Rehab plans are vital for those people who need to recover from any injury - be it a main motor injury or even a small weakness in a joint. There’s a full relationship that exists between managing your injury and yourself within that process. With any project there has to be a plan, a blueprint to be able to follow to ensure that all the various stages are covered, adhered to and completed in a timely order. When you have injured yourself there has to be a plan to ensure that you avoid the dreaded grey area of post injury. Often it may not just be the injury that sidelines us but it is the danger of re-injury and consequent issues that not only keep us sidelined, but actually prevent us from getting back into the gym, on the court or doing our chosen activity.
Injury Management Plans exist in the workplace and are all about managing your return to work safely following an injury. Rehabilitation plans are much the same - detailing specific steps, making sure that you avoid aggravating an already injured part or to prevent you from injuring something else as you dive back into moving and being.
The biggest problem with injury rehabilitation is often a return to load too quickly. This is where a specific period of 2-4 weeks comes into play. Minor injuries can easily be overcome in a matter of days, depending on the invidividual, but those slightly larger issues such as a tendon tear, or bone fracture often require more in depth ‘no action’ time. Taking 2 weeks at the beginning of an injury plan can effectively prevent you from having to endure 2-3 months of niggling, issues that keep you off the track or out of your game.
The immediate management of injuries is reducing inflammation, preventing movement and managing support so that we do not create more problems from trying to move the affected area. Once this initial management is done, the grey area of post injury becomes the danger point - how much do I do, how long and how far? When can I start running, lifting, throwing again? These are all questions that need to be answered.
In terms of rehabilitating from a sports injury there are two main concerns to consider initially:
MACRO TRAUMATIC injuries - usually from a fall, impact or abrasion These are primarily injuries that will need some acute management and gradual return to full function
MICRO TRAUMATIC injuries - are more overuse injuries and have occured slowly over time until a structure has been overloaded and issues have arisen.
The latter of these is possibly the more sinister and more difficult to manage. If you can still use your shoulder, you can possibly continue to keep reinforcing a bad movement pattern which then means the chronic issue doesn’t get addressed. A fall or break renders a structure pretty much out of commission and is sometimes an easier issue to manage. If you can’t walk you can’t stress the broken ankle.
The ultimate goal of a Rehabilitation Plan according to the IOC and International Federation of Sports Medicine is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate altogether the disability. The goal should always be a return the functional capacity of the athlete to the same or better level than before the injury occured.
When we consider an approach to injury we should consider the roles that each individual plays in the task.
ROLES:
THE ATHLETE: Now an athlete is someone that wants to return to their regular 5km Saturday morning run. It doesn’t have to be someone that is a star ball player. Any active person can call themselves ‘the athlete’.
THE COACH doesn’t have to be an actual coach. Not all of us have PT’s. The coach could simply be the person that you run with. Someone who is out on the court or field with you and has your best interests at heart. The captain on your weekend netball team. Your significant other? Someone that is your accountability person and the one that understands what it is you want to achieve. Someone who knows your goals.
PRIMARY PROVIDER: A Rehabilitation Teams approach should always be led by a primary provider that communicates clearly with both the athlete and/or the coach. This could be your Doctor, your Physio or your Surgeon. It’s the person who is going to take charge of the whole project. Your Project Manager. They don’t have to be the one ‘treating’ you but they should be the one checking your progress, seeing you regularly and measuring how you are progressing
THE REHAB TEAM: No active person is too insignificant to not have a team at their disposal. The Rehab team are the people administering the corrective techniques. This could be the Physiotherapist, the Chiropractor or Osteopath alongside the Nutritionist, Psychologist and the Manual Therapist (incl Massage therapist, Personal Trainer, Rolfer, Acupuncturist etc) who all have a specific role to play. The team oversees the nitty gritty details. They are the ones concerned with regaining integrity of their element ie bones, soft tissues and connective tissues.
The 7 Principles: Any plan is guided by a list of principles. Briefly stated herein for sports injuries.
Avoid Aggravation
Timing of Exercise - it is vital to begin a return to movement as soon as possible where Aggravation is not going to occur. Too late engaging in active rehabilitation could be detrimental to the injury itself and the return to function
Compliance - the patient has to be on board. If the athlete is not on board and committed then the process will fail. The patient should thus AGREE to the plan as it is set out before them at the outset.
Individualisation - everyone is different and various factors can impact on the plan. If these plans aren’t considered with an individuals needs, issues then it will not be successful.
