Connecting Rehab from the Training Room/ Clinic to the

Weight Room

Todd Burkey AT,CSCS

Youngstown State University

The Injury Epidemic• 30 million high school or younger participate in sports each

year.

• 3.5 million receive treatment for sports injuries each year. (CDC)

• High school athletes sustain an estimated 2 million injuries per year.

• Overuse injuries responsible for nearly half of all sport injuries.

• Surgeons seeing 4X as many injuries vs. 5 years ago ( Dr. James Andrews ).

• 1 of every 4 injuries are considered serious.

• 62% of injuries occur during practice.

• Sports related injuries increase severity with age.

Higher Level?

• Have noted more athletes entering their freshman year of college with some injury or restriction.

• 1 of every 3 have a pre existing condition due to sports injury.

• 1 of every 4 do not finish their college career due to injury.

• Injury rates seem excessive.

• 67% of college football players reported injuries at some point during their career.

• 36% of these injuries were to the knee.

• 80% of knee injuries required surgery.

The Athlete’s Knee

• ACL injuries have become commonplace (especially in females)

• ACL Injuries as a % of all injuries:

• 1) Women’s Basketball ( 4.9% )

• 2) Women’s Gymnastics ( 4.9% )

• 3) Women’s Lacrosse ( 4.3% )

• 4) Women’s Soccer ( 3.7% )

• 5) Men’s Spring Football ( 3.5% )

• ACL Injury Rate per 1000 contacts:

• 1) Men’s Spring Football ( 0.33 )

• 2) Women’s Gymnastics ( 0.33 )

• 3) Women’s Soccer ( 0.28 )

• 4) Women’s Basketball ( 0.23 )

• 5) Men’s Football ( 0.18 )

Scary Statistics… ( 2006 )

•1,042,511 injuries per YEAR

•86,875 injuries per MONTH

•20,048 injuries per WEEK

•2,856 injuries per DAY

•119 injuries per HOUR

•> 1 injury per MINUTE

Any good news?

• A careful, balanced and consistent training plan can affect risk of injury.

• Evidence suggests that training can drastically reduce incidence of ACL injury.

• According to ( ACSM ) 50% of overuse injuries in children are preventable.

• Training can not only reduce risk of injury, but can also increase performance.

•So why all the injuries?????

The Problem

• The American Sport Culture is not consistent.

• Medical care for athletes does not always cooperate with the training plan.

• Differing opinions ( although diverse ) do not help the process of preparing an athlete or safely returning them to activity.

• There needs to be a transition of care from rehabilitation in the training room/ clinic back to the weight room.

• Try to look at it as two points in the same program.

• Consistently educate each other and the athletes you are working with.

• Sport coaches ( especially youth ) need to be conscious of developing proper body mechanics before sport play.

What to Do?

• Establish stability.

•Develop mobility.

•Develop control.

•Work on stopping before starting.

•Progress training.

•Continually revisit basic mechanics.

Establish Stability

• Isometric exercises.

•Posture ( Core Strength and Endurance )

• Joint Position.

• Should probably be 1st aspect of training or rehab.

Develop Mobility

• Hip mobility is lacking in most athletes.

• Thoracic mobility is also a major issue in athletes.

• Major cause of LBP is lumbar mobility combined with hip and upper back stiffness ( McGill ).

• Hip flexor stiffness associated with hamstring injury/ re injury ( New Zealand ).

• Most mechanical shoulder pain ( impingement ) due to poor posture and scapular control.

• Mobility is not necessarily an issue of flexibility ( Mike Boyle ).

Develop Control

• Eccentric emphasis through a range of motion.

• Should precede speed work and emphasis on concentric muscle action.

• Has shown effective in treating tendonitis ( Journal of Physical Therapy ).

• Most effective at submaximal load in low volume.

Work on Stopping

• Deceleration emphasis.

• Focus on landing position in jumps.

• Focus on foot position, knee position, hip position when stopping ( front and side ).

• “ Jump Training “

• Evidence suggests deceleration training has a direct impact on risk of injury ( especially females ).

• Too often the focus is on acceleration and high speed agilities ( contributes to bad movement mechanics )

Progress Training

• Continue to develop athletes in each phase.

• Stability, Mobility, and Control should be present in nearly every phase ( prehab, training, rehab ).

• Too often these are left aside or dropped as rehab and training advances ( detraining effect ).

• Most current model is Triphasic training ( Cal Dietz ).

Example training plan

• Initial 6 weeks

• Monday ( Isometric Focus ) Pause Squat, Pause Bench, Submaximal Load

• Wednesday ( Eccentric Focus ) 5 count Back Squat, 5 count Bench Press ( Submaximal Load )

• Friday ( Concentric Focus ) Box Squat with Bands, Bench Press with Bands

• Daily deceleration drills as part of warm up.

Example rehab plan ( ankle )

• Day One ( Isometric focus ) Isometric resisted inversion, eversion, plantar flexion, dorsiflexion

• Day Two ( Eccentric focus ) 5 count heel raises, 5 count band resisted dorsiflexion

• Day Three ( Concentric focus ) band resisted inversion, eversion, plantar flexion, dorsiflexion for reps

• After acute inflamatory response has ended initiate deceleration drills on a daily basis.

Summary

• Injury rates have been on the rise, especially in youth sports.

• Training is often too advanced for skill level.

• Training/ practice/ game volume is way too high.

• You can reduce the risk of injury by developing stability, mobility and control.

• A training plan and rehab plan work best when in sync.

• Sport coaches ( especially youth ) should consider proper instruction and movement should precede gameplay.

• Thanks to Doug Smith and Juniata College for the opportunity to share and learn from this conference.

• Special thanks to Dan Wathen for the opportunity to work in this field.

• If you have any questions please feel free to email: teburkey@ysu.edu