On this episode of the #AskMikeReinold show we talk about working with high-level athletes and ways to get them to buy into your proposed treatment plan. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 208: How to Get Athletes to Buy Into Your Treatment Plan
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Show Notes
- How to Help Athletes with the Psychological Aspect of Injury
- How Physical Therapists can Specialize in Sports Rehabilitation
Transcript
Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about some of the strategies we use to get athletes to buy into our treatment plan.
Mike Reinold: Oh, well here’s our question today. Let me see. I’m my own question answerer. Let’s see. All right. Corey, from California, from Chapman University actually, which I got together with recently, Corey had a question I thought was pretty cool. He said, “When working with athletes who are very high level, and potentially have a lot riding on the therapy you’re giving them, and have expectation that they’ll get back on the field ASAP, how do you get them to buy into your treatment and plan of care that you’ve outlined for them? Especially if maybe it doesn’t fit with their own timeline? What are some strategies you’d like to implement?” This is a good one. I like the way I liked the way you phrased it too.
Mike Reinold: We’ve got high level athletes, they want to get back as fast as they can. A, how do you get them to buy into your plan? But B, how do you do that if it doesn’t fit their plan? I think that was, I think it’s a good way of rephrasing it right here. Who wants to start this lovely question?
Dan Pope: There’s so many ways to go with this.
Mike Scaduto: Yeah, I think that’s a pretty loaded question. I think first off you should have an honest conversation about the timeline that the athlete wants, and why are the two timelines not really lining up? Is it a postop patient who has unrealistic expectations coming back from surgery, and they think they had Tommy John three weeks ago and they want to start throwing it month two, and be back on the field at month six?
Mike Scaduto: I think that comes down to setting expectations for the patient, and I think that conversation you have to have early on, hopefully even before surgery, before they undergo surgery, if it’s something like that. If it’s another circumstance, I think you have to remind the athlete that you’re working for them, and maybe you have to make compromises in the plan to try and work towards their best benefit without putting them at risk for reinjury or anything like that.
Mike Reinold: Nice. Two things I liked from that, Mike, one is probably trying to set some clear expectations at the beginning of all this. Establish that early. That’s something we usually do with our athletes on their first visit or so, and we say, all right, all right. You strained your hamstring. All right, well what’s going on? We’re in season now. You got anything coming up? Oh, you’re a freshman, you’re not even playing on the team, all right. Let’s put together all the factors together, like oh, this is the senior year, and you sprained your ankle, and your last football game is this week? You got to put those factors together. Getting together and having those clear expectations.
Mike Reinold: I like what you said there, Mike, a little bit about maybe we got to, I don’t know if meet in the middle is the right term, because that’s not always the right answer, but I think I would say that nothing’s completely black and white. Unless it’s postop and you have some clear healing guidelines, nothing’s black and white. I see a lot of young clinicians and students get caught up on this where we’re like, “Oh no. Nope. You have to take two weeks off from running because I read that in a book, it has to be two weeks.”
Mike Reinold: Nothing’s black and white. People heal at different rates. We’re always trying to play with that spectrum of go as fast as we can, but not too fast to help them. There is no definitive answer. I got that thought while you were speaking, Mike, but I think that’s one of the things that, if you’re a therapist, and you’re developing your treatment plan, and you’ve got this hardcore thing in your head that, the way it should go, maybe it’s partly you that’s at fault. Maybe you need to be a little bit more like, let’s play on the fly. What else? What other strategies or tips do people have? What’s up, Dan?
Dan Pope: Going backwards, but I think this is … there’s a variety of things you can do. First and foremost, and she may be beyond this point, but I think that you need to win people over before they even come through the door. What I mean by that is that if you’re in a specific population, so I worked with Tom with fitness? A lot of times people are coming in to me because the coaches recommended, or they read about me online, or they see the background that I’ve had, and then the report is going to be that much better just because they trust you. I think that’s very, very important.
Dan Pope: What I was going to try to add to the conversation was, I think the listening is going to be extremely important, because the end of the day, we’re not here to get our own agenda accomplished, we’re there to help the person that’s in front of us. You really have to listen to that person and see what their needs are, and what their desires are, and from that point, we can start to develop a plan of care and maybe say, “Look, if you want to get back at this point, your risk of injury is potentially here, but if you follow my plan, it’s a bit better.” You’re not necessarily contradicting people, you’re just giving them the pros and the cons, and they’re trying to make a decision together.
