Rehab: How much is enough?

Discharging patients is always hard for me. It’s almost like when your high school hunny moves away to college after high school. You have so many memories of the good times and the bad, and there is potential to create so many more. But they just up and leave, moving on to bigger and better things without you (sob).

Ok, that may be a little exaggerate and a little more sappy then necessary, but there is some truth to it. A recent research article Stares et al in 2018 has given me more reason to delay discharging patients just a little longer other than just creating more memories. And of course, for their best interest not mine. I really enjoyed this research article because even though it was very specific to a certain group and sport, I believe that the idea of the conclusion could be applied to any active population looking to
return to being active after an injury. I know, this goes against everything we know about generalizing in research. But hear me out…

The research looked at muscular injury rehab training loads, return to play time and subsequent injury rate over 5 years for an Australian football team. They found that out of 66 injuries that occurred during those 5 year, 43% suffered a subsequent injury after the initial injury. Even more astounding was that 73% of the subsequent injuries occurred to a different tissue than the initial injury. That’s almost half of the athletes re-injured and almost ¾ of them with different injuries within 3 weeks of returning to sport! The main conclusion of this study was that athletes who had higher training loads during rehab, which led to longer rehab time, were at a lower risk of subsequent injury and vice versa, athletes who had lower training loads during rehab had a greater risk of subsequent injury, including injuring a different tissue.

There is a whole series of research from Tim Gabbett who showed us that spikes in workload increase risk of injury. Essentially, what Tim’s research taught us that if we have an acute increase in exercise, for example going from sitting on the couch for 3 weeks and deciding one day to run a 5k, we are putting ourselves at a higher risk of injury. This is what Stares et al found in their study on Australian football. Once the athlete’s injuries had healed, they were sent back in to play. The problem is that they had been
rehabbing for weeks prior, so their workload tolerance was not the same as the demands of the sport when they returned. This may be the reason that almost 50% suffered subsequent injuries and why almost 75% of them suffered different injuries. This is where we need to collaborate with coaches and S&C coaches to modify workouts so that they can continue to train while they rehab and so we aren’t sending them back in the game in a state of under-loading.

Obviously, this is a very simplistic explanation of Tim’s research. If you’d like to read more, just enter his name PubMed and you’ll see an abundance of very interesting research on the topic. Bottom line, as rehab professionals our main goal is to help athletes return to sport after injury. But we must also make sure they are safe to return to sport by delaying the return to increase workload and collaborating with others ensuring that we aren’t under-loading, putting them at risk of other injuries.

References
Stares, J., Dawson, B., Peeling, P., Drew, M., Heasman, J., Rogalski, B., & Colby, M. (2018). How much is enough in rehabilitation? High running workloads following lower limb muscle injury delay return to play but protect against subsequent injury. Journal of science and medicine in sport.