Sportkine 1
Inhoud
Inhoud ..................................................................................................................................................... 1
Praktijkles 1: (non)waarde preventie/screening in topsport .................................................................. 6
Waarom screening?............................................................................................................................. 6
2 type screenings ................................................................................................................................. 6
Mogelijk handige apps voor gebruik tijdens screening ....................................................................... 7
Hylyght handleiding............................................................................................................................. 7
Hylyght cycling..................................................................................................................................... 8
FMS = functional movement screen.................................................................................................. 17
Resultaten FMS.................................................................................................................................. 25
Resultaten hylyght ............................................................................................................................. 26
Blessure preventieve screening ........................................................................................................ 26
Praktijkles 2: Core stability training bij (top)sporters............................................................................ 31
Casus 1 ............................................................................................................................................... 31
Casus 1 – klinisch onderzoek ............................................................................................................. 32
Casus 1 – beeldvorming .................................................................................................................... 33
Casus 1 – Analyse .............................................................................................................................. 33
Casus 2 ............................................................................................................................................... 34
Casus 2 – beeldvorming .................................................................................................................... 34
Spondylolisthesis – wat leert onderzoek ons? .................................................................................. 35
Core stability training – wat leert onderzoek ons? ........................................................................... 35
Core stability bij (Elite-) Atleten ........................................................................................................ 36
Praktijkles 3: Technologiegebruik in sportrevalidatie ........................................................................... 46
Casus.................................................................................................................................................. 46
Opdracht............................................................................................................................................ 46
My Jump App ..................................................................................................................................... 47
Opto jump ......................................................................................................................................... 49
Augmented reality app ...................................................................................................................... 51
Fitlight ................................................................................................................................................ 51
Opto jump vs My jump app ............................................................................................................... 53
Jump testing ...................................................................................................................................... 53
Blazepod vs reflex app....................................................................................................................... 55
Control-Chaos Continuum voor basketbal ........................................................................................ 56
1
, Neurocognitive aids........................................................................................................................... 56
Praktijkles 4: Biomechanische analyse/bikefitting ................................................................................ 57
Introductie ......................................................................................................................................... 57
Overuse injuries................................................................................................................................. 59
Muscle patterns – cycling biomechanics ........................................................................................... 68
Theorieles 1: Definitie & epidemiologie sportletsels ............................................................................ 69
Definities epidemiologie.................................................................................................................... 70
Definities sports injury ...................................................................................................................... 72
Schatting van de kosten van sportblessures ..................................................................................... 75
Theorieles 2: Load management ........................................................................................................... 76
Casus 1 ............................................................................................................................................... 76
Load management............................................................................................................................. 77
Casus 1 vervolg .................................................................................................................................. 78
Needs Analyse ................................................................................................................................... 79
Casus 1 Needsanalyse ....................................................................................................................... 80
Load management bij jonge atleten ................................................................................................. 82
Casus 2 ............................................................................................................................................... 87
Load management in revalidaties ..................................................................................................... 89
Casus 3 ............................................................................................................................................... 92
Load management bij (elite) atleten ................................................................................................. 93
Samenvatting load management ...................................................................................................... 98
Theorieles 3: Rehabilitating the anterior cruciate ligament: best practices applied to (professional)
soccer players ........................................................................................................................................ 98
Introductie ......................................................................................................................................... 99
Anatomie en functie van ACL .......................................................................................................... 101
Meest voorkomende mechanismen van VKB-letsel bij voetbal...................................................... 103
