blazesports institute for applied science cdss level i curriculum 1

BlazeSports Institute for Applied Science CDSS Level I Curriculum 1

Injury Prevention for Athletes with Physical Disabilities 2

We would like to thank the following people for their contributions to the content of this presentation: Ben Johnson, EdD, CDSS Professor and Chair Dept. of Physical Education and Exercise Science Brooklyn College City University of New York Jackie McParlane, DO, FACOEP Director - Emergency Medicine Residency Program Botsford Hospital Farmington Hills, MI 3

OBJECTIVES This session will provide basic sport science insights into how injuries occur in sport and physical activity and their prevention through proper planning and training and conditioning programs. The goal is to provide the participant with an understanding of how acute and chronic injuries occur and ultimately can be reduced or even eliminated through sound planning and training. 4

OBJECTIVES 1.The session participant will identify the areas of specialization under the sports medicine umbrella and learn the important components of the coachs role in the absence of a Certified Athletic Trainer (ATC). 2.The session participant will learn about the relationship of stress and strain on musculoskeletal tissues and how each relates to both acute and chronic injuries. 3.The session participant will learn about the components of fitness and the principles of training and conditioning. 4.The session participant will learn to identify specific aspects of disability sport and physical activities that may contribute to injury. 5

SPORTS MEDICINE The American College of Sports Medicine (ACSM) defines sports medicine as multidisciplinary, including the physiological, biomechanical, psychological, and pathological phenomena associated with exercise and sport. 6

WHAT IS YOUR ROLE? Coaching Physical Education Sport Psychology Personal Fitness Training Strength & Conditioning Sports Nutrition Exercise Physiology Biomechanics Athletic Training Sports Physical Therapy Physician Physicians Assistant Sports Massage Therapy Sports Dentistry Osteopathic Medicine Orthotists/Prosthetists Sports Chiropractic Performance Enhancement Injury Care & Management 7

THE COACH Understand the role and responsibility of each person on the sports medicine team Know the state laws surrounding the ability to function as a health care provider Certified in CPR and First Aid Directly responsible for injury prevention by ensuring athletes have the proper level of fitness to participate Must engage in professional development 8

THE COACH Ensure the competitive environment (field of play) is as safe as possible Educate parents and athletes about inherent risks related to participation Ensure proper training and conditioning of athlete Monitor environmental conditions to ensure safe participation Selecting, properly fitting and maintaining equipment including protective equipment Explain importance of proper nutrition and hydration When there is no Certified Athletic Trainer 9

TRAINING AND CONDITIONING Improper conditioning is one of the major causes of sports injuries!! 10

TRAINING AND CONDITIONING A FATIGUED athlete is more prone to injury!! 11

TRAINING AND CONDITIONING Specific Adaptations to Imposed Demands SAID Principle 12

TRAINING AND CONDITIONING Cardiorespiratory Fitness Flexibility Muscular Fitness Components of Physical Fitness 13

TRAINING AND CONDITIONING Cardiorespiratory (Energy) Fitness Aerobic Anaerobic Components of Physical Fitness 14

TRAINING AND CONDITIONING Cardiorespiratory Fitness Interval Training Components of Physical Fitness 15

TRAINING AND CONDITIONING Flexibility Static (passive) Dynamic (active) Components of Physical Fitness 16

TRAINING AND CONDITIONING Factors that Affect Flexibility Anatomical Joint structure, age, gender Limited training affect Training Activity level, resistance training, stretching exercises Components of Physical Fitness 17

Loading or Force Tension Compression Shear Bending Torsion Deformation Change in shape/length Elastic limits of bone, tendons, ligaments and cartilage Failure point of tissue 18 TRAINING AND CONDITIONING Components of Physical Fitness Stress and Strain on Tissue

Force / Load Length/Deformation of Tissue Complete Failure of Tissue Plastic Region Elastic Region Serious injury of tissue begins Micro-injury of tissue begins with frequent repetition in this range Normal range for most people 19

