The pearl of long-term rehabilitation is to build a small team of core people who collaborate with other professions. Never walk alone!
Kjetil Jansrud, alpine skiing gold medallist at the 2014 Sochi Winter Olympic Games, 13 months after rupturing his anterior cruciate ligament
Sports injury rehabilitation is a dynamic, structured process that aims to:
restore the injured athlete’s function and performance level
return the athlete to sports participation in a safe and timely manner
minimise the risk of re-injury.
As previous injury is a prominent risk factor for future injury,1, 2, 3 rehabilitation is a critical aspect of our professions. In most cases, the goal should be to improve the athlete’s physical function to above their pre-injury level.
The foundation of sports injury rehabilitation is a targeted exercise program that is progressed gradually. As outlined in previous chapters (including 6 and 17), exercise therapy acts at the local tissue level and in the central nervous system. It may be used as a direct injury treatment (mechanotherapy)4 or to unload injured tissue via altered movement and muscle activation patterns. It is also important to maintain the athlete’s condition as much as possible throughout the rehabilitation process. A model of the parallel priorities of exercise prescription during the rehabilitation process is shown in Figure 18.1.
A model of the parallel priorities of exercise prescription during sports injury rehabilitation. The responsibility for implementation of the program should be gradually transferred from the medical team to the coach throughout the later phases of rehabilitation
Exercise prescription, progress and supervision is often performed by a physiotherapist (or similar health professional, for example sports rehabilitator, trainer, therapist). However, where possible, a broader multidisciplinary team including the sport and exercise medicine physician, orthopaedic surgeon and other sport scientists (such as strength and conditioning specialists) should collaborate in rehabilitation planning. It is also critical to engage coaches in all phases of rehabilitation. In the early phases, coaches need to understand the plan and appreciate the functional milestones. In the later phases they should take an increasingly active role in implementing the program (Fig. 18.1).
Active rehabilitation is often supplemented with medical and manual therapies that may enhance the effects of exercise through pain management and improved tissue adaptations (Chapter 17). The success of rehabilitation depends on introducing the most effective intervention at the right time in an adequate dosage.5
Modern sports injury rehabilitation is progressed through phases based on sound clinical reasoning, sequenced functional achievements and the completion of functional milestones. At the same time, knowledge of tissue-specific biological healing processes should be respected and will guide the rehabilitation timeline. Exercise prescription, communication and clinical reasoning are core skills for clinicians ...