COMPRESS - the injured site should be compressed using strapping, this also restricts blood flow into the injured area as it makes the blood vessels constrict, meaning swelling and will be controlled/reduced, whilst also bringing out the bruise.
ELEVATE - the injured limb should be elevated, which drains the blood from the injured area, meaning swelling will be reduced, when the leg is elevated it should be elevated above the level of the heart and held by a support of some kind.
This protocol will reduce swelling and pain as well as helping reduce injury time if performed correctly and quickly.
When using cold application the skin should go through four sensations in stages. These sensations are coldness, burning, pain/ache and finally numbness. When the forth sensation of numbness sets in the application should be removed. This is normally after around ten minutes.
After these two stages have been used it is recommended that the player does not perform any exercise so that they get the full benefit from the protocols used. This is because the main aim of them is to prevent further pain and damage to the injury and stop any further swelling.
After about 3-10 days the injury should by now have started its recovery process. The swelling may still be there has it takes longer to absorb as it is trapped underneath the sheath of the muscle. Even though the swelling has not gone down the pain may not be has bad so treatments such as heat treatment or massaging can take place. The best treatment to start the recovery process with is heat treatment as it makes the blood vessels dilate meaning that more blood can flow through them and get to the injury site taking with them more cells to help the injury get repaired quicker. Also an increased blood flow rate through the injury means swelling will be absorbed faster and dead blood cells are removed more rapidly. Heat treatment helps the muscles relax and it eases any pain that may be there. Sports massages on the injury site are another good way to treat the injury and speed up the injury process. It works as it opens the blood vessels and draws blood to the area and then it works in much the same way as heat treatment. When no treatment is being done the injured site should be supported by a bandage. This means unwanted movement is limited, and the muscles are more stable.
Exercises at this stage of the injury should concentrate on getting the injured muscles to lengthen and get stronger. Strengthening the injured muscles will make them more stable and this means the recovery process will be speeded up. If the muscles are not used they will become weak and this means the player will have to wait longer before they can start to compete again as they need to strengthen their muscles back to their original state, so it is best to start strengthening them early so they do not become weak. The lengthening of the muscles means that they do not become to stiff and helps with the strengthening.
To do this the best ways would be stretching the muscles of the injured site and holding them for between 15-20 seconds, this should be done through out the day. Another good way would be by walking around using a walking aid at first if need be. This gets the muscles working and means they lengthen and strengthen.
After around 7-10 days after the injury happened, the injury should have recovered enough to start the active rehabilitation stage. Before this can be done though some crucial checks must be undertaken to make sure the injury is in the correct state to perform these exercises.
These checks are looking for: inflammation around the injury, swelling around the injury, if either of these has not been significantly reduced then active rehabilitation should be revised. Also checks must be made to see if the leg can make a significant range of movement and to see if the injured leg can take an amount of weight bearing.
The two most effective ways of exercising the injury at this stage are: - mobilization exercises which aim to improve the range of movement and reduce the stiffness around the joint.
- Strengthening exercises which aim to strengthen the muscles around them back to their original state and so that the muscles are more stable and more likely to prevent injury to that area in the future.
The best way in which this is done are by using isometric, concentric and eccentric contractions.
Isometric contractions should be done first as this means the muscles do not have to move and it is just getting the area used to a more strenuous type of exercise again. Isometric contractions are when the muscle contracts but it does not lengthen or shorten as it just stays in a stable position.
A way to do this on this type of injury would be to by using gym equipment and set up like you are at the bottom of a squat position and hold this position with the weight upon you for 20 seconds. Take a 60-90 second recover period and then repeat. This should be done five times. Another exercise is to stand on one leg and bend down slightly so that the knee is bent at a 45 degree angle. An additional way would be to put your back flat against a wall and lower yourself down until your knees are bent at a 90 degree angle and holding it for as long as possible.
After the isometric contractions have been performed concentric contraction should be done. These are done when the muscle contracts and shortens. Ways in which this could be done are:
- doing squats
- using resistance style gym equipment, so the legs have to push outwards using the quadriceps muscles
- performing a kicking action with the injured leg
Eccentric contraction should now be performed. This type of contraction is when the muscles contracts while lengthening. Activities which can be performed to make an injured person with a dead leg perform an eccentric contraction are:
- the downwards motion of a squat
- a controlled inwards repetition using the quadriceps muscles using resistance style gym equipment
- putting the leg out straight in front of them and doing a flexion type activity to bring the leg back in towards the body
In the final phase of the rehabilitation program the injured person should start to perform the basics of their sport. This is because this phase aims to improve the player’s balance and co-ordination and restore the sport specific skills and movement patterns that they had before the injury occurred. It also aims to provide the player with psychological reassurance so that they are comfortable to play in a competitive way again when they are fully recovered.
To get the player to meet these targets, the best activity to start them off is by getting them running in a straight line. This will get the player used to free movement of the limb again. Also it will strengthen their muscles and improve their balance and co-ordination. The progression to this is running up and down hills and after this they should run diagonally up and down hills. These two activities will act further upon what they started with and push the player further towards meeting their aims. The next progression is to get the player to run and change direction quickly and maybe introduce some jumping activities to them.
When the player has successfully completed these range of activities he can then move onto skill training activities. These activities should be football related and include:
- sprinting - passing
- jumping - heading
- agility exercise (changing direction) - tackling
- shooting
When the player can complete these activities they are allowed then to return back to full training and then they can eventually, when back to full fitness start playing in competitive matches.
