NCCP Prevention and Recovery of Injury

Source: My personal notes from course taught by Suzanne Chaulk - rugby, master coach educator for 15 years

NCCP Core Competencies

Problem-solving

• Find solutions to problem of injury occurrence
• Design a functional evaluation for return to play following an injury

Valuing

• Identify rules for athletes, coaches, and officials versus those that are poorly enforced or followed, and explain what changes to make to ensure that rules are followed
• Appreciate the need for a comprehensive Prevention Action Plan (PAP)

Critical Thinking

• Select the best solutions for preventing injury based in part on science and in part on the coaching context
• Analyze technique for a power skill to determine how poor technique can result in chronic injuries
• Select the best movement patterns for preventing injury in a sport contextPrevention and Recovery: Coach Workbook

Leading

• Recommend one or more rule changes to prevent injury in your sport
• Advance your vision of a Prevention Action Plan
• Present arguments in favour of specific strategies for preventing injury

Interacting

• Share your views on virtually every aspect of your approach to injury prevention
• Brainstorm and develop a communication strategy for sharing an approach to hydration, nutrition, and sleep as recovery techniques
• Explain your rationale for selecting the components of a dynamic warm-up and a cooldown

Introduction

• Myth: Injuries are random and unexpected. Fact: Many injuries can be prevented by movement patterns and specific training. Many injuries can be expected

Learning outcomes:

• Common injuries
• Prevention and performance are linked - movement patterns, skill execution
• Plan recovery and regeneration
• Create a prevention action plan, put into practice plan (warmup, cooldown)

Common injuries

• Acute: short term injury
• Chronic: long term, persistent - often from overuse
  • Look volume and intensity and allowing time for recovery
  • Can be due to tendon tearing, repetitive force
• For gymnastics:
  • Back (lower, upper) - muscle strains, chronic
  • Head, neck - concussion, chronic
  • Knee - Ligament Sprain, acute to chronic
  • Collarbone - on falls, acute
  • Ankle, wrists - chronic
  • Shoulder - tendonitis, chronic
  • Hands - skin tears, acute - recovery: event rotation, equipment
• Robert about cycling
  • Neck, lower back issues due to core issues - chronic
  • Acute due to falls
  • Joint related for hips
• Karl - Karate
  • Head - concussion
    • impact, easier to get more over time
  • Breaks - toes, fingers - break, protective equipment
  • Knees, ankles - sprains and strains
• Dillon - freestyle ski
  • Environment, weather and wind conditions

Injuries caused by force:

Types of Forces:

• A tension force pulling or putting stretch on tissue that results in lengthening and tearing.
• A compression force crushing tissue that results in shortening and bruising.
• A shear force that results in lengthening and tearing.

Caused are impacts, overuse, and poor technique. Athletes overloading their training.

Injury Mitigation

Create balance and symmetry in body.

• Equipment
• Movement pattern
  • Functional movement testing
• Stretching
• Conditioning
  • Example: Strengthening exercises

Strategies

• Conditioning and stretching required - 3h, 1.5-2 hours is spent doing conditioning/warm up/cool down. 1 hour is focused technique
• Progressions as minimizing force on body while learning a skill
  • Progressions in practice: warm up > dynamic stretching > skill exercise
  • Reduce intensity, focus on a skill and reduce load
  • Demonstrate mental focus on a skill
• Strength, flexibility requirements prior to learning certain skills
  • Report card on progression
    • Show proper technique
    • Show accountability to parents
• People/Equipment to make things safer - mats, nets, spotting

Promoting Recovery

• Promote playing other sports, for example racing sports for aerobic energy development, team sports for hand/eye coordination and tactical abilities while resting from primary sport
• Frequency of practices

Fundamentals

• Never train hard when stiff and sore
  • What about chronic injuries?
    • e.g. sore knees of a growth spurt - see a physiotherapist
• Introduce new activities gradually
  • Skills into parts, parts need to be mastered
  • Event rotation (legs, arms)
  • Practice - event focus rotation
  • Load management, take mental breaks
• Match increases in training with increases in resting
  • Rest or low intensity station
• Poor fitness levels cause injury
  • Conditioning targets
  • Fundamental of all skills - it is a prerequisite
  • Weekly plan to prevent over use of body areas - physical, skill assessment, check weaknesses, skill development, tactical use later practice, combine all in competition situation
• Wear the right footwear
  • Right equipment, inspect equipment
  • Tie hair back
• Listen to your body
  • Tell athletes what they should feel (e.g. stretching feel tiny bit of pull and pain. Should not be painful)
  • Regularly check in on athlete
  • Accept if athletes says they are uncomfortable or an exercise hurts and given them an alternative
• Beware of the third week of heavy training. It is ok to say “no” and check the problem area.
  • If there is no pre-season, beware later parts of training if body is tired

Preparation

• Pre-season meeting with athletes and parents - Agree on warm up, cool down (if possible or do it at home)

Prevention Action plan

Practice Before

• Prevention: Check in with athletes, see how they feel, Inspect equipment, hair ties
• Recovery:

Warm Up

• Prevention: Stretching, conditioning
• Recovery:

In practice or competition

• Prevention: Skill progressions, Check in with athletes, Rest/low intensity stations
• Recovery: Rotation of events, Scheduled regular breaks when moving between events

Cool down

• Prevention: Stretching (if time is possible)

After practice

At home/between practice

Between competitions

Challenging Sport Rules

Rules/regulations/norms could be dangerous and encourage injuries. “Smart foul”.

