INDENTIFYING INJURY WHAT’S “NORMAL” AND WHAT’S NOT
Andrew Darcey Sports Physiotherapist
Andrew Darcey Rowing • London 1948 • King’s Cup Coxes Sport Sailing • Junior Australian Rep • SASI Senior Athlete – Laser • State Champion Sports Physiotherapist • SASI Rowing Program • Australian Rowing Team
Andrew Darcey
Overview • Pain • Common Injuries in Rowers – Rib Stress Injuries
• Risk factors • Screening
PAIN • No-one that is “soft” rows • 2km hurts like all hell • 6-8 minutes of torture • All rowers are tough • IF they have a niggle, it may be significant, as they are used to dealing with the pain that is required to be endured to compete in the sport
PAIN
PAIN • Pain is GOOD – it is NORMAL • Body’s Alarm System • Brain concerned with survival • Pain helps us protect tissues that are damaged • Brain also decides when pain is not a good decision – based on what it is “hearing” from the tissues
PAIN • When you exercise at most intensities, you’re going to experience some pain — that’s unavoidable • The more you exercise, the better your tolerance to pain becomes • It’s not that the pain goes away, but you get used to it
TRAINING LEVEL
PAIN
Training Load Increased Subsequent Increase in above “Protect by PainBacked Subsequent Increase in “ProtectTraining by Pain Line” Off – = athlete “sore” “Protect by Pain Line”Line”and Training No Longer “hurts” “Tissue Tolerance” and “Tissue Tolerance” Normal increase in Training Load TIME Training Level
"Protect By Pain"
"Tissue Tolerance"
PAIN So when does this go wrong? • Sudden Jumps in Training Load • Not “Listening” to Pain • “Boom - Bust” Cycle
PAIN
TRAINING LEVEL
BOOM-BUST CYCLE
Continued Increase in SuddenTraining Increase – in Training – ExceedLoad “Tissue Exceed Tolerance” Line – Increase In“Protect Training Backed Athlete by Pain line” – Off as INJURED Quickly Exceed “ProtectAthlete By Pain” INJURED – “Tissue Tolerance” althlete in Pain New “Protect By & “Tissue Further More Reduction Prone to in Re-Injury & “Protect Dropand as “Tissue Tolerance” Line = By Pain”Pain” Tolerance” as Training Load Injured Tissues Heal and “Tissue Normal increase Tolerance” Lines ADAPTATION increased Too Quickly Become More Sensitive in Training Load = REINJURY For Current Capacity TIME Training Level
"Protect By Pain"
"Tissue Tolerance"
PAIN • How much Pain is TOO MUCH? • Use Pain Scale 0 No Pain 1 2 3 4 5 6 7 8 9 10 Worst Pain Imaginable
PAIN HOW MUCH PAIN IS TOO MUCH? Normal Training • 1-3 / 10 • Pain will relieve after training “Abnormal” Pain • Sharp Pain • Burning Pain • > 3 / 10 • Does not settle after training • Affecting performance
Common Injuries in Elite Rowers
Rib Stress Injuries How Do They Occur?
Rib Stress Injuries How Do They Occur?
• Normal Bone Loading: Repetitive Bone Stress/Loading Stressed Bone Absorbed By Osteoclasts Micro Damage
Osteoblasts Lay Down Stronger Bone
Rib Stress Injuries How Do They Occur?
• Abnormal Bone Loading: Excessive Bone Stress/Loading Imbalance between Osteoclasts and Osteoblast activity Progression of Micro Damage Insufficient Repair Before Next Loading Stress Fracture
Rib Stress Injuries
Rib Stress Injuries
Rib Stress Injuries
Rib Stress Injuries Significant problem in elite rowing • Occur frequently • More likely to occur in International level rowers compared to National level (Verrall and Darcey 2014)
• Increasing prevalence in Junior and sub-elite rowing • Significant loss of on-water training
RA Study on Seasons 2009-2010 • 28 cases of CWP • 13 confirmed as bone stress injuries § 3 Stress fractures § 10 Stress “reactions”
Rib Stress Injuries
• Time “cost” of bony injury significantly higher than non-bony causes of CWP • Incidence in females significantly higher •
? Influence of bone health contributors
Rib Stress Injuries Risk Of Not Identifying Rib Stress Injuries Early • Athlete may not be removed from training • May make stress reaction worse, or develop to a stress fracture • If develops to stress fracture, an extra 13 days lost to training
Rib Stress Injuries Chest Wall Pain Protocol • Over three years RA physios collected data on seven diagnostic tests: SubjecBve Measures
ObjecBve Measures
Night Pain Pain on ADL
Deep breath Cough Sit up Push up Rib spring
Rib Stress Injuries Chest Wall Pain Protocol • If 5 of the 7 tests are “positive” for pain, the likelihood of bone stress was high • The longer this persisted, the likelihood increased:
Rib Stress Injuries Chest Wall Pain Protocol • Recommendation: § § § § §
