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You’ve been given the clear from your doctor to get back to your sport. Naturally, you’re excited and looking forward to getting back at it. However, our instinctive response to getting clear often consists of these questions: how do we return safely? How can I get back to where I was before my injury and do so without getting reinjured?

Here are a few research-based exercise strategies to implement when rehabbing an injury to ensure you get back to your pre-injury performance levels:

Start Light:

When we are given the okay from our doctors, we incline to pick up where we left off before getting injured. However, dysfunctional movement patterns are potentially what got you injured in the first place. Returning to such patterns with a high intensity immediately is asking to become re-injured. Start light, work on form, and progress slowly over time with proper movement patterns. (1)

Auto-Regulate Your Training:

Each day that we enter our training, we feel different. Some days we feel on top of the world, and some days the world feels like it is on top of us. Likewise, different individuals respond differently to the same stimuli when it comes to sports training. (2) Yet, we seldom take this into account in our training. (3,4,5).

This is a problem because when our bodies and minds feel the most run-down, we are most susceptible to injury. Auto-regulation is a training modality that takes this into account. This is the changing of training depending upon your recovery from training, psychological state, and how you feel physically.

If you are having an “off day,” you can autoregulate by lowering the volume or intensity of your training, or by taking a day off from working out, or by switching exercises to something that suits your needs (whether they be not reaggravating an injury or not causing unnecessary aches and pains or taking too much out of you psychologically.)

In other words, tier your training to your physical and psychological needs. If you feel too fatigued, feel free to lighten the load. Likewise, if an exercise is bothering an injured area, switch it out for something similar that doesn’t bother you. Research (6) shows that you might become stronger in a quicker manner because of it, which will get you back to your pre-injury performance more quickly and safely.

Utilize Tempo-Training:

Several studies (7,8,9,10,11,12,13) have validated the use of tempo training in the rehabilitation of injuries. Tempo is essentially the speed at which you are lifting. Tempo training in rehabilitation utilizes slower weight-lifting to ensure safe progression, correct technique, and facilitate the healing process with a much lower risk for re-injury.

For instance, eccentric resistance training, which entails a slow tempo (e.g., 3–5-second speed) on the lowering portion of a lifting exercise, is helpful for Achilles tendon tears, patellar tendonitis, and various knee among many other types of injuries.

In a similar vein, heavy-slow resistance training, which has slow tempos on both the lifting and lowering phases of a movement, considers the potential stress that a quick muscle contraction might place on a damaged tissue on the concentric portion of a movement a lift.

Both of these methods allow you to slowly progressively overload the muscles and promote healing while mitigating the possibility of reinjury.

Unilateral Training:

Unilateral training is an exercise technique that entails one-armed variants of exercises that normally use both arms.

For example, a unilateral version of a deadlift is a single-legged Romanian deadlift. Another example would be a single-armed dumbbell bench press instead of a standard barbell bench press.

A major source of many common injuries is muscle imbalances. Imbalances are normal. However, when these imbalances become immensely asymmetrical, making safe progress becomes quite impaired, and the likelihood of injury increases.

This is because it is the case that muscle imbalances can lead to improper technique on bilateral movements, which in turn increases the risk of injury. Thus, adding unilateral exercises to your injury rehab program will help decrease the likelihood of reinjury and will ensure that your performance on regular exercises is optimal. (14,15,16,17,18).

Citations:

1. Dhillon, Himmat et al. “Current Concepts in Sports Injury Rehabilitation.” Indian journal of orthopedics vol. 51,5 (2017): 529–536. doi:10.4103/ortho.IJOrtho_226_17

2. Ahtiainen, J. P., Walker, S., Peltonen, H., Holviala, J., Sillanpää, E., Karavirta, L., … & Hulmi, J. J. (2016). Heterogeneity in resistance training-induced muscle strength and mass responses in men and women of different ages. Age, 38(1), 10.

3. Fleck, S. J. (1999). Periodized strength training: a critical review. The Journal of Strength & Conditioning Research, 13(1), 82–89.

4. Rhea, M. R., & Alderman, B. L. (2004). A meta-analysis of periodized versus non periodized strength and power training programs. Research quarterly for exercise and sport, 75(4), 413–422.

5. Rhea, M. R., Bell, S. D., Phillips, W. T., & Burkett, L. N. (2002). A comparison of linear and daily undulating periodized programs with equated volume and intensity for strength. The Journal of strength & conditioning research, 16(2), 250–255

6. McNamara, J. M., & Stearne, D. J. (2010). Flexible nonlinear periodization in a beginner college weight training class. The Journal of strength & conditioning research, 24(8), 2012–2017.

7. Blazevich, A. J., Cannavan, D., Coleman, D. R., & Horne, S. (2007). Influence of concentric and eccentric resistance training on architectural adaptation in human quadriceps muscles. Journal of Applied Physiology, 103(5), 1565–1575.

8. Askling, C., Karlsson, J., & Thorstensson, A. (2003). Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian journal of medicine & science in sports, 13(4), 244–250.

9. Kaminski, T. W., Wabbersen, C. V., & Murphy, R. M. (1998). Concentric versus enhanced eccentric hamstring strength training: clinical implications. Journal of athletic training, 33(3), 216.

10. Potier, T. G., Alexander, C. M., & Seynnes, O. R. (2009). Effects of eccentric strength training on biceps femoris muscle architecture and knee joint range of movement. European journal of applied physiology, 105(6), 939–944.

11. LaStayo, P. C., Woolf, J. M., Lewek, M. D., Snyder-Mackler, L., Reich, T., & Lindstedt, S. L. (2003). Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. Journal of Orthopaedic & Sports Physical Therapy, 33(10), 557–571.

12. Kongsgaard, M., Kovanen, V., Aagaard, P., Doessing, S., Hansen, P., Laursen, A. H., … & Magnusson, S. P. (2009). Corticosteroid injections, eccentric decline squat training, and heavy, slow resistance training in patellar tendinopathy. Scandinavian journal of medicine & science in sports, 19(6), 790–802.

13. Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy, slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine, 43(7), 1704–1711.

14. Dragert K, Zehr EP. Bilateral neuromuscular plasticity from unilateral training of the ankle dorsiflexors. Experimental brain research. 2011 Jan 1;208(2):217–27.

15. Häkkinen K, Kallinen M, Linnamo V, PASTINEN UM, Newton RU, Kraemer WJ. Neuromuscular adaptations during bilateral versus unilateral strength training in middle‐aged and older men and women. Acta Physiologica. 1996 Aug 1;158(1):77–88.

16. McCurdy KW, Langford GA, Doscher MW, Wiley LP, Mallard KG. The effects of short-term unilateral and bilateral lower-body resistance training on measures of strength and power. Journal of Strength and Conditioning Research. 2005 Feb 1;19(1):9.

17. Schoenfeld BJ, Vigotsky A, Contreras B, Golden S, Alto A, Larson R, Winkelman N, Paoli A. Differential effects of attentional focus strategies during long-term resistance training. European journal of sports science. 2018 Mar 13:1–8.

18. Schoenfeld, B.J. and Contreras, B., 2016. Attentional focus for maximizing muscle development: The mind-muscle connection. Strength & Conditioning Journal, 38(1), pp.27–29.