Rehabilitation of rectus femoris injuries. Experience at Barcelona FC Xavier Linde & Juanjo Brau

1. REHABILITATION
OF RECTUS
FEMORIS INJURIES
Experience at FC Barcelona
4th October 2016

2.  This is a proposal of specific rehabilitation of a professional football player.
 It can be open to opinions (of course), it’s only our contribution in terms of searching a better way for healing football players in
optimal conditions.
 This presentation reflects the opinion of the authors and we are consient that this is not an absolut true.
FIRST OF ALL…
2FCBarcelona 1st Team Medical Staff

3. THE ISSUE
Soccer player 20 y.o. 1,75 cm height and 71 kg weight,
right dominant
Who suffered a complete tear of rectus femoris i
nvolving direct and indirect head of his left leg
Shooting action with non dominant limb

4.  Conservative Treatment (recommended surgical?)
 10 weeks until training back with the team normally
MUSCLE GUIDE CLASSIFICATION
FC BARCELONA
FCB Muscle guide 3.0
Grade of injury and Importance
4
?

5. 5FCBarcelona & Aspetar, Muscle injuries Clinical Guide 3.0, Januray 2015.
Evolution of RTP and Rehabilitation workout skills

6. What do we do?
This phase took place during the very early phase, 4-5 days long
Rest, Ice, Compression, Bandage
ACUTE PHASE
Better do not touch
6

7. Compression
Pants
Helps on recovering faster by reducing muscle soreness, swollen
or aedema in the injured areas, and improving circulation’s blood
return as well.
Compressive
Bandage
Compression on the muscle to keep it more stable and fixed.
Helps in reducing hematoma and pain, and gives more security
and better feeling to the player.
Compression + Ice
Combines compression and ice at the same time in the specyphic
area. Helps in anaesthesic effect, as reducing swollen, aedema
and hematoma
7
At least twice a day the whole process. Recommended 20-30’ GR + 40-60’ NT

8. What do we do?
Quadriceps activation in controlled situations/manner &
aerobic exercises
SUBACUTE
PHASE
Let’s activate!
8

9. o Manual Therapy and massage maneuvers
o Passive Stretching
o Compression (NT)
o Ice (GR)
o Radiofrequence? (athermia)
o Others…
SUBACUTE PHASE
Passive Methods
9
Foto Terapia Manual Maluc
Goals?
- Reduce restrictions & compensations
- Improve player’s feeling
- Help healing process

10. o Active tension stretching
o Mezières & Pilates
o Analytic muscle strengthening
o Muscle maintenance of lower limb
o Physical conditioning (upper trunk & aerobic)
SUBACUTE PHASE
Active Methods
10
Goals?
- Start recruitment and intramuscular coordination
- Functionalize and gain elasticity
- Stimulate body’s healing process
- Gain ROM

11. Table Muscle
Activation
Hip flexion with knee in extension
Table Muscle
Activation
Knee active extension with hip flexion
Table Muscle
Activation
Knee active extension
11

12. Table Muscle
Activation
Table quadriceps concentric exercise with manual
resistance
Table Muscle
Activation
Kabat
Table Muscle
Activation
Table quadriceps concentric exercise with manual
resistance
12

13. Table Muscle
Activation
Isometric recruitment in different ways
Table Muscle
Activation
Manual resistance exercise
Table Muscle
Activation
Concentric recruitmen with short ROM
13

14. SUBACUTE
PHASE
AEROBIC EXERCISE

15.  Active mobilization
 Dreinage, cyclic exercise with no impact to start moving.
 Progression: bycicle, ellyptical bycicle, non graviti treadmill (start 60%) and treadmill.
 Continuous workout no longer than 10’. Can be performed more in different series.
 Radiofrequency starts without temperature, or with very low temperatures, that increses as well as the injury evolves.
 Manual therapy to mantain free range of motion of the limb, and to avoid restrictions due to involuntary protection.
 Isometric and concentric (short ROM) exercises in a controlled situation.
MANUAL THERAPY & OTHERS
15
Principles
Activation and aerobic workout
IT IS BASIC TO GIVE DIFFERENT KIND OF STIMULATION TO THE MUSCLE!!!

16. MANUAL THERAPY & OTHERS
16
Principles
CRITERIA
 ACTIVE WORKOUT:
 DOES PAIN APPEAR?
 CAN THE PLAYER PERFORM THE EXERCISE?
 PROGRESSION: ROM, INTENSITY, VELOCITY.
 ISOMETRIC TO CONCENTRIC WORK

17.  MANAGING LOAD
- Exercises with series between 8-25/30 repetitions. Mixed series in the same set, in order not to work always the same long
- Rest time? Series of each exercise?
- Different estimulations to perform the same exercise. Adapt muscle’s capabilities
- Normally one session per day. If necessari double session for specific treatment.
17
WEEK’S ORGANISATION
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT?
FREE
FREE FREE FREE FREE FREE
FREE FREE

18. What do we do?
Muscle activation in the gym combined with starting phase of Return to Play
ADVANCED
PHASE
Let’s move
18

19. o Manual Therapy and massage maneuvers
o Passive Stretching
o Radiofrequency: add temperature
o Others…
ADVANCED PHASE
Passive Methods
19
Goals?
- Reduce restrictions & compensations
- Improve player’s feeling
- Help healing process

20. o Active tension stretching
o Mezières & Pilates
o Analytic muscle strengthening
o Coordination, proprioception
o Muscle maintenance of lower limb
o Physical conditioning (upper trunk & aerobic)
ADVANCED PHASE
Active Methods
20
Goals?
- Increase muscle coordination
- Functionalize and gain elasticity
- Stimulate body’s healing process
- Give different ways of stimulation

21. Gym Exercises
Pneumatic leg extension
Gym Exercises
Squat one leg with fitball
Gym Exercises
Squat double leg with fitball
21

22. Gym Exercises
Proprioception
Gym Exercises
Horizontal leg press one leg
Gym Exercises
Russian belt short ROM
22

23. Gym Exercises
Auto stretching with Panca
Gym Exercises
Simulation to shoot
Gym Exercises
Proprioception with coordination
23

24. ADVANCED
PHASE
INDOOR AEROBIC
EXERCISE

25. MANUAL THERAPY & OTHERS
25
Principles
CRITERIA
 ACTIVE WORKOUT:
 DOES PAIN APPEAR?
 CAN THE PLAYER PERFORM THE EXERCISE?
 PROGRESSION: ROM, INTENSITY, VELOCITY.
 STILL ISOMETRIC ?  CONCENTRIC  ECCENTRIC?
 CAN WE HAVE A MORE DEMANDING LEVEL OF EXERCISES?

26.  MANAGING LOAD
- Exercises with series between 8-25/30 repetitions. Rest time? Series of each exercise?
- Important not to work always the same long.
- Different estimulations to perform the same exercise. Adapt muscle’s capabilities
- Number of repetitions go decreasing as the return to play workout increases in demands.
26
WEEK’S ORGANISATION
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT
TRAINING +
TMT?
FREE
FREE FREE FREE FREE FREE
FREE FREE

27. What do we do?
Activation routine before training in the pitch
FINAL PHASE
Let’s train
27

28.  This an example of activation routine for Quad
 Basic exercises choosen from all the previous
exercises.
 Maximum 10-15’
 Perform before return to play session or partial training
with the team.
ACTIVATION ROUTINE
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29. THANK YOU VERY
MUCH FOR YOUR
ATTENTION