Inspiration

FCN søger ny fysioterapeut til U19 hold.

FCN søger ny fysioterapeut til U19 hold.

Jeg har i mange år været imponeret af FCN medicinske setup, som udefra set virker til at være et af de bedst i Danmark.

En af de store udfordringer som fysioterapeut i en klub er at få spillere til at “købe ind” på den behandling, de forebyggelsesprogrammer, og den performance optimering der bliver givet, så spillerne ikke søger ukoordineret behandling andre steder.Flere undersøgelser fra UEFA har peget på at succes blandt andet afhænger af hvor mange spiller klubben har til rådighed, og at de klubber med over 86% spiller rådighed i løbet af sæsonen, har større chance for at vinde mesterskaber end klubber med mange skader (1, 2). Derudover viser det at intern kommunikation og ledelsesstil også påvirker skades incidensen (3, 4) Derfor vil et godt velbetalte behandlingsteam med erfaring, efteruddannelse, der kan nedsætte “fraværsdage” og potentiale fraværsdage (skadesforebyggelse) være en god return of investment for klubben (5).

Derfor, er jeg også ellevild med den standard FCN fastsætter til deres behandlere på u19, når jeg ser andre elite fodboldklubber fuldtidsansætte nyuddannede fysioterapeuter for landets bedste fodboldtalenter. Når det er sagt, så var jeg så heldig selv at få arbejde i 1. divisionen som 2 års fysioterapeutstuderende og sad med ved kampene. Det var en kæmpe oplevelse og virkelig lærerigt, men set i bakspejlet, så var det nok ikke den mest ansvarlige, at min lærdom skete i et elitemiljø ved at gamble med akutte hjernerystelser, muskelskader eller til dagligt være med i beslutningsprocessen omkring retur til sport.

Jeg håber, at dette jobopslag kan være med til at sætte standarden for den kvalitetsikring der burde være i elitemiljøet, så spillere og evt. forældre trygt kan stole på de hænder tager fandt om deres talentfulde ben. Hvis du er interesseret i at blive idrætsfysioterapeut, så en varm anbefaling til at søge denne position.

Andreas

1) Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study https://bjsm.bmj.com/content/47/12/738

2) Does player unavailability affect football teams’ match physical outputs? A two-season study of the UEFA champions league https://www.sciencedirect.com/…/pii/S1440244017309957….

3) Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs https://bjsm.bmj.com/content/53/5/304

4) Is there a correlation between coaches’ leadership styles and injuries in elite football teams? A study of 36 elite teams in 17 countries https://bjsm.bmj.com/content/52/8/527

5) Preventing injuries in professional football: thinking bigger and working together https://bjsm.bmj.com/content/50/12/709

Læs også Er du bedre end en Ørn?

Inspiration

Journal Club: Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group

Delaloye JR, Murar J, Vieira TD, Franck F, Pioger C, Helfer L, Saithna A, Sonnery-Cottet B. Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database. Am J Sports Med. 2020 Mar;48(3):565-572. doi: 10.1177/0363546519897064. Epub 2020 Jan 13. PMID: 31930921.

Inspiration

Presentation for Journal Club in Aspetar Hospital December 2020

Presentation for Journal Club in Aspetar Hospital December 2020

Vallance P, Hasani F, Crowley L, Malliaras P. Self-reported pain with single leg heel raise or single leg hop offer distinct information as measures of severity in men with midportion and insertional Achilles tendinopathy: An observational cross-sectional study. Phys Ther Sport. 2021 Jan;47:23-31. doi: 10.1016/j.ptsp.2020.10.009. Epub 2020 Oct 23. PMID: 33125967.

Inspiration

Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury

Jeong J, Choi D-H, Shin CS. Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury. The American Journal of Sports Medicine. 2021;49(1):183-192. doi:10.1177/0363546520972990

Authors conclusion:

Core strength training altered the motor control strategies and joint kinematics for the trunk and the lower extremity by increasing the trunk flexion angle, VM:VL activation ratio, and H:Q activation ratio and reducing the knee valgus and hip adduction angles.

Article clinical Relevance:

Training core muscles can modify the biomechanics associated with ACL injuries in a side-step cutting task; thus, core strength training might be considered in ACL injury prevention programs to alter the lower extremity alignment in the frontal plane and muscle activations during sports-related tasks.

Core training Program

Warm-up, 1.3-km / 15 min jogging

  • Leg raise: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
  • Crunch: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
  • Superman: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
  • Plank hip twist Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched legs
  • Prone-plank Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched legs
  • Side-plank (both sides): Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched side
  • Supine bridge hold: Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched side

Stretches: 30 s each

  • Quadriceps
  • Hamstring
  • Calf stretches
  • Latissimus dorsi
  • Hip muscles
  • Pectorals/biceps
Inspiration

A TEN TASK-BASED PROGRESSION IN REHABILITATION AFTER ACL RECONSTRUCTION: FROM POST-SURGERY TO RETURN TO PLAY – A CLINICAL COMMENTARY

Article link

Movement re-training is considered an important element of rehabilitation after ACLR, but there is a lack of knowledge on the ‘how’ and ‘what’ movement re-training should occur after ACLR.

