Strength and Conditioning in the Rehabilitation Setting

When you think Physical Therapy, what do you think?  If you imagine it is a place where you get a massage, do the same exercises as everyone else (on a table) for an hour, or simply a place where you are told what you cannot do/should stop doing, you are thinking of an older model of care.  

It seems more and more that the gap between the rehabilitative field and the strength and conditioning field is becoming narrower by the day, and for good reason.  Rehab IS strength and conditioning, just on the opposite side of the continuum.  

This graph does an excellent job demonstrating the idea of a TEAM approach to a patient's care.  Worth noting is just how long we as healthcare professionals and strength and conditioning specialists can have in the rehabilitation of the strength and conditioning athlete. 

This graph does an excellent job demonstrating the idea of a TEAM approach to a patient's care.  Worth noting is just how long we as healthcare professionals and strength and conditioning specialists can have in the rehabilitation of the strength and conditioning athlete. 

When tissue gets injured it is our job to influence the healing process while maintaining progressive overload to create resiliency.  Better known as the act of accepting the demands of weight training, running and sports without being re-injured or suffering set backs.  In order to do this we must use the appropriate load, intensity and volume that challenges the injured tissue without irritating their symptoms.  

  • LOAD >> CAPACITY = INJURY
  • LOAD = CAPACITY = REHAB
  • LOAD << CAPACITY = PREVENTION

This sounds a lot like what I used to do as a strength and conditioning coach.  Create an exercise program that uses the appropriate loads, intensities and volumes that will help create positive adaptations without hurting my clients.  

The goal of rehab after all is to get the person in front of us back to their prior level of function. This can be anything from being a desk jockey to the All-American Jockey. 

When healthcare professionals do not understand strength and conditioning protocols, it will be hard to help that patient to continue to train around injury.

This is an e-mail that I received this morning from a trainer that I work closely with:

"Hey Joe. I have a question.  I have a client that is seeing a PT for some shoulder issues.  The client introduced us through email so we could work together to figure out an alternate plan of training that would allow her to get the treatment she needs for her shoulder while continuing her training. The PT responded that he wants the client to abstain from any and all exercise, like do nothing at all."

No one should ever have to hear that have to abstain from all exercise unless it is 100% warranted.  If I person can go into the gym and perform pain free movements, they should, not just to keep their body some-what conditioned, but to help keep them sane.  There are plenty of activities one can perform while still "protecting" healing tissues.  

This is where a healthcare professional who also has experience as a strength coach can really help.  It becomes very easy to understand regressions and lateralizations of exercises that will allow them to still have some training effect while recovering from their injury.

For these reasons, it becomes highly important for rehabilitation providers to understand performance, and on the flip side strength coaches and trainers to understand more of the rehabilitation world.  This will allow for better communication, and make for a much better transition from being hurt to getting back to your previous self. 

It is okay to not know everything, actually it is perfectly normal.  However, identifying areas of opportunity in our practice and linking them with patient's needs should force us to build a reliable network of providers in order to ensure that each and every patient receives optimal care and has the greatest chance for success.