10/02/2025

Sports Injuries : Assessment & Rehabilitation

A Multidisciplinary Approach for Recovery

& Performance Optimization.
The key for injuries prevention
FIFA Medical Centre of Excellence Dubai UAE
Mourad Ghrairi, Chief Medical Officer
Esther Esteban Garcia, Head of Physiotherapy

Course objectives
• Understand the role of physiotherapy in injury prevention and
rehabilitation.
• Assess common musculoskeletal injuries using evidence-based
techniques.
• Learn progressive rehabilitation protocols for various injuries.
• Apply sport-specific rehabilitation strategies for optimal RTP
outcomes.

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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“ Set of methods, techniques and actions, which

through the use and application of physical agents
prevent, recover and re-adapt people with
dysfunctions of the locomotor system, produced by
the practice of sports or physical exercise at its
different levels.
Sport Physiotherapy definition
”

World Confederation for Physical Therapy (WCPT)

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

Sport physio
Prevention Teaching
Recovery Research
Rehabilitation Disclosure

“Return to sport is not a decision taken in isolation at the end of the

recovery and rehabilitation process. Instead, return to sport should be
viewed as a continuum, paralleled with recovery and rehabilitation” Ardern
CL et al.
2016 Consensus statement on return to sport from the First World Congress
in Sports Physical Therapy, Bern

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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Therapeutic Techniques

• Manual therapy
• Manipulation
• Muscle energy techniques
• Myofascial release
• Hooks - Instrumental Myofascial
Release
• Trigger points treatment (Dry needling)
• Overall Postural Education
• Physiotherapy modalities
• Taping
• Exercise

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

Musculoskeletal Sport Injuries

• Capsule – ligament (60% of sport injuries)
• Ankle sprain – ATFL (73%), Deltoid
• Knee sprain – ACL (most common in pivoting
sports, ~30% incidence in football)
• Muscle injuries (10-55% total injuries)
• Quadriceps – Rectus Femoris
• Hamstring – Biceps Femoris (83%)
• Calf – Medial Gastrocnemius
• Back injuries
• Acute Mechanic Low Back Pain
• Discopathies
• Spondylolysis – Spondylolisthesis
• Tendinopathies
• Patellar Tendon, Achilles, Groin, Supraspinatus

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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SPORT INJURIES RISK FACTORS

Intrinsic risk factors Extrinsic risk factors

• Age • Competition level

• Sex • Game level – role
• Previous injuries • Sport clothes
• Aerobic condition • Tapes – orthosis use
• Muscle strength • Field
• Flexibility • Climate conditions
• Anthropometric measures • …
• Body composition FIFA diploma in football medicine

• Dominant limb
• Biomechanics - alignment
• …

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

Capsule-ligament injuries
ATFL
ACL
Injury mechanism
Physio - Rehab

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Ankle sprain - Injury mechanism

Ankle sprain - ATFL

• Step on others ankle
• Forced ankle inversion
(Plantar flexion + adduction + supination)

Assessment
• Anterior drawer
• Stability in inversion
• Otawa signs

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

Physio - Rehab
• Reduce the pain Reinforcement + TENS Game ready
• TENS, MT
• Reduce swelling
• Lymphatic drainage, Cold system
• Increase ROM
• MT, active mobilization
• Increase muscle strength
• Reinforcement exercises
• Restore ankle stabilization
• Proprioception
Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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ROM Proprioception

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

Knee sprain - ACL - Injury mechanism

Knee sprain - ACL Assessment

• Change of • Lachman
direction ++ • Ant Drawer
high speed
• Pivot shift
• Knee valgus +
Int rotation + • ROM
Flexion • Swelling
• Pain
Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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PHYSIO – REHAB ACL

INTERMEDIATE ADVANCED
EARLY PHASE EARLY PHASE ADVANCED
PHASE PHASE
Surgery Functional PHASE
Strengthening Return To
Recovery Movement Return To Play
(6-12 weeks / 3 Sport
(0-2 weeks) (2-6 weeks) (>6 months)
months) (3 - 6 months)

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

0-2 WEEKS OBJECTIVE TREATMENT CHECK POINTS

1. ROM 0-60ᵒ degrees PMT, Artromot 0 – 60ᵒ degrees
2. SCAR – JOINT Avoid adhesions – PMT, dressing. 2 weeks remove
REHARMONIZATION Patellar mobilizat stitches
3. PAIN Reduce TENS, Painkillers, No pain (night )
PRICE < 3 EVA Scale
4. EDEMA Reduce Dreinage, PRICE, Reduce diff
Edema Program, KT
5. GAIT Load with crutches Gait exerc

6. STABILITY Postural changes Intro Proprio

7. FUNC MOVEMNT Active ext (control) Isom exerc Q/H Co-contraction H/Q

8. STRENGTH Muscle balance Gluteus-calf-core

9. BIOMECHANICS Control posture Brace, long sitting, Remove brace

leg up
10. PSYCOLOGY Prepare long rehab Information
11+. RTP - - -

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Surgery Recovery

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

2-6 WEEKS OBJECTIVE TREATMENT CHECK POINTS

1. ROM 0-90ᵒ degrees MT, Artromot 0-90ᵒ degrees
2. SCAR – JOINT Avoid adhesions MT, Soft tissue,
REHARMONIZATION patellar mobilizat
3. PAIN Control TENS, PRICE Pain free
4. EDEMA Control Drainage, PRICE, Edema free
Edema Program, KT
5. GAIT No painful load Gait exercice No crutches
6. STABILITY Intro Proprio Stance on unstable Walking lunges
platform Huber
INTERMEDIATE ADVANCED
EARLY PHASE
7. FUNC MOVEMNT EARLY PHASE
Active flex-ext Isom exerc Q/H
PHASE
ADVANCED
PHASE Co-contraction H/Q
Surgery Functional PHASE
Strengthening Return To 2 leg mini squat
Recovery Movement Return To Play
(6-12 weeks / 3 Sport
(0-2 weeks) (2-6 weeks) ACL compex, (>6 months)
8. STRENGTH Muscle balance months) (3 -Gluteus-
6 months)CKC exerc both legs
calf-core stability Leg press (30-90)
9. BIOMECHANICS Control posture Huber, swimming- Progress resistance
pool, bicycle in bicycle
10. PSYCOLOGY Prepare long rehab Information phase
11+. RTP - - -

