Sports rehabilitation is an aspect of allied healthcare that is specifically concerned with the rehabilitation and prevention of injury in order to achieve optimum levels of functional, occupational and sports specific fitness, regardless of age and ability. In addition, sports therapists usually also prescribe exercises for strength and re-conditioning. This article will cover the 7 main principles of sports rehabilitation.
Typically, sports rehabilitation has two key goals:
- Firstly, to help patients regain their pre-injury levels of physical stamina and physical fitness (or better); and,
- Secondly, it is designed to strengthen the individual by designing programs specific (to a sport) in strength, power, and endurance, which will bring the injured person to return-to-sport.
Following injury, rehabilitation exercises usually begin as soon as possible through neuromuscular activation (for muscle stimulation) to prevent muscle loss (atrophy) and eliciting faster healing. An exercise program will be designed for each phase of sports therapy rehabilitation and will progress dynamically according to the individual’s progress and adaptation.
To achieve the above, we follow 7 Principles of Sports Rehabilitation to ensure the optimal recovery and return-to-sport for the sportspersons and athletes:
- Performance Analysis
- Continuous Goal Setting
- Combination of Physiotherapy and Sports Science
- Individually Tailored Sports Rehabilitation Program
- Variation of Program based on Patient Progress
- Re-Analysis prior to return-to-sport
- Prevention of Re-Injury
Each of these plays a particular role in bringing the injured person back to and, ideally, beyond their original performance levels. Together, they can perform the entire sports rehabilitation journey.
Performance analysis is mainly used in sports and refers to the assessment of the quality of performance of a player/athlete/coach/sportsperson. Typically, it serves as guidance to make better-informed decisions towards reaching their developmental goals. The analysis may cover a variety of performance aspects such as strength, power, mobility, flexibility, endurance, reaction, agility, biomechanics, and also the psychological state of mind.
In sports rehabilitation, performance analysis is utilized to assess the physical capabilities of a person, in particular following their injury. It is then used as baseline data to inform decision making on the selection of interventions used during the recovery journey. Moreover, it may be used from time-to-time throughout the recovery process to ensure the effectiveness of the rehabilitation approach hence optimizing recovery.
Performance analysis is a specialized discipline; hence it should be performed by qualified professionals that have a solid understanding of the human body. Ideally, this would also include knowledge of the sport that they are evaluating, to ensure a sound interpretation of the results. Additionally, standardized protocols should be followed to ensure that results are valid and reliable.
Depending on the type of sport, a typical session of performance analysis at Rehamed Therapy would begin with assessments on flexibility followed by balance, mobility, movement analysis, reaction, power, and strength. Endurance testing is then done on a separate day. This standardized flow of protocol has been implemented to minimize the presence of confounding variables (e.g., fatigue) that may affect the results, ensuring these are valid and reliable.
Most importantly, performance analysis in sports rehabilitation ensures that patients are well informed of their own physical capabilities. This allows them to have a front-row experience in their journey towards recovery and daily life. Furthermore, the results of the analysis would serve as objective data to determine their physical & mental readiness to return-to-sport in relation to the risk of injury. This alone serves as very important information that minimizes the chances of re-injury in the future.
Continuous Goal Setting
Goal setting is the most fundamental and complicated part of the sports rehabilitation process. It is complicated because it varies according to injury, injured body part, the severity of the injury and it also varies between sports and level of performance (casual, amateur to elite). This process must be discussed, negotiated, well explained, and agreed by both rehabilitation professionals and the patient (or the coaches). The timeline to achieve the goal (return to sport or return to daily life) must be reliable and achievable.
Goal setting acts as guidelines for the sports therapists to improve from one goal to another. As opposed to a time frame, the patient should be given challenges in terms of strength, skill, and ability to improve and progress between phases of recovery. Goal setting can be used as an intervention for direct rehabilitation towards a specific outcome, which can result in higher patient satisfaction and improved recovery. Further, it helps to psychologically motivate both parties to work towards the goals without missing out on important components of sports rehabilitation. Finally, it also helps evaluate the intermediate success of the rehabilitation program.
There are basic things that should be taken into consideration in designing the short- and long-term goals of a sports rehabilitation program.
- Reduction of swelling and pain are clear first level goals to begin the recovery journey. Constant pain may prohibit achievement of the rehabilitation goals such as progression to flexibility and strengthening.
- Restoring the normal range of motion is important to keep the joints mobile and flexible, increasing the proprioception and muscle activation.
