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GUIDELINES

for coaches, trainers and teachers of physical education

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CONTENT

Introduction 3

1.The project partners 4

2. The I WON project 7

3. The target 8

4. The Postulab® concept 9

4.1 Postulab® tools 11

5. The most common injuries in sport

5.1 Trunk/spine

5.2 Upper limb

5.3 Lower limb

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6. How sport injuries can be prevented 24

7. Recommendations 26

8. Bibliography 30

Contacts 31

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Introduction

The rate of physical inactivity in Europe is incredibly high and slightly increasing, as demonstrated by the Eurobarometer survey on sport and physical activity published in 2014.

Fig. 1 - Special Eurobarometer 412 -Sport and physical activity –March 2014

In response to this challenge, National and European Institutions launched several initiatives and actions to raise awareness about the benefits of sport and physical activity and to encourage more Europeans to engage in sport and physical activity.

Among these initiatives, there is also the Erasmus + Programme - Sport. In the framework of this Programme has been financed the project I W.O.N. - I Work Out now! a small collaborative partnership, that aims at increasing awareness of health-enhancing physical activity through increased participation in it.

If on one hand it is true that regular participation in sports generates physical, psychological and social benefits, on the other hand the engagement in physical activitiy also causes risk for injuries that have a deep impact on participation in sport.

According to EuroSafe, Policy Briefing "Promoting Safety in Sport: how to put actions in place” about one in five injuries treated at emergency hospital is

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related to sport activities, for the EU-27 region, the number of sports related injuries treated in hospitals can be estimated at 5.2 million cases a year.

Injury rates could be reduced by 25% if athletes took appropriate preventative action. One of these actions is a balanced training, focused on the athlete’s characteristics.

On the basis of this background, the partnership of the current project considers of crucial importance to increase the awareness of coaches and sport staff on the relevance of a balanced training programme, personalized as much as possible on athlete’s need.

In order to reach the goal, the coordinator of the project, the Italian A.D.S. Palestra Ginnastica Ferrara worked together with the Lithuanian Sport University and the Municipality of Mirandela (PT) in order to develop a guideline with recommendations useful to sport staff in order to prevent long-lasting injuries in the athletes.

The current document contains information that should help the sport staff to improve the knowledge of most common injuries and their causes and collects some recommendations that would increase coaches, instructors and physical education teachers awareness on the importance of a balanced fitness training, athlete centered.

These guidelines are followed by a series of practical examples of fitness exercises that will be illustrated in the mobile application, foreseen as the second outcome of the I W.O.N. project for the beginning of 2018.

Guidelines and app are not meant to be an exhaustive work, however it may be a starter point for trainers, coaches and sport staff that hopefully are interested in improving the well-being of athletes.

1. The project partners

The coordinator of the project I W.O.N. is the A. S. D. Palestra Ginnastica Ferrara - Palagym (PGF), an Italian non-for-profit Association founded in 1879 in Ferrara (northern Italy) with the aim of promoting “the culture and the study of gymnastics”. PGF has got more than 1.200 members and offers a wide number of group excercise classes addressed to children and adults, from 3 to 80 years old in various disciplines, such as rhythmic and artistic gymnastic, Japanese and Chinese martial arts (aikido, judo, wushu, sanda, etc), pilates, yoga, sliding, functional training, weightlifting, tacfit, modern dance and postural training. Personal trainers also provide customized fitness routines.

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In 2004, PGF moved to the new premises: the Palagym. This is a new sport centre of about 2.500 mq, with 6 gyms and additional areas providing purpose designed indoor spaces, accessible also to people with disabilities.

Finally, particularly active and significant is the experience of Postulab® (Laboratory of posture). With its highly qualified staff and the cooperation with the other sport instructors Postulab® has obtained excellent results.

PGF collaborates with local public authorities, Universities, schools and private Associations and it has a good experience in the organization of training and local events. PGF also organizes an awareness campaign in the local schools and summer camps.

PGF is inspired by the ethic principles of sport, promoting in all its activities the “culture of sport” combining in a single approach the well-being and enjoyment with fair play as a way of thinking that includes respect for others, inclusion, equal opportunities, fighting against any kind of violence.

The role of PGF in the project is to lead the project team, supervise project activities at local and international level and monitor progress and performance. Partners of the project are the Lithuanian Sport University and the Municipality of Mirandela.

The Lithuanian Sport University (LSU) has the task to coordinate the quality of the project and the work package related to the exchange of best practices, supervising the activities of preparation of the guidelines with recommendations for sport staff.

LSU was founded in 1934 in Kaunas; it became an important centre of sports science, a fosterer of physical education and sports values and traditions as well as new initiatives of HEPA (Health Enhancing Physical Activity) in Lithuania.

Since its foundation, the institution has trained over 14.000 teachers of physical education, sports coaches, physiotherapists, tourism and sport managers and other qualified specialists. Over the years many distinguished scholars, world-known coaches, prominent sports and public figures have graduated from the University. At the moment 2.000 students are studying at the University and can choose one out of 4 Bachelors, 6 Masters, including Physical Activity and Health and 1 PhD programme at the Faculty of Sports Biomedicine and out of 4 Bachelors, 3 Masters and 1 PhD programmes at the Faculty of Sports Education.

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The research projects are performed in different areas of social and biomedical sciences, such as muscle and movement control, rehabilitation, public health, physical activity and social empowerment of the disabled.

LSU maintains strong partnership with leading European Universities such as the University of Southern Denmark, Groningen Hanze University, Foro Italico University of Rome and others. It actively participates at various international Associations and Networks and is a member of several different sports organizations.

