Most athletes experience injury, and most of them do not let injury get in the way of their goals. They do whatever it takes to return as quickly as possible to the sports they love. However, this is where they often make the most missteps.
I asked Matthew Stevens, PT, DPT, and owner of Pure Physio rehabilitation center in Strongsville, Ohio, about how athletes can safely and effectively return to their training post-injury. Though seemingly simple in nature, his answers are insightful.
Too Much, Too Soon
Perhaps the most common mistake is trying to do too much before identifying the true cause of an injury. The pattern usually goes like this: something hurts, you RICE it, and you’re back in the gym a week later. However, if you have not pinpointed the root cause of the issue, you are likely to repeat the cycle.
“Injuries can often occur because of dysfunction somewhere else,” Stevens said. “That dysfunction may be a strength imbalance, a mobility or flexibility issue at another joint, or a motor-control issue resulting in altered biomechanics.”
That may require more than a few days of rest, or even a couple of weeks. “Once the underlying issue and/or cause of the issue is resolved, the likelihood of re-injury is reduced and the recovery time is decreased,” Stevens said.
Patience and Physical Therapy
After isolating the main problem area(s), an athlete may need to undergo physical therapy. Having recently experienced a shoulder injury and worked with Stevens to correct it, I asked him how best to move from a rehabilitation program back to a regular training program.
“Every sport or activity will have its own set of tests or goals that the patient should meet prior to progressing his or her rehab or returning to their sport,” noted Stevens. “I recommend incorporating your rehab into your training program until the symptoms have resolved and the underlying cause and/or imbalances have been addressed.”
And though therapy exercises may seem tedious and may not make us feel like we are making significant strides in recovery and training, we will recognize gains over time. The keys here are action and patience. Bodily tissues take a great deal of time to build up and repair themselves—especially connective tissues, which attune themselves to our activities much more slowly than muscle tissue.
Using physical therapy to recover from injury often feels like a frustratingly sluggish (and often depressingly pointless) process, but it is working. “Along the way, we are testing and retesting to ensure the athlete meets the requirements to move forward with their program,” Stevens said.
Setting up a series of progressions and milestones will help. “Generally, we are first looking to restore pain-free active range of motion, which tells us that the acute injury has healed,” he added. “From there, we start to work on any deficits in mobility, flexibility and muscle strength. Once the athlete has met the specific criteria we are looking for, we start to reintroduce more dynamic and sport-specific movements.”
Just as in your training, set up range of motion (ROM) or mobility tests for yourself or with your therapist on a periodic basis, about every 4-6 weeks. Move through the exercises methodically, making mental notes of what hurts and what doesn’t. If you are unable to complete the movement due to pain or lack of ROM, stop immediately and communicate with your therapist what you were feeling.
You can also incorporate metrics into your recovery process by scheduling regular appointments with your doctor, physical therapist, or trained professional to measure your range of motion using a goniometer (also known as a lateral protractor). Enter the results of each measurement into a spreadsheet to keep track of your progress. You can also record all of your recovery observations in a journal or a fitness-tracking app.
If you repeat these processes and review your previous notes after hitting each milestone you had set for yourself, your improvement will be apparent. “Once the issues have been resolved and proper movement patterns are restored,” said Stevens, “then the rehab exercises can start to be weaned out.”
What are some steps to avoid re-injury?
Surround yourself with with knowledgeable people (coaches, trainers, clinicians etc.) “Figure out your weaknesses and imbalances,” Stevens said. “Seek out a trusted coach or clinician to assess your movement patterns, strength and flexibility.”
Skill alone cannot save you from injury. You must have a balance in strength, mobility and skill in order to perform your best and remain injury-free. Spending a little time and money to figure that out is worth it.
Incorporate unilateral movements into your training program. I found this much more challenging than anticipated. With unilateral movements, athletes can focus their attention on correcting the balance and strength of individual limbs. For example, if your right arm is stronger than your left, in bilateral movements you place more pressure on your right arm to do the majority of the work. This puts you at a much greater risk for injury. Having balanced strength and ability in both limbs allows for better form, which in turn allows you to move more effectively and efficiently.
Set goals and have a plan. “The majority of injuries are due to errors in training—improper periodization, recovery, over-training, under-training, etc.,” Stevens said. “Develop a balanced training program that will help you reach your goals as well as address your weaknesses/imbalances.”
Much like you did in your recovery process, set milestones in your training program. Keep track of these goals and achievements in a training journal, and review your progress regularly to note patterns and help prevent injury.