Alex Rehder: Physical Therapy and High Performance in Swimming

The Evolution of Physical Therapy: From Rest to Movement

Alex Rehder highlights the paradigm shift in sports physical therapy, which has moved away from the idea of absolute rest as the sole solution for injuries. He criticizes the excessive reliance on exams like magnetic resonance imaging, which often reveal common "findings" in athletes without necessarily being the cause of pain. Kinesiophobia, the fear of movement due to pain, is a major enemy of recovery.

Currently, the approach focuses on movement and appropriate load for recovery, especially for tendons, which require stimulation to improve. The famous "ice bath," for example, has had its effectiveness questioned by recent studies. Communication between the physical therapist and the coach is crucial to adjust training and ensure efficient recovery aligned with the athlete's goals.

Injury Prevention for Open Water Swimmers

For high-volume swimmers, especially open water swimmers, Alex Rehder offers fundamental recommendations for injury prevention:

• Holistic Health: Prioritize quality sleep, stress management, good nutrition, and a balanced social environment. These are pillars of "quality of life medicine" and directly impact the body's ability to recover and perform.
• Postural Compensation: Many athletes, especially amateurs, spend hours in flexion (work, phone). Open water swimming requires long periods in extension. It is vital to perform exercises that compensate for this flexion, promoting mobility and strength in various directions.
• Specific Strengthening: Focus on strengthening the core (especially obliques), external rotation exercises for the shoulder, and glute work. An effective stroke begins in the torso, not just the arms.
• Cervical Mobility: Incorporating exercises that promote cervical mobility, such as those from water polo or breaststroke, is essential.
• Qualified Professional: Seek a physical therapist who understands the specific sport and communicates openly with the coach, ensuring treatment aligned with the athlete's goals.

Dealing with Pain and Gradual Return

When experiencing pain, Alex's recommendation is not to stop completely, but rather to reduce the load, whether by decreasing volume, intensity, or adapting training (e.g., removing paddles, focusing on sculling or kicking). The goal is to keep the athlete active and moving. Patience is fundamental for the return, which should be gradual and monitored by a team. The myth of "no pain, no gain" is refuted; health is the foundation for sustainable performance.

Alex cites examples of athletes who overcame injuries at crucial moments, such as Poliana Okimoto's intercostal injury before the Rio 2016 Olympics and Ana Marcela Cunha's shoulder pain due to her wetsuit, demonstrating that with the right approach, it's possible to compete and win even with physical challenges. The athlete's mindset often changes after an injury, leading to a greater focus on neglected aspects of training, such as leg kick or sculling, resulting in better long-term performance.

Alex Rehder concludes the episode with a valuable golden tip: "You can't perform if you don't have health." The relentless pursuit of results without attention to health leads to frustration and injuries. An intelligent approach, based on science and athlete well-being, is the path to a lasting and successful sports career, for both professionals and amateurs.