Sport injury prevention and rehabilitation

Sports Injury Prevention and Rehabilitation World-class preparation and rehabilitation of the injured athlete integrates best practice in sports medicine and physical therapy with training and conditioning techniques based on cutting-edge sports science In this ground-breaking new book, leading sports injury and rehabilitation professionals, strength and conditioning coaches, biomechanists and sport scientists show how this integrated model works in practice across the full spectrum of athlete care, from the prevention of sports injury to the assessment and treatment of injuries, and the design and implementation of effective rehabilitation programmes Crucially, in every chapter, there is a sharp focus on return to performance, rather than just a return to play The book introduces evidence-based best practice in all the core functional and professional areas of sports injury prevention and management, including: • • • • • • • • • • the performance framework for rehabilitation; end-stage rehabilitation, testing and training for a return to performance; performance frameworks for medical and injury screening; the psychology of injury and rehabilitation; developing core stability and flexibility; assessment of training and rehabilitation loads; performance retraining of muscle, tendon and bone injuries; recovery from training and rehabilitation; the influence of pain on performance; running, throwing and landing mechanics and their contribution to injury and performance Every chapter is set up as a masterclass from world-leading practitioners from a range of elite sports teams and is written to have real-world application Chapters contain best practice protocols, procedures and specimen programmes designed for high performance, with examples drawn from a wide range of individual and team sports No other book examines rehabilitation in such detail from a high-performance standpoint, and therefore Sports Injury Prevention and Rehabilitation is essential reading for any course in sports injury, sports therapy or sports medicine, and for any clinician, physical therapist, coach or sport scientist working to prevent or rehabilitate sports injuries David Joyce is an athletic performance and rehabilitation specialist who has worked at the highest levels of world sport and with multiple national, world and Olympic champions He holds masters degrees in both sports physiotherapy and strength and conditioning and has worked at two Olympic Games as a physiotherapist and performance coach (with Team Great Britain at the 2008 Olympics in Beijing and with Team China at the 2012 Olympics in London) He has also worked in elite rugby (Western Force, Hull FC and Saracens) and football (Blackburn Rovers and Galatasaray SK) He is the co-editor and key contributor of High Performance Training for Sports, presents internationally on high-performance management and injury rehabilitation, and lectures on the Masters of Strength and Conditioning course at Edith Cowan University in Perth, Western Australia David is currently the Head of Athletic Performance at the Greater Western Sydney Giants in the Australian Football League and lives in Sydney, Australia Dan Lewindon graduated with a BSc (Hons) in physiotherapy from Nottingham University in 2000 He spent three years working in the National Health Service, gaining experience in all aspects of physiotherapy, before seeking expertise in his chosen field of sports medicine Dan joined Northampton Saints RFC in 2003, working full time with the Senior Team and progressing to the Lead role in 2008 He completed an MSc in sports medicine at Queen Mary’s University of London in 2007 and a second MSc in exercise science (strength and conditioning) at Edith Cowan University in Australia in 2011 Dan was appointed Physiotherapist for the England Senior Rugby Team in 2009 and now works with them full time Dan is the co-editor of and key contributor of High Performance Training for Sports and through his work has developed particular interest and expertise in lower limb and soft tissue injury and rehabilitation Dan has lectured internationally in injury screening, rehabilitation and prevention strategies and lives in Market Harborough, England Sports Injury Prevention and Rehabilitation Integrating medicine and science for performance solutions Edited by David Joyce and Daniel Lewindon First published 2016 by Routledge Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 D Joyce & D Lewindon The right of D Joyce & D Lewindon to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988 All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Sports injury prevention and rehabilitation : integrating medicine and science for performance solutions / edited by David Joyce and Daniel Lewindon pages cm Includes bibliographical references and index Sports injuries—Prevention Sports injuries—Patients— Rehabilitation I Joyce, David, 1976– editor II Lewindon, Daniel, editor RD97.S658 2016 617.1′027—dc23 2015024428 ISBN: 978-0-415-81505-5 (hbk) ISBN: 978-0-415-81506-2 (pbk) ISBN: 978-0-203-06648-5 (ebk) Typeset in Baskerville by Apex CoVantage, LLC Contents List of contributors ix PART The performance team Reconditioning: A performance-based response to an injury (Bill Knowles) Strength and conditioning in injury prevention and rehabilitation (Ben Rosenblatt) 11 Psychology in injury prevention and rehabilitation (Tig Calvert) 22 Nutrition in injury prevention and rehabilitation (Matt Lovell) 31 PART Athletic competencies 43 Medical assessment and pre-participation screening (Mike Bundy and Lisa Hodgson) 45 The injury risk profiling process (David Joyce and Dan Lewindon) 62 Assessing and developing the kinetic chain (Ian Prangley) 77 Assessing athletic qualities (Nick Winkelman) 95 Running mechanics in injury prevention and performance (Frans Bosch and John IJzerman) 106 10 Landing mechanics in injury prevention and performance rehabilitation ( Julie Steele and Jeremy Sheppard ) 121 11 Throwing mechanics in injury prevention and performance rehabilitation (Steve McCaig and Mark Young) 139 vi Contents 12 Core stability in injury prevention and performance (Lee Burton and Gray Cook) 153 13 Flexibility in injury prevention and performance (Anthony Blazevich) 169 PART Injury processes, prevention and return to performance 179 14 Muscle injuries (Dan Lewindon and Justin Lee) 181 15 Tendon injuries (Craig Ranson, David Joyce and Polly McGuiggan) 199 16 Bone injuries (Henry Wajswelner and Sophia Nimphius) 212 17 Pain and performance (David Joyce and David Butler) 223 18 Determining return to play (Calvin Morriss and Phil Pask) 232 PART Managing the injured