INNOVATINE INJURY PREVENTION PROGRAM FOR ELITE ATHLETES.

OLYMPIACOS F.C. FOOTBALL ACADEMY –U20 & U17 TEAMS. PRELIMINARY RESULTS.

 S. Alevrogiannis1MD, G. Kakavas1, Ch. Zelenitsas2, G.A. Skarpas1 MD, A. Triantafyllopoulos¹

From: 1Athens Sports Clinic(ASC)

2 Olympiakos F.C Football Academy•  • S. Alevrogiannis MD, Orthopedic surgeon, Medical Director ASC• G. Kakavas , Physiotherapist, Chiropractor, Physio Director ASC• Ch. Zelenitsas , Chief Director Olympiacos F.C, Football Academy• G. A. Skarpas MD, Orthopedic surgeon, Medical stuff ASC• A. Triantafyllopoulos , Orthopedic surgeon, Medical stuff ASC

 

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• Scientific surveys have shown that the mean value of football injuries is almost 2.7 per game and the possibility for prevention of such injuries is more than 30%.

FIFA MEDICAL CENTRE OF EXCELLENCE

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

FIRST TIME IN GREECE THE BIOMECHANICS OF FOOTBALL PLAYERS ARE STUDIED IN CORRELATION TO NEUROMUSCULAR ASSEMBLY.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• INJURIES PREVENTION

1. SPRAINS

2. KNEE INJURIES

3. LOW BACK PAIN

4. MUSCULAR STRAINS

• Fysiotek technology– Foot scanner by Footlevelers– Axis correction system Fysiotek– Neuromuscular evaluation-screening by Insight– Muscle performance analysis by Myo Vision– Rehab exercises software by Phases Rehab

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

The diagnostic tests were held during 2 separate periods, the first being 8-9 October 2010 and the second 11-12 February 2011 at the Renti Training Centre Facilities of F.C. Olympiacos, using the Fysiotek technology.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• “FYSIOTEK” SYSTEM1. Provides info concerning hyper- or hypo- mobility of

the intervertebral and peripheral joints.2. Restores the normal function of the joints.3. Provides modern, high-tech chiropractic.4. Combines with “GRASTON” technique, for muscle

and tendon injuries.5. Assures quicker rehab protocol and return to sports

after surgical treatment or muscle injuries.6. Vertebral disc decompression and restoration of

normal spinal cord function.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• STUDY OF THE WEIGHT-BEARING (LOADING AXIS) USING A STATIC FOOT SCANNER

1. Supination

2. Pronation Mild Moderate Severe

3. Normal

The 3 arches of the footare supported by the plantar fascia and

the bone-to-bone ligaments

PREVENTION - Goal #1

Create a symmetrical foundation by - blocking excessive pronation

- supporting supination within the established normal angulation ranges .

PREVENTION - Goal #2

Provide heel strike shock protection

The natural heel strike shock absorption mechanisms are compromised with faulty pedal biomechanics making the individual more susceptible to bone marrow oedema and stress fractures.

Foot Levelers uses ZORBACEL® for increased

shock absorption

PREVENTION - Goal #3Enhance

sensory - motor reflexes

The sensory information from the feet affects muscular efficiency, balance, gait, and posture.

Radiographic Evaluation of Weight Bearing Orthotics and their Effect on Flexible Pes Planus

JMPT 1999; 22:221-6 Kuhn, Shibley, Austin, Yochum

• Discussion- Biomechanical Faults in the Pedal Foundation can adversely affect ANY of the joints and structures of the Foot/Ankle complex, lower extremities, pelvis and spine

• Conclusion-This study supports the use of a custom made flexible orthotic for the improvement of pedal structural alignment

Bone Marrow Edema Caused by Altered Pedal Biomechanics

Yochum, Barry JMPT Vol 20, No 1, 1997

Foot Levelers’ orthotics helped reduce bone marrow edema and foot pain.

Bone Physiology is altered by changing the biomechanical function of weight bearing structures

The Associate Digital Scanner

When the Foot hits the floor,

everything changes

SPINAL STABILIZERS

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

NEUROMUSCULAR ASSEMBLY• AUTONOMOUS ( thermography)• AFFERENT (motor & sensory-SEMG)

1. Mild

2. Moderate

3. Severe

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• MUSCULAR STRAIN & MYOVISION (MEASUREMENT OF THE QUALITY OF THE MUSCULAR CONTRACTION)

1. Increases the accuracy of the soft tissue U/S in order to avoid recurrence of the strain.

2. Able to detect muscular injuries and future ACL injury combined with foot scan.

3. Able to detect muscular overload-fatigue in order to avoid muscular strain.

FYSIOTEK AXIS CORRECTION

AXIS CORRECTION PATTERNS

INSIGHT SYSTEM

Uematsu S, Edwin DH, Jankel WR et al: Quantification of thermal asymmetry. Normal values and

reproducibility. Journal of Neurosurgery 1988;69:552.

