Workout Wednesday #4 Rehab & Prehab

Hello and welcome back to the final installment of our series of Workout Wednesday. We have explored three great exercises that you NEED to be including in your weekly routine with some great advise from Andy McKenzie on Bodyweight Chins, Alex Ferentinos and Dave Tait on the Deadlift, Andy Bolton and Stronglifts on the Squat and it's variations...

So, these are the things that are going to improve many facets of your goals, from strength to overall mobility, but what happens if you push too hard going for that deadlift PB and the injury sniper gets you? Injury plays a major part of everybodies training life, so we are going to look at how best to avoid injury, and what to do if you do get injured. 

I thought I might introduce myself at this point. My name is Lee Harrison and am the founder of Athleat. I usually like to remain anonymous, as the experts are the ones that deserve all of your attention! Like all good interviewers, let the people talk! But I am an ex-pro Rugby player and I have had pretty much every injury in the book, therefore I will be adding my thoughts, think of it as a bit of therapy for me. Its a raw nerve!

So firstly nobody wants to get injured, especially if your livelihood depends on it, now we are not just talking about professional sports people, but also the desk jockeys out there who couldn't make it into work because they wrecked their lower back. So don't get injured...simples. Or is it? Is it a case of just taking it easy on each and every workout to avoid injury? Train hard, but train smart.

You'll see many lads and lassies walking into the gym, determined to make the most of the bi-weekly workout, load up the bar, grip it....and rip it with the sort of form you might see in an old people home...Injury will come readily to these sorts, don't be one of them and set aside some quality time with your body!

What exercises should you be doing to avoid injury? We asked that exact question to today's expert, and got swiftly told off for asking a stupid question, far too general, not specific enough to the individual, no quick fix...damn, there goes the article, or has it given us a renewed insight into the intricacies of injury avoidance? I believe it has...

Rugby players get injured a lot. especially the pro's, its part and parcel of the job, if you went for an interview and you looked at the job description, injury avoidance and rehab would be well up there. Now that the players are getting big, fast, strong, more aggressive etc these injuries are only going to increase. So today's expert is Bob Stewart. Heard of him? Probably not, unless you were playing for Glasgow Warriors, Worcester Warriors, Gloucester Rugby, Scotland or the British Lions at some point. He the man behind the scenes helping to cart off the best rugby players in the Northern Hemisphere from the pitch and getting the gladiators of the modern era ready for the next battle. These tips and advice will not just apply to the cream of the crop though, all you MMA guys, weight training freaks, crossfit nutters and everyone else in between all need to take heed, this man knows his stuff!

Injury Prevention or Performance Enhancement? - Bob Stewart - Head Of Medical Services at Gloucester Rugby, Scotland & British Lion in 2005 and 2009

Introduction

"Aspects of injury prevention are now being integrated into most facets of all training programmes in professional sport  whether it’s being driven by coaches, strength and conditioners or medical personnel. All coaches want their athletes to be fit all of the time, all athletes want to be fit all of the time and most medical staff know they are doing their jobs if the treatment room is empty or free from recurrent injury!

Many athletes see injury prevention or “prehabilitation” as a negative process. The initial athletic screening picks up faults and a programme is put in place to stop these faults from causing injury or more worryingly, recurrent injury. The screening should be an individualised process that primarily assesses an athlete’s functional movement patterns. Other orthopaedic based tests can then be performed but selection of these tests should be driven by the results of the functional testing. The programme should then be sold as being performance enhancing – making you more efficient will make you stronger, faster, fitter. What athlete or coach would say no to that?

So whether you’re an elite or recreational athlete, if you take your sport seriously and are looking for that extra 5-10% or you have suffered from recurrent injury that limits your ability to perform, it’s worth having a qualified health professional assess your functional ability and help you achieve your goals through this process. It may be what you have been missing……"

Principle

"Almost all of our programmes revolve around the ability to control your spinal posture or “neutral spine” as it is frequently termed. This also includes your head and pelvic position which are obviously the two structures which sit at either end of the spinal column. The ability to control your spinal alignment both statically, but more importantly, in a dynamic setting, is key if you are to transfer this new found efficiency into measurable performance gains. It provides the athlete with a stable platform to connect and harness the strength and power provided by the upper and lower limbs and is therefore eminently transferrable into most athletic activity – the ability to recreate efficient movement patterns time and time again aims to reduce the effects of fatigue and the likelihood of injury. It also allows your muscles to perform the tasks that they have been designed for and your joints to use the full range of movement that they should have available to them.

