Biomechanical analysis and rehabilitation in athletes

Summary

Posture is defined as the position of the body at a given point in time. Incorrect relationship among different parts of body produces an higher tension on retaining structure that causes postural problems. Posturology is fundamental to recognize the relationship between postural attitude and some pathological conditions otherwise difficult to recognize. We can use force platform, baropodometric or dynamometric platform to analyze tonic postural system and to evaluate sensitive receptors. The main injuries in athletes are caused by cumulative trauma. Rehabilitation process is divided in three phases: an acute phase, a post-acute phase and a “return to play” phase. The goal of prevention and rehabilitation is to find and remove stress and pathologic agent, to reduce the limitation of the range of motion, control pain and come back to sport.

Posture is defined as the position of the body at a given point in time. We have a correct posture when muscular and skeletal district are balanced. When an incorrect relationship exists among different parts of body producing an higher tension on retaining structure, and body equilibrium is unpaired, postural problems may occur. Neurosensorial system, through vestibular, visual and proprioceptive mechanisms contribute to a correct posture. Moreover, specific neurophysiologic mechanisms play an important role in maintaining a correct postural tone. The principal structures are reticular formation and Deiters’ nucleus. Proprioceptive influences coming from muscular and vestibular districts, together with descending influences by cerebellum and forebrain, maintain and modulate the activity of reticular formation and Deiters’ nucleus.

Posturology is fundamental to recognize the anatomo-functional relationship between certain postural attitude and some pathological conditions otherwise difficult to recognize.

In order to study postural attitude, we can use force platform to evaluate sensitive receptors, weight, gait and stability, or baropodometric or dynamometric platform to analyze tonic postural system, either during static posture, either walking. These platforms can also be precious for the prevention of postural disequilibrium, as well as to evaluate the efficacy of therapy usually employed in sports medicine (1).

The main injuries in athletes are caused by cumulative trauma (overuse injuries) due to functional overweight, leading to conditions such as the runner’s knee, the jumper’s knee, the anterior knee pain, the iliotibial band syndrome, shin split, Achilles tendonitis, stress fractures, groin pull, muscle pull, metatarsalgia, back pain.

Most of all in athletes, postural evaluation is important to correct wrong posture with the aid of therapeutic and proprioceptive exercise, with orthopaedic insoles if occurs, to prevent injuries. After a trauma, rehabilitation is a very important step to return to sport activity in a short time. Rehabilitation process is divided in three phases: an acute phase, a post-acute phase and a “return to play” phase. During the first phase the mean goal is reducing pain and inflammation through rest and the use of medical treatment as criotherapy, laser-therapy, tecar-therapy and FANS. In this phase, according with orthopaedics, physiotherapist can start a safe and effective therapeutic exercise, as isometric training and hydrokinesio-therapy.

During the second phase, a particular attention must be paid in recovering the muscular mass and range of motion through stretching and proprioceptive exercise and isotonic training against graded resistence. In this phase physical therapy is still needed to control pain and inflammation.

The mean goal of “return to play” phase is to recover athletic skill through stretching and proprioceptive exercises, increase the strength and return to selected drill. Therapist can use taping technique in this stage (2, 3).

Time of recover depends on the severity of the injury, on age, comorbility and patient motivation. Finally the goal of prevention and rehabilitation is to find and remove stress and pathologic agent, to reduce the limitation of the range of motion, control pain and come back to sport.