Return to exercise

--Why is it important to rehabilitate before returning to regular exercise?

Being physically active is a vital component of keeping healthy. Increasing physical activity and reducing sedentary pastimes can help prevent many chronic diseases.

When pain or injury causes limitations to movement, you may find it increasingly difficult to keep active. Restrictions in range of motion lead to weakening of muscles and bone, and make keeping cardiorespiratory fitness difficult.

Physiotherapists understand the frustration of restricted movement and will help to break the barriers you have to being physically active. By addressing the correct approach to strengthening and stretching, and safely increasing activity, your physiotherapist can help you get back on track more effectively. They can also provide alternative ways to maintain your cardiovascular fitness during your rehabilitation.

Post injury or surgery, your physiotherapist will know the best exercises to minimise the risk of re-injury and regain normal function. In general, injuries improve at different rates and are determined by the type of tissue injured (muscle, tendon, joint or bone) and how severe the injury is. However, each person experiences an injury or condition differently. Although most rehabilitation goes to plan, specific problems can occasionally delay a return to exercise.

Muscle injury

Rehabilitation following injury of muscles can often progress at a quick rate, with return to modified exercise within two to three weeks. That said, muscle injuries that occur at the tendon junction or within tendons found in muscles can take much longer to settle. Exercises to regain muscle strength and flexibility, followed by speed and agility, are important in preventing re-injury.

Tendon injury

Injuries to tendons (tough fibres that connect muscle to bone) can be slow to diagnose because in the early stages the pain often reduces as you start to warm up, allowing you to continue your sport or activity. Monitoring the tendon symptoms and gradually increasing exercise can take several months, but is essential to regain tendon health.

Joint injury

Joint injuries are common, occurring in the knee, ankle, wrist, shoulder and elbow. After the acute inflammation settles, you will need to develop coordination and movement skills to adapt body strength and flexibility in order to control forces on the joint. This can take a few weeks to several months of focused effort to regain normal function and limit further problems.

For some injuries, weaknesses will remain even after the pain has settled. These weaknesses can increase your risk of re-injury. Your physiotherapist knows the common problems associated with specific injuries and can measure them, provide exercises to correct them and re-measure them to ensure your risk of re-injury is minimised.

--How do I know when I am ready to return to exercise?

Exercises are progressed throughout all stages of your recovery and your physiotherapist will use many components of your fitness to make sure you are ready for a successful return. They can perform tests to monitor your flexibility, strength, balance, range of motion and other factors to see how you are progressing. Your physiotherapist understands what movements are involved with your sport or exercise and will work along with you to achieve your goals

--What are important measures to ensure I don’t re-injure myself?

Your physiotherapist will work through any predisposing causes of your injury. These may be muscle weakness, tightness, joint restrictions or poor coordination and skill, or could be related to training error or lack of adequate or appropriate equipment. Understanding these factors and addressing them can ensure your safe return to exercise and prevent re-injury. If pain or swelling increases, then you are doing too much or the wrong exercise.

After injury there are several preventative measures you can take to prevent re-injury. This includes a good warm up to prepare the body for exercise and a gradual return to activity, taking care not to do too much too soon. This is called ‘pacing’. Controlled exposure to exercise will help reduce fear around doing the activity that initially caused the injury. Your physiotherapist can guide you towards safe exercise and will communicate with your coach, teacher and other health professionals to ensure you are back on track to physical activity.

--How can a physiotherapist help me return to exercise?

Physiotherapists are very well trained in rehabilitation following injury or surgery and understand the effects of medical conditions that may restrict your ability to be physically active. Your physiotherapist will assess your whole body, including nerves, muscles, bones and joints, to determine your current physical ability. They will then work together with you to make a plan on how to address limitations that are preventing you from reaching your goals. They also understand training loads and will guide you on the best recovery plan.

In the early stages of injury, your physiotherapist will reduce symptoms of swelling and pain using techniques such as active assisted exercise, joint mobilisation and massage. They can properly fit you with equipment such as crutches and braces to protect and support the injured area when needed. They will educate you on the correct use of equipment or taping that may help protect the injured area and reduce the risk of re-injury.

Hydrotherapy exercises in a buoyant environment support the healing body and allow strength and cardiorespiratory fitness to be maintained. Throughout rehabilitation, your physiotherapist can use hydrotherapy to challenge the body and prepare it for return to exercise and sport. Physiotherapists retrain the postural muscles (those involved in maintaining posture, such as spinal muscles, hip flexors and calves) to support and control movement, and develop motor learning with the large muscle groups to improve coordination and skill. Some of these specific rehabilitation exercises are important to continue with after you return to sport and exercise as they help prevent further injury.

Physiotherapists retrain the postural muscles (those involved in maintaining posture, such as spinal muscles, hip flexors and calves) to support and control movement, and develop motor learning with the large muscle groups to improve coordination and skill. Some of these specific rehabilitation exercises are important to continue with after you return to sport and exercise as they help prevent further injury.

--How effective is physiotherapy for helping me return to exercise?

Physiotherapists are effective at helping return people to exercise and physical activity as they have experience in the function of the body and how injury and disease affect movement. Physiotherapists use assessment and measurement tools to diagnose, plan and modify an individual rehabilitation program specific to your needs.

Physiotherapists also address factors that may predispose you to injury or limit your return to exercise. In addition to a good rehabilitation plan, factors that positively influence rehabilitation include good hydration, nutrition and adequate sleep. Poor attention to these factors may contribute to risk of injury.

By addressing predisposing factors that may have contributed to injury, your physiotherapist can use your rehabilitation period to work on impairments and enhance your skills to try and improve your performance.

Are there any particular forms of exercise I should avoid when I first return to exercise?
On return to exercise it is important to gradually increase the time and frequency of exercise so that the injured area is not stressed excessively. With a well planned, progressive rehabilitation plan and adequate pacing, most people can return to sport and exercise successfully without needing to avoid or restrict exercise. Occasionally some injuries and conditions require further consideration on when to participate. Return to contact sport or high intensity exercise that includes speed or power activities may increase your risk of injury.

Your physiotherapist can help you make the best choice for yourself that aligns with your goals on retuning to activity and communicate with other health professionals and coaches to ensure correct and adequate precautions are in place to ensure a safe return to sport.

--When is it ok to take a break from exercise?

Sometimes it is necessary to reduce the level of exercise to allow the body to recover, or to focus on rehabilitation for the particular area. However, recovery does not always require total rest, and the benefits of maintaining physical activity are extremely important to your health.

If considering a break from exercise because of injury, boredom or cost, it is worth thinking of safe, enjoyable and interesting alternatives that encourage you to keep active.

Your physiotherapist can discuss and assist in finding exercise and activities specific to your ability, keeping you motivated to stay physically active.