Boost athletes’ injury recovery and prevention by applying the concepts of force vectors, movement patterns, and power.

By Bobby Curtis, PT, DPT, SCS, CSCS, RKC

It pays to be a winner! is a popular phrase with many people today, most notably members of the US Special Forces community. When this community uses that phrase, we as a civilian society take it and unequivocally run with it, trying to paint the saying across the broadest spectrum that we can, and usually in everything we do. But this can have consequences if you don’t take care in how you get there.

We have continually placed emphasis on and have tagged excellence with having the highest numbers in the bench, squat, and clean… as well as the fastest numbers in the 40- and 60-yard dash, pro agility in the NFL combine, and let’s not forget the endurance athletes with the fastest mile times. We tend to think of athletic excellence as being defined by pure objective data with only the “result” being noteworthy, not the process through which it was achieved.

The process itself, our way of accomplishing all the previously mentioned amazing athletic feats, is usually how people, young and old alike, end up in the training room, the sports medicine PT clinic, and the least exciting place, the operating table. To simply look at the result or the process in isolation is only looking at one side of the coin, which is being a bit short-sighted—something equally terrible in anatomy and physiology, just as it is in the stock market. We as physical therapists can apply our skills and knowledge to help athletes achieve their goals in a better way.

What an Athlete Needs

So, by definition, what exactly is athleticism? While there are many definitions and different opinions, let’s make it simple. Athleticism, when you look at it in its most basic form, is getting into and out of multi-joint angles as quickly as possible. When you are a dedicated athlete who can do it faster, better, more efficiently, with more power, and ultimately with greater ease, you typically get paid for your efforts either in a collegiate scholarship or professional sports setting.

Most physical therapists (PTs) realize when we have an average consumer of our products in the clinic versus when we have an elite athlete as a consumer. Do we treat them differently or do we treat them the same? The answer is most definitely yes.

Let me explain. To be a true sports physical therapist, one needs to both understand and marry the field of physical medicine with strength and conditioning. Allowing ourselves to be humbled and learn from some of the best strength coaches in our generation regarding force vectors, movement patterns, and power allow us to truly tap into what the athlete needs in order to be a better medical steward for their physical training. We can learn from Mark Verstegen, Mike Boyle, Dan John, Pavel Tsatsouline, and Josh Henkin, to name just a few.

The Next Level

Now, there’s absolutely a time and place for mat or plinth work depending on the acuity of a pathology, as well as what the athlete can or cannot do correctly or safely from a neuromuscular and motor control perspective regarding a various task or movement pattern. However, once we can combine our highly specific manual techniques with either a push, pull, carry, squat, hinge, or plyometric pattern with proper external load, BAM! That is some awesome and powerful stuff we are giving our patients and athletes alike to have long-term success. Athletic rehab must not only focus on the power output or force production of a given pattern, but also force absorption (the brakes), as well as anti-rotation (true stability) to fully bulletproof our athletes and limit their time on our tables and in our clinics due to injury.

While there are multiple tools that a sports physical therapist can utilize to achieve these goals as part of an overall fitness regimen, in this article we are going to look at two specific tools that can both contrast and mirror one another: a sandbag and an all-in-one gym that also provides objective data.

Sandbags for Fitness

Using sandbags for fitness is not a new idea. Athletes have been using them for a long time not just to stand in for dumbbells for strength training, but to provide the additional benefits that a shifting weight load can provide. And there are now several sandbags on the market designed to be used for workouts.

One such tool is the Ultimate Sandbag, from DVRT (Dynamic Variable Resistance Training) Fitness, Las Vegas. It’s a durable sandbag with handles that are designed to resist tearing and leaking and to be gentle on skin. The company’s website points out that, “The use of sandbags for fitness may go back a long ways, but never as a serious and focused training tool.” Within sports medicine, we have had a paradigm shift in trying to understand how to incorporate fitness into our rehabilitative medicine protocols in order to give the athlete the highest possible chance of success in returning to their previous level of competition while mitigating risk of either re- or future injury. Another common myth is that external load is external load, meaning all resistance is the same no matter what, and we’ve learned in recent years that this is not true.

