Surgeons write lousy rehab programmes!

Last year I attended a conference and was particularly looking forward to listening to a range of experts (many of them surgeons – so they must be clever!) talking about the rehabilitation of tendinopathy injuries. Whilst I picked up some interesting nuggets of information, one of the overwhelming things I came out of the conference with, was the knowledge that surgeons write lousy rehab programmes!

I sat through several detailed presentations from surgeons that examined the effectiveness of eccentric exercise and was left scratching my head when the only rehab advice that was being churned out focused purely on a unimodal approach (eccentrics). I was particularly perplexed because I had just come back from America where I had presented my approach to returning athletes back to full fitness following chronic tendon related injuries.

One size does not fit all, the law of individual differences tells us this!

UNIMODAL

What I learnt at that conference was that the best people to ask about rehabilitation from injuries are the guys getting their hands dirty on a daily basis. They’ll tell you that in order to rehabilitate an athlete with tendinopathy you will need to take the ‘kitchen sink’ approach and pull out a range of strategies. In the past I’ve used the following and had success:

– Developing a decent ‘movement vocabulary’ with the athlete so that they move properly.

– Functional isometrics – the tendon responds to load and isometrics are a great way to load without ‘impact’

– Occlusion – another way of loading and developing some cross-sectional area around supporting structures to improve movement quality.

– Hypoxic – use of repeated sprint efforts in hypoxic conditions are a great way to maintain/improve fitness with minimal ‘impact’ and can provides pain free mechanical stress on the tendon.

– GPS – use of metrics to track mechanical loading in order to guide the rehab process.

 

 

 

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Nick GranthamSurgeons write lousy rehab programmes!

3 Comments on “Surgeons write lousy rehab programmes!”

  1. Mik Hempstead

    Hi Nick,
    This article, and also its companion Weak Side Rule and Strength Training, were of special interest to me since I am 3 1/2 months out from a full Achilles rupture. By all accounts my surgeon is extremely highly regarded and has indeed done a great job in repairing the injury, but seems to have failed spectacularly with regard to its re-hab. After approving removal of the CAM-boot, I had to ask him about physio and he then advised walking was all that was necessary! Since I am robustly fit and active and train regularly, and have been doing so for 30+ years, I naturally have not relied on this advice and have already started back with a controlled training program. I would however, be grateful for any suggestions of additional re-hab exercises along the lines mentioned in your article.

    BTW – I have already taken on board the suggestions in the Weak Side Rule and Strength Training article, since, predictably, I was actually doing the polar opposite. So I am already in front from having read that article.

    Many thanks Nick, for this and all the great work you do.

    Mik

  2. Bryan English

    Interesting comments Nick and I fully agree.
    The rehab programmes given out by most (if not all) surgeons are average at best and negligent at worst. Surgeons (most if not all) have no training in rehab so I do not understand why they can be so adamant to prescribe it. I assume it is to protect the surgery (which is fair enough) and to maintain control (which is not fair on the patient). On general questioning a surgeon will admit that their rehab programmes are designed through tradition (“this is the way we have always done it”) and/or through fear (“we do not want to overdo it”). Therefore the programme is prescribed with little thought of the individual concerned.
    As a physician I take on board a surgeons opinion with my post op athletes, but the majority of the time I design a rehab programme that is completely different and constructed by myself/physio/SandC staff. You are correct. The ones that get their hands dirty are the people to do the rehab. Anyone recommending rehab needs to “do it”. I have spent many years watching surgeons operate. Not once in my career has a surgeon ever come to see me doing rehab with a player. Enough said.
    Kind regards
    Bryan English

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