Becoming A Better Athlete After Injury
As an Athletic Trainer at a combined 7-12 grade Junior and Senior High school I have an interesting patient population. The school was built in 2003 and at some point there was a bit of foresight in the design and layout of the building. At the far east end of the building there is a long hallway that follows the entire eastern end of the school. This hallway from south to north is comprised of a laundry and equipment room, a room that once was a coaches/officials/away team locker room, and then the locker rooms for the male and female students. The coaches/officials/away team locker room is now my Athletic Training clinic. I have two doorways, the entry from the hallway, and a doorway that leads into a very useful weight room. On the far side of the weight room I have direct access to the main gymnasium. Due to limited clinical space, the fact that it goes largely unutilized, and my love of all things iron, I have essentially commandeered the weight room. With this in mind, and football season in full swing, this layout has proven very effective as I have direct line of sight from my clincial space into the weigh troom so that I can monitor rehab, treat, tape, etc. relatively efficiently. In a previous post I mentioned that FMS scores were showing potential as a probability value as the lowest scores belonged to individuals who had suffered injury. The pre-season and post injury scores, time frame from initial injury to re-test, injury, academic year and athletic status of the patients are as follows:
Pre-season 9 / 4 Weeks Post Injury 12 (anterior rotator cuff/labral injury) - Grade 9 RTP @ 3.5 weeks.
Pre-season 10 / 3 Weeks Post Injury 11 (MCL sprain Grade II) - Grade 12 (ETA RTP ready dependent on physician note)
Pre-season 11 / 2.5 Weeks Post Injury 14 (MCL sprain Grade I) - Grade 12 (ETA RTP Full Practice at 3 weeks)
While none of these reach the proposed FMS injury probability threshold, clinical it is interesting to see improvement as these athletes are exposed to rehabilitation programs that are heaviliy influenced by strength and conditioning training. I tend to write rehabilitation programs with a heavy strength and conditioning emphasis. However, this is not simply a lift and load philosophy, it is one based on movement from the head down, spine out, and ground up where movement precludes load in the vein of the FMS 4x4 model. As such most of my rehabilitation programming tends to look, rather simple, similar across a variety of injuries, and identical to how I write much of my strength and conditioning programming. I tend to follow an algorithm of:
Balancing neuromuscular control via TMR/RNS etc. as appropriate.
Breathing - Can the patient achieve anterior, inferior, lateral, and posterior excursion, or at the very least understand and practice diaphragmatic breathing?
Rolling - Can the patient achieve rotatory trunk control in an unloaded (or pattern assisted etc.) position?
Planking - Can the patient control linear trunk stability with static shoulder and hip integrity?
Crawling - Can the patient combine rotatory control and linear trunk stability with low load, low threshold limb movement?
Loaded Carry - Can the patient carry an object/s with shoulder and postural integrity?
Of course pain is our guide and specific alterations are made e.g. ISO walkouts and PNF strengthening etc. in the case of the acute shoulder, or quad-ASLR/RNT shuffling/monster walks etc. in the case of the MCL patients. At this stage, we are ready to address specific mobility issues, (hip extension/ASLR) incorporate basic movement patterns (hip hinge/squat) and complex movement series (turkish get up), move on to more dynamic / plyometric movement, and, of course, add load. Here I focus on movement patterns with bilateral strength first then unilateral strength, again challenging rotatory control in the process. Next we move on to competition simulation non-contact and then full practice/training as necessary. The key in my environment is to then transition what was previously their 'rehab' seamlessly into a strength and conditioning program that will benefit not only their previous issue, but help to prevent future injury, and enhance performance. It is my goal to return student-athletes/patients more ready than they came to me. This is particularly important in a setting without a strength and conditioning professional as an intermediary between rehabilitation and competition.