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A snapshot of Bill Knowles

Thanks to Nick London, the team at Yorkshire Knee Clinic, and Wayne Morton for an excellent conference on major knee injuries in sport.

Inevitably, the focus was on ACL injuries with overviews on anatomy, and injury mechanisms. However the standout contribution to the day was from internationally reknowned reconditioning expert Bill Knowles.

From the outset, his passion was evident, and whilst I’d say I’m passionate about rehab, his insights certainly gave me fresh impetus!

I’d like to focus on a couple of points:

1. The emphasis on preparation, not protection. (Note here, I said emphasis, which is not to the exclusion of protection where needed). Following injury, the period of time out from play is a time of preparation of the player to achieve “athletic normal”.  For this reason, the injury becomes a much smaller focal part of the athlete as a whole. Injury can be seen as an opportunity to maximise athletic potential in the athlete as a whole.  its about the athlete, not the injury.

2. Focus on the athlete’s timeline with respect to the envelope of healing. This is not necessarily purely protocol driven, but criteria- based: as we’re all individuals, purely chronological goals may not be accurate.

3. Focus on restoring the athlete’s capacity to generate, transmit, absorb and dissipate loads, whilst also respecting [healing] tissue homeostasis.

4. Pushing the envelope of healing. Whilst respecting the healing process and surgical post-op instructions, we have to try to push towards the upper limit of the athlete’s envelope of healing. Too often we focus on what the athlete can’t do (medical model) vs what the athlete can do!

In the absence of injury, a final critical point is to “coach the athlete to physical competence”. The focus here was literally on movement competence, achieved by what many in Physio circles may refer to as “normal movements”, much of these being achieved by simple gymnastics! Critically, the importance should be placed on mixing up movement patterns from different sports or diciplines. How often do we see in sport, our most robust athletes are those who excelled in more than one sport in their school days?

Ahead of the iminent opening of our Gymnasium at North Light Physiotherapy, lots of food for thought for sure!

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