On behalf of the badmington panamerican Confederation we warmly welcome you to our coach Corner program my name is Richard Wong and it it is my pleasure to be today’s moderator in this session we are pleased to have with us once again one of the world’s leading badmington researchers I’m referring to Professor Martin
Falstrom from Sweden who today will speak on an important topic tendon injuries in badminton the role of Ecentric training in prevention and Rehab before handing over the floor to Our Guest allow me to tell you a bit about Dr falstrom he’s a senior consultant and head of department at the rehabilitation
Medic medicine clinic in the University Hospital of Northern Sweden UMO since 1993 he has a PHD in sports medicin UMO University his thesis was badminton and achilles ton it was in 2001 he’s a professor in development at the Medical Faculty UMO University since 2018 good night Dr fstr and Welcome to
Our program we thank you for joining with our audience and receiving us from your home in um Sweden we invite you to take control and share your screen thank you Richard um I will do my very best to share the screen now uh sles the slides are changing sure yeah
Thank the floor is your sir thank you very much for inviting me to this seminar or webinars again uh it’s a pleasure seeing you all and to dis talk about one of my favorite issues that is badminton of course not badminton injuries but badminton and actually treatment and Rehab of badminton
Injuries uh tonight uh ah first of all uh who am I uh you you made a presentation I I am a badmenton player from Sweden I used to play in the garden as a child I played in the top Swedish national league as a as an adult I started working with bwf
With badminton World Federation 1995 as a onc court doctor and since uh a few months a U Back I’m a semi-professional on court doctor for bwf I wrote my PhD on badminton and Ailes tend on injuries uh about 20 years ago and I I’m working with bwf and also with the umu
University and have U every year I go to um International tournaments to be on court doctor and to help the players to fulfill the matches and sometimes of course course they can’t but I’m really interested in rehab and prevention of bedminton related injuries so I’m I say
It again I’m very happy to be here tonight in Sweden it’s tonight 7 o’cl in the evening bedminton is um a well U it’s played all over the world on competitive and recreational levels and even though there are many players around the world it’s a lowrisk sport we have an injury incidence of
About three injuries in 1,000 hours of playing time and uh most of the injuries are overuse injuries and most of a majority of the injuries are injuries in the lower extremities and most of the injuries in badminton are described as different uh injuries in tendons and in soft
Tissue and these are the common badminton injury sites elbow shoulder knee wrist and uh Achilles and as um we have discussed in previous webinars there are many different methods for treatment and Rehab of soft tissue injuries however this presentation will focus on treatment and Rehab of Achilles tendon ruptures I call it
ATR uh um when I started playing badminton many years ago I learned some um true stereotypes about aillis Tandon ruptures in badminton and one was if you don’t warm up your achillis tendon will immediately rupture if you have ailles tendon pain that’s bad because your Achilles tum
Will probably rupture if you play and also if you get an Achilles tendon rupture you will never come back to bedminton again this was what I learned when I started playing badminton but it’s not true because 94% of the killers tendon injuries or ruptures ruptures acute ruptures they
Happen in the middle or the end of the planned bedminton session there are other reasons for layers to warm up but the achilla ton rupture seem to be a result of not bad warming up it’s Pro probably more fatigue and then not warming up also if you have aillis tum
Pain it’s not true that you your achillus Tenon will probably rupture only about 15 16% of all players with a achilles Tenon ruptures have previous symptoms so 84% of the players with Achilles ton ruptures they have no previous symptoms also 80% of the players that have Achilles ton ruptures will return to
Sports activities within 12 months of course um wait a minute um but I will come back to that most of the injuries that are studied in different studies from all over the world are in recreational players but 80% return to sports activities within one year so the
Stereotypes are not true this you can cross these stereotypes because aillis T rupture is a common injury in both Elite and recreational uh Sports and uh it may lead to reduced function and activity level in the long term if you don’t have adequate rehabilitation and for some reason that we don’t
Know uh the incidence is increasing it has risen from 31 to 55 per 100,000 person year uh during the last 20 years and the median age is also increasing and there are more males than females with Achilles tendon ruptures and Racket sports are the most common activities for Achilles tendon ruptures