- As the inflammation and pain are reduced, and the range of motion reaches its goal, the therapist can now more directly focus on muscle activation. Regaining neuromuscular control means re-educating the muscle on how the muscle used to function earlier.
- Next will be improving the balance and coordination (failure to incorporate this training may cause re-injury as the patient returns to sports), followed by improving muscle strength, endurance, and power. These will be the most essential factors in restoring the function of a body to pre-injury status.
- Finally, functional rehabilitation will focus on return to sports and competition for the patient. Here, a further performance analysis is included to ensure the goals have been achieved, and injury prevention training is performed to protect from future re-injury.
Establishing effective, reasonable, attainable goals and integrating specific exercises or activities to address these goals is the fundamental part of overseeing the sports rehabilitation goals/program. Oftentimes the most challenging aspect is judging when exactly and how long to progress, change or alter the rehabilitation program to most effectively accomplish both long-and-short term goals. Through goal setting, patients can see progressive success in achieving attainable goals throughout their rehabilitation program.
Combination of Physiotherapy and Sport Science
In sports rehabilitation, both physiotherapy and sports science (and sports therapy) are utilized throughout the recovery process. They both play active roles in returning the patient to daily life and, especially sports science, return-to-sports.
By definition, physiotherapy is recognized as an allied health professional to whom other health professionals will refer patients for treatment of acute/chronic pain and physical impairments resulting from injury or trauma. On the other hand, Sport Science is a field that studies how the healthy human body works during exercises, and how sport and physical activity promote health and performance from cellular to whole-body perspective.
Sports rehabilitation and therapy are the combination of these, which includes assessing the patient, planning and implementing the treatment program, and evaluating and altering the treatment as the result of continuous evaluation.
Typically, physiotherapists initially perform the performance analysis and find the root cause and/or factors contributing to the injury. Subsequently, the physiotherapists will be plan the treatment and goal setting accordingly. Physiotherapy is typically more passive, using electrotherapy modalities (such as TENS, IFS, etc.) and manual therapies targeting soft tissue manipulation and joint mobilization.
As sports rehabilitation becomes more progressed, sports therapists will focus on more active and exercise-based therapy helping to restore balance and strength to the injured body part. This is vital in the prevention of muscle atrophy and providing joint stabilization as the basis for returning to daily and sporting activities.
Therefore, generally, physiotherapists will prescribe and create exercises for patients to return normal activity daily living. Sports science will focus more on exercises for return-to-sport as part of the patient’s rehabilitation, prevention, strengthening, and re-conditioning.
Overall, in allied health, we apply a multidisciplinary approach that consists of members of the team including the physician, physiotherapist, and sports therapist who are all valuable to the recovery goals. With the combination of physiotherapy and sports science, we are able to optimize rehabilitation and recovery. Therefore, it is vital to the patient that effective cooperation between the physiotherapy and sports science departments is provided.
Individually Tailored Rehabilitation Program
Based on the performance analysis and subsequent goal-setting, a tailored and individualized sports rehabilitation program is the design and customized by the sports therapy team. This includes the short-term objectives, long-term treatment goals, and ultimately restoration of the normal function of daily activities. However, one must take into account that each condition, as well as each individual, calls for a specific exercise program with specific aims and objectives (see Goal Setting section). The tailored program will focus on the physiotherapeutic and sports scientific goals that have been set for that individual and their injury.
As an example, for a post-surgery ACL rehabilitation, the program designed for a 20-year-old individual in high-performance sport differs vastly to a program created for a 40-year-old individual who just wants to play the sport recreationally.
Tailoring the rehabilitation programs to the individual requires an intelligent and often creative approach, as opposed to typical procedural (and repetitive) program design, as each individual responds to the program differently. As mentioned above (see Performance Analysis section), to be able to provide an effective treatment strategy, a scientific approach is utilized by testing the patients’ performance of strength, balance, coordination, etc. Before testing, the physiotherapist will need to examine, analyze, diagnose, and identify the primary cause of injury and how to prevent re-injury. To make effective progress and success to return, one must bear in mind that each treatment plan and rehabilitation have a time frame with specific goals and objectives for the patient to achieve.
A working diagnosis and sports rehabilitation are tailored made through scientific testing to achieve better recovery and faster progress in everyday functioning activities. In order to achieve this, an integrated approach involving both physiotherapist and rehabilitation specialist work hand in hand to monitor the patient’s injury, progress, and design an effective program collectively. In this case, the patient is part of a multidisciplinary process whereby they are taken through various stages of rehabilitation, can track their progress, and always know that the treatment they are undertaking is specific and optimal for their recovery.
