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 wanted to discuss with you all the differences between sports, physical therapy, and traditional outpatient physical therapy and what that means for the athletes, coaches, and physical therapists working with those athletes. I hope you guys enjoyed today’s episode, and I hope it brings some clarity on how we approach sports physical therapy in our practice. When we’re talking about the differences between what a sports physical therapist is and how sports physical therapy differs from more traditional outpatient physical therapy, really the key differences are our approach to function. And so when an athlete comes in, uh, with a. Specific injury. It could be an ankle sprain, it could be an ACL injury. It could be a injury of various degrees. But what we’re doing first is just trying to connect with that athlete and try to get an uh, trying to get an understanding of where they need to be functionally. For instance, I think that. If it’s an athlete who comes in with an ankle sprain, we’re gonna assess the degree of that ankle sprain. We’re gonna look at the functional deficits they that they have in a more objective manner. So in traditional physical therapy, a lot of those practices don’t have the means and ways to measure force output. They don’t have the means to use a force transducer to measure strength deficits side to side, or look for asymmetry. One of the things that we really focus on is key functional deficits and differences in a more detailed way. So if you’re an athlete and you have, again, a, an ankle sprain, let’s say you’re a basketball player and you come in with an ankle sprain, we’re going to take you through a functional evaluation where we put you in. Positions where we’re testing your range of motion, your strength in a weight-bearing position. We may have you do some squats or some single leg hops or some lunges. We’re gonna look at how much force you can produce through that lower extremity that’s injured, and also how much force you can absorb through that lower extremity that’s injured and compare that to the uninjured side. So that we know if you’re going to go up for a layup or a jump shot, or you know, do more fast sprinting or cutting maneuvers, that you are going to be able to apply and absorb those forces without the risk of further injury. So we’re looking at sports physical therapists. We’re looking at functional deficits in a more long-term way, in the sense that we aren’t just gonna do the same. Types of exercises visit to visit. When you come in as an athlete for your physical therapy care, we’re not only going to assess you, but we’re we’re going to prescribe specific exercises and movements to help get you back to those more functional movement patterns like. Rebounding, jumping, single leg hopping, cutting maneuvers so that you’re more comfortable when we fully release you to return to sport. I think that one of the differences with sports physical therapists, when you’re looking at the differences between sports, physical therapists and traditional outpatient physical therapists is we’re also going more in depth with our communication with. Parents, coaches, athletes, strength and conditioning coaches with the athletic trainers at their school. We spend a lot of time in communication because it’s essential that these athletes have a clear understanding of the plan moving forward once they are injured, but it’s also. It’s really important that the coaches, athletic trainers, anyone on their care team has a good understanding of where their functional deficits lie and when they can safely return to sports. We spend a lot of time in communication, whether that be on the phone, directly talking with those people, or on texting, emailing sometimes in person. We’re able to communicate if they’re nearby. So that’s really important and key for those athletes too. Be able to have a more smooth transition with return to sport. Another key difference with sports physical therapists is that we’re really assessing their psychological readiness for return to sport. So oftentimes the athlete will be functionally ready, but they’re not always mentally ready. And so it may be that we need to refer them to a sports psychologist or someone that can help. Assess and address any fears that they have in more detail about that return to sport. So sports physical therapy requires the physical therapist to have a more in-depth knowledge, in my opinion, of differential diagnosis, but also and how to get that athlete back using certain movement patterns and exercises that are more advanced in order to be able to return them to sport. So we’re not just doing the basic table exercises or some of the more basic exercises that you would see in some traditional outpatient physical therapy clinics. We’re going to progress them into more three dimensional movement patterns and strengthening exercises that involve the entire core, pelvis, hips, lower extremity chain or upper extremity chain, depending on their sport, so that they can be ready for those return to sport movement patterns. Some of the key things that we have in our clinic equipment wise, really differentiate us from other outpatient physical therapy clinics, and we’ll talk about that more in a minute. But it’s important for our athletes to understand that at our practice, our number one goal is to help you return to sport as quickly