Monitoring the Return to Sport Transition After ACL Injury: An Alpine Ski Racing Case Study

Abstract

Alpine ski racing is an extreme sport and ski racers are at high risk for ACL injury. ACL injury impairs neuromuscular function and psychological readiness putting alpine skiers with ACL injury at high risk for ACL reinjury. Consequently, return to sport training and testing protocols are recommended to safeguard ACL injured athletes against reinjury. The aim of this paper was to present a real-world example of a return to sport training plan for a female elite alpine ski racer who sustained an ACL injury that was supported by an interdisciplinary performance team (IPT) alongside neuromuscular testing and athlete monitoring. A multi-faceted return to sport training plan was developed by the IPT shortly after the injury event that accounted for the logistics, healing, psychological readiness, functional milestones, work capacity and progression to support the return to sport/return to performance transition. Neuromuscular testing was conducted at several timepoints post-injury. Importantly, numerous pre-injury tests provided a baseline for comparison throughout the recovery process. Movement competencies and neuromuscular function were assessed, including an evaluation of muscle properties (e.g., the force-velocity and force-length relationships) to assist the IPT in pinpointing trainable deficits and managing the complexities of the return to sport transition. While the athlete returned to snow 7 months post-injury, presenting with interlimb asymmetries below 10%, functional and strength deficits persisted up to 18 months post-injury. More research is required to establish a valid return to sport protocol for alpine ski racers with ACL injury to safeguard against the high risk for ACL reinjury.

Utilising one minute and four minute recovery when employing the resistance training contrast method does not negatively affect subsequent jump performance in the presence of concurrent training

“…Given that high-intensity intermittent activity requires accelerations, change of direction and decelerations to be performed with maximal force almost instantaneously through competition (Ritchie et al, 2016;Jennings et al, 2010), RSI is a particularly important attribute for team sport athletes. Furthermore, it has been shown that in athletes who have suffered significant lower limb injures that the ability to produce force quickly is often attenuated in both the acute rehab and post return to play period (Read et al, 2020;Jordan et al, 2020). Thus, the current results present a useful method of within resistance training session organisation that can augment RSI for concurrently trained athletes such as team sport athletes.…”

Peer Review #1 of "Utilising one minute and four minute recovery when employing the resistance training contrast method does not negatively affect subsequent jump performance in the presence of concurrent training (v0.1)"

“…Furthermore, it has been shown that in athletes who have suffered significant lower limb injures that the ability to produce force quickly is often attenuated in both the acute rehab and post return to play period (37,38). Thus, the current results present a useful method of within resistance training session organisation that can augment RSI for concurrently trained athletes such as team sport athletes.…”

Managing the return to sport of the elite footballer following semimembranosus reconstruction

“…Notably, at Week 17 despite modest deficits in jump height (5%) and peak power (7%), relative to pre-injury, suggestive of performance decline secondary to the injury/deconditioning, there were substantial improvements in strategy/kinetic variables such as eccentric deceleration RFD (20%), concentric impulse-100 (8%) and lower limb stiffness (13%), indicative of improved SSC ability. 11 36 Importantly, at this time point, the player had achieved 97% of pre-injury maximal speed ( figures 4 and 6 ), without full recovery of aspects of neuromuscular performance, and several weeks remained before expected return to competition to further recover these.…”

“…These data highlight both the importance of evaluating RFD-related variables following injury and of having healthy benchmark values to reduce the dependence on %ILA as a marker of status and progress. 11 12 …”