Musculotendinous problems
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This session focussed on muscle and tendon injuries, particularly hamstring strains as these are common in football. In elite Australian Rules football they account for 13% of missed games. Recurrence rates in this group are also high (25%) with the risk of reinjury being 11% in the first week, 6% in the second week and 4% in the third week. Hence primary prevention is a priority. Use of clinical tests including the slump test as well as imaging techniques such as ultrasound and MRI will help to distinguish between muscle trauma and other causes of hamstring dysfunction although in many cases this may not be possible. Hamstring avulsion from the ischial tuberosity represents a severe injury in athletes and warrants early surgical repair. Although laboratory studies show that stronger and less fatigued muscles will absorb more energy with less stretch, the clinical evidence linking strength and hamstring injury is contradictory. Some investigators advocate the use of preseason isokinetic testing of the hamstring and quadriceps muscles to identify players at risk but this is questionable. Furthermore, it is not clear whether the subsequent implementation of a strengthening regimen would lower the injury rate. There are no clinical data to show that flexibility plays a role in hamstring injury despite a sound biological rationale. Fatigue of the hamstring muscle leads to an increased duration of hamstring activity and a decrease in hip flexion during running. These changes in kinematic and electromyographic parameters may be protective mechanisms to reduce stress on the hamstrings at critical phases during the running cycle. Further research is needed to assess whether this is the case and if so, whether you can train players to use such protective mechanisms. An understanding of the mechanical basis of ldcking performance is a pre-requisite to investigating the relationship between common musculotendinous injuries and ldcldng technique. Identification of faulty technique may then be used as a marker of predisposition to injury and steps can be taken to correct technique faults. There was discussion about the role of training in hamstring and other muscle injuries. It was suggested that workload and recovery should be monitored for each player and training individualised on a weeldy basis. This would allow a better balance between work and recovery and increase the ability of each player to cope with training and playing. There was anecdotal evidence that baclcwards running may have a role in prevention and rehabilitation of hamstring injuries as it produces a greater stretch in the hamstring muscles compared with forwards running but this needs to be confirmed by experimental studies. There is scientific evidence to show that thigh pads reduce thigh haematomas. Thus, their use may be advocated in players where these injuries are more common particularly lower grades of football and those in ruck positions. In a laboratory study there was little difference between four types of thigh pads in their ability to absorb shock despite variation in mass, thickness and cost. 37.
Transcript of Musculotendinous problems
This session focussed on muscle and tendon injuries, particularly hamstring strains as these are common in football. In elite Australian Rules football they account for 13% of missed games. Recurrence rates in this group are also high (25%) with the risk of reinjury being 11% in the first week, 6% in the second week and 4% in the third week. Hence primary prevention is a priority.
Use of clinical tests including the slump test as well as imaging techniques such as ultrasound and MRI will help to distinguish between muscle trauma and other causes of hamstring dysfunction although in many cases this may not be possible. Hamstring avulsion from the ischial tuberosity represents a severe injury in athletes and warrants early surgical repair.
Although laboratory studies show that stronger and less fatigued muscles will absorb more energy with less stretch, the clinical evidence linking strength and hamstring injury is contradictory. Some investigators advocate the use of preseason isokinetic testing of the hamstring and quadriceps muscles to identify players at risk but this is questionable. Furthermore, it is not clear whether the subsequent implementation of a strengthening regimen would lower the injury rate. There are no clinical data to show that flexibility plays a role in hamstring injury despite a sound biological rationale.
Fatigue of the hamstring muscle leads to an increased duration of hamstring activity and a decrease in hip flexion during running. These changes in k inemat ic and electromyographic parameters may be protective mechanisms to reduce stress on the hamstrings at critical phases during the running cycle. Further research is needed to assess whether this is the case and if so, whether you can train players to use such protective mechanisms.
An understanding of the mechanical basis of ldcking performance is a pre-requisite to investigating the relationship between common musculotendinous injuries and ldcldng technique. Identification of faulty technique may then be used as a marker of predisposition to injury and steps can be taken to correct technique faults.
There was discussion about the role of training in hamstring and other muscle injuries. It was suggested that workload and recovery should be monitored for each player and training individualised on a weeldy basis. This would allow a better balance between work and recovery and increase the ability of each player to cope with training and playing. There was anecdotal evidence that baclcwards running may have a role in prevention and rehabilitation of hamstring injuries as it produces a greater stretch in the hamstring muscles compared with forwards running but this needs to be confirmed by experimental studies.
There is scientific evidence to show that thigh pads reduce thigh haematomas. Thus, their use may be advocated in players where these injuries are more common particularly lower grades of football and those in ruck positions. In a laboratory study there was little difference between four types of thigh pads in their ability to absorb shock despite variation in mass, thickness and cost.
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Despite the effects of hyperbaric oxygen therapy (HBOT) that have been demonstrated in the laboratory and in various medical conditions, there is little evidence available regarding its application in the treatment of sporting injuries. Given that HBOT is expensive, time-consuming and not without risk, further research is necessary to justify its use in the sports medicine setting.
Healing of achilles tendon injuries is often problematic due to reduced blood supply and slower collagen remodelling rate. A study using an animal model found that immobilisation had a deleterious effect on achilles tendon healing but active mobilisation did not provide any benefit over normal caged activity.
In summary, further research is needed in the following areas: • the kinematic and ldnetic profile of effective kicldng • differentiating local hamstring pathology from pain referred from proximal structures
in acute posterior thigh pain • the role of strengthening and flexibility in the primary and tertiary prevention of
hamstring injury • the influence of work load and recovery in predisposing to muscle injuries • the effectiveness and clinical utility of HBOT in the treatment of sports injuries
K.B.
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