Injury Prevention

October 21, 2013

3 Factors That Affect How Well You Will Do With Physical Therapy:

Education, Consistency, and Compliance

Contributed by expert: Shaun Logan, PT, DPT

Some of the biggest, actually probably the biggest, predictor of success or failure with physical therapy is consistency, compliance, and education or understanding. Compliance is a huge issue that tends to be frequently overlooked.  I would bet that the majority of the general population does not actually have a good understanding of physical therapy or they have had a previous experience with physical therapy that was bad physical therapy, which is an issue for another day.

Physical therapists are experts in human movement and injuries of the musculoskeletal system. We study, analyze, and break down human movement to determine where there are imbalances in muscle strength, muscle activation patterns, mobility, and movement patterns that have caused injury or will lead to injury.

 human movement

Humans develop compensation patterns as reactions to our environment (daily life, work, sports, exercise, etc.) throughout our lives that change the way move. Our bodies are great compensators or adapters. These patterns are often the cause of non-contact, non-traumatic injuries. These compensation patterns develop over time and typically turn into more of repetitive, over-use injuries that can lead to pain, muscle strains, ligament tears, etc. Being pain-free does not mean the issue is gone. Pain is just one of the results of the poor movement pattern, and will continue to arise if the underlying issues are not addressed. Physical therapists find and address these patterns and work to improve the quality of movement, so in the end, the body works more efficiently and safely.

So what makes people think that there is going to be a quick fix? Why do they think they can continue to perform the activity that lead to the pain in the first place? Why do they think they can just disregard what they do in physical therapy as soon as they walk out the door? Why do they often not take their physical therapists advice? In general, why do people tend to trust medical doctors more for when they can return to physical activities, such as exercise, running, sports, etc.?

                                                                                                            

The answer is fairly simple; it’s poor education on physical therapy.

Typically, the medical doctor only sees an individual once every 4-6 weeks, if that; meanwhile that same person spending 2-3 hours a week with the physical therapist – who is constantly studying their movement patterns, strength, mobility, and response to all of these exercises and activities. Let’s get something straight, injuries do not have set timelines, it is almost impossible to predict when an individual is going to be ready to return to their specific activity. Everyone responds differently to injury and treatment. Each timeline has to be on a constantly changing, sliding scale that is individualized for that specific person.  To progress the individual back to activity, the physical therapist is using the information that is constantly being collected and assessed during each movement and exercise at every visit.  By the way, most physical therapists,  are doctors as well.  Just as physicians have their doctorate in medicine (M.D.) or doctorate in osteopathic medicine (D.O.), we have our doctorate in physical therapy (DPT).

There is no question about it, physical therapy takes a lot of hard work. If physical therapy is not challenging, then that it is likely not good physical therapy. The ultimate goal is to get back to pain or symptom-free activity, which is accomplished by changing how an individual moves, using and strengthening muscles that are weak, and mobilizing joints and tissues that are tight. Most of the time they are muscles that people don’t even know exist. As physical therapists, it is our job to educate these individuals and guide them towards a pain-free level of function and safe return to their activity, or activities, of choice; with the goal of them having a better understanding of their body, and the way they should be using their body. This is how injuries are prevented. However, physical therapists have to be able to perform their jobs correctly, which takes us back to the issue of compliance and consistency.

For physical therapy to work at its best, the individuals need to realize that what they are doing and learning at physical therapy is what they need to do every time they move throughout the day.  They need to stop performing the poor, compensatory strategies and work on the movements that are difficult for them. Otherwise, they are constantly feeding into the problem and counteracting everything that is trying to be accomplished in physical therapy. Typically, they are only in physical therapy 1-3 hours a week, so what is being done outside of PT, for the other 165 hours of the week, is the most important and crucial aspect to how well their recovery will go. One of the most important aspects of physical therapy is education, consistency, and compliance.  The individuals that have the best results with physical therapy are those who are compliant and work hard. That is a very important and often over-looked key to a successful physical therapy experience.

June 25, 2013

Are you teaching your athletes the best way?

Contributed by Coach Ron McKeefery, http://ronmckeefery.com

Most of us coaches were once athletes, try to remember back to when you learned a new skill.  Chances are that you learned one way, while one teammate learned differently, and another teammate learned a third way.  As coaches we know that all athletes are not the same, but yet we often use one method of teaching.  Typically it goes something like this:

Coach – “Have you ever squatted before?”

Athlete – “No”

Coach – “Grab the bar and then squat down”.

box-squat-2

Sound about right?  Maybe we get crazy and actually just get in and show them.  The reality is that there are three ways athletes learn: Auditory, Visually, and Kinesthetically.  When teaching our athletes we make sure to use all three methods when introducing them to a new stimulus.

Sticking with our squat example, we first use verbal information.

Non-Verbal-Communication

We break down exercises into their most basic elements “Ready, Set, Go”.  We tell the athlete to grab a 45lb Bar like they would grab it to do a Bench Press, and pull the bar back towards them to feel the shelf they create with your shoulder blades and traps.  Duck under the bar and place it on that shelf.  In a good athletic position, lift the bar off the hooks and walk out 1-2 steps.  This is the ready position.  Set, place your feet slightly wider than shoulder width and take a deep breath squeezing your shoulder blades together keeping your chest up and head neutral.  Go, hinge your hips first and descend to two inches below parallel, brief pause and then forcefully return to the start position exhaling as you do.

Once they are able to talk through the “Ready”, “Set”, “Go” steps we have them call out the commands as the coach visually demonstrates the lift.  This serves to reinforce what they heard as well as allow them to see the lift.  Most athletes are visual learners.  It is what is reinforced from an early age.  Coaches even at the little league level will practice and then have film sessions to teach.  We can then take it a step further by introducing video analysis as they require more information or advanced coaching.

df_squat

Lastly we use touch and feel to teach them kinesthetically.  Where there body is in space.  This could be as simple as applying pressure to their back and chest (shoulders for female athletes) to keep their chest up.  Hands on the hips and a little pull to make sure the hinge at the hip first, or a tap on the forehead to keep their head up.  If they are having trouble with valgus/varus knees we can use bands to provide the same information.  An athlete must feel the correct position to best understand it.

coaching-the-squat-300x294

For all you die hard squatters out there this is not intended to be a thesis on squat technique, rather demonstrating how you can use Auditory, Visual, and Kinesthetic coaching cues to better your athletes understanding when teaching them a new skill.  Once you have introduced the lifts and they have effectively learned the basics then you can proceed with more advanced coaching cues and techniques.  Additionally, the three methods outlined are not an either/or.  Rather they should be used in conjunction to identify the best method to use with each of your athletes.  By using all three methods you will give your athletes the best chance at success.

                                                                                                                                                                                                                                                                                                                        

June 24, 2013

The Biggest Mistake a Coach Can Make…

Similar to Coach Vern Gambetta’s Facebook post a couple of months ago Speed Coach Lee Taft posted something along the same lines. He has allowed me to share his thoughts below. You can find out more information from Coach Taft at www.speedinsiders.com.

‘Biggest mistakes a coach can make is to not understand the maturation process of kids. Some athletes develop much later while other develop real early. How many times have you seen phenoms at the age of 10, 11, 12 years old and they are labeled the next “Great Player”….than they fade away because everyone catches and passes them up. Then there is the young athlete that coaches push to the sideline because they can’t “Keep Up” due to being smaller, weaker, slower…. Than when they are 17 18 years old they blossom into a great athlete. These are the athlete that stay competitive for years to come. DON’T GIVE UP ON KIDS!!! Coach beyond the end of your nose.’

Interested to hear your thoughts. Please post them in the comments session.