PHTY206 Lecture Notes - Lecture 18: Shared Decision-Making In Medicine, Semimembranosus Muscle, Ischial Tuberosity
Return to sport guidelines
• Outline return to training/return to sport decision making processes and considerations
• Discuss appropriate goal setting, exercise progression and sports specific training for return to
sport
• Discuss how to evaluate readiness of an athlete with a LL injury for return to
function/training/sport
• Outline how the physiotherapist might liase with other members of the sports medicine team
to ensure a successful return to sport
• Return to sport continuum
• INSERT DIAGRAM
• Return to sport readiness
o Physiological readiness
• Tissue healing
• Return to preinjury state?
o Psychological readiness
• Wants to return
• Any fear of re-injury?
o Performance readiness
• Required fitness
• Skill acquisition
• Sports injuries rehabilitation
o Consider
• Injury - acute or long standing (and its management)
▪ E.g. hamstring strain
▪ History of injury
▪ Physical examination
▪ Type of activity
• Contributing factors to injury
• Insufficient recovery from previous game
▪ Intrinsic risk factors
• Modifiable e.g. hamstring muscle weakness
• Non-modifiable e.g. age, gender, previous injury
▪ Extrinsic factors
• Training load
▪ Co-existing factors
• Lx, pelvis control
• Return to sport process
▪ Conditioning, skills, strengthening, psychological readiness, training loads
▪ Competitive level and ability to protect the injury
• Prevention of injury or -reinjury
• Clinical reasoning - sports injury
o What is the injury
o Why did it happen
• Contributing factors
• Intrinsic/extrinsic factors
• Modifiable/non-modifiable factors
o What will you do
• Treatment
• Rehabilitation
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• Prevention
o When will
• This athlete return to physio
• Stop physio
• Be ready
• Return to training
• Return to play
• Restore/increase performance
• Injury - acute or long standing
o What is the injury
o What happened
• Was the injury
▪ Contact or non-contact
▪ Acute or due to training error (overuse)
▪ 1st time injury or re-injury
o When did it happen
• During early season, mid-season or end-of season
• During training, game or competition
o Where did it happen
• In elite/community or recreational sport
• How was the injury managed?
o Acute management
• On-field, coach, emergency department, doctor, physio, investigations
o How long has the athlete
• Had the injury
• Been attending rehabilitation
o Was the injury associated with non-optimal training loads (overuse)
• Contributing factors to injury
o Why did it happen
• Any identified risk factors
▪ Intrinsic - muscle/joint/tendon function
• Modifiable
• Sleep, quality, recovery, strength, flexibility, ROM, psychological,
other physiological factors e.g. reduced fitness, other joints e.g.
Lx
• Non-modifiable
• e.g. previous trauma, age, gender
▪ Extrinsic
• Training loads, sleep time, recovery time, equipment, grounds, other
players
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• What is the athlete's main goal
o To play
• Elite sport
• Specific sport
• Any sport/exercise
• Just to e ale to hae fu? u aoud ith the kids
• ADL or back to work
• Aim for high level of function
• Return to sport rehab goals
o SMART Goals
• Specific?
• Measurable?
• Achievable?
• Realistic?
• Timely?
o Short and long term goals
• Personal
▪ Work
▪ Home
• Training
• Game/competition
• Rehabilitation planning
o Consider your assessment findings, diagnosis and goals of athlete
o Consider healing phases
o Formulate a treatment plan with specific short and long term goals based on the above
• RTS goal consideration
o Diagnosis & Prognosis
o Pathology – stage/time of healing
o The individual
o The sport
o Time of season – selections, finals
o Outcome measures
• 2016 consensus statement on RTS
o 1. Timing – RTS is a shared decision making
• Time to RTS varies independent of the type and severity of injury, reflecting the
challenge in accurately predicting injury prognosis and RTS timelines, and
highlighting the need for shared decision-making
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Insert diagram: physiological readiness, tissue healing, return to preinjury state, psychological readiness, wants to return, any fear of re-injury, performance readiness, required fitness. Injury - acute or long standing (and its management: e. g. hamstring strain, history of injury, physical examination, type of activity, contributing factors to injury. Intrinsic risk factors: modifiable e. g. hamstring muscle weakness, non-modifiable e. g. age, gender, previous injury, extrinsic factors, training load, co-existing factors. Intrinsic/extrinsic factors: what will you do, treatment, rehabilitation, prevention, when will. Stop physio: this athlete return to physio, be ready, return to training, return to play, restore/increase performance. Specific sport: elite sport, any sport/exercise, adl or back to work, aim for high level of function (cid:862)just to (cid:271)e a(cid:271)le to ha(cid:448)e fu(cid:374)? (cid:396)u(cid:374) a(cid:396)ou(cid:374)d (cid:449)ith the kids(cid:863, return to sport rehab goals, smart goals. Single-leg hop (distance: cross-over hop (distance, triple & 6-m timed hop tests, all averaged > 90% lsi at 6 to 9 months postop.
