8 Post Rehab Tips before Increasing Training Load and Preventing Future Injuries:

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There are important steps, stages and tips when it comes to patients who have had injuries, were in rehab and now are close to going full tilt into training. They are at that stage where their symptoms may have significantly diminished BUT they still need to build their strength, stability and durability to train at peak levels. At this stage if they are less than careful, they may have a set-back. Therefore it is important to have a proper plan in place in a post-rehab exercise scenario.  

In this writing I will lay out a potential plan that could be utilized that may help to get people back into a more proper training mode. This is based on my own experiences with my own injuries and from my years of experience as a therapist.

Please be sure to consult with your healthcare provider regarding your own personal plan for post-rehab training. This is for educational purposes and very general in nature. Everyone and situation is different and to get the best care for yourself, you need someone who has actually treated you or at the very least assessed you. 

The items discussed are based on general injury. This could be from an ankle sprain, chronic pain and tightness due to tight muscles and fascia to upper body injuries. I will break the reasoning behind each point.

Below are 8 key points that I will be discussing in this paper. The first 5 are actually more like stages.

1. Normalize range of motion.

2. Core strengthening.

3. Work on postural weaknesses..

4. Assess and work on any weaknesses of the Hip Flexors.

5. Balance the pelvis.

6. Work slowly to build strength both at the local area of injury and as a total functional unit.

7. Increase workload once you improve your strength base.

8. Ideally have at least 1 flexibility, stretch day in your training. Strive for at least 30 minutes.

*Cardio

Let’s start with a typical scenario. A patient/client has come to see me with lower back and hip pain on one side. The symptoms are due to muscles that are in spasm, fascia (the connective) tissue that has become tight and a general muscular imbalance of the muscles that attach to the pelvis.

This individual has had to stop training for a marathon because of the pain and discomfort. They are concurrently working with a Physiotherapist (Physical Therapist) doing rehabilitation exercises.

After 8 weeks of treatment the patient/client has significant positive changes in their symptoms. They have been discharged by the Physio with rehabilitation exercises to perform on their own.

The patient/client knows that they are better and they also understand that the exercises helped but they also know that they need more. More in regards to getting them to the point of feeling strong and stable so that they can perform at a high level for their sport.

So what should they do?

1. Normalize range of motion

The rehabilitation exercises may have included stretches and there could potentially be an improvement in range of motion. Having said this, there is an improvement but they may be short in regards to the range of motion to perform exercises properly and to function at a high level of training.

The question is, why is this important and why is this the first stage?

The answer is simple. If there is limited range of motion around a joint such as the hip, they could do strengthening exercises BUT it will only be strong within the given range that they can perform.

If you are in a sport or your training requires more range relative to your post injury range, then one needs to look at improving that via a range of motion exercises and flexibility training such as dedicated stretching.

The improved flexibility may also prevent injuries because there is more “give” to the muscles being used. This is important especially in explosive types of motions where a lot of force is exerted on the muscles and joints.

Because of the reasons listed, this is the reason why this is listed as the most important stage.

Remember this saying, “length before strength.” 

2. Core strengthening

Core strengthening can be done concurrently with normalizing range of motion. What exactly is the “core”. Below are pictures. These muscles stabilize your back acting like a brace, maintain posture and allow for efficient transfer of energy from lower body to upper body and from upper body to lower.

A strong core helps prevent injuries and NOT only to the lower body but also to the upper body as noted by a research paper written….

The more intense your training and event, potentially the more intense your core training should be.

The core is the central region where there is transfer of energy/forces from the lower body to the upper body. A weak core potentially means, weak transfer of energy  

Typically in  functional movement, the core is the weakest on most people. This exposes people with weak cores to potentially future injuries and even an increase in frequency of injuries.

A stronger core helps stabilize the back. 

3. Work on postural weaknesses

What do I mean by this? When I talk about “weakness” in regards to posture, I am NOT necessarily talking in regards to strength. What is meant by this is; what is causing your bad posture? Is it that  your pectoral muscles are extra tight and that the muscles that pull your shoulder blades back are weak and lengthened, causing a rounded shoulder posture? Could it be that your Iliopsoas muscles are tight and short and your hamstrings are lengthened and weak?

