Sports Physiotherapy

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Sports Physiotherapy
Seminar Presentation
Chan Hon Yan 99060146D Chan Man Leung
Sunny 99946540D Choi Chor Kei Leo 99199765D Fung
Mo Ching Ivy 99023277D
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Topic 2

• Mary, a 21 years old University student, belongs
  to Hong Kong Basketball Team.
• She twisted her (L) knee while landing from a
  rebound during competition 3 months ago.
• Her doctor informed her that she had suffered
  from a grade II ACL injury, and recommended Mary
  to have intensive rehabilitation with special
  emphasis on functional training.

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Outline of Presentation
Sports Skill
Gender
Pathology
Psychology
Rehabilitation Program
Return to Sports
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Introduction

• In a 5 year study, knee injuries accounted for
  15 of total basketball injuries in National
  Collegiate Athletic Association (NCAA).
• Almost 20 of the knee structure injuries are ACL
  injury.
• The ACL injury rate in women was 4.1 times
  greater in basketball.
• (Arendt Dick, 1995)

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Injury mechanism

• Non-contact
• planting cutting
• straight-knee landing
• one-step landing with
• the knee hyperextended
• pivoting sudden deceleration

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Effects on Structures after ACL injury

• Static stabilizer
• Medial menisci --- increase cross sectional area
  and volume, thickening at its attachment
• Posterior capsule --- thickening (Jackson et al.,
  1999)
• Decrease Bone Mineral Density (BMD) in the
  periarticular cancellous bone of femur and tibia
  (Boyd et al., 2000).

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Effects on Structures after ACL injury

• Dynamic stabilizer
• Hamstrings
• Quad
• Gastrocnemius

Increase demand
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Non-copers vs Copers

• Non-copers
• had instability with activities of daily living.
  
• They stiffened their knees by landing in less
  flexion and accepting weight with less flexion in
  both walking and jogging.
• May lead to excessive joint contact forces which
  have potential to damage articular structure.
  (Rudloph et al., 1998)
• ? cannot return to previous performance

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Non-copers vs Copers

• Copers
• return to all pre-injury activity without
  limitation.
• Copers demonstrated increased hamstrings EMG, may
  be a compensation mechanism.
• (Tibone Antich, 1993 and Boerboom et al.,
  2001)
• It has been suggested that Quadriceps and
  Gastrocnemius are also important for compensatory
  dynamic knee stabilization. (Nyland et al., 1997
  and Kivist Gillquist, 2001)

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Why are women more susceptible?

• Intrinsic factors (Huston LJ. et al, 2000)
• Q-angle
• femoral notch
• joint laxity
• hormonal influence - need more research to prove

irreversible
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Why are women more susceptible?

• Extrinsic factors
• Proprioception
• muscle strength
• neuromuscular control
• knee stiffness

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Risk Factors

• Proprioception (Rozzi SL. et al, 1999)
• Female took longer than male to detect joint
  motion moving in the direction of knee joint
  extension
• May be less sensitive to potentially damaging
  force

Increase risk for ligament injury
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Risk Factors

• Muscle strength (Huston LJ. Wojtys EM. 1996)
• Female athletes has weaker knee extension
  flexion strength than male

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Risk Factors

• Neuromuscular control
• Muscle recruitment pattern response to anterior
  tibial translation (Huston LJ. Wojtys EM. 1996)
• Female athlete quad-dominant
• Male athlete, men and female control subjects
  hamstrings-dominant

quad-dominate pattern more strain on the
ACL than cocontraction or contract the hamstrings
first
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Risk Factors

• Knee stiffness
• Important component to knee stability and injury
  prevention
• Mm increase the joint contact force decrease
  tibiofemoral displacement, dissipating
  potentially dangerous loads, lowering the force
  carried by the ACL and other passive structure

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Risk Factors

• Knee stiffness
• Valgus Varus stiffness (Brant JT. Cooke
  TD.,1988)
• knees in female rotate 66 more than males
  35 less stiff
• Ability to voluntarily stiffen the knee
• (Wojtys EM et al, 1999)
• Men 4 times
• Women 2 times

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Basic Skill in basketball

• Running
• Cutting
• Pivoting
• Rebounding
• Shooting
• (adapted from R J Emerson 1993)

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Running

• Change of speed and direction
• To get away from opponents
• To guard the route of offending opponent
• require slide-steps, backward steps
• Sudden deceleration stopping prior to change of
  direction
• ? knee almost fully extended twisted

