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FM JWBK446-Comfort March 15, 2010 22:11 Printer Name: Yet to Come

Sports Rehabilitation and Injury Prevention

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Sports Rehabilitation and Injury Prevention

Edited by

Paul Comfort

School of Health, Sport & Rehabilitation Sciences, University of Salford, Salford, UK

Earle Abrahamson

London Sport Institute at Middlesex University, UK

A John Wiley & Sons, Ltd., Publication

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This edition first published 2010, C 2010 John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Sports rehabilitation and injury prevention / edited by Paul Comfort, Earle Abrahamson.

p ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-98562-5 (cloth)

1 Sports injuries I Comfort, Paul II Abrahamson, Earle.

[DNLM: 1 Athletic Injuries – prevention & control 2 Athletic Injuries – rehabilitation QT 261 S7676 2010]

RD97.S785 2010

617.1027 – dc22

2010005619 ISBN: 9780470985625 (HB)

9780470985632 (PB)

A catalogue record for this book is available from the British Library.

Set in 10/11.5pt Times by Aptara Inc., New Delhi, India.

Printed in Great Britain by Antony Rowe Ltd, Chippenham, Wiltshire.

1 2010

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Jeffrey A Russell

Phil Barter

Paul Comfort and Martyn Matthews

Dr Lee Herrington and Paul Comfort

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Jeffrey A Russell

Julian Hatcher

Earle Abrahamson, Victoria Hyland, Sebastian Hicks, and Christo Koukoullis

Helen Matthews and Martyn Matthews

Rhonda Cohen, Dr Sanna M Nordin and Earle Abrahamson

Earle Abrahamson and Dr Lee Herrington

John Allen and Stuart Butler

Nicholas Clark and Dr Lee Herrington

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Preface

The concept for this book is based on the expanding

field of sports rehabilitation and injury prevention

Evidence of this expansion includes an increasing

amount of research and publications related to sports

rehabilitation and allied fields of practice such as

sports therapy, athletic training and sports

physio-therapy

Despite the number and volume of publications

in sports rehabilitation, there appears to be limited

resources that accurately and effectively account for

evidence-based practices Whilst some resources

ex-pand evidence-based practice knowledge, there is

a need to develop a complete resource that fully

explains and articulates these important principles

This current text has used an evidence-based practice

approach to fully acknowledge the many diverse

ar-eas, applications and management strategies that are

often unique to sports rehabilitation, but distinctly

different from similar fields of practice and study

Few sports rehabilitation programmes currently

provide students with the breadth of information and

practical application required for professional

prac-tice This text has attempted to bridge the knowledge

and practice gap, by considering the functional

de-velopment of the sports rehabilitator’s knowledge

and practice requirements for professional

compe-tency The text provides an up-to-date look at

dif-ferent evidence-based practice protocols and initial

assessment strategies for the screening of injury and

pathological conditions

The first few chapters introduce the scope of

prac-tice for sports rehabilitation, and then describe,

ex-plain and evaluate the initial assessment and

screen-ing procedures necessary for decision makscreen-ing and

clinical practice These chapters further provide

analysis on musculoskeletal function and

dysfunc-tion in reladysfunc-tion to systemic organisadysfunc-tion The next

set of chapters combine a useful integration of plied areas and practices of study relevant to sportsrehabilitation practice These include, amongst oth-ers, nutritional analysis, psychological considera-tions in injury management and prevention, clinicalreasoning development, and strength and condition-ing principles The book concludes with a range ofchapters devoted to different injury conditions andbody regions These chapters detail the more com-mon injuries and pathologies and argue for best man-agement strategies based on research and appliedevidence

Each chapter also contains several practical plication boxes that provide additional informationsummarising unique chapter-specific information.The majority of chapters contain applied examplesand case studies to illustrate the processes and deci-sions necessary for clinical action and management.Each case study has been carefully developed to fa-cilitate group discussion in the classroom, or for theclinician to consider as part of continued profes-sional development

ap-In addition to serving as an upper level uate or graduate textbook for students or clinicians

undergrad-in practice, the book is an excellent resource guide,filled with useful information and evidence-basedpractice considerations and applications You willwant to have this textbook on your desk or book-shelf The features of consistent organisation, casestudies, discussion questions, up-to-date references,research evidence and practical application boxes aredesigned to provide information required for effec-tive study as well as directing clinical practice.The design of this text can be compared to build-ing a house, in that each component of both the textand house building can be modelled on individualbuilding blocks In the case of the house building

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x PREFACE

these units are represented by the bricks, whereas

in the text, the individual chapters are synonymous

with these units Before one commences the building

process, there is a carefully constructed visual or

di-agrammatic plan to navigate the process; so too does

this planning apply to the design and shaping of this

text In the building process, consideration is given to

the foundation, in terms of its shape, depth, form, and

length This text has a number of foundation

chap-ters that secure the content for future development

of the other chapters The main foundation

knowl-edge is the understanding of anatomical application,

and using this knowledge to guide assessment This

anatomical foundation knowledge informs the

deci-sions necessary for clinical action in terms of injury

management Whilst bricks are important in terms of

informing the structure of a building, it is the cement

that ensures that each brick is secured and articulates

with other bricks and structures In this text, the

ce-ment is represented by underpinning themes, such

as clinical reasoning skills and abilities, that traverse

the chapters and ensures that each chapter although

perceptively different, is able to articulate with other

chapters and develop this consortium of knowledge

After completion, houses take on a new shape and

design, one which may have transformed the

orig-inal landscape; however there is always room for

change, improvement or refinement This text, in itsfinal form, has orchestrated the journey of clinicalpractice from consideration of the scope of practice,through to the essential skills necessary for decisionmaking, and concluding with a consideration of how

to manage a range of injuries and pathologies Thetext is coated with an evidence-based approach to us-ing and applying knowledge The true advantage ofdeveloping the text within an evidence-based context

is that it allows the reader to consider the existingknowledge and evidence; challenge the research; andmove towards asking different types of questions toconsider new ways of dealing with client manage-ment issues As new research becomes available,clinical practice will be questioned The contents ofthis text will evolve and change to accommodate andexplore new ideas and advances in clinical research.This book provides the architecture necessary to con-sider the real issues current to clinical practices It isimportant to use it as a map for navigating the con-cepts, principles, challenges and decisions of clinicalpractice

We hope that this book is a valuable resource bothfor teaching and as a reference for sports rehabilita-tors and clinicians

Paul Comfort Earle Abrahamson

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Acknowledgements

Thank you to all of the authors involved with the

de-velopment of this text, including those who provided

advice and feedback on each of the many drafts

Without the expertise, dedication and effort of each

of these individuals, this text would not have been

possible

Thank you to my family, especially my children,

for putting up with my ‘absences’ and long hours

staring at the laptop, during the development of this

book Your support and understanding has been more

than I should have asked for

Paul Comfort

A special thanks to the many contributors who

worked so diligently, often under difficult and

pres-surised circumstances, to write this text and to those

who provided expert reviews Also to my many

students who taught me so much about how to ulate concepts, theories and applications in a learnerfriendly manner, which helped shape the landscape

artic-of this book

To my wonderful wife, Emma, and my adorableson, Benjamin, thanks for putting up with me andproviding much love, support and understanding

