Sports Activities with Rehab Treatment:

The maintenance of cardiovascular fitness is another essential component of the rehabilitation process. No matter what type of injury the athlete has sustained, it should always be possible to design an exercise program to enable cardiovascular fitness to be maintained.

In injuries to the lower limb that require a period of restricted weight-bearing activity, cardiovascular fitness may be maintained by performing activities such as cycling, swimming or water exercises. These activities can be used in a training program that follows the same principles as the athlete’s normal training. Depending on the athlete’s particular sport, this may include a combination of endurance, interval, anaerobic and power work.

It is important to maintain these alternative training methods for cardiovascular fitness even after the patient has resumed some weight-bearing training of his or her own. The clinician must explain to the patient that while he or she is gradually returning to weight-bearing activity, the cardiovascular endurance aspect of training should be performed as non-weight-bearing.

Following complete recovery and return to sport, it may be advantageous, particularly in patients who have had an overuse injury, to incorporate some of these non-weight-bearing forms of training as a substitute for some weight-bearing training.

Progression of Rehabilitation

There are several different parameters that the therapist may manipulate to progress the athletes program to a level at which return to sport is possible. These parameters are:

• Type of Activity
• Duration of Activity
• Frequency of Activity/Rest
• Intensity of Activity
• Complexity of Activity

Type of Activity

In the early stages of the rehabilitation program, we recommend activities that do not directly stress the injured area. However, these exercises may still result in some mobilization or strengthening of the injured area, for example, tennis ground strokes following an ankle injury, cycling following shoulder impingement. Later in the program, activities specifically involving the injured area will test its integrity and prepare it for functional activity.

Duration of Activity

Once the activity is directly stressing the injured area, the time spent performing that activity must be increased very gradually. It is advisable to slowly increase the amount of time spent performing a particular activity, for example, jogging, and then hold it constant at a particular level and vary one of the other parameters, such as frequency.

Frequency

An integral part of the rehabilitation program is recovery. It allows tissues to adapt to the stress of exercise. For example, a runner with Achilles tendinopathy may initially run every third day, then every second day, then two out of every three days and ultimately six or seven days per week. On non-running days, the athlete should maintain fitness by swimming or cycling as well as performing the other elements of the rehabilitation program, for example, muscle strengthening.

Intensity

As the athlete progresses through the rehabilitation program, the intensity (speed and power) of the activity will increase. A rehabilitation program for a sprinter may involve progression from half pace to three-quarter pace to full pace. Race starts will be included later in the program. Other variables include surfaces and shoes. Progression can be made from softer surfaces to harder surfaces or from flat running shoes to spikes once full speed is achieved.

Complexity of Activity

The athlete can progress from simple activities to more complex movements. For example, a basket-baller dribbles slowly in a straight line gradually increasing speed and introducing turns, or a tennis player progresses from ground strokes to incorporating overhead shots and rallying drills before playing points competitively and ultimately six or seven days per week. On non-running days, the athlete should maintain fitness by swimming or cycling as well as performing the other elements of the rehabilitation program, for example, muscle strengthening.