Training when injured and during rehabilitation process

How much training per session is allowed?

There is no perfect answer, but for instance, when training to run, the rhythm between both legs should be balanced, and the injured side should be sharing the load equally with an uninjured side. If the required skill or rhythm breaks down, the speed or loading should not be increased until the rhythm is corrected. Work up to the commencement of pain only, because rolling eyeballs and gritted teeth are for training, not rehabilitation. Within reason, “wimping out” is permitted.

Pain may occur during rehabilitation or after the session is over, in which case:

a)      if the pain stops immediately or cessation of the activity – continue at this level

b)      if the pain continues for 20-30 seconds – stop the session! Start the exercise again from the lowest loads at the next training session, or the next day

c)      if the injury does not hurt at the time but hurts later – use NSAID’s(non- steroidal anti – inflammatory drugs) to counter and inhibit inflammatory prostaglandins

d)     if the pain is settled by the following morning – training is within injury tolerance but should not be increased

e)      if the pain is worse the following morning but settles by midday – training is at the maximum so reduce the load by 10%

f)       if the pain is worse for the following 24-48 hours – training has been well over the maximum recommended. Rest until the pain has settled. Start again with a considerable reduction in a load, about 50%, even if there is no pain at that stage

g)      isokinetic training  -  has the advantage of providing a fast angle of rotation, which has a low resistance, or a slow angle of rotation with a high resistance, and the advantage that the machines will “quit” when the patient “quits”, thus preventing muscle damage

Always stretch the injured part properly before and after exercising.

Open chain exercises

Open chain exercises are those that fix the body, load the distal part, and then move the distal part. Thus leg extension exercises require the athlete to sit, place a weight or resistance over the foot and then extend the knee. This exercise will strengthen the quadriceps but will also produce forces that can translate across the knee joint as well as through the articular surfaces. This can cause problems for the cruciate-deficient knee. These exercises do not train coordination and balance at the same time. Thus, for joint problems closed chain exercise is better, but for muscles either can be used.

Closed chain exercises

Closed chain exercises, in principle, fix the periphery and work the proximal joints and muscles. Thus, leg presses and press ups are closed chain and the forces travel through the joint, not across it. Coordination can be developed at the same time by performing exercises such as balancing on one leg, squats, hopping and jumping. These have the advantage of training the mechanoreceptors in the joints and the proprioceptive coordination required to balance and move properly, at the same time as building strength.

How to increment loads

Non-commital loads

These are exercises that can be aborted at any stage without further damage or harm to the injury, and they may be performed as isometrics, closed chain exercises, counter- balanced weights or resistance elastic bands.

The rule of 7

This can be used for the above exercises when inviting patients to build them into normal day, but the timing can be pushed to a “rule of 10” for full training sessions.

The rule of 7 is: 7 seconds work, 7 seconds rest, repeat seven times, preferably seven times a day, but three to five will do and is more achievable for the amateur than a 10 second rule.

Commital loads

These are movements that once initiated cannot be stopped, or cannot be stopped without damage, such as running, jumping, throwing, hitting and using free weights.

Early stages of rehabilitation

Should utilize non-committal loads and non-commital exercises. Isometrics should be used in the inner range( with the muscle short), progressing to mid-length, and then the outer range.

Middle stages of rehabilitation

Committal loads should be added – at low speed and slow acceleration.

Later stages of rehabilitation

The endurance of the committal movement is built up, and then speed and acceleration is incremented:

a)      Weights – use body weight and build up repetitions until the patient can handle 25-30 repetitions, and then increase the weight by, for instance 2kg, until the patient can manage 25-30 repetitions, and then continue in the same way until the desired weight is reached.

b)      Running – run 1500 metres at 10min/km, if there is no flare, decrease your time to 9,8,7:30… until the desired running pace is reached. Run each speed on two occasions, without problems, before increasing the speed. When the desired running speed is reached then increase the distance, but drop the speed down to 10min/km pace and repeat, as above, until the desired speed and distance are again reached. The distance should be incremented more slowly, probably in 1500 metre steps after first 3km.

c)      Hitting, throwing and kicking – these should be performed at slow speed, over short distance, until 25-30 repetitions produce no reaction, and then increase the distance of the throw, kick, or hit, still at a slow speed, and then reduce distance and increase the speed or force, gradually moving out the distance. Finally return to a short distance in order to increase speed and force up to the desired power.

Final stages of rehabilitation

Add pliometrics, such as bounding and depth jumping, and use the rehabilitation ladders( in one of later threads they will be explained in details).

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