and safely as possible. So we really invested in a lot of tools in our practice. To help differentially diagnose exactly what your injury is and then help you progress using some of the state-of-the-art equipment that we have here, so that you can return to sport as quickly and safely as possible and have the confidence to do that. I feel like communication is so vital. Communication is vital, and building trust. With the athlete, with the parents, and with the coaches. So when we first assess an athlete and we have them come in, we wanna really build that rapport by observing and listening to that client. Listening is so important and you can gain so much by just listening to that client and asking them the right kinds of questions. So we really wanna connect with them one-to-one and personal level. So for instance, I had a soccer player come in yesterday and when she sat down for the assessment, I just. I wanted to know about her. I said, you know, tell me about you. Where do you go to school? What grade are you in? What activities do you enjoy? Do you have any brothers and sisters? Are you from Colorado? There’s just the basic communication where you’re really interested in that individual because truly we are very interested and care about our patients, not just from a injury standpoint, but we wanna build that trust and rapport with them, and we want them to know that we are their number one fan and that we are working very hard to get them back to their sport. And so communication, whether it’s verbally, non-verbally, you know, we’re really looking for keys and how comfortable they are in our, in our practice. Are they fearful? What fears do they have about physical therapy and what do they even know about physical therapy in general? A lot of people have not had great experiences with physical therapy in the past, or they may have not had physical therapy at all. So we want to really assess their comfort level of being in our practice, number one, but also what their knowledge base about physical therapy is, and help them have a better understanding of how we approach physical therapy in our practice and how we’re going to help them. Another way that we really try to effectively communicate. In our practice, if it’s a minor, we really make good eye contact with them, parent and help engage them as well and make them feel very comfortable in that we are going to take great care of their student athlete and that we are also gonna partner with the parent and want to know what the parent’s fears and goals and desires are as well. So we really see it as a partnership between the athlete, the parent. And then the coaches and any athletic trainers or any physicians or any other healthcare providers that they have on the side. So at the first visit, I ensure that it’s okay with the parents or with the athlete or the patient that we have, that we do communicate with their other providers. So I usually make a list of who those providers are, whether it’s a. Physician, athletic trainer, massage therapist, chiropractor. I wanna know who’s involved in their care team so that we can effectively communicate with them for the athlete’s benefit. I think another thing that we do is we make ourselves very accessible to our patients and to their coaches, athletes, and families. So they have a cell phone number that they can text or call at any time. It’s a phone system that we use so that they feel confident that they can reach us at any time, and we may not be able to get back to them in the middle of the night. Sometimes we do get texts at two or 3:00 AM surprisingly, but we’ll try to get back to them as quickly as possible. We just want them to know that we are here for them and that they can communicate with us either through text, phone call, through our electronic medical record system. We make ourselves extremely accessible and try to respond very quickly to them because a lot of healthcare providers either aren’t able or do not respond as quickly, and so we try to set ourselves apart in that we develop that communication, trust and rapport early on, and we want our patients to feel comfortable and have easy access to us at that level. I think another thing that we do with their permission is that we communicate closely to athletic trainers or other healthcare providers that are in their care team, and we try to do that efficiently and quickly as well so that we can get everyone on the same page and on board. When an athlete feels like they have a team behind them that’s working for their good and that’s on their side, they’re gonna be a lot more confident that everyone’s on the same page and that everyone understands where they are at functionally and where they need to go. When an athlete comes into our practice, we want to be good stewards of their time and financial resources and maximize. Their time with us in a way that is most beneficial. So some of the ways that we do that is, you know, we don’t have patients come in and ride the bike for 15 minutes or put a hot pack on them for 15 minutes and then treat them for 10 or 15 minutes and then have a tech go through exercises with them for another 15 or 20 minutes. We spend one-on-one time as doctors of physical therapy with our patients for the entire hour. We don’t hire rehab techs or aides so that. The patient when they come in and know that they’re gonna be with us and spending quality time doing either