To my father, Charles, and my brother, Michael,thanks for always believing in me and encouraging

me to succeed and achieve in life

Last but not least, I would like to dedicate mycontribution to this book, to the memory of my latemother, Josephine, whose support, inspiration, kind-ness and generosity, will forever be cherished andrespected Thank you for believing in me and sup-porting my academic and professional development

Earle Abrahamson

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About the editors

Paul Comfort (BSc (Hons), MSc, PGCAP,

CSCS*D, ASCC) is a senior lecturer, programme

leader for the MSc Strength and Conditioning

pro-gramme at the University of Salford Paul is also

currently Head of Sports Science Support for

Sal-ford City Reds Rugby League Football Club and

co-ordinates the Strength and Conditioning for England

Lacrosse (men’s squad) He is a Certified Strength

and Conditioning Specialist (Recertified with

Dis-tinction) (CSCS*D) with the National Strength and

Conditioning Association and a founder member and

Accredited Strength and Conditioning Coach with

the United Kingdom Strength and Conditioning

As-sociation He is also currently completing a part-time

PhD

Earle Abrahamson (B Phys Ed, BA Hons, MA,

BPS, BASRaT, FRSM, BRCP, AHPCSA, HPCSA,

PsySSA) is a principal lecturer, teaching fellow and

programme leader for the Sports Rehabilitation and

Injury Prevention programme at Middlesex

Univer-sity Through his programme leadership and

teach-ing fellowship duties, Earle has developed an

inter-est in student learning and thinking Earle spent themajority of his life in South Africa, studying andworking, and moved to the UK in 2002 He is aSouth African-registered therapist and psychologistand has membership and professional registrationwith a number of UK authorities Earle has workedextensively as a sports rehabilitator with national andinternational teams, including the world strongestman event Earle sits on the executive committee

of the British Association of Sports Rehabilitatorsand Trainers (BASRaT), as their student liaison of-ficer In this role he deals with and promotes theBASRaT student experience Earle is the Middle-sex University representative for the higher educa-tion academy’s hospitality, leisure, sport and tourismsector He is currently working on a professional doc-torate investigating different learning approaches inthe development of clinical reasoning skills on un-dergraduate sports rehabilitation programmes.Earle is married to Emma and has a son, Benjamin

In his spare time he enjoys sport and is an activecricketer and tennis player He further enjoys readingand music

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Senior Lecturer and Programme Leader

for Sport Science

London Sport Institute at Middlesex University,

UK

Elezabeth Fowler

LecturerUniversity of Salford, Greater ManchesterUK

Lead Physiotherapist Great Britain WomensBasketball

Sebastian Hicks

Graduate Sports Rehabilitator

Ian Horsley

Lead PhysiotherapistEnglish Institute of SportUK

Victoria Hyland

LecturerLondon Sport Institute, Middlesex UniversityUK

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xvi LIST OF CONTRIBUTORS

Jeffrey A Russell

Assistant Professor of Dance ScienceUniversity of California, IrvineUSA

Dror Steiner

Chartered Osteopath

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Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn

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How to use this book

The text has been designed to allow the reader to

consider and understand important themes,

princi-ples and applications that inform clinical practice

Each chapter begins with an introductory paragraph

(see below) that identifies and outlines the aims and

outcomes for that chapter

The chapter aims and objectives will be emphasised at the beginning Use these to confirm your understanding of the chapter content

This chapter provides an overview, analysis, and application of clinical reasoning and problem solving skills

in the development of professional competencies within the health care profession generally and morespecifically sports rehabilitation The chapter is important as it will help you develop your thinking skills

as you progress your reading throughout the book By the end of this chapter the reader will be able tolocate and explain the role and efficacy of clinical reasoning skills within a professional practice domain.This will inform an appreciation for the complex nature of knowledge construction in relation to clinicalexplanation and judgement By considering clinical reasoning as a functional skill set, the reader will further

be in a position to explain different models of reasoning and ask structured questions in an attempt tobetter formulate and construct answers to clinical questions, issues, and decisions The chapter will furtherencourage the reader to use problem solving and clinical reasoning skills to justify substantially, throughresearch evidence, professional practice actions and outcomes

The first chapter provides an overview of the scope

of practice for the sports rehabilitator and/or allied

health care professional Within this chapter

care-ful consideration has been given to the position of

the sports rehabilitator within a sport and exercise

medicine team The chapter further deals with

is-sues around medical, ethical and legal concerns, and

uses a schema diagram to illustrate how the sportsrehabilitator works with other sport medicine prac-titioners to manage injury When reading this initialchapter, consider how your scope of practice andprofessional identity is formed Use the chapter tohelp you reinforce your code of practice and reflect

on the medical ethical and legal requirements foryour profession

The following chapters deal with issues around jury screening and performance assessment Thesechapters introduce and debate issues concerningassessment and screening, and present research ev-idence to validate claims It is useful when reading

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xviii HOW TO USE THIS BOOK

these chapters to consider how screening and

as-sessment work to accommodate a range of athletes

from different sports Clinicians who simply follow a

set programme or protocol for assessment may find

it difficult to defend clinical actions and decisions

should the athlete not improve following the

inter-vention delivered It is important to be able to relate

the content of the chapter and decide on how best to

screen or assess an athlete based on evidence from

research studies

Chapters 4–8 introduce and evaluate the physiology of musculoskeletal components These

patho-chapters are crucial when considering injury

man-agement as well as prevention strategies Each of

these chapters makes use of diagrammatic

represen-tations of the key musculoskeletal components (see

below) and highlights the healing and repair stages

of musculoskeletal injuries

The pathophysiological chapters make use of diagrams and illustrations to highlight key anatomical landmarks and pathological concerns that could impact healing and prolong recovery

Collagen (60% dw) including type I (III, IV, V, VI, XII, XIV)

Composition Midsubstance

Insertion

Proteoglycan (0.5% dw) including decorin, versican, lumican

Glycoproteins (5% dw) including tenascin, COMP, elastin

As above, but also includes:

collagen type II, IX, XI, aggrecan, biglycan

A

B T F

C M C

Reference to later chapters and consideration ofspecific treatment strategies supported by research

is evident When reading these pathophysiological

chapters it is useful to consider the primary anatomy

of the structure and its normal functional state

Con-sider how this functional state changes or

compen-sates movement as a result of trauma or pathology

Use this knowledge as a precursor to injury

man-agement and a way to shape clinical decisions and

actions

The next seven chapters encompass importantthemes necessary for effective clinical decisions and

management options Use these chapters to help

ap-preciate the sport sciences and how an understanding

of principles of strength and conditioning, ogy, nutrition, performance assessment and clinicalreasoning could be used to highlight areas of concernand move the practitioner to a more complete evalua-tion and treatment of the athlete The design of thesechapters, have been carefully considered to ensurethat you, as reader and clinician, can use importantconceptual applications in the management of theclient The themes explored within these chaptersare not unique to the chapter per se, but rather form

psychol-an importpsychol-ant thread throughout the text Exploringthe themes within these chapters will hopefully al-low the reader to conceptualise sports rehabilitationand injury prevention as a functional ongoing andworking operation that requires thought and researchevidence to fully appreciate the merit of treatmentand rehabilitation