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Functional Movement

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

6-12 WEEKS OBJECTIVE TREATMENT CHECK POINTS

1. ROM 0 >90ᵒ degrees MT, Active exerc 0 <=90ᵒ degrees
2. SCAR – JOINT Avoid adhesions. MT, Soft tissue,
REHARMONIZATION Normalize patellar mobilizat.
compensations SIJ mob, IllioPsoas,
Thoraco-L fascia, QL
3. PAIN Control - Pain free
4. EDEMA Control CryoT post activity Edema free
5. GAIT Full load Air walk, Gait exerc No limping
6. STABILITY Progressive Single leg stance on
INTERMEDIATE ADVANCED
EARLY PHASE EARLY PHASE
dynamic Proprio PHASE unstable platform ADVANCED
PHASE
Surgery Functional PHASE
7. FUNC MOVEMNT
Recovery Active flex-ext Strengthening
Movement Conc-Isom- Return To Double leg squat
begin Return To Play
(6-12 weeks / 3 Sport
(0-2 weeks) (2-6 weeks) Ecc exerc Q/H
(3 - 6 months)Begin single leg SQ
(>6 months)
months)
8. STRENGTH Muscle balance in EMS Q, dynamic Co- Exerc both legs
diff degrees of flex Contracition Cybex test <30%
9. BIOMECHANICS Control posture Walker view L >5%
10. PSYCOLOGY Prepare long rehab Information phase ACL – RSI
11+. RTP Prepare to run - Surgeon

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Strengthening

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

3-6 MONTHS OBJECTIVE TREATMENT CHECK POINTS

1. ROM Full ROM MT, Active exerc Full ROM
2. SCAR – JOINT Normalize MT ++
REHARMONIZATION compensations
3. PAIN Control - Pain free
4. EDEMA Control CryoT post activity Edema free
5. GAIT Run Progress time and No limping
speed straight line
6. STABILITY Proprioception Pliometrics Hop single leg test
2 leg drop jump
INTERMEDIATE ADVANCED
EARLY PHASE EARLY PHASE ADVANCED
7. FUNC MOVEMNT Functional
OKC PHASE
Conc-Isom- EccPHASE Countermovement
Surgery PHASE
Strengthening
exerc Q/H. Return To jumpReturn To Play
Recovery Movement
(6-12 weeks / 3 Sport
(0-2 weeks) (2-6 weeks) EMS Q to balance (>6 months)
8. STRENGTH Muscle balance inmonths) (3 - 6 months)Exerc both legs, Leg
diff degrees of flex press 80%. One leg
9. BIOMECHANICS Control posture, Speed court Cybex test < 15%
FMS
10. PSYCOLOGY Information phase Group aceptation
11+. RTP Begin to train team Surgeon - Coach

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Return to Sport

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

>6 MONTHS OBJECTIVE TREATMENT CHECK POINTS

1. ROM Full ROM MT, Active exerc Full ROM
2. SCAR – JOINT Normalize MT +
REHARMONIZATION compensations

3. PAIN Control - Pain free

4. EDEMA Control CryoT post activity Edema free
5. GAIT Run Progress time speed No limping
6. STABILITY Proprioception Twisting, turning and Hop tests 3 jumps,
cutting 6m, 6m cross
INTERMEDIATE ADVANCED Box jumps
EARLY PHASE EARLY PHASE ADVANCED
PHASE PHASE
7. FUNC MOVEMNT Functional
Surgery OKC resistance Strengthening
Conc-Isom- Ecc exerc SidestepPHASE
Return To
cutting
Recovery Movement Q/H./ 3 Return To Play
maneuver
(6-12 weeks Sport
(0-2 weeks) (2-6 weeks) (>6 months)
8. STRENGTH Muscle balance inmonths)
Regular GYM (3 - 6 months)Exerc both leg, one
diff degrees of flex Squat, Squat one leg, leg
leg press, Hamstring…
9. BIOMECHANICS Control posture Speed court, Agility Cybex test < 10%
10. PSYCOLOGY Information phase Confidence
11+. RTP Team participation Sport specific drills Surgeon - Coach

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ACL check points

• Strength - ISOKINETIC Test
• Power - Hop test, CMJ
• Psychology - ACL RSI
• Anthropometry –
Body composition ‘It is important to stress that reconstructing an injured ACL does not
make the knee normal. There is a high rate of articular cartilage
injury and post-traumatic osteoarthritis following this injury –
Date FAT% L KG M R KG M regardless as to how the injury is managed.’
12-04 14,2 5,99 6,26
Mark Fulcher
07-11 12,2 6,60 6,59 Sports and Exercise Physician FIFA Program

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

REFERENCES

Esther Esteban García - FIFA Medical Centre of Excellence Dubai

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