If your client, or you yourself, have been injured and are ready to start training again, the last thing in the world you want is for the injury to recur. What should you do?
Obviously, the answer is to carry out functional strengthening exercises (i.e. routines that mimic the demands of the sport) to bolster the part of the body which has been injured. Such exercises will shore up muscles and connective tissues that have been weakened by trauma and disuse, thus allowing the athlete to perform at his/her best and decrease the risk of future injury.
Below, we've listed some of the most common sports injuries, and provided you with a key 'rehab' exercise to build the damaged part of the body back up again. Make sure the athlete has a medical 'all-clear' before carrying out any of these exercises.
tight sore hamstrings , hamstring pulls strengthening
Solution: bicycle leg swings
To carry out bicycle leg swings, stand with your weight fully supported on your left leg (you may place your right hand on a wall or other support to maintain balance). Begin by flexing your right hip and raising your right knee up to waist height (your right thigh should be parallel with the ground). As you do this, your right knee should be flexed to 90 degrees or more. Once your thigh is parallel to the ground, begin to extend your right knee (swing the lower part of your right leg forward, unflexing the knee) until your knee is nearly fully extended (i.e. your leg is nearly straight), with your right thigh still parallel to the ground.
As your right knee nears full extension, allow your right thigh to drop downwards and backwards until the entire thigh and leg are extended behind your body (as if following through on a running stride). Your right knee should be near full extension (your leg should be straight) until it reaches the peak of the backswing. As your right hip nears full extension (i.e. as you approach the end of the backswing), raise your right heel by bending your right knee; your heel should move closely towards your bottom as you do this. As this happens, move your right knee forward until it returns to the appropriate position in front of your body, with your right thigh parallel to the ground. Repeat this entire sequence of actions in a smooth manner such that the hip and leg move though a continuous arc without stopping or pausing. Once you are able to coordinate the movement, strive to perform the swings at a cadence of at least 12 swings every 10 seconds (slightly faster than one swing per second).
Begin with one to two sets of 15 to 30 repetitions with each leg. As you become more comfortable and skilled with this exercise over a period of several weeks, progress to one to two sets of 40 to 60 repetitions. To more closely mimic the specific action of running, it is important that you increase the speed and ballistic nature of the movement over time as well.
Once you are an accomplished bicycle leg swinger, carry out the exercise with a piece of rubber tubing attached to the ankle of your swing leg and anchored to a fixed point at knee level in front of you (such tubing can be purchased from athletic-supply firms; start with beginner bands and work up to advanced models). The tubing should be stretched somewhat when you are standing in the starting position. In addition, the tension should be increased (by standing farther from the fixed point or increasing the strength of the tubing) as you gain more strength and coordination with the exercise. As is the case with all of the exercises recommended in this article, you should warm up
with at least 10 minutes of easy jogging or cycling before performing the swings.
ACL (Anterior Cruciate Ligament) Tears/Surgery
Solution: one-leg squats with lateral hops
Stand with your left foot forward and your right foot back, with your feet about one shin-length apart (your feet should be hip-width apart from side to side). Place the toes of your right foot on a step or block which is about six to eight inches high ( fig 1) Most of your body weight should be directed through the heel of your left foot.
Then, bend your left leg and lower your body until the left knee reaches an angle of about 90 degrees between the thigh and lower part of the leg. Then, hop upwards and laterally, so that your left foot lands about six to eight inches to the left of your take-off point (fig 2). Upon landing, immediately descend into another squat and again hop upward, (fig 3) but this time hop back to your original take-off point (six to eight inches back to the right).
Finally, hop to the right a distance of about six to eight inches, descend into another squat, and then hop back to the starting, straight-ahead position. Be sure to maintain upright posture with your upper body as you do this, and hold your hands at your sides throughout the squatting and hopping movement. Complete a total of 12 lateral hops (to the left and to the right) with your left leg before switching over and doing the same thing with your right leg. Perform a total of three sets with each leg, with 30 to 60 seconds of rest in between.
Make certain that you perform these one-leg squats with lateral hops only on soft ground, an aerobics floor, a wooden gym floor, a grassy surface, a rubberised track, or some other resilient surface which offers some 'give'. Hopping repeatedly on concrete or asphalt may increase the risk of overuse injuries to the lower part of your leg.
Why are the one-leg squats with hops important? Sudden changes in direction while running and jumping can re-injure your ACL, due to the increased stress placed on the knee. Lateral hopping movements help prepare the ACL and muscles around the knee for these sudden (and often times unpredictable) movements in the frontal (side-to-side) plane. It's a great exercise!
Solution: the balance and eccentric reach with toes
To carry out the Balance and Eccentric Reach with Toes, start by standing on your right foot only as you face a wall, with your right foot about 30 inches or so from the wall (you may need to adjust this distance slightly). Your left foot should be off the ground and positioned toward the front of your body, with your left leg relatively straight.
Then, bend your right leg at the knee while maintaining your upper body in a relatively vertical position and nearly directly over your right foot. As you bend your right leg, move your left toes toward the wall until they touch, keeping the left leg relatively straight. End the movement by returning to the starting position.
Then, complete essentially the same motion, but move your left foot forward and to the left, again keeping your left leg straight and attempting to make contact with the wall. Your left foot may not quite reach the wall, since you are moving in a frontal plane (from right to left) in addition to the straight-ahead, sagittal plane. Notice that your right ankle pronates as you do this (i.e. rolls inward), simulating the natural pronation which occurs during the stance phase of the gait cycle in running and forcing your right calf muscles and Achilles tendon to eccentrically control both dorsiflexion and pronation, as they naturally do whenever you run.
