All the things you need to know (that the research does not tell you) about effective diagnosis and rehabilitation in professional and Olympics sports.

Adductor related groin pain is a clinical entity and has been used in the academic research since the early 2000’s and was brought to the forefront following the Doha agreement in 2015. However, for practitioners on the front line in professional and Olympic sports it is woefully inadequate.

In this session we will discuss how to effectively diagnose the issue; How to establish a cause of the symptoms and what other areas are contributing to the issue; then how to systematically treat, rehabilitate and importantly return an athlete / player back to an appropriate performance standard.

In this session Seth will provide an update of the contemporary tendon literature whilst providing real world application.

The talk will cover tendon anatomy and structure, the principles of tissue adaptation and how this can be monitored. He will present evidence for structural adaptation and how different stimuli (loading parameters) influence this.

Seth will discuss both the positive and negative adaptions we see and how to work to control this, ensuring our athletes are able to compete at the level they need to succeed.

Seth will give reel world advice on the application of these principles within elite sports and bridge the gap between our current evidence and expert opinion.

This presentation delves into a practical interpretation of the latest research and literature surrounding the rehabilitation of high-grade hamstring muscle injuries. The discussion will broaden the understanding of hamstring injury mechanisms, moving past the typical categorizations of ‘sprint’ and ‘stretch’ injuries to explore nuances such as the roles of the intramuscular tendon and T-Junction in these injuries.

Emphasis will also be placed on the importance of sequential imaging, particularly MRI, as a cornerstone in accurately diagnosing the specific locations of hamstring injuries. This precision in diagnosis is crucial for adopting a location-specific rehabilitation philosophy, which tailors recovery protocols to the exact needs of the injured area.

Additionally, the presentation will cover the strategic selection and periodization of exercises. This involves a systematic approach to choosing rehabilitation exercises and scheduling them in a manner that optimally supports the healing process while preparing the muscle for return to full activity. Each topic aims to provide attendees with actionable insights that can be directly applied to enhance the effectiveness of rehabilitation programs for severe hamstring injuries.

Functional tests are crucial for evaluating an athlete’s recovery after anterior cruciate ligament reconstruction (ACLR) and detect remaining deficits.

In this presentation, Roula goes into detail talking about jumps when assessing return to play after ACLR.

Key discussion points:

• Selection of specific jump tests and relevant metrics during the rehabilitation process.
• Clinical insights and tips for effective jump testing.
• Understanding how testing outcomes can significantly influence the formulation of rehabilitation plans and aid in making informed return-to-play decisions.

The foot-ankle complex is the most neglected and under-rehabbed region of the lower limb.

Most of the literature have shown that the foot-ankle complex plays a vital role in the energetic output of the lower limb during explosive tasks. Therefore, this talk aims at helping practitioners at enhancing their understanding of the importance for the foot-ankle to be “mobile, strong and springy” at the end of rehabilitation. This will be highlighted by a proposed new rehab-performance framework with data-driven decisions and key technical indicators to look at. Finally, key gym-based and field-based exercises for improving the “absorbing”, “propulsing” and “springy” foot-ankle complex will be discussed and described using clinical case-studies.

You will learn:

• Why is the foot-ankle complex important in lower limb biomechanics during explosive task (sprinting, cutting, jumping, deceleration)?
• Gain a good understanding of what the scientific literature says about foot-ankle muscles biomechanical function (absorption, propulsion, stretch & shortening cycle)
• Foot-ankle complex rehab-performance new framework with data-driven decisions and key movement competency indicators
• Key gym-based and field-based exercises surfing between analytical, functional and coupling approach

Initial prospective evidence exists between how someone sprints (i.e.,”technique”) and hamstring injury risk in team sport cohorts. Our recent study explored the relationship between a simple 2D model to identify the “kick-back” mechanism and hamstring injury risk in professional football players. No relationship was found, likely due to multiple reasons, including how kick-back is calculated, but potentially also the lack of fatigue. In a separate cross-sectional study, we explored the influence of fatigue on sagittal plane sprint that in theory contribute to hamstring length. We found that individuals varied highly in how they adapted kinematically to fatigue. This in turn promotes the idea that the negative influence of fatigue should be ideally considered on an individuals level.

In this session we explore the role of sprint mechanics as a factor in the incidence of hamstring strain injuries. With hamstring injury rates continuing to rise the need for holistic injury prevention and rehabilitation strategies is becoming increasingly important. Traditional injury prevention programs have primarily focused on conditioning strategies aimed at preparing athletes for the demands of sprint running. Yet these approaches only address one aspect of hamstring injury causation, overlooking the role of sprint running mechanics. This session will discuss novel methods to assess mechanical contributors to injury in applied sessions and whether sprint running mechanics are predictive of future hamstring strain injuries. Discussions aim to bridge the gap between research and practice providing actionable insights into how we can integrate a mechanical approach to holistic injury prevention and rehabilitation programs.

