Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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I have spent the past 16 years helping athletes get back to their sport or desired activity following an injury. Whether dealing with muscle strains or ACL ruptures, every injured client shares the same goal of making a full recovery and getting back to their previous activity level. My purpose in writing a blog series on this topic is simply to share some pearls I have picked up along the way and to help others learn from my mistakes and successes.
Beyond the severity and nature of the injury itself, there are several considerations that play a significant role in the rehabilitation process including: the athlete’s emotions, goals, mental toughness, age, experience, previous medical history, relationships with parents/coaches/teammates, innate movement patterns, etc. I feel the first and perhaps most important step in the recovery process involves connecting with the athlete on an emotional level.
Injured clients want to know that their medical team (MD, PT, ATC and strength coach) really care about their well being, that they truly understand the impact of the injury on his/her life, and that they can provide the skilled care necessary to restore the body to its prior level of function. Too many times, we as health care professionals speak first espousing all our expertise and often forget to LISTEN enough. Our athletes want to feel special during this low point in their life.
Pearl #1 – Spend more time listening on the first meeting/visit to gain a thorough understanding of how the injured athlete “feels” and views their current injury. I spend the majority of my eval time interviewing the client to allow them to describe their physical symptoms, but more importantly fully elaborate on their goals, perceptions and thought processes surrounding the rehab timeline and expected outcome. Knowing how they feel (afraid, angry, depressed, etc) is essential in order to connect as well as properly motivate/coach throughout.
Many athletes (especially those who have been injured before) tend to want to dictate how things will go or pre-determine when they will be able to return to the playing field. I will re-direct them, but it is wise to listen to them tell you what did not work for them in the past. Mistakenly, they often compare their injuries to past experiences of their own or peers. While prior experience dealing with the same injury is helpful mentally preparing for the recovery process, it is critical to remind the athlete coach and family that no two injuries are exactly alike and that the recovery process will be guided by specific milestones and processes as opposed to “what happened in the past.”
Pearl #2 – Thoroughly educate the athlete on his/her condition, the anticipated timeline for return to sport and the implications for pushing too hard and fast in rehab. Never assume he/she does not want to know all the details. Emphasize that your goal is to return to sport as soon as possible but in a safe manner that ensures adequate recovery and minimizes the risk for re-injury. Telling your athletes the “why” behind each and every decision (exercise selection, reps, sets, practice limitations, etc) will help put the athlete at ease early on and foster trust and collaboration. This is an absolute must. To ensure success, we need the athlete to honestly and openly communicate throughout. I tell every athlete I work with that we are a team dedicated to the same goal – this achieves buy in from them up front as they see I am fully committed and invested in them.
In almost all cases, I find the athletes fear losing their starting position and/or letting down the coach far more than long term damage to their bodies. As such, I tell them it really is okay to rest and recover. They seemingly feel guilty about not contributing and their self-worth may markedly diminish. Recognizing this and encouraging them to be patient, stay the course and see the light at the end of the tunnel is very important. You see, the emotional and psychological healing is a HUGE part of the process during rehab. Being an advocate for the patient and not the sport provides security and emotional support for the injured client.
For those familiar with my blog, you know I like to post research updates and exercises that prevent injury and maximize performance. In my setting, I get to work with a very active population ranging in ages from 10-50 in most cases, including elite and professional athletes. I am pointing this out simply because I have an opportunity to test and measure unique and challenging exercises every day with fit, athletic clients.
As part of my world, I am often faced with restoring shoulder, core and hip stability. As clients progress through rehab and conditioning, I am always seeking advanced training options that are feasible and functional. One training tool I like to employ, especially in upper body, core and hip training is the BOSU Balance Trainer.
