Basketball: Re-Conditioning After Injury

Basketball: Re-Conditioning After Injury

Adriano Vretaros Strength and Conditioning Coach

2021

Basketball: Re-Conditioning After Injury

The Problem – I BASKETBALL PLAYERS

Training

Matches

** INJURIES **

Basketball: Re-Conditioning After Injury

The Problem – II Multilevel Nonlinear Complex Dynamic System

x

q

y

a k

w

u

h b

o

z

(Adapted from Bittencourt et al, 2016)

Basketball: Re-Conditioning After Injury

The Problem – III INTRINSIC Risk Factors

PREDISPOSED PLAYER

EXTRINSIC Risk Factors

** INJURIES ** (Yes \ No)

SUSCEPTIBLE PLAYER

Training + Competitions + Preventive Strategies (Adapted from Bahr & Krosshaug, 2005)

Basketball: Re-Conditioning After Injury

The Problem – IV Contact ACUTE Injuries Non-Contact Basketball Injuries

CHRONIC Injuries

Non-Contact

(Adapted from Cumps et al, 2007; Siegmund et al, 2008; Dalton et al, 2015)

Basketball: Re-Conditioning After Injury

The Problem – V Basketball Injuries

Load-Injury

Fatigue-Injury

(Adapted from Lewis, 2018)

Basketball: Re-Conditioning After Injury

The Problem – VI FEMALE Players

%

MALE Players

%

Head, Face, and Neck

14,2

Head, Face, and Neck

12,8

Upper Limbs and Shoulder

2,5

Upper Limbs and Shoulder

2,8

Hand, Wrist and Fingers

9,5

Hand, Wrist and Fingers

9,4

Trunk

4

Trunk

7,1

Hip and Thigh

8,7

Hip and Thigh

8,2

Knee

18,2

Knee

10,6

Lower Limbs

4,9

Lower Limbs

3,4

Ankle and Foot

35,9 *

Ankle and Foot

43,2 *

Other

2,2

Other

2,4

(Adapted from Borowski et al, 2008)

Basketball: Re-Conditioning After Injury

The Problem – VII Tissues Affected by Injuries

Muscle

Cartilage

Tendon

Fascia

Joint

Ligament

Bone

Basketball: Re-Conditioning After Injury

The Problem – VIII Financial Cost of Injuries - I

Direct

Indirect ●

Mean Medical Cost per Injury;

●

Mean Human Capital Cost per Injury;

●

Mean Comprehensive Cost per Injury (Adapted from Knowles et al, 2007)

Basketball: Re-Conditioning After Injury

The Problem – IX Financial Cost of Injuries - II NBA Teams 2014-2015 Season

Regular Season Games Lost to Injury

Salary Cost of Games Lost to Injury ($)

Minnesota Timberwolves

340

22,604,770

Los Angeles Lakers

338

28,009,937

Philadelphia 76ers

281

12,134,306

New York Knicks

262

28,120,176

Milwaukee Bucks

260

9,893,61

OKC Thunder

224

21,288,979

Miami Heat

220

21,026,069

Indiana Pacers

219

24,548,630

Houston Rockets

182

13,425,804

(Adapted from Stotts, 2015)

Basketball: Re-Conditioning After Injury

The Problem – X BASKETBALL PLAYER

Injury

Re-Conditioning Process

Rehabilitation

Basketball: Re-Conditioning After Injury

The Problem - XI ●

What kind of injury was the player affected?

How long (time loss) will be the period of absence from training and competitions?

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What is the moment you can start the physical re-conditioning?

●

●

●

How long does the physical re-conditioning process take?

What activities and criteria should be used in the physical reconditioning process? ●

When effectively ends the physical re-conditioning?

Basketball: Re-Conditioning After Injury

Scientific Team - I ●

How Does Your Scientific Team Work?

MULTI disciplinary

INTER disciplinary

TRANS disciplinary

(Adapted from Buekers et al, 2017)

Basketball: Re-Conditioning After Injury

Scientific Team - II Internal Communication Between Members of the Scientific Staff

(Adapted from Ekstrand et al, 2018)

Basketball: Re-Conditioning After Injury

Scientific Team - III Intra-Team Communications and Injuries “In elite sports, players are commonly pressured to return to play after an injury”

●

Clear Communication Between Staff Members ●

●

Continuous Management of Expectations Avoid the Probability of Premature Return

(Adapted from Ekstrand et al, 2018)

Basketball: Re-Conditioning After Injury

Lesional Context Injured Basketball Player

BIOPSYCHOSOCIAL

Physical

Emotional

Social

(Adapted from De Rose et al, 2008; Arden et al, 2016)

Basketball: Re-Conditioning After Injury

Definition ●

What is Physical Re-Conditioning?

It is a gradual process of returning to sports activities after the athlete has suffered an injury and has met the minimum acceptable clinical criteria.

