Despite all your best efforts, you acquired an injury along your training journey. Do not let this scare you. It happens to the best of us. In fact, it happens to most of us. In Lemoyne’s cross-sectional study of collegiate athletes, she reported an injury prevalence of 91%.¹ You are not alone, and we are here to help you. The big question now is, what do you do?
For the purpose of this blog, we are going to focus on steps 2 through 4. Step 1 is strictly a job for your own medical professional, and helpful tips for step 5 can be found in Part 1 of this blog post.
Disclosure Statement: Keep in mind that every injury and individual is different. What may work for one individual, may not work for another. If you ever suspect that you are experiencing any of the injuries discussed in this blog post, I fully recommend that you seek out a skilled medical help. Be sure to clear any new exercises with your medical profession, particularly if you are in the process of treating or rehabilitating an injury.
“Comprehensive” is key when it comes to developing a rehabilitation program. Rehabilitation is often confined to a box with 4 corners, RICE (Rest Ice Compression and Elevation). RICE is only the tip of the iceberg when it comes to rehabilitation and results on effectiveness have been mixed.5,6 A true comprehensive rehabilitation requires a wider range of components. Programs may include, but are also not limited too, education, strengthening, mobility, posture, balance, hydration, gait, psychology, and many more. Everything in your body is connected. Fascia, or connective tissue, connects in a chain from the top of your head to the bottom of your feet. Therefore, when looking at an injury it is vital to search up and down the chain for contributing factors. For example, you may have daily calf cramps. Yes, this could be due to something directly in your calf, but it could also be due to hydration, hormone or electrolyte imbalances, or weakness in your glutes. The cause and solution are not always in the same part of your body, or even limb.
Believe it or not, one of the best signs of a comprehensive lower extremity rehabilitation program is core strengthening exercises. Core muscles being defined as, those surrounding and attaching to your trunk and pelvis. You may be wondering how a muscle so far away from your lower extremity injury could possibly help. Here’s how: your core muscles are to your lower extremity as your brain is to your body. Your core muscles provide stability for your lower extremity, which allows your legs to function properly. Each muscle in your legs has their own support system of other muscles, ligaments, bones, and tendons that aid in stabilization for dynamic and static activation, but the ultimate tool for stability is core strength. Here are a few of our favorite core strengthening exercises to try. Ask your doctor about core strengthening, and be sure to clear these exercises with your own doctor for safety.
First, let’s look at the Wall Press Iso w/ Alt. Dead Bug.
It's one of the first exercises you will see in our Dead Bug progression series that focuses on connecting lower extremity movement and the trunk. It's a great way to improve core and trunk strength & stability.
Here are 5 coaching cues we use for the Wall Press Iso w/ Alt. Dead Bug:
Next, we will take a look at the Band Half Kneel Pallof Press
This amazing anti-rotation core exercise in the half kneel position in which the inside knee is down in this variation. This is a great challenge to some of the smaller core muscles.
Here are 5 coaching cues we use for the Band Half Kneel Pallof Press:
It is vital to take your rehabilitation plan seriously. Being patient and honest are just as important to the rehabilitation process as consistently doing your physical therapy exercises. Return to play too soon and improper rehabilitation can lead to increased symptoms, and even additional injury. Your medical professional knows that you want to return to being back on the track, field, court, or pool as soon as possible. It is important to be patient with yourself and honest both to yourself and your designated medical professional. If you find yourself getting anxious, impatient, or any slew of emotions, take a deep breath. Know that it is common to have these thoughts and feelings. You are not alone, and we are here to help. Be sure to express these concerns and emotions to your doctor as that is more than a significant part of the process of rehabilitation.
Breathing techniques and muscle activation have been proven to decrease anxiety and increase body awareness.2,3 By accomplishing both of these tasks, you are able to better prepare your mind and body to properly attack your rehabilitation plan. Here are a couple of breathing and muscle activation techniques that may help you to better focus.
1. Floor 90/90 Breathing:
2. Wall 90/90 Breathing:
Both of these instructional videos will give you the tips and tricks to mastering these breathing techniques on your own.
Medical professionals may give you a generic timeline for your rehabilitation plan, but keep in mind that these are flexible time periods. Rehabilitation plans do not progress as a single, linear, positive slope. Some weeks you might increase in strength and speed exponentially, while other weeks, you might have to take a couple steps backward. The important factor is that over time, you are generally progressing in the right direction. This is why monitoring your rehabilitation process is vital to progression. Some weeks you may feel discouraged by taking a step back, but if you are able to look at your overall progress from your starting point, it may offer a bit of comfort. Monitoring progression additionally helps you and your medical professional make proper regressions and progressions according to your progress.
Proper exercise progression is a significant part of a research-based, comprehensive return to play protocol. Measuring the workload of each exercise session with Perceived Rate of Exertion (RPE) can give you insight to injury risk.⁴ Technology also can come to our aid here. There are now apps, equipment, and other technological aids that will help you track your progress, like Plantiga. Simply monitoring workload measurements can help avoid common mistakes like increasing overall activity too fast. Exercise progression is much more complex than simply increasing resistance for weight training or speed for conditioning. For example, progressing from a traditional squat to a single leg squat is a progression of both stability and proprioception.
So if a lower extremity injury happens to you despite all of your efforts. Remember: You are not alone, it happens to the best of us. Though it may seem like a long and difficult road ahead, use this blog series as a guide to help you better navigate your rehabilitation journey.
Resources:
Christopher Havens is a Strength & Conditioning Coach at TD Athletes Edge. He recently graduated Magna Cum Laude from Salem State University in 2019 with a Bachelors of Science degree in Sports & Movement Science. Christopher completed the TD Athletes Edge Strength and Conditioning Internship Program in the summer of 2019, where he consistently demonstrated positive leadership skills, a team-first mentality and a genuine level of enthusiasm for making others around him better. Christopher has a true passion for cutting-edge research and uses current science to guide an evidence-based approach to training. For his Senior Research Thesis at Salem State University, Christopher was awarded the New England American College of Sports and Medicine Undergraduate Research Award for his research on 'Post-Exercise Water Immersion and its Effects on Heart Rate Variability'.