Return To Sport

By Cameron Allshorn

Gyms are open, boot camp is back, trails and national parks are opening their gates, community sport is on the horizon and we’re all excited!!

The lockdown has impacted each and everyone of us and we are all ready to get out a back into our hobbies and activities as soon as we can. 

With the excitement of this return comes an increased risk of injury due to the lengthy lay-off period and overall decrease in movement and activity over the past 8 weeks, add to that the cold Hobart winter days and there is a discussion to be had. This blog to outline how to safely return to activity and reduce the risk of picking up a pesky injury that could see you with another stint on the sideline just as things get going again.

The Risk

Injuries to soft tissues are the most likely to occur in this type of situation due to shortening of muscle fibers during inactivity as well as lack of load exposure. “Soft tissue injuries” cover most muscular or ligamentous injuries, in which hamstring, calf, quad and rotator cuff have the highest increased risk of injury. 

A recent ABC article has outlined the increased risk and rate of incident we have seen as sport has returned across various professional leagues.It is expected that this will spread all the way down to community level as the majority of us return without the network of a professional grade support team. 

A lot of us have turned to running and/or cycling over the past 2 months in an effort to keep active and fit which is great for our wellbeing and aerobic fitness however it does not replicate or correlate to sport specific actions such as landing, pivoting, throwing, kicking and so on. Now is the time to get back into sport specific training situations.

4-6 weeks of graded gradual sport-specific return is recommended to reduce the risk of injuries upon return which means starting now is imperative. It is likely that competitions will be eager to reboot their seasons and with calendar restrictions and venue clashes also to consider it could see match-day competition return in a quick turnaround that will not account for such a training period to occur.  

Snapshot of Professional Returns

Bundesliga (German Premier Soccer League) returned on May 24 and has seen an approximate  rate of injury increase of 3 times the pre lockdown records (.27injuries per game pre lockdown, .88injuries per game since restart) injuries have predominantly been of soft tissue nature (hamstring, calf, quad). Locally we have seen the AFL and NRL return over the past month and while there hasn’t been large spate of injuries across the board. The restart began with a number of players unavailable due to similar soft tissue injuries sustained in a shortened “pre-season” prior to the return (predominantly lower limb soft tissue injuries).

Who’s at risk

• Age >25, 

• Previous injury history (particularly in past 18 months) 

• Returning to a sport involving a lot of change of direction, quick decelerating/accelerating or lateral movement (tennis, hockey, AFL, netball, basketball) 

What can you be doing now 

Each sport and venue is likely in the process of opening up training facilities and you should check with them about access and the guidelines in place. Some restrictions may be placed on access time and amount of people allowed.

To reduce risk, you should now be considering sport-specific programs that are tailored to the requirements of your sport. However some broad protocols to follow are; 

• Warm up/ cool down with stretches and mobility exercises. 

• Lower limb eccentric exercises (hamstrings, calf, hip flexors) (these help increase overall muscle length reducing risk of tearing) 

• Gradual increase of load, duration and intensity of training.

• Sorting out any existing niggles (tight hamstring, sore hip, stiff lower back etc) before jumping into training.  

For any information or advice regarding getting you back into playing sport and the activities you loved before covid-19, feel free to contact your Osteopath for what is best suited to you. 

Injury Perception

INJURY PERCEPTION

When is an “injury” an “Injury”?

Or would that be better phrased when is a “niggle” or an “ache” an “injury”?

It is not uncommon for a new appointment to come up, and through the discussion of the case, there usually has been a tipping point as to why this person has sought treatment at this time. It can be the upcoming overseas trip, a pending new arrival to the family or the approaching season on the sporting calendar and many other reasons. In a lot of cases, the symptoms of the injury have not changed all that much over the preceding days/week however the circumstances surrounding the person has and hence the motivation to resolve the issue has changed. The perception of this injury has changed.

Recently I was following a live tweet of the Salzburg Sports Physiotherapy Symposium (SSPS) and the idea of injury perception was discussed. The discussion focused around the idea of time loss and the idea that people (or in the case of the presentation, the athlete) only consider something an injury when it impacts on performance and thus impacts on participation or involvement. Take a look at the following image showing part of the presentation.

In relation to an athlete, injury and performance are clearly defined and obvious with a clear link to ability and participation, however I think the lines get blurred when we discuss injury over a generalised population due to the variety of circumstances that are inherently changeable, to summarise, consideration of an injury is a matter of circumstance and those circumstances are always changing. (That ankle might feel really sore when it comes to taking the bins out however it doesn't feel so bad when kicking the football with the kids in the backyard)

The first aspect of this chart, - Impact on performance - across a generalised population Is variable from person to person depending on circumstances and can mean many things from our ability to work and complete tasks, our involvement with family activities and the ability to look after them to our overall enjoyment in our day to day lives. Performance is very much an athlete driven word there, if we change that to impact on daily living, it becomes a lot more relatable.  

The importance of an event is going to impact on how we perceive an injury. For an athlete this could be the difference between a regular season match or a finals game. When applied to a general population we can discuss - for instance - taking a day off work due to injury could be deemed suitable when workload is quiet but taking the day off when there is a full schedule of important meetings and so on involved,in this event the injury takes a back seat.

When it comes to self management it is a goal of mine and all the Osteopaths at Rockhopper to help people into the best position to manage their own bodies. The physical component of injury is obviously a focus point for us and our management of your injury will come in various forms from hands on in clinic treatment to out of clinic directives such as stretches, exercise programs, educational content.

However self management doesn't always mean management in isolation or on your own. A key component of self management is being able to discern when the need for follow up treatment or additional help is required. As shown in the image way up the top of this page, a key aspect of perception is understanding and if we can identify and understand an injury that will change how we perceive it and put us in a much better position to manage it now and also in the future.

So, with all the discussion here, I'd make a few changes to this chart and present it as shown below.