Poor postural alignment, for instance, can lead to alterations in how you breathe as your diaphragm becomes compromised – through fascial connections this causes inhibition / tension in your hip flexors ( psoas ), then you get reciprocal inhibition of your hip extensors ( glutes )which in turn overloads your hamstrings as they now have to help your glutes extend your hips! Your quads then work harder as they have to help your psoas flex your hip! Your calves have to help your hamstrings flex your knee and then the muscles at the front of your shin are working like mad against a tight calf!! If you add in the tension we tend to get through our head and neck positioning when we are under fatigue then it’s no wonder that we encounter injury potentially at every turn!"

Programming

"As you can probably gather from what I have just written, this entire process has to be individualised as no two of us are the same – we all have different postural anomalies, different muscle and fascial tone, different daily loading demands on our bodies. It is virtually impossible to put together a generic programme that will suit everyone! It is also worth taking into consideration what soft tissue or massage work you have done routinely as if this is also targeted in a specific individualised way it links in very nicely with your performance enhancing programme – soft tissue work should not just be used as a recovery tool!

It is essential that once your programme is in place that you stick to it – you essentially need to train your brain and not your muscles. Exercises must be used almost on a daily basis as repetition is the key to changing movement patterns and efficiency – the recruitment needs to become automatic so that it carries over directly into your chosen sport or activity. Whilst it can be frustrating at times if you can’t quite get things right it is worth persevering with as ultimately we all want to spend more time being the best we can be."

Bob Stewart.

So there you have it, the part that rings bells in my ears as an ex-pro sportsman is the exercises need to be done on a daily basis, maybe more to make it a brain training exercise than your muscles, to make it automatic, and believe me when you have had Bob cracking the whip, making you repeat exercises twice daily for 6 months...it certainly becomes automatic. Again I will reiterate the point of finding a good professional to assess you, there are many quacks out there just looking for a nice payday, so do your research!

There are some important areas to concentrate your attention on when it comes to "prehab" and as Bob tells us everything will be different for different people. But for the most part your glutes are an area that is often neglected, and we are not just talking about the big compound lifts like squat and deadlift, but the small things to do in the gym prior to your session to ensure everything is firing on all cylinders. Bret Contrares is a massive fan of glute training, and he says that the one particular exercise that would benefit everyone is the glute march.

Essentially it is supine walking, but because of the extra load your glutes are working, not a maximal contraction, but at a level where you can control your form easily. Bob was always a big exponent of the smaller glute exercises, the ones where you have to squeeze your glutes at varying degrees of contraction (i.e) 25%-50%-75%...try it, it is more difficult than it sounds, and once you can control that smaller contraction automatically (by doing it loads) the chances of certain injuries will decrease immensely.  The same technique can be used for your trans-abdominus, the deep muscles that you don't really realise are working, they stabilise the whole of the core, as they "transverse" across the abdomen, unlike many other muscle groups.

Saying that Bret Contrares is the "Glute Guy" is probably doing a disservice to all the other amazing and knowledgeable trainers in the world, as glute training is something pretty much everybody advocates. So that should be a big focus...Click here for an exhaustive list of all the best glute exercises out there...Glutes is also closely related to posture, and it is another important area, outwith your training routine (although form whilst exercising is all important) that should be addressed. Neutral is an important term in this regard, and it basically means to have your spine in the best possible position, think ballerina and you will be halfway there. A handy tip is to put a little sticker/dot on your hand/watch/rear view mirror, and every time you see the dot it serves as a reminder about your form/posture, your computer is another, as I sit here more or less slumped over it..corrected now!

Another area that should be attended to by whoever is writing your program is the neck, and as Bob says it is part and parcel of your neutral spine and should be looked at, as many upper body issues will originate in the neck. Don Gatherer is the foremost expert on the neck, and specialises in issues caused by neck abnormalities including disc degeneration and inadequacies in strength. His programs are geared towards high performing athletes who need a strong neck (not suprisingly) and his clients have included Jenson Button, Lewis Hamilton, Mark Webber and nearly all of the prop forwards with neck issues in the U.K (including me!) So, look at a neck mobility and strengthening routine (which might require a head harness!) as it will improve a whole host of problems with your upper body and lower body strength, next time you are deadlifting, feel the force of the contraction you are putting through your neck, you might be suprised!

