Summer Is A Great Time For…Physical Therapy?
Summer is an incredible time for sports. It’s also an unbelievable time for physical therapists and orthopedists. Every spring, thousands of athletes ramp up their training by adding team practices, tournaments, and extra play to their weekly schedule. Fast forward three months, then hundreds of athletes are knocked out of the game because of catastrophic injuries, overuse syndromes, and recurrent niggles.
It’s not supposed to work this way. The work you do in winter is meant to protect you from the loads of spring and summer! I still believe no athlete should ever have a training injury.
In fact, at almost exactly this time last year, I wrote an article in response to an athlete’s question: “What do I do now, because I got hurt at practice this weekend?”
Go read the full article for a step-by-step guide to navigating your injury. Today I want to focus on a fundamental concept of returning to play: rehab is conditioning, so take it as seriously as practice.
The Principle of Conditioning
Here’s an excerpt from last year’s article:
Strength and speed and conditioning is just coordination work against appropriate fatigue.
That’s a principle.
So if you’re exploring movements that do and don’t cause you pain…
If you’re looking for power and grace despite an impairment…
If you’re focused throughout the session…
…then you’re still improving your coordination and you’re doing so under mounting fatigue.
Rehabilitation *IS* training. Treat it that way!
Let’s dig into what that really means, using my own Achilles rehab as a case study.
Coach Dunte Is (Still) A Dummy
When I first injured my right Achilles tendon from ramping my jump volume from 20-25 contacts per week up to 50+ more intense contacts per week…over 10 days…I fully understood how it was my fault.
Right away, I read a few dozen papers in sport science literature about Achilles tendinosis management and I found a provider to help me rehab. On his advice, I started up my ankle ABCs in the morning and before bed, iced or heated as appropriate, and extended my warmups.
I dropped almost all jump exercises from my training so I could keep my sprint volume up. Generally, I was fine. I could train, just with a touch of stiffness the next day.
But when I then injured my left Achilles tendon, I didn’t really get it. My provider at the time was an exceptional chiropractor and sports-oriented manual therapist, but wasn’t exactly a high-power athlete himself. Granted, he had served a LOT of types of athletes, but none specifically like me – post-collegiate, amateur, slightly overweight sprinter/hurdler/jumper types.
He helped me with pain management.
He helped me with inflammation management.
He advised rest and ice and elevation and soft tissue work and moderate training volumes and all the rest.
He did what I would expect any provider to do and, foolishly, I gave him all the control over my recovery instead of managing it myself.
But when my weekly sprint volumes just kept going down, down, down and when I couldn’t clear a hurdle without sharp pain, I decided that was it for me.
For all I knew about helping athletes get back on the field after they exited physical therapy, I couldn’t see beyond my own physical pain and emotional despair toward the type of action plans I had guided athletes through for 2 years at that point. (Now remember, I was very much still learning how to be a good coach and learning to eat my own cooking, so I attribute some of this to the ego and ignorance of youth, but I still had far more tools and knowledge at my disposal than most, thus my botched rehab remains my own fault.)
I quit track for other sports and gave up on my grand visions of becoming Masters World Champion in the decathlon my first year of eligibility. That was over seven years ago; exactly the amount of time I probably needed to become excellent.
The First Step Was Admitting I Needed Help
One year ago, now living in Colorado, officially retired from coaching, and fully surprised that track & field is available here, I decided to try my hand at sprinting and jumping again.
Thirty pounds heavier?
Fully deconditioned from power work?
Six years into working desk jobs and commuting?
Half the time available to train that I used to have?
Hell yeah. Game on.
This time, I knew I couldn’t do it alone.
Coaches need coaches.
That’s one of many lessons from all those years trying other sports.
But I also need to take ownership of my recovery. I needed to approach starting again in track and field like the continuation of my previous rehab.
What I had learned from exceptional track and sport coaches during my brief retirement showed me how incomplete my previous rehab was!
With my prior provider, we never got beyond symptom management. Inflammation existed because my damaged tissues couldn’t cope with the loads of training. I was doing too much, too soon, relative to their capacity. My line above – “fully deconditioned from power work” – shouldn’t be overlooked. I needed conditioning!
This is what I mean that conditioning is overrated.
Conditioning has never been and should never be working really hard so you get sweaty and tired.
Conditioning is simply preparing your body and mind for the specific coordination your sport requires under appropriate fatigue.
A soccer player isn’t conditioned for the game by jogging 5 miles.
Jogging 5 miles is purely aerobic, linear, moderate-impact, predictable exercise.
Soccer is highly polarized, multi-directional, high-impact, reactive performance.
Jogging may be a part of conditioning for soccer (I’m against it, but it can work), but it isn’t the game, therefore it isn’t adequate on its own in preparing for the game.
Conditioning is about developing qualities. “Specific coordination” means doing game-like things at game-like intensities. “Under appropriate fatigue” means for durations, at intervals, and in contexts that mimic or slightly exceed the requirements of the game.
Armed with new understanding about conditioning, I needed to ask more rigorous technical questions about the demands of sprinting. But academic knowledge wasn’t going to serve me here; I carried a lot of fear about sprinting and jumping. And I have never been good at following my own programs for very long.
I always do better taking a program from a coach I trust because it removes my own coach brain from the experience. (This is what’s hard about being self-coached!) So I very intentionally sought a provider who had lived my injury and my recovery. I sought a provider who had counseled other athletes through the particular cop-outs and compromises and avoidance behaviors I knew I would have.