athlete 243 19 The athletic neck (Kay Robinson) 245 20 The athletic shoulder (Ian Horsley and Ben Ashworth) 259 21 The athletic elbow (Adam Olsen and Mike Reinold ) 274 22 The athletic spine (Tim Mitchell, Angus Burnett and Peter O’Sullivan) 289 23 The athletic hip and groin (Enda King) 307 24 The athletic knee (Chris Mallac and David Joyce) 322 25 The athletic shin (Andy Franklyn-Miller) 337 26 The athletic foot and ankle (Dan Lewindon and David Joyce) 346 PART Managing the training athlete 371 27 Managing pre-season and in-season training (Raphael Brandon) 373 28 Monitoring training load (Stuart Cormack and Aaron Coutts) 380 29 Optimizing athlete recovery (Christian Cook, Liam Kilduff and Blair Crowther) 392 30 Environmental stress – heat and altitude (Chris R Abbiss) 401 Contents vii PART Special considerations 413 31 The developing athlete (Ian Jeffreys) 415 32 The female athlete (N Travis Triplett and Margaret Stone) 429 33 The travelling athlete (Shona Halson and Emidio Pacecca) 436 Index 445 This page intentionally left blank Contributors Chris R Abbiss, Associate Professor – Physiology, and Postgraduate Course Coordinator, Exercise and Health Science, Edith Cowan University, Australia Ben Ashworth, First Team Physiotherapist, Arsenal Football Club, UK Anthony Blazevich, Associate Professor in Biomechanics, Director of Centre for Exercise and Sports Science Research, Edith Cowan University, Australia Frans Bosch, International Sports Performance consultant and lecturer, Fontys University, Netherlands Raphael Brandon, Head of Science and Medicine, England and Wales Cricket Board, UK Mike Bundy, Consultant in Sports and Exercise Medicine, Pure Sports Medicine, UK Angus Burnett, Project Manager, Sports Spine Centre, Aspertar, Qatar Orthopaedic and Sports Medicine Hospital, Qatar Lee Burton, President, Functional Movement Systems, USA David Butler, Director, Neuro Orthopaedic Institute, Australia; Adjunct Senior Lecturer, University of South Australia, Australia Tig Calvert, Independent Sports Psychologist, UK Christian Cook, Professor, Sports Science, Bangor University, UK; Technical Advisor, Rugby Football Union, UK Gray Cook, Founder, Functional Movement Systems, USA Stuart Cormack, Senior Lecturer, School of Exercise Science, Australian Catholic University, Australia Aaron Coutts, Professor of Sport and Exercise Science, University of Technology Sydney, Australia Blair Crowther, Research Associate, Hamlyn Centre, Imperial College London, UK Andy Franklyn-Miller, Consultant in Sports and Exercise Medicine, Sports Surgery Clinic, Dublin, Ireland Shona Halson, Senior Physiologist, Australian Institute of Sport, Australia 438 Shona Halson and Emidio Pacecca have early starts) Finally, it is advisable to avoid fatigue as much as possible before departure, focusing instead on optimising sleep pre-departure During travel There are several modifiable elements to acknowledge when travelling By optimising nutritional input and minimising musculoskeletal tightness, we can reduce the detrimental effects of travel The main elements to consider are listed below Nutrition and diet (meal timing, hydration) Dehydration is a pertinent issue with long-haul flights due to the changes in cabin air pressure and air quality Increased carbon dioxide concentration, increased ventilation rate, and a low relative humidity (10–20 per cent) with a subsequent reduction in ambient moisture have been demonstrated in commercial flights.5 This results in an increased rate of evaporation of fluid from the upper respiratory tract In combination with the increased ventilation rate, the increased fluid loss associated with evaporation needs to be replaced to prevent dehydration It is advised that an 80kg male consume 100–150ml per hour This can be in the form of water, energy drinks, fruit juice, soft drinks and hot drinks Whilst it is preferable to use water as the main source of fluids, variety is also important to ensure adequate intake Juices and sports drinks can contain high levels of sugar and are energy dense Caffeinated drinks can affect sleep, so it is advised that this is taken into consideration in terms of timing If, for example, it is late evening at the destination, having a coffee on the flight has the potential to inhibit sleep on the plane and can therefore delay the adjustment to local time Strategies to prevent musculoskeletal tightness and minimise risk of thromboembolic events Vascular thromboembolic events (VTE) are considered one of the major health problems that can be associated with flying.6 Deep vein thrombosis (DVT) and pulmonary embolisms (PE) are the two most common VTEs A number of risk factors for VTE relating to travel have been identified, including: the length of travel (2.3-fold risk with flights over hours), age of 40 years or older, women who use oral contraceptive drugs, lower-limb varicose veins, obesity (BMI> 30) and genetic thrombophilia.6 Methods to prevent VTE during flights include: avoiding dehydration, improving sitting position (allowing for legs movement/exercises), activity on the aircraft, such as walking, and preventing venous blood stasis by wearing graduated compression stockings (GCS).6 Pharmacological prophylaxis may be required in high-risk travellers Frequent movement of the ankles and knees assists in circulation to the lower limb For long-haul travel we recommend that the athletes perform 5–10 mins of walking and stretching every 1–2 hours whilst awake This reduces the risk of VTE and minimises post-travel tightness and stiffness Muscle/nerve stimulation devices have been suggested to increase venous velocity and blood flow in deep veins Whilst no studies have demonstrated the positive effects on performance or reduction in VTE risk, any changes in blood flow may be of benefit Graduated compression stockings (GCS) have been shown to reduce the risk of VTE by almost 90 per cent in standard risk patients.6 While many athletes like to wear full-leg The travelling athlete 439 compression tights, we recommend wearing properly fitted, below-knee GCS, providing 15–30mmHg of pressure at the ankle It is possible that the full-leg compression tights that finish at the ankle may act as a tourniquet around the ankle if not fitted properly and thus may increase venous pooling Compression garments can reduce the risk of DVT and reduce the swelling that can occur in the lower leg during travel Upon arrival In order to transition effectively into the time zone there are several considerations to be addressed, specifically regarding light exposure, sleep hygiene and nutrition Light exposure or avoidance Light is one of the most powerful means of altering circadian