06 Oct Rehabilitation Programs
By James Thomas
Following on from the previous post about tissue healing time frames, it’s important to relate healing back to the practical matter of recovering from injury, preventing further injury, and the importance of completing your full rehabilitation program.
When you see your Physiotherapist after injuring yourself, they will explain to you your rehabilitation plan, including how many sessions you’re likely to need, which exercises to complete at home, what manual therapy will be done, and how long all this is likely to take. How well you are able to stick to this plan, and follow it through to its completion, directly influences how well you return from your injury, in regards to both your performance, and risk of future injury.
An injury affects many systems and structures of the body. Take an ankle sprain for example, not only are the torn ligaments injured, but the surrounding muscles are affected, the ankle joint surfaces can be irritated, nerves can be sensitised, and even the bones can be painfully bruised. Your Physiotherapist considers all of these systems and structures when prescribing your rehabilitation program, taking into account the time taken for these to recover fully.
Recurrence of injuries is common, with rates as high as 34% for hamstring strains alone. It is important to consider that when rehabilitating an injury, returning to your chosen sport, work, or recreation does not necessarily mean that the rehabilitation is complete. The prevention of future injury is an essential part of the rehabilitation process.
Strengthening of new tissue
As discussed in the previous post, tissue in the body needs time to completely heal, and return to its previous compressive or tensile strength. Return to activity is usually possible before these final healing stages are complete, however completing your prescribed program assists injured tissue to return to the strength necessary to deal with the demands of your activity.
Return to pre-injury muscle strength and range of motion
Loss of muscle strength and joint range of motion is normal following injury, as the body protects the area and begins recovery. Continuing on with the strengthening of muscles and restoration of joint movement following return to activity is important, to avoid the overloading of other areas of the body. The human body is very adept at compensating for weaknesses, and can often hide these behind the overactivity of other muscles and joints for extended periods of time.
In the example of a hamstring strain, following return to sport, the other muscles that make up the hamstrings often do extra work so the body is able to move in the way it is used to. Over time, this can increase the risk of injury in these overactive muscles.
Proprioception is basically the body’s ability to detect the position and movement of the limbs. It allows the body to subconsciously make adjustments to muscle activation to maintain balance, effectively move, and respond to external forces.
Following injury, we lose some degree of proprioception of the injured joints and muscles, and those surrounding the area. This is often worsened with more serious, or chronic conditions.
One of the goals of a thorough rehabilitation program, is to restore proprioception following injury, to improve body awareness and minimise re-injury.
Progress beyond pre-injury level
Injury can sometimes be the result of a pre-existing weakness or stiffness in the body, exposed to a load that it is unable to cope with. In situations such as this, fully completing your rehabilitation program enables that part of the body to progress beyond the strength or range present prior to injury, so it is better able to handle the load it is exposed to.
Injury rehabilitation can be a complicated process, even for relatively simple injuries, and this hopefully highlights some basic reasons why ensuring you follow your rehabilitation program to its completion is important, with the end goal being to participate in your sport, work or other activities to the best of your ability.