Long-term Athletic Rehabilitation

Using the AMSC

Clinicians must consider the athlete’s holistic motor skill competency development when designing rehabilitation programs. The AMSCs are considered foundational and underpin all athletic movements⁽⁶⁾. When working with adolescent athletes who are side-lined for prolonged periods, clinicians must consider themselves critical in the athlete’s LTAD. Their role is to ensure that the athlete recovers optimally from injury and continues to develop the necessary motor skills at a rate comparable to their non-injured peers. Although this may be challenging, as the intensity of matches and training cannot be replicated in typical rehabilitation settings, clinicians must endeavor to minimize the gap and think creatively to reduce the deficits throughout the recovery timeline.

Simple and clear programs following FITT principles are crucial to building solid athletic competency foundations (see table 1). Although adding the latest fad techniques to rehabilitation programs may be tempting, clinicians must ensure that the foundational strength and conditioning movement patterns are the core of any program. Along with the AMSC, pelvic hinge, and lower-body squat patterns are critical to ensuring athletic development.

Table 1: FITT principles

When athletes sustain injuries that require them to complete long-term rehabilitation, clinicians must create a plan to develop and then progress motor skill development in line with the athletes’ sports-specific needs (see table 2). When designing rehabilitation programs, they must consider the exercise continuum and incorporate the most appropriate modality for each phase or intended goal. For example, plyometrics are essential in the late stages of recovery, whereas isometrics may be more suitable in the initial healing stages. 

Table 2: Example of an outlined AMSC plan for a rugby player recovering from a knee injury*

Table 3: Example of an outlined AMSC plan for a netball athlete recovering from a shoulder injury*

*Tables 2 and 3 represent examples of progressions for each AMSC, and clinicians must create programs that meet their athletes’ training age. A greater focus should be on foundational and isometric exercises around the injured site during the early rehabilitation phases. They progress through concentric, eccentric, and plyometric exercises toward the end of their rehabilitation or when appropriate. The non-affected limbs should train at their highest possible functional level throughout rehabilitation.

Sports-specific Motor Skills

Each sport has its unique physiological and skill demands. Integrating general motor skills, such as hand-eye coordination, and sport-specific skills, such as netball shooting, is essential when working with adolescent athletes. This meets the general LTAD and sports-specific requirements. Furthermore, it creates variability and enhances the program’s enjoyability. For example, teaching athletes to juggle integrates throwing, catching, and grasping into the early rehabilitation phases. It creates a cognitive load and is often fun for them to show off to their friends when they have mastered it. It develops hand-eye coordination, which can be progressed as they recover from injury and become more physically capable.

Clinicians must also consider the different components of motor skill learning and the effect of cognitive load on performance. Motor skill learning includes sensory perception, working memory, and long-term memory. Introducing cognitive load early into rehabilitation will ensure that athletes adapt adequately when rehabilitation progresses into the late, chaotic phases. Clinicians can use various methods to develop motor skills throughout rehabilitation, such as variable and spacing practice and the control to chaos framework.

Conclusion

Severe injury that results in long-term rehabilitation has serious developmental consequences for adolescent athletes. While on the sidelines, they may miss large periods of crucial skill development, and clinicians play a critical role in filling the gap. The AMSC framework offers clinicians a solution to develop and progress rehabilitation programs in line with the LTAD framework. It aligns the necessary injury-specific recovery requirements with general athletic development. When successfully implemented, offers adolescent athletes the opportunity to return to sports and continue on the long-term athletic development pathway.

References

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