KEY POINTS FOR CONSIDERATION n Set clear aims at each stage of the rehabilitation process n Patient education to enhance patient adherence with respect to the aims n Use a SWOT analysis to assist in achieving patient adherence/compliance n Understand the concepts of rehabilitation and tissue healing n Control tissue loading during the vulnerable subacute stage n Avoidance of a perpetuating chronic inflammatory cycle n Use of outcome measurement and photographs
controlled by a heart monitor with computerised download facility. Lower limb progressive resistance training adopted CKC exercises (squats, leg- press, step-ups), performed within a knee-angle specific to cycling (100º–170º), extending explosively on concentric contraction. Eccentric contractions are not cycling specific, and can result in greater muscle hypertrophy which should be avoided in cyclists (50).
PHASE V: PRE-DISCHARGE AND PERFORMANCE TESTING PHASE The pre-discharge phase is when the therapist makes the decision that the athlete is ‘fit to return to unrestricted activities’ and competition (13). Unlike previous stages, the pre-discharge stage is designed to provoke and expose any physiological or psychological deficiencies. The athlete is subjected to unrestricted maximal physical demands, including functional performance testing, performed over 2-3 consecutive days to enable a realistic assessment.
Ideally the athlete is assessed
each day for clinical symptoms related to any adverse reactions. Failure to meet the criteria would result in the athlete being regressed. Functional performance testing should include all sports-specific activities associated with training and competition. Resulting data should be compared against pre-injury bench-mark performance data, thus allowing direct objective comparisons. In this case study pre- injury data was not available, therefore it was agreed that performance testing would not be undertaken.
CONCLUSION
Rehabilitation of cyclists and athletes alike can be enhanced by applying
16
sound scientific principles embraced within an individualised sports-specific programme. Particular consideration should be given to activity-specific needs which can be formulated in conjuction with the athlete. Progression should be guided by functional deficits, evaluation-based criteria, and most crucially the rate of tissue-healing. Rehabilitation can be further enhanced by patient education, goal-setting, motivational and adherence strategies, all assisted by the use of a simple SWOT analysis.
Patient education and relevant
control mechanisms become more fundamental when the patient is not under continual supervision, as in this particular case study. As clearly established here, early application of PRICE in the management of acute soft tissue injury should be recognised as a crucial component in reducing recovery times.
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