Background
Working within the sports setting has been attractive to me prior to beginning the UNC DPT program. I was fortunate enough to be a part-time strength and conditioning intern for a year with UNC athletics during my time in college. This experience, alongside with majoring in exercise and sport science, and ultimately my time in PT school, has enhanced my passion for wanting to serve the athletic population. My interest in this area has motivated me to go above and beyond to participate in various activities and opportunities in order to learn more about sports physical therapy and performance enhancement. When thinking through what I might select as a capstone project topic, I reflected on a few possible ideas relating to sports physical therapy. Following this, I was eager to hear the thoughts of Haley Derr, who is my capstone project partner, as I knew we had similar interests, in addition to practicing clinicians who matriculated through the UNC DPT program such as Brandon Surber, who is one of my committee members. After speaking with them, I decided that this would be a great capstone project topic and one that presented an opportunity for significant personal growth given my passion and goals for the future.
Statement of Need
There is a pervasive generalization that physical therapists underload the patients that they treat. This can be attributed to a multitude of reasons. There is evidence to suggest that inadequate attention is given to strength and conditioning principles and methods within physical therapy education.1 This gap in knowledge can limit our interprofessional collaboration with strength and conditioning and sports performance coaches. Also, the traditional framework that physical therapists operate within typically includes a patient’s return to function, but there is a difference from return to function compared to return to sport, and even further, return to performance.2 Understanding these concepts will enable clinicians to guide one’s rehabilitation more effectively and efficiently. In addition, these principles and methods can be vital in properly treating the patient who desires to return to higher level activities, including recreational or competitive sport. Having sufficient knowledge and comprehension in this area can greatly benefit one’s clinical decision making while implementing effective exercise prescription throughout a patient’s plan of care. Within the literature, there are not many research studies that have used established strength and conditioning principles within rehabilitation.3 Physical therapists face the rising trend in outcome driven pay/insurance reimbursement that demand optimal results in an expedient fashion. In addition, recurring injuries have been shown to be a significant challenge for athletes.4-6 Thus, physical therapists must be able to utilize effective training methods to arrive at better outcomes for each patient. My capstone partner, Haley Derr, and I believe that our project addresses a need and will aid physical therapists who treat athletes and active individuals who want to return to doing what they enjoy.
Purpose
The purpose of this capstone project is to effectively educate physical therapists and physical therapy students on relevant, evidence-based strength and conditioning principles including various training methods, periodization, and energy systems training and how they might be applied in the rehabilitation setting. It is geared towards those who treat, or are wanting to treat, musculoskeletal injuries and the athletic population. The materials that are provided serve to culminate a vast body of literature in readily available formats such as an evidence table and presentation. I focused on foundational strength and conditioning principles, strategies to measure intensity/autoregulation methods, and advanced training methods within my presentation. Haley focused on periodization and energy systems training in her presentation. Another material that is provided serves to tie everything together in showing an example of how one might program a plan of care. This focuses on an athlete following an upper extremity injury/surgery (shoulder bankart repair). Haley’s case focuses on an athlete following a lower extremity (hip) surgery. With these materials, we hope to accomplish our aim of enhancing one’s knowledge and confidence in implementing relevant strength and conditioning principles and methods in an effort to achieve the best possible patient outcomes.
Products
- Evidence table: Focused on the question – which autoregulation method is supported by the literature for athletes training to improve their strength?
- Presentation: Culmination of a wide body of evidence on strength and conditioning principles and methods and their application within the rehabilitation setting
- Presentation slides
- References from presentation
- Patient case: Programmed plan of care focused on an athlete following shoulder bankart repair
- Evaluation survey
Evaluation
I met with Haley frequently while developing our products to discuss ideas and gain insight into how we might best move forward. I received feedback from my advisor and committee members on my evidence table, presentation slides, and patient case. After receiving their feedback, I implemented the changes that they believed should be made in order to best reach and educate our intended audience. I also created a formal survey that those who view the presentation and/or view the patient case can fill out submit to consider making suggested changes in the future to best accomplish our goals. The link to this evaluation survey can be found above in the products section.
Self-Assessment
Throughout this project, I enhanced my knowledge understanding of how one can implement strength and conditioning principles and methods within the framework of physical therapy. I had the opportunity to read a wealth of literature about this topic and improved my ability to understand and synthesize findings from different studies. I have an improved level of confidence with putting what I have learned to use including being able to appropriately load patients, utilize more advanced training methods, and effectively program a plan of care using periodization schemes. I am excited to present this in the future should the opportunity present itself, one possibility being an in-service for my final clinical rotation in a sports-focused clinic. I now have a newfound level of respect for clinicians who have adopted these principles and methods into their own practice. Amidst all that we do as a PT, it can be difficult to apply certain things that we may not have learned or been exposed to within our education. However, for patients who are wanting to return to higher level activities – this includes physically demanding jobs, recreation, and/or competitive sport, challenging them in an appropriate way while they are in a more “controlled environment” is necessary. Throughout this project I also have grown in my desire to develop great relationships and collaborate with other professionals wherever I end up at – whether it be fellow physical therapists, athletic trainers, or strength and conditioning/sports performance coaches. I believe that through these relationships and collaboration, I can learn even more and become better at what I do.
