rehab

This fall marks my 7th year as either a competitor or provider in collegiate athletics. During these seven years, I’ve been fortunate to do my part in 4 different programs at the Division I level. These experiences have been as narrow as a football only focus to as broad as encompassing all varsity collegiate sports. Being in college athletics long enough, you encounter both consistencies and diversities from school to school. I’ve seen a range of skill sets, coaching styles, training atmospheres, etc.

As different as one school may be from another there are always constants to collegiate athletics. There are right ways, and wrong ways to do things. This applies to all aspects of the athletics department. Leadership, work ethics, strength training, you name it. The bottom line is just as in a business, there are many things that successful athletic programs do across the board. When a high enough majority of athletes do more right than wrong things, it translates to success on the field. As a provider over the last few years and looking back to years when I was in competition, these same principles apply to athlete rehabilitation and recovery.

 

The Basis of Recovery

It is inevitable for an athlete to undergo a certain degree of wear. Eventually every athlete will begin to break down from activity in their sport. Each person is different, and will break down at a different rate or handle stress from training differently. This means that time plays a huge factor in the development of injury, dysfunction, and compensation.

When the body is being pushed to perform, it will in turn encounter an amount of breakdown and wear. This can be from workouts, practice, competition, etc. In its essence, recovery is based around supporting the healing response that naturally occurs to overcome and build from this training breakdown. The better an athlete can recover, the more they will build, perform, and avoid injury. Injury avoidance is often the least recognized in collegiate athletes, as it usually isn’t realized until AFTER injury occurs. True to form, the longer an athlete competes, the better chance of injury caused from this general wear and tear. The most common cause of muscle strains and non-contact injuries are by far excessive, repetitive stress, compensations, and chronic dysfunctional motor patterns.

 

Why Start at High School?

So why should you as a high school athlete care about this? You never feel very sore after competition or training, can get 5 hours of sleep a night and feel great in the morning, and can eat whatever you want without seeing much performance drop? Really, statistics tell us that only a fraction of high school athletes make it to the collegiate level (especially Division I). On top of that, only a certain amount actually PLAY in college. Of those who play significant time in college, few make it to the professional level. So does building recovery habits now really matter? If you’re a high school athlete who is serious about playing at a high level, yes, it absolutely does.

 

Eventually, everyone reaches a breaking point. A high school athlete can get away with 5 hours of sleep now, but what happens when he steps into a college arena, where being an athlete is literally a full time job while also having school? And as a former athlete, I can tell you that you won’t have to worry about the soreness argument. NOTHING you do at a high school level is remotely close to the challenges of workouts and practices at the higher levels of collegiate athletics. A normal practice in college is the equivalent of the hardest game you played in high school. And no training session in high school can prepare you for the demands of training at this level either. How about nutrition? I will honestly say that my one regret of collegiate athletics is not taking nutrition as seriously as I do now. I absolutely regret that I didn’t spend more time picking the brain of my strength coach on proper nutrition habits. It is a FACT that the performance you get out is a direct result from the fuel you put into it. If you are a hot rod on the drag strip, would you choose to fill your tank with a shitty, low grade 87 octane? Or would you pick a 100+ octane racing fuel? These are all recovery habits that could be changed now. Think of it this way: you are performing well now with a half-assed effort towards your body. Imagine how much better you could perform if you actually able to build a few good recovery habits now?

 

Investing in Your Body

I have seen far too many talented and determined athletes have their careers taken away from them because of injuries which could have been prevented or prolonged. This should be the single biggest point a high school athlete gets through their head. You never know when your career is going to be up, and very few people get to leave their sport of choice on their own terms. For every Michael Jordan or Peyton Manning that goes out guns blazing atop of the world as a champion, there are countless of other athletes (Derrick Rose, Bo Jackson, etc) that see their careers changed in the blink of an eye forever. And what about the athlete that somehow seems to stand the test of time? I guarantee you they spend just as much time investing in their body and its recovery as they do preparing or practicing, if not more. Two years ago, Sports Illustrated released an article about Tom Brady’s attention to his health. From diet, to sleep, to time off, and prehabilitation, there is an insane detail to the methods that Tom Brady uses to keep himself healthy.

 

*Image Courtesy of ESPN.com*

 

At the college level, specifically, a usual tell tale sign of how to tell the upperclassmen from the lowerclassmen simply by how much time they spend in the training room. Unfortunately, a good portion of them end up doing this because they are constantly beat up and now understand that the only way they will make it through the next game is by doing everything possible to heal. It’s not that they aren’t talented enough. It’s not that they can’t figure out the plays or don’t understand the game. It’s literally because their bodies are fatigued and worn to the point that they cannot perform at the level they wish to perform.

