In Motion - Rehab & Performance

Injuries are most likely to occur when the demand of the training or sport exceeds the capacity of the athlete.
The best way to reduce injury is to increase capacity.

• Weightlifting for Sports Performance •
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Weightlifting exercises produce the greatest power outputs compared to other types of exercise.
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Weightlifting movements are unique in that they exploit both the force and velocity aspects of power output by moving moderate-heavy loads with ballistic intent, research suggest that weightlifting movements and their derivatives may provide superior training effects compared to other methods.
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These findings are attributed to two primary reasons, movement specificity and the overload that the athlete can be subjected to.
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The most common movement in sports is the coordinated extension of hip, knee and ankle joints (plantar flexion), termed triple extension. Jumping, sprinting, change of direction tasks require the concrete of the triple extension movement.
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A similar coordinated triple extension movement takes place during the second pull phase of weightlifting movements, which allows these movements to transfer to sport performance.
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It should come as no surprise that better performance of weightlifting movements is related to better performance in certain tasks (e.g., sprinting and jumping).
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A simple strenghening strategy for patellofemoral pain ‘Work down the leg’. Strengthening the hip & trunk can reduce pain to facilitate exercises to target the knee. The foot & ankle is often neglected in PFP but manages a lot of load in function & should be considered in rehab.

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Whitout this baseline development of force-generating capacities, as well as the morphological and neural adaptations that are produced by resistance the athlete will not be able to generate high levels of powers.

𝐏𝐚𝐢𝐧 𝐑𝐞𝐡𝐚𝐛𝐢𝐥𝐢𝐭𝐚𝐭𝐢𝐨𝐧
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📕BACKGROUND & AIMS:
Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.
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📗METHODS:
A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base.
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📘RESULTS:
Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.
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📙CONCLUSION:
This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
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📚Babatunde OO et al. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017.

Do stronger and faster athletes have a reduced risk of injury?

The answer is easy...

When the base foundations are integrated the strength training is a game changer in injury prevention.

STRENGTH + HIGH VOLUME SPORTS TRAINING = RESILIENT ATHLETES

training is the platform in which you can build other physical capacities (power, speed, agility, fitness). AFL players don’t necessarily need to be powerlifters but having a good strength to weight ratio is extremely important if they want to play their best footy and stay away from the injury bug.

The second part to this is also very very important, the more quality training sessions these athletes complete the more resilient they become.

Rehab progression...
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Full article on page: 📝http://blogs.bmj.com/bjsm/2013/07/23/tendinopathy-rehab-progression-part-1/
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“Each component of the rehabilitation programme, in particular loading, must be manipulated in relation to the nature, speed and magnitude of the forces applied to the muscle/tendon/bone unit in order to achieve the goals of the particular management phase without causing an exacerbation of the pathological state or pain.”
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, Rehab progression...
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Full article on page: 📚 http://blogs.bmj.com/bjsm/2013/07/23/tendinopathy-rehab-progression-part-1/ ➡
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“Each component of the rehabilitation programme, in particular loading, must be manipulated in relation to the nature, speed and magnitude of the forces applied to the muscle/tendon/bone unit in order to achieve the goals of the particular management phase without causing an exacerbation of the pathological state or pain.”
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Maximum concentric strength in an exercise (the one repetition-maximum or 1RM) can increase in four ways (technique, intermuscular coordination, voluntary activation, and changes in muscle-tendon unit properties). Yet, only two of these ways (voluntary activation, and changes in muscle-tendon unit properties) can contribute to increased sports performance.

Alongside the differences in the mechanisms that determine maximum concentric strength and high-velocity strength, this framework helps explain why increasing 1RM may not always transfer as well to sporting movement as we might expect, even though the ability to produce force (under varying conditions) is the primary determinant of sporting performance.

