Phases of Rehab - Movement Literacy

Good Morning! Happy Monday!

Now that Florida State is on spring break, I took a small day trip to St. George Beach, about an hour and a half from Tallahassee. Although sitting on the beach was enjoyable, and walking the beach during sunrise was calming, I couldn’t get my mind off football and rehabilitation.

I mentioned this to a UGA student who called me for advice about getting into sports, you work long-long hours. Your mind is often on your work outside of work, on how you can improve to make yourself better as a practitioner in sports → to make your players better → to make the team better → to win games → to win a national championship or Superbowl. This might seem like a stretch to most people, but one thing I’ve learned from being a part of good teams and a part of bad teams, the little details matter, especially in high level sports.

You have to love what you do while working in sports. And to be honest, it doesn’t really feel like work anymore because of how much I love going into the facilities to work with our guys.

On to todays topic which will be about the second phase of rehab, Movement Literacy.

*The injuries discussed in this newsletter are for general educational purposes only. I am not affiliated with the athlete’s medical team, and the information shared does not reflect any insider or team medical details. Specifics about the injury are often unavailable, which can significantly influence the estimated timeline for return to play.

Movement Literacy

In the Movement Literacy phase, we have finally started to control pain and swelling of the injured site. Therefore we can begin to introduce movement patterns required by the injured tissue to inform the athlete’s brain to understand and feel confident in the movements required. This can be as simple as improving gait from an antalgic gait pattern (limp due to pain) to normalized weight shifts and flexion and extension. Then can move into double leg exercises and advance to single leg exercises. Because in most sports, besides a sport like golf, requires the athlete to play on one leg.

For example, when you are walking, both your feet are on the ground. However, as soon as you start to run, you narrow your base of support to only one foot on the ground at a time. Including single leg exercise introduces this type of movement and stability to the body again.

Reconditioning

The next part of this phase is reconditioning. This is where strength and hypertrophy of the injured tissue come into play. Due to the injured tissue, atrophy and weakness has occurred at the injured site and most likely, the area around it. We’ve already introduced isometrics which can be great for building strength in the injured tissue early on in rehab, but moving towards 3-5 sets of 2-5 reps is the next step in building strength in the tissue.

I personally believe it is important to turn the dial away from isometrics and focusing on concentric and eccentric exercises because that is what is occurring during sports. Isometric contractions, rarely if ever, occur during sport movement. However, that does not mean we ignore and never do isometrics again in the program. The focus just shifts to other types of exercises.

Once the muscle is getting stronger, than increasing reps can move the athlete into a hypertrophy phase to build symmetrical muscle mass to the uninjured limb. This can be achieved with 3-5 reps for 6-12 reps. One thing to point out, is this isn’t black and white with the sets and reps. There are overlaps between strength and hypertrophy as well as power. The big nuance is that we are turning the dial towards hypertrophy even though there is leakage into the strength bucket still.

Testing

Now that the athlete is experiencing less pain, testing can be introduced. This can be with the VALD products like force frame, dynamometer, force plates or with simple functional movement screens to see where the athlete is in rehabilitation process. This doesn’t mean we expect the athlete to perform well on the test, we just want to get a baseline to see what areas of rehabilitation need to be the focus.

*Due to my professional association with the Atlanta Falcons during preseason and my current role with the Florida State Seminoles, I will not provide educational content or commentary on any injuries within these programs during or after the season.

Stress

Stress on the tissue is introduced in the primary and secondary planes in this phase. For example, lets take the hamstring. The hamstring is primarily a sagittal plane muscle doing flexion of the knee and extension of the hip. We will obviously include exercises that stress this movement. However, we also need to introduce exercises that involve frontal plane movements and transverse plane movements. Thats because all of these planes are required to have access to during sport. So working on internal and external rotation of the hip and abduction and adduction can strengthen the muscles around the hamstring so less stress is required by the hamstring during sport activity.

Length-Tension

We have all probably seen the graph above and was or will be taught about this graph in school that demonstrates the optimal length for a muscle to contract. And in the early phases of rehab, it is important to develop the muscle within this range.

However, and somewhat of a contrary thought, it is also important to develop the muscle outside of this range. That way, the full muscle will develop strength and hypertrophy at different lengths (which in sport, muscles are often required to be strong and stable outside of this optimal length).

This is important to develop, but only after the athlete has developed strength in the optimal range without pain. These exercises come at the end of the reconditioning phase. For a hamstring injury, they would include a full range of motion RDL or back extension that puts the limb in or close to knee extension and hip flexion which lengthens the hamstring muscle increasing the amount of stress on the hamstring.

If we think about it, in the case of hamstring strains, most occur during running when the hip is flexed and the knee is extended right before or during initial ground contact. Therefore, we should strengthen the muscle in that position to be able to withstand that stressful position in sport.

This wraps up the second phase of rehabilitation. The next phase is plyometrics.