What is Rehab?
I think it is good to write on this subject, seeing that there seems to be some confusion on the whole process of Rehabilitation.
In this article, I will present our method of getting an injured Athlete back up to, and sometimes even above, Pre-Injury Performance Levels.
In other words, this is how we rehabilitate the Athlete to Competitive Shape in the shortest amount of time possible.
In it‘s simplest form, rehabilitation is, on average and generally speaking, about 50/50 Specialized Treatment paired with appropriate Resistance-Training,ie.:The application of specific Rehabilitory Exercises. The exact ratio of Treatment to Training of course is case-dependant and varies with the individual situation.
For the first half, the Treatment of choice is A.R.T.(Active Release Technique) which deals with all things soft-tissue: Muscles, Tendons/Ligaments and Nerves. Leasons(Fibrotic Scar-Tissue) and Adhesions between muscle-bundles(They stick together), between separate muscles or even muscle and nerve are broken up, The muscles and tendons become „smooth“, soft and elastic once more, circulation is restored and the biomechanics function again as they‘re supposed to.
Other Treatments might include Massage, Chiropractice, Ultra-Sound, Laser and Frequency-Specific Microcurrent to manage inflammation,etc. All of these can have their benefits in a supportive role of the rehabilitory process, again depending on the individual case.
Nutrition and Supplementation also play a role in recovery/regeneration.
For the other 50%, we will now need to focus on the actual Rehabilitation Training.
We need to ask ourselves:“What is the goal in this?“
If you think about it, this type of specialized Resistance Training revolves around strengthening, stabilizing and Structurally Balancing the injured area.
We are looking at(talking about) strengthening the muscles,tendons,ligaments and bones(especially the ligamentous attachments to the bone), and increasing the size/density of all the above. So this is a type of Strength- and what you might call“ Selective Hypertrophy-Training“, ie.:we make the right muscles and their attachments to the bone stronger and bigger. To go even farther: The right muscle-FIBERS governed by the right Motor-Units are being addressed.
What that means is that if you for example tear some fibers in your hamstrings whilst sprinting, then these are almost definitely Type IIb Fast-Twitch Fibers, governed by the High-Threshold Motor Units. To rebuild and strengthen same you will need to -in time- access those very Motor-Units and Fibers, which is done by using the correct Rep-Brackets/Intensity-Levels. Sets of 25 reps will do nothing to that end, as such a low resistance will merely access the Type I Slow-Twitch Fibers. Not the way to rehab a Fast-Twitch dominant muscle!
The basic principles of Rehabilitation Training are exactly the same as in Athletic Strength Coaching. In the Specifics there are some fine differences of course: Care, initially lower intensity-levels(relatively lighter weights), a focus on increased circulation(removal of waste-substrates, improved healing due to a better supply of oxygen, energy-substrates, amino-acids, etc.), reduction of inflammation, restoration of the range of motion, etc.
Now let‘s get back to those basic principles of Strength- , and equally Rehabilitory, Resistance-Training.
We will take the Knee as(for) an example:
There are many muscles crossing, and thus stabilizing, this major joint. All of them are important to some degree or other, eg.: the Popliteus being a more crucial one.
First, we identify the key-structures for Knee-Stability:
1.Key-Structures
These are the VMO(Vastus Medialis Oblique), the Hamstrings(Biceps Femoris Short+Long Head, Semitendinosus+Semimembranosus) and to a much lesser degree the Gastrocnemius.
Why? The VMO is a Shock-Absorber, it crosses and thus stabilizes the knee, it helps the patella to track properly, and prevents the knee from buckling-in whilst jumping and sprinting, consequently decreasing the stance-phase. So it can also improve sports-performance. As far as Knee-Health, the VMO is the Boss.
Next in line are the Hamstrings, again also important for performance.They decelerate the Tibia, prevent anterior translation of same and stabilize the knee posteriorly.
A distant third is the Gastrocnemius, which also crosses the knee posteriorly and stabilizes it there in the back.
Then we figure out how to address these structures specifically:
2.Exercises
A common argument you might hear is that, yeah, fine, the VMO is important, BUT it‘s impossible to isolate, so who cares, right?