rhythms,1 and strategic exposure to or avoidance of light at specific times can help speed resynchronisation of the body clock A number of websites as well as smartphone applications are available to assist with making calculations regarding specific timing of light exposure or avoidance Figure 33.1 is an example of a light-avoiding and light-seeking schedule for travel from Barcelona to Rio de Janeiro Light exposure is one of the best ways to speed adaptation to the new time zone Artificial light can be particularly effective and seasonal affective disorder light devices (wavelength of 450–480nm) at approximately 1,500 lux are often utilised Further, when it is difficult to avoid natural sunlight, light-blocking glasses designed to block 80–98 per cent of light in the blue range are recommended.3 Figure 33.1 Example of a light-avoiding and light-seeking schedule for travel from Barcelona to Rio de Janeiro 440 Shona Halson and Emidio Pacecca Melatonin Another powerful means of body clock adjustment is melatonin Melatonin is a hormone which, when secreted endogenously, facilitates and reinforces sleep.1 Exogenous melatonin influences the timing of the body clock and promotes sleepiness or sleep itself by providing a biological signal for night and day.1 Melatonin aids phase advancement when taken in the evening (eastward travel) and phase delay when taken in the very late evening or morning (westward travel).7 A Cochrane Review from 20028 recommended that melatonin may be used in adults when travelling across five or more time zones and potentially when crossing as few as two Doses of 0.5–5mg were similarly effective, though higher doses were more effective at inducing sleep It is important that athletes seek medical advice before taking melatonin and that a WADA sanctioned product is taken to avoid an inadvertent positive doping test Sleep hygiene Sleep is an extremely important part of performance and recovery It is essential that good sleep habits are maintained whilst travelling Setting up an optimal sleep environment can ensure good sleep and assist in overcoming jet lag The key points for an optimal sleep environment are: • • • • Darkness – ensure the windows are covered with block-out blinds Eye masks are an alternative option Noise – arrange a room where there is minimal outside noise (away from street traffic) Earplugs are also useful Avoid stimulants such as caffeine in the hours prior to sleep, as well as excessive ingestion of fluid Routine – perform a pre-sleep ritual to prepare your body for sleep This may be as simple as reading a book for 10 mins and avoiding the use of computers and smart phones in the 30 minutes prior to sleep Nutrition and hydration Maintaining adequate dietary and fluid intake is important in minimising the detrimental effects of travel and ensuring a swift return to optimal performance levels Challenges to this include: • • • • • Reduced energy needs on transit days ‘Downtime’ with increased opportunity for ‘boredom-eating’ Altered training schedules and limited access to food (especially snacks) Different foods and language barriers Timing of training/competition and scheduling of meals Poor food choices whilst away from home can result in reduced energy levels, impair muscle repair and lead to muscle atrophy and strength decay, plus gains in body fat, compromised immunity and dehydration Itineraries, changes in time zone, athlete appetite and accessibility to food can influence timing of meals whilst travelling The travelling athlete 441 Table 33.1 Practical recommendations for travel prior to, during travel and upon arrival Practical Application Key points for travel from Paris to Tokyo (Flight time 12 hours West to East with +7-hour time change) Prior to travelling: • If possible, choose a departure time late afternoon/evening to arrive mid-afternoon in Tokyo • Prepare meal plan for flight • Purchase drinks once you have gone through security checks.You should be looking at drinking 2–3 litres during the 12-hour flight Flight: Departing Paris 18:00, arriving Tokyo 12:20 (+1): • Put on compression socks • Change your watch forward hours • Eat dinner shortly after take-off • Relax and try to go to sleep Wear eye mask and earplugs if comfortable • After waking, walk around the cabin and perform some dynamic and static lower limb stretches for 5–10 mins Stairs can be useful to allow a greater variety of stretches • Continue to walk and stretch for 5–10 mins every 1–2 hours for the remainder of the flight • Eat snacks until lunchtime • Continue snacking and hydrating for the remainder of the flight On arrival (14:20 local time): • Exposure to sunlight is advised up until p.m., so it is recommended to go for a walk or easy jog outside that afternoon If there is access to a pool or beach, then some dynamic stretching and walking in the water is beneficial • Stay awake until or p.m • Continue to hydrate • Commence eating meals according to local time Following day: • You may wake up early but try to stay in bed until daylight • Light exercise in the morning and afternoon As we have said, it is important to adjust to the new time zone as quickly as possible, and eating appropriate food types at appropriate times can assist with this For example cereal for breakfast and a meal high in carbohydrates prior to sleeping can encourage a transition in time zone Overall, it is important for the athlete to maintain sufficient nutritional input, so travelling with snacks is a useful idea Cereal bars, fruit, sandwiches and nut mixes are good options, but care needs to be exercised to avoid boredom eating Having a well-planned menu including snacks can help alleviate this issue Table 33.1 represents an example of advice for pre-travel, during travel and upon arrival Medical considerations for travel When travelling, there is an increased risk of infection due to a variety of issues including air quality on flights, fatigue and change of climate There can be an increased risk of infection and exposure to diseases that may not be as prevalent as at home Vaccinations are advisable prior to travelling It is best to consult a doctor prior to departure to assess the individual risks for the athlete when travelling to specific countries The current World Health Organisation (WHO) guidelines regarding vaccinations are as follows: 442 Shona Halson and Emidio Pacecca Routine vaccination • • • • • • • • • • • • • • • Diphtheria Hepatitis B Haemophilus influenza type b Human papillomavirus Seasonal influenza and influenza A (H1N1) Measles Mumps Pertussis Rubella Pneumococcal disease Poliomyelitis (Polio) Rotavirus Tuberculosis (TB) Tetanus Varicella Selective use for travellers • • • • • • • • Cholera Hepatitis A Japanese encephalitis Meningococcal disease Rabies Tick-borne encephalitis Typhoid fever Yellow fever Prior to departing, it is important to have a concise history of athletes’ past medical history, allergies and medication usage It is also advisable to have next-of-kin details in case of medical emergency Certain allergies may require the administration of an ‘epipen’ and a method of transporting and carrying the ‘epipen’ in proximity of the athlete Divulging relevant athlete medical history to coaches, team managers and fellow players is an ethical consideration For example, if a player is diabetic or epileptic, it can be important that there is appropriate assistance provided in case of a seizure Athletes are therefore encouraged to disclose such information in order to minimise risk of adverse reactions Adequate medical supplies should be prepared Depending on location, it can be difficult to source certain supplies, so it is advised that doctors, therapists and trainers travel with a basic first aid kit comprising of disinfectant, plasters, scissors, bandages and paracetamol A sport-specific kit and equipment should be included Table 33.2 below illustrates a list of basic stock and equipment Additional sports-specific items should also be included, e.g additional wound dressings for cycling Portable cryotherapy can vary from ice bags through to compression/cryotherapy units These are particularly important in the acute management of injuries Medical practitioners travelling with athletes/teams need to consider travelling with medication As different countries can have medications with different generic names, it can sometimes be difficult to correctly identify certain medications, especially in countries with foreign The travelling athlete 443 Table 33.2 Example of medical travel kit and supplies Kit and Supplies Strapping tape Scissors Treatment table Adhesive Spray Tape remover Crutches Massage cream Hand sanitiser Cryotherapy/heat apparatus Acupuncture needles Gauze Blister care Compressive stockings Petroleum jelly Assorted splints/slings Medicines Gloves Self-treatment items (massage balls, stretch bands, foam rollers, resistance tubing) languages This can raise issues concerning anti-doping It can be advisable that medical practitioners travel with a certain amount of medication to avoid such issues Different countries have varying laws, rules and regulations regarding importation and traveling with prescription and non-prescription medication As all countries have different laws and regulations, it is strongly advised that the appropriate local authorities are contacted prior to travelling Most will require a detailed inventory of medications being carried and limitations of amounts and types Always pay careful attention to the laws and regulations of other countries when travelling abroad Registration and insurance Prior to travelling, it is advisable that practitioners check with relevant authorities concerning the local registration laws and insurance implications Countries will vary on what treatment they allow visiting practitioners to perform Contacting relevant providers in the intended travel areas can assist with this It is useful to travel with a list of local hospitals, radiology departments, pathology services and dentists in case they are required Contacting the event organisers prior to departure can be of assistance in providing these contacts It is advised that the travelling practitioner contact their specific professional indemnity insurance provider to obtain a geographical extension to cover treatment of athletes in different countries Relevant registration boards should also be contacted to confirm registration requirements for practicing within that country for short or long periods of time For athletes, it is encouraged that they are aware of their travel or health insurance so that they are aware of what it covers in terms of injury and illness Summary Travel is an unavoidable aspect of sport for most athletes Minimising the detrimental effects of travel is imperative to optimising performance By understanding the effects of travel on performance and following these practical recommendations, the athlete can be adequately prepared to perform at their best, whilst reducing the risk of injury and illness 444 Shona Halson and Emidio Pacecca Notes Arendt, J (2009) Managing jet lag: Some of the problems and possible new solutions Sleep Med Rev, 13, 249–56 Leatherwood, W E., & Dragoo, J L (2013) Effect of airline travel on performance: A review of the literature Br J Sports Med, 47, 561–7 Samuels, C H (2012) Jet lag and travel fatigue: A comprehensive management plan for sport medicine physicians and high-performance support teams Clin J Sport Med, 22, 268–73 Forbes-Robertson, S., Dudley, E., Vadgama, P., Cook, C., Drawer, S., & Kilduff, L (2012) Circadian disruption and remedial interventions: Effects and interventions for jet lag for athletic peak performance Sports Med, 42, 185–208 Giaconia, C., Orioli, A., & Di Gangi, A (2013) Air quality and relative humidity in commercial aircrafts: An experimental investigation on short-haul domestic flights Building and Environment, 67(9), 69–81 Gavish, I., & Brenner, B (2011) Air travel and the risk of thromboembolism Intern Emerg Med, 6, 113–6 Lee, A., & Galvez, J C (2012) Jet lag in athletes Sports Health, 4, 211–6 Herxheimer, A., & Petrie, K J (2002) Melatonin for the prevention and treatment of jet lag Cochrane Database Syst Rev, 2, CD001520 Index ABCDE method 26, 28 acceleration: throwing 141 Achilles tendon 117, 210; tendinopathy 116, 199–200, 202, 203–4, 207–9 acid/base balance: nutrition, 34 adductors 72–3, 90, 109–10, 112–13, 115, 199, 203, 315–16, 318 Ader, Robert 23 aerobic and anaerobic energy system assessment 102 aerobic endurance: athlete development 420–1 afferent input: foot and ankle 352, 360 agility 101–2; foot and ankle 363–4 altitude: acclimation models 408–9; acute and chronic exposure 407; exercise and 406–10; illness, injury and performance risks 407–8; landings 133–6; nutrition 409; training 409, 410 amenorrhea: female athlete 432, 433 amino acids: rehab shake 35 ankle: brain response to sprained 224; landing technique 125–6; see also foot and ankle anorexia nervosa 433 anterior cruciate ligament (ACL): case study of rehabilitation of 17–20; core stability 153; injury 5–6, 12, 63; landing injury 129; neuromuscular control during landing 127–8; rehabilitation anti-catabolic agents: healing 37, 38 arginine 35, 37, 38, 39, 40 arm: throwing pain 139–40 arm cocking: throwing 140, 141 arrhythmogenic right ventricular cardiomyopathy (ARVC) 52, 53 arthrogenic