It is highly likely that every personal trainer will, at some stage in their career, be involved in the rehabilitation and return to activity of recently injured clients. It is therefore essential for all health and fitness professionals to understand the components of a successful rehabilitation program.
Personal trainers may become involved in the post-injury rehabilitation program in one or all of the following situations:
- The injury occurs to one of your current clients during a training session with you and you are involved immediately in the post-injury treatment and rehabilitation process.
- A current client is injured in a non-PT sport or exercise session and you are involved in the rehabilitation program.
- A new client asks you to assist in their post-injury rehabilitation.
- You are contacted by a local physiotherapist or sports physician to assist one of their clients with post-injury rehabilitation.
While these are all relatively common situations, there are a number of differences that all PTs need to be aware of:
- Situation (1) – this has the added issue of professional negligence and legal liability that may impact even more on your income than a few lost sessions.
- Situations (1) and (2) – where your current client is injured can be potentially damaging to your business and income. The injury may impact on your current program and the number of sessions you are able to spend with this client.
- Situations (3) and (4) are income and session-producing situations as they involve new clients and new referral sources for you to build and expand upon.
Personal trainers need to understand the rehabilitation process if they are to ensure that when a client sustains an injury they don’t lose their business and they can attract new clients for rehabilitation work.
It is also vital that trainers encourage the injured client to train around their specific injury. This can be by replacing lower-body activities – such as jogging – with more upper-body modalities such as rowing and swimming. Do everything in your power to keep your client exercising and motivated to ensure they do not lose their hard-earned fitness gains.
Components of a Successful Rehabilitation Program
Injury rehabilitation has progressed rapidly in recent years. Many of these progressions are due to a more active approach to the rehabilitation phase, such as early post-injury mobilization, limited splinting and early inclusion of strength-training modalities. However, there are a number of fundamentals that need to be included in all successful rehabilitation programs.
Here is a summary of just some of the essential components:
- Early and correct diagnosis. All cases of pain and injury need to be referred to and investigated by a skilled health professional with expertise in the injury area.
- Individualization. Just like your clients, no two injuries are identical. Every program needs to take into account the specific injury, sporting requirements and level of training of the client.
- Early mobilization and strengthening. In the past there has been a focus on passive stretching and joint range of motion exercises before adding strength training and functional activities. However, provided pain levels are acceptable and the supervising medical professional has approved the program, there is great benefit in adding activities such as walking, jogging, swimming and strength training in the early rehabilitation stage.
- Muscle conditioning. Due to the rapid loss of muscle mass and strength post-injury, it is vital that a structured strength-training program commences as soon as possible. This may include free weights, bodyweight exercises, resistance bands and swimming.
- Motor re-education. Many injuries can be the result of motor pattern issues and imbalances (e.g., rotator cuff impingement) and other injuries can actually lead to the development of these imbalances and motor pattern problems. Look at the motor control area to ensure that correct muscle recruitment returns before the client returns to full training.
- Proprioception. Numerous injuries (especially ligamentous issues) result in a loss of proprioceptive feedback to the brain from the injured area. This lack of feedback is one of the key reasons for reinjury and must be addressed with the inclusion of balance and stability-type activities.
- Range of motion. It is common for post-injury flexibility to be diminished as a result of muscle spasm, inflammation, swelling and pain – which not only impacts the injured area but the joints above and below the problem, as well as creating motor pattern issues.
- Incorporate functional activities. Take into account – and reproduce – the activities and movements required when the client returns from injury. They also need to be replicated at the same speed, on the same surface and with the same level of fatigue to be truly effective.
- Cardiovascular fitness. One essential part of successful rehabilitation is the maintenance of cardiovascular (CV) fitness. There is nothing more frustrating for a player than to have their sporting return delayed due to a lack of CV fitness even though the injury has fully recovered. CV training encourages and promotes oxygen delivery to the injured area, increases healing and assists the injured client in staying positive.
- Psychology of injury. A positive mental attitude will accelerate recovery and assist in a successful return to activity post injury. Appreciate the importance of the client’s mental state and work on visualization of a successful return and allow them to express concerns openly in an environment of support and professionalism.
Let’s look at how these components are integrated into the post-injury rehabilitation program of a 24-year-old basketball player who has just been given the all-clear to return to some sessions with you following a mild ankle sprain.
The player was injured in a game, received immediate medical attention from the club physiotherapist and the x-ray was clear. With every client, it is essential that you obtain a comprehensive medical history so you are aware of any previous injuries.
Due to the nature of basketball, your sessions will eventually include a large range of jumping, turning and change of direction activities (including backwards running drills). Encourage the client to walk as normally as possible and start some light jogging – within pain limits and watching for post activity swelling. Ice should be applied after each walking and jogging session as a precaution. Your program will include single leg and double leg calf raises – eventually progressing to jogging and jumping drills. Analyze the player’s running technique on a treadmill to ensure no motor issues remain that may contribute to re-injury.
Structured one leg balancing activities, BOSU squats and split jumps are an important part of the program. Eyes open and eyes closed balancing activities are also included in your sessions and the ankle is taped for the rest of the season to assist in providing proprioceptive feedback.
Include a game simulation session where the player will be asked to perform game drills – on the court – with a live opponent. Use swimming sessions, the rowing machine and stationary cycling to augment and maintain CV fitness.
A Word of Warning
It is easy for health and fitness professionals to open themselves legally to issues related to injury rehabilitation and especially injury diagnosis. PTs should refer all issues of injury and pain to a suitably qualified physiotherapist or medical professional.
Failure to find a higher authority will open the trainer to the risk of litigation and serious consequences. Always act under the supervision of the treating medical professional and when unsure or in doubt ask for clarification and assistance.
Source: Fitpro Network