• Contact sport penalties
  • Obvious fouls - discourage “smart penalties”
  • Protocols for concussion
• High difficulty skills
• How could you change adherence to the rule?
  • Need consistency across referees - need better training
  • Communication with referees and coaches
  • Invite referees to training a sessions to get their view and for them to see views
  • Respect officials
• Weather allowances
• Spotting in competition - maximum mat thickness
• Norm - increasing complexity of routines
  • Sport optimization
  • Judged sport - mental push
  • Parental push
  • Speak to athletes and parents on fundamentals and risk management

12 Pak for Injuring Prevention

• Can be used in warm up, before skill training, and off season training.
  • In practice before movement/skill is similar
  • Daily athlete off site exercise
• Train symmetry of skills (jump + land)

12 PAK

• Core movements and you can add variations (simplified, made more context).
• Made for train to train/compete phase

See page 14 and onward of reference manual and temporary video folder

All can be done in warm up or station at an event. Static positions and small movements like bridge, push up, deadlifts can be encouraged at home.

• Bounding/Dynamic One-foot Landing
• Dynamic Plank
• Push-ups
• Side Jumps Over a Line
• Side Lunges
• Side Sliding on a Smooth Surface
• Supine Bridge
• Walking Lunges
• Zig Zag run
  • Change direction
  • Knee, ankle stability

Which 6 of these would be useful for gymnastics?

• Bounding/Dynamic One-foot Landing
  • Lady bug mat, hula hoops, chalk
  • Bunny hop
  • Watch from side / 45 degree profile
  • Look at arms and foot position
• Push-ups
• Side jumps
• Supine bridge
  • Check flexibility of athlete
  • Core control
  • Warm up, mental preparation of flexible back
• Walking Deadlifts
  • Check fatigue
  • Ensure balance
• Walking lunges
• 5 - I, T, Y, W
  • Demo movement
  • Spread out end line, 12 athletes, spread out
  • Coach stand at side line during exercise
  • Look at shoulder, flexibility
  • Watch out for shoulder issues, eliminate imbalance

Key coaching points

• Symmetry, are both sides of body/movement equal
  • Compensations lead to injury
• Stability
• Posture and alignment
• Knees over feet
• Minimal swap
• Is athlete aware of their body position - video/mirror

Summary of Day 1 learning above

• Common injuries and causes of injuries
• Build prevention action plan
• Role of sport rules/culture that contribute to injuries and our roles in prevention
• Training fundamentals (listen to your body, progressions)
• 12 pak movement patterns to prevent injury

Dynamic Warm-Ups

• 10+ minutes of activity to prepare athletes mentally and physically

• Dynamic warm up goals:

  • Increase heart rate, muscle temperature (increase athlete performance)
  • Improve body’s force capacity (increase athlete performance)
  • Train neural pathways, mental preparation
  • Provide working muscles energy from energy systems for sport
    • Active muscle groups and neurons
    • Ligaments, joints
  • Reduce risk of injury

• Specificity - modify warm up based on practice content

• A Walks / A Skips

• B Walks / B Skips

• C Walks / C Skips

• Walking Deadlifts

• Spider Man

• Walking Lunges

• Walking Lunges with Trunk Rotation

• Side Lunges

Specific warm up, vaulting running concentration

• Jumping (1, 2 leg, backwards, sideways)
• Skipping
• Short sprints
• Joint rotations
  • Leg swings
• Lunges
• Jog for general warm up
  • high knees
  • butt kicks
• Core warm up
  • abs
  • leg raises, stars, kip ups
  • planks
  • dead bugs
  • partner workouts

Specific warm up

• Competition - survey environment, then prepare
• Remind athletes about purpose of dynamic stretches
• Leave time for recovery

Cooldown

• Lower heart rate gradually - go back to resting
  • Athletes should know how much cooldown they need
• Relax and stretch muscles, lengthen muscles
  • Static stretching
• Flush stuff that adds to fatigue: lactic acid
• Speed up recovery
• Decrease risk of injury

Example:

See Stretching - Stretching

• Static holds
  • Head
    • Rotate and hold
  • Shoulder
  • Core
  • Back
    • Child’s pose
    • Bug
  • Glutes
  • Hips
  • Legs
  • Hamstring, quads
  • Ankles
  • Feet
• Static stretching - 1-2 times, 15 seconds
• Yoga
  • Stable positions

Overuse injuries

Example: Front roll, front handspring

Front dive, under use arms, over use back, drill: handstand/roll flat into a mat Lack of leg drive, under-use legs, over use neck, drill: look forward where you are going

Example: take off, jumping skill

• Uneven take off from legs - push with the feet, eyes, horizon
• Leaning too much on landing

Observing power skills issues - 12 pak

Self-coaching

Athlete self coaching and awareness helps them self correct.

