HERNIA

systems where the resistance is fixed and the speed of movement is variable, the iso- kinetic dynamometer applies the opposite effect. The speed of movement is fixed and the resistance varies, being dependant on the torque applied by the player. The control of movement speed makes it a use- ful rehabilitation tool as acceleration and deceleration (which form the basis of most sports movements) often exacerbate exist- ing injuries.

Active assisted bouts of work encourage sub-maximal contraction of the relevant muscle groups in a functional standing position (Fig.13). Active assisted work can also be used later in the rehabilitation pro- gramme to re-educate sub-maximal eccen- tric work.

Isometric work (where the muscle con- tracts against a force but does not shorten in length) in side lying enhances the sta- bilisin g effect o f (Fi g.14). Concentric/eccentric (the muscle dynami- cally shortens and lengthens) rehabilita- tion protocols replicate normal movement patterns.

Isokinetics allow numerical data and graphs to be produced, which may be used as baseline results or for comparative information.

It is important to develop func- tional patterns and rehabilitation schedules related to the player’s position and to correct any deficits on pre/post operative testing. The physiotherapist must think lateral- ly and relate all isokinetic work to the specific nature of the sport.

Soccer specific rehabilitation Throughout the medical programme it is important to make any reha- bilitation work as sport specific as possible. It is important therefore that the medical team have a thor- ough understanding of

the

demands of the sport and the posi- tional requirements of the player. Only then can any rehabilitation programme be designed to assist a full recovery and test when the player is ready to return to full training. Once the wound has healed, consideration must be given to restoring the aerobic and

36 SportEX Acceleration/Deceleration Angular Runs

mine if extra fitness work, on top of the normal training programme, is required.

Figure 15 shows many of the physical and skill attributes that are demanded of the soccer player. Each of

these particular

Figure 13: Isokinetic work in functional standing position

skills and physical characteristics also pos- sess various subdivisions. For example, heading the ball requires various skills such as:

● Glancing headers, which use the force of the cross to re-direct the ball

● Headers on goal ● Clearing headers, aiming for distance and height

● Backward headers Figure 14: Isometric adductor work in side lying

anaerobic capabilities of the player. If pre- vious records exist of cardiovascular fitness (the Yo-Yo or Bleep test) then information gleaned on the individual’s maximum heart rate allows the physiotherapist to plan training zones for the individual. Each car- diovascular fitness session should involve heart rate monitoring even when the play- er returns to full time training to deter-

Goalkeeping Skills Heading

Passing (long) Turning Jogging Sprinting Tackling

All players will have individual strengths and weaknesses in each area, but it is important that the rehabilitation pro- gramme covers those that were affected due to pain or restriction in movement prior to corrective surgery. For example, defenders tend to be wary of playing a long, diagonal pass; wingers are wary of crossing the ball, particularly when the ball is running away from them. Both these actions require the striking leg to flex, adduct and rotate at the hip joint. Rotation may be medial or lateral depend- ing on whether the pass is played with the inside, top or outside of the foot. This action produces a large shear- ing motion across the pelvic region and will obviously apply stress to the site of injury. This can be com- pounded if the player has to pro- duce the same action with their non-dominant foot. The reverse pattern of extension, abduction and lateral rotation can also pro- duce problems over the repair site, the action necessary when ‘winding up’ the leg to strike the ball.

Dribbling Collision Passing (short)

In individuals with restricted mobility in these planes of move- ment, a physical or mental reluc- tance to fully extend the leg may arise as this functional position can have a ‘dragging’ effect over the site of

the mesh repair. Shooting Crossing

Figure 15: Functional characteristics essential in the rehabilitation of the injured soccer player

Consideration should also be given to the standing leg following such a repair, as any shearing force pro- duced will run throughout the entire pelvic ring and not solely in a localised section at the site of trauma.