While strength & conditioning (S&C) professionals as well as professionals in physical therapy continue to try to bridge the gap between one another, there sometimes remains a disconnect where one side might lack confidence in the processes of the other. Not only can physical therapists be unaware of how strength and conditioning principles can be applied to expedite the healing process, but there are many strength coaches who abuse the trust of therapists and attempt to get athletes to advance through the rehabilitation process too quickly.

When applying S&C principles to rehabilitation, communication between coach and therapist while working through these four main areas can help each side to understand the other. These four areas are: using nutrition to provide the supporting resources; restoring mobility in ranges that do not cause discomfort; rebuilding tissue tolerance and strength within those restored ranges in a speed-controlled manner; and implementing graded levels of sports movements within those ranges. This cycle of stress-application is repeated as the athlete is able to access new ranges.

1. Nutrition

During the inflammation phase when most of the work done to heal the tissue must be passive, be conscious of including the following in the diet. Like everything else, simplifying the approach to this will help to create an efficient system that can be used in the present and in the future.

Fish Oil

The first thing is to optimize the Omega-3 and Omega-6 relationship, as this is what will facilitate a smooth transition through the healing process. I have an article on high-dosing fish oil for the purpose of recovery here (despite the title of the article, it isn’t just about concussions). Suffice it to say, aim for 7g-15g of EPA + DHA per day with a dosage that descends by 2g on a weekly basis. Although some claim that dosing Omega-3’s too high can interfere with blood clotting, Dr. Michael Lewis’ has put those concerns to rest in his book, “When Brains Collide,” and the information he provides on his website: brainhealtheducation.org, where he states it would take dosages upwards of 30g/day before the risk of reduced blood-clotting became a problem.

Collagen

Glycine administered at 10g per day in the evening prior to bedtime, or adding collagen to your diet in a supplement form such as Vital Whey Collagen has been shown to help provide the building-blocks to regenerate soft-tissue (fascia, muscle, tendons, and ligaments).

Vitamins and Minerals

Upping your intake of Copper and Vitamin C also helps with the formation of collagen, so consider supplementing with these or increasing your intake from food sources (fruits for Vitamin C or beef liver, lentils, oysters, and kidney beans for Copper).

2. Restoring Mobility

This speaks for itself. During the Repair phase as new tissue is being laid down it is susceptible to forming adhesions that restrict the movement of joints, leading to a loss of motion at the joints in question over time. It is important that during this time that resistant-type stress is applied particularly safely so as not to disrupt the new tissue formation, but more importantly, that the joints involved are placed through ever-increasing ranges of motion so that they can be accessed for remodeling and strengthening when the time is right.  

Do not force ROM (range of motion) instead, access what ranges you are able without discomfort and build robustness (talked about next in sections 3 and 4) in those ranges first. Afterward, attempt to access the previously unattainable ranges.

3. Tissue Tolerance and Strength

During the Remodeling phase the new tissue that has been laid down must be stressed so that the collagen fibers align in the directions required for its function. Therefore, re-expose the tissue to lactate and micro-trauma, and as it recovers from subsequent low-volume/intensity bouts of this, begin to increase the volume and intensity of the stress exposure.

I wrote five blog posts in a series dubbed: The Philosophy of Progression, which talk about the factors around which training programs are built. It is of great importance that while building tissue tolerance and strength the factor of speed (tempo) is taken into consideration. Be sure that the speed of the repetitions is carefully controlled during this phase. At any given load, start with slower speeds and move to faster speeds as tolerance and strength are rebuilt.

‍4. Sports Movements

Lastly, after and whilst the tissues regain strength, exposing the tissue to movements which replicate the demands of sport is crucial because - aside from injuries resulting from contact- poor execution of said movements for reasons related to technique or fatigue are likely what contributed to injury in the first place. This is where confidence in the ability to return to previous levels of performance is earned. Use the same graded system of lower to higher volume & intensity as you used when building tolerance and strength. These sports movements should be based on multi-planar power and focus on the ability to decelerate and utilize the stretch-reflex.

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As you are able to access new ranges (section 2) you would repeat the process for strengthening and preparing them for sport (sections 3 and 4).

Athletes often experience psychological barriers after the trauma of injury- especially when surgical repair is involved. Overcoming these barriers is a crucial part of the rehabilitation process. The return-to-sport formula above will not only help with this but will also assist the healing tissue to remodel itself along the lines of stress that the athlete is going to face in competition.

Happy Training