Prehabilitation Before Rehabilitation

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Performing Strengthening and Stretching Exercises will Help Reduce Injury Risks Before an Injury Occurs.

"Prehabilitation" is nothing new to many therapists, professional athletes and trainers, but it is now becoming more widely recognized by the mainstream medical community and individual athletes as a means to help eliminate the possibility of an injury before it ever occurs.

Prehabilitation incorporates strengthening and stretching exercises for specific groups of muscles in order to help reduce the risk of injury, before an injury actually occurs. It is the "an ounce of prevention is better than a pound of cure" approach to physical training, albeit for work or recreational activities. Pre-habilitation is sport and work-specific and addresses common injuries and strength imbalances that occur in the particular sport or activity that the individual is involved.

For example: A common injury suffered by tennis players is lateral epicondylitis, or Tennis Elbow. This is often caused by the high forces involved in the backhand as the musculotendinous or tenoperiosteal junctions of the extensor mucles that cross the elbow joint are overstressed due to lack of overall strength of the finger, wrist and elbow extensor muscles. The constant gripping of the tennis raquet, coupled by foreceful wrist and elbow extension, wrist and forearm supination and external rotation of the shoulder during the backhand swing, against a fast moving object, causes jarring, vibration and microtrauma to occur at the musculotendinous and tenoperiosteal junctions of the extensor group at the elbow junction. This repeated trauma to the extensor group can cause micro-tears, swelling and result in atrophy of the extensor group. The result is a muscle imbalance that occurs between the flexor and extensor groups.


Prehabilitation would require the stretching and lengthening of the flexor group and the strengthening of the extensor group beyond the amount of force that is applied to it when repeatedly hitting a backhand. If the force applied during each backhand stroke is 100lbs. X 40 backhands, then the extensor group needs to be strengthend in order to withstand 120lbs. X 60 backhands.

Prehabilitaion requires that the muscle group is strengthened in order to perform the sport or activity and not that the muscle group is strengthend while performing the sport or activity. Strengthening the muscle group beyond what it will be called upon to do, or beyond its normal strength requirements, will help reduce the possibility of an injury occuring.

Knowing this information about the sport or activity that you perform, and the fact that injuries are common, the personal trainer or clinical therapist working with a tennis player, carpal tunnel patient or any other situation should recommend exercises to develop the strength and stability for each individuals need. This will avoid any potential strength imbalance and raise the individuals ability to withstand the forces of the the sport or activity performed, therefore "pre-habilitating" the injury.
  • Force: A computer mouse and keyboard require only a light touch so be aware of the amount of force you are using. It is said that each keystroke applied takes about 4oz. Of pressure and if you add this up, by the end of the day you have applied more than 50,000 lbs of pressure. Think if you were in the gym long enough to lift 50,000 + lbs. Per day? When you apply this exercise to the finger and wrist flexors only, they are going to get stronger and tighter than the opposing extensor muscles and a muscle / joint imbalance will eventually occur. Balance must be maintained between these two muscle groups to prevent the onset of RSI'S.

Muscle imbalances like this occur throughout the entire body and must be addressed before injury occurs:

The following is a brief summary of common injuries of the upper extremity, the sports and activities in which they often occur, and recommended pre-habilitation stretches and exercises.

Shoulder Tendonitis

Sports: Swimming, Tennis, Javelin, Discus, Shot Put
Work: Construction, painting, housework, cleaning, etc.

Shoulder tendonitis is related to weak rotator cuff musculature and an imbalance of strength in the shoulder. The following are exercises that would be very useful for shoulder injury "pre-habilitation".

STRETCHES:
  1. Low/Mid/High Chest.
  2. Anterior Deltoid.
  3. Internal Rotators.

EXERCISES:

  1. Rear Diagonal Pull. (Upcoming version of FLEXTEND ®) This exercise works the whole of the rear deltoid, rhomboids, teres minor and major, supraspinatus and infraspinatus.
  2. Single Arm Row. (Upcoming version of FLEXTEND ®)
    This exercise works the rear deltoid, rhomboids, mid trapezius and latissimus dorsi muscles.
  3. External Rotation. (Upcoming version of FLEXTEND ®)
    This exercise works the infraspinatus and teres minor muscles along with the posterior shoulder group.

Lateral Epicondylitis

Sports : Tennis, Golf
Work:
Typing, construction, etc.

Often this injury occurs because of poor technique, which places too much strain on the wrist and elbow musculature. This stress can be offset by strengthening the wrist and elbow muscles, particularly the finger, wrist and elbow extensors and wrist and forearm supinators.

STRETCHES:

  1. Finger / Wrist Flexors.
  2. Wrist / Forearm - Ulnar Deviators.
  3. Wrist / Forearm Pronators.

EXERCISES:

  1. Palm-Up Elbow Moving or Palm-Up Isolated Extension Exercises with FLEXTEND ®.
  2. Thumb-Up Elbow Moving and Thumb-Up Isolated Extension Exercises with FLEXTEND ®
  3. Supination Isolated Exercises with FLEXTEND ®.

Carpal Tunnel Syndrome

Sports : Tennis, Javelin, Shot Put.
Work:
Typing, Mousing, Writing, Driving, Assembly, etc.

Often this injury occurs because of a muscle imbalance between the strong, overused flexor muscles that "close" the hand and the weak, underdeveloped extensor muscles that "open" the hand. This injury can be offset by stretching and lengthening the overly restrictive flexor muscles and strengthening and shortening the underdevelped finger and wrist extensor muscles in order to correct the muscle imbalance and increase the space within the carpal tunnel.

STRETCHES:

  1. Finger / Wrist Flexors.
  2. Wrist / Forearm - Ulnar Deviators.
  3. Wrist / Forearm Pronators.

EXERCISES:

  1. Palm-Up Elbow Moving or Palm-Up Isolated Extension Exercises with FLEXTEND ®.
  2. Pronation Exercises with FLEXTEND ®.
  3. Supination Isolated Exercises with FLEXTEND ®.
 AUTHOR: Mr. Anliker is a Therapist and Inventor of Therapeutic Exercise Products that are utilized by Corporations, Consumers and Medical Facilities around the world for the prevention and rehabilitation of repetitive strain injuries.