Welcome to the PT Rebels Podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.

On today’s episode, I’d like to welcome Brooke Ewart to the program. Brooke is a long time friend and sports counselor who I highly respect, and I wanted to bring Brooke on today just for her to share her insight and her experience with the athletes in the sports counseling realm. Thank you, Brooke, for joining me today. And can you please tell our audience a little bit about yourself and your experience?

Brooke: For sure. My name’s Brooke Ewart. I originally grew up in Southern California. I was super interested in athletes even in high school, just like what was the difference between an elite athlete versus just a regular run of the mill athlete. And that led to taking classes in college on sports and athletes and psychology. Then felt like I had a big pause that came when we started having kids and just felt like there really wasn’t probably a market at the time for sports counseling.

And so I went back to my, I went back and got my grad, or I went back to grad school when I was really at like the peak of our kids being in elementary and middle school and high school and just found that it was just such a need that was missing that athletes did not have anyone to go and talk to if they were having mental health needs or any issues that were coming up, even through injuries. And so I felt like this was a calling and really have enjoyed the last six and a half years of working athletes in that capacity.

I started Rocky Mountain Sports Counseling Center in 2017, and so we’re going on six and a half years now in that. And I’ve also gone back to school to get my doctorate so that I can teach others how to work with athletes in the same capacity, because this is also a need at the university level. There’s not enough people coming out being trained to actually know the ins and outs of working with athletes and their mental health.

Dr. Fick: That’s fantastic. Brooke, can you tell us more about some of the specific athlete programs that you’ve had the privilege of working with in the community?

Brooke: Yeah, so over the last probably three or four years, that’s really intensified, but I would say since COVID specifically, teams have come and asked for support for their athletes, and so we work with the Colorado Rapids DA. We work with the American Raptors Rugby team. We work with USA cycling. And then we work for a number of local high schools, with Valor, with Littleton High School, specifically with Rock Canyon, and a lot of that has just come from referrals within those organizations.

Like knowing someone who knows what we do and then partnering with them, and I’m sure there’s some teams I’m forgetting in there, but it really is such an interesting partnership because once there’s a referral, the community builds around coming and also de-stigmatizing mental health support for athletes. And so those athletes that we work with know who we are. There’s a very low lag time between a referral and the actual athletes speaking to us, and I would say that is actually within 24 hours. These organizations understand it very well. They know the process so that there’s not a lapse in time for the athlete once they’ve spoken about their mental health to getting a phone call to us.

Dr. Fick: I think that’s a really key point. One of the things that I appreciate with my partnership with Brooke is that I know that if I reach out to her, she is able to reach out to that athlete quickly and provide help quickly to them. What type of athlete do you recommend that we send to you?

Brooke: Yeah, I would say anyone that is somewhat of an elite athlete starting from the age of 12 or 13. And the reason I would kind of even there’s, we could probably see kiddos who are younger than that, but all the way up to the Olympic level. And when I say that cutoff, I think it’s because sometimes when they’re younger, their issues are not intensified enough yet. But if they are younger and an elite athlete, it’s a very short stint in counseling because they just haven’t gotten a lot of time with their, or they don’t understand themselves enough to speak into themselves.

And so what that would look like is like, literally, I don’t think there’s a single sport that we haven’t seen at this point. I mean, honestly, I’ve, like, we’ve seen ultimate Frisbee people we’ve seen, hockey and track and cross country. I mean, we could, I could sit here and go through every Olympic sport. I mean, there’s so many, but I think the more realization within the community of sports and people who work with the athletes, we’re seeing more and more and more athletes reach out, because they really don’t fear the stigma like they used to.

Dr. Fick: I love the fact that the athletes aren’t fearing the stigma as much. I really have noticed that in office, one of the things that I try to do is recognize some signs and symptoms in the athletes that we work with and with their families that come in in order to help optimize their treatment plan with physical therapy and to help maximize their performance. And Brooke, what are some of the things that I should recognize as a physical therapist that should just be immediate referrals to you?

Brooke: Yeah, I think part of that is like, you know them best and so when you are seeing a lack of motivation, a, I don’t have the will to even do my sport. It’s such a red flag to me because they love their sport and when it’s not fun anymore or when they’re like dreading going and they’re really, really good, or they’re feeling super burnt out, it’s probably important just to start recognizing like, is this depression or is this, like their mood is down for a significant amount of time. What do we look at for with them?