Over the last decade the LSU has participated in a great number of international projects in the area of physical activity for children, including LLP/Erasmus intensive programs, LLP/Erasmus Curriculum Development Programme.

The second partner is the Municipality of Mirandela situated in the Norte Region with a population of about 23.850 inhabitants (data 2011).

It is a dynamic Municipality that became a reference in sport in the northeast of Portugal.

The city is the home to the oldest sports club in the Region and the sports movement exists since the beginning of the XX century. Since 1996, Mirandela hosts annually National and International sport events like the European Jet Ski Championship, becoming also the Jet Ski Capital of Europe. Since the late 80’s, Mirandela host also the annual International Kickboxing event, whose world Champions live and practice in the City, as well as other several athletes who had represented the National Teams in sports such as Football, Basketball, Table Tennis, Field Hockey, Athletics, Chess and Adapted Sports. Mirandela is a national reference in Table Tennis; local clubs boast individual champions and many collective championships.

The Municipality strategy is to promote a well-balanced performance, fitness and health of athletes and amateurs by increasing the quality, accessibility and management of facilities, doctors and coaches. Furthermore, it has encouraged the exchange of “know-how” and experience among sport staff thanks also to the participation to European Programmes.

The Sport Unit of the Municipality daily cooperates with 26 sport Organizations such as Olympic Committee, National Federations, Regional Associations and Local Clubs. There are 21 different sports and 865 official athletes members of National Federations.

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Every year, conferences and seminars are organized in order to share experience and best practice with local sport clubs, specifically in management, coaching and training, heath, fitness and injury prevention; nevertheless, there is still a long way to a fully acquire a good knowledge on injuries prevention.

Mirandela’s coaches need to learn more about this issue in order to promote the well-being of the athletes and as consequences to obtain better results.

Finally, Mirandela is partner of several European projects financed in the framework of Erasmus + Programme – Sport. Thanks to this participation a good experience in dissemination of sport related projects has been developed. Mirandela, as partner of I W.O.N. project, used the know-how acquired in the coordination of the dissemination activities.

2. The I W.O.N. project The project started in January 2017 and involved an International team

composed of Italian postural gymnastic trainers and artistic gymnastic coaches, Lithuanian University professors and physiotherapist and a sport manager and a physiotherapist from Portugal.

Thanks to the project I W.O.N. the partners had the opportunity to exchange their experience. They worked together in order to have a comparison and collect useful material for sport staff, having in mind the specific aim of the project: to protect young athletes from health and safety hazards by improving training conditions, increasing sport staff awareness on the importance of a balanced and adapted training programme, in order to prevent young athletes from long-last injuries.

The idea of the project is based on the experience of the partners and it is also the result of a research, conducted at EU and National level in the field of the project: risk injuries in sport, education of coaches/standard protocol of training, drop-out from sport due to long-lasting injuries.

There are many factors that impact on the potential occurrence of an injury. There are internal, or intrinsic, risk factors that are part of an athlete's characteristics, such as age, gender, general level of fitness and playing skills that make him/her predisposed to injury. There are also external factors related to the environment and equipment/attributes used while playing, that make athletes susceptible to injury. These factors, often in combination, will determine whether a specific event will occur and result in an injury. Intrinsic factors such as health, fitness level, skills and 'previously sustained injury' are a significant predictor of new injuries. These intrinsic factors may predispose athletes to

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injury or may protect them from injury.

In the I W.O.N. project, attention is paid specifically on the intrinsic risk factor related to training and fitness level, that is a modifiable factors on which project partners would like to focus and contribute to improve.

The analysis of the state of the art highlighted that standardized training protocol and not well-educated sport staff on specific needs of young athletes are two important factors that can affect the occurrence of long-lasting injuries.

Some sports have their typical injury patterns and it is essential for coaching staff to fully understand these patterns.

Also the experience of the project partners demonstrates that sport injuries have a deep impact on participation in sport drop-out and a strong influence on the well-being of young athletes. On the basis of this background, the partnership considers of crucial importance to increase coaches and sport staff awareness on the relevance of balanced training, focused on a complete functional re-education.

In order to increase the awareness on the I W.O.N. topics, activities as local events in the Universities and schools are promoted, local public authorities and journalists are involved and invited to the meetings; several articles are published on specialist on-line magazines and on the local media and a project website has been created.

3. The target

Coaches are not often trained enough in order to prepare balanced training programmes that develop an harmonic and healthy body.

Besides, some sports have their typical injury patterns, sometimes coaching staff do not fully understand these patterns.

On the other hand, training practices tailored to the specific type of sport, allows more athletes to prevent long-lasting injuries or to return more easily to participation after an injury.

The present guidelines are addressed to coaches, trainers, teachers of physical education that wants to take care of athletes, amateurs or professionals, with the aim of increasing their awareness on the importance of a balanced training programme, centred around each individual athlete (The Long-Term Athlete Development model (LTAD model) Ford et al. (2011).

The recommendations illustrated below are addressed to coaches, trainers and teachers of physical education to create a structured method of injuries prevention.

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Ford et al. (2011) The Long-Term Athlete Development model: Physiological evidence and application. Journal of Sports Sciences, February 15 2011; 29 (4) 389-402

4. The Postulab® concept

Starting point of the guidelines has been a method tested in the Laboratory of Posture (Postulab®) developed in Palestra Ginnastica Ferrara that pays special attention to structural and functional integrity of athletes from 3 to 16 years old.

The Postulab® is a registered trademark of the Laboratory of Posture, whose concept was created in the mid-1990s but consolidated in 2006, when it was decided to integrate the thirty-year experience of the coaches of artistic gymnastics with the skills developed by the trainers of postural gymnastic.

