SPORTS REHABILITATION

training to minimise loss of fitness during this time. It is important that the predominant metabolic pathway for energy supply during the athlete's given sport is identified and trained as part of a rehabilitation programme. The three main sources of energy supply are, aerobic, anaerobic lactate and anaerobic glycolytic. Aerobic endurance is a key component of sports where the athlete is required to perform a cyclical task, usually over a long distance, in as short a time possible (eg. cycling, running and swimming). Anaerobic endurance on the other hand characterises sports which involve high intensity activity over short distances (eg. 100m sprint) or a number of intermittent high-intensity bouts of activity over a fixed time (eg. football).

When determining the exact nature of fitness training for rehabilitation, care should be taken to ensure that the correct energy system is being trained and that adequate time is allowed for recovery and physiological adaptation. The nature, intensity, duration and work:rest ratio of individual endurance training sessions should reflect sporting demands. The nature of training used should minimise stress on the injured tissues while simulta- neously exercising muscle groups involved in the athlete's sport. Aerobic and anaero- bic endurance can be effectively trained using pool-based conditioning or cardio- vascular equipment such as a bicycle ergometer, cross-trainer, rowing ergometer and step-machine.

PROGRESSION OF SPORT- SPECIFIC EXERCISES As rehabilitation progresses, increased emphasis should be placed on the perfor- mance of sport-specific skills in prepara- tion for return to training and competition. Exercises performed during this phase should be the natural progression of those already completed since the beginning of rehabilitation. It is essential that perfect technique and correct limb alignment are maintained during all exercises and that emphasis is placed on powerful, efficient and safe movement. It is also imperative that once technique fails the exercise is stopped.

The same management goals in terms of seeking to enhance sensorimotor control, motor control stability, strength, range of motion and endurance should remain, how-

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ever more complex drills that challenge some or all of these elements simultane- ously should be implemented. One way in which this may be achieved is through the phased introduction of multi-planar movements. During the early stages of rehabilitation it is advisable to challenge strength and control through only one plane. It is usually best to begin with sagittal plane control, which may be trained through unidirectional running or lunging-type movements; as control improves, skill tasks such as throwing and catching or kicking a ball may be introduced. Further progression may be achieved through the use of lateral movements, followed by rotational movements and then any combination of all three planes of movement. The introduction of multi-sensory stimuli such as calling or signalling commands, moving around the athlete and introducing more people into the drill will further increase the difficulty of the task

Prior to return to sport, rehabilitation should, as far as is possible, challenge the athlete in a manner that reflects the challenges experienced in training and competition. This will involve carrying out, in the usual training environment, skills that are particular to the athlete's sport. For example, if the athlete is a hockey player, it is necessary to carry out exercises on a hockey pitch with a stick and ball, which replicate movements performed during a match such as shooting for goal, moving into position, tackling, defending and set-piece plays. Progression of field based rehabilitation should involve an gradual increase in pace and intensity, competition, fitness demands, decision making, unanticipated movements, space and time limitations, the use of sporting/training equipment and, where applicable, the introduction of physical contact.

Once the athlete is able to perform sport specific skills at high intensity without pain or functional impairment, they may recommence training. It is advisable that the athlete continues with maintenance exercises for a period of time following return to competition in order to minimise injury recurrence. Examples of such maintenance programmes include eccentric hamstring strengthening, balance and agility drills and flexibility training.

CONCLUSION Individualised rehabilitation planning that safely challenges and enhances athletic ability has the capacity to quickly return an athlete to competition and reduce the likelihood of injury recurrence. Rehabilitation of the injured athlete requires a wide range of skills and depends on the integration and progression of various interventions from the five subcategories of: sensorimotor training, motor control stability training, strength training, range of motion enhancement and endurance training. Progression of rehabilitation should be guided by the rate of healing of the injured tissues and the ability of the athlete to safely and effectively perform specific skills. Effective rehabilitation should emphasise the restoration of normal function and employ specific exercises that reflect the demands of the athlete's sport.

THE AUTHOR:

Dr Phil Glasgow is head physiotherapist at the Sports Institute Northern Ireland and a graduate of the University of Ulster. His doctoral studies investigated factors influ- encing exercise induced muscle damage and its management. As a keen clinician, he has worked within high performance sport for a number of years managing elite athletes from a wide range of disciplines including rugby union, hockey, athletics and gaelic football. He is particularly interested in the

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