The Development of a Return to Performance Pathway Involving A Professional Soccer Player Returning From A Multi-Structural Knee Injury: A Case Report.

This case report describes a male professional soccer player returning to match play (English Championship League) following a medial meniscectomy that occurred during the course of rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction. The player underwent a medial meniscectomy eight months into an ACL rehabilitation program and following 10 weeks of rehabilitation successfully returned to competitive first team match play. This report outlines description of the pathology, the rehabilitation progressions, and the sports specific performance requirements of the player as they progressed through the return to performance pathway (RTP). The RTP pathway included nine distinct phases with evidenced based criteria required to exit each phase. The first five phases were indoor as the player progressed from the medial meniscectomy, through the rehabilitation pathways to the "gym exit Phase". The gym exit Phase was assessed with multiple criteria: a) capacity; b) strength; c) isokinetic dynamometry (IKD); d) hop test battery; e) force plate jumps; and f) supine isometric hamstring rate of force (RFD) development qualities to evaluate the players readiness to start sport specific rehabilitation. The last four phases of the RTP pathway are designed to regain the maximal physical capabilities (plyometric and explosive qualities) in the gym and included the retraining of on-field sport specific qualities utilizing the 'control-chaos continuum.' The player successfully returned to team play in the ninth and final phase of the RTP pathway. The purpose of this case report was to outline a RTP for a professional soccer player who successfully restored specific injury criteria (strength, capacity and movement quality), physical capabilities (plyometric and explosive qualities). and on-field sport specific criteria utilizing the 'control-chaos continuum.' Level of Evidence: Level 4.

Factors influencing optimum countermovement jump performance and movement strategy in Championship professional football players: implications for player profiling.

Single leg countermovement jump (CMJ) is a common profiling test influenced by sport, age, sex and playing level. Controlling for these confounding variables, outfield players from an English Championship squad (n = 36) were retrospectively categorized as best (n = 10) or worst (n = 10), based on mean single leg CMJ height and flight time:contraction time ratio. Movement strategy was quantified as force-time history metrics differentiating eccentric and concentric phases. Jump height revealed that best performers elicited greater rate of force development in both phases (P ≤ 0.033), with concentric impulse the strongest predictor of performance. Time ratio also differentiated best performers as utilizing a shallower (P = 0.002) countermovement, with concentric rate of force development the strongest predictor of good performance. Successful jump height performance can mask ineffectual eccentric and stretch shortening cycle neuromuscular characteristics. Time ratio is therefore advocated as the key performance indicator, with movement strategy prioritized over gross outcome measures.

The Influence of Injury History on Countermovement Jump Performance and Movement Strategy in Professional Soccer Players: Implications for Profiling and Rehabilitation Foci.

CONTEXT: Professional soccer players who have sustained a lower limb injury are up to 3× more likely to suffer a reinjury, often of increased severity. Previous injury has been shown to induce compensatory strategies during neuromuscular screening tests, which might mask deficits and lead to misinterpretation of readiness to play based on task outcome measures. OBJECTIVE: To investigate the influence of previous injury in professional soccer players on countermovement jump (CMJ) performance and movement strategy. DESIGN: Cross-sectional. SETTING: Professional soccer club competing in the English Championship (tier 2). Patients (or Other Participants): Outfield players with a minimum of 6 years as a professional. INTERVENTION(S): Players were categorized as previously injured (n = 10) or not injured (n = 10). All players completed double- and single-leg CMJ trials. MAIN OUTCOME MEASURES: CMJ performance was quantified as jump height and flight time:contraction time ratio. CMJ movement strategy was quantified as force-time history, differentiating eccentric and concentric phases and CMJ depth. RESULTS: Double-leg CMJ was not sensitive to previous injury in performance or movement strategy. In contrast, single-leg CMJ performance was impaired in players with previous injury, who generated significantly lower eccentric and concentric peak force and rate of force development, and a deeper countermovement. Impaired single-leg CMJ performance was also evident in the nonaffected limb of previously injured players, suggesting cross-contamination. Hierarchical ordering revealed that the eccentric phase of the CMJ contributed little to performance in previously injured players. In noninjured players, the eccentric rate of force development and concentric peak force were able to account for up to 89% of the variation in CMJ performance. CONCLUSIONS: Single-leg CMJ is advocated for player profiling, being more sensitive to previous injury, and negating the opportunity for interlimb compensation strategies. Movement strategy deficits in previously injured players suggest rehabilitation foci specific to eccentric force development.