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Learn more about Rehab, Sports Medicine & Performance

rehabilitation

The 2017 Australia Open Tennis tournament had an impressive finish.  At the age of 36, Roger Federer became the men’s champion, and 35 year old Serena Williams defeated her 36 year old sister, Venus Williams to become the women’s champion.  In the world of professional tennis, a mid-thirties champion is a rarity and to have it happen in both the men’s and women’s divisions is a sign of things to come.  Rehabilitation and conditioning science have improved the results athletes can achieve in the gym.  Athletes are staying healthier by eating better and training smarter.  Take a look at some other recent examples:

Oksana Chusotivina (photo by Zelda F. Scott)

Tom Brady, 39 years old. The quarterback for the New England Patriots will be leading his team in Superbowl LI.  He is confident he can continue to compete for another five years.

Drew Brees, 38 years old.  The starting quarterback for the New Orleans Saints feels he can play for several more years.

Kristin Armstrong, 43 years old.  Won a gold medal in cycling at the Rio Olympics at the age of 42.  This type of success is amazing in a competition that greatly favors youth.

Dara Torres, 49 years old.  This twelve-time Olympic swimmer medallist competed at 41 years of age and won a silver medal in three events at the 2008 Summer Olympics.

Oksana Chusotivina, 41 years oldOksana is gymnast from Uzbekistan that competed against teenage gymnasts at the Rio Olympics.

Meb Keflezighi, 40 years old.  Competed in the Marathon at the Summer Olympics in Rio.

These performances illustrate how proper training and nutrition can produce a high level of performance in athletes thought to be too old to compete.  We are all going to get older.  It does not mean we are going to get weaker, slower, and more sedentary.

Michael S. O’Hara, PT, OCS, CSCS

recovery_road

REAL WORLD RECOVERY

Many times patients, employers, rehab nurses, athletes, coaches, and insurance companies have unrealistic expectations in regards to rehabilitation recovery times. It falls to the physical therapist to explain the healing and recovery “time line.” These guidelines are applicable to the patient who undergoes a rotator cuff repair, lumbar fusion, tibia plateau fracture, humeral head fracture, etc… Understanding the duration and the level of effort required to fully regain function can keep a patient focused and eliminate disappointment.

Recovery Reality
If you have systemic health issues such as rheumatoid arthritis, diabetes, etc…. your recovery will take longer. The older you are, the longer your recovery will take. That professional athlete who went back to basketball, three weeks after a knee arthroscopy—he is 24 years old and you are 48 years old. It is going to take you much longer. The weaker you are at injury onset, the longer your recovery will take. If this is a second, third, or fourth injury of the same joint—the recovery will take longer.

Consistency is king in recovery. The individual who follows the program and performs the work will recover sooner. Many patients want to order off the rehab menu—I will have this and this but none of that. In these cases, recovery will take longer and be less effective.

You will probably have to work on more than your injured / post surgical joint during your recovery. The body is an interconnected machine and weakness / limited movement in one area can create the tissue breakdown in other areas. The post ACL repair patient often needs extensive strengthening of the hip. The shoulder pain patient will have to address postural issues in the neck.

Very often you have to change your lifestyle during the recovery period. Yoga after a back surgery may be on hold for nine months. Road running after a surgical repair of your ankle can be off the program for up to a year. After a reverse total shoulder replacement, you may not be able to chop firewood for twelve months.

Progress is never linear. You have good days and bad days—this is normal. You feel and move better for three or four therapy sessions and then you have a few sessions of greater symptoms and more limited function. Do not collapse, despair, call the president–stay with the program and realize that time is on your side.

TIME LINES

Onset – Three Months
This is the in the physical therapy clinic rehabilitation phase.

The inflammatory phase of the injury / surgery resolves.

Active and passive movement of the joint improves.

Depending on the injury / surgery, pain resolution occurs later in this phase.

A protocol of rehabilitation activity may be in effect for certain surgical procedures.

Most patients have regained 60-70% of the function at the end of three months.

