Does a training plan only apply to athletes?

An athlete’s training plan is a roadmap for tracking their progress and documenting their peak performance. This training plan also helps athletes build confidence and reduce anxiety during competitions. It is equally imperative for patients to create a training plan during the rehabilitation process. As the rehabilitation phase progresses, training plans act as building blocks for therapeutic exercise applications. These plans document the specific areas to be worked on and guide the progression of exercises. 

The steps towards a training plan for rehabilitation

Despite similar injuries, every patient is unique. A systematic screening approach helps to identify strengths and weaknesses in different domains in order to maximise the individual’s potential and address the specific problem each patient encounters. These screening domains can be divided into two broad facets: subjective and objective.

Subjective

The first step in developing a rehabilitation training plan is to gain an understanding of how the patient perceives their current ability and the functional goals to be achieved. After that, the plan’s progression depends on the patient’s commitment and effort. The timeline and progression of the program depends on the patient’s physical demands in the social environment i.e. a deskbound job versus physically demanding work may influence the timeline. For experienced clinicians, directing the examination and observation process to obtain the underlying cause of the problem and outline the priority for treatment is an extremely valuable skill.

Objective

To formulate a training plan and guide progression in rehabilitation, ongoing physical assessment, including but not limited to physiological, biomechanical, motor control and fatigue resistance screening is conducted. To understand the spectrum of movement limitations, one needs reliable and valid decision-making about the type of assessment. For example, tissue damage and post-injury impairment both can result in physical activity limitations and temporary functional restrictions. Therefore, screening for mobility or biomechanical deficiencies may affect rehabilitation training plans. Thus, identifying the root cause of the problem is essential for resolving underlying problems.

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Figure 1. The spectrum of movement limitation

Assembly information and action

The specificity of the training plan includes appropriate exercise selection relevant to the activities associated with the demands of sports or daily living. This includes the muscles and muscle actions involved, load, velocity and range of motion. Physical activity for daily living and sports demands, common injuries, and the underlying cause of the problem should all be considered during the preparation of the plan.

Progression and goals

The immediate goals of rehabilitation are to protect and restore range of motion and to prevent muscle inhibition. Progression to intermediate rehabilitation includes minimal pain and restoration of at least 75% of the range of motion on the non-involved side. The goals of the intermediate rehabilitation stage are continued protection of involved tissues or structures and regaining functional proprioception of the affected body part or region. To progress to advanced rehabilitation, an individual needs to achieve close to full range of motion on the non-involved side and at least 60% strength on the non-involved side.

The advanced rehabilitation stage involves precise overloading and specificity to restore muscular strength, muscle endurance and improve neuromuscular control. Once strength is at least 80% of the non-involved side, with coordinated and symmetrical movement of the entire body, an individual can progress to the function stage. Goals of return to function consist of returning to previous functional levels and preventing re-injury, which require an in-depth understanding of an individual’s physiological function, movement biomechanics, and neuromuscular control for sports and functional movements.

The advantages of moving early

Frequently, intermittent movement and loading of tissues are critical for nurturing healthy tissue physiology and maintaining movement mechanics. Disused and immobilisation of body parts will adversely affect bone, joint capsule and skeletal muscle physiology. Cardiorespiratory function and aerobic fitness are also negatively altered as a result of body part disuse and immoblisation. The negative physiological and mechanical alterations that occur following disuse are potentially mitigated when appropriate subsequent exercise interventions are applied. However, sensitisation occurs post-injury in the periphery and within the central nervous system, facilitating greater vigilance of the internal and external environments. This amplified processing of potentially threatening stimuli more easily engages the appropriate protective outputs, including changes in motor patterning and glial-enhanced nociception. When these adjustments outlast a period of tissue threat, there are subsequent long-term changes in the neurological processing of sensory information, in motor coordination and in activity of the relevant higher centres involved. Such central processing of peripheral inputs allow modulation in both directions: either more sensitivity or, at times, more inhibition. Therefore, early interventions are key to positively altering a particular physiology and mechanical function within a clinically reasoned rehabilitation process.

A training plan is the use of strength training and other conditioning methods to physically prepare athletes for sporting performance or return to function after injury. Using this concept to design effective rehabilitation programs can better prepare an individual to return to sports or functional activities. The ability to exert force is dependent on modifiable neural and morphological factors. In order to evoke such adaptations, strength training programs should seek to provide overload and take into account the specificity of the stimulus. Creating a training plan the enables patients to be successful in rehabilitation requires the precision and experience of the clinician. Therefore, every patient is an athlete, and our clinicians are coaches. Every patient’s success is our top priority.