When we come back from an injury, there is always a process of trying to re-engage with the program that we were once connected. We are keen and eager to once again be back in the swing of activity after an enforced period of downtime. The eagerness and excitement is intoxicating and we have all the motivating forces at play that we can muster. But at times, our bodies are not exactly ready for what it is we want and need to do. So how best to return to the field after a rehabilitation.
The most important factor in returning to activity is a “Graduated Return” . This means a slow and measured return to the movement without overloading a freshly rehabilitated joint or muscle. The known actions are trained, intuitive and known to us are ready to be included in our regimen again yet we must consider the intensity of this return and adjust it accordingly. And this can be the most difficult part of returning to form.
We want to start out mimicking that which we did before. A runner will want to go back to running, a court player back to the action of swinging and shooting, a lifter back to doing the ‘composite’ lifts and getting the CNS (Central Nervous System) to re-engage with the movements. We all know the squat is a great exercise but it is also the one that is most difficult to get right. Such a complex and multi-dimensional movement needs action in all of the main joint spaces of the body all combined together in a synchronicity of trained action. You cannot create this type of synchronicity without actually performing the full lift in as complete action as possible.
Working on getting the co-ordination back of these movements is priority. Attempting the movement without load is important. Revisit the mechanics of the movement and perfect them. Now this does NOT mean breaking down the movement into separate parts. For example, a clean and jerk lift should not just be broken down into a squat and an overhead press separately. While this is valuable to refine motions and certain strength elements, research in sports science proves that breaking down a motor skill into it’s individual parts and perfecting them separate from each other does not translate to perfecting the combined movement itself. The elements of co-ordination and external stimulus needing adaption (such as fatigue, resting power to generating power, stability after stress etc) means that you need to create as great a ‘performance likeness’ as possible to truly train the required skill. Training motor skills in separate parts has been discarded in sports training in favour of ‘match like simulation’ and performing in as ‘real time’ an event as possible. Nothing beats match practice to create match fitness.
Using your movement co-ordinations and repetitive training to work form and function in a required movement is about training the CNS as much as training the muscles and joint spaces to perform an action. In this way, you have to remind your nervous system of the co-ordinated effort required to perform certain movements. In much the same way as the latter part of rehabilitation involves reintroducing small jumping and stimulated movement patterns, so to must this part of the process begin to bring into play the complete movement with external stimulus (read ball, racquet, bar, bat) as is needed in the game scenario. In short – work on your form again. Knowing how to co-ordinate and replicate the movement pattern without load is vital.
Once you have moved through this stage, the rebuilding of power and strength has to come at a slow, yet consistent pace. The scientific approach can be employed here and having a measure in place helps to give you an equation that can be applied to the rehabilitation. Working off a 1RM (one rep maximum) concept, this is your one rep maximum load point is a good place to start. For many of us, we haven’t yet figured out our one rep load maximum. Knowing what your 1RM load is means you can start to make calculated judgements of what you should and shouldn’t be lifting and this should be informing your weight or load resistance.
In terms of load, the suggested protocol for beginner lifters is what should be considered. This tends to come in at around the 70-80% 1RM loading. I would hazard that as a return to form you should drop this to 50-60% of 1RM loading. Working on form and function for the first week of training and then gradually increasing this to 70-80% of 1RM for the following week which then leads to 80-90% of 1RM for the consecutive 3rd week. Following this protocol, you should be able to work up to your maximum loading over a manner of 3-4 weeks. You could also take a more conservative approach of beginning at the 30-40% loading and then gradually increasing incrementally PER WORKOUT by the smaller increments (2-5kg depending on percentage of 1RM) to increase adequate muscular loading on the strength component.
If we are speaking in terms of an athlete involved in movement and on field experience I would suggest following a Gradual Linear Progression as proposed by Kelly Starret who proposes a 4 part system of loading in movement.
· Position – working with the movement progression, beginning to get full movement and angles of movement in respective joint spaces.
· Load – start by establishing a resistance level at the 30-40% of tension that was the previous maximum load of a client and progressing with linear progressions of 2-5kg per workout.
· Volume – working with a volume increase and increasing the sets and repetitions of sets going upwards from 2x5 to something like 3x8 to build resistance and capability
· Speed – lastly introducing speed and actions with fast twitch nature to replicate on court or on field experience. Increasing the time quotient of performing actions and building aerobic capacity through challenging time constraints and resistance under time.
With these measures in place you are more concerned with monitoring how an athlete or subject is able to move from one measure to the next. Staying ahead of pain and monitoring recovery after exercise means not pushing the body to that point where it has to fail to test the limit of the injury or movement.
Now it is very easy to transfer all this information and reloading formatting into another sporting situation. For example, a runner would have the same equations being applied but in terms of distance and intensity. If a regular run was a 14km load or a weekly load around the 50km mark, a graduated return would still be to apply the percentages of return to the weekly amount. Say 60% of 50km over 1 week. Then incremental increases would be the same until the desired full load was achieved.
You can also apply this to a ‘on field’ situation whereby time on field was reduced to quarters, halves or periodic times on field. Utilising positions as well would be advantageous in that a striker may play as a back for a period followed by moving up into the mid field or forward line until they were ready to be fully installed in their specialist position. All the while the supervised training regimen is built around keeping an eye on a returning player and ensuring that in training, they can begin to push into the realms of full load but without risking reinjury or overloading. This is the coaches responsibility as much as the players and coaches should be aware of injury reloading and have a program in place within the drills and skills to ensure that players are ‘managed back into’ play effectively.
These are but two examples of trying to keep an athlete back on track and being able to gradually increase the amount of load that they can endure without pushing them beyond what they are capable of enduring with the risk of re-injury or post acute injury. If the graduated approach is followed then the minimisation of re-injury is the result and the rebuilding of CNS conditioning along with muscular endurance and efficient joint mobility.
This all results in the least amount of chance of overloading an injury and risking further impairment of a structure post rehabilitation. It’s a slow process but it is about adhering to the principle of ‘starting from scratch’ to begin again. This essentially results in athletes being able to take the court or return to performance with the assurance that they can once again push forward into new regimes without the fear of injuring again or being at risk of over stimulating compromised structures.