And I think it’s always the one-offs, like, you know, honestly, like if I heard an athlete say, I do not feel like I want to live anymore, it’s just an immediate referral to Rocky Mountain Sports Counseling Center because we are trained to deal with that. Physical therapists have some knowledge of what to do, but probably the referral is just so important because we know the measures and the steps to take. And what even how to rank, you know, is this, is this just thoughts or is there, do they have means to do it? And so we take that very seriously with all the therapists who, all the counselors who work with us, because we want them to keep pushing, but also like there are times to shut them down too and go like this, you’re not in a healthy place mentally.

And then I think too, just like things that I’ve thought of too that are like eating disorders. Like when you see athletes who are really struggling with food or you know, addictions, you guys are usually apt to know what’s different about them. Or if you’re like, wow, their weight is down significantly, like something’s going on. It’s just always good to like reach across that aisle and go, Hey, like, we’re concerned about this athlete. What do you think? You know, you guys have the DEXA scans and you know you have all the means and, but we’re partnering, like that’s a partnership for us with you guys, because again, we want the athlete to compete. We want them to get back out there, but if they’re prohibiting themselves in some way, you know, through an eating disorder or through an addiction, or even just anxiety and depression, I mean, those things can really, really start to affect the athlete to the point where, you know, they’re not even wanting to do their sport anymore. It’s just, you know, dread.

Dr. Fick: Right. I think it’s such a key role that you play, and I’ve seen such a difference in the athletes that I’ve worked with have success in being able to feel like they can talk to someone who actually can listen and understand that that’s such a vital role in their overall sports performance and recovery plan from physical therapy. Thinking about some particular athletes without giving specifics, can you think of a couple of success stories? Just talking about maybe an issue, whether it be anxiety or depression that the athlete was dealing with and how you’ve been able to help them successfully return to sport and process through those things.

Brooke: Yeah, I think what I think, I’m gonna kind of go on two different tangents with this one, but one, I’m gonna talk about injuries for a second and utilize that route first when we see athletes who are injured. It tends to be that we become sort of the sports season for them, which is to give them space, to give them the time to process what’s going on in their brain to kind of grieve loss of season at the same time. Then also, you know, it can also replicate some things.

In my mind, I’m always thinking like, what else do you like to do besides sport? Because now you don’t have it. So we start to have these like retirement conversations. Not that they’re gonna retire at the time, but it’s just like, Hey, at some point you’re gonna retire. So like, let’s talk about what would that look like during, because this is gonna replicate it the most closely that we can. So not to get too deep in the weeds of that when they’re injured, but also just to start saying like, who are you away from your sport? And when you ask that question, you see a little bit of a confused look because most of them have not developed that part of themselves. So they don’t have a lot of hobbies because they’re all sport all the time. So we try to pull back a little bit and start developing the second phase of who they’ll be one day, but also like letting it kind of rise. So two parallel points at the exact same time.

So, and then just even success stories that we’ve seen with athletes. I mean, oh man. I think the things that make me so happy are to see athletes who really struggle with anxiety, try to figure out how to get around it, which is, I’m super nervous. And then we give them tools, you know, whether that’s breathing techniques or mindfulness or visualization. Just things that give, that they can use that, you know, take them away from the stress that they’re feeling. I mean, sometimes it’s just simple things like put a stick of gum in your mouth and like, let the energy go to a piece of gum instead of it being in your stomach. Or how do you eat in a healthy way before a meet so that your, your nerves aren’t, you know, your stomach’s not a ball of nerves. Just trying to help them to kind of look at the whole picture.

But that’s so fun for me to see when they leave and they don’t need to come back anymore because they’re like, I’ve got this, like, I don’t feel as nervous as I used to, but I also see major transitions. Sometimes between the sophomore and junior year, that’s where we see the biggest stressors because there’s so much intense pressure and they’re looking at the super long future of like, oh, I want to just want to go to college. And then it’s like all they’re putting so much pressure on themselves for that scholarship or whatever it is that they want to do. And once they realize just have fun and just enjoy it. The process, I think they, there’s a mindset shift that happens specifically between the sophomore and junior year, and I see it every time that I always tell every parent like, just like, let’s get through this year. And then like they start to actually take ownership of like their anxiety themselves were like, I don’t need to put this much pressure on myself. I should be having fun because sport is supposed to be fun. And I think that the athletes forget that. Like it is fun. It’s just there’s a lot of pressure and you’ve gotta learn how to navigate it too.

Dr. Fick: Exactly. And that’s one thing I wanted to touch on. We see athletes struggle from when they transition from high school to collegiate athletic to professional athletics. What are some of the tools that you think would be most beneficial for athletes to have moving from the high school to collegiate level. How can they seek your services to help improve upon some of those tools that they need?

