This post delineates the typical structure of a rehabilitation program at Buan Physio, providing insight into what individuals should anticipate during their recovery.
If you're reading this post, you've most likely suffered an injury and are keen to get back to sport as quickly as possible. It is essential to have a thorough understanding of what a successful rehab programme entails, and what lies ahead. This process will be unique to you, your injury and your set of circumstances. Having realistic expectations of what your rehabilitation should look like, will ensure that there are no surprises down the line. You must be aware of the criteria that you need to pass, in order to earn the right to return to competition again. I call this, knowing what the top of the mountain looks like. Once I know what the demands of your sport are, I work backwards from this end-point, to outline your specific rehab journey.
You may have attended physio in the past for various injuries, however the rehabilitation process at Buan Physio will likely be slightly different. Too often I have clients attend the clinic who have sustained a previous ankle sprain for example, but they have never hopped or jumped in their rehab. It's no surprise then that they are now presenting with a re-injury. The comprehensive rehab process at Buan Physio ensures that you rehab thoroughly, which will not only enable a return to sport, but will also help reduce the risk of future injury. I understand that this process may not be for everyone, and that is ok. Contrary to belief, quick fixes don't exist. Even a 'simple' ankle sprain, is often more complicated than people think, especially given the fact that 40% of individuals go on to develop chronic ankle instability. Too often I see clients stop rehab when their pain has gone, as they think that they're ready to return to sport.
You will be pain free at a certain stage post-injury; however, it is important to note that this does NOT indicate your readiness to return to sport. Meeting specific criteria, via testing is the most effective and only way to demonstrate your readiness.
Establishing goals throughout the rehabilitation process is crucial to achieving a successful return to sport. The pain and swelling that are initially present following an injury, can often lead to arthrogenic inhibition. In simple terms, this is where pain and swelling impede muscle activation due to reduced neural activity. Even when your pain and swelling have resolved, sub-optimal muscle activation can remain a problem. Therefore, if this inhibition is not targeted and resolved with appropriate rehab exercises, the body will be forced to choose a sub-optimal strategy to complete tasks. For example, following a knee injury, the quadriceps are often inhibited. But we need our quadriceps to help us jump. If the quadricep muscles are not progressively strengthened with exercises, the body will often either choose a hip strategy to help complete the jumping task or the quadricep muscle of your uninjured leg will perform the majority of the work. This then puts your other knee at a greater risk of injury due to it working excessively. Note : this is sometimes observed following ACL surgery, where individuals inadequately rehab their injury and they end up rupturing the ACL of their previously uninjured leg.
The bottom line is that passing your specific 'return to sport criteria' is the safest and most effective way to ensure a successful return to sport. In order to offer context, the subsequent criteria (see table below) provides an example of the evaluation parameters utilised to determine an individual's eligibility to resume straight-line running, following a lateral ankle sprain.
Return To Straight-Line Running Criteria (example only)
Streams / Physical Qualities | Benchmark Score | |
1 | Swelling | Zero or Trace |
2 | Pain | <2/10 |
3 | Reported Instability | Zero |
4 | Ankle Dorsiflexion Mobility | >90% symmetry on a knee to wall test |
5 | Single-Leg Stability | >90% YBAT; pass coopers & BESS Tests |
6 | Calf Capacity (Gastroc) | >90% symmetry & >20 repetitions |
7 | Big Toe Maximal Strength | >90% symmetry & >3 N/Kg |
8 | Reactive & Explosive Strength ** | Completed Landing, Jumping & Hopping Progressions |
9 | Running Preparation | Completed running prep drills |
* >90% symmetry means that there cannot be any more than a 10% difference between sides on testing.
** For reactive & explosive strength testing, specific variables such as ground contact time, jump height and velocity are assessed to determine your readiness.
My responsibility is to provide a professional opinion regarding your likely injury, outlining the necessary steps for recovery, and determining the appropriate timing for your return to sport. The decision to adhere to this guidance ultimately rests with you.
Our 5 Phases of Rehabilitation
The table below outlines the 5-phases of rehabilitation here at Buan Physio. Completing exercises in one phase will earn you the right to progress to subsequent phases. Skipping phases or performing exercises sub-optimally will likely lead to issues arising when you start to run again. This 5-phase process is proven to work!
