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Some commonly-described rehab and prehab protocols aren't making you better, they're making you worse. Instead of restoring proper movement and strength, they lead to rigidity and reduced stability.

When you hear about rehab - and the newly-fashionable prehab, which you do before you train so you don't have to do rehab - you expect a set of exercises carefully designed to restore natural and effective movement to damaged or twinged joints.

Instead, all too often, you're getting poorly designed exercises designed to correct a problem that doesn't exist and creating a new one in the process.

Before we go any further, let me say that if you're seeing a doctor, physio/physical therapist, chiropractor or other professional and you're getting better, don't think I'm saying you're wrong. I'm not. Good advice is the best thing you can get. 

The first problem with rehabilitating the shoulder is that it's extremely complicated. The rehab process isn't necessarily complex but the joints of the shoulder are interrelated, fast-moving and highly mobile.

Too many times, people want a quick fix to a problem they accumulated slowly. One-idea rehab programs, as we'll see, do more harm than good. 

I want to look at two areas of rehab where what's on offer typically seems to underperform. 

We'll start with ankle rehab, and then look at shoulder rehab.

In each case, we'll try to figure out why recovery rates from these rehab protocols are so low.

Ankle rehab

Ankle rehab doesn't result in a 'fixed' ankle a lot of the time. If you've sprained your ankle once, there's a 70% to 80% chance you'll sprain it again. Every additional sprain contributes to the likelihood that there will be further additional sprains: it's called chronic ankle instability. There's a god chance you know someone who has it if you don't have it yourself, and if you ask them they'll probably talk about their ankle injury in terms like, 'it just went.'

The cause of the collapse - the reason your ankle 'just goes' - is usually ascribed to muscular weakness. The muscles that push the sole of your foot down towards the ground, called plantar flexion, are much stronger than those that pull your foot up towards your knee , called anterior flexion. Similarly, the muscles that turn your foot inwards, so the little toe is lower than the ball of your foot, are stronger than those that raise your little toe and push the ball of your foot downward. By far the most common ankle sprain injury follows that pattern - the little-toe edge of the foot is on the ground and the ankle turns over with the ball of the foot off the ground.

Add in the excessive movement caused by the tissue damage from the original sprain and the solution looks like: 

1. make the muscles in your ankle stronger, and

2. reduce the mobility of the ankle while it recovers.

So along with non-steroidal anti-inflammatory drugs, you'll typically be given a brace or support for your ankle, and a regime of exercises to strengthen the weak muscles that got you hurt.

Apart from the inadvisability of taking NSAIDs for soft tissue injuries, and leaving out the RICE/METH argument: the problem with this approach to rehabilitating ankles is that it doesn't focus on the actual cause of the injury.
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