The final section of the text is dedicated tojoint-specific injuries and pathologies These chap-ters introduce the injuries and specific assessmenttechniques by considering evidence-based practiceprotocols These chapters tie together the impor-tant consideration for injury prevention and manage-ment The chapters culminate in applied case stud-ies (see below) that are used to illustrate the thoughtprocess and clinical decision mapping necessary foreffective injury management It is important to con-sider how decisions are reached and what processesneed to be examined as opposed to simply reaching adecision

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rBecomes very low grade and almost unnoticeable with rest

rThere is irritable pain when coughing and sneezing

rFeels ‘sore’ in the groin when sitting upright for a while

rPain in the deep inner groin when squeezing the legs together,particularly in bed

Pain was described as exercise related and variable between 1and 7 on the 10 point scale

There were minimal impingement signs with hip flexion-ad

Each injury-specific chapter makes use

of an applied case study to frame the clinical issues and consider appropriate and evidence-based treatment and rehabilitation programmes Use these studies to check your own

understanding and decide on whether you agree with the clinical

management and/or decisions discussed within the study

There was no discomfort on stretch

Stork views of the pelvis, standing on one leg and then the other excluded pelvic instability, pubic symphysisand hip pathology

The patient was referred to a surgeon for opinion.

During surgery the following groin disruption was identified in the operative report:

rtorn external oblique aponeurosis

rthe conjoined tendon was torn from pubic tubercle

rdehiscence between conjoined tendon and inguinal ligamentEach element of this groin disruption was repaired surgically

Treatment and rehabilitation

Normal protocol for the first day post operation included stand and walking with gentle stretching andstability exercises

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xx HOW TO USE THIS BOOK

Five days post operative ultrasound ascertained core stability to be poor and Transversus Abdominisactivation (Cowan 2004) was achieved with practice, using patient visualisation of the ultrasound real-timeimage for re-education

Adductor exercises (Figures 20.4–5) were encouraged one week post op, several times per day

Closed chain exercises for stability (e.g., Figures 20.6–9) combined with slow controlled squats progressing

to single leg squats, were developed two weeks post op with hydrotherapy for flexibility and stability

Swimming, cycling and cross-trainer elliptical exercise developed in the third week

After four weeks he started straight line running build ups alternate days

rShould a longer period of conservative treatment and rehabilitation take place before referral for surgery

rShould the patient have been referred for other investigations, e.g ultrasound scan or MRI

rWhat other areas of the body may contribute towards this athletes injury

In summary, the contents of this book, are signed to evoke clinical decisions based on research

de-evidence The chapters are sequenced to allow the

reader to develop an appreciation for understanding

and analysing clinical practice and actions

Individu-ally the chapters provide a framework for alising different scientific applications and practices,but collectively they form a compendium of clin-ical knowledge, cemented by clinical practice andframed within an evidence-based context

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University of California–Irvine, USA

Introduction and aims

The popularity of physical activity in all of its forms

continues to steadily increase More than just the

do-main of elite or professional athletes, the populace

enjoys a variety of recreational pursuits from hiking

and running to skiing and surfing, from badminton

and tennis to cricket and hockey In such

endeav-ours many participants find that injury is inevitable

Unfortunate circumstances are not confined to those

engaging in rugby or “X games”, daredevil sports

like Parkour, kitesurfing or acrobatic bicycle

jump-ing, although clearly these carry a high cost in

physi-cal trauma (Young 2002; Spanjersberg and Schipper

2007; Miller and Demoiny 2008) Young footballers

and senior golfers alike are prone to injury, as are

Olympic performers and “weekend warriors”

be-cause injury does not discriminate (Delaney et al

2009; Falvey et al 2009) Likewise, non-traditional

athletes such as dancers (Fitt 1996; Stretanski 2002;

Koutedakis and Jamurtas 2004) will not escape

in-jury (Bowling 1989; Garrick and Lewis 2001;

Bron-ner, Ojofeitimi and Spriggs 2003; Laws 2005)

Whether they are pursuing gold medals or leisure,those who participate in physical activity require

both proper preventive training and proper

health-care; they will benefit greatly from experts who can

deliver these Sport rehabilitators and other allied

health professionals have much to offer physicallyactive people This chapter aims to:

rdefine the role of the sport rehabilitator as a

mem-ber of the sport injury care team;

rpromote individual and organisational alism within the field of sport rehabilitation;

profession-rprovide a framework for ethical conduct of sport

rehabilitators and related professionals;

rdescribe legal parameters that must be ered by those in sport rehabilitation and relatedfields

consid-The role of the sport rehabilitator

Preparing an individual to successfully participate

in sport requires, by its very nature, expertise frommultiple specialities Managing the injuries thatoccur to sport participants also requires input frommany specialists Thus, at any given point the athletemay be surrounded by a team of professionals,including the coach, club manager, conditioningspecialist, biomechanist, physiotherapist, nutrition-ist, exercise physiologist, chiropodist, chiropractor,

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4 INTRODUCTION TO SPORT INJURY MANAGEMENT

Table 1.1 The variety of sport medicine team members who work with athletes (see also Figure 1.1)

Medicals and surgeons Para-medicals Sport scientists Sport educatorsGP

Chiropodist

Sport dentist

Consultants:

Orthopaedic surgeonGeneral surgeonNeurosurgeonCardiologistRadiologistPhysiatristNeurologist

Sport rehabilitatorPhysiotherapistOsteopathChiropractorMassage therapistSport optometristAcupuncturistFirst responderAlternative therapy practitioner

BiomechanistExercisephysiologistSport psychologistNutritionistKinesiologist

CoachConditioning specialistPhysical educatorClub manager

osteopath, sport optometrist, sport psychologist,

sport dentist, GP, consultant and, indeed, sport

rehabilitator (Table 1.1 and Figure 1.1) Depending

on the sport, an athlete’s level in the sport and

the venue, all of the listed professionals may not

be involved in care Further, some professionals

may be qualified to administer more than one care

speciality However, regardless of the situation the

management of sport injury is a team activity, and

the sport rehabilitator plays a key role

The British Association of Sport Rehabilitatorsand Trainers (BASRaT) administer the credential