In multidirectional sports, side-step cutting can be an injury inciting event associated with anterior cruciate ligament (ACL) injury, due to the propensity to generate hazardous mechanical loads. Although there are several ACL injury risk factors, sub-optimal biomechanical movement strategies and techniques can increase ACL loading, but can `be addressed through targeted profiling and intervention. In this presentation, Tom will: 1) Introduce and discuss the biomechanical and technical determinants of ACL loading during side-step cutting and the ACL injury mechanism; 2) Evaluate key literature pertaining to side-step cutting technique modification and discuss the implications for ACL loading and performance; and 3) Share an evidence-based cutting development framework to improve side-step cutting biomechanics in athletes.

A clinical case will be used in the delivery of a return to play pathway after a significant soleus injury. Case information will be leveraged to highlight key loading strategies and progression across the management process – from injury onset to a return to
elite performance. Clinical and performance-focused monitoring will be embedded to signpost tenets of optimal management, as well as the important role they can play in risk mitigation. A range of existing and emerging data will support the approach, while highlighting ways ahead for practitioners and researchers

In this engaging presentation, Alan will introduce his speed-based approach to rehab with a primary focus on his Fast > Fit methodology.

With the help of case study examples, this presentaiton will challenge your coaches eye, help you identify common patterns in ACL running mechanics, and offer detailed and simplified frameworks that you can take away to utilise and drive forward your own rehab practise.

Practitioners working across field and court sports need to know how to return their athletes safely and effectively to running post injury. To do this well, requires clarity on the specific task demands an athlete must be prepared for upon return to play and also in-depth understanding of how to logically progress the intensity and complexity of running specific activities.

This session will show you how to develop a rehab running framework aligned to the demands of your sport and how to implement a principles-based approach to systematically progress an athlete through the return to running process. This session will also provide you with strategies to adapt your approach and decision-making processes to the individual in front of you.

This presentation explores the components that might be important to consider when reviewing recurrent hamstring injuries or in fact any other recurrent lower limb muscle injury.

It utilities Michael’s experiences combined with science-based frameworks, processes and principles to provide the audience with tangible takeaways to implement whilst giving autonomy to the coach/practitioner to apply it within their own context

In this presentation, Bob will start off by outlining his rehab philosophy from a global lower limb perspective but also from a PCL specific perspective. He will then go into detail about a case study in the lead up to the Rugby World Cup in 2023 where an athlete was attempting to get fit from a PCL injury.

In this case study, Bob will outline the injury context, rehab timelines and highlight the key learnings including:

• What changed due to time constraints?
• What was pushed due to time constraints?
• What he might have done differently if there was no time pressure?
• What he would do if faced with the same problem again?

Hamstring injuries are the most common injuries in football, with the biceps femoris being the most frequently injured muscle. Managing these injuries is particularly complex when the T-Junction is involved. The reinjury rate is very high, and sometimes surgical repair is needed to return to the highest competitive level.

This case report about an elite footballer who underwent T-Junction surgical repair aims to demonstrate the challenges of this type of rehabilitation.

By sharing imaging, data, and videos of the entire process, I intend to present a practical approach to guiding this insidious journey, which lacks clear guidelines and criteria, to a successful return to play.

There is limited research on rehabilitating medial patellofemoral ligament (MPFL) reconstruction in the general population, with even less evidence for high-level contact athletes. This case study tracks the recovery of a Division I American football commit following MPFL reconstruction over a 10-month period. Unlike most cases, this study had baseline performance metrics that enabled objective criteria for progress from the beginning of rehabilitation to returning to the field. Despite encountering obstacles, this case will delve into the challenges faced and the solutions discovered along the way. Utilizing isometric testing, isokinetic testing, force plate data, and kinematic assessments facilitated a more precise selection of interventions tailored to address identified deficits. The rehab program drew from evidence used in anterior cruciate ligament (ACL) reconstruction rehab but also included adjustments for physiological differences between the surgeries. Ultimately, this approach led to the athlete returning to play stronger, faster, and more agile than before, fully prepared for the upcoming season.

This case study showcases an 8-month journey supporting a gymnast’s Paris 2024 competitive aspirations following an osteochondritis dissecans (OCD) diagnosis. A comprehensive diagnostic test battery, including 3D force plates, was utilised to formulate both an injury mechanism hypothesis and the return to train and performance strategy. An already constrained Olympic selection competition timeline was further challenged by the need for platelet-rich plasma (PRP) injections which required a period of offloading from daily & sports related weight bearing activities. Through a collaborative, holistic and bespoke approach the gymnast was successful in being selected to represent Team GB.

Outcomes from both ACL injury and reconstructive surgery are generally poor, with low numbers returning to sport (or previous function) and relatively high risk of developing knee osteoarthritis. One potential solution to this is a more criterion-based approach, where the patient has to pass tests to progress to the next stages of rehabilitation, rather than the process being time based. This has the advantage of both improving confidence and compliance, through the attainment of these short-term goals. The aim of this talk is too present this data driven approach to progression through ACL rehabilitation. It will identify key stages in rehabilitation, the key tests related to them and when in the rehabilitation process to undertake them. Also discussing the advantages and disadvantages of the tests and alternates which could be used. At the end of the talk participants should have a clearer plan for ACL rehabilitation and understand when and in which direction to progress their patients.