When four-time skating national gold medal winner Luqman Shaikh hurt his adductor muscle during a coaching camp for the Roller Skating Asian Championship in 2010, he realised it could have been avoided. The injury was caused due to an overuse of the muscle rather than triggered by an accident on the rink. Shaikh had come into the camp on the back of national gold medals in three skating events: Road Race, Time Trial, and Rink Race. Once the assessment of his injury came out, Shaikh decided to seriously pursue physiotherapy as a profession. Shaikh, who now has a Masters in Sports & Exercise Science & Medicine, runs a clinic called Prehab 121 Physiotherapy & Academy in Pune and has worked with football clubs Glasgow Rangers (Scotland), FC Pune City (used to be a part of the Indian Super League), and with athletes who are part of JSW Sports.
“When I went to the UK to study, my outlook towards physiotherapy completely changed. Everything was based on scientific evidence, in line with the latest technology, and with assessment techniques I’d never thought of,” he says. But the thought that he could have avoided that groin injury in 2010 has stayed with him, prompting him to start focusing on injury prevention and prehabilitation.
The technical difference between prehab and rehab is that the former is an exercise routine which prepares people for impending surgery, while the latter is a post-injury or surgery routine to resume the functioning of the injured area. However, the definition of prehab now also includes a set of exercises to be done on a regular basis to avoid injury in one’s weaker muscles. These weak muscles are identified after assessments that, according to Shaikh, “help identify stability, mobility, and muscle imbalances. The tool has been designed to assess limitations in individuals.”
Shaikh regularly ties up with gyms, and I happened to meet him in Pune in 2018 to complain of knee issues, usually flare-ups of old injuries sustained while playing football. After an assessment, the workout I was given was mainly to strengthen my glutes, quadriceps, and hip flexors so that my knee would not be overloaded. Using mainly bands for mobility stretches, this retrained my knees to point slightly outward and in line with my ankles while performing exercises (this is the correct form). I continue to do these workouts regularly even today, and it helps me continue playing my favourite sport.
There are a few basic assessments you can perform at home if you’re worried about certain parts of your body getting sore more easily than others. “One of the most common issues which people have but ignore are weak glutes. If your glutes are weak, your leg starts internally rotating, because the muscle that helps your posture neutrality is not strong. Then the knee starts compensating for ailing glutes, and when that fails, it will pass the load to the feet and this will result in a functional flat foot. The lesson is that it was never an injury at first, but now is, because you avoided your glute strength.”
One assessment that all physiotherapists will put you through is the overhead squat. The video below highlights some important points about this assessment. “The overhead squat observes full coordinated mobility and core stability, with the hips and shoulders functioning in symmetrical positions,” says Shaikh.
Doing some glute strengthening even for 10 to 15 minutes a day can help one avoid lower body injuries, including chronic lower back pain. A 2015 study published in the Journal of Physical Therapy Science on the effects of gluteus muscle strengthening exercise says this:
“In exercise therapy programs for chronic low back pain patients, adding hip muscle strengthening exercise to lumbar segmental stabilization exercise will be very helpful for rehabilitation and maintenance of smooth daily life.”
It’s not like prehabilitation is new to India. With the rise of Indian leagues across various sports over the past decade, there has been a steady increase in the application of sports science to training. But it can be said that this is limited to an elite level. “A young swimmer was asked by his coach to do functional training one day. You would think that being a swimmer, he wouldn’t have a lot of issues. But you’d be mistaken. He developed patella tendonitis due to it. So we have to make sure injury prevention programmes are highlighted at younger ages,” says Shaikh.
He adds that the biggest hurdle specialists like him have to overcome is convincing coaches and parents of young athletes of the efficacy of prehab. “Sometimes we have to tell the coach that your athlete will get injured. This prediction part is what is hard to swallow. To put it simply, prehab for athletes is teaching them to move in a way to avoid injury. How to land, how to have a mind-body connection with ground forces, and how to be ready for match specific events.”
Think of prehab as injury insurance. The easiest way to accommodate your routine would be to make it part of your warm-up. And irrespective of whether you workout or not, here’s a quick at home glute-strengthening workout.