I came across an article recently that was written by athletic trainer and strength coach Mike Boyle. He discusses his frustration with vague restrictions from various medical professionals for rehab prescriptions that prohibit and restrict training on injured athletes to complete rest, to the affected area for __X__ number of weeks. I can absolutely relate to this predicament. I have been a Certified Athletic Trainer for 22 years and a Certified Strength and Conditioning Specialist for 7 years. I have seen countless injuries to athletes, clients and patients, and many times, we receive similar physician notes and physical therapy protocols on a seemingly weekly basis. As a medical professional myself, I also find it frustrating trying to understand the logic behind some of these restrictions. In the end, we all want the client or athlete to return to their activity or sport as quickly and safely as possible. If we have a better understanding of how the body reacts to systemic exercise and movement prescriptions, we may be able to work together to achieve better outcomes.
Coach Boyle makes a great point, that there needs to be tact, when approaching the situation with the injured athlete, parents and the treating physician. One way to break trust, undermine medical professionals, and get involved in a litigious situation, is to go against medical orders and begin to train without consent. Having the evidence-based practices and documentation to back up your training philosophies as it relates to training injured athlete, can go a long way in helping athletes return to play quickly, and safely, without having to “rest” with non-activity for weeks on end.
One way to approached different situations with injured athletes as coached by Mike Boyle, is to get them to understand that they may be 25% “injured” but they are 75% “healthy.” While training, we need to be careful with the injured appendage, but can certainly train the other body parts as long as we aren’t causing additional irritation or pain. I feel that mentally, this philosophy can go a long way into building trust with your injured athletes, while attacking great outcomes with return to play protocols. We all know that the best ability is availability, and you can’t win games if you’re in the training room.
I believe you can still elicit a systemic response to the entire cardiovascular and musculoskeletal system by training around the injured area. Common sense should tell us that training the lower extremities while in a sling for a shoulder injury can contribute to increased systemic circulation and blood flow that might help oxygenate surrounding tissues and help dissipate swelling from the injured area. If the prescription for an injury is to “rest” for _x_ weeks, wouldn’t common sense also tell us that muscles not related to the injured site would atrophy and become untrained, which in the long run, would put the return to sport back even more than it should be?
In a researched phenomenon coined the Contralateral Approach to Exercise Rehab, Dr. Kim Christiansen stated: “One way to provide the stimulus of early exercising to an injured area, while avoiding excessive irritation, is by using contralateral exercise. This neurological phenomenon (also called "cross education" or "cross transfer") has been identified for many years, yet rarely is used by clinicians treating an acute injury. While this procedure is particularly helpful in the treatment of shoulder and ankle, it can be used successfully for many areas of the body.” This approach is precisely what this article is all about.
In a study done by researchers in 1992, 20 adults had hamstring and quadricep muscle groups tested prior to an 8 week protocol for a baseline. Ten adults did single leg strength training on one extremity and 10 adults were a control group with no strength training. At the end of 8 weeks the control group saw no change in strength training to either leg, while the single leg tested athletes showed increase in strength, power and endurance to BOTH extremities, even while only training one extremity at the time!
If range of motion and strength are KEY to any rehabilitation protocol, I am not sure why anyone wouldn’t find a way to train around an injured body part. If strength is truly proven to have a “cross transfer” effect, why would anyone restrict movements that aren’t contraindicated to the specific body part? The best thing you can do with an injured athlete is to give them confidence with movement and allow them to be like themselves “again” as soon as possible after surgery or injury. If you are not working the non-injured body parts as soon as safely possible, you are doing the athlete a disservice as a medical professional. Coach Boyle implores all therapist, athletic trainers and/or strength coaches, working with competitive athletes, “think about two rules: 1) Do No Harm 2) be As Aggressive As Possible Without Breaking Rule 1”.
The Center for Physical Rehabilitation is on the cutting edge of post rehab screening and return to play protocol programming. We use Move2Perform software that utilizes evidence based movement and strength tests, calculate into an algorithm to measure and analyze and safely predict readiness to return to play after injury and surgery. With this data we have been able to quantify to the patients and physicians, objectively, that they are ready to return safely with piece of mind that their patient’s rehabilitation will mitigate a future injury from coming back “too soon” from rehab.
To learn more about the Center for Physical Rehabilitation and their Sports Performance model for physical therapy, athletic training and strength & conditioning, please visit www.pt-cpr.com.
Joe Chiaramonte, AT, ATC, CSCS, MFR
Byron Center High School Sports Med & Bulldog Power
Center for Physical Rehabilitation
Head Athletic Trainer
Director Strength & Conditioning
References:
http://movement-as-medicine.com/2488-2/
https://www.strengthcoach.com/public/Training-Injured-Clients.cfm
https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=51461