The recovery process in sports injuries can be a tedious process. They aim is to restore full playing capabilities and boost optimum performance. Detailed ahead is the broad outline defining a cookie cutter approach to injury rehabilitation. The athlete should understand each step of the recovery process for better knowledge of the implemented modalities, stopping frustration and allowing clarity in the process.
The phases of injuries are split into 4 sections. The phases start as soon as the injury occurs.
Phase 1- Inflammation
Inflammation is the body’s first defence to injury, its’ the removal and recreation of cells in the body and begins the body’s healing process. Swelling can start within hours of injury and not peak until 1-3days post, the area could not be healed for weeks post. It’s aim is to identify the stimulus, rid the body of waste products and enhance healing.
Upon injury the initial response is macrophages and dendrites recognize these stimuli through Pattern Recognition Receptors (PRRs). This starts an immune response which initiate cytokines (like histamine and prostaglandins) and chemokines.
The initiation of cytokines cause blood vessels to dilate, resulting in increased blood flow (hyperaemia). This allows fluids, proteins and immune cells to exit the bloodstream into the affected tissue. This causes swelling (edema) and redness (erythema).
Chemokines in damaged tissue and immune cells release signals which recruit white blood cells (particularly neutrophils and monocytes) to the site of inflammation.
Neutrophils- Complete phagocytosis, engulf and destroy pathogens and debris.
Monocytes- Differentiate into macrophages, which are part of the process of clearing debris and initiating tissue repair.
Tissue repair begins when the debris is cleared through phagocytosis.
Collagen is produced from fibroblasts, the main structural protein in connective tissue, which helps rebuild and scar.
Angiogenesis (formation of new blood vessels) occur to supply oxygen and nutrients to healing tissue.
Now threat is neutralised, tissue repair begins, anti-inflammatory cytokines help resolve inflammatory response. Exudate is drained from via lymphatic system.
Tissue gradually returns to normal structure and function through collagen creation. Collagen creates a loose mesh by day 4/5 then gradually strengthens along the line of resistance.
Signs of inflammation include;
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- Flushed skin
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- Pain or tenderness
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- Swelling
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- Heat
When inflammation is present, it’s important to let the body’s natural processes take place, the protocol commonly used is rest, ice, compression, and elevation.
A more adapted system is POLICE- Protection, Optimal Loading, Ice, Compression, Elevation. Which inspires pain free movement.
Other therapeutic method like mobilizations can be used at grade 1 or 2 to help maintain motion in the joint.
Phase 2- Restore Motion
In this phase, the main goal should be to restore ROM to 70-80 degrees of normal.
The main focus is stretching in order to stimulate the muscle to contract perfectly, however other therapy techniques that can be used are:
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- Electrography
- Soft tissue manipulation (sports massage)
- Mobilization (Grade1-3)
Important to maintain strength and proprioceptive ability as much as possible. This ensures proper healing and will help return the athlete to sport quicker. It can also promote the healing process through movement and blood flow.
However, too much stress may cause issues with the injury. Balance is essential in this phase.
Phase 3- Strength, power, endurance development
Important in this phase the athlete has complete ROM and flexibility. It’s now time to restore the strength back to pre-injury level.
Inactive muscles can freeze like icicles, easing the athlete in is essential to re-activate them and restore proper function.
Begin open chain kinetic exercises to restore more strength and balance. Movement patterns familiar to their sport can aid in returning to sport.
Plyometric exercises can be considered for increase power, agility, and endurance.
Phase 4- Return to sport
By now the athlete should be returning to sport.
Any excessive muscle imbalance and other limiting factors should be ironed out.
Full fitness and skill levels returned.