Brooke: I love it. The transition periods are my absolute favorite. Like some of my favorite times with athletes because I think there’s, again, so much learning about yourself and who you are. So I think it’s managing expectations like what are the things you want to get out of this experience? Resetting goals for those times and like also just like, again, relaxing and remembering like you’re transitioning from one level to the next because you wanted to do it, but it’s also supposed to be fun in the midst of that. And I know there’s a lot of pressure each one of those stages, but also like when I’ve seen athletes transition from college to the pros. I think that’s one of the harder times that I agree with. It’s the same thing at high school and on college, just a little bit different.

When you are in college, you are probably one of the best on your team, and now you go to the pros and everybody was the best on their team, and so you’ve gotta reset some expectations of like, okay, I’m probably gonna have to bid my time on the bench. I might not start this first or first year or two. That’s okay. It’s like you have to keep working, you have to keep going. You have to have the same intensity that you had before that got you to that next level. But the same with high school to college, right? It’s the same. Like you’re probably, unless you’re like the elite of the elite, you’re probably not gonna be a starter your freshman year unless again, like you just have come in with some incredible skills. So like relaxing, enjoying the process, being in college, having fun, but also like staying super hyper-focused on why you’re there and what you want to do in those next four years.

Dr. Fick: Yeah. That’s great information. Thank you. One question I have as a parent, I’m a parent of four children, and athletes. What can we, what can we play as parents and how can we best support our student athletes who are in junior high school? College? What advice do you have for us as parents?

Brooke: Yeah. Oh, I love this. This is like my, one of my favorite topics because we’ve had four kiddos who have been athletes too, and it’s like, I think just loving them for who they are as a human being first. You know, seeing them as that. Remembering that you’re putting a ton of energy into their development as like person first. And then the athlete second, and I mean they know, they already feel pressure from parents because they want to please us. And so, you know, saying, I like my job is just to love you in this process and to support you.

You know, finding people around your student athlete who are also mentors or someone that you trust that they can talk to, so it’s not you having to be their therapist or you not having to be their physical therapist. I mean, all these roles that we play, because I think honestly, like just even having that separation takes pressure off of us as a parent because then someone else that we trust is like in their world, giving them probably the exact same advice, but there doesn’t feel like there’s that pressure.

And I think this is like another thing too, if this, I want this to come across so much like we love the athletes that we work with. I mean, literally we try to go to as many sporting events of theirs as we can, or we try to watch videos or we try to be as heavily invested as we possibly can because we want them to know that we’re all in on their team. And they’re so much fun too. Like that is where we get to see a totally different version of them in the therapy realm. We’re working and we’re talking and we’re going through skills and you know, giving them tools of how they’re gonna like navigate. But then when they go do their sport, we get to see what they love to do. And that is so fun for us.

But I think, you know, when we’re the parent and to step back and just to be like, hey. I’m just here for you. I’m gonna love you if you make a mistake or if you are the best you’ve had your best day. It’s like teaching them that you’re gonna be the exact same person in both circumstances too.

Dr. Fick: Yeah, I really appreciate that advice and I’ve seen that true with our, you know, with our own kids. So thank you for that. Another question I had for you is, what advice do you have for coaches? And you know, I think that there are coaches out there that probably would want to ask you, what can we do to best support our athletes’ mental health? And what signs do we look for in order to best help them and support them and refer them out to you when needed.

Brooke: Yeah. Honestly, like when I think of this question, I get asked this often because the coaches fear that they’re gonna miss something. And it’s kind of the same as what I said with Gina and like physical therapist too. It’s like when you see something off with the kid, be on the phone with a sports counselor, just say, Hey, like, I’m really concerned about this kiddo. I’m gonna give them your name, I’m gonna give them your number, and I would like for you to speak with them. I can’t ever reach out the opposite direction, like it has to come through the referral, but unless, you know, they’re like the parent said yes or the kid said, please reach out.

But I think just watching and observing what’s going on, you, they know those kids so well and if, and even if it’s just like an inkling that something’s off, it’s just better to either reach out to the parent or reach out to the kiddo and say like, I think you need extra support right now. And I think there’s, this is kind of what’s so amazing about the referrals is there’s so much trust built on your side and there’s so much trust built on the coach’s side. I think the more that coaches speak out about their own personal experiences with mental health, the better because it breaks again, that stigma, right? Like, oh, my coach has never had any problems. Like as soon as they say, I went to a counselor once because I was struggling with a relationship or whatever it is immediately that like wall comes down and the coach is real, and the coaches has, has had some issues that they’ve needed to see someone for and that builds this incredible wall or this incredible bridge to like come seek support. And they will, they will remember that and it will feel like they’re not the only person that’s ever experienced themselves.

