“How long do you think it will take to get better?”
It’s a question we often get asked as a Physio and truthfully, it is sometimes difficult to answer.
There are so many factors to consider including diagnosis, severity, injury history, age of the person, training history, response to load, rehab compliance, psychosocial factors – I could go on.
Obviously time frames are important because nobody wants to spend more time away from their sport or hobbies than they have to, but the more we understand about injuries, the more we realise they’re not solely time dependant.
For a long time, there has a been a disconnect between medical professionals and the coach. Whatever tests or exercises we do clinically don’t replicate the loads of a full training schedule, so what can we do to help an athlete back to their chosen sport and avoid re-injury?
“Just ease back into it”
What does that mean to Jane if her sport is CrossFit? She’s cleared to attempt 1RM snatches, handstand push-ups and muscle-ups, just because she “rested” her injury for X weeks? Any relative deload from training is going to have a detrimental knock on effect to your injury’s surrounding muscle tissue. Your injury is feeling good now, but don’t be naïve. Going back to snatches straight away would be like trying to build a house starting at the top floor, and wondering why it’s not holding up. Build a base, first.
The phases of rehab outlined below were actually formed for the rehab of an ACL reconstruction post-operatively, but the principles remain the same for most of rehab. You just might start at a different phase and it might not take you long to reach the next phase as an ACL reconstruction (it really shouldn’t) – but you must earn the right to advance to the next phase by showing complete competence in your current phase.
For example, if you’re attempting a heavy snatch, but you can barely overhead squat it, you shouldn’t have to be injured to know it might not be a good idea. So if you’re not ready for heavy 1RM attempts or AMRAP muscles ups – what are you ready for?
Building the base. High volume and tempo training. Slowing down the selected exercise and doing it at higher reps with lower intensity means the muscle is kept under tension for longer and drives tendon and connective tissue remodelling. This is why resting might not be your answer. The same way astronauts lose bone density when they spend time out in space, our bodies need a stimulus to adapt. You might start easy while you take a relative deload from the aggravating factors of your injury, but once you’ve actually started intensifying the 12’s, 10’s and 8 rep schemes, you’ll see its no walk in the park.
This post is by no means exhaustive and isn’t the answer to everyone’s problems but its more to demonstrate that rehab is goal driven rather than time based. It’s a great opportunity to work on technique and other aspects you might be lagging in. If you’re finding it hard to gain momentum with your injury and you keep hurting yourself in a particular aspect of training, don’t “ease back into it”. Dominate in the previous phase and rehab hard.
Written by Daniel Morrison