Strength Training and Rehabilitation
Strength training is an umbrella term for using exercises to build muscle strength and can be achieved using free weights, weight machines, resistance bands or body weight exercises. As with any exercise – to see changes, particularly at the beginning, these exercises should be performed 2-3 times a week.
Strength training can be done safely and precisely, and if preferred aided by machines, so that you can pursue fitness without aggravating existing injuries or risking new ones — it’s also a critical rehabilitation advantage that is underrated or missed entirely when someone has an injury or pain (tending to rest it and stop using it for a while potentially leading to deconditioning, loss of strength and flexibility).
Non-Rehab Strength Training
Reps – how many repetitions or times you complete a specific move (exercise) in a row (i.e. complete 12 repetitions).
Sets – how many groups of repetitions you will complete (i.e. complete 12 repetitions with a short rest, then complete another group of 12 reps – this equals 2 sets).
If starting from ground level, whether it’s your first time completing strengthening exercises or the first time in a long time, starting with 1-2 sets of each exercise consisting of 8-12 reps is a great place to start. You can gradually increase to completing 3-4 sets once you can comfortably complete 2 sets of 12 reps.
The American College of Sports Medicine gives various formulas, but generally the most commonly seen are:
- 4-6 reps for heavy weights to increase muscle size (hypertrophy)
- 8-12 for general strengthening
- 10-15 reps for muscular endurance
These are great for general strengthening workouts when there are no injuries present.
Rehab Strength Training
Rehab or therapy exercises are not aiming to bulk up muscles, but are instead meant to help retrain the muscles to help them work in a more functional way. Once the issue is being better managed or improved, we can then work on building muscles.
Exercises designed to help you recover and rehabilitate can be completed more frequently than heavier strength training, as they’re not as stressful on your body. Generally, rehab exercises can be completed 1-3 times per day. If it’s comfortable and not causing pain, the exercises can be broken up so you can spend a few minutes completing 1-2 exercises in the morning and a couple of different exercises later in the day. Physio should be as simple for you to fit into your daily routine as possible. For some this will be taking 10 minutes at a certain time in the day to focus on the exercises, so they know they’ve done them and can get on with everything else before and after. For others, doing a few minutes each time is far easier to squeeze in while the kettle is boiling or (my absolute favourite way to elbow in some rehab time) while cleaning your teeth with an electric toothbrush! 🙂 Most brushes are timed for 2 minutes, that’s 4 minutes a day where the resistance band can be tied securely around a door handle or something secure, and used to complete 2-3 sets of an exercise.
How many sets or reps should I do for rehab?
Detailing the number of reps and sets can vary dependent on several things. Your therapist would base these on what you tell them concerning:
- How long have you had the injury – is it acute or chronic (chronic pain is generally accepted as pain lasting more than 12 weeks)
- Is the injury a sprain (ligament), strain (muscle/tendon), tendonitis (inflammation of a tendon), etc.
- Pre-existing comorbidities
- What is the effect the prescribed exercises are having on the area you’re training – is it making it better or worse
Rehab should be responsive to you too. You’re not a robot, and while we’d all love to have a body that runs like a well oiled machine, its condition can change continuously and react to new exercises and movements with feeling pain, stiffness, inflammation etc. Generally speaking, with rehab exercises you can use a resistance or weight that allows you to complete 10-20 reps over 1-2 sets. When you can easily complete 25-30 reps over 2-3 sets, you’re ready to increase the resistance. Likewise, if when trying to complete an exercise you find it too difficult to use good form and would have to compensate to carry on, stop the set there. Never sacrifice quality for quantity – it’ll cost you a lot more in the long run as it’s one of the fastest ways to injure yourself further. A well practised rule for how many reps to complete is to do as many as you can with good form, until your muscle feels an ache of fatigue (no sharp pains!), then try to complete a couple more still with good form.
Aiming for 1-3 sets of therapeutic exercises are useful. The more reps you can do, usually the less sets you need. Starting a new exercise you may find 5-10 reps is all you can do and while you can complete 3 sets you need a minute break between each one. As you get stronger and the exercise feels more fluid, you can find yourself completing the Physios favourite number (3 sets of 10 reps) and even adding a couple more reps on to that too before increasing the resistance.
Stretches are slightly different in that as we are using these to increase flexibility of a muscle to aid recovery, and each move should be held for at least 30 seconds. That half a minute helps the muscles to completely relax as you breathe slowly, aiming to get as much benefit as possible from the time. If you want a metaphorical Best in Class badge, the gold standard is holding for 30 seconds for 3 sets (3 reps x 30 secs). If time is not your friend, try and hold the stretch for up to a minute for less sets.
Between your sets, remember to give yourself a short break of 15-20 seconds. For those at the start of their rehab program, you may feel more comfortable having a slightly longer rest of 45-60 secs. As the injury improves, you will find the recovery time can be reduced between sets.
Remember to listen to your body
In summary, I know there are a lot of tips on here, but the bottom line is – listen to your body (really listen), it will let you know what you should and shouldn’t be doing. When you are first starting out, I would strongly recommend seeing a Physiotherapist, even if it’s just for an initial assessment. Many offer digital appointments whether over the phone or on Zoom if you don’t have the time or ability to get to a clinic. They can work with you to build an exercise program tailored to your needs and give you advice based on your goal(s).
When I see someone for the first time, I’m often asked, “how long do you think until it will be better?” There are so many factors involved that will affect the outcome including the type of injury, whether it’s the first time or a repeated issue, the person’s current state of health (including comorbidities) and at what stage of the healing process the injury is in. Generally speaking, those injuries associated with local inflammation will typically heal within 7-28 days. If there are comorbidities, issues with healing in the past or the cause of the injury is still present, it can take a lot longer. I truly hope the above information is useful to you, it’s important to remind ourselves that not all templates fit all people so making small changes in different areas to find the right treatment can be really useful. Seeing a Physiotherapist or another health professional can help you get a better understanding of how rehabilitation may look for you.