The younger players are mostly healthy and still getting away with their crappy habits and are nowhere to be seen in the building up until practice or workouts. Now that being said, some of the players do actually get it. Some have figured out that they feel better and need to be investing time to keep them from breaking down. They realize that when pro teams come calling, there are just as many factors riding on their health as there is their ability to play the game. When an NFL team signs a player, they are doing so as a business who is making an investment. No one would buy a product which is used and in bad shape.

 

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*Image Courtesy of Sports Illustrated*

 

So for the high schooler, what can be learned from this? If you are serious about wanting to play at the next level, think of it as an investment. An investment in building recovery habits is an investment in a future career. Just like in actual investing, the earlier you can begin, the more you can get out of the investment over time. Your body will not break down all at once today, tomorrow, next week, etc. It will break down slowly over time and by the time you realize you need to invest, you have run out of time to get much return out of it. Learning to spend the time building proper recovery habits and seeking out professional help to identify your weaknesses will allow you to better achieve what all athletes eventually lust for, longevity. I know as a provider, that if I get a young athlete in who is injured, I have a chance to make an impact on their recovery habits. Pain is a huge motivator, and in athletes, losing the chance to compete is an even bigger one. So I know I have a window of time in which I can persuade them of the importance of proper recovery habits. On the other hand, I know if I get a veteran player who is injured and has not spent much time in the training room, I have a limited chance of instilling any good habits into him, and thusly protecting his career. It’s simply a case of the amount of time an athlete has spent towards investing in their body’s longevity. So imagine if high school athletes, along with guidance from their coaches and parents, started investing in those habits now. They would already have a head start on doing things right. Once again, there are right ways and wrong ways to do things, and the right way to ensure a long career is to build recovery habits now.

 

Mid-South Spine and Sports Performance is invested in the continual process of providing the best in sports performance care for our athletes and patients. One of these products have been our recent addition of Foot Levelers functional orthotics. These orthotics are providing a much needed support system for an often neglected are in many athletes, the feet. In an effort to continue this investment towards optimal performance care, we are now offering $100 off the next 6 orders for two pairs of orthotics. This is a limited promotion on Foot Levelers, which will last through October.

Since announcing their availability, I’ve received a lot of questions about Foot Levelers, and the different options, recommendations, and applications for their use. Currently there are almost a dozen different sizes and functions of orthotics that are available through Foot Levelers. The typical question I receive because of this is, what orthotic should I get, or what is the difference between one orthotic and another? In most people looking to buy orthotics, we typically recommend they buy two pairs. Just as most people have multiple pairs of shoes for different functions, the same is needed from an orthotic. With all the different combinations, it may get a little confusing and needs some clarification. For this reason, I’ve separated these orthotics into 4 groups: Athletic, Casual/Everyday, Business/Dress, and Work. Each group has its own specific need which narrows the field down to only a few options and also helps determine which two pairs you need the most.

 

Athletic:

In athletics, the number one identifier and measuring stick is performance. No matter the sport, performance at the end of the day comes down to the production and application of force. Whether you’re cutting, jumping, squatting, etc., performance is directly dependent on the body’s ability to resist, produce, and withstand forces. In most cases, the common denominator where force exchanges between the internal environment (the body) and the external environment is the foot. Even in throwing or hitting, a large amount of force must be transmitted from this location. Because of this, the athletic group needs an orthotic that improves transmission of intense forces in the three arches of the foot. Additionally, this orthotic needs to have a high amount of support to keep forces from being absorbed, which can cause wear and even injury in the foot and lower extremity.

 

Casual/Everyday:

This orthotic is all about comfort and support. An everyday orthotic doesn’t need to meet the rigorous force transmission standards as an athletic orthotic. It’s function is to maintain proper propulsion and force transmission through a mild to moderate amount of forces required for walking and standing. This orthotic will also be designed to allow more airflow and reduce sweating to keep it fresh over its lifetime.

 

Business/Dress:

This category of orthotics has the most variety, as it is geared towards addressing the different shapes and structures of dress shoes for both men and women. Men’s dress shoes come in many different shapes, especially in the toe box area, and many women’s dress shoes have very little room available for a typical orthotic. Most dress shoes are made for looks and not for comfort. Traditional men’s dress shoes have a very solid sole which can cause the heel and ankle to jam after walking or standing for long amounts of time. In general a more solid shoe will cause more rigidity in the foot and limits the foot’s ability to unlock during normal motion. Women’s dress shoes can be on either end of the spectrum, either too flexible or too rigid. For women, a foot levelers orthotic specific to this group comes in full and partial length to accommodate for the space factors while still providing the right amount of comfort and support for proper movement.