assessments or functional training during that whole hour, so they’re not wasting their time on some of those other things that they could just do at home. We also don’t do the same exercises that are on their home exercise prescription or that they could be doing on their own at home. So at each visit, we’re doing a functional assessment that may be more lengthy at the first visit. On subsequent visits, we’re also taking them through functional movement patterns to see where their deficits may lie that day, how they’ve responded to previous treatments. And we prescribe specific exercises according to what we’re trying to accomplish functionally with that athlete to help them improve and help them meet their functional goals. So for instance, if we have a patient who has had a bone stress injury. They’re trying to return to running. We’re going to take them through some functional movement patterns to see if they have any deficits in their spine, hips, pelvis, lower extremities such as knee, ankle, foot. We look at those assessments in terms of range of motion and strength, and then we target our exercises during that treatment session, and those exercises should and probably will vary from treatment to treatment. Then we tailor those exercises for what we’re trying to accomplish that day so that we’re not just wasting the athlete’s time on exercises they could just do on their own at the gym, but they’re really getting a lot of one-on-one direct feedback during those exercises and during that training, we’re also spending time educating them on why we’re doing it and what we’re trying to accomplish through that exercise so that they can really focus from a neurological standpoint on the key components of that exercise. And have results from that exercise in a more functional way. So for instance, if we’re trying to return that athlete back to being able to, you know, run, what we’re gonna do is have them start being more comfortable with loading weight through that foot. So we may do a, you know, band assisted jumping exercise, or we may do a. Step off landing where they absorb forces through the foot and are more comfortable with loading that foot prior to running 1, 2, 3, 4 miles, either on the alter G treadmill or on land. So there’s a very specific functional progression that we go through at each treatment and each treatment session will look differently depending. Their functional progression and how well they’re doing in terms of range of motion, strength, mobility, and overall confidence in using, uh, the injured limb. This is one of the things I think sometimes that gets missed when we look at physical versus mental readiness for return to sport. And we know specifically for certain types of injuries. For instance, with ACL reconstruction, when an athlete’s gone through ACL injury rehab, they may functionally pass all their tests. We give them a psychological readiness for return to sport test. They may not feel confident in returning to that sport. And it’s essential that we really address this because we know injury rates do increase when athletes aren’t mentally ready for return to sport beyond the ACL injury, there’s so many other injuries that we could talk about. We have a athlete ambassador right now who had a bone stress injury and a surgical repair for that injury and. When we ask how she’s feeling in terms of loading that foot or how even her foot is feeling, sometimes she’ll say, well, I don’t know. Okay. I guess. And so it’s that hesitancy early on to even have an awareness or, or sometimes have fears based on how that foot feels and with progressing or loading that more functionally. So we really have to check in at each visit, honestly, and see how they’re feeling that day about their injury. And once we address that early on, we’re constantly checking in, you know, how’s your knee feeling today? How did it feel at your last visit? How do you feel about, you know, starting to do a run progression today? Are you fearful or are you excited? And so we really check in with them to see what their feelings are about that so that we can address that and talk through that with them versus saying, Hey, this is what we’re gonna do today. This is what’s on your protocol. That doesn’t make a lot of sense if the athlete has fears or has hesitations about progressing in that way. So we really try to address that at each visit. But if, if it’s something that goes beyond our means and our resources, what we do is we refer them out to a sports psychologist. Who can spend more time with them one-on-one, addressing any fears or underlying issues that they may have that are tied to those fears so that they can overcome those and not have a higher risk for re-injury when they return to sport, if they’re not mentally prepared to do so. So this goes back to how we differ as sports physical therapists from traditional outpatient physical therapy. You know, we never truly discharge our patients. One of the things that kind of drove me crazy in traditional outpatient physical therapy is you’re really encouraged to, after you did your initial evaluation, solve them for four to six visits. Then you discharge the patient and send them on their way. Yes, we do essentially get the athletes to a point where they’re ready to return to sport, but we don’t really need to discharge that patient, especially say those words and officially like, you know, send them on