muscle inhibition (AMI) 5–6, asymmetries: kinetic chain 88–90, 91 athlete recovery 392, 398–9; cold-water immersion (CWI) 392, 396, 399; compression garments 396; endocrine system 393, 394; hot-water immersion (HWI) 392, 396, 399; immune system 393, 394; light exercise 394–5; neuromuscular system 392; nutrition 396–7; physiological interactions 393–4; prescribing recovery programme 397–8; pyramid of tools 398; resistance exercise 392–3; soft tissue therapies 395–6; stretching 395 athletes: circulation and vasodilation 36–7; designing a landing training program 130–6; de-training timescales 373, 374; female 429–34; immune function 37; injury equation 63–4; injury-specific supplementation 39; management of bone stress 220–1; monitoring the returning 240; neck pain 246–7; nutrition for stabilising 32–6; pain and chronically injured 228; rebuilding 36–9; regeneration 37; returning to sport 27–8; stretching training 169, 176–7; targeted spine conditioning 301; travelling 436–43; see also long-term athlete development (LTAD) athlete sustainability program (ASP) athlete triad: female 432–4 athletic development 6–7, 424, 425 athletic foundation: long-term athlete development (LTAD) 422–3 athletic kinetic chain 77–8 athletic qualities: aerobic and anaerobic energy system assessment 102; agility 101–2; jump and hop assessment 98–9; maximal power 97–8; maximal strength 96; profile, 95; rate of force development 96–7; sprinting speed 100 balance performance: foot and ankle, 356–7 basal metabolic rate (BMR) 33, 38 biomechanical analysis: kinetic chain 82 biomechanical overload syndrome: anterior 338, 341–2; centre of mass 340; extrinsic risk factors 338; features of 337–8; kinetics 340; posterior 338, 342–3; posterior chain length 344; presentation of pain 338; rare cases 344; running kinematics and 339–40; 446 Index running re-education 341–3; shoe selection and shin pain 339; walk-to-run programming 343 biomechanical stress: non-plastic structures, 11–12 biomechanics: bone injury 218, 219; landings 121–9 body composition assessment 40 body cooling: heat and exercise 404–6 body positioning: female athlete 431 bone 212; classification of stress fractures 217; health assessment methods 214; management of stress injuries 220–1; pathopsychology of chronic stress 216; risk factors for injury, 218–20; strength 214; stress injury 215–16; structure of 212–14; supplementation 39 bone mineral density (BMD) 214 brain: pain as output of 223–4; pain neurosignature 225; rehabilitation of body and 229–30 branched chain/essential amino acids (BCAAs/EAAs) 32, 33, 35, 38 bulimia nervosa 433 cardiac MRI 53 cardiac screening 50–1 case studies: back pain in female hockey team 14–15; rehabilitation of ACL injury 17–20; soccer player assessment 72–4 catecholamines: athlete recovery 393, 394 cervical spine injuries (CSI): prevalence 245–6 chop-and-lift techniques: core 166 chronically injured athlete: pain and 228 chronic exertional compartment syndrome (CECS) 337 circulation: nutrition 36–7 citrulline 35, 37, 38, 39 closed chain (CC) rehabilitation: shoulder 264–7 cognitive functional therapy: spine 298–301 cold-water immersion (CWI): athlete recovery 392, 396, 399 competition performance 20 compression garments: athlete recovery 396 concentrated flavonoid extracts 34 conditioning: spine 294, 296, 301 continuous passive motion (CPM) contralateral arm mirroring 262 core 153–4; assessing competency 154–66; global core muscle performance 155, 156, 160–2; half-kneeling chop pass 160–1; keys to stabilization 167; kinetic chain 84–5; local core muscle performance 155–6, 162–6; medicine ball bounce 160, 161; movement pattern screening 155, 156; standing long jump 161–2; Y-balance test 156–9 cortical bone 212–14 cortisol 384; athlete recovery 393, 394 cortisol-modifying agents 40 countermovement jumps (CMJ) 385–6 creatine 35, 38, 40, 397 Crossed Syndromes 276 cryokinetics: foot and ankle 355 deceleration: throwing 141, 143 depth (drop) jump (DJ) 98–9 de Quervain’s disease 199, 203, 204 diagnosis: hip and groin 308–10 double-limb landings 122–3, 127 dual energy X-ray absorptiometry (DXA) 214 Dynamic Relocation Test (DRT) 262 Dynamic Rotary Stability Test (DRST) 262 eating disorders: female athlete 432, 433 eccentric bias essential 192 echocardiogram (ECHO) 52; 12-lead (ECG) 51, 52 elbow: biomechanics in sport 274–5; interval golf program 287; interval tennis program 286; interval throwing program 283, 284, 285; isometric strengthening 277, 278; plyometrics 278–83; rehabilitation 275–83, 285–7; Thrower’s Ten Program 276; throwing injuries 143–6 electrical stimulation: muscle injury 189–90 elite athletes: landing training program 130–6 Emotional Freedom Technique (EFT) 27 endocrine system: athlete recovery 393, 394 energy balance: nutrition 33 exercise: altitude and 406–10; body cooling 404–6; heat acclimation 404; heat and 401–5; heat gain and loss mechanisms, 402; tendinopathy management 207–8 exercise stress test 53 exit criteria: foot and ankle 353–4; muscle injury 194; neck assessment 255 explosive strength 97 external load 381 extracorporeal shock wave (ECSW) therapy: stress fractures 221 Eye Movement and Desensitisation and Reprocessing (EMDR) 27 fatigue: continuum 381; foot and ankle 360; jet lag 436–7; management 12; marker 383; muscle 79, 185; neuromuscular 385–6; throwing and 147; travelling athlete 436–7 fatty acids 35–6 Federer, Roger 79, 80 female athlete: amenorrhea 432, 433; biomechanical considerations 430–1; body positioning 431; disordered eating 432, 433; female athlete triad 432–4; hormones 431–4; Index 447 menstrual cycle 432; osteoporosis 432, 433–4; pregnancy 434; rate of force development (RFD) and power 430; strength and muscle development, 430; strength levels 429–30; training 429–30 fitness marker 383 flexibility training: athletes 169, 176–7; feedback tool 176; kinetic chain 85; periodisation of stretching 171–3; range-of-motion 169; sporting performance 170–1; stretching 169–71, 173–5 follow-through: throwing 141 foot and ankle: acute phase rehabilitation 351–2; agility 363–4; biomechanics 347–8; consequences of injury 348–9; cryokinetics 355; dynamism and ground reaction force 358–9; early afferent input 352–3; exit criteria 353–4; fatigue 360; functional kinematics 354–5; functional performance tests 361–2; impact-free rehabilitation 357–8; injury prevention 367–8; instability training 355–6; lateral and torsional stress 359–60; localized strength 357; mobile adaptor 348; motor control 360; occlusion training 361; positional variation 356; programme construction 350–1; proprioceptive/balance training 355; psychological support 353; rehabilitation 349, 350–67; return to performance 362–3, 365–6; running 