Working on your posture may help with preventing injuries. A good example of this is the individual who has rounded shoulders because of tight pectorals and weak Intrascapular muscles (the muscles between the shoulder blades).

This position puts your shoulders in a biomechanically terrible position, especially when it comes to bringing your arm up over your head. This position can affect one of the Rotator Cuff tendons, the Supraspinatus tendon. In this position when raising your arm, the tendon can abut against a bony structure called the Acromion. Over time this tendon can become irritated, potentially causing wear and tear on the tendon.

Imagine a competitive swimmer. Swimming requires potential overhead motions with the arms. Due to this motion, there typically is a rounded shoulder posture that is observed with people that swim competitively. 

As an individual that over uses the muscles at the “front” of the shoulders, it is a very good idea to consistently and at a higher frequency perform exercises that correct shoulder and neck posture.

Posture correction may affect your mechanics in a positive way as to prevent potential injuries.

4. Assess and work on any weaknesses of the Hip Flexors.

In regards to this, it is especially important to assess the Iliopsoas muscle. Other hip flexors such as the Rectus Femoris and Tensor Fascia Latae may also be dysfunctional and cause issues. In fact presentations may have two or more hip flexors causing pain and dysfunction. 

The Iliopsoas muscle, if dysfunctional, may cause all sorts of issues. This could be from lower back and hip pain to groin and upper thigh discomfort. 

The root of this issue may be determined by how the muscle may present. For example, you may have lower back pain on one side. Could it be that there is shortness and tightness of the Iliopsoas on one side, rotating the spine causing pain on one side? What if the person has a pain where the lowest segment of the lumbar spine seems to feel “compressed” on the sacrum? Could it be that there is tightness and shortness of both sides, rotating the pelvis forward and downward causing a wedging of the lowest lumbar segment to the Sacrum.

These are just two examples of potential presentations. Due to how complex presentations may present it is a very good idea to have it assessed by a professional such as a Chiropractor, Physio/Physical Therapist or Massage Therapist, to determine your needs.

5. Balance the pelvis.

What does this mean? Below is a diagram of the Pelvis and the muscles that attach to it. Muscles such as the Hamstrings, Rectus Femoris, Adductors, Glutes, Erectors attach to the Pelvis.

The Pelvis can become highly dysfunctional and potentially cause chronic pain and tightness. This can be due to muscle imbalance. For example, you can have short and tight Rectus Femoris and Gluteus Medius on one side along with weak and lengthened Hamstrings. This may cause that side of the Pelvis to be rotated forward and downward causing muscles in the lower back, such as the Quadratus Lumborum muscles to compensate and work harder to stabilize the lower back and Pelvis. The person may present with one sided lower back pain.

Balancing the Pelvis is a continuation of the previous 4 points that have been discussed. 

What usually happens is that over time individuals who may have an imbalanced Pelvis may notice nagging chronic pain and tightness that slowly builds over time. Typically, in the initial phase the person may be able to stretch and reduce the discomfort. However as they continue training or intensifying their training, they may notice the issue becomes harder and harder to get rid of.

When it eventually gets to this point, it is a good idea to consult with a rehabilitation professional to hopefully help you make corrections before it becomes a more prolonged issue.

Depending on the results of assessment, the professional may give you specific exercises to help you with your condition.

6. Work slowly to build strength both at the local area of injury and as a total functional unit.

This seems like a very common sense approach. You want to build the area of local injury along with improving functional strength through functional training.

What does this mean? It means your training should include strengthening that trains the body to work together in sequence. A good example is a baseball hitter. The final motion through the hitting plane is through the forearms and wrists. But the action of hitting requires sequential motions from the feet through the hips, spine and eventually through the arms and wrists.

It makes minimal sense just to train and isolate the forearms and wrists when it requires a coordinated flow of force from bottom to top. 

If you are able to break down the actions of your specific sport you may be able to find exercises that you can add resistance that “mimic” the motions of that particular sport/event.

The key is specificity, The more specific, the better.

If you are unsure, this is another case where it is probably a good idea to consult with a rehab/fitness professional.

7. Increase workload once you improve your strength base.

Workload is dependent on the type of sport/event you are training for. The workload for a marathoner is different from a sprinter. It seems very obvious. 

If you have noticed I have emphasized the adage of “slow and steady progress”. I will underline this again. 

