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Athletic development specialists dedicated to the art and science of excellence in movement

An Update on Kara…And Thoughts on the Synergy Between Rehabilitation and Performance

We’ve received several inquiries regarding Kara’s recovery from her crash at World’s that resulted in seventeen fractures of her right scapula.   I’ll take this opportunity to provide an update for all those interested.  The goal we have taken in her rehab strategy has been to bridge the gap between rehab and training.  The most effective means to accelerate the return-to-play process is to create open lines of communication between professionals working within a complementary system of values and techniques.  We have been fortunate to team with an excellent physical therapist in this process, Dr. Chuck Cole, DPT of Momentum Physical Therapy

A traditional approach is to erect barriers between the worlds of medicine and performance: the medical professional just says when the athlete is able to start training again and just gives yellow light or green light.  The coach, with minimal communication from the docs, is left to employ a ready-fire-aim strategy.  In a modern approach, there is open communication to assess and correct movement flaws, whether those flaws predated the injury, developed to protect against pain, developed around damage.  Broken bones don’t function as well as non-broken ones!  Since pain produces unpredictable results and pain science is a specialized field unto itself, it is the medical professional’s role to peel-back the layers of the pain matrix to triage further interventions.

We had one individual say, “why should you as the coach care what PT she goes to; shouldn’t it be her choice?   Why do you (the coaches) get a say in who HER physical therapist should be?”   Personal choice is undoubtedly a critical part of the patient/clinician selection process.  Other considerations for Kara included proximity to home and insurance carrier.  However, synergy between the medical staff and the coaching staff also ranks high on the priority list to accelerate a return to normal training...and sometimes is the key to return to training at all.  I know this type of approach may sound foreign to athletes at the recreational level, but it is the direction the sports medicine field is moving in the elite and professional ranks.    

Consider this: The #1 predictor of future injury is previous injury.  The mechanism of the injury does not matter nor does the site of injury.  If you get hurt, you are at risk to get hurt again.  When you get hurt, motor control and conditioning are impaired during the convalescence period, in addition to any preexisting impairments.  The transition between the rehab center and training ground is an abyss for many athletes, often because medical and performance elements speak different languages and view each other with suspicion (though sometimes a level of suspicion both ways is merited…).  

Because we use complementary models with the Functional Movement Screen and Selective Functional Movement Assessment, we know exactly what Dr. Cole is working on and can move into the performance realm in a way that supports the rehabilitation protocol.  Truthfully, it doesn’t matter if you use FMS/SFMA or other system, so long as communication is open.  One benefit to the FMS/SFMA marriage is using similar terminology.  Most important is creating synergy to resolve pain and restore quality movement.  We’ve been fortunate to have access to her appointments and able to communicate openly to build on the goals of each rehabilitation session. 

The Process

Three main foci during her rehab have been to restore shoulder external rotation, shoulder flexion (upward reaching), and scapular stability.  Let’s look at why these movements are important in a global sense, and how we can address these from a performance angle during convalescence.    

External rotation

This is part of a generalized rolling pattern.  Our first form of locomotion as an infant is to roll.  Shoulder rotation is part of that movement pattern.  Although ballistic lateral movements aren’t possible with a fractured scapula, we can support the rehab protocol by reinforcing the oral, facial, ocular, and auditory movement patterns we have spent over a year working on with Kara.  Remember, as a visually impaired athlete, her movement quality depends vitally on other sensory elements beyond the musculoskeletal system.  These elements are important for non-visually impaired athletes as well, but have greater importance in the visually impaired population.  Before the baby actually rolls, it explores different planes of movement.  Because a serious injury reduces anyone toward a more infantile state of movement, returning to basics is vital to prepare for the advanced athletic demands we’ll return to next year. 

Shoulder flexion/Thoracic spine extension

Shoulder flexion and thoracic spine extension are part of the reaching and uprighting movements of a young child.  What might seem like “boring PT exercises” actually form the basis of more complex motor patterns that we use to maintain upright posture on the bike and in daily life.  We take uprighting for granted as adults, but when you can’t use your arms to reach objects and push yourself off the ground, you appreciate the importance of these movements.  Without these basic movements, you never get upright! 

Two possible outcomes happen when overhead range of motion is lost.  One is that the brain closes itself off to that part of its world.  A second possible outcome is that the body will seek overhead movement via excess use of other extensors, such as the neck or lower back.    We can combat this via the same training of oral-facial drivers used to train the rudiments of rolling patterns. 

Pulleys = Creeping, Crawling. 

Once the baby rolls over and uprights itself, it then wants to move forward.  Two early locomotive patterns available to the baby are creeping and crawling.  Again, we have an example of a “boring PT exercise” that transitions nicely into performance training.  Creeping and crawling both demand scapular stability and limb coordination.  A pulley exercise is basically a crawling exercise with less stability demand, though when Kara began PT this exercise was extremely difficult!  Locomotive development not as critical on bike as in running/swimming, but overall movement ability is a priority for a blind athlete.  In terms of performance, we have been gradually increasing the isometric load that her trunk can bear via exercises like wall supported planks. The better we can reinforce these neural connections, the more advanced state she’ll be in when able to train as normal again.

Summary

In the last few weeks, we’ve been able to reintroduce some light cycling on the trainer.  She’s still not able to ride on the road due to the road vibrations, but that will come in due time.  For now, we’re happy to have seen progress in these difficult three months and look forward to continued progress toward London in 2012.   

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