Issue 31 Spring 2012 - Bases

Additional input
Psychological input addressed the following aspects:
1. Re-evaluation of the impact of the pain stimulus on the athlete
2. Enhancement of healing using neurobiological facilitation
3. Re-establishing trust and confidence in using the knee
Nutritional support included the following:
1. Nutritional aids for tendon healing and muscle hypertrophy
2. Factors influencing immunity including probiotics, zinc and
vitamin C
3. Given his history of stress fracture, the athlete’s vitamin D status
was assessed.
Strength diagnostics
The force closure capacity of the athlete’s knee joint was assessed
by recording isokinetic eccentric and concentric peak torque
at 60°/s, 180°/s and 300°/s. The results indicated that there was
appropriate neuromuscular function of the hamstrings, but a 20%
discrepancy in peak torque production of the knee extensors
at 60°/s velocities. To determine the functional relevance of the
strength discrepancies, a single leg countermovement jump was
undertaken. There was a 21% difference in jump height, 16%
difference in peak force production and 27% difference in reactive
strength index (jump height divided by push time). It was observed
that the athlete could not control the rotation of his pelvis on
his left leg as well as he could on the right, which exposed his
patella tendon to greater shearing forces. The difference in jump
performance and stiffening characteristics of the knee is likely
to have been related to the difference in peak force production
of the knee extensors. In addition, the knee extensor muscles of
the injured knee had less capacity for force absorption thereby
exposing the patellar tendon on that side to more stress.
Observations
• The left patella tendon may have been under greater strain than
the right during bilateral loading tasks (e.g., squatting) as there
were different force production capacities between legs
• The athlete may have been exposing the patella tendon to
greater shearing forces on the left leg due to the lack of hip
stability when producing high forces
• The athlete required greater hamstring strength on both legs to
improve capacity for force closure in both knees.
Training solutions
• Introduction of a high load single leg strength programme using
exercises that require rotation control of the hip and heavy
loading of the quadriceps (e.g., Bulgarian Split Squat)
• Introduce bilateral high force hamstring training (e.g., full range
concentric & eccentric Nordic Curl)
• Introduce exercises to improve the ability to control pelvic
rotation by improving oblique strength (e.g., lateral rollouts,
barbell side bends and split Pallof presses).
Above: Providing optimal injury rehabilitation
Courtesy Caryl Becker
Stress and recovery
The Rest-Q questionnaire (Kellmann & Kallus, 2001) was
administered at the start and the end of the week and
demonstrated an increase in perception of recovery whilst
perceptions of stress reduced slightly. This showed that the athlete
was in a better psychological state to continue his rehabilitation
effectively.
Summary
The athlete completed a comprehensive week at the IRU and
was discharged back to the care of his own support team with
suggestions for both clinical and training strategies to continue to
progress his rehabilitation. He made a full recovery.
This case study highlights how long-term injury at a local site can
be caused by long-term strains in other parts of the body (Myers,
2009). An injury may manifest locally because of a remote inherent
weakness, or a seemingly unrelated previous injury, and not solely
due to local strain. Identifying these pathways with an integrated,
clinically-led and scientifically-based strategy allows effective release
of chronic strain and restoration of systemic function.
The IRU is a collaboration between the British Olympic Association (BOA) and the English
Institute of Sport (EIS) and provides residential, intensive rehabilitation to Britain’s top athletes.
words: Ashleigh Wallace
A former South African hockey international, Ash has worked for over 15 years with a
variety of elite sports, including GB rowing & GB/England hockey and has attended both
Olympic and Commonwealth Games. Ash combines her role at the IRU with being an EIS
Lead Physiotherapist.
Dr Anita Biswas
Anita is a specialist in sports and exercise medicine and has worked with the EIS for
several years. Anita was formally the Chief Medical Officer for the GB Paralympics team
and has attended three Paralympic Games and a Commonwealth Games, as well as a
number of World and other major championships with a variety of sports.
Ben Rosenblatt
Ben is a Senior Rehabilitation Scientist at the IRU with a background in strength and
conditioning. He is currently undertaking a PhD in biomechanics and strength and
conditioning. He has several years of coaching and sport science experience including
work in the USA, professional football, rugby and Olympic sports.
References
Gunn, C.C. (2002). The Gunn approach to the treatment of chronic pain:
intramuscular stimulation for myofascial pain of radiculopathic origin. Edinburgh:
Elsevier Science.
Kellmann, M. & Kallus, K.W. (2001). Recovery-stress questionnaire for athletes:
user manual. Champaign, IL: Human Kinetics.
Korner, M. (2010). Interprofessional teamwork in medical rehabilitation: a comparison
of multidisciplinary and interdisciplinary team approach. Clinical Rehabilitaion, 745-755.
Loeser, J.D. (2001). Bonica’s management of pain (3rd ed.). Lippincott Williams & Wilkins.
Myers, T.W. (2009). Anatomy Trains (2nd ed.). Edinburgh: Churchill Livingstone Elsevier.
The Sport and Exercise Scientist n Issue 31 n Spring 2012 n www.bases.org.uk
7