THE GAP BETWEEN REHAB AND PERFORMANCE
This blog was written by OPEX Ambassador and CCP Coach, Andy Ewington, from Dublin, Ireland. Andy helps his online and onsite clients at Adroit Fitness bridge the gap between injury and optimal health and performance as a remote coach and Neuromuscular Physical Therapist.
Follow Andy on Instagram here. Visit the Adroit Fitness website here.
Injuries are an unfortunate outcome when training and often come with some time on the sideline. It’s a frustrating situation to be in, especially when they seem to reoccur or never really clear up. Often pain or altered movement becomes the new normal, or is accepted because many other people have it.
As a coach, it can be just as frustrating seeing a client get injured or feeling helpless during their recovery. They complete their rehab and are feeling good, but it’s not long before they’re feeling that same pain or reinjure themselves. This is the result of there being too big of a gap between their rehab, which is often designed to become pain-free, and their training, which is often designed to challenge them.
To successfully bring a client back from injury we need to make sure that the rehab begins to look a lot more like training before going back to full training.
How to Help Your Client Get Through Injury
Here are four ways to help you and your client get through injury and come out more resilient than ever.
1) Build a network of trusted practitioners
A lot of us as coaches are keen to help, but we all need to know when it’s time to refer out. One of the best things to have is a therapist who holds similar values and is happy to work alongside you. It’s good to have a network as not everyone likes or responds to the same treatment styles.
2) Assess don’t guess!
This is a very common piece of advice for good reason. OPEX CCP teaches you ways to assess your clients and these can be used along their path to recovery. These are important in avoiding injury as they can be built into their long-term program design, not just an initial assessment. A deload week after a period of intense training can be a great time to include some assessments to make sure your client is moving well. Some exercises double up as an assessment and are great to put into warm-ups.
3) Create a roadmap to recovery
If only certain movements aggravate an injury, then they are the only ones that need to be removed. Your goal is to give them exercises that will eventually lead back to that original movement. Giving them targets along the way helps keep them on track and see their progress.
4) Keep your clients training
A lot of clients will avoid telling you they are feeling tight/stiff/injured for fear you will take away all their training. If you have 1 & 2 in place then it becomes easier and easier to keep them training.
Here’s an example of these four principles applied to a common avatar.
A client has recurring shoulder pain when snatching. They appear to move well and have good mobility and movement patterns, but are still experiencing persistent pain.
1) Refer out to a trusted medical provider for diagnosis
You get a report back that it is a shoulder impingement issue causing inflammation and pain. The client is told to avoid snatching until pain-free. They will work on rotator cuff strength (program given by physio) and then re-introduce these movements.
2) Assess what you can within your scope
Watching a video of your client, you notice that the painful shoulder loses position as they pull from the floor. This causes the barbell to be out in front and the shoulder to be in a compromised position during the turnover and catch.
Using what we have learned in CCP the following assessments would be of value: Scratch Test, Reverse Plank, FLR, Powell Raise and DB Ext Rotation. You notice that the Powell Raise and DB Ext Rotation are below expected for structural balance.
3) Roadmap to Recovery
The physio has given an exercise routine to get the client out of pain which should be adhered to. Additionally, since we have highlighted the instability of the shoulder through video analysis and assessment, once cleared for loading we should begin focusing on improving these areas before a return to full snatching
4) Keep them Training
The focus is on improving shoulder stability and strength. Now that the client is pain-free we can get to work with this as our priority. The client needs strength and motor control which needs to be learned without fatigue and in movements they can control. So we will start by selecting more strict movements that will target the right areas and move towards more dynamic, full movements over time. The turnover in the snatch is the main problem so we can still do some overhead pressing. Once cleared by the physio, an example day might look like:
A1) Pressing Snatch Balance @ 33X1, 5 reps x 4 sets; rest 30s
A2) DB Cuban Rotations @ 3030, 8-10 reps x 4 sets; rest 90s
B1) Snatch Grip Romanian Deadlift @ 4040, 4-5 reps x 4 sets; rest 30s
B2) Seated Box Jump x 1.1.1 x 4 sets; rest 2 minutes
C) DB Powell Raise @ 3011, 8-10 reps x 3 sets; rest 30s / arm
Which could progress over time to:
A) Segment Snatch Pull with 2s pauses @ 2”, Knee, Mid Thigh, 3-4 reps x 4 sets; rest 2 min
B1) Muscle Snatch x 1.1.1.1.1 x 4 sets; rest 10s; rest 60s
B2) Snatch Balance @ X3X1, 3 reps x 5 sets; rest 90s
*Keep the Muscle Snatch light. Focus on maintaining shoulder position during first and second pull.
C) DB Powell Raise @ 3011, 8-10 reps x 3 sets; rest 30s / arm
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