Postulab® is the combination and integration of various methodologies: the traditional methods of re-education proposed by Williams, Cailliet and Charrière are integrated and combined with modern methods such as Mckenzie's mechanical therapy, Feldenkrais method, Mézières method, Sukoff’s global posture re-education, Alexander method, Postural Reflexes Method, Functional Recovery, Trunk Stabilization, Lumbar Protective Mechanism, Proprietary Re-education, and Bioenergetics.

The method used is chosen on the basis of the goal to be achieved, taking into consideration the needs and characteristics of the athlete.

Postulab® priority is the well-being of the person, who should be gradually supported in dealing with his/her pain, so that he/she is able to recognize feelings and messages that the body send, increasing his/her self-confidence achieved through personal engagement and physical and psychic training.

The features of the Postulab® concept are based on the consideration that the complexity of our body requires a multidisciplinary approach to posturology. The postural reorganization is in fact the body in its entirety and the postural rehabilitation protocol therefore normally involves the collaboration of a team of specialists in various sectors but all with posturology skills. Only in this way the postural rehabilitation programme will have a better impact on improving the general well-being of the person, in a functional and lasting way. A correct postural rehabilitation approach should ultimately aim to normalize the general center of gravity of the body, both in the static and dynamic form, by means of inputs capable of eliminating the present psychic and physical blocks, creating new equilibrium and more functional physical strategies. All this allows, beyond the limits of "subjective interference" of the human eye, a careful initial analysis

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of static and dynamic posture, and hence the preparation of a precise postural rehabilitation programme, with performance being verified through periodic checks.

The postural rehabilitation, of course, needs to be supported by a customized physical rehabilitation program, which may include, as appropriate, manual techniques of movement and breathing. Naturally, disadvantageous mental and dietary attitudes need to be modified. The postural system of the body, feeling more functional free of blocks (physical and psychological), will begin immediately postural adjustment.

Before starting the postural classes in Postulab®, posture and functional problems are defined: observe the athlete in order to identify the existing problem and to study the possible causes is a prerequisite. Only after the evaluation phase it is possible to schedule a personalized training protocol that is transferred to the athlete thanks to theoretical-practical teaching, in order to facilitate a conscious learning. During the postural classes objects are used: small balls, thera-bands, sticks, balance cushions and other little accessible equipment useful to facilitate a correct posture and quick intervention or solution. Naturally, the original protocol chosen is subject to modification on the basis of the progress of the person and periodically there is a testing and an assessment of the results obtained.

The improvement of the athlete’s well-being in the training classes of Postulab® is pursued following several steps: first of all, muscle elasticity and joint mobility is developed to prevent or eliminate muscular contractures; then, the strength and resistance is improved. During each phase respiration is essential, together with concentration and self-relaxation.

Through body control techniques and through neuromuscular re-education proprioception is pursued and motor skills, a correct posture and a body balanced is obtained. Finally, thanks to the stabilization a good quality of movement is reached, deep muscles are engaged and a correct posture is maintained. The validity of this methodology has been demonstrated by the decrease in the number of injuries over the years of PGF athletes, as well the decrease of pain with an improvement of performances.

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4.1 Postulab® tools

The tools used in the Postulab®) concept are unique and original in their genre. They were developed by staff instructors with the precise aim of adapting them to single athlete's need.

By studying motor deficiency, the therapeutic goal to be attained was achieved and finally the creation and then the development of technical aids, that could bring the athlete to the improvement of the painful situation and the more effective execution of the technical gesture.

Finally, it was decided to include the use of these tools within a preventive-level work programme, before, during and after the training session. The results achieved during the years are more than satisfactory.

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5. The most common injuries in sport In recent years, more and more athletes are undertaking intense training at

younger ages or participating in multiple sports in one season. Therefore exposing themselves to more opportunities for acute injury and increasing their risk for overuse injuries. Participation in a sport inevitably entails a risk of injury. The most commonly injured parts of the body are the ankle and knee, followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle, shoulder, foot, back, hip and hamstring (Adirim & Cheng, 2003).

The most common sports injuries are (Palmer-Green, 2015): • pulled muscles (Groin pull, Hamstring strain, Strained back); • ankle sprain; • shin splints; • knee injuries (ACL tear; patellofemoral syndrome, runner’s knee); • tennis, Golfer’s elbow (epicondylitis); • shoulder (rotator cuff injuries, shoulder impingement) injuries; • plantar fasciitis; • Achilles tendinitis.

Sprains are injuries to ligaments, the tough bands connecting bones in a joint. Suddenly stretching ligaments past their limits, deforms or tears them.

Strains are injuries to muscle fibers or tendons, which anchor muscles to bones. Strains are called “pulled muscles” for a reason: Over-stretching or overusing a muscle causes tears in the muscle fibers or tendons.

Syndromes (Patellofemoral, Osgood-Schlatter) — injury resulting from the repetitive movement.

5.1 Trunk/spine

Spondylolysis Spondylolysis is a stress fracture of the pars interarticularis caused by

repetitive spinal extension and rotation. Sports requiring these movements, such as dance, figure skating and gymnastics, increase the risk of spondylolysis (Purcell, 2009).

Athletes present with insidious onset of extension-related back pain. Hamstring flexibility is reduced and there may be pain with impact activities (running, jumping). A physical examination shows hyperlordosis, paraspinal muscle spasm and hamstring tightness (Purcell, 2009).

