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Return to Play/Training and Effective Injury Prevention Strategies!

My name is Kevin Feely, and I am currently the owner and head therapist of the Kevin Feely Athletic Therapy Clinic. My background in this line of work came from having studied Athletic Therapy and Training in DCU for 4 years from 2010 to 2017 (with a 3-year sabbatical in between!) and followed by a Master’s degree in Strength and Conditioning which I completed in IT Carlow for year in 2018. Personally, working in sport has been something I have wanted to do from a very young age whether as a player or in capacity as a coach/therapist/performance specialist and I have been very lucky to have had the chance to do both of those things in my career to date.

 

In this short piece I will discuss some of the lessons I have learned both professionally and personally in the rehab process, some of the more common injuries I see and ways to manage them, challenges involved in trying to safely return to training after the off-season, and some strategies on how best to minimise your injury risk and maximise your performance once you start back into your playing season.

 

Personally, I was unfortunate enough to suffer a couple of medium- and long-term injuries in recent years which had a huge impact on how I approached both rehab and injury prevention going forward. Not being able to do what you love because of injury really creates a sense of being grateful for every opportunity you get to play at full fitness. Making the decision not to take these opportunities for granted resulted in a big improvement in how I prepared my body for my sport day to day. The mental void that a medium- or long-term injury leaves in your life creates several challenges that must be overcome to successfully return to play. The physical challenges tend to be easier to overcome as the solutions are given to us via rehab exercises. As athletes we tend to be very good at doing what we’re told so in my experience generally the physical effort required to overcome injury is rarely an obstacle. Reflecting on my most recent injury (Achilles tendon rupture), something that had a huge impact on my recovery was the attitude of the two medical professionals I dealt with at the time. I was naturally catastrophising at the time of the injury and assuming that my season the following year would be over but a short conversation with the surgeon who was repairing my Achilles helped to shift my mindset. He emphasised the fact that he expected I would return in 6 months provided I was diligent with rehab and did exactly as I was told regarding rehab. He spoke of the importance of getting back weight bearing as soon as possible after surgery and gave me some timelines on when I could start some light strength and mobility work. These timelines were much sooner than I had predicted going in to see him and his plan helped create a sense of me being in control of my own destiny again and stirred up some motivation to meet this new challenge head on. Likewise, my first physio session 5 weeks after the surgery was equally inspiring. The physio was realistic and pragmatic but also very positive about what I had done to date and what I could achieve going forward with hard work. This was exactly what I needed to hear from a motivation standpoint and this attitude is one of the principles I have carried with me into my professional career since when dealing with patients with medium or long term injuries.

As I mentioned previously, once the rehab work was prescribed, carrying them out was never an issue as we are always searching for ways to fill the void left by not being able to train as normal and rehab helps to do this. What was tricky was not getting too downhearted about how long out of sport I was going to be, and having to watch your teammates compete without you. To overcome this mental challenge I found a few different effective methods that helped keep me on track.

The first thing was to stay in the present. What can I do right now in the short term? And how will I measure this success? For me early on the goal was to be fully weight bearing, doing double leg heel raises, and to be able to bend my knee forwards 2 or 3cm. This was what the surgeon told me was realistic after 6 weeks so this what I put all my focus in to. Narrowing your focus like that can really help to keep you from feeling down, and hitting those targets helps to give you the feeling of accomplishment you so badly miss from doing something well in training. I also kept a long term goal in the back of my mind throughout the rehab process (to be back for the first Allianz league game at the start of January). I would allow this thought to float into my mind during rehab sessions to provide extra motivation and a stimulus for visualising what that would like. I could picture very clearly what this would look like, and I strongly believe this visualisation was another key contributor to a successful return to play.

Another important strategy in overcoming the mental challenge of long-term injury was to put focus on other areas of physical fitness you could focus on that wouldn’t harm the recovery of the injured tissue. For me this was focusing on upper and lower body strength, my aerobic conditioning with off feet methods, and my body composition through putting a bit more focus on my dietary requirements relative to my calorie expenditure while injured. This principle is something that I apply to the return to play and rehab strategies of all my patients and athletes. There are several benefits to doing this. From a physiological standpoint it puts you in the best possible position to be as fit as possible when the time comes for you to return to play, reducing the effect that fatigue might have on any potential recurrences. There will naturally be an element of deconditioning that happens following injury and a huge element of a successful return to play is how well you limit this. Creating some goals around strength, body composition and aerobic or anaerobic conditioning helps keep added motivation and importantly can provide the badly needed endorphin hit that you miss by not training and playing. This is such a big help in keeping your mood and mindset in a good place and giving you the sense of accomplishment of hitting goals and targets no matter how small they are. The caveat to this is that there’s also huge benefit to broadening your interests and horizons during a period of long-term injury. For me this meant putting a bit more time and focus in to my work, taking some time mental and physical breaks with weekend trips, and enjoying a few more beers than I would normally get to do during a heavy in-season period! The power of keeping your mind occupied and enjoying yourself while you have the chance can’t be underestimated with a medium or long-term injury.

 

Regarding the more common injuries I have been dealing with lately, there has undoubtedly been a huge trend towards overuse and repetitive strain issues. Generally these injuries come from a sudden shift in training emphasis and intensity that results in areas of the body becoming heavily overloaded at intensities and volumes that they are not used to. The predominant tissues to get injured because of this sudden spike in training load are tendons. And for weight bearing exercise this has usually meant patellar (kneecap) and Achilles tendon issues with Achilles tendon pain being the most prevalent issue I have seen to date.

