“If people don’t understand playing a football game is like getting into a car accident, multiple car accidents, depending on the position that you play. And then you have to kind of, and he talked through his week on what he felt Monday, Tuesday, Wednesday. So when I heard it, I was like, huh, should we be addressing their rehab differently?”

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.

Dr. Fick: Hi. Welcome to the podcast everyone. I’m here with my good friend, Jamie Moore. And Jamie, welcome. It’s so good to have you on the podcast again, and we wanted today to talk to you. I’ve gotten a lot of requests lately about what does it look like to work with in-season athletes? You treat a lot of NFL athletes, so just kinda wanted to pop in here and just get your thoughts on like where you’re at in your season with these athletes and what does that look like for you right now?

Jamie: Yeah, it’s been, it’s been a pretty interesting dynamic, I think to say the least. When we’re starting to adjust, what does in-season truly look like? How do we differentiate the different parts through the year preseason, off season, preseason in season, post-season? So it’s been interesting kind of growing in, I guess the sports PT world really. I think the more research we look at, we talked last time about load management and so like, I think that’s a huge thing looking at like what does load management truly look like in season and how do we start to taper what we’re doing to simultaneously reflect what’s going on and what they need for the week. So what I have started to do recently is really look at, on Sunday when I get like the initial communication with an athlete on what they plan to look like for the week, once, twice, three times. How do we break down that week pending? Nothing changes. Things always change with the schedule, but something that’s might start more soft tissue base, more neurological reset at the start of the week and then progresses, like some movement, some loading, and then making sure we’re having like high level neurological implementation towards the end of the week. That’s what I’ve been trying to do. I think the more that I’ve been surrounded by these athletes, the more I try to tailor position specific, but also nervous system specific. Like, what do these things look like? What does the process look like for them? It’s been challenging to say the least. ’cause we don’t know, right. On the private side, we don’t know what the team’s doing.

Dr. Fick: I was wondering Yeah. You don’t get a lot of communication.

Jamie: No, and for me, like most athletes, the team doesn’t know that they’re coming to see me.

Dr. Fick: Gotcha.

Jamie: So I have to do a lot of, what did you do today? What did they do for your treatment? ’cause I’m not gonna now double up. So if they did this, like, okay, what other aspect, what did they miss? Which unfortunately happens pretty truthfully. Like okay, they only addressed this local impairment. Like what global impairment can we start over gone to facilitate the growth that we’re looking for throughout the week? It’s definitely hard though, ’cause you don’t get to spearhead what’s happening.

Dr. Fick: Right, right. That’s what I was wondering is how much input you had on the other side. So that can be a little challenge or barrier sometimes, I’m sure. But I, for athletes at that level, I also think, you know, they know their bodies well. They generally know. They’re very in tune with at least what they think they need or at least the areas I think they need to work on. So I think that’s helpful, you know, for that in, in that way. As well. What are some of the most common injuries that you deal with in season right now?

Jamie: I think it changes season by season, right? I think this year, this year I’m seeing a lot of ankles. I don’t know if there’s like the turf prevalence of what’s going on with this NFL turf. A ton of ankles, ankle sprains. Right. Like I would say right now, 40 or 50% of my in season stuff is ankle based. I don’t know if it’s volume. I think there’s tons of things. I have my own theories on the epidemic of lower body injuries that’s going on in the NFL and how it’s changing. But I would say a lot of ankle, a lot of hip stuff, not as much shoulder, which isn’t really that surprising. Right. Most of them are running and hitting and doing stuff like that. We do get, but yeah. A lot of hips and a lot of ankles.

Dr. Fick: Yeah. What’s one of the most serious injuries that you’ve seen this year so far?

Jamie: Probably so I had a client come in with a grade 3 MCL sprain and a grade two PCL sprain. Which is pretty, it’s tough to treat. Yeah. Well, I mean, I hadn’t had torn Achilles, but they’re done for the year, so right. When there, there’s only so much that I can help with there. Yeah. We just go to the regular rehab process. But yeah. Some of that knee stuff that happens with the impact of the trauma of football. Right. You can’t prevent it. No. Like we try to do the injury prevention stuff. We try to have those conversations. It doesn’t matter how strong you are when another 350 pound grown man falls on top of you. Yeah. What it’s gonna happen. It, yeah. Right. There’s no way to prevent it. So it’s just keeping people’s body resilient.

Dr. Fick: Right. Can you speak more about the neurological, like active recovery process that you go through and some of the neurological training that you were talking about or approach that you’re, that you’re using with these high level athletes?

