Back in May, I was contacted by Simon Bares, a 19-year-old professional Rugby player in Toulouse, France (@toulouseolympiquerugby) since he was planning a short holiday trip to Malta with his family. He has been undergoing ACL rehabilitation following his injury in 2022, and wanted to continue with his rehab during the 12 days in July in Malta. We kept in contact throughout the weeks prior to his visit in Malta so we could coordinate 3 sessions during his stay.

I admit, I am not a big expert in Rugby, especially rugby rehabilitation, but the beauty of physiotherapy is that if one understands the kinematics going through the sport, the main musculature needed to minimize the risk of injury and also understanding the pathology, one can come up with a good rehabilitation program.

I always tell my students to keep it simple, challenging but most of all, FUN! ACL rehab tends to become repetitive, boring and slow unless you use your creative brain. Simon was in phase 1 of plyometric stage of his rehabilitation and prior to progressing him to jogging I wanted to ensure that his body was ready to do so. There are various criterias to confirm plyometric stage 1 but the ones I usually refer to are:

• <1 pain at Rest & <2 pain during activities of daily living ( I prefer if this is described as discomfort only)

• Full knee extension range of motion and >120 degrees of knee flexion

• Shows <20% asymmetry in loading during a bilateral squat (no side shifting)

• Isometric knee extensor strength of >75% of the uninjured side.

Since he passed all criteria with flying colours we practiced bilateral plyometrics focusing on landing kinematics. At this stage we practiced jogging and also confirmed that he was ready to do so too.

One must keep in mind that there’s a degree of overlap between stages especially since technically jogging is a continuous form of single leg “plyometric”. International guidelines show that to progress to stage 2 one must have the ability to -

• Run on a treadmill for 10 minutes at 8km/hr

• good bilateral landing + single leg squat kinematics

• perform at least 8 single leg reps on a leg press at minimum 1.25x his body weight

• isokinetic knee extensor + flexor strength >80% of uninjured side

This was the stage that I believed Simon should be at since he had achieved these already a few weeks prior to our appointments, but was never exposed to running yet. For this reason we focused on achieving Running to hybridly progress between running technique and stage 2 of plyometrics.

The below are snippets from our three training sessions. Feedback was given throughout on focusing on kinematics. While newer evidence is moving away from focusing of knee over toe importance, post ACL, I personally like to give that kind of external focus to get more and more confidence into single leg landings.

During these videos one can notice the element of unbalanced weight in barbells, kettlebells and dumbells. This improve the element of motor coordination and muscle firing. The element of instability using bosu balls and gumballs help increase feedback and core activation during exercises

Prior to his injury Simon was chosen for the U19 France National team, and I wish him the best of luck for his professional career and thank him for this opportunity to working with such a committed athlete!