This is a picture of the U the cough the the cough muscle is uh built from three different muscle portions the gastrus muscle that are two different um bellies on the muscle and then you have the deeper belly the Solus muscle and these three uh muscles together shape the Achilles tendon that
Um is inserted here in the achillis in the heel bone and makes the makes the uh foot can do a a toe rise so flexion of the foot and the ton structure this ton is built from very dense strict uh not so elastic fibers so they are packed
Dense together most of them parallel but there are also fibers that cross each other and get links and surrounding um fibers but and that means there is a little kind of elastic elasticity in the tendon so it can be stretched a bit you see on the left uh on to the left in
This in this slide you can see the unstretched tendon but then when the the tendon stretches the the fibers get more and more more stretched and then you can see on the right side that it can be stretched and stretched and stretched but then you come to a point where
Either um a lot of over a lot of over stretching might lead to an injury but a very tough um stretch might lead to an acute tendron rupture and what is interesting is that the The Killers t consists of tendon parts of all these three muscles and
They are twisted around each other and that is probably a contributory case of a kill ten rupture because when these muscles do not coordinate when they don’t work very well together there might be a tension in the in the united tendon that might uh be a cause to the rapture
That we don’t know but this tendon differs from other tendons in the body the Achilles tendon is a very strong tendon but it’s different from many other tendons because it’s three tendons twisted around each other and the contributory causes what what causes do we have well the structure as I just said
H um the older you get the higher is the risk male sex also is a higher risk than female sex sometimes you see after uh when you study a ruptured tendon you can see that there are vascular or degenerative changes in the tendon even though you don’t have any pain before the rupture
Overweight might Perhaps Perhaps uh cause an extra load to the tendon uh and the overload might be acute or more long-term stress or fatigue that causes uh at the end the tendon ruptures the muscular discoordination between the three cough muscle bellies and of course the technique what
Technique do you have what equipment do you have your shoes and also the environment that is the surface and the the the floor in the court and there is also some um evidence that previous cortisone injections in the area near and around the Achilles tendon might lead to uh higher risk for
Achilles tendon ruptures as I said in the beginning that it’s not achillis t ruptures are not connected with uh a lack of warming up most often the injury occurs without any warning symptoms no pain before uh you have a sudden dorsy flexion of the ankle as when you move to
For example the back end or for corner and then accelerate back in the in the court again it often happens in the middle or the end of the playing session and what you expect what you experience is a sudden loss of function in the ankle the player falls on the floor and
With or without local pain and uh I’ve been around for many times when this has happened and sometimes the player just looks surprised or confused what happened they don’t know because it doesn’t hurt in the beginning but they feel that they have no function in the
Foot and uh most often the diagnosis can be determined by an interview you can see what happens you can feel with your finger uh follow the achilla tendon and compare with the other foot but also there is the classic Thompson test when you squeeze the the cough muscle and
Then this the heel should move the foot should move if the achillas tendon is okay but if the achillas tendon is to totally ruptured uh the tomson test will um be positive so that means uh nothing will happen with the foot but that’s not an 100% uh sure correct test
Because sometimes the test is false because you can have as you see the red thing in the picture you can have an extra muscle the plantaris muscle that is a small muscle that can simulate the that the Thompson test is positive because there are muscle fibers all the
Way from the knee down to the heel that means when you squeeze the the muscle the cough muscle the foot might move due to an intact intact plantor muscle so sometimes not always but sometimes you have to do ultrasonography or MRI to confirm the diagnosis ultrasonography is just as
Good as MRI and M much cheaper but uh that depends on what they have in the clinic where you the play the player will go to there are different uh diagnosis sometimes you have a partial achillus tendon rupture that means not the whole tendon ruptures and you can walk on the
