Training equals rehab, rehab equals training is a phrase that was coined by the American physio Charlie Weingroff. For me, the phrase means that rehab and training do not stand separately from one another. They are a continuum that blends seamlessly together. Parts of the rehab process sit at one end of the spectrum and parts of standard training are at the other the rest sits in the middle being neither one nor the other. Properly progressed rehab should resemble basic strength training and properly performed strength training has an injury preventative aspect.
Rehab
If we look at the rehab process it has to, in my opinion, progress through 3 phases; pain reduction, building strength & creating robustness. To this end what separates quality rehab work is the progressive increase in the demands of the work done. These phases can be fluid in length depending on where the individual starts the process from. What you can’t do is miss one out a step and expect to get quality, long lasting results. The lines get blurred, and they should get blurred, in the later stages of building strength and creating robustness.
At the point where the lines get blurred is where we start to increase the load used. Your classic rehab resistance level of light theraband is fine at the very beginning of the treatment process. Unfortunately, once we are past the pain reduction/very early strengthening phase it does not provide sufficient stimulus for change and heavier loads must be applied.
To create the change we really need to load the tissues up. To this effectively eventually requires an external load. In the beginning, the exercises will be pretty much standard gym type movements. We will use squats, deadlifts, lunges etc to increase the demands on the lower body.
Sports specific demands
If we take running as an example then the use of classic weight training movements allows us to expose you to the type of load that you will experience when running. This prepares you for the types of forces that you will experience when you are running. From weight training, we then move into plyometric type drills. Plyomterics provide us with a way of preparing you for the loading rates that you will experience when you run. With both weight training and plyometrics we are able to safely create aspects of the types of loading you will experience when you run.
Rehab equals training because…
It is this progressive approach to loading that make rehab equal training. There should not be any difference in terms of how we approach it as the basis of good rehab is a graded exposure to increasing demands, just like training.
Training
When it comes to training itself how does training equal rehab I hear you ask. You’re training itself should have a “rehab effect” as all your supplementary work, that is any conditioning or weight training, should be done with a focus on good form.
Lets take lifting as an example and use the squat. If you use good technique and work with weights that you can handle in good form you will increase your range of movement at the hip and ankle. You will also be able to generate more force through these ranges. This ability to generate more force gives you a great deal of wiggle room in terms of what you can withstand.
Your warm up will often look like rehab too. Much of what we use in warm up routines are the very same low level exercises used in early rehab. The fact that we can put them together to help maintain your ability to move well is just a handy way of making use of them.
Overuse or Underuse
Your training in itself has a protective element to it. The more you train, up to a point, the greater the protective benefit your training has. Many injuries aren’t so much over use injuries rather they are caused by under use. By this I mean if you go from running 2 days per week for 30 minutes to 3 per week for 30 minutes and then get injured it isn’t an overuse injury.
What has happened is that you don’t have sufficient conditioning in the structures to withstand the sharp increase in volume. You have effectively jumped up by 1/3 in terms of volume. It would have been better to split the hour of running into 3 sessions and then built the time up as you adapted. An overuse injury would be to rapidly go from a high volume to an even higher volume. It is recommended to try not to go higher than 10% over your normal training load.
Training equals rehab because…
Your training equals rehab, or maybe prehab but that is a poor term to be honest, because it should be designed to help prevent injury. It should be well thought out and progressive in nature. It should contain movements or exercises that are designed to help you move well.
In this video I go through some of what is included in our hamstring return to play. You will see how it progresses from low level work to very demanding work. Work that is the very same as you will see in a performance program.
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