This document discusses the rehabilitation process for quadriceps muscle injuries from initial injury through return to play. It begins by covering injury classification and the muscle architecture of the quadriceps. It then discusses muscle mechanics in running and kicking sports. Rehabilitation stages are outlined from early isometric exercises to advanced functional training mimicking sports movements. A case study is presented of an athlete who suffered multiple quadriceps injuries and underwent a rehabilitation process focused on hypertrophy, tendon elasticity and returning to high intensity running.
Glomerular Filtration and determinants of glomerular filtration .pptx
Quadriceps Muscle Injury Rehab: From Injury to Return to Play
1. Quadriceps Muscle Injury:
From Injury Day to Return to Play
VIIIth MuscleTech Network workshop
FC Barcelona, 3rd-4th October 2016
James Moore
Head of Performance Team GB
Intensive Rehabilitation Manager – British Olympic Association
2. Mechanism
Under striding vs. bwd lean vs. Hip extension vs. backswing vs. VGRF
Sports Mechanism
Sprinting vs. Kicking (high vs. low velocity of limb movement)
Location
Proximal vs. Mid vs. Distal / Tendon vs. Muscle vs. Fascia
Size / Grade
0, 1, 2, 3, 4
Functionality
Of the region (architecture) vs. The individual (kinetics) vs. Sport Specific
INJURY PROFILE / CLASSIFICATION
Marshall 2002
20. PHYSICS OF KICKING
• During kicking – hip has the highest net
force with a ballistic impact
• 15% of kinetic energy is absorbed by the
ball
• Thigh is moving at up to 5000
/sec
• Remaining force dissipated through the
body
• Traction / eccentric load on the groin
Barfield 1998
21. MAXIMAL EFFORT KICKING IN SOCCER
Charnock 2009
Adductor longus was active throughout the
swing phase
Maximum activation and eccentric load
occurred at peak hip extension
27. Effective DDx & Classification
1st 48 hours is critical – do not be afraid to off-load with crutches
Athlete Profile
Sport Profile
Athlete specific clinical outcome measures
Need to pass clinical measures at each stage – stretch, force, palpation
Capacity Assessment within the rehab
KEY DECISIONS
28. EARLY STAGE - Isometric
CKC, Hip focus OKC, Knee focus CKC, Ankle focus
Prescription – 6 second isometric, 5 reps, 4-8 sets
29. INTERMEDIATE STAGE - ECCENTRIC
Proximal vs. Distal focus
Prescription – 5 sets of 5, on 402 tempo
30.
31. Repeated bike sprint efforts
(>140rpm) 30s duration – GH production (Stokes 2010)
Single leg strength endurance challenge
1 Leg Hack Squat vs. Step Ups
Speed frequency loading in Quadriceps
Velocity & Volume
Drop Jump capacity
Return to running
32. ADVANCED STAGE – FUNCTIONAL RTR
Prescription – 10 reps, 10 second x3 = 1 set
33. Decline Bench Dynamic Flexion
Gravity
Wt of limb
Contralateral
Ms Activation
&
Force
41. Diagnosis is key
Design based on architecture
Design based on sport demand
Design based on athlete profile
Use outcome measures that equate to running
Use outcome measures that equate to kicking
Add in variability
SUMMARY
42. Background -
• 2006 - CWG Gold – Bilateral Achilles repair.
• 2007 - WC Gold, 2008 OG Gold
• 2009 – WC 5th, Pars fracture and HHT
• 2010 – 80% complete rupture – direct & indirect heads of RF, 10cm
retraction
• Mechanism – High speed running in PPT, on foot contact
• Focus – hypertrophy of Iliacus & Psoas
• 2011 – recurrent myofascial tears distal MTU with tendonopathic changes
and Myositis Ossificans
• Focus – regaining tendon E absorption – L-T & F-V relationship.
ATHLETE CASE STUDY