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Fig. 2.

https://www.google.it/search?q=Spondylolysis+in+gymnastics&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi1mMSL_onXAhXEbRQKHe_XAtwQ_AUICigB&biw=1536&bih=710#imgrc=T5iCsmeKJH-P3M:

Posterior element overuse syndrome Posterior element overuse syndrome, also known as ‘hyperlordotic back pain’

or ‘mechanical/muscular back pain’, is a constellation of conditions involving the posterior spine, including muscle-tendon units, ligaments and facet joints (Purcell, 2009).

An insidious onset of extension-related back pain, similar to spondylolysis. There is focal tenderness of the lumbar spine and the paraspinal muscles may be tender. Investigations in this setting are typically negative (Purcell, 2009).

Vertebral body apophyseal avulsion fracture Repetitive spinal flexion and extension can injure the ring apophysis,

resulting in fractures that may posteriorly displace into the spinal canal, along with the intervertebral disc. Avulsion fractures occur in sports such as volleyball, gymnastics and weightlifting. Athletes get acute-onset flexion-related lumbar pain, similar to disc herniation, although with no associated neurological symptoms. On examination, there may be spinal flexion and extension limitation, and paraspinal muscle spasm (Purcell, 2009).

Fig. 3.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=avulsion+fracture+Vertebral+body+spinal+&oq=avulsion+fracture+Vertebral+body+spinal+&gs_l=psy-ab.3...68351.177202.0.177458.10.10.0.0.0.0.320.1136.4j4j0j1.9.0....0...1.1.64.psy-ab..1.0.0....0.NEE9xzmK680#imgrc=JKf4R03qvpYunM:

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Disc herniation Only 11% of young athletes with low back pain have acute disc herniation of

the lumbar spine (3). Pain is usually acute in onset, flexion-related and associated with back muscle spasm, hamstring tightness and, sometimes, buttock pain. Radicular symptoms (muscle weakness, paresthe-sias) are uncommon. Examination demonstrates decreased flexion, positive straight leg raise and occasionally decreased reflexes/strength of the lower extremities (Purcell, 2009).

Fig.4.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=lumbar+spine+Disc+herniation+in+sportsmen&oq=lumbar+spine+Disc+herniation+in+sportsmen&gs_l=psy-ab.3...98619.101342.0.102156.13.13.0.0.0.0.277.1091.3j3j2.8.0....0...1.1.64.psy-ab..5.0.0....0.3sO6ujwLEyw#imgrc=E0jw-uus1YPcnM:

5.2 Upper limb (according to Sports Therapy UK) Injuries of the limbs can be acute, chronic or repetitive, from mild to severely

disabling in severity. The prevalence of upper limb injuries is 23%. The common upper extremity injuries are the shoulder, followed by elbow and wrist. The type, biomechanics and frequencies of the use of the body parts determine the injury patterns. Shoulder injuries are more common in cricket players, during delivery or follow through of the bowler or throw of the fielder, either acute or chronic. Pain in the upper extremity, to shoulder and elbow are common in throwing sports, racquet sports and swimming while wrist pain is common in young gymnasts. Elbow injuries are common in athletes with over the head and arm motions. In chronic conditions, either lateral or medial epicondylitis (50%), popularly known as tennis elbow or golfers elbow are due to repetitive valgus or varus stress impacts. This repetitive stress pathology from mild to severely disabling to the sportsman is a common challenge to clinicians or physiotherapists in management. The musculoskeletal disorders, general or related to tendons, muscular, joints nerves or vascular, need a variety of management skills involving clinicians, physiotherapists and rehabilitation specialists (Putty, 2010).

Rotator Cuff Strain

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Structures affected: supraspinatus (supraspinatus fossa); infraspinatus (posterior surface of the scapula); teres minor (posterior surface of the scapula); subscapularis (anterior surface of the scapula); muscle strains normally occur at the MTJ but can also occur in the muscle belly. Graded 1st, 2nd and 3rd degree according to severity and the number of fibers left intact.

Signs and Symptoms: sudden pain felt around the shoulder during activity; localized pain on palpation; a palpable dip may be felt in the muscle if there is a complete rupture; pain at end ROM.

Biomechanics of injury: most likely to occur during eccentric muscle action; high impact or unexpected force is usually associated with muscle strains; muscle imbalance between agonist and antagonist pairs will make the athlete more susceptible to muscle tears.

Fig. 5. https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Rotator+Cuff+Strain+&oq=Rotator+Cuff+Strain+&gs_l=psy-ab.3..0l3j0i30k1j0i24k1l6.68964.68964.0.69703.1.1.0.0.0.0.59.59.1.1.0....0...1.1.64.psy-ab..0.1.59....0.TJ7OkaZExdM#imgrc=ixawixIuq42DPM:

Frozen Shoulder Structures affected: also known as adhesive capsulitis; affects the whole

shoulder capsule; often only effects one side; condition is unique to the shoulder; the fluid within the joint capsule become ‘sticky’ making the joint hard to move.

Signs and Symptoms: recent surgery or immobilisation; slow onset of shoulder pain and stiffness; pain worsening at night; pain worsening when pressure is placed upon the effected side; decreased ROM; not being able to complete everyday tasks such as putting a coat on; muscle atrophy from lack of movement.

Biomechanics of injury: often occurs in the older population, more commonly in women; this can be as a result of trauma or surgery to the joint. immobility after an injury can lead to the onset of this condition; can also spontaneously happen, with no known cause. The fluid in the capsule becomes inflamed, leading to scar tissue formation within the capsule, allowing less free movement within the join.

