The Activity is the Rehab
The purpose of a rehab plan shouldn't be just to get you out of pain and heal the injured area, but to prepare you to return to your sport or activity feeling confident and ready to go. This is something that is often missing from rehab. I’ve worked with countless patients who either completed rehab but didn’t feel they were ready for sports again, or who never progressed beyond simple rehab exercises and were still dealing with their injury. A great way to bridge the gap between rehab and a return to your activity is to incorporate the activity into the rehab; the activity is the rehab.
When and how we do this depends on factors like the type of injury, how long it has been present, the level of pain or sensitivity, and the sport itself. For example, for a runner who just sprained their ankle, we’re going to manage their pain and swelling and work on range of motion and strength before we worry about running again. But for a runner dealing with a hamstring tendinopathy, we may still be able to incorporate some running with modified parameters into their rehab if they can tolerate it.
The reason we need to incorporate the activity into the rehab plan comes back to the S.A.I.D. principle. With continued participation in a sport, we not only develop specific adaptations to that sport, but also a level of tolerance to its demands and forces. Each sport is going to have its own unique demands on the body, and nothing can prepare you for your sport like doing the sport itself.
Looking at running again since many sports involve some form of it, each stride can result in 2-3 times a person’s body weight going through their leg at a slower pace, and up to 6-8 times body weight at faster paces. Depending on the individual, the injury and equipment available, it may be very difficult to achieve these kinds of loads with rehab and strengthening exercises alone. Simple plyometric exercises like hopping and jumping come close to reproducing these forces and can be a great introduction, but ultimately if the goal is to return to running, then at some point the body has to be exposed to running again.
It’s important not to create a false dichotomy and think that strengthening isn’t important. Strength and rehab exercises build the physical strength and power needed for the sport and support the rehab process. Sport-specific activity prepares the body for sport by reintroducing those unique demands. Likewise, it doesn’t mean we just push through pain to maintain training tolerance. A good rehab program brings the exercises and activity down to a level the person can tolerate, and builds up from there.
Incorporating the sport into the rehab can also be great from a psychological aspect. Having to stop doing an activity you enjoy can make recovery seem more unattainable as thoughts of never being able to return may creep in. Finding ways to incorporate some degree of the sport can help you feel like a return is possible and provide encouragement along the way.
Rehab shouldn’t end when the pain fades; it should end when you feel prepared, and nothing can prepare you for your sport like doing the sport itself. Modify it to what you can tolerate, and build from there. That’s how you bridge that gap physically and mentally.