“Graduate Sport Rehabilitator,” which is abbreviated

ENTS

OR A C

R

SATHLETE

MEDICALS & SURGEONS P

A R A - M E D I C A L S

S P O R T S C I E N T I S T S SPORT EDUCATORS

Figure 1.1 Diagram showing the breadth of sport injury

management Note that in the situation of an athlete who

is a minor child, the parents or carers become part of the

management scenario

to “GSR.” According to this professional society,

“a Graduate Sport Rehabilitator is a graduate levelautonomous healthcare practitioner specialising inmusculoskeletal management, exercise based reha-bilitation and fitness” (British Association of SportRehabilitators and Trainers 2009b) Further, BAS-RaT outline the skill domains of a Graduate SportRehabilitator as being:

rprofessional responsibility and development

rprevention

rrecognition and evaluation of the individual

rmanagement of the individual–therapeutic vention, rehabilitation and performance enhance-ment

inter-rimmediate care

Whilst prevention of injury is certainly desirable,the reality that athletes will be injured is part of sportparticipation Thus, the sport rehabilitator must al-ways be prepared to administer the care for whichthey are trained The ideal place to begin providingthis care is pitchside or courtside where the circum-stances surrounding the injury have been observedand evaluation of the injury can be performed prior

to the onset of complicating factors such as musclespasm Any sport rehabilitator who expects to offerthis type of care must possess the proper qualificationand additional credentials to support it Minimum

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THE ROLE OF THE SPORT REHABILITATOR 5

Table 1.2 Components of the British Association of Sport Rehabilitators and Trainers (2009b) skill domains

Professional responsibility and development Record keeping

Professional practice – conduct and ethical issuesProfessional practice – performance issuesPrevention Risk assessment and management

Pre-participation screeningProphylactic interventionsHealth and safetyRisks associated with environmental factorsRecognition and evaluation of the individual Subjective evaluation

Neuromusculoskeletal evaluationPhysiological and biomechanical evaluationNutritional, pharmacological, and psychosocial factorsHealth and lifestyle evaluation

Clinical decision makingDissemination of assessment findingsManagement of the individual – therapeutic intervention,

rehabilitation and performance enhancement

Therapeutic interventionExercise based rehabilitationPerformance enhancementFactors affecting recovery and performanceMonitoring

Health promotion and lifestyle managementImmediate care Emergency first aid

EvaluationInitiation of care

abilities include cardiopulmonary resuscitation, first

aid, blood-borne pathogen safeguards, strapping and

bracing, and practical experience (in a proper clinical

education programme) with the variety of traumatic

injuries that accompany sport participation

Further-more, working with certain sports – such as cricket,

ice hockey and North American football – requires

specialised understanding of protective equipment

that includes how to administer care in emergency

situations when the injured athlete is encumbered by

such equipment

BASRaT’s (2009b) Role Delineation of the Sport Rehabilitator document details the implementation

of the skill domains listed above into a scope of

practice Table 1.2 outlines the components of each

domain; these are further subdivided into knowledge

components and skill components to create a

frame-work both for the education of sport rehabilitators

and the extent of their capabilities to serve as

health-care professionals

A brief introduction to a similar type of sporthealthcare provider in the United States of Amer-ica is useful here as a comparison Certified Ath-letic Trainers (denoted by the qualification “ATC”)are “health care professionals who collaborate withphysicians to optimize activity and participation

of patients and clients Athletic training passes the prevention, diagnosis, and intervention

encom-of emergency, acute, and chronic medical tions involving impairment, functional limitations,and disabilities” (National Athletic Trainers’ Asso-ciation 2009b) The National Athletic Trainers’ As-sociation, the professional body of Certified Ath-letic Trainers, has existed since 1950 Standards

condi-of practice are set and a certification tion is administered by the Board of Certification(2009) to ensure that the profession is properlyregulated Most individual states in the USA alsorequire possession of a licence in order to prac-tice as an athletic trainer Comparable to the role

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examina-6 INTRODUCTION TO SPORT INJURY MANAGEMENT

delineation skill domains for sport rehabilitators

listed above, the requisite skills of Certified

Ath-letic Trainers are categorised into 13 content areas

(National Athletic Trainers’ Association 2009a):

1 foundational behaviours of professional practice

2 risk management and injury prevention

3 pathology of injuries and illnesses

4 orthopaedic clinical examination and diagnosis

5 medical conditions and disabilities

6 acute care of injuries and illnesses

7 therapeutic modalities

8 conditioning and rehabilitative exercise

9 pharmacology

10 psychosocial intervention and referral

11 nutritional aspects of injuries and illnesses

12 health care administration

13 professional development and responsibility

These content areas define how Certified AthleticTrainers are educated and how they retain the ATC

credential via continuing professional development

hours (called continuing education in the USA, with

the participation increments called CEUs, or

contin-uing education units) As with Graduate Sport

Reha-bilitators, accountability to such standards is

imper-ative for sustaining the integrity of the profession

Continuing professional development

There is no place pitchside for healthcare

practi-tioners who cannot perform the required duties that

arise under the pressure of managing injury during

sporting competition Therefore, a fundamental

re-sponsibility of the sport rehabilitator – or any other

healthcare practitioner – is to secure a high

stan-dard in their education Certainly this encompasses

the undergraduate and postgraduate courses and the

motivation to embrace diligence and excellence in allrequired modules, work placements, internships andthe like The knowledge required and tasks allowedfor specific professional qualifications are usuallydictated by professional organisations As mentionedabove, BASRaT hold sport rehabilitators to a highstandard of education Once a qualification is at-tained, however, another educational process ensues:professionals must engage in continuing profes-sional development (CPD) The importance of thiscannot be overstated CPD helps the sport rehabili-tator not only maintain their skills, but acquire newones that broaden one’s ability to offer high qualityhealthcare to athletes, clients and patients More-over, knowledge in sport science and sport medicine

is constantly evolving as further basic and applied search is undertaken Adequate CPD helps the sportrehabilitator stay abreast of these developments.CPD courses afford exciting opportunities for per-sonal enrichment Many topics are germane to thefield and a veritable subculture exists to provide ad-equate chances for professionals to enlist in train-ing courses that match every ability, need and de-sire Most professional societies, including BASRaT,advise their members about suitable courses andthe required quantity of CPD hours Advanced lifesupport, manual therapy, pitchside emergency care,strength training, exercise testing, specialised jointexaminations, rehabilitative exercise and manage-ment of non-orthopaedic injuries and conditions areonly a few topics representative of the wide gamut

re-of re-offerings

A qualification in basic cardiopulmonary citation for healthcare providers (i.e BLS/AED –Basic Life Support/Automated External Defibrilla-tion) is considered a minimal credential that should

resus-be kept up to date by periodic skills retraining TheResuscitation Council (UK) and the European Re-suscitation Council publish the appropriate standardsfor BLS and AED training (European ResuscitationCouncil 2009; Resuscitation Council (UK) 2009);the latter also maintains a calendar of many life sup-port courses offered around Europe, including theUnited Kingdom

