Starting Loads in Rehabilitation?

[dan_how]

Hi Guys

Sorry I’m late to the thread, but an interesting read and very current. Funnily enough, this is something I base a lot of load management on, even after RTT. The daily understanding of changes in A:C loads is paramount to management, as opposed to weekly values, otherwise you miss a large proportion of the stress placed on someone. Daily status with respect to a A:C ratio therefore allows you to forecast the difference between a planned load, and moving a specific session to a day later in the plans of rehab. Something simple, but very effective nonetheless. Textbook periodisation effectively goes out of the window, as everyone will respond in a varied manner to an exact same external stimulus, responses will be therefore dependent on the last 3-4weeks of cumulative load for each person.

We work hard on a principle of “maintaining residuals” and of maintaining high but safe chronic loads as often as possible becomes protective in nature. Funnily enough, and retrospectively, most soft tissue aggravations/issues in teams ive worked with have manifested themselves around a week after a full week off, and as such, im nowadays reluctant to give so much time off feet. Drip feeding load is protective in my eyes. In addition, sport specific context to a A:C ratio (absolute values, weekly schedule, session intensities etc) is key. For example, a A:C score of 1.0 may look great, but is it at the minimum operating level/threshold for your sport? Eg, chronic and acute loads for HSR metres, of 100m on average across those time periods is extremely low, whereas 400m for the same time frames may be much closer to full training demands, and therefore should be the end focus of the RTT progressions. Reflecting after each RTT session should refer to this context/reference point for your sport.

The magic bullet wont exist across all sports for the “start point” in terms of load. BUT, either way, what works really well is setting a standard “return session/initial session”. From here, you always have a consistent reference point for you and an MDT to reference. In the sport I work with, alongside the physio, we work based on the injury and length of time out for a lower limb injury. A short term injury (<3wks off feet) will require a certain entry/initial session, whereas a medium (4-8weeks) and long term (8weeks +) will require different go to initial sessions. However, at stage 1 of a short term injury, the initial session may be the stage 2 for the medium term injury, and so on.

If it was a 3week offload period (short term), we still would have some data to consider within his chronic load, as we work on 4week chronic period. Therefore the initial session load for a short term injury would be set at 2x (6x100m Tempo runs), on 60s rolling clock, with 3mins btw sets. We use the first set to build the initial 4 reps from a 19s pace, to 18, 17, and 16s, with the 5th rep at 15s. We ask the player to maintain this pace for all remaining reps. This accrues a reasonable amount of HSR and could create spikes, but the key is that we aim to keep full training doses high and so we set our HSR targets for a return session high too. Again, context specific is key, so if game/training demands higher/lower then this would need to be adjusted to meet specific sports needs. The fact that these early sessions are linear controlled running loads means also spikes are less likely to manifest in injury compared to comparable loads made up of repeat fatiguing efforts, with many change of directions.

For a long term injury, say an ACL, initial sessions are likely to be alter G based. You can definitively work out how much of the planned work is set > HSR, by logging speeds/work periods. If running at 70% bodyweight, you may wish then to factor your total HSR ditstance to 0.7, to account for this. Its not an exact science, but, just because we cant GPS this load, doesn’t mean it shouldn’t me included as part of RTT and A:C ratios. From there onwards, actual on feet sessions may simply be 2x(8x50m) 4mins between sets, and of a set slow pace, to accrue low speed on feet load. Each session, or every other thereafter, will likely increase in intensity. The beauty of monitoring A:C ratios daily as opposed to weekly, means that with a little maths, you can easily forecast A:C ratio responses for the subsequent 7d of planned load, and adjust accordingly based upon what the athlete can/actually compeltes.

Whatever the lower limb injury, having a process that you can repeatedly perform for your players is great as it gives you the practitioner a reference point, and adjustments can be made accordingly. We expect through thorough rehab, a player to tolerate this load that we plan as the initial session. We can monitor responses (tightness, fatigue, subjective awareness) and if unable to complete this session, it tells us there is more to be done until the player can progress.

Would keen to hear your additional thoughts guys – thanks
Dan