Rehab Vs Training

Too often, rehab lacks focus and meaning, is repetitive, uninspired and not challenging enough.
Ashleigh Flanagan
November 1, 2022

What is the difference between rehab and training?

Exercise rehabilitation and training are, in essence, the same thing. With rehab, you are working from the point of injury or illness to your previous level of function or athletic performance. With training, you are increasing your performance and capacity to meet new demands or achieve new goals. Both rehab and training should be goal specific and require progressive loading.

It helps to consider rehab as part of a training continuum but with different short-term goals. Rehab isn't just an easier or less intense version of your regular training. It's important to identify specific rehab goals to get the most out of it and avoid frustrations. For example, following a hip injury, identifying 'restore range' as a rehab goal will likely dictate an approach other than 'continue training as usual but reduce the load'. Often 'continuing as usual, but less' results in longer rehab and without progress towards acheiving training goals.

Rehab goals may change quickly. For example, the day after surgery, your goals may be to get out of bed and prevent post-surgical complications. After a couple of weeks, your rehab goals may be to optimise tissue healing, manage fatigue and gradually return to your usual activities. To achieve this you can't be doing the same exercises Day 14 as your were Day 1. Effective rehab is goal specific and requires progressive loading.

Overload is a fundamental training principle and means that training stimulus needs to be significant enough to require tissues / systems to develop to meet these new challenges. This is referred to as SAID- Specific Adaptation to Imposed Demands. To continue to progress, capacity needs to be continually challenged. For example, starting with theraband exercises for a rotator cuff injury may be appropriate, but they may only be useful for a short time.

Exercise load is more complex than sets, reps, and frequency. In the context of rehab, intensity, complexity, and recovery may need more consideration. You need to be mindful that your capacity is compromised, so the load required to drive adaption is less. During rehab, it's even more important to focus on the basics such as sleep, rest, nutrition and hydration that support healing and recovery.

Effective rehab is goal specific and requires progressive loading

Training is inherently meaningful because it is goal focused. The biggest rehab mistake is programming that is repetitive, uninspired and stripped of meaning. Ideally, your rehab should 'feel' like your training. You need to be clear on how your rehab relates to your training. I believe 'meaning' is more important than load or exercise selection when it comes to rehab. It doesn't matter how good a program is; it doesn't help if you don't do it. 

Your body wants to heal, so rehab doesn't have to be perfect. Even if you do everything 'right', recovery still takes time, and can't be rushed. For example, a low-grade muscle tear takes approximately 2-8 weeks to repair. While this varies a lot due to individual factors such as general health, age, location of injury etc., doing the 'best rehab' won't negate the time it takes for the biological process of tissue repair to occur. It will always take time. So it's important to understand how long recovery from your surgery / injury / illness takes. 

My tips for meaningful, relevant general rehab are:

Be goal focused. Set rehab goals and review them frequently.
Ensure your program works towards your goals and you understand how it will get you back to training.
Prioritise sleep, rest, nutrition and hydration. Healing takes a lot of energy.
Be mindful and listen to your body. Modify your program as you need. 
Make rehab enjoyable: Train with friends, Move in nice settings, Do what feels nice.
Be curious and avoid ego.
Stay involved with your training community, e.g. Do rehab at team training, keep score, manage music, or record practice.
Don't compare your rehab with anyone else. Rehab is different for everyone.
Be aware of the natural history / expected recovery / tissue healing times.
Consult your specialist/ rehab consultant for specific guidance.
Be patient. It takes time, but your body has an incredible capacity to heal and recover.

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