General principles of rehabilitation

a)      Rehabilitation needs to be performed little and often, at least three to five times a day. Thirty minutes, three times a week is not sufficient.

b)      Exercises should be developed to train the uninjured parts of the body and maintain cardiovascular fitness, but rest the injured part until the injury can withstand controlled incremental loads.

c)      Athletes are targeted achievers and will use any method to achieve the goals that are set for them. This will include “cheating” by developing new skills with which to achieve their current target. This new skill may not be the best skill for highest level of performance. For example an injured athlete at point A has to recover to a skill at point C. It is  better to move slowly along the path to C than rush to skill level B and then discover that no path leads point B to point C. A prime example would be retraining quadriceps, only to find that the fast progress made to achieve a straight leg raise has been made by rotating the tibia externally so that the knee joint is held straight by the articular surfaces locking across the joint, rather than by the quadriceps strength. This athlete is then unable to support a step down, which loads the joint through the knee as opposed to locking the articular surfaces. Later, this athlete will have to stop rehabilitation and return to basics to reprogramme the correct skill.

d)     Rehabilitation of a skill that produces the best performance must not be sacrificed for a skill that enables a return to match play faster but which has a less effective performance.

e)      Target setting should always be positive:”do this” rather than “don’t do that”.

f)       “Overload” injuries should not occur in training.

g)      Training must not delay or retard healing.

h)      Skill function and pain should control rehabilitation, not an arbitrary time scale.

i)        It is better to delay a week or two to play at 100% than return and play all season at 90%.

j)        Stretch injured muscles after training, warm-up injured spot first before training, and do longer warm-up for injured area.

k)      Left to themselves, athletes will tend to train what they are good at; therefore, rehabilitation is the time to work on their weaknesses.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English