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Zach
azewsk
i and M
agee
Spo
rts Therap
y Services
Handbook of
Sports Medicine
and Science
Sports Therapy Services Organization and Operations
An IOCMedical CommissionPublication
CITIUS • ALTIUS • FORTIUS
EDITED BYJames E. Zachazewski & David J. Magee
Handbook of Sports Medicineand Science
Sports Therapy ServicesOrganization and Operations
Handbook of Sports Medicineand Science
Sports Therapy ServicesOrganization and Operations
EDITED BY
James E. Zachazewski, PT, DPT, SCS, ATC
Clinical DirectorDepartment of Physical and Occupational Therapy
Massachusetts General HospitalBoston, MA;
Adjunct Assistant Clinical ProfessorGraduate Programs in Physical Therapy
MGH Institute of Health ProfessionsCharlestown, MA
USA
David J. Magee, PhD, BPT
ProfessorDepartment of Physical Therapy
Faculty of Rehabilitation MedicineUniversity of Alberta
Edmonton, AB, Canada
A John Wiley & Sons, Ltd., Publication
C© 2012 International Olympic CommitteePublished by John Wiley & Sons, Ltd
Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific,Technical and Medical business with Blackwell Publishing.
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Designations used by companies to distinguish their products are often claimed as trademarks. All brandnames and product names used in this book are trade names, service marks, trademarks or registeredtrademarks of their respective owners. The publisher is not associated with any product or vendor mentionedin this book. This publication is designed to provide accurate and authoritative information in regard to thesubject matter covered. It is sold on the understanding that the publisher is not engaged in renderingprofessional services. If professional advice or other expert assistance is required, the services of a competentprofessional should be sought.
Library of Congress Cataloging-in-Publication Data
Sports therapy / edited by James E. Zachazewski, David J. Magee.p. ; cm. – Handbook of sports medicine and science
Includes bibliographical references and index.ISBN 978-1-118-27577-1 (pbk. : alk. paper)I. Zachazewski, James E. II. Magee, David J. III. International Olympic Committee. IV. Series:
Handbook of sports medicine and science.[DNLM: 1. Athletic Injuries–therapy. 2. Athletes. 3. Internationality. 4. Sports
Medicine–methods. QT 261]
617.1′027–dc232012020850
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may notbe available in electronic books.
Cover image: C© IOC: Photographers – Field Hockey, Huet; Tennis, Tobler; Ice Hockey, Nagaya;Weight Lifting, Kishimoto; Gymnast, JuilliartCover design by Opta Design
Set in 8.75/12pt Stone Serif by Aptara R© Inc., New Delhi, India
1 2012
Contents
List of Contributors, vi
Foreword, viii
Preface, ix
1 Sports therapy—Who? What? When? Where?Why? and How?, 1James E. Zachazewski and David J. Magee
2 A history of sports medicine and sportstherapy, 9James E. Zachazewski, Arthur J. Boland,and Nicola Phillips
3 The role and importance of the sportstherapist: pre-event, event, andpost-event, 19Suzanne Werner, Peter Drugge, Tommy Eriksson,Asa Lonnqvist, Ulrika Tranaeus, andLotta Willberg
4 Hosting international Olympic events:providing host therapy services atmajor games, 25Randy Goodman
5 Pre-Olympic team travel: logistical andtreatment considerations, 41Masaki Katayose and David J. Magee
6 Olympic event: logistical and treatmentconsiderations, 48Nicola Phillips and Caryl Becker
7 The importance of communication:understanding the importance of the eventto the athlete, coach, and others, 68Bill Moreau and Peter Toohey
8 Considerations for working with professionalathletes versus nonprofessional amateurathletes during Olympic events, 79Sergio T. Fonseca, Juliana Melo Ocarino,Thales Rezende Souza, Anderson Aurelioda Silva, Jose Roberto Prado Jr, Natalia FrancoNetto Bittencourt, and Luciana De MichelisMendonca
9 To compete or not to compete followinginjury during Olympic events, 91Tony Ward
10 Sports nutrition and therapy, 103Louise Burke and Ron Maughan