“These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction.

Deviations from these normal values will allow suspicion of neurological pathology to be quantified and therefore can improve assessment and lead to proper clinical management.”

Segmental Model• Sensory irritation via the recurrent meningeal nerve results in a sympathetic response of vasoconstriction.

• A “break” may be noted at the level of involvement.

• Subluxation, organic disease, or drugs may cause this response.

Tonal (Nonsegmental) Model• A subluxation at any level of the spine may produce thermal changes throughout the spine.

• Failure in adaptation causes the pattern to become fixed and stable.

Clinical Observations• In healthy, non-subluxated persons, thermal patterns will be continually changing, and will exhibit acceptable symmetry.

• In acute and subacute subluxations, there will be levels out of range, yet there will still be some variability in the pattern.

Clinical Observations (Continued)

• In chronic, long standing subluxations, the pattern will be fixed, and there will be levels out of range.

• Levels of asymmetry are not necessarily the levels of primary subluxation.

Clinical Observations (Continued)

• Chronic organ dysfunction or drug use may result in a persistant focal segmental asymmetry.

• Thermal patterns monitor autonomic activity. Levels of thermal asymmetry may not correlate with levels of muscular asymmetry seen on the SEMG scan.

Indications for SEMGAny 3 of the following:

• Palpable muscle spasm• Palpable asymmetry of muscles• Asymmetrical ranges of motion• Paraspinal tenderness• Paraspinal pain reported by patient• History of spinal trauma

Indications Continued• Nerve root irritation• Antalgic gait or lean• Diminished or asymmetrical paraspinal muscle strength• Thermographic evidence of paraspinal dysfunction

As A Screening Test• SEMG is an excellent screening test for evidence of muscle dysfunction associated with vertebral subluxation.• It is appropriate for screening asymptomatic persons.• Reliable; painless; non-invasive, radiation-free.

Causes of SEMG Changes• Vertebral subluxation (symptomatic or asymptomatic).• Splinting• Spasm• Antalgic compensation• Scoliosis• Hypotonia

Interpretation• Pattern• Symmetry• Amplitude

*Increased

*Decreased

SEMG Scan Protocol• Seated neutral posture• Full spine scan• Should be performed before adjustment and any therapies• May be affected by drugs, particularly those which produce alterations of muscle function

Proving Medical Diagnosis an Prognosis M. Houts, JD and L. Marmor, MD

“Properly used, the EMG scanning technique is far more persuasive in the courtroom than is a report of needle EMG…You can present the jury with mathematical, tangible, physical evidence which they can see.”

Spector B: Surface electromyography as a model for the development of standardized procedures and reliability testing.

JMPT 19792(4):214.

• Attached electrode paraspinal SEMG yielded correlation coefficients ranging from 0.73 to 0.97.

• “Excellent” to “very good” test-retest reliability.

Komi P, Buskirk E: Reproducibility of electromyographic measurements with inserted wire electrodes and surface

electrodes. Electromyography 1970;10:357.

• Average reliability of inserted electrodes: 0.62

• Average reliability of surface electrodes: 0.88

Giroux B, Lamontagne M: Comparisons between surface electrodes and intramuscular wire electrodes in isometric and

dynamic conditions. Electromyogr Clin Neurophysiol 1990;30:397.

• Trapezius and deltoid muscles were assessed with wire and surface electrodes.

• SEMG was more reliable than inseted wire EMG on day-to-day investigations.

Thompson J, Erickson R, Offord K: EMG muscle scanning: stability of hand-held electrodes. Biofeedback Self Regul

1989;14(1):55.

• Mayo Clinic study comparing attached SEMG electrodes with hand-held scanning electrodes.

