– Derek M. Hansen – November 3, 2008 –
I spend a lot of time working with young athletes in the age range of 18 to 25 years. Most of them are male, but many of them are also female. While most of my work with these athletes involves getting them bigger, stronger and faster, I also spend a lot of time managing injuries and restoring movement – probably more than I would like, but it has to be done to move forward. Interestingly enough, my athletes very rarely get injured while I am working with them. The injuries mostly occur while they are playing or practicing their sport.
When an athlete incurs an injury, I am the first one to jump in and teach them that they need to view their injury as an opportunity to rapidly improve their situation. I let them know that we have a plan in place that will yield success. And once they are over the initial shock and awe that accompanies a significant injury, we begin to put that action plan into motion. But athletes are still wary of their prospects and tend to be less optimistic about the outcome.
Unfortunately, many people believe that rehabilitation is about lying on a physiotherapy table and receiving treatment, usually in the form of electro-stimulation, ultra-sound, ice, hot-packs and other modalities. I spent the summer of 2007 in Spain working with a client, and had the opportunity to meet a skilled massage therapist that worked with famed cyclist, Miguel Indurain. When I asked him what he did to treat injuries and get his athletes ready, he simply showed me his hands.
While the Spanish massage therapist is on the right track, I have also learned that rehabilitation is also about putting the athlete into a position where they can heal themselves. This may sound like a strange concept, but when examined more closely, it is not a difficult goal to attain. Often I hear about doctors and therapists telling athletes what they cannot do as part of their rehabilitation (i.e. don’t lift weights, don’t run, don’t move). I’ve learned from experts like Charlie Francis, Al Vermeil and Rob Panariello that there are many opportunities to train injured athletes in a way that not only furthers their recovery, but also gets them prepared to operate at full capacity when their injury has fully recovered. Rehabilitation must be about realistic opportunities, not restrictions.
Putting this process into words that an athlete can understand can sometimes be difficult. The athletes are depressed and only know how they are feeling at that particular point in time. They are cautious and pessimistic.
The Process Revealed
One athlete in particular, who recently suffered a significant medial collateral ligament (MCL) strain, required a comprehensive explanation of what to expect for his rehabilitation under my supervision. I chose my words carefully and came up with an analogy that I felt he could relate to. Here is a summary of my explanation:
“Imagine that you are on a first date with a girl that you’ve been trying to get together with for quite some time. You want to impress the girl, perhaps get some limited physical contact (even for a symbolic victory), but don’t want to offend her or send the date into a downward, flaming tailspin. This scenario is no different than your knee rehabilitation process.”
“With the rehab of your knee, we are trying to do as much work as possible to regain joint range-of-motion, muscle strength, muscle coordination and general function. In some cases, we need to be aggressive in order to make progress. However, we are also going to be very careful to not engage in activity that puts you at risk for further or more severe injury. So, like the first-date scenario, we are looking for a good rate of progress, without the risk of rejection, unnecessary pain and humiliation.”
“On the first date, you may make some compliments to your date. These are safe bets that should only result in positive impressions on your date. This is similar to doing unloaded knee flexion and extension drills to gain range of motion. Not much risk and lots of benefit. If you take your date out to dinner and make a point of ordering her food for her, this could be as risky as trying to do a body-weight squat without making sure that the quad can contract forcefully enough to stabilize the knee. Additionally, if you try to kiss your date on the first outing, you may be putting yourself at significant risk if you haven’t made sure that the right circumstances are in place. Do you have the green light – based on other cues that you have picked up – to do some linear acceleration drills at moderate velocity?”
“The whole point is to get to the next date – or workout – with an opportunity to further your fortunes. You want to be constantly moving in the upward direction. You do not want to be flat-lining and going nowhere. You want to make sure you gain range of motion, strength, coordination and confidence with every workout. Similarly, when dating, you want to feel like you are getting closer to your date, gaining trust and connecting on several levels. If you don’t do enough work on your date, you will also go nowhere fast. And, you will be lucky if you get the opportunity for a second date. This would be similar to simply getting ultra-sound on your knee, with the odd ice-pack and hot-tub excursion, expecting fantastic results.”
“An overly aggressive approach is also bad. A premature butt-pinching or taking off your shirt in the middle of the date could result in a very quick end to the evening. This would be equivalent to trying to do lateral shuffles in cleats on a turf field. Additionally, unwarranted grabbing motions toward a date’s upper torso area would be right up there with weighted-vest box jumps one week after the injury. Stupid, stupid, stupid!”
Being well removed from the “dating” scene, I’m not sure if all of this information is still relevant with today’s young people. But my athlete quickly got the picture that he should be aware of his progress and what he had accomplished in his previous day’s workout – as it would set the tone for the next workout. My analogy may not be as well received by female athletes, but it might still provide general picture of what to expect in their rehabilitation process. Getting to the next date and eventually hitting a home run is what we would hope can happen with all of our rehabilitating athletes. Through careful guidance, a common sense approach to choice of exercise and an awareness of tissue adaptation, you can ensure that all your athletes recover in a timely fashion – as well as have a healthy social life.