Saas-Fee, March 9th 2016
Return to play/sport
Insights into a complex problem
Dr Boris Gojanovic
Health & Performance
Hôpital de La Tour, Meyrin, Switzerland
[email protected]
@DrSportSante
www.drsportsante.com
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Boris
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RTP
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Consensus RTP Bern 2015
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What is RTP/RTS ?
Important to define:
• Level of competition
• Return to what: play «sports», competition, previous level,
continued progress
• Return for how long= RTP sustainable?
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How this talk will affect your
knowledge or practice re: RTP
You will know more about how to
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Ride The Pachyderm
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@adammeakins
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BJSM March 2015;49(6)
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Different, different, but….same
ACL
Muscle
Concussion
Overuse
RED-S
Infectious
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#ACL
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RTP - What are we talking about ?
100%
75%
50%
RT Sports
82% 81%
RT pre-injury level
63% 65%
55%
44%
RT Competitive level
65%
38%
<24m
>24m
Ardern C et al, BJSM 2014;48:1543
Ardern C et al, BJSM 2011;45:596
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2014
2011
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The ACL RTP story
1.0
6-9-12
months
Movement
quality
3.0
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ROM
Swelling,
pain, laxity
Strength
quads/hams
LLSI
Power &
balance
Hop tests
Psychol.
factors
2.0
Scores
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Survey experienced surgeons – Petersen
Criteria for return to play
Use of clinical score
Petersen, Arch Orthop Trauma Surg 2103;133:959
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Return to Competition Score - RTCS
• Isokin, isometric, power (SJ, CMJ)
• Hops (1, 3), drop jump
• Stabilometry
• Clinical: swelling, ROM
• KOOS-SAS
• Subjective (by tester) movement
evaluation
Kalberer et al, Schw Z Sportmed Sporttrauma 2013
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Muscle injury - #Hamstring
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Time to RTP prediction
Hamstring acute pain (history injury, palpation, stretch, contraction, +MRI).
Mean time to RTP = 44±18 days,
 95% of athletes RTP between 8 and 80 days (mean ± 2*SD)
10 20 30 40 50 60 70 80
injury
No element can help
predict it more
accurately in this study
RTP
Moen MH et al, BJSM 2014;48(18):1358
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Try to tell Christian…
«After my scientific analysis
based on research, my
estimation is the player has a
95% chance of RTS within a
time frame of 1 to 50 days (but,
on average, 24 days).
You understand that it is not
easy…»
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Can MRI be predictive ?
Time to RTP
NO
MRI edema volume
Wangensteen Arnlaug et al, BJSM 2015;Aug 24
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INJURY
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RTP
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Askling-H test
1. Maximal slow active extension
2. Very fast ballsitic test
Symptoms?
Askling CM et al, KSSTA 2010;18:1798
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Shrier I et al, BJSM May 2015
Step 1 – Tissue health
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Step 2 – Tissue stress
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Step 3 – risk tolerance
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Overuse
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Restoring the balance
Managing Load progression
Training stress balance
Banister model (1975)
Tissue/neural adaptation
Halson S, Sports Medicine 2014;44(2)S139
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By Ben Clarsen, au Aussie in Norway
Introduces
the idea of
RFP
Removal
from play
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Whose decision – Ian Shrier
1.
2.
Shrier I et al, BJSM 2014;48:394
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Rational
Emotional
Accuracy (Dx)
Road map
Protocol
Tools
Measures
Integration
Scores
Monitor
Quality control
Risk assessment
Athlete
Readiness
Fear, confidence
Relatedness
Elite sports
Media, Fans
Coach
Nations
Management
Sponsors
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«Switch» by the Heath brothers
(2010)
The fallacy of decision-making is that one
can rationally steer the elephant.
Chip & Dan Heath advise us to:
1. Direct the rider
2. Motivate the elephant
3. Shape the path that the pair must follow
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Future path is made of…
1. Athlete motivation, social & psychological factors
Ardern CL et al, BJSM 2013;47:1120
 profiling, coping enhancement
2. Specific testing with use of modern wearables
 on field, improve fear of re-injury & self-confidence
3. Big data analysis of individual athlete characteristics (pre/post)
4. HuManagement (thanks Robin Sadler!)
5. Team dynamics
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Can you wait one more month, please ?
At 6 month post surgery, every
month you wait before allowing RTP
=
24 % reduction re-injury
Havard Moksnes
24%...PER MONTH
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Or a few months to come back stronger?
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RTP
Luck Cash
Protection Equipment
Nutrition Alternative
Right load Big picture
Team support Empowered staff
Fitness level Health literacy
Attitude
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Injury as an opportunity
1. Work on aspects little or not trained until then
(technique, education in sports, nutrition, mental)
2. Personal development (school, studies, professional or
private/family project)
3. Social/community development  image, brand &
contribution
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Time…
Rarely is it spoken about, but
athletes can «benefit» from an
injury in different ways
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Monitoring et visualisation hebdomadaire de la progression du RTP
Teamwork
Not only for team sports
Sports medicine (includes all
healthcare professionals) and
sports science need to wirk
together
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The key 5 points of RTP
1.
2.
3.
4.
5.
RTP = attitude
Injury = opportunity
Teamwork  communication
Plan = essential  management
Athlete = partner at the centre
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Yaf2017.org
@YAFfoundation
Robert Malina
Evert Verhagen
Asker Jeukendrup
Karim Khan
Lars Engebretsen
Mario Bizzini
Jason Gulbin
Franck Chotel
Rintje Agricola
Grégoire Millet
Marco Cardinale
Neeru Jayanthi…
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Thank Thank you
4245
T - @DrSportSante
T - @SwissSportsMed
(compte officiel SSMS)
W - www.drsportsante.com
E – [email protected]
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