Recently, Shannon Perrine of WTAE Channel 4 News in Pittsburgh featured a story on a patient of ours, Karla White. The focus of the story being Karla's same-day hip replacement surgery. It was a short, yet informative piece on the work of her surgeon and the rehabilitative process with special attention to the factors that played a role in a very successful outcome. If you have not seen the story, head to our Facebook page and check it out. All of our social media links are here on the website. You'll find them at the top of the page.
After the story aired yesterday, I had a number of thoughts that came to mind. Primarily these thoughts centered around how many medical professionals and the general public have a misunderstanding of the training and qualifications of chiropractors and strength & conditioning specialists. Especially as they relate to rehab, be it from injury or surgery. Many may find it unconventional and, at times, silly that one seeks out the professional help of a chiropractor or strength coach for the oversight of their rehabilitation.
Traditionally, once a patient is ready to begin post-surgical rehab, this process is guided by a physical therapist. It’s conventional thought and accepted practice. You have surgery, then you go to physical therapy.
That said, there are post-surgical patients who will seek out a chiropractic rehabilitation specialist to manage their rehabilitation. And, depending upon the setting and patient, strength & conditioning specialists may be involved as well.
Now there may be a few thoughts running through your mind right now. Maybe thoughts such as:
“Wait….chiropractors aren’t qualified to do post-surgical rehab!”
“Why would you use a strength & conditioning specialist for a rehab patient? Those are only for athletes!”
This news story has opened up the opportunity to help educate, so let’s address these questions or concerns.
Are chiropractors qualified for post-surgical rehab?
The reality is, when patients seek a provider for their post-surgical rehab, they may choose to seek a professional who is not a physical therapist. Some may not have the flexibility to make their own decision, but for those patients are looking for the best person for the job and they will exercise their right to make that decision. Regardless of title (PT or DC), patients must be in the hands of a provider who has the professional training and expertise to handle their rehabilitation appropriately. Providers must be competent and efficient for the sake of minimizing post-surgical complications and improving outcomes.
I’ve highlighted this before in previous writings, but my residency truly provided professional training very few chiropractors ever receive. During my 3+ year residency, I managed or co-managed numerous spinal, shoulder, hand/wrist, hip, knee, and foot/ankle post-surgical rehabilitation programs. Our department at Palmer College of Chiropractic worked with local orthopedic and neuro surgeons to co-manage routine as well as highly complicated surgical cases within the Quad City area. Meaning, we saw everything from athletic injuries to total joint replacements.
I don’t stress this to simply pump my own tires, but to convey to our audience that I’m not new to post-surgical rehabilitation and there are chiropractors out there that have similar training and expertise as well. We don’t exist on the level of physical therapists nor are we claiming to be physical therapists. Physical therapists have their own unique training and skill set. The ones I know do outstanding work for their patients.
The point I’m trying to make is that it is possible for chiropractors to have a background in functional and post-surgical rehabilitation. These chiropractic rehabilitation specialists are qualified and are capable of successful post-surgical rehab outcomes.
What is the value of Strength & Conditioning during post-surgical rehab?
For all those that want to be evidence-based, exercise and strength training literally helps more musculoskeletal conditions that all other treatments. The same can be said of post-surgical rehab as it is all about regaining range of motion, strength, and functional capacity. If you have the privilege of having a knowledgeable and qualified strength & conditioning specialist in your corner, they will provide enormous value to the post-surgical recovery process.
Yes, the involvement of strength coaches may be more commonly used in the athletic world, within the collegiate, professional and international ranks. But, when available in the private sector, they add an immense advantage as the rehabilitative process is very time sensitive and it’s critically important no time is wasted. The more quickly a post-surgical patient can regain adequate strength and movement quality through gradual exposure to the functional demands of strength training, the more quickly they are able to return to their activities of daily living, job, or sport with confidence and minimal complication.
Strength coaches are experts in what almost all musculoskeletal conditions will benefit from: exercise and strength training. Keep in mind, they must have the appropriate qualifications. Not all strength coaches are created equal and those that are capable of being involved with a post-surgical patient are rare. I can't stress that enough. These professionals understand their role and the best results are seen when they work together with the rehabilitation specialist to ensure ideal outcomes for the patient.
