HERNIA

Passive or active assisted movement often supplements active mobilisation work, which is encouraged from the end of week one (Figs.9a&b).

Isometric, concentric and eccentric con- traction of the musculature around the abdomen, pelvis and hip joint should then be introduced into functional exercises. Balance and proprioceptive elements can also be incorporated into these exercise drills. This increase in workload is assisted with the use of various pieces of inexpen- sive and simple equipment.

1) The stability ball This piece of equipment is both versatile and effective in abdominal and pelvic re- education as it assists in strength, propri- oceptive and flexibility work (Fig.10). Most individuals only picture strength work involving the use of equipment such as weights or individual units, which isolate a muscle group, are performed in a fixed plane and have a stable support base. Strength training drills using a stability ball isolates the specific muscles being retrained, but due to the unstable base of support, places physical demands on the abdominal and spinal musculature in order to keep balance while sitting on the ball. Rhythmical flexibility work using the ball allows the player to progress a stretch very simply and ensures a smooth flow from one exercise to another. Intensity of work can be altered by narrowing or widening the base of support, using gravity to assist or resist, introducing other pieces of kit such as dumbells or clinibands or simply by changing the size or inflation of the ball.

2) The medicine ball Medicine ball work may be old fashioned but in terms of abdominal and pelvic reha- bilitation it is a very useful tool. It allows the physiotherapist to produce drills, which mimic sports specific activity, can exercise both the anaerobic and aerobic energy systems and provides a strength, flexibility and proprioceptive element to rehabilitation. Medicine ball drills also allow the individual to incorporate power work into the rehabilitation routine. In soccer, the goalkeeper with a PAWD injury can exploit numerous throwing drills, which help to regain functional speed of movement (uni- and multi-planes) in the torso and upper limb, with a subsequent increase in power.

Figure 10: Use of stability ball in abdominal reha- bilitation

3) The rocker board and trampet Most physiotherapy and rehabilitation clin- ics will possess a mini trampet and various types of rocker and wobble boards, primar- ily for knee and ankle rehabilitation. In the PAWD patient, these items can add an unstable base component to any exercise drill, thus encouraging spinal and abdomi- nal correction via related muscle contrac- tion (Fig.11).

4) Bungee cords Elasticated cables of varying resistance allow the physiotherapist to produce func- tional drills for the injured player with a large emphasis on concentric/eccentric co- contraction. This is a vital area of rehabil- itation that is often neglected and with a little imagination can provide an endless number of sport specific drills (Fig.12).

Functional activity in any sport requires a stabilising component but also active flex-

Figure 11: The use of a rocker board to produce an unstable base of support during pelvic control work

ion, extension and rotation. Rectus abdo- minis and the external obliques, which are predominantly responsible for active trunk flexion and rotation, and erector spinae and latissimus dorsi for extension, should not be neglected in the rehabilitation process. It is important therefore that any rehabilitation programme used following repair of PAWD has the correct balance of exercises that work primarily through a full range of flexion and extension and those that involve stabilisation.

Isokinetics Isokinetic dynamometers are often used in the rehabilitation of lower and upper limb injuries in soccer players. They can also be used following a repair of a PAWD. In direct contrast to the rehabilitation equip- ment mentioned in the previous section isokinetic units are very expensive and so use of them is limited and dependant on accessibility. Unlike conventional weight

Figure 12: The use of bungee cords to produce a functional Z-drill for a soccer player SportEX 35