Sports rehabilitation training

Raphael Brandon sets out some rehabilitation training regimes to safeguard athletes’ baseline strength and conditioning

No one would wish injury on any athlete, but they are a reality for most, so it is extremely useful to learn to treat rehabilitation in a positive way. The time an athlete spends recovering from injury can be turned to good advantage for conditioning training. In the course of normal training, athletes tend to concentrate on the specific aspects of fitness that have the most benefit and direct relationship to performance. Thus endurance runners spend the vast majority of their training hours running, and tennis players spend most of their training hours on court hitting balls.

Yet there are many elements of training that can be directly or indirectly beneficial to an athlete’s performance. The runner may benefit from leg strength training, but has not had time to fit it in; the tennis player may need to increase speed but does not focus upon it. As athletes have to prioritise their precious training hours, many find it impossible to fit in everything that might be required of them.

Periods of rehabilitation from injury can be used as opportunities to follow conditioning programmes that focus on different training elements – those that the athlete would normally neglect for lack of time. The type of activity chosen must be one that will not adversely affect the injury. But even within this obvious limitation, there is usually an activity type and goal that the athlete can achieve during the rehab period.

Here we set out some types of conditioning work that can be carried out during injury rehabilitation. These training programmes are intended to run alongside the specific rehab exercises that the athlete will be undertaking for their injury.

The setting of alternative goals that improve overall athletic ability and conditioning levels is a sound method of keeping an athlete focused in times of injury and can be important for their self-efficacy – their confidence that they are moving towards their sporting goal.

Injury: Lower limb fracture or joint sprain

Conditioning aim: Upper body strength

Sports in which higher levels of upper body strength arguably improve performance include: rugby, combat sports, water polo and swimming, rowing and canoeing. But this programme is also beneficial for individuals who have below average upper body strength for their event, regardless of sport.

The key principle of the programme is to develop balanced muscu- lature, front and back of shoulder girdle and arms. Exercises for the rotator cuff are included to help prevent any shoulder-joint overuse type injury.

Three programmes are outlined:

* novice: suitable for those with a limited strength training history

* intermediate: for those with good strength training history

* hypertrophy: targeting the build-up of muscle mass.

Programme 1: Novice (Table 1)

Frequency: 2 to 3 times a week

Programme duration:4 to 6 weeks (Thereafter, if the athlete’s injury means they still have time to devote to upper body strength training, you will need to progress the programme)

Resistance:The correct weight for any exercise will be the one at which the final set in the series is difficult to complete with good technique.

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Programme 2: Intermediate (Tables 2 and 3)

Frequency: 2 to 3 times a week, alternating between A and B programmes

Programme duration:4 to 6 weeks

Resistance: Select weights that require some effort to complete the set, but without fatiguing until the last set.

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Programme 3: Hypertrophy (Tables 4 and 5)

Frequency:Alternate between A and B, performing each programme 2 times a week

Duration:4 to 6 weeks

Resistance:Set weights that result in complete fatigue (failure) by the final set of each exercise.

Use short rest periods between sets to limit muscular recovery in order to induce hypertrophy.

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Injury: Any lower limb injury

Conditioning aim: Non-impact aerobic fitness

For most athletes it will be important to maintain baseline cardio fitness during any layoff for injury. This menu of workouts will be suitable for maintaining the endurance that all team and individual players require. Games players tend to have moderately well developed VO2max levels, eg 45 to 60ml/kg/min. It is feasible to maintain this level of fitness with non-impact or cross-training methods. Choose the workout most appropriate to the athlete’s particular injury, fitness level and goals.

Specialist endurance athletes with VO2max levels greater than 60ml/kg/min will need more advanced and tailored maintenance training than given here.

Use the Miller formula(1)to estimate maximum heart rate: HR max = 217 – (0.85 x age)

Use the score unamended for the Versaclimber (Table 6) but subtract 5bpm for the row (Table 7) and cycle ergometers (Table 8), as these exercise modalities invoke slightly lower maximum heart rates.

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Injury: Upper limb injuries that allow running

Conditioning aim: Speed

Upper limb injuries that keep an athlete out of their sport but still allow them to run (eg, a wrist fracture in a football or rugby player) offer the opportunity to develop speed.

You should note that to develop speed requires the athlete to practise technique as well as improve their general conditioning, so it really needs the input of a coach in addition to following a set programme such as given here.

There is good research supporting the use of resisted sprinting for the development of straight-line acceleration in games players(2). Regular practice of maximal sprints over 20-40m, pulling a sled of 15-20% of bodyweight, seems to be effective in increasing speed over these distances.

It is likely that for the games player who needs to be fast, but who is not a sprint specialist, this kind of training provides a specific power development stimulus. From this research it seems that games players could derive some good improvements in speed, even without the input of a specialist coach.

Workouts must be performed fresh (not after endurance or heavy strength training) and must be preceded by a good dynamic warm-up and a number of easy strides (relaxed running at full stride, no sprinting) over 50-60m.

Frequency:2 per week (1 each of A and B)

Duration of programme:4 to 6 weeks.

Speed conditioning: A

Intervals:8 x 40m maximal resisted sprints

Resistance:Pull a 10-15kg sled attached to a harness on the athlete’s trunk

Rest intervals:2 to 3 mins full recovery between sprints

Intensity: Maximum effort for each work interval.

Speed conditioning: B

Intervals: 4 x 30m maximal resisted sprints

Resistance:10-15kg sled

Rest: 2 to 3 mins between sprints

Followed by: Intervals: 4 x 30m max sprints