Emphasizing co-contraction and scapulothoracic and glenohumeral stability is essential for optimal shoulder function. But more importantly, addressing kinetic chain function in the shoulder, torso and hips is a must if we are to soundly address energy leaks and reduce injury risk. To that end, I like to incorporate unstable closed kinetic chain training when my athletes are ready. The video below demonstrates two upper body step-up progressions (forward and side-to-side) on the BOSU Balance Trainer that I utilize for higher level clientele.
Upper Body Step-ups
Regression – in place stepping (this can be used to prepare clients for the step-ups)
This regression can also be a very effective training tool especially if the client lacks sufficient strength, endurance and form to execute the full step-up patterns. Pain and form should always guide exercise selection and progression.
Below are two links to my Functionally Fit columns describing the execution and application of these exercises:
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I am pumped as we will be able to offer the same elite level training and nutrition services that are offered at other locations in AZ, FL, TX, CA and MA. I will continue in my role as supervisor and sports physical therapist and look forward to all the great things to come. If you are not familiar with AP, check them out at www.athletesperformance.com.
Click here for a detailed press release from Raleigh Orthopaedic Clinic. I am confident this new venture will help me sharpen my saw and become an even better clinician and performance training expert.
Working with athletes of many disciplines affords me an opportunity to look at many shoulders week to week. Increasingly, I am seeing more Crossfit athletes for various shoulder problems. In many cases, they have rotator cuff tendonitis, impingement, AC joint pain, labral pathology or a combination of the aforementioned issues. The other big group of athletes I see is throwers.
These two groups share many of the same dysfunctions including posterior shoulder tightness and decreased mobility. Tightness in the pecs and lats is commonplace. I feel latissimus tightness often goes unnoticed or perhaps is not an area of emphasis in prehab/rehab plans. Tight lats will restrict elevation and contribute to postural dysfunction.
With restricted elevation, athletes may turn to excessive spinal extension and/or rotation to achieve elevation necessary (e.g. overhead squats, snatches, throwing) and this can contribute to poor movement patterns. I have also seen this impact volleyball players asymmetrically with serving and hitting.
Lat tightness can easily be assessed by placing the athlete supine and simply asking them to bring the arms completely overhead. While most people do not have 180 degrees of flexion, I feel working to achieve elevation greater than or equal to 160 is completely reasonable. The body often uses abduction and external rotation to make things work (and this is natural for throwers), but the more pure elevation capacity we have the the better.
Crossfit involves lots of pull-ups and throwing heavily utilizes the pecs and lats for acceleration. It only follows that muscular tightness in this region may need to be addressed. Step one often involves soft tissue mobilization/compression techniques. I prefer to use a Trigger Point ball or Grid to work on the soft tissue mobilizing it on the wall (TP ball) or floor (Grid) in an elevated position.
Next, I like to employ active mobility work. I recently featured a simple exercise using the BOSU Ballast Ball in my PFP column. The pictures below reveal a rolling double arm version, as well as a single arm method/progression. These active movements can also be complimented by sustained holds as desired.
For a more detailed description and application of this exercise, click here to read my “Functionally Fit” column. I had one Crossfit enthusiast see me for limited shoulder mobility as it was hindering his overhead lifts and causing back pain. He had about 130 degrees of shoulder flexion. Daily STM using the foam roller, mobility work and some stretching increased his elevation by 10 degrees in 2-3 short weeks.
So, the take home message is that overhead athletes should assess and address this limitation if it is present as it may cause kinetic chain issues and energy leaks. Improving mobility will better enable utilization of proper muscle activation and optimal movement patterns.
I hope you had a wonderful Thanksgiving Holiday. Today is Small Business Saturday, and as a small business owner I like to bring attention to it. In light of that, I am offering a whopping 40% off all my products today until the end of the day on Cyber Monday (3 days only).
This is my way of saying thanks to my readers and supporters. So, if you have been thinking about buying a book, DVD, or foam roller now is the perfect time to take advantage of this deal.
Click here to see all the inventory. To receive the discount, simply enter coupon code SBS12 and hit apply prior to checking out. Happy Holidays!
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