 

Work:

This group of orthotics are designed specifically to resist heavy wear and keep forces from being absorbed in the foot. There is no such thing as a light weight work boot, and for those who wear them every day for 40+ hours a week, it’s a weight that is felt in the foot. Most work boots are designed to be rigid and tough in order to withstand an everyday beating that most shoes cannot take. Now compound that boot design with the hard and unforgiving surfaces like concrete, metal, and support platforms that this group usually stand or walks on, and its impossible to ignore the amount of force going into the foot. This causes a multitude of issues as the foot absorbs the brunt of these forces as it is not able to properly move through its normal motion to transmit these forces in the the rest of the body or out to the external environment. For this group of orthotics, a huge emphasis is placed on durability and support.

 

How Do I Pick the Correct Two Pairs?

For most patients that we see, the most common first orthotic is the athletic one. As most of our patients live an active lifestyle, they need an orthotic that provides the right support, regardless of their activity. From there, we typically recommend an orthotic that fits your next most common activity, work. If you are an execute who travels a lot for important business, pick the business category. A trainer at the gym, or at a desk job with a laid back attire? Go for the casual orthotic. How about electricians, plumbers, construction workers? They need a work orthotic that will handle their high loads of stress. Remember, if you’re not sure, you can always ask and we will make sure to find the orthotic that best fits your scenario. Just remember, this limited promotion is good for the first 6 orders and lasts until October, so don’t wait too long!

 

As always, for further information on how Mid-South Spine and Sports Performance can assist your needs, contact our office by phone: (901) 573-2526, email: drdetweiler@midsouthssp.net, or by visiting NBSFitness.net.

Everywhere you look these days, there’s another scheme at work.

“Get rich quick!”
“Lose 30 lbs in 30 days!!”
“New trick for six pack abs fast!”

Thing is, they’re all bullshit. Now, I know that’s a grand statement. Some things may have some efficacy here and there, but most don’t. You see it in the supplement industry, you see it in pharma, and you see it in rehab.

Whoa. Rehab? Yeah, I said it. Maybe not so much from the specialists, but this culture affects how people expect us to practice.

One of the most frequent questions I get is this: “I hurt X, how long will it take for me to be back lifting heavy?” The single act of hearing that question prompts quite possibly the least thought out response I can muster : “12-16 weeks”. Oftentimes, this may hurt the individual’s feelings. He or she knows I’m a physical therapist, and has heard people say how good I am at what I do. They come to me with stuff so destroyed I can barely wrap my head around it, have been told surgery is the only fix, and ask what I can do to get them back lifting. Here’s the rub: if you have a symptomatic serious injury, and a top notch surgeon says they need to go in there and fix it, I’d typically recommend you listen.

Otherwise, you’ll try all kinds of exercises, working around you injury, thinking it feels better a few weeks later until you try the movement that injured it in the first place, and BOOM, reinjury happens. Then you try something else. All that time could have been spent productively rehabilitating a post-operative repair and have you back in the game far sooner than expected. At this point, I’m sure some of you are thinking I’m a little angry and riled up tonight. Perhaps I am slightly, but I have a perfectly good reason.

At NBS, we have the luxury of amazing trainers and programming minds working hard to make sure the lifters and clients alike are receiving the best possible programming to achieve their goals. You will consistently hear people say “I have never done this, but I’m willing to give it a try.” They BELIEVE in the program and TRUST those at the helm that the process will work. They trust that all those reps, jumps, sore days and the like will add up to improved performance and better living through strength and fitness. It’s almost a no-brainer, and you see that same term bandied about by all those well known coaches across the internet. It’s a growing phenomenon. TRUST THE PROCESS.

Now, I really wish that we could make the same strides in regards to rehab. Nothing comes quickly when it comes to fixing you body. I can make some adjustments, stretch what’s tight, etc and provide rapid relief, but you have to continue to manage that tissue long term or it will go right back to what it was. It’s even more tedious after an operation, unfortunately. For 99.9% of the population which is not genetically elite, it will take time to heal, and then time to strengthen, and then time still before you’re back at it with the iron. Most post-operative reinjuries of repaired tissues happen 6-8 weeks after surgery. Why? Because that’s when things start feeling “normal” again, and people typically ignore their therapists and doctors and try to go back to daily activities at their previous rate. It just doesn’t work that way. You heal at a fairly fixed rate, and other than some exogenous hormones, there’s no way to speed it up. Listen to the timelines and stick to it. The PT will always progress you when they feel the time is right.

My main point with writing this is simple: TRUST THE PROCESS. Most physical therapists coming out of school today have a doctorate. It requires an intensive level of schooling to achieve, and I think that should garner a certain level of respect when we make recommendations to the progress of your rehabilitation. Now, some of us think differently than others, and may introduce certain exercises or activities earlier than others, but the bulk of the process remains the same: the tissue must heal before it can be strengthened. Once it can be strengthened, then one must take particular care to ease back into previous strength based activities or risk reinjuring tissue. Listen to your therapists. TRUST THE PROCESS. We are in the trenches with you trying to get you back up to speed. We want you to be able to compete again. Listen. Learn. Pass on. And once again:

TRUST THE PROCESS.