TRAINING AND CONDITIONING Stretching Techniques Passive Static Active Ballistic Dynamic Combined Proprioceptive Neuromuscular Facilitation (PNF) Components of Physical Fitness 20

TRAINING AND CONDITIONING Static Stretching Most common method Excellent for increasing ROM Appropriate for all athletes Safest method of stretching due to slow, controlled movements 30 second hold 3-4 repetitions Components of Physical Fitness 21

TRAINING AND CONDITIONING Ballistic Stretching Bouncing movements Stretch not held Invokes stretch reflex Higher potential for injury NOT recommended for increasing flexibility Different from plyometric training Performed within existing ROM Components of Physical Fitness 22

TRAINING AND CONDITIONING Dynamic Stretching Functional, sport-specific movements NO bouncing Ideal during warm-up Incorporate multiple joints Maintain body temp Time efficient Not as effective for ROM increase as static or PNF stretching Components of Physical Fitness 23

TRAINING AND CONDITIONING PNF Stretching First used in neuromuscular rehabilitation Relax muscle with increased tone or activity Can be ore effective than static stretching Usually requires a partner Three Types Hold-Relax Contract-Relax Hold-Relax with Agonist Contraction Components of Physical Fitness 24

TRAINING AND CONDITIONING Muscular Fitness Flexibility Strength Power Endurance Components of Physical Fitness 25

Force Motion Motion Energy Energy Injury Potential 26 Components of Physical Fitness TRAINING AND CONDITIONING

Strength The maximal force a muscle group can generate at a specified velocity Velocity (v) = change in position change in time v = displacement time Components of Physical Fitness 27

TRAINING AND CONDITIONING Strength The maximal force a muscle group can generate at a specified velocity Force (F) = mass x acceleration acceleration (a) = change in velocity change in time Components of Physical Fitness 28

TRAINING AND CONDITIONING Components of Physical Fitness 29 F = m ( v / t) Maximize or Minimize Force??? Force = Mass = Change in Velocity = Time =

TRAINING AND CONDITIONING Power The ability to generate force rapidly Power = Work / time Components of Physical Fitness 30

TRAINING AND CONDITIONING Endurance The ability to perform repetitive muscular contractions against some resistance Components of Physical Fitness 31

TRAINING AND CONDITIONING Components of Physical Fitness 32 Muscle Balance Train anterior and posterior muscles uniformly

TRAINING AND CONDITIONING Components of Physical Fitness 33 Muscle Balance

TRAINING AND CONDITIONING Warm-up/cooldown Motivation Overload Consistency Progression Intensity Specificity Individuality Stress Safety Principles of Conditioning 34

TRAINING AND CONDITIONING Warm-up 15-20 min. General Increase heart rate, blood flow, body temp., respiration rate, perspiration and decrease joint viscosity Stretching Static Vs Dynamic Specific (technical skill) Principles of Conditioning 35

TRAINING AND CONDITIONING Cooldown 5-15 min. Brings heart rate back to baseline Prevents blood from pooling in lower extremities Stretching helps relax muscles, maintain ROM Principles of Conditioning 36

TRAINING AND CONDITIONING Motivation Vary the training program to keep it fresh Utilize proper goal setting to maintain motivation Overload Gradually increase the imposed demands to realize continual results Maintain muscle balance Principles of Conditioning 37

TRAINING AND CONDITIONING Consistency Training and conditioning must take place 2-3 times per week to realize change Progression Gradually increase the intensity of the program Intensity Increase intensity rather than quantity/duration Principles of Conditioning 38

TRAINING AND CONDITIONING Specificity Develop the program to address specific fitness goals Begin with general fitness, then move to sport-specific Aerobic, anaerobic, power, speed, endurance, flexibility, etc. Individuality Adjust the training program to meet the needs and progression of the individual athlete Principles of Conditioning 39