It is my experience that patients/clients when feeling very good have a general tendency to up the intensity very quickly. As a therapist, I try to dissuade patients/clients from this. I have seen many cases over the years where setbacks have occurred because of being over enthusiastic about training.

Pace yourself and think long term. You may have to skip one event because of an injury but because of your patience, you may end up doing many more events in the future because of the way you decided to progress. 

What you want to avoid are long term and prolonged setbacks that may hold you back from training. 

8. Ideally have at least 1 flexibility, stretch day in your training. Strive for at least 30 minutes.

A severely under rated portion of your total training program is the focus on flexibility. Typically, stretching and flexibility training are rushed. Some do5 minutes of stretching either before or after working out.

It is an after thought. Over the years because of my career as a Massage Therapist who focuses on aggressive treatments and have had injuries in the past, I have learned the importance of a good flexibility protocol complementing the other portions of training.

Combine my personal experience with my experience with chronic injuries, I understand how important this aspect is.

I call it a “flexibility” protocol as opposed to just “stretching” because I would also like to include foam rolling,pressure points and techniques for the fascia. This is of course, if you understand and know how to utilize these tools. If you have watched a number of our videos, we have a few of them that speak on specific pressure points and techniques for the fascia. You might want to try typing “fascia” or “pressure points” in the search bar and you will get videos regarding your search.

Soon we will be adding protocols that you can access as a paid member.

Your protocol should be very focused and have at least one day where you really take your time with your protocol. This may take between 30-45 minutes. This is along with your flexibility training during your typical workouts. 

As an example this is my protocol: 

I train 4-5 days a week. At the tail end, I spend approximately 20 minutes on a focused flexibility protocol. Every couple of weeks or so, I will spend about 30 minutes on flexibility training, where I use stretching, foam rolling, pressure points, techniques to the fascia and breathing exercises.

On a daily basis, every morning after I wake up, I will do stretching, range of motion and breathing exercises. Typically, this lasts about 10 minutes a day. 

By the way, I have been doing this routine for about 7 years now, consistently. My protocol is more for my career and the hope is that it translates to longevity. 

The flexibility protocol may help with injury prevention. The key is in the intent and focus that you perform the techniques. What you may find also is that it also can improve general wellbeing.

Another key that you want to take into consideration is doing a protocol that works on the whole body as opposed to just focusing on one muscle or body part. For example, it’s great to perform stretches for the Triceps but are there actual motions/stretches that improve the flexibility of muscles that may work together for example, the Triceps along with Latissimus Dorsi muscles and Deltoids?

You want to look at your body in what I call “chains”. You may have already noticed this concept. For example you may have rotated your trunk a certain way and may have noticed tightness in the upper thigh groin area. Or you may have been stretching your Tricep and noticed a pulling sensation of the Lats into your lower back.

These are examples of “tightness chains”. This may develop from habitual chronic actions that tighten an overworked chain of muscles (these are muscles that may work together in sequence) and the fascia  over time.

Just like with functional strength training, it is a good idea to do a “functional” flexibility protocol, targeting tight chains. I will have more on this in later posts.

*Bonus: Cardio training

The importance of cardio training specifically from a sports performance stand point is that it can help improve muscular endurance. Improving muscular endurance is beneficial in that it can help maintain exercise technique for a longer duration.

As muscles become tired, what can happen is that technique starts to fail and as technique fails, may cause injury.

Improved muscular endurance may help with managing technique for longer, especially as you increase your intensity.

Improved cardio may also help with repair and recovery and this is obviously important in consistent high intensity training.

Final Thoughts

There are important steps, stages and tips when it comes to patients who have had injuries, were in rehab and now are close to going full tilt into training. There is a missing link from rehabilitation to full tilt training. That link is a very important component to longevity of training and injury prevention.

Typically, individuals attempt to go straight into full-tilt high intensity training, once they feel better. As both an observer as a therapist and one who has had multiple injuries, this methodology may get exposed and potentially cause longer term setbacks.

Ideally, one should have a game plan to bridge rehabilitation with intense training. A proper game plan may help with injury prevention and a longer lifetime within your activity or sport.

Hopefully, this writing has given you information to further help you in your training especially if you just had a recent injury. 

Lastly, if you are interested in a sample protocol, please let me know in the comments below. Thank you for reading this blog. We will see you in our next post!