4 Phase Injury Recovery Roadmap [A Coach's Guide]

There is a moment that everything changes. All of us, at some point in our athletic careers, have dealt with injuries or a close association with one. Mine came one Thursday morning on a quiet turf field in October.

Myself and two fellow co-workers made our way onto the slightly chilly turf field and started our usual dynamic workout: high knees, butt kicks, lunge series, and sprint buildups. We set up four low 8-inch hurdles in front of us, one yard apart. Our intent was to use the hurdles for quick pogo hops into 5-yard burst sprints.

One hop, two hops, three hops, then... boom... loud pop... no hop.

My immediate reaction was:

“Did someone kick me?”

“Did someone throw a ball and hit me?” 

I looked behind me and no one was within 10 yards. I took a step and knew my immediate thought was correct: something was wrong. There was no immediate pain, but I couldn't walk. My bachelor’s degree is in athletic training, so I am well-versed in injuries. I had a very strong suspicion of what was wrong. The physical therapist I work alongside came out of her treatment room to me sitting on the ground. A couple of quick squeezes of the calf (a diagnostic test used by athletic trainers and physical therapists), and my suspicions were confirmed: an Achilles tendon rupture.

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At that moment so many thoughts went through my head: where do I go from here? I've helped so many of my athletes work through injuries and now it was time to help myself.

Through my experience, I was able to grow and learn positive and successful ways to deal with an injury. Now is my time to share my experience and the knowledge I gained.

Strength and conditioning coaches are a vital component in the recovery of athletic injuries. I strive to assist strength and conditioning coaches to have a better understanding of the injury process. Injuries occur in all types and severities. Some require surgery, and others do not. Some last days, and others last years. It is our job to help athletes from the time of their injury to the moment they step back on that field. 

We will discuss strategies and an outline to get your athletes back faster and better both physically and mentally.

Real Life Example: ACL Tear

Injury: ACL tear

Individuals Involved: Athlete, family, athletic trainer, strength and conditioning coach, and sport coach. The athletic trainer will administer immediate medical attention. They will be the one to decide whether or not a referral is needed and whom to seek further medical attention from. Once this is established, they will help schedule an appointment with a doctor.

Immediately Post-Injury: In an ACL scenario, a referral to an orthopedic doctor is necessary. The doctor will see the athlete and determine if surgery is needed.

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Post-injury, Pre-surgery phase: Here is a “golden window” for the strength coach to get involved. A lot of atrophy will occur post-surgery. The stronger the athlete is going into surgery, the stronger the athlete will be coming out of surgery. If time allows before the surgery, it is ideal if the athletic trainer and strength coach are able to collaborate and come up with a “pre-surgery” training program for the athlete.  

Surgery: Only medical involvement.

Immediate Post Surgery: Athlete will meet with the physical therapist after the initial postoperative period to get an initial evaluation and determine therapy course.

The Road Ahead: While the athlete is in physical therapy, the athletic trainer, strength coach, and sports coach should be actively involved, but in different roles. We need to start blending the process of therapy and performance. Many different people and components are involved in a successful recovery. The better the athlete's “team of people” work together, the easier the road to recovery will be.

All parties involved must set egos aside and do what's best for the injured athlete. Everyone needs to be involved and understand their most effective role. Rehab team consists of the athlete, family, sports coaches, athletic trainers, doctor, and physical therapist. The rehab team and process is a continuum that overlaps.

With that being said, we must all realize our specialties and where we can be most influential. That's where the progress lies. Allow other professionals to excel at their part so you can focus on yours. Keep everyone informed about the process, expectations, realistic timelines, and modifications

  • The athletic trainer can communicate with the physical therapist to establish limitations.
  • The strength Coach and sports coaches should be briefed by the athletic trainer regarding what the athlete’s limitations are.
  • It is then up to the coaches to find productive ways to keep the athlete involved in as many aspects as possible. Keeping the athlete involved will not only help physically, but mentally.

