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Injury prevention How to make every session count www.nwconditioning.com

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Injury prevention

How to make every session count

www.nwconditioning.com

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Neil Welch MSc ASCC• BSc Sports science and physiology

• MSc Strength and conditioning

• S&C coach for the the England alpine ski team

• Work with athletes from multiple sports including rugby, cricket, rowing and triathlon

• Founder of nw conditioning strength and conditioning consultancy

• Run biomechanist at Profeet

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Session overview

• Common injuries and their mechanisms

• Practical - how to screen for these injuries

• Practical - injury prevention strategies

• Using the whole training session

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Learning outcomes

• Learn to identify potential mechanisms of injury in athletes

• Learn what to do to help prevent injury occurrence

• Learn how to implement those strategies into your training sessions

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Common injury types

• Acute impact trauma - not much we can do about impacts, nature of the sport, although better strength and conditioning will mean better ability to concentrate

• Pulled muscles are definitely preventable, need; – Appropriate strength through full range of motion– No bilateral imbalances– Limit agonist antagonist imbalances

• Connective tissue injuries such as tendon/ligament ruptures we can have some say in reduction

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Common injury areas

• Lower leg - achilles

• Shoulder injuries

• Hamstring

• Knee

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Injury prevention or improved performance

• Injury prevention is a conservative approach

• As coaches we are looking to improve our athlete’s performance

• Improved performance goes hand in hand with injury prevention

• Developing strong, mobile and balanced athletes will reduce injuries

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Achilles tendon

• The connective tissue link between the calf muscles and the heel (calcaneous)

• It is the strongest tendon in the human body

• Stores elastic energy while running improving efficiency

• Has been suggested that the limiting factor in human sprinting speed is achilles tendon strength

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Achilles injury mechanisms

• High impact forces force the tendon to dissipate force

• Lack of range of motion about the ankle

• Lack of strength in the muscles of the calf

• Growth spurts can cause a time lag in the change of length of muscles overloading the tendon (known as Sever’s disease)

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Achilles injury prevention

• Increase the strength of the calf muscles

• Ensure appropriate range of motion about the ankle

• Improve shock absorption of the whole system (landing mechanics)

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Shoulder injury mechanisms

• The shoulder girdle is made up of 3 joints and is inherently instable

• This makes it particularly vulnerable in an overhead position

• Common injuries therefore in overhead sports e.g. tennis, cricket, javelin

• Due to imbalance between internal concentric movement and external eccentric movement

• Poor scapula function

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Shoulder injury prevention

• Need to be aware of whole body biomechanics and how they effect range of motion

• Opening the hips improves range of motion and reduces load on the shoulder

• Work on the brakes, ability to slow down the movement is important

• Correct patterning of the scapula is very important

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Hamstring injury

• Most prevalent muscle strain 6-29% of all injuries

• High re-injury risk of 12-31%• Recent research showing injury rates not

improving– Ekstrand et al 2011 looked at injury rates for 7

consecutive seasons– 23 professional European football clubs– Unchanged competitive and training injury rates

• Whatever strategies have been in place haven’t been working

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Hamstring injury links

• Lack of flexibility in hamstrings and hip flexors• Lack of gluteal activation in extending the hip• Weakness of core musculature• Weakness in the hamstrings themselves – 2.5 x bodyweight

per running stride• Chronic fatigue• Previous injury• Research is mixed on the exact causes, mainly because of

isolationist approaches, likely to be a mix of all these

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The knee - ligaments

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• 4 ligaments in the knee

• Collateral ligaments prevent lateral movement

• Cruciate ligaments prevent anterior posterior movement

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The knee - musculature

• Significant musculature surrounding the joint

• Imbalance can put altered load on the ligaments

• Lack of strength can increase load on the ligaments

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Causes of ACL injury

• Weakness in musculature about the hips and core

• Particularly vulnerable in a position of knee valgus

• Knee valgus can lead to MCL strain and increase risk of ACL injury

• Usually involves a rapid deceleration of the joint, therefore increased strength is a requirement

• More susceptibility with females

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Female athletes and ACL injury