Foot but it hurts and that is must be diagnosed with ultra sonography or with MRI you can also have an ankle Distortion or a fracture that might have similar but most often the fractures or distortions they they go they are very painful and there is also one interesting
U diagnosis called the tennis leg and that is when you have a rupture often on the medial side the inner side of the cough muscle a little longer up on the on the cough muscle when it suddenly snaps and and you get pain not in the tendon but some centimeters U
Over the tendon and very interesting is that this is a quite common condition but it’s the whole healing process is quite different from aillis tendon ruptures because the prognosis is 99% good uh even though you don’t do any surgery or nothing but uh when you have
The rupture t cm more lower down on the on the Upper Limb the prognosis is different you have to have other treatment because it’s the tendon and not the muscle that snaps so what happens in the acute treatment immobilization just as other soft tissue injuries you refer the patient to appropriate medical facility
For assessment diagnosis and perhaps uh ultrasound or um ultrasonography or MRI and further management and then you come to the question surgical or non-surgical treatment there is today no consensus what is the best treatment what is the uh best treatment if you want to get a good function and go good
Healing I have my personal opinion I might tell you later but I have my personal opinion about that uh surgic surgical treatment there are different techniques uh either the open technique uh you open the skin you see the the it’s not like cutting a tendon it’s like uh when you a rope gets
Uh when you snap a rope so you have to put the ends together of most of and you have to put in extra tendon uh substance to make it heal or you can do the the percutaneous you have small uh openings in the skin and you work with another
Technique to make uh uh put the ends together you have a cost for two weeks and then you start uh mobilization you have a Walky brace you have wedges in the beginning to have more uh the toes pointing down but then more and more to a 90° in the ankle you should have
Supervised Physiotherapy and there are risks with surgery because you can have problems with the wounds uh they can have adorations you can have infections and you might also uh damage injuries when you do the surgery depending on the technique the other alternative is non-surgical treatment and then you must have a cast
Cast with the planter flection in the beginning and then you um have wedges and more and more lift the toes up to more 90° in the ankle and uh after 8 weeks you have a neutral position of the ankle and you should have supervised physiotherapy during the whole time the
Risks are quite higher for rupture if you do the non non-surgical treatment and also elongation of the tendon the tendon doesn’t get shorter but the tendon gets longer and that means you can’t U two years after uh conservative or non-surgical treatment there is a 20%
Risk that you can’t make a a heal rise because uh the the 10 is so tall is so long that when the cve muscle is contracted nothing happens in the Anor and you should have a individual tailored rehab program no matter if you have surgery or not uh in the beginning just
Mobilization to move the ankle then more and more uh loading on the tendon um to much then uh 3 months 6 to 11 weeks early mobilization and more and more um mobilization and return to sport from 3 to 12 months and physical activity that’s for example bicycling and so most
Often three to four months after the injury but every case is different so you have to have individual guidance and I’ve taken a few pictures from a paper by silver nuggle and um co-workers that’s you can see that the early rehab phase that’s 6 to 11 weeks you should have physical therapy
Physical training not too often but two or three times a week um and uh home um um movement exercises daily that a bike uh ankle range of motion stretching and so on heel rise and so on on and also balance exercises because you also lose a coordination in the in the leg and
That’s you don’t only lose muscle strength you also lose um uh coordination that means you have to train your balance gradually uh and you see as U if um if um the patient meets the criteria of single leg heel Rises at 90% of height then you can start more and
More jogging bilateral Hops and so on and uh at least to be at least 12 weeks after injury at three months if you can do five single leg standing heel Rises uh then uh it’s you could start more and more running uh progression more and more intense running and so
On and it’s suggested that between uh heavy loading of the of the uh tendon you must have a few days for Recovery between the sessions and if you are aiming to return to racket Sports and that is what we are interested in you should gradually include exercises to replicate the