Variation of Program
The principle of variation is the process where the exercises in a program are altered to expose the patient’s body to an entirely new training stimulus. This can be done by changing the exercise program, frequency, load, volume, or rest periods depending on the goal setting and, in particular, the progression of the patient’s injury, rehabilitation progress, and overall fitness. Having variation in the exercises program will ensure consistent performance improvements and lower the risks of over-use injuries. Furthermore, it helps prevent overtraining, alleviate boredom, and to maintain training intensity.
Variation based on the patient’s progress through their exercises can proceed depending on pain (or lack thereof), range of motion, strength & balance test, or complete performance analysis. Typically, a strength test can be (re-)performed every 4-6 weeks of the sports rehabilitation program, to understand the patient’s readiness for the next stage. For example, moving from rehabilitation exercises program to strength and re-conditioning.
In addition, the physio-and-sports therapist should measure the range of motion and assess the pain scale during every session. This allows the rehabilitation team to decide to proceed (or not) with the next variation, based on the patient’s progression and ability to handle more challenging exercises in their training program.
The human body is amenable to growth and change, and at a cellular level, is very efficient at making positive or negative adaptations. Therefore, rehabilitation is a complicated and recurring process, because as your body continues to adapt it becomes more efficient at the tasks you’re asking it to perform. Variation based on progression is the mechanism to trick your body before it can adapt to the exercises, reducing their effectiveness. This is very important to the patient and their rehabilitation, primarily to avoid hitting the dreaded training plateau, and to prevent further injury.
Re-Analysis Prior to Return
Nearing the end of the sports rehabilitation process, functional performance testing is undertaken to determine the athlete/patient’s remaining limitations and their readiness to return to sport. It’s important for the athlete to be aware of any physical limitations that may affect their sporting activities. In addition, functional performance testing provides objective measures to gauge an athlete’s progression through the rehabilitation process.
Similar to performance analysis, functional performance testing provides a baseline, objective information on the level of fitness and performance traits (mobility, balance, strength & power, endurance, reactivity, etc.). Based on this, we can inform decision-making in optimizing performance & injury prevention, as well as assessing the physical readiness of the athlete.
Ultimately, functional testing prior to return-to-sport helps the sports therapist measure and review a patient’s status through their program. Measuring a patient’s progress is an important part of rehabilitation training, as each phase in rehab has individuals’ goals and objectives that must be prioritized according to the patient’s injury status. Therefore, it is also a key part of releasing the patient to sporting activities, helping prevent re-injury.
Prevention of Re-Injury
The final stage of sports rehabilitation is the prevention of future and/or re-injury. Due to any injury or surgery, we tend to lose strength, mobility, flexibility, muscle function, and proprioception. It is possible to regain it all during sports rehabilitation but, depending on the injury, there is often a higher risk of getting the same injury again either on the same site or the opposite limb.
After the long arduous journey of physiotherapy and rehabilitation, re-injury is a major blow both physically and psychologically. Therefore, the road to recovery does not stop once an individual can return to sportfully, it progresses into injury prevention. From the name itself, injury prevention is somewhat self-explanatory: it is intended to prevent either re-injury, further injury, and/or getting injured in general.
The basis of injury prevention is adapting the exercises performed during sports rehabilitation and incorporating them into a strength and conditioning (S&C) program. A general S&C exercise regime is sometimes not sufficient to prevent injury as there are many aspects to cover aside from muscle strengthening. In order to prevent injury, it is important to upkeep and improves mobility, flexibility, stability (static and dynamic), strength, power, and last but not least, cardiorespiratory fitness.
In Rehamed, we focus on the goals of an individual and adjust the injury prevention program to said goals. As most people in Rehamed come due to an injury, our injury prevention program will focus on eliminating the initial cause of the injury. For example, if the injury was caused by a tight and weak muscle group, we will educate the individual on it (why it happens, how it happens and how to avoid it) and focus preventing the muscle group from getting weak and tight again in the injury prevention program.
Regardless of whether an individual has been previously injured or not, injury prevention is still an important aspect of the sport (and active daily living in general). Physically recovering from the injury is only part of the process, the mental aspect/journey of injury recovery is equally as taxing, if not more. However, as the saying goes, “prevention is better than cure”.
If you want to know more about the principles of Sports Rehabilitation, feel free to give us a call at 03-50315946 or send us a Whatsapp or Make an Appointment. We at Rehamed Therapy are always here to help!