Basketball: Re-Conditioning After Injury
Adriano Vretaros Strength and Conditioning Coach
2021
Basketball: Re-Conditioning After Injury
The Problem – I BASKETBALL PLAYERS
Training
Matches
** INJURIES **
Basketball: Re-Conditioning After Injury
The Problem – II Multilevel Nonlinear Complex Dynamic System
x
q
y
a k
w
u
h b
o
z
(Adapted from Bittencourt et al, 2016)
Basketball: Re-Conditioning After Injury
The Problem – III INTRINSIC Risk Factors
PREDISPOSED PLAYER
EXTRINSIC Risk Factors
** INJURIES ** (Yes \ No)
SUSCEPTIBLE PLAYER
Training + Competitions + Preventive Strategies (Adapted from Bahr & Krosshaug, 2005)
Basketball: Re-Conditioning After Injury
The Problem – IV Contact ACUTE Injuries Non-Contact Basketball Injuries
CHRONIC Injuries
Non-Contact
(Adapted from Cumps et al, 2007; Siegmund et al, 2008; Dalton et al, 2015)
Basketball: Re-Conditioning After Injury
The Problem – V Basketball Injuries
Load-Injury
Fatigue-Injury
(Adapted from Lewis, 2018)
Basketball: Re-Conditioning After Injury
The Problem – VI FEMALE Players
%
MALE Players
%
Head, Face, and Neck
14,2
Head, Face, and Neck
12,8
Upper Limbs and Shoulder
2,5
Upper Limbs and Shoulder
2,8
Hand, Wrist and Fingers
9,5
Hand, Wrist and Fingers
9,4
Trunk
4
Trunk
7,1
Hip and Thigh
8,7
Hip and Thigh
8,2
Knee
18,2
Knee
10,6
Lower Limbs
4,9
Lower Limbs
3,4
Ankle and Foot
35,9 *
Ankle and Foot
43,2 *
Other
2,2
Other
2,4
(Adapted from Borowski et al, 2008)
Basketball: Re-Conditioning After Injury
The Problem – VII Tissues Affected by Injuries
Muscle
Cartilage
Tendon
Fascia
Joint
Ligament
Bone
Basketball: Re-Conditioning After Injury
The Problem – VIII Financial Cost of Injuries - I
Direct
Indirect ●
Mean Medical Cost per Injury;
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Mean Human Capital Cost per Injury;
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Mean Comprehensive Cost per Injury (Adapted from Knowles et al, 2007)
Basketball: Re-Conditioning After Injury
The Problem – IX Financial Cost of Injuries - II NBA Teams 2014-2015 Season
Regular Season Games Lost to Injury
Salary Cost of Games Lost to Injury ($)
Minnesota Timberwolves
340
22,604,770
Los Angeles Lakers
338
28,009,937
Philadelphia 76ers
281
12,134,306
New York Knicks
262
28,120,176
Milwaukee Bucks
260
9,893,61
OKC Thunder
224
21,288,979
Miami Heat
220
21,026,069
Indiana Pacers
219
24,548,630
Houston Rockets
182
13,425,804
(Adapted from Stotts, 2015)
Basketball: Re-Conditioning After Injury
The Problem – X BASKETBALL PLAYER
Injury
Re-Conditioning Process
Rehabilitation
Basketball: Re-Conditioning After Injury
The Problem - XI ●
What kind of injury was the player affected?
How long (time loss) will be the period of absence from training and competitions?
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What is the moment you can start the physical re-conditioning?
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How long does the physical re-conditioning process take? What activities and criteria should be used in the physical reconditioning process? ●
When effectively ends the physical re-conditioning?
Basketball: Re-Conditioning After Injury
Scientific Team - I ●
How Does Your Scientific Team Work?
MULTI disciplinary
INTER disciplinary
TRANS disciplinary
(Adapted from Buekers et al, 2017)
Basketball: Re-Conditioning After Injury
Scientific Team - II Internal Communication Between Members of the Scientific Staff
(Adapted from Ekstrand et al, 2018)
Basketball: Re-Conditioning After Injury
Scientific Team - III Intra-Team Communications and Injuries “In elite sports, players are commonly pressured to return to play after an injury”
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Clear Communication Between Staff Members ●
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Continuous Management of Expectations Avoid the Probability of Premature Return
(Adapted from Ekstrand et al, 2018)
Basketball: Re-Conditioning After Injury
Lesional Context Injured Basketball Player
BIOPSYCHOSOCIAL
Physical
Emotional
Social
(Adapted from De Rose et al, 2008; Arden et al, 2016)
Basketball: Re-Conditioning After Injury
Definition ●
What is Physical Re-Conditioning?
It is a gradual process of returning to sports activities after the athlete has suffered an injury and has met the minimum acceptable clinical criteria.
