The Musculoskeletal Screening and preventio at Back on Track Sports Physiotherapy:
There are maily two types of sports injuries: traumatic and overus that could be acute and chronic. An injury that occurs suddenly, such as a sprained ankle caused by an awkward landing, is known as an acute injury. Chronic injuries are caused by repeated overuse of muscle groups or joints and include cramps, tears and strains. With increased exposure to sport in the adolescence period, there is higher risk of overusing the muscles, tendons and bones. Sports physiotherapists ares trained in planning and teaching exercises that address musculoskeletal strength and flexibility factors that predispose people to injury. By identifying deficiency in strength and flexibility, they will prescribe exercises to address these issues and prevent further injury (Source: APA)
Selective prevention for :
-Athletes younger than 25 years old
- Aboroginal and some other ethnical group
Highly incicated prevention for athletes at risk with:
-Past history of hip/knee/ankle/calf/quads/hami injuries
Primary preventitive program:
- Eccentric Strength
- Develop symmetric eccentric strenght
- Optimal lower extremities strenght-endurance
-Develop a sound load management and tournament planning program
- Hip joint stiffness and hip flexor tightness
-Restore Ankle ROM
- Restore deficiencies in Active knee extension test
- Buil up a good isometric strenght bilaterally
The young, elite tennis player can develop harmful imbalances in flexibility and strength in areas that are subject to repetitive tensile overload. These imbalances will create chronic maladaptations that have been shown to intensifying incorrect learned movement patterns. Eventually this poor patterns of movements combined with mismanagement of training principle and years of tournament play will increase the risks of injuries and limits the performance. There are high quality studies that show some balance adaptations in flexibility, endurance, strength and speed may not be positive which can result in further increased risk of injury and decreased performance. Furthermore, inefficient biomechanics, poor technique and inadequate physical conditioning will impair ultimate performance and create conditions for increased injury risk. Please Download a tennis fact sheet from Sports Medicine of Australia. Hjelm et al (2012) found that a previous injury regardless of body location was found to be an injury risk factor in two year study of junior tennis players in Sweden.
According to the study of Saccol et al (2010) elite junior tennis players without shoulder injury have shoulder rotation muscle strength imbalances that alter the normal functional ratio between the rotator cuff muscles. These differences in strength may not seem to affect athletic performance temporarily, but detection and prevention with exercise programs at an early age are highly recommended.
The MSK screening provides clear directions to implement corrective exercises which will assist in diminishing deficiencies and correcting imbalances seen in elite young tennis players.
A- Normalise muscle imbalances (The rationale behind this is that there are detectable and correctable abnormalities of muscle strength and length that are fundamental to the development of many musculoskeletal pain and dysfunction. Identifying of these abnormalities, deficiencies and restoring them with corrective exercises before injury has occurred must be integral part of any injury prevention strategy).
B- Biomechanical and technical correction (Regular and repetitive training provide a good way of uncovering these weak areas of the body. If you have knees that are put under heavy stress, because of your unique biomechanics during exercises, your knees or other area are likely to hurt when you engage in your sport for a prolonged time. After recovery, you re-establish your desired training load without modification to your biomechanics then your knees or weak chain are likely to be re- injured).
C- Restore joints, soft tissues and nerve mobility
D- Regain symmetric flexibility
E- Neuromuscular control and proprioception retraining (activation in isolation and static balance).
The treatments and rehabilitation process follows a structured and multi-phase (five phases) approach which consists of:
-Symetric neuromuscular activation and control in isolation
-Develop coordination of the muscles, strenght-endurance, static balance and core stability (commence basic-advanced Pilates program)
-Develop an aerobic and anaerobic capacity/power
-Basic agility drills
-Develop symmetric eccentric and isometric strenght
-Build up sports (tennis) functional strengthening and dynamic balance
- Develop a sports specific speed, agility and explosive power (Plyometrics)
Maximal oxygen uptake ( VO 2max)
Aerobic and Anaerobic capacity: Aerobic capacity is the ability to maintain a moderate to high work output for prolonged time, while anaerobic capacity is the ability to perform very high workloads repeatedly in short bursts. It is essential to train aerobic capacity as individuals with high baseline endurance (higher VO2max) are more resistant to fatigue and will have a greater rate of recovery. This is supported by research, which found that tennis groundstroke hitting accuracy decreased by 69% from rest to volitional fatigue, while service accuracy decreased by 30%. Training the anaerobic system (initially off court/field then transfer to on court/field) plays an important role in improving player's tolerance to lactic acid build up and therefore their ability to cope with the acceleration and deceleration nature of many sports such as Tennis , all codes of Football and netball. Maximal oxygen uptake or, as it is commonly called, VO 2max, is the maximum amount of oxygen that your body consumes per minute during endurance exercise. VO 2max is important for prolonged High-Intensity Intermittent Exercise as it is an important determinant of the ability to sustain high-intensity exercise for longer than four to five minutes (McArdle et al. 2001).
