Spor Yaralanmalarından Korunma Yaklaşımları

Abstract

Amaç: Bu çalışmanın amacı spor yaralanmalarından korunma yaklaşımları ile ilgili geçmişten günümüze literatürde yer alan bilgilerinin derlenmesidir. Yöntem: Bu çalışmada spor yaralanmalarının görülme sıklığı, spor yaralanmalarından koruyucu yaklaşımlar ve tarihçesi, spor yaralanmaları oluşturan iç ve dış risk faktörleri, sık görülen spor yaralanmalarının mekanizmaları ve spesifik sebepleri, yaralanma modellerine özel geliştirilen koruyucu egzersiz programları hakkındaki bilgilere 1984-2024 yılları arasındaki literatüre PubMed’de taranarak ulaşılmış ve sonuçları derlenmiştir. Bulgular: Spor yaralanmalarından korunmaya özgü ilk kavramsal modeli Willem Van Mechelen geliştirmiştir. İleriki dönemlerde bu kavramsal model Bahr ve Holm tarafından genişletilerek spor yaralanmalarının çok etmenli sebepleri, yaralanma mekanizmalarının iç ve dış faktörlerle ilişkileri anlatılmıştır. Ayrıca her bir spor türüne özgü yaralanma paterni tanımlanmıştır. Ayak bileği sprainleri, akut diz yaralanmaları, hamstring strainleri, en sık görülen spor yaralanmalarındandır. Spesifik geliştirilen koruyucu yaklaşımlar ve koruyucu egzersiz programları yaralanma mekanizmalarına ve spor branşlarına özgü geliştirilmiştir. Tüm koruyucu programların ortak olarak dayandığı esaslar ise; propriyosepsiyon çalışmaları, core kuvveti, nöromusküler antrenman, kas hafızası, doğru teknik, tüm beden ve alt ekstremite pozisyonunun kontrolüdür. Sonuç: Sporla ilgilenen klinisyenlerin önemli rolü fiziksel aktivitede ve spora bağlı yaralanmalarda risk faktörlerini minimuma indirmektir. Birçok farklı spor branşında sık görülen yaralanma mekanizmalarına özgü geliştirilen koruyucu yaklaşımlar ve egzersiz modelleri ile spor yaralanmalarını önemli ölçüde azaltmak mümkün olabilir.

Keywords

• Egzersiz
• Spor Yaralanmaları
• Yaralanmaları Önleme

Sports Injury Prevention Approaches

Abstract

Aim: The purpose of this study was to review the studies including protective methods from sports injuries in the literature. Methods: In this study, the information about the incidence of sports injuries, the protective methods from the sports injuries and their history, internal and external risk factors of the sports injuries, the mechanisms and specific causes of the most common sports injuries, and the protective exercise modalities specifically developed according to injury mechanisms were collected from PubMed search using the literature between 1984 and 2024, and the results were reviewed. Results: Willem Van Mechelen developed the first conceptual model specific to sports injury prevention. This conceptual model was later expanded by Bahr and Holm to explain the multifactorial causes of sports injuries and the relationship of injury mechanisms with internal and external factors. Besides, injury patterns were defined specific to the each sport type. The most common sports injuries were ankle sprains, acute knee injuries, and hamstring strains. The specific protective approaches and exercise programs were developed for each injury mechanisms and sports branches. The common principles of all the protective programs were proprioception exercises, core strength, neuromuscular training, muscle memory, correct technique, whole body and lower extremity position control. Conclusion: The important role of the sports clinicians is to minimize the risk factors in physical activities and sports-related injuries. It may be possible to significantly reduce the sports injuries with protective approaches and exercise modalities developed specifically for the injury mechanisms in many different sports branches.

Keywords

• Exercise
• Sports Injury
• Injury Prevention

References

1. Alentorn-Geli E., Myer G. D., Silvers H. J. & Samitier G. (2009). Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surgery, Sports Traumatology, Arthroscopy, 17(7), 705-729.
2. Andersen T. E., Floerenes T. W. & Arnason A. (2004). Video analysis of the mechanisms for ankle injuries in football. American Journal of Sports Medicine, 32(1), 69-79.
3. Andersson S. H., Bahr R. & Clarsen B. (2016). Preventing overuse shoulder injuries among throwing athletes: A cluster-randomised controlled trial in 660 elite handball players. British Journal of Sports Medicine, 51(14), 1073-1080. DOI:10.1136/bjsports-096226.
4. Bahr R. & Holme I. (2003). Risk factors for sports injuries-a methodological approach. British Journal of Sports Medicine, 37(5), 384-392. DOI: 10.1136/bjsm.37.5.384
5. Bahr R. & Krosshaug T. (2005). Understanding injury mechanisms: A key component of preventing injuries in sport. British Journal of Sports Medicine, 39(6), 324-329. DOI:10.1136/bjsm.2005.018341
6. Bahr R. (1997). Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand Journal Medicine Science Sports, 7(3), 166–171.
7. Bahr R. (2007). Can we prevent ankle sprains? (MacAuley D., Best T.M., 2) Evidence-based Sports Medicine. Malden: Blackwell.
8. Bahr R. (2014). Demise of the fittest: Are we destroying our biggest talents? British Journal of Sports Medicine, 48(17), 1265–1267.

