What is Rehabilitation in Sports?
The World Health Organization defines rehabilitation as: “A set of interventions designed to optimize function and reduce disability in an individual with a medical condition as they interact with the environment.” In sports, rehabilitation is often considered to be optimal recovery state Form (anatomy) and function (physiology). 
Sports Rehabilitation Aims
Sports injury rehabilitation is a dynamic process with the following goals :
- Restoring Athlete’s Function and Performance Levels
- Resuming sports participation in a safe, efficient and timely manner
- Reduce the risk of re-injury
Considerations in Sports Rehabilitation
Two things to consider in sports rehabilitation are the athlete’s usability and function and form. 
- Athlete Availability = Rehabilitation enables individuals to maintain or return to their desired level of activity
- Function vs. Form = Rehabilitation can restore optimal function with or without form
Zachrisson et al.  investigated the availability of athletes and the incidence of overuse injuries in Swedish elite athletes during a sporting season. They reported the following :
- The monthly injury rate for a season corresponds to periods of high training volume, such as conditioning phases and training camps
- The low athlete availability (below or slightly above 80%) reported in this study at the event group and individual levels suggests that many athletes in this Swedish cohort may not be able to reach their full athletic potential
Function vs Form
Form = Structure (that is, anatomical structures such as tendons, ligaments, joint capsules)
Function = a product of a structure that performs a specific role or athlete’s ability
There is a close relationship between form (structure) and function. However, if we consider that humans are complex, we can see why function is not always directly related to structure.  For example, athletes may compete at a high level, but if they undergo imaging studies, they may Signs of an existing condition. Imaging may show impairment of form (structure) but not function. An example of this is:
- MRI findings of symptomatic and asymptomatic shoulders were similar in young elite swimmers. An asymptomatic shoulder can have many different abnormalities on MRI that may be radiologically significant but not clinically significant. 
Read more about form vs function here: Structure vs Function
Planning a Rehabilitation Programme
When planning a rehabilitation program, it is important to consider :
- Tissue healing
- Requirements of the sport
- Goals of the athlete
- Psychological Aspects and Athlete Behavior
- Contextual factors such as:
- Athletes discover their game and environment
- Micro-planning——short- and medium-term planning
- Macro planning – medium and long-term planning
- What does the rehabilitation program need to achieve?
- Healing of a specific structure?
- Pain reduction?
- Improve function?
- Or a mixture of elements?
- Consider muscle properties:
- Strength vs endurance
- Is there a link between muscle properties and pain?
- Does strengthening around specific areas improve pain, or is there no relationship between muscle properties and pain (i.e. pain persists even after strengthening)?
- Consider the length of meetings and the frequency of meetings needed for an effective rehabilitation program
- Consider the content of the recovery plan – what are the goals and are there opportunities?
Rehabilitation programs must take into account the fact that the patient’s (athlete’s) goal is to return to the same activity and environment in which the injury occurred. Functional capacity after recovery should be the same, if not better, than it was before the injury. The goal of  The rehabilitation process is intended to limit the extent of injury, reduce or reverse injury and loss of function, and prevent correction or elimination of disability. 
Rehabilitation is an Opportunity
The goal of sports rehabilitation is to safely and effectively return the athlete to an optimal level of function in the shortest possible time with a reduced risk of re-injury. There are various rehabilitation programs.
In the case of a first injury, the goal of rehabilitation is to prevent re-injury. With recurrent injuries, the goal is to prevent re-injury, but also to identify causative factors and address them. Sometimes athletes complain about a glitch, and the goal of rehab may be to prevent that glitch Freedom from injury (in other words, the athlete has a medical complaint, but we don’t want this complaint to become an injury that could affect training and competition availability).
Rehabilitation provides an ideal opportunity to fully assess the individual athlete and understand why they suffered a particular injury. 
Rehabilitation does not exclude hands-on therapy
Exercise rehabilitation does not always rely on exercise therapy alone. Whichever elements a physiotherapist chooses to apply, they should be evidence-based and applied in the correct context. Some of these methods can include soft tissue therapy acupuncture and electrotherapy such as Shockwave therapy. The goal of health professionals should be to ensure good outcomes after rehab, but also to empower athletes and ensure they are not overly reliant on any strategies offered by physiotherapists. The literature also shows that athletes’ and The skill of the clinician/expectations regarding the mechanism and effect of the treatment are important determinants of outcome. 
