13 - Injury Prevention for the Athlete

Question 1

What is the purpose of the warm up?

Answer 1

The purpose of a warm-up prior to physical activity is to optimize performance, prevent injury and arouse psychological acuity. Warming up, as the name implies, results in an increase in core body and muscle temperature. The physiological outcomes of warm-up that drive the potential to improve performance1 include:

Increases of:
- Peripheral blood circulation
- Soft tissue elasticity
- Synovial lubrication of the joint(s)
- Oxygen uptake kinetics
- Adenosine triphosphate turnover
- Muscle cross-bridge cycling rate
- Muscle fiber conduction velocity

Decreases in:
- Viscosity of the inter-membranous lubricants
- Cardiac trauma from sudden/strenuous exercise

Question 2

What is an active warmup?

Answer 2

Any submaximal activity that facilitates a 1° Celsius increase in the body’s internal core temperature.

Question 3

Should a warm up cause fatigue?

Answer 3

No. The warm-up protocol should not cause fatigue that might impair performance and lead to possible injury. Rather, warm-up protocols must elicit the internal physiological changes necessary to promote performance and prevent injury without overtaxing the athlete.

Question 4

What is a good indicator that the warm up has been effective?

Answer 4

A mild sweat is broken.

Question 5

What is the transition phase?

Answer 5

The time between the warm up and working out.

Question 6

What should be done at track or swimming meets to help keep the athlete ready?

Answer 6

Passive warming techinques.

Question 7

What are some warm up protocols?

Answer 7

• A submaximal/non-fatiguing activity
• Stretching
• Sport-specific movements
• Injury prevention techniques
• A gradual progression in the intensity level and movement specificity for the activity.4
• Increase in speed from half-tempo to “game pace” by the conclusion of the warm-up.4

Question 8

What are three common foot overuse injuries?

Answer 8

• A submaximal/non-fatiguing activity
• Stretching
• Sport-specific movements
• Injury prevention techniques
• A gradual progression in the intensity level and movement specificity for the activity.4
• Increase in speed from half-tempo to “game pace” by the conclusion of the warm-up.4

Question 9

What are some foot injury prevention protocols?

Answer 9

Stretching Achilles tendon and calf muscles with bent and straight legs, performing calf and anterior tibialis strengthening, and towel crunches for the toes and foot muscles.

Question 10

What is the most common reported sport injury?

Answer 10

Ankle sprain

Question 11

What is the injury rate for ankle sprains in HS?

Answer 11

1 in 17

Question 12

What is the most common ankle sprain?

Answer 12

lateral (Anterior Talofibular ligament)

Question 13

What is the percentage of an ankle re-sprain?

Answer 13

47-73%

Question 14

After severe ankle sprain, how long does it take for osteoarthritis take to set in?

Answer 14

34.3 years.

Question 15

How is a lateral ankle sprain caused?

Answer 15

The typical mechanism of injury for a lateral ankle sprain is forced plantar flexion and inversion of the ankle during landing on an unstable or uneven surface.

Question 16

Athletes with a lateral ankle sprain are how much more likely to get one again?

Answer 16

5x

Question 17

Which sports are the most likely to sprain an ankle?

Answer 17

sports involving planting and cutting or the use of rigid boots, putting athletes participating in football, soccer, rugby, wrestling, lacrosse, skiing, and ice hockey at risk for this injury.

ACL injuries are overwhelmingly (70–75%) non-contact in nature and almost always occur as the body undergoes rapid deceleration.52,67–71 The three major non-contact events described as being responsible for ACL injury are: (1) planting and cutting, (2) straight knee landing, and (3) one-step landing with a hyper-extended knee.72 Large shear forces are placed across the knee when performing these types of maneuvers and may result in a high degree of ACL strain (Figure 13.15).

Question 18

What are some general steps to prevent and rehabilitate ankle injuries.

Answer 18

• Restoring range of motion at the ankle in closed kinetic-chain dorsiflexion through stretching (Figures 13.3 and 13.4).
• Strengthening of the ankle musculature
• Functional activities (hopping, lateral movements, cutting maneuvers).41
• Progression in number of repetitions, speed and direction over the course of several weeks.41

Prevention programs appear to be most effective for individuals with a history of ankle sprain.46

Question 19

Knee injuries account for what % of college and HS sports?

Answer 19

50%

Question 20

Are men or women more susceptible to ACL injuries?

Answer 20

both are relatively equal, but women have a slightly higher chance of rupture.

Question 21

From athletes who get ACL surgery, what % return to sports?

Answer 21

75%

Question 22

For those that suffer from an acute knee injury, what % get arthritis and after how long?

Answer 22

7x more likely to get AO 25 years after injury.

Question 23

What is the Q-angle?

Answer 23

measure the vector forces applied to the patella

formed by a line drawn from the anterior superior iliac spine to the central patella and a second line drawn from central patella through the tibial tubercle

Question 24

People that have patellofemoral pain (PFP) generally have what symptoms that causes the pain?

Answer 24

decreased quadriceps flexibility, shortened reflex time of the vastus medialis oblique, reduction in vertical jump performance, increased medial patellar mobility, increased distance between the medial tibial condyles of the right and left legs (tibial bowing) and increased quadriceps strength as factors associated with the incidence of PFP.

Question 25

What causes an ACL rupture?

Answer 25

combined loading state of excessive tibial rotation and knee valgus that researchers have described the ACL to be at greatest risk of injury

Question 26

What are some ACL prevention techniques?

