Strength Training: the Key to

Long-Term Injury Recovery?

Sarah Wilcox - 19 January 2025

When it comes to recovering from injury, the process doesn’t end once the pain subsides. Achieving long-term recovery and regaining optimal function often require more than rest or basic physiotherapy. Understanding the process of healing can help you put into context what your body is trying to do and can help manage your frustrations when trying to get back to the activities you want to. Strength and conditioning (S&C) play a pivotal role in supporting tissue healing and promoting functional recovery, ensuring you can return to your activities stronger and more resilient than before. Here’s why strength training is a cornerstone of effective rehabilitation.

SO WHAT HAPPENS WHEN WE HEAL?

Tissue healing is a complex process that occurs in three primary stages: inflammation, proliferation, and remodelling. What happens during these phases?

1. Inflammation (0-7 days): The body initiates the healing process by clearing damaged cells and preparing the area for repair.

2. Proliferation (4-21 days): New tissue begins to form, including collagen production in tendons and ligaments.

3. Remodelling (21+ days): The newly formed tissue is strengthened and organised to restore its functional capacity.

Strength training, when introduced appropriately during the later stages of healing, aligns the fibres of tendons, ligaments, and muscles in response to the mechanical loads applied. This alignment improves tissue resilience and manages the risk of re-injury (O’Sullivan et al., 2017).

STRENGTH TRAINING SUPPORTS RECOVERY!

1. Stimulates Collagen Production. Collagen, the primary structural protein in tendons and ligaments, is vital for their strength and elasticity. Resistance exercises encourage collagen synthesis and promote the alignment of fibres along the lines of stress. This process not only enhances the tensile strength of the healing tissue but also prepares it to withstand the demands of your daily activities and sport (Morrissey et al., 2013).

2. Facilitates Bone Healing. When recovering from a bone fracture, strength training plays a significant role in the remodeling phase of healing. Weight-bearing and resistance exercises stimulate osteoblast (bone-forming cells) activity, promoting bone mineral density and the formation of new bone tissue. For example, progressive loading through controlled movements such as squats or step-ups can improve the structural integrity of the healing bone while preventing bone loss in adjacent areas (Turner & Robling, 2013). Importantly, the intensity and type of exercise should be carefully prescribed to avoid overstressing the healing site.

3. Improves Muscle Strength and Balance. Injuries often lead to muscular atrophy and imbalances due to reduced activity. Strength training helps rebuild muscle mass and restore symmetry, ensuring the injured area is adequately supported. For example, targeted strengthening of the quadriceps and hamstrings post-ACL reconstruction can prevent compensatory movement patterns and improve knee stability (Buckthorpe et al., 2019). 

4. Enhances Neuromuscular Control. Injury disrupts the communication between the nervous system and muscles, leading to impaired coordination and control. Incorporating functional strength exercises, such as single-leg squats or step-downs, can retrain neuromuscular pathways and improve proprioception, helps to manage the likelihood of future injuries (Gokeler et al., 2013).

5. Supports Gradual Return to Load. Progressive overload—gradually increasing the intensity and volume of exercises—is a fundamental principle of strength training. This approach allows the injured tissue to adapt to increasing demands safely and in a timely manner, bridging the gap between passive rehabilitation and the demands of sport or physical activity (Heinemeier & Kjaer, 2011) thus ensuring you have the capacity to undertake your desired activities again.

6. Promotes Psychological Confidence. Injuries often affect not just the body but also the mind, causing fear of movement or reinjury. Strength training empowers you by building physical competence and confidence, which are critical for successful return to activity (Podlog et al., 2010).

HOW I DESIGN A STRENGTH AND CONDITIONING PROGRAM FOR RECOVERY.

An effective rehabilitation-focused S&C program should be individualised and progressive. Key considerations I use are:

1. Stage of Healing: Match exercises to your current phase of recovery to avoid overloading the tissue prematurely.

2. Exercise Selection: Focus on compound movements that mimic functional tasks, complemented by isolation exercises to target specific weaknesses.  

3. Load Management: Monitor intensity, volume, and frequency to ensure progressive overload without exceeding the tissue’s capacity.

4. Integration of Plyometrics: Once sufficient strength is restored, plyometric exercises (e.g., jump training) can be added to enhance power and elasticity – if your goals necessitate it.

STRENGTH TRAINING BEYOND RECOVERY. The benefits of strength training extend far beyond injury recovery. Regular resistance training improves bone density, joint health, and overall athletic performance. It also manages the risk of future injuries by enhancing the body’s capacity to absorb and distribute force efficiently.

AND FINALLY. Strength training is not just a tool for athletes; it is a fundamental component of long-term injury recovery for anyone looking to regain function and prevent future setbacks. By promoting tissue resilience, restoring muscle balance, and building psychological confidence, S&C bridges the gap between rehabilitation and peak performance.

References:

• O’Sullivan, K., McAuliffe, S., & Deburca, N. (2017). The effects of eccentric training on lower limb flexibility: A systematic review. British Journal of Sports Medicine, 51(5), 36–44.

• Morrissey, D., Roskilly, A., & Morrissey, M. C. (2013). Mechanotherapy: How physical therapists can influence tissue repair. British Journal of Sports Medicine, 47(9), 529–536.

• Turner, C. H., & Robling, A. G. (2013). Mechanical loading and bone formation. BoneKEy Reports, 2, Article 255.

• Buckthorpe, M., Wright, S., & Parekh, B. (2019). Rehabilitation following anterior cruciate ligament reconstruction: A systematic review of current literature. Sports Medicine, 49(4), 645–662.

• Gokeler, A., Benjaminse, A., Hewett, T. E., et al. (2013). Feedback techniques to target functional deficits following anterior cruciate ligament reconstruction: A review of literature and clinical application. Physiotherapy in Sport, 14(2), 88–96.

• Heinemeier, K. M., & Kjaer, M. (2011). In vivo investigation of tendon responses to mechanical loading. Journal of Musculoskeletal and Neuronal Interactions, 11(2), 115–123.

• Podlog, L., Dimmock, J., & Miller, J. (2010). Anxiety and return to sport following injury: The role of self-determination. Psychology of Sport and Exercise, 12(6), 646–652.

Disclaimer:
The content on this blog is for informational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always consult your physician or a qualified healthcare provider if you have concerns about your health or specific medical conditions.