The 4 Steps of Sports Physiotherapy That Will Help You Recover From Injury
Sports Physiotherapy has come a long way since I had 2 knee surgeries a few years ago.
I had experienced the first 2 steps of the process but that’s were my Physiotherapy input ended.
It made me realise that if I wanted to be good at my job as a Sports Physiotherapist, I would need to further my knowledge and experience to be able to complete the final 2 stages of the process with my clients.
So, what are the 4 steps of the process?
A diagnosis of your injury is vital so that the correct treatment is implemented.
The last thing you want, is to be spending time and effort on a treatment that is not going to work.
A Physiotherapist will gain an insight to your injury through a detailed subjective and objective assessment.
Subjective assessment consists of asking questions such as:
- How did it happen? i.e. twisting injury, overstretched during a sprint
- What are your symptoms? i.e. pain, swelling, bruising
- Is it getting better or worse?
- Has it happened before?
Objective assessment consists of a physical examination:
- Observation – looking for obvious swelling, bruising or deformity
- Palpation – pressing on different structures around the painful area
- Range of movement – flexibility of the joint and muscles
- Strength – check for weakness or pain in muscles and tendons
- Special tests – for joints, ligaments and nerve injuries
- Functional tests – looking at movements such as squats, lunges, heel raises etc.
A detailed Physiotherapy examination allows us to make a decision to what structures have been injured, what has caused it and how to treat it.
Physiotherapy treatment comes in different forms but the ones I implement are based on what researchers have proven to work, and from my own experiences.
I will briefly discuss each one that I most commonly use:
You are probably thinking this isn’t a treatment! It is important for the injured person to understand what their injury is, how to recover from it and how long it is going to take. It will improve their motivation and compliance with treatment and exercises.
Soft Tissue Therapy
A hands-on approach to improve flexibility of shortened muscles and tendons. It is also useful for treating areas of tension or trigger points.
Joint mobilisation or manipulation
Sometimes joints become stiff or don’t move the way they should. For example, a Physiotherapist will apply pressure to parts of the lumbar spine so that they move more easily when you flex or rotate your lower back.
Taping or Strapping
With sprained ligaments, it is sometimes useful to tape or strap joints to provide stability in order to do specific rehabilitation exercises, or just to carry out everyday activities, until the injury heals.
Depending on the stage of recovery and your sport, exercises will be prescribed to improve flexibility, strength, balance, speed, endurance, agility and skill.
3. Return To Sport
This can be a difficult decision for a Sports Physiotherapist. Athletes will want to get back playing as soon as possible but it is the Physiotherapist’s job to decide if they are at the risk of getting injured again.
Some things we have to consider before returning to sport are:
- Have the symptoms cleared i.e. pain, joint instability
- Is strength and range of movement returned to normal
- Have they completed advanced stage rehabilitation exercises specific to their sport i.e. jumping, landing, sprinting, turning
- Are they able to meet the work load of a training session/match i.e. a footballer may need to run between 8-12km in a session
- Is there a fa fear of re-injury?
Once back playing, it is essential to monitor progress and implement the next stage of recovery.
4. Injury Prevention
Once a player returns to sport it is easy to ‘switch off’ from all the hard work of rehab.
It is very important to follow through with an injury prevention programme.
For instance, the most common time for hamstring re-injury is within 2 weeks of returning to sport. The rate of hamstring injuries recurring within 2 years is 14-63% (2).
Players with an anterior cruciate ligament (ACL) repair have a 7% chance of re-injury (5), even after 9 months of hard work in the gym.
Professional footballers who have sprained their ankle will have 9% chance of spraining their ankle again over the season (6)
Examples of Injury Prevention Programmes
It is quite easy to implement an Injury Prevention Programme into the normal routine of training.
The International Federation of Association Football (FIFA) have successfully implemented the FIFA 11+ warm-up to reduce the risk of injuries.
Studies of it’s effectiveness make it worthwhile:
50% reduction of anterior cruciate ligaments (ACL) injuries in female footballers who completed it twice weekly (1).
46% reduction in all injuries in male soccer players (Silvers) who completed it 2-3 times weekly (3).
The Gaelic Athletic Association (GAA) introduced the ‘GAA 15: Injury Prevention Programme‘.
It takes 15 minutes to complete and is recommended to be completed before each training session and matches.
Studies have shown it to reduce injuries by a massive 66% (4).
It is important to get the correct diagnosis so that the correct Physiotherapy treatment is given.
The decision to return to sport is based on completing a comprehensive rehabilitation programme that involves maximising performance and reducing the risk of re-injury.
It is important for the athlete to look after their bodies after the recovery process, in order to reduce the risk of their injury recurring.
1. Bizzini, M. & Dvorak, J. (2015) FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. British Journal of Sports Medicine, 49, 577-579.
2. De Vos, R. J., Reurink, G., Goudswaard, G. J., Moen, M. H., Weir, A., & Tol, J. L. (2014). Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. British Journal of Sports Medicine, 48(18), 1377-1384.
3. Sadigursky D, Braid JA, De Lira DNL, Machado BAB, Carneiro RJF, Colavolpe PO. (2017) The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Science, Medicine and Rehabilitation, 9:18.
4. Schlingermann, B. E., Lodge, C. A., Gissane, C., & Rankin, P. M. (2018). Effects of the Gaelic Athletic Association 15 on Lower Extremity Injury Incidence and Neuromuscular Functional Outcomes in Collegiate Gaelic Games. The Journal of Strength & Conditioning Research, 32(7), 1993-2001.
5. Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D. (2016). Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. The American Journal of Sports Medicine, 44(7), 1861-1876.
6. Woods, C., Hawkins, R., Hulse, M., et al (2003). The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains. British Journal of Sports Medicine, 37, 233-238.