approaches in athletic performance enhancement

www.rehabtrends.com.ph +639178684353 [email protected]

http://www.rehabtrends.com.ph/

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!!!!!!!!!!!!www.rehabtrends.com.ph!!

[email protected]!

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REHABTRENDS,! INC.! is! an! accredited! provider! of! continuing! education! by! the! Professional!Regulation! Commission.! It!was! established! on!May! 2011! by! a! group! of! professional! physical!

therapists.!The!organization!regularly!conducts!postgraduate!courses!that!provide!its!members!

and!other!stakeholders!with!an!opportunity!for!professional!growth!and!advancement!through!

current!updates!in!the!practice.!

!

!

MISSION!STATEMENT!!REHABTRENDS,! INC.!commits! itself! in! providing! continuing! education! to! professional! Physical!

Therapists! and!Occupational! Therapists! in! order! to! promote!development! and! improvement! in! the!

quality! of! its! health! care! practice! in! the! Philippines.! It! aims! to! provide! world! class! lectures! and!

seminars,! dealing!with! the! latest! evidenceObased! approaches! to!Physical! Therapy! and!Occupational!

Therapy!practices.!Its!ultimate!goal!is!to!contribute!in!the!advancement!of!the!allied!medical!practice!

in!the!Philippines.!

!

VISION!STATEMENT!!

By!the!end!of!May!2019,!REHABTRENDS,!INC.!envisions!itself!as!the!centre!of!continuing!education!in!the!

allied! health! profession! known! for! its! competent! ! and! dedicated! partners! to! provide! unbiased! and!

updated!practices!nationwide!whilst!upholding!the!culture!of!excellence.!

!

KEY!PRINCIPLES!OF!REHABTRENDS,!INC.!!

• Excellence!

• Accessibility!

• Affordability!

• Innovation!

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• !• !

MANAGEMENT!

COURSE!BACKGROUND!

!Multidisciplinary! sports! management! involves! all! of! the! members! of! sports! management! team! that!

deals! with! the! enhancement! of! athletic! performance! and! the! treatment! and! prevention! of!related!

to!sports!and!exercises.!Prevalence!of!sports! injuries! in! the!Philippines! increases!as!many!Filipinos!are!

now! engaged! in! active! lifestyle.! Sports! Rehabilitation! offers! a! scientific,! evidenceObased! approach! to!

individualize! the! plan! of! treatment! and! rehabilitation.! The! team! collaboratively! uses! progressive!

techniques! to! ensure! the! safest! and! most! effective! rehabilitation! possible! and! incorporates! injury!

prevention!education!to!help!avoid!future!injuries.!This!oneOday!postgraduate!course!will!introduce!the!

postgraduate!students!to!holistic!approaches!in!enhancing!athletic!performance.!

.!

PROGRAM!OUTCOME!

!At!the!end!of!the!course,!the!postOgraduate!students!will!be!able!to!distinguish!and!delineate!the!

different!roles!of!sports!medicine!team!in!the!enhancement!of!athletic!performance.!

INTENDED!LEARNING!OUTCOMES!

At!the!end!of!the!session,!the!students!will!be!able!to:!

• Distinguish!the!roles!of!members!of!the!sports!management!team!in!athletic!training!• Consider!the!influence!of!athletes’!morale!in!their!performance!• Apply!the!different!principle!of!strength!and!conditioning!in!their!practice!• Demonstrate!the!some!onOfield!management!of!acute!and!overuse!injuries!in!athletes!

• Discuss!and!explain!the!common!team!sports!injuries!and!its!prevention!

• Apply!the!criteria!to!safely!allow!the!athlete!to!continuing!playing!even!after!injury!• Discuss!the!evidences!of!the!current!injury!management!

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May!22,!2016!

!! !!!!8AMO5PM!!

!!!!5th!Floor!BasilioOValdez!Hall!Our!Lady!of!Lourdes!Hospital,!Sta.!Mesa,!Manila.!

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!!!!!

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!!!!!

!Mr.!Randolph!M.!Molo,!MD,!FPOA!

!!Dr.!Molo!is!an!orthopedic!sports!physician!specializing!in!arthroscopic!surgeries.!He!is!currently!the!section!

head!of!the!Shoulder!and!Elbow!Surgery!St.!Luke’s!Medical!Center.!Dr.!Melo!is!the!PRO!of!the!Philippine!

Orthopedic!Society!of!Sports!Medicine!and!the!treasurer!for!the!Philippine!Shoulder!Society.!He!is!an!active!

consultant!for!the!Section!of!Sports!medicine:!!Institute!of!Orthopedics!and!Spots!Medicine!at!St.!Luke’s!

Medical!Center.!

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!His!current!research!topic!is!on!Quadriceps!Surface!EMG!Firing!Patterns!following!a!Distal!Patellar!Realignment!Procedure.!Dr.!

Molo!has!also!published!and!presented!a!number!of!research!papers!locally!and!internationally.!!

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Dr.!Molo!is!presently!a!lecturer!for!the!Philippine!Sports!Institute!of!the!Philippine!Sports!Commission.!He!is!also!the!

Musculoskeletal!Module!Coordinator!for!the!Ateneo!School!of!Medicine!and!Public!Health.!He!has!also!an!extensive!experience!

in!being!the!resource!speaker!for!seminars!and!lecturers!internationally.!!