Risicofactoren .................................................................................................................................. 104
Reinjury risico .................................................................................................................................. 106
Diagnose en assessment van ACL-letsels ........................................................................................ 108
Pre-operatieve considerations ........................................................................................................ 111
Chirurgische procedures en postoperatief management ............................................................... 113
Postoperatieve revalidatie fases ..................................................................................................... 115
Revalidatiestrategieën en -technieken ........................................................................................... 117
Blessurepreventie en return to play criteria ................................................................................... 122
Case Studies and Real-World Examples .......................................................................................... 126
Laatste ontwikkelingen en onderzoek op gebied van ACL-revalidatie ........................................... 127
2
,Theorieles 4: First aid in sports injuries – eerste hulp bij sportongevallen......................................... 129
Eerste hulp in het algemeen............................................................................................................ 129
Specifieke sportblessures ................................................................................................................ 131
Theorieles 5: Hamstringblessures en FAI in hockeyspelers ................................................................ 147
Hamstrings....................................................................................................................................... 147
Injury classificatie ............................................................................................................................ 148
Anatomie hamstrings ...................................................................................................................... 148
Incidentie van injury ........................................................................................................................ 148
Letterclassificatie............................................................................................................................. 149
Voorkomende mechanismen .......................................................................................................... 152
Biceps femoris? ............................................................................................................................... 153
Risicofactoren .................................................................................................................................. 153
Preventie ......................................................................................................................................... 158
Revalidatie ....................................................................................................................................... 162
FAI .................................................................................................................................................... 166
Definitie FAI ..................................................................................................................................... 166
Positieve beeldvorming bevindingen .............................................................................................. 166
Beeldvorming .................................................................................................................................. 166
Etiologie ........................................................................................................................................... 169
Symptomen ..................................................................................................................................... 170
Klinische tekenen van FAI (assessment) .......................................................................................... 171
Interventie: chirurgie....................................................................................................................... 175
Interventie: physio-led .................................................................................................................... 177
Take home message ........................................................................................................................ 180
Theorieles 6: Overbelastingsletsels in de atletiek ............................................................................... 180
Introductie ....................................................................................................................................... 180
Javelin Elbow (speerelleboog) ......................................................................................................... 182
“Understanding Javelin Elbow” ....................................................................................................... 182
Anatomie en biomechanica van ellebooggewricht ......................................................................... 184
Etiologie en pathogenese van Javelin Elbow................................................................................... 187
Klinische presentatie van Javelin Elbow .......................................................................................... 190
Fysiek assessment van Javelin Elbow .............................................................................................. 191
Diagnose van Javelin Elbow ............................................................................................................. 193
Revalidatieprincipes voor Javelin Elbow ......................................................................................... 194
Progressief oefenprogramma.......................................................................................................... 195
Jumper’s knee.................................................................................................................................. 201
3
, “Understanding Jumper’s knee” ..................................................................................................... 201
Anatomie en biomechanica van het kniegewricht .......................................................................... 201
Etiologie en pathogenese van Jumper’s knee ................................................................................. 202
Klinische presentatie van Jumper’s knee ........................................................................................ 203
Chronische peesproblematiek: classificatie .................................................................................... 204
Fysiek assessment van Jumper’s knee ............................................................................................ 204
Diagnose Jumper’s knee .................................................................................................................. 208
Revalidatieprincipes voor Jumper’s knee........................................................................................ 208
Progressief oefenprogramma.......................................................................................................... 212
Theorieles 7: Schouderproblematiek en enkelblessures bij volleyballers .......................................... 214
Definitie schouderinstabiliteit ......................................................................................................... 214
Normale beperkingen...................................................................................................................... 214
Epidemiologie .................................................................................................................................. 215
Classificatie ...................................................................................................................................... 217
