To be straightforward, I’m sick of seeing athletes being disserviced by our healthcare system.
Athletes are unique and have unique demands.
They’re unicorns in a healthcare system that’s only designed to treat horses.
Our mainstream healthcare systems are designed to keep you alive and get you back to climbing stairs and jogging down the road- that’s a long way away from hitting a game winning step back in isolation, winning a man coverage rep with a 50/50 ball in the red zone, or sliding into home plate to beat the tag by a fraction of a second.
When I was studying for my physical therapy licensure boards, the exam prep book asked a question about what we should do when an athlete who had an ACL reconstruction was 12 weeks post surgery and was out of insurance visits.
Despite having the option to request more insurance visits or see them out-of-pocket, the exam prep book stated that we were supposed to discharge them from physical therapy and send them home with some exercises to do on their own.
They explained that: “At this point, they’re pretty functional. You can’t justify medical necessity.”
My jaw hit the floor. 12 weeks is only 3 months.
If everything is going great in your rehab, then we’re just starting to lightly jog at 3 months.
This isn’t a process that you can rush. We have pretty solid research suggesting that for every 1 month that you return to sport prior to the 9-month mark, you are 51% more likely to retear your ACL.
So, if you still waited twice as long as that, you’d be somewhere around 153% more likely to retear.
The only thing worse than tearing your ACL is retearing your ACL.
Regular physical therapy school education doesn’t prepare clinicians to deal with athletes who want to perform at a high level.
Our insurance companies try to minimize the amount of money they have to pay, which means their care gets rushed and not completed.
Rehab settings are often not equipped to keep the rest of their body as strong and athletic as possible during this down time.
Add that all up and it’s a pretty messy situation for athletes in such a vulnerable position.
If you want to maximize the rehab for your athletes (and maximize the amount of athletes who want to rehab with you), here are some big pillar items to address:
1) Additional sports training and experience
Physical therapy training is designed to make general physical therapists who can work in hospitals, skilled nursing facilities, and general outpatient clinics with people trying to get people back to walking around the block.
Athletes don’t fit that mold. You need to be someone who can maximize high performance.
This knowledge and skill set can only come from additional training and experience.
One option is to get your CSCS (Certified Strength and Conditioning Specialist through the NSCA).
I’m biased toward this route. I think that the only way you can really get good at taking an athlete back to high performance is to first know how to get them to high performance when they’re healthy.
However, a lot of PTs will take the CSCS test, but have never actually trained athletes in that role. That makes the CSCS certification much less useful.
You have to get in the trenches and learn how to coach.
Volunteer at your local university’s S&C department. Get an internship at an S&C facility. Shadow the best strength coaches you can find.
Practical experience trumps theoretical book knowledge (though they are both important).
The other viable option is to go through residency and/or obtain your SCS (board-certified sports specialist in physical therapy).
This is a test that physical therapists can take to signify they’ve spent time rehabbing athletes and have a deeper understanding of their needs.
2) The ability to develop return to sport plans (with actual numbers)
Choose your cliche:
Those who fail to plan, plan to fail.
What gets measured gets managed.
They both apply directly to what your athletes’ rehab should look like. You absolutely, 100% need to work on the physical structures (improving strength, range of motion, proprioception, etc.). Most PTs know this.
However, you also need a load management plan for when you’re getting back into your sport or sporting movements.
Injuries happen when the amount of stress that’s placed on your body is more than it can handle.
Our body can adapt to handle more and more stress over time, but it can’t be ramped up too quickly.
The general rule of thumb is to increase workloads by 10% each week.
If you have a baseball or softball player coming back from a shoulder injury, they should have a throwing program that counts your throws and measures the distance.
If you have a volleyball player coming back from a knee injury, they should have a jumping program that counts your jumps and measures the intensity.
If you have a track athlete coming back from a hamstring strain, they should have a return to sprint program that tracks distance and intensity.
Your differentiating skillset isn’t the actions you perform, it’s in the knowledge that you have and the knowledge you can communicate.
3) The capacity for individualization
Items #3 and #4 might be out of your direct control, but it shouldn’t stop you from being innovative and finding solutions.
Athletes are unique individuals with unique needs. That means they need a unique rehab strategy and that requires attention.
There’s a time and place for moving them into groups with other athletes (they should still have their own plan). In fact, small groups are a great way to stop being isolated away from their friends and to incorporate training the rest of their body to stay strong and athletic while rehabbing.
However, when they’re in the early stages where things are unpredictable, you need to make sure you are able to have all eyes on them to make small adjustments.
4) A setting equipped for athletes
I’ll keep this one short. How can you get ready to sprint and change direction if you don’t have a space to sprint and change direction? How can you get strong enough to handle the huge forces of your sports without weights above a 40 lbs dumbbell? (Sprinting forces can be over 5x your bodyweight with each step).
Physical therapy for athletes should look a lot like training, but with unique considerations and modifications.
5) A “post-rehab” pathway
Once an athlete is back to health, the goal is to stay healthy.
Establish a network/system to set athletes up with a quality strength and conditioning coach to keep them healthy and take their performance to a higher level.
If you like this article, you can get a lot more information like this by subscribing to my newsletter at gtperformancecenter.com/athlete360.
Best,
Zach
Dr. Zach Guiser, PT, DPT, CSCS