Injury Prevention, Dynamic
Warm-ups and Concussion
Management
George Lampron, PT, DPT
Caitlin O'Connor, MS, LAT, ATC
George Lampron, DPT
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Played for University of South Carolina Gamecock Ultimate
2007-2011
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Graduated from U of SC 2011
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Graduated from Midwestern University with DPT degree in 2014
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Played for Beachfront Property 2011-2013
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Cash Crop 2016
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Trained in Dry needling with continued education in managing
athletes and running mechanics
Caitlin O'Connor, MS, LAT, ATC
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Graduated from University of Connecticut in 2006
(BS in Athletic Training) and NC State in 2008 (MS
in Sports Management.
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Has worked as an outreach AT for Select Physical
Therapy since 2008.
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Area Sports Medicine Coordinator since 2011.
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Has worked with athletes of all ages, but focused on
concussion management of MS and HS athletes.
Injuries in Ultimate
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Ultimate is a unique
combination of endurance and
explosion
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This blend increases risk for
soft tissue injuries (sprains
and strains)
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Repeated loading with poor
mechanics increases injury
risk
Injuries in Ultimate
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Overall incidence of ACL
injuries in people up to 20 is
121 out of 100,000
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Has risen 2.2% annually over
the last 20 years
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Females 3-8 times more
susceptible than males playing
the same sport
Why the increase in ACL
Injuries?
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Some evidence with female athletes of skeletal
causes
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Main cause is biomechanical
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Poor performance of squatting, jumping, cutting,
and landing leading to abnormal forces at the knee
joint
Common Mechanical Faults
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Increased knee valgus
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Increased anterior tibial translation
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Increased ankle pronation
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Decreased hip mobility
Knee Valgus
Anterior
translation of
the tibia
Usually accompanied by
increased valgus and
increased lumbar flexion
Limited Hip Mobility
Leads to increased anterior
translation, decreased glut
activation
Ankle Pronation
Leads to knee valgus
increasing risk for injury
So, What do we do?
Start with training the squat
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Simple correctives using
cueing and bands
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Practice squatting "the right
way"
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Knees over toes, butt back,
chest high
Increase Glut Activation and
Strength
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These common deviations
lead to increased quad
activation and decreased
activation of glut and
hamstrings leading to
abnormal forces at the knee
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Fixing mechanics is the big
thing, but also need to
increase strength
Dynamic Warm-ups
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Static stretching has been proven to decrease
muscle strength for the next 30-60 minutes
following stretching
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Dynamic stretching pre-activity 5-10 sec holds
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Static stretching post-activity
Dynamic Warm-up Goals
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Increase muscle elasticity
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Promote glut and hamstring activation
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Increase blood flow to posterior chain muscles
Dynamic warm-ups, how do
we do it?
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Begin with light jogging
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Include squatting and hip hinging
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Introduce dynamic activities in a controlled way,
increase intensity as you go
What does it look like?
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Jog
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Hip flexor and pigeon stretching
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SQUATS
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Walking lunges forward and sideways
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Walking SLDL
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Walking leg swings
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High knees and butt kicks
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Side steps and push offs
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Broad jumps
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Thrusters
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Go-Go-Go
Concussion Management
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From WebMD- Definition of concussion: “A
concussion is a type of traumatic brain injury that is
caused by a blow to the head or body, a fall, or
another injury that jars or shakes the brain inside
the skull.” CORRECT
•
When you google “What is a concussion?”:
“temporary unconsciousness caused by a blow to
the head. The term is also used loosely of the
aftereffects such as confusion or temporary
incapacity.” INCORRECT
Is it a bruise?
“Concussions do not kill
people, mismanagement of
concussions kill people”
- Dr. Kevin Guskiewicz – UNC Chapel Hill
SECOND IMPACT SYNDROME – when the brain swells
rapidly after a person suffers a second concussion when
the symptoms of the first have not resolved fully.
-extremely rare, but it is has been evident that symptoms will be
more severe and the athlete will have more residual effects if they
continue to exacerbate symptoms with activity.
Gfellar-Waller Concussion
Awareness Act- est. 2011
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Outlines the importance of education on concussions, emergency action in treating
concussions, and post-concussion protocol information.
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Mandatory for all NC public school systems.
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Main points:
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Any athlete who presents with one or more symptoms of a concussion may not remain in
or return to competition that day (Symptoms can take 24-48 hours to fully develop)
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Emergency room and urgent care physicians should not make clearance decisions at the
time of the first visit (see list of appropriate medical personnel)
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In order to clear an athlete an athlete should be completely symptom-free both at rest
AND with cognitive stress, then with full physical exertion.
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RTP protocol - 5 days!
Other key points…
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Important to limit school as well (you wouldn’t make an
athlete play Ultimate with a broken leg  don’t make them
learn with an injured brain) Physicians will typically provide
“Return-to-Learn” restrictions.
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Athlete should not begin RTP protocol unless symptom-free
for 24 hours and cleared by a licensed physician to begin.
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Athlete should not advance to the next stage of the protocol
unless they are symptom-free for 24 hours (if symptoms
return, they stop that stage and start again once symptomfree)
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Athlete should not return to competition until final signed
clearance by appropriate medical personnel.
Complete Rest or Active
Rest?
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Practice is immediate rest but there is not much empirical
evidence to show that cognitive and physical rest help TBI’s
recover quicker – that has been the standard of care.
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We do know that limiting the chances of a second impact
improve results/and keeping symptoms below a threshold
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Physical Therapy is effective in rehabbing concussions that
have unresolved symptoms after the first 7-10 days of
recovery.
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New evidence is showing that “multiple active rehabilitative
strategies” (Collins, M.W.) might be more effective- including
starting activity within 48 hours of diagnosis.
•
More research is needed
Any Questions?