTT  2010  Time  loss  5  months    

3.  Special  cases    

• Case  2  

17:51   26  

May  2011    Pop  During  a  match      

3.  Special  cases    

• Case  2  

17:51   27  

3.  Special  cases    

• Case  2  

17:51   28  

June  2011  

3.  Special  cases    

• Case  2  

17:51   29  

3.  Special  cases    

• Case  2  

17:51   30  

3.  Special  cases    

• Case  2  

17:51   31  

September  2011:    4  months  post  injury    No  pain  Deformity  in  posterior  right  thigh  The  player  was  worried  because  the  coach  didn’t  call  him  to  play  The  coach  said:  “  he  isn´t  as  fast  as  before,  he  needs  to  train  a  lot  in  speed  skills”  

3.  Special  cases    

• Case  2  

17:51   32  

September  2011:    

Atrophy  Biceps  femoris  (long  head)    EMG:      the  Obial  and  peroneal  nerve  aren’t  affected  IsokineOc  test:    deficit  flexors  in  all  speeds  testd  37%-­‐  53%    Diagnosis:    • SelecOve  denervaOon  of  LH  BF  (  (terminal  branches)  • The    asynchronous  movement  between  BF-­‐ST  and  SM  could  have  injured  the  terminal  branches  by  shearing  • Good  prognosis  in  6  to  24  months      

3.  Special  cases    

• Case  2  

17:51   33  

17:51   34  

3.  Special  cases    

• Case  2  

3.  Special  cases    

• Case  2  

17:51   35  

Hamstrings  Strength    electroesOmulaOn    isokineOcs    in  several  posiOons  and  methods  

 Specific  football  training    Core  stability    The  coach  called  him  to  play  at  november  2011  ,  but  the  isokineOc  parameters  have  been  recovered  october  2013      

3.  Special  cases    

• Case  2  

17:51   36  

3.  Special  cases    

• Case  2  

17:51   37  

Rigth  

3.  Special  cases    

• Case  2  

17:51   38  

LeA  

3.  Special  cases    

• Case  2  

17:51   39  

promig  

3.  Special  cases    

17:51   40  

• Case  2  

240  cc  esq-­‐dreta  

Follow  up  28  m  (  no  injuries)  

Bilateral  extensors  strength  is  constant    

The  right  flexors  strength  has  been  growing  in  every  test  

Now  he  is  simetric  in  all  parameters  

This  process  could  be  a  reinjury  risk  factor  in  other  injured  players  

Lluís  Til    Sports  Medicine  &  Orthopedics  FCBarcelona  

Olympic  Training  Center  (CAR)  Consorci  Sanitari  de  Terrassa  (CST)  

Return  to  sport  aAer  hamstring  injury