When the PT becomes the Patient

Flashback to the middle of January, I’m flying down the slopes for the first time, feeling like I’m finally getting the hang of this skiing thing, until I wasn’t. All the sudden I found myself out of control and in a matter of seconds I was face down in the snow. Deer Valley: 1, Me: 0.

A few days later I found out I would need surgery to repair my broken collarbone. I was so upset thinking about all the things I couldn’t do. I couldn’t workout like I used to, couldn’t play lacrosse, couldn’t shoot hoops, couldn’t shower or brush my hair like a normal human being. I remember my first question to the surgeon was when can I start running and lifting again? He was quick to remind me that once my plate and screws were removed, I would have holes in my bone that would need time to calcify and remodel. He continued to tell me I would need to be more careful once the hardware was removed because if I were to fall on my shoulder soon after that my clavicle would “most likely shatter”. I also asked about playing sports and he quickly shut down that idea by telling me he did not think I should chance that until close to the end of the year. Hearing this was a lot for me to take in and not the way I wanted to start 2020. I had so many plans for the spring and summer-I wanted to play in a lacrosse league, sign up for a tough mudder, the list goes on.

Fast forward to 6 weeks after my surgery when I FINALLY got out of my sling and cleared for PT that consisted of ROM as tolerated and a weight limit of 5# for the next 6 weeks. I remember first trying to lift my arm above my head in his office (in supine) and my surgeon being very happy with my motion but I was not. As a life long athlete I could not wrap my head around the fact that lifting my arm above my head was so hard, not to mention painful. I was always the type of athlete that pushed through pain. I never told my coaches or trainers when I was hurt. I never wanted to sit out or be seen as weak so I pushed through hip labral tears, concussions, ankle sprains, etc. (which I now realize is the extremely naive thought process of a 20 year old)

Needless to say, I have been having this internal battle with myself throughout my rehab so far. On one hand, the PT in me 100% understands why things feel the way they do. I understand the healing process and how muscles atrophy. I realize that when your arm has been in a sling and immobile for 6 weeks, moving into new positions is going to be challenging, uncomfortable, and painful. I know this is normal and that it’s ok to feel this way. I know that my progress won’t be linear and that too is normal. The PT in me can see how I am progressing and sees all the little improvements I am making in range of motion and strength. I know that as I continue to expose myself to these positions again my tolerance will improve and I will get stronger and be able to continue to do more. 

On the other hand, the athlete and competitor in me just wants to be better now. The athlete in me sees the end goal, being able to do all the athletic things I used to be able to without pain and the same way I always have. The competitor in me thought I would be cleared of the sling and be 100% day 1. The athlete in me, who pushed through injuries, endured 2 a days in all the elements, pushed through exhaustion on the field/court cannot understand why those things were doable, but standing and lifting my arm up to 90 degrees seemed impossible.

I have been humbled by this experience and forced to remember how important the little goals are in PT. Focusing on the day to day changes and acknowledging these small victories rather than dwelling on the fact that you aren’t “there yet”. A week after ditching the sling, I couldn’t lift my arm above 60 degrees actively and after a week or so of rehab I was able to get to 140 with minimal compensations and a lot less pain. Now at about 4 weeks of being sling free, I have full ROM with minimal compensation and no pain.  now I can get to about 140 with minimal compensations and a lot less pain. A couple weeks ago, putting any kind of force into my shoulder was very uncomfortable and my arm was so weak it would shake immediately. Now, I can put some weight through it for about 30 seconds to a minute before it shakes. A couple week ago, running made my arm and shoulder feel achy at around a mile and a half and now I can run closer to 6 before it starts to feel achy. If I constantly stress on the fact that I am not 100%, not only would I be negative all the time about my recovery, but I would miss out on all the small things I am now able to do that I couldn’t a week ago. This is something I will make sure I do as a PT with my patients-do my best to keep them positive and remember to cheer for them and all their small victories.

Another major thing I have had to overcome during this process so far is frustration. Even when I do acknowledge my improvements, it’s still frustrating for me to struggle to lift a 1 pound dumbbell or not be able to do certain lifts that normally would be simple. Knowing that I am improving does not make things any less frustrating. It’s frustrating that I have to concentrate so much when raising my arm up to do anything. It’s still frustrating that reaching to open a cabinet is still uncomfortable. It’s frustrating to have to rely on people to help me with simple tasks, especially when I’m not used to asking for help. I’ve learned that it’s okay to be frustrated. I’ve been frustrated a lot and I’m sure I will keep doing so throughout the rest of my recovery, but you can’t stay frustrated. Instead, use the frustration to keep bettering yourself. Rehab is not linear, there will be good and bad days and that is all normal. This experience has really opened my eyes to the fact that there will be many ups and downs throughout recovery,  but you have to continue to trust the process, take things one day at a time and stay positive remembering all the little improvements are adding up to get you to your end goal.

