Injury rehab programme

An injured sportsman is like a sick gorilla - no use and a lot of trouble. The coach has to deal with the mind as well as the body in maintaining the athlete's equilibrium.

I heard a story about one of our leading middle-distance runners who went out to a training camp and injured himself on the first day. 'Right,' he said. 'I'm on my holidays now,' and off he went to the pool hall for the next week. This approach scores high marks for relaxation but very few for intelligence.

The first thing to do is obviously to get treatment, but the very next thing is to redesign the programme and start on rehabilitation. A few days away from the regular training programme can have a very beneficial effect, particularly if the athlete has been training very hard. The injury may force him to take a rest which the body needs and he will be much better for it. However, total inactivity is a bad thing, especially since most top-class sportsmen are accustomed to an organised programme and may lose their sense of direction if deprived of it.

The first step is to decide which movements the injury will and will not allow. If we take for an example a lower-leg injury to a runner - shin splints or a stress fracture - then running itself is ruled out as an exercise and so are sports which involve running on hard surfaces. However, it should be possible to construct a programme which will train most of the attributes of a runner so that he can go straight back to running training when the injury has cleared up. It may even be possible to improve his capabilities in some respects - those things which he has not had time for.

The attributes which make him a good runner are: A. An efficient cardiovascular system B. A good power-to-weight ratio C. Strong leg muscles D. Good local muscular endurance E. Good general endurance F. Above-average flexibility G. Strong motivation to succeed
For attribute A, we can recommend cycling, both static and outdoor, swimming, including 'wet-vest' interval training or using an ergometer either of the rowing type or the cross-country skiing type. Daily monitoring of his resting pulse rate and use of a pulse monitor to get the required exercise level will maintain or even improve his cardiovascular system.

For attribute B, he needs to weigh himself regularly, to watch his food intake and to burn off enough calories in the various types of exercise to keep his weight down to its normal level.

For attribute C, weight training using fixed resistance, as in the Multigym, Schnell or Nautilus systems, is the best thing, but the other activities will all help. The attraction of weight training is that it is measurable, and the athlete can work to a schedule and see that he is actually improving both his strength and his endurance in the exercises he is allowed to do.

Attribute D may present problems, since he will be unable to use exactly the same action in training as he would in running. Cycling on a cycle ergometer is probably the best thing here, as he can increase the resistance and follow a definite programme, eg, 6 x 2 minutes hard cycling, with an equal-time recovery.

General endurance, attribute E, allows plenty of variety, but I would choose walking as the best activity, wearing boots and walking on soft ground to prevent any shock to the injury. The advantage of a prolonged, low-intensity exercise is that it is therapeutic; it allows the athlete time to think, it calms him down and gives him the assurance that he is doing something positive.

F is for flexibility, something in which many athletes are lacking. The important thing here is continuity. A series of exercises, depending on the injury, should be planned to last 15-20 minutes a day, generally after some other type of exercise has got his muscles warm. It should be possible to make the athlete more flexible at the end of the rehab course than he was before the injury.

What the programme could include
A typical weekly programme might take the following form:
Monday- Friday mornings: 15 minutes on static bike or rowing machine, followed by 10-15 minutes flexibility exercises
Monday lunchtime: 15 minutes weight training in gym Monday evening: walk or cycle to pool, 20-minute swim
Tuesday evening: 60 minutes cycling, with several hard bursts up hills
Wednesday: as Monday, but include 68 x running in wet vest, I minute fast, I minute slow
Thursday afternoon: 60 minutes fast walk in boots, plus light jogging Friday afternoon: rest
Saturday: 2-3 hours walking, with 5 minutes flexibility exercises each hour
Sunday: 60 minutes hard cycling, 20 minutes steady swim, 30 minutes walk/jog uphill
The last attribute, a strong motivation to succeed, is the very one which makes it possible for the athlete to work on such a programme, even though he may not be able to train at his usual sport. Last year I got to know Dieter Baumann, the Olympic 5OOOm champion in Barcelona. He suffered an ankle injury at the beginning of the 1993 season and was unable to do any serious training. He kept up a programme of cycling, swimming and gym work right through the summer and kept his fitness so that he was able to get back to off-road and off-track running in the winter of 1993/94. Whereas a lesser athlete might have been discouraged by being unable to race, the strength of character which enabled him to win the Olympic title in 1992 put him back on the track in 1994, fit enough to win the Europa Cup 5000 in his first major race.

As with other forms of training, the way to make a long rehabilitation spell tolerable is to periodise it, spending, say, six weeks on weight and ergometer training, moving on, as mobility improves, to pool and bicycle training, and setting specific targets for these, over a period of three or four weeks. Specific flexibility exercises, as recommended by the doctor and the physio, will be part of the programme almost every day. Walking should be started as soon as it is safe, and this can move on to slow jogging on soft surfaces, then running slowly up a gentle slope.

Whatever the injury, athlete and coach should never give up. The training of the will which stems from overcoming adversity will make the athlete much stronger in the competitive situation - one has to look no further than Roger Black as an example.

Bruce Tulloh

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