Sports Injury Rehabilitation: the secret to mobility

Episode 5: The secret of mobility revealed: Here’s how to regain range of motion as soon as possible following injury 

Motion is Lotion: This advice applies to all your mobility and flexibility training, not just injury 

Getting full range of motion back in a joint, muscle or soft tissue after a surgery or injury is often a big stumbling block for athletes despite being key to long term success and the avoidance of reinjury. This is especially true of elbows and knees, as in the case of an ACL reconstruction or in this series, a bicep tendon repair. My surgeon told me to expect a reduced ROM and when I saw him a year after the surgery for a follow up, he was surprised that I had full range in my elbow and could tolerate tension at end ranges.  

I was able to achieve this because I stuck to 2 important rules that apply not just to injuries but to all attempts to improve flexibility: 

1.       Start moving early. 

2.       Use neural tricks to overcome barriers. 

Move early 

Your joints are covered in cartilage which is avascular, in other words, it doesn’t have a blood vessel network bringing it nutrients. The cartilage receives nutrients via diffusion from movement – you literally squeeze life into them by moving. Whilst muscles have a good blood supply and can heal when immobilised (even though lots of negative changes also occur with immobilisation) the joints, which govern your ability to move, need movement themselves to be healthy.  

When I had my cast removed post-surgery, I was put into a brace and restricted from straightening my arm any further than 60 degrees of elbow flexion. This was to give the repair time to heal and not place undue stress on the repair site and it is common practice for many injuries to involve a period of restriction. I was also very restricted in bending my arm – I couldn’t brush my teeth with that arm as I was unable to get my hand to my face. I therefore had the ability to move my forearm through a narrow range either side of a 90-degree bend, so that’s what I did.  

Use gravity to your advantage 

Start by taking gravity away and finding a position where your muscles don’t have to deal with gravity and moving the joint. 

Snack on Movement 

The key to this is little and often –take regular 5-10 minute “movement snacks” throughout the day – 5-10 times a day is good.  

Trick your body into range 

If you read my blog you will have heard me using the terms hardware and software to describe how your body functions. In case you haven’t, this is what I mean: 

Hardware: Physical tissues like muscles and tendons, how big they are and the quality of their ingredients, like collagen. Using high reps to grow a muscle is a hardware upgrade.  

Software: The nervous system: the brain, spinal cord and peripheral nerves and all the communication that happens within them. Training the nervous system to recognise that straightening an arm quickly won’t hurt it is a software upgrade.  

When you take a body part that is restricted, such as an elbow following a bicep surgery, to a range that is uncomfortable, you run into limitations in both hardware and software. The hardware part, in my case the muscle and tendon, have adapted to being shorter. In the case of my tendon, the end had been snipped off following the rupture and it had been pulled through a little hole in my forearm bone and buttoned down the other side, so it really was shorter than before. The software controls the extent to which the muscles can lengthen, and it puts the brakes on if it senses danger. Following injury, the sensitivity of the system is increased such that even trying to straighten my arm produced a big “woah there” from the nervous system.  

Happily, you can kill two birds with one stone and target BOTH limitations with the right type of exercise.  

Here’s how to do it: 

1.       Take the affected limb to the first point of restriction. Let’s use the example of trying to straighten my arm. 

2.       At this precise point/joint angle, apply some force to the muscle you want to lengthen, either by tensing it or using an isometric contraction against something immovable.  

3.       Hold the tension for 5 seconds. 

4.       Now relax, exhale and actively take the movement a little further into the stretch. 

5.       Consciously recruit and tense the muscle on the opposite side (in this case the tricep) as you try to move into the stretch. Do this for 5 seconds too.  

6.       Repeat this process 3-5 times. You should notice that on each occasion you should be able to gain a few degrees of new range following the tension-relaxation cycle.  

At first, when the arm was weak and tender, simply tensing my bicep muscle in this position was enough to achieve the result. Later, I could apply pressure to my hand with my other arm and do an isometric “curl” against my other arm before relaxing into the stretch. Following that, I could use a tricep extension exercise after the contract-relax cycle to bring more range. 

Why is this so effective?  

Progressively applying force to the tissues in the position of restriction upgrades both software and hardware. It teaches the nervous system that the joint/limb can bear load in that position without insult, rewiring the software to allow the body to express force in that position in future. At the same time, it trains the connective tissues to lay down collagen in response to the loading and builds the strength and endurance of the muscle fibres to produce forces around the joint and stabilise it.  

Thinking back to episode 4 and the concept of reconnection, these timed holds where you practice switching your muscles on and off also build coordination and give your brain excellent, detailed feedback about the involved body part – a magic combination that, when applied correctly, leads to rapid gains in Range of Motion that set you up to win.  

If you want to know more about managing injury or you need a custom designed return to play programme, contact me here