Injured Post-Operative Athlete

The injured/post-operative athlete must progress through a planned sports rehabilitation (SR) progression to conclude with an optimal return to play/performance desired outcome. For over a decade we have continually developed and adapted my good friend and one of my mentors, Hall of Fame Strength and Conditioning Coach Al Vermeil’s Hierarchy of Athletic Development for the SR athlete (Figure 1A). The training principles and exercises that produce the world’s best athletes may also be adapted into the SR setting.

It is important to note that each physical quality in the hierarchy is dependent upon the optimal development of its physical quality predecessor beginning with the foundational physical quality of strength. It is acknowledged that strength qualities are restored earlier during SR than explosive strength (power) qualities (Figure 1B, Angelozzi 2012). The rate of force development (RFD) is essential for ideal athletic performance. At the time appropriate strength levels are established, specific explosive strength exercises should be introduced early in the SR process due to the extended time requirement to reestablish the SR athlete’s RFD.

Many surgical procedures (i.e. ACL, PCL, meniscal repair, etc.) are also accompanied by biological healing limitations. One common biological healing (time) constraint is high knee flexion (ROM) angles and the execution of deep knee bend exercises in the full weight-bearing (FWB) posture.

RFD may also be achieved in a seated position (i.e. isokinetic knee extension/flexion), however, if an athlete is sitting during sport competition they aren’t playing. The best athletes in the world are those that can apply the most force into the ground (impulse, RFD) in the shortest period of time (amortization). Therefore, when deemed safe and appropriate, it is recommended that RFD be enhanced in the standing FWB position. Two (2) exercises that may be incorporated early and safely in the SR program design are the mid-thigh clean pull (MTCP), a derivative of the Olympic lifts, and the push press (PP). Both exercises are not technically difficult to execute and are very effective in enhancing RFD in the standing FWB posture.

The MTCP and PP are lower extremity exercises that require a great amount of force to be applied into the ground surface area in brief periods of time. Both exercises require limited (approximately 30°) knee flexion with lower consequential ground impact forces when compared to other commonly prescribed explosive strength activities.

The MTCP (Figures 2 and 3) provides superior levels of RFD, peak ground reaction forces and peak RFD qualities generated in less time compared to other common SR and sports performance activities and evaluative tests. The PP exercise (Figure 4) also produces great amounts of explosive strength (up to 5 – 5+ horsepower), with lower consequential ground impact forces and knee flexion angles compared to trap bar jumps and squat jump execution and landings.

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