Elite Rehab: Physical Therapy for Superathletes

Working with elite athletes can be challenging and time-consuming, say experienced PTs who have worked with this patient cohort, yet helping rehabilitate these finely tuned physical specimens is rewarding far beyond the marketing value they bring.

“There is nothing better than seeing that you helped get an athlete back into competition to help their team,” says Jason C. Chun, MPT, SCS, ATC, CSCS, director of physical therapy at Elite Sports Physical Therapy in Fremont, Calif. Chun, a board-certified sports clinical specialist, has worked with Olympic-caliber athletes, triathletes, and professional athletes in the National Basketball Association, National Football League, and in Major League Baseball.

Contrary to what one might expect, working with athletes like these is in many ways easier than working with the general public, Chun says, because the athlete is motivated to return to competition as quickly as possible.

“It’s not always true, but for the most part, athletes pick up the exercises prescribed for them quicker than those who are not active on a regular basis,” he says. “Secondly, with the strength and flexibility they require in their sports, athletes are also set up better for rehabilitation after surgery.” Robert Forster, PT, CEO, and founder of Forster Physical Therapy and Phase IV Scientific Health & Performance Center in Santa Monica, Calif., says elite athletes make great rehab partners. They follow instructions explicitly, and make it their job to get healthy as soon as possible.

“Working with results-driven athletes provides an opportunity to see what works and what doesn’t when the sole focus is to achieve increased function and decreased pain,” he says. “They are often so finely tuned that the clinician sees results in intervention nearly immediately. Misses are obvious as well. This, of course, is rewarding in its own right, giving one confidence to stay the course when delivering the same therapies to the general public.” Forster has worked with Pete Sampras, Maria Sharapova, Jackie Joyner-Kersee, and Kobe Bryant, among others, and has benefited from putting his treatment skills to the test in what he describes as “the high-stakes arena of elite athletics.”

Referrals to treat elite athletes usually come from a word-of-mouth network of athletes and professionals, Forster says, who seek knowledgeable therapists who are easy to work with. “Athletes’ handlers don’t need another ego to work with,” he reflects.

PT for performance

Bob Moore, PT, founder of Moore’s Elite Athletes Academy, which has several Connecticut locations, says establishing your clinic as a place where results occur in a timely fashion, as well as being located in a community where elite athletes live, helps attract such clientele. “The reputation one develops is based on expertise, commitment, and imparting the knowledge that we all have in a very progressive way,” he says.

Forster advises that to begin developing an elite athlete clientele, you have to gain experience treating competitive athletes, usually on a volunteer basis. He recommends contacting local high school and club sports teams, as well as youth organizations such as Little League, which are often open to volunteer help.

Chun agrees that sport-specific knowledge is a must when working with elite athletes, along with an understanding of strengthening and conditioning programs. “More and more athletes are performing Olympic lifts, plyometrics, Pilates, and yoga, especially at the elite level, so the sports PT must understand a little bit about each of these areas to address any issues that could arise for an athlete,” he says. Working with elite athletes can be a great experience, Chun says, but there can be drawbacks: “If you travel with sports teams or work full time with sports teams, that is a lot of time that you are away from family,” he notes. “Most professional athletic trainers [and] physical therapists do not work a regular 40-hour week.”

Practical PT

Another drawback to working with elite athletes is that they can become extremely anxious and worried. “And if you do not know how to channel those feelings and behaviors, it can create stress for all parties,” Moore says.

Forster says that, when possible, it’s best to treat injured athletes twice daily to resolve the injuries faster. It also keeps them on task and prevents depression and anxiety about missing competitions and training time. “This allows more repetition of goals and rehabilitation philosophy,” he says. “You will usually find a very active listener in injured athletes, who are focused on doing whatever it takes to get back.” Among the tools most effective in treating elite athletes, he says, is cross-fiber friction massage for most connective tissue disorders, used to release scar tissue and improve function and performance capacity.

“Next is a well-thought-out and carefully progressed therapeutic strength and flexibility program, again for its ability to improve function. We find phonophoresis with dexamethasone very effective in reducing inflammation, and the ultrasound does well to prepare the tissues for deep tissue friction massage,” he says. Ultrasound contrasts are very effective in improving pain and inflammation, Forster says, and all treatments end with ice; athletes are advised to ice three to five times daily for 20 minutes with ice cubes and water in a plastic bag or using an ice bag. Gel packs are not effective in managing inflammation and swelling, he says, because they don’t stay cold long enough to reduce temperatures within deeper tissues, and yet may initially come out of the freezer too cold, placing athletes at risk for frostbite.

“An effective icing program is the single most important thing an athlete can do when treating their own injuries in addition to protecting the injured tissues from additional aggravation with bracing or taping during cross-training and daily activities,” Forster says.

Coaches, parents, and teammates can hinder an athlete’s recovery by putting pressure on them to return to action too early. Coaches often think they know what’s best for an athlete, basing it on personal experiences rather than medicine.

But Chun says there are times when he allows athletes to return to action before they are 100 percent better. He follows certain guidelines, but will make exceptions for elite athletes.

“Far be it from me to tell an athlete they cannot compete at the Olympics, NCAA Championships, or the Ironman triathlon if they have been training for that their whole life. If they will not cause irreparable damage to their body, I make sure they understand all the risks, so then they can make an informed decision,” he says.