Rehabilitation of Sports Injuries: Current Concepts


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Coordinators: Puddu G., Giombini A., Selvanetti A.

Ready to get back in the game? Book an assessment for sports rehabilitation physiotherapy at a clinic near you today.

Rehabilitation of Sports Injuries : Giancarlo Puddu :

In another study, the compliance of the injured athletes in the rehabilitation process was investigated and it was revealed that practical guidelines and specific strategies, increase effective communication and active listening, encourage social support and positive outlook as well as pain management can improve the compliance to a sports injury rehabilitation program.

Sports Injury Rehabilitation. About Sports Injury Rehabilitation Sports injury rehabilitation is a safe, therapeutic approach that helps athletes effectively treat pain and achieve optimal performance with: Targeted exercises to help you return to pre-injury function Personalized exercise prescription to improve mobility restrictions Reduced susceptibility to further sport-related injuries Preparation to avoid recurring injury episodes Achieving peak athletic performance Looking for sports injury rehabilitation to treat a recent injury?

Sports injury rehabilitation treats a range of conditions, including: Acute sports injuries Strains Sprains Muscle, tendon and ligament repairs Tendonitis Hand injuries Shoulder dislocation Foot or ankle dysfunction Surgery rehab The sports injury rehabilitation program will benefit those with: Post-operative injuries ACL reconstruction Meniscus tears Rotator cuff repair Acute and chronic musculoskeletal injuries Sprains and strains Tedonitis and bursitis Find a physiotherapy clinic near you and book an assessment for sports injury rehabilitation today.

How it Works Sports Injury Rehabilitation is a multi-disciplinary approach to the prevention, evaluation, and treatment of injuries. Once pain and swelling are reduced, progressive reconditioning treatment will begin. As progress is made, the athlete and trainer can work together towards re-establishing strength. We offer interval programs to complete the rehabilitation for a number of other athletic pursuits including golf, tennis, and volleyball.

Introduction

Arthroscopic procedures for the shoulder and elbow are minimally invasive, allow for evaluation of the entire joint, and are available to treat the overhead athlete. These procedures can be used for debridement of lateral epicondylitis in the elbow, labral repair in the shoulder, and even rotator cuff repair. Open ligament procedures about the elbow including direct ligament repair or ligament reconstruction Tommy John are also part of our treatment program. As the level and intensity of competition rises, injury can occur to the knee ligaments and the articular cartilage joint cartilage.

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We offer a wide range of services for the injured knee including the most current concepts in anterior cruciate ligament reconstruction ACL. Meniscal injuries are often seen in the injured knee with an ACL tear. More advanced options such as meniscus transplantation are also part of our treatment pathway. These injuries can sideline young and middle aged athletes.

Conservative options are tried first and include bracing, corticosteroid injection, and viscosupplementation injections like Synvisc. In cases that require surgery, advanced procedures allow for debridement, repair, or replacement of damaged cartilage. These procedures include microfracture, osteochondral autograft transfer, and even implantation of allograft donor cartilage. Autologous Chondrocyte Implantation ACI is a two stage procedure that can be used to graft large cartilage defects from cells taken from your own knee.


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The first procedure is an arthroscopic evaluation and biopsy to obtain your cartilage cells. These cells are grown and multiplied in the laboratory for weeks. The second surgery includes an open procedure to prepare the damaged site for implantation of the cells. The cartilage cells are implanted and held in place by a periosteal patch taken from the tibia shin bone. High tibial osteotomy can be used in cartilage and ligament reconstruction procedures to unload a damaged joint compartment and restore the normal alignment of the injured knee.


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  • This procedure can be used as the primary operation or in conjunction with other reconstruction procedures. During the procedure bone can be removed or added. The osteotomy is held in place with plates and screws made from stainless steel or more advanced materials. Recent news articles have reported on the benefits of platelet rich plasma PRP in the treatment of sports injuries. Traumatic knee injuries increase risk for the development of post-traumatic osteoarthritis PTOA. Individuals with a previous knee injury have a Brown et al. Despite the short-term and long-term risks, many athletes desire to return to cutting and pivoting sports, which increases the risk of additional injuries.

    Sports Injuries in the Foot and Ankle - UCLAMDCHAT Webinars

    Safe return to sports after a traumatic injury is the responsibility of all healthcare professionals involved. Despite best efforts, athletes returning to high-risk activity and demanding sports after a knee injury are at greater risk of sustaining a second injury. Many post-surgical rehabilitation guidelines are based solely on time from surgery and permit individuals to return to sports-specific activities between months; however, very few guidelines provide any objective criteria for assessing an athlete's readiness The lack of clear objective criteria measuring patient function in sport-specific activities, and for returning to sports may place the injured athlete at risk for re-injury or suboptimal performance.

