1. Sarah Jane McDonnell MPhyt(Sport) MExSc(S&C)
Head of Rehabilitation
Sport Ireland Institute

2. High Performance Sport Health Model
The Integrated Performance Health Management and Coaching Model
Managing an athlete through their sporting pathway: junior, development and transition into HP set up
Screening
Load Tolerance: internal and external factors
Common Rowing Presentations: best practice
Low Back Pain
Rib Stress Injuries

3. The Integrated Performance Health Management and Coaching Model.
H Paul Dijkstra et al. Br J Sports Med 2014;48:
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

4. Rehab Role Rehab: Maximise Athletes Ability to Train Many parts:
So dependent on relationship management: ability to be adaptable and responsive
Building relationships, athlete, coach, PD other support team members. The importance of belief systems, especially from own personal experience
Major part of the role to maintain training stimulus when injured.

5. Athlete Development
Develop the athlete before you develop the specialty. Physically literacy comes before specialization
Know the basics, know them thoroughly & never stray even at the highest level.
Peak Height Velocity: relationship to injury at the age it occurs some research in team sports around high incidence of injury with players/athletes who have growth spurts later. Probably mutli-factorial but older you are greater exposure to training etc
Everybody’s message needs to be consistent about developing all systems simultaneously.
Issues around selection at age grades, culture of turning up to trials injured. Need to provide a “safe” environment to report injury
In boys growth plates don’t fully fuse until 21 girls 18/19
In developing athletes often more likely to have a bony presentation as in this pop this is there weak spot as opposed to the older athelte
During these phases of growing deficits in proprioception
Transition from junior to U23s/Senior and the weight making aspect

6. Screening Controversial:
Risk (=probability), prediction (=certainty). Two very different concepts that are erroneously used together
identification of modifiable factors (internal or external) which could be manipulated to reduce chance of injury
But how do you know these apply to the individual in front of you?
You know through understanding of the value of evidence, combined with your clinical expertise (and common sense)
In treatment and secondary prevention I agree - but for primary prevention screening/preassesment hard to justify
Rowing:
Hip mobility
Rib Cage Mobility
Ankle Mobility
Trunk and pelvic endurance????

7. Load Tolerance: internal and external factors

8. Common Rowing Presentations: best practice
Belief systems play a huge role
Being aware the athlete management requires all involved to have input
Informed athlete, coaches, s&c etc make for a more effective environment to manage and issue

9. Rowing Injury Data 10/ /2016

10. Low Back Pain
The strongest predictors for low back pain (LBP) were shown to be:
A previous history of LBP
Volume of ergometer training (especially sessions >30mins and static ergs)
Number of total training hours and years rowing
Restricted hip motion 
Less strong correlations were found for:
A history of rowing before the age of 16
Time in season e.g. winter risk is higher due to more time spent on the ergo
Fatigue
Most low back pain is self limiting : however if underlying issues not addressed will become recurring
Maintaining a normal training load whilst avoiding both aggravating factors and complete prolonged rest is therefore important
Most LBP is chronic and asoc with vol and kinematics
Studies emphasized importance of full hip ROM and achieving anterior pelvic rotation at catch
Novice rowers and those with a hx of LBP tend to use high levels of lx flex with ltd pelvic rotation (further deterioration with increasing workload and fatigue)

12. Rib Stress Injury

13. Rib Cage Mobility
Foam Rolling into extension with intension/purposeful
T-Stretch
Hip openers: pigeon variations
Band walks

14. Questions
@sj_sportsphysio