Assistant!Professor!Valentin!C.!Dones!III,!PhD,!MSPT,!PTRP,!DMS!!Dr.!Dones!have!regularly!coOauthored!several!internationally!and!locally!published!research!papers!in!the!

field!of!anatomy,!fascia!and!manual!therapy.!He!develop!the!Biomechanical!Taping!Technique!and!

continuously!do!series!of!researches!to!prove!the!effectiveness!of!the!aforementioned!technique.!He!

finished!his!PhD!degree!in!the!University!of!South!Australia.!

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Dr.!Dones!is!also!an!experienced!clinician!who!specializes!in!Integrative!Manual!Medicine.!!He!took!up!various!international!

courses!and!certification!in!manual!therapy!abroad.!He!is!a!certified!manual!therapist!and!Dorn!method!specialist.!He!also!hold!

consultancy!position!in!Health!Hub!Pro!Clinic!and!Contour!Rehabilitation!and!Wellness.!

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Dr.!Dones!is!also!an!experienced!academician.!Currently!he!serves!as!the!Chair!of!the!Department!of!Physical!Therapy,!College!

of!Rehabilitation!Sciences!of!the!University!of!Santo!Tomas.!He!also!talked!in!various!international!and!local!conferences,!

conventions!and!seminars.!

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Mr.!Michael!Magpantay,!PTRP,!DMP!

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Mr.!Magpantay! is! an! experienced! sports! clinician!with!more! than! 10! years’! experience.! He! finished! his!

graduated!in!the!University!of!Philippines!Manila!in!2006.!He!is!currently!the!Head!Physical!Therapist!of!the!

Moro!Lorenzo!Sports!Center.!He!is!also!the!Head!Physical!Therapist!of!the!PBA!team!Talk!and!Text.!!He!was!

the!team!Physical!Therapist!of!the!ATENEO!Men’s!Football!Team.!He!is!a!certified!sports!physiotherapist.!

He!finished!the!3Omos!intensive!training!on!onOfield!management!in!sports.!He!is!also!a!certified!DORN!Method!practitioner.!He!

attended!various!training!in!manual!therapy!sports!physiotherapist.!

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[email protected]!

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Mr.!Reil!Vinard!S.!Espino,!CSCS,!MSHMS,!MTAI!

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Mr.!Espino!had!a!broad!experience!in!being!a!sports!and!conditioning!coach.!He!is!the!current!sports!and!

conditioning!coach!for!the!Global!Port!Batang!Pier!PBA!Team.!He!is!also!the!strength!and!conditioning!

coach!for!the!UST!Tiger!Cubs!Basketball!team!and!the!UST!Tigresses!Basketbal!team.!He!was!previously!

the!Sports!and!conditioning!coach!for!the!Cebuana!Lhuilier!Basketball!team!from!the!PBA!DOleague.!!

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Mr.!Espino!has!published!a!number!of!research!papers!and!has!been!able!to!present!some!of!them!internationally.!Research!

topics!focus!more!on!sports!management!and!physical!fitness.!!

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Mr.!Espino!is!a!tenured!faculty!member!and!is!now!the!current!Department!Char!for!the!Sports!Science!Department!of!the!

College!of!Rehabilitation!Sciences!at!the!University!of!Santo!Tomas.!!He!used!to!be!the!supervisor!for!the!clinical!internship!

program!of!the!said!department.!He!has!also!been!invited!to!be!a!lecturer!and!resource!speaker!for!various!seminars!and!

conventions.!!

Mr.!Marcus!Jarwin!A.!Manalo!

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He!has!been!a!sports!psychologist!specialist!for!the!Association!of!Boxing!Alliances!in!the!Philippines!since!

2013.!He!has!extensive!experience!in!sport!psychology!of!different!sports!such!as!basketball,!volleyball!and!

softball.!He!finished!his!masters!of!science!in!Exercise!and!Sport!Sciences!(exercise!and!sports!psychology)!at!

Texas!Tech!University,!Lubbock,!Texas,!USA.!

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Mr.!Manalo!has!been!an!assistant!professor!of!the!College!of!Human!Kinetics!in!the!University!of!the!Philippines!since!2013.!He!

has!talked!in!various!lectures!and!seminars!for!sports!psychology.!!

Mr.!Emmanuel!V.!Papa!

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Mr.!Papa!has!wideOranging!experience!for!13!years!as!a!sports!professional.!He!has!recently!was!the!Head!

coach!of!the!UP!Women’s!Basketball!Team.!He!has!experience!in!being!the!sports!and!conditioning!coach!of!

different!nonOprofessional!and!professional!teams!such!as,!the!San!Miguel!Beermen!of!the!PBA,!Pacific!

Pipes!Basketball!Team!of!the!PBA!DOLeague!and!the!Saint!Pedro!Poveda!College!High!School!Basketball!

team.!!

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Since!2011,!He!has!been!an!assistant!professor!for!the!UP!College!of!Human!Kinetics!in!Up!Diliman.!He!was!also!a!lecturer!for!

the!Enderun!Colleges.!He!also!has!been!a!speaker!for!various!seminars!and!lectures.!!

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[email protected]!

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Time! Topic! Speaker! Method!of!Teaching!7:00O8:00!AM! REGISTRATION!

8:00O8:30!AM! Opening!Ceremonies!

8:30O9:30!AM! • Defining!the!roles!of!members!of!the!

sports!management!team!

o Team!Coach!

o Strength!&!Conditioning!o Nutritionist!o Psychologist!o Physical!Therapist!o Sports!Physician!

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Mr.!Papa!

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Interactive!Lecture!

9:30O11:00!AM! • Sports!Psychology:!Preventing!BurnOout!

in!Athletes!

o Factors!affecting!Morale!of!the!athlete!

o Approaches!in!encouraging!athletes!

