I'm spending a lot of my time working alongside a range of medical professionals so I'm always interested in finding out the best approach to rehab. My experience tells me to adopt a 'belt and braces' approach and it would seem that the research agrees. A recent study (Neuromuscular Training for Sports Injury Prevention: A Systematic Review Medicine and Science in Sports and Exercise 2010 42 (3) 413-421) confirms that when it comes to rehab we need to throw everything we have at the problem.
Sport comes with its own problems, namely injuries. The most common injuries are sprains, dislocations and ligament ruptures occurring at the knee, ankle, hand, elbow and shoulder. Once you've compromised a joint with an injury like a ruptured ACL, chances are that at some point in the future you'll develop additional problems such as early development of joint osteoarthritis. What was once a problem reserved for older adults is now a very real problem for young adults and much of what we do during injury rehabilitation is shutting the gate after the horse has bolted. What we need to do is work hard on preventing injuries in the first place.
I regularly incorporate a range of proprioceptive and neuromuscular and sensorimotor training into my athletes training sessions in an attempt to reduce the incidence of injuries. Whilst there is a ton of research into the area, and it appears to make sense to incorporate this type of training, not all of the research has been of the highest quality.
Researchers in Germany have recently completed an extensive review of all of the available literature to assess the effectiveness of proprioceptive/neuromuscular training in preventing sports injuries.
Do 'prehab' programmes really work?
The review showed that balance training is effective in reducing the risk of ankle sprains by 36% and that this type of training was more effective in athletes with a previous history of sports injury than those without. Great news if you have blown your ankle. The bad news is that when the researchers reviewed the available literature looking at knee ligament injuries or upper extremity injuries, they couldn't find any evidence to support the use of balance training in the prevention of injuries or the reduction in severity of injuries. So balancing on a wobble board isn't going to solve all the injury problems. But what about taking a multi-intervention approach?
The review showed that when several interventions such as balance, strength training, jump training or stretching were used the results were more promising. Multi-intervention strategies were effective at reducing the risk of lower limb injuries by 39%, this risk of acute knee injuries by 54% and the risk of ankle sprains by 50%. Studies also showed a preventative effect on ACL injuries and upper limb injuries.
So what does this review tell us? Well we've not found the holy grail but what we do know that if we are going to spend time developing 'prehab' programmes we need to ensure that they are multi-intervention strategies. To be honest this has always been my approach. As I said at the start, I like to adopt a 'belt and braces' approach to training. Typical training sessions will hit the following areas:
1. Pre-activation drills - exercises designed to 'switch the lights on'. Simple drills like mini-band walks, hop and hold combo's to activate the neuromuscular system.
2. Core - I hit the core using a combination of vertical and horizontal core stabilisation and strength exercises. It's no use having strong knees if you've got a weak core.
3. Strength - The body has to be able to withstand the demands of the activity. It needs to be strong and robust and athletes need to lift weights using compound multidimensional lifts.