Physical preparation and return to performance of an elite female football player following ACL reconstruction: a journey to the FIFA Women’s World Cup

Abstract

ACL injuries are among the most severe knee injuries in elite sport, with a high injury burden and re-injury risk. Despite extensive literature on the injury and the higher incidence of injury and re-injury in female athletes, there is limited evidence on the return to sport (RTS) of elite female football players following ACL reconstruction (ACLR). RTS is best viewed on a continuum aligning the recovery and rehabilitation process with the ultimate aim — a return to performance (RTPerf). We outline the RTS and RTPerf of an elite female football player following ACLR and her journey to the FIFA Women’s World Cup, including the gym-based physical preparation and the on-pitch/sports-specific reconditioning. We used the ‘control–chaos continuum’ as a framework for RTS, guiding a return above pre-injury training load demands while considering the qualitative nature of movement in competition. We then implemented the ‘RTPerf pathway’ to facilitate a return to team training, competitive match play and a RTPerf. Objective information, clinical reasoning and shared decision-making contributed to this process and helped the player to reach her goal of representing her country at the FIFA Women’s World Cup.

Injuries in elite‐level women’s football—a two‐year prospective study in the Irish Women’s National League

“…28 The strength, power and proprioceptive exercises included in these programs are unlikely to provide sufficient neuromuscular stimulus for elite-level female players playing at the highest levels of the women's game. Taberner et al 29 provide a good example of the type of strength and conditioning programming required to prepare elite-level senior female players for the demands of match play.…”

“…Alongside musculoskeletal screening and implementing injury risk mitigation programs for ankle, thigh, knee T A B L E 5 (Continued) and hip/groin injuries, medical personnel and strength and conditioning coaches need to develop expertise in rehabilitating these injuries. 29 One of the challenges for medical personnel in elite-level women's football is that, despite lateral ankle sprains being one of the most commonly reported injuries, [4][5][6][7][8][9][10][11][12][13]15 there are no evidence-based criteria to inform return-to-sport (RTS) decisions for players recuperating from an acute lateral ankle sprain injury. 30 Likewise, despite the large injury burden associated with ACL injuries, the evidence underpinning current RTS test batteries in relation to the risk of graft rupture and contralateral ACL rupture is weak.…”

Characteristics of Complex Systems in Sports Injury Rehabilitation: Examples and Implications for Practice

“…For on-pitch rehabilitation, activities should begin with simple drills and advance to more complex exercises [ 80 ]. A control-chaos continuum (CCC) could be followed on-field, where rehabilitation training constraints progress from high control to high chaos [ 82 ]. 9.…”

Unilateral Maximal Isometric Hex Bar Pull Test: Within-Session Reliability and Lower Body Force Production in Male and Female Freeski Athletes

“…Finally, common isometric MVC modalities include the isometric leg press (Granacher et al, 2011 ; Bogdanis et al, 2019 ), isometric knee extension (Kubo et al, 2006 ; Noorkõiv et al, 2014 ), isometric squat (Markovic and Jaric, 2004 ; Eliassen et al, 2018 ) and isometric mid-thigh pull (West et al, 2011 ). These methods are often utilized in training interventions investigating neuromuscular responses to exercise (Taipale et al, 2014 ), exploring mechanisms of fatigue (Izquierdo et al, 2009 ) and can also be incorporated into rehabilitation processes (Maestroni et al, 2019 ; Jordan et al, 2020 ; Taberner et al, 2020 ). Despite the advantages of the isometric tests listed above, there are limitations to these methods.…”

“…Although the demands of freeskiing have not been quantified, when taking into consideration the incidence and location of injuries often occurring to the knee and lower extremities (Flørenes et al, 2010 ; Steffen et al, 2017 ; Palmer et al, 2021 ), assessing unilateral lower body strength could be warranted. Evaluating athletes' force producing capabilities at several stages during the rehabilitation process can help identify and resolve deficits in neuromuscular performance (Maestroni et al, 2019 ; Taberner et al, 2020 ). Moreover, monitoring lower limb strength can provide objective information to help guide task progressions and support inter-disciplinary decision making on important functional milestones such as initiating running, jumping and plyometric activity (Palmieri-Smith and Lepley, 2015 ; Buckthorpe et al, 2020 ).…”