Strength Training, Conditioning, and Periodization Principles for the Orthopedic/Sports Physical Therapist

Background:

I have always enjoyed working within the sports medicine department and working with athletes. My background in sports and strength and conditioning made this an easy capstone project to pursue. I have worked within the weightroom at UNC and alongside other ATC’s who are managing the acute injuries of athletes. I have also helped co-lead a sports journal club for my program with my capstone partner. I have a deep passion for this field and area of physical therapy and intend to continue working with athletes and in the sports sector post-graduation.

My capstone partner and I both agree that there is a gap in knowledge regarding common lifting principles, exercise programming, and understanding how to properly load and progress a patient who is experiencing a common orthopedic injury. Our pursuit is to help bridge the gap between interdisciplinary team members and improve the skills and qualifications of physical therapist to properly program an athletes rehabilitation program from day one post-op to prior level of performance.

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. As physical therapy students, we are not educated on strength and conditioning principles and methods. This gap in knowledge can limit our interprofessional collaboration with strength and conditioning & 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.¹ Understanding the concepts within the proposed capstone topic will enable clinicians to navigate this space and framework 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 & conditioning principles within rehabilitation.² 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.^3-5 Thus, physical therapists must be able to utilize effective training methods to arrive at better outcomes for each patient. We believe that our capstone project addresses a need and will aid physical therapists treating athletes and those who are active return to doing what they enjoy.

Purpose:

Our development of two separate lectures, an evidence table, and two case study examples is intended for students of physical therapists and current practicing clinicians who are working in the orthopedic and sports sector and are looking to further their own growth and development in relation to strength and conditioning and programming. This material is not typically taught during PT school – within reason because this area of discussion is not applicable to every PT – but it is something that is important to know and understand for those who are working in sports and orthopedics.

There is a wide gap in the knowledge between physical therapist who are treating the same injuries and if we can regulate the expectations when we take an athlete through a full rehabilitation program then the standard of care across the board will improve. This is a simple tool that can easily be utilized by all practicing clinicians to develop appropriate progressions for in-clinic sessions and home exercise programs that challenge the athlete. The goal is to improve return to performance outcomes and allow these athletes we treat to return to playing at a level they want.

Products:

Evidence Table: Is there one periodization approach while resistance training for improving strength in athletes?

Programming for the Rehab Professional: PDF of Lecture

VoiceThread Lecture: Programming for the Rehab Professional

LE Case Study: Post-op Hip Labral Tear

Survey for Evaluation:

Evaluation

There was a constant evaluation of information during this process that allowed a greater opportunity to improve, discuss, and determine the effectiveness of the material we created. Austin was a great source of resources – recommending different content and articles that were pertinent to our project. We were able to divide content to address different components to create a multistep process of understanding for our target audience. The synthetization of information between the two of us helped the development of our case studies which are intended to provide a real-life example of the approach and application of our information. We created a survey for our audience to determine the usefulness of this information that we encourage anyone who utilizes our materials to fill out to further determine the effectiveness and potentially demonstrate limitations for improvement.

Self-Assessment:

Researching and further learning regarding this topic came easily and naturally because of my passions and intended pursuit to work within this sector of physical therapy. The development of an evidence table provided an opportunity to truly understand the benefit and effects of periodization for athletes and created a transition to apply this to a lecture. The most difficult part was creating a lecture that had the appropriate information without overwhelming the audience with data and information but also showing the benefit and importance for a rehab professional.

Acknowledgement:

I would like to thank my advisor Dr. Deidra Charity for her support, feedback and knowledge to help develop this capstone project. She was a great wealth of knowledge and encouraged us to develop materials that were of high quality and could be beneficial to many students and clinicians. As someone who works in the orthopedic department and is involved heavily in the sport section of our program she was the perfect person to help my partner and I develop this capstone project.

I would also like to thank Dr. Brandon Surber and Dr. Nick Mahaffey for their support during the development of this project. They were both a wide wealth of knowledge, giving advice whenever we asked, providing quality research to help guide the project, and gave an ear and sound advice for any hiccups or concerns I had. The quality and content of this capstone project would not be the same without both of their support.

I want to thank my capstone partner Austin Kliewer for willing to undertake this project with me. I know our interests in physical therapy align and we both have a strong passion for it. I am very glad you approached me about working on this endeavor together and being the responsible one by keeping tabs on progress, due dates and all of the fine details that went into this project. I want to thank him for keeping a store of every research article that had even a slight note of strength and conditioning within in because it made it that much easier to synthesize the extensive amount of research that is out there. I also want to thank him for being a sounding board for all of the ideas that I had and letting me rant endlessly (in the best possible way) about this topic.

I also want to thank all of the physical therapist and rehab professionals who I admire in this field and who’s research and knowledge that fueled and guided the development of our capstone project. It is inspiring to know there are individuals who are doing so many amazing things out there.

Finally, I want to thank the physical therapy department here at UNC for the support and guidance to let me pursue an area of interest that I feel so strongly about. They have been a home unlike any other and I am incredibly grateful for all of the opportunities and everything I have been able to learn here.

References:

1. 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
2. Reiman MP, Lorenz DS. Integration of strength and conditioning principles into a rehabilitation program. Int J Sports Phys Ther. 2011;6(3):241-253.
3. 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
4. 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
5. 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