APPLIED REHABILITATION

SPORTING CONTEXT 2 - RUGBY REHABILITATION OF AN ATFL INJURY

As outlined above, rugby involves primarily open skills that require the athlete to respond to changing situations. When rehabilitating a rugby player with an ankle injury it is important to gradually introduce, under controlled and predictable conditions, movement patterns commonly involved during a rugby match. As the ability of the athlete to safely complete the challenge improves, the complexity and unpredictability of rehabilitation exercises should be increased. Sensorimotor training while throwing, catching and kicking a rugby ball can help maintain the athlete's 'feel' for the game.

As with the rehabilitation of the high jumper, running should be commenced using simple slow straight line jogging. Curved runs should then be introduced and progressed by increasing speed and reducing the arc of the curve. Once curved runs can be completed without difficulty, figure of eight running over a distance of approximately 40m should begin; the size of the figure of eight should then be reduced and speed of running increased. Given that sudden directional change and player evasion are vital elements of an outside-half's game, emphasis should now be placed on progressing the difficulty of running skills. The following sample progression may be used to develop dynamic movement skills; the difficulty of each stage can be enhanced by increasing speed and reducing available space (see box).

Once the athlete can complete each of these tasks successfully, further progression using the introduction of decision making, unanticipated movements, competition and physical contact is indicated. A number of authors have identified that unanticipat- ed movements require different neuromuscular control strategies and place significantly different stresses on joint structures than

REHABILITAION EXERCISE PROGRESSION

anticipated movements. Besier et al (18) have observed that unanticipated movements rely more on generalised co-contraction of muscles around a joint than anticipated movements. Similarly, Myer et al (19) reported that varus and valgus stress on the knee joint can be increased by up to 100% during unanticipated cut- ting manoeuvres when compared to anticipated equivalents. As a result, rehabilitation drills that include progressively difficult unanticipated challenges are extremely beneficial. One of the most effective ways of introducing unanticipated movements is through the introduction of controlled competitive challenges such as tackle drills and one-on-ones. Space and speed limitations can be helpful in the early stages to emphasise skill elements and enhance safety. As able, the degree of competition, level of con- tact and difficulty of the task should be increased using modified rugby training drills. Return to play can be facilitated through the gradual introduction of the athlete into small-sided games of touch rugby, controlled contact sessions and training matches prior to return to full competition.

Throughout the rehabilitation process attention should also be directed towards the maintenance and development of sport-spe- cific strength and endurance. The use of low impact gym equip- ment such as a bicycle ergometer, cross-trainer, stepper and row- ing ergometer can significantly enhance fitness whilst minimising stress on injured structures. Conditioning for rugby should reflect the fact that it is a discontinuous, multi-activity sport played at high-intensity over a period of 80 minutes and should challenge the predominant metabolic pathways used to sustain this type of physical demand. Similarly, weight training that balances muscle hypertrophy with speed, power and reactive strength is recom- mended.

5m 10m 15m 20m

1. Using marker cones, perform snake runs and multi-direc- tional shuffles, 2. Run-stops; from a 60% run the athlete must come to a complete stop within 5 steps. Progress by increasing the speed of the run and reducing the number of steps allowed before stopping,

3. Run to lunge; beginning at a 60% pace the athlete must come to a complete stop in a deep lunge position on the affected side.

4. Cutting drills; increase the angle of directional change through 300 900

, 450 and 1800 sportEX medicine 2007;32(Apr):17-22 21 ,

5. Shuttle runs; progress by emphasising the speed and sharp- ness of turn

6. Spins; starting at a speed of 50% the athlete must spin 3600 ,

without slowing down, 7. Rotational jumps, from a stationary position, the athlete jumps vertically and turns 900

landing, progress by introducing 1800 and 3600 rotations.

clockwise/anticlockwise before , 2700