Table 1. Rehabilitation Protocol Purpose Describing the Criteria to Design the Exercises in Each Phase, the Goals and Test to Progress Between Phases, and RTP Criteria a.
| Acute Phase | Subacute Phase | Functional Phase | |
|---|---|---|---|
| Exercise design criteria | |||
| Proprioception | Start on a stable surface and progress to light instability (soft mat, dynadisk or similar). Knee flexion, start 0° and progress until 30°. Static movement and progress to low unstable dynamic. | Increase instability (bosu, balance board, rocker board or similar). Knee flexion, progress to 45°. Moderate reactive/strength movement. Active and wide movements. | Unstable surface. Knee flexion progress to 90°. Intense strength and reactive movements. |
| Core | Static exercises on stable surface in frontal, sagittal and transverse planes. | Dynamic exercises in frontal, sagittal and transverse planes from stable surface and progress to one unstable point; unstable elements progressing in instability (soft mat to fitball). | Dynamic exercises on two unstable points. Exercises in standing position reproducing functional movements (acceleration, deceleration, and dynamic stabilization). No limit. |
| Flexibility and rom | Stretch with ESH ≤ 45, avoiding pain. | Stretch with ESH ≤ 70, avoiding pain. | No limit. |
| Strength and power | ESH ≤ 45, avoiding pain. Isolated knee flexion or hip extension exercises, progress to combine both actions. When starting CKC exercises, first unipodal and progress to bipodal. In the corresponding ESH star with ISOM, progress to CONC and ECC and progress in muscle length avoiding pain or discomfort. | ESH ≤ 70 avoiding pain. In the corresponding ESH, progress in analytic movements length, velocity and load to the maximum effort; and increase combine movement demands. OKC and CKC uni and bipodal exercises. | No ESH limit. Progress in length, joint velocity, load and complexity. Horizontal strength application exercises. |
| Neuromuscular and fitness | ESH ≤ 45, avoiding pain. Start on a soft surface and progress to hard (to reduce eccentric contraction). Start walking on treadmill and progress until V max ≤ 8 km/h, 5% slope to decrease ESH | ESH ≤ 70 avoiding pain. Start on a soft surface and progress to hard. Run on treadmill, progress until 70% of athletes maximal speed, 3 % slope to decrease ESH | No ESH limit. On hard surface. Progress until maximal speed, start on flat and progress to negative slope |
| Goals and test to progress | No pain or discomfort during exercises. To find and maintain a neutral spine position in static (laying, standing or sitting) and during exercises. Isometric knee flexion strength, decubito prono knee flexion 45° and hip 0° > 50% of previous data or uninjured leg (dynamometer or similar). Isometric hip extension strength, decubito supine hip flexion 45° and Knee 0° > 50% of previous data or uninjured leg (dynamometer or similar). Full knee and hip isolated tested ROM | No pain or discomfort during exercises. Not tilting the pelvis or flattening the spine during exercises. Isometric knee flexion strength in decubito supino knee flexion 25° and hip flexion 45°, less than 10% asymmetry from previous data or uninjured leg (dynamometer or similar). Isometric hip extension strength in decubito supino knee 0° and hip flexion 70°, less than 10% asymmetry from previous data or uninjured leg (dynamometer or similar). Less than 10° asymmetry in in AKET Less than 10° asymmetry in the Active Hip Flexion Test. Modified Thomas test > 5 and symmetry below horizontal. Deep squat test (50). Single leg squat (51). Runner pose test (51). In-line lunge test (50). | No pain or discomfort during exercises. Correct spine control and strength transfer during exercises. Integrate strength, neuromuscular and proprioceptive work. Hip strength test in bipedestation knee 0° hip at maximum hip flexion achieved in contralateral leg, no asymmetry (dynamometer or similar). Isokinetic criteria: Differences higher than 20% should be avoided in absolute values. Normal isokinetic ratios No asymmetry in the Active Hip Flexion Test. No asymmetry in AKET |
| Criteria | |||
| Functional Test | A normal week training with the group, without pain, discomfort or "fears". Normal performance by GPS or similar (distances, speeds, accelerations), and HR data (training zones%, etc). | ||
| Athlete “psycho” | Full performance feelings and no fear/doubts from player or similar expression to describe a positive feeling from the subject. | ||
| Clinical Test | Free pain maximal eccentric knee extension in decubito prono hip 0° knee 90° and moves to 0°; and free pain maximal eccentric hip extension in decubito supine knee 0° hip 0° and moves to 70°. | ||
aAbbreviations: aKET, active knee extension test; CKC, close kinetic chain; CON, concentric; ECC, eccentric; ESH, elongation stress on hamstrings; HR, heart rate; ISOM, isometric; OKC, open kinetic chain; ROM, range of motion.