Basketball: Re-Conditioning After Injury Professionals Involved in Re-Conditioning - I 1)- Physician
2)- Physiotherapist
Sport Scientist
3)- S&C Coach (Adapted from Vretaros, 2002)
Exercise Physiologist
Basketball: Re-Conditioning After Injury Professionals Involved in Re-Conditioning - II (2)- PHYSIOTHERAPIST
(1)- PHYSICIAN
Diagnostics
(3)- S&C COACH
Re-Conditioning Process
Basketball: Re-Conditioning After Injury
The Process - I BASKETBALL RE-CONDITIONING PROCESS
(1)- Return to TRAINING
(2)- Return to SPORT
(3)- Return to PERFORMANCE
(Adapted from Arden et al, 2016)
Basketball: Re-Conditioning After Injury
The Process - II (2)- Return to SPORT
(1)- Return to TRAINING “Athlete-Centred”
Injury Type (3)- Return to PERFORMANCE (Adapted from Arden et al, 2016; Taberner et al, 2019)
Basketball: Re-Conditioning After Injury
The Process - III Re-Conditioning Process
CONTROLLED Activities
CHAOTIC Activities PROGRESSION
Properly controlled movements
Movement based on the reality of matches
(Adapted from Taberner et al, 2019)
Basketball: Re-Conditioning After Injury
The Process - IV Re-Conditioning Process - Apply Progressive Mechanical Loading - Gradually Restore Mechanical Rigidity - Use Metrics Based on Training Loads - Return to Physical Fitness Pre-Injury Values (Adapted from Taberner et al, 2019a)
Basketball: Re-Conditioning After Injury
Return to Training - I CHARACTERISTICS ●
Final Rehabilitation Stage ●
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Pain Monitoring
Player Psychological Security ●
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Adapted Training Adequacy of Loads
(Adapted from Arden et al, 2016)
Basketball: Re-Conditioning After Injury
Return to Training - II ACTIVITIES: Intensive and Extensive ●
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Return to running (linear)
Front running, lateral running, backpedal ●
Low impact forces
ENDURANCE: aerobic STRENGTH: (Adapted isometricfrom training and anatomical Taberner et al, 2019)adaptation
Basketball: Re-Conditioning After Injury
Return to Sport - I CHARACTERISTICS ●
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Integral Training
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Increase Specific Skills
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Gradual Load Increase
Monitor Injury Symptoms (Y\N)
(Adapted from Arden et al, 2016)
Basketball: Re-Conditioning After Injury
Return to Sport - II ACTIVITIES: Intensive and Extensive ●
Introduce changes of direction (with ball and without ball) ●
●
Introduce short accelerations \ decelerations Introduce medium accelerations \ decelerations ●
Introduce elements of technical skills ENDURANCE: aerobic and anaerobic
STRENGTH: hipertrophy and maximal strength (Adapted from Taberner et al, 2019)
Basketball: Re-Conditioning After Injury
Return to Performance - I CHARACTERISTICS ●
Final Phase of Re-Conditioning ●
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Game Pace Acquisition
Gradual Return to Matches
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Control of Minutes on the Court
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Player Efficiency Ratings (PER)
(Adapted from Arden et al, 2016; Siu et al, 2020)
Basketball: Re-Conditioning After Injury
Return to Performance - II ACTIVITIES: Intensive and Extensive ●
Introduce long accelerations \ decelerations ●
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Running speeds
Acc\Dec demands (playing positions) ●
Jumps \ Landings + SSCG
ENDURANCE: aerobic and anaerobic STRENGTH: power and power endurance (Adapted from Taberner et al, 2019)
Basketball: Re-Conditioning After Injury
Gradual Performance Activities Overview Metabolic Training
Strength Training
Linear Running
Isometric Training
Short Accelerations \ Decelerations
Anatomical Adaptation
Medium Accelerations \ Decelerations
Hypertrophy + Maximal Strength
Changes of Direction
Jumping + Landing Preparation
Long Accelerations \ Decelerations
Power + Power Endurance
Running Speeds 1)- Aerobic and 2)-Anaerobic Small-Sided Conditioning Games
(Adapted from Taberner et al, 2019; Taberner et al, 2019a)
Basketball: Re-Conditioning After Injury
Periodization - I Periodization in the Re-Conditioning Process
Linear Model
Non-Linear Model
(Adapted from Lorenz & Morrinson, 2015; Kakavas et al, 2020)
Basketball: Re-Conditioning After Injury
Periodization - II LINEAR Model ● a
Basketball: Re-Conditioning After Injury
Periodization - III NON-LINEAR Model ● a
Basketball: Re-Conditioning After Injury
Training Load - I Monitoring Training Loads During Re-Conditioning Process
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EXTERNAL EXTERNAL LOAD: LOAD:
1)- Volume, intensity, density, frequency and complexity; 2)- Distance traveled, number of accelerations, number of decelerations, number of changes of direction, number of jumps, average speed, playerload, etc.
