What are the key principles of rehabilitation?

Regardless of what day it is in the week, a movement-based practitioner always hears, “what is the best exercise for the pain”, followed by the client pointing out which body part has endured an injury.

Of course, the process of rehabilitation is tailored to the person and their specific injury. However, there are a few cornerstone principles that repeat almost every time.

In this article, we are breaking down this subject and exploring the key principles of rehabilitation.

A general comment on rehabilitation programs:

Firstly, it is important to note that everyone is different. Therefore, each rehabilitation program is individual. This is why it is imperative to combine education and exercise prescriptions for all rehabilitation programs.

The key elements of a successful rehabilitation program include a combination of an explanation, precise prescription, modification for specific areas, utilisation of available facilities and beginning the program as soon as possible.

Finally, understanding the response to soft tissue injuries can impact on recovery time frame.

The two phases to consider:

On the road to recovery, there are two main phases that you should consider. The first one is the acute inflammatory phase, which occurs anywhere between zero to 72 hours.

The next phase is the healing phase. This can occur anywhere between two days after injury to six weeks.

Furthermore, the progression of rehabilitation follows these five key principles. They are the type of activity, duration of the activity, frequency of activity/rest, the intensity of activity and complexity of the activity.

If these principles are met with an adequate work-to-rest ratio and set optimally to the individual’s condition, this can determine how quickly the individual will return to sports.

 Important factors of rehabilitation:

1.      Muscle conditioning:

●       You need to consider two principles - specific adaptations and overload.

●       Components of muscle conditioning: muscle activation & motor re-activation, muscle strength, power and endurance.

2.      Flexibility:

Range of motion of joints and soft tissues (injuries can result in scarring and joint stiffness) aim for early restoration of range. The benefits of stretching include, increase flexibility, and muscle relation, reduce muscle soreness, improves circulation, helps prevention of excessive adhesion, promotes strong adaptable scarring and reduces muscle resistance.

3.      Neuromuscular control (proprioception: balance & awareness):

This places Importance on nerve impulse conduction and information processing of the central nervous system. Evidence suggests comprehensive/injury-specific neuromuscular training has demonstrated a reduced rate of recurrence of injuries in lower limbs. An example: Remember that time you played egg and spoon race? That there is neuromuscular control in your fingers, arms and whole body, so that you don’t drop the egg.

4.      Functional exercises:

This requires a combination of strength, power, endurance, flexibility and neuromuscular control eg. sit-to-stand, walking, jogging, running or anything you would do daily. All exercises need to be progressed as individuals can tolerate them.

5.      Sports-specific skills:

Once adequate strength, power, endurance, flexibility and neuromuscular control have been met, and no pain with functional movement, then a graduated return to training may commence.

A strength and conditioning coach would assist and guide the individual back through tasks of increasing program difficulty. If there are signs or symptoms of injury exacerbation, the program may not progress and the level of activity should be reduced. Other skills can be maintained throughout recovery while the injured limb is recovering e.g., knee injury, seated basketball shots etc…

6.      Correction of abnormal biomechanics:

Can be noticed from the time of the injury and throughout the rehabilitation, as a result of muscle imbalance/weakness. It is important to understand that these abnormalities in movement can predispose to overuse injuries from one side compensating for the injured side. This correction is important as part of the rehabilitation process to allow for optimal and efficient movement. Ways to correct this may include muscle stretching, strengthening, muscle awareness retraining, strapping tape and education.

7.      Cardiovascular fitness:

Maintaining cardiovascular fitness should be part of the rehabilitation program to include a combination of endurance, power, and aerobic and anaerobic activities. Allowing the injured area to rest while substituting for other cardio-based exercises e.g. Swimming, cycling, boxing etc… will allow the individual to return safely back to training and avoid overloading the working tissues.

8.      Psychology:

Whenever an injury occurs, the individual will only focus on the pain, fear and possible reoccurrence. This negative feedback loop can hinder an individual’s ability to progress through their rehabilitation program, as this can increase stress and tension. Resulting in potential increased pain and poor biomechanics.

Factors affecting psychological impact on rehabilitation:

1.      Type of injury

2.      The circumstance of injury (e.g., A week before the grand final)

3.      External pressures

4.      Pain tolerance

5.      Education around the injury, tissue healing & rehabilitation

6.      Support system

7.      Financial pressures

To allow for optimal healing, minimising as much stress internal/externally will allow for greater awareness and reduced levels of frustration and pain. Strong evidence has suggested that a biopsychosocial method can help manage and allow individuals better manage their pain and rehabilitation process. Throughout performing functional exercises, individuals should be encouraged to use psychological skills such as mindfulness to change their focus from discomfort to how the movement should feel e.g. muscle relaxation to relieve tension, visualisation).  If the individual continues to struggle with psychological challenges then a referral to a medical health professional in psychology will be beneficial for short and long-term recovery. ratters you or your organisation may have. To find out more, please contact us 

Please note, the contents of this article do not constitute professional advice, are not intended to be a substitute for professional advice and should not be relied upon as such. You should seek movement-based advice or other professional advice in relation to any particular matters you or your organisation may have. To find out more, please contact us.

 Reference:

1.      Brukner. P, Kahn. K. Clinical Sports Medicine Series. 4th ed. McGraw Hill Professional. 2014. Chp 12 Principles of Rehabilitation: Kinch M, Lambert A. 6(3) 179–91p

2.      Riebe. D. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. Lippincott Williams & Wilkins.2014. Section III Chp 7 Exercise Prescription. 161-190p.