Acknowledgements
I would like to thank my advisor Dr. Deidra Charity for her help throughout this process. I want to thank both Dr. Nick Mahaffey and Dr. Brandon Surber for all their guidance and expertise that they offered. I am appreciative of everything that you all have done for me!
I also want to thank Haley Derr, my capstone project partner. You have offered great insight and have been an awesome classmate and friend! You sacrificing your valuable time to meet, talk about, and encourage me and it is greatly appreciated. I have no doubt that you will go on to accomplish great things!
Finally, I want to thank each of my classmates. You all have been amazing of these last three years, and I am extremely grateful to have gone through the UNC DPT program alongside you! We’ve had so many memorable moments together. I am excited to see the awesome things that each of you will do in the future. You all are the best!
References
- Handlery R, Shover E, Chhoun T, et al. We Don’t Know Our Own Strength: A Survey of Strength Training Attitudes, Behaviors, and Knowledge in Physical Therapists and Physical Therapist Students. Phys Ther. 2021;101(12):pzab204. doi:10.1093/ptj/pzab204
- Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853-864. doi:10.1136/bjsports-2016-096278
- Reiman MP, Lorenz DS. Integration of strength and conditioning principles into a rehabilitation program. Int J Sports Phys Ther. 2011;6(3):241-253.
- Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med. 2009;37(8):1586-1593. doi:10.1177/0363546509332500
- Finch CF, Cook J. Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries. Br J Sports Med. 2014;48(17):1276-1280. doi:10.1136/bjsports-2012-091729
- Bitchell CL, Varley-Campbell J, Robinson G, Stiles V, Mathema P, Moore IS. Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review. Sports Med Open. 2020;6(1):58. Published 2020 Dec 3. doi:10.1186/s40798-020-00286-3
6 Responses to “Strength Training, Conditioning, and Periodization Principles for the Orthopedic/Sports Physical Therapist”
Trey Miles
Austin,
This project is great! I am glad that I looked at it now during this rotation, as I have already had to apply some of these concepts and principles for athletes. There was so much that I learned from viewing the VoiceThread and will apply some of the training methods mentioned. I also appreciated the rehabilitation hierarchy for athletic development. While I was aware of the building block nature of rehabilitation, I appreciated that you used the word optimal. In order to be optimally explosive, we must optimally develop strength. This is very relevant for my current experience and I plan to utilize this information in the clinic. Great work this will be an excellent resource!
Trey
haley1
Austin, I could not be more impressed with the work you put in and the way this capstone project came out. I really believe this is high quality content that will be helpful for future clinicians. This was such a great opportunity for learning and diving into the sports physical therapy world. Thank you Austin for all of your hard work. I could not have asked for a better partner!
Sammi Iannucci
Really awesome job! Slide after slide was filled with such useful information – from key terminology that all PTs should be familiar with to the 1RM equations, exercise dosing based off training goals, and ways to individualize and adjust basic guidelines such as with APREs – all while keeping the information tied to the research and applied to rehabilitation. The case example was also a really nice addiction to the project to demonstrate these principles applied in practice. This is definitely a resource I will keep handy.
Carson Matthews
Austin and Haley, awesome job! I can tell you all put a lot of attention and effort into this project and I’m glad to see it come together with such detail. Based on my clinical experience, I agree with the sentiment that physical therapists frequently underload the patients they are treating. I’m sure there are a litany of reasons why this may be the case and I wonder what you think the main reason is? I think a big reason is because they aren’t aware of the periodization principles you lay out in this capstone. I honestly wish I had this as a resource before my outpatient orthopedic clinical because I found myself falling into this trap as well. Your voicethread was well organized and evidence-based, without overwhelming the listener with trivial information. Overall, wonderful job! Can’t wait to see what the future holds for you in this area of physical therapy.
Austin Kliewer
Carson,
Thank you so much for the kind words! I agree that there are likely a number of reasons that we may not adequately load the patients that we treat. One of the main reasons in my mind is that there is hesitancy around challenging patients with the right amount of intensity given the gaps in our education. I know from personal experience it can be easy to think that the actual amount of load/intensity needed to elicit strength adaptations may be “too much” for a patient given their pain, own hesitancy/fear, etc. I believe another reason may be that we have constraints given the environments that we work in – one example being that the heaviest weight in a clinic may be a 30 pound dumbbell/kettlebell. However, this should give us the space to be creative. Thank you again for your thoughtful response!
Megna Mishra
Austin,
You and Haley did an amazing job with this!!! I can see y’all passion for this project continue to grow as we went through school together. The time, effort, and thought you put into this is very very evident. You all added just great value to this program and knowledge base it provides. This project not only relates to sports, but to all PT practice! Can’t wait to watch you shine!!