Post-Surgical Rehab Success is All About Team
The success of the post-surgical rehab program is not solely dependent upon any one specific individual involved in the process. Successful post-surgical outcomes take on a team dynamic. In this case, the surgeon, rehabilitation specialist, strength & conditioning specialist, and patient all had critical roles.
The Surgeon
For Karla, she had a tremendous orthopedic surgeon in Dr. Julius Huebner. Due to a congenital condition and progressively worsening degenerative joint changes to the left hip, Karla underwent direct anterior approach total hip replacement in late May 2016. This surgical approach is essentially a “surgical strike” as described by Dr. Huebner in the video. His surgical procedure resulted in no damage to adjacent tissues and structures. The procedure was a precise as you can get, enabling same-day hip replacement surgery and a faster recovery.
The Rehabilitation and Strength & Conditioning Specialists
In preparation for her surgery, she worked with the team at Gallagher Performance during the months prior to her surgery to improve her post-surgical rehab outcomes. Her pre-surgery rehab program enabled Karla to remain as functional as possible during that time. Pre-surgical rehab programs are never easy and quite challenging. However, Karla is a tremendous patient who demonstrated nothing but commitment and patience, knowing that the work she did prior to surgery meant having that much less to do post-surgery.
Likewise, during the course of her post-surgical rehab program, Karla worked one-on-one with either myself or Ryan. I managed the early phases of her rehabilitation recovery, implementing manual therapy and exercise. This continued as she progressed to more strength training focus in her rehab. That's when Head Performance Coach, Ryan Gallagher, designed and implemented her strength & conditioning program. The collaborative focus was on developing ideal movement patterns to spare her joints, thus improving the health and relative function of her legs, hips and spine. Exercise selection and progressions were based on post-surgical guidelines, tolerances, and functional capacity all while ensuring adequate strength and movement control were demonstrated.
The Patient
As for Karla, she was the ideal patient. She was compliant and motivated throughout the entire process. Karla loves to be active and workout, which only added to her motivation. A motivated patient is so refreshing to work with for countless reasons. The rehabilitative process can be frustrating at times, with obstacles and ups-and-down marking the road. As challenging as rehab can be physically, rehab can be even more challenging mentally. To her credit, Karla was always willing to work, even when she was frustrated or progress was slow. She always worked hard and focused on the little details. It’s because of her attitude that she demonstrated and her drive to regain the quality of life she desired that she is where she is today.
Summing Up
The combined team effort was the key to the success of this post-surgical rehab story. This theme must be present to ensure a patient has the outcomes they desire. It’s a privilege to be involved, providing our services to complement the team effort required during the post-surgical process as we recognize our role in the rehabilitative process. We thank Dr. Huebner for his medical expertise, Karla for being outstanding to work with, and WTAE’s Shannon Perrine for her excellent coverage of the story.
At Gallagher Performance, our focus is on developing the resilience of our clients and patients. We are committed to utilizing cutting-edge, patient-focused progressions to help every individual we work with not only achieve but also exceed their goals. With our extensive training and knowledge in chiropractic, manual therapy, sports injuries, rehabilitation, and performance-based training, we work with all individuals who are interested in living healthy, active, and pain-free lives.
More related reading:
https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/
Physical Preparation vs Fitness: Know the Difference
For athletes new to GP, physical preparation is a term that is unfamiliar to them. Sure they are familiar with “strength and conditioning” or “speed and strength” programs. Many of these athletes come from high schools and colleges that have a strength and conditioning (S&C) coach. If they do not have the luxury of having a S&C coach at their high school, they are often familiar with the “Bigger, Faster, Stronger” programs that many coaches hand out to their players, especially our football players.
There is a movement within the S&C industry that has more and more coaches referring to themselves as coaches of “physical preparation”. The concept of physical preparation, as it pertains to athletes, incorporates much more than simply strength and conditioning. Buddy Morris, current Head Strength/Physical Preparation Coach for the Arizona Cardinals, has said:
“We're coaches of physical preparation. What we do encompasses more than just conditioning and strength. There are a lot of variables we have to look at it with each individual athlete and each individual group. In this country, I think if anything, we place too much emphasis on strength. I'm not downplaying the importance of strength, but I think we put too much emphasis on it and too much volume."Physical preparation accounts for both performance enhancement as well as injury reduction measures. It's important to us that our athletes understand the concepts of physical preparation and why the services and training they are receiving at GP have only one goal in mind: to prepare each individual athlete to meet the demands of their sport and competitive season.
