Rehab Roadmap to Optimal Performance

The purpose of this study was to identify if a group-based hybrid injury prevention program utilizing key factors from previous research with the addition of an individualized approach can modify the injury risk category of athletes. 

A preseason, group injury prevention training program with individually prescribed corrective exercises, resulted in a significant number of subjects decreasing their injury risk category. The primary statistically significant decrease of injury risk category was seen in the Moderate Risk individuals moving down to Slight. There were three athletes that moved from the Substantial Risk category to Slight, however, this change was not statistically significant. 

Key Words: Movement system, injury prevention training program, risk category,

Are You Truly Preparing Your Patients for a Return to Performance?

We've all been there. A patient arrives post-injury or surgery, you work diligently to get them to "normal," and they eventually get discharged. But what if "normal" simply isn't enough? What if we're overlooking crucial elements that contribute to future re-injury? That’s the core question we're exploring in the first course of our Rehab Roadmap to Optimal Performance course series, and the answers have the potential to transform your rehabilitation approach.

Here's the truth: We've been overly focused on returning people to activity, rather than focusing on returning them to optimal performance. This isn't just about wording; it’s about securing long-term success and preventing the frustrating cycle of re-injury.

Here’s what we're covering in this first course:

The Power of Checklists: We introduce discharge testing checklists. These are not just forms to complete at the end, they’re a roadmap to guide the entire rehabilitation process, starting on day one. We use the checklist to identify each patient's desired functional level (ADL, fitness, running, sport) and then select tests based on that level.

The Need for Change: We discuss into the current rehabilitation landscape, emphasizing the need for more rigorous and systematic discharge testing. Current research reveals that a significant percentage of individuals don't return to their pre-injury participation levels, and, even more concerning, many experience re-injury. This is unacceptable, and we, as rehabilitation professionals, have the capacity to change peoples lives forever.

Moving Beyond "Normal": Simply restoring range of motion and strength is insufficient. We must restore the entire body to its baseline function and then strive to surpass it. This involves addressing risk factors that can lead to future injuries, rather than solely addressing the current injury. We are learning that healthy individuals demonstrate less than a 5% difference between their left and right sides, and our goal should be to achieve this level of symmetry with our patients. Beyond that, we must consider population norms for those returning to high-demand activities that establish a safety margin that ensures they are resilient enough to withstand the demands they'll encounter.

Multifactorial Risk Factors: We explore the concept of multifactorial risk assessment. This includes factors such as prior injury, perceived recovery (SANE score), movement asymmetries, performance deficits, and even psychological readiness. We understand that injury risk isn't due to a single factor, but is a combination of elements that should be assessed together. We have algorithms using these risk factors, and those in the higher-risk categories are significantly more prone to non-contact injuries.

Real-World Application: We examine real-world cases to demonstrate how checklists guide test selection based on individual needs and goals. We recognize that someone aiming to return to sport must progress through all categories (ADL, fitness, running, and sport testing), and not just tests specific to their desired activity level.

Patient Communication is Key: We hear about a patient whose belief in his recovery was ignited by clear communication around his discharge testing, and we recognize that clear expectations throughout the rehabilitation process are important.

As rehabilitation professionals, we have the mission of enabling people to live their lives to the fullest. This first course is about posing challenging questions and disrupting the status quo. Are we genuinely preparing our patients for success? The answer is found in a more comprehensive, systematic approach that prioritizes restoring the whole body, addressing risk factors, and using data-driven decision-making.

Following the completion of this course, participants will:

• Understand the limitations of traditional rehabilitation approaches that focus solely on returning to activity and how this can contribute to re-injury.

• Understand the importance of a "Begin with the End in Mind" approach, where rehabilitation is guided by the patient's desired functional level, not just the resolution of immediate symptoms.

• Understand how seemingly minor injuries can lead to compensatory movement patterns and increased risk of future injury.

