Exercise as part of rehab. Injuries are never part of the plan. No one enjoys the pain and inability to compete at your best and no one wants injuries to happen again. Regardless of the severity, an injury will always result in damage to the tissues, which includes loss of strength, endurance and stability. To fully restore the area to its pre-injured state, it is imperative to re-establish:
The only way to address all these deficits is…EXERCISE!
Researchers consistently find no better treatment modality than exercise. When compared with more passive options like electrical 
stimulation, ultrasound, and joint manipulation for chronic low back pain, exercise repeatedly produces superior long-term outcomes. If a ‘miracle cure’ did exist, IT WOULD BE EXERCISE! Think of how you feel after a Pilates or yoga class or after a fitness session in the gym – you feel stronger, more aligned, and, even if you’re a little fatigued, more energized. Exercise is widely known for being able to activate our muscles and nervous system, improve strength, and help to restore the body – both in our daily lives and in our recovery from injury. Beyond the visible benefits, exercise also triggers a rush of endorphins, the chemicals in our body that help us to feel good and decrease our sensations of pain. Exercise effectively takes the pain away! It’s no wonder that exercise has become the gold standard in rehabilitation modalities.
Exercise is the gold standard in pain relief, however, during the initial stages of rehab, passive modalities such as manual therapy, are valuable treatments to help activate pain relief and restore alignment. While these modalities may offer immediate benefit, it is rarely long-lasting. Thus, once the body is “put back together” you must work to keep it there. That’s when things get physical!
With any injury, whether it is a joint dysfunction, muscle strain, ligament sprain, or broken bone, the surrounding muscles spasm to protect the area from further damage. After addressing any dysfunctions and breaking the pain-spasm cycle, we must teach the overactive muscles to ‘turn off’ and the proper musculature to ‘turn on’ to enable us to move optimally – comparable to hitting the “reset” button. The first step in this process is to establish stability. Stability is the ability of the musculature and connective tissues to control joint position, which is especially important in a dynamic sport such as tennis. The only way to establish stability is muscle activation through EXERCISE!
The muscles of the body can be categorized into small stabilizing muscles, referred to as the “local” muscles, and the bigger, more powerful muscles, as “global” musculature. While we need to train both local and global muscles, it is essential that the early stages of rehab focus upon activation of the stabilizing musculature. These stabilizing muscles can be compared to endurance runners, constantly working to maintain proper alignment of the body. Without stabilizers, the body will over-recruit the large (“global”) power muscles, which will produce greater force through the injured area, and can cause rehab to fail or re-injury to occur. For example, in low back joint pain or dysfunction: without activation of the small stabilizer muscles of the spine to align each individual vertebra, the large power muscles, such as the obliques, will generate large amounts of torque through each vertebral joint. With every tennis stroke, this force will accumulate, eventually resulting in breakdown and injury. Therefore, activation and stability exercises should form the foundation of any treatment protocol. As you improve and are able to build upon this foundation, stability work should continue as part of an injury-prevention maintenance program that is carried out indefinitely.
Before you can transition to a maintenance program, there are a few more steps to take. The first step is to focus rehab towards re-programming functional movement patterns and building strength. Following injury, the surrounding musculature becomes inhibited, leading to dysfunctional activation and subsequently altered movement patterns. For example, think about hitting a serve following a 
hamstring strain. Initially, the timing and coordination of serve mechanics may be altered, even though the strength of the hamstring has been restored to normal. If the hamstring muscle does not turn on and off at the correct time and/or in the proper sequence, the body, particularly the hamstring, will once again be under undue load. Therefore, it is essential to re-train functional movement patterns, not just strength. Rehab of these patterns helps to improve the ease and efficiency of sport-specific movements while also facilitating proper neuromuscular activation. Through rehab, the body can re-learn activation and sequencing, firing the proper muscles at the right time and in the right order – establishing effective and efficient movement, while providing protection from future injury. And as a bonus, simply improving the neuromuscular activation can help to improve strength, without the need to lift heavy weights too early in the recovery process. Studies have shown that when starting an exercise program, many of the strength gains over the first 4-6 weeks are simply due to neuromuscular adaptations! No other modality can boast the same results!
At this point in the rehab process, you will be feeling pretty good – potentially pain-free! Just because the pain has subsided, doesn’t mean rehab is complete. Once the foundational layer has been established, the pain has decreased, and the movement patterns have improved, it is now time to work on the function to refine and strengthen sport-specific patterns along with the associated musculature. True strengthening, of both the injured area as well as the entire kinetic chain, is essential when returning from any injury, even more so when returning to a professional sport! Targeted strengthening allows us to maximize gains in the regions of the body that need them the most and adds another layer of protection against future injury – an essential component of any rehab program! Engaging the entire kinetic chain and training the links within and between each segment focuses on the strength and stability of the body as a whole. Training the entire kinetic chain during the rehab process helps to ensure that the correct muscles are activating at the correct times – after all, tennis is a full-body sport that relies on precisely timed execution from all parts of the body! Achieving the fundamentals is critical to Performance Health. When this component of the rehab process is ignored, not correctly implemented, or rushed, the risk of re-injury is enormously higher.
The body has an amazing ability to heal itself. That’s exactly why exercise is such a powerful tool. Not only does the act of exercise provide pain relief, but through a targeted rehab program, the body can build itself up stronger and protect against further injury. See a Physical Therapist to get started on your program today!
The information provided within this Physically Speaking topic is for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice. If you have my health or related questions or concerns, please consult your physician or other qualified health care.
A special thanks to the author, WTA PHCP, Lindsey Elizondo, DPT, ATC, LMT, CSCS