Appendix: Olympic sports medicinecontacts, 117James Green II and Gayle Olson
Index, 123
v
List of Contributors
Anderson Aurelio da Silva, MScDepartment of Physical TherapySchool of Physical Education, Physical Therapy &Occupational TherapyUniversidade Federal De Minas GeraisBelo Horizonte, MG, Brazil
Caryl Becker, MScChief PhysiotherapistBritish Olympic AssociationLondon, UK
Natalia Franco Netto Bittencourt, MScMinas Tenis ClubeGraduate Program in Rehabilitation SciencesUniversidade Federal de Minas GeraisBelo Horizonte, MG, Brazil
Arthur J. Boland, MDDepartment of OrthopaedicsSports Medicine ServiceMassachusetts General HospitalBoston, MA, USA
Louise Burke, APD, PhDHead, Sports NutritionAustralian Institute of SportAustralian Sports CommissionBruce, ACT, Australia
Peter Drugge, PT, ATCCapio Artro ClinicStockholm, Sweden
Tommy Eriksson, DNStockholms Naprapat Institute ABTaby, Sweden
Sergio T. Fonseca, PhDDepartment of Physical TherapySchool of Physical Education, Physical Therapy &Occupational TherapyUniversidade Federal De Minas GeraisBelo Horizonte, MG, Brazil
Randy Goodman, PT, DIP,Sports PT, BScClinical Specialist in Sports PhysiotherapyUniversity of British ColumbiaKelowna, BC, Canada
James Green II, BSGraduate Programs in Physical TherapyMGH Institute of Health ProfessionsCharlestown, MA, USA
Masaki Katayose, PT, JASA-AT, MSc, PhDDepartment of Physical TherapySchool of Health SciencesSapporo Medical UniversitySapporo, Hokkaido, Japan
Asa LonnqvistCapio Artro ClinicStockholm, Sweden
David J. Magee, PhD, BPTDepartment of Physical TherapyFaculty of Rehabilitation Medicine
vi
List of Contributors vii
University of AlbertaEdmonton, AB, Canada
Ron Maughan, PhDSchool of Sport, Exercise and Health SciencesLoughborough UniversityLoughborough, UK
Luciana De Michelis Mendonca, BScINCISAGraduate Program in Rehabilitation SciencesUniversidade Federal de Minas GeraisBelo Horizonte, MG, Brazil
Bill Moreau, DC, CSCSManaging Director, Sports MedicineUnited States Olympic CommitteeColorado Springs, CO, USA
Juliana Melo Ocarino, PhDDepartment of Physical TherapySchool of Physical Education, Physical Therapy &Occupational TherapyUniversidade Federal De Minas GeraisBelo Horizonte, MG, Brazil
Gayle Olson, ATC, MSWellness CoordinatorDepartment of Physical and Occupational TherapyMassachusetts General HospitalBoston, MA, USA
Nicola Phillips, PhD, MScPresident, International Federation of SportsPhysical TherapyCardiff UniversityCardiff, UK
Jose Roberto Prado Jr, MScCentro Universitario Augusto MottaRio de Janeiro, RJ, Brazil
Thales Rezende Souza, MScGraduate Program in Rehabilitation SciencesUniversidade Federal de Minas GeraisBelo Horizonte, MG, Brazil
Peter Toohey, ATC, MSLake Placid Olympic Training CenterUnited States Olympic CommitteeLake Placid, NY, USA
Ulrika Tranaeus, DN, MScStockholm Sports Trauma Research CenterKarolinska InstituteStockholm, Sweden
Tony Ward, M. Sports PhysiotherapyDepartment of Physical TherapiesAustralian Institute of SportBelconnen, ACT, Australia
Suzanne Werner, PT, ATC, PhDStockholm Sports Trauma Research CentreKarolinska Institute;Head of ResearchCapio Artro ClinicStockholm, Sweden
Lotta Willberg, MDOrthopedic SurgeryCapio Artro ClinicStockholm Sports Trauma Research CenterKarolinska InstituteStockholm, Sweden
James E. Zachazewski, PT, DPT,SCS, ATCClinical DirectorDepartment of Physical and Occupational TherapyMassachusetts General HospitalBoston, MA;Adjunct Assistant Clinical ProfessorGraduate Programs in Physical TherapyMGH Institute of Health ProfessionsCharlestown, MAUSA
Foreword
It must be appreciated that a wide variety of profes-sionals are involved with athletes in order to pro-vide these competitors with the highest possiblequality of care. In the organization of major sportcompetitions such as the Olympic Games, carefulconsideration must be given to the planning andthe organization of all services from the immediatemedical care to be provided through to the eventualtherapies for return to competition.
