WHEN BEING SAFE IS NOT SAFE! - Blog

[Guest Prosoft Admin]

This week I answered a listener question that I think was meant to be directed at athletes but may have just as powerful or even more profound meaning for Physical Therapists and other healthcare providers.

“When rehabbing an injury, can’t being tentative create another injury? How do you avoid that?”

As I said – I think this was probably originally meant for the athlete them self. And I agree totally. Too often I see athletes who’ve gone back to sports prematurely and they’ve felt a bit tentative and for some that’s led to another injury. This listener is spot on – - – we don’t want athletes lacking confidence and returning before it’s the right time. While for some they survive this transition period and end up a success story, still for too many others this scenario ends in a brand new injury or a worsening of the original injury.

At PEAK PERFORMANCE we want to see athletes take a proper progression of gradually more demanding sport like forces before going back to actually playing. While it’s normal for an athlete returning after injury, whether a surgery or non-operative, whether major or minor…feeling some concern or having a heightened sense of wanting to be careful can accompany that excitement that athletes feel on game day. Certainly what needs to be avoided though is that sometimes paralyzing level of hesitancy or tentativeness that patients sometimes experience when inside they know they aren’t quite ready yet or who may have an unhealthy level of fear or anxiety about the potential for injury.

But we really believe strongly too, that the Physical Therapist MUST also avoid being too tentative. It’s incumbent on us to design progressions that start with a successful motion or pattern or plane of movement and the present a definite challenge to our athletes so they can gain new COMPETENCE. It’s then this very competence that compounds over time into CONFIDENCE.

COMPETENCE builds CONFIDENCE.

That means we have to be careful to use our biomechanical knowledge along with our understanding of a particular sport and even the uniqueness of that player’s position demands so we can incorporate appropriate and authentic challenges for the body to respond to.

When you were a little kid can you imagine what would’ve happened if you were only allowed to play in the backyard? That’s sort of “playing it safe”… in a risk minimized, fenced in or enclosed and protected environment…when you then took those lessons learned out to the front yard? Without proper preparation and gradual challenges and learning, how would that “backyard” athlete ever know that they shouldn’t just run out in the street to get a lost ball? As a parent you really can only ever feel comfortable letting your kids play out front when they prove they realize the authentic truth that there is some danger beyond the sidewalk and it’s critical that they display an awareness that running past the sidewalk for a lost ball can’t happen – unlike in the safety of a backyard where you can go run after just about any rolling ball.

It’s not walways “safe” to play it safe, right. In fact, the safety of living in the backyard can prove to be a real liability if a kid is released out into the front yard without a proper transition and training.

Too often we see rehab programs that were sort of “sterile” or too safe. Knee rehab is a great example. We’ll often hear of generic balancing drills on a BOSU ball or balancing while passing a ball with a partner. Non-specific challenges. No regard for directions of the injury mechanism. No specific cueing regarding that specific injured tissue loading. Another knee example…practicing landing with the knee always and consciously directed over the 3rd toe during jumping and hopping or lunging drills.

I do get that. I understand where they’re coming from. Ideal mechanics maybe. Working to train up and reinforce what is maybe a more desirable pathway. If you’re moving north-south or vertically, then there usually doesn’t need to be a great magnitude of east-west motion going on. But let’s stop for a moment and think about what happens in the actual game to that knee. What’s the authentic stresses this part must deal with?

In a knee, we know that side to side and twisting motions will be a part of what many athletes will experience during their sport, during cutting and change of direction. The real question is…have we, as Physical Therapists, done a good job of helping that knee and entire body for that matter, be ready for what actually will happen.

There’s often a difference between what we’d LIKE to see happen and what ACTUALLY happens. Our job is to know what actually happens and to design a biomechanically authentic yet safe progression of forces to build competence. Athletes need to be prepared for the “what if’s” that happen. For the time your knee does twist inside a bit. For that time you land oddly with your foot turned outwards instead of in that perfect alignment you’d always drilled in practice. Prepared for the time when you may have to fall on the ground.

If you or your young athlete need help preparing for a return to sport or activity and you are trying to avoid tentativeness and you want to BUILD CONFIDENCE BY GETTING COMPETENT then give us a call at 218-0240.