Review written by Dr Teddy Willsey info


In recent years physical preparation, strength and conditioning, and sports medicine have made tremendous progress in terms of scope and complexity. While the former two fields of preparation and performance development embrace the concepts of periodization and long-term planning, the rehabilitation field has been slower to incorporate big picture planning, sport specific preparation, and consideration of the entire athlete.

The purpose of this article was to review periodization within the context of rehabilitation and preparing athletes for return to play. The article concludes by using case studies to show how a periodization model can be applied to individual rehabilitation cases. This article aims to increase the average clinicians' understanding of how they can consider periodization and training variables within their rehabilitation and return to sport planning.


General Adaptation Syndrome

The article begins by introducing and defining general adaptation syndrome, (GAS) a theory pioneered by Hans Selye. As this model relates to sport physical therapy, therapeutic doses of stress are introduced and applied to tissue as it progresses through specific periods of rehabilitation in the return to sport model. The body's ability to respond to each stressor depends on its current recovery capacity.

The GAS syndrome governs all physical adaptation. An ideal stress level must be met for positive adaptations. For example, if a hamstring injury rests and pain diminishes, this does not mean it is ready for return to sport. If the hamstring is not sufficiently re-strengthened and exposed to high speed running, it will likely re-injure. Clinically, an "easy" or risk averse rehabilitation protocol can end up doing greater harm by not preparing the athlete or injury for the inevitable demands of their sport.


Periodization represents the splitting of the annual training calendar into more manageable segments. In a rehabilitation setting, periodization can signify the movement of one stage to the next. While many rehabilitation professionals may use protocols, they are not typically considering the reconditioning and return to sport form of the entire organism. Furthermore, the final goal of rehabilitation is typically joint specific recovery rather than return to sport, oftentimes leaving a fairly wide gap between discharge and return to full performance.


Physical therapy paid for by insurance and third party payers typically follows rules of only treating the injured body part and strictly defining "medical necessity." A short-sighted and local only viewpoint of physical rehabilitation and recovery can limit overall adaptation and function for higher level patients. For example, a high-level athlete with an ACL injury should do everything within their power to maintain aerobic capacity and power during the entire rehab process. The secondary physiological concerns of rehabilitation for athletes is often ignored to their own detriment.

Athletes are put at a greater risk of reinjury with increased levels of fatigue secondary to preventable deconditioning. While it is known that maintaining fitness of the entire body is important, many outpatient facilities are not equipped to provide this for their patients. There must be a cultural shift in sports performance specific rehabilitation in order to bridge this gap. Instead of allowing therapeutic exercise and the passage of time to heal an area, a disproportionate emphasis is often placed on pain relieving modalities, immediate treatment effects, and passive modalities rather than on maintaining physical readiness.



For the clinical application section I will use the ACL case study cited in this paper and frame the rehabilitation protocol within periodization principles. The first phase or mesocycle of rehabilitation is known as general physical preparation (GPP) and broken

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