Knowledge, ability and wisdom

It is important for professional healthcare providers

to distinguish amongst knowledge, ability andwisdom These are distinct, yet interrelated,

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P1: OTA/XYZ P2: ABC

characteristics that all sport rehabilitators must strive

for as they provide care to the public Knowledge is

the learning and understanding of facts that form

the basis for practice It provides the information

on which a successful career is built Ability is the

application of knowledge Thus, knowledge really

is not useful until a person accomplishes a task by

applying it

Wisdom, though, is like the glue that holds a fessional career together It is the most difficult –

pro-but also the most significant – of the three to garner

because it is gained over time as one matures and is

exposed to an ever-widening variety of experiences

Wisdom considers both the available knowledge and

ability, mixing them in the right proportion to elicit

the best result within a given set of present

circum-stances Whilst this may seem somewhat esoteric,

the three characteristics are fundamental to success

and all healthcare professionals draw on each of them

everyday

Ethical considerations

Ethics refers to a set of concepts, principles and laws

that inform people’s moral obligation to behave with

decency Part of this is the necessity to protect

peo-ple who are in a relatively vulnerable position, such

as a patient or client in a healthcare setting Similar

to other professionals, each sport rehabilitator must

consider themselves a healthcare practitioner and,

therefore, under an ethical obligation for inscrutable

professional conduct Sport medicine presents

chal-lenging parameters within which to apply an ethical

framework (Dunn et al 2007; Salkeld 2008), due

largely to the high public visibility of sport itself

This is perhaps an even more significant reason for

the sport rehabilitator to ardently ensure that their

practice falls under appropriate accountability

Unfortunately ethical dilemmas do not alwayslend themselves to clear, objective dispensation;

thus, governing bodies codify guiding principles for

conduct The Code of Ethics of the British

Associ-ation of Sport Rehabilitators and Trainers, shown in

Table 1.3, is an example of guidelines that promote

proper behaviour

In healthcare the field of ethics sets appropriateand acceptable standards to protect the public from

damages incurred at the hands of unscrupulous or

incompetent practitioners and the deleterious effects

of unwarranted or dangerous diagnostic or

therapeu-tic interventions Respect for the dignity of humans

is placed foremost and healthcare practice must commodate to this high standard There are a number

ac-of circumstances that occur in sport that can strainthe typical application of ethics; areas where diffi-culties arise include:

rdecisions about return to sport activity with a

per-sisting injury

rpharmaceutical therapies to assist participation

rparticipation of children, especially in high-risk

sport

rsharing of confidential athlete medical tion amongst practitioners, or between practition-ers and public representatives, such as the press

informa-rergogenic aids, such as anabolic steroids and blood

“doping.”

Of these, treating an athlete’s medical tion with confidentiality is likely to be the most dif-ficult and frequently compromised, particularly inthe pitchside environment (Salkeld 2008) Salkeldsuggests that several competing challenges and pres-sures collide pitchside to create ethical dilemmas: theclose proximity of an injured player to other play-ers and coaches when being examined, the publicvisibility of an injury, the interests of the sportingclub and the desire of the coaching staff to receiveinformation about the injury coupled with the con-comitant desire of the player to shield this infor-mation from the coaches Additional areas of con-temporary ethical challenges for practitioners caringfor athletes include informed consent for care, drugprescription and use of innovative or emerging tech-

informa-nologies (Dunn et al 2007).

The most appropriate way for the sport tator to manage potentially difficult ethical predica-ments is to practise diligently under an approvedethical code, such as that of the British Associa-tion for Sport Rehabilitators and Trainers, and to de-cide how individual ethical quandaries will be han-

rehabili-dled prior to being confronted by them The

conse-quences of infractions are severe and have resulted

in revoked professional licences, registrations andcertifications, and have ended careers in particularlyegregious cases

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Table 1.3 The Code of Ethics of the British Association of Sport Rehabilitators and Trainers (2009a)

PRINCIPLE 1: Members shall accept responsibility for their scope of practice

1.1 Members shall not misrepresent in any manner, either directly or indirectly, their skills, training, professionalcredentials, identity or services

1.2 Members shall provide only those services of assessment, analysis and management for which they are qualifiedand by pertinent legal regulatory process

1.3 Members have a professional responsibility to maintain and manage accurate medical records

1.4 Members should communicate effectively with other healthcare professionals and relevant outside agencies inorder to provide an effective and efficient service to the client

Supporting Legislation: Data Protection Act 1998; Human Rights Act 1998

PRINCIPLE 2: Members shall comply with the laws and regulations governing the practice of musculoskeletal management in sport and related occupational settings

2.1 Members shall comply with all relevant legislation

2.2 Members shall be familiar with and adhere to all British Association of Sport Rehabilitators and Trainers’Guidelines and Code of Ethics

2.3 Members are required to report illegal or unethical practice detrimental to musculoskeletal management in sportand related occupational settings

PRINCIPLE 3: Members shall respect the rights, welfare and dignity of all individuals

3.1 Members shall neither practice nor condone discrimination on the basis of race, creed, national origin, sex, age,handicap, disease entity, social status, financial status or religious affiliation Members shall comply at all timeswith relevant anti-discriminatory legislation

3.2 Members shall be committed to providing competent care consistent with both the requirements and limitations oftheir profession

3.3 Members shall preserve the confidentiality of privileged information and shall not release such information to athird party not involved in the client’s care unless the person consents to such release or release is permitted orrequired by law

PRINCIPLE 4: Members shall maintain and promote high standards in the provision of services

4.1 Members shall recognise the need for continuing education and participation in various types of educationalactivities that enhance their skills and knowledge

4.2 Members shall educate those whom they supervise in the practice of musculoskeletal management in sport andrelated occupational settings with regard to the code of ethics and encourage their adherence to it

4.3 Whenever possible, members are encouraged to participate and support others in the conduct and communication

of research and educational activities, that may contribute to improved client care, client or student education andthe growth of evidence-based practice in musculoskeletal management in sport and related occupational settings4.4 When members are researchers or educators, they are responsible for maintaining and promoting ethical conduct

in research and education

PRINCIPLE 5: Members shall not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession

5.1 The private conduct of the member is a personal matter to the same degree as is any other person’s, except whensuch conduct compromises the fulfillment of professional responsibilities

5.2 Members shall not place financial gain above the welfare of the client being treated and shall not participate inany arrangement that exploits the client

5.3 Members may seek remuneration for their services that is commensurate with their services and in compliancewith applicable law