347–8, 362–3; sand 359; structure 346–7; taping 366–7; testing limb symmetry 356–7; volume and load consideration 361; walking 347–8; weightbearing training 360 foot placement: running mechanics 116–19 foot posture: landing 127 force-time graph: landing 125 front foot contact (FFC): throwing 140, 144, 145 functional kinematics: foot and ankle 354–5 Functional Movement Screen 156 Functional Movement Systems (FMS) 155 functional performance: assessments 237–8; foot and ankle 361–2 functional stability threshold (FST) 259, 260 FUNdamental: athlete development 418 fundamental movement screen (FMS) 421 gender: bone injury 218 generic warning index (GWI) 64–5, 72, 73 gingko biloba 32, 37, 39 glenohumeral internal rotation deficiency (GIRD) 89, 148, 203, 263 glenohumeral joint (GHJ) 140, 259, 266 glutamine 35, 38, 40 gluteus maximus 117, 118, 196, 261, 313, 315 gluteus medius 85, 109, 315 gluteus minimus 313, 315 glycine 32, 33, 35, 39 golf: interval program 287 gravitational forces (Gz): neck injuries 245, 247, 249 green tea 32, 33, 34, 39 groin see hip and groin Groth, Samuel 86, 87 ground reaction force (GRF): bone 218–19; foot and ankle 346–7, 349, 358, 362; kinetic chain 83; knee 323–5, 328–9; landing 122–5, 127; maximal power 97; running 106, 108, 115; shin pain 338, 342 growth hormone (GH): athlete recovery 393, 394 hamstring: rehabilitation 17–20, 190, 191; running 112–13 healing process: anti-catabolic agents 38; meals supporting 33 heart rate: internal load measure 381–2 heart rate recovery (HRR) 383 heart rate variability (HRV) 383–4, 389 heat: acclimation 404; body cooling 404–6; exercise and 401–5; gain and loss mechanisms 402; illness, injury and performance risks 403–7 heel-off running 107, 108, 116–18 hip and groin: anatomical diagnosis 308–10; biomechanical assessment of 310–12; differential diagnosis 308; level performance 312, 313–16; level performance 312, 316–18; level performance 312, 318–19; level performance 312, 319–20; magnetic resonance imaging (MRI) 309–10; presenting problem 307–8; rehabilitation 312–20; return to competition 320 hips: landing technique 125–6; range of motion 313–14; running 118–19 hockey players: back pain in female 14–15 Holter test, 24-hour 53 holy basil 40 hop and stop: core 155, 156, 161–2 hormones: female athlete 431–4 hot-water immersion (HWI): athlete recovery 392, 396, 399 hydration: travelling athlete 438, 440–1 hypothalamic-pituitary-adrenal (HPA) axis, feedback system 23 ice: muscle injury 187 iliopsoas 89, 110–14, 118, 203, 308–9, 314–15 imaging 49: muscle injury 186; tendinopathy 204 imbalances: kinetic chain 88, 90, 91 immune action: support and stimulation 37, 38 immune system: athlete recovery 393, 394 448 Index jet lag: travelling athlete 436–7 joint position sense (JPS) 260, 264, 266 joint stress: kinetic chain 80 jump and hop assessment 98–9 landings: athlete training for injury prevention 129; biomechanics of 121–9; considerations for good technique 125–9; developing ability 133–6; mobility development 133; monitoring load 136; training program design for elite athletes 130–6; wrong 129 lateral and torsional stress: foot and ankle 359–60 lifting see Olympic lifting light exposure: travelling athlete 437, 439 limb symmetry: foot and ankle 356–7 load compromised athlete (LCA) 5–6; knee injury 334–5 load transfer: hip and groin 317 localized strength: foot and ankle 357 long-term athlete development (LTAD): aerobic endurance 420–1; athletic development 424, 425; athletic foundation 422–3; FUNdamental 418; models of 417–19, 422–7; motor skill development 419; optimal sports performance 415–16; performance actualisation 425, 426, 427; performance development 424–5, 426; physical literacy 419; rationale for 416–17; skilled performance 421; speed 420; strength 420; trainability of youth 419–21; training to compete 419; training to train 418; training to win 419; windows of opportunity 419–21 low back pain (LBP) 91, 289, 291–4, 296–7, 302 lower-limb, throwing 148–9 lysine 40 kinetic chain 77, 91; assessing 80; asymmetries 88–90, 91; biomechanical analysis 82; developing 83; flexibility training 85; hip and groin 316–17; imbalances 88, 90, 91; injury 79–80; knee 323–4; musculoskeletal screening 82, 83; neck as part of 250; performance 78–9, 81–2; plyometric training 84; sport-specific training 83–4; technical correction 85, 88; tests of 81; training movements 83–4; training the core 84–5; types and variations of athletic 77–8; weightlifting 84 knee: force-absorber and force-generator 322–3; kinetic chain 323–4; landing technique, 125–6; load-compromised athlete 334–5 knee rehabilitation: capacity to decelerate 330–1; phases of 324–34; protection and healing 325–7; reactivation of muscles 326–7; removing effusions 325–6; return to contact training 332–4; return to function 328–31; return to performance 331–4; sand-based training 331–2; strength and motion 327–8; trampoline drills 332 magnetic resonance imaging (MRI): hip and groin 309–10; muscle injury 186; tendinopathy 204 maximal power 97–8 maximal strength 96 medial tibial stress syndrome (MTSS) 337, 338, 342–3 medical examination: health screening 49; imaging studies 49; neurological screening 48–9; respiratory disease screening 48; travelling athlete 441–3 medical history, 47–8, 51–2; form, 54–9 medications: muscle injury 188 medicine ball throws: core 155, 160, 161 melatonin 437, 440 menstrual cycle: female athlete 432 mobile adaptor: foot and ankle 348 mobility development: landing technique 133 monitoring training load: biochemical markers 384; cortisol 384; countermovement jumps (CMJ) 385–6; data analysis 387–8; day-today application 388, 389; dose-response relationship 380–1; fatigue 381, 383; fitness impact-free rehabilitation: foot and ankle 357–8 inflammation: eating to support and regulate 34; fatty acids 35–6; immune system reaction 36; step-by-step guide 34 injured athlete: reducing anxiety in 25–6 injury: kinetic chain 79–80 injury performance: landing training 129 injury prevention 11–12, 28; assessing susceptibility 68–9; foot and ankle 367–8; muscle re-injury 195–6; neck 256; throwing 143–6 injury risk model 13–14; factors 13; training interventions 14 injury risk profiling 62–3; assessments 68–70, 73–4; case study 72–4; developing a screening tool 64–71; disrupting injury equation 63–4; generic warning index (GWI) 64–5, 72, 73; risk factors 67; screening frequency 71–2; specific warning index (SWI) 66, 73 in-season training 373; balancing training and recovery 374–6; strength and power strategies, 376–7 instability training: foot and ankle 355–6 insurance: travelling athlete 443 internal impingement: throwing 142–3 internal load: heart rate 381–2 Index 449 