Ranger - Athlete Warrior - Fort Benning · 2018-10-03 · Sports Medicine Approach •Early...
Transcript of Ranger - Athlete Warrior - Fort Benning · 2018-10-03 · Sports Medicine Approach •Early...
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Ranger - Athlete – WarriorPrinciples of Sports Medicine
MAR 2011
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Components of RAW
• Performance Nutrition
– Nutrient needs
– Ideal body composition
– Supplements
• Mental Toughness
– Ideal Performance State
– Fatigue counter-measures
– Endurance events
• Functional Fitness– Strength
– Endurance
– Movement skill
• Sports Medicine– Prevention
– Early intervention
– Multi-disciplinary team
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Sports Medicine
Sports medicine for Rangers involves the
prevention and treatment of injuries in elite
performers with the ultimate goal of achieving
100% individual and unit combat effectiveness
and strength.
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Sports Medicine Mission
•Ensure each Battalion is at the highest level of
physical fitness during the JORT cycles and
world wide deployments.
•Prevent avoidable under recovery /and traumatic
musculoskeletal injuries through unit training
assessments, individual physical assessments,
individual and key leader education on injury
prevention and human performance optimization.
•Provide immediate orthopedic evaluations, a
definitive diagnosis and evidenced based
physical therapy for a rapid return to duty.
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Sports Medicine Approach
• Prevention
– Injury Screening • Modified Functional Movement Screen
• ID Ranger at Injury Risk
• Conducted by Physical Therapist and HPOCs
• Movement deficits are addressed
• On-going validation of modified FMS and other screening tools
– Principles of RAW• Avoid overuse injuries through planned progression/scheduling
• Develop optimal movement skills (core stability, agility, skillful power production)
• Create balanced strength and flexibility (develop Push and Pull)
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Sports Medicine Approach
• Early intervention– Don’t ignore injuries– Leaders are responsible for taking care of their men
• Multi-disciplinary team– Extensive commo between BN staff (medics, PA, PT, surgeon)
and specialist (Ortho, neurology, etc) at the post or local hospitals
• Rehab/Return-to-Duty Transition– Rangers must finish rehab– Pain is a liar…because you don’t hurt doesn’t mean you are
100%...or even 70%!
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Sports Medicine Approach
•Protective Equipment
•Posture
-Too much of any posture is bad- Good postures balance stress
- Bad postures promote imbalances
•Ergonomics/Biomechanics
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S.A.I.D. Principle
• Tissues adapt to the stress placed upon them
– This is why posture and biomechanics matters
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Balancing Performance and Injury Prevention
Incre
asin
g
Injury
Threshold
“The Human Factor”
Increasing Exposure (i.e. time or mileage)
Stop increasing
training here!
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Training Assessment
•Injury Data:
Data input from JAN 01 through APR 02
–New complaints only
–Includes data from OEF
–838 total new complaints
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Training Assessment
• 34% of all injuries are due to overuse
– Running
• Duration - > 5 miles
• Route Selection - Airfield
• Frequency - 5 days a week
– Lifting
– Rucking
– Body Mechanics
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Training Assessment
•12,166 days lost from training because of
profiles
•TOP THREE CAUSES
–#1 Airborne Ops - 2,632 days (22%)
–#2 Overuse Injuries - 1,582 days (13%)
–#3 Other (non duty hours) - 1,505 days (12%)
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Training Assessment
Overuse Trauma Run Trauma Training
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Training Assessment
• Most Jump Injuries secondary to
PLFs
– Increased Distance Running
– No Implemented Plyometric
Training
– Minimal Agility Training
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Training Assessment
B CO HHC
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Training Assessment
•838 total injuries
•282 overuse injuries = 34% preventable injuries
•26 overuse ISB only = 3.1% preventable
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Training Assessment
•Follow on injury metrics•After implementation of Combat Focused Physical Training
-Data input from JAN 03 through FEB 04-New complaints only-Includes data from Operation Iraqi Freedom-433 total new complaints
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Training Assessment
• 14,985 days lost from training because of profiles
• TOP THREE CAUSES– #1 Airborne Ops – 4,609 days (30%) increase in jump
injuries and profile length secondary to two combat jumps with significant lower extremity fractures and dislocations with multiple surgeries and revisions and profiles for over 300 days.
– #2 Combat Trauma – 2,270 days (15%) includes Rangers on profile for over 300 days due to shrapnel injuries and multiple surgeries.