Assessment/onderzoek ................................................................................................................... 220
Physical examination/fysiek onderzoek .......................................................................................... 222
Symptoom modificatie .................................................................................................................... 222
Laxiteit/instabiliteit ......................................................................................................................... 224
Performance testen ......................................................................................................................... 227
Neuromusculaire testen .................................................................................................................. 228
ROM................................................................................................................................................. 230
Neurologische examinatie ............................................................................................................... 230
Medische beeldvorming .................................................................................................................. 231
Chirurgie .......................................................................................................................................... 232
Samenvatting assessment ............................................................................................................... 233
Management ................................................................................................................................... 233
Revalidatie – eerstelijnsmanagement ............................................................................................. 233
Make sense of pain.......................................................................................................................... 234
Belasting/belastbaarheid ................................................................................................................ 235
Oefentherapie ................................................................................................................................. 235
Proprioceptie ................................................................................................................................... 238
Sensorimotorisch............................................................................................................................. 239
Revalidatie samenvatting ................................................................................................................ 239
Chronic ankle instability (CAI) – chronische enkelinstabiliteit ........................................................ 240
Epidemiologie .................................................................................................................................. 240
Anatomie ......................................................................................................................................... 240
4
, Etiologie ........................................................................................................................................... 242
Assessment – onderzoek ................................................................................................................. 247
Revalidatie ....................................................................................................................................... 256
Theorieles 8: Hand- en polsletsels gerelateerd aan muurklimmen .................................................... 262
Artrokinematica............................................................................................................................... 262
Common injuries – Veelvoorkomende letsels................................................................................. 267
General principles............................................................................................................................ 277
Theorieles 9: Achillespeestendinopathie in duursporten & planning en periodisering ..................... 281
Inleiding ........................................................................................................................................... 281
Definities Achillespees tendinopathie ............................................................................................. 282
Types Achillespees tendinopathie ................................................................................................... 283
Symptomen Achillespees tendinopathie......................................................................................... 283
Onevenwicht B-BBH ........................................................................................................................ 283
KO Achillespees tendinopathie ....................................................................................................... 284
Management Achilles tendinopathie .............................................................................................. 285
Fase 1 management Achillespees tendinopathie ........................................................................... 286
Fase 2 management Achillespees tendinopathie ........................................................................... 287
Fase 3 management Achillespees tendinopathie ........................................................................... 288
Fase 4 management Achillespees tendinopathie ........................................................................... 289
Management Achillespees tendinopathie – Alternatieve therapie ................................................ 289
Revalidatie vs training ..................................................................................................................... 290
Take home message ........................................................................................................................ 293
Theorieles 10: Mentale belasting van de (professionele) atleet ......................................................... 293
Inleiding ........................................................................................................................................... 293
Algemene Energie Balans ................................................................................................................ 294
Fysieke Energie Balans: Slaap .......................................................................................................... 294
Slaap ................................................................................................................................................ 300
Fysieke Energie Balans: Voeding ..................................................................................................... 301
Algemene Energie Balans ................................................................................................................ 305
Mentale Energie Balans: Doelorientatie ......................................................................................... 305
Mentale Energie Balans: klimaat orientatie .................................................................................... 306
Mentale Energie Balans: Flow ......................................................................................................... 308
Mentale Energie Balans: twee systeem theorie.............................................................................. 308
Mentale Energie Balans: Stress ....................................................................................................... 309
Algemene Energie Balans ................................................................................................................ 312
Conclusie ......................................................................................................................................... 312
5
, Praktijkles 1: (non)waarde preventie/screening in topsport
Waarom screening?
Meestal bij begin seizoen: pre-participation screening
• Blessurerisico’s inschatten
• Blessurepreventieve programma’s opstellen
• Time away from pitch minimaliseren
Soms herhaald in loop van seizoen
• Vooruitgang?
• Aanpassing schema’s?