• Understand the need for rigorous and systematic discharge testing with objective criteria, and that this should be a continuous process from day one, rather than a one-time event.

• Understand the components of a discharge testing checklist, including identifying the patient's desired functional level and selecting appropriate tests.

• Understand the concept of multifactorial injury risk, recognizing that it is a combination of factors, and not just a single element.

• Understand the importance of restoring limb symmetry, recognizing that deviations may indicate compensations or underlying impairments.

• Understand the need to achieve or exceed population norms, to create a safety margin for individuals returning to high-demand activities.

• Understand how to identify and normalize risk factors for future injury, like previous injury, perceived recovery, and movement asymmetries.

Do you want to bridge the gap between injury rehabilitation and peak performance? Many rehab programs overlook the importance of fundamental movement. The Assessing Fundamental Movement course provides a systematic approach to identify deficits, implement evidence-based strategies, and optimize patient outcomes to ultimately maximize performance and reduce risk.

Here's what you'll get in this course:

Introduction to a Systematic Approach: Learn how conducting movement assessments in a systematic way can identify the changes that occur after injury and also highlight risk factors for future injury. Discover how to modify and normalize these factors to improve performance and reduce the risk of future injuries through example impairments.

Apply Cutting-Edge Research: Understand the research surrounding movement assessment and how previous injuries can impact motor control. Explore how pain alters motor control unpredictably, potentially leading to a cycle of compensation and further injury.

Maximize Efficiency: Learn how to quickly assess multiple risk factors through fundamental movement testing. Discover how to efficiently identify the root cause of dysfunction through SFMA breakouts

Utilize Discharge Checklists: Understand the necessity of standard operating procedures for determining readiness after injury. Use discharge checklists as a tool to reduce errors and ensure complete resolution of patient issues.

Following the completion of this course, the participant will…

• Recognize the importance of systematic movement assessment in identifying changes that occur after injury.

• Recall that previous injury is a primary risk factor for future injury.

• Identify modifiable risk factors that persist after rehabilitation.

• Define how pain can alter motor control in unpredictable ways.

• Understand the purpose of discharge checklists in determining readiness after injury.

• Recognize examples of potential causes of dysfunctional multi-segmental rotation, such as thoracic spine mobility, oblique/pec trigger points, or hip internal/external rotation mobility.

• Identify the components of a comprehensive movement assessment including range of motion, fundamental movement, balance, and performance testing.

• Understand the relationship between core stability and knee ligament injury.

• Understand the importance of including static balance (eyes open and closed) as part of fundamental movement testing.

"3 Core Systems & Their Gauges: Rehab Roadmap to Optimal Performance" is a pivotal course designed to bridge the gap between rehabilitation and achieving peak athletic performance. It emphasizes understanding, testing, and training the inner core and outer core. The course also introduces an often overlooked additional core system involving prime movers and synergists, with an understanding of the interplay of these three unlocking potential in athletes.

This course will help you learn:

• The importance of normalizing the inner and outer core.

• How synergists and secondary stabilizers become overused when substituting for primary core stabilizers.

• How to generate maximal tissue tension and full relaxation.

• How to test inner core function through volitional and reflexive methods..

• How to assess global core function using tests like pelvic dissociation, prone bridge, and trunk stability push-ups.

The course highlights that a lack of improvement or continued pain can often be traced to the inability to maximally create tension and fully relax. Injury frequently occurs when there are barriers to being able to achieve this. Understanding these core systems will enhance rehabilitation outcomes and improve athletic performance, leading to faster, stronger, and more durable athletes. The course is based on a discharge checklist and designed with the end in mind. Enroll today to transform your approach to rehabilitation and performance training.

Objectives:

Following the completion of this course, the participant will:

1. Recall the importance of the inner and outer core.

2. Identify the three core systems: inner core, outer core, and prime mover systems.

3. Recognize examples of inner core muscles, such as the diaphragm, transverse abdominis, pelvic floor, and multifidus.

4. Recognize examples of outer core muscles, such as external obliques, internal obliques, rectus abdominis, and erector spinae.

