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Thomas Nemeth

Maximising Performance: How to Get the Most Out of Your Rehab & Exercise

Meet Jim.

Jim is a truck driver who hurt his back lifting a box into his truck.

Jim saw a physio who gave him some stretches and told him to avoid heavy lifting.

Jim did his stretches twice a day, and a few days later was able to get back to work.

Two weeks later Jim came back to the physio because his back started hurting again.

Jim is upset because he has been doing all his stretches and he hasn’t been bending or lifting anything heavy.

Jim is starting to think that physio doesn’t work…

Meet Sarah.

Sarah is a soccer player who recently started getting some knee pain during training

Sarah did a quick Google search for the “Best Exercises for Knee Pain”, and started doing these every day. Sarah also spoke to her friend who injured her knee at calisthenics, and Sarah’s friend recommended some knee exercises that her physio had prescribed.

Six weeks later, Sarah is still getting knee pain, and she is considering stopping soccer.

Sarah is upset because she has been doing all sorts of knee exercises, but hasn’t had any improvement.

Sarah is starting to think that physio doesn’t work…

Have you ever felt like Jim or Sarah? Unfortunately these sort of stories are something we come across all the time as physios. And like Jim and Sarah, it is often not for a lack of trying to exercise and listen to the right advice. However the problem lies deeper than this — the exercises done and advice given often does not go far enough. The result? Ineffective exercise rehab that does not translate to a successful recovery. Let’s dive further into this …

What Makes Rehab & Exercise Ineffective?

Ultimately, the goal of rehab exercise and strength training is to prepare a person’s body to be able to handle the demands or rigors of their work, sport, and general daily activities. Quite often, the exercise being done either does not adequately meet these demands, or the exercise does not translate or transfer appropriately to the work, sport, or activities being done. So not only does this mean that work or sporting performance is impacted because gains in the gym aren’t being seen in daily life, but it means that the risk of injury starts to increase because the demands are greater than the person’s capacity. And so just like a chair might break if you stacked enough weight on top of it, a person’s body will break down if it is under more strain or load than it can handle.

What Makes Rehab & Exercise Effective?

In the world of exercise and rehab, people talk about “Principles of Training” — rules, if you will, for how to exercise effectively. Different sources will vary slightly in the total number of principles, but here we will explore 5.

1. Specificity

Muscles will change in structure to adapt to the types of loads and stressors it experiences during training, and so we want to be training muscles in a similar way that they would be used during our work or sport. This would include similar speed or intensity, similar movements, and generally similar muscle groups that are trained.

So for Jim from our earlier scenario, simply doing some stretches is not going to help his body adapt to a job that involves lifting and bending. Some of these stretches may be helpful to settle Jim’s pain, but his rehab program should also include specific exercises that simulate — you guessed it — lifting and bending.

2. Individuality

Every person’s body is different. Some people are naturally more stronger or more flexible, some will gain muscle at a faster or slower rate, and of course there are differences across different age groups and between males and females. Everyone will fall at a different point on the spectrum from where they are now to where they need to be for their work or sport. – So when training, we want to train at a level appropriate to the individual, considering a person’s individual training needs. This can be an issue with things like you-tube exercise videos or exercise advice from instagram gurus, because they are targeted to a large audience, and we can’t assume that they will be appropriate for each person’s abilities and for each person’s sport.

Thinking back to Sarah from earlier, her Google exercises and her friend’s rehab exercises fall into this error of not accounting for Sarah’s individual needs and individual abilities.

3. Progressive Overload

As described earlier, muscles change structure and adapt to how we train them, and so in order to make significant changes and improve strength over time, we need to continually challenge muscles close to their maximum capacity. If you do body weight squats and lunges for a whole year, you’re going to get really good at doing the exercise, but you aren’t going to gain much muscle mass and strength, and you’re certainly not going to gain much power and speed.

Looking at Jim and Sarah, they each fail to meet this principle, but for two different reasons. Jim’s stretches fail to overload his muscular system, and do not challenge his body enough to create meaningful adaptations over time. On the other hand, Sarah’s exercises might have been challenging enough to start with, but over 6 weeks her muscles will not have undergone much change if her exercises were not progressed over this period.

4. Variety

Most sports and many jobs and daily activities are not done in one direction, one speed, and with both feet on the ground at all times. And so tying in closely with Principle 1 of “Specificity,” exercise needs to reflect the variation of the tasks we intend to perform. Soccer for example requires agility, speed, strength, power, and balance. And so a training program for people who play soccer or other field sports might have many variations of a squat: like a barbell squat, single leg squat, split squat, squat jump, etc. And this type of variation can sometimes just be more interesting and help keep an athlete more engaged with their program. Even for someone like Jim who drives trucks and isn’t necessarily an athlete, he still needs to be able to climb up and down steps and stairs, twist and bend, and lift items of various shapes and weight — and so a program for him might include different variations of bending and twisting: like a barbell deadlift, bent over row, pallof press, etc.

5. Reversibility

The principle of “Reversibility” can best be summed up by the notion of “Use it or Lose It.” When exercise is stopped for an extended period, there can be a de-training effect, where a person’s performance will regress. We therefore need to keep loading muscle to keep adapting.

The Principles of Training: Specificity, Individuality, Progressive Overload, Variety, and Reversibility. Each component plays an important role in maximising performance, and ensuring a person is getting the most out of their exercise program or rehabilitation. So if you are feeling stuck like Jim or Sarah and thinking that the rehab you are doing just isn’t working, it might mean that one or more of these principles are not being fully considered.

Needing help with a thorough rehabilitation plan? Having difficulty making a full recovery to your chosen sport or day-to-day activity? Give us a call on 9455 1177 to book an appointment with our physiotherapists or click the link below.