REHABILITATION

throughout the movement, and 8-10 repe- titions are performed emphasising the low- ering portion of the movement as before.

Phase (III) Training in phase (III) is designed to form a bridge between rehabilitation exercises and sport itself. The emphasis now is train- ing specificity, that is matching the exer- cises as closely as possible to the demands of sport. Phases (I) and (II) have re-estab- lished muscle balance around the hip and the subject is now able to take full body- weight on the affected leg while maintain- ing optimal lumbo-pelvic alignment. They can perform multiple repetitions of this movement showing that postural endurance has been built up. However, they have only performed a limited number of exercises so their ‘exercise vocabulary’ is quite restricted. Furthermore the exercises in phase (I) and (II) were not matched to a particular sport, but were designed to isolate the body area causing pain.

In phase (II) the subject performed the mini-squat exercise which emphasised leg and pelvic alignment while flexing the knee. This is now progressed with eccentric step walking. The subject simply uses walk- ing down stairs/steps as an exercise. The lowering phase should be emphasised to take 5-8 seconds with each step and 8-10 steps should be practiced per set. This emphasises muscle work while minimising repetitive joint movement. Once this can be performed pain free, normal gait timing is used and a greater number of repetitions performed. A typical programme would include 3-5 sets jogging up steps and walk- ing down. This motion is progressed finally

ACTION/SPORT GIVING SYMPTOMS

■ Step aerobics

■ Squat in weight training ■ Sitting into low chair

■ Racquet sports ■ Road running ■ Fell running

■ Cycling ■ Sking

to step running where the subject jogs up the steps and then jogs down. There are obvious safety considerations with jogging down steps, and the trainer/ coach must emphasise these and ensure that the action is performed in a controlled fashion at all times.

In terms of muscle work, a deeper step is harder because the range of motion is greater. However as the pain of ITBS occurs early in the range of motion, increasing the number of repetitions rather than the range of motion is a greater challenge to the ITB itself. In a similar vane, total time is a pro- gression for this condition.

The next exercise is slope running. Although running down a slope is less demanding in terms of muscle work than running down stairs, slope running can be performed for a longer period before fatigue sets in and this greater time increases the requirement of alignment control to prevent friction onset. Sets of 3- 4 minutes are used to begin, building to 10-15 minutes. A sidestep action may also be used with the affected leg as the down- hill leg. If alignment is degrading towards the end of the set, postural endurance is being lost. The point at which the set is stopped should therefore be when align- ment begins to be lost rather than when the timescale of the set is completed.

The phase (III) exercises here have emphasised postural endurance during the eccentric component of running (down- hill) because this is the motion which most often gives rise to symptoms. However, if the condition has occurred in

ECCENTRIC ACTION USED IN PHASE (III) REHABILITATION

■ Step down from low step leading with unaffected leg

■ Squat onto medium height stool ■ Squat onto medium height and then low stool

■ Slow lunge leading with affected leg ■ Declined 10° road run ■ Declined 20° slope run with / without sidestep

■ Static cycle varying saddle height ■ Mini-squat on balance (wobble) board maintaining bent knee position.

other sports, movements specific to those sports should be chosen.

THE AUTHOR

Christopher Norris is a chartered physiother- apist with a masters degree in rehabilita- tion. He is a visiting lecturer to several uni- versities both in the UK and abroad, and is the author of 6 books on sport and exercise. His textbook 'Sports Injuries' (see p24) is out in July in its 3rd edition and is a rec- ommended text on most sports based cours- es. Chris also runs two private clinics in Manchester and Cheshire treating sports people of all levels.

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