A common sense guide to rehab - part 1

One of the things I spend a lot of time talking to my patients about is rehabilitation. It’s something that’s commonly misunderstood, I think - when I say the word, too many people associate it with the sheets of dull and apparently pointless exercises that they were once given by a physiotherapist. But that’s not what rehab is really about, any more than maths is really about doing pages of long multiplication sums, or exercise is really about going to the gym and spending twenty minutes on a treadmill.

Rehabilitation, in a nutshell, is how you get from where you are now to where you want to be. Your starting point could be chronic back pain, or recent shoulder surgery, or a ligament sprain that you picked up playing football the other day; and your goal might be to get back to playing top level sport, or digging the garden, or playing the guitar, or just returning to work. Whenever we put together a rehab plan, it’s important to make a detailed assessment not just of where you are right now, but also of where you’re trying to get to. Then we construct a path - a series of stepping stones, if you like - to go from one to the other.

This might seem simple and obvious, but let’s contrast it with the most common approach that I see to injuries. Suppose Bob, a delivery driver who plays squash a few times a week, wakes up one day with a sore elbow. His GP advises him to rest it for a while and see if it gets better, so Bob cancels his squash games and tries to avoid lifting heavy packages at work. After a few weeks the elbow does indeed start to feel better, so Bob goes back to his normal activities - and then wakes up the next day right back at square one. He decides that he didn’t rest it for long enough, so he takes some more time off. By the time he realises that this approach isn’t working, it’s been 18 months, and his regular squash routine has been replaced by a Netflix and pizza habit.

While rest can be a useful part of our toolkit when it comes to treating injuries, very often it’s over-prescribed, or used inappropriately. For a very minor injury, giving it a bit of time off may be all it needs; but for many of problems I see, no amount of rest, <em>on its own</em>, will get a person back to where they want to be.

In the early stages, the exercises might be very basic. I use similar exercises for many of my patients with back pain, regardless of whether they’re elite athletes or sedentary office workers. But as we progress, the plan becomes increasingly specific to that person’s goals. If I’m helping Rachel to rehab a shoulder injury, then it matters whether she’s a dancer, or a violinist, or a climber, or a new mother or a rugby player. Each activity places a different set of demands on that shoulder, and we’ll need a different path to get there.

What can you do if you don’t have access to a therapist who can help with this? Obviously, it’s easiest if you can find someone to guide you through the process, who’s used to navigating around the common pitfalls. But perhaps your doctor, physiotherapist or osteopath has got you back to doing “ordinary activities”, but is at a loss for how to help you get back to running or playing golf. In part 2, I’ll look at some general tips for people returning to activity after injury.

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