9. Brukner P., Khan K. & Clarsen B. (2014). Brukner ve Khan's Clinical Sports Medicine (Second Edition: 2). Sydney: McGraw-Hill Education.
10. Caine D., Purcell L. & Maffulli N. (2014). The child and adolescent athlete: A review of three potentially serious injuries. BMC Sports Science Medicine and Rehabilitation, 10(6). DOI: 10.1186/2052-1847-622
11. Dadebo B., White J. & George K. P. (2004). A survey of flexibility training protocols and hamstring strains in professional football clubs in England. British Journal of Sports Medicine, 38(4), 388–394.
12. Dick R., Ferrara M. S., Agel J., Courson R., Marshall S.W., Hanley M. J. et al. (2007). Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System. Journal of Athletic Training, 42(2), 221–233.
13. Ekstrand J., Hägglund M., Kristenson K., Magnusson H. & Waldén M. (2013). Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: An 11-year follow-up of the UEFA Champions League injury study. British Journal of Sports Medicine, 47(12), 732–737.
14. Freckleton G. & Pizzari T. (2014). Risk factors for hamstring muscle strain injury in sport: A systematic review and meta-analysis. British Journal of Sports Medicine, 47(6), 351–358.
15. Gabbe B. J., Bennell K. L., Finch C. F., Wajswelner H. & Orchard J. W. (2006). Predictors of hamstring injury at the elite level of Australian football. Scandivanian Journal of Medicine Science Sports, 16(1), 7–13.
16. Giza E., Fuller C., Junge A. & Drovak J. (2003). Mechanisms of foot and ankle injuries in soccer. American Journal of Sports Medicine, 31(4), 550–554.
17. Hägglund M., Walden M. & Ekstrand J. (2006). Previous injury as a risk factor for injury in elite football: A prospective study over two consecutive seasons. British Journal of Sports Medicine, 40(9), 767–772.
18. Hartig D. E. & Henderson J. M. (1999). Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. American Journal of Sports Medicine, 27(2), 173-176. DOI: 10.1177/03635465990270021001.
19. Heiderscheit B. C., Hoerth D. M., Chumanov E. S., Swanson S. C., Thelen B. J. & Thelen D. G. (2013). Identifying the time of occurrence of a hamstring strain injury during treadmill running: a case study. Clinical Biomechanic (Bristol, Avon), 20(10), 1072–1078.
20. Hewett T. E., Myer, G. D., Ford, K. R., Paterno, M. V. & Quatman, C. E. (2006). Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. American Journal of Sports Medicine, 34(2), 299-311. DOI: 10.1177/0363546505284183.
21. Hootman J. M., Dick R. & Agel J. (2007). Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), 311–319
22. IOC Medical Commission, International Olympic Committee, International Olympic Committee. Olympic Solidarity. Sport Medicine Manual. (1990). Hurford Enterprises Limited.
23. Jenkins W. L., Killian C. B., Williams D. S., Loudon J., Raedeke S. G. (2007). Anterior cruciate ligament injury in female and male athletes: the relationship between foot structure and injury. Journal of American Podiatric Medical Assocation, 97(5), 371–376.
24. Jonhagen S., Nemeth G. & Eriksson E. (1994). Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility. American Journal of Sports Medicine, 22(2), 262–266.
25. Kannus P. (1993). Types of ınjury prevention. Sports Injuries; Basic Principles of Prevention and Care (Editör: P.A.F.H. Renström, 4). The Encylopedia of Sports Medicine. Oxford: IOC Medical Commission Blackwell.
26. Karlsson J. & Andreasson G. O. (1992). The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study. American Journal of Sports Medicine, 20(3), 257–261.
27. Karlsson J., Verhagen E., Beynnon B. (2009). Preventing ankle injuries (Editör: Roald Bahr, Lars Engebretsen). IOC Handbook of Sports Medicine and Science—Sports Injury Prevention. Oxford: WileyBlackwell.
28. Kaufman K. R., An K. N., Litchy W.J. & Chao E.Y. (1991). Physiological prediction of muscle forces, II: Application to isokinetic exercise. Neuroscience, 40(1), 793–804.
29. Kerkhoffs, G. M., Van Den Bekerom, M. & Elders, L.A. (2012). Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British Journal of Sports Medicine, 46(12), 854–860.
30. Kilic O., Maas M., Verhagen E., Zwerver J. & Gouttebarge V. (2017). Incidence, aetiology and prevention of musculoskeletal injuries in volleyball: a systematic review of the literature. European Journal of Sport Science, 17(6), 765–793.
31. Kilic O., Van Os V., Kemler E., Barendrecht M. & Gouttebarge V. (2018). The “Sequence of Prevention” for musculoskeletal injuries among recreational basketballers: A systematic review of the scientific literature. The Physician and Sportsmedicine, 46(2), 197–212.
32. Komatsuda T., Sugita T., Sano H., Kusakabe T., Watanuki M., Yoshizumi Y. et al. (2006). Does estrogen alter the mechanical properties of the anterior cruciate ligament? An experimental study in rabbits. Acta Orthopaedica, 77(6), 973–980.
