The first image that comes to mind when we think of strength training is someone with bustling biceps lifting an extremely heavy weight. This could not be further from the truth. Strength training typically needs 70% of 1 maximal repetition to elicit a neuromuscular response, however, this can be achieved in many ways:
- Body Weight
- Resistance bands
- Weight training
- Unilateral (Single limb)
Strength and conditioning training involves movement training, resistance training and plyometric training (explosive jumping). It is used to increased muscular strength, endurance and power while improving body awareness and stability.
The first two questions most clients will ask is why this injury occurred and how can I prevent it happening in the future. Strength and conditioning training has been proven to reduce pain and increase functional outcomes after injury, reduce injury rates in sports and increase functional performance. The evidence speaks for itself…….
What is the evidence behind doing strength training after injury?
Strength and conditioning training and more specifically resistance training has been used successfully to rehabilitate a variety of injury types and body parts. A study by Kristensen and Franklin-Miller (2012) showed that resistance training increased function outcomes in 1500 people with a variety of back pain, knee pain, tendon problems and post hip surgery. Resistance training has been shown to significantly reduce pain in shoulder and neck related injuries (Andersen 2014, Gross 2015) Heavy resistance training has been shown to change collagen fibres at the muscle-tendon junction which is a significant finding for those who suffer from tendon related pain (Jakobsen 2016).
These studies tell us that not only is strength training safe to complete while someone is injured, it is also highly effective at reducing pain and restoring normal function.
What is the evidence for reduced injury rate and sports performance?
There is a growing body of evidence that resistance training not only improves your pain and function after injury, it can also prevent further injury and increase your performance upon return to activity. A study that reviewed interventions to reduce injury rates of over 26,000 athletes showed that strength training and proprioception training (training the body’s sense of position) reduced acute injury rates by 1/3 and overuse injury rates by ½. Resistance training for runners has long since been an essential part of any marathon preparation program. A combination of resistance and plyometric training has been shown to improve running economy of high level mid to long-distance runners (Balsalobre-Fernandez 2015). A combination of upper and lower body dry land strength training has been shown to increase 50-meter swimming performance (Loturco 2015).
The good news here is that if you continue with S&C after you have rehabilitated your injury you can improve your sports specific performance while reducing your rate of injury
So why isn’t everyone doing it?
One of the biggest barriers to the use of resistance training is the fear of aggravating an already injured or previously injured body part. The key to success in rehabilitation is the load (or pressure) the injured tissue is subject to. When a body part is injured it usually cannot take as much load as it previously could. An injured shoulder struggles to lift the arm overhead, a painful lower back struggles to lift the shopping off the ground. In both instances, the affected body part has lost the ability to take the load of the desired activity and thus the movement results in pain. Rehabilitating an injury can be tricky and can sometimes lead to aggravation.
So why come to physio for strength training?
Recent evidence suggests that the design and progression of the strength and conditioning program is more important than the exercises. When an injury is involved it is a case of what exercises to do when, how to progress the program and when to increase intensity and load. As physiotherapists, we look at an injury from both sides of the fence and therefore your primary contact when it comes to applying strength training to an injured body part. We look at the underlying pathology and potential previous underlying issue and the optimal exercises that will get you back to full function and WHEN you are able to complete AND progress these exercises.
A strength and conditioning program can be designed by myself or any of the physiotherapists to target specific weakness that may be affecting your pain and function. This can be an isolated program or compliment a pre-existing Pilates-based program.
References:
Kristensen, J., & Franklyn-Miller, A. (2012). Resistance training in musculoskeletal rehabilitation: a systematic review. Br J Sports Med, 46(10), 719-726.
Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med, 48(11), 871-877.
Gross, A., Kay, T. M., Paquin, J. P., Blanchette, S., Lalonde, P., Christie, T., … & Goldsmith, C. H. (2015). Exercises for mechanical neck disorders. The Cochrane Library.
Andersen, C. H., Andersen, L. L., Zebis, M. K., & Sjøgaard, G. (2014). Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial. Journal of occupational rehabilitation, 24(2), 316-324.
Loturco I et al. (2015) A Correlational Analysis of Tethered Swimming, Swim Sprint Performance and Dry-land Power Assessments. Int J Sports Med.
Balsalobre-Fernandez et al (2016) Effects of Strength Training on Running Economy in Highly Trained Runners: A Systematic Review with Meta-analysis of Controlled Trials. Journal of Strength and Conditioning Research
Author: Patrick McGreal
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