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Fig. 6.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Frozen+Shoulder+&oq=Frozen+Shoulder+&gs_l=psy-ab.3..0l10.227227.227227.0.227563.1.1.0.0.0.0.194.194.0j1.1.0....0...1.1.64.psy-ab..0.1.194....0.Y4NkatPXZLY#imgrc=p8nnK4OjZ6Wl5M:

Shoulder (glenohumeral joint) Instability Structures affected: the joint (head of the humerus and glenoid fossa);

muscles surrounding the shoulder joint, particularly the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis).

Signs and Symptoms: complaint of discomfort around the joint; laxity in the joint during sport and everyday tasks (i.e. throwing a ball or just carrying shopping bags); history of dislocation.

Biomechanics of injury: trauma driving the humerus away from the pit (either dislocation or subluxation); ligament laxity within the joint; muscle weakness, particularly the rotator cuff muscles; hypermobility, meaning the athlete has laxity in all joints.

Fig. 7.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Shoulder+instability+glenohumeral+joint&oq=Shoulder+instability+glenohumeral+joint&gs_l=psy-ab.3...4910.12313.0.13106.16.16.0.0.0.0.1070.1579.0j2j1j7-1.4.0....0...1.1.64.psy-ab..12.0.0....0.ln4Z-WZyZlQ#imgrc=BXZUmiEul9rmGM:

Golfers Elbow Structures affected: the medial epicondyle, origin for the flexor and pronator

muscles of the wrist.

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Signs and Symptoms: gradual onset of pain on the lateral side of the elbow; pain when flexing or pronating the wrist actively or against resistance.

Biomechanics of injury: repetitive strain placed upon the flexor and pronator muscles; activities such as golf, forehand tennis and baseball players all commonly suffer this injury; not as common as lateral epicondylitis.

Fig. 8.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Golfers+Elbow+&oq=Golfers+Elbow+&gs_l=psy-ab.3..0l10.104736.104736.0.105056.1.1.0.0.0.0.158.158.0j1.1.0....0...1.1.64.psy-ab..0.1.158....0.FtBT_Lg5w3Q#imgrc=eqQGYXHjt8O75M:

Tennis Elbow Structures affected: the lateral epicondyle, common origin for the extensor

and supinator muscles. Signs and Symptoms: gradual onset of pain on the lateral side of the elbow;

Pain when extending or supinating the wrist actively or against resistance. Biomechanics of injury: most common in tennis (also known as tennis

elbow); common causes in tennis include excessive use of backhand, change in or poor grip size and string tension, technique and overuse; stresses places upon the supinators and flexors of the wrist; poor strength.

Fig. 9.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Tennis+Elbow+&oq=Tennis+Elbow+&gs_l=psy-ab.3...91541.91541.0.91801.1.1.0.0.0.0.0.0..0.0....0...1.1.64.psy-ab..1.0.0....0.arqiJQpQhik#imgrc=MbQ__mBOWEA3RM:

Elbow Dislocation Structures affected: humero-ulna dislocation; radio-ulna dislocation.

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Signs and Symptoms: sudden pain felt on impact inflammation; dislocation; pain with pronation and supination; localised tenderness on palpation; obvious deformity; unable/unwilling to move the arm.

Biomechanics of injury: humeroulna dislocation occurs when the radius and ulna displace posteriorly to the humerus often occurring from hyperextension; Radioulna dislocation is the tearing of the annular ligament and interosseus membrane, can occur from direct impact to the lateral elbow.

Fig. 10.

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Carpal Tunnel Syndrome Structures affected: compression of the median nerve in the carpal tunnel, most commonly affects older adults. Signs and Symptoms:change in sensation in the hand a fingers, localized pain with palpation over the anterior aspect of the wrist, flexion of the fingers may become weak, adduction and abduction of the thumb may become weak and painful, holding the wrist in a flexed position will increase the pain. Biomechanics of injury: overuse in sport and with action such as typing on a computer, bony abnormality, excess fluid retention, can be associated with fractures and dislocations where fragments of bone are displaced.

Fig. 11. https://www.google.it/search?q=wrist+tunnel+syndrome&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjcsbe-oYvXAhUFJFAKHbfrCXQQ_AUICigB&biw=1536&bih=759#imgrc=RA28ILRdt6P60M:

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5.3 Lower limb (according to Sports Therapy UK) The lower extremity is the most commonly injured anatomic area in sports. It

is important to have a thorough knowledge of these injuries as also the anatomical structures involved in different types of injuries. Football, hockey, baseball, lawn tennis, badminton, volleyball, kabaddi, kho-kho and all sprinting events including long and high jumps as also all throwing events like discus and javelin cause a number of lower limb injuries, which need to be attended urgently and dealt in the most advanced scientific manner, so that recovery of the sports person is quick and complete.

Hip Joint - Sprains Structures affected: sprains are categorised into 1st, 2nd and 3rd degree

dependent upon the severity of the tear and the percentage of fibers that have torn. Any of the ligaments of the hip joint can be damaged Iliofemoral, ischiofemoral, pubofemoral ligaments. Complete rupture will result in the hip being dislocated, this can be very serious and should not be attempted to be relocated by anyone who is not medical trained

Signs and Symptoms: obvious deformity of third degree tear. Pain with passive movement of the joint. Instability of the joint Poor ROM. Pain on active movement; inflammation; dislocation; weak.

Biomechanics of injury: excessive rotation; excessive abduction; rotation of the core while the feet are fixed.

Fig. 12.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=groin+strain++in+gymnastics&oq=groin+strain++in+gymnastics&gs_l=psy-ab.3...30738.30738.0.31457.1.1.0.0.0.0.0.0..0.0....0...1.1.64.psy-ab..1.0.0....0.LeYwEzCvLko#imgrc=qB3fUAhSIilcNM:

Osgood Schlatter’s Syndrome Structures affected: tibial tuberosity (insertion point of the quadriceps

tendon).