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P1: OTA/XYZ P2: ABC

Legal considerations

An additional concern when providing care to

ath-letes is the increasingly litigious aura that pervades

much of Western society Sport rehabilitators and

other practitioners of sport injury care are subject

to lawsuits brought by athletes and their

representa-tives (e.g parents, carers) As previously mentioned,

consistently following an appropriate code of ethics

and continually educating yourself via CPD are two

ways to ameliorate the risk It is also crucial that

sport injury professionals maintain malpractice and

liability insurance cover, a caveat for which BASRaT

ensures compliance of its member Graduate Sport

Rehabilitators

The discussion of legal liability first needs a tive citing the proper way of acting that is acknowl-

direc-edged by courts when deriving judgments “The man

on the Clapham omnibus” is a common phrase in

English law that denotes a person who acts truly

and fairly (Glynn and Murphy 1996) with all

facul-ties that would be expected under the circumstances

(An American equivalent is “a reasonable and

pru-dent person.”) A structure of accountability is

funda-mental to application of this concept Within a given

context it may be modified appropriately; healthcare

is only one realm to which it pertains (Glynn and

Murphy 1996) Whilst being afraid of the

poten-tial for litigation in a sport healthcare environment

would unnecessarily constrain a well-qualified

pro-fessional, undeniably sport rehabilitators and other

healthcare practitioners must be cognisant of the

in-herent risk of being sued for wrong actions (acts

of commission) or for inaction when action is

war-ranted (acts of omission) Instead of being

intimi-dated, one should take all necessary steps to reduce

the likelihood of a lawsuit as much as possible

The tenet of a “public right to expertise” was posed for the sport and physical education fields

pro-more than 25 years ago (Baker 1980, 1981) The

general concept states that members of the public

have the right to expect that those who offer

them-selves as professionals in a given field of

endeav-our are qualified as experts in that field In the

con-text of sport rehabilitation, affording the public this

right is paramount because of the potential for

se-vere consequences when healthcare providers are

inadequately skilled or make errors in practice or

judgement (Goodman 2001)

Countless legal cases transcend recent decades(Appenzeller 2005) as plaintiffs (people filing a law-suit) persist in claiming negligence by defendants(people being sued) such as healthcare providers,coaches and institutions Generally a negligenceclaim must show the following (Champion 2005):

rthere is a verifiable standard of care to which the

defendant should be held

rthe defendant had a duty to care for the plaintiff

rthe defendant breached their duty

rthe plaintiff sustained damages or injury

rthe damages or injury were caused by the dant’s breach of the duty

defen-Risk of exposure to legal liability related to care in sport usually occurs in four main areas, thefirst three of which are related to one another (Kaneand White 2009):

health-1 Pre-participation physical examination – Ascreening process to evaluate the athlete’s phys-ical and mental status prior to engaging in sportshould be a fundamental requirement before suchengagement occurs

2 Determination of an athlete’s ability toparticipate – Whether confronted with signs andsymptoms pitchside, courtside, in a first aid facil-ity, in a polyclinic, or elsewhere, proper decisionmaking about an athlete’s fitness to participatemust be made in accordance with current health-care practice

3 Evaluation and care of significant injuries on thepitch or court – Healthcare professionals not onlymust be well-qualified, they must deliver care that

is appropriate for a given situation Concussions,spinal cord injuries and hyperthermia are threeexamples of injuries requiring urgent, specialiseddiagnostic and treatment procedures A sponsor-ing club, university, school or organisation mustensure that a plan is in place to adequately respond

to emergency situations that may arise in sport

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Table 1.4 Some examples of negligence that can lead to injury litigation in sport

Area of potential

negligence Examples

Facility safety Poor condition of the surface of the pitch, court, track, etc (e.g holes, uneven surfaces)

Unsafe equipment (e.g exposed sharp edges, broken or rusted parts)Unsafe practices (e.g reduced visibility if lights are not used when training held at night)Impeding objects that are not part of the sport activity

Failure to intervene when players do not use safe techniquesMismatched players (e.g adult players participating together with young players)Protective equipment Failure to provide proper protective equipment

Failure to require use of protective equipmentImproper fit of protective equipment

Documentation of injury Failure to maintain injury records

Failure to maintain treatment and rehabilitation recordsFailure to maintain confidentiality of records

Falsifying or altering medical recordsAppropriate care Failure to follow proper care protocols

Failure to refer injured player to healthcare professional of greater experience or higherqualification

Failure to remove injured player from participation

4 Disclosure of personal medical record

informa-tion – Confidentiality is a fundamental right andexpectation of all patients and clients, includingathletes The sport rehabilitator must take care

to not convey – even unwittingly – informationabout an athlete’s case to others without the ath-lete’s permission

Additional concerns for the sport rehabilitatorthat relate to potential injury circumstances in these

general categories are accumulated in Table 1.4

(Anderson 2002; Champion 2005; Kane and White

2009)

Following a review of pertinent legal cases, man (2001) corroborated that those who supervise

Good-teams could be liable if they or their sport healthcare

providers failed to perform properly in any of these

specific areas:

rProvide appropriate training instruction

rMaintain or purchase safe equipment

rHire or supervise competent and responsible

per-sonnel

rGive adequate warning to participants concerning

dangers inherent in a sport

rProvide prompt and proper medical care

rPrevent the injured athlete from further

compe-tition that could aggravate an injury (Goodman

2001, p.449)

Finally, Konin and Frederick (2005, p.38) fied six common mistakes sport healthcare providersmake in caring for athletes; these are shown belowand provide key areas for attention by sport rehabil-itators:

identi-1 Not establishing baseline (i.e “normal” jured) data with respect to a patient/athlete

unin-2 Accidentally verbally breaching a patient’s vacy

pri-3 Not knowing rules and regulations related to fidentiality of patient information and medicalrecords

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con-C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an

P1: OTA/XYZ P2: ABC

4 Making decisions based on experience and

in-stincts rather than seeking appropriate tive advice

authorita-5 Not educating a patient/athlete about a therapeutic

modality intervention

6 Underestimating the amount of documentation

re-quired with catastrophic injury events

In short, sadly there are virtually no limits to whatone can be sued for with respect to managing sport

injury This should be so sobering that the prudent

sport rehabilitator will prepare accordingly to reduce

as much as possible the likelihood of this occurring

Conclusion

The sport rehabilitator is a key member of the sport

injury management team As such, you must adhere

to several important professional, practical, ethical

and legal principles Properly equipping yourself to

administer acute injury management in the venues

where practice will be undertaken – whether

pitch-side, courtpitch-side, trackpitch-side, in a clinic or elsewhere –

is vitally important However, simply being prepared

to deliver care required by sport participants does not

sufficiently qualify a sport rehabilitator, or any other

sport health professional for that matter Proper

eth-ical and legal frameworks are integral to success, as

well Without these underpinnings the most skillful

healthcare worker will not be able to sustain their

practice under the guidelines deemed appropriate by

civilised societies

In summary, this entire textbook is devoted to suring the reader’s success in sport rehabilitation or

en-a relen-ated field It is en-a welcome instructionen-al resource

to the student, but it is a valuable informational

ref-erence to the clinician, too There is a wealth of

material presented where the authors offer insights

from their knowledge, abilities and wisdom in order

to equip the reader for excellence in their career post

References

Anderson, M.K (2002) Fundamentals of Sports Injury

Management Philadelphia, PA: Lippincott Williams

and Wilkins

Appenzeller, H (2005) Risk management in sport In

Ap-penzeller, H (Ed.) Risk Management in Sport: Issues

and Strategies, 2nd edn Durham, NC: Carolina

Aca-demic Press, pp 5–10

Baker, B.B (1980) The public right to expertise (part 1)

Interscholastic Athletic Administration, 7 (2), 21–23.