Dr. Fick: I would agree with that. There’s some coaches that I work with who are very open and honest with their past struggles and personal history with different things that they dealt with in their lives, and I think that that really helps to break down the barriers for the kids so that they feel comfortable knowing that it is okay to talk to someone, and actually it’s gonna really, really help them and maybe help them avoid some, you know, issues along the way that they potentially could struggle with. What would you tell a student athlete who has maybe lost a friend to, you know, sudden death related to suicide or the really tough things in life where, you know, you’re going along and you lose a friend like that, and how do we help our student athletes handle that? And what advice do you have for them?

Brooke: I think part of it is not holding it in what you’re feeling. I think sometimes athletes just think, oh, I’ll just like ignore it and I won’t think about it. But the body is very interesting and the brain is very interesting too. It will make sure that you process it and whether that comes out in like some sort of your own anxiety or a panic attack or something, your body will make sure that you’re gonna process through it. And so I think one is talking with somebody either like myself or a close friend or a parent or a coach, but also as the community that was around that person. Sometimes it’s just real. I’ve seen really great group therapy groups go around a suicide and that can be so beneficial for the kids who are on the team of the athlete.

And like, I think there’s freedom there to know I’m not the only one experiencing this grief at this exact same time, or this person’s a little bit further ahead than I am in their grief process. Or this person’s really lagging behind me to make sure that we’re like watching out for others too. And I think, you know, just being kind to yourself, not a, you know, I think you’re probably gonna feel the grief very, very real and deeply and that’s okay. And I think that’s very normal. And there will be a point where you might feel guilty because you’re having fun and you’ll be like, oh, this person’s not around anymore. I think it’s all of that is a normal experience around a teammate that has or has or gone that you have that’s gone through suicide.

Dr. Fick: So if you’re a teammate and you’re, you’re noticing potentially some signs and struggles with a fellow teammate. What would you list as some of the common red flags to look for as a teammate to be able to either talk to that teammate or a coach or a parent about some struggles that you see so that we can feel like, yes, we see something, we’re saying something, we’re doing something proactive when we have concerns. What are those red flags you looking for as teammates?

Brooke: Yeah, I think this year I’ve had a couple of these situations where teammates have spoken out because they were so concerned about an athlete being withdrawn. Very down, talking down about themselves, even saying very blatant things like, I don’t think I’m gonna be here tomorrow. So once. And it’s interesting, I’ve noticed more and more that the more that teammates speak up, the more readily that a teammate will seek support. And there again, like there has to be pretty good channels, right? Like if the teammate says something to a manager or a coach and they’re like, Hey. We see this in our teammate if they’re, the channels are tight and no one’s keeping secrets, which is kind of the key for teams is like, don’t keep secrets.

You know, if you are really concerned about a teammate, say something. You are not a, you’re, again, you’re not a therapist. You don’t need to take care of this on your own, especially if you’re 17 or 16. Like you can talk to the athlete and say like, I’m really concerned about you. I’m gonna talk to Coach about you. That at least opens up some doors that people are hopefully would be more honest with each other. And it’s really tricky, right? Because you just like want to be like, oh, I’m fine, you know? But I think if the athletes are honest with their teammates or with their coaches, it does, it really does open so much, so much more for honesty and quick action.

Dr. Fick: Right. I think quick action is what we’re looking for in a lot of these cases that you’ve highlighted, so I think that’s really important. What are some general great mental health strategies on a daily basis? Sports recovery slash mental health that our athletes can just be doing to help promote healthy mental health strategies and stress management?

Brooke: Yeah, I mean, I think sports are stressful. I think it’s just, if we’re gonna be honest, like if there’s a time that you need or a benchmark that you need, it’s stressful to get there. But it doesn’t have to be the be all, end all either. Like I think there’s ways to deal with stress in general, right? Like talking, I think is key, but also, you know, having those like really good short-term goals that kind of help you to get from one place to the next. I would call those like stairs. It’s like we have this one and then we’re, we’re trying to get to the next one, and so those are the things that kind of keep us interested. I do this for my job. I’m sure you do this for your job. We all have goals and so teaching those like early strategies of like how to like navigate through a disappointment when a goal doesn’t come through, but also like how do you readjust and then the expectations piece.