The co-editors of this handbook, Professor JamesZachazewski and Professor David Magee, have as-sembled a cohort of contributing authors who rep-resent the leading practitioners of the therapiesemployed with athletes. While earlier publicationsin the Handbooks of Sports Medicine and Science se-ries have dealt with particular sports from theOlympic Summer and Olympic Winter Games and
the general topics of sports injuries, sports nutri-tion, strength training, and sport psychology, thishandbook focuses on the pre-event organization,the considerations for international travel, the se-lection of appropriate therapies, and the specializedroles of specific therapeutic professionals.
A wealth of information is hereby provided forthe planning and provision of therapy services forathletes competing in major sport events. We wel-come this high-quality addition to the Handbookseries!
Dr Jacques RoggeIOC President
viii
Preface
Competitive sports date back to the earliest writtenrecordings of the history of man. The same is alsotrue for the knowledge of sports injuries and theircare. The broad collective term used today to de-scribe this body of knowledge and its application tothe injured athlete is “sports medicine.” While theuse of the term “medicine” most often signifies thephysicians’ contributions to the medical manage-ment of the injured athlete, history shows us thatmuch of the care provided to the injured athletehas been rendered not only by physicians but alsoby a multitude of other professionals. These non-physicians’ areas of expertise and concern usuallyencompass the study and management of the phys-iological and mental changes and the nutritionalrequirements as they relate to the injury preven-tion, the conditioning strategies, and the rehabili-tative processes, or the “sports therapies” necessaryto prevent injury and return of the athlete to a safecompetitive level.
Much has been written over time regarding the“specific therapy” required from a clinical perspec-tive to prevent injury or return of an injured ath-lete to competition. The editors did not feel that,in a brief publication such as this handbook, wecould contribute significantly to this broad body ofknowledge. Therefore, our goal in developing thishandbook for the IOC Medical Commission was toprovide a somewhat unique look at “sports ther-apy” and contribute a work to the international
community that would assist a multidisciplinaryprofessional audience to gain better understandingof “sports therapy” with regard to establishing anddelivering the diverse “sports therapy” services re-quired for athletes at international, national, andregional sporting events.
In keeping with the spirit of internationalcooperation and sharing that the Olympic Gamesrepresent, the editors have assembled an in-ternational panel of experts and authors fromaround the globe representing Australia, Brazil,Canada, England, Japan, Sweden, and the UnitedStates. Collectively, we have tried to provide theinternational Olympic community with a guidefor the development and delivery of sports ther-apy services at large international competitions.Each author has not only contributed his orher expertise but, more importantly, also sharedhis or her practical experience with the reader. Indeveloping the chapters, we have asked the authorsto write from the perspective of being a profes-sional consultant hired to provide informationregarding sports therapy services in a format thatwould outline for the reader the issues that mustbe considered when developing sports therapyservices leading up to and during major sportingevents.
James E. ZachazewskiDavid J. Magee
ix
Chapter 1Sports therapy—Who? What? When? Where?Why? and How?James E. Zachazewski1 and David J. Magee2
1Massachusetts General Hospital, Boston, MA, USA2University of Alberta, Edmonton, AB, Canada
Introduction
When exploring any topic or area of study, onecan learn a great deal by asking and answering thequestions of Who? What? When? Where? Why?and How?� What is the definition or meaning of this topic orarea?� Who is this topic or area of study important to?Who is involved in this area?� When is it important to be aware of this topic andarea of study?� Where is this area of study practiced or impor-tant?� Why is this topic and area of study important?� How does an individual successfully gain knowl-edge and competence in this topic and area ofstudy?
Answering these questions allows one to gainoverall insight into the topic or area of study and todecide if further exploration is necessary or desired.Included within our answers to these questions aresome factors that should be considered in order todevelop a strategy to gain further knowledge, com-petence, and expertise concerning sports therapy.
What is sports therapy?