Mike Reinold: I like that. I think you phrase that really well, Dan, too. I think that feeds into a lot. What I said too, where there is no black and white, everything has a risk reward ratio. You just got to put that together. I think you said that really well. Len, was that you?
Lenny Macrina: Well, I think a lot of it comes, you have the conversation and you’re like, “Oh, let’s look at you now. Let’s see how you move. Let’s see how you present. I like your thoughts. I think we can do a lot of that, but let’s just see how you move.” Then you start doing the assessment or the evaluation, and you start seeing objective stuff, or even they start reporting some stuff and you’re like, well, for me, I do a lot of muscle testing with the handheld anemometer.
Lenny Macrina: If I see a loss of strength, but particularly in a baseball player who’s coming back from Tommy John, because I got a bunch right now that are … they think they’re ready to throw, and it’s four months out until they can throw, and then I start doing some of my assessments of them, and they’re presenting with a pretty good cuff weakness, I don’t think it’s time to throw.
Lenny Macrina: Then I have to figure out, all right, let’s maybe wait a month. This is why I think we can wait a month. You see the numbers here. You feel the difference when I resist you. Let’s buy more time, because let’s calculate if we add an extra month of strengthening and don’t throw, how does that affect the backend? How does that affect your time to come back? Well, it really won’t because I’ll be ready now in February, versus January. It won’t really affect me for my spring season. Perfect. I think we found some stuff that we could work on, and I think it’s still not going to affect your season.
Lenny Macrina: I think a lot of the times that stuff falls into place perfectly, and believe it or not, you end up finding a happy medium, and you can justify it by some of your assessment stuff that you do. I think getting the person to buy in, like Dan said, and really get a good conversation going, and you’re listening, and you’re open to it, and you have to justify it with something objective if you’re going to really, significantly change their program. I think it oftentimes comes out in some of our testing that we do. That’s how I can oftentimes get around that.
Mike Reinold: I think that’s great. I think then what you would do there, and I think we may all do this, but I think this is a huge component to it is that you then have a criteria-based approach, and you go backwards, and you say like, “All right, look, you want to get back into football after a hamstring screen, okay. Well, here’s what we need to do first. Let’s go backwards. To play football, you need to be able to like sprint, cut, and run and jump. Right. Great. You’re limping right now. Just walking. We got to get to there. Great. All right. What’s our criteria to sprint then? Let’s get to that, like all right, well, we need to be able to jog with a one out of 10 pain, or something like that.
Mike Reinold: Great. Okay. What’s our criteria to start jogging? Well, all right. You need good range of motion without pain, you need decent strength, that type of thing. Here’s where you are, here’s our criteria to go through these phases. If you do it with a phase-based approach like that, then I think what you can do too, is you can say, “Look, in my experience, this takes four to six weeks, but I don’t know. Maybe you’re a good healer.” Whenever anybody says that, that’s always the scary … or no, that’s more pain. I have a really high pain tolerance. Those are always the worst.
Mike Reinold: Sometimes people heal at a faster rate. Look, this usually takes four to six weeks, but we’re going to go by the criteria, and here’s your objective measurements that Lenny just took, and I found some issues. Once these go up to here, then we can start this. Then once we do that, we can do that. Is that make sense? I think that’s pretty neat. Lisa, I want to hear from you. I’ve got an interesting thing for you too. As a pretty high level athlete yourself, collegiate and stuff like that in the past, you’ve done a lot of cool things. Maybe you hear it from your perspective as the athlete that then turned into the physical therapist, but I wanted to hear your thoughts in general.
Lisa Russell: Yeah. I’ve been there. It’s how I met Lenny. Rowers generally are this athlete. Generally, people come to me when they’re on the brink of breaking, They come to me because their back is hurting, and their hip is hurting, and their knee is hurting, and they’re scared about their ribs starting to hurt. They have to go down to Princeton to race in a selection. We got to try and make the national team in two weeks, and it’s like, okay, how do I do this?
