Prehabilitation to Avoid Rehabilitation!

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A couple of months back I was scanning through some newsletters and a particular article caught my attention. At first I thought it may have been a spelling mistake, but when I took the time to re-read the heading I was intrigued.

"Prehab to Avoid Rehab!"

What followed was a concise, well written article that embodies a lot of what I believe in, and a lot of what I endeavour to promote and teach. I thought the article was so good that I asked the author if I could re-print it here. He agreed, and what follows is his complete article.

Ken Johnson (LATC / PTA) USASportsMed@aol.com
Team 2002 Sports Therapist
Sports Injury Prevention, Management, Evaluation and Prehabilitation

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Would you like to take control of sports injuries?
Athletes of all levels can avoid many sports injuries with Prehabilitation, (Prehab). Even though there is an inherent risk in all athletic activities, many injuries can be avoided. The percentages increased toward a greater likelihood of staying healthier and performing better with a strong prehab program.

What is Prehab?
Prehab is a personalized exercise program that continually evolves. It provides sports specific focused exercises and activities for athlete's needs. The philosophy is simple. Prevent injuries. The development and execution of an effective program can be complex. The practice of prehab and its success relies greatly on an athlete's ability to commit to prevention. The development of the program needs to be progressive and periodically re-evaluated to change with the athlete's needs.

Who Should Prehab?
Athletes of all levels should include a prehab program in their training. The more advanced the athlete, the greater the need for a prehab program. As an athlete's body matures within a sport, their body adapts to the physical demands of training. Too often repetitive movements and the daily stresses of training cause negative effects within their bodies. This limited training technique may cause tightness of muscle groups, imbalances of strength, coordination or muscle stabilization. These imbalances occur naturally with activity and are reinforced with each workout. These imbalances are often the root of many training injuries and may predispose athletes to greater risk of injury during training and competition.

What Should be in a Prehab Program?
A personalized Prehab program should address total body balance and consider sports specific needs. It balances the range of motion, strength, coordination and stabilization. Comparing left to right, front to back, upper to lower body is the basic premise. Exercises and sports specific skills and drills are focused on an athlete's weaknesses.

The majority of prehab programs should focus on coordination and stabilization of the hips, stomach and back "core". Core instability is common and is often due to the lack of a proper training program. Many athletes and coaches use traditional protocols of upper and lower body lifting or basic sprinting and lifting routines, outside of regular practice drills. This leaves the core without a direct focus or training routine.

A Prehab program should be constantly updated to match the athlete's progress. Activities in a prehab routine can be a subtle focused exercise or a complex sequence of movements designed for dynamic stabilization or to improve an athlete's skill. Adding dimensions of skill, 1 on 1 competition or scoring values can stimulate an athlete's focus and improve the success of a program. Using tools from traditional sports and physical therapy programs can add options. Tools like a foam roll, balance boards, weighted and exercise balls can also make a program unlimited in design.

When Should an Athlete Prehab?
As indicated, Prehab should be practiced before an injury places an athlete on the sideline and into a sports rehabilitation program. Unfortunately, it often takes an athlete and staff many injuries to decide to initiate a prehab program.

Depending on an athlete's training cycle, prehab can be done within a practice session or as an independent workout. Three or four exercises in a warm up or cool down, a few exercises while resting or waiting a turn in practice, or a detailed tedious workout focusing on an athlete's weaknesses. Full workouts can be designed for off days or active rest days. Mini prehab workouts are great for team travel and recovery days. In any case, a prehab program should be a regular part of an athlete's training routine.

Who Designs a Prehab Program?
Athletes should be screened for imbalances. Objective measurements of active range of motion and strength, biomechanical observations, past medical history, present health status and input from support staff should all be considered when designing a program. This screening should be performed by a qualified professional. A licensed healthcare professional, such as an Athletic Trainer, Athletic Therapist, Sports Therapist or Physical Therapist with additional sports training, can design a program. These practitioners should have experience with a variety of high level sports, ie. football, wrestling, swimming, decathlon, "New generation" golf and as in my case, Olympic level gymnastics and women's bobsled. Experience with these sports can be beneficial to developing prehab programs. It is important to note that a hands-on practitioner would benefit the athlete most. Participating practitioners should have the physical ability and skill to be interactive with the athlete during a session.

The ability to challenge and motivate an athlete is the difference between success and failure with respect to a tailored prehab program. Knowledge of the chosen sport, the athlete's needs and open communication are the keys to success with prehabilitation.

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