Same injury. Different athletes. Different rehabilitation? Athlete profiles and injury rehabilitation

I recently had a conversation with one of the physiotherapists in the clinic about tailoring rehabilitation to type of athlete. Athlete profiling has become more popular in recent sports science research. In particular the work of JB Morin and his team have started to highlight that in running and jumping athletes the force-velocity profile of the athlete can be relatively easy to calculate. What this means is that the way in which somebody creates movement is usually related to the use of a force strategy (using strength and force application) or velocity strategy (increased limb or segment movement speed). Obviously there are athletes that are good at both, so it is important to look at the profile as a spectrum rather than as being in one camp or the other. The conversation ventured into sports that were hybrids such as team sports or even aerobic in nature. With these sports the profile looks at the type of athlete and what makes them successful. An example could be a midfielder in Australian rules football. The profile of these athletes can be vastly different, some are explosive, strong, able to create clearances, but may lack the aerobic tank to spend the whole game in the midfield. Others are the run all day midfielders that utilise aerobic conditioning to outwork their opponents.

Understanding these profiles in sport has a big effect on why an athlete may develop an injury and how we must address the injury. If we use the example of the two players described in AFL, if they were both to sustain a hamstring strain (grade 1, musculotendinous junction, biceps femoris) the reason for the injury may be very different.

Let’s make some assumptions and work through the scenario.

The explosive player is likely to be physically powerful, faster and have good jumping and off field gym strength, including hamstring strength. The aerobic engine athlete is likely to have high playing and training capacities, have reasonable speed, but better at speed endurance and repeat running efforts, have adequate strength for the sport but not be a beast in the gym.

So what would this mean for their injury development. More than likely the explosive athlete does not lack strength, they are mostly likely to develop a hamstring injury due to fatigue, too much high load game or training exposure, or potentially poor running mechanics. The aerobic athlete is unlikely to have a fatigue related hamstring strain, but more likely to lack high strength, particularly when at high speeds, for example when sprinting for a ball for example. Again we cannot discount running mechanics, however for this example, let us say they both run adequately well. So the development of the same injury is caused by completely different scenarios.

So should the rehabilitation be the same? Probably not.

With the first athlete, the rehabilitation should address the underlying tissue damage and expose them to graduated training and game play, however in order to reduce the risk of reinjury, a large focus should be placed on increasing conditioning of the athlete and then a strict use game day rotation system to reduce likelihood of getting to a significantly fatigued state, is likely to have a better effect than the common protocol of strengthen the hamstrings even further.

With the aerobic athlete the rehabilitation may be significantly focused on increasing overall strength capabilities as well as hamstring strength and velocity producing capabilities  so that future exposure do not contribute to reinjury.

As you can see understanding the athlete profile has significant influence on why they develop injury and how you need to manage return to sport and future injury risk.