Injuries in sport happen; however, your recovery time can depend on the severity of the injury, effective management and accurate diagnosis. For some injuries, healing will take a couple of days or weeks. For others, however, recovery time frames can be protracted. Regardless of the overall duration, through injury rehabilitation, is critical, and effective management is typically undertaken in a staged approach.

There are nearly as many ways in which this is completed as there are injuries. However, most physiotherapists will aim to guide you through four broad phases of injury rehabilitation. What are these four steps to expect during the injury rehabilitation process? Read on to find out.

PHASE 1. Protection and Offloading
Adequate protection and offloading are vital for a few reasons. Firstly, it protects

the affected area from experiencing any more damage. Take the example of a

fracture, muscle tear or ligament injury, all will require some level of protection to

protect them in the initial phases. Secondly, protection not only avoids your injury

from getting worse, but it also promotes an internal environment to support healing.

It is worth noting that for the first few days following injury, inflammation is

progressively increased, associated with the breakdown and removal of damaged

tissue and debris from the site of injury.

Finally, and perhaps the most obvious is that injuries in this stage are often

associated with significant pain. Offloading of the affected area is necessitated by

the simple inability to continue to load the affected area. The term offloading here is used in place rest, and many tissues do not require or are worsened by absolute rest.

PHASE 2. Protected Reloading and Reconditioning
Following the initial phase of management, subacute management should be commenced. Put simply, some strain is applied to the affected area or injury. For muscle injuries, this may take the form of using light weights, in lower limb fractures it may take the form of increasing the amount of weight that can be applied. Carefully managed loading of the affected area at this stage can not only seep recovery but also result in improved resilience of the repair.

In addition to rehabilitation of the specific area of injury, it is critical to not lose sight of all other conditioning. Maintenance of strength and conditioning, core muscle capacity, mobility, cardiovascular capacity and mental rehearsal skills, and practice skills, drills and technical aspects are often possible. I will, almost without exception, talk to athletes at this stage about “pulling the work forward”. What I mean by this is not letting the injury interrupt work for unaffected areas: I want my patients focused on what they can do, not what they can’t.

PHASE 3. Sport Specific Strength, Conditioning and Skills
Your injury has settled, you have maintained the rest of the body. You are tolerating simple loading, it’s time to get serious. Often athletes will get to this stage, pain is gone, strength is looking good, and range of motion has been restored, and they feel ready to play.

However, failure to address deficits in higher-level capacities can result in marked increases in the risk of reinjury. These include things such as:

• Cardiovascular endurance
• Muscular endurance
  
• Muscular power
  
• Rate of force development
  
• Change of direction capacity
  
• Agility
  
• Balance
  

PHASE 4. Return to Sport
Return to sport is where you know if you have done your job right. If an athlete has been both physically and mentally prepared, then this should be a smooth process. Even in instances where an athlete has met all objective targets, ideally, they are eased back into playing loads. In team sports, with a season this can be a process of increasing game time to get the specific work hardening of playing before return to full games at full intensity.

With individual athletes, or where a single event is being built to this can be more complicated. Its difficulty to complete a trial ironman or ultra-marathon for example, and as such different strategies’ may be used such as participation in shorter tune-up events, competition in training with teammates or completion of sections of competition at or above race pace.

PHASE 5. Injury Prevention
The final and often overlooked phase of management is the prevention of reinjury. Injury prevention at its core the process of identifying and managing risk factors with athletes during and following return to play. This difficulty is in navigating the completion of this prevention work, in what are often hectic athlete training and work schedules. This necessitates a careful balancing of work to promote incremental gains in performance, with that aimed a preventing injury.

In conclusion, effective rehabilitation should always be a staged process aimed at promoting recovery, expediting return to sport, optimizing performance, and preventing reinjury. It is very important to not only rehab the injured area but to also keep in mind of your overall functional movement for a safe return to sport.

Sport Injuries

​​Smitty's Plan for O​rthopedic Rehabilitation & Training