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.

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 Term
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 Term
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
• Age
• Time available for training
• Numbers involved
• Facilities
• 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.

The general purpose of exercising is to improve specific components of your fitness. Exercise will improve heart and lung function, tone and strengthen muscles, reduce body fat and maintain spine and joint mobility. Whether you are an athlete, or a person exercising for health and fitness, the principles and philosophy are the same. Start SLOWLY, increase the intensity GRADUALLY, ensure there is a SPECIFIC reason for each exercise, workout REGULARLY (every second day) and ensure your programme is designed for QUALITY rather than quantity.

SCREENING
Prior to commencing any exercise programme, it is important to identify any medical or physical conditions that may be aggravated by exercise. For the majority of people, physical activity should not pose any problems, however it is recommended that you discuss any medical issues with your physician. In particular, pregnancy and osteoporosis generate many questions in relation to exercise. Even though everybody is different, awareness of the following information could prove valuable.

PREGNANCY
As the pregnancy advances, the lower back has a predisposition to arch quite significantly. Development of your abdominal muscles early in pregnancy will help counteract the strain on the vertebral column later in pregnancy.
Overstretching is also strongly advised against during pregnancy as the body releases the hormone relaxin to calm the body's ligaments hence creating high susceptibility to sprains and strains.
lying on your back if you have reached your 4th month of pregnancy, as the foetus may obstruct the blood flow to the heart. Blockage of blood flow to the foetus may also occur. In addition be aware that: exercise may cause spontaneous abortion in the first three months of pregnancy; pregnant women may also suffer from overheating and lower blood sugar levels than they normally would; and lastly consult qualified obstetric personnel before commencing your exercise programme.

OSTEOPOROSIS
Evident in approximately 30% of post menopausal women, osteoporosis is characterised by a decrease in bone mass and 'brittle' bones more susceptible to fractures. Bone loss can occur in the vertebral bodies and may lead to spinal nerve compression, possible bone fracture and the development of postural problems. The exact cause of osteoporosis is largely unknown, however research indicates that smoking, lack of calcium in diet, inactivity, extreme thinness and oestrogen deficiencies are all contributing factors.
Exercise is vital to keeping bones strong, particularly walking but one must avoid rough terrain where sprains or accidents may occur. Finally consult your doctor and dietician for hormonal and dietary advice.

INJURY PREVENTION
An important factor of injury prevention involves being aware of any structural abnormalities. Again, these do not preclude you from exercising but may require certain modifications. Conditions such as bowed legs, knocked knees or uneven leg lengths may lead to injury over time especially with high impact activities. For example, many women who have a wide pelvis and knocked knees experience excessive rubbing and subsequent pain under the knee cap otherwise known as chondromalacia. Those with a tendency to excessively pronate (roll in at the ankle) or supinate (roll out) when running, skipping or race walking increase their risk of injury e.g. shin soreness. Weight supported or low impact activity is best. A qualified physical therapist can design a successful corrective programme for those with acute abnormalities. Alternatively, altering the cushioning of your shoes with custom-made orthotics may correct the problem

OTHER ISSUES
Shin splints - Nagging pains down the front of the shins - where muscle expansion during exercise is restricted by the muscle covering (sheath) and inflammation of the fibrous membrane covering the surface of the bone. Shin splints are common in high impact programmes.

Prevention - Avoid excessive toe bouncing and wear a well cushioned shoe. Complete rest and proper medical attention are the only solutions to those already suffering this ailment.
Stress incontinence - The first sign of stress incontinence is a small leakage of urine when coughing, laughing, lifting heavy objects or bouncing up and down during exercise. It may be caused by a defect or weakness in the urethral sphincter (bladder exit) or by a weak pelvic floor, which is unable to counter the inside abdominal pressure, built up during repetitious bouncy exercise.

Prevention - Five pelvic floor contractions, ten times per day, may assist in clearing this problem. These exercises can be done at any time of the day. Physiotherapists with a special interest in obstetrics will gladly help you learn pelvic floor contractions.
Insomnia - Insomnia is most prevalent in novices who exercise too vigorously, particularly close to bedtime. It is not advisable to exercise within two hours of going to bed. It takes approximately two hours for the physiological and neurological stimulation of exercise to subside - in some cases such as newcomers to exercise this process may take a little longer. The good news is that people who exercise regularly tend to sleep more soundly than the unfit.