For the injured athlete: An athletic trainer and physical therapist discuss returning to sport
You’re a high school or collegiate athlete and you’ve recently encountered an unfortunate development, which may, for a time, feel like the end of the world.
An injury.
It’s significant enough that you’ll need extended treatment, maybe surgery. You’ll miss time, whether it’s practice, games or maybe the remainder of the season.
You have one goal: Get back as soon as possible.
That won’t be easy.
It takes hard work, dedication and trained specialists who are willing to provide individualized treatment specific to your injury and sport. You’ll deal with physicians, physical therapists, athletic trainers. How they mesh daily, and how you embrace their instruction and care, goes a long way to getting you back on the court, field or rink.
Physical Therapist Corinne Meisel and Athletic Trainer Holly Blenker have dedicated their careers to helping athletes return to sport. For the past 13 years, they have worked together at Saint John’s University in Collegeville, Minnesota, a Division III school with 11 varsity sports as well as club and intramural teams.
They’ve seen it all and continue to be passionate about helping athletes return to sport. As part of March’s National Athletic Training Month, we’re highlighting the relationship between an athletic trainer and physical therapist while letting you, the athlete – or athlete’s parent – get a better understanding of what to expect when a sports injury occurs.
Corinne and Holly took time to answer questions about returning athletes back to their sports healthy and ready to compete again. Responses are edited for brevity and clarity.
When does the process start for returning an athlete to competition?
Corinne, P.T.: “We're almost always analyzing that from the beginning when we see them. Although there are some situations when they're obviously not ready – they walk into the physical therapy center after having surgery and they're on crutches or their shoulder is in a sling, it doesn't take a lot for us to go, ‘Yeah, you're obviously not ready to go.’”
Holly, A.T.: “I think the beginning phase is so crucial. One, that they're getting that care they need early on. And two, that the communication is there, and they understand why physical therapy is important. Because so many times (the mentality is), ‘Let’s wait it out.’ And it's like, ‘No, let's get started on it early.’”
If athletes are receiving sports physical therapy does that mean they shouldn’t practice or play?
Corinne: “We make sure everybody knows just because you're in physical therapy doesn't mean you can't play. Physical therapy is often necessary for athletes to be able to get back to play . But they aren't always mutually exclusive, and I think that makes it so much more confusing and complicated for athletes.
That’s where the physical therapy and athletic training relationship melds so well. The athletic trainer may say, ‘I'm still going to let you play for these reasons, but in order for you to continue to be successful, or in order for you to get to the next level … physical therapy will help with that.’”
Holly: “We really do emphasize that. You need to be doing X, Y and Z, and I might not be able to watch over you while doing it. That's why we want you in physical therapy, so you are getting back and you’re playing better or staying healthier longer, because that's what physical therapy is going to do for you.”
What are the distinct differences and advantages of working with an A.T. and a P.T. during the sports injury process?
Corinne: “I like to look at it as I'm there to take the more precise measurements or the more precise tests. It’s almost like I’m the scientific lab part. I'm doing these tests and I'm figuring this out. And then I tell the athletic trainer, ‘The athlete did this, this and this. Now, do it in the real world and see what happens.’ We're gathering data. That data can sometimes be high tech. We have things like motion sensors. We have force plates. And sometimes it can be very simple:
Can you do that motion in the (center)? For example … running on the treadmill is nowhere near the same as running on a soccer pitch, but at least if you pass my scientific test, the athletic trainer can see how well that’s put into place. And they might come back and say, ‘It can’t be put into place because they need to have more push off.’ And then we go back to the lab and work on those kinds of things.”
Holly: “Corinne can run those numbers, and I think that's so important, because (the athletes) can see that testing, all those objective measures throughout. … So, when we're getting them back to play, they can say, like, ‘OK, I've made these steps. These are objective measures that I can see.’ By the time they're lacing up their cleats and they're not on the treadmill anymore and they're getting on the field, they're going to feel a lot more comfortable because they've seen that progress (through Corinne’s data).”
Does that data from sports physical therapy sessions come up in the athletic training room?
Holly: “Oh my gosh, yes. I had an athlete that just left treatment and was like, ‘I was with Corinne, and I'm at this percentage on my force plates.’ And that’s good, because it's less of a step I have to overcome with them, just on the mental side. Because they've seen that objective data, as opposed to me being like, ‘No, you're ready. You're doing these things. You can do this, I promise.’ Because that is a hurdle to overcome. Being able to see those numbers, see how it's grown (gradually), it really is so beneficial for us.”
