A GUIDE TO SPORTS AND INJURY MANAGEMENT Commissioning Editors: Claire Wilson, Rita Demetriou-Swanwick Development Editor: Sally Davies Project Manager: Joannah Duncan Designer/Design Direction: Charles Gray Illustration Manager: Merlyn Harvey Illustrator: Chartwell, Cactus A GUIDE TO SPORTS AND INJURY MANAGEMENT Mike Bundy MBBS MRCGP DipSportsMed(Bath) FFSEM(UK) Sports Physician, Pure Sports Medicine, Kensington, London, UK Andy Leaver BSc(Hons) MCSP SRP Head Physiotherapist, Bath Rugby Club, Bath, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010 © 2010 Elsevier Ltd All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practition- ers, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appro- priate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. The Working together to grow publisher’s libraries in developing countries policy is to use paper manufactured from sustainable forests www.elsevier.com | www.bookaid.org | www.sabre.org Printed in China DVD CONTENTS The DVD accompanying this text contains: The Interactive Diagnosis Tool Posterior view Video clips Inferior view Multiple Choice Questions relating to Superior view each chapter in the book Acute The Interactive Diagnosis Tool Lower leg Anterior view The tool aids diagnosis of common Posterior view injuries and opens as a colour image of the selected part of the human Shoulder body (e.g. ankle and foot). The user Anterior view clicks onto the image to bring on Posterior view screen a more detailed anatomical drawing of that body area. The user Spine can choose to view the ankle from Cervical – posterior view anterior, inferior, lateral, medial and Lumbar and sacral – anterior/lateral/ posterior views. posterior views Within each of these views the user Lumbar and sacral – posterior view moves the cursor over the image and Thoracic – posterior view as trigger points on the image are highlighted the various diagnoses pop Thigh up on screen. The diagnoses are split Anterior view into acute (red), chronic (blue) and Posterior view referred (green) diagnoses. There are over 200 common injuries diagnoses Upper limb included in the tool. Anterior view Medial view COMMON INJURIES Lateral view Posterior view Ankle and foot Wrist and hand Anterior view Anterior view Forefoot (anterior view) Posterior view Inferior view (sole of foot) Lateral view VIDEO CLIPS Medial view There are video sequences of all the Midfoot (anterior view) techniques and exercises indicated in Posterior view the text by the icon. To look at the video for a given technique, click on Buttock the relevant item in the contents list Posterior view (lumbar spine to mid on the DVD. thigh) Assessment of the ankle joint Groin and pelvis Ankle dorsiflexion Anterior view Ankle eversion Lateral view Ankle inversion Posterior view Ankle plantar flexion Knee Anterior drawer test for the anterior Anterior view talo-fibular ligament Lateral view Posterior impingement test Medial view Syndesmosis test Assessment of the knee joint Neers test Anterior drawer test for the anterior O’Briens test cruciate ligament (ACL) Resisted empty and full can tests Dial test for the posterolateral corner Scapulohumeral rhythm Lachman’s test for the ACL Sulcus test McMurray’s test for the meniscii The ‘Scarf’ acromioclavicular joint test Patello-femoral joint glides Posterior drawer test for posterior Upper limb nerve provocation cruciate ligament (PCL) tests Posterior sag test for the PCL Upper limb tension test (ULTT 1) – Valgus stress test for the medial median nerve bias collateral knee ligament (MCL) Upper limb tension test (ULTT 2) – radial Varus stress test for the lateral collateral nerve bias knee ligament (LCL) Upper limb tension test (ULTT 3) – ulnar nerve bias Assessment of the hip joint Hip flexion Assessment of lower limb Hip medial and lateral rotation stability and muscular control Ober’s test One-legged squat Quadrant test Test for impingement of the anterior Warm-up stretching programmes capsule of the hip Dynamic stretching warm-up Thomas test Static stretch warm-up Lumbar spine assessment and Proprioception/balance exercises lower limb nerve provocation BOSU hops tests Single-leg BOSU balance Lumbar flexion and extension Single-leg BOSU squats Slump test Straight leg raise Weight training examples Bench press Assessment of the sacroiliac joint Squat (SIJ) SIJ kinetic test – forward flexion Rehabilitation exercises Stork test Eccentric Achilles tendon exercises Eccentric patella tendon exercises Assessment of the elbow joint Knee drives Valgus stress test for the medial Nordic hamstring exercises collateral elbow ligament (MCL) Varus stress test for the lateral collateral Core stability exercises elbow ligament (LCL) Floor core exercises Gym ball core exercises Assessment of the shoulder joint Apprehension and relocation tests Other Empty and full can tests 30-second neurological examination Hawkins Kennedy test Application of a cervical collar Preface As a training sports physician I felt there was a lack of teaching material that was both practical and which suited my way of visual learning. I was desperate to find a book or DVD that took me through symptoms, signs, investigation and manage- ment combined with a list of possible differential diagnoses that was visual and reflected how we manage patients in the clinic. I was pleased to find that after working together with Andy at London Irish Rugby Club he had a similar train of thought. We therefore hatched the idea of developing a book and DVD that was very practical, visual, and, most importantly, gave