Posted on

Case Study: Professional Lacrosse Player Post-Op Groin Surgery

There are too many abstract discussions in the performance space these days about how to train and rehabilitate athletes.  These circular arguments usually yield nothing substantive or actionable because providers spend too much time defending their ideology and trying to articulate why they are in the right instead of just being transparent and “showing their portfolio”.  As an example, investors should demand that financial advisers share their own portfolios instead of pontificating about macroeconomic theory. Words matter but what people do when they have skin in the game reveals more about them than their explanatory justifications for said actions. 

Continue reading Case Study: Professional Lacrosse Player Post-Op Groin Surgery

Posted on

The Silver Rule of Return To Sport Protocols

Clarity of expectations among surgical and rehabilitation providers is paramount following an extensive surgery like an ACL reconstruction. Post surgical protocols are one way to control or manage expectations. Generally, the point of contention between surgeons and physical therapists/athletic trainers is who decides what the protocol should look like. Physical therapists tend to reason that surgeons don’t have enough direct experience working with athletes outside the operating or examination room to dictate the patient’s progression. Conversely, the sentiment among many surgeons is that they effectively “own” the patient even after the surgery because they assumed the greatest risk and exercised the care that requires the most training and skill. An orthopedic surgery gone awry can result in permanent disability and even death. The worst case scenario rehab wise is a recurrence of the original injury (e.g. retearing the ACL during a change of direction scenario or disrupting a repair site via overly aggressive mobilization early on) in which case the surgeon would have to clean up the mess- again. Both parties’ concerns seem legitimate on the surface so what’s a reasonable compromise?

Continue reading The Silver Rule of Return To Sport Protocols

Posted on

Case Study: Hamstring Tendinopathy In Professional Distance Runner

Hamstring Tendinopathy Blog

There are too many abstract discussions in the performance space these days about how to train and rehabilitate athletes. These circular arguments usually yield nothing substantive or actionable because providers spend too much time defending their ideology and trying to articulate why they are in the right instead of just being transparent and “showing their portfolio”. As an example, investors should demand that financial advisers share their own portfolios instead of pontificating about macroeconomic theory. Words matter but what people do when they have skin in the game reveals more about them than their explanatory justifications for said actions. 

The point of these case studies is not to suggest that what we did in any of these situations is particularly good. If we’re being honest, we don’t always have robust outcome measures to suggest that what we do really “works”. More often than not, we default to the eye test. We coach and own our decisions. The intent here, therefore, is to be completely transparent about what we did when an athlete’s time, money, and readiness was at stake in hopes that other providers share their experiences and contribute to a more genuine collective conversation.

Background

Female professional distance runner (event withheld to protect identity) with left hamstring tendinopathy x 2 months that kept her from running more than 10 miles a week during that period. Athlete also works full time as a medical researcher and is currently applying to medical school. Athlete had substituted running volume with swimming and biking to avoid symptom provocation and maintain training load. Athlete reported for her initial evaluation with us in late March 2019 with the goal of competing at the USATF Championships in July. She had received treatment (mainly manual therapy) from other providers prior to her evaluation with us and reported transient relief but nothing that allowed her to increase her running volume to normal levels.   

Continue reading Case Study: Hamstring Tendinopathy In Professional Distance Runner

Posted on

Anatomy Is Overrated

Anatomy Is Overrated Blog

“Richard Feynman’s father, Melville, taught his son, the difference between knowing the name of something and knowing what goes on:

See that bird?  It’s a brown-throated thrush, but in Germany it’s called a halzenfugel, and in Chinese they call it a chung ling and even if you know all those names for it, you still know nothing about the bird.  You only know something about the people; what they call the bird.

Now the thrush sings, and teaches its young to fly, and flies so many miles away during the summer across the country, and nobody knows how it finds its way.

Doesn’t this tell us something in the sense of learning?  Words or names don’t constitute knowledge. Knowing the name of something doesn’t help us understand it.”

-Bevlin’s Seeking Wisdom, the “secret f’ing weapon” according to Mladen Jovanovic

Anatomy is overrated for physical therapists and movement professionals.  To preempt the strawman responses, anatomy is not unimportant. Anatomy is just not typically taught in a manner that contextualizes its real utility.  Traditionally, the study of anatomy is akin to memorizing the instruction manual (including all the parts and unique nomenclature- effectively learning a new language) for a car in hopes of becoming a better driver.  During my first semester of physical therapy school I was responsible for identifying every muscle, bony landmark, blood vessel and nerve in the body. Almost eight years later, I would most certainly fail any of the written or practical exams from that course.  I can no longer draw the brachial plexus from memory. My current inability to do so does not diminish my appreciation for how the brachial plexus is important conceptually. If clinical practice alone does not reinforce the information tested in an entry level course, however, then said course is a means of initiation or selection, not a precondition for clinical competence.

Continue reading Anatomy Is Overrated

Posted on

Case Study: Hamstring Pull In High School Sprinter

Case Study: Hamstring Pull In Sprinter

There are too many abstract discussions in the performance space these days about how to train and rehabilitate athletes. These circular arguments usually yield nothing substantive or actionable because providers spend too much time defending their ideology and trying to articulate why they are in the right instead of just being transparent and “showing their portfolio”. As an example, investors should demand that financial advisers share their own portfolios instead of pontificating about macroeconomic theory. Words matter but what people do when they have skin in the game reveals more about them than their explanatory justifications for said actions.

The point of these case studies is not to suggest that what we did in any of these situations is particularly good. If we’re being honest, we don’t always have robust outcome measures to suggest that what we do really “works”. More often than not, we default to the eye test. We coach and own our decisions. The intent here, therefore, is to be completely transparent about what we did when an athlete’s time, money, and readiness was at stake in hopes that other providers share their experiences and contribute to a more genuine collective conversation.

Continue reading Case Study: Hamstring Pull In High School Sprinter