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Here's Exactly What to Focus On In Your Rehab (and What to Skip) — Transcript

by MOVE Physiotherapy · 2,519 words · 389 segments · language en · Watch on YouTube

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0:00Welcome to wealth,
0:02the whiteboard of wisdom. So, we've had
0:04a bit of a development at move and we've
0:07managed to build some new offices and we
0:09have in every single room a different
0:12whiteboard, but this one is going to
0:14become the whiteboard of wisdom where
0:16every week we are going to put out there
0:18a different lecture, a different piece
0:20of information that is ultimately
0:22designed to help you fix your injuries
0:24and get back to what you love doing.
0:26Today, I'm going to walk you through the
0:28hierarchy of rehab so that the aim is
0:31when you finish this lecture, when
0:33you've watched it to the end, that you
0:35will know exactly what the key things
0:36you need to focus on, whatever your
0:38injury is, to make the biggest bang for
0:41buck and the biggest meaningful change,
0:43not just to get pain free, but to have a
0:45long-term results. So, at the base of
0:48our pyramid, we have two key things and
0:50these are the underpinning foundations
0:52of any successful rehab and they are
0:55strength training and aerobic capacity.
0:58The key thing that you need to
1:00understand about these two, it's not
1:01about hitting certain levels of
1:03strength, it's not about hitting certain
1:05levels of aerobic capacity or more
1:07commonly known as fitness,
1:09it is that improving these, whether
1:13that's on a local basis at the key joint
1:16or on a global basis, will essentially
1:18give you more buffer. And it's like
1:21living life on a bowling lane with
1:24higher barriers on each side. And
1:26essentially, they're going to be really
1:28protective qualities because one of the
1:30key things that they're going to mean,
1:32the higher levels of strength and
1:33fitness that you have, the less cost of
1:37everything else that you do. So, what I
1:39mean by that is in the common reason
1:41that people get injured is because they
1:43have poor aerobic capacity, yet they go
1:45for an hour-long run, they play rugby
1:47which is 80 minutes, they play netball
1:49which is 60 minutes, they play football
1:51which is 90 minutes and when they get
1:53into sort of
1:5575, 80% of the width through the game,
1:59their aerobic capacity is being used up
2:03essentially. They're getting to the
2:04limits of their fitness. But what that
2:06means is it starts to erode other
2:08physical qualities such as strength so
2:12that then when they go to sprint, they
2:14go to change direction, they don't have
2:16the strength available to tolerate that
2:18movement. And this is one of the really
2:20key things that we look at with every
2:22single client we work with, whether
2:23that's online or in person here at our
2:25clinic in Harrogate. We go through a
2:27full assessment. And if you are
2:30interested to know a little bit more
2:31about how we do work, use the top link
2:33in the bio. That'll take you to an
2:35application form and we'll send you all
2:36of the information that we need that you
2:38need based off your specific injury,
2:41which is why we use the application
2:42form. But essentially, the more strength
2:46you have and the more aerobic capacity
2:48or the higher levels of fitness, they're
2:51just going to protect you. The other
2:52really key thing that it will do, and
2:54this is what's so unique about our
2:56approach here at Move, is that
2:58improvements in these two will skyrocket
3:00your performance. A higher performing
3:02person, a higher performing athlete, and
3:04I use that loosely because the big
3:07misconception about us here at Move is
3:08that we only work with athletes or
3:10healthy or active people. But the reason
3:13I use the word performance is because it
3:14can be viewed through any lens. If
3:16you're a higher higher performing
3:18athlete, you will perform at a higher
3:20level so therefore you'll become less
3:22likely to get injured. But if you're a
3:24mom, a dad, a grandparent, and the
3:26meaningful thing to you is running
3:28around in the garden, I'm a dad of two
3:30now so I know how exhausting that that
3:32can be. And you want to run around, be
3:34able to pick them up, throw them around,
3:37then having higher levels of
3:39performance, better levels of strength,
3:40better aerobic capacity will mean that
3:43you can do that more. You are less
3:45likely to get hurt and you can do it for
3:47longer, you can do it more consistently,
3:49and you're going to be able to do it for
3:51into later life. So, we're improving
3:53quality quality of life and longevity by
3:56actually improving levels of
3:58performance. And it's that switch
4:00between performance is just active
4:01individuals who view themselves as
4:03athletes to I need to perform at my best
4:05possible level through my specific lens.
4:09And the next thing as we go up the
4:10hierarchy, and this was a hard thing to
4:12separate, but it these two are so
4:15foundational that improvements in these
4:17will improve everything else
4:20is movement quality. And there's three
4:22key components to movement quality.
4:24There's the actual control and
4:27coordination of a movement. So, what the
4:29movement looks to the naked eye when you
4:31do it. And how muscles coordinate with
4:35each other, how the brain coordinates
4:37the the
4:38the movement. And one of the big things
4:40that people get wrong with movement
4:42quality is that their intent is poor.