Mr.!Manalo! Interactive!Lecture!

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11:00O12:30!PM! • Strength!and!Conditioning!

o Principles!of!Agility!and!Speed!Training!o Plyometrics!

o Periodization!o Principle!of!Strength!Enhancement!

Mr.!Espino! Interactive!Lecture!

&!Demonstration!

12:30O1:30!PM! Lunch!

1:30O2:30!PM! • Common!Injuries!in!Team!Sports!

o Acute!Injuries!

o Overuse!Injuries!

o Prevention!

Dr.!Molo! Interactive!Lecture!

2:30O4:00!PM! • OnOfield!Injury!Management!

o Acute!Injuries!o Overuse!Injuries!o Criteria!to!allow!athlete!to!continuing!playing!

Mr.!

Magpantay!

Interactive!Lecture!

&!Demonstration!

4:00O5:00!PM! • Biomechanical!Taping!

• EvidenceObased!Approaches!in!Injury!

Management!

o Manual!Therapy!Techniques!

o Thermal!Modalities!

o Taping!

o Bracing!

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Dr.!Dones! Interactive!Lecture!

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!!!!!!!!!!!!www.rehabtrends.com.ph!!!!!!!!!!!!!+639178684353!!!!!!!!!!!!rehabtrends.inc@gmail.com!

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Defining!the!Roles!of!Members!of!the!Sports!Management!Team!By:!Mr.!Emmanuel!V.!Papa!

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I. ROLES OF A STRENGTH & CONDITIONING COACH a. Assists in Maintenance, Supervision of Sports Facility / Gym b. Assists in Identifying, Purchasing of Equipment c. Can either Supervise or Assist in Internship programs d. Design, Implement, Conduct, Monitor e. Coordinates with Physiotherapists and Sports Doctors

II. THE PHYSIOTHERAPIST

a. Coordinates with Head Coach re: Health / Injury Status of the players b. Coordinates with the Strength and Conditioning coach re: Program Design c. Consults / Coordinates with Team Physician (status, meds or

supplementation) d. Injury Management

III. STRUCTURE

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a. Delegation

i. Constant communication ii. Assigns clear, defined roles iii. Willingness to adjust iv. Treats utility with respect v. Decisiveness

b. S & C coach i. Assists in Time Management requirements of certain athletes (Games &

Practices ) ii. Assists in regulation of training frequency, intensity, volume

c. Physiotherapist

KEY TO SUCCESS: Communication

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Sports!Psychology:!Preventing!Burn5out!in!Athletes!By:!Mr.!Marcus!Manalo!

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Physical, Emotional, and Social withdrawal from a formerly enjoyable sport activity

• emotional and physical exhaustion • reduced sense of accomplishment • sport devaluation

as a result of chronic stress and motivational changes in the athlete

Gould & Whitley, 2009

• 72% of the athletes reported some staleness during their sport season.

• 66% of Atlantic Coast Conference athletes experienced some overtraining, on average twice a year

• 47% reported feeling burned out at some point during their college careers

Silva, 1990

High-level burnout symptoms

• 980 elite adolescent athletes • 1-9% of females • 2-6% of males

Gustafsson et al., 2007

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FACTORS RELATED TO BURNOUT IN COACHES

• Pressure to win • Administrator or parental interference or indifference • Disciplinary problems • Multiple roles • Intense personal involvement

RED FLAGS

• changes in emotions (e.g., irritability, moodiness, disinterest) • cognitive functioning (e.g., difficulties concentrating) • decreases in strength and coordination • physiological changes (e.g., appetite loss, increased resting heart rate), and • greater susceptibility to illness

ASSESSING BURNOUT: THE MASLACH BURNOUT INVENTORY

• A reliable instrument for measuring burnout that has been adapted and modified for use in sport and exercise

• Maslach Burnout Inventory subscales ! Emotional exhaustion ! Depersonalization ! Personal accomplishments

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AUTONOMY • A sense of choice and ability to make own decisions

BELONGING • A sense of being part of something bigger than oneself; caring and being cared for

COMPETENCE • A sense of being capable of doing things which are valuable to us and those around

us

Deci & Ryan, 2000

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PREVENTING BURNOUT (ADDITIONAL)

• Take time off and relax. • Set short-term goals for competition and practice. • Learn self-regulation skills (e.g., relaxation, imagery, goal setting, self-talk). • Have fun. • Balance

ADVICE FOR COACHES

• Give support, show empathy, and reduce the importance of outcome. • Have two-way communication with players. • Cultivate personal involvement with players. • Gather player’s inputs. • Understand players’ feelings.

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Strength!&!Conditioning!By:!Mr.!Reil!Vinard!S.!Espino,!CSCS,!MSHMS,!MTAI!

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I. Principle of Program Design A. Principle of Specificity

i. Program should be specific to the sport and should meet the individual needs of the athlete

ii. SAID Principle (Specific Adaptations to Imposed Demands) - We get GOOD at we DO

B. Principle of Individualization

i. As a result of our different genetic predispositions and hormone levels everyone reacts differently to exercise.

1. High Responders 2. Low Responders

ii. Consider: 1. Age 2. Medical History 3. Posture 4. Prior Training 5. Current Fitness

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C. Principle of Overload i. Positive Adaptations

1. with correct levels of stress and recovery the body will adapt and grow stronger.

ii. Negative Adaptations 1. Levels of stress are too high or recovery is insufficient,

adaptations will occur initially but progress will slow or even stopped.

iii. Optimal Overload 1. Maximal stress placed on the client for optimal training gains

without increased risk for injury 2. Based on age, experience and genetics

iv. Point of Failure 1. Point at which form and technique deteriorate and risk of injury

increases.

