Original paper
Effect of an integrated functional stability program on injury rates in an international netball squad

https://doi.org/10.1016/j.jsams.2005.11.002Get rights and content

Summary

The cost-effectiveness and efficacy of athlete profiling and injury prevention programs is influenced by procedural specificity, philosophy of athlete development within the sporting body and the dynamics within the multidisciplinary team (MDT). This article reports on the implementation of a multidisciplinary approach to injury reduction and performance development in an international netball squad. Problems with player compliance, training anxiety and injury rates sparked a decision to seek an alternative training approach. A reactive sports medicine system, poor player self-responsibility and inadequate player understanding of the anatomy and biomechanics of sound training, inadequate screening procedures and perceived conflict between sports science and sports medicine personnel were identified as causative factors. A new program was designed where common objectives were identified, and individual roles delineated. A functional profiling session was performed as a team activity and comprised player self-evaluation and netball specific movement analysis. Mechanisms of injury, training anxieties and modification of the overall program to ensure continued progression rather than a false plateau were illustrated through this process. From the above findings a strategy was outlined and comprised a foundation programme, a transitional phase, specific prophylactic programs, and sport specific sessions. A consistent approach was formulated across all disciplines in order to maximise transference of the new training program (TP). Training compliance was increased and interdisciplinary conflict prevented when dealing with different levels of training tolerance. Rate of injury in all vulnerable areas was markedly reduced. No training or overuse related injuries were sustained. Addressing fundamental functional problems and working openly and cooperatively towards a common goal, the members of the MDT were able to prevent injury, make significant gains in physiological performance and improve players’ confidence and commitment to training over the defined period.

Introduction

The efficacy of athlete profiling and injury prevention programs is influenced by a variety of factors. Procedural clarity, philosophy of athlete development within the sporting body and the dynamics within the multidisciplinary team (MDT) all contribute to the cost- and time-effectiveness of these programs. This article reports on the implementation of a program designed to address injury rates and support sports performance development in an international netball squad.

Welsh netball had throughout its history achieved only modest results, and limited support had been received from sports science or sports medicine. The squad (n = 17; mean ± s; age 25.86 ± 2.61 year, height 172 ± 7.78 cm, body mass 75.37 ± 15.17 kg) had little experience of detailed training prescription; however, in July 2000, through the support of the Home Country Sports Council, the Welsh Institute of Sport Netball Academy was established with clearly identified development initiatives to be implemented. These included sports science and sports medicine support, with the eventual aim of providing sports physiology, sports psychology, physiotherapy, strength and conditioning and nutrition input.

Of these, physiology and strength and conditioning support were established first. As the squad had never previously participated in a structured training program (TP), the players were initially resistant to the required discipline and, although progress was made, improvements on physiological testing were marred by an increasing injury rate.

At this time, physiotherapy was being provided only when a player sustained an injury. Because of the absence of an appointed team physiotherapist, players sought treatment from an array of practitioners, and conflict between medical practitioners and strength and conditioning personnel increased player anxiety, eroded compliance and impeded progress in the program. This is reflected in the observations of Reid et al.1 where conflict between professionals within the MDT can impact on the support services provided to the athlete. This was particularly acute when new and unfamiliar training programs were introduced, and poor communication between professional staff enabled players to manipulate sports science personnel and evade effective training when coming back from an injury.

In response to these difficulties, an external physiotherapy consultant was approached to evaluate players’ physical capabilities and troubleshoot the strength and conditioning programme. Changes were implemented in program structure, MDT dynamics and player management.

Section snippets

Procedure

A meeting of an MDT (coach, physiologist, physiotherapist and strength and conditioning coach) was held to establish goals and program structure. Given that the external consultant came from a physiotherapy background and that significant pre-existing conflict between sports medicine and strength and conditioning adversely coloured expectations from staff already in place, this time was also important to allow MDT members to express concerns, be reassured that their professional experience was

Results

Prior to inception of the functional stability programme (FSP), a high rate of overuse as well as traumatic injury was occurring among the players. These included lower back, ankle, knee and shoulder injuries. An audit comparison of the injury rates is illustrated in Fig. 1.

In the first period of the FSP, those players with chronic or recurrent injuries received modified programs to address and rehabilitate their problem area while still meeting the physiological objectives of the specific

Discussion

Three broad categories needed to be managed in order to make an impact on the squad's injury rates. These could be designated as procedural, philosophical and organisational.

The procedural issues could be considered to be the skeleton of the intervention, and included content of the profiling, timing of the testing and integration of the remedial and developmental training into the program.

Choice of profiling content can determine whether or not the procedure is worth investing time and money

Practical implications

  • Impacts on injury rates require an entire program and not just sports medicine approaches. This requires cooperation and integration within the multidisciplinary team and will sometimes require a significant restructuring of the existing plan.

  • Well-designed functional profiling procedures can yield relevant information for both performance and prevention. Results should be shared with the multidisciplinary team and examined for their implications for all aspects of the program. The program

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