Strength training guidelines for the injured athlete. (Powerline).

INJURIES ARE AN unfortunate reality in athletics. Lost playing time adds insult to the injury when it negatively affects the athlete's frame of mind. Keeping injured athletes as safely active as possible helps with both their physical rehabilitation and, just as important, their mental outlook.

Allow us to offer some suggestions on the lines of communication: medical staff, strength coach, and athlete.

A fundamental rule when dealing with an injured athlete is to keep the lines of communication open with the athlete and the athletic trainer/primary care physician.

The strength coach is always the second phase of the rehabilitation process. Clearance must be granted from the acting medical personnel before any activities are undertaken in the weight room.

Once the clearance is given, the three involved parties (athlete, coach, and trainer/physician) should meet to discuss all of the procedures to be performed in both the training room (initial rehab), in the weight room (secondary rehab), and on the field of play (functional rehab), along with their rationale. It is vitally important for the athlete to have a firm understanding of the "how's" and "why's" for all of the procedures to be undertaken.

This three-way line of communication should be a mainstay throughout the entire process.

Getting Active Again

Most medical and conditioning practitioners believe in getting the injured athlete active as soon as possible. Depending upon the nature and severity of the injury, it is vitally important to maintain some degree of the pre-existing fitness level.

Initially, this may involve some "hydra-training" in a small, waist-deep rehab pool that provides varying current speeds (Photo 1). We use such a pool in the early rehab stages for lower extremity injuries and other situations where running in a full weight-bearing mode is impossible. Stationary biking is another mode often used in the early stages of lower extremity rehab.

For those who cannot perform weight-bearing exercises of any type during the initial rehab period, we prescribe interval workouts on an upper body ergometer (Photo 2).

Heart rate can be monitored for appropriate intensity and, of course, the duration of the workouts can be gradually increased to allow for overload. Both the medical and conditioning personnel should come to a consensus on all gradations and progression in the workload.

For strength-training purposes, one of our cardinal rules is to continue resistance work for any area of the body that can be safely targeted without negatively affecting the injury. When given medical clearance, this includes working joint areas that are proximal (above) and distal (below) the injured joint.

If the injury involves the knee, we will continue to work the hip and ankle/calf area with prudence and care. This will help maintain some of the strength in those areas and prevent unnecessary atrophy (loss of muscle size).

For example, a hip and back machine (Photo 3) allows for training of the large musculature in those areas that are proximal to the knees.

Sometimes, resistance work is contraindicated for an injured limb because the medical staff has decided it would be best to keep it as immobile as possible for healing purposes. If possible, work should be performed with the contralateral (opposite) limb (Photo 4).

Here's why: There is a neuromuscular process known as "indirect" or "cross-transfer," which, in effect, means that some strength gains will be incurred by the injured side by exercising the opposing limb. While the overall strength gains may be minimal, at best, in the injured limb, some strength increase is better than none.

Chart Progression

Progression is a key element in all training endeavors, but it is especially paramount when dealing with an injured athlete. This is due to the fact that the athlete now has a new "starting" point, in that the injured area may lose much of its initial strength level due to forced immobility or, at best, severely restricted activity.

Tracking and comparing the initial post-injury strength level with subsequent gains provides valuable information on the healing process and the correct timing for increasing the workloads.

This information is also imperative for gauging the transitional process from the sports medicine room to the weight room -- where the heavier, more intense wok can begin.

Getting Back In The Mix

Next comes that all-important point in time when more sport/position specific work can commence. While the athlete may have been working on many functional aspects of his sport during the course of rehab, the medical and strength staffs must determine a target date on which to become more aggressive in training specificity.

This will include an emphasis on the skills required of the particular sport, as well as some strict controls on frequency, duration, and intensity of the skill work to allow both the muscular and neural systems time to adapt to stresses that have been dormant for a while.

Final Rep

As we mentioned earlier, the benefits of this active rehab process supercedes the physical -- it is also a great way to ease the mental anguish of lost practice and playing time. The athlete will see, feel, and experience a great sense of accomplishment as healing and improvements take place.

Remember: Coaches should never take any rehab procedures into their own hands without the consent and direction of trained medical personnel and/or certified sports medicine professionals.

SEND YOUR QUESTIONS TO: Ken Mannie, Michigan State University, Duffy Daugherty Building, East Lansing, MI 48824 [phone] [e-mail]