Basketball: Re-Conditioning After Injury Professionals Involved in Re-Conditioning - I 1)- Physician

2)- Physiotherapist

Sport Scientist

3)- S&C Coach (Adapted from Vretaros, 2002)

Exercise Physiologist

Basketball: Re-Conditioning After Injury Professionals Involved in Re-Conditioning - II (2)- PHYSIOTHERAPIST

(1)- PHYSICIAN

Diagnostics

(3)- S&C COACH

Re-Conditioning Process

Basketball: Re-Conditioning After Injury

The Process - I BASKETBALL RE-CONDITIONING PROCESS

(1)- Return to TRAINING

(2)- Return to SPORT

(3)- Return to PERFORMANCE

(Adapted from Arden et al, 2016)

Basketball: Re-Conditioning After Injury

The Process - II (2)- Return to SPORT

(1)- Return to TRAINING “Athlete-Centred”

Injury Type (3)- Return to PERFORMANCE (Adapted from Arden et al, 2016; Taberner et al, 2019)

Basketball: Re-Conditioning After Injury

The Process - III Re-Conditioning Process

CONTROLLED Activities

CHAOTIC Activities PROGRESSION

Properly controlled movements

Movement based on the reality of matches

(Adapted from Taberner et al, 2019)

Basketball: Re-Conditioning After Injury

The Process - IV Re-Conditioning Process - Apply Progressive Mechanical Loading - Gradually Restore Mechanical Rigidity - Use Metrics Based on Training Loads - Return to Physical Fitness Pre-Injury Values (Adapted from Taberner et al, 2019a)

Basketball: Re-Conditioning After Injury

Return to Training - I CHARACTERISTICS ●

Final Rehabilitation Stage ●

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Pain Monitoring

Player Psychological Security ●

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Adapted Training Adequacy of Loads

(Adapted from Arden et al, 2016)

Basketball: Re-Conditioning After Injury

Return to Training - II ACTIVITIES: Intensive and Extensive ●

●

Return to running (linear)

Front running, lateral running, backpedal ●

Low impact forces

ENDURANCE: aerobic STRENGTH: (Adapted isometricfrom training and anatomical Taberner et al, 2019)adaptation

Basketball: Re-Conditioning After Injury

Return to Sport - I CHARACTERISTICS ●

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Integral Training

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Increase Specific Skills

●

Gradual Load Increase

Monitor Injury Symptoms (Y\N)

(Adapted from Arden et al, 2016)

Basketball: Re-Conditioning After Injury

Return to Sport - II ACTIVITIES: Intensive and Extensive ●

Introduce changes of direction (with ball and without ball) ●

●

Introduce short accelerations \ decelerations Introduce medium accelerations \ decelerations ●

Introduce elements of technical skills ENDURANCE: aerobic and anaerobic

STRENGTH: hipertrophy and maximal strength (Adapted from Taberner et al, 2019)

Basketball: Re-Conditioning After Injury

Return to Performance - I CHARACTERISTICS ●

Final Phase of Re-Conditioning ●

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Game Pace Acquisition

Gradual Return to Matches

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Control of Minutes on the Court

●

Player Efficiency Ratings (PER)

(Adapted from Arden et al, 2016; Siu et al, 2020)

Basketball: Re-Conditioning After Injury

Return to Performance - II ACTIVITIES: Intensive and Extensive ●

Introduce long accelerations \ decelerations ●

●

Running speeds

Acc\Dec demands (playing positions) ●

Jumps \ Landings + SSCG

ENDURANCE: aerobic and anaerobic STRENGTH: power and power endurance (Adapted from Taberner et al, 2019)

Basketball: Re-Conditioning After Injury

Gradual Performance Activities Overview Metabolic Training

Strength Training

Linear Running

Isometric Training

Short Accelerations \ Decelerations

Anatomical Adaptation

Medium Accelerations \ Decelerations

Hypertrophy + Maximal Strength

Changes of Direction

Jumping + Landing Preparation

Long Accelerations \ Decelerations

Power + Power Endurance

Running Speeds 1)- Aerobic and 2)-Anaerobic Small-Sided Conditioning Games

(Adapted from Taberner et al, 2019; Taberner et al, 2019a)

Basketball: Re-Conditioning After Injury

Periodization - I Periodization in the Re-Conditioning Process

Linear Model

Non-Linear Model

(Adapted from Lorenz & Morrinson, 2015; Kakavas et al, 2020)

Basketball: Re-Conditioning After Injury

Periodization - II LINEAR Model ● a

Basketball: Re-Conditioning After Injury

Periodization - III NON-LINEAR Model ● a

Basketball: Re-Conditioning After Injury

Training Load - I Monitoring Training Loads During Re-Conditioning Process

●

EXTERNAL EXTERNAL LOAD: LOAD:

1)- Volume, intensity, density, frequency and complexity; 2)- Distance traveled, number of accelerations, number of decelerations, number of changes of direction, number of jumps, average speed, playerload, etc.

