TENDINOPATHY SYMPOSIUM 2017 SCHEDULE

 

Professor Jill Cook – JC

Craig Purdam (FACP) – CP

Ebonie Rio
- ER

Sean Docking – SD

 


 

Friday  6:30-9:30pm

MASTERCLASS – PRESENT EVIDENCE/LATEST RESEARCH 

Time Topic
6:30 DINNER
7:30 Revisiting the continuum of tendinopathy…again? – CP/JC
7:50 Characteristics and evidence around pain in tendons – ER
8:15 SUPPER
8:30 How do tendons adapt to load? SD
8:50 Management of tendinopathy in season – ER/CP
9:10 What to do if it’s not working? – JC/CP

 

Saturday  9:00am – 5:00pm

SYMPOSIUM

Time Topic
9:00 Tendinopathy – basic science and clinical presentations– SD/CP
9:45 The pain of tendinopathy – bottom-up, top-down where are we at?– ER
10:30 MORNING TEA
11:00 Tendon imaging – SD
11:45 Understanding load – CP
12:30 LUNCH
1:30 Assessment of tendinopathy and differential diagnosis – JC/ ER
2:15 Phases of rehabilitation – JC/ER/CP
3:00 AFTERNOON TEA
3:30 Adjunct therapies and adolescent tendons – JC/SD
4:15 Q/A

 


 

Sunday  9:00am – 4:00pm

WORKSHOPS

Rotating 4 workshops:


1. JC – Achilles/Glut tendons


2. ER – Patella


3. CP – Hamstring


4. SD – Imaging – when, how, what does it tell us?

Time Topic
9:00 Workshop 1
9:45 Workshop 2
10:30 MORNING TEA
11:00 Case studies
11:45 Clinical presentations and other tendons
12:30 LUNCH
1:30 Workshop 3
2:15 Workshop 4
3:00 AFTERNOON TEA
3:30 Q&A / concluding remarks

 

KIDS – HOW MUCH SPORT IS TOO MUCH?

As sports injury managers, we are often asked this question, and especially regarding children and adolescents, with the expectation that ‘kids shouldn’t get injured’.

In a general sense ‘too much’ sports or activity is related to the individual CAPACITY (red line below).  Each body has a capacity to endure a certain LOAD, with many variables playing a role.  If the individual is active above this capacity, then the body is more at risk of injury. Importantly the body can increase its capacity.

This is called the training effect.

Capacity

 

By working just in the right range, we get a training effect that increases the capacity of the body, tissues, bones and joints, to handle sport and activity as per diagram 2 below.

Capacity2

The calculation is not as simple as shown, as day-day and month-month other factors can affect capacity including fatigue, lack of sleep, diet, poor immune function, stress and hormone changes.  During the growth phase of children many of these ‘other factors’ come into play, as well as the mechanics of the body and the unique nature of the way muscles attach to bone during puberty.

How much sport is too much is difficult to quantify.  In adults and children pain and soreness can be a good guide, as well as fatigue and wellness.

For a TRAINING LOAD INJURY (ie not a specific acute injury but soreness or pain due to overload) one can pain monitor – soreness which is a maximum of 1-2/10 is tolerable and maybe normal during and for 24 hours after activity, but any higher ratings OR pain that limits training/playing is too much.  Activity needs to be modified or decreased.  Extreme fatigue or being unwell related to activity is another indicator that activity should be modified or reduced.

 

In children growth and development phases are from 8-16years with girls slightly earlier, and the capacity of the individual will vary greatly with spurts of growth and hormonal change.

 

TAKE HOME MESSAGE:

  • Capacity of the body is key.
  • Rest and over-activity is bad = need to do just enough to maintain and improve capability and fitness.
  • PAIN MONITOR – over-load injury >2/10 pain or not resolving or affecting performance needs activity modification or advice.
  • FATIGUE and BEING UNWELL will decrease capacity – pull back if this is occurring.
  • Control what you can control – can’t control growth but can control CAPACITY (ie conditioning training) and ACITIVITY – if your child is continually sore and breaking down take advice regarding these 2 options.

 

For more information about athlete load management go to physiosports.com.au/blogs or email paul@physiosports.com.au

ARE THERE SPECIFIC GUIDELINES FOR KID’S PARTICIPATION IN SPORT AND ACTIVITY?

As parents, coaches and injury managers we look for the magic number regarding the amount of sport our kids should undertake. What is clear is that children and adolescents need to exercise. The question is do we know how much exercise and what type of training and play will optimise their athletic development rather than compromise it resulting in injury.

The recent study ‘The Youth Physical Development Model: A New Approach to Long-Term Athletic Development’ by Lloyd and Oliver (2016) gives a nice description of many different types of activity in strength and conditioning training and relates the type of training to the BIOLOGICAL or MATURATION age of the child.

In SUMMARY, before the ‘growth spurt’ that occurs in adolescence (the early teenage years), one should focus on basic strength, movement skills, speed and agility. It is important in this phase to jump, land and do strength activities to optimise bone development.

Once the ‘growth spurt’ begins one can take advantage of growth hormones and optimise muscle bulk with hypertrophy work (i.e. weights), power and sports specific skills BUT only if the athlete is competent.

YPD for females

The YPD model for females. Font size refers to importance; light pink boxes refer to preadolescent periods of adaptation, dark pink boxes refer to adolescent periods of adaptation. FMS = fundamental movement skills; MC = metabolic conditioning; PHV = peak height velocity; SSS = sport-specific skills; YPD = youth physical development.