• The scanning technique correlated well with the “gold standard” of attached electrode technique.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• RESTORATION OF NORMAL WEIGH-BEARING AXIS

SEVERE SOLE DEFORMITY: genetic-predisposing factors

SEVERE NEUROMUSCULAR CHARGE-LOAD:

Multifactorial → training programmes, training shoe pads, training courts-playgrounds etc.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• PHYSIOTHERAPY & REHABILITATION

GOALS:

1. Propioception

2. Muscular contractility improvement

3. Neuromuscular assembly

4. Functional Re-education

INDIVIDUALIZED REHAB PROTOCOL according to age, role playing, past medical-injury history, training needs.

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• Number of candidates: 63• Number of people examined:1st study: 49 (78%)/ 2nd study: 40 (63.5%)

– Pronation: 49 (100%), 40 (100%)– Supination: 0, (0%)

MATERIAL

CANDIDATES EXAMINED

0

10

20

30

40

50

60

70

78%

CANDITATES EXAMINED

0

10

20

30

40

50

60

70

63.5%

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

RESULTSAXIS FEET SCANNING

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

RESULTSNERVOUS SYSTEM SCANNING

0

20

40

60

80

100

MILD MODERATE SEVERE

0

2

4

6

8

10

12

14

16

18

1st W9 2nd

W28

Stress-Intensity

RESULTSNERVOUS SYSTEM SCANNING

MILD43%

MODERATE28%

SEVERE30%

1st 2nd

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

RESULTSNERVOUS SYSTEM SCANNING

MILD MODERATE SEVERE

U17 14 4 2

U20 3 7 10

1

3

5

7

9

11

13

15

17U20

U17

1st

2nd

RESULTSNERVOUS SYSTEM SCANNING

MILD MODERATE SEVERE

U17 14 4 2

U20 3 7 10

5%

15%

25%

35%

45%

55%

65%

75%

85%

95% U20

U17

1st 2nd

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

ALL PLAYERS WITH SEVERE NEUROMUSCULAR DYSFUNCTION ARE PRONE TO INJURY.ALL PLAYERS WITH SEVERE FEET DYSFUNCTION ARE PRONE TO ACL INJURIES AND ANKLE SPRAINS.

RESULTSNERVOUS SYSTEM SEVERE DYSFUNCTION IN CORRELATION WITH PLAY ROLE.

1st

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

ALL PLAYERS WITH SEVERE NEUROMUSCULAR DYSFUNCTION ARE PRONE TO INJURY.ALL PLAYERS WITH SEVERE FEET DYSFUNCTION ARE PRONE TO ACL INJURIES AND ANKLE SPRAINS.

RESULTSNERVOUS SYSTEM SEVERE DYSFUNCTION IN CORRELATION WITH PLAY ROLE.

GOALKEEPER DEFENDER MIDFIELDER OFFENDER

U17 0 1 6 5

U20 0 7 6 1

1

3

5

7

9

11

13

U20 U17

2nd

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

RESULTSAXIAL CORRECTION

SEVERE FEET SCANNING : 17 ( 35%)SPINAL SEVERE INVOLVEMENT : 12 (25%)

1st test

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

RESULTSAXIAL CORRECTION

SEVERE FEET SCANNING : 11 ( 28%)SPINAL SEVERE INVOLVEMENT : 8 (20%)

1 2

0

5

10

15

20

25

30

35

40

45

SEVERE FEET SCANNING

1 2

0

5

10

15

20

25

30

35

40

45

SPINAL SEVERE INVOLVEMENT

20%28%

2nd test

PREVENTION PROGRAMME vs

INJURIES

ENHANCED PERFORMANCE vs

RANKING

INJURIES PREVENTION PROGRAMME FOR F.C. OLYMPIACOS PIRAEUS (U20 & U17 TEAMS)

• INJURIES PREVENTION IS THE ULTIMATE GOAL IN PRESENT SPORTS MEDICINE AND ORTHOPAEDIC SURGERY.

• RESTORATION OF ACQUIRED OR CONGENITAL DEFORMITIES OF THE FEET CAN AND WILL IMPROVE AN ATHLETES’ PERFORMANCE AS WELL AS DECREASE THE POSSIBILITY OF AN INJURY.

• THE “FYSIOTEK” PREVENTION SYSTEM, CAN PREDICT WITH ACCURACY THE POSSIBILITY OF AN INJURY AS WELL AS THE MUSCLE OVERLOAD, IF CARRIED OUT AT LEAST TWICE A YEAR AND IN COMBINATION WITH THE LABORATORY KAI ERGOPHYSIOLOGY TESTS.

NOTE: The system is radioactive-free and can be used by medical staff as frequently as it is decided.

CONCLUSIONS

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