When the athlete is released from physical therapy, it will then be up to the athletic trainer to continue the rehab process and the strength coach to start to progress the athlete back into the group. This is a time where communication is key and many parties are involved. As the rehab progresses, the strength and sports coach can become more involved.

** In an ideal situation, the athlete's “team of people” is able to sit down and develop an action plan of daily, weekly, monthly, and long-term goals for the athlete. If this is not possible, there are other ways for the team to communicate. (Ex: conference calls, email threads)

(Sidenote: not every injury requires surgery or a total stoppage from sport, it is all dependent on severity) 

The 4-Phase Outline

Now that we have discussed a specific scenario, let’s look over a general outline on how strength coaches can be utilized.

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Four main phases of injury recovery:

  • Acute phase: Pain control, possibility of prehab 
  • Surgery Intervention: Minimal involvement
  • Recovery Phase: We can educate ourselves and aid in exercise modification - be inventive
  • Performance Phase: Athletic development and skill - where we excel; always remember that tendons and ligaments take 3-4 times as long to adapt to stresses placed upon them as muscles.

1. Acute Phase

Dealing with the injured athlete can be difficult. We must help them acknowledge where they are in the process and accept the hand they have been dealt. It is okay to be upset and mad at the situation... but realize that won't change the situation, and it may make it harder.

After a few deep breaths, help them figure out where they are exactly and the next positive step they can take. Be sure to refer them to the appropriate medical personnel.

Check in with the athlete to ensure they are getting the best treatment. Have the sought out a doctor? Are they going to their appointments? What was their diagnosis? Do they have any limitations?

The first stage is a lot of pain management. Athletic trainers and physical therapists are crucial to help with this phase. Modalities can be used to reduce and control their pain.

Choose to be positive! “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”- Viktor E. Frankl

As coaches we must recenter ourselves and realize the two different perspectives: the athlete's and the coach's.

Acute Phase Athlete Perspective

  • Daily focus: Needs to identify what he/she can do each day
  • Needs to be engaged: Still actively have a role, but the current role may be different than before

Acute Phase Coach Perspective

  • Daily Focus: Small victories with the athlete
  • Check in with the injured athlete frequently: Be present
  • Find ways to keep the athletes involved

Remember roadblocks and setbacks will happen, we all make mistakes. So assess and reassess daily. Note progress and keep a strict workout log for the athlete, so the athlete will be able to visualize their progress. We tend to forget how far we have come, especially on days we are frustrated with our performance.

2. Surgery Phase

Depending on the injury, its severity, the athlete, and the situation, surgery may be the next phase. If surgery is required, there will be minimal involvement from the strength coach at this phase. It is vital to check in with the athlete and reassure them that you care. You may not be able to actively train them at this time, but you are still there for them.

3. Recovery Phase

In the recovery phase, the strength coach will begin to get more involved.

There are many more tools in your tool box than just lifting weights for recovery. This is the time to sit down with the athlete and educate them on strategies to utilize, including:

  • Active rest/recovery: Biking, low level movements, walking
  • Sleep/napping
  • Nutrition: Before, during, and after; eat anti-inflammatory food
  • Hydration
  • Training loads
  • Massage/self-myofascial release
  • Breathing: Meditation, yoga
  • Compression: Socks, leggings, normatec
  • Hydrotherapy
  • Cryotherapy
  • Sauna/heat stress
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Modifying Exercises

Charlie Weingroff expertly discusses modifying exercises in progressions, regressions, and lateralizations. He states the best strategy is to essentially meet the athlete where they are. For example: you know the athlete needs to hip hinge, but can not perform a traditional deadlift in order to get the response they need or want.

  • Possible progression: adding weight, bands, chains, etc.
  • Possible regression: decreasing weight, pulling from blocks, etc.
  • Possible lateralization: change the bar to trap bar, manipulate stance, hand position, etc.

