I’m happy with the message that was sent but in honesty, I think it did backfire some. I had some smart therapist friends who had their patients come in with a copy of my article with the idea that their therapists were incompetent and didn’t understand their unique needs as a patient. I really didn’t mean to give this notion nor do I believe this in any way. Most physical therapists hold a doctorate level education and work all day everyday getting people out of pain. They’re good at what they do and deservedly so. I think the article pushed some patients to lose any and all faith in their therapists and I didn’t mean to do that.
What I think IS a more fair assumption is that our two professions just don’t know each other well enough. As a trainer/coach, when was the last time you called your patient’s therapist or doctor to ask about specific advice on what your client should and shouldn’t do? As a therapist do you regularly speak with your patient’s coaches/trainers to see how they are progressing back to their sport and recommend ways to ease back? I believe that if we understood each other’s roles better there would be much less animosity and more importantly, better patient/client outcomes. Here are my top five reasons that therapists and trainers should talk more.
It’s easy for a therapist to have negative feelings toward [insert fitness trend/sport/activity here] because they see injured patients in their clinic from that said activity. What isn’t seen are all of the healthy happy people who don’t get hurt and live happily ever after. They don’t always see the attention to detail the trainers go through to ensure patient safety. This was one of the major points of my previous article. It’s easy to stay in your own world and be biased because of what you’re exposed to.
I think a lot of coaches and trainers are just as guilty of this. What trainers should understand is that we do see injured patients from x, y, z activity. Here’s an example: In our discussion on kipping pullups at crossfit HQ we came to the conclusion that kipping pullups are generally safer and produce less injury then other exercises and when progressed properly that they are just as safe as a strict pullup.
As soon as that video became available in the crossfit journal and youtube I got several emails from various people about how they tore their rotator cuff and or labrum while kipping. I’ve also witnessed some people having to be whisked off in an ambulance because they weren’t gripping the bar tightly enough while kipping, falling and injuring themselves. Are these anomalies? To a degree. Do we see this everyday in the gym, no. However, it occurs.
I believe we should be doing what we can to minimize this risk despite being a relatively safe exercise (I even teach burpees in a way to minimize stress on the knee). Trainers are going to get invaluable info from therapists because therapists see where their clients are getting hurt, are identifying trends and can help with preventative strategies. I think this is where trainers need to pay attention and it’s definitely a way trainers can set themselves apart from others in the industry (Because as far as I see not many out there are communicating with therapists).
2) Two Worlds of Valuable Information
I’ve made this analogy before. I don’t know my head from my butt when it comes to cheerleading, ballet or dance (although at times I’ve been known to cut up a rug or two). However, I do get some patients who walk through the door who were injured doing these activities. My first action? Figure out what the heck these sports are all about so I can have a fighting chance of helping this patient. Know who has access to a cheat sheet of information to help you along the way? The patient’s coach. They’re going to have a plethora of insider information to help you out. If you aren’t speaking to these coaches and trainers you might be missing some valuable information that would lead to a successful rehabilitation and return to sport.
On the trainer side of the equation, when I was a fledgling strength and conditioning specialist I got my first patient who recently underwent an ACL repair. She was still in therapy and I really had no idea what I could and couldn’t do with her. The first thing I ended up doing was calling her therapist. I honestly had no idea what to do and was deathly afraid of her knee exploding spontaneously throughout the session. To make a long story short, the therapist calmed me down and gave some fantastic recommendations as far as what I should be addressing. Win, win. I looked like an all-star and my client got back to collegiate sports successfully.
I was just speaking with a co-worker of mine today who had a client who’s doctor told her not to squat again for the rest of her life (The client was 28). Now I don’t know the specifics of that client’s particular situation but my next logical question is now how do you get down to the toilet? I’ve had several patients tell me a similar stories from their doctors (Now to the doc’s defense it may not have been the doctor’s exact words but somewhere along the lines the patient started believing this).
I tend to think that most doctors don’t always believe that their patient shouldn’t be squatting (or insert any other activity here), they just don’t have the time, expertise or resources to show them what a proper squat looks like and the circumstances where they should and shouldn’t be squatting. However, some people make a living showing people how to squat properly (therapists and trainers both). If the doctor knew of a good therapist/trainer they trusted it would have been as easy as writing down a phone number for the patient. I think a lot of times this gets lost in the translation just because a medical professional doesn’t have the time to do the job themselves.
Another example is in an ACL patient of mine. She’s a phenomenal athlete and I’d really like to rehab her from A-Z and do some additional strength and conditioning before she gets back to her sport. However, insurance issues don’t allow for that. She does have a fantastic athletic trainer at her school though that has been enormously helpful in her rehab process. All of this would never have happened if I decided not to pick up the phone and call.
I think I’ve already delved into this one but I think it’s worth mentioning again. Different professionals each have different valuable skills that when added together can greatly improve our patient’s outcomes. At the end of the day we’re doing what’s best for our patients and clients. Ya, you’re tired at the end of the day or just want some peace and quiet during lunch (or if you’re me it’s a mad dash to finish notes) but the communication is a vital part of the puzzle. We’ve got our patient’s best interest at heart and if we’re ignoring the wisdom of another profession we’re doing ourselves a disservice.
So in conclusion, get on that phone. Start speaking to those coaches where your patients are coming from. Trainers and coaches start talking to your patient’s therapists. Together we can become better.
I feel like that last line was straight out of an afterschool special program of some sort,
P.S. If you enjoyed this article then sign up for the newsletter to receive the FREE guide – 10 Idiot Proof Principles to Crossfit Performance and Injury Prevention as well as to keep up to date with new information as it comes out via weekly emails.
4 Reasons Why You Can’t Perform Kipping Pull-ups and Muscle-ups
The Good, Bad and Ugly of Crossfit as a Form of Fitness
FPF Podcast Episode 30: Gymnastics, Crossfit and Safety with Dr. Dave Tilley
The Best Exercises For Crossfit Shoulder Health
The Missing Ingredient to Crossfit Success and Longevity
10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation
Crossfit WOD Programming 12/2/2013 – 1/6/2014
Fitness Pain Free Podcast Episode 28: Crossfit and Gymnastics with Team USA Gymnast David Durante