In addition, providing video feedback, we also need to look at additional factors that result in compensatory strategies that were identified in the Wren et al study. Hartigan et al J Ortho Sport Phy Ther 2013 looked at Kinesiophobia (fear of movement) prevalence in ACLR athletes. What the authors found was that a lot of athletes scored high on the Tampa Scale for Kinesiophobia following ACLR. This is a research based valid measure of fear of movement in athletes. Whether it is the chicken before the egg or egg before the chicken, what we do know is that athletes high high Kinesiophobia move differently. They are more hesitant to move to the involved side, tend to shift their weight away from the involved side and have less control of the limb in single limb activities. So is it the subconscious awareness of the movement or lack of stability that creates the fear or is it the fear that creates the lack of stability. Sadly there are a lot of athletes that are discharged from PT who still demonstrate a lot of kinesiophobia.
The answer is not real clear. What we do know is that you can train them out of it. Before I knew what kinesiophobia was, the young athlete pictured here presented to my office for a return to play (RTPlay) assessment. During his history he stated:
- I am not confident moving to that side
- That side does not feel the same
- I don't feel like I am as strong on that side
- I am nervous cutting to that side.
Ardern et al Am J Sports Med 2013 showed that athletes who have had an ACLR have relinquished this sport locus of control to the health care provider. So what the heck is that and why does it matter? As an athlete, who is in control of your destiny as an athlete? Who controls how hard you work? Who determines how hard you practice? Who determines how much you effort you put out on the field. Ultimately, who determines you success in sports? The answer in most cases is you, the athlete. You are in control of your destiny. You have the sport locus of control. You are in control of your destiny in sports.
Following an injury or ACLR, the athlete, many times for the first time, reliquish this sport locus of control to the health care provider. So suddenly someone else tells them what they can do at the gym, when they get off crutches, when they can start doing drills, practice with or without a brace and when they can get back to sport. In other words, someone else has the Sport Locus of Control. This lack of control can lead to depression and can add to kinesiophobia. So, it is vital that we give that control to the patient in visit 1. I am often heard saying, I am simply a coach and an educator, I will coach you along the process and educate you why we do what we do but at the END OF THE DAY IT IS UP TO YOU! In that one sentence, I am passing the sport locus of control over to the athlete.
In addition to passing the sport locus of control onto the athlete, we must also think through how we can impact kinesiophobia starting immediately in the first visit. What we have found that works very well is:
- Educate the athlete why you do what you do - they are much more likely to do if they know why.
- Pair with other ACLRs who are later in the process. This will create conversations and they will see how far along they will be in 3 weeks, 2 months, 4 months - it is encouraging.
- Start full weight bearing as soon as possible. This will help to normalize gait, aid in reducing qua atrophy and reduce risk for lack of TKE with gait.
- Start single leg activities as soon as possible. This is NOT balance but things like single leg squats, single leg hops, etc. This will build confidence.
- Push quality over quantity. We know it is the magnitude and speed of valgus that cause injury. Make sure they control that throughout the range of motion prior to proceeding.
- Make them work hard. Push them hard but safely. People are often amazed at what they can achieve.
Too touchy for you? Me to. Next week we will talk about specific training to control dynamic valgus. Please make sure to check out our new website at www.iceperform.com where our goal is to help you help others. #ViPerformAMI