TRAINING AND CONDITIONING Stress If you are engaged in a program that meets multiple times per week, understand that the athlete has other stressful aspects to their life and may need time away from training Safety Environment Education Principles of Conditioning 40

PERIODIZATION Individualized Organizes training and conditioning into cycles Timely peak performance Helps reduce injury Helps avoid overtraining Principles of Conditioning 41

PERIODIZATION Principles of Conditioning 42 SeasonPeriod/PhaseType of Training Off-seasonTransition Period (postseason) Unstructured, recreational Preparatory PeriodCross training Hypertrophy/ endurance phaseLow intensity, high volume, general Strength PhaseModerate intensity, moderate volume, begin sport-specific PreseasonPower PhaseHigh intensity, decrease volume, highly sport-specific In-SeasonCompetition PeriodHigh intensity, low volume, skill training, strategy, maintain strength and power

AGE CONSIDERATIONS Youth Ensure emotional and cognitive maturity to follow directions Focus on muscular strength and endurance, flexibility, and cardiorespiratory endurance Limit heavy loads and moderate progression Principles of Conditioning 43

AGE CONSIDERATIONS Older Adults Consider pre-existing health conditions Aerobic and resistance training beneficial Begin with low-intensity and low-volume in untrained participants Moderate progression Principles of Conditioning 44

INJURY CONCERNS BY IMPAIRMENT/DISABILITY Athletes who use Sport Chairs Athletes with Amputations Athletes with Cerebral Palsy Athletes with Visual Impairment 45

1.Most common injuries are strains & muscular injuries of upper extremities 2.Overuse Injuries 3.Fractures of hands from falls & collisions 4.Overdevelopment of anterior muscles, weakness of posterior muscles 46 ATHLETES WHO USE SPORT CHAIRS

AUTONOMIC DISREFLEXIA Can be life threatening! Conditions, below the level of injury, that may lead to autonomic hyperreflexia include : Full Bladder Constipation or a full bowel Pain Infection Skin breakdown Ingrown toenail Sudden temperature changes in the surrounding environment Symptoms may include: High blood pressure Low heart rate Anxiety or agitation Severe pounding headache Sweating above the level of the injury Nasal stuffiness 47

Treatment Sit athlete up/dangle legs down Removal of Stimuli Catheterization Loosen tight clothes Anti-hypertensive medication Complications Seizures pulmonary edema myocardial infarction cerebral hemorrhage AUTONOMIC DISREFLEXIA Can be life threatening! 48

1.Risk for skin irritation or breakdown. 2.Use appropriate padding and friction eliminating material ATHLETES WITH AMPUTATION 49

Seizures relatively common in this population Increase in lactic acid production => muscle fatigue Wheelchair users have higher upper extremity strains, sprains, overuse Ambulatory athletes have more knee injuries Be aware of the role spasticity plays Crashes ATHLETES WITH CEREBRAL PALSY 50

No visual cues May have different biomechanics May expend more energy because of lack of visual cues Watch for earlier fatigue & overuse injuries Crashes ATHLETES WITH VISUAL IMPAIRMENT 51

Overuse Injuries Dehydration Heat Illness Cold Injury Acclimatization Seizures Pressure Ulcers Prosthetics & Orthotics Multiple Sclerosis Brittle Bones Concussions MEDICAL ISSUES OF CONCERN Across the Spectrum

OVERUSE/CHRONIC INJURIES REPETITIVE MOTION INJURIES Bursitis / Tendinitis Plantar fasciitis Patellofemoral syndrome Sprains and strains Stress fractures Lower back injuries

54 DEHYDRATION

Drink water before, during & after event DO NOT rely on thirst as indicator of when to drink Drink COOL beverages Drink 480ml for every.45kg lost Begin fluid replacement immediately Sports beverages should have carb concentration of 4-8% 55 DEHYDRATION