Return to the starting position and then carry out essentially the same motion, but with your left foot crossing over the front of your body and going to the right as you attempt to touch the wall. As you do so, your ankle supinates, as it naturally does toward the end of the stance phase of the gait cycle. Then return to the starting position. Do a few (4 to 6) reps (the straight, left, and right motions make one rep) on your right foot, and then attempt the same exercise with your body weight supported only on the left foot and your right foot moving ahead. A useful feature of this exertion is that it also does a fine job of strengthening your knee and hip muscles and coordinating their activities with what is happening down at the Achilles and calves.
Never attempt the Balance and Eccentric Reach with Toes unless you have warmed up properly. If you've been prone to Achilles-tendon problems, here's a good routine to get into: at the very beginning of your workout, warm up
by jogging easily for 10 minutes. Then, carry out the Balance and Eccentric Reach with Toes before continuing on with the rest of your session.
To make sure you don't put too much stress on your Achilles at first, use slow speeds of motion, modest ranges of motion (not very much bending at the knee), low resistance (just your body weight), and very few repetitions (only 4 to 6).
Once you're comfortable with doing the exercise Balance and Eccentric Reach with Toes, you can begin incorporating greater speeds, larger ranges of motion at the knees and ankles, heavier resistances (starting with very light dumbbells held in the hands and moving up to heavier 'bells), and more repetitions (starting with 7 to 10 and gradually moving up to three sets of 20 to 30 reps). The idea is to progress in difficulty as you progress in strength and coordination.
Solution: toe walking with opposite ankle dorsiflexion and toe grasping
To toe-walk with opposite-ankle dorsiflexion, stand as tall as you can on your toes - while BAREFOOT. Balance for a moment and then begin walking forward with slow, small steps (take one step every one to two seconds, with each step being about 10 to 12 inches in length). As you do this, maintain a tall, balanced posture. Be sure to dorsiflex the ankle and toes of the free (moving-ahead) leg upward as high as you can with each step, while maintaining your balance on the toes and ball of the support foot. Walk a distance of 20 metres for a total of three sets, with a short break in between sets.
Toe Walking with Opposite-Ankle Dorsiflexion is important because the muscles of the feet require good strength to control the forces associated with landing on the ground as you run. This toe-walking exercise helps to develop the eccentric (support) strength and mobility in the muscles of the foot and calf, as well as the plantar fascia and Achilles tendon (eccentric strength means hardiness as these structures are being stretched out). The exercise also works the foot and ankle through a broad range of motion, especially the foot which is bearing weight on the ball and toes. The exercise also improves balance and stability, which are critically important for athletes in general.
To engage in Toe Grasping, stand barefoot with your feet hip-width apart. In an alternating pattern, curl the toes of your right foot and then your left foot down and under, as though you are grasping something with the toes of each foot. Repeat this action (right foot, left foot, right foot, etc.) for a total 50 repetitions with each foot. Rest for a moment, and then complete two more sets of 50 reps for each foot. Try pulling yourself across the floor (smooth surfaces work best) for a distance of three to six feet as you become more skilled at this exercise.
Toe grasping develops strength, coordination and flexibility in the muscles of the foot that run parallel to the plantar fascia and help support the longitudinal arch of the foot. This exercise also strengthens selected stabilising muscles of the calf and shin. Your range of motion during the 'grasping' action will improve over time, as will the range of motion of the entire foot.
Shin splints (medial tibial stress syndrome)
Solution: heel step-downs
To carry out Heel Step-Downs, begin with a standing, natural, erect body position, with your feet about shoulder-width apart, and then step forward with one foot. The length of the step should be moderate - as though you were walking in your normal manner. When your heel makes contact with the ground, stop the foot from fully plantar flexing, ie, use your shin muscles to keep the sole of the foot from making contact with the ground. After heel contact, the ball of your foot should descend no more than an inch toward the floor or ground; your foot is held in check by the eccentric contractions of your dorsiflexors (shin muscles). Return your foot to the starting position (back by the other foot), and repeat this basic stepping action a total of 15 times. Then, shift over to the other foot and complete 15 steps. Progress to three sets of 15 reps over time.
Once you are the master of the basic heel step-downs, perform the same exercise - but with dramatically longer steps. Using lengthier steps will increase the accelerating forces placed on the dorsiflexors and force them to work more forcefully and quickly, as they must do during running. Start with one set of 15 reps of long steps per foot, and progress to 3 x 15 on each foot over time.
After you've become skilled with the long-step heel step-downs, you're ready to carry out the heel step-downs from a step or bench, which will increase the forces on your shin muscles to the greatest extent - and build the greatest amount of strength. Use a bench or exercise platform which is about four inches off the ground to carry out your stepping. Except for beginning each step from a bench, your movements are the same as they are in the basic step-downs; the idea is to land on the heel of the forward foot and then use the shin muscles to prevent the sole of the foot from making contact with the ground (again, don't let the ball of the foot move downward by more than an inch). The actual length of the step is moderate at first (you can progress to long steps later). As before, begin with 15 reps per foot, and progress to three sets of 15 reps as you gain strength and coordination.
Important point: while these exercises will help you come back from a performance-limiting injury, they can also be used to prevent injury in the future. If you have a weak area which is currently okay but is prone to trouble (hamstrings, Achilles tendon, plantar fascia, etc.), carry out the appropriate exercise described above on a regular basis to lower your injury risk.