Sports Medicine How is injury rehabilitation managed?

Rehabilitation procedures Rehabilitation aims to restore the injured site so that the athlete can return to practice and competition without pain, and with the same range of movement they had before the injury. Successful rehabilitation procedures reduce the chance of re-injury RICER StretchingStrengtheningConditioning Training Return to Play

Progressive mobilisation –It is important to progressively introduce movement to the injured area once the RICER technique has been applied. –Gradually moving the injured area using light stretches and rotations will reduce the build-up of scar tissue and allow greater mobility in the injured part.

Graduated exercise –Gradually returning the body to pre-injury condition takes time and should be undertaken slowly. –When an injury occurs, muscle fibres seize and scar tissue builds up. –Stretching assists the muscles to regain elasticity so that they can contract and extend without injury. –PNF stretches are best for a rehabilitation program.

–Strengthening surrounding muscles using isometric exercises to progressively increase the muscle length is important. –Weights can assist in building up muscle strength and restoring the muscles to their pre-injury strength. –Strengthening is a method of injury prevention, as stronger muscles are able to cope with greater demands on joints, therefore reducing the likelihood of an injury occurring.

Training –Full participation in training is hindered during the injury period. –Injured athletes should undertake modified training sessions to enable their injury to heal.

–An athlete may complete the training session at a lower intensity to ensure the injured area is not aggravated, but over time they will return to full-intensity sessions. –A rehabilitation program has been successful when an athlete is able to undertake a full training session and participate in all elements—including warm-up, skills, drills, match play and a cool down—without any pain in the injured area.

Use of heat and cold –Injuries can be treated using heat packs or cold packs. –This will depend on the type of injury and the length of time since the injury occurred –Ice can be used instantly on all injuries, as it reduces swelling and pain, restricts the blood vessels, which reduces the blood flow to the injured area and inflammation. –Cold treatments can include ice in bags, ice packs, ice gels and ice baths.

–The use of heat can be used to treat injuries –As heat increases blood flow, the use of heat on sore muscles and tendons will help to relax them and increase their elasticity. –Heat treatments include hot packs, ultrasound treatments and whirlpools. –While heat can make body tissue more mobile, if inflammation is visible, ice should be used.

Return to play If an athlete returns to training and competition too soon after an injury, they run the risk of re-injury. Even when an injury has healed, there are specific measures that need to be taken to ensure the injury does not recur. In some instances, medical clearance must be given before an athlete can return to play.

Indicators of readiness for return to play –If an athlete has undertaken a rehabilitation program successfully, an injured area should have returned to its normal functioning. –An athlete is ready to return to competition when they are able to perform all the skill and fitness components of their sport. –The injured area should have: elasticity and flexibility in the injured muscles strength in the surrounding muscles to support joints during movement full range of movement no pain.

Monitoring progress (pre and post-test) –To ensure the injured area has returned to its normal functioning, conducting sport- specific tests will provide both coaches and athletes with information on the athlete’s fitness and skill ability. –Using a test specific to the sport, can give an indication of how their fitness and skill level is progressing after the injury. –The test will also place the injured area under competition pressures to see how the body responds.

Psychological readiness –An injury can impact on an athlete’s psychological wellbeing. –Athletes may feel that they may lose fitness, or their spot in a team, if they do not participate in training sessions. –This may lead to depressive episodes, which in turn can affect their approach to rehabilitation. –Depending on the type of injury, the trauma from sustaining the injury may affect an athlete’s ability to participate. –When rehabilitating the physical injury, it is therefore important to rehabilitate an athlete’s mental capability, and make sure they are psychologically ready to restart training and competition.

Specific warm-up procedures –When returning to play after an injury, an athlete’s routine needs to include warm-up stretches and drills that are specific to the injured area. –Ensuring muscles are warm, stretched and ready for physical activity is important in preventing further damage.

Return to play policies and procedures –Sports clubs have a responsibility to ensure that policies and procedures are in place for players returning from an injury. –Clubs have a duty of care to ensure athletes are fit to return to training and competition when they are injury-free—not before their injury has healed.

Ethical considerations –When athletes are injured, they are faced with many dilemmas about returning to their sport. –Elite athletes in particular feel pressure from their coaches, teammates, sponsors and society to be back on the field as soon as possible. –These added pressures can force an athlete to return to competition before the injury is completely healed, running the risk of further damaging the area. –Athletes may choose to use pain killers that numb the pain, such as cortisone injections, but this numbness sets an athlete up for further damage as they cannot feel the injury and hence will not feel the pain when they incur more damage.