S&C in rehab

One of my 2014 aims is to write more often, this is the start of it. I want to cover a number of different areas, one of which is the role of the strength and conditioning coach in rehabilitating injury. It’s a big area so should give me plenty to talk about.

Most of the rehab based coaching I’m doing is with chronic injuries or conditions like low back pain rather than short term injuries like hamstring tears although high hamstring tendon issues crop up often enough. Either way, they occur for a reason, and in order to rehab it and prevent it happening again you have to change something. This requires an understanding of the potential mechanisms for the injury in the first place, of which there are usually many to pick from. I’ll admit here that my first port of call is usually to look at biomechanics rather than training loads and recovery although these have been issues a few times (each time with runners, more is better though right?). Developing a good understanding of biomechanics and anatomy (check out the essential anatomy 2 app) is important for this.

Once you have some understanding of the mechanisms you need to know how to spot them in the athlete. This is a tough game and I’m constantly fighting a battle with my confirmation bias (recent read, worth a shot).

The way I do this is to watch as many people move as possible. I observe gait patterns (walking and running), seated postures, moving up and down stairs and picking up and manipulating objects (It gets a little annoying, I kind of feel like Ben Affleck in Daredevil which if you haven’t watched, don’t). In all populations. I look to what default patterns people fall into and I copy them. I think it’s important I know what it feels like to move a certain way, how it differs to the way I move and the way I want to get people to move. It gives me context for when I coach the athlete/patient.

When screening, I try to use activities that involve distractions or situations where they don’t know they’re being screened. Tests change people. I often use warm ups for this purpose and film the movements I want to focus on. I tend to use movements I associate with certain injuries or that the person has identified as causing pain. I’m not a huge FMS fan, I’ll use some of the movements if I think it appropriate, but that’s rare for me. If I want to score a test battery I’ll tend to use Kelvin Giles physical competency assessments, I find it more versatile.

Once I think I have a mechanism or 2, I show them to the athlete/patient and explain it to them. This is where video is so important. On so many occasions I’ve been explaining to someone about their hip slipping out to the side on a step up or knee movement on a lunge. Only when I show them on video do I realise they had no idea what I’m talking about. They then correct the movement straight away. It’s really helped me to develop my cuing. Once I’ve explained it, I pick a fight with it. I go after it with the tools I think will do the most damage, this is where exercise selection comes in…..which I’ll cover in another blog.

Neil Welch

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