Injury is a part of sport and one of the most difficult times in an athlete’s career is often when they are trying to return from injury and regain function to allow them to perform at the highest level. A lot goes into preparing an athlete who is coming back from injury from all parties involved – rehab professional, strength coach, sport coach, and the athlete themselves. I thought I’d record a few of my random thoughts on this topic from the standpoint of strength and conditioning. I am not a rehab professional; however, a strength coach should be instrumental in assisting athletes who are rehabbing and should work with the rehab professional to make some of the thoughts below build into a solid program:
1. Don’t get out of shape
The best way to get in shape for your sport is to not allow yourself to get out of shape. Too often, when an athlete gets injured, there is this feeling that they must be “shut down” from all activity. This ends up being problematic because not only is the athlete being put into a state where, psychologically they feel like are “broken”, but the athlete is also losing valuable time that they could spend training around their injury (while it is being treated) to not lose fitness or potentially improve in other capacities.
2. There needs to be a plan
Oftentimes the strength coach doesn’t feel comfortable dealing with an athlete that is injured and thus provides a substandard program, which doesn’t adequately achieve the needed training stimulus. Additionally, the medical staff may not be knowledgeable about training means and methods to construct a proper training program for the athlete. Thus, the athlete is put into a position where they are unable to succeed. Having a plan leads to success. Knowing where to go with the training process comes from everyone being on the same page and addressing the athlete’s needs as an individual. This is where I firmly believe that Charlie Weingroff’s Training = Rehab makes the most sense. It isn’t about exercises, it is about principles. If you understand how to lateralize and/or regress your best program via a principle based system the athlete never loses out. The athlete will achieve what they need while rehab is taking place. In essence, training never stops for the athlete.
3. Rehab needs to progress and not be soft
Much of the training approaches being marketed to both clinicians and trainers these days are centered around what I would refer to as “soft”. The exercises are typically done in a very safe environment (on the ground), at a slow and controlled speed, and limit the intensity being placed on the body. I am all for progressions and simple to complex, slow to fast, and low intensity to high intensity, definitely makes sense. However, it is important to make sure those progressions actually take place. Too often I see people trying to return an athlete back to sport doing very slow and passive exercises and the clinician is often happy that the athlete can perform these movements pain free. The only issue with this is that those movements have very little carryover to the athlete running down the field/court/track at full speed!! To return someone back to sport you must first start by understanding the sport and the physical demands the athlete must be able to tolerate. Having a well constructed needs analysis is the first step that all strength coaches should make when they start working with a sport. Write it down, refine it as you learn more, and use it to help develop programs that properly address the needs of the sport. If the idea of rehab/training stops at clam shells, x-band walks, crawling patterns, and planks, there is probably going to be problems later on down the road when the athlete is going to have to do something more dynamic. Those exercises sound more like a starting point to me. In fact, those exercises are probably best served as a staring point in the warm up, as they do not reflect the necessary loading that needs to take place for an athlete to return to play. The tissue needs to go through the proper stress and strain in order to adapt and allow for continued progress.
4. Assess & Monitor
I purposely left out eval here because I believe that all rehab professionals do a proper evaluation of the athlete when they are injured. Assessment really has more to do with assessing where the athlete is physically as well as assessing what the demands of the sport are, and how the athlete should be trained to meet those demands. Monitoring is a key aspect often overlooked in the rehabilitation of an athlete. The only way to know whether or not the athlete is improving is to monitor them. This doesn’t just mean auditing painful patterns or movement dysfunction. Monitoring should go a step further and be inclusive of other physiological systems, in addition to the musculoskeletal system, to ensure that the athlete is not losing fitness during their injured period. This will allow you to make informed decisions about how the athlete is progressing (or not progressing).
These are just some random thoughts I put down based on reading various discussions on social media about training and rehab. At times, I feel like our profession has lost its way as discussions often shift towards the rehab side of things or “fixing” people. Movement is only one capacity and, while important, should not be emphasized over any other capacity. All physical capacities should be taken into consideration, particularly when an athlete is returning to play from an injury. The strength coach should develop a principle based approach that is specific to the needs of the sport and should work with the rehab professional in order to ensure that the athlete is provided the proper training stimulus at the right time.