One challenge for many physical therapists is bridging the gap between basic rehabilitation and getting back to high level training. The same goes for coaches and trainers. How do we help return athletes back to full training following their physical therapy rehabilitation?
Over the past several weeks I’ve been putting together some of my favorite advanced exercises for specific areas of injury. Check it out!
Advanced Hip Rehabilitation (Femoral Acetabular Impingement FAI). Here are a few of my favorite advanced rehabilitation exercises when returning from hip pain. … 1) Tempo Paused Front Squats – Individuals with FAI typically have issues in the bottom of a deep squat. Pivotal to rehabilitating FAI is finding a squat stance that an athlete can safely hit their desired squat depth without causing impingement symptoms. A front squat is a nice movement to help return to squatting because it requires less hip flexion then a back squat and generally feels better in folks with FAI. Utilizing a slow lower helps to reinforce good technique and the pause in the bottom will help athletes build strength and capacity in the bottom of the squat for when they return to olympic lifts. Tempos also reduce the total load the athlete is able to use which will decrease stress in comparison to faster / heavier squat variations. … 2) Rear Foot Elevated Split Squat from a Deficit – Single leg variations are excellent for athletes with FAI and generally don't cause symptoms. I like utilizing a deficit because it mimics the amount of hip flexion athletes will need to get back to during deep squats. Utilizing a safety squat bar and assist with the arms allows us to load heavier again helping to mimic the forces the hip will eventually be exposed to when we return to heavy squatting. … 3) Side Bridge Abduction – This is a very challenging lateral hip and core exercise that will help to strengthen the lateral hip structures believed to be a player in folks with FAI. … #physicaltherapy #physiotherapy #hip #hippain #rehabilitation #strength#exercises @powermonkeyfitness @championptp #squatting #squat#olympiclifting #olympicweightlifting #crossfit #powerlifting #FAI #femoralacetabularimpingement
Advanced Shoulder Rehabilitation⠀ …⠀ In the later stages of shoulder rehabilitation we need targeted exercises that are specific to what our athletes are trying to get back to. Here are 3 of my favorites with some explanations.⠀ … ⠀ 1) Dumbbell Push Press with Slow Eccentric – Overhead pressing is one of the toughest exercises to get back to after having a shoulder injury. Typically athletes have the most difficulty (at later stages of rehab) with lowering heavy weights from overhead (Think lowering heavy push press and jerks). Dumbbells are excellent (over barbells) for rehabilitation because they strengthen the injured side equally to the non-injured side. The slower eccentric is nice for tendon health but also great for building strength and stability during the lowering portion of the press (where athletes usually have difficulty)⠀ …⠀ 2) Low Retro Crawling – Many of my athletes are trying to get back to closed chain pressing exercises like pushups, handstand pushups and dips. Crawls are wonderful because they're closed chain in nature (just like the movements we want to get back to) and give a ton of core and scapular challenge. The lower you try to get your chest and hips toward the floor during this crawl variation, the harder it gets, making it an excellent advanced rehab exercise. ⠀ …⠀ 3) Single Arm Cable Pull-down – Rowing exercises are excellent for shoulder health, so are single arm exercises. One very overlooked motion is single arm overhead pulling. Building symmetry after injury is very important in all planes of movement. This is even more important if you wish to get back to double arm overhead pulling movements (pull-ups, muscle-ups and toes to bar). Single arm pull-down help us make that transition back to more challenging pull-up and muscle-up variations.⠀ …⠀ @powermonkeyfitness @championptp #physicaltherapy #physiotherapy #shoulder #shoulderpain #rehabilitation #strength #exercises #shoulderworkout
Working with a lot of field athletes I naturally see a ton of hamstring strain injury. Here are a few of my favorite rehabilitation exercises for these folks.⠀ …⠀ 1) Kickstand Deficit RDL – This one is great for a variety of reasons. Kickstand RDLs allow you to load the hamstring even more then you'd be able to with a traditional single leg deadlift. Kickstand deadlifts are also still mostly a unilateral exercise which helps to target the injured area thoroughly. Getting STRONG is very important for hamstring rehab and kickstands fit the bill here. One top of that the deficit allows athletes to train the hamstrings closer to end range of motion. According to research by Tim Tyler getting "long and strong" with hamstring rehab helps to reduce future recurrences.⠀ …⠀ 2) Glute Ham Raise – Everyone loves Nordic Hamstrings for strain rehab and prevention (and for good reason). They're great for rehabilitation and future injury recurrence. However, the glute ham raise actually takes the hamstring through an even larger range of motion then a traditional nordic hamstring improving end range strength and thus reducing future injury recurrence.⠀ …⠀ 3) Single leg Val-slide leg curl – Single leg val-slide curls are great because they're both an open chain exercise and because they emphasize eccentric hamstring strength. Hamstrings are often injured during the eccentric (and open chain) portion of running (during the terminal swing phase of running). This exercise mimics the same action the hamstrings must do to prevent future injury.⠀ …⠀ What hamstring exercises do you like to use?⠀ …⠀ #physicaltherapy #physiotherapy #hamstring #strain #rehabilitation #strength #injury #exercises @powermonkeyfitness @championptp
Here are some of my favorite advanced rehabilitation exercises to help your athletes return to training after knee pain.⠀ …⠀ 1) Front Rack Reverse Lunge Off Deficit: Single leg strength training is great for knee pain. Putting weight in the front rack keeps the torso more upright and increases stress on the quads and subsequently the patellofemoral joint, making it a great late stage PFPS exercise. I also like to add a deficit to increase knee flexion (depth of knee bending) and further challenge the patellofemoral joint.⠀ …⠀ 2) Super Clams: Hip strength is hugely important for knee pain rehabilitation. This variation works hip abduction, extension, external rotation and lateral core strength. These motions are also known weaknesses which occur following knee pain. Super clams are "super" efficient at cleaning up these weaknesses.⠀ …⠀ 3) Sled Drags: Heavy backwards sled drags really blow up the quads. They're basically like a continuous set of very challenging terminal knee extensions. They also tend to be very nice on the knees because they don't involve a lot of knee flexion (bending) but the heavy loading can still challenge the quads greatly.⠀ … ⠀ Give these variations a shot! What are your favorite advanced knee pain rehab exercises? #physicaltherapy #physiotherapy #runnersknee #knee #knee pain #rehabilitation #strength #quads #advanced
So there you have it, a few of my favorite rehabilitation exercises to help make that transition easier from hurt to fully functional. Do you guys use any of these in your training or practice?
Dan Pope DPT, OCS, CSCS
Mindset: A Key Component to Health and Rehab
Does Lack of Sleep Cause Pain?
Keys to Fix and Prevent Shoulder Pain
Shoulder Impingement Part 7: Stages of Rehabilitation
How to Work Pain Science Into Treatment for Athletes
What You Need to Know About Pain to Get Out of Pain and Back to Training
How Much Pain Can We Push Through During Rehabilitation?
Should You Push Your Patients Into Pain During Physical Therapy Exercises?