Thursday, 21 February 2013

My Experience With Performance Therapy & ART

I was prompted to write this blog post after reading Stuart McMillan’s own post on Performance Therapy and Matt Price’s tweet on twitter asking “Should a trainer/coach do therapy? When is it ok & when is it not? 

Before I begin I wanted to say Stuarts post was extremely informative and real world.  This is how it works in legitimate high performance sports.  Athletes are given every opportunity to train, recover, and rehab in an optimal setting. 

I was exposed the benefits of therapy in a training environment back in Ottawa in the mid 1990’s when I was a strength coach for the Quebec Nordiques.   I was introduced to Dr. Mark Lindsay, who was working in Ottawa at a local sports clinic.  He introduced me to ART and some of his therapy techniques which were way ahead of their time.  Dr. Lindsay began working on a number of my clients who suffered different issues that I saw in the gym and through my own assessment.  To witness these athletes receive 2-3 treatments and step back into the gym and perform was incredible.  For many years I worked with a number of athletes in the area of what I will call post physio rehab.  Mostly mobility, corrective exercise and strength training, but nothing as quick or as efficient to what ART could do.  With that, I felt the need to set myself apart and enhance my tool kit, this technique would be of great value to my career.

In 1998 in Chicago Illinois I took part in the first group ART course for the upper extremity.  It was the most intensive 5-day course I had ever taken, which required 2 months of prep work and practice before I ever got there.  I was fortunate to have the help of Dr. Lindsay at that time to help me with the moves and completely understand the neuromuscular anatomy.  Ironically in this particular ART course, it was the first time they allowed non-chiropractors to attend.  In addition to myself, there was strength guru Charles Poliquin, Gina Perez an Ottawa strength coach now based in Calgary and another massage therapist whose name escapes me.  The course was a little intimidating to say the least but we all graduated to become ART providers for the upper extremity.

This new tool was just so valuable to my clients.  The ability to get my hands on an athlete’s subscap or teres minor when the shoulder was not moving properly gave them instant relief and allowed them to continue training with no issues.  My intent was never to be an ART therapist, my intent from the very beginning was to enhance what I do in the strength and conditioning room.  I leave the real therapy to the AT’s and physio’s who in most cases oversee the athlete’s rehab program.

So with that all being said, Matt Price’s tweet question of the day Should a trainer/coach do therapy? When is it ok & when is it not? And Stuart’s post was all very interesting to me.  My direct answer to Matt would be yes.  In my opinion good Strength coaches do therapy every day in some form or another in the conditioning room.  That might be a rotator cuff exercise that was necessary as a result of an assessment, it might be a hip and back exercise as a means to progress the rehab the athlete may have received from an AT, or its just ensuring proper movement patterns for positive transfer to sport.  But….. there are times when us strength coaches cross that so called barrier that have been put up by the “therapists” that can result in trouble.  Let me share with you a story that happened in 2009/10 season with the Montreal Canadiens. 

Yes I made it onto the big screen at the Bell Centre
In January of 2010 Mike Cammilleri who was one of our top forwards at the time suffered a grade 2 MCL sprain that was close to being a grade 1.  If anyone knows Mike Cammilleri, he plays and trains with great intensity.  (with Matt Nichol @M_nichol from a cheap plug for a good friend & colleague).  So 5 days after the injury, Mike approached me and asked me give him everything I can do in the weight room to help his knee.

This was taken before the MCL injury
He was out of his walking brace and moving along fine, but was wearing a custom brace, just in case.  Generally with an MCL injury, once the swelling is down and the pain has somewhat subsided, you can focus on sagittal plane work.  The sooner you can do this without any significant pain, then the quicker potential you have to recover by re-engaging the nervous system to fire muscles that have likely been dormant for a while. 

So I had him cycle for 6-8 minutes to loosen up, we did some foam rolling and we then worked on the following:

Vibrating platform static bilateral stance 5 x 60 sec @40hz in a quarter squat position – the result was pain free

Supine Ankle Hops on a MVP Shuttle with the equivalent of him using only 30% of his body weight (this piece unloads the body of its own weight) 3 x 10 hops – the result was pain free.

Front squat 3 x 8 on a slow 3:0:3 tempo with 65 lbs – result was pain free.

DB RDL 3 x 8 with 30lb DB’s – the result was pain.

So what did I do?  I could have just said “ok Mike you are done, everything else was good but the RDL caused pain so lets stop” this would have been the safe thing to do.  But I had an athlete with me, who was extremely motivated to get better and an issue with an exercise that seemed to cause some pain.  I knew because of the MCL injury the fascial lines up the adductors were going to be very tight, leading all the way down to the pes anserinus ligament.  So instead of shutting him down, I put him on the massage table, I gave him some ART all along his adductors down to his VMO, but not over the ligament.  I also worked a bid of medial hamstring. I treated him for a total of 6 or 7 minutes.  Mike got off the table and tried the RDL again.  After 8 reps he looked at me and smiled and said “Goldy, that is perfect” We finished the sets, he iced down after and went home in a great state of mind.

The next morning as I walk into the Habs strength room, I have to pass through the therapy area. As I go by, I notice Mike is on the table getting his treatment from one of the therapists.  He looked up at me, smiled and winked.  Just then the therapist looked up at me and said “hey Lorne, I don’t know what you did to Mike last night, but he looks better and feels better, what did you do?  I then started to tell him the whole story as described above.  He was nodding his head in agreement the whole time, until I got to the description of the ART of his adductors.  The guy started yelling at me “NO NO NO you cant do that, you just broke up a self adhesion mechanism that protects his knee”  I just about lost it with this guy right there.  I responded, “did you just hear what you said to me? He looks better and feels better!!! That is what it is all about!” and I slowly walked away.

I had never heard of this so called “self protective adhesion” before.  So I called Dr. Lindsay and asked him about it.  He had not ever heard of such a thing and indicated the most important thing in a speedy rehab is getting function back ASAP and re-setting the nervous system.  I thought we had accomplished that.  Nevertheless, the therapists then reigned in Mike and slowed down his training to a level they were comfortable with.

Is this performance therapy, training, or just stretching?

Was I wrong for doing what I did?  I don’t think so.  Should I have consulted the team therapists first, maybe….and this is where there is an issue.  It seems that instead of working as a team, certain people like to take ownership of specific areas in pro sports therapy/training.  I have seen this often in my 20+ years in the NHL.  The unfortunate part here is sometimes the athletes suffer the result of the training and strength staff not working well enough together.  I know in my private business this never happens, as I have a good team of therapy and coaches working together to ensure the focus is on the athlete.  At the end of the day this is the only thing that matters. 

I have never scored a game winning goal in the NHL, but I have trained many who have….Hopefully they keep on doing it, and we can all just get together for a common goal and keep our athletes healthy.