Why you should plan rehab programs for athletes differently

2017. Anneisha McLaughlin-Whilby of Jamaica lies injured. REUTERS/John Sibley

There are two reasons why clinicians should consider rehabilitating athletes differently than other individuals. Firstly, athletes are already highly trained with muscular adaptations for their sport. Secondly, they desire to return to a level of performance beyond community-based activity. Therefore, they start with a baseline of strength beyond most individuals, and they need to return to or go beyond that point when they return to sport.

However, too many athletes are lumped into the same rehab protocols as everyone else or placed in a group setting where the training is averaged across the group’s ability. Those who haven’t participated in a resistance program before their injury will make gains no matter the protocol of sets, reps, or resistance. But, athletes need a program structure that returns strength in muscles used to a training stimulus.

A group of researchers at the University of Tampa wondered how to structure a training program in a population already accustomed to resistance training(1). They recruited 26 resistance-trained male volunteers and randomly assigned them to one of two groups. One group (n=11) participated in an eight-week hypertrophy training (HT) protocol only. The other (n=15) performed a strength-training regimen for three weeks and then executed the hypertrophy training routine for five weeks (STHT). Both groups performed their exercises twice a week. Before beginning the study period, all subjects performed the same lower-limb workout for three weeks ( 4 sets x 8-12 rep max, 2x/week).

During the study period, the participants performed back squat and leg press 45º exercises. Both groups began their workouts with a warm-up of 1 set x 8 reps at 50% 1-RM, then 1 set x 3 reps at 70% 1-RM. The HT protocol progressed to 4 sets x 8-12RM with one minute of rest between sets and five minutes of rest between exercises. If the subject exceeded 12 reps, they increased the resistance of the exercise. After the warm-up, the STHT group performed 4 sets x 1-3RM with three minutes rest between sets for the first three weeks. Then they assumed the same HT regimen as the first group.

The researchers measured the growth in the size (via ultrasound) and the 1-RM strength of the vastus lateralis before the study began, after three weeks, and at the conclusion of the study. They found that while both groups experienced increases in strength and size, the STHT group demonstrated significantly greater gains in both. However, when analyzed for time, the STHT group’s absolute gains were significantly greater after the first three weeks, but not after the HT period of the last five weeks.

Practical implications

This study demonstrated that resistance-trained individuals achieved more significant strength and size gains when they performed a training protocol that consisted of a strength-training phase before a hypertrophy phase. The authors suggest that the heavier loads implemented early in this approach stimulate type II muscle fibers, which are bigger and grow faster than type I. Thus, along with bigger muscle size, the subjects developed greater power and increased their 1-RM.

This approach has implications when training athletes who play sports that require frequent sprinting or power moves (soccer, tennis, football, etc.). Consider a soccer player who is post-ACL repair. The recommended rehab course for such athletes is at least nine months. Eight or more weeks before their anticipated return to sport, begin a strength training phase that incorporates heavy loads with low reps. After three weeks, transition them to a hypertrophy phase to maximize muscle growth and strength.

This study examined young adult men with a mean of five years of resistance-training experience; thus, the authors urge caution in extrapolating the findings to other populations.  The results also may not translate to other muscles or the upper extremities. In addition, the study did not control for diet, which also contributes to muscle building. However, it highlights that clinicians should consider resistance-training principles and resistance-phase scheduling when rehabilitating athletes as they are already adapted to stimulus training, unlike the general population.


  1. Research in Sports Medicine,DOI: 1080/15438627.2020.1853546
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