Lisa Russell: The challenging thing is, typically, they’re not the only athlete involved in the decision of training plans and everything. Typically, people are in a boat with somebody else. It adds just another layer that you can’t just say, “Okay, you need to take a break for X amount of time.” Because then their partner also can’t do the work they need to be doing in that way. Telling a rower to just stop doesn’t happen.
Mike Reinold: I feel like Dave would say that with gymnastics too. It’s not always about stopping, it’s about, okay well, what other things can we work on?
Dan Pope: Yeah. I had the most success with what Dan was talking about. Just talking to the athlete and figuring out, okay, what’s their expectation? What do they want to get back for? Then I usually show them how they’re moving, and point out to them, “Hey, you can’t do X, Y, Z right now, and that causes pain. We need to get these things at least a little bit more under control before you can really be able to accomplish what you want to.” I think one of the hardest things to do as an athlete, when looking for that rowing race day, you’ve trained for years to get to this point.
Dan Pope: I find that it’s best to have the conversation, depending on how much time you have, of like amending their workload, and displacing some of the particular pain causing stresses into other things, and just giving them ways to still feel in control, and to still feel like they’re making progress, whether it’s, you got to spend every night doing this foam rolling, or this mobility drill, or different things to improve their body feel and decrease their pain while you’re trying to figure out what to do with their workload and training plan.
Dan Pope: I definitely, while Dan was talking, I was like, “Yep, that’s a hundred percent the conversation I always have is like, where are you at? What are you trying to accomplish? Let me tell you the things that you’re putting yourself in danger for.” This ultimately is the athlete’s decision, to go and try and race, and do what they need to do, knowing that they’re at risk for injuring themselves, but to the point where they’re going to really be out of it. I always like to give them that power and give them that information to really understand their body, and understand the risks, and to give them some tools to try and fix it, bandaid it, or if you have some time, actually fix it.
Mike Reinold: Yeah. At the end of the day, I think you just said it there at the end a little bit here. We work for them. We’re here to help them achieve their goals, and if they’re like, “No, look, I’ll take the chances. I know I only have a 20% chance of getting back pain free, but I got to play this weekend.” Then all right. Make sure everybody’s on board, the parent, the coach, the athlete, all those things. You do your best. If you’re adamant they can’t play because you think they have a 0% chance, then it’s your ethical right to bring that up. Otherwise it’s, let them help make the decision, but we’re educators, we need to help educate them a little bit with that. That’s good.
Mike Reinold: I think Lisa brought up some good perspectives too from the athlete that they’re letting their team down a little bit. We talked a little bit about this, the mental aspect of injuries, a bunch of episodes ago on the podcast, but yeah, there’s probably some other things going on too. Maybe this timeline doesn’t fit because they have this pressure from the outside. Maybe trying to help them deal with that in those concepts too, or maybe still finding ways that they can make themselves better. Scaduto’s low back hurts when he’s golfing. Well, that’s a little different. He’s just trying to break 90 every weekend. Where somebody training for the Olympics, man, this is it. If you get injured the week before the Olympics, you’re screwed.
Lisa Russell: Luckily, you got a whole another year this time.
Mike Reinold: Yeah, because this year we have five years. It’s a lot different. Mike can just stay at home and put and chip in his basement. Somebody else that’s been preparing for a long time is, we got to be careful. Just be careful we’re not on this high horse, I think, as physical therapists that they can or they can’t do certain things. I think there’s a bit of a spectrum we should consider. Awesome. Great question. Thanks so much for submitting. If you have more questions like that, head to MikeReinold.com, click on that podcast link, and we will keep doing it, either at home or at Champion. If it’s snowing or raining, what’s the post office thing? By-
Mike Scaduto: Rain, sleet, snow, fire, and ice. Something like that.
Mike Reinold: Fire and ice. I think that’s Game of Thrones. You just threw in Game of Thrones somehow.
Lenny Macrina: By land, by sea, or by air.
Mike Scaduto: That’s FedEx, isn’t it?
Mike Reinold: No mailman is delivering your mail if your house is on fire, Mike. They can come back tomorrow when the flames are out. Awesome. Hey, thank you so much, and we will see you on the next episode. Let’s social distance elbow bump.
Mike Scaduto: Boom. Wipe it off now.
Mike Reinold: Boom. Yeah. Then Purell it, and go wash your hands.
