If you've watched a day of football games this year, chances are you've seen your fair share of injuries.  It's inevitable.  Each year sports get faster, quicker, and more powerful.  Players are getting stronger earlier and coming back from injuries quicker.  And all wrapped up in the middle of this evolution of sports are companies designing new jerseys, new helmets, new shoes, and now, new technology to track performance.  Sports are on it's way to a revolutionized game, one that allows coaches and medical staff to track everything from heart rate, movement speeds, and even CNS function.  But here's the kicker....very few teams are using these tools.  

Numerous articles and research studies have come out with how much injuries cost team's bottom lines.  Take for example my passion, basketball.  The NBA last year lost a combined total of $358 million to players injuries.  My beloved Lakers alone lost $44 million to injuries!  What gives?  Isn't sports performance training and rehabilitation getting more advanced?  The answer is yes, but there is also a lot of bad information out there that becomes gospel-like.  

This is where things become interesting.  Tools like Omegawave that can help the medical staff understand the players recovery and stress levels, and GPS systems like Catapult can measure biomechanical fatigue. But too much of this data's potential is untapped really.  I mean, its really a lot at one time.  Imagine getting all this input daily during the course of the season.  You can get scatterbrained with it.  After all, its impossible to train everything in one day, yet many try to do it anyway.    

So where does this leave us?  One thing is clear: sports physical therapists, performance coaches, and athletic trainers will all be using this data to optimize recovery in athletes.  When prices drop, the innovative therapists will use these tools in the clinic to program rehabilitation on a weekly basis.  The eyes can only see so much and we can only ask so many questions to gauge our athletes' mood/stress levels.  An athlete may say they feel great or want to do more, but our Omegawave system may tell us that their stress levels are too high from that lack of sleep the night before or that girlfriend they just broke up with.  An ideal future would be where physical therapists and sports performance coaches merge to use these tools and help make sense of all this data.  An ideal future would be team owners realizing that if they spent just a little more on medical staff who were innovative and willing to put in the time to use the technology, they might just get a better product.  An ideal future would be physical therapists and strength coaches working together in a team environment to prevent injuries better.    

It's a fun time to be in sports medicine.  It'll be interesting to see how these systems shape the future of rehabilitation and performance.  

- Brian

See more information on Omegawave here and here.  

Lately I have been seeing more and more hamstring strains as football season is underway.  This brought me back to some of my old literature reviews from residency and my own personal research.  Interestingly enough, many of the hamstring studies are poorly designed and have conflicting evidence.  However, this review did a nice job breaking down some of the strengths and flaws of these studies.  Additionally, the authors gave their opinions on some of the findings which I found especially useful.  Below are some of the highlights....

Previous Injury:  

-  "In humans, MRI has shown evidence of scar tissue for up to 1 year after an athlete’s return to sport. The presence of scar tissue can alter muscle transmission pathway, decrease tendon/aponeurosis complex compliance, and consequently lead to a modification of deformation patterns in the muscle tissue adjacent to the fibrous scar."

Flexibility: 

-  "However, the evaluation methods used to measure hamstring flexibility have been criticized for their static approach and inability to differentiate from lumbopelvic flexibility, which in turn has not been shown to be related to injury rates.

- "During running, the psoas of the contralateral leg had a greater influence on hamstring length than the hamstring itself."

Strength:  

- "The fact that most studies assess isokinetic strength during single joint movements may be one of the reasons for the current controversy since the hamstrings’ moment arms at the hip are nearly twice the length of those at the knee during the end of swing phase running."

- "However, a recent Cochrane Systematic Review conducted by Goldman and Jones has concluded that there is insufficient evidence to state that the protocols of eccentric training have the capacity to reduce hamstring injuries."

- "We believe that one major limitation may be the generalized use of the Nordic hamstring exercise, which works the knee flexors eccentrically but with the hip in a fixed position. During any movement, such as the swing phase of a sprint, the hip is not fixed but instead moves and works in coordination with the rest of the segments of the body."

Core Stability:

- "There are many hypotheses that associate hamstring injuries with lumbopelvic stability."

Architecture of Hamstring Muscle:

-  "It's been reported that hamstring injuries related to sprint actions affected mainly the proximal part of the biceps femoris, whereas overstretching injuries mainly involved the free proximal portion of the semimembranosus muscle."

-  "It is well accepted that the prevalence of biceps femoris injury is much higher than the medial hamstrings."

Neural Tension: 

-  "Neural tension has not been shown to be a risk factor24 but it may indirectly have an affect through decreased ROM."


- Brian