Shoulder rehab/prehab is the last area that I am going to mention in this non exhaustive list (there is so so much of it!). Another area that is utilised in nearly all of the compound lifts that are so important to your routine. Like all muscle groups around a joint, you need the following for it to be effective, flexibility, proprioception, strength, all of which will help to keep the inner workings of the joint healthy through all of your exercises. Andy McKenzie advocates these areas, especially in trying to avoid injuring your shoulders whilst performing the chin/pull up. So get into a routine of "prehabbing", your glutes/core, neck and shoulders prior to every session, and not only will you increase your performance by a considerable margin (as much as 10% as Bob Stewart suggests), but you will keep your body in the bost possible condition to avoid injury...

And to help all of the above areas...deep soft tissue massage. This is either seen as a method that people use AFTER an event, when you are a bit sore, or when you are in need of a bit of a pampering...Deep tissue massage is not a pleasant activity, it is not performed in a room with stones spouting water, soft lighting and plinky plonky music, a good sports massage is usually on a physio bed performed by half man/half gorilla with hands like a bunch of bananas, (Athleat's Gregor Edmunds trained in massaging horses for that reason.) It is an effective preventative method, serving to get your muscles free from all the knots that can effect your posture and biomechanics. Get a good massage professional and get them to go DEEEP! If you can't afford a good massage, then invest in a good foam roller. If you have specific area's that need attention then grab a tennis ball and work that area, if you want, the step up is a golf ball...

What happens if you do pick up an injury, serious or otherwise? What should you do? Go home and cry to your mummy? Well maybe a little bit. There is a well known wisdom when it comes to an injury. Everyone has heard of it. R.I.C.E. Rest. Ice. Compression. Elevation. Do this immediately following an injury, and you will be far better off in the long term cycle of your own particular injury. There are a couple more pieces of wisdom that have been passed down from Bob, and other fitness professionals that you might want to know about...

• Never take ibuprofen immediately following an trauma injury, it will interrupt the natural inflammatory process which, believe it or not, actually helps you recover, the body is an amazing thing! Wait 72 hours before you start popping pills.

• As bad as you may feel don't hit the bottle after an injury, again it will interrupt the natural inflammatory process, but this time in reverse, making it go into overload! If you have a knock on the quad at a footy match, then head out on the piss then you are endangering your life! Sounds extreme? Well compartment syndrome is a big possibility, and it can kill you. Find out more here.

• Try to ingest plenty of Omega 3's found in Fish, Grass Fed Beef and supplements, as they will reduce inflammation in the bloodstream and help to speed the whole process along.
  

After you have followed the right procedure following an injury, how can you get back to training as you did before? You will need some time, but after assessments by medical professionals who will be able to advise you as to the timescales, you need to start light, what activities are a good start?

• Well head to the pool, and get some active recovery going, and although swimming is a great exercise to keep up a bit of conditioning whilst you are injured, we want something a bit more specific to the way you train normally. So aqua jogging, in both shallow water standing on the floor of the pool, and deep water using a floatation vest etc is a great way to get moving again without the load.

• Train your glutes against the weight of the water with various exercises, or if your injury is shoulder related get below the water and do the shoulder rehab exercises! Its a great way to get back into it, and will see you recover much quicker than you would otherwise.

• Get regular ice baths and or contrast baths to accelerate the healing process. Little tip, in an ice bath try not to stay completely still, otherwise a warm layer of water will form and therefore be less effective, although this depends on your mental toughness. The Welsh Rugby squad even have a machine designed for race horses that creates a whirlpool effect of freezing water being pumped around the horse shaped bath, no escape! There is also evidence that ice baths can be effective at a slightly warmer temperature, but why take anything to chance, once you are in an ice bath, its cold...hence the name an ice bath, so just man up and get it in.
  

• Invest in a good pair of compression leggings to accelerate the healing process. This garment will apply constant pressure to your muscles to tempt them into increasing the flow of oxygen, and therefore washing away all those toxins and lactic acid in there. Although they can also be useful for endurance events.
  

Utilise these methods and equipment and you really will have all bases covered and be able to return from injury, not just with that injury "fixed", but follow all the rehab pointers and it will become a performance enhancer, to come back fitter, stronger and better than ever.

Remember the wise words, rehab is not a once a week activity, it is something that takes time, effort, but the rewards will be great in both the short and long term. Just like everything else you do...there are no quick fixes....only hard graft.

Happy Re & Pre Habbing!