(Let‘s analyze that statement:-) (Let‘s take a closer look at that statement)
The VMO is a member of a muscle-group,the Quadriceps, and that‘s by far not the only muscles in the anterior thigh. So whilst it is true that it would be difficult to isolate the VMO, just as basically any muscle will not be truly isolated with conventional Resistance-Training, nobody said this is what you should do.
What needs to be done instead is to EMPHASIZE the targeted area, not to isolate it. And that is very possible, indeed.
As a matter of fact, we do it all the time: in Structural-Balance Training, it‘s an important factor in „Prehabilitation-Training“(injury-proving), and last but not least to improve Athletic Performance, as stated above.
Same applies to the other two: the Hams and the Gastroc.
So the choice of Exercises is essential, but it‘s only one of many steps.
Now it‘s time to design a Rehabilitation-Training Program:
3.Loading Parameters: (in no particular order)
A:Exercise Selection(it doesn‘t stop there), B:Exercise-Order(very important, too), C:Reps(these basically determine the Intensity, or how heavy a load you work with), D:Sets, number of(essential for the strength/hypertrophy and hormonal-responses), E:Tempo(Time-Under-Tension per Rep), F:Strength-Qualities addressed(again here we determine the Training Response), Rest-Intervals(these influence which Energy-Systems you will access, and also the Hormonal-Response to the Training)
You can see that the right exercises are important, but that‘s by far not all you need to optimize this critical process.
Let‘s talk about the Hormonal Response:
Interesting for us here is one hormone in particularly:HGH. Human Growth Hormone is the main-man for Rehabilitation, because it‘s job is to burn fat, build muscle and, yes: Repair Tissues!
So higher levels of this substance will speed up the regeneration of the injured structures. It is possible to increase plasma HGH-levels dramatically with correct manipulation of Loading-Parameters.
Regrettably, most totally disregard this.
4.Periodization.
Adaptation has it‘s benefits and it‘s draw-backs: Adaptation to resistance-training means the muscle gets stronger and/or bigger. That‘s what we want.
Once the body has finished adapting to certain specific loading-parameters though, it will not respond to them any farther, no matter how hard you work.
Basically it says: „OK, you‘re not impressing me with THAT anymore!
hat‘s when it‘s time for change! Change of Loading-Parameters, that is.
To be most effective, we use a complete overhaul, EVERYTHING gets switched; exercises, reps, sets, rest, etc.
Then we‘re rolling again, for a time. And then we switch again, etc., etc.
5.Hypertrophy-Reserve
Maybe you have heard of the premise of „Strength-Reserve“. It basically means that the greater your Strength-Levels, the easier it is to perform a task at a certain set resistance. For you it‘s a relatively lesser effort.
Hypertrophy-Reserve is what we use to our advantage when we have a Strong Athlete and/or we have some time before surgery, for example. The point here is that the Athlete will likely waste some muscle mass post-surgery.(even though this can largely be avoided)
(to a great extend)
Simply, the more muscle mass an Athlete has the more he can afford to temporarily drop, and the faster he will regain it.
For a „holistic“, complete, in other words OPTIMAL Rehabilitation of Injuries, all of the above needs to be utilized. If Athletes use only the one or the other part of this complete process, they‘re missing the whole picture, and will most definitely pay for it. That is unfortunate, and more importantly, unnecessary.
I continuously keep hearing of Athletes, a year or even two years out of injury, still doing the same ineffective rehabilitation training, still not nearly fully rehabbed.
It doesn‘t have to be that way. Maybe you can‘t fix everything all the time in the rehab-setting, but MOST things can be fixed, if you but know how.
And when i say fixed, that‘s just what that means: good as new and better.
(There‘s a lot of sense in getting the injured Athlete back in a better shape than pre-injury; if the injury happened because the Athlete was maybe not very stable, not properly injury-prooved, ie.:Structurally Balanced and Strong, than that should be remedied before they‘re allowed back into the sporting arena.)
I know of an Alpine Skier who in a fall ruptured ALL of the ligaments in his knee. He was medically cleared for Alpine Skiing 16 weeks later. If the Doctor tells you that you‘re good to go on this, your knee IS rehabbed.
THAT‘S how it is supposed to be.
Deila
