a horrendous angle. In medical terms this is into excessive knee valgus, meaning that the knee collapses inwards due to a force to the outer side of the joint.
consistent with this mechanism. So what does this actually mean?
Technical bit out of the way, what does this mean for Ben Youngs? If the injury is as reported, an MCL rupture, then Ben Youngs faces a lengthy spell on the side-lines. Often, this may require surgical intervention particularly if other structures are injured alongside, but it can in some cases also be managed non-operatively.
Whatever the outcome is for Youngs, he will have to follow a strict rehabilitation protocol. This will focus initially on reduction of swelling and regaining range of motion, which can be challenging. Soft tissue massage and cryotherapy (cold treatment) will both likely be utilised in this stage. Emphasis will be placed on proprioceptive exercises. Proprioception is the ability to know where your limb is in relation to space, which is often compromised following injury. Failure to address this in early stage rehabilitation can potentially lead to risk of re-injury moving forward. Good examples of early stage proprioception exercises are single leg balance, progressing to eyes closed or to an unstable surface such as a BOSU.
There will be an early focus on strengthening the quadriceps, hamstrings, calves and glutes. Often, following trauma to the knee, the quadriceps rapidly atrophy (decrease in size) and people experience quadriceps lag. This is basically when the patient is unable to activate the muscle effectively. The strengthening programme, alongside modalities such as electrotherapy (neuromuscular electrical stimulation), has been shown to improve strength and muscle function following traumatic knee injury, which is vital considering his elite sporting career. Conventional gym exercises such as the leg extension or hamstring curl will likely be used, with a focus on eccentric hamstring strength. Eccentric hamstring strength is extremely important to address and is often overlooked. In any sport involving changes of speed/direction, the hamstrings undergo high velocity length changes, so strengthening whilst lengthening is vital. A good start would be active knee extenders or single leg divers, before progressing to more functional exercises such as the Nordic hamstring curl later on in the rehab process.
The gym-based rehabilitation will continue long after return to rugby specific rehabilitation, even once back playing. Studies show that with knee injuries such as ACL reconstruction, it is recommended to continue rehabilitation and strengthening up to 12 months post-return to play!
It will be interesting to see whether Ben Youngs requires surgery on his knee. Once this is decided we can continue the blog with a more in-depth picture of the rehabilitation path that he will follow. He has a long journey ahead whichever decision is taken, and we would like to wish him the best of luck from all at Park Lane Performance and Rehabilitation and Sedgley Park Rugby Club.