Student Athletes and Rehab: A Cohesive Plan of Care Approach Including Physical Therapists by Madeline Heil

    

    As a former Division I student athlete, I can be the first to attest to the fact that there is much on our plate. Between going to classes, homework, studying, multiple practices a day, making sure you get enough sleep, fueling properly, travel, catching up on work, ect. The list goes on. However, notice that in that list, PT/rehab was not mentioned. Often, as athletes in college and in high school, we are trying to make it to the “next thing”, and we do not prioritize rehab nor strengthening for reducing the risk of injury. Time is the largest factor in this issue. Between juggling all the expectations, fitting in pehab or rehab is low on the to-do list. Then, we are faced with an injury, or a pain, and the last thing we want to do is attend rehab because it takes up time and could potentially put us out of practice. We all know that will “ruin” our chances of performing at our best. So, we let it slide, until our pain or injury is unmanageable. 

    This mindset is real for many student athletes. The issue is that with injuries, athletes either push through their pain until they cannot physically handle it anymore, or they can become injured and experience “kinesiophobia”, or the fear of movement. This is largely due to the athletes’ fear of reinjury. Chao-Jung Hsu et al. describes this in their article “Fear of Reinjury in Athletes” by saying that this can negatively result in physiological changes (e.g. muscle guarding) and psychological changes (lack of trust in injured site). This can negatively affect rehabilitation outcomes and cause return to play to be prolonged.1 It could also cause the athlete’s skill level to never return to what it was pre-injury. 

    This is where social support comes in. Athletes are faced with challenges when they have injuries, and their social support system in one of the most important factors in positive rehab outcomes. In a study done on 49 collegiate athletes, the social support provided by ATCs had the greatest influence on the injured athletes rehab and their overall health.2 When I read this, I agreed with the statement that ATCs can positively influence an athlete’s recovery, and it got me thinking, what if PTs could also be trusted and part of this journey for athletes?

    One of the first matters that should be considered is to clearly define the role of PTs in the plan of care for student athletes. Sports medicine doctors and ATs have their clearly defined roles3, but what if PTs are seen as a necessity? In a qualitative study done by Alison Marks et al., they used semi-structured interview questions to ask professional and retired basketball players’ perceptions of PT services and injury prevention techniques.4 Almost all of the athletes knew that PTs helped with post-injury rehab, and a majority of the athletes did not recognize the PTs role in injury prevention. Some did realize that PTs could do prehab but admitted that they did not utilize it. They also reported returning to a healthcare provider they trusted the most, which was the team athletic trainer. This is a continuum of the report previously mentioned that ATCs can positively influence their athletes’ rehab. How do we, as PTs, show our expertise to these athletes, create a cohesive and time efficient plan of care, and become the provider that athletes trust?

    First, I propose we must advocate for our profession. Too often we are lumped in with rehabilitation instead of prehabilitation, and we turn into PTs who act as glorified ATCs. To own up to our degree and our knowledge of the human body as movement specialists, we must show a different set of expertise and skills that set us apart from the other medical team members and show our value. I believe one of the first steps to do this is to promote prehab and target athlete’s pain and biomechanics before it becomes an actual injury. What sets PTs apart is our unique skill to understand human movement versus an ATC who is predominately a “quick fix” and works mainly in rehab after an injury takes place. Perhaps if PTs were managing care from the beginning, injuries would not be prolonged to the point of sitting out during practices or the season, and thus the time spent in prehab would offset more time spent in rehab.

    Second, as PTs, we are trained in the International Classification of Functioning, Disability, and Health (ICF) model, so we also take the athlete’s whole person into consideration when we treat. This means that we can use a Biopsychosocial outlook to treat the athletes. Often, student athletes are looked at as just athletes, without considering their academics or personal life goals. As PTs, we can ask them their goals on and off the field/court and be a part of their medical team who they can trust.

    Lastly, I propose that by being a PT, we can encourage movement that will help with kinesiophobia. If an athlete has a fear of movement, especially after injury, we are trained to think outside the box. Maybe the athlete is afraid of the PT or ATC touching their painful site, so we can teach them how to be hands on with their own body for treatment and introduce gentle movement. We can also try gentle and small movements with the athletes and build up their confidence before return to sport. O’Connor et al. suggests in the article Post-injury fear-avoidance and confidence in readiness to return to sport in Irish collegiate athletes, “Low confidence and fear avoidance was identified, particularly in those with a severe injury or high pain levels. Identifying, and providing psychosocial support to athletes experiencing, these issues is recommended.”5 As movement experts, we can build a relationship with these athletes and earn their trust with a cohesive prehab and rehab approach. 

    Overall, if PTs showed their expertise and vast background knowledge of the human body, we could be at the forefront of athlete’s prehab and rehab while creating a time efficient and cohesive plan of care, looking beyond “just the athlete” and seeing the whole person.

References

1. Hsu CJ, Meierbachtol A, George SZ, Chmielewski TL. Fear of Reinjury in Athletes. Sports Health. 2017;9(2):162-167. doi:10.1177/1941738116666813

2. Clement D, Shannon VR. Injured athletes' perceptions about social support. J Sport Rehabil. 2011;20(4):457-470. doi:10.1123/jsr.20.4.457

3. Zarro M, Silverson O, Soenksen W, et al. Roles And Responsibilities Of The Physical Therapist In Collegiate Athletics: Results Of A National Survey. IJSPT. 2022;17(6):1128-1135. doi:10.26603/001c.38015

4. Marks A, Courtney CA, Healey WE. Perceptions of Physical Therapy and The Role of Physical Therapists  In Injury Prevention Among Professional Basketball Players: A Qualitative Study. Int J Sports Phys Ther. 2023;18(5):1186-1195. Published 2023 Oct 1. doi:10.26603/001c.88137

5. O'Connor S, Moloney A, Beidler E, et al. Post-injury fear-avoidance and confidence in readiness to return to sport in Irish collegiate athletes. J Sports Sci. 2022;40(17):1973-1980. doi:10.1080/02640414.2022.2123519