I’m not gong to sugar coat it, this whole experience for me has been extremely difficult. I’ve really relied on my faith in everything happening for a reason and I’ve tried my best to find some positivity. The silver lining for me has been simply going thought the rehab process myself as a patient. I have wanted to be a physical therapist for as long as I can remember. I have always had a passion for wanting to help people and have always loved how much movement and exercise can really help improve someone’s life. I’ve seen so many of my friends go through injuries and work hard in PT to come back 100%. After going through an injury on my own, I think it is safe to say I have an even deeper appreciation for the rehab process and a better ability to connect and truly understand my patients. Oh and also learned I am NOT a skiier

What true Sports Physical Therapy Means to Me

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.

Single Leg Exercises

I recently wrote a blog post for Citizens Athletics on some of my favorite single leg exercises and why I choose them. Check out the article on the citizens athletics website to learn more about the Rear Foot Elevated Split Squat, The Pistol Squat, the Split Squat and why or when I choose to implement each one in my training or rehab programming.

Alyssa RFESS photo.jpg

The Importance of Mentorship

As a new grad, one of the biggest things I was looking for with my first job was strong mentorship—and I cannot even begin to express how thankful I am for the amazing group of mentors I have with both Teddy and Wesley as well as everyone at Healthy Baller.  

At Healthy Baller, I am fortunate to have mentors helping me grow in many aspects of sports performance. I get to learn from 2 incredibly knowledgeable sports performance physical therapists and the group of amazing strength and conditioning coaches at HB.

Teddy & Wesley both carve out time in their already busy schedules to meet with me almost every week to go over different things. Sometimes we talk about clinical reasoning—treatment ideas, ways to communicate better with patients, research articles, etc to help me develop my skills and grow into a better PT. Sometimes its more business and career growth—talking about my goals as a PT, how to expand and grow, & challenging me to do things I haven’t (create content, talk to teams etc). 

In addition, we have regular staff meetings to discuss overall growth at HB. We have movement sessions where we discuss different ideas, drills, movements, lifts etc. Everyone bounces ideas off of one another making small changes to drills to progress/regress them etc. I love these meetings and they are such a great way for us to all continue to learn. 

The culture at Healthy Baller is one of a kind and I am blessed to be in a work environment where everyone is willing to help one another learn and so passionate about working with athletes and helping them to grow in all aspects of their sport. 

Advice for Aspiring PT Students

I wanted my first blog post to help those looking to pursue PT school. First, congrats on either your acceptance or decision to become part of an amazing profession. Here are my top 5 pieces of advice

  • 1. Be Prepared & Ready to Work: PT school is hard.🤓PT school is a doctorate program and you have to be prepared to put in the time and effort. It’s a grind💪🏼for sure but believe me, its worth it. At times you may want to give up or question if you can do it. Believe in yourself because you can and you will get through it. I remember looking back on my first semester of anatomy and remember how hard it seemed at the time. But guess what? I got throughs it and so did my classmates: AND so will you. 
  • 2. Find your Support: Whether this be your family, friends, or even professors. You need to have people in your life that you can lean on when times get hard, help to support you and push you to be your best, and make the three years of school enjoyable. I don’t think I would have made it through school without my family, great group of friends I made at school that helped me study, kept me sane, and made life fun OR my amazing professors. Having relationships with your professors can make such a positive impact on your experiences in school. I was fortunate enough to have professors who were amazing role models and educators but also had fun with us outside of the classroom and who truly cared about us as individuals. Make sure you find your support no matter who/what this looks like or you
  • 3. Be A Sponge: One of the best things a professor told me in school was to be a sponge. As students, we’re young and have so much to learn; so take it all in. Drop the ego and be ready to absorb and learn from all different kinds of educators, PTs, and SPTs. Even if you don’t 100% agree with their thoughts, be a sponge and take it in because you have so much to learn and different schools of thought and research will shape you into the clinical you are working towards becoming. This is especially important on your clinical rotation where you will be exposed to different settings and many different clinical styles. Don’t be closed off-just be open to learn, willing to try things and always ask questions. Also, don’t be afraid to reach out to PTs in the area the are woking in the setting/facility that you want to be in one day. Take the opportunity to ask them questions or even shadow them while you’re in school. Just try to take advantage of every opportunity .
  • 4. Keep Your Passion: Don’t ever forget why you chose to pursue a career in physical therapy. No matter how hard school may get, or how hard a certain patient case may seem. Don’t let any of the negativity dull your spark and passion for the profession. ✨
  • 5. Have fun: Most importantly, don’t forget to have fun and enjoy the 3 years. While it may be hard at time, take the time to enjoy life-Remember it is your last few years before having to adult.(whatever that is🤷🏼‍♀️) Enjoy the time with friends you make, do things you want to do for your own mental health, and take time to explore the new city that you’re in. I was lucky to be in beautiful Charleston, SC and loved exploring new restaurants, coffee shops, happy hours, and of course going to the beach whenever I could. PT school will be hard, but it should also be some of the greatest years of your life so don’t waste the years in the library-keep experiencing life ❤️