Return to play descion making in real time.pptx

need for the rtp criteria

1. Return to Play

2. INJURY Injury refers to damage to the body produced by energy exchanges that have relatively sudden discernible effects

3. Types of Injury Cause Body tissue Duration Direct Indirect Overuse Soft-Tissue Hard-Tissue Acute Chronic

4. RTP Return-to-Play (RTP) is the decision-making process of returning an injured or ill athlete to practice or competition. This ultimately leads to medical clearance of an athlete for full participation in sport.

5. Importance of RTP Recovery Risk Management Performance Optimization Legal and Ethical Considerations Psychological Readiness

6. RTS-Perspective Athlete - Return to sustained participation in sport in the shortest possible time (goal focus) Coach - Relative to the athlete’s performance on RTS (performance focus) Clinician - Prevention of new (or recurring) or associated injuries (outcome focus)

7. RTS- Continuum 1.Return to participation- Participating in rehabilitation, training (modified or unrestricted), or in sport, but at a level lower than his or her RTS goal. It is possible to train to perform, but this does not automatically mean RTS. 2. Return to sport (RTS)- Has returned to his or her defined sport, but is not performing at his or her desired performance level. 3. Return to performance- The athlete has gradually returned to his or her defined sport and is performing at or above his or her preinjury level.

8. RTS-Models Biopsychosocial model Strategic Assessment of Risk and Risk Tolerance ( StARRT ) Optimal loading—‘the Goldilocks approach’

9. Biopsychosocial model

10. StARRT

11. Assessment of Health Risk Athlete Demographics Signs and Symptoms (pain, swelling) Medical History Special Test

12. Assessment of Activity Risk Type of sport Position played Limb Dominance Competitive Level Ability to protect Functional test Psychological Readiness

13. Risk Tolerance Timing and Season Pressure of Athlete (desire to compete) External Pressure (Coach, Family) Masking of Injury (analgesics) Conflict of Interest (financial stability) Litigation ( if restricted or permited )

14. Goldilocks approach Monitoring the training load during the current training week (acute) against the average of preceding four training weeks (chronic) provides an acute:chronic workload ratio. Helps in planning load progressions in RTS

15. Shared Decision Making

16. Hamstring The hamstring muscle complex occupies the posterior compartment of the thigh and is comprised of three individual muscles. Biceps femoris Semitendinosus Semimembranosus Innervations - Common peroneal nerve Tibial nerve

17. Mechanism of injury 1. Stretch Type - Excessive Hip Flexion + Hyperextended Knee 2. Strength Related - High Eccentric Load (during late swing phase) Predisposed by - Lack of Eccentric Strength - Fatigue

18. Types Grade 1: Mild Strain, Only few fibres Grade 2: Half the fibres damaged/ruptured Grade 3: More than half fibres or Complete Rupture

19. Clinical Examination History- sudden onset of posterior thigh pain, sometimes accompanied by an audible or “ sensory pop ”,causing the immediate cessation of activity Pain - Can be rated by the athlete after injury (NAS/VAS) can be used as a reference point when monitoring symptoms throughout rehabilitation in rehabilitation Palpation - Grade of Tenderness, Discontinuity of muscle fibers Range of motion- Active/Passive movements Strength Testing Investigations-MRI

20. RTP Criteria ( Currently used)

21. RTP Criteria ( Suggested ) Respect Natural Healing

22. Exercises-Which/WHY ? Isometrics- Isometrics during the early stages of HSI rehabilitation are introduced Progression to the next phase after pain and strength between-limbs strength during isometric knee are resolved Eccentrics- high-intensity loading appears to be a key component of interventions proven to increase hamstring strength, lengthen long head of the biceps femoris muscle fascicles, and reduce the HSI risk Hamstring lengthening via the extender, diver, and glider exercises, the Askling L protocol reduced RTS time compared with conventional and multifactorial interventions Concentrics- Proceed after Eccentrics. Continue to strengthen hip extensors from the initial stage right up to active participation

23. Askling -L protocol

24. Anterior cruciate Ligament The anterior cruciate ligament (ACL) is one of the two cruciate ligaments which stabilizes the knee joint by preventing excessive forward movements of the tibia or limiting rotational knee movements. Primar y functions R e s t r ai n t t o li m it a n t erior disp lacement o f the tibia Prevent hyperextension of knee Se c onda r y functions R e s t r ai n t t o t i bia l r o t a t i o n and v aru s / v algus angul a t i o n a t f ul l e x t ension.

25. Mechanism of Injury Co n t act and hig h - e n e r g y t r aum a tic inj u r ies: Tackles , Collisions Are of t en associ a t ed with othe r l i g ame n t ous and men i s c al injur i e s . Non c o n t act: Cu t ti n g (Changing direction rapidly) Stopping suddenly while running Landing from a jump incorrectly

26. Clinical Features ACUTE INJURY “Popping sound” heard by the patient Pain with swelling. Knee effusion ( Haemarthrosis ) Loss of full range of motion Tenderness CHRONIC INJURY (INSTABILITY/GIVING WAY) Discomfort while walking

27. Grades

28. Concussion A clinical syndrome of biomechanically induced alteration of brain function typically affecting memory and orientation, which may involve loss of consciousness

29. Signs and symptoms

30. Grades

31. Return to Play Guidelines

32. Concussion Assessment SCAT-7 (Sports Concussion Assessment Test) Cobalt (Concussion balance test) VOMS (Vestibular oculomotor Motor Screening)

33. General Guidelines for Rehab