I watched a Big Bash cricket game over the weekend, where a player landed on his outstretched arm and fractured his collarbone. This triggered thoughts of how to return that player to full contact, after his injury. We are often excellent at rehabilitating range of motion and strength following injuries, but how good are we at returning a player to full contact, without recurrence of injury? As we know, the greatest risk of an injury is unaccustomed activity and a large increase in load. In returning a player from an injury, we must gradually reintroduce contact, as well as training load.

This is an example of a return to full contact protocol, used with my rugby union players. It would also be relevant for NFL, AFL, rugby league and martial arts/wrestling type sports. We use this protocol for athletes returning from any shoulder, neck, back, knee and ankle injuries. The biggest focus in on gradually returning to tackling and landing onto hard surfaces.

Throughout this return to contact protool, players recovering from shoulder dislocations or AC joint injuries are taped for additional proprioceptive feedback and support. Most players continue to be taped for the remainder of that season, then using the following pre-season to further rehabilitate so they no longer require taping. Examples of the taping techniques I use are below, these are the basic tapings which I modify based on individual injuries. I might also tape a player's AC joint for someone returning from a C7 nerve root injury, to give additional support to the shoulder girdle on their affected side.

Acromioclavicular Joint Taping

Glenohumeral Joint Taping (Anterior Joint Dislocation)

Start under arm, tape around back of arm

The player should return to full contact once they achieve Stage Five without pain. They should continue extras for a minimum of four weeks after returning to play.

Stage One - Return to Contact Protocol

Criteria to Begin Stage One:

Bench Press/Bent over Row must be at least 80% of pre-injury strength
Rotator Cuff internal & external rotation - full strength, 100% of other side and pre-injury strength

Training:

Shoulder warm-up drills (stick/rope rotations, up and overs) - see video below
Pummelling - 30 seconds x 5 rounds, 1 minute rest in between - see video below
Drop to the Ground - 6 repetitions x 3 sets, 30 seconds rest between sets - see video below
Drop to ground and roll, reduce landing load through shoulders/AC joint, take force through scapula & thoracic spine
Extras - ball proprioception drills (draw alphabet on wall with ball, bouncing ball against wall, juggling etc)

Proceed to Stage Two once Stage One is achieved pain-free.

Stage Two - Return to Contact Protocol

Criteria to Begin Stage Two:

No pain in Stage One
Bench Press/Bent over Row must be at least 80% of pre-injury strength
Overhead Strength at 80% of pre-injury status

Training:

Shoulder warm-up drills (stick/rope rotations, up and overs)
Pummelling - 30 seconds x 5 rounds, 1 minute rest in between
Standing Wrestle - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions - see video below
Standing Wrestle with a Ball - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions
Drop to ground, push up immediately 10 repetitions x 3 sets, 30 second rest in between
Extras - ball proprioception drills at 0, 90 and 135 degrees (draw alphabet on wall with ball, bouncing ball against wall, juggling etc)
Fast Band Drills - external & internal rotation at 90 degrees abduction - see video below

The above video shows the different wrestling moves that most contact sports utilise, in returning their players to full contact. Thank you to the Ulster Rugby Club for their excellent videos. For more videos, go to their youtube channel "Ulster Rugby Resources".

Stage Three - Return to Contact Protocol

Criteria to Begin Stage Three:

No pain in Stage Two
Overhead Strength at 80% of pre-injury status

Training:

Shoulder warm-up drills (stick/rope rotations, up and overs)
Pummelling - 30 seconds x 5 rounds, 1 minute rest in between
Standing Wrestle - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions
Wrestle to the Ground - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions
Drop to the ground, push up immediately 10 repetitions x 3 sets, 30 second rest in between
Get back to your feet, wrestling opposition player - see video below
Extras - ball proprioception drills at 0, 90 and 135 degrees (draw alphabet on wall with ball, bouncing ball against wall, juggling etc)
Return to boxing if appropriate (not appropriate in posterior shoulder dislocation)

Again, thank you to Ulster Rugby Club for their excellent videos. This demonstrates returning to your feet after a breakdown, gradually preparing players for tackling in Stage four.

Stage Four - Return to Contact Protocol

Criteria to Begin Stage Four:

No pain in Stage Three
Strength returned to normal

Training:

Shoulder warm-up drills (stick/rope rotations, up and overs)
Pummelling - 30 seconds x 5 rounds, 1 minute rest in between
Standing Wrestle - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions
Drop to the ground, push up immediately 10 repetitions x 3 sets, 30 second rest in between
Tackling Drills with Pads - see video below
- 5 tackles each shoulder off three steps
- 5 tackles each shoulder off 3 steps, starting on ground pushing up to standing
Tackling Drills with Players
- 5 tackles each shoulder off 15 metres
Extras - ball proprioception drills at 0, 90 and 135 degrees (draw alphabet on wall with ball, bouncing ball against wall, juggling etc)

Stage Five - Return to Contact Protocol

Criteria to Begin Stage Five:

No pain in Stage Four

Training:

Shoulder warm-up drills (stick/rope rotations, up and overs)
Pummelling - 30 seconds x 5 rounds, 1 minute rest in between
Standing Wrestle - 10 seconds on, 10 seconds off for 1 minute x 5 repetitions
Drop to the ground, push up immediately 10 repetitions x 3 sets, 30 second rest in between
Tackling Drills with Pads
- 5 tackles each shoulder off three steps
- 5 tackles each shoulder off 3 steps, starting on ground pushing up to standing
Return to normal contact at training
Extras - ball proprioception drills at 0, 90 and 135 degrees (draw alphabet on wall with ball, bouncing ball against wall, juggling etc)

As you can see from the above video, player's must be prepared for full contact before returning to sport. The above drills get their bodies accustomed to this activity, reducing the risk of a secondary injury on their return to sport. This contact protocol would go alongside a running and strength rehabilitation protocol, based on the individual's needs.

This is just an example of some tackling drills, wrestling and return to landing. This can be adapted to different sports, with throwing and landing sports, no wrestling would be needed. Instead more focus would be placed on landing and rolling techniques, to prevent serious injuries (such as the broken collarbone sustained diving for a cricket ball on the weekend).

For more information on end-stage knee rehabilitation, read this blog to get some ideas!

Alicia

References

Ulster Rugby Resources via youtube at "https://www.youtube.com/channel/UC4MeztUP_iJ_XSiT_Uxd48A"