What is considered the "terminal" phases of rehabilitation and what should we as sports clinicians do in that time frame? This is arguably a time frame that many sports clinicians think about and struggle with, as authors Dan Lorenz and Mike Reiman allude to in the following article.
So what gives? Do we work on power/agility/strength/speed? What about sports biomechanics? How do we achieve this? This article serves as a starting point for those questions.
Clinical Point #1: "The terminal phases of a rehabilitation protocol should be a hybrid of sports physical therapy and strength and conditioning"
Clinical Point #2: "The terminal phase of rehabilitation is defined as the time frame from when the athlete is completing an algorithm- based progression (anthropometric measures, range of motion, strength, isokinetic testing, functional tests) to when he or she is released to participate in sports"
One of the important points of this article is that it discusses the current thoughts on how to improve performance. Those thoughts included: traditional weight training, plyometric training, and dynamic weight training. The rest of this article breaks down definitions, examples, and ideas when training for strength, power, speed, endurance, and training using energy systems/metabolic capacity.
1. Eccentric exercise- Evidence points to eccentric strengthening being superior to concentric strengthening for increasing total and eccentric strength, in addition to muscle mass. The authors also point to eccentric training being found to be more effective than concentric training for improving rate of force development.
2. Variable resistance training- using elastic bands or heavy chains. It is important to understand that using these tools, load increases when the muscle has increased leverage during early phases of the lift and decreased during later phases of lift. The authors point out that while chains may not be realistic in the clinical setting, bands may be used with dumbbells (DB bench press, push jerks, split jerks, etc).
1. Complex Training- alternating biomechanically similar high load weight training with plyometric exercises. Theoretically this should build in the postactivation potentiation. Postactivation potentiation is based on the contractile history of a muscle influencing the mechanical performance of subsequent muscle contractions.
2. Contrast Training- using high and low loads in the same training session. Example used: "The athlete may perform 6-repetition sets with loads between 60% and 80% of 1 RM, alternating with 6- repetition loads between 30% and 50% 1 RM at maximum speed to increase power".
** Evidence has supported increased VJ, sprint performance, and agility in soccer players with complex & contrast training. **
3. Plyometric Training- most well known power type training. Full recovery recommended in between sets if using plyometrics alone to allow maximum power production.
4. Olympic Weightlifting- maximizes power and requires full body coordination, strength, and balance. Authors note: requires a longer time to teach athlete. Authors recommend breaking down movements with PVC or wooden dowel for teaching purposes. Additionally, dumbbells may be more realistic than barbells and useful from the unilateral and neuromuscular control points of view.
1. Varied pace sprints- running relaxed at high intensities and "recharging" the nervous system between maximal bouts
2. Resisted sprints- recruit increased muscle fibers and increase neural activation. Can use weighted sleds or running with tethered resistance.
3. Assisted sprints- improves stride rate and elastic energy production.
*** "With fatigue, sprinting form is potentially sacrificed, thereby negating the positive effects of speed training" ***
1. General endurance- trained by low loads (30% of 1RM), short rest periods (10-30s), and reps (20-150).
2. Specialized endurance- speed endurance and strength endurance
a. Speed endurance- generating tension over long periods of time without a decrease in efficiency
b. Strength endurance- developed with 25% to 50% of 1RM, with a moderate tempo of repetition performance (6-120 rep/min)
3. Mixed intensity interval training- to facilitate sport specific endurance in soccer: 30-90 second intervals of varying intensity over 6 minutes.
Metabolic Capacity/Energy System Specificity
1. Using the essential 3 energy systems (ATP-PC, lactic acid, aerobic system) for specificity with training athletes. Football example: average play runs 7-10 seconds with about 20-60 seconds rest. Ways to improve metabolic capacity= using heavy duty ropes (alternating arms, chop pattern, see-saw pattern, etc)
Additional Clinical Pearls
1. Backward medicine ball throw is a reliable indicator of upper body power
2. Performance enhancement techniques should be highly specific to the athlete's sports demands.
3. Power relates directly to agility and speed
Overall, this article can give the sports clinician a review of different components of athletic performance, definitions of strength, power, speed, and endurance, and examples of ways to increase each component. Physical therapists in general do not get specific strength and conditioning training but the sports clinician needs to understand and know how to implement those principles. Additionally, sports clinicians must adequately understand the importance of mimicking the biomechanics of the athlete's desired sport, position, and function (jump, run, kick, etc) while including performance enhancement in the terminal phases of an athletes rehabilitation.