Prehab: Preventing Injuries Before It's Too Late

We have all heard the term REHAB (rehabilitation) as it applies to improving function or restoring someone’s physical health from injury or illness. And there is no doubt that physical rehab is a successful route to take after injury, surgery, or any illness that may have negatively affected your physical function.  

But what about PREHAB (prehabilitation)?? Not as many have heard about this because of the insane amount of gray area associated. Rehab is pretty well defined in a general sense.... You get hurt, then you do some combination of rehab techniques to get better.  Very simplified, but easy to understand. Prehab is a little more tricky; a lot of coaches or athletes would define it as a set of corrective exercises to improve muscle strength in “weak” areas, some may define it as just training smart to avoid injury, and others may say it’s about having a really thorough warm-up before a training session.  

From my personal experience I would say they are all right, but what they are missing is the importance of individualization as it applies to the athlete. So I will define prehab based on my own experiences working with Crossfit athletes, weightlifters, powerlifters, and the general population:

 

PREHAB is preventative/proactive approach to an athlete’s training that addresses individual body structure, body tone (stressors both physical and mental), training variables (volume, frequency, intensity), injury history, current movement competence, and current sport demands/goals while minimizing risk of injury.

 

Think of prehab not only as a supplement to training, but also inclusive to the form/positions performed within a training session. It takes into account EVERYTHING. The only way to stay proactive is to monitor how the training session is performed, understanding the athlete’s body type/where the most stress is placed, and providing helpful positions (or supplemental exercises) to minimize future injury risk while maximizing performance.

Why is prehab important for Crossfit Athletes?

Essentially when you think about it, prehab is really just proper training with a fundamental knowledge about correct form, anatomy, physiology, and fatigue; while providing correct supplemental techniques to support training volume, intensity, and frequency. Of course this is a simplification of a topic that is insanely complex, but, it makes sense. It is all about understanding where the “breakdown” may happen and either adjusting the form of the exercise and/or altering the training variables (volume, intensity, and frequency) while adding some healthy positional activity or tissue work to aid in recovery.

The goal as coaches, athletes, trainers, and physical therapists is to ALWAYS reduce the risk for injury and INCREASE performance capability.  With that in mind, the sport of CrossFit can be rough on the body, hence the need for a prehabilitative approach to training and recovery.  When training variables and supplemental activity is neglected, the risk for injuries increase drastically.

 

Do your Prehab! Don't be this guy......

(he didn't do his Prehab)

 

So let’s review…..  

Big Take Home Points for CrossFit Prehab:

1. Train Hard AND Smart
2. Understand where the athlete will “breakdown” based on injury history, training variables, and body structure
3. Add supplemental movements/positions and tissue work to ensure proper recovery.

Now let’s look at an example of how prehab fits into supplementing CrossFit

Case study (patient I am actively monitoring):

• 35 year-old, 175-pound male has been regularly performing CrossFit for about 10 years
• He is advanced in the sport and demonstrates competence with standard CrossFit movements
• He has been complaining of numbness and tingling in his right arm and into his hand
• He experiences episodes of forearm weakness and pain in the flexor region
• Presents with mild excessive extension in his lower back

**Although I am a Licensed Physical Therapist, the principles I have been using to treat this patient are no different than a sound prehab program. More importantly, if anyone does present to you with nerve-like pain and symptoms please refer out if you are not qualified to assess or treat them**

**Many details below have been abbreviated for the specificity of this article**

 

Here is what I assessed:

• Tissue quality around his shoulder girdle (pecs, lats, traps, biceps/triceps)
• “Unloaded” movement quality (moving arms overhead, bending forward/rotating side-to-side, ability to protract/retract, ability to flex his lower back and touch his toes)
• “More dynamic” movement quality (performing a push-up, row, pull up, front/back squat, hinge, lunge)

Here is what I found:

• Lack of ability to segmentally extend thoracic spine while reaching overhead which places excessive stress on his lower back
• Lack of full protraction/retraction of scapulae during push-ups
• Not going into a full overhead reach position in the bottom of a pull up (elbows were also not fully straight)
• Lacked an ability to flex/round his lower back and smoothly bend over

What I did to help him:

• Performed manual tissue work to both pecs, lats, and forearm flexors
• Used quadruped (hands and knees) breathing patterns emphasizing low back flexion with shoulder protraction to minimize the extension pattern he exhibited
• Stretched his forearm flexors to restore a baseline range of motion
• Incorporated push-up with full protraction and retraction on a neutral lumbar spine
• Re-educated him on full shoulder motion during rows and pull-up variations
• Educated him about how to monitor CrossFit frequency, volume, and intensity during this recovery period   

Results:

• 5 weeks later he has no pain or symptoms down his R arm into his hand
• His global movement during CrossFit has improved
• He is currently performing CrossFit at a high level again
• He has the basic tools necessary to compete on his own and not worry about lingering pain/symptoms

To summarize the above:

• Tissue work was performed
• Supplemental movement was added (in addition to his CrossFit training)
• Movement education was provided
• CrossFit frequency, volume, and intensity were reduced mildly

You may respond:

“Wasn’t this just rehab because you’re a PT and he was injured?”

Technically it was because my goal was to reduce his pain and return him to prior function. However, he continued to perform CrossFit throughout this process and I was essentially monitoring his progress throughout. What I performed and how I performed it is no different than if he had absolutely no pain at all. Prehab boils down to understanding the athlete and their sport demands while making necessary adjustments to form, training variables, and/or supplemental recovery techniques.

I hope you enjoyed this article and found it useful. If so please be sure to like our Element 26 Facebook Page and also join our community at The Athletic Weightlifter Facebook Group . I look forward to interacting with you soon!

For those of you with further questions, please feel free to leave a comment or send an email to me directly at support@element26.co.