Signs and Symptoms: inflammation of the bony prominence (tibial tuberosity), this will appear more projecting than the unaffected side – bony growth over long period of suffering the syndrome. Localised pain on palpation; pain when contracting isometric/isotonic against resistance; pain worsens after activity.

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Biomechanics of injury: following a rapid growth period; more common in boys aged 10-15; high levels of activity; the tendon repeatedly pulling at the patella bone.

Fig. 13. https://www.google.it/search?q=osgood+schlatters&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi4x-La5ojXAhUSnRQKHW0CBlcQ_AUICigB&biw=1536&bih=759#imgrc=zXzdE0W9tEzgnM

Runners Knee - ITB Friction Syndrome Structures affected: iliotibial band on the lateral thigh.

Signs and Symptoms: lateral knee pain; pain when flexing and extending the knee; pain worsens with running; weak hip abduction; pain on palpation of the ITB.

Biomechanics of injury: overuse injury most common in long distance runners.

Fig. 14. https://www.google.it/search?q=patellofemoral+pain+syndrome&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiigvOZ54jXAhWFuhQKHdXNBeAQ_AUICigB&biw=1536&bih=759#imgrc=AAMOeXDn9nOJ7M:

Ligament sprains - MCL, LCL, PCL, ACL Structures affected: MCL – medial joint line; LCL – lateral joint line

(attaching on the head of fibula); PCL – medial femoral condyle to the posterior

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edge of the tibia; ACL – notch of the distal femur and lateral femoral condyle to the tibial plateau.

Signs and Symptoms: swelling (amount varies according to severity and ligament); dislocation; localised pain on palpation for MCL and LCL; pain on weight bearing particularly when bending the knee.

Biomechanics of injury: MCL – often associated with twisting with the foot planted or impact from the lateral side of the knee forcing the knee into an increased valgus angle; LCL – impact to the medial side of the knee forcing the knee into an increased varus angle; PCL – not often injured, possible with impact to the front of the tibia when the knee is flexed; ACL – again associated with twisting to change direction, or a backwards fall.

Fig. 15.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Ligament+sprains+-+MCL%2C+LCL%2C+PCL%2C+ACL&oq=Ligament+sprains+-+MCL%2C+LCL%2C+PCL%2C+ACL&gs_l=psy-ab.3...669305.669305.0.670035.1.1.0.0.0.0.61.61.1.1.0....0...1.1.64.psy-ab..0.0.0....0.Rnbzn7PgoHI#imgrc=1qYy3a8zR1ANGM:

Achilles Tendonitis Structures affected: Achilles tendon usually 2-3cm above insertion. Signs and Symptoms: localised tenderness; stiffness; sometimes a ‘creaking’

sensation. Biomechanics of injury: overuse; possible lack of flexibility to

gastrocnemus and soleus; poor footwear and lack of shock absorption to heel; musculoskeletal Imbalances.

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Fig. 16. https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Achilles+Tendonitis+&oq=Achilles+Tendonitis+&gs_l=psy-ab.3..0l10.157376.158787.0.159036.3.2.1.0.0.0.64.120.2.2.0....0...1.1.64.psy-ab..0.3.124....0.gOtszOZOJT4#imgrc=XeW6-Gyq3udUUM:

Ankle (Inversion and Eversion) Sprains Structures affected: ATFL – just anterior to the lateral malleolus; CFL –

directly inferior to the lateral malleolus; deltoid – inferior aspect of the medial malleolus; sprains are categorised into 1st, 2nd and 3rd degree dependent upon the severity of the tear and the percentage of fibres that have torn.

Signs and Symptoms for all ligaments: localised pain on palpation; pain on weight bearing; inflammation and dislocation; poor stability; feeling very weak.

Biomechanics of injury: all movements are forced and usually occur from impact or rolling over on the ankle; ATFL – excessive inversion and plantar-flexion of the ankle; CFL – excessive inversion of the ankle; deltoid – excessive eversion of the ankle.

Fig. 17.

https://www.google.it/search?biw=1536&bih=710&tbm=isch&sa=1&q=Ankle+%28Inversion+and+Eversion%29+Sprains+&oq=Ankle+%28Inversion+and+Eversion%29+Sprains+&gs_l=psy-ab.3...53831.53831.0.55556.1.1.0.0.0.0.57.57.1.1.0....0...1.1.64.psy-ab..0.0.0....0.aZHP8se2x84#imgrc=5s-KIOO3JLqq4M:

Shin splints (Periostitis) Structures affected: anteromedial aspect of tibia; lower half of the tibia. Signs and Symptoms: pain and inflammation on the lower half of the leg;

pain worse at beginning of activity and easing with time throughout training;

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pain returns shortly after activity; some palpable lumps at the medial portion of the tibia.

Biomechanics of injury: overuse injury; poor biomechanics when running (foot or knee); poor footwear; change in surface or training intensity; muscle imbalances.

Fig. 18.

https://www.google.it/search?q=shin+splints&source=lnms&tbm=isch&sa=X&ved=0ahUKEwilz7eT_InXAhXLXBQKHesjBF4Q_AUICigB&biw=1536&bih=710#imgrc=yRcEkGoUz3pp6M:

Plantar Fasciitis Structures affected: plantar Fascia, sole of the foot, particularly felt around the

heel of the foot.

