Docstoc

Soccer Soccer Staying on the Field Andrew Getzin

Document Sample
Soccer Soccer Staying on the Field Andrew Getzin Powered By Docstoc
					Soccer: Staying on the
        Field


                      Andrew Getzin, MD
        Clinical Director Sports Medicine and Athletic
                         Performance
                   agetzin@cayugamed.org
            www.cayugamed.org/sportsmedicine
               Overview
• Injury Data
• Hamstring strains
• Injury prevention
                Statistics

• Most popular sport in
  the world
• 200,000 professional
  soccer players
• 240 million amateur
  players
            Nature of Soccer
• Contact sport
• Low static- High Dynamic
• High-moderate intensity
  sport
  – Physically demanding
• Aerobic
  – Running: long-distance
    and sprinting
         Injury Incidence- ER visits
•   1990-2003, 2-18 years old
•   1,597,528 injuries over 13 years
•   Mean age = 13.2, Gender = 58.6% male
•   Body parts:
    – Wrist/hand 20.3%, ankle 18.2%, knee 11.4%
• Diagnosis:
    – Sprain/strain 35.9%, contusion/abrasion
      24.1%, fracture 23.2%


Leininger, AJSM 2007
  Injury Incidence- US High Schools

• 2.39/1000 hours of participation
  – Higher rate during competition (4.77) than
    practice (1.37)
• Diagnoses
  – Ligament sprains 26.8%, muscle strains
    17.9%, contusion 13.8%, concussion 10.8%
• Body part
  – Ankle 23.4%, knee 18.7%, head/face 13.7%,
    thigh/upper leg 13.1%


Yard. AJSM 2008
                   Risk Factors
• Increasing age
• Female gender
  (schmidt-Olsen 1991,
  Concussion and
  ACLs, Putukian,
  2002)
• Prior injury- i.e. ankle
  (Soderman, 2001,
  Emery, 2006)
• Position?
                 Injury Rates
• Overall injury rates
  – Higher than
    American Football,
    basketball, field
    hockey, rugby
    (Wong 2005)
• Concussion rate
  – Similar to American
    football, ice hockey
    (Al-Kashmiri, 2006)
           Hamstring Anatomy
• Muscles
   – Semimembranosus
   – Semitendinosus
   – Long and short head
     of biceps femoris
   – Hamstring portion of
     adductor magnus
• Originate from the
  pelvis and insert
  distally into the knee
Hamstring Mechanism of Injury
• Sprinting or Jumping
• Usually occurs with
  eccentric loading- slowing
  down
• Poor flexibility?
• Strength imbalance
• 62% occur in competition,
  32% in practice
• Increased risk at end of
  halves and with
  prolonged training
• 34% recurrence rate
  Clinical Presentation and History
• Sudden onset of pain
  in posterior thigh
• May or may not have
  a pop
• Loss of strength
• Transient sciatica
               Physical Exam
• Area slightly swollen,
  tender, may or may not
  have ecchymosis
• Important to palpate
  hamstring for possible
  defect or avulsion
• Passive knee extension
  and hip flexion increased
  pain
• The more proximal to the
  origin the injury- the
  longer the return to play
            Taking Shoes Off Test




Zeren. Clin J Sports Med 2006
                   Imaging
• Limited role for plain
  x-ray, can help
  exclude avulsion
  fracture
• MRI helpful with
  prognosis, often serial
  MRI
• ?worth the cost
      Early Treatment: day 0-7,
        Inflammatory phase
The correct early treatment for an acute
  hamstring strain includes:
A: RICE (rest, ice, compression, elevation)
B: Immobilization
C: Advil and/or Tylenol as needed
D: all of the above
       Sub-acute Treatment
All are appropriate sub-acute treatments
    except:
A. Initiate range of motion exercises a few
    days after the injury
B. Progress to jogging when ready
C. Gradually initiate eccentric loading
D. Play X-box all day while resting your
    hamstring
                      Hamstring Rehab
 • 24 athletes with acute
   hamstring strain
 • Stretching and
   strengthening group
 • Progressive agility
   and trunk stabilization
   group
 • RTP 37.4 vs. 22.2
   days


Sherry and Best. J Ortho Sports PT 2004
     Chance of Recurrence After Return
       from Injury- Australian Football
                   League




Orchard, John; Best, Thomas M.
Clinical Journal of Sport Medicine. 2002.
   Hamstring Return to Soccer
When is the best time to return to play?
A. When Full Range of Motion and
   symmetrical strength is achieved
B. When there is no pain at full practice
C. The day before the championship game
D. Other
      Hamstring Injury Prevention
 • 30 players from
   Sweden premier
   division
 • 10/15 hamstring
   injuries in the control
   group
 • 3/15 hamstring
   injuries in intervention
 • Intervention improved
   running speed

Askling. Scand J Med Sports 2003
     The PEP Program: Prevent Injury
       And Enhance Performance
Decrease in ACL
Injuries in trained
Female athletes
• 2001: 88%
• 2002: 78%




Mandelbaum,. Am J Sports Med 2005;33:1003-1010
       Decrease in Ankle Injuries
 • 116 male and female
   volleyball teams from
   Dutch 2nd and 3rd division
 • Control group and
   intervention group did
   balance training
 • Significant decreased risk
   of ankle sprain- in
   individuals with previous
   sprains



Verhagen. AJSM 2004
       Accidental Compensation
             Corporation
• New Zealand federal
  program that covers
  resident or visitor to
  New Zealand
• http://www.acc.co.nz/i
  ndex.htm
• SportSmart
  programme
       1. Screening
Assessing
health and
fitness before
playing
identifies injury
risk
  2. Warm-up, Cool Down
        and Stretch
The right preparation for
mind and body makes for a
better performance.
Cooling down helps the
body to recover and is a
good time for flexibility
3. Physical Conditioning
 Staying in
 condition means
 playing to your
 maximum
 potential
      4. Technique

Know how to
play safely with
good technique
5. Fair Play
Good sport is about
positive attitude- playing
fair and enjoying the
game
6. Protective Equipment

Protect yourself
against injury by
using the right
equipment
7. Hydration and Nutrition
Eating the right food
and drinking
adequate fluid helps
maintain health and
sports performance
  8. Injury Reporting
Gathering information
about injuries and
monitoring how and
when they occur help in
injury prevention- and
improve the game for
everyone
      9. Environment
It is not only the
weather that
counts- safe
surroundings
means safer
play
10. Injury Management
Getting the right
treatment
sooner means
less pain and a
faster recovery
Thank You

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:1/5/2012
language:English
pages:34