Read more here: http://ow.ly/bSNo30iJYhu

Increase Your Step Rate to Decrease Knee and Hip Joint Loading
[knee pain solution]
Got a cranky knee that bugs you when you run? Try decreasing your step rate (how fast your move your feet) to take pressure off that knee!
While not a solution for faulty mechanics, weakness, or muscle length issues, changing your step rate on your runs is an effective and fast way to decrease the load on your knees and hips, potentially even reducing your pain. A study in 2011 by Heiderscheit et al found that by increasing your step rate by 10% (at a consistent speed), it significantly lowered the amount of mechanical energy absorbed at the knee (a 34% decrease!!) and hip! Even a 5% increase in step rate decreased load at the knee by 20%!
This happens because as step rate increases, the step length is shorter. Think about it, if you are moving your feet faster, but staying at the same speed, then the amount of distance you cover per step (step length) has to decrease. Because the step length decreases, it means that your heel is closer to your center of mass and the amount of force (braking impulse) you must absorb from the ground is reduced.
Common Questions:
❓Does increasing my step rate 10% mean I will have to work harder/breathe harder❓
NO. Greater oxygen consumption is required when step rate is increased by more than 10% of preferred, while increases less than or equal to 10% of preferred reveal minimal change in metabolic cost.
❓If I run at a faster rate than normal with an increased step rate, will I still have less loading on my joints❓
NO. The decrease in energy absorption is due to the decrease in step length, not necessarily the rate.
Citation: Heiderscheit 2011 Med Sci Sports Exerc.

Increase Your Step Rate to Decrease Knee and Hip Joint Loading
[knee pain solution]
Got a cranky knee that bugs you when you run? Try decreasing your step rate (how fast your move your feet) to take pressure off that knee!
While not a solution for faulty mechanics, weakness, or muscle length issues, changing your step rate on your runs is an effective and fast way to decrease the load on your knees and hips, potentially even reducing your pain. A study in 2011 by Heiderscheit et al found that by increasing your step rate by 10% (at a consistent speed), it significantly lowered the amount of mechanical energy absorbed at the knee (a 34% decrease!!) and hip! Even a 5% increase in step rate decreased load at the knee by 20%!
This happens because as step rate increases, the step length is shorter. Think about it, if you are moving your feet faster, but staying at the same speed, then the amount of distance you cover per step (step length) has to decrease. Because the step length decreases, it means that your heel is closer to your center of mass and the amount of force (braking impulse) you must absorb from the ground is reduced.
Common Questions:
❓Does increasing my step rate 10% mean I will have to work harder/breathe harder❓
NO. Greater oxygen consumption is required when step rate is increased by more than 10% of preferred, while increases less than or equal to 10% of preferred reveal minimal change in metabolic cost.
❓If I run at a faster rate than normal with an increased step rate, will I still have less loading on my joints❓
NO. The decrease in energy absorption is due to the decrease in step length, not necessarily the rate.
Citation: Heiderscheit 2011 Med Sci Sports Exerc.

About

The is a key component in building an base. Many common misconceptions of how to activate the core can lead to wasted time and possible injury. Targeting specific muscle groups effectively can build core endurance, increase strength, and reduce injury.

A majority of athletes describe core exercises as “doing crunches or sit-ups.” While these exercises do activate muscles in the core, they are not necessarily core exercises.

The core can be considered the surrounding muscles that support your spine, provide stability, and help generate power during athletic movements. They consist of not just a specific muscle group, but a multitude of muscles that work together to provide optimal support and function.

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- 4 weeks reconstruction.

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Whitout this baseline development of force-generating capacities, as well as the morphological and neural adaptations that are produced by resistance , the athlete will not be able to generate high levels of powers.

seems be effective as for Rotator Cuff related (5 years follow-ups).

What’s the future of Sports Medicine?
Repost from:
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It’s easy to lose the focus on the essential when we start dreaming about genetic manipulation, biological treatments and tissue engineering solutions. Those are amazing areas of a new generation of treatment approaches and we should keep our eyes on them but we cannot let them to take our attention off the essential: PREVENTION.
What’s better than finding the cure for a disease? It’s to find a vaccine to prevent it. In sports medicine we should think the same way.
Injuries occur due to intrinsic and extrinsic factors and there are many known and for sure many others to be discovered.
Looking to our injury risk pyramid it’s easy to understand that: ⚠️Regarding the intrinsic factors, we can only influence the modifiable ones, and we can also agree that most of them can be addressed through a proper individualized long-term athletic development program (LTAD). We also know that the earlier we start the program the more impact it will have in the athletes’ career.
⚠️Extrinsic factors are crucial, specially training methodology/load management which represents the foundation of the pyramid.
For the future, Sports Medicine scientists should focus on:
⚠️Early development of strategies to build up more resilient athletes (LTAD)
⚠️Development of the areas of knowledge around the concept of “optimal load”. Improve accuracy of load (internal and external) measurement tools and upgrade our understanding of the impact of load in our different body systems.

Don’t destroy young talent, test your athletes properly before returning them to sports!
This study found that not meeting six clinical discharge criteria before return to sport was associated with a four times greater risk of rupture
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Meeting six specific objective discharge criteria before return to sport after ACL reconstruction rehabilitation was associated with approximately one-quarter the risk of ACL graft rupture.
For every 10% decrease in the hamstring to quadriceps strength ratio there was a 10.6 times higher risk of sustaining an ACL graft rupture .