Stay strong my friends.
Taylor Weglicki, PT, DPT
Owner/Director of Strongman PT, PLLC

 

A Treatise Against Foam Rolling

Taylor Weglicki, PT, DPT

For some time now, mobility has been taking the fitness industry by storm. Everyone is too tight, we sit like crap, we move like crap, and only the foam roller and mobility workouts of the day can fix it. Now before everyone jumps down my throat about this, remember: it’s only a tool for the tool box. The way you hear some people bandy about on the internet, foam rolling/mwod could cure cancer.

I’m not saying that neither of these options is useful. Quite the opposite really: they can be amazingly useful, but only if done right. Mobilizing every day is useful for the absurdly tight with terrible movement patterns, and I often use this with my own patients – but only in 1-2 week intervals. Mobilize everything, everyday, and soon you’ll be dumping torque and tightness left and right. Literally.

My goal for this article is to discuss foam rolling in particular: why it’s good, why it’s bad, and why you should honestly think about why the hell you’re using it. This process in my own training resulted in a complete revolution in my warmup, and subsequently considerably less pain before, during, and after training. I’m hoping this article can help do the same for you.  Now let’s get down to it.

Look at him. So supple. I bet he foam rolls every day.

(http://www.korduroy.tv/wp-content/uploads/legacy-uploads/uploads/image/image/655/Kord-exercise.jpg)

Get Your Learn On

First thing’s first. The Science. Yeah, we fancy, huh? So, the scientific term for foam rolling is SMR, or self myofascial release. It’s a nifty style of soft tissue work often used by chiropractors, massage therapists, and physical therapists for a particular purpose: INHIBITION. You read correctly folks, inhibition. So what about all those minutes of foam rolling you’re doing before your workout? That work is essentially turning off the muscle groups through a concept known as autogenic inhibition(1). Many people have experienced this in a different way. Everyone knows the feeling of going for a max effort attempt, and then suddenly it seems like your body simply shuts off. That right there, folks, is the activation of the autogenic inhibition reflex from the Golgi tendon organ to prevent muscle tearing, thus inhibiting the muscle and “saving” it.

The development of high tension is the key. Therapist will often use focal point tension on trigger points to elicit the same effect. Trigger point work feels like hell (as can foam rolling, but it’s highly effective when used properly. It can be therapeutic, but can also be detrimental to your performance. You do something similar when you foam roll at length. That’s why those nasty spots that feel so bad when you’re rolling suddenly seem to relax and feel better. You’ve inhibited the tissue and caused it to ease up on its focal point contraction.

 

Knowing Is Half the Battle

How many of you go attempt a max deadlift after a massage session? Or get under the bar for a record setting squat after being adjusted by the chiropractor? Hopefully at this point the NBS team has taught you better than that. You shouldn’t do it. If you go attempt to straight in to heavy work after inhibiting primary structures, something is going to fail. Could be muscular, could be ligamentous, but something will fail. On a similar note, then, why do you foam roll before a heavy workout? Why?

My major point here is this: THINK about why you’re warming up. Are you doing a particular thing for a purpose? Or because you read it was useful somewhere on the internet? Inhibition can serve to help us in certain circumstances, but gone (should be) are the days of foam rolling from head to toe for 20 minutes prior to training. It doesn’t make sense. So stop it, and attack your warm-up from a different angle. David and I both have options that should work pretty well. Feel free to come talk to us and ask. Or read any of David’s articles really.

But I Love It, and Can’t “Let It Go”

She can let it go. But does she even lift?

(http://www.alexisdelchiaro.com/wp-content/uploads/2014/03/Disney-Frozen-Let-It-Go-4.jpg)

I’m not saying you have to give up your precious foam rolling completely. Not at all. I’m just saying use that noggin’ of yours and make sure you’re doing it with a purpose. On training days? Use it only to inhibit that which needs inhibiting. In most lifters, you’re looking at IT Bands, maybe adductors, and maybe calves. That’s it. Don’t stretch your back over the roller, don’t pop your midback on the roller before a workout. Just don’t. Mobilize intelligently and with a purpose. Best times to go all in on the foam roller are after meets, during deloads, or on off days. Feel free to roll the snot out of everything after you can after a rough ME day. Just be smart about what you’re doing on the days that you train. Your body will feel better, and you’ll perform better as a result.

 

Now get in there and lift heavy.

 

Questions? Comments? Concerns? Cries of Outrage? Leave them in the comments section below!