BIOMECHANICAL ISSUES IN SPORTS PHYSIOTHERAPY AND REHABILITATION

Abstract

In the last decades the number of people participating in sports and leisure time exercise activity has increased tremendously (Westerstahl et al., 2003). Due to this raise in participation the incidence of sports injuries increased, which resulted in a boost for medical interventions. For example, in the Netherlands with a population of about 15 million, there is an allover incidence of 3 injuries per 1000 hours spent on sports. One of these 3 injuries needed medical care (van Mechelen et al., 1992). Many injured athletes or leisure time sporting persons not only consult their sports physician (team physician), but also rely on the professionalism of the sports physiotherapists to increase the speed of their recovery and reduce time off of their sports and training (either competitive or a lower level of exercising). Sports physiotherapy is a specialty widely recognized as a profession with its own body of knowledge and as such represented in the World Confederation of Physical Therapy (WCPT) by the International Federation of Sports Physiotherapy (IFSP). As members of the sports medical team, sports physiotherapists are active in the prevention and rehabilitation of sports related lesions. Sports physiotherapists work with athletes of all ages and abilities, at individual and group levels, to prevent injury, restore optimal function and contribute to the enhancement of sports performance after injury, using sports-specific knowledge, skills and attitudes to achieve best clinical practice (Bulley &. Donaghy, 2005). Furthermore, sports physiotherapists are pioneers in their field, critically challenging, evaluating practice and developing new knowledge through research. However, for many years, sports physiotherapists have been relying too much on authority and non-scientific methods rather than on hard evidence for their clinical decision-making. With the risk of oversimplifying, it can be stated that many injuries are the result of a biomechanical “overuse” of the musculoskeletal system, either in an acute (trauma) or a chronic (fatigue) state. The rehabilitation of injured athletes to their functional pre-injury status is confronted with the loading capability of the injured tissue and its interaction with the known training principles (variation, overloading, specificity and recovery). Depending on the progression of the wound healing, the injured tissue may (and must) receive more and more loading in order to heal and regain functionality. Therefore, restoration of function will depend merely on the phases in which the immunological system is restoring the injured tissue (Cabri & Gomes-Pereira in E. Müller et al., 1998). For example, in muscle injuries, it is known that these phases of repair are linked with the amount of loading the injured tissue can bear (loading capability) and that early mobilization will contribute to increased efficacy of repair (Järvinen et al., 2005). In this context, biomechanical studies contribute much to the knowledge of loading on the musculoskeletal tissues during (rehabilitation) exercises, both quantitatively and qualitatively.