Lactate threshold refers to the highest exercise intensity that can be maintained with less than a 1.0 mmol .L -1 increase in blood lactate above the pre-exercise level (McArdle et al. 2001) . This exercise intensity is commonly thought to be the maximum that an individual can maintain for a prolonged duration of exercise.
Research on players
A recent study by prominent Norwegian researchers examined the effect of aerobic training on VO 2max and soccer match performance (Helgerud et al. 2001) in 19 high-level youth soccer players. The results from this study demonstrated that eight weeks of extra interval training significantly increased VO 2max by 10.8 per cent, treadmill running velocity at lactate threshold by 13.1 per cent and increased running efficiency (amount of oxygen used for the same speed) by 6.7 per cent. Importantly, the results also demonstrated that increased aerobic fitness did not affect sprinting velocity, weightlifting strength, jumping power or kicking accuracy.
Other match analysis results showed that the increased aerobic fitness:
These findings demonstrate that an increased aerobic capacity offer significant performance benefits in sports that require intermittent sprints over a longer period.
Aerobic capacity is the ability to maintain a high work output for a long period of time, while anaerobic capacity is the ability to perform very high workloads repeatedly. It is essential to train aerobic capacity as individuals with high baseline endurance are more resistant to fatigue and will have a faster recovery. This is supported by research, which found that tennis groundstroke hitting accuracy decreased by 69% from rest to volitional fatigue, while service accuracy decreased by 30% (Davey et al. 2002). Training the anaerobic system plays an important role in improving an individuals' tolerance to lactic acid build up and therefore their ability to cope with the stop-start nature of many sports.
Speed is an vital part of every sport and can be expressed : maximum speed (explosive), elastic strength (power) and speed endurance (SE).
Plyometrics is based on the understanding that a concentric muscular contraction is much stronger if it immediately follows an eccentric contraction of the same muscle (stretch shortening cycle). Higher than normal forces are put on the body during plyometric exercises so it is very important for the athlete to have a optimal foundation of general strength and endurance.
The golden rule of any physical conditioning program is specificity. This means that the movement you perform in training should match, as closely as possible, the movements encountered during competition.
Most importantly focus on offloading over-loaded muscles and correcting the identified deficiencies in screening rather than on-court training, squad training and playing tournaments (skill acquisitions and stability program are the main focus at the grass root level from 9-12 year old).
This adjustment to the training principle is necessary in order to override the old pattern and restore the new pattern (reducing compensatory mechanism).
This will allow the establishment of the correct kinetic chain to facilitate the smooth, synchronised, coordinated and sequential transition of forces from ground reaction force to ball contact and recovery. This sequential and balanced involvement of each link is required to create efficient force and stability of the joints in order to gain optimal performance with minimal risk to injury.
Download a football fact sheet from Sports Medicine of Australia
We then need to do the same process with the upper body as the shoulder complex does not function in isolation (a long way still to go). Dynamic Stability and balance between force coupling on scapula and shoulder muscles is required in order to produce efficient transfer of force and synchronous movement of shoulder complex.
This process results in improved biomechanics, controlled loads of overhead high-velocity forces during the serve and reduces the mechanical stress on the shoulder girdle. The communication between coaches and Sports Physiotherapists is a key element in order to modify techniques and optimise kinetic chain efficiencies. This holistic approach will ensure the maintenance of healthy athletes and enhance the athletic performance (training principle, core stability and injury prevention management). Although there is growing medical evidence outlining the necessity of protecting the young elite tennis player?s shoulder, there is inadequate tennis-specific research to implement restrictions similar to other sports (eg fast bowling limits in cricket and pitch count limits in baseball).
Download a netball fact sheet from Sports Medicine of Australia.