1.) Master Your Mind
You may be surprised to see psychology at the top here, but this is honestly one of the most important parts of pain & injury
rehab. Many people who have suffered with pain for a while feel that there bodies are fragile, and they develop what we call kinesiophobia (fear of movement). Therefore, we talk about pain and what it means for the client, and often, we even encourage acceptance of pain (not always!), rather than simply trying to avoid it at all costs, which we will come back to in point number 3.
We also educate our clients on how variables such as mood, sleep, stress, and more, can influence pain. If you slept poorly and have worse pain, that doesn’t mean you have done any more ‘damage’, as pain can be amplified for many reasons other than just the biological tissue factors.
Ultimately, the mind just can’t be ignored, and it’s particularly important for those who have had pain for a long time. If you’re a trainer, this is something you can also apply in your coaching practice, as you don’t have to be a
physio to educate clients on the effect of mood, sleep, etc. on their pain.
2.) Smart Exercise Planning
Most of the clients that we work with have goals other than just being pain-free. As a
result, their training plan is not just ‘rehab’, it’s mixed. If you have knee pain, for example, we will focus on dedicating exercises to knee rehab, but we also ensure to develop the rest of the body, your cardio, etc. This ensures that you maintain other components of fitness, which is one of the biggest mistakes we see in most rehab programmes.
Initially, we tend to reduce volume (e.g. number of sets, running mileage, or other activity-specific volume parameter), intensity (e.g. %1RM, proximity to failure / RPE, running pace), and adjust other training parameters such as range of motion, exercise selection, running cadence or terrain, and more. This lays the foundation for what we
will discuss in point number 3, as we believe that some training is almost always possible and that rest is very rarely the best solution for overcoming injury.
We believe that good rehab should
encompass good strength & conditioning principles, and that divorcing the two leads to poorer outcomes. Especially for athletes.
3.) Exposure Over Avoidance
The third pillar permeates the
first two. That is, graded exposure. Lots of rehab advice is based around avoidance: don’t lift heavy weights, stop running, etc. While this is sometimes appropriate, we believe that you can always be working on something productive, and that nudging your exposures forward is the best way to encourage adaptation and recovery.
For example, let’s say your someone who has had back pain for years. You’ve developed the aforementioned kinesiophobia, and both your psychology and physical body are currently intolerant of any movements that challenge your back (e.g. deadlifts). We might start with getting you to do some very basic movements to bend over and reach toward your toes. Once you show us, and
yourself (most importantly), that you can do this, we will then introduce a light kettlebell, then a heavier kettlebell, then a barbell with reduced range of motion, and eventually, you’re doing full barbell deadlifts.
The process of graded exposure is not just about gaining physical strength or tissue adaptations. It’s also about building the mental resilience, confidence, and self-efficacy, that are core psychological factors in pain & rehab. Challenge and strengthen both body and mind.
Conclusion
Of course there is more to how we deal with pain & injury, but the principles outlined here can be applied to any injury. Whether it’s rehab after ACL reconstruction or a back ‘tweak’ in the gym, the same principles apply. Naturally, factors such as tissue healing times, musculotendinous vs neurological factors, etc. will vary between injuries, but what we would like for you as
trainers and trainees is to appreciate the core principles so that you can introduce some of these into your practice.
If you need expert coaching with support,
guidance, and accountability, you can work with our Expert Coaching Team now. Click here to get started!
