Physiotherapists often use the word rehabilitation; to regain correct function of the muscles, ligaments joints and nervous system post injury to ensure re-injury does not occur. Most athletes or workers despair at being injured and urgently seek early reintegration to work or the chosen sport – especially if it is finals’ time.
Rehabilitation takes time; but it is essential for the safe return to activity. For example, evidence suggests that 30% of anterior cruciate ligament reconstructions (a major knee ligament) will undergo a second surgery within 2 years of returning to sport.
It is up to the clinician/ Physiotherapist to set realistic expectations on return to sport or work timeframes, and continuously adjust these to reflect the patient’s condition and ability at each stage.
Rehabilitation should begin immediately following an injury and aim to develop re-activation of muscle activity, followed by strength, power, and endurance. Correct timing of exercise progression and appropriate treatment allows positive tissue adaptation and on-going progression. Achieving full muscle function is vital to successful rehabilitation.
When the re-modelling phase has reached a plateauing level and the pain has reduced to minimal, only then is return to competitive sport deemed safe. There are guidelines as to how long this process takes, but every person is different.
Post injury
Following injury, a muscle can undergo rapid muscle wasting / weakness due to the swelling, the level of pain, and lack of use. Even short periods of inactivity cause a reduction in strength, and endurance.
In the inflammatory phase, relative rest is important but as the repair phase commences it is important that advice on rehabilitation is taken on board to minimise scar tissue and to ensure effective re-modelling occurs.
Progressions
Rehabilitation is mostly progressing exercises, although manual therapy (massage, mobilisation, dry needling) can be used to release tight muscles. This can help the correct muscles to activate and ensure that efficient biomechanics is being achieved. It is very important that the exercises are monitored carefully to check on correct technique and that the right loading is placed on muscles and tendons. Within rehabilitation, muscles not only need to be strong, they need endurance and some need to be powerful and explosive.
Initial exercises will be to isolate the injured area and then as progress is made, more functional exercises / sport or activity specific exercises are added to ensure safe return to work and / or the chosen sport. Only with progression of the exercises does effective re-modelling occur which reduces the risk of re-injury.
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