Removing athlete from water for 4 days Allows non-bony causes of CWP to settle Prevent worsening of bony cases (stress reaction to stress fracture) May save two weeks of training later on Assessment of athlete by doctor/physio that are members of RA preferred practitioner network
Rib Stress Injuries Chest Wall Pain Protocol
Rib Stress Injuries Chest Wall Pain Protocol • Recommendation: § Stress Reaction § 3-4 Weeks Off Water § Stress Fracture § 4-6 Weeks Off Water
Rib Stress Injuries Chest Wall Pain Protocol
• Reduction in total time lost in 2011 and more than 1/3rd days lost to bony injury • Sustained reduction in time lost to bone stress injuries
Risk Factors • Rib Stress Injuries: – Bone Health
• Reduced Oestrogen Levels • Poor NutriVon – Calcium – Vitamin D
• EaVng Disorders • Energy Balance
Risk Factors • Rib Stress Injuries: – Training Load • Sudden Increase Training Load • Sustained Increased Training Load • Insufficient Recovery Between Sessions
Risk Factors • Rib Stress Injuries: – Technical
• Insufficient Recovery Between Sessions • Over-‐use of upper body in early part of stroke phase – Breaking arms early
Risk Factors • Rib Stress Injuries: – Technical
Risk Factors • Rib Stress Injuries: – Technical
• Insufficient Recovery Between Sessions • Over-‐use of upper body in early part of stroke phase – Breaking arms early – Scapula Control
Risk Factors • Rib Stress Injuries:
Risk Factors • Rib Stress Injuries: – Technical
• Insufficient Recovery Between Sessions • Over-‐use of upper body in early part of stroke phase – Breaking arms early – Scapula Control – Poor Leg Drive
Risk Factors • Rib Stress Injuries:
Risk Factors • Rib Stress Injuries: – Technical
• Insufficient Recovery Between Sessions • Over-‐use of upper body in early part of stroke phase – Breaking arms early – Scapula Control – Poor Leg Drive » Increased load upper body
Risk Factors • Rib Stress Injuries: Pectoralis Major
Serratus Anterior
External Oblique
Pectoralis Minor
Intercostals
Risk Factors • Rib Stress Injuries:
Risk Factors • Rib Stress Injuries:
Risk Factors • Rib Stress Injuries: • Co-‐contracVon of Serratus Anterior and External Oblique (Gregory et al 2002, ChrisVansen and
Kanstrup 1997, Karlsen 2000, Pinciob et al (n.d.), Karlsen 1998, Holden and Jackson 1985)
• FaVgue of Serratus Anterior Belfer and Guskiewicz 2000, McKenzie 1989)
(Warden et al 2002,
Risk Factors • Rib Stress Injuries: • Other Factors to Assess: • SVffness of Chostochondral, Costovertebral, Chostotransverse and PIV joints
Risk Factors • Rib Stress Injuries: • Other Factors to Assess: • SVffness of Chostochondral, Costovertebral, Chostotransverse and PIV joints – Effect on “Bucket Handle” acVon of Ribs
Risk Factors • Rib Stress Injuries: • Other Factors to Assess: • SVffness of Chostochondral, Costovertebral, Chostotransverse and PIV joints – Effect on “Bucket Handle” acVon of Ribs
• SVffness in Joints distal to Thorax – Hips – Ankles
How Do You Know If Your Athletes Are Risk Of Injury? • Get their body assessed by a Sports Physio trained in Musculoskeletal Screening for Rowers • Gives a “snap-‐shot” of the key flexibility parameters required for the sport • Compare against known “benchmarks” to see where you need to work on
Rowing Musculoskeletal Screenings • Flexibility – Ankles – Hips (Hamstrings, Hip Flexors, Gluteals)
• Thoracic/Lumbar Spine – Flexibility and Symmetry
• Scapula Control • Ergo Technique
Flexibility • Important to allow: – – – –
Muscles to work at their opVmal angles Generate more force Reduces strain on spinal structures Allows beler length of stroke
Hip Flexion Hamstrings Gluteals
Ankle DF Calves
Ergo Technique • Hip Bunch up Catch: – Determined by flexibility of Spine, Hips, Knees and Ankles
• Rockover: – Determined by strength of abdominals and hip flexors, as well as flexibility of Hamstrings Rockover Angle Catch Angle Finish Angle
Results
Colour Coded Green: Good Yellow: Not Ideal – Needs Work Red: Poor - Significantly Needs Work
Comment on Result of Test
Exercises to Address any weakness found
What Do You Do If You Think Your Athlete Is Injured? • Listen to your athletes – they know their bodies • Sustained and Significant Aches and pains are NOT normal in rowing • Modify training as appropriate • Seek prompt advice from a health professional that KNOWS about the sport of rowing
QuesVons?
FURTHER ADVICE Head To: www.lept.com.au/rowingsa Enter Your Name & Email Slides Emailed To You
FURTHER ADVICE Contact:
Andrew Darcey Sport Physiotherapist SASI Rowing Physiotherapist Australian Rowing Team Physiotherapist 76a Kensington Rd Rose Park SA 5067
Western Hospital 168 Cudmore Tce Henley Beach SA 5022
Ph: 8364 6800 Email: andrew@lept.com.au