Sports Physical Therapy for Optimal Physical Performance

As a long-time entity in the healthcare space, physical therapy has established its niche in many sectors, functioning primarily as an ancillary service to conventional medicine. But over the past decade or so, physical therapy has been claiming a larger slice of the healthcare pie, as obesity and sedentary lifestyles cause mobility issues that fall outside the scope of conventional treatment. However, athletes and physically active people do not fit the same paradigm as sedentary populations, and sports rehabilitation therapy is carving its own unique niche in rehabilitative medicine.

Understanding the difference between conventional physical therapy and rehabilitative sports therapy can help you select the most appropriate treatment path for your injury or pain syndrome. Learn what sets the two apart, and why sports therapy may be a better choice, even if you’re not an athlete.

Conventional vs Sports Physical Therapy – What’s the Difference?

Historically, most people see a medical doctor for acute or chronic pain, expecting to find a solution that puts them back on track. What many don’t know is that medical doctors are trained to manage metabolic disorders and pain syndromes with drugs and steroids – their ability to correct mobility issues from a mechanical perspective is limited at best. Even sports medicine doctors often fail to see the big picture, focusing on the injury itself, without considering related factors that need to be addressed in order to return the athlete safely back to play. And while surgery is sometimes necessary to repair structural damage, it has its limitations – patients still need full-spectrum rehab before returning to physical activity.

Once pain management has run its course and surgery has been performed, patients are typically referred for physical therapy to address mechanical issues disrupted by the injury. However, physical therapy is an umbrella term covering a broad spectrum of treatment approaches regarding quality, expertise, and effectiveness. Finding the right provider for physical therapy services that are tailored to your unique condition is key to achieving optimal recovery and long-term results.

Many physical therapists work shoulder-to-shoulder with doctors, relying on medical referrals as the bread-and-butter of their business revenue. Hospitals often provide in-house or satellite physical therapy services as part of their corporate business model. In such scenarios, patients are often referred pre- and post-surgery (prehab and rehab), or after a traumatic event that has impacted their mobility.

Mainstream physical therapy is frequently conducted in a group setting, where a single therapist works with multiple patients in the same time slot. Treatment protocols are typically generic, providing one-size-fits-all solutions for similar conditions, without factoring in the unique characteristics or expectations of individual patients.

Medical referrals for physical therapy are usually covered by health insurance, but the scope of billable procedures is strictly defined. Medical insurance does not typically recognize or cover holistic therapies that treat damaged fascia – a primary contributor to pain and dysfunction that must be addressed before a patient is ready to begin physical therapy. But due to insurance restrictions, treatment is usually limited to a specific region, using only procedures approved by the insurance provider.

For example, in the case of a knee injury, fascial restrictions may be present in the upper or lower leg, but insurance will only cover procedures that directly treat the knee. For the most part, the goal of conventional physical therapy is to achieve baseline functionality that enables a manageable return to everyday activities, but not necessarily to intense physical activity..

By contrast, sports physical therapy sets a higher bar, and demands a deeper level of expertise. Many sports therapists have had their own skin in the game, coming from athletic and fitness backgrounds that translate well to sports rehabilitation. Sports therapists understand that baseline functionality is not enough for their patients – the goal is to progressively move the patient toward pre-injury performance levels and beyond, so they can safely return to play with confidence.

Sports Therapy Diagnosis and Assessment

Sports therapy diagnosis and assessment help to determine the nature and severity of an injury or condition. Armed with that information, decisions can be made about the most appropriate treatment protocol. The process typically begins with a detailed history of the events leading up to injury, review of symptoms, and a physical exam to look for swelling, bruising, deformity, or asymmetry. Patients may be referred for imaging to visually assess damaged tissues.

Active and passive tests for strength, function and range of motion typically follow the physical exam, along with specific tests to confirm or deny suspected damage, and assessments for sport-specific movements. While a number of standard assessments are available that require little or no equipment, new technologies are proving to be invaluable tools for extracting quantitative data that more precisely informs diagnosis and decision-making.

