Phase 4: Return to Sport; Injury Prevention

Aim:

During this phase the emphasis is on quality, not quantity.  To reflect this the training load has been reduced, and team training has been introduced.  Team training will be a gradual re-introduction beginning with straight line running and ball handling drills before progressing to complex cutting drills and sudden changes of direction.

Cross-training has been incorporated to prevent overtraining and secondary injuries. Gym sessions are still performed 3 days per week and will be used primarily for sport-specific drills, to address imbalances and weaknesses, and to further develop strength.

Introducing sport-specific neuromuscular and proprioceptive based training into a warm up has been consistently shown to reduce the likelihood of injury from contact and non-contact mechanisms (Pollard et al, 2006; Mandelbaum et al, 2005; Gilchrist et al, 2008; Silvers et al, 2007).  Adherence is important to ensure the effectiveness of these programs, therefore we introduce injury prevention exercises as part of the training during phase 4, to be carried on once athletes are discharged.

ACL Phase 4

Sample Exercise Session Phase 4

Exercise Sets / Duration Resistance Reps Recovery
WARM UP
       
Mini tramp jog 5 Mins     90 secs
PEP sport-specific dynamic warm up (see Trewrehab.com) 10 Mins     30 secs
SPORT-SPECIFIC STRENGTH & NEUROMUSCULAR CONTROL
       
Eccentric step downs with foam 1 Min   2 90 secs
Single leg Romanian deadlift 2   10 90 secs
Lateral step downs with foam 1 Min   2 90 secs
Forward hurdle hops – over and back 30 secs   2 90 secs
Jump into bounding for distance 3   6 90 secs
Single leg ricochets – fwd/bwd 30 secs   2 90 secs
Triple hop and hold 3   6 90 secs
Single leg lateral bound onto foam 3   6 90 secs
Compound functional movement 1 (sport specific)        
Compound functional movement 2 (sport specific)/strong>        
Compound functional movement 3 (sport specific)        
COOL DOWN
       
Deep water running 10 Mins      
ROM (as required)
       
ITB foam roller 20 up and back     Alternate

Sample Training Program Phase 4

TYPE VENUE MON TUE WED THU FRI SAT SUN
Prescribed Exercise Home / Gym 60 Mins 60 Mins 60 Mins
Cardio Pool / Bike / Run 45 Mins
Team Club Grounds 90 Mins 90 Mins
Cross Outdoors 4pm - 45 Mins

Explanation of training types:

Cardio = Deep-water running and swimming, spin bike, treadmill

Strength = Strength, proprioception and sport-specific plyometric exercises

Team = Team training (gradually progressed)

Cross = Cross –training activities such as running and cycling