It's been over a decade since I first started working as a Strength Coach, and in those 10+ years I've been witness to what I consider pretty colossal shift in how those who are injured train and prepare to return to their sport.
While working my 6 month internship at the Physical Therapy clinic (which led to 2 years working in that setting), I was blessed to be surrounded some incredibly experienced and talented Physical Therapists, including those who had been in the field for over 10 years, those who did frequent presentations at Conferences, to those who swam at the Division 1 level as athletes, and who worked for the US Olympic Field Hockey team as the Athletic Trainer. Combine these 2.5 incredible years, along with hanging around the Athletic Trainer's room during my time as a Manager/Assistant Video Coordinator for the Pitt Men's Basketball program, my time as an intern for the Pitt Strength & Conditioning Department, and I've been a fly on the wall long enough to tell you that combining Global athlete strength & conditioning along with the rehabilitation of the injured body part, is an absolutely instrumental part of an athletes return from injury.
So why is this often neglected- even today, when we know better!?!?
Before we get into the meat of the issue here, bear in mind that there are some injuries, such as injuries to the spine or torso, where additional training can be very limited. Also keep at the top of your mind the fact that the non-rehab training should be worked in conjunction with what the PT is doing in the clinic. This is incredibly important so as to ensure the athlete is getting a proper balance between training stress and rest (this is paramount!!!) such that the body is able to focus on repairing the injury, and not have the additional training detract from the desired/intended efforts of the Rehab activities.
In the words of Les Brown "What someone thinks of you, does not make you". Unfortunately, as an injured athlete, to whom a large part of their identity is tied to their performance and participation in their chosen sport, this can be an incredibly tough road to go down. It is for this very reason that it is incredibly vital to help the athlete get back to competing and playing at their top level as quickly as they are able to. And, allowing them to experience throughout the rehabilitation process, that they are both physically and mentally improving, are still capable of competing, and that they are more than their injury may "label" them.
These objectives, in large part, can be achieved through the athletes continuity of training through other appropriate avenues while they rehab the injured area (i.e. Arm bike for an athlete with an injured lower limb) Again, I must stress that the focus of the athletes training program must be primarily on the recovery from the injury, and as such the training, nutrition, and recovery realms absolutely must be changed/adapted in order to meet the athletes different demands during this period i.e. Passive Range of Motion sessions for a joint that has has connective tissue stitched, such as a shoulder or knee, changes in macronutrient and phytonutrient balances to help maximize recovery, scheduled post-PT naps, etc.
Having been through three major injuries in my sports career, and having two of them rehabbed thoroughly, and to a high degree with great PT's, and the other treated "just to get me back to daily activities", I can tell you that it is incredibly frustrating to experience the last type of PT… so much so, that it crushes an athletes confidence when it comes to their sport, thus making their return to sport even that much more difficult.
Perhaps that last injury with poor PT treatment is where I made the decision to help athlete going through what I had, in order to allow them to return to their sport stronger and better than before- not filled with doubt and wondering if they would ever be the same...let alone play at the same level.
I want to be clear about this- my story does not have your typical "fairy tale" ending:
I didn’t get to attain my dream of playing at the Division 1 level, and I didn’t turn pro overseas…
Having a grade 2 ankle sprain in high school, at the beginning of my 10th grade year- after a summer of learning from the best possible coaches out there, and looking to bring my game up a few levels- my injury decimated my newfound confidence, and undermined a full summers worth of hard work of drills for skills, and conditioning which had brought my game up significantly.
With the help of my PT, Al, who was a former Division 1 Football lineman, and who pushed me mentally and physically more than I had ever been pushed before, I managed to return to the court with the best fitness to that point in my career, and a new-found confidence.... I dropped 43 points in my first game back, and had 8 assists, 2 steals, and the game-winning 3 pointer from the corner as time expired in overtime- all in 36 minutes of playing time.
While the rest of my high school career didn't go as well as I wanted, and I didn't get to play in college as I had hoped, the tipping point in this story is that the Physical Therapy managed to combine general/global conditioning and strength alongside my rehab had allowed me to even have a shot at playing at a decent competitive level again... Yet this is missing for so many athletes these days.
So what do we do about it?
Physical Therapists are often not able to help as much as they would like
First, we must come to recognize that generally, the physical therapy "target" is to get people back to daily activities. That's it.
