Knowing what you can and cannot do is the crux of any rehab program and pushing the envelop of this is where changes occur and, ultimately, you get back to doing the things you enjoy.
We can run tests until the cows come home but the bottom line is what can you actually do before things begin to hurt. We may be test you in a number of different exercises for our subjective and objective tests in the clinic but these really only give us a guide as to what you are capable of.
When placed in a more real world situation we are going to get much more useful information about what you are capable of before your symptoms start to return. This is really valuable information as we always want to be pushing this envelope in order to elicit the adaptations that we need to happen for you to return to full fitness.
It is this real world “testing” that is one of the reasons why I never suggest to completely avoid the activities that you normally do. Yes they may need scaled back a bit, or a lot, but without them we can lose perspective on what it is we are trying to achieve. That is to say have you running, lifting, playing sport, climbing Munros etc.
The body is pretty stingy with it’s resources and will only use them when it has to. It is quite possible then to find that the rehab exercises are doing a great job and your ability to perform them is improving, your movement is improving and your pain reducing but when it comes to the tasks that you really want to do this begin to break down
If we take running as an example as it is relatively simple verses say golf.
It may be as a runner that you are completely fine at an easy pace up to 6 miles but at 7 miles things start to ache a bit over the last mile and maybe a little after the run but at 8 miles you are sore during the last couple of miles, immediately after the run it continues and into the following day.
The spot that we want to be around is generally around where there is the possibility of some soreness but not sufficient that it lasts beyond performing the activity itself.
If we sit to far below the point where symptoms are provoked then we end up in a situation where the load is to low to elicit change and you begin to de-train. Too high and we provoke to much of a reaction and make things worse resulting in having to wait for things to calm down again before being able to make any progress.
There comes a point in the rehab process where we need to test things. There is a need to find out just what you can do before your symptoms return. In essence then the information we need is;
- How far/how much can you do can you do without pain?
- If it gets sore, how sore is it on a scale of 1 -10? (1 being barely noticeable & 10 being take me to hospital)
- How long does the pain take to settle?
If we take the numbers from the running example above we can see that your training runs want to sit around 7 miles, 6 is too easy and 8 too hard. Being able to maintain your easy pace over 7 miles with little discomfort allows us to have a very measurable marker as to how things are progressing. If at this pace you are gradually able to move towards 8 miles without increasing the pain levels beyond a 3 without any lasting pain then we know that things are moving along nicely.
This applies to any activity you can think of. You want to maintain things at a level that create a little bit of irritation, not necessarily every session but there needs to be enough of them that you know you aren’t cruising along not demanding anything of your body. It’s in finding this balance between what is enough to elicit a positive change and what is too much that the Sports Therapist, Physio etc really earns their money and if your they aren’t pushing you into a bit of discomfort and challenging you they aren’t really doing you any favours.
If we go back again to the injured runner. If we assume that the overall volume of the running has been reduced this gives you ample time between where work runs we can be done on improving any strength, flexibility or control issues that have been identified at the beginning of the rehab process. These tests are a means to an end and simply allow to see if injured areas are improving outside of of the activity itself. So whilst it is good to see improvements they aren’t the be all and end all of the process. If they are improving but performance isn’t then we know that something else is the issue. This said, if these haven’t been done before then the overall impact can be quite large.
Another important point of keeping chosen activity in the mix is to avoid of being scared of what might happen when you return to it.
You might say our motto is “Thoughtless, Fearless, Movement” which is to say that we want you to move in a manner that you don’t fear it or think about it. We can’t really achieve this if we remove running from your rehab if you are a runner, golf from your rehab if you are a golfer etc etc. We may need to regress things from the point of view of how much you are doing but, ideally, we don’t want to remove it altogether as this means there is a fear hurdle to be overcome at the point we return it to your program. As Greg Lehman says our job is to “Calm shit down, build shit back up”.
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