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#41 Do “rehab/prehab” exercises work?
Whenever I see any of my athletes or patients for treatment, my number one form of treatment is exercise. How do we know which exercise to choose for rehabilitation? The exercises that makes them stronger.
The SAID principle is Specific Adaptation to Imposed Demands. In an overly simplified definition it means that the human body will adapt to what you do to it.
This means that I need to have a thorough understanding of the athlete/patient.
If my athlete is injured, then I need to choose the least painful exercise that challenges the painful movement/injured tissue. Then when they adapt to the exercise, I choose another one and/or load the exercise.
What about Prehab/mobility exercises like different forms of stretching or trigger point techniques for injury prevention?
If I have a patient who is untrained/deconditioned, then “traditional” rehabilitation exercises may fit the bill, but what about athletes who already have a great foundational strength? I need to think differently because these rehab exercises aren’t going to cut it. Why not? Because, these exercises won’t necessarily make them stronger. Why am I so insistent on strengthening people? Because people are weak. Do I sound harsh? Maybe, but if you understand what sort of peak loading occurs at each joint during simple jumps and landing, then you’ll understand why people (not just athletes) need to be strong in order to prevent injury and why we need to strengthen in order to rehabilitate injury.
In numerous studies (see reference list), we can find that in vertical jumping and landing, the peak loading in the knees, hips and ankles were about 6.9-9.0 body weight, 5.5-8.4xbody weight, and 8.9-10xbody weight. That seems like an insanely high amount of loading through the joints, how do we absorb such high forces? Our skeletal system provides the majority of support, however so does our muscular system. If we are not strong enough to absorb the aforementioned forces, then our risk of injury skyrockets. Think about it, if I weigh 85kg then, my ankles alone will need to absorb 850kg of force. If I am not strong, then I run a severe risk of injuring my ankles, or knees, or hips.
If I solely rely on my skeletal system to support and absorb forces, then the weakest link in the chain is going to give out. The weakest link could be any structure in the surrounding joint; muscles, ligaments, tendons, bones, you name it. Out of those structures the only thing we actually can control are our muscles. So train them. Train them to be strong and be strong in every position possible.
So to answer the main question, do “rehab/prheab” exercises work? Yes. If the exercises make your athlete stronger.
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Cheung, K., Hume, P. A., & Maxwell, L. (2003). Delayed onset muscle soreness. Sports Medicine, 33(2), 145-164.
Havelin, J., Imbert, I., Cormier, J., Allen, J., Porreca, F., & King, T. (2015). Central sensitization and neuropathic features of ongoing pain in a rat model of advanced osteoarthritis. The Journal of Pain.
Leatt, P., Reilly, T., & Troup, J. G. (1986). Spinal loading during circuit weight-training and running. British Journal of Sports Medicine, 20(3), 119-124.
Shelburne, K. B., Torry, M. R., & Pandy, M. G. (2005). Muscle, ligament, and joint-contact forces at the knee during walking. Medicine and science in sports and exercise, 37(11), 1948.