2 type screenings
Movement screen
• Bewegingspatronen
• Bepalen hoe een persoon natuurlijk wenst te bewegen
• Blessurerisico inschatten op basis van afwijking van “normaal bewegen”
• FMS
o Natuurlijke beweging objectiveren
o Minimale instructies geven
o Makkelijk scoringssysteem
▪ Perfect: 3
▪ Met compensaties: 2
▪ Onmogelijk: 1
▪ Pijn: 0
▪ When in doubt: score low
▪ Bij bilaterale testings bepaald de laatste score de totale score
o 3 clearing testen
▪ Als pijn: medisch professional contacteren = kinesitherapeut (screening
wordt soms ook door personal trainers uitgevoerd)
o Voor alle sporten hetzelfde
Gerichte screening
• Bepaald deel van bewegen in detail bekijken
• Cut-off score bepalen wat een blessurerisico is
• Hylyght (Belgisch platform)
o Gebaseerd op geïdentificeerde risicofactoren voor blessure
o Kijken naar specifiek aspect van bewegen
▪ Lenigheid
▪ Stabiliteit
▪ Kracht
▪ …
o Afhankelijk van sport
6
Inhoud
Inhoud ..................................................................................................................................................... 1
Praktijkles 1: (non)waarde preventie/screening in topsport .................................................................. 6
Waarom screening?............................................................................................................................. 6
2 type screenings ................................................................................................................................. 6
Mogelijk handige apps voor gebruik tijdens screening ....................................................................... 7
Hylyght handleiding............................................................................................................................. 7
Hylyght cycling..................................................................................................................................... 8
FMS = functional movement screen.................................................................................................. 17
Resultaten FMS.................................................................................................................................. 25
Resultaten hylyght ............................................................................................................................. 26
Blessure preventieve screening ........................................................................................................ 26
Praktijkles 2: Core stability training bij (top)sporters............................................................................ 31
Casus 1 ............................................................................................................................................... 31
Casus 1 – klinisch onderzoek ............................................................................................................. 32
Casus 1 – beeldvorming .................................................................................................................... 33
Casus 1 – Analyse .............................................................................................................................. 33
Casus 2 ............................................................................................................................................... 34
Casus 2 – beeldvorming .................................................................................................................... 34
Spondylolisthesis – wat leert onderzoek ons? .................................................................................. 35
Core stability training – wat leert onderzoek ons? ........................................................................... 35
Core stability bij (Elite-) Atleten ........................................................................................................ 36
Praktijkles 3: Technologiegebruik in sportrevalidatie ........................................................................... 46
Casus.................................................................................................................................................. 46
Opdracht............................................................................................................................................ 46
My Jump App ..................................................................................................................................... 47
Opto jump ......................................................................................................................................... 49
Augmented reality app ...................................................................................................................... 51
Fitlight ................................................................................................................................................ 51
Opto jump vs My jump app ............................................................................................................... 53
Jump testing ...................................................................................................................................... 53
Blazepod vs reflex app....................................................................................................................... 55
Control-Chaos Continuum voor basketbal ........................................................................................ 56
1
, Neurocognitive aids........................................................................................................................... 56
Praktijkles 4: Biomechanische analyse/bikefitting ................................................................................ 57
Introductie ......................................................................................................................................... 57
Overuse injuries................................................................................................................................. 59
Muscle patterns – cycling biomechanics ........................................................................................... 68
Theorieles 1: Definitie & epidemiologie sportletsels ............................................................................ 69
Definities epidemiologie.................................................................................................................... 70
Definities sports injury ...................................................................................................................... 72
Schatting van de kosten van sportblessures ..................................................................................... 75
Theorieles 2: Load management ........................................................................................................... 76
Casus 1 ............................................................................................................................................... 76
Load management............................................................................................................................. 77
Casus 1 vervolg .................................................................................................................................. 78
Needs Analyse ................................................................................................................................... 79
Casus 1 Needsanalyse ....................................................................................................................... 80
Load management bij jonge atleten ................................................................................................. 82
Casus 2 ............................................................................................................................................... 87
Load management in revalidaties ..................................................................................................... 89
Casus 3 ............................................................................................................................................... 92
Load management bij (elite) atleten ................................................................................................. 93
Samenvatting load management ...................................................................................................... 98
Theorieles 3: Rehabilitating the anterior cruciate ligament: best practices applied to (professional)
soccer players ........................................................................................................................................ 98
Introductie ......................................................................................................................................... 99