About

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▪️Reports of low back pain vs age follow a bell curve when graphically represented. The prevalence of back pain increases as we get toward mid age, and then it slowly decreases as we get older.
▪️Arthritis follows a linear progression. The prevalence of arthritis is relatively low in our 20’s, but will gradually increase over time.
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▪️What this means?
The correlation between arthritis and low back pain is poor. You can present with no back pain and that shows moderate-severe arthritis; or you can present with severe back pain and imaging with no arthritis.
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▪️Can you have back pain and arthritis? Yes. It is important to understand arthritis is normal. It can be a contributor to you back pain, but it is only one piece of the puzzle.
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📚 Videman T et al. Associations between back pain history and lumbar MRI findings. 2003. Spine. 28:582-588

D O M S:

DELAYED ONSET MUSCLE SORENESS (DOMS) is something everyone reading this has probably experienced. Some feel their heaviest DOMS 24 hours after a workout, whereas others know they pay the most for their leg days 2 days later. Both are normal responses to exercise.
What is DOMS? DOMS is perceived as a dull, aching pain in the affected muscle, often combined with tenderness and stiffness. The pain is typically felt only when the muscle is stretched, contracted or put under pressure, not when it is at rest. This tenderness, a characteristic symptom of DOMS, is also referred to as "muscular mechanical hyperalgesia.” There are other working theories behind DOMS that attempt to explain the mechanism at a cellular level. Most deal with the presence of histamines, inflammation, prostaglandins, and other cellular markers of pain.
What causes DOMS? Although the mechanism is not completely understood, the pain is thought to be a result of contractile tissue microtrauma- mechanical damage to the muscle on a very small scale. DOMS is increased with eccentric exercise, as this is thought to create more microtrauma to the muscle. On the contrary, DOMS can be controlled by emphasizing concentric-only exercise for applications like training for in-season athletes.
What doesn’t cause DOMS? It’s not Lactic Acid. Lactic Acid is a byproduct of cellular metabolism and it typically clears within 1 hour of exercise. The best work out does not cause the most DOMS either. DOMS is a result of exposure to new movement and new range of motion. It decreases with repeated efforts of the same workout: This specific adaptation to imposed demands is the cornerstone of a sound training program.
How do I help DOMS? There are many anecdotal and bioscience ways to combat or reduce DOMS, including temperature manipulation, stretching, myofascial work, etc. The best researched method to improve DOMS is simple light cardio. If your legs are toast after a workout, don’t let that stop you from exercising again. It’s OK to exercise when you’re sore, just understand you might be limited and make sure to get a good warm-up.

50 % of hamstring re-injuries occured within 25 days after return to sport. 79 % of them were in the same muscle = same location.

Delayed or inadequate rehab? Too early return to sport? Load management?
https://www.ncbi.nlm.nih.gov/pubmed/27184543

Encouraging young athletes to get optimal amounts of sleep may help protect them against athletic injuries. 😴😴😴 Many should prioritise this over recovery drinks, stretching, ice baths, foam rolling and other popular remedies. Sleep is often an untapped resource to optimise recovery. And it’s 🆓. 📝Study:
http://journals.lww.com/pedorthopaedics/Abstract/2014/03000/Chronic_Lack_of_Sleep_is_Associated_With_Increased.1.aspx

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▪️INTEGRATED APPROACH▪️
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In this age of performance coaching, the separation between the therapist and the coach needs to be abandoned. An integrated approach is key, you can't hope to know everything, but don't be ignorant to think an S&C coach doesn't need to know clinical based skills and reasoning, by the same token a therapist needs to know how to apply strength & power methods.
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An athletes career is spent going between the two worlds, this should consist of smooth transitions, not competing agendas.

In Motion - Rehab & Performance updated their address.

Encouraging young athletes to get optimal amounts of sleep may help protect them against athletic injuries. 😴😴😴 Many should prioritise this over recovery drinks, stretching, ice baths, foam rolling and other popular remedies. Sleep is often an untapped resource to optimise recovery. And it’s 🆓.

📝Study:
http://journals.lww.com/pedorthopaedics/Abstract/2014/03000/Chronic_Lack_of_Sleep_is_Associated_With_Increased.1.aspx

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Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions Coronary artery disease pathogenesis and treatment urgently requires a paradigm shift. Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong. A landmark systematic review and meta-analysis of observational studies showe...