Particular sport that means to about half a year after the injury you can bit by bit return to racket Sports uh and the coach and the physiotherapist has to discuss how to come this way uh what movements in this particular racket sport tennis has some very spe special
Techniques in serving for example in bedminton you have a lot of jumps and uh and other uh footwork that needs to be evaluated how to load and how not to load but you have to do it step by step I have been around um yeah this comes after six months about 50% have
Come back to sports activities after 12 months more than 80% are back on the sports uh activities but not Ben most studies are on recreational players I have been I uh personally met a few uh top International and top National and top International Players we had one player
In the men’s in Sweden’s top League uh he had his ail tendon rupture in late April one year he was playing 100% in January next year that means 7 months later seven or eight months later we also had in World Championships in Anaheim in in uh America United States
We had a play with an ailles tendon rupture that was in August one year and the year after he was playing on the top International level so but on the other hand we have players that especially those who have come up to 33 34 years they they find it too difficult to come
Back on the on the top level again too much training and too much time so it’s very diffic very big individual differences but there is a high long-term risk for deficits in heal rice if you have conservative treatment non-surgical treatment lack of strength lack of endurance and lack of
Coordination even if the player comes comes back to sports that means you have to have a physiotherapist or a coach doing tests on balance coordination strength to see that the player has equal strength coordination and and uh endurance in both legs they can play but if they have
Uneven U function in the both legs you might have more and more uh other injuries so individual and adequate rehub is very important after ailles tendon rupture but you can make it all the way with the right with a correct treatment and a a good and continuous uh
Rehab uh you can read about this we have an a very good International quite new international scientific journal called uh International uh Journal of rort science that is that has Open Access and it’s that we have badminton people in the in the edit uh in the editors are
Um well they are very um what you call it established in racket Sports and we have a lot of interesting papers in this uh International Journal of Racket Sports Science and uh we have written a paper about tendon ruptures and how to handle how to rehab and many of the pictures I’ve
Shown you are from this paper uh that was we were uh six uh authors from Sweden that made this paper so you can uh copy the link and then uh read the read the whole paper in the Open Access um Journal so I quit there and would like
To see if you have any questions thank you okay thank you very much Dr fom we moved on to our question and answer section please if you have any questions or comments you want to share write them in the chat box we have a comment here from sanie
Sharma he’s a senior NIS badminton coach India he says the recovery of young players is easy but veterans always struggle after getting injured how to rehab them 60 years I guess 60y old players yeah um that’s an interesting question uh first of all I would like to say
That uh aill acute aill T ruptures in very young players is you don’t see it often I over the years I’ve been around badminton I’ve seen one case of acute ailla ton rupture in in in a in a player uh that was 17 or 18 years old and uh
That player was did not it was a female player and she was rather too thin than too heavy so that might be another problem of U bad nutrition and uh it should be like a stress fracture you can see when you have more anorectic problems and so too much
Training and too less too little to eat but the question about uh older players is of course um do you have other risk factors that you need to take care of is the is the player well fit is this is it a heavy player and uh also what about
The technique but uh I think if you you must have a have a very good uh what you call it endurance to to I mean it takes a lot of months to get back it takes I mean it takes half a year to come back and the
Risk if you don’t do rehab carefully to not only uh go to for badminton but go for strength training uh coordination training you might get new injuries and perhaps you also might get ruptured so what I would do is to take it very slowly in a player that is 50 60 years
Old because everything takes more time so I will I just uh if I just uh pick out an answer I would say that you must count on twice the time if you have an older player and take it very easy with loading because the the Heat heing of the tendon is slower uh
The re rebuilding of the muscles are slower so you have to tell the player and motivate the player that this will take time but you might come back on the previous level but it takes a lot of time for you and of course if the player is overweighted or there are other