4:44There's you can do the same exercise in
4:46two very different ways and elicit very
4:49different training adaptations or
4:52improvements in how you feel and how you
4:55move and how you perform because of the
4:57intent behind the movement quality. The
5:00other really key thing, which I've noted
5:02here, is core contractions. So, when you
5:04think about
5:06the easiest way to think about it is
5:08when you walk,
5:10you
5:11stay relatively level. So, I step
5:13forwards and I'm just keeping moving on
5:16the same plane of move movement. But
5:19most of the work that you would do in
5:20the gym is down and up. It has an
5:23eccentric and it has a concentric.
5:26But a core contraction is when all of
5:28the muscles work synergistically
5:30together, so they coordinate and they
5:32co-contract together, and they you work
5:34a little bit more isometrically to
5:37absorb the force and then push you
5:39forwards rather than this. Which one
5:42would look really stupid, but two would
5:45be really inefficient. So, movement
5:47quality is the next tier up on our
5:49hierarchy. Next is capacity,
5:53hypertrophy, and plyometrics.
5:57So, I was maybe going to separate these
5:58out, but the reason I've put them
6:00together is that
6:03these are really key parts of a
6:06a high-quality uh rehab continuum. And
6:10here at Move, we use a six-step rehab
6:11continuum. And the reason for that is we
6:15want to build control and dampen down
6:17the pain first, then we want to build
6:19capacity and endurance, which is a type
6:22of strength. Then we want to make sure
6:25that we have um
6:28the appropriate levels of hypertrophy,
6:29so muscle volume, because that'll tell
6:31us a lot about how robust a joint would
6:33be or um how robust a limb would be.
6:36Before then, we move into much strength
6:39markers and plyometrics and along that
6:41continuum, and that's always individual
6:43to each person, their injury, and what
6:44their needs are. And what their goals
6:46are. But, the reason I put them all
6:48together is because these are really key
6:50KPIs that someone needs to tick off
6:53through an effective and safe rehab
6:55program. Because what we end up doing
6:57here at Move is we help a lot of people
6:59who have failed previous approaches. And
7:01the reason that they failed previous
7:03approaches is cuz they blindly gone
7:05through a rehab continuum. I'm going to
7:07come into it at the top of the uh the
7:09hierarchy, but what most people do, and
7:11the big mistake, is that they wait for
7:13the pain to dampen down. And then they
7:15just go back to the activities that they
7:17went to before. And the reason that that
7:19doesn't work is because they're not
7:21ticking off their KPIs, so the key
7:23performance indicators, so key goals
7:26based on specific physical qualities
7:28that allow you, and this is something we
7:30talk about all the time. Hopefully, you
7:32can see that on the camera. To earn the
7:34right to progress and not skip steps.
7:37Because people who skip steps, and
7:39people who don't earn the right to go
7:41back to hopping, jumping, running,
7:43playing sport, end up back at the
7:45beginning of that rehab journey because
7:47they don't have the underpinning
7:49physical qualities, big enough
7:50foundation to tolerate the demands of
7:52the things that they're trying to do.
7:54Next in one of the more overrated, in my
7:57opinion, is flexibility mobility work,
8:00particularly static uh flexibility
8:03training or mobility training and banded
8:05exercises because if you
8:09move really well in the gym, squats,
8:12lunges, different things like that, and
8:14you add external load, so you build
8:17strength, you're going to get more bang
8:19for buck out of your flexibility and
8:21mobility training.
8:22There is research that shows that, and a
8:24lot of the the flexibility and the
8:26mobility training that people do is very
8:28transient. And what I mean by that is it
8:30creates a short-term effect. And
8:33actually, as we go up
8:35this hierarchy, where
8:38long-term effect,
8:40medium-term effect, short-term effects.
8:43So, what we're looking for is bang for
8:45buck at the bottom, foundations, things
8:47that's going to last the test of time.
8:49And as we go up, it's more novel
8:51stimulus is that you can create a quick
8:53change in how your body feels and moves.
8:55But if you only focus on that, then that
8:58will be why you end up back at square
9:00one. If you enjoy flexibility mobility
9:03training, I'm not saying don't do it,
9:04but do it as it creating a window of
9:06opportunity where you've slightly
9:08improved body feels, so dampen down some
9:11pain signals, you've improved a little
9:13bit of range of motion, and layer it in
9:15there with strength work and movement
9:17quality, which is going to mean that you
9:19own that position and the new ranges of
9:21motion that you've created, creating a
9:24longer-term adaptation that you keep,
9:26rather than stretching your hamstrings
9:28today, going about your day, waking up,
9:30and it being exactly the same tomorrow.