Answer 26

the most common treatment being quadriceps and hip musculature strengthening.89,95,96 Weight-bearing exercises are more functional than non-weight-bearing exercises because the multijoint movement requirement facilitates a more functional pattern of muscle recruitment and stimulating proprioceptors (Figure 13.18),97 making weight-bearing activities preferable

Proprioception-balance training (Figure 13.19)100–104 and plyometric-agility training (Figure 13.20)87,88,105,106 are the two main programs recommended for preventing ACL injury. Other common training techniques incorporated in an ACL injury prevention exercise programs are technique-movement awareness training101,102,105 strength training,87,88,102,104–106 and flexibility training.87,88,105

Question 27

What % of athletes experience a low back injury?

Answer 27

6-15%

Question 28

What is the most common cause of disc injury?

Answer 28

combination of motion with compressive loading

Question 29

What are the two spine positions that cause disc pressure?

Answer 29

increases with lumbar flexion (e.g., excessive forward trunk lean)113,115,116 and decreases in lordosis (e.g., low back rounding)
lateral bending can also cause problems

Question 30

What core muscles help to reduce spine stress?

Answer 30

transverse abdominus and multifidus activation

Question 31

What causes Sacroiliac Joint Dysfunction?

Answer 31

he flat surfaces of the sacrum and ilium make the joint susceptible to shearing forces (Figure 13.23).121 If SIJ stability is not maintained, loads cannot be transferred efficiently between the trunk and legs. This results in abnormal loading and development of pain.

Question 32

What core muscles help to reduce Sacroiliac Joint Dysfunction?

Answer 32

The transverse abdominis and internal obliques play a significant role in resisting shear loads across the SIJ and maintaining stability.121–124 Therefore, proper execution of an abdominal drawing-in maneuver during performance should enhance the stability of the SIJ joint and efficient transfer of forces (Figure 13.24).

Question 33

What steps can be taken to reduce low back injury?

Answer 33

Studies have concluded that strengthening exercises targeting the lumbar spine, lower limbs, and abdominal muscles were successful to decrease pain and improve function.

Question 34

What % of gen-pop will get shoulder pain and how long will it last?

Answer 34

21% total, with 40% lasting for at least one year

Question 35

What are some factors that may lead up to shoulder injuries?

Answer 35

Degenerative changes may also affect the rotator cuff by weakening the tendons over time through intrinsic and extrinsic risk factors,131,138–142 such as repetitive overhead use, increased loads raised above shoulder height,143 head-forward and rounded shoulder posture,144 as well as altered scapular kinematics and muscle activity.145–148 Those factors are theorized to overload the shoulder muscles, which can lead to shoulder pain and dysfunction.

Question 36

What is a rotator cuff strain?

Answer 36

Rotator cuff strains occur when a muscle group is overexerted causing micro-damage within the muscle belly and tendon resulting in immediate inflammation and decreased muscle function

Question 37

What is a capsuloligamentous injury?

Answer 37

deficits in the passive stabilizing structures of the shoulder such as the anterior, posterior, or inferior glenohumeral ligaments and the glenoid labrum

Question 38

What is shoulder impingment?

Answer 38

defined as compression of the structures that run beneath the coracoacromial arch (Figure 13.26). The impinged structures include the supraspinatus and infraspinatus tendons, the subacromial bursa, and the long head of the biceps tendon (Figure 13.27).

Question 39

What is the most common cause of a dislocated shoulder?

Answer 39

abducted and externally rotated arm; for example, during a fall on an outstretched arm or reaching behind and to the side to tackle someone.

Question 40

What are some shoulder injury prevention tips?

Answer 40

Soft tissue mobilization and self-myofascial release techniques should be used to increase extensibility of the overactive muscles. Static or neuromuscular stretching exercises should then be performed for 30–45 seconds on these muscles. Isolated strengthening exercises should be used to facilitate the underactive muscles of the scapulae.

Question 41

How many sport related concussions occur each year?

Answer 41

1.6-3.8 million in the US

Question 42

What type of training should be performed to prevent concussions?

Answer 42

must strengthen the anatomy that controls the movement and positioning of the head.157 To mitigate concussive forces being transferred to the brain, the muscles of the head and neck segment must be strengthened. The head and neck muscles serve as shock absorbers by dampening impulsive forces and slowing the acceleration of the head, slowing the movement of the brain.

Question 43

For each lb of added neck strength, what is the reduction of concussion risk?

Answer 43

5%

Question 44

What is the goal of a rehabilitation program?

Answer 44

to get the athlete back to competition and stronger before the injury

Question 45

What are the stages of rehabilitation and who provides care for each?

Answer 45

Stage one - traumatized area is managed by sports medicine staff.

Professional coach may train other areas in the body to retain strength in healthy areas.

Stage two - athlete regains pain-free ROM. Cleared medical staff to resume strength training. Focusing on blood circulation to prior injured area to help promote more healing. Minimal joint stress (high reps and slow tempo).

Stage three - focus on returned injured side back to baseline or even stronger. Once injured side is at 75-85% recovered, bilateral movements can be used.

1. Pain-free movement.
2. No noticeable signs of swelling.
3. Reestablishes full range of joint/muscle mobility.
4. Regains and/or exceeds pre-injury strength levels.
5. Develops necessary level of metabolic fitness to safely participate in a practice setting.