Sports Rehabilitation Key to Olympic success Bruce Paton Musculoskeletal Extended Scope Physiotherapist вЂ“ UCLH Outline вЂў Introduction вЂ“ Case study to show why rehab is important вЂў Principles of rehabilitation вЂ“ вЂ“ вЂ“ вЂ“ Tissues and healing Optimally loading tissues and adaptation Aims of rehabilitation Specificity of training per olympic sports вЂў UCLH вЂ“ Musculoskeletal pathways now and in past Introduction вЂў вЂў вЂў вЂў вЂў вЂў Alistair Brownlee 22 yo triathlete Winner of ITU WC series 2009 Feb 2010 вЂ“ Femoral Stress Fracture Physiotherapist- Emma Deakin Return to competition June вЂ“ madrid Winner final race ITU WC series вЂ“ Budapest sat 11 th sept 2010 вЂ“ Times overall time 01:42:26 В» Swim (1500m) 00:17:12 В» Bike (40km) 00:53:54 В» Run (10km) 00:30:00 вЂў How does and athlete get to this level training ? вЂў What does the athlete do if they get injured ? Rehabilitation principles вЂў Rehabilitation Follows many of the same principles of training вЂў training dealing with strengthening normal tissues ( Nb holds true for athletes & normal population) вЂў Rehabilitation involves strengthening injured tissue Tissues and Healing вЂў After injury вЂ“ stages of healing вЂў Body does a lot of our work !! вЂў Thankfully it works to heal itself ! вЂў Tissues have capacity for strengthening with training (Adaptation) вЂ“ They adapt to the loads placed on them вЂ“ Science expanding knowledge Increase intensity session Longer recovery required Increase Frequency Reduced rest tissue weakening TISSUE STRENGTH Adaptation progressive overload = tissue strengthens T IME Tissues and Loading вЂў Different tissues ADAPT and HEAL differently вЂ“ Time scales вЂ“ Recovery times вЂў What is OPTIMAL loading for strengthening tissues ? вЂў Ie how do you pitch the athleteвЂ™s loading correctly вЂў Secret to good rehabilitation вЂ“ вЂ“ вЂ“ вЂ“ вЂ“ Correct PACING OF LOADS/TRAINING Frequency Intensity Duration of loading RECOVERY TIME !! В» Often a difficult factor for olympic athletes В» make me better Yesterday!! Increase intensity session Longer recovery required Increase Frequency Reduced rest tissue weakening TISSUE STRENGTH Adaptation progressive overload = tissue strengthens T IME Aims of Rehab вЂ“ Early вЂў вЂў вЂў вЂў вЂў вЂў Manage Pain Manage inflammation Protection - Brace / tape Normalise movement Muscle Control/ Recruitment Maintain fitness вЂў PSYCHOLOGY Aims of Rehabilitation middle stage вЂў вЂў вЂў вЂў вЂў вЂў вЂў Address Biomechanics Muscle flexibility Restore joint movement Muscle Strength Neurodynamics Proprioception/ Balance Cardiovascular fitness вЂў PSYCHOLOGY Aims of Rehabilitation late stage вЂў M strength Endurance вЂў Speed and power вЂў Impact tolerance / Tissue hardening вЂў Direction change / Pivoting/ Agility вЂў Coordination/ Technique вЂў Control / core stability вЂў Sports Specific work вЂ“ Return to training / sport вЂў Future jt protection and prevention of re injury вЂ“ clear all Contributing Factors вЂў PSYCHOLOGY Specificity вЂў Olympic sports вЂў Paralympic sports вЂў Each has very specific demands вЂў Rehab needs to take into account the demands of the sport вЂў TRx and Tq knowledge Olympic sports Aquatics Handball Archery Hockey Athletics Judo Modern Pentathlon Badminton Rowing Basketball Boxing Canoeing Cycling Equestrian Fencing Football Gymnastics Sailing Shooting Table Tennis Taekwondo Tennis Triathlon Volleyball Weightlifting Wrestling Paralympic sports Archery Rowing Athletics Sailing Boccia Shooting Cycling Equestrian Sitting volleyball Swimming Football 5-a-side Table tennis Football 7-a-side Wheelchair basketball Goalball Wheelchair fencing Judo Powerlifting Wheelchair rugby Wheelchair tennis Contributing factors Extrinsic вЂў Equipment вЂў Surfaces вЂў Footwear вЂў Training schedules вЂ“ Science Intrinsic вЂў Skill Technique / movt pattern вЂў Strength / flexibility вЂў Biomechanics Prevention вЂў Long term thinking вЂў Science contribution MSk Rehabilitation pathways at UCLH вЂў NHS experience Rehabilitation вЂ“ Many units lack facilities and expertise to allow В» High level strengthening В» Paced return to sport вЂ“ Discharge before full return UCLH Strengths вЂў Consultants with sports background вЂ“ Incl SEM consultant вЂў вЂў Strong multidisciplinary communication Gym based pathway вЂ“ Facilities вЂ“ Expertise Diagnosis / Screening пѓІ Prehabilitation пѓІ +/- Surgery пѓІ Rehabilitation вЂ“ Early stage 1:1 вЂ“ Middle stage 1:1 / Gym пѓІ Late stage Gym вЂ“ Return to training вЂ“ Return to sport Rehabilitation at UCLH вЂў Facilities вЂ“ Dept вЂ“ Gyms вЂ“ Hydrotherapy вЂў Systems вЂ“ Gym based rehab systems В» Advanced Gps вЂў 1300 pts since dec05 В» Early stage вЂў 700 pts since feb 07 ) В» Upper / Lower Limb В» Spinal Rehabilitation at UCLH Expertise вЂ“ Long Hx of rehab for high level athletes вЂ“ Physios working with professional sports teams background вЂ“ University teaching links вЂ“ Research studies вЂ“ Inter trust Inservice training Links вЂ“ UCL В» ISEH В» Sports MSc вЂ“ Pct вЂ“ BOA / EIS and External sports groups Rehabilitation Opportunities вЂў Opportunities вЂў Systems вЂў Expertise вЂ“ Volunteering вЂ“ Further training / teaching вЂ“ Research strategy вЂў Links вЂ“ BOA вЂ“ UCL ISEH and sports MSc вЂ“ LOCOG Conclusion вЂў Successful rehabilitation вЂ“ expertise in knowing В» demands of sport В» Behaviour of healing tissues вЂ“ Skills in В» Optimal pacing of rehabilitation and training В» Effective management of contributing factors вЂў Excitement of Games in London вЂ“ Logistics вЂ“ Volunteers ( 70,000 reqd / 40,000 paralympics) вЂў Opportunities for UCLH вЂ“ Strong capabilities вЂ“ Strong links вЂњTo contribute to building a peaceful and better world by educating youth through sport practiced without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play.вЂќ International Olympic Committee, вЂ�Fundamental PrinciplesвЂ™, Olympic Charter "To Enable Paralympic Athletes to Achieve Sporting Excellence and Inspire and Excite the World". International paralympic movement - Vision and Mission statement Thank you for listening Questions ?