Fatigue

During the recovery phase, the athlete may face types of fatigue they have never been exposed to. Fatigue is defined as our inability to continue an exercise at a given intensity. Different types of fatigue consist of:

  • Metabolic (energy) - training loads
  • Neurological (nervous system) - new stimulus
  • Psychological (emotional) - stress
  • Environmental (climate) - surroundings
  • Physical - how you feel

Be sure to discuss the multiple variations fatigue with the athlete and different strategies to better cope with them.

Goal setting

  • Process vs. outcome goals: Process = things we can control; outcome = things we cannot control. Process = showing up everyday; outcome = a specific number.
  • Talk about facing adversity
  • Reteach posture, core, engagement/creating tension, breathing

*Never forget cross crawling in the recovery phase - Tim Anderson from Original Strength is a great resource. Crawling helps reset our bodies and repattern our movement

Our role as strength and conditioning coaches:

  • Less is more.
  • Modify exercises to meet their limits.
  • Safety and consistency will be our key.
  • Challenge the athlete physically and mentally.
  • Understand that it is tough and everyone perceives situations differently. Pain can be difficullt to manage due to its inconsistency.
  • Be creative with your exercises and never forget to have fun. Games can be a great way to keep engagement, not just for your injured athletes... but for all. Find ways to keep them together with the team.
  • It's all about creating tension. Coiling and recoil.
  • Muscles, tendons, and ligaments all have different adaptation periods.

Sample ACL Recovery Protocol

Total body day one: 6 months post right ACL allograft repair

Keep it simple and identify limitations:

  • Draw out training a block that fits your training principles and abides by limitations stated from medical staff for the injury.
  • Add in some fun/games
  • Keep in communication with the medical staff
  • Implement each day and adjust as necessary due to pain, swelling, etc.

Limitations: limit anterior shin translation

  • Warmup
  • Hurdle step over/step unders 2 x 2 minutes -  1 minute rest with calf stretch
  • 5 push-ups to down dogs + 5 pvc pipe dislocates - circuit x 3
  • KB swing 4 x 10 - posterior chain development
  • Waiter walk 4 x 10 yards each arm - teaches overhead position and stability
  • Box front squat 4 x 4 reps - vertical shin - still builds leg strength and power
  • Pallof press 4 x 10 reps each - teaches tension
  • Renegade row 2 x 5 each - core engagement, pulling motion
  • Chin up 2 x 5 - we make our athletes maintain a hollow hold position for keep the core more engaged and really own the movement
  • Hollow hold 3 x 15 seconds - teach tension

Here we keep vertical shins on most of the movements as the graft is still healing. The hurdle step over/unders height is changed to allow more of a high lateral lunge focusing on lateral movement, allowing the hips to move.

4. Performance Phase

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The man who grasps principles can successfully handle his own methods. The man who tries methods, ignoring principles, is sure to have trouble. - Ralph Waldo Emerson

This phase is up to you and the principles you believe athletes should train by. This phase is where the athlete is in your full control and ready to take the field. Need some help with this phase? Check out the article.

Final Thoughts & Strength Coach Takeaways:

  • We have to remember we cannot prevent injuries, but we can decrease the likelihood of injury. We will do our best to decrease the movement inefficiencies and increase the relative strength of our athletes.
  • Teach proper nutrition.
  • Nutrition, movement, and strength all aid in better recovery, which in turn equates to better skill and decreasing rate of reinjury and increasing performance. 
  • As coaches we do not have control over everything, so we must: accept what we can not control, educate on what we know, and coach what makes the biggest difference. We want to give our athletes autonomy so that they can make the best decisions possible.

ARE YOU A BETTER COACH AFTER READING THIS?
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About The Author

Ryan is the Director of strength and conditioning at Pro Performance RX In Morgantown, West Virginia. Ryan has been working in the private sector with hundreds of youth athletes for the last 5 years. He is always excited to talk training and dig deep into the Why. Never stop learning, growing and adapting. In the great words of Bruce Lee be like water.

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