Rehabilitation of ACL Injury in the Handball Player

Abstract

Handball players with ACL injury (whether treated surgically or non-surgically) must complete a high-quality, supervised, criterion-based rehabilitation programme with high adherence. The overarching goal of rehabilitation after ACL injury and/or surgery is to restore knee function so that the player can participate fully in all aspects of life, with an acceptable risk for reinjury and post-traumatic osteoarthritis. Rehabilitation for the handball player with ACL injury should commence as soon as possible following the injury to ensure optimal loading and facilitate tissue healing, to build the player’s confidence and motivation and to provide the best opportunity for the player to reach his or her sports participation goals. Individualised rehabilitation that emphasises the physical performance characteristics needed for successful handball performance must incorporate criterion-based progressions that also respect the time required for biological healing. Quality rehabilitation should address five key phases, with each phase building on the functional gains made in the previous phase: prehabilitation (for players having ACL reconstruction), acute phase (impairment focus), intermediate phase (dynamic knee stability focus), late phase (sport-specific focus) and injury prevention phase (manage workload focus). Managing effusion and pain throughout rehabilitation provides a helpful guide for optimal loading of the knee. It is also important to consider the overall acute and chronic workload of the player, especially before returning to training and competition. Psychological factors including motivation, reinjury anxiety and confidence may be addressed during rehabilitation using goal setting and consistent assessment and feedback.