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D. Principle of Progression i. Acute Exercise Variables – dictate how difficult an exercise is.

1. Training Intensity 2. Load 3. Sets 4. Repetitions

Note: rest, tempo, ROM, neural demand – alternative exercise variable**

E. Principle of Variation i. Periodization

1. Practice of systematically cycling acute exercise variables in order to fulfill the principle of variation, prevent performance plateau, and avoid over training.

II. Program Design Variables (Resistance Training)

STEP 1: Needs Analysis

• Evaluation of the Sport o Movement analysis o Physiological analysis o Injury analysis

• Assessment of the Athlete o Training Status

! Type of Training Program (Sprint, Plyometrics, Resistance) ! Length of recent participation in previous training program ! Level of intensity involved in previous training program ! Degree of exercise technique experience

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Training Status

Current Program

Training Age

Frequency (Per Week)

Training Stress

Technique Experience/ Skill

Beginner (Untrained)

Not training or just began training

<2 mos. < 1-2 None or low

None or minimal

Intermediate (Moderately trained)

Currently training

2-6 mos. < 2-3 medium Basic

Advanced (Well trained)

Currently training

1+ year 3-4+ High High

• Physical Testing and Evaluation o Primary Resistance Training Goal

Sport Season Sport Practice Resistance Training

Resistance Training Goal

Off Season Low High Hypertrophy and muscular endurance (initially)

Strength and power (Later) Preseason Medium Medium Sport and Movement Specific

(Strength, power or muscular endurance depending on the sport)

In Season High Low Maintenance of preseason goals

Postseason Variable Variable Not specific (may include other activities)

STEP 2: Exercise Selection

• Exercise Type

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o Core and Assistance Exercises o Structural and Power Exercises

• Movement Analysis of the Sport o Sport-Specific Exercises o Muscle Balance

• Exercise Technique Experience • Availability of Resistance Training Equipment • Available Training Time per Session

STEP 3: Training Frequency

• Training Status • Sport Season • Training load and Exercise type • Other Training

TRAINING STATUS FREQUENCY GUIDELINES (Sessions/Week)

Beginner 2-3

Intermediate 3-4

Advanced 4-7

SPORT SEASON FREQUENCY GUIDELINES (Sessions/Week)

Off-season 4-6

Preseason 3-4

In-season 1-2

Postseason 1-3

STEP 4: Exercise Order

• Power, Other Core, Then Assistance Exercises • Upper-and Lower-Body Exercises (Alternated) • “Push and “Pull” Exercises (Alternated)

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• Supersets and Compound Sets

STEP 5: Training Load and Repetitions

• LOAD o Most simplistically referred to as the amount of weight assigned to

is an exercise set – is often described as the most critical aspect of a resistance training program.

• Relationship Between Load and Repetitions o One Repetition Maximum (1RM) - the greatest amount of weight

that can be lifted with proper technique for only one repetition o Repetition Maximum (RM) - the most weight lifted for a specified

number of repetitions

Percent of the 1RM and Repetitions Allowed (%1RM-repetition relationship)

%1RM Number of Repetitions

Allowed

100 1

95 2

93 3

90 4

87 5

85 6

83 7

80 8

77 9

75 10

70 11

67 12

65 15

1RM and Multiple-RM Testing Options

• Actual 1RM (directly tested) • Estimated 1RM from a multiple-RM

test (e.g., a 10RM), or • Multiple-RM based on the number

of repetitions planned for that exercise (the goal repetitions; e.g., five repetitions per set).

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LOAD AND TRAINING ASSIGNMENTS BASED ON TRAINING GOALS

Training Goal Load

(%1RM)

Goal

Repetitions

Strength ≥ 85 ≥ 6

Power: Single-effort

Power: Multiple-effort

80-90 1-2

75-85 3-5

Hypertrophy 67-85 6-12

MuscularEndurance ≥ 67 ≥ 12

STEP 6: Volume

“Describes the total amount of weight lifted in a training session.”

Examples of Load Increases

Description of the Athlete Body Area Exercise Estimated Load Increase “Smaller, weaker,

less trained”

Upper Body 2.5-5lb (1-2kg)

Lower Body 5-10lb (2-4kg)

“Larger, stronger, more trained”

Upper Body 5-10+ (2-4+kg)

Lower Body 10-15+lb (4-7+kg)

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Volume Assignments Based on the Training Goal

Training Goal Goal Repetitions Sets

Strength ≥ 6 2-6

Power: Single-effort

Power: Multiple-effort

1-2 3-5

3-5

Hypertrophy 6-12 3-6

Muscular Endurance ≥ 12 2-3

STEP 7: Rest Periods

Training Goal Rest Period Length Strength 2 – 5 min

Power: single effort event 2 – 5 min Power: multiple effort event 2 – 5 min

Hypertrophy 30 s - 1.5 min Muscular Endurance < 30 s

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FACTORS AFFECTING ACCELERATION AND SPEED

A. Anatomical Differences B. Physiological FactorsMuscle Fiber

i. Body Fat ii. Age iii. Gender iv. Mechanics

SPEED IMPROVEMENT TRAINING PROGRAMS

A. Functional Strength And Power B. Plyometric Training C. Sprint Loading D. Form Training E. Speed Drills F. Speed Endurance Training G. Sprint Assisted Training