From an outsider’s viewpoint, our programs may look very simple. And depending on the athlete’s age and training experience, our programs can be very oriented on the fundamentals. But the biggest mistake our athletes can make is assuming simple means easy. Our programs are very demanding.
Physical preparation is one area where many programs fall short in their attempt to develop athletes. Young, well-intentioned athletes want to improve their current fitness and/or strength levels. This is all well and good, but what some coaches and athletes must understand is there is a difference between fitness and preparation. It's one thing to be "fit", it's an entirely different story when it comes to be prepared for sport competition.
Preparation vs Fitness
I recently was given the privilege of developing and coordinating the off-season strength/physical preparation program for the Franklin Regional ice hockey teams. To say I am honored would be an understatement and it is a huge compliment to our business. This is a tremendous undertaking and one that comes with many challenges. Many of these young hockey players are novices when it comes to strength training, needing a solid foundation of stability, strength, and neuromuscular control. Others have more training experience and also play for other amateur hockey organizations in the Pittsburgh area. Some of these kids play 60+ games a year. Understanding the stress their bodies endured during the competitive calendar and collision nature of the sport must be considered in the development of their training program to promote continual adaptation and proper preparation for the upcoming season.
This is where the development and preparation of the athlete must match the biodynamic and bioenergetic demands of the sport of ice hockey, not merely developing “fitness” or “strength” levels. Considerations of biodynamics (biomechanics, kinematics, and kinetics) will govern what exercises are used in the development of the athlete. Bioenergetics characterizes the nature and contribution of the human bioenergy systems towards training and competitive actions.
The development of physical abilities and specialized work-capacity will be specific to the training stimulus. This follows the SAID principle (Specific Adaptations to Imposed Demands). To help us understand the concept of specialized work capacity and how truly specific the development of “fitness” levels can be, let’s consider the nature of most team sports.
When considering the physical abilities that make an athlete successful in sports such as hockey, soccer, basketball, and lacrosse, what comes to mind is speed, power, strength and anaerobic-alactic capacity. To achieve athletic potential, all these abilities are necessary to train and develop so that physical abilities match the demands of sport.
What is not listed above and often a missing component in many S&C programs is developing the athlete’s ability to accelerate or how quickly an athlete can increase their speed. It is a rare occurrence in hockey, as with other team sports, that an athlete reaches top speed and must sustain that for an extended period of time. What you see far more often is that the ability to accelerate is a constant factor in athletic success.
Charlie Francis stated that most 100m sprinters do not reach top speed until 60m into the race. In other words, these athletes are accelerating for the first 60m of the race. This is not just true of sprinters, but the majority of other athletes as well and this has implications on their training.
According to Coach Francis, the major requirements for the 100m race are broken down as follows:
- Start/acceleration: 0-30m
- Speed/maximum velocity: 30-60m
- Speed endurance: 60-100m
In this day and age, the marketing of gimmick products or programs towards athletes is driving much of the training industry. High-speed treadmills, High-Intensity Interval Training (HIIT) programs, speed/agility schools are designed to increase pocket books, yet often can fail to deliver promises on performance enhancement when it comes to speed, acceleration, power, strength, or energy system development as they relate to a specific sport.
The ability to accelerate has major implications for explosive, alactic-aerobic sports. Athletes participating in these sports must have the ability to perform repeated bouts of acceleration and recover quickly. Acceleration ability is trained through plyometrics, acceleration training, and strength training. The ability to recover quickly is developed through proper energy system development of both the aerobic and alactic components. This doesn’t mean that an athlete needs a separate and specialized program for each of these components to be trained. Rather it means a well-organized and structured program must account for biodynamic elements, acceleration/speed, plyometrics, strength training, and an understanding of the positional bioenergetic (energy system) demands of the sport. These attributes must be understood and trained accordingly.
Related Articles:
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Why Athletes Should Avoid HIIT Programs
Common Mistakes in Developing Young Athletes
Don't Fall for the Speed Trap