1 | Injury Protection | Provide the optimal conditions for healing to occur |
2 | Load Introduction | Develop local tissue capacity, key lift patterns & running prep drills |
3 | Strength Accumulation | Develop hypertrophy, max & reactive strength; & commence running |
4 | Team Training Introduction | Continue phase 3 exercises & return to team training |
5 | Return To Performance | Return to competition & continue to develop athletic potential |
On-Field Rehabilitation (OFR) Stages 1-5
Your on-field or on-court rehabilitation commences during phase 3. The running preparation drills that you have been completing in phase 2 will have prepared you for the demands of straight-line running. Straight-line running volume is built up over a period of time, with a focus on the quality of movement being key. We don't want slow sloppy running when returning from a lower limb injury. You will be asked to complete a certain number of running metres in a set time, which means that you're running at a specific speed. Note : prolonged periods of injury, particularly those involving more severe injuries, can contribute to a deterioration in physical fitness. Consequently, this may necessitate an extended duration of OFR.
Gradually, decelerations and accelerations are introduced, along with change of direction speed drills. Drills that are pre-planned in nature initially, progress to more reactive chaotic representative tasks as you progress through the 5 stages of OFR. Drills will begin to incorporate the use of the ball, in addition to engaging in contact work. The quality of movement throughout all 5 OFR stages is paramount, with both video analysis and a coaching eye employed to ensure this objective. Ultimately, stage 5 sessions should bear a strong resemblance to a team training session.
Long-Term Injury Rehabilitation
For more substantial injuries or for those injuries that will entail a length period away from sport (e.g. ACL reconstructive surgery, achilles tendon rupture, bone fractures, surgeries), outlining your rehab journey is crucial. Creating a periodisation plan, as outlined below, that encompasses essential phases, stages, primary and secondary priorities, along with key milestones, serves to divide the rehabilitation process into smaller, more manageable segments.
Key Elements of a Successful Rehab Programme :
Communication & Accountability
I would argue that communication is the cornerstone of any successful rehabilitation programme. You will be asked to regularly communicate with me via the exercise app, emails, whatsapp and/or phone calls. Receiving feedback from clients after they have commenced new rehab exercises is important, as I have found that new or updated programmes will nearly always require slight adjustments for various reasons.
Another aspect that I place emphasis on is accountability. Asking individuals to record completed rehab and/or gym sessions, can help to ensure that the work is actually being accomplished. Many of the individuals that I see are either students or they have full time jobs, so life can get in the way sometimes. If I know exactly how many sessions that they have completed, I can confidently programme more challenging exercise progressions. Conversely, there may be weeks where individuals have examinations or they are sick, and therefore are unable to complete the desired number of training sessions. Ignoring this information and progressing an exercise programme, will probably lead to undesirable results.
Respect
Respect is a two-way street. All I ask is that you turn up on time for sessions, having completed any rehab exercises to the best of your ability. Watching the exercise videos on the App is key to ensuring that you're performing these optimally. In return, I promise to be fully present during each session, in order to help you achieve your goals. Should you need to reschedule a session, I respectfully ask for a minimum of 24 hours notice. This will make the appointment slot available for another client to utilise.
The Equipment We Use To Optimise Your Rehabilitation
Compex : I use a neuromuscular electrical stimulation device following injury to increase the electrical signal to muscles again. The pain and swelling that occur following an injury can often lead to arthrogenic inhibition. Compex basically sends an electrical impulse from the machine to the muscle, with the aim of activating as many muscle fibres as possible. Some examples include the calf muscle following ankle sprains, ankle fractures and calf tears; or the quadricep muscle in knee injuries / surgeries.
Dynamo (Isometric Strength Testing Device) : Dynamo Tests Your Isometric Strength. Obtaining Baseline Scores Informs Us Of Where You Currently Are. Re-Testing Occurs Following An Exercise Programme To Gauge Your Improvement.
Blood Flow Occlusion Cuffs : I use VALD AirBands (blood flow restriction training) in the early stages of lower limb injury rehabilitation, to build muscle & increase strength
StatSports GPS : I use a GPS Tracker To Record Key Running Based Metrics Associated With Your Sport. Decelerations, Accelerations, High Speed Running & Total Distance Ran Are The Key Parameters Recorded.
Polar H10 Heart Rate : Alongside GPS Data, I Also Use Heart Rate To Ensure That Your Are Training In The Correct Training Zones, Therefore Achieving The Most From Your Training Sessions.
Conclusion
As a sports physiotherapist and strength and conditioning coach, ultimately my primary aim is to guide an individual safely and thoroughly through the rehabilitation process and back to playing sport. I believe that this is best achieved by following an adaptable systems-based approach, where regular objective testing guides decision making. I understand that this rehab process is not going to be for everyone, especially for someone looking for a quick-fix. However, for individuals seeking comprehensive rehabilitation for an injury with meticulous attention to detail, Buan Physio is here to help you return to sport.
Success Stories
"My 15-year-old son attended Buan Physio for a couple of months due to a knee MCL sprain. The rehab programme involved strengthening exercises with on-field rehabilitation. My son was very happy as Declan made it fun and we were very satisfied with the treatment and delighted to see him back at sport. We would highly recommend Buan Physio."
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