 

While specific sporting load guidelines are limited across all sports, governing bodies of Cricket and Baseball have published articles which outline age appropriate fast bowling and pitching loads respectively to help minimise risk of injury in children. Furthermore, consensus statements exist to help guide how much time kids should be engaged in organised sport and training per week. These recommendations are outlined below.

 

CRICKET:

Recently Cricket Australia published a number of guidelines surrounding fast bowling loads for adolescents. These have been designed to minimize the risk of injury.

AGE GROUP SPECIFIC GUIDELINES

AGE GROUP  
Under 11 2 over limit each spell & 4 over limit per match
Under 13 4 over limit each spell & 8 over limit per match Target* of 100-120 balls per week
Under 15 4-6 weeks bowling preparation before the season 5 over limit each spell & 12 over limit per match Target 100-120 balls per week
Under 17 6-8 weeks bowling preparation before the season 6 over maximum each spell & 16 over limit per match Target 120-150 balls per week
Under 19 8-10 weeks bowling preparation before the season 7 over limit each spell & 20 over limit per match Target 150-180 balls per week

*weekly targets are a combination of training and match bowling

 

BASEBALL:

Elbow and shoulder injuries are common in adolescent baseball pitchers.  These injuries are often the result of overuse, poor conditioning or suboptimal pitching technique.

Recommendations to avoid these injuries were outlined by the American Sports Medicine Institute in 2013:

  1. Monitor levels of fatigue, often associated with deteriorating technique as well as with decreased accuracy or pitching speed. If these signs are beginning to surface, allow a break from pitching/throwing.
  2. Furthermore, if a child reports pain in the elbow or shoulder, cease throwing activities and seek an expert’s opinion.
  3. Allow a period of 2-3 months with no competitive overhead throwing per year.
  4. Prevent pitching duties on multiple teams with seasons that overlap.
  5. A child should not have both pitching and catching duties. This places too great a load on the upper limb with the throwing requirements.
  6. Ensure spikes in pitch counts are offset with increased rest in the days following.
  7. Pitching more than 100 competitive innings in a calendar year in considered an injury risk.
  8. Emphasise the importance of correct technique prior to a velocity focus.

 

A consensus statement from the American Orthopaedic Society for Sports Medicine recommends several measures to prevent burnout and injury in children including ‘avoiding over-scheduling and excessive time commitments’. (LaPrade, et al. 2016)

As a rule of thumb kids should limit the number of hours they participate in organised sports each week to the number of years they’ve been alive — or less. ‘So a 10-year-old should not play or practice more than 10 hours a week,’ (McGuine, et al. 2017)

IN SUMMARY:

  • Strict activity guidelines are scarce.
  • ‘Hours for age’ has no evidence but can be a guide.
  • No need to specialise early – a broad range of sports may be beneficial.
  • Be aware of stages of maturation – wait until late puberty and spurt before commencing ‘super heavy’ strength and plyometrics work.
  • Monitor pain, fatigue and wellness, and rest, sleep and eat well.
  • Avoid excessive spikes in load.

 

 

References:

McGuine, T. A., Post, E. G., Hetzel, S. J., Brooks, M. A., Trigsted, S., & Bell, D. R. (2017). A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes. The American Journal of Sports Medicine, 0363546517710213.

LaPrade, R. F., Agel, J., Baker, J., Brenner, J. S., Cordasco, F. A., Côté, J., … & Hewett, T. E. (2016). AOSSM early sport specialization consensus statement. Orthopaedic journal of sports medicine, 4(4), 2325967116644241

 

SHOULD MY CHILD FOCUS ON THEIR BEST SPORT, OR DO MANY SPORTS?

With the remarkable amount of resources being invested into the sporting world, the popularity of youth talent identification programs has increased sevenfold. In Australia, these elite youth programs are popular in the AFL, tennis and basketball settings. These programs have the long-term aim of developing elite athletes from an early age, thus guiding them along a specific sporting journey. Because of this, many parents are unsure whether their child should focus on a specific sport, or continue to diversify.

Cote (et al. 2009) has previously outlined key concepts of athletic development, concluding:
1) Playing different sports in the younger age groups does not effect one’s potential for elite sport participation after puberty.

2) Variety in sporting involvement at a younger age is linked to a longer sporting career and a decreased likelihood of drop out.

3) Exposure to a range of sports positively influences youth development in the areas of relationship formation, behavioural tendencies and an understanding of healthy habits.

4) Injuries may be more likely if a high-school student specialises in one particular sport (McGuine, et al. 2017), or this increase in injury rate could be related to an increased volume and intensity (Di Fiori, et al. 2014).
With the evidence considered, your child will benefit from participating across a range of sports at an early age, which prevents injury and improves participation and well-being, without impacting their chances of reaching an elite level once they mature.

 

 

References:

Côté, J., Lidor, R., & Hackfort, D. (2009). ISSP position stand: To sample or to specialize? Seven postulates about youth sport activities that lead to continued participation and elite performance. International Journal of Sport and Exercise Psychology, 7(1), 7-17.

DiFiori, J. P., Benjamin, H. J., Brenner, J. S., Gregory, A., Jayanthi, N., Landry, G. L., & Luke, A. (2014). Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med, 48(4), 287-288.

McGuine, T. A., Post, E. G., Hetzel, S. J., Brooks, M. A., Trigsted, S., & Bell, D. R. (2017). A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes. The American Journal of Sports Medicine, 0363546517710213.