Jamie: What I. I’ve heard a couple people speak about it and I’ve always like loved to look at the neurological correlation that we have with the nervous system and muscle activation, human body, human movement, and I’ve, I’ve been doing that for a while. I’ve been teaching for rock tape. We talk about that a lot. And then I started to think like, what does that taper process look like for an in-season athlete? So I’ve always been a big believer that in-season treatment should look different than out of season treatment ’cause of the demands on the body. But it’s really interesting, like when we think of the global. Physical therapy world, our general patient come in two to three times a week, like they’re not preparing actively for something. I actually heard an interview this year, George Kittle. This is what kind of made me start thinking about it. George Kittle said, people don’t understand playing a football game is like getting into a car accident, multiple car accidents, depending on the position that you play. And then you have to kind of, and he talked through his week on what he felt Monday, Tuesday, Wednesday. So when I heard it, I was like, huh. Should we be addressing their rehab differently? Right? Like, should we be addressing how we’re looking at what we’re doing with them differently? And I think once I, once I kind of had that like eye-opening experience, it was, oh wow. So from a neurological standpoint, like for me, let’s say we’re doing like three times a week of treatment in the beginning of the week, it’s a very, very, like low level neurological, parasympathetic, like sit on the table, minimal movement, no loading, like feel good stuff. Usually NFL off days, Tuesday. So that’s usually when guys are feeling the worst or at least what I’ve seen. And then usually we’ll do like a Wednesday night or potentially Thursday night, after. And that’s where I try to get some movement, try to get some more movement prep. Obviously unloading them, they’re lifting, can we get range of motion and move through this range of motion. And then Friday, I really try to do as a little parasympathetic nervous system stuff as possible. Sometimes guys need it, and I totally understand that. But if we can start to springboard that nervous system and kind of prepare that nervous system and get ready to jump, ideally that’s a Saturday thing the day before. But sure, I don’t have the ability to see guys on a Saturday. So yeah, I, I try to do as like a little soft tissue work on Fridays and really as much like loading movement and the loading depends and depends on what someone’s going through, but I try to do as little. Feel good stuff on Friday if possible.

Dr. Fick: Yeah, I like it. I like that approach. We try to use that approach as well, and I think it really just prepares them and gives them confidence too. They feel good after, right? And they feel like, all right, I’m ready to do this now. Yeah. So I really like that approach as well. One question I had is, I’ve noticed some trends myself, but I want your opinion, like what are some of the most surprising. Functional deficits that you see for athletes at that, you know, higher level that you wouldn’t necessarily expect? In an NFL athlete?

Jamie: I would say probably like 50 to 60% of NFL players that I work with have significant hip limitations. Yeah. Significant. That’s what I would say. Significant hip range of motion limitations. Which is crazy ’cause a lot of them say they work on them. Right. And so exactly. A lot of them are like, oh, I’m, I’m flexible this. Right. Like, I work on my hips. Yeah. You know, I’m like. You’re 28 years old. Yeah. You say you’ve been working on your hips like since high school. Where is the Yeah. Yeah. That’s probably the biggest thing, and I think what I’ve tried to dive into a little bit deeper is like the al rotational human lid, right? And the coupling of internal external rotation, particularly with what they’re doing. I think every position needs it, and so many athletes are just so limited in internal and external rotation and what does that look like? That’s probably the biggest. I think it no, no longer comes as a surprise, like I expect it. Versus in the beginning I was like, what is happening?

Dr. Fick: Absolutely. We noticed that as well. At the hip, I, if I would ask myself the same question, it’s the hip and I go to test it, and there the, and as I’m testing, like, oh yeah, I work on this all the time, and, and I, I go into internal rotation. There’s. Almost none. Exactly. Then you go into external rotation and you’re, they’re like, Ooh, that’s tight. Wonder why that’s tight. I work on that. And so like, you know, diving into like, what, what that means. But, you know, we see hamstring injuries, we see lower extremity injuries. There’s a high level NFL athlete that I can think of right now, that ankle injury. He had significant limitations in dorsiflexion. He had significant limitations in tibial, internal or external rotation. Yeah. And so when you start to kind of play around with those, like fine tuning those things, that’s like, especially for an athlete at that really higher functional level, what that transfers or transitions them into being able to do terms of movement makes such a difference. Even it’s just small at that level. So. I I, and also balance for me, just the neuromuscular control and single leg stability. I’m shocked sometimes at these like higher level NFL like wide receivers are running back who, have very, very poor, like single leg neuromuscular control. Yeah. I’m like, wow, how are they, how are they not injured more actually? So, you know, I see that what I’ve, what I’ve tried to add in with some of that, like loading stuff on Friday is actually like, to that point, and there’s a lot of. Single leg control stuff. Yeah. I don’t like to call it balance exactly. ’cause I think balance has this like a negative connotation. Yeah. B, as physical therapist, we think of balance standing on a blue airex pad. Right. So yeah, what I tried to do is try to implement like as much split stance or single leg work as I can. And it’s not hard, right? I’m not trying to like throw weight on a bar, but it’s. Step ups, lateral movement, curtsy lunges to single right stance. I think it’s such a huge thing that we don’t pay attention to. But in human movement, you’re always on one leg. Like everything we’re doing with running is, there’s only one leg on the ground. So if you, we struggle to control what one leg is doing, how are we supposed to progress? How are we supposed to keep going?

