As an athlete or active individual, many of us are not fortunate enough to avoid The Piper that looms around, waiting for the chance to catch up to us one day and demand our payment for playing so hard.
I’ve personally been involved in Martial Arts & Fitness for over twenty years, ranging from studying, fighting competitively, sports, stunts, teaching, coaching competitors, and finally running my own facility. Through that time I’ve had the opportunity to train with an enormous amount of amazing (and not so amazing) people and still continually strive to seek out the answer to the question: “What makes a good martial arts facility?”
Yes, when you play hard, sometimes you have to pay hard and deal with injuries. Many individuals are lucky enough to only incur minor injuries that do not require surgery, and simply require rest and some alternate form of activity for a few weeks. Some of us will not be as fortunate, and require more time off, spending time in physical therapy and possibly even surgery.
After the initial shock of injury subsides and you have dealt with your less-than-ordinary in- jury, your athletic life does flash before your eyes and certain questions begin to fill your head:
“Will I be able to compete again?”
“Will I still have the strength and speed to do so?”
“How long am I going to be out of com- mission?”
As a former competitive athlete, and having been in this position a few times in my career, I have experienced these feelings several times and headed down the long comeback trail starting with surgery and then recovery. For major injuries, surgery is often the fix but only the tip of the iceberg. The recovery process will deter- mine whether or not you get back to your activi- ties in a timely manner and whether or not you perform at a high level once again.
Physical Therapy’s Role in Recovery
The typical protocol for a severe injury that may or may not require surgery usually involves a stint in physical therapy. Most physical therapy programs are a great springboard towards progressive recovery and aide in getting you back on track with the therapist’s primary concern focusing on restoring range of motion (ROM), functional use of the injured joint, and rehabilitation of minimal strength needed to maintain those two aforementioned qualities.
Rehabilitation is a long road with the typical severe injury, requiring anywhere from five to twelve months until full recovery is achieved. As great as physical therapy can be, its protocols usually only last a few weeks to two months at the most based on the doctor’s prescription and what your health insurance will cover. What starts off as a bright and shiny journey down the yellow brick road of success can lead you into the dark void of a partially rehabilitated joint and the consummate question of: “What do I do now?”
This article will give you several tips on how to continue your progress after your physical therapy sessions end to ensure that you are on the fast track to physical freedom and well on your way to regaining your athletic glory.
Injury Recovery Rule #1: Natural Progression Over Control Progression
As trite as it may sound, life after therapy leaves you fending for yourself. Whether you like it or not,yournextstepstowardsrecoveryaresolely dependent on your inherent will to succeed. At times, you may feel lost and overwhelmed, but you have to set those feeling aside and keep moving forward.
If you cease forward progress in rehabilita- tion, not only will you most likely never fully recover, your body may get worse over time. If you are not able to eventually use your injured joint for what it is intended for, the body will attempt to compensate by using other joints and muscles which will in turn leave your body more susceptible to other injuries around the currently healthy joints and muscles. This, of course, can lead to even more debilitating injuries in the future.
You must also realize that the trials of every- day life apply to injuries as well. It may initially feel like you are moving at a snail’s pace with your recovery, taking a step backward after going two steps forward. It is critical that you focus on the positive gains you make. Taking the occasional step back due to pain, mild swelling, and muscle tightness is okay, as long as these effects are short lived and overall long-term progression is made.
Remember to dedicate yourself to getting over your injury, make a habit of getting yourself even stronger than before, and soon you will find yourself better able to perform all of the activities you want to.
Injury Recovery Rule #2: Taking Physical Therapy With You
After your physical therapy sessions get the ball rolling towards recovery, it will eventually become easier to discern what is working and what is not. Like I mentioned earlier, the primary goal for physical therapy is to restore lost Range Of Motion (ROM) due to the injury and/or surgery and to establish a baseline level of strength. Mobility within the injured joint should be a primary concern for a new injury, and proper ROM should be established and maintained within the first year.
For these reasons, you should choose mobility drills that have previously worked best for you during physical therapy and continue to use them during your next stage of training. Mobility drills are great to add to the beginning of your training session because they can act as a warm up in conjunction with your rehabilitation movements.
Injury Recovery Rule #3: Low Load, High Reps: Remedial Strength Training
When your ROM increases and you are inching closer to getting back to full range within the classic strength training movements like squats, deadlifts, and bench presses, there might be one problem: your strength has not caught up yet. Remedial high repetition strength training is a necessary means towards your goal.
High rep work should consist of low loads (i.e. light weights) and have the end result of strengthening the joints and muscles throughout a larger ROM. For these types of exercises I am a big fan of using bands for their distinct ability to accommodate resistance.
With resistance bands, you are able to further your ROM within the movement while still performing a rigorous workout using the movement. Simply stated, as the band gets stretched more with your increasing ROM, the greater the resistance will become.
For hip and knee injuries, band training provides strength and stability within the joints. Band Terminal Knee Extensions and Lateral Walks both strengthen and stabilize the muscles around the injured joints. Band work can be slightly tedious, less entertaining than your favorite lifts, and sometimes time consuming.
If I am pressed for time, I will perform more sets on the injured side versus my stronger side. I will typically do three sets on my injured side and one on my good side to allow time to get all of my other lifting in. For shoulder injuries, rotator cuff work (internal and external rotation), front, lateral raise, and eventually overhead motions are a great way to strengthen the shoulder at the various angles it needs to be mobile and strong.
Injury Recovery Rule #4: The Next Step: Isometrics
Yes, this Old School staple is great at building strength during your recovery process. Isometric training is simply finding a position and staying in that position for a certain amount of time while you build tension in the muscles and eventually fatigue. Isometric training is “angle specific,” meaning you get stronger at the angle you train at and it has marginal effect at other ranges.
The most common form of rehabilitation for the hips and knees are wall squats. Therapists have their patients sit in a squat position with their bodies close to the wall in case they need support. Initially, this exercise is done at a shallow angle and as the mobility and strength increase, it can be taken to a lower position.
After therapy, you will want to add some more advanced isometrics like lunge position isometrics and even standing single leg isometrics. One of my favorites to train hip and knee stabilization is the Single Leg Standing Isometric where you add band tension around the working leg making the hip and knee muscles contract and work harder to maintain a stable position.
Upper body isometrics are not as common in the physical therapy setting but are also quite effective in regaining strength. The first types of isometrics to start to strengthen the shoulders would be simple weighted holds with dumbbells or kettlebells. I would start with a light front or lateral hold and then progress to overhead.
The second phase of isometrics would be a closed-chain type like a Push Up or Dip position. These are much more aggressive because of the compressive force on the shoulder where the hand is in contact with a stable surface.
I typically like to perform isometrics at the end of my workout because they can be a bit taxing on overall strength, so it is better to do them with what you have left rather than drain your energy at the beginning of a workout. Use a time range that is comfortable for you, usually a 10-30 second interval is sufficient.
Being injured is never fun and the thoughts as well as the processes involved in rehabilitation are a daunting task. After your initial physical therapy, it is imperative that you always keep moving forward. Adding some of these inter- mediate and advanced training tools will help you get back to where you were before and may even make you better than you were before. So remember: stay focused and determined, and go out there and make it happen!