Things you might think of to prevent the player from new ruptur I don’t I that’s the best answer I can get give you okay all right um we have one here let me break out the old translator uh okay so SAS says what do you think about treatments complimentary for example I guess
Acupuncture um acupuncture might uh be a good painkiller or relieve the pain but pain is most often not the problem in acute in in tendon ruptures uh it’s not the pain that uh of course in rehab in the rehab uh period if the play player has pain and you
Follow the program and the and the the training might be painful of course you can use acupuncture it will not uh make the healing go quicker but it might uh lessen the pain help you not to lose Time by that the player says it’s I have
Too much pain I cannot practice and so on but it’s no healing but it’s a good way of trying to relieve the pain okay sanjie has a interesting question here how to connect mind body and soul I mean neuromuscular coordination yeah um always that’s my my
Uh I I I prefer always when I see players with the injuries in a leg that might be the ankle might be the knee or the kill t I’m so happy because I have another leg to compare with so everything you can do with one leg you should be able to do
With the other leg uh and if you can’t do it the rehab is not ready yet and what I for example recommend uh many of the players is when they watch TV stand in the with one stand and balance in the sofa you don’t have to
Buy the uh an expensive equipment M to balance boards and all that you it’s enough to stand in the sofa on one leg and hold your balance and watch TV or read a book or whatever and if you if I read a good book it’s also I get my mind and soul I
Get I I’m only joking but you can use you don’t have to have the uh um expensive equipment you can do it way back home you can stand on one leg when you brush your teeth and everything you can do with your good leg you should do it with your injured
Leg before you are ready with a rehab and that means strength that means coordination and that means endurance everything from standing on one leg jump uh jumping on one foot and all that that’s my opinion so try to get it natural training when I work in the
Office I can stand on one leg and and and uh work with my laptop for example okay all right uh in the meantime some other while we’re waiting for the questions to come in you quoted earlier that um in the beginning it was three in 1,000 um injuries for participants or in
In 1,000 hours of play and then you said later on that um it’s no increased um do we know when those studies took place initially when the first but it has been U uh it has been over the last uh I can look at my uh my in what so
In in Sweden we have seen a difference from 2001 to 2012 and in Denmark they have seen a difference from 1994 to 2013 so it’s the last 10 20 years uh the incidents has gone up I have my I think that one thing that might influence there
Are some theories that it’s not body weight overweight that causes uh the risk this these are theories I don’t know if there is any evidence but it’s not the number of kilograms or pounds it’s the if you are overweighted it might be the metabolic situation with more uh blood fat and uh
More I mean higher blood glucose higher blood fat and another metabolic situation that makes the tendon be not so strong as when you are you have another metabolic situation so it might not be the number of kilos it might be the metabolic situation that causes you to have overweight that might influence
The quality of the tendon and that is what I have been thinking about when I meet uh people that are quite overweight and have ailla tum problems that not it’s not about reducing the kilograms it’s it’s it’s about getting a better metabolic situation that might slowly slowly slowly make the quality of the
Tendons better but I have no evidence for that but I have read U studies where they have asked these questions and tried this uh uh hypothesis so and that might be I mean we know that in the western world uh at least people are getting more and more
Uh high blood lipids and high worse metabolic situations and that might lead perhaps lead to uh not so good quality on the tendons perhaps but that’s a theory okay and these studies these studies were done on specifically badminton players or were these just athletes in general
Uh and this has have been on uh not only badminton players but there is uh we have an old old study now nowadays people don’t play so much badminton in Sweden anymore because we play floor ball instead badminton is going down but we had a study a big study in Sweden
Several years ago that showed that 50% of all Achilles tendon ruptures were caused by Sports and 50% of the sports related Achilles tendon injuries were caused by badminton so badminton was 25% of all ailla ton raptures 25% badminton 25% other sports and then 50% there were other reasons in the in the whole