their way to where they feel like there’s been sort of a disconnect between you and, and. They’re further endeavors with return to sports. So what we say is, look, we, you’ve met your goals, you’re functionally ready for return to sport. We’re gonna communicate where you’re at functionally with your parents, your coaches, your, your athletic trainers, your strength and conditioning coaches, so that they can continue to help take you to the next level. We will send programs in writing or written instructions or, you know, email or text instructions to those people in there on their team. Whether it be coaches or athletic trainers or strength conditioning professionals, we will give them detailed instructions on where the athlete is at functionally and what they can or can’t do in terms of their return to sport when they’re fur fully released for return to sport. We also communicate that with test results. We go back to those objective measures and say, all right, this is why we’re comfortable with releasing an for return to sport and. They have a, you know, 5% or less asymmetry side to side and the injured limb, they are psychologically ready for return to sport. You know, strength wise, they’re good range of motion. Mobility wise, they’re good. And here’s a few of the things that you can continue to work on, but one of the things we really pride ourselves in is continuing to connect with that athlete, and we have them come back for. Either biweekly, weekly, or monthly maintenance check-ins, or maybe it’s after, you know, two or three months we set, we go ahead and set an appointment for them to come back for a check-in, and we also tell them, Hey, I want, I want you to let us know in X amount of time how you’re feeling about this, any fears or concerns that you have, and let’s address those early so that you feel fully ready and capable to play at a hundred percent without restriction and without fear of re-injury. So one of the ways that we continue to build rapport with our athletes, coaches, and local teams is that we continue to stay in close contact with them. We contact them by phone, text, email, newsletter. We reach out to them just to let them know, Hey, we’re here. We care. How are you doing? How. We ask the coaches, Hey, how is your athlete looking in practice? How are they in competition? Do you have any concerns? So we really do a lot of check-ins. We spend a significant amount of time after hours doing so because number one, we really care. And number two, that’s gonna help the athlete feel confident and know that if they do have an injury in the future, that they’re gonna remember us and and want to come back and see us. What I would say to, you know, the listeners out there, if you are an athlete and you are in a practice where you may not feel like you are in the best physical therapy situation for return to sport, and in order to meet your goals, you need to get different answers or seek a different provider. We are always here for you and we make ourselves accessible no matter what to our. Local community. So if you just have questions, we offer free discovery sessions where you can come in, talk to us about your injury. We will, you know, make sure that you’re a good fit for our practice. We’ll help you feel at ease. We’ll help build that trust or rapport early on so that if you. Are in need of our physical therapy services as sports physical therapists, you’ll have a good knowledge and confidence level that we can help you. And so I would just say that if you’re seeking and searching for answers about your specific pain or injury, we are always here for you and we know how to help you. We have the tools as sports physical therapists in our practice to be able to help you. And for instance, you know, we have diagnostic ultrasound, we have tools such as deep tissue laser, we have shockwave, we have specific tools for athletic related sports related injuries such as tendonitis, Achilles tendonitis, patellar tendonitis, Osgood Slaughter’s disease, Seavers disease. Just some of the overuse type of injuries that we see with maybe hamstring tendonitis or certain bone stress injuries. We’re well equipped in our clinic to handle that. We have an anti-gravity treadmill that can offload your body weight and get you back to full function faster than if you were just trying to progress your running on land after injury. We have blood flow restriction training so that that helps you speed up and accelerate recovery and prevent muscle atrophy after injury again, we do offer functional testing through our force plate analysis and force transducer, the vol dynamo. So that we can accurately assess objectively where you’re at. So we, we want you to know that we feel like we are experts in our community as sports physical therapists. We’re here for you and we can help you, and you don’t have to, you know, be in a more traditional outpatient setting where you’re not receiving the care that you need. And, and wasting time. We know that your return to sport is very important to be able to return as quickly and safely as possible. And that’s what we do here at Fit Physical Therapy and Sports Performance. And we will help you in any way, in every way that we can. So please reach out to us through our website, through text or phone or email. We’ll be glad to help you and offer scheduling within 24 hours so that you don’t have a long wait time to get in to see us.