To me this is arguably the most important part of the job. At least during competitive periods. Our opportunity to improve biomotor ability is primarily in the off season. We discussed in last month’s blog In Season Training that we can still improve, just not the primarily focal point as in season. 

The elephant in the room is that a person injured is a reflection of what we could have done differently in the off season. Particularly from a biomechanical or bioenergetic perspective – either they were not capable of getting into a position that they could not recover from or were fatigued and compromised ability to stay in a position they could recover from. This sets the platform to reverse engineer the process to get them back to competition without getting injured. 

Starting at the end is a good strategy most of the time. However, this is working with an undetermined timeline with less focus on developing specific qualities other than removal of pain or managing it to a degree where they can return to competition. Framing this as what is the most important or potentially the most available aspect we can train becomes the priority. 

Although we want to work with Sports Medicine in that this is their domain and take the primary lead in this, we can support the process. From a biomechanical perspective can we restore or improve ROM. This may be taboo considering that the ATC or PT is working to restore this, but the more we can all be on the same page and be responsible the better. If not within the injured area, can we develop ROM in other joints? 

From a bioenergetic perspective can we maintain fitness while rehabbing? This is where you will have to be creative to simulate practice/game like situations with an injury. If they can not perform weight bearing activities, your ability to condition athletes through either creative program design or exercise selection becomes paramount. If they can locomote, just at a reduced speed with limited COD, how do you improve fitness while preparing tissue tolerance? Again, communication and collaboration with sports medicine is foundational. 

The final aspect is the psychological component to being injured. This is where you will have to be at your best to support an injured athlete. They are removed from their environment, their social circles, they are detached from what gives them validation, they will have more than good days – you need to give them a win. Your goal is to make whatever it is that you are doing constantly net positive. They have to improve, their ego and pride is fractured, you need to repair that as much as rehab an injury. 

Build confidence with things they can do. Simplify and let them blossom. As the old saying goes “when they are trying to climb out of a ditch, give them a rope not a shovel.” 

You know there will be something they can be successful with, more times than not it will be upper body. We could argue that increasing cross sectional muscle area or stimulating mTOR pathways or increasing general circulation is good for the injury repair cycle. More importantly is the confidence with something they can achieve when everything else is the opposite. 

Scheduling wise will be the biggest challenge: 

• With the team?

  • Downside: with their teammates

    • Hard to see everything and adjust to simplified program they can execute on their own

  • Upside: limits something you will need to add to their day

• Separate from the team?

  • Downside: separate from team

    • Can create a more customized program that you can control 

  • Upside: opportunities to talk and let them vent

  • Downside: something you will have to add to their already crammed schedule

• During Practice? 

  • Downside: complete detachment from their teammates/coaches

    • Outside: limits options and becomes a challenging program 

    • Inside: no one sees you, and can create questions on how much progress is being made

  • Upside: scheduling is easier, possibly protection from being pulled into drills or confrontation with difficult coaches

This is something you will have to be patient with. Your primary objective is to support the athlete and their needs. It does not matter what you want or what is best for you. You will have to weigh the pros and cons of anything you do, which takes time to unpack the best course of action to take. Patience and prioritization of what matters is the only way to make it through this.