(Adapted from Gabbett, 2020; Petway et al, 2020)

Basketball: Re-Conditioning After Injury

Training Load - II Monitoring Training Loads During Re-Conditioning Process

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INTERNAL INTERNAL LOAD: LOAD:

1)- OBJECTIVE: Heart rate, lactate, creatine phosphokinase, testosterone\cortisol ratio, VO2max, etc 2)- SUBJECTIVE: RPE, monotony index, strain index, wellness questionnaire, TQR questionnaire, etc

(Adapted from Fitrianto et al, 2018; Paulauskas et al, 2019; Gabbett, 2020; Petway et al, 2020; Brini et al, 2020)

Basketball: Re-Conditioning After Injury

Training Load - III Monitoring Training Loads During Re-Conditioning Process ACWR (acute:chronic worloadratio): ratio): ACWR (acute:chronic workload

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1)- Acute Training Loads (weekly basis) - FATIGUE 2)- Chronic Training Loads (3-6 weeks) - FITNESS SAFETY Zone ~0.8-1.3

RISK Zone ≥1.5 The 10% rule (≤10-25%) - ?

(Adapted from Gabbett et al, 2016; Gabbett, 2020a; Gabbett, 2020b)

Basketball: Re-Conditioning After Injury

Training Load - IV Monitoring Training Loads During Re-Conditioning Process ●

Muscle injuries

Errors and\or Spikes in Loads: ~1-2 weeks ~3 weeks

Tendon injuries

~3-4 weeks

Bone injuries (Adapted from Tibana et al, 2017)

Basketball: Re-Conditioning After Injury

Training Load - V Monitoring Training Loads During Re-Conditioning Process

Load DISTRIBUTION

Load CONTROL

Plan the Program

Monitor Responses (Adapted from Meneses, 2020)

Basketball: Re-Conditioning After Injury

Progression Criteria - I Pain Tolerance

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Load Tolerance Strength + Neuromuscular Control Aerobic and Anaerobic Capacity Range of Motion

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●

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Joint Stability Tenderness Inflammation or Swelling Effusion

"Injury Type-Dependent"

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●

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Girth Other

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(Adapted from Creighton et al, 2010; Bahr et al, 2012)

Basketball: Re-Conditioning After Injury

Progression Criteria - II (1)- Health Status

(2)- Participation Risk

- Athlete Demographics; - Symptoms; - Medical History; - Physical Exam; - Lab Tests; - Functional Tests; - Psychological State; - Potential Seriousness

- Demands of Sport; - Position Played; - Limb Dominance; - Competitive Level; -Ability to Protect

(3)- DecisionMaking

- Season Period; - Pressure from Player; - External Pressure; - Masking the Injury; - Conflict of Interest; - Fear of Litigation

(Adapted from Creighton et al, 2010)

Basketball: Re-Conditioning After Injury Relationship Between Physical Fitness and Injury Symptoms Hypothetical Model of the Relationship Between Physical Fitness (yellow line) and Injury Symptoms (red line) in the Three Phases of Re-Conditioning

Return to Training

Return to Sport

Return to Performance

Basketball: Re-Conditioning After Injury

Return to Performance Duration Injury Type

RTP Duration ● a(weeks)

Authors

Achilles tendon rupture

~40-80

Lemme et al, 2019; Carmont et al, 2020; Siu et al, 2020

Soleus muscle strains

~5

Pedret et al, 2015

Ankle sprains

>4

McKeon et al, 2014

ACL rupture

~24-60

Lohmander et al, 2007; Nagano et 2011; Brophy et al, 2012; Oiestad et al, 2018; Wellsandt et al, 2018

Repair of the rectus abdominis and adductor longus

~5

Short et al, 2016

Hamstring strain

~1->5

Cohen et al, 2011; Reurink et al, 2014

Adductor strain\tear

~4-9

Patel et al, 2020

Shoulder subluxations\dislocations

~3-8

Lu et al, 2020

Cervical, thoracic, and lumbar spine injuries

~12-48

Huang et al, 2015

Hand and finger fracture

~4-17

Morse et al, 2017

Concussions

~1-3

Patel et al, 2019

Basketball: Re-Conditioning After Injury

Risk of Injury After Return

Recurren ce risk

RECURRENCE RISK (muscle strains)

↑

15 weeks after return to performance

Week since return to performance

(Adapted from Orchard et al, 2020)

Basketball: Re-Conditioning After Injury

Final Considerations - I ●

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Re-conditioning is a gradual process of returning to competitive activity after an injury;

There are three phases in the re-conditioning process: 1)return to training, 2)- return to sport and 3)- return to performance; ●

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The process involves being athlete-centered and dependent on the type of injury;

It is important to prescribe appropriate activities for each phase and monitor training loads; Observing the progression criteria would minimize errors in decision making.

Basketball: Re-Conditioning After Injury

Final Considerations - II ●

THANKS!!!

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E-Mail: avretaros@gmail.com