Sports physiotherapy not only helps in the management of sports injuries, but is also a pivotal tool for injury prevention and performance enhancement. The SingHealth Duke-NUS Sport & Exercise Medicine Centre shares more.
Sports physiotherapy not only helps in the management of sports injuries, but is also a pivotal tool for injury prevention and performance enhancement. Often the first point of contact for many patients, general practitioners can play an active role in initial injury treatment and referral to a sports physiotherapist where beneficial.
WHAT IS SPORTS PHYSIOTHERAPY?
Sports physiotherapy is a specialised field of physiotherapy that focuses on the prevention and management of injuries related to participation in sports and exercise.
Sports physiotherapists treat and rehabilitate athletes who have been injured, and help them to return to their sports as quickly and safely as possible. They provide evidence-based advice on safe participation in sporting activities for individuals of all ages and levels of ability, as well as play a pivotal role in helping athletes enhance their performance.
INCREASING SPORTING PARTICIPATION AND INJURIES
In Singapore, there is a growing number of residents participating in sporting activities. Based on a national survey conducted by Sport Singapore, regular participation in sporting activities reached an all-time high of 74% in 2022, with more people taking part in walking, jogging and calisthenics.1 The same survey also found that teens aged 13 to 19 were participating in higher-intensity sports such as basketball, football and badminton.1
Correspondingly, there was an increasing number of people with sports- and recreational-related injuries ranging from fractures and dislocations, to other upper and lower limb musculoskeletal injuries such as sprains and strains.
Figure 1 Physiotherapy running track and gyms at Singapore General Hospital
MANAGEMENT APPROACH FOR SPORTS INJURIES
Following an injury, a multidisciplinary team approach is often needed to provide high quality care to the injured athlete. This team usually consists of a sports physician, sports physiotherapist and other healthcare professionals such as a sports surgeon, podiatrist, exercise physiologist, dietitian or sports psychologist.
The GP’s role
General practitioners (GPs) have an important role as they are often the first point of contact for people seeking medical advice for their sport- or exercise-related injury.
GPs can provide the initial injury management before referring patients onwards to the appropriate multidisciplinary team member.
The sports physiotherapist’s role
Sports physiotherapists perform comprehensive assessments to determine the root cause (and likely contributing factors) of how the injury occurred and the anatomical structures that have been damaged.
Following which, they, with their wide range of treatment approaches, will formulate an individualised rehabilitation programme to facilitate patients in their recovery process and return back to sports.
Phases of sports rehabilitation
Initial rehabilitation phase
Sports rehabilitation during the acute phase aims to protect the injured tissues while allowing the healing process to take place. Rehabilitation at this phase will consist of maintaining or improving mobility, flexibility, strength and balance.
Correcting muscle imbalance and doing modified physical activities while managing the pain and swelling may also be required. Rehabilitation programmes at this stage can include taping and strapping, cryotherapy, ultrasound therapy, massage therapy and a home exercise programme.
The sports physiotherapist may also recommend alternative training for athletes who are injured. This would mean adopting a different type of training method to condition the body while not stressing the injured region. For example, a runner with knee pain can try deep-water running in a pool or swimming to maintain aerobic fitness.
The injured athlete should be progressed carefully from one phase to the other. Thus, the criteria or milestones for progression to the next phase must be determined based on function rather than time.
The sports physiotherapist will carry out a sports-specific functional assessment to determine if the injured athlete can be progressed to the subsequent rehabilitation phase and eventually towards full participation in sports.
A comprehensive rehabilitation programme must also include proprioceptive training.
After an injury, particularly for joint injuries, the athlete may have impaired coordination in the joint. If the coordination is not recovered, the athlete may be predisposed to reinjury. Thus, progressive rehabilitation exercises such as balance drills, running drills and plyometrics drills are important to recondition any proprioception impairments.
SPORTS INJURY PREVENTION
The sports physiotherapist will advise patients on ways to prevent injury or reinjury. This would include advice on further strength and conditioning – to ensure that the athlete has the capacity to meet the demands required in sports, in order to prevent injury.
For example, a soccer player recovering from a hamstring strain would need to continue to strengthen and improve the flexibility of his injured hamstring, as well as other muscle groups required for soccer activities.
Injury prevention will also include training load management with an emphasis on not overtraining. Furthermore, the sports physiotherapist will have to work together with the coaches and trainers to help the athlete back to full fitness and performance.
Pre-participation screening in sports or physical activity is very important. The goal is to identify any potential risk factors for injury or death, so that they can be addressed before the individual starts participating in sporting activity.
The GP’s role
The screening may consist of medical examinations and subjective history taking by GPs to identify potential risk factors for medical conditions such as cardiovascular conditions or asthma.
The sports physiotherapist’s role
The role of the sports physiotherapist in pre-participation screening is to identify any abnormalities in movement patterns or function that may predispose the individual to musculoskeletal injuries.
The aim of the musculoskeletal screening is to assess recovery from any previous injury, and assess the presence of suspected risk factors for future injury. This can also help to facilitate optimal musculoskeletal health and optimise performance.
For example, a screening of a basketball player with a history of recurrent ankle sprains and poor ankle function would mean that the player may require additional rehabilitation – to prevent further injury before returning to full activities or sports.
All in all, sports physiotherapy can improve the outcomes of an injury or condition through preventative, restorative and rehabilitative means for individuals of all ages and levels of ability. A multidisciplinary team approach is also needed to rehabilitate the individual as a whole.
GPs can consider referring patients to a sports physiotherapist for treatment and management of injuries.
Shared decision-making and realistic goal-setting with patients are also important to ensure satisfaction, and that they are safe to return to their sports and activities.
Survey, N.S.P., Singapore is more active than ever! Insights from the National Sport Participation Survey conducted annually between 2018 and 2022. 2022.
Seah, P.Z., et al., Risk Stratification of Paediatric Sports Injuries Seen at a Tertiary Hospital. Ann Acad Med Singap, 2020. 49(12): p. 955-962.
Ms Lim Fen Ru Josephine is a Senior Physiotherapist with the Department of Physiotherapy in Singapore General Hospital (SGH). She has worked in the area of musculoskeletal and sports physiotherapy and has vast clinical experience across a wide range of musculoskeletal conditions. Ms Lim is the leader of the Physiotherapy Sports Service at SGH. She is also an educator in the SGH Musculoskeletal Physiotherapy Residency Programme and has been involved in training other physiotherapists to better prevent and manage sporting injuries.
Adjunct Assistant Professor Philip Cheong is a Senior Principal Physiotherapist at Singapore General Hospital. Prof Cheong also concurrently holds the appointment of Director of Research at the SingHealth Duke-NUS Sport & Exercise Medicine Centre. He is a highperforming healthcare leader and experienced physiotherapist with over 20 years of experience in the healthcare industry. His professional interests encompass musculoskeletal sciences, sports physiotherapy, risk-stratified care management, chronic pain management and the integration of technology in healthcare delivery.
GPs can call the SingHealth Duke-NUS Sport & Exercise Medicine Centre for appointments at the following hotlines or click here to visit the website:
Singapore General Hospital: 6326 6060
Changi General Hospital: 6788 3003
Sengkang General Hospital: 6930 6000
KK Women's and Children's Hospital: 6692 2984