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Bridging the Rehab-to-Performance Gap

Injury, whether minor or catastrofic, is an inevitable part of the sporting world. Appropriate conditioning strategies not only optimize performance but also decrease the risk of sustaining injury, Effective rehabilitation post-injury is vital to prevent recurrence of the same injury or occurrence of a new injuries. Professionals responsible for getting and keeping athletes on the pitch, field, track or court therefore play an undeniably important role in the sportsman's career.

Post-injury athletes typical progress through the different phases of rehabilitation and might pass through the hands of different health and fitness professionals. The initial phases are typically the responsibility of a physical therapist, while the later phases might be managed by an athletic trainer, biokineticist or strength and conditioning coach. Once the athlete has been cleared to return to play, it is the responsibility of the coaching staff to ensure optimal performance.

Experience have highlighted the rehab-conditioning-performance gap. With this I mean that throughout the rehabilitation process few professionals ask themselves if they have truly prepared the athlete adequately for hand-over to the next professional. In the initial phases of rehabilitation physical therapists for example might not utilize proprioceptive or strengthening strategies that will directly complement the conditioning strategies implemented in the next phase. On the flip side, a conditioning professional might incorporate strengthening strategies that directly counteract the work the PT has done, thereby compromising the injured site. Additionally, the specific conditioning methods might not prepare the athlete adequately to perform optimally in his chosen sport.

Consider for example an athlete that sustained an ACL injury. Post-operatively, in the first phases of post-surgery rehabilitation, the physical therapist would usually be responsible for restoring the knee's range of motion and strength of the surrounding muscles while protecting the surgical site. An example of conventionally prescribed quad strengthening exercises, are seated knee extensions. While this is a safe exercise that does activate the quads muscle, it is done with the hips in 90 degrees flexion. There are very few functional and athletic movements that require full knee extension with the hip in 90 degrees of flexion. So even if though the quad is strengthened in this particular pattern it does not guarantee muscle strength in another pattern (principle of dynamic correspondence). Some might argue by saying that squats, which are considered more functional, are also included in the initial rehab program and progressed by adding load in the conditioning phases. However, more often than not patients are taught to place most of their weight in the heel during the performance of the squat. Any movement that is plyometric in nature, such as running and jumping, is performed from the forefoot which activates a completely different muscle chain compared to a heel activated squat. So once again, while the quads are strengthened, it does not guarantee improved performance as the functional pattern in which the muscle was strengthened does not mirror that of the athletic movements the athlete's chosen sport requires.

Regardless of the differences in scope of education and practice of the respective professionals involved in preparing an athlete for performance, the following should be kept in mind: During the process of injury rehabilitation, all parties involved are working with the same athlete, with specific anatomical structures and physiological systems, that have to move in a specific way to achieve a desired outcome. Methods employed throughout the different phases of getting an athlete back to performing optimally, should therefore complement and amplify each another. Additionally, all rehab and performance specialists have the basic principles of anatomy, physiology and biomechanics in common. Prior to prescribing an specific exercise regime professionals should ask themselves the following: Does this exercise target the specific anatomical structures in a manner (velocity and duration) and pattern that mimic that of the biomechanics of the specific athletic movements the athlete would be required to execute during participation in his/her sport.

In summation, rehab and conditioning should not be viewed as mutually exclusive processes and each phase to should complement the next as well as the athlete's ultimate performance goals. Exercises prescribed in each phase of the rehabilitation process should be thought through and not merely included in a regime because of its popularity in general practice. If in doubt about a specific exercise go back to the basic principles of anatomy, physiology and biomechanics...they have been around for 100's of years and are still applicable!

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