• More occurrence of ACL injury than males• Due to hormonal, anatomical and neuromuscular

differences• Neuromuscular control deficits: strength, power or activation

patterns• Ligament dominance: imbalance between ligament and

neuromuscular control of knee stability• Quadriceps dominance: imbalance between quads and

hamstrings• Leg dominance: imbalance from leg to leg• Trunk dominance: inability to activate core correctly

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Knee injury prevention

• Ensure adequate hamstring strength

• Work on posture and pelvic alignment

• Correct takeoff and landing mechanics – work on the brakes

• Develop movement and force reduction and production in all 3 planes of motion

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Screening

• Allows progression to be monitored

• Can show the athlete why they need to be doing the exercises/training they have been set

• It can highlight those most at risk and allow the coach to target specific work to those athletes

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Methods of screening: Hop and stop• Measures differences in force production and stability

relative to height

• Gives quantitative information to compare on an ongoing basis

• Is quick and easy to administer

• For details and reminder of protocol see athlete by design

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Methods of screening: Tuck jumps

• Again, quick and easy to administer

• Feet 35cm apart, slight knee bend and jump using an arm swing bringing the knees up to parallel with the floor

• On landing immediately go straight into the next jump continuing for 10 seconds

• The athlete should be encouraged to land softly using a toe to midfoot rocker and keep the same footprint on landing

• The athlete should be instructed to stop if they show a sharp decline in technique

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Methods of prevention

• Now we have an idea of the mechanisms of injury, we can target those areas to help prevent them

• You don’t have to train individual muscles unless to address a specific imbalance or rehab program

• By training the correct movement it makes prevention functional and will improve performance

• These movements will help long term physical preparation

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Get stronger!

• The stronger your athletes, the greater the ability to produce reduce and stabilise force

• Reduction in potential for injury, prevention is better than cure

• Focus on whole body strength not individual muscles

• First strength gains are neuromuscular, you get better at the movements.

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Jumping and landing

• Focus on technique– Maintain correct knee alignment– Landing on forefoot rocking back to mid-foot– Keep the noise down– Brace core

• Progressions:– Increase height– Change direction– Introduce rotation– Single leg

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Activating hip abductors

• To help maintain proper alignment at the knee

• Exercises working against a lateral resistance during uni or bi-lateral exercises– Band squats– Split squats/lunges– Monster walks– Side lying leg raises

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Addressing quad dominance: Hamstrings

• Looking to load the Hamstrings eccentrically

• Number of possible exercises to use– Good mornings– Stiff leg deadlift– Stiff leg deadlift variations

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Calf work

• Calf stretching – straight leg, bent leg and big toe raised

• Calf raises – – slow eccentrics and bounces– Whilst walking

• Plyometric work – ankle hops – Low load short sets of below 10 on each leg

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Addressing leg dominance

• Even out through correct bilateral technique

• Use of single leg exercises– Single leg squats– Split squats– Lunges

• Increase the load on the non-dominant leg

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Core

• Important to use and train core musculature in the correct way

• Pelvic tilt awareness• Use of the abdominal Brace• The big 4!

– Curl ups– Bird dogs– Glute bridges– Side bridges

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Shoulder

• Thoracic mobility

• External rotations

• Wall angels

• Scapula activation

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Athlete education

• Education plays an important role, create the all round athlete

• Help the athlete to understand why they’re doing what they’re doing

• Get the athletes to coach each other, will embed the technique

• Will give greater adherence• Encourage self awareness, the athlete should be able to

feel where they are going right and wrong

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Flexibility

• Calf• Hamstring• Hip flexor• Glute• Quads• 3D stretching

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Making every session count

• Your time with your athletes is valuable, we need to make sure none of it is wasted

• The warm up, it is a substantial percentage of training and contact time

• Need to plan this as much as the technical components of our sessions

• Include jumps, landings, lunges, squats, accelerations and decelerations

• We have to do better than a run around the pitch and some stretching

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Use your down time

• Your athletes will need to rest during a session, especially if it’s high intensity

• Technical sessions often lower in intensity • Possible to plan small exercise blocks into the session

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Get creative

• You can incorporate a lot of these movements into your technical drills

• A jump, a lunge, a hop. These are all useable and the beginning or mid way through a drill.

• Alter your start position• Alter your finish position• Alter the direction of the drill

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Any Questions?

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Thank you for your time

[email protected]

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