1. Returning to Netball Following ACL Injury:
Defining and Evaluating Sport-Specific Rehabilitation
Ros C. Cooke (1) & Dr Lee Herrington(2), English Institute of Sport, Manchester(1&2), University of Salford (2) United Kingdom.
of lead
Injury
Restoration
Reconditioning
Return to Performance
Purpose
Develop Netball  specific return to training and competitive play guidelines to complement the English Institute of Sport (EIS) ACL Management guidelines (Herrington et al 2013).
Introduction
Netball is a sport predominantly played by females at the elite level and is currently the largest female participation sport within the UK. It requires movement patterns involving cutting, landing and deceleration within a single step, meaning Netball is a sport where ACL and knee injuries are common. Management of ACL injuries often requires surgical intervention to achieve passive mechanical stability of the knee, although this does not guarantee that individuals will return to sport or their previous activity level. Criterion tests to guide a successful return to sport are lacking within the literature.
Results
Mean time for athletes returning to full training was days post operatively (+/- 30.6) with a return to competition (international/national level) at days post operatively (+/-44.8). Mean number of days from point of injury to return to competition was 348.7days (+/-45.6).
Mean Limb Symmetry index (LSI) for single (98.2% +/- 3.89), triple(97.8% +/-4.2) and cross over hop (99.5%+/-2.98) at return to training was achieved which improved to 101.9%(+/-2.01), 101.2%(+/-5.7) and 102.6%(+/-5.8) respectively. Mean Tuck Jump Scores remained stable at 3.5 points at return to training, and 3.3 points at return to competition. All athletes were reselected into the high performance program with two athletes selected for senior international competition.
Limb Symmetry Index = Score for Involved limb x100
(expressed as a %)
Score for Uninvolved limb
Method
Part 1: 2 Round consensus generation using modified Delphi method. Involving Netball technical coaches (N=4), Strength & conditioning coaches (S&C) (n=4) and physiotherapists (N=2). All coaches worked within the England Netball High Performance programme. All S&C coaches and physiotherapists worked within the EIS and had direct contact with Netball athletes. Participants were asked to define the key activities and outcomes for athletes progressing from unilateral load phase (single leg squatting etc) to unrestricted sport specific training.
Part 2- Prospective Case Series.
These guidelines were applied to 4 Athletes who had undergone ACLR surgery (August – September 2013).  
Athlete
Technical Coach
Team Mates
Family & Friends
S&C
Physio Dr
Psychologist
Nutrition
Reconditioning
Return to Performance
Technical Stages during Return to Performance
1:Predicted  
Change of Direction
Examples: Feeding, wall work, Indian file, fan drill within the circle
Main Focus: Conditioning
2: Unpredicted Change of direction and controlled contested drills
Examples: defended on first phase of drill, variable ball placement
Main Focus: Conditioning in context of netball specific movements & ability to repeat at high intensity
3: Contested both as attacker and defender
Examples: Ability to dictate change of direction when attacking or defending. Position specific skills. Build confidence to take contact
Main Focus: to reproduce fitness tests to above pre injury levels & complete consistent training
4. Unrestricted Training &
Matchplay
Examples: Increasing volume of match-play at relevant performance level
Main Focus: Technical & Tactical Skills
Conclusion
Sport-specific rehabilitation needs to be defined by the requirements of the sport to enable athletes to acquire appropriate physical skills and capacity to match these requirements.
Functional Performance  Tests  provide key information as to when to progress and should be considered in conjunction with physical performance markers relating to strength and aerobic capacity.
Combining this with technical skills is important, particularly in a team sport where interaction between athletes and being part of the team will influence overall performance.
Having a clear pathway enables all parties to be informed and have ownership across the stages of rehabilitation, enabling the athlete to perform to their full potential and make a successful transition back to the performance environment.
The results of this study demonstrate how this transition can be achieved with high-level Netball athletes who; returned to play successfully, were available for selection and increased their performance level with selection into the podium programme.