Principles of rehabilitation

Regardless of the type of sports injury, the principles of rehabilitation are often the same. We recommend seeking professional advice before embarking on any rehabilitation program. It is important to understand that everyone is different and will respond to different exercises and treatment regimes at different rates.

Rehabilitation programs should aim to restore muscle strength, endurance and power, improve flexiblity, priorioception and balance as well as more sports specific or functional exercises.

How soon can I start rehabilitation?

Rehabilitation exercises should begin as soon as possible (after the initial inflammatory phase – 72 hours) and should 'usually' be done been pain free with a few rare exceptions. Be careful with the phrase “no pain, no gain” as in most cases this is not the case. Pain is the body’s response telling you to stop or slow down and if ignored, healing will be impaired.

There are a few exceptions to this, such as the tendinopathy protocols used to rehabilitate Achilles and patella tendon injuries. A medical professional’s advice should be sought before embarking on such a regime as more harm can be done than good if carried out incorrectly. It is also important that the athlete understands the reasons for following a particular treatment regime or exercise program. For a rehab program to be successful the following tips are important:

  • Begin as soon as possible, once the initial inflammation phase has passed (usually 72 hours post injury).
  • Understand why and how you are doing the exercises or treatment.
  • Follow a precise but individualized exercise program to follow.
  • Make the most of the available facilities.

Restoring muscle strength

The first phase of rehabilitation is to progressively load the damaged (pathological) tissue (e.g. ligament, tendon or muscle) to restore its’ strength (often referred to as tensile strength).

There is plenty of evidence to support this theory and if the load is too great for the damaged tissue to withstand, it will fail and healing will be back to square 1. Loading tissue that is repairing is a delicate process and should be led by pain felt during the exercise or the following day. Both of the latter usually indicate that the load during the exercise was too high and needs to be reduced. It is strongly advised to listen to your body and its reaction to exercise.

Restoring muscle endurance and power

Endurance is the muscles ability to work repeatedly without fatiguing. Muscle endurance is especially important in endurance sports such as long distance running or cycling but is also important in sports such as football and rugby which involve repeated bursts of exercise (called interval exercise).

Muscle endurance is also important for the body’s core muscles which support the pelvis and spine and as their name suggests, they provide core strength whilst performing various exercises.

Muscle power on the other hand is the ability to produce force quickly. This is vital in explosive sports such as sprinting and long jumping. In order to improve muscle power, it is essential to have a good base of muscle strength.

Improve flexibility

Flexibility is the the ability to extend or stretch without breaking. The term is usually used to describe muscles but can also be used to describe a movement involving a number of muscles (e.g. bending forwards in standing).

Whilst flexibility is very important, caution should be used in improving flexibility without also improving strength at the same time. If a muscle gets “longer” but not stronger then it will be weak in the additional flexible range and be prone to injury e.g. developing more hamstring flexibility by stretching without also strengthening the muscle.

Proprioception & balance

Proprioception is the human body’s ability to detect movement and soft tissue stress and trigger a reaction to prevent injury e.g. reaction when stepping off a kerb to prevent an ankle sprain.

This is a very under estimated but extremely important part of the rehabilitation process for 2 reasons. Firstly, proprioception is often dampened or slowed down following an injury and needs to be re-trained and secondly, some people have poor generally proprioception and they are significantly more prone to injuries.

In essence, the way to improve proprioception is to perform exercises to improve balance and reaction times of the muscles surrounding the joints.

Read more about Proprioception……

Functional exercises

Functional exercises are related to the sport or activity you are returning to. There are a number of generic exercises that can be applies to multiple sports and should be performed in the early stages of rehabilitation.

However, to effectively and efficiently return to the specific sport during which the injury occurred it is important to perform exercises that replicate activities and movements in that particular sport. For example, if returning to rugby, it is important to perform drills that are used in training such as tackling or passing. Muscles, ligaments and tendons adapt to the stresses and strains that they are placed under and therefore they adapt to specific activities and sports. It is important to bear this in mind when performing late stage rehabilitation.

Stages of Rehabilitation

There are 3 recognized stages of rehabilitation and these are:

  • Early stage rehabilitation is gentle exercise allowing for the damaged tissue to heal. This stage is often rushed and will result in poor quality healing and will be prone to re-injury.
  • Mid stage rehabilitation involves progressively loading the muscles/tendons/bones or ligaments to develop tensile strength producing a healed tissue that will be able to withstand the stresses and strains of everyday life and exercise.
  • Late - the final stage (late) of rehabilitation is where the tissue adapts and is stressed using functional exercises and drills to ensure the body is ready to return to play.