Pre-season screening and injury prevention
Issue: Volume 29 Number 1
With the emphasis in sport to produce positive results and maintain high participation, athletes, coaches and administration staff look towards sports medicine for assistance in minimising injury, improving rehabilitation and enhancing performance. Media attention to the process of injury management and the science of high performance encourages the use of techniques aimed at elite athletes in athletes still in a development or participation stage. Occasionally, these techniques such as screening, ice baths and massage, may not obtain the edge that perhaps good ‘old fashioned' practice could!
So how can sports medicine assist sport? This article discusses the use of athlete physical screening, prehabilitation, and includes sport management gems that may assist in a successful season.
Medical screening of sporting participants is important primarily in the older athlete or those who have not participated in any form of regular physical activity. A generalised medical screening of all athletes and coaching staff can help to identify those at risk of complications from exercise. Examples are the athlete with asthma or diabetes, or a coach with high blood pressure. Precautionary guidelines and management plans can be organised in consultation with a GP or sports medicine practitioner. A good reference spot is Sports Medicine Australia, a multidisciplinary national organisation of sport sciences and sport medicine professionals dedicated to enhancing the health and performance of the community through safe participation in sport and physical activity.
Physical screening of athletes is used to identify the current musculoskeletal condition of the athlete. Screening should best be performed early in the pre-season phase of training. Screening can also involve the use of sport specific fitness testing to ascertain the athletes’ preparation for sport. A physical assessment of the athlete allows the sport physiotherapist to obtain base data which can:
- identify past and current injury, which can lead to specific exercise prescription aimed at managing the condition and preventing further injury
- highlight inter-player differences - direct conditioning training programs to be set for various levels of fitness, indicate parameters required for the sport and encourage the lower level athlete to strive to higher levels of participation
- determine physical changes over time, which is particularly important in the growing athlete and athlete participating in long hours of training/competition for one or more sports
- assist exercise prescription for musculoskeletal conditioning - effective physical conditioning involves measurement, review and modifications to exercise training programs involving sport science and sport physiotherapy
A typical physical screening of athletes includes measurement of:
- posture
- gait assessment
- muscle length and joint flexibility
- neuromuscular assessment
- functional-specific testing.
For most sporting clubs and athletes, screening that includes the first three listed above are sufficient to provide useful input for training and performance. At a high performance or elite-sport level, neuromuscular assessment may consider muscle recruitment patterns and functional sport testing may include strength, speed and anaerobic power tests, for example. As screening can be time consuming and costly, it should be succinct and planned.
Even a base-level screening from a sport physiotherapist on posture, muscle tightness/ weakness can be of great benefit to the junior team or recreational player who does not consider themself to be an ‘athlete’.
It is generally accepted that the athlete who is ‘balanced’ from left to right side, upper body to lower body and front to back should be able to perform at their potential. Numerous sport studies have reported that tight muscle groups and joints may predispose muscles, tendons, ligaments and even bone tissue to stressful physical loads. Over time inflammation may occur or the load could result in trauma and injury.
Of interest are studies from the European football (soccer), where hamstring strains were costly in terms of player downtime and rehabilitation. Physical screening of hamstring flexibility highlighted that some players had particularly tight hamstrings.
A stretching program was instigated to improve the flexibility of this particular muscle group. A review of football injuries at the end of the new season demonstrated an increase in the rate of hamstring tears despite the improved flexibility.
Screening needs to be clinically reasoned by the sport physiotherapist , as multiple factors may be predisposing the athlete to a particular injury. To expand this further the term 'relative flexibility' needs some thought. An example is a simple, long sitting toe touch. The test could screen as positive for the athlete reaching her toes and negative for being unable to reach the toes. It could be more sensitive and measure the distance between fingers and toes. However, both of these tests do not provide information on where the movement is occurring. Is the movement a result of a flexible spine, hip joint, hamstring muscle, or mobile shoulder joint? Each sport may require different components: for example, rowing compared to hurdles. Screening needs to have objective measures and the information gained be presented to the athlete and the coach in a way to assist any recommended interventional management. All screening information that is shared between coaching and sport science staff requires the consent of the athlete or parent/guardian.
Once the screening and any recommendations occur, it is important to review the athlete and training periodically to ensure the desired outcomes of a particular program are obtained or modified. This ‘prehabilitation’ of potential physical risk to injury and performance directs an individual approach to the training program. By maintaining a regular sports medicine staff, rapport builds between the staff member, athlete and coach. The channels of communication allow greater understanding of the demands of the sport and enable the sports medicine practitioner to assist the athlete in potential improvement in performance and injury occurrence.
In the adolescent athlete, the use of review throughout the season can highlight changes in physical characteristics related to growth that predispose to injury. Likewise in the developing higher-level athlete, repeat screening examination can indicate when training overload may be occurring.
Physical screening programs are an opportune time for the sports medicine practitioner to educate the athlete, coach, team and family on ‘smart sport’ practice. This may include information on acute injury management, recovery methods, nutrition and sport psychology.
In elite sport programs access to these services may exist. However, for the individual athlete or club, a good sports medicine practitioner such as a sports physiotherapist is well placed to provide components of these valuable tools.
The athlete or team that employs a professional approach to training and games with regards to the above may have a psychological advantage over opponents by presenting an organised routine. Attention to these ‘smart sport’ practices is one way of increasing the performance of your athletes in sport. Utilising the services of a Sports Physiotherapist is a step in a positive direction.
