case report — sport d’élite fisiotruaisch
Caso 1. ACL Reconstruction – Return to Snow Performance
Profilo atleta:
Sci alpino competitivo, 22 anni. Lesione completa LCA in gara.
Performance Assessment (4 mesi post-op):
- Deficit quadricipitale 28%
- LSI hop test 72%
- Ridotta Rate of Force Development
- ACL-RSI ridotto
High Performance Rehabilitation:
- Strength training progressivo ad alta intensità
- Eccentric overload
- Reactive plyometrics
- Perturbation training
- On-snow graded exposure
Return-to-Performance Criteria:
- LSI > 95%
- Quad deficit < 10%
- Simmetria neuromuscolare
- Psychological readiness adeguata
Outcome:
Ritorno competitivo a 9 mesi senza re-injury.
EBM Reference:
Grindem et al., 2016; Kyritsis et al., 2016 – Criteria-based return reduces re-injury risk.
Caso 2. Chronic Achilles Tendinopathy – Elite Runner
Profilo atleta:
Runner competitivo 10 km. Dolore achilleo cronico da 6 mesi.
Assessment:
- Ridotta stiffness tendinea
- Deficit heavy slow strength
- Load spikes in training
Intervento:
- Heavy Slow Resistance training
- Progressione energy storage
- Plyometric rebound training
- Monitoraggio carico (acute:chronic ratio)
Outcome:
Ritorno a personal best in 16 settimane senza recidive.
EBM Reference:
Malliaras et al., 2013; Silbernagel et al., 2007 – High-load strengthening improves tendon capacity.
Caso 3. Hamstring Grade II – Sprint Athlete Profilo atleta:
Profilo atleta:
Velocista 100–200 m, lesione grado II.
Assessment:
- Deficit eccentrico 25%
- Asimmetria sprint mechanics
- Ridotta esposizione alta velocità
Intervento:
- Carico progressivo precoce
- Nordic hamstring progression
- High-speed running exposure >95%
- Monitoraggio GPS
Outcome:
Ritorno sprint a 98% velocità massima in 8 settimane, nessuna recidiva.
EBM Reference:
van Dyk et al., 2019 – High-speed exposure reduces recurrence risk.
Caso 4. Recurrent Ankle Instability – National Level Athlete
Profilo atleta:
Pallavolista livello nazionale con distorsioni recidivanti.
Assessment:
- Deficit dynamic balance (Y-Balance)
- Ridotta reattività peroneale
- Altered landing mechanics
Intervento:
- Reactive landing drills
- Perturbation training
- Change-of-direction mechanics
- Feedback con force platform
Outcome:
Ritorno alla competizione senza episodi nella stagione successiva.
EBM Reference:
McKeon & Hertel, 2008 – Neuromuscular training reduces recurrence.
Caso 5. High Load Lumbar Pain – Endurance Trail Athlete
Profilo atleta:
Trail runner competitivo con lombalgia ricorrente.
Assessment:
- Nessuna patologia strutturale
- Ridotta trunk endurance sotto fatica
- Spike di carico pre-gara
Intervento:
- Strength-based trunk training
- Periodizzazione del carico
- Fear reduction strategies
- Conditioning performance-based
Outcome:
Ritorno ultra-distance con miglioramento split in salita.
EBM Reference:
Foster et al., 2018 – Exercise-based management is gold standard for non-specific LBP.
Riferimenti Bibliografici (APA 7)
- Grindem, H., et al. (2016). Simple decision rules reduce reinjury risk after ACL reconstruction. British Journal of Sports Medicine.
- Kyritsis, P., et al. (2016). Likelihood of ACL graft rupture: Criteria-based return to sport. British Journal of Sports Medicine.
- Malliaras, P., et al. (2013). Achilles and patellar tendinopathy loading programs. British Journal of Sports Medicine.
- Silbernagel, K. G., et al. (2007). Continued sports activity in Achilles tendinopathy. American Journal of Sports Medicine.
- van Dyk, N., et al. (2019). Including high-speed running in rehabilitation. British Journal of Sports Medicine.
- McKeon, P. O., & Hertel, J. (2008). Systematic review of ankle instability rehabilitation. Journal of Athletic Training.
- Foster, N. E., et al. (2018). Prevention and treatment of low back pain. The Lancet.