// Injury & Rehab: the components of a successful post-injury rehabilitation program

Injury rehabilitation has progressed rapidly in recent years. Regardless of the specifics of the injury, there are a number of fundamentals that need to be included in all successful rehabilitation programs says Paul Wright.

Every good personal trainer will, at some stage of their career, be involved in the rehabilitation and return to activity of recently injured athletes and clients. It is essential, therefore, to understand the components of a successful rehabilitation program.
Personal trainers may become involved in the post-injury rehabilitation program in one, or all, of the following situations.

a) The injury occurs to one of your current clients during a training session with you and you are involved immediately in the post-injury treatment and rehabilitation process.

b) A current client is injured in a non-PT sport or exercise session and you are involved in the rehabilitation program.

c) A new client asks you to assist in their post-injury rehabilitation.

d) You are contacted by a local physiotherapist or sports physician to assist one of their clients with post-injury rehabilitation.

These are all relatively common situations, but there are a number of differences that every personal trainer should be aware of, including:

Situations (a) and (b), where your current client has been injured, can be potentially damaging to your business and income as the injury may impact on your current program and the number of sessions you are able to spend with this client.

Situation (a), where the injury occurs in one of your training sessions, has the added issue of professional negligence and legal liability, which may have a greater impact on your income than a few lost sessions.

Situations (c) and (d) are income and session-producing situations as they involve new clients and new referral sources for you to build and expand upon.

It is vital that trainers encourage the injured client to 'train around' their specific injury, e.g. replacing lower body activities, such as jogging, with upper body modalities such as rowing and swimming.

You must do everything in your power to keep your client exercising and motivated to ensure they do not lose their hard earned fitness gains.

Ten components of a successful rehabilitation program

Injury rehabilitation has progressed rapidly in recent years, with many advances due to a more active approach to the rehabilitation phase, i.e. early post-injury mobilisation, limited splinting and early inclusion of strength training modalities. Regardless of the specifics of the injury, however, there are a number of fundamentals that need to be included in all successful rehabilitation programs.

The following list summarises ten of these:

1. Early and correct diagnosis. All cases of pain and injury need to be referred to, and investigated by, a skilled health professional with expertise in the injury area.

2. Individualisation. Not all athletes or injuries are identical, so each and every program needs to take into account the specific injury, sporting requirements and level of training of the client. The post ankle sprain rehabilitation program for a middle distance runner will differ significantly from that of a high level basketballer.

3. Early mobilisation and strengthening. In the past there has been a focus on passive stretching and joint range of motion exercises before adding strength training and functional activities. However, provided pain levels are within a suitable range and the supervising medical professional has approved the program, there is great benefit in including activities such as walking, jogging, swimming and strength training in the early rehabilitation stage.

4. Muscle conditioning. Due to the rapid loss of muscle mass and strength post-injury, it is vital that a structured strength training program commences as soon as possible. This may include free weights, bodyweight exercises, resistance bands and swimming.

5. Motor re-education. Many injuries can be the result of motor pattern issues and imbalances (e.g. rotator cuff impingement) and other injuries can actually lead to the development of these imbalances and motor pattern problems. It is essential that all post-injury rehabilitation programs look at the motor control area to ensure correct muscle recruitment returns before the athlete returns to full sport.

6. Proprioception. In a similar light to point 5 above, many injuries (especially ligamentous issues) result in a loss of proprioceptive feedback returning to the brain from the injured area. This lack of feedback is one of the key reasons for re-injury and must be addressed with the inclusion of balance and stability-type activities.

7. Range of motion. It is common for post-injury flexibility to be diminished as a result of muscle spasm, inflammation, swelling and pain. In addition to impacting the injured area, this also affects the joints above and below the problem, and creates motor pattern issues. Many high level sporting clubs undergo rigorous pre-season range of motion testing so that all players have accurate pre-season (and thus pre-injury) ROM results, with this data used to determine when a player is able to return to sport.

8. Incorporate functional activities. All rehabilitation programs must take into account, and reproduce, the activities and movements required when the athlete returns to the field post-injury. They also need to be replicated at the same speed, on the same surface and with the same level of fatigue to be truly effective.

9. Cardiovascular fitness. One essential part of a successful rehabilitation program is the maintenance of cardiovascular fitness during the injury and recovery period. There is nothing more frustrating for a player whose injury has fully recovered than to have their sporting return delayed due to a lack of cardio fitness. Cardio training (of a suitable and pain-free form) of injured athletes encourages and promotes oxygen delivery to the injured area, increases healing and helps the injured athlete stay positive.

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10. Psychology of injury. There is no doubt that a positive mental attitude will accelerate recovery and assist in a successful return to sport post-injury. A good rehabilitation program appreciates the importance of the athlete's mental state, includes visualisation of successful return and allows the athlete to express concerns openly in an environment of support and professionalism.

A word of warning

It is easy for fitness professionals to open themselves up to legal issues related to injury rehabilitation and especially injury diagnosis. For this reason, personal trainers should refer all issues of injury and pain to a suitably qualified physiotherapist or medical professional.

Failure to find a higher authority will open the trainer up to the risk of litigation and serious consequences. Always act under the supervision of the treating medical professional and, when in doubt, ask for clarification and assistance.

Paul Wright, BAppSc (Physio), DipEd (PE)
Paul is the owner of Get Active Physiotherapy with two clinics in St Leonards (Sydney), one being inside a Fitness First club. Paul can be reached on 02 9966 9464 or via www.getactivephysio.com.au