Why do sports people recover so quickly from injury?

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Sharyl Shaw
8 years ago
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1 It s s just a flesh wound Why do sports people recover so quickly from injury? Paul Coburn Sports Physiotherapist Clinical Leader HSG Clinical Consultant Comcare

2 WorkSafe Victoria workers injured every year In past 5 years, Victorians have lodged a claim 2.7 billion in treatment and compensation costs

3 AFL injuries 8 players out injured every week Salary cap $ Injuries in Salaries alone $1.428 Million per club per year Injuries across all Clubs in Salaries $24 Million per year

4 Injury incidence per club per year Injury Type Incidence per club per year Hamstring Strain 6.1 Groin Strain 3.4 Ankle 2.5 Knee Cartilage 1.5 Shoulder Sprains 1.3 Knee ACL 0.7 Concussion 0.5 Facial Fractures 0.5

5 Games missed per incident Injury Type Games missed per incident Knee ACL *17.6 Shoulder Sprains 5.9 Knee Cartilage 5.7 Groin Strain 4.1 Hamstring Strain 3.4 Ankle 2.9 Facial Fractures 2.4 Concussion 1.6

6 Traditional injury approach Dr/physio puts players out if injured Coach Coach If they can t t train, I don t t want to see them

7 Players are a limited resource

8 Modern Sports Medicine approach Dr/physio focus is optimising game time provided there are no safety risks Coach Coach maximises team performance by altering training load to limit player injury

9 Sport Medicine approach 1. Early diagnosis 2. Prognosis discussed with athlete 3. Return to sport plan constructed 4. Early treatment 5. Psychological support 6. Graduated loading that is sport specific 7. Club support 8. Facilities and equipment 9. Regular updates on recovery 10. Alternate duties for long-term injured

Early treatment 5. Psychological support 6.

10 What can we take from the Sports Medicine approach to assist us in optimising return to work?

12 How does the employer replicate Sports Medicine approach? 1. Establish a Medical Team 2. Encourage workers to see the Medical Team promptly 3. Agree on a plan for Return to Work 4. Speak to Medical Team to determine what the worker CAN DO? 5. Support early treatment 6. Have a high threshold for questioning liability 7. Set the tone for everyone to support worker 8. Utilise local treaters facilities 9. Obtain updates on workers recovery and plan 10. Utilise alternate duties to overcome fear of RTW

Speak to Medical Team to determine what the worker CAN DO? 5. Support early treatment 6.

13 1. Establish a Medical Team Pro-actively establish a relationship with local GPs Refer Refer patients Stick Stick to requirements of alternate duties Demonstrate genuine compassion for the worker s s injury

Stick Stick to requirements of alternate duties

15 1. Establish a Medical Team Meet Meet with local physiotherapists pro-actively Refer Refer patients (even more relevant for physio practices)

16 2. Encourage workers to see the Medical Team promptly Patients Patients understanding of condition can impact on recovery The The longer it takes to get to a competent practitioner, the more misinformation they will receive Implement early referral

recovery The The longer it takes to get to a competent

17 Graph of RTW with time

18 3. Agree on a plan for Return to Work Systematic Review risk factors for delayed return to work of people with Back Pain 21 studies reviewed the results of these studies provide strong evidence that perceived ability to work is associated with future back pain disability Linton 2001

reviewed the results of these studies provide strong evidence that

19 3. Agree on a plan for Return to Work Plan Plan ensures all stakeholders are on the same page for Recovery Ensures Ensures early response to lack of recovery

20 4. Speak to medical team to find out what the worker CAN DO? Why is this important for the worker? 1. Safety 2. Improved health outcomes

21 4. Speak to medical team to find out what the worker CAN DO? Safety Safety is essential however should not be employed indiscriminately to the detriment of recovery

22 4. Speak to medical team to find out what the worker CAN DO? Safety What specifically would result in further deterioration of the worker s s condition? = Restrictions What specifically?

