1. Injury Prevention, Dynamic Warm-ups and Concussion Management
George Lampron, PT, DPT
Caitlin O'Connor, MS, LAT, ATC

2. George Lampron, DPT
Played for University of South Carolina Gamecock Ultimate
Graduated from U of SC 2011
Graduated from Midwestern University with DPT degree in 2014
Played for Beachfront Property
Cash Crop 2016
Trained in Dry needling with continued education in managing athletes and running mechanics

3. Caitlin O'Connor, MS, LAT, ATC
Graduated from University of Connecticut in (BS in Athletic Training) and NC State in 2008 (MS in Sports Management.
Has worked as an outreach AT for Select Physical Therapy since 2008.
Area Sports Medicine Coordinator since 2011.
Has worked with athletes of all ages, but focused on concussion management of MS and HS athletes.

4. Injuries in Ultimate
Ultimate is a unique combination of endurance and explosion
This blend increases risk for soft tissue injuries (sprains and strains)
Repeated loading with poor mechanics increases injury risk

5. Injuries in Ultimate
Overall incidence of ACL injuries in people up to 20 is 121 out of 100,000
Has risen 2.2% annually over the last 20 years
Females 3-8 times more susceptible than males playing the same sport

6. Why the increase in ACL Injuries?
Some evidence with female athletes of skeletal causes
Main cause is biomechanical
Poor performance of squatting, jumping, cutting, and landing leading to abnormal forces at the knee joint

7. Common Mechanical Faults
Increased knee valgus
Increased anterior tibial translation
Increased ankle pronation
Decreased hip mobility

8. Knee Valgus

9. Anterior translation of the tibia
Usually accompanied by increased valgus and increased lumbar flexion

10. Leads to increased anterior translation, decreased glut activation
Limited Hip Mobility
Leads to increased anterior translation, decreased glut activation
Ankle Pronation
Leads to knee valgus increasing risk for injury

11. So, What do we do?

12. Start with training the squat
Simple correctives using cueing and bands
Practice squatting "the right way"
Knees over toes, butt back, chest high

13. Increase Glut Activation and Strength
These common deviations lead to increased quad activation and decreased activation of glut and hamstrings leading to abnormal forces at the knee
Fixing mechanics is the big thing, but also need to increase strength

14. Dynamic Warm-ups
Static stretching has been proven to decrease muscle strength for the next minutes following stretching
Dynamic stretching pre-activity 5-10 sec holds
Static stretching post-activity

15. Dynamic Warm-up Goals Increase muscle elasticity
Promote glut and hamstring activation
Increase blood flow to posterior chain muscles

16. Dynamic warm-ups, how do we do it?
Begin with light jogging
Include squatting and hip hinging
Introduce dynamic activities in a controlled way, increase intensity as you go

17. What does it look like? Jog Hip flexor and pigeon stretching SQUATS
Walking lunges forward and sideways
Walking SLDL
Walking leg swings
High knees and butt kicks
Side steps and push offs
Broad jumps
Thrusters
Go-Go-Go

18. Concussion Management
From WebMD- Definition of concussion: “A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull.” CORRECT
When you google “What is a concussion?”: “temporary unconsciousness caused by a blow to the head. The term is also used loosely of the aftereffects such as confusion or temporary incapacity.” INCORRECT

19. Is it a bruise?

20. “Concussions do not kill people, mismanagement of concussions kill people” - Dr. Kevin Guskiewicz – UNC Chapel Hill SECOND IMPACT SYNDROME – when the brain swells rapidly after a person suffers a second concussion when the symptoms of the first have not resolved fully. -extremely rare, but it is has been evident that symptoms will be more severe and the athlete will have more residual effects if they continue to exacerbate symptoms with activity.

21. Gfellar-Waller Concussion Awareness Act- est. 2011
Outlines the importance of education on concussions, emergency action in treating concussions, and post-concussion protocol information.
Mandatory for all NC public school systems.
Main points:
Any athlete who presents with one or more symptoms of a concussion may not remain in or return to competition that day (Symptoms can take hours to fully develop)
Emergency room and urgent care physicians should not make clearance decisions at the time of the first visit (see list of appropriate medical personnel)
In order to clear an athlete an athlete should be completely symptom-free both at rest AND with cognitive stress, then with full physical exertion.
RTP protocol - 5 days!

22. Other key points…
Important to limit school as well (you wouldn’t make an athlete play Ultimate with a broken leg  don’t make them learn with an injured brain) Physicians will typically provide “Return-to-Learn” restrictions.
Athlete should not begin RTP protocol unless symptom-free for 24 hours and cleared by a licensed physician to begin.
Athlete should not advance to the next stage of the protocol unless they are symptom-free for 24 hours (if symptoms return, they stop that stage and start again once symptom- free)
Athlete should not return to competition until final signed clearance by appropriate medical personnel.

23. Complete Rest or Active Rest?

24. Practice is immediate rest but there is not much empirical evidence to show that cognitive and physical rest help TBI’s recover quicker – that has been the standard of care.
We do know that limiting the chances of a second impact improve results/and keeping symptoms below a threshold
Physical Therapy is effective in rehabbing concussions that have unresolved symptoms after the first 7-10 days of recovery.
New evidence is showing that “multiple active rehabilitative strategies” (Collins, M.W.) might be more effective- including starting activity within 48 hours of diagnosis.
More research is needed

25. Any Questions?