Dr. Fick: Exactly. There’s one, NFL wide receiver I can think of right now. He is been all over ESPN. The news about the. Significant different types of injuries that he’s had this year. And I remember just watching him from about 10 feet away last year, just attempt to do, you know, just some simple like single leg neuromuscular control activities. And I thought that’s the first time I’d ever seen him kind of in person. And as I watched him across in the performance center, I thought that guy’s gonna be injured. And sure enough, he’s got some significant issues going on right now, but, you know, we, we wanna, you know, help these athletes obviously not get into this situation. Right. What are you doing? You know, we talked about in season, what do you recommend off season, not only with your NFL athletes, but with with high school collegiate athletes to help kind of target and tackle some of these things?

Jamie: I’d say the biggest thing right now is loading. There’s been like such a transition, which like as my theory on the correlation of hamstring, Achilles that we’re having, right. There’s been such a transition to like finesse in football. Footwork and speed work, and there’s like, we’re moving away from loading tissue, right? Squatting, deadlifting, like sled work. Just like heavy load. I think that is what I tell really? 95% of athletes and parents of athletes. It’s like your kid needs to load, right? It’s like the basic SAID principle specific adaptation to impose demands. Right? If we’re not exposing the body to the potential. Forces and demand that we’re gonna need in sport, there’s no reason why we wouldn’t get injured. Right, exactly. Our body’s not prepared for that. So by playing, forget football. Right. Like by playing field hockey all year round and not weight training and not like teaching your body to tolerate higher forces. Like what makes you think that your body’s gonna be able to tolerate a higher force when something bad happens. Exactly. And they, they don’t know how to. Exactly. I think there’s so much education that we do as physical therapists. I’m sure you do in your practice as well. Just really get the coaches, athletic trainers, parents really on board with that because. Yeah, it’s really important. You know, we, we see them oftentimes, you know, in season where we’re like, oh, I got a game. I gotta play. I gotta do this. Well, now they’re already injured. Yes. You’re really just trying to piece them back together. The parents are stressed out, they’ve got paid for all this money for this out of town tournament, and you’re like, well, you’re kidding. All this shouldn’t really play but it, but you know, I think looking at, I think loading is probably the number one thing. That we need to be focused on with these athletes and, and just the importance of it. A lot of our, especially youth athletes, the demands of them, what they’re, what they’re asking their bodies to do, at a very young age, and they’re specializing at such a early age, and they are so unprepared tissue wise to be able to tolerate and handle that volume. So, that’s probably the number one thing that you and I both see.

Dr. Fick: Yeah. You know, in our practices, it, it sucks, right? I think. The progression of youth sports has gone to a place that I don’t like. I’m not happy with where it’s at. I don’t like it. Yeah, you, these kids specializing at like 10, 12 years old, they’re only playing one sport. Right. So like right. We see a lot of baseball players and I’m like talking to these parents and these 12 year olds parents are telling me they pitch all year round. Yeah. And I’m like, no, off the, oh, we shut them down for two months a year. Right. But there’s no like return to throwing. There’s no off season. It’s just in season. In season. In season. In season two months. Right. It’s like, it’s scary, so, right. I think our injury rates continue to go up. Now I do believe that there is a lack of education out there, like globally, so, but yeah, it’s been, it stinks to see like how many youth athletes are going through injuries. It’s, I think it’s just a lack of knowledge and education. Yeah. By the coaches, by the athlete, and by the parents.

Jamie: A hundred percent agree. And I think. The biggest service we can do for our clients is just that education piece. And I know that, you know, one of the reasons why we’re doing this podcast right now is just to kind of hone in and hammer that in. Right. So, well Jamie, thank you so much for talking with me.

Dr. Fick: Of course. I love it. I look forward to more talk. We can maybe start a little series.

Jamie: A hundred percent. Alright, well thank you and we’ll talk soon.