Saturday, March 20, 2010


What is rehab? (I know the picture is talking about another type of rehab but it makes me giggle.)
It is the concept of taken something broken or not 100% of its full operating capacity and restoring it too its optimum capacity. People can do this by taking themselves through ranges of motion that will facilitate that joint, muscle, connective tissue, bone or whatever it is and at the same time strengthening it.

I see current programs take too long to get tissue healthy and the client pushes themselves too hard on their own. I also see clients not taking it easy enough at the beginning.

The first 5 are common Rehab concepts or you will hear about consistently. The last 4 are things that I think are not in most rehab practices.
  1. If you are out of balance and things are not symmetrical you need to "rehab"!
  2. If the injury is acute you need to chill out
  3. If the injury is persistent but does not stop you from going through a ROM then use it but do so in a smart way.
  4. All injuries and imbalances need to be trained loaded and unloaded
  5. All injuries should be taken through a normal ROM
  6. All injuries should be stressed but not forced. (there are times to force something but be careful and make sure you do this with a good PT)
  7. If you are in rehab don't just rehab that one injury. Treat the whole body as an injury
  8. Super high intensity training (anaerobic) releases a cocktail of rehab chemicals. Train HARD but safely.
  9. If you have to wear a brace to do something you shouldn't be doing it.
If you are out of balance and things are not symmetrical than you need to "rehab"!
If my left leg bends farther than my right or my right shoulder has too much ROM then when I do a movement that is designed for balance the body is going to stress one side harder. Say we are doing an overhead squat. OHS is holding a weight overhead and then squatting into a full squat, while the weight stays directly over the center of the foot and the heel is loaded/pushing through the ground.
So, we are OHS and our left leg and shoulder are not as flexible as our right side. When we squat our body is going to load asymmetrically. This is great for an asymmetrical day but what happens when you need it to load symmetrically. It cant. Something is going to give. This means that you are going to be inefficient through your body and the neural patterns will make this a norm loading pattern a norm. This will create a compromise.
The argument is that while you are performing the movement the body will only be able to go as far as the compromised or the tighter joint. My answer is that sometimes that will happen but more often than not a person will load the short side and or the unstable side in a compromising way. If you are paying attention and training it as a rehab movement it is more likely that you will not overload something. More often than not, if you are not being watched then you will force/compromise the tight side to get into the "proper" position causing more damage. I see it all the time with movements. This does not mean don't train a movement that highlights your compromises, because you want to see your weaknesses. It means pay attention and have someone watch you. It also means that you need to do some tissue mobilization, massage, foam roll etc.

If the injury is acute chill out.
If it hurts when your not doing anything, it is wrong and if it hurts after you did something you probably did too much. Most people hurt and "play through it". Don't. It hurts because something is wrong. Mobilize tissue and take the hurt/damaged area through a scaled ROM. If my shoulder hurts I am going to work on all the shoulder muscles with golf balls, tennis balls, cords and then start taking it through the max ROM I can without causing more pain. It takes about 6 weeks for soft tissue to be usable. So, during that 6 weeks plan on training around it and plan on rehabbing it specifically. Give it time to heal. If your car has a flat and you take the wheel off and half plug the tire and then put a little air in it, get frustrated stick the tire back on the car and drive away the tire won't serve you. Take the time to fix it!

If the injury is persistent but doesn't keep you from going through a ROM then use it but in a smart way
If it continues to hurt when you are using it, odds are you are not using it properly. If you are then you are not doing enough of the soft tissue work and ensuring that you warm it up and cool it down. I don't like to warm stuff up but in the case of rehab I demand it to be done.

At the beginning it may hurt through a ROM but it should be that good kind of hurt.

All injuries and imbalances need to be trained out both loaded and unloaded as well as symmetrically and asymmetrically.
Every injury is a mechanical misuse of the body. Either it was too hard of a movement or the angle of the movement was asking the joint to do something that is not possible. All tissue has resilience to getting pushed around but at some point it fails. ALL tissue will fail at some point. Don't take it to that point and if you take it close to that point give it time to heal. Think of a blister. That tissue was rubbed and rubbed until it couldn't handle it anymore and a blister formed. If you do the same thing the next day it will get worse. Give it a break.
So, if it is imbalanced train that imbalance out!
If you can do a pistol (one leg squat) on one leg but not the other, train the other leg to perform the same. If you don't at some point you will try and do something and the imbalance will cause a funky load in the body and create an injury.
Odds are it will never be exactly the same, especially since we throw and kick with specific feet/hands, but you can get them very very close by training them that way. By doing so, you will be a healthier, faster, longer lasting human.
So, symmetrical is Olympic lifts while one sided kettlebell lifts would be asymmetrical. There are hundreds of each type of movement (sym/asym) but OLY lifts and KB lifts are a really wonderful place to start.