Specific Sequence - any program needs to follow the therapeutic and healing times of the body. You cannot start jumping without first landing.
Intensity - intensity must be present to create adaption. Managing the intensity so as NOT to cause aggravation is primary. But intensity must be applied to create integrity in the structure.
TOTAL PATIENT - means measuring all the other elements such as Cardiovascular fitness, maintenance of the unaffected structures with strength, ROM and co-ordination. There is always a way to be trained even with an injury.
Components
The areas that need to be monitored and addressed to ensure adequate recovery are primary elements of testing and measuring. You should be regularly having sessions to ‘measure’ the difference in these pillars of injury management
Pain Management - ensuring that inflammation and pain is kept under control. Obviously if you are wanting to get back into movement, pain has to be managed and prevented from compromising movement. The other element associated with pain is inflammation and reducing inflammation creates the best environment for healing and progressing an injury.
Flexibility - when we get injured, things contract. fibres that are broekn heal, but they heal shorter and other structures that may be impeded may lose some of their range of motion. post injury flexibility is also compromised by muscular spasm and swelling. Getting full flexibility and previous range of motion post injury is vital for a return to full functionality.
Strength - hypertrophy and weakness of structures post injury is an obvious concern and building strength and integrity back up in affected soft tissues is ipmortant.
Endurance - this is a key factor as often an injury can prevent us from partaking in activites that help to keep our cardiovascular endurance up. Finding solutions to movement patterns to still allow us to train our endurance is important not only for the Cardio system, but for the ability for muscles to function under load and stress across longer time frames.
Proprioception and Co-ordination - when we tear fibres then joint stabilty becomes compromised. The Central Nervous System often needs to re-establish it’s understanding of firing sequences and proprioception of stability and training these elements in movement is important to regain the vital balance and intrinsic relationship of the neural system alongside the muscular and connective tissues.
Psychology - the immediate result of injury is often shock. There is also an adaptive response to injury of denial which helps to manage emotional responses to stress. However in rehabilitiation, this denial can be counter productive. Having the mental toughness to adhere to programs and push through stress to return to was once easy and known can be a most difficult aspect of rehabilitation and often a debilitating one. Preparing the mind for a return to competition, to have the confidence to push again and battle the perceived movement with the knowledge and confidence that the injury will hold strong is an oft overlooked part of sports injury rehabilitation.
Stages of Rehabilitation
When we go through the stages of rehabilitating an injury the patience that is required to endure the slow and arduous return to basic movement patterns is often the tired and frustrating element. Sitting and waiting and knowing when you can and when you can’t do basic known movements is vital for the effective rehab process. When do I walk on my ankle? When should I start moving my shoulder? That same question of how much and when? Knowing the stages of recovery helps with re-assuring the frustrated athlete that the Primary Provider knows when to initiate movement and load.
Initial Inflammatory - 4-6 days. Immobilisation and complete rest whilst broken tissues and structures rest and take time to go through the vital inflammatory part of the healing. Intervention here from therapists is minimal and medication to manage pain and R.I.C.E techniques are the basic go to here. Sometimes ROM exercises can begin to occur here and this can be assisted or done solo. But really = its time for feet up.
Intermediate Stress - 6 -21 days. This is the danger phase. Loading up too much and too quickly only results in further injury and over stress of the structure. Its a conditioning phase where we start to ask the muscles and soft tissues to start to take the smallest amounts of stress. Encouraging tissues that have mended to be strong and bear load, withstand extension and flexion and minimise restriction. These small introductions to stress begin to give way to higher intensities and speed towards the latter part of this stage.
Advanced Stage - 3 weeks to 6 months. This advanced stage is where you are beginning to build up real levels of strength and stability. the finer motor control should already be in place and now it is about moving with speed, load and under stress in a controlled environment. That may not be back out on the field where spontaneous elements can challenge the body, but you should start to be loading up the affected areas and getting them to once again connect and co-ordinate with the rest of the body in the movement patterns that were known and at the level that the athlete was performing pre injury.
It is vital that we train our body to the point where it can withstand what it is that we are asking of it. That can be a 5km run or an ultra marathon. But at whatever level you are ‘competing’ your rehabilitation from injury needs to match that intensity and be formulated to work the body to the point where it can return to the action with full confidence and knowledge that the injury has been properly rehabilitated and is back to full function. Ensuring that you have approached injury in this way means that you should be fully functional when you choose to go back on the court. If you want full function you need to follow the pillars of Rehabilitation Plans and consider all the elements to ensure you get back to 100%.
