Hands on therapy versus strength work?
Always remember your principles of injury, inflammation and recovery
I am commonly treating patients who are returning to activity after having surgery.
Common surgeries are Anterior Cruciate ligament reconstruction, Caesarian section, Disectomy etc. Guidance within the hospital system on discharge covers basic function tasks, wound management and the start of pelvic floor exercises where appropriate. However once a basic home exercises program has been completed and the wound has healed there is a always a gap between functional strength and the strength and control that injury requires to return to running / sport.
Claire had completed Physiotherapy rehabiltiation protocol for 6 months after ACL reconstruction but presented with failure to return to running at 12 months. Her walking was pain-free, but on assessment she had stiffness into full knee extension as well as full ankle dorsiflexion on her operated side. She could completed only 2-3 single leg heel raises on her operated side and only 3-4 static lunges without fatigue. Indicating both her calf muscle and gluteal muscles remained significantly weaker than her non-operated side.
Claire
- Return to running; An average 2 x 10km per week
There were other contributing factors
- History of back pain over 10 years
- Heel raise in shoe to allow tear site to heal supported and in a shortened position
Following surgery you are required to maintain strength around the injury site as well as basic global strength to allow your injury and previous injuries to return to running load. This is a requirement for as long as you continue to run. Where non surgical injuries can resolve and not need attention, surgical injuries always need mobilising and strength exercises to match your needs and aims otherwise the site can weaken quickly (usually this happens over 6-12 weeks).
Management for Claire involved 6 sessions of hand on work to mobilise her knee, ankle and back. As well as developing a structured program focusing on quality movement patterns, endurance and running specific exercises. We phased her into a return to run program after 4 weeks of strength and she is now running her previous volume with no reaction in her surgical site, achilles tendon or her back. She will need to now complete her Physio program x 1-2 week per week to keep her injuries strong.