383; heart rate 381–2; heart rate recovery (HRR) 383; heart rate variability (HRV) 383–4; interpreting data 386–7; muscle damage 384; neuromuscular fatigue 385–6; physiological markers 383; quantifying 381; rating of perceived exertion (RPE) 382, 387, 389; salivary vs blood markers 385; testosterone 384; testosterone/cortisol ratio 385; wellness inventories 383 motor control: foot and ankle 360; spine 292–3 movement pattern screening: core 155, 156 movement proficiency: assessment 69–70, 74 movement training: spine 299–300 multidimensional speed and agility (MDSA) 9–10 multidirectional performance: hip and groin 318–19 muscle 183–4; architecture 183; damage 384; fibre type 183; function 181–2; injury process 184–5; pathophysiology 185; plasticity of 184; structure 183 muscle injury: acute phase 187–90; dynamic correspondence 192; eccentric bias essential 192; electrical stimulation and occlusion training 189–90; exit criteria 194; grading 186–7; hamstring rehabilitation 191; ice 187; loading 188; managing 187–95; preventing re-injury 195–6; progressive loading 190–4; reconditioning 193; repair 185; return to running 192; return to training and performance 194–5; role of imaging in 186; specific testing 194–5 muscle slack 112 muscle tendon junction (MTJ) 183–4 muscle tendon unit (MTU): as force amplifier 182; imaging 186; as shock absorber 182 musculoskeletal screening: kinetic chain 82, 83 musculoskeletal system: role of tendons 199–200 neck: assessment 248–9; characteristics of healthy 247–50; exit criteria 255; injury prevention 256; managing injuries 250–5; pain in athletes 246–7; part of kinetic chain 250; prevalence of injuries in sport 245–6; return to performance 255 neurological screening 48–9 neuromatrix 224–6; sports 226–7 neuromuscular control: landing 127–8 neuromuscular fatigue 385–6, 389 neuromuscular system: athlete recovery 392 neurosignatures: pain 224–6 nutrition: acid/base balance 34; altitude training 409; athlete recovery 396–7; deficiencies 34; energy balance 33; fatty acids 35–6; injury-specific supplementation 39; rebuilding the athlete 36–9; regeneration 37; return to competition 39–40; stabilising the athlete 32–6; strategies 31, 32; travelling athlete 438, 440–1 obliques 154, 276, 315 occlusion training: foot and ankle 361; muscle injury 189–90 Olympic lifting: landing training program 130–3 one-repetition maximum (1RM) 96, 97 optimal sports performance 415–16 ornithine alpha ketoglutarate (OAKG) 35, 37, 38 osteoporosis: female athlete 432, 433–4 over-stretching: muscle 185 over-striding: running danger 115 overtraining syndrome 381 oxytocin 23–4 pain: challenge of 223; chronically injured athlete 228; neuromatrix and neurosignatures 224–6; output of brain 223–4; personal experiences 227; sporting performance 227–8; tendon 206–7 pain neuromatrix 224–6 patellar tendon 83, 121, 126, 199, 202–4, 206, 208–10, 323, 330 pathophysiology: chronic bone stress 216; muscle injury 185 peel back phenomenon: throwing, 143 pelvis: injury-free running, 110–11; throwing, 144 performance: jet lag, 437; kinetic chain, 78–9, 81–2 performance actualisation: long-term athlete development (LTAD) 425, 426, 427 performance development: LTAD 424–5, 426 performance model peripheral quantitative computed tomography (pQCT) 214, 215 physical examination 51–2 placebo effect 24, 25, 396 plantar fascia 199, 203, 347 plyometrics: elbow 278–83; kinetic chain 84; knees 328, 334; shoulder 267–70 positional variation: foot and ankle 356 positive psychology interventions (PPIs) 25–6, 28 positive running model 108–9 post-traumatic stress disorder (PTSD) 26–7 posture: hip and groin 313 power training, 376–7 pregnancy: female athlete 434 pre-habilitation needs 50 pre-participation screening (PPS) 45, 46; cardiac MRI 53; cardiac screening 50–1; 450 Index consequences of process 49–50; echocardiogram 52; elite 46; exercise stress test 53; Holter test 53; medical examination 48–9; medical history 51–2, 54–9; physical examination 51–2; process 46–8 pre-season training 373; balancing training and recovery 374–6 Profile of Mood State Questionnaire 382 proprioception: foot and ankle 355 protein synthesis: regeneration 37 psychology 22; ABCDE method 26; application of theory in practice 25–6; identifying psychological ill health 26–7; injury prevention 28; motivation 26; psychological health, 28–9; reducing anxiety in injured athlete 25–6; returning to sport 27–8; support for foot and ankle 353; theoretical basis of rehabilitation 22–4; thoughts and beliefs in rehabilitation, 24 psychoneuroimmunology (PNI) 22, 25 pycogenol 37 quadratus lumborum 67, 89, 162 rapid eccentric/active lengthening contraction: muscle 184 rate of force development (RFD) 96–7; female athlete 429, 430 rating of perceived exertion (RPE) 20, 382, 387, 389 reactive agility test (RAT) 101–2, 364 reconditioning: 4; model 5, recovery strategies: athletes 394–5 red blood cell analysis 34, 35 regeneration: nutrition 37 registration: travelling athlete 443 rehabilitation 3, 229; brain and body 229–30; closed chain 264–7; competition performance 20; criteria-driven approach 16; elbow 275–83, 285–7; end-stage 235, 236; foot and ankle 350–67; hip and groin 312–20; integrated scapulothoracic 271–2; knee 324–34; model of 233; neck injuries 250–5; philosophy 349; psychology 22–4; quantifying process 236–7; restoration of sensorimotor system 264; restoration of shoulder functional range of motion 263, 264; return to throwing 149; running 114; scapula 270–2; shoulder 262, 263; strength and conditioning 15–16, 20; success of 240–1; tendinopathy 208; thoughts and beliefs in 24; throwing 149, 152 rehabilitation needs 50 rehab shakes 35 resistance exercise: athlete recovery 392–3 respiratory disease screening 48 return to competition: hip and groin 320 Return to Competition (RtC), 3, 4; model of transition from injury, 233; nutrition, 39–40; phases, 7–8 return to contact training: knees 332–4 return-to-performance (RTP): criteria 95–6, 103; end-stage rehabilitation 235, 236; foot and ankle 365–6; knees 331–4; neck 255; rehabilitation programme 234–5 return to play: spine pain 302 Return to Play (RTP) 7–8; monitoring returning athlete 240; role of coach 239–40; sport- and position-specific testing 238, 239; strength and conditioning (S&C) 232; success of rehabilitation 240–1; training vs fitness test 239 Return to Running Program 9, 10, 192, 328 return to sport: tendon pain recovery 209–10 Reuleaux, Franz 77 rhodioloa rosea 40 risk see injury risk profiling risk factors: bone injury 218–20; injury risk model 13; lower back pain 14; sporting injuries 67 rotator cuff: importance of 261 rugby tackle: functional joint instability 260 rugby training: exit