Rehabilitation of Injuries
Rehabilitation is all about the process of returning back to activity in the safest and shortest time with minimal expectation of recurrence. This process involves a specific and progressive approach dependant upon the activity or goal aimed at. Part of this process is goal setting.
Getting this part of the process right is vital to success. Without it chaos and serendipity will reign. The plan may look good on paper but putting it into practice will involve some flexibility and keen observation and evaluation on the parts of both the Therapist and the Patient.
Goal setting is planning, plain and simple, although the process is not so simple. The processes of setting realistic goals or targets for patients to reach can help their progress but goals must be time based and measurable. That is to say there must be a way of evaluating these goals and this can only be done if the goals are examined at regular intervals and there exists a measurable component in the goal e.g. How much faster can you do 25 repetitions?
Goals can be one of 3 types:
• Long Term
• Intermediate Term and
• Short Term
Long Term - Planning Ahead
Long term planning is about the future aspirations of the athlete, e.g. what target would the athlete wish to achieve in 4 years and how you will they structure a progressive approach to achieving the goal set at the end of the period. Therefore long-term goal setting tends to deal in years opposed to months. The Therapist does not normally carry out a major role in long term planning but may act as a consultant. However in the sense of rehabilitation the long term goal will be full recovery and return to sport at the level attained prior to the injury.
Intermediate goals are perhaps best seen as stepping stones to a long term goal and are measured usually in months opposed to weeks. These goals help to keep the athlete motivated towards achieving one of their long term goal of which there can be many. Intermediate goals are good ways to check that you are on track or not. At every stage of goal setting, reflection, evaluation and planning is essential and if students are not hitting their intermediate term goals it is a good sign that:
• Perhaps the training programme is wrong or needs modified
• Then individual is not trying enough
• The goal is unattainable or unrealistic for the time scale
• The individual is injured, etc.
Short terms goals are usually stepping stones to intermediate goals and are measured normally in weeks or even days. These goals are highly motivational and even the simplest of things can make a difference
If you can imagine a staircase, it represents different goals of varying size and magnitude. Each step may represent days, week or months and is dependent on success. There may even be, in the case of short-term goals, a number of smaller goals to achieve before achieving an intermediate goal. Perhaps an intermediate goal will be the achievement of a number of short term goals opposed to one significant event.
When planning out goals the Therapist will be very mindful of the following:
• The ability level
• Time available for training
• Numbers involved
• The competitive schedule or proposed grading date
• Identify individuals and groups on whom the plan is based
• The goals set
• The skills and knowledge required
• The sequence of work adopted
Remember of course that the Therapist will have the full recovery foremost in mind for the patient and the process the patient will be taken through will ultimately result in this goal.
In the early stages of injury the patient/athlete may experience pain, swelling, inflammation, and loss of function of a specific body part e.g. not able to stand on the foot due to an ankle sprain. The job of the Therapist will be initially to reduce the swelling, and help the patient athlete protect the ankle from further damage. Often therapists used strapping and bandages etc to minimise the use of the affected body part which serves to protect it during recovery.
As the patient/athlete recovers the Therapist will endeavour to encourage the patient/athlete to move the affected part initially this may be assisted by the therapist. As the patient/athlete continued to improve the Therapist will gradually increase the load on the patient/athlete by either increasing resistance or by bearing their body’s weight.
In the case of a soft tissue injury, this has the effect of re-orienting fibrous repair tissue to meet the existing tissue, thereby making a small strong scar as opposed to a diffuse weak scar. This will be crucial to those who engage in sport that require good extensibility in the affected part.