Brian Schiff’s Blog

One of the biggest issues I see today in youth sports is an abundance of overuse and preventable musculoskeletal injuries due to improper conditioning, lack of recovery or both. In the current era of sports specialization and the hyper-competitive pursuit of college scholarships, an athlete can unknowingly be placed in a comprising position with respect to his/her physical and mental health. Coaches and parents may push a player to participate in a weakened or vulnerable state.

Now, more than ever, athletes who do focus in on a singular sport need a year-round training plan to match their year-round sport demands. In order to stave off injury and avoid burnout, a successful plan must accomplish the following:

1. Implement de-loading periods along with scheduled rest in the training and competitive cycles
2. Periodize the training to peak at the desired times
3. Allow for adequate time to ramp up training and sport specific activity in order to condition the body for the high demands of the sport and safely move from the athlete’s “floor” to the “ceiling”

A surefire recipe for injury and soft tissue failure is progressing training loads too fast, where the athlete often endures too much acute workload without enough time to build up an adequate amount of loading tolerance or chronic workload. I see this frequently in baseball pitchers (shoulder and elbow pain), female soccer and basketball players (patellofemoral pain), along with many athletes who suffer soft tissue strains including hamstring, hip flexor and groin injuries.

Tim Gabbett, published an excellent clinical commentary in the October edition of JOSPT (1) that highlights the importance progressing training loads to minimize injury risk and optimize performance. Specifically, he discusses the concepts of “floor”, “ceiling” and “time” as it relates to developing rehab and performance plans.

Floor – the athlete’s current level of capacity

Ceiling – the capacity needed to perform the specific acuities of their sport

Time – an athlete can safely progress from the floor to the ceiling when afforded enough time

Further, Tim discusses how an injured athlete can actually fall behind in conditioning and end up in the “basement” in terms of training capacity. This presents additional challenges in getting the injured athlete back safely, particularly if it is in-seasonwith a shorter time window. He presents an option of raising the floor when an athlete enters rehab or if he/she will be on an extended break from training to ensure the loading capacity not drop below the floor to the basement, but rather increase the height of the floor, perhaps allowing the athlete to eventually reach a higher ceiling (greater loading capacity) later on.

According to Gabbett, there are 5 key ways to ensure athletes are prepared for competition:

1. Maintain adequate training load during the offseason and while injured.
2. Identify the ceiling and make sure the training load is in line with the sport’s demands.
3. Assess individual differences in training tolerance. We need to consider young versus older athletes, injuries, training history, aerobic fitness and physical deficiencies to do this properly.
4. Identify and prepare for the most demanding parts of competition.
5. Coaches need to plan enough time to move from the floor to the ceiling considering the physical demands of the sport, capacity needed to perform these activities, and individual limiting factors that may impede the ability to meet these demands.

Having spent a considerable amount of my career working with high level amateur and professional athletes, I am well aware of the narrow windows of time to compete and recover with weekend tournaments and professional schedules. It takes a lot more time to get in elite shape and only a few days to begin detraining. Cross training, smart and progressive rehab and clear communication with coaches, training staff and the athlete is essential in managing an injury for a high level athlete.

In addition, I always tell my athletes the only thing worse than not competing at all is going out and performing poorly. Without proper training and rehab plans, athletes will eventually fail mechanically. I often encourage the athlete to communicate clearly in terms of pain response on a scale of 1-10 during, immediately after and for the 24 hour period following rehab to assess the body’s response to loading. Using these concepts and the floor, ceiling and time as discussed by Tim Gabbett, strength coaches, sport coaches and rehab professionals can all refine their methods to put the athlete in the best position to succeed and reduce injury risk.

References:

1. Gabbett TJ. How much? How fast? How soon? Three simple concepts for progressing training loads to minimize injury risk and enhance performance. J Orthop Sports Phys Ther. 2020 Oct;50(10):570-573.

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.

Continue reading…

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:

1. Listen to the spoken and unspoken words
2. Observe everything (movement, emotion, and facial expressions)
3. Encourage the athlete or client to communicate freely, frequently and most importantly honestly
4. 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
5. 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. 
6. 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.
7. 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.