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Cutting

• Use of technique such as fake, stops and pivot to
  get away from opponent
• Cutting method
• Side-step Cut
• Cross-over Cut
• Require sudden change of
• Speed
• Direction

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Pivoting

• Use of technique getting away from opponent by
  moving body and step one or more steps on one
  foot while keeping the other stationary

?
Produce tibia torsion to knee
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Points to consider in return to sport

• Position
• Habits in
• performing skills

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Position

• Center
• Perform much pivoting under net for scoring
• Require more strength in jumping
• Many collision and body contact under net
• Need more proprioceptive training for balance
  during landing
• May consider any uses of brace to prevent
  re-injury

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Position

• Wing Guard
• Perform many high speed cutting
• and shooting with 2-steps stop
• Perform much dribbling
  
  
  
  
• Abilities required
• High power in initiating movement
• High agility with sudden change of cutting
  direction or pace
• need to ? stabilization of knee agility

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Habit in Skills

• Kirkendall DT et al (2000)
• Cutting maneuver with less knee hip flexion
  with knee valgus
• ? Higher injury rate of ACL
• training to perform cutting with knee ? flexion
• ? ACL injury reduced by 89

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Psychological Support

• Explain to player
• nature and severity of the injury
• prognosis for recovery
• recommended courses of therapy
• estimate time frame of rehabilitation
• Reassurance and support
• Peer support

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Visual-Motor Behaviour Rehearsal (VMBR)

• Rehearse an entire performance
• e.g. Landing with proper foot placement
• Review and correct a specific performance
• e.g. Remind herself the wrong habit in sport
• Practice approaching the crowd or competition
  with confidence

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Goals of rehabilitation

• Gender aspect
• To minimize possible risk factors for recurrence
  of ACL injury in female basketball player
• Sports aspect
• To restore physical capacity in competing in
  basketball games
• Psychological aspect
• To overcome fear associated with the injury
  movement

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Functional Training

• Perturbation training
• Plyometric training
• Agility training
• Sport-specific training

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Perturbation Training

• Techniques involving perturbation of support
  surfaces
• roller board
• tilt board
• roller board stationary platform
• Induce compensatory muscle activity

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Advantages of Perturbation Training

• Fitzgerald et al., 2000
• Enhance the probability of successful return to
  high-level physical activity
• perturbation group with greater long-term success
• Improve knee stability
• reduce the risk of continued episodes of giving
  way of knee during athletic participation

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Plyometric Training

• Neuromuscular training
• Develop power, strength coordination
• involve a prestretching of muscle ? induce the
  stretch-shortening cycles

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Plyometric Training

• Goal
• Decrease reaction time between eccentric
  lengthening of mm and concentric mm contraction
• Increase power

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Advantages of Plyometric training

• Hewett et al, 1996 1999
• Decrease landing forces
• Increase vertical jump height
• Improve knee stabilization
• Improve hamstring-to-quadriceps strength ratio
• Decrease incidence of knee injury in female
  athletes

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Examples of Plyometric Training

• Hewett et al, 1996 1999
• Cone jump
• Jump, jump, jump, vertical

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Agility Training

• Allow pt to adapt to
• quick changes in direction
• quick starting and stopping
• cutting pivoting
• improve proprioception
• Agility training significantly improves mm
  reaction time in response to anterior tibial
  translation (Wojtys et al, 1996)

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Figure-of-eight Drills

• gradual change of direction
• allow adaptation to cutting activity
• Longer distances ? shorter distances
• (smaller surface area ? tighter 8 )
• backward 8

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Cutting Maneuver Drills

• Sidestep cut
• Crossover cut
• half-speed ? full-speed
• 45o ? 60o ? 90o cutting
• Carioca

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Shuttle Run

• Involve straight plane running, acceleration,
  deceleration, cutting pivoting

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Others

• SEMO drill
• incorporate forward, backward, diagonal
  acceleration and lateral movt

Start
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Sport Specific Training

• Start when full speed agility training was
  achieved
• sport specific tasks are added during the agility
  training
• For basketball player
• Dribbling skills
• Ball catching
• Ball passing

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Sport Specific Training

• Started w/o being opposed
• Progressed to one-on-one opposition
• Progressed to real competition

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Question Answer Session
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References

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• Baratta R. Solomonow M. Zhou BH. Letson D.
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• Boden BP. Dean GS. Feagin JA Jr. Garrett WE Jr.
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• Boerboom AL. Hof AL. Halbertsma JP. van Raaij JJ.
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