From Rehab to Performance, Part 4

Earlier installments of this series of posts from Bridging the Gap from Rehab to Performance touched on the first segments of an organizational system for caring for patients/clients from table to field: Pain Generator, Motion Segment, Psychomotor Control, Somatosensory Control.

Here in Part 4, we’ll move from the clinical to the functional and performance related segments.

Fundamental Performance

As we start to look toward performance, we begin to address fundamental strength:
Does each muscle have the basic foundational strength to carry out the task we are asking it to do?

Does each muscle have the ability to fire, against gravity, with resistance?

During standardized manual muscle testing, does each muscle possess the ability to perform at a foundational “five out of five” strength—normal muscle strength per manual muscle testing principles?

If not, we have some basic strength training work to do. We cannot build power—the forceful application of strength—without first building baseline strength.

In this stage, we need to reestablish fundamental strength and, ultimately, power. Deploying foundational corrective exercises for strength will work well during this phase. Correctives derived from FMS, SFMA, PRI, MAT and strength and conditioning training are used to produce the strength to prepare for more powerful movements.

When introducing power, it does not matter whether this is from a kettlebell, Olympic lifting or another approach. Use whatever you think will work best for a client, given their medical history, sports background, training age and performance needs.

Fundamental Advancement
During the fundamental advancement phase, we study how to display foundational strength—fundamental performance—as an expression of power, and apply this power to general athletic movement. This is the phase where we introduce power production and focus on linear movement, multi-directional movement, jumping and landing.

For example, an athlete must be able to achieve the fundamental positions needed for acceleration before we program sprints. Athletes need to be able to manage the forces created during the acceleration and then be able to safely decelerate to avoid injury.

During this progression of bridging the gap, a recovering athlete must relearn proper backpedaling, shuffling, jumping, landing and basic footwork techniques before returning to full practices and games. These fundamental athletic skills are required in every athlete, in different combinations, and at various loads and speeds.

This is the time to rebuild the foundation of athletic movement.

The primary goal at this point is to retrain universal athletic movements and power creation and management. This is when we use the skills from the strength and conditioning models. It is up to you whether you follow principles employed by EXOS, Michael Boyle, Dan John, standard CSCS formulas or any other approach.

Attention to your individual client’s needs based on the medical history, the sport and your experience will serve your client well.

Advanced Performance
Once we get to performance, the unique requirements of each sport and the different positions start to come into play. For example, whether a football player is a wide receiver or an offensive lineman, both athletes need to run, but an offensive lineman most likely needs acceleration mechanics more than absolute speed mechanics.

Consider a baseball player and a soccer player: The former needs to run around the bases and to various fielding positions while paying attention to where a ball is as it flies through the air, while the latter must run down and across the pitch with a ball at foot, avoiding opponents along the way. Although these athletes share fundamental athletic movements, each sport and each position within a sport have different needs from a movement perspective, and we address those needs in a slightly different way.

This brings us to a fundamental concept when organizing an intervention:

Are we offering something to the athlete that is diagnosis-specific, diagnosis-inclusive or client-specific?

Our treatments in the pain generator and motion segments are typically based on the diagnosis—these are diagnosis-specific. In the early rehab phase, it is important to know whether we are dealing with a bursitis or tendonitis, and it matters how that pain generator is affecting the entire limb or motion segment.

As we move forward through rehabilitation, the interventions become diagnosis-inclusive. This means that most likely, we prescribe some form of “core stability” work to everyone in the facility—however we choose to define core stability. The 60-year-old golfer gets a set of core stability exercises, as does the 14-year-old high school football player and the 24-year-old professional athlete. These are different age populations with different performance goals and, probably, different diagnoses, but they all need some type of “core stability” to improve the conditions.


Finally, as we work our way toward the more performance-centric end of the bridging-the-gap model, we must be more client-specific. The firefighter and the professional athlete will both need to function at a very high level, but they will do it in different ways. The quarterback and the pitcher may both be professional athletes, but their jobs require different skills. We need to consider the individual needs of the athletes in order to restore full function and return them to their sports.

This performance phase aims to return the client to the sport, with position-specific functions needed for that sport and position. As with the rehabilitation interventions, it does not matter which performance model you choose. These are your personal preferences and prerogative as a practitioner or coach.

Be sure to include skills coaches in this segment, as it is essential to enable the client to meet the unique technical demands of the sport and position. You can also apply movement analysis to ensure the client has regained full capacity in each of the main movement patterns needed to retake the field.

Part 5 of this article will continue to focus on the performance segments of Organizational System: Fundamental Performance, Fundamental Advancement and Advanced Performance.

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