Episode 3: Treatments We Use At ProActive

This blog post is taken from a transcript of our audio podcast with minor edits. Please excuse any grammar issues. Enjoy

Welcome back to the proactive perspective.  And in this episode, I'm going to talk about the treatments we use that set us apart from other physical therapy clinics. Before we get started today, just keep in mind that nothing you hear in this podcast or read in this blog should be considered medical knowledge or advice. It's simply for entertainment purposes. If you have an injury currently or a former injury and you want to start, getting rehab for that or working back into the gym, you should be evaluated by your physician or physical therapist first.

In the previous episodes of this podcast, I've mainly talked about testing, and we'll go back to that in upcoming episodes, but today I want to talk about the treatments we use at Proactive that set us apart. Now, that's not to say that other physical therapy clinics are bad and that they get things wrong, because a lot of them get things right and it's kind of a product of the system. Our insurance model in the United States only pays for minimal treatments, but our population also has very low activity requirements in the US. So most of them only need minimal treatments to get them back to their level of function.  So most clinics do a really good job with what we call the starter pack.  So that's getting the patient out of pain, restoring their range of motion, and then getting a base level of strength that's required for a base level of function. At that point, our patients are usually discharged and most of them go back to their regular activity without any problems.

But for many of them, what happens is they go back to their regular activity that requires more functional demands or more strength and then they just get reinjured. So they get stuck in this endless cycle of rehabbing, being discharged, getting back into their activity without somebody to give them those guided steps. And a lot of times what they'll do after going through the cycle a couple times is they'll just stop with those higher level activities.  And now let's think about this from the athletes perspective. Their base level of activity is way higher than what you're going to get covered in a physical therapy clinic. And I'm not just talking about professional or college level athletes, even our middle school and high school athletes, and even those that might not even be playing for a team. You have a lot of kids that go to gym class and they go all out in gym class or after school they might be part of intermural or they just go home and they're playing on the street or in the culde-sac or they go to the field and they play all out with their friends, right? they're still athletes. And that's actually where a lot of the injuries have. Most injuries that you'll see in a physical therapy clinic for athletes, they're not college level.  It's the neighborhood kids. It's the kids that go to the local schools. And so, just like a regular population, they're going to get that starter pack; they're going to get out of pain. They're going to restore the range of motion. They're going to restore their base level of strength and base level of function. And they're going to start getting back into athletic type exercises or activities, but then they're going to be discharged.

Not only are most PTs not trained to handle these kind of patients, we don't learn this stuff in school, You learn the very basic and a lot of it is on the job training. You learn the very basics in PT school and you don't learn how to do strength and conditioning. You don't learn the exercises to get athletes back to those higher levels.  Even as an athletic trainer, you do learn higher levels of rehab, but most of the time when you're an athletic trainer, you're leaving the strength and conditioning up to the strength and conditioning coaches so you're not even taught a lot of this in athletic training school.  You have a lot of athletic trainers or PTs who went to exercise science as their undergrad so, they may have gotten a little bit of it there, but most people who are actually trained in this, it's because they've sought it out, They've went to weekend courses or they've taken online courses or they're just big meattheads, too, and they know what it's like to be in a gym and they've learned it on their own, So, even if you have a PT or an athletic trainer who knows how to work an athlete up into a full return to play, most clinics that you go to aren't going to have the equipment to do it.

It's starting to become a little more regular now. You might have a PT who works out of a CrossFit gym or who rent space in a regular gym. but if you go into most, franchised PT clinics or little mom and pops places, you might have a kettle bell that's, 25 pounds. You might have dumbbells up to 10 pounds, but most of the time all you're going to see is ankle weights that go up to 10 pounds. You're going to have some, resistance bands, but that's it.  You're not going to find a lot of the equipment that you actually need to train these athletes or these higher level patients to get back to their activity without reinjuring.

And look, I get it. I've worked in these kind of PT clinics or in these systems where you have bare bones equipment. And like I said, for the majority of adults and even some of the kids in the US, That's enough to get them, out of pain and back to their normal level of function and they go on and they do just fine.  But it's when you have those higher level athletes or just people with really active lifestyles that they kind of get failed by that system. And so I've had to work around those constraints and tried to, coach them into how to go into a gym program and how to, integrate these different concepts in. So I understand what that's like.

So here at Proactive, we kind of start off with the same things that you'll find in most clinics, like what I call the starter pack, right? Those are exercises or interventions or manual techniques that we use to get the patient out of pain. but then we try to find what are those contributing factors that either caused the injury, that contributed to the injury, or what are things that are dysfunctional since they've had the injury. 

