prehab

The World of PreHab

This subject follows on from a discussion we were having on the ABC’s of Osteopathy a few weeks back because people wanted to delve deeper into these topics. This list is by no means exhaustive, and I can give those who are interested additional resources.

We will start at the beginning and work our way chronologically through injury. Before we begin, I want you to understand the commonality between Pre-Hab, Re-Hab, and Mo-Hab. It’s Habilitation, which means:“supplying a person with the means to develop maximum independence in activities of daily living/sport through training or treatment.”1

Keep in mind that the three expressions have the same goal, but are used at different stages along the injury spectrum. They aim to make you better, either in injury prevention or injury recovery. There are no black and white divides between the expressions and there is also a lot of overlap.

As we go through the various terms, I will use a case example to help illustrate the points. Tony, a 28 year old, desk based worker who has been fairly active and injury free most of his life. He has just signed up for his first Olympic lifting competition in three months time.

What is PreHab in Sports?

It is training preparation that aims to prevent/reduce the risk of injury in your chosen sport. It can be achieved through training that develops our capacity to do sport 2,3,4. A more fancy term that is often used is proprioceptive neuromuscular training, which is a broad selection of exercises that are used as a warm-up.

We are going to focus on three types of exercises within the habilitation world:

  • Balance – often contributed to by three systems; visual, vestibular (inner ear) and proprioceptive (musculoskeletal system). We will just focus on the proprioceptive system. (examples of these exercises would be standing on one leg, hopping and trying to maintain balance)
  • Perturbation – an unconscious reaction to an unexpected outside factor. (A common way of doing such exercises is standing on an unstable surface (e.g. wobble board) were you are unsure of which direction it will move)
  • Agility/Plyometric – the ability of the body to change position efficiently i.e. being nimble. (examples: Jumping, 20 yard shuffle, and clapping push-ups)

Where should Tony start with these exercises in the hope to prevent an injury? Let’s assume that Tony is fairly able in the lifts and has the ability to achieve all required positions.

Balance – Split jerk, as it requires more balance than the other sections of the lift, due to the unilateral nature of the stance. Here, Tony’s warm up could include hopping onto alternate legs, lunging into the stance, or something similar to the demonstration in this video:

Perturbation – Front squat, as its unlikely that Tony’s Olympic lifting platform will move too much. So, having an unstable surface to train on would not be the most effective option. However, sometimes Tony may not receive the bar in an equal load left and right, therefore squatting with some unstable loads on either side of the bar may be a good option. Obviously, using the correct rack position for Olympic lifting is a must. 😉

Agility/Plyometric – In Olympic lifting, agility is well taught, and can be trained through the lift itself, starting with sub maximal weights and practicing the speed of the movement, such as in the dip drive on the jerk. One could also use box jumps, utilizing the innate explosive nature of the movement. When it comes to multidirectional sports, such as tennis or football, the use of ladder agility drills is important.

The aim of these exercises is to build Tony’s capacity so when he is training/at the competition, his body is prepared for all eventualities.

Next month, we will see what happened to Tony during his comp!

References:

1. Accessed 17.2.13, http://medical-dictionary.thefreedictionary.com/habilitation (adapted).
2. Hewett TE, Lindenfeld TN, Riccobene JV, Noves FR. 1999. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports med.
3. Accessed 15.2.13, http://xa.yimg.com/kq/groups/19520777/336902774/name/Medicine+and+science+in+sports+and+exercise+2009+Zech.pdf.
4. Topp R, Swank AM, Quesada PM,Nyland J, Malkani A., 2009. The effect of prehabilitation exercises on strength and functioning after total knee arthroplasty. J.pmrJ