Monday, December 17, 2018

Improving Movement When It Matters - Part II

Last week we talked about Kinesiophobia or the fear of moving.  This week we are going to continue along that line of discussion to talk about your impact on psychological movement. 

Recently I had the honor and pleasure of co-chairing the National Sports Medicine Conference with Dr. James Andrews and Kevin Wilk, PT, FAPTA.  During this conference, Dr. Andrews did a Keynote Speech entitled "My Life In Sports Medicine & The Quest For Excellence In Your Career".  This was a chance for physical therapists and athletic trainers to hear from one of the best about what he has learned throughout his career and what we can take away from that.  One of the things he mentioned is that sports medicine is hard work!  You have to keep up on the literature, be continuously learning and work hard to get to the top or be the best.  He also talked about "don't ever underestimate the impact that you have on the physical and psychological impact of the patient".  This is most evident in those patients who suffer an ACL injury and are on the long hard road of recovery and return to sport.

Ardern et al AJSM 2013 studied the psychological factors that impact an athlete's ability to return to sport.  In this study they talked about two things that can greatly impact an athletes ability to return to sport is fear of reinjury and sport locus of control.  We have talked about Kinesiophobia or fear of movement which plays into the fear of re-injury but does not encapsulate the totality of fear of reinjury (which we will talk about shortly). 



Fear
As with Kinesiophobia, fear of re-injury is addressed in some similar ways.  There are things we can do in rehab that will reduce the fear of re-injury and which should start day 1.

  • Education - fear during rehabilitation comes from uncertainty and lack of confidence which can be eliminated with education. 
    • Educate the athlete about the surgery, the graft and healing process of, what the stages of rehabilitation will be and what the steps will be for returning them to sport. 
    • Educate them on movement and how controlling the movement will help in reducing risk of re-injury. 
    • Educate them on the importance of single limb training and control of frontal plane motion during single limb training
    • Educate them on their role in the rehabilitation process
*Providing this education also has a multiple effect on fear.  By you providing this education, this builds the athlete's confidence in you as their provider.  The athlete having confidence in you as their provider will give them more confidence when you move them through the phases of rehab and progress them to single limb activity as well as more sports specific conditioning types of activities*
  • Early single limb training - starting very early in the process with single limb training.  Even if this is weight shifts to single leg balance with support or single leg press, the sooner single limb activity is started the quicker the asymmetry is addressed and the faster they will build confidence in the limb.
  • Progression to single limb performance training - moving the athlete to more aggressive types of single limb performance training under controlled conditions (in a the clinic or under your guidance) will build confidence.
  • Coach - sometimes taking off your rehabilitation hat and putting on your coaching hat can be difficult for some providers.  But in the later phases of rehab as we move to more aggressive training, the ability to coach an athlete through more difficult training while being mindful of proper movement will help the athlete see what they can really accomplish.
Another psychological factor that can have an impact on movement and an athlete's psychological readiness is sport locus of control.

Sport Locus of Control

Sport locus of control is a psychological term that originated by Julian Rotter in 1954. It considers the tendency of people to believe that control resides internally within them or externally.  In other words, the athlete is in control of their destiny or their destiny is determined by something else.  Throughout an athlete's athletic career, they have been in control of their destiny.  They have come to learn, that they are accountable for their actions and their performance.  If they train hard, put in the time and the effort, then they will perform better and have better results.  They are in control of their athletic destiny.  For an athlete, to have this control is important.

After an injury (especially an ACL injury), many athletes see this as a loss of control.  Their destiny is now in the hands of the surgeon and the surgical technique that was performed.  Their destiny is in the hands of the therapist or athletic trainer and how good they are at ACL rehab.  For the athlete, they have lost complete control of the situation and are now reliant on others for their future destiny.

So this is psychology, can I impact that as an athletic trainer or physical therapist?  You had better believe it!  In the words of Dr. Andrews, "Don't ever underestimate the impact you have on the physical and psychological impact of the patient".  So how do you positively impact Sport Locus of Control and give that control back to the athlete?  All of this starts on DAY 1!

  • Educate the athlete on the injury, anticipated course of rehabilitation and THEIR ROLE in the process.  Let them know their outcome is dependent on what they put into the game, how well they listen to their coach (you) and how well they execute the plays (rehab and home exercises).
  • Coach - coach them through the process.  Encourage them when they need it and yet push them hard when indicated.
  • Empathy not sympathy - be empathetic to your players and have the ability to put yourself in their shoes.  But don't let your empathy turn to sympathy and babying the athlete along the way. 
  • Encourage don't discourage - there will be days to address the psychology of your athlete and step things back a little but also days to push them hard through it in an encouraging manner.  Remember the psychological impact the injury has on them and their life.  Coaching them through that is where champions are made.
  • If your attitude sucks, get out.  Don't ever let your bad day become the athlete's bad day.  We are there to do a job, build people up physically and mentally.  If you let your bad day be reflected in the clinic or athletic training room, it will impact every athlete you touch that day.  DON'T do it.
Next week we will start to look at single limb training and why that is such a critical part for restoration of proper movement and maximizing carry over to sport.  If you enjoy this blog, please share with your colleagues and follow us on instagram @ bjjpt_acl_guy and twitter at @acl_prevention.  #ViPerformAMI #ACLPlayItSafe


Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training and a competitive athlete in Brazilian Jiu Jitsu for 5 years.