In fact, the University of Wisconsin-Milwaukee conducted a study on the ultimate sandbag fitness system, which stated, “According to the results of this study, the use of Ultimate Sandbags during a lunging exercise elicits a greater heart rate and estimated energy expenditure than the use of dumbbells. These findings suggest that Ultimate Sandbag Fitness may elicit a greater relative exercise intensity than dumbbell training.”

What is great about having to control the sometimes-uneven load when using a piece of equipment like the Ultimate Sandbag is greater reflexive core activation, which is what we’re looking for in both daily life and athletic endeavors. Planks and isolated transverse abdominis contractions just don’t do enough to affect great carryover to tri-planar movements and explosive patterns that we ask of our athletes.

Another great effect previously mentioned is the greater cardiovascular effort required to initiate, move, and maintain proper movement with the use of a tool like the Ultimate Sandbag. No matter if it’s a grade I lateral ankle sprain that keeps an athlete out of the game for 5 to 10 days, or an ACL reconstruction that takes 10 months to rehab, cardiovascular deconditioning starts on day one of an injury because of an inability to train at the peak levels required to maintain one’s relative fitness. Using a tool like this is one way we can help to mitigate this decline.

All in all, when you have a product designed by both a strength coach and a physical therapist that can move across the entire spectrum, that tool could be the solution to a lot of problems that both fields respectively encounter.

All-In-One Gym Plus Data

Portable gyms that can be used for multiple exercises can provide great value, as can pieces of equipment that provide objective data so you can gauge a client’s progress not just over time, but also at different points during a single therapy session. I believe equipment that combines both of these benefits is something that any clinic or sports medicine practice could utilize.

A great example of this is the Keiser Functional Trainer. It doesn’t take up a lot of clinic space, and with its small footprint it can be used in a variety of pushing/pulling directions to allow the patient optimal levels of success. According to Keiser, based in Fresno, Calif, “Just because you can pull a cable in a variety of directions doesn’t make it functional. It’s pulling at the speed we perform that makes it truly functional.”

One reason I like using the Keiser Functional Trainer is that it’s quiet, except for its compressor, which helps to utilize air resistance and also helps to make the equipment’s movement smooth and safe for the patient. But even more than that, I appreciate the fact that it has a power output meter that spits out numerical information each second that a repetition is performed, providing beneficial objective data about the watts of energy elicited.

When seeking additional information regarding left versus right symmetry and whether post-injury or post-surgery output equals that previous to said injury, we can know in a matter of seconds if that athlete or competitor is safe to return to sport. With the objective data being spit out, we can also tell at what percentage of maximum output that each rep is performed (if the last rep was 82% of maximum output, for example). This means that if we are seeing fatigue toward the middle to end of the set, we can alter the resistance necessary to maintain proper movement patterning as well as power output relative to the resistance.

With insurance reimbursement parameters ever changing and companies wanting reliable and measurable data, soon will be gone the days of “poor, fair, fair plus, good, etc” to describe a physical therapy client’s progress and coming are the days of measurable limb symmetry, range of motion, and power output. This machine helps you to be at the cutting edge of the paradigm shift upon us in the field of orthopedics and sports medicine.

Reaping the Rewards

As sports physical therapists, we can help our clients by making use of the knowledge and tools at our disposal. This includes developing preventive and rehabilitative exercises incorporating the added dimensions of force absorption and anti-rotation as well as utilizing equipment and techniques that can harness and measure their positive effects. PTP

Bobby Curtis, PT, DPT, SCS, CSCS, RKC, is a partner and clinic director for Vista Physical Therapy & Sports Medicine – McKinney & Allen in McKinney, Texas. For more information, contact [email protected].

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