Then I sat with that provider to discuss the needs of my activity in excruciating detail. I shared my training logs, my previous bests, my goals, and my concerns.
First, she listened. That’s essential.
Second, she asked more questions. That’s essential, too.
Third, and truly only at the very end, she addressed my fears directly.
She told me things would be hard, that I would encounter fear over and over, and that progress would come slowly. She set expectations before we moved on.
The Conclusion We Reached About My Rehab
After nearly three hours of discussion spread across two sessions, she finally gave me what I “wanted” (because everything else was very much what I NEEDED): I simply hadn’t done rehab that conditioned me to sprint.
If I did that rehab concurrent to low-volume sprint training AND if I honored our traffic light system of when to push, when to back off, and when to stop entirely, I could reasonably push up my volume week on week for a long time.
Pain was not BAD; pain was a message. I needed to acknowledge that pain, honor that pain, and explore that pain before deciding how to proceed.
She gave me language and tools and principles to use to evaluate my own pain. And she promised to be available when I needed help.
I went away for two weeks to play with the basic PT exercises she gave me (this wasn’t flex-against-Theraband stuff; this was controlled, dynamic loading; this was pre-plyometric stuff!) and to start with training I felt confident I could execute.
Afraid of maximal acceleration, as I was? Stair runs.
Afraid of landing single-legged like me? Jump rope.
Then remain hyper-sensitive to pain: is this yellow-light pain or red-light pain? What about the morning after? What about 24 hours later?
Every day was an experiment. But every day, I had specific progressions in mind for my incremental loading in PT exercises and I had specific thresholds in my mind for tolerable volume in training.
For months, I thought of the modified exercises she assigned to me as the rehab and my training as the test lab. That’s all wrong: the combination of PT evaluations, homework exercises, and training experiments was all conditioning.
Back To What Conditioning Really Is
Strength and speed and conditioning is just coordination work against appropriate fatigue.
If you’re exploring movements that do and don’t cause you pain…
If you’re looking for power and grace despite an impairment…
If you’re focused throughout the session…
…then you’re still improving your coordination and you’re doing so under mounting fatigue.
My physical therapist had become my S&C coach.
She was helping me move from “here” to “there”, always seeing the end state even when I could not.
She had a vision of me performing in my sport at the level I’m aiming for, then walked back through every major milestone I will need to hit along the way until she reached where I was starting: weak and afraid and deconditioned.
Rehab Is Conditioning
My PT is Cathy Campbell of Colorado Sports Physical Therapy. She has built an incredible team that understands sports performance. They are coaches who happen to be licensed physical therapy providers. As savvy as I am in coaching YOU back onto the field, what I needed most was a coach to get me back on track to my goals.
I don’t need her as a track coach (I hired one already).
I don’t need her as a strength coach (I follow programs from one already).
I don’t need her as a speed coach (I get advice from one already).
I need her as a conditioning coach. I just needed conditioning coaching much more comprehensively than I originally expected.
When you choose to work with any coach, you’re choosing someone to walk the path to your goals with you. You’re choosing someone who will help you feel accomplished and successful at every step along that path. And you are choosing someone who will push you into what you need, even when what you want is to shirk it.
Frankly, it takes a long time to find a provider who can do all of this with you. When you’re hurt, time is what you feel you have the least of. So find your provider before you need them, much like you fill your bottle before you’re thirsty.
But you’ll know you found the right provider when they don’t let you make a distinction between “rehab” and “training.” The right provider for an athlete is a coach who understands your injury. If you’re fortunate enough to find a medical professional to fill this role, you have everything you need to prepare for and thrive in your sport.
If Your Provider Can’t Be Your Coach
However, even if your rehab provider only gives you the “not in pain anymore” exercises, you still have options. Benefiting from those options starts with your mindset, not with your roster of coaches.
Rehab is as much part of your conditioning as your technical practices and your weight training and your speed work. Give rehab the same attention, diligence, and investment that you do timed 60 meter fly runs. Give rehab the same commitment, effort, and focus that you do studying defensive sets.
Make rehab central to how you prepare your body to perform. Do the exercises. Monitor your progress. Insist on improving. And keep pushing the types of movements used in your rehab toward movements used in your sport.
Still build a care team.
Still be the project manager of your recovery.
Still have a variety of experts in your corner, so you never have to coach yourself through the toughest moments.
But when you commit to doing putting rehab at the center of your training, you’ve committed to improving your coordination under appropriate fatigue. You’ve committed to doing conditioning the right way.
And you’ve committed to being so well prepared for your sport in fall and winter, that you can go practice in spring and perform in summer…without needing to go “back” to rehab.
Being well prepared for your sport means being conditioned. If you get hurt, nothing should change about your commitment. It just means your starting point is a little farther back than you wanted.
Resources
If you want to learn more about guiding your own care, I recommend Gina Fick’s podcast “PT Rebels“.
If you want guidance for knee injuries, see a good doctor, then also read Dr. Carmen Bott’s writing on the topic.
If you want a plan for recovering from hamstring injuries, see a good doctor, then also read Boo Schexnayder’s article on the topic or invest in Brendan Thompson’s hamstring book.
If you need a good doctor to talk through your injury (and you’re in Colorado), see Cathy’s team at CSPT or Gina’s team at Fick PT.
If you aren’t hurt and want to keep it that way – or if you’re done with PT and uncertain how to proceed – work with me.