High Performance Lessons from Athlete Rehabilitation

Prior to 2017, I had barely any experience working with injured athletes, nor did I ever expect to take on a role where rehab would be an integral responsibility. However, as part of the hire into my role as Performance Coordinator with the Cleveland Indians (maybe officially the Cleveland ‘Guardians’ by the time you are reading this), I was tasked with serving as the rehab strength and conditioning coach in addition to the more ‘traditional’ strength & conditioning coordinator deliverables.

At the time, I had no idea what I was doing. Before that role, the bulk of my exposures with injured-athletes probably looked an awful lot like those of many other caring, hard-working and well-meaning, but ultimately very busy S&C coaches: investing every ounce of our faculties on planning and facilitating the training of the other 99% of our athletes — the non-injured ones — so much so that it can be a challenge to see beyond that day’s workout when it comes to modifying training for the rehab crew.

Surely you know what I mean? If it is a lower-body day, we get the bulk of the team motivated and started on their lift, and only then do we manage to grab our injured athletes’ workout cards to scratch out “Squat” and replace it with “Single-Leg Leg Extensions”; if it is a total-body lift and they have a lower-body injury — well, I suppose it is an upper-body-only day (again).

It is an understandable default for a busy coach, and I was a long-time perpetuator of this approach myself. But, with my new role came the the unique challenge of not just focusing more on our rehab athletes, but caring for each individual athlete and case as if they were their own team. What I quickly learned was, with each athlete came a novel situation: sure, you could have three athletes with UCL sprains beginning their rehab the same week, but each could have very different timelines at the on-set, ranging from a handful of months (e.g. non-invasive rehab and injections) to somewhere between 12 and 18 months (e.g. UCL repair or reconstruction). Then factor in how those timelines interact with the time of year: does the athlete have the potential to return to the championship competition season this year, or is it the start of an extended off-season for them? Or, could they be getting their ‘off-season’ now ahead of time, with the chance to play winter-ball once they are cleared? It became clear that each athlete essentially needed their own “annual” plan or macro-/meso-level planning beyond the micro-level adjustments. But of course, no matter how we plan for each of these cases, there will inevitably be speed-ups and set-backs, peaks and valleys in the rehab process that will necessitate the alteration of their plan more often than you might think —or more often than I had thought at least.

A very long-winded way, indeed, of noting a lesson I immediately learned that was quite simple, but incredibly important and much needed at the time: my old mode of thinking about training injured athletes (just making time for them when I could, adjusting the team’s program each day on the fly) was not going to cut it. Every rehabbing athlete’s care requires so much more in order to make their return-to-performance process as effective and fulfilling as possible. Not only is this the reality, but it is truly what each person deserves.

And, I learned so much more from my handful of years working as a Rehab Strength and Conditioning Coach (and eventually working to support another Rehab S&C Coach). Namely, I learned how much I didn’t know, and how vital it would be for me to collaborate with others to make up for this (in the immediate term), while also learning as much as possible to allow me to be more effective over time in my own right.

So, I spent much of my free time in the Athletic Training Room, in the Medical office, and alongside the Physical Therapists. I asked a lot of questions — I mean a lot of questions — and we organically built rapport with each other across departments — PT’s, AT’s, S&C’s, and all those touching the rehab athletes throughout the day. We also set up regular formalized meetings to discuss each player and their status. As a staff, we essentially became our own “rehab team”.

What I did not know at the time was that this is pretty much standard of care in high-performance settings, rehab or not. Call it the High Performance Model or the implementation of Performance Teams; either way, I personally did not have the slightest idea that we were somehow aligning ourselves with practices that I should have already known about. I didn’t know what I didn’t know, but I’d imagine everyone else on the team did know, however, which is why they were so willing to answer my questions and support my growth — it was all for the betterment of athlete care.

As with growth and experience in most other areas of life, with time you begin to compare what you have recently learned and applied with past experiences and your observations of other people, environments, and cultures. In my case, it became easier to discern what teams, programs, and professionals possessed more collaborative, curious, and caring practices in alignment with high performance characteristics. It also became clear all of the ways that I had fallen short in the past, and potential ways that I could be better coming into new situations in my current role, as well as those with future teams tasked with developing athletes and people.

