Monday, June 1, 2015

To Change Movement - We Must 1st Change

No matter what side of the debate you sit on in regards to the health care, one thing is clear.  Change is needed!  As a physical therapist, I can say that a lot of the changes will negatively impact me and my practice.  That said, there are some very good things that will be coming out of the change and that is forcing more accountability in the care that is provided.  For physical therapists to have to be forced to measure outcomes is appalling.  Frankly, this should have been done over 15 years ago.  If we had, the standard of treatment that is provided today would be elevated and reflective of current evidence.  In my humble opinion, the term evidence based practice should not exist.  Instead, it should be the standard of practice that health care providers use the latest research to drive the way we practice.  But the sad reality is, this is not the case. 
The intent of our blogs is to present the most current research and provide us with how we might interpret this in application of what we do as health care providers, coaches or performance specialists.  It is one person’s opinion and as we all know there are multiple ways to interpret the literature.  The intent is to use research to question some of the conventional wisdom.  For someone to simply do things the way we always have because it works is not innovation.  What if we could use the research to tweak what we do to make it that much better?  There is a fine line between research and what can be practically applied in the clinic or field.  But true leaders and innovators are constantly striving to do that.  Take what we know from the research and find innovative ways to apply that to what we do in the clinic or on the field for even superior results.
The reality is that injuries impact future performance.  In 2012, McCullough et al found that only 43% of high school athletes who had an ACL reconstruction returned to their prior level of performance. In 2014, Rugg et al found that Division I athletes who suffered a knee injury prior to their Division I athletic career were at higher risk of re-injury, spent more days on the disabled list and cost the university more in health care dollars during their Division I athletic career.  So, iIs that necessarily a performance issue?  Heck yeah!  If I recruit a star player who has had a previous knee injury and he is on the sidelines 50% more of the time and injured, then he is not adding to my team’s performance.   
In April 2015, Ardern et al looked at athletes 2 years out from ACL reconstruction who had not returned to sport one year post.  Interestingly enough, they found very similar results to that of McCullough et al, where 66% had returned, only 41% were playing at their pre-injury level of sport and 25% were playing at a lower level.  This study also found that one of the factors influencing return to play at pre-injury level was psychological factors.  This highlights several key factors.  One is that an athlete returning to sport does not necessarily mean they are returning to the same level of sport or performance.  The other is the psychological impact that an injury can have on an athlete impacts their future performance.  Ardern et al further highlighted the impact psychology has on return to prior level of play in his 2013 paper.  Here, the authors found the major psychological factors influencing an athlete’s ability to return to the same level of sport were psychological readiness, fear of re-injury, and sport locus control (ability to control their destiny). 
So what is the take home from this.  One is that we simply have to get better at preventing the injuries!  We will talk about that in a minute.  But the second point is we need to address the psychology of the athlete early in the process.  One key take away is the role of the rehab provider in psychologically preparing the athlete and providing them the sport locus control.  If you are not personally vested in assisting the athlete achieving success, if you approach it with apathy, then you are doing the athlete a serious disservice.  Your psychological state has a direct and profound impact on the athlete.  As a provider, our role is as an educator and coach, with emphasis in this case on coach.  Coaching is not passive.  It is methodical in approach, motivational, inspirational and purposefully driven to the end goal all while also being empathetic to the athlete.  Empathy does not mean baby the athlete but relate to the athlete!  If done right, it also gives the athlete the sport locus control.  Making sure they know they have a responsibility and active role in the process and it takes hard work, persistence and determination, but at the end of the day, they can and will control their destiny.
Next week, we will continue this discussion.  If you like what you see, please SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.
Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at

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