By Keith Cronin, DPT, OCS, CSCS
Being on the end of rehabilitation, injured athletes cross my path daily. Now some (around 50%) are simply the result of misfortune: sprained ankle sliding into second base, torn ACL from a lineman collapsing on his leg, or a collision on the volleyball court resulting in a rotator cuff tear. Simply put: crap happens.
Then there are the other 50% 1. These athletes suffer from injury are the result of:
- Overtraining
- Undertraining
- Poor body mechanics
- Improper training routines
- Poor lifting technique
- Pushing through pain/injury
- Ignoring warning signs of problems
These are things that perhaps you already know….but here are few you may not. After years of treating young athletes with chronic pain and injury, here are the TOP THREE types of individuals who you have to pay special attention to.
#1 They Are Non-compliant
Non-compliance extends far beyond “they don’t listen.” These are individuals who regularly go against sound advice, are very bull headed about what they want to do, or simply just do not follow through with recommendations. They do what they want and not what needs to be done. They commonly shortcut training sessions, only focused on playing the game. When faced with minor injuries, too regularly these individuals skip out on rehab exercises.
Once sidelined with a couple of injuries, some snap out of it and start listening. Many do not. The attitude of the “rules don’t apply to me” is endemic to this type of athlete. From the therapeutic side (particular to chronic pain) I recently read up on a research presentation from Washington University that on average 50% (ranging from 20-80%) of individuals do not successfully rehabilitate chronic pain due to non-compliance1,2. I would surmise that my practice would support those findings. Non-compliance with these athletes, regardless of their athletic talent, is only going to stifle their opportunity in sports.
Strategy to Keep Healthy: You have to barrage these individuals with the science of sport. Articles, research, presentations—basically anything that is put together by some expert in a field that produces or treats top-notch athletes—can be helpful. Recommendations from professional athletes are also a good source, as that is usually how they see themselves or where they want to be. Talking about injury prevention is typically useless because they are not hurt, therefore, the rules of physics currently do not apply. Also using scare tactics of “this is what could happen” most often falls on deaf ears. Once they get into my world, they tend to listen a little better, but that is because there is now pain or problems that are limiting sports. These individuals are tough to deal with, but if you can drill it in their heads that a good strategy helps produce a better athlete, you stand a better chance of keeping them out of the spiral drain of chronic injuries.
#2 They Have a Poor Understanding of Pain and Injury
This group falls into two classes. The first thinks that a paper cut is a reason to call the orthopedic surgeon. This individual will limp and moan at just about anything. The second believes that extremes of pain are normal. I had one tell me, “My back has hurt for six years and makes it hard to go to sleep.” That child was 14. For whatever reason, these individuals have a hard time conceptualizing what is normal.
Strategy to Keep Healthy: These athletes in particular are often the ones who should be evaluated by a physician, athletic trainer, or physical therapist. Treating young athletes with either of these extreme mindsets requires a significant amount of education. Talking about how pain is generated, perceived, and ultimately treated in the brain and body is more often more of a medical discussion. The emotional swings—whether apathetic or manic—are easier to handle in a clinical setting. If you have athletes who show signs of over-magnifying injury or obviously under-reporting, it is important to encourage the athlete’s parents to seek medical assistance. Children have far more capacity to understand these topics than we give them credit for. Most often, they simply need a push in the right direction.
#3 They Are “Dynamically Deficient”
This is a polite way of saying that the athlete in question is a train wreck waiting to happen. They have poor mechanics, bad form with lifting, and are uncoordinated to the point where chewing gum and walking could result in an ankle sprain. These individuals seem to trail behind their peers with developing body skills such as jumping, running, cutting, squatting, etc. They may or may not be injured frequently but as a coach or youth fitness specialist, you know something is “off.”
Strategy to Keep Healthy: If the child is constantly hurt, definite medical intervention or encouragement to seek further rehabilitation is warranted. Now if you have these athletes on your team or in your program they will require extra attention. Don’t let them skip steps! For instance, if you are running a sports training program and you have a couple athletes who have trouble doing squats, make sure they master the movement before moving on. This does get tricky in that you do not want to make them feel “left behind,” but here is where education comes in. Talk with the parents on the importance of reinforcing training at home. Bring parents into a session or show where the issue is so that they can provide more support. Most young athletes develop at a normal pace but some get left behind and the last thing you want them to feel is that “they are broken.” These individuals take up a little more time but from experience, it is worth it in the end to see someone whose attitude changes from “I CAN’T” to “I CAN.”
Sports are a team approach and that includes communication among athletes, parents, coaches, athletic trainers, physical therapists, and physicians. As adolescents grow older, these various state of minds can bend, completely change, or just get worse. Either way, it is important to identify precisely why an athlete is constantly hurt before figuring out what to do and how to do it.
1 DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. Clin J Sports Med. 2014;24(1):3-20.
2 Van Dillen, Linda. “Adherence: An Important but Often Forgotten Determinant of Treatment Effectiveness.” Presentation at Washington University in St. Louis, MO for the Program in Physical Therapy. January 13th, 2015