DESIGNING AN AGILITY PROGRAM

A. STRUCTURE THE WORK OUT PLAN

• Plan a specific goal for each movement session • Strive for perfect technical execution • Quality over quantity • Simple skills to complex skills • Fundamental movement skills to special or specific skills • Attack fundamental limiting factors systematically • Provide accurate feedback

QUICKNESS

A. Biomechanical Considerations • 100 m sprints provides a poor model of teaching sports quickness or

acceleration • Limited utility for sports

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• Mechanical demands of the sport: eccentric power, dynamic balance, proprioception, balanced flexibility

B. Anatomical And Physiological Considerations • Stop and start • Sensory receptors in the muscles • Myotatic stretch reflex • Intrafusal and extrafusal muscle fibers

C. Neuromuscular Considerations • Brain rehearse specific movement patterns • Stored motor patterns of explosive complex mov’t • Increased firing rate of motor neurons, maximal recruitment of ft muscle

fibers, quicker reactions, more explosive force productions D. Bioenergetic Considerations

• ARP – PC system

STOPPING & STARTING

A. Majority of injuries occur not in the acceleration but during the deceleration and stopping

B. Improve stopping with full stop and start quickness drills C. Don’t forget upper body quickness D. Maintain a ready position E. Perform at full out effort F. Regeneration time

INCORPORATING QUICKNESS DRILLS IN PRACTICE

A. Increase number of foot contacts to achieve in set time B. Increase lateral distance C. Increase drill movement pattern D. Decrease the time to complete a drill course E. Incorporate visual and auditory stimuli

TRAINING FLOW

A. Resistance Training or Cardio Training B. WARM UP

a. Pillar Prep b. Gluteal Activations

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c. Neural Prep d. Movement Prep

C. SAQ Drills or Plyometrics D. Strategies E. Cooldown

III. Periodization IV. Warm Up and Movement Preparation V. Speed, Agility and Quickness Drills VI. Plyometrics VII. Resistance Exercises VIII. Endurance Training

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On$field!Management!Management!Team!By:!Mr.!Michael!D.!Magpantay,!PTRP!

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I. General Guidelines a. Know the rules of the game b. Save life c. Emergency Care d. Control Bleeding e. Immediate Pain Relief f. Avoid Delaying the game***

II. Decide a. To continue OR To Stop b. Athlete's Aubjective c. Assessment d. Scenario

III. Injuries a. Fracture

i. direct or indirect trauma ii. localized pain and tenderness iii. localized swelling and bruising iv. deformity v. restriction of movement vi. Splint vii. send to ER

b. Dislocation/Sublaxation i. Dislocation – dissociation of articulating surfaces of the joint

1. Shoulder 2. Elbow 3. Finger 4. Hip 5. Knee 6. Patella 7. Ankle

ii. Sublaxation – articulating surfaces of the joint remain partially in contact with each other

iii. Reduce ASAP - distract then relocate iv. immobilize

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v. ER? c. Knee Sprain

i. Special Test ii. Instability test iii. immobilizer iv. mostly not an emergency

d. Ankle Sprain i. Ottawa ankle rules ii. Open basket weave taping

e. Muscle Strain i. Pain on resisted movement ii. compress iii. dont stretch iv. no massage

f. Contusion i. direct blow causes muscle damage with bleeding ii. "charley horse" - anterior thigh iii. stretch

g. Cramps i. relax ii. stretch iii. massage

h. Tendon Tear i. dont stretch ii. immobilize in shorted position iii. ** Achilles tendon Tear - (+) thompson / simmond test

i. Skin Cuts i. apply pressure - control bleeding ii. disinfect iii. close with steri strips / skin glue iv. deep cut may need sutures - ER

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Biomechanical!Taping!&!Evidence3based!approach!in!Injury!Management!By:!Assist.!Prof.!Valentin!C.!Dones!III,!PhD,!MSPT,!PTRP,!COMT,!DMS!

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OBJECTIVES

A. Present evidences on: a. Kinesiotaping b. Dry Needling c. Cervical Manipulation d. Cryotherapy

B. Present latest evidence on: a. Biomechanical Taping

I. KINESIO TAPING

Parreira PdCS, Costa LdCM, Hespanhol Junior LC, Lopes AD, Costa LOP (2014) Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy 60:31-39

o Included Studies ! Shoulder pain in two trials ! Knee pain in three trials ! Chronic low back pain in two trials ! Neck pain in three trials ! Plantar fasciitis in one trial ! Multiple musculoskeletal conditions in one trial

o Intervention: KT was compared with sham tape/placebo, no treatment, exercises, manual therapy and conventional physiotherapy

o Outcome measures: pain intensity, disability, quality of life, return to work, global impression of recovery

o Results: 12 RCTs with 495 participants ! 6.1 points on 10 point PEDro Scale ! Random allocation, between group comparisons and point estimates ! No blinding of therapists, intention-to-treat analysis, blinded participants,

concealed allocation ! None received funding ! Three reported sample size calculation

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! KT was no better than sham taping/placebo and active comparison groups

II. BIOMECHANICAL TAPING a. Effectiveness of Biomechanical Taping Technique and KinesioTaping with

Gentle Passive Stretching on shoulder pain, range of motion and function of individuals with Myofascial Pain Syndrome: A Randomized Controlled Trial

Dones VCIII, Regino JM, Aldea JM, Brito AM, Hipolity ZB, Minaldo, FJ, Navarro RJ, Sangalang RA, Tomas MK

