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Rehab to Performance: What’s Missing?

In the world of athletics, rates of injury and re-injury continue to climb, despite the best efforts of well-intentioned rehabilitation professionals practicing evidence based medicine; the traditional adherence to “protocols” designed to get the the athlete back on the field as quickly as possible usually leads to more problems down the road. As a physical therapist, I have worked with thousands of athletes over the years, and the biggest problems I usually witness are with athletes restored to “functional capacity”, who end up experiencing a related injury, or injury to the same site as before, anywhere from 3 months to a year after being cleared for return to play. This is unacceptable. 

How can this be? Was the rehab professional incompetent? Was the protocol poorly designed? Or, maybe the athlete is just injury prone? The answer is D, none of the above. The problem is hidden behind ignorance and lack of communication. All too often, athletes are discharged from rehab, having been essentially cleared by the insurance companies (because they will not continue to pay), and left to fend for themselves. In the eyes of the insurance company, the athlete has reached his or her “functional capacity.” They are pain free, and have requisite joint range of motion. However, there exists a large gap between what is deemed basic human function, and the high physical demands of sport performance. 

Not Just the "Get Back Coach"

Unfortunately, most rehabilitation professionals are hamstrung by the insurance companies, or simply don’t have a basic understanding in the principles of strength and conditioning to take the athlete to the next level. Enter the strength and conditioning coach. The strength coach has a huge responsibility in helping an athlete return to play from injury. This is where athletes get lost in the weeds. There should be consistent, clear communication between rehab professionals and strength coaches, to allow for a smooth continuum of care for that athlete. The athlete will be able to improve performance and decrease their chance for re-injury if they have a team of support. 

Regardless of the professional directing the athlete’s care, there is a fundamental need to focus on movement quality, and to develop a system for cleaning up dysfunctional movement patterns. Athletes come to us searching for answers, and it is our responsibility to quiet their fears, educate them about the process of healing, and raise their ceiling for development. Getting them back on the field, pitch, or court is not the end goal. Any “doctor” can release them to full activity with a sloppy signature. It is our obligation as coaches to help them enjoy the process of working through adversity, and making them a better human than before they were injured. 

Rehab is Training and Training is Rehab

There really isn’t a difference between rehabilitation and performance. Typically, the rehab professional (PT, Chiro, ATC, etc.) does their “thing,” desensitizing pain and restoring basic human function. On the other side of the coin, the strength coach does their “thing,” improving strength, stability, power, and speed. Shouldn’t they be speaking the same language? Whether you are recovering and trying to regain quad control to straighten your knee, or working compensatory acceleration in a squat to improve your power and speed, the human body responds the same way, and the goal of enhancing performance is also the same. Rehabilitation strategies utilized by a physical therapist and training strategies utilized by the strength and conditioning coach have the same goal:improve qualities and traits of the human system. 

Pain and Movement

The only logical separation in professions is the presence of pain. Pain is the factor that usually decides who is “quarter-backing” the care of the athlete. Yet, movement is the main feature that ties the two together. We can have athletes who are injured and in pain, or injured and not in pain. Other athletes may be “hurt,” in pain, and need to move better. Another group of athletes may not be in pain, and simply need to optimize their movement and become stronger in order to decrease their risk of injury. This is a continuum. The process to get from point A to point B amongst any of these groups is the same. The only difference is each athlete will be starting at a different point along that athletic continuum, and may require the supervision of one professional more than another depending on their placement. 

Master Your Movement: Visualize and Attack 

However, it’s never that simple, especially with the advent of the micro-gym community. More strength coaches than ever are now being exposed to “athletes” who are hurt, in pain, are shitty movers, or a combination of all three. As strength coaches, you need to be prepared to handle these situations as they come through your door. You will have to deal with everyone, from the dreaded chronic back pain guy with stiff hips who moves like a robot, to the hyper-mobile Gumby girl with shoulder and neck issues from too many spin and yoga classes. Are they all required to go to rehab? Some, maybe, depending on the severity of the issue at hand, your personal skill set, or comfort level. However, I am here to tell you now that the majority of these people can and should be helped by you, Coach. What we do as professionals is an art; it is a unique and rooted in science, guided by individuality. Each will require different interventions, and some may be more difficult than others, but progressive exposure and overload of movement is the key factor. 

In the upcoming series Streaming Rehab to Performance, you will learn about the various limiting factors stymieing your athlete’s return to the game (or exercise), and how implementing the principles provided through the Power Athlete Methodology will help you understand your role as a strength and conditioning coach in bridging the gap between rehabilitation and performance. 

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Matthew Zanis

Power Athlete Block One Coach at Power Athlete
PT, DPT, FAAOMPT, OCS, ATC, CSCS Former baseball catcher and an avid outdoorsman. Worked with Division 1 basketball, football, and track and field at the University of Pittsburgh, along with the Pittsburgh Pirates and Arizona Cardinals organizations. Received a Bachelors in Athletic Training from the University of Pittsburgh in 2011 and a Doctorate in Physical Therapy from Duke University in 2014. Is board certified in Orthopedics and a Fellow through the American Academy of Orthopedic Manual Physical Therapists. Is a PT with the United States Olympic Committee and USA Shooting. Currently operates his performance therapy practice in Scottsdale, AZ with Dr. Tom Incledon of Causenta Wellness, and became a Power Athlete Block One Coach in September of 2017.

Dr. Zanis utilizes the Power Athlete Methodology to optimize performance, reduce injury risk, and rehab his clients and athletes through movement assessment, coaching, and individualized program design.

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