It’s a flex: Rudraneil Sengupta on modern sports medicine
Doctors are pushing the limits of recovery by leveraging supporting muscles. It also helps when an athlete knows her body well.
In August, Vinesh Phogat underwent surgery to reconstruct her anterior cruciate ligament (ACL), following a knee injury. In January, she was back in competition, powering her way through to gold at the Senior National Wrestling Championships.
That is a dramatically short timeline that is simply not supposed to happen. How did it?
Well, that’s how far modern sports science has come.
The ACL is one of the four major ligaments in the knee, and runs diagonally through the interior of that joint, linking the thigh bone to the shin bone. Its main function is to stabilise rotation of the knee, and prevent the lower leg from extending too far outward.
Athletes who need to move fast and change direction swiftly are often in danger of rupturing the ACL. An ACL tear is the most common injury in football and wrestling.
In surgery, an ACL is typically reconstructed with grafts. It generally takes six to nine months for the ligament to return to full strength and elasticity, depending on the degree of initial damage.
There is no way to speed up that process. The ACL still cannot heal in under six months. But doctors and physical trainers have begun to push the limits on what is possible within that timeframe, by leveraging supporting muscles.
The most celebrated example of this so far has been South Africa rugby captain Siya Kolisi, who had ACL surgery in April and rejoined his team at the Rugby World Cup in August. In sporting circles, this is still viewed as something of a miracle. It may soon be the norm.
For her recovery, Phogat worked with South African physiotherapist Wayne Lombard, the man who turned the Indian women’s hockey team’s fitness around ahead of the Tokyo Olympics. “She’s a fighter, on and off the mat,” Lombard says, “but that’s a double-edged sword. She has the mentality to keep pushing for her goal, but that means we have to be extra careful that we don’t push so hard that she gets injured again.”
The key problem for an athlete in recovery is this: how does one stimulate the muscles enough so that they regain strength and volume, without straining the joints and ligaments while they heal?
Two modern training protocols Lombard followed with Phogat address this question.
“We did a lot of blood flow restriction or BFR training, and a lot of training while hooked on to an EMS (electrical muscle stimulation) machine,” Lombard says. “Both these things allow us to do exercises with low loads, but still get a massive physiological response.”
EMS machines have been used for decades in hospital settings, to help patients regain muscle strength and control. It does this by sending electrical pulses directly to the muscles, via patches worn on the body. In sports rehabilitation, the electrical pulses artificially stimulate intense contractions in target muscles — commensurate with the conditioning they would receive in intense training — while the actual weights and loads used remain low, allowing joints and ligaments more time to heal. Essentially, it’s like doing squats with a 20 kg load, but getting the benefits of lifting, say, 40 kg instead.
BFR training follows the same philosophy of low load and high response, but it does this by constricting blood flow to targeted muscles. The athlete wears a cuff on or near the target muscle group, which is inflated to a certain pressure to get partial arterial restriction and complete restriction in the veins, before the athlete does a set of low-load lifts. Research indicates that BFR accelerates both muscle growth and strength significantly, compared to low-load exercises done without BFR, and helps build muscle endurance and bone density.
Knowing where to draw the line remains vital, and self-awareness is key here. As Lombard puts it: “At the end of the day, how well an athlete recovers depends on how well she understands her body. And Vinesh really knows her body.”