• 32 participants with Myofascial Pain Syndrome • 10 males, 22 females; • mean age of 34.16 years old (p<0.05). • Comparing the results of Days 1 and 5, significant improvements on

Numeric Pain Rating Scale and Disabilities of the Arm Shoulder and Hand (p<0.05) were noted after Biomechanical Taping and Kinesiotaping application.

b. Sonographic Changes On Common Extensor Origin And Improvement In Hand Function By Biomechanical Taping On Elbows With Lateral Epicondylalgia: A Case Series Study

Dones VCIII, Suarez CG, Lleva JM, Borbe AL, Cheng KA, Dioso AC, Geronimo MD, Laigo AP, Nakahata RF, Sebastian NE

! Methods ! On Days 1, 8 and 12, participants graded their pain through

numeric pain rating scores and quantified their functional capacity through the Patient Rated Tennis Elbow Evaluation.

! Biomechanical Taping was applied by the senior physiotherapist on painful elbows. All participants only received Biomechanical Taping on Days 1, 3, 5, 8 and 10.

! Results: ! There was a general trend towards the resolution of hypoechoic

areas on the CEO of affected elbows treated with Biomechanical Taping.

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! This could be reflected with a significant difference in the perceived pain and function scores of the participants noted in the PRTEE (p=0.0156) between the first and last day of the study.

Fascia without Lesion Fascia with Lesion

Fasica with & without Lesion

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BIOMECHANICAL TAPE

• Tapes your pain away • Improve functions • Adjunct to exercise regimen

A. Inception of Biomechanical Taping a. Elbow fracture b. Adhesive capsulitis c. Piriformis syndrome d. Hamstring strain e. Levator scapula strain f. Referred tenderness in muscles (cervical joint problems)

B. Current: Musculoskeletal disorders a. Frozen shoulder b. Bicipital tendinitis c. Wrist strain d. Ankle sprain e. Upper trapezius strain f. Low back syndrome g. Adductor strain h. Patellofemoral pain syndrome i. Lateral collateral ligament strain j. Hamstring strain

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C. Indications a. Trigger points in muscles b. Lesions in Fascia

D. Contraindications/Precautions a. Allergic reactions to Band-aids b. Damaged frail skin c. Sunburn d. Skin cancer e. Conditions getting worse or not improving

BMT is a POWERFUL TAPING TECHNIQUE

First session: During exercise • A day of no tape

Second session: Keep the tape on for two hours • A day of no tape.

Third session: Keep the tape on for four hours • A day of no tape.

Fourth session: Keep the tape on for overnight. • A day of no tape

BMT Across Fibers

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E. Types of BMT a. Functional BMT b. Standard BMT for muscles c. Standard BMT for fascia d. Structural BMT for joints

F. Functional BMT a. Quick test if BMT is beneficial to patient’s case b. Steps:

i. Provoke the pain. ii. Tape the limb at rest. iii. Re-assess

G. Standard BMT for muscles a. Muscle Manipulation Techniques b. Isoconcentric contraction c. Isocentric contraction d. Isoeccentric contraction

STEP 1. Apply the base BMT skin tape. STEP 2. Do isoconcentric contraction for 3x7SH. STEP 3. Apply two strips of BMT skin tape. STEP 4. Do isocentric contraction for 3x7SH. STEP 5. Apply two strips of BMT skin tape. STEP 6. Do isoeccentric contraction for 3x7SH. STEP 7. Apply two strips of BMT skin tape. STEP 8. Apply a strip of BMT fascia tape with muscle in lengthened position.

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III. DRY NEEDLING Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM, Tucker M (2013) Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-Analysis. Journal of Orthopaedic and Sports Physical Therapy 43(9): 620-634

• Results: o The methodological quality scores ranged from 23 to 40 points, with a mean

of 34 points (scale range, 0-48; best possible score, 48). o The findings of 3 studies that compared dry needling to sham or placebo

treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling.

o Dry Needling vs Sham (2 studies): Dry needling decreased pain after 4 weeks with wide confidence interval

o Dry Needling vs Lidocaine (2 studies): Lidocaine injections may be more effective in reducing pain than dry needling at 4 weeks.

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• Advantage of Dry Needling o Save time and energy o Penetrate to deep tissue o Generate immediate and long lasting effect o Effective for chronic cases

• Deep Dry Needling o More painful but more effective technique o Insert the needle into the MTrP with manipulation of needle for 10 seconds o Generate the Local Twitch Response (LTR) or painful sensation at the

symptomatic area (Deqi) o Soreness after treatment

• Finding the MTrP o Localized tenderness o Deep palpation cause pain and soreness o Taut band o Local twitch response at stimulation

IV. INTRAMUSCULAR STIMULATION • The Gunn Approach developed in 1973 • Treatment for Myofascial Pain • Radiculopathic Origin • Background

o Developed by Dr. Chan GUNN in 1970s o Radiculopathic model of pain o Utilizes needle to penetrate muscle tissue that become shortened from

distress, to release muscle shortening, which compresses on and irritates the nerve

V. CERVICAL SPINE MANIPULATION a. Puentedura EJ, March J, Anders J, Perez A, Landers MR, Wallmann HW, Cleland JA (2012) Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports. J Man Manip Ther 20(2) PMC3360486

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b. Chung CLR, Cote PC, Stern P, L’Esperance G (2013) The Association Between Cervical Spine Manipulation and Carotid Artery Dissection: A Systematic Reivew of the Literature. Journal of Manipulative and Physiological Therapeutics 38(9): 672-76

• Results:

o Did not find any epidemiologic studies that measured the incidence of cervical spine manipulation and internal carotid artery dissection (ICA).