NEVER consume energy drinks prior to competition 56 DEHYDRATION

57 HEAT ILLNESS Signs and Symptoms Heat Cramps Dehydration Thirst Fatigue Transient muscle cramps

58 HEAT ILLNESS Signs and Symptoms Heat Exhaustion Profuse sweating Cool, clammy skin Chills Dizzy/lightheaded Persistent muscle cramps

59 HEAT ILLNESS Signs and Symptoms Heat Stroke Body temp 104 Hot, dry skin Staggering Disorientation Loss of consciousness Tachycardia (100-120 bpm) ACTIVATE EMERGENCY ACTION PLAN

60 COLD INJURY Athletes with SCI Less sensitive to the sensation of cold on the skin surface Diminished perception of skin temperature change Diminished capability to stabilize core temperature Unable to induce shiver response

61 COLD INJURY Prevention Strategies Educate athletes and coaches on prevention, recognition and treatment Maintain proper hydration and food intake Develop event and practice guidelines to make participation decisions Proper clothing Rewarming opportunities

ACCLIMATIZATION 62

Hypersynchronous discharge of the cerebral neurons Range of types Factors Increasing Incidence of Seizures: Dehydration Stress Hypoglycemia Hyperventilation Electrolyte Imbalance Head Trauma SEIZURES 63

PROSTHETICS & ORTHOTICS 64

Most common in athletes with paralysis or athletes unable to move themselves Can occur with orthotics & prosthetics Check for ulcers/skin breakdown regularly Begin treatment as soon as noted PRESSURE ULCERS 65

Concerns in Sport Heat Over Exertion MULTIPLE SCLEROSIS 66

Concerns in Sport Fractures Breaks Low Impact Exercise Improves bone density OSTEOGENESIS IMPERFECTA 67

Traumatic Brain Injury (TBI) Wear proper protective equipment Ensure all equipment is maintained and safe Wheelchairs and anti-tip bars CONCUSSIONS 68

Maddocks questions combine scientific validity with a quick simple and practical tool which can be administered either on-field or on the sidelines. Any incorrect response indicates concussion and requires removal from the playing field for further medical evaluation CONCUSSIONS 69

Which field are we at? Which team are we playing today? Who is your opponent at present? Which half/period is it? How far into the half is it? Which side scored the last touchdown/goal/point? CONCUSSIONS 70

www.cdc.gov/concussion CONCUSSIONS 71

INJURY PREVENTION STRATEGIES 72 Safe environment Appropriate, well maintained equipment Individualized training Warning signs of injury Warm-up, stretching, and cool-down Appropriate training prescription Mode, duration, frequency, intensity, progression

Rest and Recovery FATIGUE FATIGUE FATIGUE The chance of musculoskeletal injury increases significantly when fatigued 73 INJURY PREVENTION STRATEGIES

Use basic common sense and logical thinking to prevent or reduce injuries! Remember that FORCE leads to MOTION that leads to ENERGY that leads to INJURY The bodys tissues have physiological/biomechanical limitations that, if exceeded, will lead to injury One must limit or reduce force applied to and by the body while also avoiding extreme deformation of body tissues in unnatural positions. Chronic fatigue and overtraining is the enemy of the athlete with or without a disability TAKEAWAYS FROM THIS PRESENTATION 74

Baechle, T. R., & Earle, R. W. (Eds.). (2008). Essentials of Strength Training and Conditioning - National Strength and Conditioning Association (3rd ed.). Champaign, IL, USA: Human Kinetics. Martens, R. (2004). Successful Coaching - American Sport Education Program (3rd ed.). Champaign, IL, USA: Human Kinetics. Prentice, W. E. (2008). Essentials of Athletic Injury and Management (7th ed.). New York, NY, USA: McGraw-Hill. Spengler, J. O., Connaughton, D. P., & Pittman, A. T. (2006). Risk Management in Sport and Recreation. Champaign, IL, USA: Human Kinetics. ADDITIONAL RESOURCES 75