Sport should be considered in the broadest contextwhen answering the question of “What?” Accord-ing to the Merriam Webster Dictionary (2010):
Sport is a physical or recreational activity, usuallyengaged in for pleasure, that an individual is in-volved in either as a single athlete or participant,or in a group or team format.As a consequence and requirement of successful
sport participation, especially at elite and Olympiclevels, various types of training and activitiesare required. Unfortunately, participation in sportsometimes results in adverse physical or men-tal/emotional/behavioral consequences to the ath-lete. Treatment of these adverse physical or men-tal/emotional consequences often requires sometype of therapeutic intervention (i.e., the treatmentof disease or disorders by remedial agents or meth-ods). The therapy, or the treatment of the physi-cal, mental, emotional, or behavioral adverse con-sequences of sport, is provided by a wide arrayof professionals to allow the athlete to return topractice and/or competition. The definition, num-ber, type, background, educational preparation,
Sports Therapy Services, First Edition. Edited by James E. Zachazewski and David J. Magee.© 2012 International Olympic Committee. Published 2012 by John Wiley & Sons, Ltd.
1
2 Chapter 1
expertise, and experience of these health care pro-fessionals vary broadly on an international basis.This variability may be due to history, culture,sport bias, economics, or access to therapeutic re-sources to name but a few. In many countries,Olympic committees and professional associationshave established minimum requirements for clin-icians who wish to work at Olympic events orfacilities. For the purpose of this book, the term“sports therapy” is best defined as “the provision ofnon-surgical, non-pharmacologic interventions bya broad array of professionals to help the athlete al-leviate the adverse physical, mental, emotional orbehavioral adverse consequences of sport and allowthe athlete to return to an optimal level of health,well being and competitive function.”
Who practices sports therapy
There are a multitude of professionals who supportan elite athlete from a clinical therapeutic basis. Thetype of therapy delivered, and which professionalwill provide that therapy, may differ from coun-try to country. This difference in delivery may bebased on things such as educational preparation,licensure requirements (if any), availability, andthe cultural environment of the country and sport.In many cases, there is overlap of what individu-als in each profession may provide relative to an-other professional. Some of the types of overlap thatmay exist are summarized in Table 1.1 (Booker andThibodeau 1985).
That being said, one must never forget the impor-tance of the “psychological bonding” between theathlete and the health care professional. This bond-ing can lead to increased confidence and comfortof the athlete when dealing with different healthcare professionals.
Sports Physiotherapist. Physiotherapy (orphysical therapy as termed in the United States)is defined as “the treatment of disease, injury, ordisability by physical and mechanical means (us-ing massage, regulated exercise, water, light, heat,and electricity).” Depending upon the country,physiotherapy was established as a profession soon
after the end of World War I. As a result, phys-iotherapists have played a significant role in thetherapeutic management of injured Olympic andPara Olympic athletes almost since the inceptionof the modern games. The establishment of therole and skill set of the physiotherapist throughthe utilization of exercise, massage, and othertherapeutic means goes back much earlier, to thetime of the ancient Greeks and Romans, as canbe seen when reading Chapter 2, “A History ofSports Medicine and Sports Therapy.” Modern day“sports physiotherapists” also play a prominentrole in the emergency management of injuries thatmay occur during competition or training. Theeducation, training, and professional preparationof physiotherapists vary from country to country.The general course of study and initial preparationof physiotherapists has great breadth, taking intoconsideration all ages, and types of pathologies,diseases, and injuries. In all instances, sportsphysiotherapy is a further course of study and areaof subspecialization, after initial generalist prepara-tion, and commonly, these physiotherapists havespecialty certification in sports therapy to deal withthe unique requirements and care of athletes. Thissystem of training allows for greater breadth anddepth of preparation combined with specific topicsapplicable to sport, and the care and prevention ofsports injuries by the sports physiotherapist. Educa-tion and training to become a sports physiothera-pist vary from country to country with educationalpreparation ranging from different types of certifi-cation to bachelors, masters, and clinical doctoraldegrees. Training of physiotherapists generally andspecifically for sports physiotherapy tends to followa medical model in most countries. Many sportsphysiotherapists, when not directly involved withsports teams, work in hospitals and private clinics.
Athletic Trainer. Athletic training is a profes-sion and course of study that is found predomi-nantly in the United States, although some othercountries such as Canada and Japan have also seenthe development of this profession. The role thatthe athletic trainer plays with the Olympic levelathlete may be similar to that of the sports phys-iotherapist depending upon the sport and coun-try. The education and preparation of the ath-letic trainer centers around athletic-, sport-, and