Anatomie en functie van ACL .......................................................................................................... 101
Meest voorkomende mechanismen van VKB-letsel bij voetbal...................................................... 103
Risicofactoren .................................................................................................................................. 104
Reinjury risico .................................................................................................................................. 106
Diagnose en assessment van ACL-letsels ........................................................................................ 108
Pre-operatieve considerations ........................................................................................................ 111
Chirurgische procedures en postoperatief management ............................................................... 113
Postoperatieve revalidatie fases ..................................................................................................... 115
Revalidatiestrategieën en -technieken ........................................................................................... 117
Blessurepreventie en return to play criteria ................................................................................... 122
Case Studies and Real-World Examples .......................................................................................... 126
Laatste ontwikkelingen en onderzoek op gebied van ACL-revalidatie ........................................... 127
2
,Theorieles 4: First aid in sports injuries – eerste hulp bij sportongevallen......................................... 129
Eerste hulp in het algemeen............................................................................................................ 129
Specifieke sportblessures ................................................................................................................ 131
Theorieles 5: Hamstringblessures en FAI in hockeyspelers ................................................................ 147
Hamstrings....................................................................................................................................... 147
Injury classificatie ............................................................................................................................ 148
Anatomie hamstrings ...................................................................................................................... 148
Incidentie van injury ........................................................................................................................ 148
Letterclassificatie............................................................................................................................. 149
Voorkomende mechanismen .......................................................................................................... 152
Biceps femoris? ............................................................................................................................... 153
Risicofactoren .................................................................................................................................. 153
Preventie ......................................................................................................................................... 158
Revalidatie ....................................................................................................................................... 162
FAI .................................................................................................................................................... 166
Definitie FAI ..................................................................................................................................... 166
Positieve beeldvorming bevindingen .............................................................................................. 166
Beeldvorming .................................................................................................................................. 166
Etiologie ........................................................................................................................................... 169
Symptomen ..................................................................................................................................... 170
Klinische tekenen van FAI (assessment) .......................................................................................... 171
Interventie: chirurgie....................................................................................................................... 175
Interventie: physio-led .................................................................................................................... 177
Take home message ........................................................................................................................ 180
Theorieles 6: Overbelastingsletsels in de atletiek ............................................................................... 180
Introductie ....................................................................................................................................... 180
Javelin Elbow (speerelleboog) ......................................................................................................... 182
“Understanding Javelin Elbow” ....................................................................................................... 182
Anatomie en biomechanica van ellebooggewricht ......................................................................... 184
Etiologie en pathogenese van Javelin Elbow................................................................................... 187
Klinische presentatie van Javelin Elbow .......................................................................................... 190
Fysiek assessment van Javelin Elbow .............................................................................................. 191
Diagnose van Javelin Elbow ............................................................................................................. 193
Revalidatieprincipes voor Javelin Elbow ......................................................................................... 194
Progressief oefenprogramma.......................................................................................................... 195
Jumper’s knee.................................................................................................................................. 201
3
, “Understanding Jumper’s knee” ..................................................................................................... 201
Anatomie en biomechanica van het kniegewricht .......................................................................... 201
Etiologie en pathogenese van Jumper’s knee ................................................................................. 202
Klinische presentatie van Jumper’s knee ........................................................................................ 203
Chronische peesproblematiek: classificatie .................................................................................... 204
Fysiek assessment van Jumper’s knee ............................................................................................ 204
Diagnose Jumper’s knee .................................................................................................................. 208
Revalidatieprincipes voor Jumper’s knee........................................................................................ 208
Progressief oefenprogramma.......................................................................................................... 212
Theorieles 7: Schouderproblematiek en enkelblessures bij volleyballers .......................................... 214
Definitie schouderinstabiliteit ......................................................................................................... 214
Normale beperkingen...................................................................................................................... 214
Epidemiologie .................................................................................................................................. 215
Classificatie ...................................................................................................................................... 217
Assessment/onderzoek ................................................................................................................... 220
Physical examination/fysiek onderzoek .......................................................................................... 222
Symptoom modificatie .................................................................................................................... 222
