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BLESSUREPREVENTIE BIJ SPORTAANVANG/SPORTPARTICIPATIE

Nele Mahieu

Dept. Rehabilitation Sciences & Physiotherapy

Fac. Medicine & Health Sciences

Ghent University

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� Prof. Dr. Erik Witvrouw � Vakgroep Revalidatiewetenschappen en

Kinesitherapie � Universiteit Gent � verschillende doctoraten

� Prospectief onderzoek � Risicofactoren � Letselpreventie

Better safe than sorry…

� About 50% of professional soccer players get injured 1.8 times during one season

� Mean duration of injury/time off: 34 days

� 1/3e of all injuries : duration =5-10 days

Importance of injury Prevention

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Is prevention of injuries possible???

Literature: yes, BUT…= Only with a correct focus

(results depend on scientific approach)

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Medical screening

Injury prevention screeningAim:

Create a Musculoskeletal profile

Injury prevention program

SEQUENCE OF PREVENTION OF SPORTS INJURIES

Van Mechelen 1992

Step 1• Establish extent of sports injury

problem

Step 2• Establish aetiology &

mechanism of injuries

Step 3• Introduce preventive measures• Follow up

INJURY PREVENTION APPROACH IN SOCCER

Step 1

• Establish extent of sports injury problem• What is the injury incidence is

soccer?

Step 2

• Establish aetiology & mechanism of injuries• What are the risk factors for these

injuries?

Step 3

• Introduce preventive measures• How can we measure these

risk factors?

Step 4

• How can we create aninjury risk profile?

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SOCCER

Step 1• What is the injury incidence is

soccer?

Step 2

• Establish aetiology & mechanism of injuries• What are the risk factors for these

injuries?

Step 3

• Introduce preventive measures• How can we measure these

risk factors?

Step 4

• How can we create aninjury risk profile?

Dauty & Collon, 2012

Dauty & Collon, 2012

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Not only good impression of incidence, type of injury, conditions (match, practise), playing position, but also on

severity, age dependency for soccer IN GENERAL

BASKETBAL

Step 1• What is the injury incidence is

basketbal?

Step 2

• Establish aetiology & mechanism of injuries• What are the risk factors for these

injuries?

Step 3• Introduce preventive measures• Introduce preventive measures

Borowski et al 2008

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Most common type of basketbal injuries

� 44% Ligament sprains� 18% Muscle/tendon injuries� 9% Contusions� 9% Fractures� 7% Concussions

Who gets injuries ?

� Guards get most frequently injured (50%)� Forwards (35%)� Centers (14%)

INJURY PREVENTION APPROACH

Step 1•What is the injury incidence in soccer/basketbal?

Step 2• What are the risk factors for these

injuries?

Step 3• How can we measure these

risk factors?

Step 4

• How can we create aninjury risk profile?

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Get a good idea of the mechanism of these injuries in soccer

15% unexpected movement12% set off/landing after jump10% Twisting/turning9% shooting

I) Identify when injuries happen in basketbal?(injury mechanisms)

� Rebounding (25%)� Defending (15%)� General play (17%)� Bal handling/dribbling (9%)� Shooting (8%)

� Collision with other player (22%)� Jumping/landing (17%)� Stepped on/kicked (13%)

Injury mechanisms in basketbal

Women:More injured while dribbling and running

Males:more injured while rebounding, collision

with other player

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Identify when injuries happen in basketbal

� Ankle/foot injuries:jumping/landing (30%), stepped on (13%); rotation

with planted foot (11%)

� Knee injuries:collision with other player (25%);

rotation movements (20%);jumping/landing (19%)

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� 2 filmpjes

Prospective studies on intrinsic risk factors JUNGE 2002, Witvrouw et al 2003, Croisier et al 2008, 2010,

Zazulak et al 2007, Fousekis et al 2010, Engebretsen et al 2010, 2011

N =200-300 N = Y N = X

follow-up

II) Identify the risk/predisposing factors

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PROSPECTIEF ONDERZOEK

1-2-2013(c) 2011 SpartaNova

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� Oorzaak / gevolg � Vaak gecontroleerde populaties (STR,

defensie, LO) � Grote groepen nodig (power) � Labotesten – veldtesten

We are able to built injury predictionmodels

(cox regression equations)

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INJURY PREVENTION APPROACH

Step 1• What is incidence of injuries in soccer?

Step 2• What are the risk factors for these

injuries?

Step 3• How can we measure these

risk factors?

Step 4

• How can we create aninjury risk profile?

Validation of lab tests into field tests

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INJURY PREVENTION APPROACH

Step 1• What is the injury incidence is

BASKETBAL?

Step 2

• Establish aetiology & mechanism of injuries• What are the risk factors for these

injuries?

Step 3

• Introduce preventive measures• Introduce generic preventive

measures

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Multistation Proprioceptive Exercise Program Prevents Ankle Injuries in Basketball.

EILS, ERIC; SCHROTER, RALF; SCHRODER, MARC; GERSS, JOACHIM; ROSENBAUM, DIETER

Medicine & Science in Sports & Exercise. 42(11):2098-2105, November 2010.

DOI: 10.1249/MSS.0b013e3181e03667

Fifa 11+ program is effective in preventing injuries in elite male BB playersLongo et al, 2012

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http://www.klokavskade.no/en/Project/144---The-11-plus/

http://www.klokavskade.no/no/Skadefri/Fotball/SPILLEKLAR/

Injury prevention approach from 90’s to today

Introduction of general prevention programs

Good results!

But,…

Can we do better???

INJURY PREVENTION APPROACH

Step 1• Establish extent of sports injury problem• Injury Incidence in soccer

Step 2• Establish aetiology & mechanism of injuries• Risk factors for these injuries

Step 3

• Introduce preventive measures• How can we measure these

risk factors?

Step 4

• How can we create aninjury risk profile?

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INJURIES

RISK FACTORS

TESTS

RISK PROFILE

IP TRAINING

SEQUENCE OF PREVENTION OF SPORTS INJURIES

Van Mechelen 1992

Step 1• Establish extent of sports injury

problem

Step 2• Establish aetiology &

mechanism of injuries

Step 3• Introduce preventive measures• Follow up

Follow –up van dat risicoprofiel

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� Meten en weten welk risico uw sporert heeft is belangrijk …

� Maar nog veel belangrijker is het adequaat handelen � Oefenschema � Begeleiding van dit oefenschema � Eventueel doorsturen voor meer uitgebreide

screening ( bijv. Spartanova)� Re-test na het beëindigen van het programma

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Injury prevention screening

Aim:

Create a Musculoskeletalprofile of athlete

Injury prevention program

Aim:

Create a profile of injuredregion

Return to play

I) Primary prevention II) Secondary prevention

Return to sport� I) functional sport movements

� II) Functional injury-specific movements

� III) Screening risk factors

� INJURY PREVENTION WORKS!

� SEQUENCE OF INJURY PREVENTION

� KEYSTONES � LABO TESTS VS. FIELD TESTS

� AFTER PREVENTION PROGRAM: FOLLOW UP / RETEST

� FUTURE RESEARCH � INJURY RISK PROFILE FOR EACH ATHLETE

� RETURN TO SPORT

TAKE HOME MESSAGEp 42

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BEDANKT VOOR JULLIE AANDACHT!

Nele.Mahieu@ugent.be