Signs and Symptoms: heel pain often on the medial aspect (origin of fascia). Pain worse in the morning and often easing with movement, as the fascia warms up. If no treatment, pain can worsen with increased activity, as the fascia will tighten. Pain on the outside of the foot due to overcompensation.

Biomechanics of injury: overuse injury, the plantar band is placed under constant stress, normally from running. Normal pronators who are supinating. People who excessively pronate will suffer greater strain on the fascia. Tight calf muscles can cause plantar fasciitis, by increasing pronation of the foot. Poor footwear (limited medial arch support)

Fig. 19.

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

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References

Adirim, T. A., & Cheng, T. L. (2003). Overview of injuries in the young athlete. Sports Medicine, 33(1), 75-81.

Majewski, M., Susanne, H., & Klaus, S. (2006). Epidemiology of athletic knee injuries: A 10-year study. The knee, 13(3), 184-188.

Palmer-Green, D. (2015). Epidemiology of Sports Injuries. ABC of Sports and Exercise Medicine, 1.

Gluck, G. S., Bendo, J. A., & Spivak, J. M. (2008). The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. The Spine Journal, 8(5), 778-788.

Kruse, D., & Lemmen, B. (2009). Spine injuries in the sport of gymnastics. Current sports medicine reports, 8(1), 20-28.

Banerjee, R., Palumbo, M. A., & Fadale, P. D. (2004). Catastrophic cervical spine injuries in the collision sport athlete, Part 1. The American journal of sports medicine, 32(4), 1077-1087.

d'Hemecourt, P. A., Gerbino, P. G., & Micheli, L. J. (2000). Back injuries in the young athlete. Clinics in sports medicine, 19(4), 663-679.

Willson, J. D., Dougherty, C. P., Ireland, M. L., & Davis, I. M. (2005). Core stability and its relationship to lower extremity function and injury. Journal of the American Academy of Orthopaedic Surgeons, 13(5), 316-325.

Putty, B. B. (2010). Upper limb injuries in sports. British Journal of Sports Medicine, 44(Suppl 1), i3-i3.

Olsen, O. E., Myklebust, G., Engebretsen, L., Holme, I., & Bahr, R. (2005). Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. Bmj, 330(7489), 449.

Purcell, L. (2009). Causes and prevention of low back pain in young athletes. Paediatrics & child health, 14(8), 533.

6. How sport injuries can be prevented There are many risk factors contributing to the large number of sports

injuries. These may be intrinsic and extrinsic. Risk factors must be identified as far as possible, the injury mechanism and its severity. An injury pattern related to a certain activity may then result in the development of an injury prevention programme. (Peterson, Renstrom, 2016).

Meeuwise et al (2007) developed a model that involves both, intrinsic and extrinsic risk factors that may affect the athlete (Figure 6.1).

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Fig.20 . Risk for injury

General risk factors for injuries can include improper training, exercise without warming up, repeated monotonous training, incomplete rehabilitation and returning to sport too soon after injury, improper sporting techniques. The factors and mechanisms causing the injury must be identified. The “sequence of prevention” can be seen in Figure 6.2.

Fig. 21. An overview how prevention can be managed

Coaches, trainers and teachers of physical education are recommended to

integrate the exercises of postural gymnastic in their fitness programme, adapting it as much as possible to the needs of the athlete.

In order to prepare an efficient training programme it is important to combine the various techniques, merging the traditional postural gymnastic methods with the most modern scientific results, in order to identify the best protocol, personalized and centred on the needs and characteristic of the single athlete.

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In short, the following steps are recommended:

1. Observation of the athlete in order to evaluate the existing problem and to study the possible causes, the effects and incorrect postures of each subject.

2. Scheduling a suitable and personalized training protocol for the athlete, using targeted and multiple-effect fitness exercises. This method is effective for achieving all the objectives set.

3. Use of easily accessible equipment (small balls, thera-bands, sticks, balance cushions, etc.) to facilitate the work of the coach so that the prevention exercise is done more easily and more often during the workout.

4. Theoretical-practical teaching in order to obtain the maximum effectiveness of the technique, to facilitate conscious learning, self-execution and self-correction.

5. Modifications to the protocol applied and to the fitness exercises chosen, to make the preventive intervention appropriate to the single athlete and his/her morphology.

6. Testing and Assessment in order to verify the results obtained. Check for eventual pain or postural imbalances.

7. Recommendations The key factors in injury prevention are: I. Proper warm-up. The general warm-up should consist of light physical

activity, the aim is to elevate heart rate and respiratory rate. The warm up programs should consist of three parts, beginning with running exercises (Part 1), followed by exercise to develop strength, balance, muscle, core stability (Part 2) and exercises specific for certain sports (Part 3).

The programme of warm-up exercises used to prevent injuries: 1 part: Warm-up exercises (30 seconds and one repetition each) Jogging end to end Backward running with sidesteps Forward running with knee lifts and heel kicks Sideways running with crossovers (“carioca”) Sideways running with arms lifted (“parade”) Forward running with trunk rotations Forward running with intermittent stops Speed run 2 part: Technique (one exercise during each training session; 4 minutes and 5x30 seconds each) Planting and cutting movements

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Jump shot landings Balance (One balance mat or wobble board, one exercise during each training session; 4 minutes 2x 90 seconds each) Passing the ball (two leg stance) Squats (one or two leg stance) Bouncing the ball with eyes closed Pushing each other off balance Strength and power (2 minutes and 3x10 repetitions each) One quadriceps exercise” Squats to 80º of knee flexion Bounding strides (Sprunglauf) Forward jumps Jump shot-two legged landing “Nordic hamstring lowers” (2 minutes and 3x10 repetitions each (Olsen et al., 2005).

