Short to Long Rehab
The short to long approach to rehabilitation within team sports is relatively new and has drawn its influence from track-based training. It has gained more popularity and ever growing due to the perceived ability to return athletes to training and game time at an earlier time frame. Identifying and using intensity markers from GPS such as maximum speed, acceleration, deceleration and change of direction. This differs from the more ‘traditional’ process where the entry to on feet is jogging, usually around 5 to 5.5 m/s with the aim of targeting total volume first and gradually introducing high intensities later down the line.
As a practionor that has worked in both processes my personal and professional preference is to adopt the speed-based approach. When I started running players using the more traditional volume based approach, it never made sense to me. Firstly to be able to conditioning an athlete within rehab we have limited time during short to medium term rehab and running at under 5m/s around a pitch was easy to proscribe and seemed apprehensive. I often found that introducing the intensities later in the process created lots of soreness that required re-planning and organisation of the rest of the week. Due to this there was no room for covering regressive intensive movement patterns. So, flipping the process on its head made more sense to give exposure to acceleration, in which we can then condition the athlete more meaningfully. Also, exposure to high speed or max velocity and deceleration gives us a better of higher tissue conditioning stimulus than compared to gym based rehab.
The fundamentals of this approach is to expose players to these movements as early as possible during rehab. Using more simplistic, regressed drills that are derived from either of the previously identified high intensity actions to give a progressive exposure to the end product. The first step to start getting the athlete to make the shapes of these actions through motor control and co-ordination based rehab that typically initiates and runs through the rehab process from start to finish. Once we start in a static and vertical position we can progress either one of these two initial stages.
Starting in a static position is the first port of call as it requires a isometric contraction. This can be self-mediated in the initial stages and then progressed to movement within a static position. Here the focus is on making the shape of acceleration, deceleration or up right running where co-ordination of muscles, joints and posture are achieved. Which can give the athlete the feeling of a certain position and a feminisation of what they should be trying to achieve. This type of drill would be an athlete pose or athlete frame (A Frame) where they push against a wall or static object. This can be completed using double or single leg depending on what stage the athlete is at or how far you need to regress the drill. This can then be progressed to with movement, giving the athlete the instruction to sink into the hole and drive out to embrace the start position. This is the same for each movement, start static, introduces movement through that range maintaining the same postures and sensation as we add in complexity, intensity and volume.
This strategy allows for system learning first through motor control and co-ordination to higher functioning movement patterns that mimic our ultimate goal. Each regressed exercise or drill teaching and reinforcing fundamental positions and movements required for the desired high intensity action. Allowing for a much smoother and easier transition to locomotive, over ground rehab.
So, where do we start with this approach in rehab?
We start with a linear track over 30-40m in length with markers every 5-10m. All the drills start with vertical positioning with limited horizontal. The horizontal component comes in as the athlete is moving forward over a set distance. We start with A skips, which positioning is very similar to that of the A frame we touched on previously. We should now start to see that there is commonality in differing drills. Adding in B skips, differing pogos and dribbles to give differing stimulus, as we would in the gym with different exercises. This is then proscribed, again, like we would do in the gym.
We can then run a concurrent program and as we work on over ground vertical drills, continue to develop more horizontal stimulus in the gym. Through the use of a prowler press or plyometrics to help support this development. Or we can choose to progress within session to add in more horizontal drills as we go. This heavily depends on the type and location of injury, length of time out, athlete and practioner competency.
In addition to giving the player an earlier entry to pitch based rehab through the start of static based drills through to over ground ones we gain an insight to the movement strategies of the player. As a practionor our role should not only be to address the injury but also highlight adopted movement strategies. Here we should be able to see through the coaches eye, video analytics or objectives. With the goal of making the more efficient, effective and/or robust within training and game time. When a player is fully participating in training and regularly playing games identification of any potential movement strategies is very difficult to intervene with and implement. In rehab, we have the time and ability to identify and address these which we aim to become an integral part of training and automatic, so they no longer need to think about it; it just happens.
Using the process, I have found that my athletes are more engaged in their rehab, understand the process more and feel more prepared when re-entering into training.
Adopting this strategy, form me, has helped me make sense of the on-field rehab process and my ultimate aims while individualising and understanding my athletes needs and gaps at this stage for my athletes.