I’m currently working with a young lady who's a soccer player who a year ago she sprained her ankle. Right now I'm working on her for a cartilage injury in her knee but in working with her, she's having difficulty squatting. Just in her assessment, she's, weight shifting off of that side and her squat mechanics aren't that great. So, how much of it's coming from the knee? So, we kind of start looking at other things, too. And I'm looking at her ankle, and she is lacking a huge amount of dorsif flexion on that injured ankle from a year ago, She doesn't have the joint mobility in that ankle to allow her to squat. So, we have to clear that up because she's not going to be able to squat until we clear up her ankle. So, we try to find ways to work around those movement patterns, but we're also treating that. That's a very low hanging fruit that we can address, So, we try to find what are your contributing factors.  As I mentioned before, it could be a movement dysfunction like the young lady I mentioned. it could be a movement restriction for her that's a big part of it is that she has a movement restriction in her ankle. That doesn't allow her to squat. that doesn't mean that caused her knee injury. when you get slide tackled and that actually causes it and you actually sublux your patella out of place, that's kind of the leading contributor that caused the injury. But her having that movement restriction in her ankle isn't going to allow her to do the basic movement patterns and needed to rehab her knee.

But it can also be strength deficits. So here we have the isokinetic machine so we can actually measure what is weak and then we can quantify it because if you have somebody that they have a 40% weakness in a muscle group and that can be contributing to their inability to perform that movement pattern and until you clear that up you're not going to be able to get the movement as a whole cleared up.  So you got to find low hanging fruit.

After we've kind of cleared up some of those most basic things, a lot of the rehab I like to use comes from our basic human movement patterns. And for the upper body, that's going to be a pushing or a pulling motion. And the lower body, that's going to be a hinge. That's going to be a squat. It's going to be like a split pelvis, like a lunging position. Okay. but then I also like to work on trunk rotation or rotation of the body as a whole. That's a human movement pattern. And then we also have carries.  So, a lot of my rehab and a lot of my strength training that I use with athletes comes down to those basic human movement patterns and you can't really clear those up until you work on those individual strength issues and those movement issues, So, we're integrating in the whole time even during the starter pack, right?

When we're doing those early initial phase exercises, I'm trying to work in these basic human movement patterns given and we're having to work in the constraints of the injury, of their pain, of their weakness, or of their movement restriction. But as those clear up, we're moving fully into those, right? We're working on I like to vary up. I like to have sometimes where we're going lighter for higher rep, but I also like to work in days where we're going a little bit heavier for lower rep.  Speed of movement is huge. It's one thing to be able to squat, And a lot of people just load up weight. Okay, let's you get good at squatting a 20 pound goblet. Let's go to a 50 pound goblet. Okay, let's go to a barbell and get heavy heavier and heavier. But a lot of people aren't working on the speed of movement because if you jump, a jump is just a squat, but you're doing it fast enough in the concentric phase that you're overcoming gravity, right?

So you have to work in a variety of resistances and a variety of speeds. I like to work in multiple planes of motion, So you have to have all these components that you build together to get that athlete back. And it's all about finding what is their level of function because you're going to rehab a baseball player and a soccer player really pretty much the same in that starter pack exercises.  But as you start to get in more and more along the process, you have to build in what are the demands that athlete is going to face in their activity or their sport. And you have to build those in, right? So it's not just about the way that I rehab somebody and the theories and the foundational sciences that we use and the different progressions. A lot of it comes down to the equipment as well, right?

We have a lot of equipment here at Proactive that you will not find in most PT clinics. I'm kind of known as the isokinetics and force plates guy. So, we use isokinetics. that way we can find out and measure what are our strength deficits. but we also use that for our rehab as well. if you think about it, if I'm testing somebody once a month and they're in here twice a week, that machine's only being used one time a month for a test, but they're in here twice a week working on the machine with an intervention for strength, So, a big part of isokinetics is the treatments that we use. And the same goes with our force plates, right? You can test somebody, but are you using that equipment to actually work on an intervention?