information from both a physician’s and physiotherapist’s perspective. The project has taken several years to develop and the final product will hopefully be of value to sports physicians, physiotherapists, osteopaths, chiropractors, sports masseurs and all those training in these fields as well as keen athletes. Mike Bundy London, 2009 Having worked as a physiotherapist in sport for a number of years, it has become very apparent that there are a vast number of clinical signs, tests, techniques and exercises that clinicians have to remember. While there are a number of other textbooks available, I have yet to find one that has taken me through the assess- ment techniques to the clinical findings and then to the rehabilitation techniques to treat the injury in an easy-to-follow and visual manner. Having worked with Mike for a number of years, we felt that we could produce a book which would provide clinicians with all the necessary information to accurately assess, diagnose and rehabilitate a wide variety of commonly occurring sports injuries in a new and exciting format. In doing so, we have incorporated photographs into the book and videoclips onto the interactive DVD to highlight a number of the important tests and exercises. We hope that all the clinicians who read this will find it very useful. Andy Leaver London, 2009 Acknowledgements We would very much like to thank Chris West and Hannah Bundy for agreeing to be in the photographs and would also like to thank Sarah Mitchell, Sarah Bundy and Phil Leaver for all their help in taking the photographs and video clips. M.B. A.L. 1 Chapter Training and conditioning CHAPTER CONTENTS Aerobic training 2 Training zone 2 Maximum heart rate 3 Aerobic testing 3 VO max testing 3 2 Bleep test 3 Types of aerobic training 4 Interval training 4 Fartlek training 4 Conditioning games 5 Heart rate monitors 5 Anaerobic training 5 Strength training 6 Principles of training 6 Specificity 6 Strength 6 Power training 7 Hypertrophy training 7 Endurance training 7 What equipment to use? 7 Free weights 8 Weight machines 8 Injury prevention 8 © 2009 Elsevier Ltd, Inc, BV 1 DOI: 10.1016/B978-0-443-06813-3.00004-1 Chapter | 1 | Training and conditioning The conditioning of athletes is an area which has become very popular and that has made significant advances in recent years. It is an ever-changing discipline because there has been a much greater emphasis placed on athletes being at the peak of physical condition for their sporting event, whether this be by having a greater cardiovascular capacity or being ‘fitter’ or by being stronger. This has led to strength and conditioning coaches being widely employed in most sporting disciplines to devise training programmes to ensure that the athletes are at the peak of their physical condition so that they are able to compete at the best of their ability in their competitions or matches. It is, however, an ever-changing area with new and different concepts being devised all the time in an attempt to push the boundaries of physical performance and give the athlete an edge over their competitors. This is achieved by the strength and conditioning staff analysing the specific demands of each individual competitor. The physical demands obviously differ between sports but they can also differ between team mates who play in different positions on the same team. For example, the strength and conditioning programme for a prop in rugby will be quite different to that of a winger on the same team because of the different physical demands placed on each of them in the game. Therefore, it is very important to remember that the programmes need to be tailored to the individual and should be sport-specific for the greatest benefits to occur. For example, a cyclist needs to cycle and sports which are running-based, such as football and rugby, need their athletes to run and so on. This chapter will discuss some of the different training techniques that are being employed and give some examples of useful sessions for some athletes. AEROBIC TRAINING Aerobic training is simply where oxygen is present and is used to generate energy when the glycogen stores in the muscles are broken down to produce glucose and hence allow muscle contractions to continue. It is the most common type of training and that done by members of the public who are trying to ‘keep fit’. This is because it has been shown to have numerous health benefits: • It improves the efficiency and strength of the cardiac (heart) muscle itself. This causes hypertrophy or enlargement of the heart, which leads to increased pumping efficiency and consequently a reduction in the resting heart rate. • It strengthens the respiratory muscles which facilitate the flow of air into and out of the lungs. • It increases the number of red blood cells to which oxygen binds and hence aids its transportation around the body and to the muscles. • It improves the efficiency of circulation which helps reduce blood pressure. • It can help in reducing stress as the exercise triggers a hormonal release which is involved in controlling anxiety and alertness levels. These factors have been shown to help reduce the risk of cardiovascular disease and hence produce significant health benefits. Consequently, aerobic exercise in a variety of forms has grown in popularity in the non-elite sporting population to maintain health and keep fit. Training zone The training zone is the heart rate that needs to be achieved by an athlete for the benefits to the cardiovascular system to be achieved. The individual needs 2