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VI. CRYOTHERAPY

a. Beakley C, McDonough S, MacAUley D (2004) The Use of Ice in the Treatment of Acute Soft-Tissue Injury. The American Journal of Sports Medicine 32(1): 251-61

! Results

• Twenty-two trials • mean PEDro score: 3.4 out of of 10. • Marginal evidence that ice plus exercise is most effective, after

ankle sprain and postsurgery. • Little evidence to suggest that the addition of ice to compression

had any significant effect (hospital inpatients)

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• Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.

! Conclusion • Many more high-quality trials are needed to provide evidence-

based guidelines in the treatment of acute soft-tissue injuries.

b. Hubbard TJ, Aronson SL, Denegar CR (2004) Does Cryotherapy Hasten Return to Participation? A Systematic Review 39 (1): 88-94.

! Results

o 4 studies had Physiotherapy Evidence Database (PEDro) Scale from 2 to 4.

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Guidelines!for!Completion!of!the!Course!(APPROACHES!IN!ATHLETIC!PERFORMANCE!ENHANCEMENT)!

!The!continuing!professional!education!(CPE)!council!for!Physical!and!Occupational!Therapy!of!the!Professional!Regulation!Commission!have!revised!the!guidelines!for!awarding!CPE!units!or!newly!called!as!CPD!units!(continuing!professional!development!units).!!The!participants!of!a!CPE/CPD!accredited!course!should!be!evaluated!to!ensure!that!the!program!outcome!and!intended!learning!outcomes!of!the!course!were!met.!All!participants!of!this!course!are!required!to!complete!the!following!evaluation!method:!!1.!Formative!Evaluation!!The!formative!evaluation!is!a!short!essay!type!of!examination!that!aims!to!reinforce!the!learning!of!the!participants!for!the!aforementioned!course.!This!formative!evaluation!should!be!submitted!at!the!end!of!the!course.!All!participants!are!encourage!to!finish!the!formative!evaluation!during!the!allotted!time!to!avoid!cramming!and!to!ensure!the!quality!of!their!outputs.!Please!turn!the!page!to!see!the!allotted!pages!for!the!formative!evaluation.!!2.!Summative!Evaluation!!This!evaluation!will!be!given!as!an!online!examination!in!a!multiple!choice!format.!Please!see!page!allotted!for!Summative!Evaluation!Guidelines!for!the!complete!instruction!on!this!one.!

!!!!!!!!!!!!!!!!

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[email protected]!

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FORMATIVE!EVALUATION!Multidisciplinary!Sports!Management:!Approaches!in!Athletic!Performance!Enhancement!

May!22,!2016!

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COMPLETE!NAME:!________________________________________________________!

(Surname,!!! ! First!Name! ! ! !Middle!Initial)!

PROFESSION:!

(!)!Physical!Therapist!(!)!Occupational!Therapist!(!)!Physician!(!)!Sports!Science!(!)!Others![Pls.!indicate:!

__________________)!

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1. Briefly!define!the!different!roles!of!members!of!sports!management!team.!(Defining!the!Roles!of!

Different!Sports!Management!Team!Members)!

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2. Briefly!enumerate!the!different!factors!affecting!Morale!of!the!athlete!and!suggest!some!

approaches!in!encouraging!athletes.!(Sports!Psychology)!

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3. In!3!sentences,!briefly!summarize!the!strength!and!conditioning!principles.!(Strength!&!

Conditioning)!

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!

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[email protected]!

!

FORMATIVE!EVALUATION!Multidisciplinary!Sports!Management:!Approaches!in!Athletic!Performance!Enhancement!

May!22,!2016!

!

!

COMPLETE!NAME:!________________________________________________________!

(Surname,!!! ! First!Name! ! ! !Middle!Initial)!

PROFESSION:!

(!)!Physical!Therapist!(!)!Occupational!Therapist!(!)!Physician!(!)!Sports!Science!(!)!Others![Pls.!indicate:!

__________________)!

!

4. In!3!sentences,!briefly!discuss!some!common!team!sports!injuries!and!how!to!prevent!it.!

(Common!Team!Sports!Injuries)!

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5. In!3!sentences,!briefly!describe!some!onafield!management!of!acute!and!overuse!injuries!in!

athletes.!(Onafield!Injury!Management)!

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6. In!3!sentences,!briefly!summarize!the!key!points!of!the!lecture.!(Evidence!based!Approaches!in!

Injury!Management)!

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SUMMATIVE!EVALUATION!METHOD!!(MULTIDISCIPLINARY!SPORTS!MANAGEMENT!COURSE)!

!A!day!after!the!course,!the!attendees!will!be!required!to!answer!an!online!examination!that!can!be!found!on!our!website:!http://rehabtrends.com.ph/details/sportsmanagement.php!! *Please&take&note&that&the&online&portal&for&the&exam&will&appear&after&a&day&after&the&course&& *Attendees&will&be&given&3=days&to&finish&the&evaluation&!!The!online!examination!will!be!in!multiple!choice!format.!And!questions!will!deal!more!on!the!application!the!discussed!topics!during!the!course.!All!resource!speakers!where!given!until!May!15,!2016!to!submit!their!question!to!ensure!quality!their!assigned!questions.!A!2aitem!applied!questions!will!be!asked!for!each!Intended!Learning!Outcomes.!!!The!following!are!the!test!blue!print!for!this!course:!!PASSING!REQUIREMENT!

