Leinster Rugby Elite Performance Conference Blog Part 2

Posted: December 19, 2013 in Uncategorized
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Injury Rehabilitation through Communication, Progression and Specificity

 For anyone who plays sports being injured is….. Well its crap, annoying, painful and most of all frustrating. I write this as I sit here slightly leaning to the left nursing my right hip and recovering from hip impingement surgery.  It takes time and hard work to get back to play, especially with environmental factors such as work and family, and that’s only for us amateurs. So how do the pros do it? With all the support staff and resources available to them, why can it sometimes take so long to return to play for these guys?… Oh and crutches just make you and everything you do awkward!

Leinster Rugby’s head of rehab Steve Smith, gave a presentation on Bridging the Gap and return to play to help explain why and how!

Communication between the athlete, Physio, S & C Team and the coach, who all have their part in the athletes return to play, is vital. Naturally, the player and coach want to know how long he will be out for whilst the physio and S&C team need to communicate to see if there is any conditioning work the athlete can do whilst injured, also the specific rehab work he may be doing needs to be monitored by both to make sure the injury is healing with no adverse effects.

A breakdown in communication here can lead to the player returning to play too soon and redoing the same injury and possibly to a greater extent.

 

A Physio, an Injured Athlete and a Demanding Coach walked into a bar…………………….

The Physio is what Steve described as the fulcrum of the situation; it is he or she who designs the rehab plan and treatment that must be undertaken by the injured athlete. The physio must continually monitor the athlete’s progress and decides when the next stage of the plan can be implemented. He deals with any setbacks such as a player not progressing at an expected rate by re assessing the exercises used or extending the amount of treatment time as needed, all this while acting as an amateur physiologist in order to keep an injured athlete motivated and in a positive state of mind.

The Athlete must understand the severity of the injury and why he has to spend so long rehabilitating. He also must know the specificity of the rehab (why he is doing what he is doing), particularly at the stage where everything appears to be fine and he is still not ready to return to play (managing expectations), he must trust the physio’s advice and stick to the plan in order to progress and has to understand the risk involved in further damaging himself by returning to play early.

The Coach is like the Athlete here in that he needs to know the severity of the injury and how long he can expect his player to be out for; this allows him to plan for the interim period without him. He also needs to understand that there may be setbacks and regressions and not to apply to much pressure on anyone including the injured party to return to play early. The coach also has to help with the athlete’s reintegration period, allowing him to be involved with the team in whatever role suitable at the different stages of rehabilitation.

 

3 stages of Rehabilitation

In the slides from the presentation you will see that there is a progressive chart changing from red to blue. It is marked Protective, Developmental and Sports Specific and monitors these areas across 2 planes, Neuromuscular (Gym work) and Movement (Field work). This is the tool used by Leinster Rugby to track and monitor an athlete’s rehabilitation.

The blue shows the players progress in the outlined area while the red shows what is yet to be achieved. Once the chart is fully blue the athlete is in “The Blue Zone” as described by Steve and is ready to return to play. Let’s look at this chart at 3 stages as the athlete progresses.

 

Screen Shot 2013-12-19 at 20.37.22

At this stage you can see that the athlete has reached 90% of his baseline strength and has taken part fully in some speed mechanics and agility drills without any adverse effects and has therefore completed the Developmental phase on both planes. However we also see he has not fully completed any contact sessions, speed repeats or power training sessions, and is still in the sports specific phase of rehabilitation.

Screen Shot 2013-12-19 at 20.39.19

 

Here we see that the athlete has completed or reached all requirements within the Sports Specific stage, and is now ready to train fully in both planes to assess if he can return to play.

 

The Blue Zone

Screen Shot 2013-12-19 at 20.40.19

The chart is now completely blue denoting that the athlete has successfully trained fully twice in both planes with no problems and is now ready to return to play; the gap has been bridged………

What did you do to yourself and when to start?

The mechanism of injury is important in deciding the rehabilitation plan i.e. what exercises to prescribe etc. Steve showed us a clip of two players injuring hamstrings in totally different ways, one was simply a player sprinting with ball in hand and suddenly pulling up hopping on one leg., a familiar sight to most people involved in any field sport. The other was a player at the bottom of a ruck with his leg hyper extending along the ground due to the awkward way he hit the ground, that and the weight of two or three professional rugby players slamming down on top of him.

By analysing the footage of the injury actually happening they were able to assess whether the damage was in the belly of the muscle or the origin/insertion, this along with MRI, iso kinetic testing etc. allows the rehabilitation process to start off on the right note in that exercise selection and movement patterns can be more specific to the type of injury potentially reducing “the gap” between injury and play.

Steve told us that the time to start rehab was straight away, be it applying ice or stabilising the injured limb, the sooner the process can begin the better.

Conclusion

So, how do we summarise all this? Well, it’s quite simple, once the injury has been diagnosed, assessed and graded, a rehabilitation plan is drawn up around a time frame for the athlete who is constantly monitored and assessed throughout the 3 stage process, the coach is kept updated on the players current state, and once all physical targets have been achieved by the athlete without any problems, he simply returns to play. It’s all that easy (please read that last bit with a large dollop of sarcasm)

Leinster Rugby monitors and assesses everything they do in order to deliver fit rugby players to competition, from S&C programmes, athlete’s functional movement, diet and mood state, no stone goes unturned in any part of the rehabilitation process.

I hope this blog is of some use to you and that I’m not boring you to tears with my simplistic writing, (I’m new to this) as always if you were at the Elite Player Conference and feel I have left anything out please don’t hesitate to let me have it on the chin, and if you need or want to get in contact with me you can message me on the Facebook Group Elite Strength and Conditioning, just follow the link below.

Regards, Stan.

https://www.facebook.com/groups/460351000705965/

If you want to catch up on Part one of Eoins blog then click the following link  http://wp.me/p3F2Qp-wq

Thanks Eoin for your guest blog we really appreciate the time and effort you put into writhing it and its great for guys who couldn’t attend the Leinster conference.

Coach James

 

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