    Objective criteria are critical to ensure that athletes are fully rehabilitated and their knees are ready to meet the demands of their sport. Recovery of full function, return to prior activities, and long-term joint health are all goals of the athlete, surgeon, and physical therapist; yet there is little consensus to guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.

    Currently, there is no system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to compile all individualized data to standardize education about the risks of re-injury to the knee and the likelihood of returning to sports. The utilization of these profiles may provide a more accurate and complete representation of an athlete's current status. The purpose of this paper is to build on the conceptual framework for the restoration of limb-to-limb symmetry in its role of secondary and tertiary knee injury prevention by 1 reviewing the epidemiology related to traumatic knee injuries, 2 identifying the risk factors that are associated with re-injury and poor knee function, 3 providing recommendations for objective measures utilizing limb-to-limb symmetry as a performance-based criteria for readiness to return to activity.

    While it is difficult to quantify the number of anterior cruciate ligament ACL injuries, recent estimates in the US have reported 81 per , individuals between the ages of 10 and 64 or about , per year 13 - 15 with over , arthroscopic ACL reconstructions ACLR 8. ACL surgeries account for Meniscal injuries are the fourth most common knee injury in high school athletes In , medial and lateral meniscal surgeries were the first and third most common arthroscopic surgeries, respectively 8.

    Over the six-year time frame, the number of meniscectomies decreased in favor of meniscal repairs 20 , a trend recommended by literature due to the impact on OA. Similar to ACL injuries, meniscal injuries are not common in isolation Almost one million individuals are affected annually by articular cartilage injuries 21 , Small asymptomatic lesions left untreated can increase in size, resulting in a painful knee joint Articular cartilage damage after traumatic knee injuries increases the risk of cartilage degradation in all three knee compartments Consequently, articular cartilage damage is a strong risk factor for the development of osteoarthritis after knee surgeries 31 , Athletes with allografts are five times more likely to require a revision compared to those with autografts There is no significant difference in second injuries between athletes with hamstring autografts and bone-patella-tendon-bone BPTB autografts; however, at year follow-up, there were more ipsilateral injuries in the hamstring group and more contralateral injuries in the BPTB group Furthermore, positive family history doubles the odds for both ipsilateral and contralateral rupture Injury side contralateral vs ipsilateral is associated with age and graft angle, respectively Women with a history of ACL injury are at greater risk of a second ACL injury with fold greater risk of injury compared to healthy controls and four times greater risk than men with a history of ACLR While most studies have reported an overall greater number of contralateral injuries compared to ipsilateral graft injuries 33 , 38 - 40 , women are six times more likely to suffer a contralateral injury 33 , 40 , whereas, men are three times more likely to injure their reconstructed graft When compared to the older age groups, the youngest age group had a six-fold increase in risk for ipsilateral and three-fold increase for contralateral injury Leys et al.

    In collegiate athletes, more athletes who had a primary ACLR prior to college went on to have a second injury compared to those who had their primary ACLR during college Failure for all meniscal surgeries ranges from Athletes with meniscal repair and concomitant ACLR have a lower risk of revision for their meniscus injury 43 - 45 , suggesting that restoring passive knee stability reduces the incidence of further meniscal damage.

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    Isolated lateral meniscal injury, earlier surgery, older age, and surgeons performing a high volume of meniscal repairs per year also decreases risk of revision 43 , Subsequent operation rates are greater for meniscal repairs compared to partial meniscectomies, greater for partial lateral meniscectomies compared partial medial meniscectomies, and greater for medial meniscus repairs compared to lateral meniscus repairs After microfracture, those with a single defect have a lesser failure rate than individuals with multiple defects Those who had a prior surgery that penetrated the subchondral bone and marrow have a greater failure rate in autologous chondrocyte implantation ACI than those who have no history of surgery In a comparison of individuals who required multiple chondral surgeries, those who received ACI as a first line treatment had lesser failure rates and better International Knee Documentation Committee Subjective Knee Form IKDC scores compared to those who had microfracture as their first surgery.