In its basic form, movement re-training after ACLR is about progressing a patient through gradually more demanding tasks from the point of being able to walk to being able to perform highly complex sports movements. However, there is a lack of guidance on when to implement certain tasks (e.g. when to begin running) and how to transition between tasks. This paper presents a 10 task progressions system which can form an important aspect of the movement-based re-training process, providing structure and patient autonomy. Monitoring knee function and movement and neuromuscular status to safely transition between these tasks is important.

1. Normal walking gait 
2. Bilateral squat
3. Unilateral foundation exercises – Single leg squat4. Bilateral landing5. Running6. Bilateral plyometrics – Bilateral drop jump
7. Unilateral landing/ deceleration –Single leg deceleration8. Unilateral plyometrics –Single leg drop jump
9. Change of direction ability/coordination – 90º cut maneuver10. Sport-specific movements – Movement control under sport specific change of direction
SUMMARY Establishing clear task-based progressions can provide structure to a rehabilitation approach and give autonomy and motivation to a patient after ACLR. This clinical commentary presents 10 task-based progression which can be used by clinicians for their patients who intend to return to sporting activity after ACLR. Progression through a task and between tasks is based on respecting the joint, strength, movement quality and muscle soreness. 
The presented task-based framework is evidence informed and based on applying theory into practice. 

Buckthorpe M, Tamisari A, Villa FD. A TEN TASK-BASED PROGRESSION IN REHABILITATION AFTER ACL RECONSTRUCTION: FROM POST-SURGERY TO RETURN TO PLAY – A CLINICAL COMMENTARY. Int J Sports Phys Ther. 2020;15(4):611-623.

Inspiration

Blood Flow Restriction Combined with Electrical Stimulation Attenuates Thigh Muscle Disuse Atrophy

The aim of this study was to investigate the effects of repeated application of BFR+EMS on preserving skeletal muscle mass and strength during a period of limb disuse. It was hypothesized that repeated BFR+EMS treatment would be more effective than repeated BFR treatment without EMS for attenuating the loss of quadriceps mass and knee-extension strength during a 14-day leg unloading period

Subjects

A mixed-sex group of 30 healthy, young individuals (14 males, 16 females; age: 22 ± 3 years; body mass index: 23 ± 3 kg.m -2) who were naïve to BFR training were recruited from the university and surrounding community.

Study design

Participants were randomly allocated to either the control (CON; n = 10), BFR (n = 10), or BFR+EMS (n = 10) group. All three groups underwent a 14-day period of single-leg muscle unloading through use of a knee brace and crutches. Unloading was performed using the left leg of all participants to allow safe operation of a motor vehicle during the study. Over the 14-day
unloading period, participants had no intervention (CON), or underwent treatment with either BFR or BFR+EMS twice daily, 5 times per week, for a total of 20 treatment sessions.

Interventions

BFR was performed with the participant in a sitting position using arterial occlusion accomplished via a PTSi automated tourniquet system (Delfi Medical Innovations Inc. Vancouver, Canada). Full arterial occlusion was chosen to maximize the metabolic stimulus and adaptive training response (18). An 11-cm wide tourniquet cuff was positioned proximally around the left thigh and inflated to a pressure that was minimally superior to systolic pressure (≥ 2 mmHg), allowing for arterial occlusion. This pressure, also referred to as the lowest effective occlusion pressure (LOP).

Muscle stimulation for the ITT was performed using a constant current high voltage stimulator (model DS7AH, Digitimer, Welwyn Garden City, Hertfordshire, UK) where evoked twitches were delivered to the knee extensors transcutaneously using two custom electrode pads, previously described by Dalton et al. (17). Electrodes were placed perpendicular to the long axis of the femur, with the proximal pad at ~5 cm above the kneecap and the distal pad ~10 cm above the proximal electrode, covering the anterior aspect of the thigh completely.

BFR + Muscle stimulation in combination

Discussion

Data reported here suggests that repeated BFR+EMS treatment represents an effective interventional strategy to attenuate muscle disuse atrophy, which is known to lead to reduced functional capacity (21- 23), a shift in fuel metabolism (24), impaired muscle insulin sensitivity (25), a decline in basal metabolic rate (26, 27), and an increase in body fat mass (28). Given the ability to use BFR+TEMS as a “passive” treatment modality requiring no external load, these data are relevant to persons immobilized from injury or illness, persons who are differentially-abled or confined to a wheelchair, astronauts living in reduced gravity environments, or others seeking to minimize the consequences of muscle disuse atrophy. Specific applications to those rehabilitating from sports and orthopaedic injuries are perhaps obvious, and with the known association of muscle mass with cardiometabolic health and acute blood sugar maintenance through glucose uptake (29, 30), it is possible that further applications exist for persons who are faced with acute or chronic forced sedentarism.

…..

However, we believe that BFR+EMS likely presents a more effective method to attenuate muscle loss compared to EMS alone as a previous study shows a greater recruitment of muscle fibers when blood flow is restricted during electrically evoked muscle contractions (37) compared to when electrically evoked muscle contractions are performed without blood flow restriction.

In conclusion

In conclusion, the combined treatment of BFR+EMS uniquely preserves muscle mass during a period of limb disuse, while BFR treatment without EMS did not protect against this expected disuse atrophy. These results suggest that BFR+EMS treatment, but not BFR treatment alone, represents an effective interventional strategy to attenuate muscle atrophy during a period of disuse and this may have implications across a variety of health and performance applications wherein disuse cannot be avoided.