Presentation by Bruce Paton 15 September 2010

Sports Rehabilitation Key to Olympic success Bruce Paton Musculoskeletal Extended Scope Physiotherapist – UCLH

Outline • Introduction – Case study to show why rehab is important

• Principles of rehabilitation – – – –

Tissues and healing Optimally loading tissues and adaptation Aims of rehabilitation Specificity of training per olympic sports

• UCLH – Musculoskeletal pathways now and in past

Introduction • • • • • •

Alistair Brownlee 22 yo triathlete Winner of ITU WC series 2009 Feb 2010 – Femoral Stress Fracture Physiotherapist- Emma Deakin Return to competition June – madrid Winner final race ITU WC series – Budapest sat 11 th sept 2010 – Times overall time 01:42:26 » Swim (1500m) 00:17:12 » Bike (40km) 00:53:54 » Run (10km) 00:30:00

• How does and athlete get to this level training ? • What does the athlete do if they get injured ?

Rehabilitation principles • Rehabilitation Follows many of the same principles of training • training dealing with strengthening normal tissues ( Nb holds true for athletes & normal population) • Rehabilitation involves strengthening injured tissue

Tissues and Healing • After injury – stages of healing • Body does a lot of our work !! • Thankfully it works to heal itself !

• Tissues have capacity for strengthening with training (Adaptation) – They adapt to the loads placed on them – Science expanding knowledge

Increase intensity session Longer recovery required

Increase Frequency Reduced rest tissue weakening

TISSUE

STRENGTH

Adaptation progressive overload = tissue strengthens

T IME

Tissues and Loading • Different tissues ADAPT and HEAL differently – Time scales – Recovery times

• What is OPTIMAL loading for strengthening tissues ? • Ie how do you pitch the athlete’s loading correctly • Secret to good rehabilitation – – – – –

Correct PACING OF LOADS/TRAINING Frequency Intensity Duration of loading RECOVERY TIME !! » Often a difficult factor for olympic athletes » make me better Yesterday!!

Increase intensity session Longer recovery required

Increase Frequency Reduced rest tissue weakening

TISSUE

STRENGTH

Adaptation progressive overload = tissue strengthens

T IME

Aims of Rehab – Early • • • • • •

Manage Pain Manage inflammation Protection - Brace / tape Normalise movement Muscle Control/ Recruitment Maintain fitness

• PSYCHOLOGY

Aims of Rehabilitation middle stage • • • • • • •

Address Biomechanics Muscle flexibility Restore joint movement Muscle Strength Neurodynamics Proprioception/ Balance Cardiovascular fitness

• PSYCHOLOGY

Aims of Rehabilitation late stage • M strength Endurance • Speed and power • Impact tolerance / Tissue hardening • Direction change / Pivoting/ Agility • Coordination/ Technique • Control / core stability • Sports Specific work – Return to training / sport

• Future jt protection and prevention of re injury – clear all Contributing Factors

• PSYCHOLOGY

Specificity • Olympic sports • Paralympic sports

• Each has very specific demands • Rehab needs to take into account the demands of the sport • TRx and Tq knowledge

Olympic sports Aquatics

Handball

Archery

Hockey

Athletics

Judo Modern Pentathlon

Badminton Rowing Basketball Boxing Canoeing

Cycling Equestrian Fencing Football Gymnastics

Sailing

Shooting Table Tennis Taekwondo Tennis

Triathlon Volleyball Weightlifting Wrestling

Paralympic sports Archery

Rowing

Athletics

Sailing

Boccia

Shooting

Cycling

Equestrian

Sitting volleyball

Swimming

Football 5-a-side

Table tennis

Football 7-a-side

Wheelchair basketball

Goalball

Wheelchair fencing

Judo Powerlifting

Wheelchair rugby Wheelchair tennis

Contributing factors Extrinsic • Equipment • Surfaces • Footwear • Training schedules – Science

Intrinsic • Skill Technique / movt pattern • Strength / flexibility • Biomechanics Prevention • Long term thinking • Science contribution

MSk Rehabilitation pathways at UCLH •

NHS experience Rehabilitation – Many units lack facilities and expertise to allow

» High level strengthening » Paced return to sport – Discharge before full return

UCLH Strengths • Consultants with sports background – Incl SEM consultant

• •

Strong multidisciplinary communication Gym based pathway – Facilities – Expertise

Diagnosis / Screening  Prehabilitation  +/- Surgery  Rehabilitation – Early stage 1:1 – Middle stage 1:1 / Gym

 Late stage Gym – Return to training – Return to sport

Rehabilitation at UCLH • Facilities – Dept – Gyms – Hydrotherapy

• Systems – Gym based rehab systems » Advanced Gps • 1300 pts since dec05

» Early stage • 700 pts since feb 07 )

» Upper / Lower Limb » Spinal

Rehabilitation at UCLH Expertise – Long Hx of rehab for high level athletes – Physios working with professional sports teams background – University teaching links – Research studies – Inter trust Inservice training

Links – UCL » ISEH » Sports MSc

– Pct – BOA / EIS and External sports groups

Rehabilitation Opportunities • Opportunities • Systems • Expertise – Volunteering – Further training / teaching – Research strategy

• Links – BOA – UCL ISEH and sports MSc – LOCOG

Conclusion • Successful rehabilitation – expertise in knowing » demands of sport » Behaviour of healing tissues – Skills in » Optimal pacing of rehabilitation and training » Effective management of contributing factors

• Excitement of Games in London – Logistics – Volunteers ( 70,000 reqd / 40,000 paralympics)

• Opportunities for UCLH – Strong capabilities – Strong links

“To contribute to building a peaceful and better world by educating youth through sport practiced without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play.” International Olympic Committee, ‘Fundamental Principles’, Olympic Charter

"To Enable Paralympic Athletes to Achieve Sporting Excellence and Inspire and Excite the World". International paralympic movement - Vision and Mission statement

Thank you for listening Questions ?