Rehab vs Training Methods

Nikki Donovan

Same goals and principles, different starting points.

Similarities:

Progressive overload

Increasing strength and resilience

The need for intensity and volume

For good results, adequate recovery is essential


Differences:

Training = neuromuscular education

Rehab = neuromuscular re-education

Meaning that the reason for the injury in the first place is usually compensations, poor movement patterns, less-than-ideal recovery methods, overtraining etc - essentially the body breaking down in some way and therefore needs to be re-educated properly.

Relative Stress:

Training for performance = stress on the body (this response is needed for adaptation).
In the injury rehab world, our job as clinicians is to help patients increase function, so we need to cause some amount of stress through our rehab methods.

Performance is a relative term - different goals for inactive 75 year old and a 20 year old elite athlete. But the principles of rehab are the same.

Relative stress causes physiological adaption and performance gains - so both patients need to be exposed to similar relative stress - it's just how these stresses look that changes.

This tends to be where the industry can fall short, as obviously the athlete's level of stress would need to be much higher in order to result in physical adaptation.

Replicating each individual's daily lifestyle habits and training/sport is therefore really important and not to be overlooked.


Late stage Rehab - How will you go from banded rotator cuff work to doing muscle ups?

Another thing I have noticed is that late stage rehab can be overlooked. This isn't a criticism, but an observation. Most initial exercises are spot on, and a lot of time is spent here.

Maybe the client has lost motivation by the time we get to later stages, or is it a lack of understanding by the clinician of the client's needs/sport? Perhaps its nobody's fault.

Buy-in from clients is also difficult at later stages of the programme as they are now pain/symptom free, excited to get back into training and can feel as though they are already "fixed".

Progression is important, especially if you're planning on going back to performing complex movements under fatigue.

Progressive Overload:

A well known concept for training programmes, but also essential for effective rehab.


What is it?

Gradually increasing stress placed on the body

Body adapts to demands placed on it, being able to handle increased load by becoming faster, more efficient, stronger etc

If we don’t place this stress on the body, it will become complacent, causing a training ‘plateau’ (no increase in strength, power, speed or endurance)

This is widely used as a principle in strength and conditioning, but can be overlooked in injury rehab.

So what if an exercise is..

Too easy?

If no longer physically challenging, its time to progress

Ensure progression is gradual and consistent (the progression should make sense!)

Prioritise correct technique in new progression

Don’t be afraid to regress or change the progression if necessary

Advance in small increments (and don't jump ahead!)

Too hard?

If you cant maintain proper form, if it's causing pain, or if you just cant feel the exercise working, the progression might be too intense

Maintaining form is very important, while we are using progressive overloading to get the best rehab results, we don’t want to cause different injuries with poor form and inappropriate progression choices

Pain is an important indicator and can also interfere with your ability to perform an exercise effectively

A little pain and discomfort is to be expected at some stages of rehab, work on the 4/10 rule – if an exercise is less painful than 4/10 then continue, if it's above a four or it worsens as the reps/sets go on, stop and regress the exercise.


Volume vs Intensity:
Two very different approaches here.

Rehab - increase volume before intensity (volume = sets and reps, intensity = speed, weight), in order to build tolerance to load etc.

Use load tolerance tests, manage pain levels etc for feedback and accept that every day can feel different (ups and downs).

Training - intensity is king. This is where the magic happens. It hurts. This is what gets you fit.

Principles for Training and Rehab:

Increase training stimulus without exceeding your bodies capability to recover.

Focus on technique and form as a priority.

I might have gone off on a bit of a tangent, but just to give you a few ideas regarding training and rehab principles.

Working as a clinician and CrossFit coach allows me to bridge the gap between rehab and training with my clients, especially at late stage rehab.

Every programme I write, I keep these principles in mind.

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