The Importance of the Rehabilitation Pathway
Blackburn’s Blog Take 3
Welcome back to my blog, so far, we have journeyed through ‘The Past, the Present and the Future’ and Blackburn’s Quiz and for my third blog, I hope to take you through a far more personal journey highlighting the importance of ‘Injury Rehabilitation’.
Since a young age, I have always been active, so it was of no surprise to my family and friends when I joined the Forces. Since the age of 20, I have been actively engaging in operations, exercises, conducting training and participating in sport and a broad range of outdoor activities which include canoeing/kayaking, mountaineering, mountain biking, skiing and rock climbing. I have been extremely fortunate to have been given so many fantastic opportunities, I mean who doesn’t like getting paid for climbing a mountain, skiing down slopes and working alongside such a wonderful group of men and woman.
But In 2018, and dare I say during a warm-up routine I was taken by surprise when I experienced a popping sensation in my left hamstring; immediately this led to two things, firstly a re-enactment of an overinflated football player diving to the ground and secondly an attempt to crawl unnoticed to the changing rooms before the ‘Banter’ had set in.
My initial diagnostic was, ‘well that was unpleasant’ and I decided to rest the affected area and give it time to recover but a few weeks later and I was still suffering from an acute pain. I had hoped that the rest would have allowed the affected area to settle but when there was no change, I then decided to consult a physio whose initial diagnostic and rightly so was a torn hamstring. Great I thought, ‘6 weeks and I will be back to business’, but when 8-10 weeks had passed and still pain was noticeable, I became a little dubious to what was going on but true ‘squaddie style’ I decided to persist through - I just presumed that I must take longer to heal.
Eventually I was reassigned to my new job and as 2019 passed the whole experience became a blur, except every time that I broke into the smallest sweat, I was getting a dull pain from my heal to my glute (my bum). This was definitely not normal and after a little toing and froing I decided to get it medically checked. After attending several medical appointments, I was diagnosed with a partial ruptured hamstring ligament, in the doctors terms ‘your ligament is waving back at you and the rest has congealed into a spiders web’.
I was referred to the Institute of Sport and Exercise Health in London and explained that I can carry on enjoying what I do but tailored to a level which doesn’t evoke pain, or there is an option of having the ligament surgical reattached. The success rate of the hamstring functioning normally was not guaranteed but they felt that the operation would not regress the affected area. With alot to digest and the Atlantic on the horizon (excuse the pun), I decided to lean into my friends for advice. Do I persist with the pain noting I still enjoy my job as a RAPTC Instructor, or do I grab the bull by the horns…. Well, I think the next photo says it all.
I mean ‘come on’ who puts an arrow on the injured leg, if I wasn’t already worried, I was now. But 3 hours later and after plenty of TLC by a wonderful team of surgeons, doctors and nurses from the University College Hospital, London, I was recovering well with the most delicious ‘ham sandwich’.
During the whole do I, don’t I scenario, I made it abundantly clear to myself that should I choose to go ahead with the procedure, I would fully immerse myself into the rehabilitation pathway. This was very important to me; I was very conscious of the efforts provided by the NHS and the Army medical chain and I was very mindful of the opportunities at hand. My body has always supported me well throughout my endeavours and it was time to give back.
Protection and Offloading
Between Sep - Nov 20 I gave myself adequate protection and offloading, all which are vital for a few reasons. Firstly, it protects the affected area from experiencing anymore damage. Secondly, protection not only avoids your injury from getting worse, but it also promotes an internal environment to support healing. The support received by the army and my home unit, 3 RSME was outstanding. I was strictly informed to offload for 4 weeks at home (shame) and on my return I was embedded into a structured physio programme provided by the Military Primary Care Rehabilitation Facility (PCRF).
Protected Reloading and Reconditioning
After completing the initial phase of management, it was time to apply some strain to the affected area. Carefully managed loading of the affected area was slowly applied to support recovery but also help in improve the resilience of the repair.
I was extremely focused at preventing a reappearance of the injury and more importantly I wanted to make the affected area more robust. I was acutely aware that over the years I had both overused and applied a low level of maintenance to both my hamstring and glutes. As I edged through the months of Dec – Feb 21, I learnt how to remain disciplined and focused. With the guidance and advice from the Physio I was able to successfully complete a gradual bank of exercises ranging from 60-90 minutes.
Sport Specific Strength, Conditioning and Skills
Neary 7 months post operations and I was starting to see the fruits of my labour and by eck was I super excited to be moving onto the next phase. My injury had settled, and I had now transitioned from the Physio to the Exercise Rehabilitation instructor (ERI). On my first session I purposely told myself not to ask too many crazy questions, i.e when will I be deadlifting, when will I be rowing, phrases that no doubt are notoriously annoying to an ERI, I know they annoyed my Physio:
Me - ‘So, Mr Physio when can I sit on a rower’,
Physio - Not yet!!!,
Me - In maybe a month then???
Physio - No comment
Truth to be told, I already knew the answer and I already knew how important it was not to rush and truth be told I was a little nervous about jumping on a rower - I mean come on, it’s all lower limb right. However with the help of the ERI, I was now embracing simple weight loading exercises and with my strength and range of movement increasing weekly I was on track to implementing playing loads.
Return to Sport
Mar 21 onwards – Even with maintaining a physical and mental presence and communicating well throughout the rehabilitation phases returning to sport should be a smooth process and even with the absolute best of athletes you should always be eased back into playing loads. For me this has meant simply sitting on a rower and increasing the time by 2 minutes until I reach 30 minutes, it doesn’t seem like a lot and it isn’t in comparison to rowing the Atlantic but this short term rowing target has allowed me to fully embrace and enjoy the sessions without overloading too quickly in a short space of time.
With my first 30 minutes completed and with no signs of discomfort of the affected area, I felt a lot more positive. With my second target in reach combined with a sturdy prehab programme and plenty of rest, I was confident that the foundations had been set to complete my first 10 km row. So, on the 16 Mar, I set down my water, uploaded a little bit of Pitbull (don’t ask) and after tightening off the straps I started rowing. And now with a 10km row comfortably under my belt I feel more confident at implementing a program that has longevity, is fit for purpose, prevents further injury and allows me to comfortably sit on a rower for long periods of time.
Realistic Training: Completing a Morning Routine
Injury Prevention
The final and often overlooked phase of management is the prevention of reinjury/injury. Identifying and managing risk factors to mitigate Injury prevention is essential to reaching the end goal. The following are basic steps I have embedded into the overarching program:
· A varied fitness program
· Plenty of strength and conditioning training
· Staying hydrated
· Flexibility and Mobility
· Using the right equipment
· Rest
· Good nutrition
· Know when to stop
· Learn the right technique
Conclusion
Effective rehabilitation has allowed me to expedite my return to training safely. Promoting the recovery pathway has been key throughout and without the fantastic team that is the medical chain, friends and family I would not be sat on a rower, listening to a little bit of Pitbull, preparing to sip Pina Colada on Antigua’s beach 😉.
Thankyou to the team for their patience and reassurance, the Army and NHS Medical Chain, 3 Royal School of Military Engineering, my friends and of course my mum who travelled 4 hrs to pull up my knickers, look after spud and mow my lawn.
By Victoria Blackburn, Force Atlantic Future Plans Lead.