The Importance of Rehabilitation – Conversation with Sports Physiotherapist Gréta Hepp

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

Gréta Hepp (GH): 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 professional practice there. I know a few Italian sports rehabilitation professionals and I could say that conditions there are different. Why did you come back? What did you bring with you? What can you put to use here at home?

GH: In Italy, prevention and rehabilitation play a huge role for athletes. Teams have multiple movement therapists and physiotherapists who work together with coaches. In addition, there are sports rehabilitation centers in the country where professional, safe, and as-fast-as-possible rehabilitation can begin immediately after musculoskeletal surgeries. Time matters for athletes: the longer they are out of training, the more their muscles deteriorate.

At home, early rehabilitation is often missing; athletes might receive one or two exercises in the hospital. In most cases, physiotherapy starts after the stitches are removed. Athletes come to me 3–6 months later with problems like insufficient muscle strength, lack of muscle development, persistent pain, or fear of starting to run again. Of course you can still help in these cases, but it would be better if they sought help as early as possible.

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

GH: Since professionals make a living from sport, a high-quality, comprehensive, and as-quick-as-possible recovery is extremely important to them. This can only be achieved with active rehabilitation and never with strict bed rest. Rehabilitation can and should be done even if one leg is in a cast! That is what modern medical devices are for. For example, we can reduce the thinning of inactive muscles and the adhesions of connective tissue structures. This way we gain a lot of time for later stages.

Amateur athletes are not under the same financial pressure, but time out still causes them a serious “loss.” An amateur cannot dedicate enough time to training, so their development is slower. If they miss weeks due to an injury, an entire season might be wasted for them. 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 have to go back to work with pain and limited movement, they will not be able to perform their duties. In short, it matters to everyone how the recovery process goes.

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

GH: Yes. In movement rehabilitation, muscle stimulators can be used very effectively; I use them most often. I first encountered the technique in Italy, and we conducted a lot of research with the device on cruciate ligament injury rehabilitation. I even went through the training program myself! Four years earlier I had anterior cruciate ligament (ACL) surgery and I was curious whether, after so many years, it could still improve my operated leg. It worked very well for me and our research results were excellent!

I most often use the stimulator when the operated limb cannot yet be moved but the muscles still need stimulation. I also frequently use it at higher intensities during active exercises when a muscle's strength lags behind the others.

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

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

Anyone who runs or cycles 3–4 hours a day, or trains intensively, places a heavy load on their joints and ligaments. If the body is not properly prepared, joint instabilities or connective tissue overloads often develop. Chronic problems of the Achilles tendon, plantar fascia, knee, and hip joints are very common.

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

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

GH: Athletes mostly come to me with knee and ankle problems. It is common for them to 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 essential! I will treat a runner completely differently than a handball player.

ZZs: What was your toughest case?

GH: I consider a difficult case to be someone who does not want to cooperate with me. I had an athlete who was forced to come. Unfortunately we could not progress because they did not do their home exercises, or not as often as required. After a few sessions I saw no point in continuing, as it was not good for either party.

ZZs: What are you proud of?

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

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

ZZs: I wish you successful rehabilitation work!

GH: Thank you very much!