    Despite a greater failure rate, however, the microfracture group still participated in the same amount of physical activity and at the same frequency and intensity as the ACI group Athletes who had not returned to sport 12 months after surgery were just as likely to be playing 39 months after surgery as those who had returned to play at 12 months Self-reported function was different between those playing some sport and those who stopped all activity Five years after surgery, those who had not returned to sport have worse functional and self-report scores than those who had returned In athletes under 40, nearly a quarter of those after medial meniscectomies and over half of those after lateral meniscectomies had pain at the time of return to sport; however, pain and swelling were not related to the size of the meniscal resection.

    For most NBA athletes who returned, minutes played per game, points per game, and steals per game decreased compared to pre-surgery. There is conflicting data concerning length of NBA career after microfracture, with some finding no difference 61 and others finding a decreased likelihood -LR of 8.

    A history of knee injury, regardless of type, places an individual at a greater risk of subsequent injury. In a study of National Collegiate Athletic Association NCAA athletes, those with a history of knee surgery missed more days of sport, had a greater number of knee injuries, and received more magnetic resonance imaging MRI tests and surgeries than those athletes with no prior knee injury Former top-level male athletes with a history of knee injury have a nearly five-fold risk to develop OA Sports participation and history of ACL injury are both significant risk factors for the development of OA, but meniscal injury in combination with ACL injury may be one of the most potent combinations causing a ten-fold increase in risk compared to age-matched controls 66 , Total knee arthroplasty and other reconstructive surgeries have advanced significantly in the last decade, allowing former athletes to remain active.

    However, at a rate of nearly , per year, with an expected increase to 3. Risk factors for re-injury or suboptimal performance upon return to activities. In order to develop a system using rehabilitation indicators for profiling recovery after knee injury or surgery, an understanding of the non-modifiable and modifiable factors that can influence recovery or risk of re-injury is needed.

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    A centralized portal that can track the longitudinal record of rehabilitation indicators can then be used as a means to define an athlete's recovery performance profile. Additionally, profiles can be utilized in establishing criteria to identify thresholds for safe return to sport. Furthermore, the profile can be used as a reference for any rehabilitation specialist interested in developing a similar recovery monitoring system.

    While patient demographics e. Younger athletes with knee injuries typically return more frequently and earlier to sports than older athletes 69 , Primary knee injury and subsequent 2 nd knee injury may be sex-specific. While the incidence of injury to the ACL is greater in men due to the greater exposure to sports, women have a relative risk of injury two to eight times greater than men 74 , Similarly, differences in patient-reported knee function do not appear to be sex-specific 76 , although women may return to less demanding activity levels after ACLR 77 , Range of motion ROM symmetry is unique to the individual; however, a knee extension loss of as little as 3 o is associated with poor post-surgical, patient-reported outcomes and task-specific activities 79 - Knee ROM asymmetries are also associated with degenerative joint changes 79 , Muscle strength deficits are pervasive after knee injury and surgery 82 - Muscle strength limb-to-limb symmetry has been proposed as an important marker for readiness to return to unrestricted sport 86 - Pre-operative quadriceps strength deficits are predictive of poor functional outcomes after ACLR 92 - While hamstring strength deficits may be present after knee injury or surgery, these deficits do not influence clinical or functional outcomes - However, the hamstrings-to-quadriceps ratio for torque production has been reported as a factor in primary ACL injury risk model , Quadriceps strength deficits can persist for months or years after any knee joint surgery, in spite of rehabilitation 84 , Consistent deficits in quadriceps strength have been found after surgery for the ACL, meniscus, and articular cartilage within the first year , 2 years , , and up to 7 years - Quadriceps strength asymmetry can also be reflected in other impairment measures.

    Quadriceps index QI is expressed as a percentage of the peak value of the quadriceps muscles on the involved side divided by the peak value of the quadriceps muscles on the uninvolved side. QI is a better predictor of hop test distance than graft type, presence of meniscal injury, knee pain, or knee symptoms After meniscectomy, particularly in middle-aged athletes, greater quadriceps strength is associated with better self-reported knee joint function on all five subscales of the Knee Injury and Osteoarthritis Outcome Score KOOS The KOOS is a knee-specific, patient-reported instrument for knee injuries that can lead to post-traumatic osteoarthritis.

    The form includes 42 items in five separately scored subscales: Pain 9 items ; other symptoms 7 items ; function in activities of daily living ADLs; 17 items ; function in sport and recreation Sports; 5 items ; and knee-related quality of life QoL; 4 items Balance and postural deficits have been reported after knee injury, and in particular, after ACL injury and reconstruction. Various assessments have been used to evaluate risk of injury, current status, and the magnitude of improvement after an intervention While static postural tasks may provide useful clinical information, dynamic postural tasks may provide a more accurate representation of sporting activities.