All injuries should be taken through a normal ROM
Now, it should be taken through the max ROM that is possible for that injury. You keep working the injury until you can get it through a normal, healthy ROM.
If you can't do it yourself then have someone do it for you. Be nice to it but work it through as much ROM as you can handle.
Begin loading the ROM as soon as possible but only move it through the ROM you can absolutely 100% control. If it only stays stable through a tiny bit of your passive ROM its okay, just ensure that you are also having the injury moved through a ROM while unloaded. Rehab isn't roses, hugs and kisses. It hurts a little.

All injuries should be stressed but not forced. (there are times to force something but be careful and make sure you do this with a good PT)

People baby their rehab or stop doing it because it "feels" better. It is not better. Do all of the required rehab and make sure to take time off of full out training until your are cleared. A basic idea is that if it feels good give it another two weeks of "rehab" before giving it the green light to go all out. When you think that it is better use it and if it is overly sore or different than the others take it a little easier on it next time. Keep checking it that way once a week or so and when it comes back feeling like the others you can use it full out.

If you are in rehab don't just rehab that one injury. Treat the whole body as an injury

An injury in the ankle screws up the whole system all the way up to the neck and shoulders. This means that if you are injured and just train around it or "work through it" you are demanding other joint/soft tissue systems to take up the slack. This will cause more injury. If you are injured it is ridiculously important to ensure proper movement patterns. If it hurts do something else.
Also there is going to be an inflammatory response in that injury but it will affect the whole body. So, your whole body is "swelling". Treat it that way.
If you have a flat tire and you are driving fast the rest of the car will not be able to keep you safe. Something else will give out because it cant pick up the slack. Fix the flat and check out everything else to make sure it is not damaged.

Super high intensity training (anaerobic) releases a cocktail of rehab chemicals. Train HARD but safely.
This almost sounds like it is contradictory to the above point but it can be supportive. When you train anaerobically your body will release good brain growth chemicals, (VEGF, read Spark by john ratey) HGH, human growth hormone, and will balance your estrogen and testosterone levels, as well as so many other wonderful feel good and fix it chemicals.
I will do a whole post dedicated to anaerobic training and its benefits to include a part about this in more depth.

Knee injury, get in a pool and sprint across the pool get out and do 10 pushups repeat 10x as fast as you can.

or 10 pushups 5 pullups, 10 rounds in less than 5 minutes

then work a scaled squat. Wrap a chord/belt/rope around a pole/tree/door knob and use the arms to lower you and help you stand.

Or add that into a workout.
This is just one example but pay attention to the idea and look at how many variations that can be applied

If you have to wear a brace to do something you shouldn't be doing it.
Most people feel something that hurts a little and brace it or worse they preventatively brace something. This is a bad idea.
If you take the mobility out of and ankle and tape it, brace it etc. you will take the stability out of the knee. You WILL DAMAGE the knee by immobilizing the ankle.
If you train properly you will be able to run, jump, cut, accelerate, decelerate, turn, lift something heavy off angle, take a fall, you get the idea, without damaging yourself. If it hurts when doing something look at your mechanics and your training. If either are slacking then you will get injured.

Lastly, don't take anti-inflammatorys unless absolutely necessary. They pull important nutrients from connective tissue. They will presently take down swelling but long term cause damage to the damaged area.

Icing is okay, ice massage is better, but for a short period of time about 5 min at a time. Ice massage is taking some ice and rubbing the injury directly.

Work all the surrounding tissue first, before working the damaged spot. If you work the surrounding area, that tissue can pick up a little more slack from the injury. Secondly, the body splints its own injuries. It will tighten up the surrounding tissues to keep you from using it the wrong way. If you loosen that tissue up it will help the healing process.

Use the damaged area but do so in a smart way and be nice to it. Push it but then let it rest.

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