Population okay so badminton accounts for quite many of the Achilles tendon raptures for some reason actually I just wondering because I don’t know about I don’t know about pedal tennis and and uh no I don’t know okay no well I was just wondering if um if if the scoring the scoring system
Change had anything to do with it because we underwent the we we used to play the 3x 15 and now we moved to the 3x 21 but we now we’re now doing rally points so I’m wondering if the intensity of the game has caused um a shift in the the number of
Injuries because now you have to get going right from the very beginning I’m not sure because was they changed the scoring systems system about 20 years ago to get shorter matches but nowadays the players also defensively very good so they still play for 50 60 Minutes even though you have a new scoring
System so actually bwf is thinking about changing the scoring system again because the matches are too long but I’m not sure I my personal opinion is that the surface or the play in court has more it’s more important what is the surface uh how hard is the surface than
The length of the matches but on the other hand as I told you earlier it’s in the end or the middle and the end of the playing pan playing session that you you ailles Chon ruptures so of course if you play two hours the risk might be higher
Than if you play one hour but U most of the injuries happen in U competitive and recreational players they still lose it but I’ve seen about over the years about 10 top players from National and international level that have have ailles ton ruptures and that have been
They used from 20 to 35 years old okay um sanjie is looking at this from a very holistic View or a wide of view I should say he says how important is knowledge of anthropometry in badminton it’s interesting because in uh I can take a compare with volleyball
In volleyball you get that it’s quite uh common with Patell tendon problems and some uh young players that pain very very hard get a lot of problems with the Patell the knee tendons and perhaps some players should not play volleyball because it’s too much jumping for that particular person
And then you might of course say is bedminton a sport for you or not on the other hand uh it’s uh if you look at the players that play on on the top level it’s not so often you have ailles ton ruptures so I mean these players that train fif
Practice 15 20 25 hours a week I mean they don’t this is not the big mass of players that get their kill of tendon ruptures the most of the players are the players that go once a week to play recreational badminton and then something happens so of course it’s uh
And um I think it’s more important I think about the metabolic situation I think about um how the the total metabolic situation is for the player if that might be a risk or not so on the other hand you can play badminton to get that better metabolic situation
So oh I can’t really answer that it’s a good question but I’m sorry I can’t give you any good any good okay all right all right um well we spoke you spoke a little bit earlier in the the in the webinar um so the question is what are the treatment options for Achilles
Tendon ruptures you went over that both Surgical and nonsurgical you I don’t think however you answered which one you would prefer no do you want me to do it do you want me to do it sure let’s let’s you know it’s it’s always good to get you
Know a leading expert’s opinion now if I if I had if I had an Achilles tendon rupture I would like to have surgery that’s um because there is a 20% risk of losing uh your heel rice I mean there’s a big risk of getting a worse
Function even if I can walk and and so on but if I want to continue playing badminton I would really like to have a surgery even though there are risks for infection but I would would probably try to find the best surgeon it’s but uh I don’t think I have the
Uh I don’t think I would wait for the whole um what do you call it a conservative treatment I would like to have surgery and and start practicing as soon as possible that’s my personal opinion okay but I have no evidence that’s my only opinion that’s my only opinion
Okay all right uh it doesn’t seem we have we have any more questions coming in right now um maybe we’ll get some in the YouTube um comments anyways thank you very much Dr fstr for sharing such an interesting presentation with us it has been very enriching to talk with you
And to analyze the different situations that occur in our sport thank you so we have Gabrielle from Brazil okay and it says a competition we had last weekend here in MinGa and also many thanks to the following persons Sebastian and Amelia from Argentina Wanita from Bolivia Gabriel from Brazil David from Canada
Brenda from Costa Rica Jose and Willian from Colombia Louisa from Guatemala Claudia from Mexico Carlos Max GMO and Arturo from Peru Andis from Sweden eigor from Benin Edward from Denmark benen Hari from Madagascar and sanjie from India on behalf of badmington panamerica we thank you for your participation and
Hope that you enjoyed today’s session stay well and stay Safe A