Review of Practical Conservative Treatment of Pain in Recreational and Elite Athletes surveys current practice and solutions in the sporting setting.  A short summary of the findings of this review can be viewed here: Practical management of pain in athletes
The International Olympic Committee has published a consensus statement on pain management in elite athletes. In this statement, the available evidence for several non-drug pain management strategies used by physiotherapists is discussed. These include :
- Modalities and massage
- Movement, strength and conditioning
- Psychosocial interventions
- Sleep and nutrition
Read the full consensus statement here: IOC consensus statement on pain management in elite athletes. 
Strength training and conditioning are effective recovery tools after injury. Muscular strength Endurance and strength are the force-generating capabilities necessary for recovery from exercise. Rehab programs often use suggested schedules for higher levels of exercise, but it is It is important for rehabilitation healthcare professionals to ensure that movement progression is also based on functional and objective measures. 
Athletes need a combination of muscular endurance and power to perform activities unique to their sport. Therefore, when recovering from an injury, they should also perform strength training at varying rates and durations throughout the rehabilitation process. FITT (frequency intensity type and Timing of exercise prescription) principles can be applied and varied to accommodate appropriate phases of recovery and rehabilitation. 
Read more about FITT here: Basic Exercise Principles
- Principles of Exercise
- Introduction to Therapeutic Exercise
Exercise Prescription – Equipment
When developing rehabilitation exercises, the availability of necessary equipment needs to be considered. Many professional athletes are in one centralized location with access to all necessary equipment space and a multidisciplinary team environment. But other athletes may not have access to All of these services are provided when training abroad or traveling for competitions. The availability of equipment, training space, and multidisciplinary support should always be considered when developing rehabilitation.
Read more about training during the pandemic to gain insight into sports and equipment prescriptions here: Training During COVID-19 Lockdown: Knowledge Beliefs and Practices from 12,526 Athletes in 142 Countries and Six Continents
Exercise Prescription – Dosage
- Muscle properties
- It is important to know what needs to be achieved in terms of muscle properties – eg is the goal strength or endurance?
- It is important to determine the maximum repetition percentage (1 RM) that should be achieved.
- Resistance training is an effective tool for improving muscle fitness such as endurance and size.
- The repetition continuum or strength-endurance continuum is often used to specify specific load recommendations.
- Muscle Strength – Heavy Low Reps: 1 – 5 reps per set, 80% – 100% of 1 -repetition max (1RM)
- Hypertrophy – Moderate reps with moderate load: 8 – 12 reps per set, 60% – 80% of 1RM
- Muscular Endurance – Light Load High Reps: 15 reps per set, load less than 60% of 1RM
- Read more: Load recommendations for muscle strength hypertrophy and local endurance: a reexamination of the repetition continuum 
Exercise Prescription – Pain
Exercise-induced hypoalgesia may be a positive effect of an exercise program. However, this is a complex phenomenon and there are still many unexplained factors (i.e., underlying mechanisms, contextual factors, etc.). Evidence for exercise-induced hypoalgesia is unclear, methodological The quality and quality of research needs to be improved before reliable and valid recommendations can be made for clinical practice. 
Bonello et al.  reported inconclusive evidence for exercise-induced hypoalgesia in patients with localized musculoskeletal pain. The authors note that further research is needed to understand exercise-induced hypoalgesia in different musculoskeletal populations. 
Read more: Exercises and Activities in Pain Management
Rehabilitation – Kinetic Chain
The Importance of Full Kinetic Chain Rehabilitation
Integrating the entire kinetic chain into a rehabilitation strategy is critical for good outcomes. The term kinetic chain refers to “the sequential task-specific activation of body parts in functional movement patterns.” 
An efficient power chain will allow proper transfer of mechanical energy throughout the chain and facilitate function. A weak link or inefficiency in the overall power chain can affect the force transmission in other parts and may cause other parts of the chain to compensate for this energy loss. This is hypothesized to be a predisposing factor that increases the risk of injury. 