33. Konradsen L., Olesen S. & Hansen H. M. (1998). Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. American Journal of Sports Medicine, 26(1), 72–77.
34. Lauersen J. B, Andersen T. E. & Andersen L. B. (2018). Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: A systematic review, qualitative analysis and meta analysis. British Journal of Sports Medicine, 52(24), 1557–1563.
35. Lauersen J. B., Bertelsen D. M. & Andersen L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11), 871–877.
36. Liddle N., Taylor, J. M., Chesterton, P. & Atkinson, G. (2024). The effects of exercise-based injury prevention programmes on injury risk in adult recreational athletes: A systematic review and meta-analysis. Sports Medicine, 54(3), 645-658.
37. Maehlum S. & Daljord O. A. (1984). Acute sports injuries in Oslo: a one-year study. British Journal of Sports Medicine, 18(3), 181–185.
38. McBain K., Shrier I. & Shultz R. (2012). Prevention of sports injury I: A systematic review of applied biomechanics and physiology outcomes research. British Journal of Sports Medicine, 46(3), 169–173.
39. McHugh M. P., Tyler T. F. & Mirabella M. R. (2007). The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. American Journal of Sports Medicine, 35(8), 1289–1294.
40. McIntosh A. & Bahr R. (2009). Developing and managing an injury prevention program within the team (Editör: Ronald Bahr, Engebretsen Lars, 1). IOC Handbook of Sports Medicine and Science—Sports Injury Prevention. Oxford: Wiley-Blackwell.
41. Meeuwisse W. H., Tyreman H. & Hagel B. (2007). A dynamic model of etiology in sport injury: The recursive nature of risk and causation. Clinical Journal of Sport Medicine, 17(3), 215–219.
42. Mjolsnes R., Arnason A. & Osthagen T. (2004). A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scandinavan Journal of Medicine Science in Sports, 14(5), 311–317.
43. Neilson, V., Ward, S., Hume, P., Lewis, G. A. & McDaid A. (2019). Effects of augmented feedback on training jump landing tasks for ACL injury prevention: A systematic review and meta-analysis. Physican Therapy in Sport, 39, 126–135.
44. Nieves J.W., Melsop K. & Curtis M. (2010). Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. Phsical Medicine and Rehabilitation, 2(8), 740–750.
45. Petersen J., Thorborg K. & Nielsen M. B. (2011). Preventive effect of eccentric training on a cute hamstring injuries in men’s soccer: A cluster-randomized controlled trial. American Journal of Sports Medicine, 39(11), 2296–303.
46. Petushek E. J., Sugimoto D., Stoolmiller M., Smith G. & Myer G. D. (2019). Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis. American Journal of Sports Medicine, 47(7), 1744-1753. DOI:10.1177/0363546518782460.
47. Pope R. P., Herbert R. D., Kirwan J. D. & Graham B. J. (2000). A randomized trial of preexercise stretching for prevention of lower-limb injury. Medicine and Science in Sports and Exercise, 32(2), 271–277.
48. Stephens M. B. & Beutler A. (2007). Principles to Help Prevent Youth SportsRelated Injuries. American Family Physician, 75(11).
49. Timmins R. G., Bourne M. N., Shield A. J., Williams M. D., Loranzen C., Opar D., (2016). Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): A prospective cohort study. British Journal of Sports Medicine, 50(24), 1524-1535. DOI:10.1136/bjsports095362
50. Van Mechelen W., Hlobil H. & Kemper H.C. (1992). Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Medicine, 14(2), 82–99.
51. Verrall G. M., Slavotinek J. P. & Barnes P. G. (2001). Clinical risk factors for hamstring muscle strain injury: A prospective study with correlation of injury by magnetic resonance imaging. British Journal of Sports Medicine, 35(6), 435–439.
52. Verrall G. M., Slavotinek J. P. & Barnes P. G. (2006). Assessment of physical examination and magnetic resonance imaging findings of hamstring injury as predictors for recurrent injury. Journal of Orthopedic Sports Physical Therapy, 36(4), 215–224.
53. Warden S. J., Davis I. S., Fredericson M. (2014). Management and prevention of bone stress injuries in long distance runners. Journal of Orthopedic Sports Physical Therapy, 44(10), 749–765.
54. Webster K. E. & Hewett T. E. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaetic Research, 36(10), 2696–2708.
55. Wu H., Brooke-Wavell K., Fong D. T. P., Paquette M. R. & Blagrove R. C. (2024). Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Medicine, 54(5), 1249-1267. DOI: 10.1007/s40279-024-01993-7
56. Yamamoto T. (1993). Relationship between hamstring strains and leg muscle strength. A follow-up study of collegiate track and field athletes. The Jounal of Sports Medicine and Physical Fitness, 33(2), 194–199.
57. Zazulak B. T, Hewett T. E., Reeves N. P, Goldberg B. & Cholewicki J. (2007). Deficits in neuromuscular control of the trunk predict knee injury risk: A prospective biomechanical-epidemiologic study. American Journal of Sports Medicine, 35(7), 1123–1130.