RESEARCH SUMMARY: What does the rehabilitation and return to sport process look like for an elite footballer following a high grade hamstring injury?

Original research title: ‘Managing the return to sport of the elite footballer following semimembranosus reconstruction’ (Taberner et al., 2020)

Authors: Taberner, M; Haddad, F. S.; Dunn, A; Newall, A; Parker, L; Esteban, B; Cohen, D. D.

Year: 2020

Purpose

Few studies have described the return to sport (RTS) process and presented objective data collected during rehabilitation following injury to the semimembranosus. Accordingly, this case report outlines the management and return to sport (RTS) process of an English Premier League footballer following a high-grade semimembranosus proximal tendon tear and reconstructive surgery.

Key findings

• Off-pitch rehabilitation progressively integrated high-intensity isometrics, high-strain eccentrics and exercises requiring intermuscular control (specific to the injured limb). The gym based physical preparation also presented an opportunity to the player’s jump-landing performance and overall athletic ability.
• On-pitch rehabilitation followed the control-chaos continuum and progressed from highly structured, lower intensity drills (control) to less structured, higher intensity sports specific drills requiring greater cognitive awareness (chaos)
• Objective data from isometric posterior chain tests, Nordic tests and countermovement jump tests were incorporated into the decision-making process regarding the progression of rehabilitation, return to participation and return to sport.

Return to sport (RTS) process

Early rehabilitation – Phase 1 (Weeks 1-7)

Early rehabilitation consisted of two phases. The initial phase (Weeks 1-7) consisted of physiotherapy care and involved minimising pain/swelling, re-establishing range of motion and minimising muscle atrophy (including the implementation of nutritional strategies).

Early rehabilitation – Phase 2 (Weeks 8-12)

The second phase of early rehabilitation (Weeks 8-12) consisted of gym-based physical preparation. This phase initially consisted of isometric contractions and progressed to dynamic movements (e.g. hip thrusts, split squats) and eventually high strain eccentric contractions (introduced at Week 10).

Return to participation (Weeks 13-17)

The next stage of rehabilitation, return to participation, consisted of gym-based physical preparation and on-pitch/sports-specific re-conditioning (Weeks 13-17). The on-pitch/sports specific conditioning was progressed using the control-chaos continuum, from highly structured, lower intensity drills (control) to less structured, higher intensity sports-specific drills requiring greater cognitive awareness (chaos). The gym-based physical preparation was progressed and running mechanics, isometric exercises, jump-landing preparation exercises and strength and power exercises were all incorporated.

Return to sport (RTS) (Weeks 18-20)

Following this, the RTS process lasted 3 weeks (Weeks 18-20) and consisted of progressively integrating the player back into team training.Throughout the RTS process, objective markers of progress included the following:

• Isometric posterior chain test (using VALD’s ForceDecks) – the player lay in a supine position with the hip and knee joints of the limb being tested in 90 degrees of flexion. The hip and knee joints of the contralateral limb remained fully extended. The player pushed their heel into the force plate as hard and as fast as they could for approximately three seconds. Key metrics included peak force and force at 100 ms.
• Nordic (using VALD’s NordBord) – average eccentric knee flexor force and between-limb asymmetry across 3 trials was assessed.
• Countermovement jump (using VALD’s ForceDecks) – data from countermovement jumps tests were compared to the player’s pre-injury data. Multiple metrics were examined, including jump height, flight time:contraction time ratio, concentric peak force, concentric peak power, concentric impulse and eccentric peak power.

Read the full research paper here.

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