Sports Rehabilitation Key to Olympic success

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Sports Rehabilitation Key to Olympic success

• Bruce Paton
• Musculoskeletal Extended Scope Physiotherapist
  UCLH

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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

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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 014226
• Swim (1500m) 001712
• Bike (40km) 005354
• Run (10km) 003000
• How does and athlete get to this level training ?
  
• What does the athlete do if they get injured ?

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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

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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

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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 athletes 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!!

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Aims of Rehab Early

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

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Aims of Rehabilitationmiddle stage

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

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Aims of Rehabilitationlate 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

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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

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Olympic sports

• Handball
• Hockey
• Judo
• Modern Pentathlon
• Rowing
• Sailing
• Shooting
• Table Tennis
• Taekwondo
• Tennis
• Triathlon
• Volleyball
• Weightlifting
• Wrestling

• Aquatics
• Archery
• Athletics
• Badminton
• Basketball
• Boxing
• Canoeing
• Cycling
• Equestrian
• Fencing
• Football
• Gymnastics

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Paralympic sports

• Rowing
• Sailing
• Shooting
• Sitting volleyball
• Swimming
• Table tennis
• Wheelchair basketball
• Wheelchair fencing
• Wheelchair rugby
• Wheelchair tennis

• Archery
• Athletics
• Boccia
• Cycling
• Equestrian
• Football 5-a-side
• Football 7-a-side
• Goalball
• Judo
• Powerlifting

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Contributing factors

• Extrinsic
• Equipment
• Surfaces
• Footwear
• Training schedules
• Science

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

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MSk Rehabilitation pathways at UCLH

• Diagnosis / Screening
• ?
• Prehabilitation
• ?
• /- Surgery
• ?
• Rehabilitation
• Early stage 11
• Middle stage 11 / Gym
• ?
• Late stage Gym
• Return to training
• Return to sport

• 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

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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

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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

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Rehabilitation Opportunities

• Opportunities
• Systems
• Expertise
• Volunteering
• Further training / teaching
• Research strategy
• Links
• BOA
• UCL ISEH and sports MSc
• LOCOG

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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

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• 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
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Thank you for listeningQuestions ?