Consider the type of sport the athlete is involved in (water extreme sports vs land extreme sports) and the athlete’s ability (e.g. wheelchair Paralympic athlete) when incorporating the entire kinetic chain into a rehabilitation program. 
- Examples of engagement across the kinetic chain
- Tennis – 50% – 55% of the total kinetic energy required by the legs and torso to generate the serve
- Baseball—Important requirements for effective baseball pitching are external shoulder rotation and range of motion and control as well as lumbopelvic hip stability and gluteal activation 
- Throwing athletes with reduced hip abduction strength and hip range of motion may be at increased risk of shoulder and elbow injuries 
Athletes of all levels aim to perform and improve performance. Many variables affect this pursuit of performance, e.g. :
- Emotional control
- Nutritional control
- Injury management
These factors require specific knowledge and expertise of professionals trained in these fields, for example :
- Sports physicians
- Strength and conditioning coaches
- Sports scientists
- Performance analysts
Take boxing as an example: British Boxing coordinates and integrates various members of a multidisciplinary team through an Individual Athlete Program (IAP), where the athlete’s full recovery is planned and understood by all involved members. often The role of the physical therapist in this process is to provide guidelines about what is going on and to work to bring the multidisciplinary team together. 
- Multidisciplinary Teams in Sport: A Narrative Review 
- ‘How’ multidisciplinary teams effectively reduce injuries in professional sports settings
- Leading the way to healthy performance: Leadership requirements to enhance the health and performance of elite sports teams 
Improving Athlete Expectations
Carroll et al.  explored what recovery after a musculoskeletal injury meant to participants and whether they wished to recover. In this qualitative study, the following points were highlighted:
- Recovery can be summarised as:
- “[C] Complete symptom cessation and painless function”
- “Despite residual pain, [R] regained function”
- Expectations were driven by:
- A desire for a clear diagnosis
- Believe (or not) in the clinician’s prognosis
- Previous experiences
- Others’ experiences and attitudes
- other sources of information, such as the internet
- A sense of self as resilient
Expectations seem to be related to hopes and fears. Therefore, clinicians are advised to consider both when negotiating realistic goals for clients and educating clients about their injuries and recovery. This method is recommended for nonspecific Musculoskeletal pain without a clear diagnosis and treatment may not fully improve the pain. [twenty two]
Read the full article: How well do you want to recover and what does recovery really mean? A qualitative study of expectations after musculoskeletal injuries. [twenty two]
Adherence to Rehabilitation
Adherence to a rehabilitation program for athletes with sports injuries is an important consideration. This persistence or compliance has implications for the recovery process. Motivational factors that help athletes stay in the recovery process Including :
- Social support
- Having goals during rehabilitation
- Internal and external pressures
In the study by Hildingsson et al. The following are also important for athletes :
- The desire to achieve personal goals
- Passion for their sport
- Strong athletic identity
- Importance of relatedness with the team
- Maintaining their physique
Athletes want to make autonomous decisions and be in control of their lives. An athlete-centered approach is relevant to rehabilitation needs, and physical therapists are uniquely positioned to empower athletes and help them achieve their goals. [twenty three]
Read the full article: Perceived motivators of female soccer players during rehabilitation after a sports injury – a qualitative interview study. [twenty three]
Strategies to Enhance Adherence
Gledhill et al.  provided clinicians with four strategies to improve patient compliance with rehabilitation. These strategies are:
- Build strong relationships and provide quality social support
- Provide athletes with clear, honest and understandable information
- Encourage patients to keep exercise social
- Clinicians can do this by scheduling rehabilitation sessions in a team setting (i.e. on the sidelines while the team trains on the field)
- Support the patient’s autonomy
- Encourage the athlete to be autonomous
- Using Goal Setting Techniques with Athletes
- Goal setting will help improve adherence as athletes will become more efficient and focused.
Read the editorial here: “I want you to believe – it’s not my ability to create change, it’s yours”: Four Strategies to Improve Patient Compliance in Rehabilitation
Adherence to Rehabilitation in Sports
Christakou and Lavallee  listed three theoretical approaches to sustained sports injury rehabilitation. all these are:
- Protection motivation theory
- The decision to adopt protective health behaviors involves two cognitive approaches, the threat assessment process and the response assessment process.