This is strongly reflected in the fact that the number of PT visits is often limited to 20-30 a YEAR (TOTAL) by insurance companies, and these few sessions are incredibly precious, as even they are often barely enough to get someone back to daily activities after a catastrophic injury, or a major surgery.
Top this off with the fact that many PT's are pushed to complete a large number of visits per day in order to meet billing quotas, and this makes for a perfect storm of "just get the patient back to daily activities" due to time and resource limitations in the PT setting. This is at little to no fault of the PT, as they are just trapped within the system and the limitations it imposes upon them.
While paying out of pocket may be an option for some of you reading this, it can be incredibly expensive, and thus unattainable for many.
Coaches: Step up to the plate!
Coaches tend to miss the fact that when an athlete is in physical therapy, there is an opportunity for an athlete to work on a variety of other areas that will contribute to their continued athletic development, BUT this must be recognized in order to be taken advantage of.
We must begin to think beyond the label of an athlete being injured, and recognize the fact that THIS is the time where we can truly MAKE the athletes will and determination infallible. It is an incredibly vulnerable time for the athlete, one in which they will often have negative self-thoughts, bouts of depression, and even "go to a dark place" which can totally derail them from their pre-injury optimistic and positive character.... and this can have a massively negative lifelong effect.
THIS ADVERSITY IS WHERE THE ATHLETE DISCOVERS THEIR TRUE ABILITIES, AND HOW FAR/HARD THEY CAN PUSH THEMSELVES.... IF they are coached through the injury, and shown they are more than their injury/ the label it has bestowed upon them amongst their teammates and peers.
Steps that you as the coach, parent, or team-mate can take:
-Talk to the athlete and have them ask the PT for guidance as to what else they can do while they are rehabbing an injury.
***This should be overseen by a certified and experienced Strength & Conditioning specialist with experience in this area, OR by the PT themselves- see my note below***
-Have the athlete learn more about their chosen sport as they come through the rehab process, and try to help them learn as much as possible while they have that “big picture perspective. This could be done by asking them to serve as an "assistant coach" to help with team practices/functions (within their injuries limitations), or otherwise finding ways for them to stay included with team functions.
Perhaps most importantly, ensure that the athlete is included in the team activities throughout the injury process, as logistics will allow.
For a professional cyclist, this may not be very feasible, as the team will be constantly travelling, which can significantly interrupt continuity of care for the athlete and their injury. That being said, technology can really help to keep the athlete engaged, as just being present in the pre-stage team debriefings via skype or phone, can allow the athlete to hear what is going on, and to even contribute to the teams plan for the day (and success) thus keeping them involved, engaged, and mentally sharper, as they go through the recovery process.
Of course at the professional (cycling) level, much of this will be decided by the Director Sportive and the Sports Medicine Team, although often times if the athlete shows true and sincere interest, they will be kept involved in some way.
As the athlete goes through this process, an invaluable tool can be seeking out a Certified and Experienced Strength & Conditioning Specialist who understands the recovery process and has experience working with the Sports Medicine team to get the athlete back to their sport stronger, and better than before.
But make sure this professional has real hands-on experience in this kind of setting. While many trainers will say that they’re comfortable working with these things, being comfortable, and actually knowing what one is doing is separated by the width of the Grand Canyon, and must not be meddled with…After all, we each only have one body, and must ensure that we are treating it with the absolute best possible guidance and programming possible. Do NOT trust your athlete in the hands of a trainer who thinks they can read a few articles online, and is now magically "qualified" to work with an injured athlete.
An injury is not an athlete simply being "out for x number of days/ weeks", it is a very real opportunity to help your athlete improve and come back stronger, smarter, and better than before they were injured- but you must set them up for success, by making the concerted effort to find the right tools, making use of the FULL Sports Medicine Team, and technology.
For more resources on helping your injured athlete through the internal and external tribulations of Rehab and return to sport from injury, speak to your athletes Athletic Trainer, Physical Therapist, or Sports Medicine Team, but keep in mind that in some settings you may be limited as to the information you can attain due to local, state, regional, or federal regulations, such as HIPPA.
Want to learn more about the injury recovery process? Check out the Injured Athletes Toolbox at http://injuredathletestoolbox.com