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Preventing injuries in winter sports
Emanuel T. Papacostas, MD Sports Orthopaedic Surgeon
Sports Clinic Thessaloniki
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Preventing injuries in sports
Preventing injuries in winter sports
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Sports Vs winter sports
• Equipment
• Extreme weather conditions
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Risk factors
Extrinsic • Technique
• Equipment • Training • Environment
Intrinsic • Sex • Age • Anatomy
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Goals
• Epidemiology • Common injuries • Severe injuries • Causes
• Prevention tips • Specific programs
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Epidemiology
• 3 injuries / 1000 skiers / day
• 1st grade ligament or muscle DEATH
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Sakamoto Y, Sakuraba K AJSM PreView, March 4, 2008
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Sakamoto Y, Sakuraba K AJSM PreView, March 4, 2008
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Sakamoto Y, Sakuraba K AJSM PreView, March 4, 2008
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Competitive snow sports
• NO data published (yet)
• All publications for both competitive and recreational sports
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Hypothesis for competitive winter sports
• More overuse injuries • More muscle & tendon injuries
• Same patterns as in other sports
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Prevention
FOCUS ON • Knee
• Muscles
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Differences in disciplines
• Skiers
• Snowboarders
• Knee • Thumb • Spine
• Knee • Shoulder • Wrist – Elbow • Spine
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Common injuries
• Knee • Thumb • Shoulder
• Fractures
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Knee injuries ACL • 24 – 25000
tears/year in USA • Twisting or landing
from jump
Meniscus Cartilage
Lead to Osteoarthritis Have to be prevented
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Menisci
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Cartilage
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Leading to OA
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Thumb injuries
• Ulnar collateral ligament sprain – tear
• Caused by STRAPS
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Shoulder injuries
• Dislocation • Rotator cuff tear • Fractures • Acromioclavicular injuries
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Fractures
• Tibia • Ankle • Wrist • Clavicle
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SEVERE INJURIES
• Collision on fixed object
• High speed
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Severe injuries
Head & neck • 5 – 10% of all injuries • 16000/year in USA • 7000 could be prevented if helmet was
used
Abdominal/trunk • Snowboard (jumping)
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Concussion
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Causes of injuries
• Aggressive skiing • Equipment problems • Weather conditions
•Conditioning
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Conditioning
• Balance
• Aerobic & anaerobic fitness
• Muscle parameters
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• Regarding ACL injuries, we know that certain situations increase the risk of this injury –
• o Attempting to get up whilst still moving after a fall • o Leaning right back on your skis or attempting to sit down after losing control • o Attempting to recover from an inevitable fall • o Landing after a jump off balance to the rear with the legs straight. • To avoid ACL injuries remember the four golden rules* – • 1. WHEN YOU’RE DOWN, STAY DOWN - Don’t try to get up if you’ve fallen until
you stop • sliding • 2. KEEP YOUR KNEES FLEXED - Don’t fully straighten your legs when you fall -
try and keep • them bent • 3. DON’T LAND ON YOUR HAND – Keep your arms facing upwards and
forwards • 4. LAND WITH YOUR KNEES BENT – Don’t jump unless you know where and
how to land. • Always land on both skis with your knees bent
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http://a1977.g.akamai.net/f/1977/1448/1d/webmd.download.akamai.com/1448/cobrand/aol/Slideshows/skistre
tches/skistretches01.html
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Pre Participation Examination
PPE as a tool for PREVENTION
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Organizing PPE
• No of participants • Place - time • Stations – HELP
HISTORY Vision Anthropometric features ENT – Dental Cardiovascular Respiratory Locomotor system Chest X-ray – blood tests
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Test & maximize performance
SPORT ADJUSTMENT
Detailed examination of motor system Recognize individual anatomy % fat estimation Muscle flexibility – joint ROM
Muscle strength – endurance - symmetry Exercise physiology Field tests
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Detailed examination of motor system
• Knees • Ankles • Hips • Spine • Shoulders
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Recognize individual anatomy
• Varus – Valgus Knees
• Femoral anteversion (in - out toeing)
• Pes cavus – Pes planus
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Muscle flexibility – joint ROM
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Muscle strength – endurance - symmetry
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Exercise physiology
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When PPE???
• Beginning sports • Beginning of season • Change of training level
• 1 month before starting (6-8/52)
• Partial PPE 3 -4 times annually
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Injury Prevention Tips
• Improve conditioning • Check & adjust equipment • Gradual increase of training load (day,
week, month, year) • Rest when tired • Respect nature • Hydrate (not overhydrate) • Use helmet & wrist guards
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PREVENTION Program
• All year long training • Off snow training
• Fitness • Flexibility • Muscle power – endurance - symmetry • Core stability • Propioception
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Flexibility
• Hams • Quads • Gluteal – piriformis • Adductors – ITB • Calf muscles
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Muscle power – endurance - symmetry
• Isometrics Isotonic (endurance) • Concentric eccentric
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Core stability
3 Χ 5΄΄ 3 Χ 10΄΄ …… 3 Χ 30΄΄
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Propioception Day 1: 3 Χ 3΄ Day 2: 2 Χ 5΄ Day 3: 2 Χ 10΄
Stage 1: Both feet & balance with hands Stage 2: Both feet without balance Stage 3: Both feet without balance, ball play Stage 4: One foot & balance with hands Stage 5: One foot without balance Stage 6: One foot without balance, ball play
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Thank you