The Stages Of Rehabilitation
The 4 stage rehabilitation system to return to play minimising the risk of re-injury
We train a lot of athletes with the aim of getting stronger and faster for their sport and reduce the risk of picking up an injury. We also work with athletes who have long term injuries and require structured rehabilitation to return to play as quickly and safely as possible limiting the risk of re-injury. So, what are the processes we go through in rehabilitation? These stages are all dependant on the type and severity of injury as well as the demands of the sport. Rehabilitation strategies should be designed individually as no two cases are the same. In this article, we will talk about the stages of rehabilitation.
THE VIDEO: The Stages Of Rehabilitation
The regeneration phase of rehabilitation is the stage where, we allow the injured area to rest and recover. For muscle tears, inflammation and strains of tendons, we can use ice packs and for sprains we can use supportive braces. It is important that pain is avoided to avoid further aggravation of the injured area and allow the body to begin to repair itself. Physiotherapy will ensure that joints remain mobile and recovery can be accelerated. This process is case specific. Some injuries can progress through this stage in a matter of days, others may be weeks or even months depending on the severity of injury i.e. acute tendinitis vs grade 2 hamstring strain vs ACL rupture.
During the early stages of rehabilitation, we should look to isolate the injured area. This may include the use of machine weights avoiding compound exercises. Progressive load and progressive volume increases will develop the structural characteristics of the injured area and accentuate the heeling process. Recovery at this stage is important and no pain should be recorded during activities. Cardiovascular activities should also be pain free. If you have been out for a prolonged period of time, begin with aerobic activities such as walking or light running gradually progressing the duration and then intensity.
During the mid stage of rehabilitation, begin to include more sport specific activities for example, passing in football or light throwing if returning from a shoulder injury in cricket. You shouldn’t try and do as many repetitions of these activities as you would in full training. Gradually build up the quantity and intensity of activity over time. Don’t just go into kicking a ball 50 yards down field or going into maximal fast bowling in your first sessions back in training. Begin to increase the intensity of your conditioning with sport specific change of direction and begin to increase your anaerobic conditioning i.e. high speed running. You should be able to complete some maximal bouts of activity.
At the end stage of rehabilitation, you should be able to complete any task asked of you for example, hits in rugby, maximal sprints in football or boundary throws in cricket. At this stage, we are building a load tolerance to transition towards full training. We want to avoid spikes in load, continually building intensity and duration to match the demands of training. It is important to integrate technical and tactical aspects of match play at this time to adequately prepare an athlete for return to play. If a player goes straight back into full training without building his tolerance to load, the athlete will be at a high risk of re-injury due to the body not being prepared for the demands of sport.
Return to play
Once athletes can perform all sport specific tasks and have a tolerance to the demands of training, it is important to start to integrate players back into their squads and regular training. This can mean completing the warm up with the team, before performing a conditioning session, progressing on to a full practice. Plan ahead and explain to your player why they are doing limited practices and give a clear timeline to return to game and full practice to maintain player motivation and buy-in for each session.
When there are no physical limitations and the athlete is able to cope with the demands of training after a pre-determined amount of time, they can begin to enter competitive games. It is important to be mindful of the amount of time they are playing in relation to the load they can theoretically tolerate to minimise the risk of re-injury.
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We can apply these principles and stages to a variety of sports and injuries. Working through these stages is important, especially for long term injuries. The time spent at each stage is dependent on the severity and type of injury. Some, may progress through the stages in as little as a week others, may take 9 months to a year. Don’t rush your rehabilitation and be patient to avoid being back where you started and have to endure the processes of rehabilitation all over again.