 

Managing tendinopathies can be a tricky business and tends to change from case to case. However, there are some nice tips that I can advise on which will help to kickstart the rehab process whether it is a hip, knee, or Achilles tendon issue someone has. In most assessments you get for a lower limb tendon injury you will have tests carried out to determine what potential deficiencies you may have in strength and mobility that may have contributed to the tendon becoming irritated (eg. Weak lateral hip muscles, poor lumbo-pelvic control, reduced ankle mobility or big toe mobility). Correcting these deficiencies is an important part of the rehab process but just as important is to gradually start loading the irritated and sensitive tendon once the initial pain has started to settle to a tolerable level. Early on this means performing ‘isometric contraction’ exercises designed to specifically load the affected tendon and my advice is to begin this process as soon as possible with any tendon injury if the pain intensity remains at or below a tolerable 4-5/10. Isometric contractions involve exercises that load the muscle or tendon without any change in length happening in that muscle. For example, for an Achilles tendon injury this might involve a single leg heel raise where you hold your heel off the ground in the same position for a sustained period (usually 45-60s in the early stages). As well as safely loading the affected tendon, these exercises can also have a pain-relieving effect to make simple activities like walking and running seem a bit easier! I have loads of examples of these types of exercises on my Instagram page if you want to see more (https://www.instagram.com/kevinfeelyat/).

 

It is important to note that this is only the beginning of the rehab journey as far as tendon pain is concerned. Gradually progressing and increasing the load while constantly monitoring pain levels is compulsory for tendon injuries and the best way to do this is with the advice of a therapist or trainer who can help you put together an appropriate plan to get you to whatever your goal is.

 

There is a constant stream of soft tissue injuries occurring with the teams I worked with as players’ bodies tried to re-adjust to unpredictable, intermittent, high intensity, change of direction-based training that comes with returning to team sport seasons. A high number of hamstring injuries occur as players return to repeat sprint training, however, the most common soft tissue injury I came across last season was undoubtedly quad strains. Most likely this was because of the increased kicking demands in sports like soccer, Gaelic Football, and rugby. These injuries can result in time losses from training of anywhere from 2-8 weeks and in a time where seasons are being squeezed in to short, very match heavy schedules, this can mean an entire playing season wiped out for a player. It is so important that every player takes some measures to prepare their body for return to group and contact training in the weeks leading up to your season starting.

 

For me, this return to play prep can be divided in to 3 sections: gym work (or home based strength work), pitch/field work, and recovery work. From a gym perspective, some graded strength training of the most frequently injured tissues is incredibly important. For hamstrings this might mean incorporating exercises like the Nordic hamstring exercise, or weighted Single Leg Romanian Deadlifts into your programme. For reducing groin injury risk this would mean Copenhagen Adductor Plank and Lateral Lunges. For quads, exercises like Rear Foot Elevated Split Squats and Reverse Nordics are great. Even those 6 exercises performed as a lower body strength session twice a week (3-4 sets of 6-10 of each) would be highly beneficial in a 4 week block leading back to training. Plyometric exercises are another great way of prepping the body for high speed and change of direction work, but they are a topic for another day I think! A quick YouTube or Google search of any of those exercises will bring up some nice video demos for you.




First image: Nordic Hamstring Exercise | Second image: Copenhagen Adductor Plank


From a running perspective, if you have been a slave to the long distance runs for a while then leading up to the start of the season is the time to change this! Yes it’s important to set an aerobic or endurance foundation of fitness early on in your season but the closer you get to matches/intense training the more important it is to start sprinting again. Start with low volumes and distance and gradually increase from week to week. In field sports it is unlikely that you will ever be sprinting flat out for longer than 40-60 metres (barring an intercept try in rugby!) so there is no need to do that in training. Work off distances ranging from 5-40 metres at top speed, with rest times of around 60 seconds for every 10 metres covered. Total distance at top speed covered for the whole session should be around 300-350 metres. Change of direction drills also need to be incorporated at this stage as well. There is a wide variety of drills that can be used but the ones I like best are curved or ‘S’ runs at top speed, shuttle runs at varying distances, figure of 8 runs, and T test runs. These bring most of the change of direction type movements you will use in training. Again, long recovery times are necessary for this type of work as you are performing each rep maximally. Your last job on the pitch now is to get back doing the fun stuff! Skills drills, kicking, passing, shooting all need to be gradually brought back into your routine now to have your body ready for doing all these things at higher intensities once training starts back. Use your imagination and experience to design drills and skills work for yourself in this regard and don’t be afraid to add a conditioning element to them as well by carrying out the drills with a time constraint and a recovery time limit.

 

The last section I mentioned was recovery work. By this I don’t mean investing in compression boots, massage guns, or foam rollers, I mean including days during the week of total rest. If your normal training schedule involves 3 pitch sessions and 2 strength sessions in a week then do not be tempted to do more than this before training starts back. The last thing you need is to be injured before you even start back into it! Focus on the basics of recovery like getting 7-9 hours’ sleep a night, eating adequate amounts to meet your calorie expenditure from training, and staying on top of hydration levels. Aim to eat a meal containing carbohydrates and protein in the hour window after you have trained and look to rehydrate with 1.5 litres of fluid for every kilogram of fluid lost during the session over the next couple of hours (weighing yourself before and after a session will tell you how much fluid has been lost to sweat during training). The main thing is to listen to what your body is telling you and manage your load according to how you are feeling both physically and mentally.

 

It might seem like a lot to be thinking about for a simple training session but these are the small things that if done well will go a long way towards keeping you fit and healthy and allowing you to be performing at your best for your team week in week out. Best of luck with the season ahead to all the sports men and women out there and if you have any questions on any of the topics brought up here don’t hesitate to get in touch! (kfathletictherapy@gmail.com, www.kevinfeelyathletictherapy.ie)

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