Long term rehab is a scary, isolating and frustrating space, and the semi-professional and private sectors can amplify these emotions due to a raft of issues unique to these environments. I've been lucky enough to work with some great Physiotherapists, Sports Doctors and other Health Professionals who have given me the freedom and backing to experiment with different methods and to push the boundaries, so I wanted to share some of my key focus points during the acute phase of a long term rehabilitation in these sectors. This is a critical phase of time where you can either lose the athlete into a short term abyss of self-pity, isolation, and physical/mental decay or you can hone in on the process and set them up for a rise from the ashes which, as a coach can be an unreal experience to be a part of!
Between the Ears
The mental health benefits of continuing to train as soon as you can post injury might be the single most important role we can play early on. Forced complete rest can lead to an athlete feeling their identity slip away, by facilitating an athletic outlet we can combat the aforementioned negative effects of this phase of rehab. Too often we see athletes taking too much time away from a facility or sporting club and fall into a rut, leading to a lot of junk time 'resting & recovering' while in reality putting themselves so far behind the proverbial eight-ball it makes the road back look increasingly impossible. While there is certainly a place for a bit of "me time" to process the injury and what it means for them as an athlete, it's rarely as long as some people take.
The physical benefits of continuing to train vs. the negatives of ceasing training are huge, from the injury site to a cellular level. Here's a few ways I attack Phase I of a long-term rehab;
1. Cross-education refers to training the non-injured contralateral limb to both prevent excessive muscle atrophy and stimulate hypertrophy and strength gains in the injured limb. It means there’s nothing wrong with still hitting a heavy strength day on that un-injured leg after some positional isometrics for rate of force development, you’re actually doing your injured leg a favour by getting some strength and power carryover from the other leg while still in a cast or brace. The other benefit is that they can still feel like an athlete and be explosive using strength-speed/power methods and other sensible exercises without having to just perform “boring rehab exercises”. You're really only limited by your imagination!
2. Blood Flow Restriction (BFR) partially restricts arterial blood flow to the limb resulting in blood pooling during passive rest or by creating a hypoxic environment for the skeletal muscle to work in during resistance or aerobic exercise. Passive BFR (P-BFR) can be done as soon as 3 days post-surgery and can prevent enough muscle atrophy to make it worthwhile doing, until the tissue can tolerate some form of loading and you can supercharge your hypertrophy training with resistance exercise BFR (BFR-RE). You don't have to be as extreme with your percentage of occlusion as some research/guidelines suggest either, keeping the athlete fairly comfortable while achieving solid hypertrophy gains without having to load the compromised tissue and risk pissing it off!
3. Energy System Development; my personal take is that aerobic system development should take priority in this phase. This system plays a major role in assisting the cardiovascular and lymphatic system with the inflammation and regeneration process, while not inducing the nervous system fatigue anaerobic/alactic system work does; there's plenty of time for repeat efforts on the assault bike in Phase II!
4. Twiddle Your Thumbs or Level Up; use this time to set athletic development goals in areas that haven’t been affected by injury. It might be the perfect opportunity to chase that first bodyweight pull up for the athlete. They might be an athlete that typically struggles with force absorption, now’s the perfect time to hit their legs with a dose of eccentrics while recovering from shoulder surgery and it won’t matter that they pull up sore.
You can help the athlete bring all aspects of long-term rehab together by using this time to chat with the athlete's physiotherapist about previous injuries, niggles and struggles to try and kill two birds with one stone. It's also a great opportunity to discuss their current nutrition strategies with the local or club Dietician/Nutritionist. It is paramount to get the message across regarding the importance of nutrition during rehab via a discussion about things like protein intake for tissue regeneration and appropriate quantities of quality food for their body composition goals will set a great platform to improve their current nutrition strategies and carry it right through to creating better habits post rehab. Last but certainly not least, making sure they still have connection with coaching staff, playing group (if team sport) and are participating in any way they can to stay involved and feel included is essential for their wellbeing. This might be as simple as delaying their gym session by twenty minutes so they can still get some touch in or attend their line/team meeting. Obviously, this section applies a little more to the semi-professional and elite sport sectors, but it can still be applied in the private sector via thoughtful discussion, questioning, and subsequent advice; think of how many times you’ve been asked, “what can I do at training tonight?”.
Regardless of phase, the single biggest point of difference you can have as a coach or rehab professional is to have a consistent framework and systems that you apply when creating a plan, helping to steer your programming while allowing the athlete to gauge where they're sitting in the grand scheme of things. This will not only set you apart as a professional and coach, but most importantly will instil confidence in your athlete that staying the course will lead to the most beneficial outcome for them, which is a return to performance.
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