Bridging the Gap from Rehab to Performance

In a clinical and performance world where there are so many experts to follow, the development of a philosophical training model can be difficult to create and implement, especially for the less-experienced practitioner.

Rather than trying to be exclusive or exclusionary, it is important to recognize that many schools of thought, when broken down to their core principles, focus on the same things. All techniques, exercise types, schools of thought and training principles are valuable when bridging the gap from rehab to performance.

That said, let’s start our exploration by taking a closer look at the shared segments that comprise these systems. This is not a dogmatic classification system. Many interventions or schools of thought might fall into more than one category. Each intervention has many parts to it, and in your thought process, one might fit into an entirely different category than listed. This is fine. As you begin to understand the system, think about where each of the phases, disciplines and concepts fits into your personal practice.

All models fit, all disciplines fit and all “gurus” fit when we work to bridge the gap between rehabilitation and performance. Whatever your specialty, decide where that school of thought lies in this system as you create a process to return athletes to sports performance.

We will look at an overview of each category next. (Bridging the Gap from Rehab to Performance expands upon them in individual chapters.)

Briefly, think about when a client comes to you in pain. Say, for example, the person is a soccer player with a painful groin. First, we need to decide what tissue is the issue. We need to identify the pain generator.

Is the pain coming from a torn muscle or tendon in the adductors or in the abdomen? Is the pain coming from the hip-joint capsule impinged between two bones? Is the pain coming from a degenerated joint surface? Are all structures of the hip normal and the pain is coming from the low back or the central nervous system?

Once this is determined, we need to ensure the joint is moving properly in relation to those around it. Does the hip have full range of motion? Is flexibility normal? Are all aspects of the joint working well so it can fit within the system as part of a whole? Can the lumbar spine stabilize in order for the hip to move? Are there limitations at the ankle that could be affecting the hip? This section will take into account the entire motion segment.

We then need to make sure the right muscles are firing at the right time. We need to ensure there is proper psychomotor control. Is the glute acting as a prime mover for hip extension or are the hamstrings or lumbarparaspinals dominating the movement pattern?

From here, we move into somatosensory control. We consider all aspects of the neurological system, including reflexes, visual, vestibular and all the neuromotor programming aspects affecting how the motion segment moves or why pain is being generated. This is the largest and most complicated category and certainly influences and is influenced by every other aspect.

Next, we have fundamental performance. Not only does the hip itself have foundational strength—which could also fall under the motion-segment category—but we look to see that the entire system has proper fundamental strength to be expressed as power in our next category, fundamental advancement.

It is within fundamental advancement that we begin to move at various loads and speeds, introducing fundamental athletic movements such as acceleration, crossover, drop step and more.

Finally, in advanced performance, we begin to meet the client-specific goals of returning to an activity. Whether the client is a hockey player, lacrosse player or laborer, we introduce the specific movement requirements that must be mastered prior to returning to the activity.

Of course, underlying this whole strategy are the biopsychosocial factors that influence how we each have a different response to pain and to a team’s interventions. The biochemical, nutritional, and genetic factors of each person’s biology will affect the mindset, mood, and attitude of the person. The societal, familial and cultural influences on a person will impact how that person responds to any stimulus. The biopsychosocial influencers are the individual factors we must consider every time; they will never be the same for any two people.

No single part of the continuum is necessarily a prerequisite to another. Many of these areas can and should be addressed simultaneously as an athlete progresses from table to field. However, these all need to be considered prior to an athlete successfully returning to play.

In the next post, we’ll go more in-depth regarding the first topic: Pain Generator.

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