We all know injuries can be difficult physically, but have you thought about the psychological side?
How long?
How long until I’m pain free?
How long until I’m able to run, able to cycle/dance/play sport?
This is the first and most important thing people would like to know after an injury or surgery.
So how do we know?
Do we just wait for a particular amount of time to pass or are there other things to consider?
When people get injured not only do they have damage to the tissue (muscle, ligament, bone) in question but they also often experience losses in strength, capacity and power.
When looking to return to performance it is important to make sure that these losses are addressed and are returned back to pre-injury levels. If we don’t do this, you’ll actually be at a higher risk of injury than you were the first time around.
However achieving this is never linear. People progress and improve at different rates, for a number of reasons. These may be training history, age, gender, genetic factors, adherence to the rehab, previous injuries, access to gym, we could go on.
Considering this, when someone first presents to us, it can be difficult to give an exact timeline for the rehab. If we do establish an exact timeline, any of these factors can cause the rehab to take sometimes significantly more or less time than we expect.
Here is an example of the same injury taking two different timelines:
Patient A and B are both rehabilitating from an ACL reconstruction.
Patient A consistently goes to the gym 2-3 x per week is more likely to be ready for a safe return to sport at 12 months than someone who only goes to the gym once per week or goes through phases of low rehab attendance (Patient B).
If we give these two people the same timeline of 12 months, then two things may happen.
Patient A who does their rehab diligently and doesn’t see any major road bumps might return and end up spending 1-2 ‘extra’ months ‘rehabbing’ when they could have been out practising and playing their sport.
On the other hand, Patient B experiences a couple of problems throughout their rehab and can’t train as often because of their busy work schedule. As their improvements are slower and inconsistent they likely need another 3-4 months prior to safe return to sport. Problem is they expect 12mths so despite not being ready they either end up disappointed or return to sport with a significant chance of reinjury.
So how do we know? If not time, when are we ready?
So now that we know that we cannot confidently use time as our only measure for safe to return to sport, what is the alternative?
We need objective, measurable tests to be able to determine if someone has restored these physical abilities.
Historically physios have tried to determine a patient’s strength just by feel, but this lacks sensitivity and is not accurate (Bohannon, R. (2012). Technology has come a long way. Here at BASE when we test we use devices to provide us exact and accurate measures of strength, power and capacity.
Our clinicians use these devices to be extremely confident that when a patient returns to sport they are best prepared to perform and with a reduced risk of re-injury (Younger, et al (2009).
We separate our rehabs into different phases and in each of those phases we have different testing criteria. We will go further in depth with these criteria in a later edition of BTF but for now all you need to know is that our patients only move on to the next phase if they meet the criteria for that phase.
We treat each patient as an individual, taking into consideration the unique factors that influence their rehab journey.
What do I need to know?
Essentially, rehab should be very personal and individualised for the person with the injury.
Be wary if you are being told that all you need to do is rest for 1-3 weeks or that “you will be good to go in 3 months, just do this program”.
The rehab probably won’t be tailored to you in a way that is going to best support you in your return to sport.
If you’re not testing or measuring you’re guessing.
Reference List
- Bohannon, R. (2012). Hand-held dynamometry: A practicable alternative for obtaining objective measures of muscle strength. Isokinetics and Exercise Science, 20(4), 301-315.
- Younger, J., McCue, R., & Mackey, S. (2009). Pain outcomes: a brief review of instruments and techniques. Current pain and headache reports, 13, 39-43.