The Importance of Rehabilitation – Conversation with Gréta Hepp, Sports Physiotherapist

Dr. Zátrok Zsolt (ZZs): What is your official qualification? What do you do?

Hepp Gréta (HG): According to my Italian diploma I am officially a sports physiotherapist; in Hungary this is accepted as a rehabilitation specialist or movement therapist.

ZZs: You studied in Italy and also gained your practical experience there. I know a few Italian sports rehabilitation professionals and I can say the conditions abroad are different. Why did you return home? What did you bring with you? What can you use here?

HG: In Italy prevention and rehabilitation play a huge role for athletes. Teams have several movement therapists and physiotherapists who work together with coaches. There are also sports rehabilitation centers where after musculoskeletal surgery a professional, safe, and as-quick-as-possible rehabilitation can begin immediately. Time matters for athletes: the longer they are out of training, the more their muscles deteriorate.

At home, early rehabilitation is often lacking; athletes may receive one or two exercises at the hospital. In most cases physiotherapy only begins after suture removal. Athletes come to me 3–6 months later with problems such as insufficient muscle strength, lack of muscle development, pain, or fear of starting to run again. Of course we can still help in these cases, but it would be better if they sought help as early as possible.

ZZs: Movement rehabilitation concerns both amateur and professional athletes, but not only them. What kind of help can people get from you?

HG: Since professionals earn their living from sport, a high-quality, comprehensive, and speedy recovery is extremely important to them. This can only be achieved through active rehabilitation and certainly not by strict bed rest. Rehabilitation can — and should — be started even if one leg is in a cast! This is where modern medical technology devices come in. For example, we can reduce the thinning of inactive muscles and the adhesions of connective tissue structures. This way we can gain a lot of time later on.

Amateur athletes are not under the same financial pressure, but their absence causes serious "losses" too. An amateur cannot spend as much time training, so their progress is slower. If they miss weeks because of an injury, a whole season can be lost. Speeding up recovery reduces that "loss."

For the average person it also matters when they can return to work. If rehabilitation is inadequate and they must go back to work with pain and restricted movement, they will not be able to perform their duties. So nobody can be indifferent to how the recovery process goes.

ZZs: Many devices help rehabilitation. Do you have such equipment? Which is your favourite and why?

HG: Yes. In movement rehabilitation muscle stimulators can be used very effectively, and these are the devices I use most often. I first learned the technique in Italy; we conducted a lot of research with the device on cruciate ligament injury rehabilitation. I even completed the training program myself! Four years before that I had an anterior cruciate ligament operation, and I was curious whether after so many years the device could still improve my operated leg. It worked very well for me, and our research results were also very good!

I most often use the stimulator when, after surgery, the limb cannot yet be moved, but the muscles still need stimuli. I frequently use it at higher intensity during active exercises as well, when a muscle's strength lags behind the others.

ZZs: Many athletes suffer from chronic pain and seem to think it's a natural consequence of hard training. Do you encounter such cases?

HG: Of course, there are many such cases! The most common cause is inappropriate loading or poorly structured training. Often athletes are not aware of their limits and do not receive feedback about dysfunctions (poorly performed movements). Chronic pain can develop from this later on.

Anyone who runs, cycles, or trains 3–4 hours a day puts great strain on their joints and ligaments. If the body is not properly prepared, joint instabilities or connective tissue overloads often develop. Chronic pain in the Achilles tendon, plantar fascia, knee and hip joints is very common.

These conditions could be prevented if we emphasized prevention: assessment, individualized training plans based on that assessment, addressing deficits, and proper recovery. If someone wants to be time-efficient, they can choose to use muscle stimulation devices, as they also make warm-up and recovery more effective!

ZZs: What are the most common complaints people come to you with?

HG: Athletes mostly come to me with knee and ankle problems. Many arrive with chronic pain, and many ask for help to return to training as quickly and safely as possible after surgery. In such cases sports-specific exercises are indispensable! I will treat a runner completely differently than a handball player.

ZZs: What was your most difficult case?

HG: I find it difficult when a patient does not want to cooperate. I had an athlete who was forced to come. Unfortunately we couldn’t make progress because they didn’t do their home exercises or didn’t do them as often as required. After a few sessions I saw no point in continuing together, since that’s not good for either side.

ZZs: What are you proud of?

HG: I am most proud that many of my athletes (mainly footballers, handball players, volleyball players) became more successful in their sport after rehabilitation than they were before!

ZZs: How can people contact you? Via Facebook: Hepp Gréta under the name pre- and rehabilitation coach.

ZZs: I wish you successful rehabilitation work!

HG: Thank you very much!