From Rehab to Performance
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May 23, 2017
By Tim Koba, MS, ATC
No athlete likes to be injured. The thought of doing rehabilitation means time away from the sport, training and social interaction with the team while they are on the road to recovery. On the surface, it may appear training for performance and rehabilitation are quite different. However, when you dig a little deeper you can identify the underlying goals are similar and the opportunity exists for the rehabilitation process to lead to greater performance.
When designing a program, one starts with the end goal in mind. So, for strength the goal is identifying the specific needs of the athlete, sport and position. For rehabilitation, it means identifying the goals for the rehabilitation process such as restoration of motion, decrease in pain and improvements in functional movement. There comes a time in the rehabilitation process where the opportunity exists to improve sport movement.
Both strength and conditioning programs and rehabilitation programs utilize testing to assess athletes, track progress toward identified goals and make necessary adjustments. The main differences are that strength testing assesses strength, power and fitness in healthy athletes, while rehabilitation focuses on assessing pain, movement quality, imbalances and weaknesses. This rehab assessment allows for the identification of functional impairments that both contribute to injury and limit performance potential.
As the rehabilitation process progresses and athletes have regained pain free motion, control, balance and endurance, the next step is to introduce sport and performance based movement. This is the time to transition athletes back to the strength coach, or if that is not an option, to increase their level of rehab intensity. During this final stage of the rehabilitation process, athletes are being re-integrated into strength programs.
Once this final stage of the rehabilitation is achieved, athletes are being retrained in movement quality. For many athletes, this also includes injury prevention. Many sports have different injuries associated with it and many of those injuries have identified prevention strategies. This phase of rehab allows the Athletic Trainer to implement those strategies. This is the time to teach how to land from a jump absorbing force softly, learn to change direction by dropping their hips and generate rotational power through their legs to limit strain on the upper extremity.
At the rehab level, this is higher level training, but at the strength level, this is all assumed. This discrepancy can contribute to injuries in the first place. At the strength level, retraining fundamental movement can be time consuming and limit the availability for higher level conditioning, but at the rehab level, this is an ideal time to administer this training.
This gap from rehab to performance is where many athletes are discharged from therapy. They have achieved their rehab outcomes, but are not quite level for the performance training necessary to their sport. When athletes are integrating back to their sport during this period, it is important to recognize while they are recovered from their injury, they are not necessarily at their peak level. Throwing them back in to full participation without adequate progression may not be in their best interest. Like with all aspects of training, progression is the key to long term success. The gradual overload of increased intensity is what leads to long term sporting success.
From the strength and conditioning perspective, this is the time to build upon the foundational work that was done in rehabilitation. As the athlete recovers from their injury, they will be excited to work hard to keep up with their team. Adapting their rehab exercises into a warm up routine can reinforce proper movement mechanics. Strength exercises can then be built on top of this foundational movement, much like a standard strength and conditioning program.
The long-term goal is to exceed pre-injury level of play. The best way to achieve that is to take a broad view of the variables that impact performance and implement progressive exercises that transition from injury recovery to sport training.
- Rehabilitation and strength and conditioning have different end goals, but similar processes
- Injured athletes are encouraged to continue to train non-impacted body systems
- Integrate rehab principles with strength training during the final stage of rehab and initial stage of strength
- Implement rehab exercises into warm up protocols to reinforce neuromuscular control and movement patterns achieved during rehab. This also doubles as injury prevention to decrease risk of additional injury
Reiman, M. & Lorenz, D. (2011). Integration of strength and conditioning principles into a rehabilitation program. International Journal of Sports Physical Therapy 6(3), 241-253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164002/
About the Author
Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.