I see this so much with athletes. It’s like their expectation is that they want to win. This huge event, but they don’t even know how to get there. Or once they have like achieved it or like just about to achieve it, they’ll change the goal super fast and it’ll be like completely out of bounds of what it was originally. So like celebrating when they get to those benchmarks and be like. I got a 10.9 and like now, like I want to get a 10.8. Like what’s realistic, but also like surprising yourself and celebrating those like really good moments instead of just blowing past them. Whether that’s like going out to dinner as a family and celebrating it or you know, like writing it in, you know, a goal book and being like, Hey, I achieved this today. This felt amazing. Now I’m hungry for more. So it’s like kind of constantly adjusting things, but also like really sitting down and figuring out like, how do I navigate through sport? Because it’s tough. I mean, it’s just mentally draining, but again, like just having fun with it, but also being hungry every single day.

Dr. Fick: Yeah. Thank you. That’s excellent advice. One of the questions I have too is what if you just, what if you as an athlete really blow it? What if you go to a big national stage and you’re on the starting line and you fall start? Or what if you trip in the race and you can’t finish the race, and that was a race that you were hoping to win on a big national stage. How do you process that? How do you handle that as an athlete? How do you move forward?

Brooke: Yeah. These are like the hard questions of life, right? Like when these things happen, you like are so bummed in the moment, but then you know, you look back and go, what did that teach me? What do I gain from it moving forward? How do I go around this? You know, same situation in the future, not letting it become just a repeated pattern too. But you know, it’s so interesting sport. There’s so many analogies with life too, right? Like, it’s like there’s so many things that sports replicate in life. Like, you’re gonna have moments where you stumble, you’re gonna have moments where you think you’re gonna go. And sport gives so many analogies to the future in the sense of like, oh, I’ve experienced this before in sport and now I’m a business owner and I’m going through that same thing too.

I think, you know, life isn’t perfect. We’re gonna make mistakes and like athletes tend to be the most perfectionistic and can’t make any mistakes. And again, like there’s reason for that, but it’s also like, it’s not reality. And so when there’s a disappointment to process through it, to say like, this is how I’m feeling. Not bottling up those feelings and just like being like, okay. Blank. Slate next, next meet. This is where I go from here and this is how I navigate around it. And I think too, you know, there’s a piece of grief, like I know I’ve mentioned that a few times. There’s a piece of grief that happens when you make mistakes, but it’s like, okay. I might like pretend that that didn’t happen, but it did. And so now I’ve gotta like feel those like really hard feelings of disappointment or like sadness or anger. Like anger would be a key point to any disappointment. But like how do you show that in appropriate way or how do you deal with that in an appropriate way? Then, you know, again, moving forward from there, I think it’s just about resiliency and how do you get through it.

I mean, kids who are gritty and resilient tend to do really well in sport because they’ve learned how to navigate the life or the sport. Tough things that come up. And again, I could, I mean, I saw a few years ago, this was like the best analogy that I can think of. Our daughter, Delaney, who’s a ballerina, we went and saw the world’s best ballerina. Like she was just incredible. We got to see her in London perform. She came out and slipped and fell and I looked at Delaney and I was like, everybody can fall. She can fall. Everybody can fall. And that was such a good, I think, example for her of like, even though we’ve idolized some people that they never make mistakes, they have, they have done something and it’s just, they’ve somehow navigated through it and have been more resilient and continue to push.

Dr. Fick: Absolutely. If someone is listening to this podcast and they have the realization that they really feel like it would be very helpful to work with a sports counselor. How do they get in contact with you?

Brooke: Yeah, so Rocky Mountain Sports Counseling Center. There’s a website. It’s all the whole name spelled out, just to make it as difficult as possible for everybody. I don’t know why I did that when we first started, but it is Rocky Mountain sports counseling center.com altogether. You can reach out on the website, you can see all of our phone numbers. There are four of us now with a couple more coming on this fall to help out. Because we continue to see these surges of athletes who are finally like saying like, I need help. I think that’s the first key is I need help and then working through. How are they gonna navigate through a new season or their season that’s coming up? Or you know, processing through an injury, whatever those things are Like, we’re so open, we just want athletes in there talking. I think because when they start to work on themselves, they figure out like, oh I can get through this. You know, and it feels so tangible.

I also tell people this all the time. Our goal is not to keep athletes in there forever. I do not want athletes in there for a year or two. For us, it’s like my goal is like probably three to six months and then you start to take the tools that you have and when you have issues, come on back and let’s navigate through those. But you’re never there for that long ever again.

Dr. Fick: Yeah. Thank you. Work for the patients and the referrals that you see from us. We’ve seen great success and with those athletes and we are just so appreciative of how successful you are helping them and how quickly that you’re able to see them once we do refer them to you. So thank you and thank you for being available to us today. I think this is really valuable information for our practice and our population that we see, so thank you so much.

Brooke: You’re welcome. Thank you.