Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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I just returned from the Sports Physical Therapy Section’s annual conference in Las Vegas. There were plenty of great presentations from various industry leaders. I thought I would take a moment and summarize a few key points from the conference that may be helpful to clinicians and consumers alike.
The conference theme was the power of innovation. Hot topics covered were blood flow restriction therapy, cupping, dry needling, eccentric loading for tendiopathy, weighted ball training, and kinesiotaping and laser therapy to name a few. Below are some takeaways worth mentioning:
- Blood flow restriction (BFR) training can be used to help reduce muscle atrophy after surgery, improve muscle protein synthesis and provide a way to increase strength with loads as low as 20-30% of 1RM for clients unable to tolerate heavy loading
- BFR is not superior to nor a substitute for high intensity training (need to push weight to see best strength gains), but it can be used as an adjunct to training. It also produces an increase in IGHF1 after exercise.
- BFR should not be used before higher intensity activities such as HIT, plyometrics, SAQ, etc.
- Clinicians and strength coaches should consider Olympic lifting derivatives as an alternative to traditional lifts if there is concern with catch phases or biomehcanical/physical concerns. Examples include high pulls/snatch pulls instead of traditional cleans and snatches.
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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.
Today’s blog post is about an observation and fundamental tenet of my practice today as a sports physical therapist and fitness professional. Having been in the business of rehabbing and training the human body for 15 years, I feel qualified to say I know a thing or two about training and exercise.
Perhaps one of the greatest pearls I can pass along as it relates to being a health and fitness professional involves the art of teaching. You see, I have witnessed firsthand the desire people have to attain knowledge when it comes to their bodies. Just look at how quickly and often people take the web in search of answers from the latest ab workout to the source of and remedy to their every ache and pain.
We live in a society of information overload. Unfortunately, the web, YouTube, FB, Twitter and so on give just about anyone a stage to philosophize and sound off as an “expert.” Many people who claim to know how to “train” you for this and that have little to no real world experience doing it, nor do they possess enough pre-requesite knowledge to truly be considered an expert.
I find many people mistakenly look for what they perceive to be the most “in” or “intense” training they can find, as they believe this is the way to finally meet their goals. In reality, what they should be seeking is someone interested in teaching them how to better understand their own body and how to apply the proper training principles to it in order to bring about the desired result they are so desperately seeking.
Training typically involves putting together drills, workouts or routines to challenge clients physically. Teaching, on the other hand, is centered on educating clients how to listen to their bodies and use that feedback to appropriately adjust physical loads and exercise programming to avoid injury and make positive physical adaptations.
I was asked to comment on a thought provoking blog post on MyPhyscialTherapySpace.com. There is ongoing discussion with respect to the exact role a therapist should play in the continuum of care for patients. I enjoyed reading the posts on there and I have posted my reply on my blog for you to see (not to mention the fact the blog site would not let me post my entire repsonse in a single comment). To read the original post click the link below:
Now my comments…….
I would say as a cash based practitioner currently living in the sports performance and post-rehab fitness realm (I own a fitness training facility), I would say that many of my therapy colleagues do not truly understand how to push and/or fully rehabilitate people to a high enough level that meets the pre-injury functional capacity.
I often see referrals that have already failed traditional rehab or are getting inadequate therapy. Why? In many cases, PT’s are following basic protocols, not supervising exercise progression closely enough, moving too slowly or in some cases (ACL rehab) moving too fast. I also find clinicians are often hesitant or perhaps unwilling to change treatment progressions within the sessions, reps or sets even if the client’s response to the stimulus indicates such a change.
At this phase of my career, I have been around long enough and successful (or rather blessed) enough to be considered an expert in my field. This affords me the opportunity to see and work to fix complicated client issues as well as teach others how to do the same.
One mistake I see time and time again in rehab and sports training is a lack of sound sequential and functional progression. I blame part of this on the demise of insurance programs as we once knew them as therapy sessions are now limited both in scope of coverage and number of visits. But, the rest of the blame often falls squarely on the shoulders of therapists, doctors, sports performance specialists and coaches. Okay, parents may deserve a spot in my blame circle too.
Why do I say blame? Well, to be honest we often mislead or let down athletes recovering from injury by not listening enough, pushing them too hard, not pushing them hard enough, using outdated or irrelevant protocols, or incorrectly assuming they will heal like the last person with injury X. Sound at all familiar? Ever wonder why some people with the same injury recover differently and/or suffer a re-injury so soon after going back to sport?
Now, read on as this blog post is not a rant. The point I want to be crystal clear on is that we as caretakers and health providers of young athletes must be on our game at all times. This means we must be willing to continually learn and drop our assumptions, standard protocols, experiences and such at the door each time we see a new case. We must apply and adjust our plan based on each individual we see.
Ont thing I am certain of is that no two humans are exactly alike. Therefore, we must consistently assess and re-assess. I believe the real magic if you will that at times occurs for me with my athletes is less a result of my own doing and more a result of my intuition and ability to communicate and extract information at critical times from my clients.
You may think that this happens in every therapy clinic and sports training realm, but trust me when I say that line of thinking is naive. I have personally heard and witnessed too many failed rehab stories and examples of lackluster care/training to validate it. As trainers and rehab specialists, we must be willing to do the following to maximize the success of our clients:
- Listen to the spoken and unspoken words
- Observe everything (movement, emotion, and facial expressions)
- Encourage the athlete or client to communicate freely, frequently and most importantly honestly
- Craft a daily plan based 100% on how the client is doing at that very moment in time – this is tough as you may have to scrap your entire preplanned workout
- Challenge our own beliefs, assumptions and strategies all the time – it becomes easy to get stuck in a rut or fall back on doing the same thing for similar problems. We must guard against complacency in our programming. We must always seek new and better ways to do things.
- Involve the athlete/client in the decision making process – in other words explain the “why” behind things and relate it to their activity, rehab or sport. Most of the time they will work harder and cooperate more when you do this simple thing.
- Provide routine progress updates verbally (I call them affirmations) to the client and their family. We all like to know how we are doing and being vague and having no clear direction or goals is simply unacceptable. Encourage your clients and let them know how they are progressing in straightforward terms.
These are just the seven biggies that come to my mind right now. The takeaway here is that training and rehab is and always should be exacting, yet flexible at the same time. Fluid, seamless tweaking and adjusting are hallmarks of all the greats. Clients should accept nothing less than this precise, analytical and results driven process, nor should we be willing to offer any less.
Following this blueprint will accelerate recovery, maximize performance gains and minimize injuries. Isn’t that what it is all about? Here’s to harnessing our passion and giving the absolute BEST to those we are fortunate enough to serve.
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