Specifically, one of the greatest lessons learned from my time in the Rehab role is the standard of care for which we should strive: an athlete-centered approach supported by an integrated team working together to utilize every resource and tool available to develop the athlete.

Healthy or injured, baseball, field hockey, or figure skating, high school or professional, large or small budgets… no matter the athlete(s) under our guidance and the circumstances we find ourselves in, this is the standard of care for which we should strive. I emphasize “strive”, because it is important to be realistic: will we always have the skills, tools, or resources ourselves in our jobs to achieve this standard of care? Unfortunately, no, most will not. Even if we do, will we always be able to hit the mark? Certainly not, that would be an unfair expectation. Will we ever be able to reach “The North Star”? Of course not, but that doesn’t mean it can’t still guide us.

But, what does striving for this mark actually entail? A personal belief of mine is that everything should start with the player: the player should be the center of their own developmental process. This is both in the metaphorical sense — their best interests are always put first, and providing them best care is our priority — as well as the literal sense in that they are brought right into the center of their own process: the athlete feels as though they are in the driver seat of their development, helping to make decisions whenever reasonably possible, providing feedback as often as desired, educated on the process as much as they are capable of handling, and ultimately empowered to take stake in their own development.

In the rehab process, this can look like sitting on the same side of the table with the athlete in their first week to outline the initial timeline, to answer any questions that they have up front, and to lay out what we expect of them and (maybe more importantly) what they can expect from us. It can look like genuine curiosity when asking for program feedback or even when asking the simple question of, “how are you doing today?” It can look like thoughtful and organic conversations — about their rehab, of course, but also their personal life (because they are inseparable, really). And, it can look like well-informed, but yes, sometimes messy compromises. And, the underpinning themes here can be applied to non-rehab athletes: being thoughtful, curious, caring, collaborative, and communicative; asking more than telling; partnering rather than prescribing.

This, of course, requires an immense amount of time and mental energy as a coach or practitioner. And, it may not come easy at first. But, with the deliberate practice of this level of care comes the growth of emotional intelligence and communication skills, as well as the more tangible skills of how to better tailor a plan for an athlete’s specific needs, and to fit it within a framework that works in your unique environment.

With the athlete placed in the driver seat and armed with the skills necessary to take the wheel, it is then up to the supporting personnel to serve as the race team for the journey — the pit crew, the crew chiefs, the spotters — providing information, resources, methods, and ultimately expertise to the athlete all along the way. As the support staff gets larger (in some cases, the S&C coach may be doing everything on their own, or only in conjunction with one Athletic Trainer), the more important it will be to integrate its own form of a “Performance Team”, ensuring that there is an effective flow of information across department lines. Where there are ‘silos’, there are bound to be information gaps or blocks, and where there are those gaps and blocks, there can often be mistakes, misunderstandings, redundancies, and ultimately disjointed experiences for the athlete.

For example, consider what good it does to collect workload data if it only lives with or is valued by the sport scientist, analyst, or strength staff? A more simple example: consider how much smoother and more appropriate a player’s training day could be if the an Athletic Trainer is willing and feels comfortable to communicate with others on the performance team that a particular player doesn’t seem to be feeling their best that day. With a great exchange of information, stronger plans can be developed, more confidence can be had in program adjustments, better goals can be set, and ultimately players will be put in better positions to succeed because their resources are aligned around them.

This approach to player development — influenced, personally, from my experiences in the rehab setting — will most likely take time to develop and apply. And, it probably looks quite different in your setting compared to mine, and compared to his, her’s and their’s. But, realistically, the value is more so in the overarching themes behind it all: putting people first, exemplifying strong-teammate behavior, and having elite staff-to-staff and staff-to-player interactions. Find a way to bake that into your own program’s recipe, and no matter what your ‘secret sauce’ turns into, it will be well on its way to being top-notch.

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