criteria 194; field testing 238, 239 runners: tibial stress fracture 338 running: accelerated program 193; foot and ankle 347–8; hip and groin 318; kinematics, 339–40; re-education 341–3; return to 192, 362–3; technique philosophies 339; walk-torun programming 343 running-based anaerobic spring test (RAST) 102 running mechanics: foot placement 116–19; full contact 115–16; hamstring loading phase 112, 113; heel-off 116–17; heel-off to toe-off 118–19; importance of pelvis 110–11; injury 112–19; muscle slack 112; over-striding danger 115; positive running model 108–9; running cycle 106–8; scissors motion 114–16; toe-off posture 109–10, 112; transverse plane movements 117–18 salivary vs blood markers 385 sand-based training: foot and ankle 359; knees 331–2 scapula: importance of 261; rehabilitation of, 270–2 schizandra 40 scissors motion: running 114–16 Index 451 screening: assessment frequency 71–2; benefits of 46; cardiac 50–1; principles of 45–6; see also pre-participation screening (PPS) secretagogues 37, 40 shin pain: biomechanical overload syndrome 337–8; biomechanical overload syndrome (BOS) 337, 344; shoe selection 339 shoulder: assessment of integrated function 261–2; closed chain rehabilitation 264–7; dynamic defence of 260–1; functional stability threshold 259, 260; integrated scapulothoracic rehabilitation 271–2; plyometrics 267–70; range of motion 148; rehabilitation 262, 263; rehabilitation of scapula 270–2; restoration of functional range of motion 263, 264; rotator cuff importance 261; restoration of sensorimotor system 264; scapula importance 261; strength 148 shoulder abduction: throwing 144, 146 shoulder injuries: throwing 139, 142–3 side-lying external rotation (SLER) 194, 266, 268 single-limb landings 122, 126–7 sleep: travelling athlete 440 soft-tissue injuries: supplementation 39 soft tissue therapies: athlete recovery 395–6 specific warning index 66, 73 speed: athlete development 420 spine pain: assessment and monitoring tools 302; assessment framework for athletes 290; characteristics 291–2; cognitive functional therapy 298–301; diagnosis 291; extrinsic factors 292; injury mechanism 289, 291; intrinsic factors 292–7; management planning 297–8; managing acute 297–8; prevention 302; psychological factors 296–7; return to play 302; team approach 302–3 sports: applying neuromatrix paradigm in 226–7; conditioning hip and groin 317–18; elbow biomechanics 274–5; field testing 238, 239; massage for athlete recovery 395–6; pain and performance 227–8; stretching after 174–5; stretching before 173–4 sport-specific training: hip and groin 319–20; kinetic chain 83–4 sprained ankle: brain response to 224 sprinting speed 100 standing long jump: core, 155, 161–2 strength: athlete development 420; athletic 96; female athlete 429–30; landing training program 130–3 strength and conditioning (S&C) 11, 232; case studies 14–15, 17–20; coach 20, 232; end-stage rehabilitation 236; foot and ankle 352–3, 357–8, 360, 365–6; injury prevention 11–12; injury risk model 13–15; rehabilitation 15–16, 20; return to competition model 233 strength training 376–7 stress injuries: bone 215–16; classification of fractures 217 stress-strain index (SSI) 214 stretching 169–71; after exercise 174–5; athlete recovery 395; avoiding 176; before exercise 173–4; periodisation of 171–3; pre-exercise programme design 174, 175; training program 173–5 stride: throwing 140, 143 striding out: landing 126–7 sudden cardiac arrest (SCA) 50–1 sudden cardiac death (SCD) 50–1 supplementation: injury-specific 39 taping: foot and ankle 366–7 team approach: spine pain 302–3 technical correction: kinetic chain 85, 88 tendinopathy: Achilles 208; diagnosing 204; imaging 204; management of 199; mobility and weakness 203; patellar 208; principles of exercise prescription 207–8; progression to 201–4; rehabilitation 208; risk factors 201–2; staging 205–6 tendon: in-season load management 209; pain 205; pain management 206–7; returning to sports 209–10; role of tenocyte in function 200–1; role within musculoskeletal system 199–200 tennis: interval program 286 testosterone 384; athlete recovery 393, 394 testosterone/cortisol ratio 385 Thrower’s Ten Program 276 throwing: golf 287; interval program 284, 285; tennis 286 throwing mechanics: analysis of biomechanics 140–2; arm pain 139–40; assessment of 146, 149, 152; elbow injuries 143–6; fatigue 147; lower-limb 148–9; physical adaptations in throwers 148; rehabilitation 149, 152; shoulder injuries 142–3; trunk function 148–9; whole body motions 139, 149–50; workloads 146–7 time under tension (TUT): training 261, 340, 373, 376–7 toe-off: running, 107, 108–12, 114, 117–19 trabecular bone 212–14 training: around injury 4–5; athlete development 418–19; balancing recovery and 374–6; de-training timescales 373–4; 452 Index developmental 375; developmental stimuli 373–4; maintenance 376; stretching in program 173–5; see also in-season training; monitoring training load; pre-season training training load 136 training movement: kinetic chain 83–4 trampoline: gravitational forces 254; kneeinjured athlete 331, 332 transverse plane movements: running 117–18 travelling athlete: fatigue 436–7; hydration 440–1; jetlag 436–7; medical considerations 441–3; melatonin 440; nutrition 438, 440–1; planning travel 437–9; registration and insurance 443; sleep hygiene 440; vaccination 442 TRIMP (Training Impulse) concept 382 trophy position 85, 86 trunk flexion: throwing 144 trunk function: throwing 148–9 trunk motion: landing 128–9 trunk rotation: throwing 144 turmeric 33, 38 ultrasound (US): muscle injury 186 ultraviolet B (UVB) radiation: bone injury 218 upper body propulsion: hip and groin 319 vaccinations: travelling athlete 442 vasodilation: nutrition 36–7 vitamin C 32, 39, 40 vitamin D: bone injury 218 volume/load training: foot and ankle 361 walking: foot and ankle 347–8 warning index 64–5, 72, 73 weight-bearing training: foot and ankle 360 weightlifting: kinetic chain 84 wellness 383, 389 workloads: throwing 146–7 World Anti-Doping Agency (WADA) 37, 39, 440 Y-balance test: core 156–9 youth: athlete development 419–21 ... internationally in injury screening, rehabilitation and prevention strategies and lives in Market Harborough, England Sports Injury Prevention and Rehabilitation Integrating medicine and science for... an injury (Bill Knowles) Strength and conditioning in injury prevention and rehabilitation (Ben Rosenblatt) 11 Psychology in injury prevention and rehabilitation (Tig Calvert) 22 Nutrition in injury. ..Sports Injury Prevention and Rehabilitation World-class preparation and rehabilitation of the injured athlete integrates best practice in sports medicine and physical therapy with training and