II. Appropriate sports gear and clothes. It is important to verify that athletes wear the correct clothes and footwear gets the correct gear (helmet, gloves, protective pads, etc.).

III. Keeping the safety rules and following them. Everyone must respect the rules. Coaches, trainers and teachers of physical education have a duty to raise awareness of the importance of complying with rules.

IV. Avoid playing through pain. If the athlete complains of a pain, it is advisable to suspend the workout.

V. Practicing: a) Strengthening exercises b) Stretching exercises. c) Core stability exercises. d) Endurance training. e) Modified exercises if problem persist.

VI. Teach proper technique. This is particularly important for young athletes who are still learning and need their habits enforced during activity.

VII. To encourage sportsmen to drink enough fluids. Trainers should increase the awareness on the importance of hydration before, during and after playing sports.

VIII. Avoid overtraining. Trainers are invited to pay attention to the overtraining of a single athlete. Fatigue takes away protective mechanisms and increases risk for all injuries.

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Practical example of the warm-up used in the prevention of injury in the Postulab® concept:

1) Static movement (on the spot) Activate Joints -Wrist, Elbows, Shoulders, Hips (pelvic), Knees and Ankles. 2) Dynamic Movement (Plan) Walking adding different movements: • rolling the feet as you walk • small lifts of the knees as you walk • rolling the shoulders as you walk • slow running

Running with different ways of lifting the legs: • kick forward with knees bent (repeat to the back) • straight legs forward then behind • lateral running crossing the feet • sideward gallop • skip

3) Static & Dynamic Lengthening exercises for arms legs and trunk, on the spot. Elevation and stretching exercises (sitting and standing) • Torso rotations (swinging) • Flexing and extension of the truck • Tilting (bending sideways) • Leg and arm elevation • Stretching arms legs and torso

4) Specific exercises for each sport.

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The objectives recommended are:

1. Muscle elasticity and joint mobility/stretching exercises. Through muscle extension techniques and joint mobilizations, to prevent and eliminate muscular contractions and retention and to preserve joint and connective tissue integrity.

2. Strength and resistance. Through specific muscular reinforcement exercises and cardio-respiratory training, so as to "counteract" physiologically the force of gravity.

3. Breathing. It is very important to keep to inhalation and exhalation phases in sports.

4. Proprioception and motor skills. Through technical requisition, appropriation techniques of body control, through neuromuscular re-education and acquisition of increasingly complex systems of movement.

5. Concentration and self-restraint. Conscious use of the neuro-associative conditioning of visualization and self-perception of one's body in space.

6. Balance. The ability to stay upright or stay in control of body movement, and coordination and to move two or more body parts under control smoothly and efficiently.

7. Stabilization. To reach good quality of movement, to engage deep muscles, to improve posture and prevent body injuries.

8. Plyometrics. Activities that enable a muscle to reach maximal force in the shortest amount of time. This training focuses on learning to move from a muscle extension to a contraction in a rapid or "explosive" manner, such as in specialized repeated jumping.

References

Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC medicine, 10(1), 75.

Olsen, O. E., Myklebust, G., Engebretsen, L., Holme, I., & Bahr, R. (2005). Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. Bmj, 330(7489), 449.)

Bahr, R., & Engebretsen, L. (Eds.). (2009). Sports injury prevention. Wiley-Blackwell.

Meeuwisse, W. H., Tyreman, H., Hagel, B., & Emery, C. (2007). A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clinical Journal of Sport Medicine, 17(3), 215-219.

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Peterson, L., & Renstrom, P. A. (2016). Sports Injuries: Prevention, Treatment and Rehabilitation. CRC Press.

Casais L., Martinez M. (2012). Intervention strategies in the prevention of sports injuries from physical activity. In K. R. Zaslav (Hrsg.), An international perspective on topics in sports medicine and sports injury (pp. 355-378). Rijeka: InTech. DOI: 10.5772/25804

S. Wood, M. A. Bellis (2010). Sports injuries. A review of evidence for prevention from the UK focal point for violence and injury prevention. (http://www.cph.org.uk/wp-content/uploads/2012/08/sports-injuries-a-review-of-evidence-for-prevention.pdf)

8. Bibliography

1. The role of core training in athletic performance, injury, prevention and injury treatment. John M.Cissik, in SCJ (Strength &Conditioning USA) vol. 33 number 1.February 2011. 2. Scienza e pratica dell'allenamento della forza, Calzetti e Mariucci Editore,2008 3. Ginnastica posturale, ginnastica di massima efficacia per l'uomo di oggi. Article of Giovanni Chetta www. http://besport.org/sportmedicina/ 4. Lo sport fa bene quando è fatto bene, piccola guida alla prevenzione degli infortuni sportivi, linea guida n.6, Febbraio 2011 a cura di: Dott. Attilio Bernini 5. La prevenzione delle lesioni del crociato anteriore nelle atlete- Roberto Benis SCJ (Strenght &Conditioning ITA) number 19 Genuary-February 2017 6. Swimming – hypermobility of shoulders and elbow (Hubley–Kozey, Stanish, 1990)

7. Javelin, baseball – hypermobility of shoulders (Zarins et al.,1983; Northrip, Logan, McKinney) 8. Effect of Foam Rolling and Static Stretching on Passive Hip-Flexion Range of Motion (Journal of Sport Rehabilitation, 2014, 23, 296-299) 9. The effect of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review(Int J Sports Phys Ther. 2015 Nov; 10(6): 827–838.)

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CONTACTS

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IRENA CIKOTIENE LSU (LT)

PAULO JORGE ARAUJO MIRANDELA (PT)

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