    Some of these tasks may be simple, such as the Star Excursion Balance Test and Y-Balance tests , while others require instrumented equipment , Though some authors have tried quantifying limb symmetry for postural deficits, evidence is limited Performance-based measures can be used to assess a combination of muscle strength, neuromuscular control, confidence in the injured limb, and ability to complete sport-specific activities Many drills and performance-based measures are double-legged tasks; however, the performance may mask persistent deficits in the injured lower extremity Therefore, single-legged tasks should be used after knee injuries to detect side-to-side differences, evaluate function, monitor progress of rehabilitation, and assess readiness for return to sports , - Single-legged hop tests measure distance, time, or height and typically involve multi-movement patterns i.

    Side-to-side limb symmetry appears to have a critical role in the prevention of injury and return to sports after knee injuries. Varying performance standards i. However, this range provides health care professionals no indication of an expected standard or a timeline on which they should be achieved. Early after injury or surgery, individuals have poor single-legged hop LSI and substantial limb-to-limb differences 83 , , LSI calculated from the cross-over hop for distance and 6-meter timed single-legged hop tests can also predict self-reported knee function at one year after ACLR.

    Despite improvements in single-legged hop performance and symmetry in the first year after ACLR 83 , , athletes two years after surgery have greater asymmetries in single-legged hop distances when compared to controls Poor LSI and large limb-to-limb differences prior to seven months after ACLR reconstruction can be a concern, as most post-surgical rehabilitation guidelines enable individuals to return to sports-specific activities between 4 to 6 months , It is likely that sports-specific activities are more challenging than landing from a planned hop in a controlled environment, thus the deficits seen in single-legged hop performance may be magnified, potentially predisposing the ipsilateral or contralateral knee to injury.

    Because hop testing assesses current knee function, individuals with poor LSI may exhibit suboptimal performance on the playing field and may be placed at greater risk for injury 88 , , When comparing individuals after ACI and after microfracture, those after ACI have greater single hop asymmetry than those after microfracture six and twelve months after surgery.

    However, there is no difference between the groups in cross-over or 6-meter timed hop tests at six and twelve months. Persistent symptoms, such as knee pain, joint swelling, stiffness, instability, or weakness, are common reasons many athletes cite for not returning to preinjury activity levels One year after ACLR, athletes who had not returned to sports reported an average pain intensity of 1.

    Upon returning to sport after meniscectomy, pain and effusion can persist and should be monitored Pain can have a role in the decision-making process for allowing athletes to safely return to sports, but it should not be the sole determinant.

    [Rehabilitation after sports injuries. Current concepts and data].

    Pain and effusion can be reliably monitored using a pain-monitoring scale , soreness guidelines , and the modified stroke test Joint effusion is an over-accumulation of fluid within the joint capsule, indicating inflammation or irritation Joint effusion can be helpful in establishing a diagnosis, determining exercise progression, and monitoring progress. The presence of effusion can impair adjacent muscle function and alter knee motion , The presence of no effusion is also a significant contributor for the likelihood of return to sports one year after ACLR Monitoring of joint effusion can be practically, reliability, and clinically useful.

    The modified stroke test and effusion grading scale offers an objective means of measuring and assessing knee joint effusion This modified stroke test is performed by sweeping fluid proximally out of the medial sulcus of the knee, and then performing a distally directed sweep along the lateral knee and watching for a wave of fluid returning to the medial sulcus An increase in effusion following treatment that does not return to baseline likely indicates that treatment progression was too aggressive.

    Furthermore, individuals should be able to demonstrate the ability to tolerate lower loading demands without pain or swelling before progressing to higher loads. Symptomatic knee joint instability giving way is a hallmark of knee joint injury. Giving way episodes are usually described as buckling at the knee similar to the initial injury.

    Rehabilitation of Sports Injuries: Current Concepts Rehabilitation of Sports Injuries: Current Concepts
    Rehabilitation of Sports Injuries: Current Concepts Rehabilitation of Sports Injuries: Current Concepts
    Rehabilitation of Sports Injuries: Current Concepts Rehabilitation of Sports Injuries: Current Concepts
    Rehabilitation of Sports Injuries: Current Concepts Rehabilitation of Sports Injuries: Current Concepts
    Rehabilitation of Sports Injuries: Current Concepts Rehabilitation of Sports Injuries: Current Concepts

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