Power Development & Restoration in Rehabilitation

Understanding how exercise selection and execution affects joint and muscle loading is critical in performance and rehab training, particularly when looking to develop or restore power. Let’s take a look into how we can manipulate some traditional power development methods to restore power during the different phases of rehabilitation.

Restoring power around a recently injured or operated site can be tricky, which is why I like to use the following type of contrast work once the joint is capable of handling some load but may not be ready for the impacts of sprinting or plyometrics to restore power yet. 

When choosing power restoration or development exercises in a re-loading phase we want to start to integrate the injured tissue/joint back into some power work but still not put it in a painful or vulnerable position. I have found the below power circuit/contrast method to be highly effective in this phase where we are looking to develop power in the healthy surrounding areas while protecting vulnerable structures from too much stress. For example we can see that something like a Russian Kettlebell Swing allows us to develop predominantly hip peak power/speed-strength whilst still not placing the ankle under any stress that could potentially regress the rehabilitation.

• Rate of force development isometric e.g.

  • Knee injury - Overcoming hip iso: 2sec build 4sec push @90%

  • Ankle injury - Overcoming single leg deadlift iso: 5sec @95%

• Peak power or speed-strength exercise w/ concentric bias e.g.

  • Knee injury - Hang pull from blocks x3 @light-mod

  • Ankle injury - Russian kettlebell swing x6 @mod-heavy

• High velocity/oscillatory e.g.

  • Ankle injury - Supine straight leg tantrums x6sec

  • Shoulder Injury - Rear delt bottom position neutral oscillatory x6sec

Once the injured site has undergone sufficient healing we can transition into a re-loading phase where our methods might start to integrate or blend exercises that target both healthy & healing tissues together to restore power to the affected area. Here is an example of an athlete returning from a knee arthroscope where during the protection phase deep knee flexion was contraindicated:

Protection Phase

• Overcoming hip iso x2sec build 4sec push @90%

• High hang muscle clean x3 @light-mod

• Supine straight leg tantrums x6sec

Re-Loading Phase

• Overcoming hip iso x5sec @100%

• Power clean from blocks x2 @mod-heavy

• Prone bent knee tantrums x6sec

Example of athlete returning from Latarjet shoulder surgery:

• Overcoming prone single arm row x2sec build 3sec go @90-95%

• Sled power pull x3 @light-mod

• Single arm bent over row oscillatory x6secs

Once again we are carefully selecting exercises that do not place the injured site in vulnerable positions but at the same time slowly expose it to the velocities and forces it needs to bridge the gap between the gym and game speed by allowing it to play a small role and be supported in these movements by more dominant structures. The prone bent knee hamstring tantrums in the prior example highlight this method, which involves slowly progressing the distal hamstring/healing patella-femoral joint in the rehabilitation via the following continuum*:

• Isometric

• Slow concentric/eccentric

• Slow eccentric

• Dis-advantaged low load high velocity

• Low load high velocity (neither advantaged or disadvantaged)

• Advantaged low load high velocity

*Yes, each line or tree branch would expand a lot and can be different for different injuries and different people, this is just a way to visualise a thought process.

Now there's obviously a lot of other shit going on around the distal hamstring work! However this thought process is not only to ensure our training facilitates a restoration of power amongst the other work being done in the rehabilitation program, but also allows for constant screening of the athlete during their recovery as we are more likely to find small or large discrepancies in confidence, strength and power throughout this continuum than we are in traditional testing such as a countermovement jump or isometric mid thigh pull. Athletes are master compensators and will find a way to cheat these traditional tests in order to pass your rehab test so they can play, whereas there is no cheating high velocity or oscillatory movements in vulnerable positions making them great natural screening tools: “training is testing”.

Now if you've made it this far and you’re questioning why even bother with power restoration or development during early phase rehabilitation I applaud you - critical thinking is *ahem* critical especially in rehab so if you work in a small clinic or are time poor with athletes I’d spend your time elsewhere. However if we’re talking about returning athletes that are willing to dedicate time to their rehabilitation 2-3 sessions a week and come back to sport in better condition than they were, then restoring power early on is critical for the following reasons:

• Teaching the restored or newly built tissue (via your structural hypertrophy training in early rehab) how to sequence, pattern and fire quickly will lead to shutting off the alarm systems around re-training movement quicker and also lead to being able to reintegrate and maximise your return to traditional power training in the next phase

• Shutting off the aforementioned alarm systems earlier that have been put up to protect the injured site and restrict potentially dangerous movements will allow for more significant reductions in awareness and pain (in most cases), and a huge increase in the athlete’s confidence in both their injured site and about the rehab process in general

• We can achieve improvements in power in the healthy tissues and later on the injured tissues by affecting things like rate coding, co-contraction speed, early rate of force development leading to performance gains once the athlete is back in business and ideally have them come out of rehab a better athlete

Finally, I think making sure an athlete can move fast again plays a massive role in restoring an athlete's confidence in their body during rehabilitation. This is a reason I place a premium on pushing the boundaries with this stuff in the mid-late phases of rehabilitation as the confidence in the gym can bleed onto the court/field and allow them to move more freely when it comes to their return to sport training and on field rehabilitation. Athlete's are smart creatures and the more conservative one's especially need to know their body will grant them access to specific ranges, velocities etc. before they begin to explore what their body is now capable of, so in my experience this type of athlete benefits from this work the most.

Speaking of confidence restoration and trust in one's body, it's a topic definitely not spoken about enough as a major factor in rehabilitation and funnily enough is probably up there with the most critical - maybe I should write another blog…