Following an injury

Return to play following injury: Fingers crossed or an assessment paradigm?

The pressures to return a professional sportsman back to full fitness and competition following injury can be intense.  The pressure factor is multi-faceted and can come from the management and coaches, the player themselves and the media.  Clinicians are also internally driven to deliver an ‘optimal’ rehabilitation programme that is neither too conservative nor too reckless. 

Advances in rehabilitation theory and practice have progressed exponentially over the last 15 years. For example, the return to play (RTP) time for players following ACL reconstruction has more than halved (Shelbourne and Nitz, 1990; Delay et al, 2001; Francis et al, 2001).  However, identifying when it is ‘safe’ for an athlete to return to full unrestricted activity remains controversial.  More recent studies have suggested that full recovery is not always used as an indicator for a player to return to training and competition, the use of RTP evaluations following injury is variable and there is a high incidence of re-injury in certain sports such as Rugby Union (Beardmore et al, 2005).

This presentation will cover end stage rehabilitation for the lower limb with specific reference to ACL rehabilitation.  Strategies for developing the explosive lower limb power necessary for many sports will be presented. The use of Functional Performance Tests (FPT) for pre-season testing, training and rehabilitation programmes will also be discussed. Furthermore, FPTs may also assist in identifying a safe return to play, thus minimising the risk of re-injury.

References

Beardmore AL, Handcock PJ, Bentley S (2005) Return-to-play after injury: practices in New Zealand rugby union. Physical Therapy in Sport (In press)

Delay BS, Smolinski RJ, Wind WM, Bowman DS (2001) Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. American Journal of Knee Surgery 14:85-91

Francis A, Thomas RdeWM, McGregor A (2001) Anterior Cruciate ligament rupture: reconstruction surgery and rehabilitation. A nation-wide survey of current practice. The Knee 8: 13-18

Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. American Journal of Sports Medicine 18: 292-299

Zoë Hudson PhD MCSP

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Platelet Rich Plasma (PRP)

An innovative treatment, for  Musculoskeletal Pathologies , PRP uses your own blood for healing muscle, tendon and ligament injuries. 

A common form of healing is scarring which affects function . Most of the Current therapies  treating sports Injuries  do not change the intrinsically poor healing properties. Given this situation, biologically based strategies involving the stimulation of cell activities through the delivery of Growth Factors have attracted considerable interest. 

Platelet Rich Plasma is derived by placing a small amount of your blood in a filtration system which separates red blood cells from platelets. The high concentration of platelets (containing a high level of Growth Factor) is then injected into the injured tissue which initiates the body’s natural healing response.

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Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes

Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.

Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.

Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Conclusion: We conclude that the instability repair using

a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.

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