24 Is return to work good for you? Unemployment was associated with a doubling of suicide rate in the UK There was little or no association between suicide and measures of socioeconomic status such as social class and housing tenure once the association with unemployment had been taken into account Lewis & Sloggett,, BMJ, 1993

25 Is return to work good for you? Re-employment employment of unemployed adults improves various measures of health and well-being, such as self-esteem, esteem, self-rated health, self-satisfaction, satisfaction, physical health, financial concerns The beneficial effects of re-employment employment depend mainly in the security of the new job, and also on the individual s s motivation, desires and satisfaction Waddell and Burton 2006

26 Getting the Good News Out There WorkSafe Victoria s s August 2011 Advertising Campaign

28 Why not wait until they re 100% Don t t underestimate apprehension of transition from not at work to returning to work Fear Fear of re-injury is as real as the injury itself Graduated exposure to a threatening stimulus is a widely accepted means of re- engagement

29 5. Support early treatment Treatment is based on what are the aggravating factors and what exercises/activity a person can do Is constantly changing Primary benefit of Physios? They understand how a worker can work with an injury

30 Case Study High speed Motor Vehicle Accident 16 year old Apprentice Injuries: fractured tibia & left hand fracture non union and infection muscle & skin grafts Hospitalisation for 2 months Wheel chair for 3 months Seen at Physio at 5 months

31 Examination External fixation Partial weight bearing to 50%

32 Surgeon Not good outcome Battling to save lower leg Expect fusion of ankle joint later that year Concerned that the patient would develop depression

33 Return to work Initial recommendation wait 12 months Physiotherapist Understanding of physical limitations Pre-existing existing relationship with employer Organised early Voc Rehab referral Returned to work on modified duties and hours 6 months

34 IEQ IEQ 6. Have a high threshold for questioning liability Scale Scale for sense of unfairness in relation to injury 12 questions The The IEQ prospectively predicted RTW but not pain severity Sullivan et al

35 6. Have a high threshold for questioning liability Doubt Doubt on a workers condition Places Places onus on the worker to prove it Many Many soft tissue injuries don t t show up clearly on scans Only Only clear method of proof for the patient is Disability This This means not returning to work

36 7. Set the tone for support of injured worker Players want to come back because they miss the camaraderie of the team In the workplace this is achieved by: 1. Positive messages indicating the return of the worker is anticipated 2. Avoidance of negative messages of issues with bureaucratic hurdles to resuming work e.g. don t t want you back until you are 100%

37 Supervisor training to optimise the response to injury 38% Reduction in no. of claims Cost of claims reduced between 25 36% at 7 months follow up Training Communicating with workers about pain and injury Understanding the nature of musculoskeletal pain and discomfort Problem Solving using ergonomic principles Maintaining communication Shaw et al 2006

38 8. Utilise local facilities Most Physio practices these days have great facilities However like the football team, rehab must progress onto the field of play i.e. worksite

39 9. Obtain updates on worker s recovery Players return to sport is modified weekly based on recovery Action is taken on either lack of recovery or good progress Information can be gathered from 1. The worker directly 2. The medical team depending on your relationship

40 10. Utilise alternate duties to overcome fear of RTW Fear Fear of reinjury is often only appreciated by those who have been injured Just Just being at work can address this barrier but requires patience from employer

41 Play the Percentages Most Most teams who win the Grand Final win every match of the year The The leading teams don t t radically alter their game plan because they lose a few games Don t t throw out principles of management based on a handful of negative cases

Employer s Guide to. Best Practice Return to Work for a Stress Injury

Employer s Guide to. Best Practice Return to Work for a Stress Injury Employer s Guide to Best Practice Return to Work for a Stress Injury Employers Guide to Best Practice Return to Work for a Stress Injury 1. Early Intervention 2. Claim Lodged 3. Claim Acceptance 4. Return