INJURY, EXERCISE AND POST-OP GUIDELINES

The team at The Injury Clinic have created a set of guidelines that relate to the management of commonly seen presentations at the clinic. We will continue to add to this list over time. 

Not all injury and post-operative presentations require specific guidelines and targeted benchmarks; but they do help to hold us all accountable in achieving best outcomes.

These guidelines have been created based on the most recent evidence available and draw on clinician expertise and further training in specific areas. 

A brief overview has been provided below…

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HAMSTRING INJURY

Hamstring injuries are common amongst the active and sporting population, and they are a common presentation to The Injury Clinic. 

Strength & Conditioning Coach, Ben Calnin has worked closely with physiotherapists at The Injury Clinic to create a guideline to return to running post hamstring injury. 

It is a comprehensive guideline based on the most recent evidence, his expertise as a strength coach and the expertise of physiotherapists who work at the clinic.

 

Phases within this guideline include:

Phase 1: Healing and Patterning 

Goal – To promote healing of the injured tissue, while trying to regain full, pain free range of motion of the hamstring.

Phase 2: Hamstring Strength and Co-contractions

Goal – To strengthen hamstrings in specific positions that are relevant to our movement.

Phase 3: Strength at Length 

Goal – To increase eccentric strength of the hamstrings and introduce running at a controlled intensity

Phase 4: Rhythmic and Chaotic 

Goal – Strengthen and expose the hamstrings to faster, more chaotic movements; return to ‘modified’ training and begin ‘return to maximal straight line work’

Phase 5: Full Function

Goal – To successfully return to full intensity activity; we turn our focus to a return to sport

 

Clients progress through phases dependent on severity of injury, pre-injury strength and the result of testing conducted throughout the guideline. 

Specific exercises are chosen to achieve the goal of each phase; the exercises selected are dependent on the capabilities and previous experience of each individual.

 

ACHILLES TENDINOPATHY

Achilles tendon presentations are common at The Injury Clinic. They can be difficult to manage, and a return, or progression, to high load activity must be well managed and well controlled to be successful.

The Injury Clinic physiotherapist, Joel Martin, is actively involved in research into Achilles tendon presentations, has combined his extensive knowledge of the available evidence and his clinical expertise to produce a guideline that assists clients in managing their load and progresses them safely towards their goals.

 

Phases within this guideline include:

Phase 1: Pain Reduction

Goal –  To reduce local tendon pain and improve tolerance to strength work (loading)

Phase 2A: Preparation and load exposure

Goal – To expose tendon to high load and progress dependent on pain response

Phase 2B: Consideration of run load

Goal – To consider and progress run load towards client goals, if applicable. 

Phase 3: Consistency

Goal – To achieve consistency with both run and strength load

Phase 4: Maintenance

Goal – Exposure to high loads, change in environment, fast efforts, long runs with consideration of overall loading

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ACL

ACL reconstruction surgery is a significant surgery that requires a commitment to post-operative rehab to ensure successful outcomes.

The Injury Clinic physiotherapist, Sam O’Connor has a special interest in both pre and post operative management of ACL injuries. Following completion of further professional development specific to ACL injuries and an extensive knowledge of the best available evidence, Sam has created a guideline to assist clients in returning to pre-injury functional levels. 

Sam works closely with The Injury Clinic strength coach to ensure that strength goals are achieved and appropriate progressions are made with consideration to tissue healing time frames and individual capabilities. 

Testing is performed with both Sam and Ben (strength coach) at appropriate intervals to ensure a targeted team approach to your rehab. 

The Alter-G Treadmill is integrated into your rehab, allowing a faster return to more functional exercises, inclusive of running. 

 

Phases within this guideline include:

Phase 1: Healing and movement

Goal –  To allow healing, promote movement, and normalise gait

Phase 2: Proprioception and Patterning

Goal – To increase range of movement, improve general conditioning and establish key motor patterns

Phase 3: Strength and function

Goal – To develop strength and improve function. 

Required dosages need to be adhered to (strength, hypertrophy/endurance); A focus is given to improve single leg control, commencing early plyo/landing mechanics and light jogging.

Phase 4: Power and plyometrics

Goal –  Sport specific preparation; Development of power/speed with a focus on improving jumping/landing/directional change; High speed running mechanics and responses to external stimuli/perturbations are included dependent on client goals and chosen sport

Phase 5: Returning to sport 

Goal – Return to competitive play; This phase may not be appropriate for all clients

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