Assume athlete has a good grasp of skill.

What are strategies?

• Video, mirrors in training environment so athlete can see skill position
• Compare performance - race time
• Ask athlete how they felt, ask what they could improve? - reflective learning
• Remind athletes where to look and to not close their eyes
• Recognize changes in positions by feeling a position
• Trace positions on floor/equipment/environment that athlete can use as markers
• Tell athlete where a certain body part should face/position
• Mental rehearsal - cue words prior to skill
• Athlete journals
• Have athlete explain execution to another person

Return to Play

Considerations:

• Length of time away, fitness
• Doctor approved return
• Physical and mental readiness for training. Do they have a fear in a sport situation or using a body part?
• Conduct functional evaluation for return to play

Integration into practices:

• Conditioning
• Stretching
• Light aerobic exercise (cycling, low intensity conditioning)

Common Injuries

Knee injuries

e.g. athlete has general soreness, physiotherapy

• Meet with athletes, parents, support staff
  • Agree there are agree return to play protocol
  • Sign off on injury and return policies
• Check athlete feels, what doctor/physiotherapist has assessed through recovery
• Run functional movement evaluation
• Consider high force / repeated force frequency
• Low/no impact: swimming

Concussion

• Mostly accidental
• Do a baseline test for comparison
• Mandated protocol in page 32 reference guide
  • Lower duration and intensity, increase technicality of work
  • No/lower contact
• Check with athlete during training
• Maintain flexibility, physical fitness (includes nutrition)

Recovery and Regeneration

Facts:

• Many athletes are over trained / compete in a fatigued state;
• It’s hard to get athletes to recover
• Recognize signs and symptoms of fatigue is hard. As coaches, need to be observant

Signs/symptoms:

• Red faced, breathing hard despite short work out
• Looking sleepy / not focused / poor listening. May have poor technique
• Pain during “regular” stretches, reduced flexibility

Injuries:

• Bruises, Knee, back, head - accident can occur while doing a skill such as a bad landing or fall
• Sprain, muscle strain from reduced flexibility

Field Test / Heavy Legs

Testing fatigue

e.g.

• Vertical jump test in volleyball, can be included warm up
• Broad jump - measured jump distance - heavy legs
• Held handstand - maximum time
• Climb rope hands only - time
• 10 jumps
• Stop jump
• Walking deadlift - form
• Timed run

Recovery and regeneration techniques

• Work-rest ratio: Water / event break - in middle of event rotations, increase for “hot days”, eating half way in practice
• Active rest / low intensity practices - e.g. before competition
• Period recovery - once a week practice, by season
  • high/low workouts
  • pre-competition recovery with uniforms
• Cross-training and recreational sport
  • “Fun” training session
• Rest days
• Psychological - mental focus of an element, athlete still perform the same skill at slightly lower intensity
• Massage: foam rollers, rockers on your back
• Contrast:
  • ice/hot baths
  • pool
• Postural - static positions, handstand lying down, resting

Hydration, Nutrition, and Sleep

• Be flexible, give guidance

Hydration

• Replace water lost in sweat

• Prevents loss of performance due to dehydration

• Maintain core body temperature

• Regularly hydrate, do not wait until you are thirsty

• Sports drink? for 60+ minutes without interruption

Nutrition

Before

• Fluid and high carbs, protein, low fat
• Watch out for spicy, fatty foods
• Timing: large 3-4 hours, 2-3 medium, small snack 1-2h - fruit, energy bar, trail mix, juice, yogurt for longer break
• Bag, sandwich, fruit (snack/bar/trail mix), soup

During

• Fluid and electrolyte, carbohydrates to maintain energy (blood glucose)
• Snacks: fruits, energy bars, juice, smoothies

After

• Protein, carbohydrate, fluid

• Replace energy, nutrients

• Snack: Fruit, juice, vegetables, soups - similar to snacks

Sleep

• “Rest as hard as your train”
• It can have negative effects on performance, slow down recovery, and compromise the immune system.
• Approaching competition, decrease:
  • Caffeine
  • Outside stressors
• Travel
  • Start aligning clocks at home before arriving
  • Maintenance nutrition

Communication

• Pre-season meeting
• Policies
• Require snacks for training
• Team food area