Have you ever had an acute injury playing sport, such as an hamstring tear or sprained ankle?
Have you worked hard to get back to playing, to then re-injure either the same structure or another injury?
If so you aren’t alone. Reinjury rates in sport are high and this is partly due to an incomplete rehabilitation program.
Athletes are great at reducing pain and improving their symptoms but poor at finishing off their rehab journey and ensuring they are reducing their risk of re-injury. It is important to not only focus on optimising healing of the injured structure but to strengthen and prepare that structure for the demands of the sport.
*This is a rough guide to how a rehabilitation program may look. Keep in mind every injury and individual is unique, hence guidance from your Physiotherapist is important.
The Rehab and Return to Play Process
Typically we look at breaking down an athletes’ rehab into four phases.
Phase One – Pain and symptoms:
- Improve range of motion, decrease pain and swelling
- Correctives and exercises that don’t compromise healing and promote capacity of the supporting tissue.
- In this phase the theraband is in its prime!
- Load stays low but the volume is high (think 3-4 sets of 10-15 reps).
Phase Two (strength):
- Throw away the theraband and bring out the dumbbells, barbells and machines!
- At this stage we look to progressively strengthen the injured area.
- Think progressive overload with your exercise prescription.
- The volume should start moderate and slowly drop, while the intensity slowly increases (e.g. week 1-2 of this phase – 3 x 8 reps, week 3-4 – 3 x 6, week 5-6 – 3 x 4).
- In this phase the athlete should be using weights/loads that take them close to failure, i.e. only have 1-2 more reps ‘in the tank’ at the end of the set.
Phase Three (power):
- Time to drop the weight but move the bar faster now!
- Think ballistic training, plyometrics, banded resistance training, and complex and contrast methods (e.g. supersetting a heavy exercise like the squat, with a light exercise with a similar movement pattern like the box jump).
- In this phase our exercise prescription looks to build global power, i.e. express the strength attained from the last phase as rapidly as possible! 3-4 sets of 3-5 reps with long rest periods of 3min+ between sets are best for power development.
Phase Four (training integration and return to sport):
- Depending on the injury and physio/coaching team there should be criteria that the athlete must meet before integrating back into training.
- It is a good idea to build up to full training over several weeks, as jumping straight back into full training after only doing rehab work will result in a big spike in training load, placing the athlete at an elevated risk of injury.
- In the gym and on-field during this phase, our exercise prescription looks to include sport-specific drills, and prep athletes for the demands of their competition.
There are lots of factors that determine how quickly to progress through these phases and what exercises are best. These include but are not limited to:
- Location and size of the injury
- The athletes physical characteristics
- How the injury occurred
- Demands of the sport
- Role of the athlete in the sport
- Previous functional level of the athlete
- How the athlete is responding to the exercises
- Other injuries that the athlete may have suffered or is dealing with
- Demands of the athlete outside of the sport (work/life)
- and the list goes on……
This is part of the reason why it is important to be guided by your Physiotherapist during your rehabilitation program. Your Physio can assist in optimising healing whilst decreasing the risk of re-injury or injuries another deconditioned structure.