Are there certain numbers or movements you target when analyzing improvement?
Corinne: “There’s this weird magic number, 10%, if we are looking at a difference between one side and the other. So right leg versus left leg, we want them to be within 10% performance of each other. Everyone's different, right? A soccer player’s quad strength is going to be different from an offensive lineman’s strength, if we're just looking at it as an absolute number. But if you're comparing an athlete’s right to left, it should be similar. … And it's not just strength. It can work that way for range of motion, balance.”
Holly: “Every athlete, every case, is going to be individualized: Where the recovery is, where that person's mindset is. Honestly, where we are in the season, where they are in their careers, what their long-term plans and goals are. Those conversations are ones we have to have with the coaches. And it is nice when we have all that data to present.”
Once the numbers are in a good spot with physical therapy, what’s the next step for the athletic trainer?
Holly: “We're not going to throw you onto the field and let's see what happens. That's not what we're going to do. … With football, I’ll get a weekly report from Corinne about where everyone's at. Once they're easing into doing footwork, then they're going to be doing ladder drills in their cleats. Then they’ll move into (individual drills), and we're going to watch that and see what they're doing. Are they guarding the injury in a certain way? Are there things they're avoiding? Are they avoiding it because they're still some sort of functional disability or is it just a mental block or a fear?”
Are you able to gauge the mental aspect of readiness in your evaluations?
Corinne: “We also have tests for that, like a confidence scale. I purposely don't tell them, ‘I'm going to administer a confidence scale for you today.’ But we do have different questions we ask, and we do have data that, if they're scoring in this range, they might not be ready with their confidence. If it's not an actual confidence thing, we also consider kinesiophobia, that fear of movement or avoidance of that movement. We have ways we can test for that and break it down.
It’s an issue in many individuals, so we’re basically working on that before they even know it could be an issue. We’ll work on gaining that confidence and trust in those movements in a safe manner, so that when we progress them to the next level, it doesn't seem like a big step.”
Holly: “The ones we have the most success with are the ones we’ve been able to let them take ownership of what they're doing and ease them into things as opposed to making them feel like the physical therapist or the athletic trainer is right next to them every second, watching them. Those are the people that struggle and have those mental barriers, because there hasn't been that feeling of ‘I am in control of my own destiny, depending on how hard I work and what I do.’”
Are there any signs you look for as far as those mental hurdles?
Holly: “Body language, both on and off the field. Body language around their teammates and around their coaches is very telling sometimes. If you are noticing that they're fine with you, but then the second their teammates get around, they're hiding back into the shadows. It’s like, ‘What's going on?’”
Do you encourage your athletes to speak up if they are uncertain about things or if they aren’t sure why they are being instructed to do something?
Holly: “My goodness, yes. You can only take ownership of your recovery if you understand what's going on. So, the more we can educate them, the more they can understand why we are doing what we’re doing, and it makes them buy into what the process is and helps them trust you.”
Corinne: “One of the reasons I love working in the university setting is because these people are lifelong learners. They've committed to that. And so, to some degree, physical therapy isn't any different. It's just a course you didn't want to sign up for. You had to.”
Who makes the final call on getting a player back to sport?
Corinne: “It's always a fun thing when the athlete asks that question, and everyone's pointing fingers at the others. Not because we don't want to make the call, but because we are such a group. I’m like, ‘These are the things I'm going to look for, and then I'm going to talk to the doctor. And the doctor's seeing these things. And I'm talking to Holly, and she sees these things.’”
Holly: “I think it's the whole sports medicine team. The physician is a big part of it. Are they comfortable – specifically if the athlete is coming back from a surgery – with that person getting back on the field? It's a group decision.”
Is there anything else to add to this discussion?
Holly: “When it comes to the return-to-play process, the athletes and the parents must understand no one factor is going to be why they're returning. There’s not a set amount of time. ‘Well, it's been six weeks, so I'm supposed to be back.’ There are so many things (to consider) and that's why we have a team approach.”
Corinne: “I would go along with what Holly's saying. There is not a specific scientific thing where we can lay it all out and know this is where you're going to be in this many weeks, or this is exactly how it's going to work. And I think that that's tough. … Just understand that even though medicine is a science, we can't give a strict, exact timeline because we can't control the body's healing.”