If you ask me why I got into physical therapy, my answer is easy, to help treat athletes. As a former D1 athlete, helping athletes get back to their sport is something I am very passionate about and why it is so important to me. Sports rehab goes beyond the general information we learn in school. It’s about really understanding the demands of the sport and the athlete in front of you and knowing how to truly prepare them for a safe return to their sport.
Sports specific rehab is more than just throwing a soccer ball or a baseball in an athlete’s hands during their session (while this can be helpful, and I do like to try to get an athlete’s hands on the ball, or stick in their hand, etc as soon as I can). It’s more about fully understanding the demands of the sport and knowing how to truly prepare an athlete for a safe return while giving them the confidence to get back out there.
6 Key Components of Sports Rehab:
- Injured athletes don’t need rest: Athletes don’t need rest when they are injured. Too many times, athletes are told to rest, and most of their treatment is done on the table with passive exercises. While rest can be a component, especially early on there are ways we can keep our athletes engaged and feeling like an athlete with other exercises. Athletes are very active, and their rehab should be too. Their rehab shouldn’t be passive, and they should not spend most of their time on the table. Getting injured and being sidelined for any amount of time sucks so it’s important to get them active in some way. For example, an athlete with a lower extremity injury who cannot weight bear can do seated upper body strength training and some form of cardio early on (seated med ball slams, seated battle ropes, etc.) There are ways we can train around the injury to keep athletes feeling athletic.
- Properly loading them with weights: Properly loading an athlete is a huge component to an athlete’s rehab. Sets of 20 with 5-pound dumbbells throughout the entire rehab process is not enough, and in my opinion, is a disservice to our athletes. An athlete’s sport requires high demands for sprinting, cutting, jumping, etc. Our goal should be to get these athletes strong. Especially in these positions they will be in for their sport. Their sessions should be hard, and they should feel tired after rehab. Keep in mind- there is nothing wrong with sets of 20 early on to help them relearn the movement pattern, but as we shift into them getting closer to playing, their weights should be going up and their reps should be going down. [Using the RPE (rate of perceived exertion) scale can be an excellent way to make sure we’re properly loading]. In addition to having the knowledge, athletes should also be rehabbing in a facility that is equipped to challenge them and make real strength adaptations.
- Exposing them to sport specific movements: This includes both aerobic and movement/plyometric components and exposing them in both closed and open environments. If an athlete is returning to football and they have not done any kind of hard change of directions drills or practiced running a route at full speed, they are not ready to go back. It is our job to get them performing these movements hard. Athletes are competitive, so timing them or racing them is a great way to get them to go 100% because they will either want to win the race or beat their time.
- Challenging their cognitive demand: Rarely is an athlete focused on 1 thing in their sport. They are having to perform the move they are making, anticipate their next play, read the defense (or offense) etc. We can’t only expose them to simple tasks. Challenging them cognitively while performing sports movements is crucial. For example, have them react to your voice for a specific movement, or have them think/answer questions. This forces them to perform the movement and task at hand while having to think about something other than what they are doing at that specific moment.
- Checking in to see where they are mentally: Being injured takes a huge toll on an athlete mentally. Checking in to see where they feel they are physically and mentally is a very important component to rehab. Sometimes, an athlete may be ready to go back physically, but if you talk to them, they are scared to return or afraid of re-injury. [This is more common in athletes with a surgical injury such as an ACL-R (ACL Reconstruction). For my ACLR athletes, I like to use the ACL RSI to help get an idea where they are mentally. I give this form to my athletes multiple times throughout their rehab to see how their mindset changes over the course of therapy. This lets me know if I am doing my job well and making sure I am helping to improve their confidence and exposing them enough to the demands of their sport.]
- Education on the Return To Play (RTP) component: This, in my opinion, is an undervalued component to physical therapy. Too often, athletes get cleared to return to their sport based off a general timeline and with little guidance on how to return and what that process looks like. If you are coming back from an ACL-R, you should not be cleared to play and then the next day go through a full practice. There is a gradual return that should happen towards the end of rehab. Starting with returning to stick drills, foot drills, ball handling type drills with no contact. Then you begin to introduce more advanced drills and participating in 50% of practice, then full contact etc. After they have gone through multiple full contact practices, they can be cleared for 25% of a game, then 50%, etc. An athlete cannot go 9 months for example for an ACLR without playing to a full game day 1 of being cleared. This process must be gradual, not 0-100.