Here are some advanced diagnostic and assessment tools:

• High-resolution diagnostic ultrasonography allows for dynamic imaging in real time, with the capacity to visualize multiple regions and structures in a single in-office session, for fast and accurate diagnosis.
• The UNOSO ProbeFix is a wearable ultrasound device that lets clinicians visualize damaged tissues during sport-specific actions, to observe muscle activation patterns and interactions with adjacent structures.
• 3D Motion and Gait Analysis leverages technology to collect and analyze activity-specific data about critical movement parameters such as joint angles, mass distribution, muscle activation patterns and more..
• ShowMotion™ objectively analyzes movement quality via motion tracking sensors, strategically placed on the patient’s skin. ShowMotion provides valuable insights about inefficient muscle coordination patterns that reduce motor efficiency.
• ForceFrame is a comprehensive system for testing individual muscle groups for strength and symmetry on both sides of the body. ForceFrame isolates muscle activation to identify imbalances, asymmetrical muscle strength, inefficient muscle coordination patterns, and compensation strategies.

These and other cutting-edge technologies are revolutionizing the diagnostic process by providing objective and precise tools that take the guesswork out of diagnosis, ensuring that patients receive the most effective and appropriate treatment for their condition.

Stages of Holistic Sports Rehab

Sports injuries don’t just affect the injured structures and tissues – they affect the whole patient, both physically and mentally. Peak athletic performance demands mechanical synchronicity throughout the entire organism. After an injury, the body automatically reroutes muscle firing patterns to offload the damaged tissues, creating compensation patterns that become habitual. At the same time, a bad injury can leave mental scars that reduce confidence and cause hesitation in the heat of play, increasing injury risk.

Sports injuries typically affect multiple tissue types that require tissue-specific therapy in the early phases of rehab. Once the injury has healed, work must be done to restore coordinated muscle recruitment patterns by retraining neuromuscular pathways. We must also restore efficient joint kinematics and recalibrate muscle tension, to synchronize strength and range of motion on the right and left sides of the body.

Sports rehab is progressive in nature, beginning with tissue healing and restoration, and gradually progressing to advanced exercises and skills training. In the past, therapists relied on standardized timelines for return-to-play, but new technologies enable us to personalize and monitor the healing process, to ensure that patients are not released until they are fully rehabilitated.

Advanced technologies can help us in the early stages of injury rehab by providing feedback, monitoring progress, and protecting tissues while rebuilding strength. For example, the Kineo intelligent loading system leverages AI to create customized variable loading protocols for functional training, core strengthening, agility drills and more. Blood flow restriction training (BFRT) allows patients to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Phases of sports injury rehabilitation include:

1. Acute phase, lasting days to weeks. In this phase, tissues are protected, and pain and inflammation are managed and controlled.
2. Subacute phase, where manual and regenerative therapies and orthobiologics help to steer and accelerate the healing process. Controlled movement and stretches may be introduced during this phase.
3. Rehabilitation phase that includes progressive strength training, dynamic range of motion exercises, drills for balance and proprioception, and low-impact cardiovascular exercise. During this phase, intrinsic and extrinsic feedback training restores neuromuscular pathways and optimizes muscle coordination patterns.
4. Functional phase, with sport-specific training tailored to the athlete’s sport and role. The goal is to regain pre-injury performance levels and restore confidence in the rehabilitated structures.
5. Return-to-sport phase, where the athlete returns safely to training and competition, with confidence and minimal risk of re-injury.

Who can Benefit from Sports Physical Therapy?

For athletes, sports therapy provides multiple benefits ranging from injury rehabilitation to performance and skills enhancement. To return safely to play, athletic injuries must be fully rehabilitated. But you don’t have to be an athlete – or even have an injury – to benefit from sports physical therapy.

People who choose sports therapy over conventional physical therapy include:

• Runners who want to perfect their gait and avoid injuries
• Fitness enthusiasts who want to fine-tune their exercise technique
• Postpartum moms who want to get back to physical activity
• Older adults who want to improve balance, mobility and stability
• Former athletes whose old injuries were never properly rehabilitated
• Novice runners and athletes who want to acquire skills and good technique
• Elite athletes who want to advance in their sport and gain a competitive edge
• Anyone with an injury or pain syndrome who wants to regain optimal pain-free mobility

Optimize Mobility and Stability for the Best Quality of Life

Injuries are always unexpected, and most people have no idea where to turn when life throws them a curveball. Medical doctors can help manage pain, and surgeons can put you back together if you’re really busted up, but when it comes to restoring efficient mechanics that optimize mobility and stability, holistic sports therapy is your best hope for a long, active and productive life.

About the Author

Dr. Lev Kalika, DC clinical director of NYDNRehab, is an internationally recognized expert in diagnostic and musculoskeletal ultrasonography, with multiple research papers to his credit. Dr. Kalika has studied with some of the world’s most prestigious experts in diagnostic, fascia, and nerve ultrasonography, and has presented his research at multiple international conferences. Click here to view Dr. Kalika’s full body of work.