Random Thoughts on Coming Back from Injury & Brian's 3 tips for training/rehab of athletes

I wanted to share this article with you all today for a couple of reasons.  Primarily, I wanted to talk about Patrick's point number 3:  Rehab needs to progress and not be soft.  I couldn't agree more.  Too often I see therapists who work with athletes that do not truly get them ready for their return to sport.  Rehabilitation for an athlete MUST be different because their demands are different.  Basics may be similar and time needs to be spent on them but when an athlete is ready to go back to sport they must have performed enough demands in rehab to practice their skill.  Below are a few points I feel should be considered when rehabbing athletes.  


1.  Sports are Reactive, train accordingly.  
     - What I mean by this is that we must not only go spend the time on the basics but then evolve the rehab.  For example, when training lateral movements, the motor control & strength needs to be there at slower speeds but then progressed to faster speeds.  Once the athlete can do this MULTIPLE times then they NEED to be progressed again.  How do we do this?  Reactive training.  Forget the cones and the mirror, we use these way to much.  Instead point and direct or use verbal commands for a specific direction.  Observe movement and/or videotape for the athlete and yourself.  See the differences between the reactive movements and planned movements.  Are they consistent?  If not, find out why and re-train/re-assess.

2.  Perform a needs analysis and train accordingly.
     -  Are they a baseball player or basketball player?  Pitcher or Point Guard.  Again, could the basics be the same? Yes, they very well might be and they need to be well done before progressing them.  But once they are ready to progress make sure you look at the biomechanics of their sport.  Training a point guard vs a power forward is going to be very different.  Make sure you understand this from day 1 of rehab.  Then make it the goal to rehab them so they can perform their specific position activities.  Not the skill of the sport because thats not our job.  Our job is to make sure they can move well within the context of their sport & position.  To make sure they have adequate stability and mobility to perform their skill (shooting, dribbling, etc).  

3.  Be individualized and objective
     -  This one is really easy to fall out of.  When craziness occurs its easy to lose track of objective measures and individualization.  But this is so important.  Just because you have two baseball pitchers coming back from Tommy Johns does not mean they should get the same rehab program.  Again, basics may be the same.  But maybe one of them has underlying shoulder or hip issues while the other does not.  Therefore, rehab will be different for each.  Lastly, objective measures must be used.  How do you measure progress?  This goes back to Patrick's point number 4 where he talks about monitoring.  If you are rehabbing a jumping athlete's right ankle then make sure you are objectively measuring things.  Measure both ankles height with jumps for example.  Measure ROM, strength, and a Y-balance.  Something needs to be measured to properly monitor progress.  At the same time don't get too hell bent on measurements.  An athlete could have the same jump height side to side but look horrible on one side.  See if your athlete is taking off and landing similarly to the opposite leg.  Be objective but don't lose sight of movement.  

- Brian

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