Chapter 4. How to recover from an injury
DR MALCOLM READ’S TRAINING LADDERS FOR REHABILITATION
The secret of a successful comeback is to put the injured area through a graduated series of exercises, each one a little more demanding than the last. This is how and why the following training ladders were devised. They have been used successfully by many people, from ballroom dancers to ballet dancers, from typists to taxi drivers, from Little League hopefuls to world and Olympic champions. The principles are always the same.
Starting on the bottom step of the ladder, the injured person works his or her way through these prescribed exercises. It is important to realize that all movement is a skill; in a simple form of exercise such as running there is a rhythm and balance between each leg. During rehabilitation, loss of rhythm may indicate that muscles other than the injured ones are being used to reach the training target.
It is important to carry out the exercises correctly and to stop at the first sign of pain. If pain occurs, you may be damaging the injury further. If the pain or ache goes away after 20 seconds, the exercises may be continued. If the ache or pain persists:
• Stop.
• Wait 24 hours.
• Begin again from the first step.
If there is a loss of rhythm, stay at the same level or drop back one step on the ladder to regain rhythm. Do not push on to the next level, even if there is no pain. If you cannot complete the first steps properly you will not be able to perform the higher steps correctly. The new session should start from the bottom but, when reaching a higher level, you may cut down on the number of repetitions of the earlier steps. Treat them as a warm-up.
No two injuries are alike, so the rate of healing will vary from person to person. By using these training ladders, any athlete can assess when he or she has done too much. To find out which ladder plan is right for you, first diagnose your injury using the Top-to-Toe guide in Chapter 3 Correct treatment and training are given there, referring you to the appropriate ladder plan if necessary.
Other sports, such as tennis, badminton, squash and baseball require special rehabilitation ladders for the arms. These are also included. The General muscle ladder (page 166) spells out the principles that apply to any injury, setting out a step-by-step return to full match fitness.
HOW MUCH TRAINING TO DO WHEN INJURED
• Intensity should just reach the point of pain. Stop, allow pain to settle, then continue. If the pain lasts more than 20–30 seconds, stop. Train again next day.
• If injury doesn’t hurt at time but hurts later, use NSAIDs.
• If pain settled by following morning, then training is within injury tolerance.
• If pain is worse the following morning, but settles by midday, you are training at the maximum, so reduce the load by about 10%.
• If the pain is worse for the following 24–48 hours, then you have been training well over the maximum recommended. Rest until settled. Start again, with a considerable reduction in your load – of about 50%.
• If you are making good progress, do not increase speed and distance, or weight and number of repetitions, at same time. Increase distance first, speed later; number of repetitions first, then weight.
CROSS-TRAINING ROUTINES
Training using sports different to your specialty sport helps to protect all injuries and also keeps you fit. The different routines referred to in the ladder plans are explained below.
Heels
A simple but useful set of exercises to strengthen calf muscles and Achilles tendons. Stand on ground with both feet together; then go up and down gently into the tiptoe position. When you can do 20 repetitions, with no pain, do the exercise standing on just the left leg, then on the right.
Next, stand on edge of step; face inwards, with both feet together. Raise and lower your heels as far as possible. Again, after 20 repetitions with no pain, do the exercise standing on one leg, then the other (see step 5, page 171).
BASIC PATTER ROUTINE
The secret is in not lifting the feet far off the ground. What we call a slow patter is more like fast jogging on the spot with knees kept low. Feet must be lifted only 1–2 inches/2.5–5 cm off the floor. A fast patter has the same low knee and foot lift, but you must patter as fast as you can. It is testing yet simple.
Routine for an unfit athlete ( 3 minutes)
| 1 minute | slow patter |
| 5 seconds | fast patter |
| 50 seconds | slow patter |
| 5 seconds | fast patter |
| 50 seconds | slow patter |
| 10 seconds | fast patter |
Rest for 3 minutes, while doing stretching exercises. Repeat above routine at least twice, preferably four times.
Routine for a fairly fit athlete ( 5 minutes)
| 50 seconds | slow patter |
| 10 seconds | fast patter |
| 40 seconds | slow patter |
| 20 seconds | fast patter |
| 50 seconds | slow patter |
| 10 seconds | fast patter |
| 30 seconds | slow patter |
| 10 seconds | fast patter |
| 50 seconds | slow patter |
| 30 seconds | fast patter |
Rest for 3 minutes while doing stretching exercises. Repeat above routine at least once, preferably three times.
Routine for a fit athlete ( 13 minutes)
Do the routine for an unfit athlete once, followed immediately by routine for fairly fit athlete twice.
Skipping routine
Swimming routine
Swimming is an excellent way to keep the muscles toned up, especially when you cannot run through injury. The water supports the body’s weight but does not offer great resistance. Although less muscle power is required, the pulse rate is still raised by swimming. Try to run in water, using a flotation jacket for stability. Don’t just run with a high knee; try to take large strides, really pulling with the hamstrings.
If you are suffering from a neck injury, then it is difficult to turn your head sideways (freestyle), or hold the head up (breaststroke). Use a snorkel, so that you can continue training, but keep your head still.
Routine for poor swimmer/non-swimmer
Jump in, swim or flounder across the width of the pool; climb out using good leg; stand up. Now turn around and repeat the routine for 3–5 minutes. Rest for 3 minutes while doing stretching exercises. Repeat above routine at least twice, preferably four times.
Routine for good swimmer
As above, but swim one length of the pool each time.
Rowing routine
Use a rowing machine for a thorough workout for legs, arms and abdominal muscles and to build stamina. Untrained rowers will find this much harder work than expected!
Make sure you sit with a straight back and firm stomach muscles (core stability):
• Press equally hard with both legs. Try to get both knees to travel at same rate, especially when locking them straight.
• Lie back at end of stroke to exercise stomach muscles; do not do this if you have back problems.
• Vary hand grip (either over top or underneath) if arm muscles ache.
• Each machine has a different pull, so adjust your own routines accordingly.
• If you have knee problems, do not throw knee out to the side. Try to keep knees in line with first and second toes as you move backward and forward. Drawing a mark over midline of kneecap will help you see if you waver around.
Routine for long-distance/stamina events
Work so that you can still carry on a conversation, even if you are panting a bit. At least 10 minutes, though more than 30 minutes preferable.
Routine for middle-distance events and running ball games
2 minutes long distance, 1 minute sprint so that you don’t have enough breath to chat. Rest 3 minutes. Repeat as often as you like.
Routines for sprint events and martial arts
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