Laxiteit/instabiliteit ......................................................................................................................... 224
Performance testen ......................................................................................................................... 227
Neuromusculaire testen .................................................................................................................. 228
ROM................................................................................................................................................. 230
Neurologische examinatie ............................................................................................................... 230
Medische beeldvorming .................................................................................................................. 231
Chirurgie .......................................................................................................................................... 232
Samenvatting assessment ............................................................................................................... 233
Management ................................................................................................................................... 233
Revalidatie – eerstelijnsmanagement ............................................................................................. 233
Make sense of pain.......................................................................................................................... 234
Belasting/belastbaarheid ................................................................................................................ 235
Oefentherapie ................................................................................................................................. 235
Proprioceptie ................................................................................................................................... 238
Sensorimotorisch............................................................................................................................. 239
Revalidatie samenvatting ................................................................................................................ 239
Chronic ankle instability (CAI) – chronische enkelinstabiliteit ........................................................ 240
Epidemiologie .................................................................................................................................. 240
Anatomie ......................................................................................................................................... 240
4
, Etiologie ........................................................................................................................................... 242
Assessment – onderzoek ................................................................................................................. 247
Revalidatie ....................................................................................................................................... 256
Theorieles 8: Hand- en polsletsels gerelateerd aan muurklimmen .................................................... 262
Artrokinematica............................................................................................................................... 262
Common injuries – Veelvoorkomende letsels................................................................................. 267
General principles............................................................................................................................ 277
Theorieles 9: Achillespeestendinopathie in duursporten & planning en periodisering ..................... 281
Inleiding ........................................................................................................................................... 281
Definities Achillespees tendinopathie ............................................................................................. 282
Types Achillespees tendinopathie ................................................................................................... 283
Symptomen Achillespees tendinopathie......................................................................................... 283
Onevenwicht B-BBH ........................................................................................................................ 283
KO Achillespees tendinopathie ....................................................................................................... 284
Management Achilles tendinopathie .............................................................................................. 285
Fase 1 management Achillespees tendinopathie ........................................................................... 286
Fase 2 management Achillespees tendinopathie ........................................................................... 287
Fase 3 management Achillespees tendinopathie ........................................................................... 288
Fase 4 management Achillespees tendinopathie ........................................................................... 289
Management Achillespees tendinopathie – Alternatieve therapie ................................................ 289
Revalidatie vs training ..................................................................................................................... 290
Take home message ........................................................................................................................ 293
Theorieles 10: Mentale belasting van de (professionele) atleet ......................................................... 293
Inleiding ........................................................................................................................................... 293
Algemene Energie Balans ................................................................................................................ 294
Fysieke Energie Balans: Slaap .......................................................................................................... 294
Slaap ................................................................................................................................................ 300
Fysieke Energie Balans: Voeding ..................................................................................................... 301
Algemene Energie Balans ................................................................................................................ 305
Mentale Energie Balans: Doelorientatie ......................................................................................... 305
Mentale Energie Balans: klimaat orientatie .................................................................................... 306
Mentale Energie Balans: Flow ......................................................................................................... 308
Mentale Energie Balans: twee systeem theorie.............................................................................. 308
Mentale Energie Balans: Stress ....................................................................................................... 309
Algemene Energie Balans ................................................................................................................ 312
Conclusie ......................................................................................................................................... 312
5
, Praktijkles 1: (non)waarde preventie/screening in topsport
Waarom screening?
Meestal bij begin seizoen: pre-participation screening
• Blessurerisico’s inschatten
• Blessurepreventieve programma’s opstellen
• Time away from pitch minimaliseren
Soms herhaald in loop van seizoen
• Vooruitgang?
• Aanpassing schema’s?
2 type screenings
Movement screen
• Bewegingspatronen
• Bepalen hoe een persoon natuurlijk wenst te bewegen
• Blessurerisico inschatten op basis van afwijking van “normaal bewegen”
• FMS
o Natuurlijke beweging objectiveren
o Minimale instructies geven
o Makkelijk scoringssysteem
▪ Perfect: 3
▪ Met compensaties: 2
▪ Onmogelijk: 1
▪ Pijn: 0
▪ When in doubt: score low
▪ Bij bilaterale testings bepaald de laatste score de totale score
o 3 clearing testen
▪ Als pijn: medisch professional contacteren = kinesitherapeut (screening
wordt soms ook door personal trainers uitgevoerd)
o Voor alle sporten hetzelfde
Gerichte screening
• Bepaald deel van bewegen in detail bekijken
• Cut-off score bepalen wat een blessurerisico is
• Hylyght (Belgisch platform)
o Gebaseerd op geïdentificeerde risicofactoren voor blessure
o Kijken naar specifiek aspect van bewegen
▪ Lenigheid
▪ Stabiliteit
▪ Kracht
▪ …
o Afhankelijk van sport
6
