lluis til. sports medicine & orthopedics - fcbarcelona; olympic training center (car); consorci...
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Return to sport after hamistring injuryTRANSCRIPT
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
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• 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
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Extrinsic factors in the inciOng event
3. Special cases
• Case 1
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MTJ proximal biceps LH grade 3 ST and SM are also affected in a low grade
3. Special cases
• Case 1
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Proximal tendon is agached Medial common tendon has lost tension
Which is the best therapeuOc opOon???
3. Special cases
• Case 1
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2 PRP aAer haematoma evacuaOon RTP 4 month
3. Special cases
• Case 2
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Footbal player Born 1994
Pseudoarthrosi 2º MTT 2010 Time loss 5 months
3. Special cases
• Case 2
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May 2011 Pop During a match
3. Special cases
• Case 2
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3. Special cases
• Case 2
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June 2011
3. Special cases
• Case 2
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3. Special cases
• Case 2
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3. Special cases
• Case 2
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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
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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
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3. Special cases
• Case 2
3. Special cases
• Case 2
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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
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3. Special cases
• Case 2
17:51 37
Rigth
3. Special cases
• Case 2
17:51 38
LeA
3. Special cases
• Case 2
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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