Baker, B.B (1981) The public right to expertise (part 2)

Interscholastic Athletic Administration, 7 (3), 22–25.

Board of Certification (2009) What is the BOC? Omaha,

NE: Board of Certification (accessed 14th August2009), <http://bocatc.org/index.php?option=com

content&task=view&id=27&Itemid=29>

Bowling, A (1989) Injuries to dancers: prevalence,

treat-ment and perception of causes British Medical

Jour-nal, 298, 731–734.

British Association of Sport Rehabilitators and Trainers

(2009a) Role Delineation and Definition of Graduate

Sport Rehabilitator (GSR) Salford: British

Associa-tion for Sport Rehabilitators and Trainers (accessed27th July 2009)<http://www.basrat.org/role.asp>

British Association of Sport Rehabilitators and

Train-ers (2009b) Role Delineation of the Sport

Rehabil-itator Salford: British Association for Sport

Reha-bilitators and Trainers (accessed 14th August 2009)

<http://basrat.org/docs/basrat role delineation.pdf>

Bronner, S., Ojofeitimi, S and Spriggs, J (2003)

Occupa-tional musculoskeletal disorders in dancers Physical

Dunn, W.R., George, M.S., Churchill, L and Spindler, K.P

(2007) Ethics in sports medicine American Journal of

Sports Medicine, 35 (5), 840–844.

European Resuscitation Council (2009) European

Re-suscitation Council Edegem, Belgium: European

Resuscitation Council (accessed 27th July 2009)

<https://www.erc.edu/new/>

Falvey, E.C., Eustace, J., Whelan, B., Molloy, M.S., sack, S.P., Shanahan, F and Molloy, M.G (2009) Sportand recreation-related injuries and fracture occurrenceamong emergency department attendees: implications

Cu-for exercise prescription and injury prevention

Emer-gency Medicine Journal, 26 (8), 590–595.

Fitt, S.S (1996) Dance Kinesiology New York: Schirmer

Books

Garrick, J.G and Lewis, S.L (2001) Career hazards for

the dancer Occupational Medicine, 16 (4), 609–618.

Glynn, J.J and Murphy, M.P (1996) Failing

accountabili-ties and failing performance review International

Jour-nal of Public Sector Management, 9 (5/6), 125–137.

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Goodman, R.S (2001) Sports medicine In Sanbar, S.S.,

Gibofsky, A., Firestone, M.H., LeBlang, T.R., Liang,

B.A and Snyder, J.W (Eds) Legal Medicine, 5th edn.

St Louis: Mosby, pp 448–450

Kane, S.M and White, R.A (2009) Medical

malprac-tice and the sports medicine clinician Clinical

Or-thopaedics and Related Research, 467 (2), 412–419.

Konin, J.G and Frederick, M.A (2005) Documentation

for Athletic Training Thorofare, NJ: Slack.

Koutedakis, Y and Jamurtas, A (2004) The dancer as a

performing athlete Sports Medicine, 34 (10), 651–661.

Laws, H (2005) Fit to Dance 2 London: Dance UK.

Miller, J.R & Demoiny, S.G (2008) Parkour: a new

ex-treme sport and a case study Journal of Foot and Ankle

Surgery, 47 (1), 63–65.

National Athletic Trainers’ Association (2009a)

Compe-tencies [online] Dallas, TX, USA: National Athletic

Trainers’ Association [accessed 14th August 2009]

<http://www.nata.org/education/competencies.htm>.

National Athletic Trainers’ Association (2009b) What

is an Athletic Trainer? Dallas, TX: National

Ath-letic Trainers’ Assocation (accessed 14th August 2009)

<http://www.nata.org/about AT/whatisat.htm>

Resuscitation Council (UK) (2009) Guidelines,

med-ical information and reports London:

Resusci-tation Council (UK) (accessed 27th July 2009)

<http://www.resus.org.uk/pages/mediMain.htm>

Salkeld, L.R (2008) Ethics and the pitchside physician

Journal of Medical Ethics, 34 (6), 456–457.

Spanjersberg, W.R and Schipper, I.B (2007) Kitesurfing:when fun turns to trauma – the dangers of a new extreme

sport Journal of Trauma, 63 (3), E76–E80.

Stretanski, M.F (2002) Classical ballet: the full contact

sport American Journal of Physical Medicine and

Re-habilitation, 81 (5), 392–393.

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medi-cal coverage Current Sports Medicine Reports, 1 (5),

306–311

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14

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The main aims of this chapter are to introduce

musculoskeletal screening and outline the available

methods and the related reliability and validity

is-sues This chapter will allow the reader to gain an

understanding of musculoskeletal screening and its

role in injury prevention, identify the

musculoskele-tal screening methods available including a

discus-sion of the validity and reliability of screening

meth-ods The chapter will finally recommend a screening

procedure for injury risk identification

With the need for athletes to play an increasing number of fixtures, the enforced breaks

ever-due to injury need to be decreased Several

ap-proaches can be taken to ensure that the athlete is

trained and prepared so that any possible problems

are either dealt with before they arise or measures

are in place so that treatment can be administered

rapidly upon injury Injury prevention is a process

whereby the athlete is screened through a variety

of tests to identify any potential problems with

their musculoskeletal composition These problems

can then be identified and training practices put in

place to either eradicate these problems or reduce

their possible impact Several procedures are used

by sports practitioners with varying degrees of

success as the need for one common procedure

for musculoskeletal screening becomes apparent

Several researchers have attempted to identify

which methods offer the highest degree of accuracyand validity (Gabbe et al 2004; Miller and Callister2009; McClean et al 2005)

Pre-habilitation can often be overlooked in themakeup of a sports support team, which can oftenlead to problems being overlooked and the team orindividual not performing to their potential through-out their season due to injury In contrast someprofessional clubs spend too much time on reme-dial level pre-habilitation and not enough time onhigh intensity training that meets the demands ofthe sport Procedures need to be implemented to en-sure the amount of training days and competitivesessions missed are minimised Practitioners need to

be proactive with their treatments plans and not rely

on the traditional reactive plans In order for this

to be the case practitioners need to be fully aware

of the latest research and methods in the area ofneed through continued professional development.These plans often commence during the offseason

or the early part of pre-season During this periodthe athlete can be assessed without the demands ofcompetition, which will enable the practitioner togain the knowledge needed to plan for the upcomingseason

