PHYSICAL therapy meme

What to do when athletes are not improving?


In this episode of the #AskMikeReinold show, we talk about how we deal with lack of progress, if not regression, in our athletes when rehabilitating from injury. To see more episodes, subscribe and ask questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 234: What to do when the athletes are not improving?

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Transcription

Student:
Hayes of Tampa wants to know if you already have athletes who don’t improve with conservative care?

Mike Reinold:
Fantastic. Okay. Thanks Johnny, I appreciate it.

Lenny Macrina:
So what are you doing?

Mike Reinold:
It’s awesome. So Hayes from Tampa says, do you ever have any athletes who don’t improve with conservative care? If so, what are you doing? I like this question. Pretty good, isn’t it? Because that’s the humble pie question. I’ll start and just say no, all of my people are always improving. I do not know. I mean, who wants to take this one? I mean, to answer your question, Hayes, briefly, and then maybe we can all kind of explain a little bit of why we’re seeing this, why it’s happening, and what we can do about it. But yeah, as you step into your career you’ll find that, I mean, we can’t fix everything. We do a really good job of putting people in a position to be successful, but sometimes they’re either too far down the line or sometimes they don’t help themselves, and sometimes that’s part of the problem too. So I will say yes, of course, we definitely deal with it. Let’s see. Has anyone had any experiences or something to share on maybe why this is happening? Who wants to step in first?

Dan Pope:
I guess I’ll say a bit.

Mike Reinold:
One at a time. All right, you’re on your feet, Pope.

Dan Pope:
Okay. I guess as a new grad you really want to help people as much as possible. So when someone isn’t making the progress you want, it’s really disturbing. I think what’s important to keep in mind first and foremost is that a lot of these conditions, A, take longer to improve than you might think. So many months, often traditional physical therapy, maybe four to six weeks. How many people will improve during this time? And the second track does mean better? Often times, better does not mean that you have a complete resolution of symptoms, but that you make some kind of improvement. So I think that’s probably the first thing to keep in mind before you start saying, “Okay, I failed, I did something wrong. That person has to have surgery, ”or something like that.

Mike Reinold:
I love it. It makes sense. And good point right there. I mean better doesn’t necessarily mean a hundred percent sometimes, especially if you’re an athlete getting ready for a season or in season, there’s probably some tough stress he’s facing on his body. Sometimes it’s best to just allow them to start over. So who else wants to jump in? Lisa?

Lenny Macrina:
Go ahead, Lisa, do it.

Lisa Russell:
Sure. Just can you hear me?

Mike Reinold:
Yes.

Lisa Russell:
Okay. Just a simple example, even last week I brought in a high school athlete who was looking for help with knee pain. And he had a history of [inaudible 00:05:07] and his tibial tuberosity was quite thick. There was a very large bone proliferation. And he was looking for help with that knee pain like, “Oh, sometimes I hit him in the corner and it really hurts.” And I was like, “Well, I can’t change that. It’s bone. I can’t change that. “So I feel like I’ve learned how to try and let someone know basically, I can help you with this bubble of things. But if it’s a bone thing or something that would require a surgical change. if you really wanted to I couldn’t do anything about it. And it was like a super simple, I mean PT just isn’t going to change that kind of pain. So, yeah, that was just recently. So just a simple example.

Mike Reinold:
Yeah, good point. I mean, sometimes we can’t change the anatomy of a lot of people. So I think it’s a good second thought process here, sometimes anatomically, if you have a predisposed anatomical position then maybe an alignment issue with your hips or something, and you pick a sport. that just happens to be driving bone into bone, for example, I mean, that’s something we’re going to have a hard time doing. Who else? Who else has something here? What’s the matter, Len?

Lenny Macrina:
Yeah, I mean I deal a lot and Scaduto can probably talk too, but we deal with baseball obviously. So we do a lot of unoperated wounds or trying to be unoperated Tommy John wounds or labral tears in the shoulder. And once someone introduced me in the docs, no go to PT, there is a way to avoid surgery. We need to set up a game plan in advance. So I think the key for this person is, what are you trying to achieve during this rehab? And how long do you think we have? And then you have to plan if we don’t reach our goals i.e. painlessly anything, throwing or whatever, then you have to have a date where you potentially need to. having this conversation where we may be referring you to the doctor. So for us, I plan ahead. If I can get you to this point and throw and you’re pain free, then you’re good. But if you’re still in pain right now and we’re having surgery, I can save your next season or the next, no matter what you try to happen, because I know it’s going to take nine to 12 months of rehab.

Lenny Macrina:
So you won’t see that much with an ACL. A lot of people talk about copers and non-copers, but for us the elbow UCLs and shoulder labrums we are strategizing, which we found in our objective metrics, you have an obvious weakness, you had pain because you’re doing too much, and maybe it was a volume issue, or you’re doing a new program, weight balls or something like that. And then we break it down and come up with a game plan for them and create smaller goals so that we can achieve it. Otherwise, we almost have a deadline so we can get you ready for the next season.

Mike Reinold:
Yeah. And a lot of times that doesn’t work, right, Len? Because maybe structurally, maybe you’ve damaged your ligaments so much that it’s just past the point where it’s going to heal, so great. What’s up, Dave? What do you think?

Dave Tilley:
Yes, I think it’s unfortunately the elephant in the hall for my sport, for gymnastics, but Lisa was talking about things you can control versus things you can’t control, where you can’t control others. I have a lot of dead ends where in my heart I realize that the gym that they are a part of, the coach they work with, the influence of parents, and that sort of thing is that maybe they need to change their thoughts about how much they train and how many reps they do and their strength conditioning. And it’s such a hard conversation to have, but there were times when I just thought, “Well, until we really had a hard conversation about why you train six days a week. week and five hours a day, and you don’t want to do anything in the offseason, but doing gymnastics is a very difficult battle.

Dave Tilley:
So as a young, new graduate, like Dan said, I kind of wanted to save everyone and see if I can change the world and you quickly realize that some people just aren’t willing to hear what you have to say. And so, I mean, we have great systems, I think, at Champion and people always refuse to have their ears open. So you have to realize, okay, I’ve done everything I can and I’ll help you. But I think there is a bigger fish to fry here.

Mike Reinold:
I like this. And I think the only other thing I would add, very briefly, just to wrap up, I guess, is that a lot of times when we’re dealing with athletes who have a problem, we don’t just shut down completely. shoot them down and rehabilitate them to that really low baseline with just an infinite amount of time. A lot of times we try to flirt with that line of injuries, where we try to get them back as quickly and safely as possible, but we flirt with them as fast as we can. Sometimes this is the most important thing we do. So sometimes we dive too much into that. So kind of like what Dan said at the start of this is right, sometimes we have to define which is better, I guess that’s the question, but something to keep in mind.

Mike Reinold:
Such a good question. I think this has been very helpful as I think a lot of people are probably dealing with this. And I think a lot of people early in their careers are very aware of that. They feel bad that we can’t help everyone, but just remember that even the progress you make with someone, even if they don’t completely solve their problems, is probably pretty substantial progress for them. . If they end up having surgery or something like that, it will likely make their postoperative success rate even higher. So there are still a lot of advantages to doing this sort of thing. So great question, Hayes, enjoy it. Thank you very much for submitting one. If you have a question like this, head over to MikeReinold.com, click on that podcast link, and keep asking. Please again, iTunes, Spotify, go ahead, rate, review and we’ll see you in the next episode. Thanks again.



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