- Personal investment theory
- Personal motivation, self-confidence, and perceived choices will determine motivation in a given situation.
- Cognitive appraisal model
- This model posits that post-injury behavior is influenced by emotional responses to the injury. These emotional responses are thought to occur due to an interaction between personal and situational factors.
Enhancing Adherence to Rehabilitation
For successful rehabilitation, a partnership and collaborative effort between rehabilitation professionals and athletes is required. Athletes sometimes have difficulty adhering to a rehabilitation program due to cognitive issues (understanding the nature of the injury and goals of treatment) and prognosis) emotional issues (issues such as anxiety and anger) and behavioral issues (athletes feel they need to do something about their injury). Sports rehabilitation professionals are under pressure not only to apply their rehabilitation skills to the situation, but also to address Issues such as athlete anxiety and potential outcomes of recovery. Christakou and Lavallee  suggested some practical strategies that can improve adherence to rehabilitation :
- A critical step in the rehabilitation process is ensuring athletes are well informed and educated about their injury. This will have a positive impact on their persistence and personal goals, and will increase their confidence in the efficacy of recovery methods.
- Communication (Listening – Active)
- Roberts et al.  measured verbal communication during initial physical therapy exposure and reported that it comprised 49.8% of physical therapists and 33.1% of patients in their study sample. Physiotherapists provide patients with a wealth of information; 12.5% of this information is recommendations or Advice when meeting for the first time.
- In a follow-up study measuring the prevalence and nature of speech interruptions during back pain consultations, Roberts and Burrows  highlighted that “clinicians were seven times more likely to interrupt than patients”. The main reason for being interrupted by a clinician is “Seek” or “give” additional information.
- Learn more:
- Communication skills
- Skills to Enhance Communication
- Thought Stoppage
- Athletes who have a negative cognitive assessment of an injury tend to have negative thoughts, which can lead to emotional disturbances and subsequent possible non-adherence to rehabilitation programs. “
- A physical therapist can encourage athletes to recognize negative thoughts about their injury and emphasize that this is a normal reaction. The aim is to transform these negative thoughts into positive feelings using pragmatic statements. Some examples of these statements are :
- I want to complete the recovery process
- I’m improving and I’m going back to sports
- I want to play again this season
- This injury is only a small threat to my sports career
- I am going to start winning medals again
- I am going to have full strength
- Enhancing Athlete’s Beliefs
- Beliefs about the meaning of the recovery process can determine adherence to recovery. It is important to explain to athletes the meaning or connection between what they are doing and what they are going to achieve. This also improves the overall coping strategy.
- Share information about your progress, such as: Your range of motion is improving.
- Use short-term goals (objective measures)
- Goal setting provides a motivational strategy to influence efforts to achieve goals. It increases concentration and enhances perseverance.
- Achievable and quantifiable measures are needed to support this process. (e.g. exercise intensity balance range)
- Enhancing Pain Tolerance
- It’s important to remember that pain is a very subjective emotional and sensory experience.
- Athletes may stop adhering to their rehabilitation program if they believe that any pain they feel during or after training is detrimental to their recovery, or simply because they cannot tolerate the pain.
- Clinicians can enhance coping strategies with appropriate pain education.
- Social Support
- Social support from coaches, teammates, friends, and parents can improve an athlete’s adherence to a rehabilitation program.
- Discussing their previous injuries and recovery successes with teammates provides an opportunity to improve rehabilitation compliance and athletic success.
- Purpose of rehabilitation
- What will the outcome be?
- Definition of success
- Adherence to rehabilitation
- Planning and structure
- properly explained to all parties involved
- What types of intervention
- Collaboration between multidisciplinary teams
- Consider the kinetic chain of recovery as well as the person and ensure appropriate support
- Judicious use of evidence-based complementary therapies when needed
- Focus on athlete empowerment, educating athletes and being clear and honest when providing information
- Rehabilitation in Sport
- Principles of Rehabilitation
- Components of Rehabilitation
- Stages of Rehabilitation
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