Screening can be completed through a variety oftests including physical activity tests, functional as-sessment and questionnaires These all have varyingstrengths and weaknesses and are also dependent onthe practitioner who is carrying out the screening

Sports Rehabilitation and Injury Prevention Edited by Paul Comfort and Earle Abrahamson

C

2010 John Wiley & Sons, Ltd

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16 INJURY PREVENTION AND SCREENING

Regardless of the method chosen the aim is to

iden-tify a series of risk factors that will enable any

po-tential problems to be identified and diagnosed The

findings of the athlete screening can be assessed for

risk of injury so that plans can be made to reduce the

level of risk for the athlete

Screening methods

The approach taken by the leisure industry as a

whole towards injury prevention is one that involved

a health screening questionnaire The questionnaire

can often be modified to include a few general

musculoskeletal questions which, if answered

nega-tively, can then result in the athlete being referred

to their GP The method of screening which

in-cludes this GP referral approach is very general and

mainly focuses on reduced liability of the

adminis-tering facility or practitioner Although this approach

would not be recommended when working with

ath-letes in sport rehabilitation, the use of a

question-naire is often overlooked, even though research has

shown it to be a useful screening tool Research by

Dawson et al (2009) suggests that through the use

of the Extended Nordic Musculoskeletal

Question-naire (NMQ-E) (see Figure 2.1) potential pain areas

and consequential problems can be identified The

questionnaire needs to be administered by a suitable

practitioner and not the athlete involved, ensuring the

results are valid Research suggested that in

conjunc-tion with relevant funcconjunc-tional assessments this

ques-tionnaire was a useful starting point in the screening

process The results found that prevalence of

mus-culoskeletal problems could be correctly diagnosed

and treated effectively The reliability of the

ques-tionnaire used was tested over a series of trials with

the same results shown, indicating the validity and

repeatability (Dawson et al 2009) Figure 2.1 clearly

shows the important areas of the body so the athlete

knows which part the questions are related to and

then follows a logical order through the area

identi-fying the degree of any possible pain The questions

then follow a logical order down the body covering

all the general points of the body The results can

then be passed on to a sports rehabilitation

practi-tioner for further focused functional assessment of

the identified problem areas (Dawson et al 2009)

Assessment by the means of questionnaire is not,

of course, a new methodology, but the integration

with functional and physical tests to form a holistic

process is The way in which the screening elements

are integrated into the injury prevention process canhave a large impact on the athletes involved If ath-letes feel part of this process then they could takeownership and really fully commit to the measurethat is ultimately proposed If athletes are insuffi-ciently involved then they might see the process andresultant programme as unnecessary and thereforenot worthy of expending too much energy on Theother situation is where the athlete could learn toomuch and become de-motivated about their long-term future in the sport and as a result not commit.The latter two scenarios will mean that the practi-tioners plans may fail and the problems identifiedwill probably arise with a negative effect on perfor-mance

A more simplistic approach to questionnaires canalso produce good results in reducing the amount

of tests that an athlete needs to perform The duction of testing time is important in large squads

re-as the amount of time the practitioner spends withthe athlete reduces the amount of time the coachcan spend working on sport-specific training There-fore, the need to develop a useful tool to identify themembers of the squad who do not need any furthertesting or those who can be dealt with in a reducedfashion is important The process shown in Figure2.2 indicates a simple pathway to group the squadinto different levels of testing through a simple set ofquestions This has been shown to be reliable in iden-tifying conditions and more importantly not missingany problems The questionnaire again needs to beadministered by a practitioner to insure the validity

of the answers (Berg-Rice et al 2007)

When the screening questions shown in Figure2.2 were completed by a practitioner the potentialinjuries were correctly found in 92% of athletesscreened When the same process was completed

by a non-practitioner only 80% of cases where tively screened Although the results of the screeningprocess show that it needs to be conducted by the rel-evant practitioner, the overall impact on the averagenumber of days lost through injury was still similar

posi-23 (non-screened) versus 21 days This suggests thatstringent follow-up tests are still needed to ensurethat problems are dealt with effectively (Berg-Rice

et al 2007)

The initial questionnaire used for screening canalso access the athlete’s psychological state towardsinjury and the social factors that could affect theirown approach to problems The Orebro Muscu-loskeletal Pain Screening Questionnaire (OMPSQ)

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18 INJURY PREVENTION AND SCREENING

Do you plan to take the diagnostic APFT?

Are you presently on Profile?

Do you want a referral to the TMC?

Have you had an injury within the last 6 months?

Does the injury still bother you?

Do you want a referral to the TMC?

Refer to TMC

(If athlete is already on profile, TMC referral is discretional)

Perform the Complete Screen

Do you feel that you can safely take the diagnostic APFT?

Do you presently have an injury or are you experiencing pain in your arms, legs, back, neck or hip? Where?

No

Figure 2.2 Initial screening questions (Berg-Rice et al 2007) Reproduced, with permission, from Berg-Rice, V.J.,Conolly, V.L., Pritchard, A., Bergeron, A., & Mays, M.Z (2007) Effectiveness of a screening tool to detect injuries furingarmy health care specialist training Work, 29, 117–188, © 2007 IOS Press

has been used in research to look at potential

prob-lems and the subject’s pain avoidance The athlete’s

injury history will have an effect on their ability

to deal with injury and how they rate their current

musculoskeletal state The OMPSQ factors into the

score: fear avoidance; how well the person perceives

they can deal with pain; how distressed they have

been in the past about injuries; and the athlete’s own

rating of their function These scores were then

com-bined and factors given to the rating to produce three

predicting factors of how many days the athlete will

miss on average a year The first predicting factor was

the function group of questions, which significantly

(p= 0.001), predicted the amount of ‘Sick’ days the

athlete would have over the course of a three-year

period (Westman et al 2008) The functional ment questions looked into how athletes perceivedthe injury affected them and their ability to perform.The second factor that significantly predicted theamount of the missed training days due to problemswas the pain factor The athletes’ pain and injury his-tory was factored into this predictor to significantlypredict the amount of days the athlete would missduring the next three years, (p= 0.0026) (Westman

assess-et al 2008) The final factor in this questionnaire,which was labelled fear-avoidance and was the painthat the athlete had experienced, did not significantlypredict the amount of missed training days Thelast factor included the athlete’s fear of training duethe perceived affect it would have on an injury and

Tiêu đề	Sports Rehabilitation and Injury Prevention
Người hướng dẫn	Earle Abrahamson, London Sport Institute at Middlesex University
Trường học	School of Health, Sport & Rehabilitation Sciences, University of Salford
Chuyên ngành	Sports rehabilitation and injury prevention
Thể loại	sách tham khảo
Năm xuất bản	2010
Thành phố	Salford

Định dạng
Số trang	328
Dung lượng	5,52 MB