9:32So many people again that we work with
9:33online and in person tell that same
9:35story. I was given these three
9:37stretches, and they kind of made me feel
9:38a bit better, but then the pain comes
9:40back. It's the same story that we hear
9:42time and time again.
9:44Next is passive treatment. Now, massage,
9:47manipulation, acupuncture needles, um
9:51dry needling, foam rollers are a big
9:53culprit. Again, very similar to
9:56flexibility mobility,
9:58it is a useful tool, but it is not a
10:01foundational rehab methodology, tool,
10:06um
10:07modality, whatever you want to think of
10:09it as. It creates windows of opportunity
10:12where pain is dampened down and ranges
10:14of motion are different, but there is
10:16zero research that actually links
10:18massage, manipulation, needles to
10:20long-term outcomes from a rehab
10:22perspective. It these two essentially
10:24create the window of opportunity. I'm
10:27even going to write it there. Window of
10:30opportunity, the woo.
10:32That's a nice acronym.
10:34The window of opportunity to do more of
10:36this,
10:38building capacity,
10:40building movement quality, building
10:42strength,
10:43building aerobic capacity. This is what
10:46this does.
10:47And the tip of the tier, and maybe my
10:50biggest bugbear at the moment from an
10:52injury and a rehab perspective, is
10:54complete rest. Now, this is the common
10:56thing. If you live in the UK, you go and
10:58see your GP, rest it for 6 weeks and
11:01come back if it's still a problem.
11:03And that is so foundationally and
11:06principally the worst thing that you can
11:08do for this one reason.
11:11And the reason is
11:14imagine you get hurt, you get injured at
11:18this current level of performance,
11:20whatever that might be. You have this
11:22much strength, this much aerobic
11:23capacity, this much mobility, this much
11:25endurance capacity, hypertrophy,
11:28uh power, plyometric ability. And your
11:30body has let you down and can't the
11:32demands of the things you're trying to
11:34do and you rest,
11:36those physical qualities aren't getting
11:38any better.
11:39Over 6 weeks, those physical qualities
11:41are dropping and dropping and dropping
11:43to a point where yeah, you might feel a
11:46bit better. The reason you feel better
11:48is because you've avoided the painful
11:49activity for a period of time. You've
11:51not fixed some of the underlying roots
11:53and drivers behind it. You've actually
11:57degraded
11:58or deconditioned. Essentially, you've
12:01lost strength, you've lost aerobic
12:03capacity, you've lost movement quality,
12:05you've lost you lose muscle mass
12:07hypertrophy, you will
12:10reduce your mobility and your
12:11flexibility. And then because you feel a
12:13bit better, you go back and try and do
12:16the things that you were trying to do
12:18before. And you can see quickly how
12:20people get stuck in this spiral of
12:22injury, rest, return, re-injury, injury,
12:25rest, return, re-injury. And I've done a
12:28previous video about that. Well, this is
12:30the biggest mistake that people make.
12:32It's common in the NHS, it's common from
12:34GPs and actually we're getting a lot of
12:36people now that are coming to us and
12:38saying I asked AI, I asked ChatGPT, I
12:40asked Claude, I asked Gemini and it
12:41advised rest and maybe trying these
12:43couple of exercises. The reason it's
12:46wrong is because it deconditions you.
12:48Any exercises that it's suggesting are
12:50just going to be generic, they're not
12:51going to be specific to you, your story,
12:53your injury and what your goals are and
12:55I'll talk about that in another video.
12:57But ultimately, for the biggest bang for
12:59buck, strength and aerobic capacity are
13:01the foundations of everything you do.
13:03Move well, build capacity, hypertrophy,
13:06earn the right to progress through your
13:07plyometrics and then get back to running
13:09if that's meaningful to you. Use
13:12flexibility and mobility training and
13:13passive treatments if they make you feel
13:15a little bit better and allow you to do
13:17more of this. And there is always
13:19something you can do,
13:21whether you believe you're in the most
13:23pain imaginable, in which case you
13:25probably need to be escalated to A&E and
13:28to more specific medical care.
13:32And
13:33there will always be something you can
13:35do, whether that is training your upper
13:37body, if you've got a lower body injury,
13:39doing off-feet conditioning. And this is
13:41what we specialize with whenever we work
13:43with anyone on our pro recovery and
13:44performance plan. We take full control.
13:47We do all your physio, all your rehab,
13:49all your strength and conditioning, so
13:50you're training. We do We make you
13:52fitter, stronger, so that at the end of
13:53working together, you not just fix the
13:55pain, you finish it far more confident,
13:58much better levels of performance, far
14:00more resilient, so that you can have
14:02every confidence going back. Hope that
14:04makes sense. If you have got any
14:05questions and comments, put them down
14:07below. And this video here is what
14:09YouTube recommends that you watch next.

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