– #3 Overuse Injuries - 751days (5%) a drop in 8% • Decrease due to unit injury prevention training and early
intervention for injuries sustained
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Training Assessment
•OEF II 2002 (1st six weeks): 31 overuse injuries/16% of Company’s combat strength degraded
- Running daily (sometimes twice a day)-Improper Lifting
•OEF III 2004 (1st six weeks): 3 overuse injuries/100% combat strength maintained at Company level
- All individuals who had not attend CFTC in past year- All staff members
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Overuse/Under Recovery Injury
• Repetitive stress
• Bend, bend, break
• Posture and biomechanics may pre-dispose individuals
• Principles of exercise are usually violated
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REPETITIVE USE
TISSUEOVERLOAD
TISSUE
FATIGUE
PARTIAL
TISSUE FAILURE
LOSS OFSTRENGTH AND
FLEXIBILITYOVERUSE
INJURY
Psychological
DistressPAIN &
INADEQUATE
TISSUE REPAIR
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Kolpan, JAMA 248: 3118, 1982
More Running = More
Injuries
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Running Frequency, Injuries & Cardiovascular Endurance
Frequency (days/week)
Injury Incidence (percent)
Change in CV Endurance
(%VO2/2-mi run)
0 0% -3.4% / -:30
1 0% 8.3% / 1:06
3 12% 12.9% / 1:48
5 39% 17.4% / 2:24
Pollock, ML. Med Sci Sports. 9(1), 1977
Training: running 30 min, 85-90% MHR
3-5 days/week 225% increase 35% increase
:36 faster
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Running Duration, Injuries & Cardiovascular EnduranceDuration (min/day)
Injury Incidence (percent)
Change in CV Endurance
(%VO2/2-mi run)
0 0% -.7% / -:06
15 22% 8.7% / 1:12
30 24% 16.1% / 2:00
45 54% 16.9% / 2:18
Pollock, ML. Med Sci Sports. 9(1), 1977
Training: running 3 days/week, 85-90% MHR
30-45 min/day 125% increase 5% increase
:18 faster
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Acute Injury
• Moderate-high energy force that disrupts tissue
• Swelling/redness/heat/tend-erness to touch
• Limping
• Lost range-of-motion
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Stages of Soft-Tissue Healing
• Inflammation (acute)
– Generally lasts 2-3 days
– Treatment: manage pain/swelling; protect the injury; active motion as tolerated
• Repair (sub-acute)
– Begins toward end of first week and lasts 2-3 weeks
– Treatment: controlled, pain-free motion; maintain overall fitness if practical
• Remodeling (chronic)
– Variable length; tendon/ligament may take 1-2 years
– Treatment: progressive stress until full function is restored
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Factors that Impede Healing
• Age
• Poor Diet
• Corticosteroids/NSAIDs
• Diabetes
• Anti-coagulants
• Prolonged immobilization
• Excessive soft tissue gap
• Excessive motion or stress/repeat injury
• Smoking
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PRICE-M Injury Treatment Model
• Protection: Sling, cast, brace, crutches, etc
• Rest: Usually not total rest. X-train if possible
• Ice: Apply frequently first 48 hrs
• Compression: Apply evenly…don’t constrict circulation
• Elevation: Keep injured part above the level of the heart when possible
• Mobilize: Motion prevents stiffness, but must be right amount at the right time.
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Purpose of Rehab
• Restore optimal movement
– Joints must have right mix of mobility/stability
– Muscles must have the right mix of length/strength to move the joints
– Nerves must know when to fire the muscles
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Flexibility & Injury
Flexibility by Quintile
Incid
ence (
%)
of
Inju
ry
Jones, et al, MSSE Vol. 25 (2), 1993 Sit and Reach Test
Q1
Loose
Q2 Q3 Q4 Q5
Tight
44
33
20
38
49
0
10
20
30
40
50
Q1
Loose
Q2 Q3 Q4 Q5
Tight
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Flexibility Culprits
Hip Flexors Pecs Posterior Calf
Stretch these muscle groups
on a regular basis
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Recovery
• Nutrient content and timing
• Contrast baths
– Heat/cold alternating
• Easy motion
• Massage
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Connective Tissue
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Products to AidSoft-tissues
• Foam Roll Massage Stick Swiss Ball
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Rehab is more than stretching
and exercise with elastic bands…
…it’s about balancing mobility and stability and
grooving movement patterns that make a difference.
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QUESTIONS
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Fitness
Intensity
Fitness
Injury