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Exercise selection in rehab

So, following on from my last post, you’ve picked up on what you think is the mechanism of injury and you’re going after it. In my own mind, this is the same as coaching any other athlete. The only difference is that with an uninjured athlete your focus is more performance based like increasing vertical jump or change of direction speed. In rehab, my main driver is to make a change in the way the athlete moves and to strengthen any structures that need it. Performance is still on my mind but in these instances, the athlete isn’t visiting me to jump higher, their primary aim is to get back on the pitch.

So, exercise selection. This comes from a clear idea of what areas you think are going to have the biggest impact on getting back to competition. Strength, mobility, neuromuscular control and postural change are all areas that may be considered. This will narrow down your selection. Other considerations are logistical, what equipment do they have access to, what’s their training age, how well do they respond coaching, there’s no point selecting exercises that are going to be butchered as soon as they are unsupervised. There are plenty of occasions where I’ve pulled an exercise during a session because the athlete isn’t able for it, I have a finite amount of time to coach the exercise so I always have a plan B. This is something I’ll explain to them.

I also have to be militant about the technique and learning environment. The athlete has had their go at self organising in their previous environment and it got them injured. I have to create a new attractor state and that means creating rules so that they spend as much time away from the old one as possible. As I start to see changes, I can increase the difficulty for the athlete and challenge that new state to further reinforce it. It’s no different from normal S&C work except I allow less variability in the movements initially.

With actual exercises themselves, I will change them to suit the individual. Change foot positions, ranges of motion and cues depending on what I want the athlete to get out of it. I don’t think there’s always a single way to do an exercise. For example a step up, sometimes I’ll start with both feet on the floor, sometimes 1 on the box, sometimes just on the ball of the foot on the step. I’ll target attention to the direction their head travels, what they do with their foot, their body movement over the foot, their knee drive or hip hike depending on what I need to alter in their movement. I don’t have a single script for each exercise. I’ll try to experiment a bit too, if something works then great it’s a keeper, if not I’ve learnt something and it gets put to one side.

The main idea I have in my head is that I have to rehab the injured athlete and not the injury. As a result there is always an element of individualisation.

 

Neil Welch

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