Participants!should!get!a!General!Weighted!Average!of!not!less!than!75%!in!order!to!pass!the!evaluation.!The!program!outcome!below:!

“Postagraduate!students!will!be!able!to!distinguish!and!delineate!the!different!roles!of!sports!medicine!team!in!the!enhancement!of!athletic!performance.”!

RESULTS!OF!THE!EXAM!!Exam!results!will!be!posted!on!the!link!stated!above.!To!maintain!privacy!of!the!postgraduate!student,!the!serial!number!of!the!certificate,!instead!of!the!name!of!participants!will!be!posted.!These!results!will!also!be!submitted!to!CPD!council!as!part!of!the!post!evaluation!compliance!report.!!

Intended!Learning!Outcome! Focus!of!the!Question! Weight!• Distinguish!the!roles!of!members!of!the!sports!management!

team!in!athletic!training!Case!Analysis!on!the!identification!of!roles!of!sports!rehab!team!

12.5%!

• Consider!the!influence!of!athletes’!morale!in!their!performance!

Case!Analysis!on!the!application!of!the!technique!on!motivating!athletes!

12.5%!

• Apply!the!different!principle!of!strength!and!conditioning!in!their!practice!

Case!Analysis!on!the!application!of!the!strength!and!conditioning!principles!

12.5%!

• Demonstrate!some!onafield!management!of!acute!and!overuse!injuries!in!athletes!

Case!Analysis!on!the!application!of!the!correct!onafield!management!for!acute!and/or!overuse!injuries!

12.5%!

• Discuss!and!explain!the!common!team!sports!injuries!and!its!prevention!

Case!Analysis!on!the!prevention!techniques!for!a!certain!team!sports!injury!

12.5!

• Apply!the!criteria!to!safely!allow!the!athlete!to!continuing!playing!even!after!injury!

Case!Analysis:!Criteria!to!safely!allow!the!athlete!to!continue!playing!after!injury!

12.5%!

• Discuss!and!explain!the!application!fascial!manipulation!for!hand!pain!disorder!

Case!Analysis!on!the!application!of!the!technique!on!hand!conditions!

12.5%!

• Discuss!the!evidences!of!the!current!injury!management! Evidence!of!certain!injury!management!discussed!

12.5!

SEMINAR(FEEDBACK(FORM!Approaches*in*Athletic*Performance*Enhancement!

May$22,$2016!�

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A. In#a#scale#of#1#to#5#or#NA#(1#=#unsatisfactory,#5#=#very#satisfactory,#na=not#applicable),#encircle#one#number#to#rate#your#degree$of$satisfaction)with)the)following)statements.!

! Score! Comments!

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Voice&and&projection!

Clarity(of(speech(! 1"–!2"–!3"–!4"–!5%!na##! !

Good$general$impression! 1"–!2"–!3"–!4"–!5%!na! !

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Content!

The$seminar$covered$what$I$was$expecting! 1"–!2"–!3"–!4"–!5%!na! !

Did!we!achieved!the!program!outcome?! ! !

• To#distinguish)and)delineate)the)different)roles)of)sports&medicine&team&in&the&enhancement&of&athletic(performance.!

1"–!2"–!3"–!4"–!5%!na! !

Did!we!achieved!the!intended!learning!outcomes?! !

• Distinguish)the)roles)of)members)of)the)sports)management'team'in'athletic(training!

1"–!2"–!3"–!4"–!5%!na! !

• Consider)the)influence)of)athletes’)morale)in)their&performance!

1"–!2"–!3"–!4"–!5%!na! !

• Apply%the%different%principle%of%strength%and%conditioning(in(their(practice!

1"–!2"–!3"–!4"–!5%!na! !

• Demonstrate*the*some*on%field&management&of& 1"–!2"–!3"–!4"–!5%!na! !

SEMINAR(FEEDBACK(FORM!Approaches*in*Athletic*Performance*Enhancement!

May$22,$2016!�

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B. Please&comment&on&how&the&seminar&was&helpful&to&you.!!

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C. Please!specify!topics!presented!in!the!seminar!that!were!specifically!interesting.!

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D. How$did$you$know$about$the$seminar?$(check$the$appropriate$choice/s)!!

____Facebook)Ads)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))_____)RehabTrends)Email!____Facebook)Groups))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))_____)RehabTrends)Website!!!!!!!!!!(Pls.&Specify&the&group:____________________)&&&&_____Others&&&&&&&&&&(Pls.&Specify:&_______________________)!____Facebook)Events!____RehabTrends$Like$Page!

E. Are!you!a!REHABTRENDS!Member?!(!)!Yes!(!)!Not!yet!

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acute&and&overuse&injuries&in&athletes!

• Discuss&and&explain&the&common&team&sports&injuries(and(its(prevention!

1"–!2"–!3"–!4"–!5%!na! !

• Apply%the%criteria%to%safely%allow%the%athlete%to%continuing(playing(even(after&injury!

1"–!2"–!3"–!4"–!5%!na! !

• Discuss&the&evidences&of&the&current&injury&management!

1"–!2"–!3"–!4"–!5%!na! !

Significance/usefulness-of-topic-in-the-profession! 1"–!2"–!3"–!4"–!5%!na! !

Sufficient)duration)for)demonstration)to)fully)understand)the$application!

1"–!2"–!3"–!4"–!5%!na! !

Value&for&MONEY!(Worth'it?)! 1"–!2"–!3"–!4"–!5%!na! !

Overall'rate'of'satisfaction! 1"–!2"–!3"–!4"–!5"–!na! !

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