Injury management in heavy training or preparation phases Ian Scarborough M. Sports Physiotherapy Wakefield Sports Clinic

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Basic Training Theory The body needs to be physically overloaded to improve fitness The body needs to be physically overloaded to improve fitness Athletes need to give their body rest to recover from the physical workload to get the most out of training Athletes need to give their body rest to recover from the physical workload to get the most out of training Improvements in fitness occur after training (with rest and recovery) Improvements in fitness occur after training (with rest and recovery)

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Load Management Identify the load place upon an athlete Identify the load place upon an athlete Game demands Game demands Training and Competition frequency/duration Training and Competition frequency/duration Extraneous demands (family, study, sports) Extraneous demands (family, study, sports) Identify the available downtime for the athlete Identify the available downtime for the athlete Coordinate loading and unloading to best allow for training gains, recovery and injury management Coordinate loading and unloading to best allow for training gains, recovery and injury management

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Heavy phase May vary depending upon training level May vary depending upon training level Elite level – national teams Elite level – national teams Elite level – SASI / AVL and state teams Elite level – SASI / AVL and state teams Development level – SASI / School teams Development level – SASI / School teams Period of time where emphasis is upon considerable workload with minimal rest lasting 4-6 weeks Period of time where emphasis is upon considerable workload with minimal rest lasting 4-6 weeks

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Preparatory phase Period of time preceding competition where emphasis is upon replicating competitive expectations Period of time preceding competition where emphasis is upon replicating competitive expectations Duration is usually 2-4 weeks Duration is usually 2-4 weeks Training content is mainly high match replication drills with minimal skills focus Training content is mainly high match replication drills with minimal skills focus

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Demands of Volleyball Per Game Per Game Spiking Spiking Heavy: 60 spikes Heavy: 60 spikes Moderate: 40 spikes Moderate: 40 spikes Light: 20 spikes Light: 20 spikes Jumping Jumping Heavy: 150 jumps Heavy: 150 jumps Moderate: 100 jumps Moderate: 100 jumps Light: 50 jumps Light: 50 jumps Training load – 280 Training load – 280 Competition – 360 Competition – 360 Training load – 800 Training load – 800 Competition Competition Blocks, serves, spikes Blocks, serves, spikes

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Overload Requirements of the body to sustain these demands Requirements of the body to sustain these demands Tissue damage Tissue damage Adaptation of tissues Adaptation of tissues Fatigue: physical and emotional Fatigue: physical and emotional

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Overuse Injuries Early signs and symptoms Early signs and symptoms Complaints of skill related soreness Complaints of skill related soreness Soreness lasting an hour post training Soreness lasting an hour post training Rubbing the affected area Rubbing the affected area Trying to stretch out sore spots Trying to stretch out sore spots Reduction in skill performance Reduction in skill performance Frustration with skill outcomes Frustration with skill outcomes

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Injury Prevention Ensure fitness and coordination Ensure fitness and coordination Required for training drills and competition Required for training drills and competition Recognize training loads Recognize training loads Ensure limitations on number of skill repetitions per training Ensure limitations on number of skill repetitions per training Ensure recovery time between training sessions Ensure recovery time between training sessions

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Recognize Training Loads Number of trainings per week Number of trainings per week Number of games per week Number of games per week Number of spikes/jump per training/game Number of spikes/jump per training/game Number of weight or jump trainings Number of weight or jump trainings Number of social games Number of social games Number of other sports (training / games) Number of other sports (training / games)

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Find Time for Recovery Training Plan over week; month; year Training Plan over week; month; year Include Include Training days/sessions (incl weights) Training days/sessions (incl weights) Study sessions (incl homework) Study sessions (incl homework) Work sessions Work sessions Competition days / weeks Competition days / weeks Family commitments Family commitments Plan for looking after self (recovery) Plan for looking after self (recovery)

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Training Plan / Diary DayMonTuesWedThFriSatSun AmSchoolSchoolSchool Cricket or Netball State DDSchoolSchool Reserve or State League PmSASIClubStateSASI

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Dilemma 4 different volleyball coaches 4 different volleyball coaches All want their athlete to train full capacity All want their athlete to train full capacity Difficulty communicating between coaches Difficulty communicating between coaches Differing heavy phases and competition dates Differing heavy phases and competition dates 1 Athlete 1 Athlete Keen to play / practice as much as possible Keen to play / practice as much as possible Fear of exclusion if not involved 100% Fear of exclusion if not involved 100% Young, fit and invincible! Young, fit and invincible!

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Strategy Prioritize trainings for competitions Prioritize trainings for competitions Taper other trainings to allow recovery for priority training Taper other trainings to allow recovery for priority training Vary athletes demands at repeated training sessions Vary athletes demands at repeated training sessions

Injury Management

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Rehabilitating injuries Acute Acute Rest from all activity Rest from all activity RICER RICER Maintain muscle activity and joint ROM Maintain muscle activity and joint ROM Graduated return to fitness and loading Graduated return to fitness and loading Graduated return to volleyball Graduated return to volleyball Overuse Overuse Relative rest ICE Technique analysis Maintain skill and fitness Graduated return to aggravating activity Identify overload and adapt

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Return to fitness Cross training to maintain aerobic fitness Cross training to maintain aerobic fitness cycling, rowing, swimming cycling, rowing, swimming Weight training to maintain strength Weight training to maintain strength Body weight exercises Body weight exercises Overload for non injured parts Overload for non injured parts Agility to maintain court speed Agility to maintain court speed

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Return to sport Skills retraining Skills retraining Uninfluenced by injury at 50-75% Uninfluenced by injury at 50-75% Influenced by injury at 25-50% Influenced by injury at 25-50% Develop movement control Develop movement control Improve ability to make position Improve ability to make position Controlled environment Controlled environment Delay competitive training until 100% Delay competitive training until 100% Progress intensity if pain free during the session as well as the next day Progress intensity if pain free during the session as well as the next day

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Return to competition Graduated inclusion into game Graduated inclusion into game Ensure player manages injury on the bench Ensure player manages injury on the bench May require rest from game to facilitate inclusion in future competition May require rest from game to facilitate inclusion in future competition

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Injury Management Doctor, Physio, Trainer, Other health professionals Doctor, Physio, Trainer, Other health professionals Ensure communication (verbal or written) Ensure communication (verbal or written) Identify limitations and capabilities Identify limitations and capabilities Facilitate rehabilitation at and between trainings or competitions Facilitate rehabilitation at and between trainings or competitions Incorporate injured athlete into training Incorporate injured athlete into training

Ian Scarborough M. Sports Physiotherapy Copyright 2007 At training Ensure good warm up (sweating) Ensure good warm up (sweating) Allocate time for athletes to attend to rehab exercises Allocate time for athletes to attend to rehab exercises During warm up During warm up During aggravating activity or break in play During aggravating activity or break in play Have ICE or Contrast baths available Have ICE or Contrast baths available Ensure time allocated for warm down and stretching Ensure time allocated for warm down and stretching Ensure athletes have snacks and hydrate Ensure athletes have snacks and hydrate

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Between trainings Reinforce application to rehab activities Reinforce application to rehab activities Identify suitable recovery strategies Identify suitable recovery strategies Communicate with other coaches and parents about load expectations for athlete Communicate with other coaches and parents about load expectations for athlete Communicate with athlete about progress Communicate with athlete about progress

Ian Scarborough M. Sports Physiotherapy Copyright 2007 Conclusion Self management requires self monitoring of training and competition loads Athlete-sports health team needs to manage these loads to incorporate injury rehabilitation This is difficult to achieve if the coach isn t on board! Communicate