(Adapted from Gabbett, 2020; Petway et al, 2020)
Basketball: Re-Conditioning After Injury
Training Load - II Monitoring Training Loads During Re-Conditioning Process
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INTERNAL INTERNAL LOAD: LOAD:
1)- OBJECTIVE: Heart rate, lactate, creatine phosphokinase, testosterone\cortisol ratio, VO2max, etc 2)- SUBJECTIVE: RPE, monotony index, strain index, wellness questionnaire, TQR questionnaire, etc
(Adapted from Fitrianto et al, 2018; Paulauskas et al, 2019; Gabbett, 2020; Petway et al, 2020; Brini et al, 2020)
Basketball: Re-Conditioning After Injury
Training Load - III Monitoring Training Loads During Re-Conditioning Process ACWR (acute:chronic worloadratio): ratio): ACWR (acute:chronic workload
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1)- Acute Training Loads (weekly basis) - FATIGUE 2)- Chronic Training Loads (3-6 weeks) - FITNESS SAFETY Zone ~0.8-1.3
RISK Zone ≥1.5 The 10% rule (≤10-25%) - ?
(Adapted from Gabbett et al, 2016; Gabbett, 2020a; Gabbett, 2020b)
Basketball: Re-Conditioning After Injury
Training Load - IV Monitoring Training Loads During Re-Conditioning Process ●
Muscle injuries
Errors and\or Spikes in Loads: ~1-2 weeks ~3 weeks
Tendon injuries
~3-4 weeks
Bone injuries (Adapted from Tibana et al, 2017)
Basketball: Re-Conditioning After Injury
Training Load - V Monitoring Training Loads During Re-Conditioning Process
Load DISTRIBUTION
Load CONTROL
Plan the Program
Monitor Responses (Adapted from Meneses, 2020)
Basketball: Re-Conditioning After Injury
Progression Criteria - I Pain Tolerance
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Load Tolerance Strength + Neuromuscular Control Aerobic and Anaerobic Capacity Range of Motion
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Joint Stability Tenderness Inflammation or Swelling Effusion
"Injury Type-Dependent"
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Girth Other
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(Adapted from Creighton et al, 2010; Bahr et al, 2012)
Basketball: Re-Conditioning After Injury
Progression Criteria - II (1)- Health Status
(2)- Participation Risk
- Athlete Demographics; - Symptoms; - Medical History; - Physical Exam; - Lab Tests; - Functional Tests; - Psychological State; - Potential Seriousness
- Demands of Sport; - Position Played; - Limb Dominance; - Competitive Level; -Ability to Protect
(3)- DecisionMaking
- Season Period; - Pressure from Player; - External Pressure; - Masking the Injury; - Conflict of Interest; - Fear of Litigation
(Adapted from Creighton et al, 2010)
Basketball: Re-Conditioning After Injury Relationship Between Physical Fitness and Injury Symptoms Hypothetical Model of the Relationship Between Physical Fitness (yellow line) and Injury Symptoms (red line) in the Three Phases of Re-Conditioning
Return to Training
Return to Sport
Return to Performance
Basketball: Re-Conditioning After Injury
Return to Performance Duration Injury Type
RTP Duration ● a(weeks)
Authors
Achilles tendon rupture
~40-80
Lemme et al, 2019; Carmont et al, 2020; Siu et al, 2020
Soleus muscle strains
~5
Pedret et al, 2015
Ankle sprains
>4
McKeon et al, 2014
ACL rupture
~24-60
Lohmander et al, 2007; Nagano et 2011; Brophy et al, 2012; Oiestad et al, 2018; Wellsandt et al, 2018
Repair of the rectus abdominis and adductor longus
~5
Short et al, 2016
Hamstring strain
~1->5
Cohen et al, 2011; Reurink et al, 2014
Adductor strain\tear
~4-9
Patel et al, 2020
Shoulder subluxations\dislocations
~3-8
Lu et al, 2020
Cervical, thoracic, and lumbar spine injuries
~12-48
Huang et al, 2015
Hand and finger fracture
~4-17
Morse et al, 2017
Concussions
~1-3
Patel et al, 2019
Basketball: Re-Conditioning After Injury
Risk of Injury After Return
Recurren ce risk
RECURRENCE RISK (muscle strains)
↑
15 weeks after return to performance
Week since return to performance
(Adapted from Orchard et al, 2020)
Basketball: Re-Conditioning After Injury
Final Considerations - I ●
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Re-conditioning is a gradual process of returning to competitive activity after an injury;
There are three phases in the re-conditioning process: 1)return to training, 2)- return to sport and 3)- return to performance; ●
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The process involves being athlete-centered and dependent on the type of injury;
It is important to prescribe appropriate activities for each phase and monitor training loads; Observing the progression criteria would minimize errors in decision making.
Basketball: Re-Conditioning After Injury
Final Considerations - II ●
THANKS!!!
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E-Mail: avretaros@gmail.com