Aside from that, here at Proactive, we have barbells, we have a squat rack, we have a trap bar system, I have a weighted cable system, right? We're going to use all these to integrate that those movement patterns and to get that overload. I have a Bulgarian split squat stand. We have dumbbells up to 70 pounds. It'll get heavier, but right now I only have up to 70. We have kettle bells. I have medicine balls.  So, I have a lot of the things that you're going to find in a regular gym, but then I have things that are kind of mixed between the gym and the physical therapy. We have the shuttle MVP that allows us to get somebody squatting with no load. So, if you just had a surgery and we want to start integrating that movement pattern of the squat, I can put you on there, but it has absolutely no weight. But the system also goes all the way up to 720 lbs. So as you get stronger and stronger, we can load you heavier. But it's also a jump trainer. So most of the time, let's just say for ACL's, you're not going to start doing any plyometric or jump training until around months three or four. But I can load you up at, a quarter, 25% of your body weight or 50% of your body weight and have you jumping on my shuttle way before you actually do it on the ground. But then as you get better and better, I can load you heavier than your body weight.  So that way as you're getting back to your sport, we're introducing loads and forces and speeds that are well above anything you're going to see on the field, But other than that, I have a belt squat system. So if you're that athlete that has a low back injury and you want to squat to work your legs, but we don't want to compress your spine, we can load you up on the belt squat. Or if let's say you're a basketball player and a lot of our basketball players, they want to work their legs, but they don't want to compromise their spine. So, we can load them up on the belt squat. We have a great GHD system, so you can work that low back in the core, but you can also use it for your Nordics, we have agility systems that you're not going to see. Yes, we have the basics that you might find in some clinics like we have the agility ladder, we have some hurdles, we have some cones, but then we also have the blaze pods it's going to work on that reactionary training and I like using those with our basic agility systems. we have a box that we use for jumping. It goes all the way up to 30 inches, right? So we can have you do depth jump, you do drop jumps from higher and higher levels. aside from that, we have a sled. I don't have a turf inside my clinic, but right outside my door, I have a field, So, I can take you outside and we can push and pull the sled. I have a parachute system that I've used with patients, so we can get that resisted running. we have all the different balance trainers that you're going to find in most pet clinics. But then I bought a next level, because I've had neck problems in the past, too. So, I bought a next level system. So, if you're that patient or that athlete that gets that neck strain and you go to a PT clinic and you do those most basic exercises, but then you get back to your sport and you just strain your neck again, right? We have some of the different things that you can use to get that higher level of strengthening just on things like your neck that you won't find.

I'm a big manual therapy therapist too. I do the joint mobilizations, but I love using cupping systems. I love using the instrument assisted or the scraping. I like taping techniques, right? I know a lot of PTs out there especially if they're not athletic trainers, they don't believe in taping and bracing, but being an athletic trainer and having injuries before, I know how much difference that a McConnell tape or using a taping technique on a shoulder can really assist.  Now, that by itself isn't going to do anything, but it can help them to perform the exercises. I'm a big believer in modalities. I have the basic set of modalities here. So, we can do them. I have a class three laser, right? So, I have these basic modalities and again a lot of PTs don't use them anymore, but being an athletic trainer where they're used heavily especially having injuries. I've had nasty hamstring strains in the past and I know exactly how much that E stem and ultrasound combo can do. And if you use that at the beginning of a session, you're going to have a much better session and get more out of it, So, we have that as so we have all these different things here, the equipment here at Proactive that you're just not going to find in other clinics. And then we also have the knowledge and expertise to get you to those higher levels to kind of transition you from what I call the basic starter pack exercises into your gym. So that way when you're actually discharged and you actually go back to your sport, you're used to the loads that you're going to receive. You’re used to the speeds that you're going to see.

And so those are some of the different things at Proactive that set us apart from your regular PT clinics. So whether you are a higher level athlete or somebody that is just a higher level that wants that extra strength conditioning background to your rehab. or let's say you've rehabbed somewhere else and you've gotten stuck in that cycle of, getting the basic exercises, then going back to your sport and then going back to your sport and getting reinjured. So, you're stuck in that cycle and you need to have that extra level of intensity or somebody you've finished your rehab elsewhere and you're not ready to go back to your sport.

Let's say you're an ACL athlete and you've done your five to six months of rehab, but we know you're not ready to go back to your sport because we can do your testing, We can find out exactly how much more strength conditioning you need. you can come in here and you can get that higher intensity training with the equipment that you need with the knowledge that you need to take you from where you need to be. So, that's what sets us apart here at Proactive.  So, if anybody wants to contact us, you can check out our website, which is proactiveathleticperformance.com. You can find us on Instagram. I post a lot of things on there. but seek us out, right? We'll get you ready. We'll get you back to not just being out of pain. not just getting back to your activity, but also improving your performance, So, there's a whole performance aspect that we didn't even discuss in this conversation today. We'll leave that for another one. So, that's it for today, guys. Thanks for listening.