People with sedentary work can return to their occupations. More strenuous occupations will require further conditioning.

Three – Six Months
You exercise three or four times a week. Ideally, you visit the physical therapist for progressions of the training program.

You can expect some level of discomfort. The post surgical shoulder will still not feel like the non surgical shoulder. The lower back will have days of stiffness. These episodes are normal and part of the recovery process.

Strength is still limited and you will have to work on corrective exercises for the next three months. Resist the temptation of an early return to your Olympic lifting, Warrior Run, or Zumba class.

Individuals with strenuous occupations undergo a work conditioning program.

Most patients have regained 85-90% of their function at the end of six months.

Six – Nine / Twelve Months
This is the point that most people stop all formal rehab exercise activity.

The more active you are and the more demanding your lifestyle the more you need to continue to train through this phase.

I personally believe this is the most important recovery phase for spinal patients. You never completely recover from a spinal injury—you actively manage the problem.

I encourage everyone to work with a trainer on your fitness program. Exercise is like medicine. Take the proper dose for your specific problem and the results are magic.

The focus of your training should be to get stronger.

Nine / Twelve Months – Death
Consistent maintenance of the machine that carries you through life can dramatically improve the quality of that existence.

The biggest predictor for a future injury is a prior injury. Stronger individuals are less likely to get injured and have to travel back through the nine month rehab process.

Michael S. O’Hara, PT, OCS, CSCS

I have received several requests for more recommendations on postural restoration exercises.  This is the second of three articles.  This pair of exercises is a good choice for overhead athletes such as tennis and volleyball players.  Watch for number three next week.

Most of us drive, commute, do computer work, watch television, and often sleep in the same position.  We become stuck in a forward flexed thoracic spine posture that rotates the shoulder blades downward and pushes the head forward.  Long-term postural flaws will limit your strength, functional mobility, and are the precursor to many of the pain problems we treat in physical therapy.  Your fitness program should eliminate, not feed, these postural problems.  I have some postural restoration training suggestions that nearly anyone can implement into his/her fitness program.

Many strength coaches and physical therapists have found that performing a mobility exercise followed by an activation (strengthening) exercise produces more expedient changes in postural flaws.  Your goal is to increase the restricted movement pattern and then strengthen through the newly acquired range of motion.

TRX “Stoney Stretch” and Belly On Ball “Y”s

Stand facing away from the TRX strap.  Place the handles at eye level on either side of your head.  Step forward with the right leg and simultaneously reach the hands up in a letter Y shape.  The TRX will provide an effective mobilizing stretch to the shoulders and upper thoracic spine.  Do not hold the stretch for more than three seconds.  Step back and then repeat with the left leg.  How far forward you step depends on your shoulder and upper thoracic spine mobility.  As your ability to move improves,  the step can be progressed to a full forward lunge.  Perform five repetitions with each leg and then move to the Belly on Ball Y exercise.

Position yourself face down over the top of a physioball.  You need a fairly firm ball that does not flatten out when placed under load.  Keep your spine stable and the chest off the ball.  Lengthen the neck and thoracic spine.  They should not move at all during the exercise.  Keep the gluteal muscles tight and legs extended.  Start with the arms in front of the shoulders on either side of the ball.  The shoulders should be externally rotated (keep a thumbs-up position of the hands).  Raise the arms overhead like a football official signaling touchdown.  This will create a letter “Y” shape with your torso and arms.  Hold the arms overhead for three counts and then lower back down in a controlled fashion.  Repeat for 10-12 repetitions.

Common mistakes include using a ball that is too small or too soft, swinging the arms up and down instead of in a controlled fashion, failing to hold the arms overhead for three counts, and/or extending the cervical spine (looking up) instead of maintaining a lengthened position through the spine.  You can make the exercise more challenging by adding dumbbells.

Click on the link below for a video demonstration of the above exercises:

 http://www.youtube.com/watch?v=ujoDgmzAsAQ&feature=youtu.be

-Michael O’Hara, P.T., OCS, CSCS

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