5. Define the role of prime mover muscles, such as latissimus dorsi, gluteus maximus, and psoas major.

6. Recall the concept of generating maximal tissue tension and full relaxation for optimal performance and rehabilitation.

7. Identify that the core is the link to generating tissue tension.

8. Recognize the anticipatory nature of the inner core and its role in providing local stability.

9. Identify that pain changes motor control.

10. Recall examples of volitional and reflexive methods to test inner core function.

11. Identify examples of tests to assess global core function, such as pelvic dissociation, prone bridge, and trunk stability push-ups.

12. Recognize that secondary stabilizers/synergists such as hamstring complex, rectus femoris and adductors can become overloaded when substituting for primary core stabilizers.

13. Define a high threshold strategy where large global core muscles are inappropriately active during activities which would not warrant such a response.

14. Recall components of hamstring strain injury prevention programs, such as core stability and eccentric loading of hamstrings.

"Winners don't just learn the fundamentals, they master them". This course echoes that sentiment, emphasizing that a deep understanding and consistent monitoring of foundational elements like range of motion are crucial for rehabilitation and performance. Unlock the key to optimal performance with the fourth course in the Rehab Roadmap to Optimal Performance series!

Essential for Authentic Performance: Just as pro baseball players refine their swing by hitting off a tee, mastering range of motion fundamentals ensures that complex rehabilitation techniques are built on a solid, authentic base. When fundamental range of motion is normalized, complex movements can be performed with authenticity. Here’s what you will get with this course:

Addresses Seemingly Small Deficits: The course highlights how seemingly minor changes in range of motion, such as a slight loss of knee extension, can lead to significant issues like anterior knee pain.

Comprehensive Approach: The course covers key areas like ankle dorsiflexion, knee hyperextension, lumbar locked rotation, and shoulder range of motion, providing a holistic understanding of how these elements interrelate.

Monitoring Fundamentals: The course emphasizes monitoring the fundamentals of range of motion throughout the rehabilitation to performance process.

This course is designed for rehabilitation professionals like you, who understand that mastering the fundamentals is essential for achieving authentic, lasting results.

By the end of this course, you'll be able to:

• Identify range of motion deficits that contribute to pain and dysfunction.

• Apply practical techniques to improve range of motion in the ankle, knee, and shoulder.

• Incorporate range of motion exercises into functional movement patterns for enhanced performance.

Objectives: 

Following the completion of this course, the participant will: 

1. Recognize the importance of ankle dorsiflexion range of motion, particularly in relation to its role in biomechanics and the proprioceptive system. 

2. Identify the total normal degrees and the degree of asymmetry of closed chain dorsiflexion associated with increased risk in multiple populations. 

3. Identify negative consequences from a lack of full knee hyperextension, such as anterior knee pain, decreased quad function, and increased injury risk. 

4. Connect anterior knee pain after ACL reconstruction with a failure to obtain full knee hyperextension postoperatively. 

5. Identify key prevention strategies to improve knee extension range of motion. 

6. Recognize risk factors associated with shoulder range of motion in an overhead athlete. 

7. Recognize the importance of spine rotation, cervical rotation, hip mobility and ankle mobility in throwing. 

8. Identify methods to measure horizontal adduction and shoulder extension range of motion.

Are you ready to revolutionize your rehabilitation practice and unlock optimal performance for your patients?

Unlock the power of evidence-based strength training in rehabilitation with Strength Fundamentals: Rehab Roadmap to Optimal Performance! This comprehensive course, the fourth in our series, is designed to equip you with the essential knowledge and practical tools to effectively restore function and enhance performance for your clients.

Explore the critical role of isolated muscle strength testing and learn how to objectively assess deficits using techniques like isokinetic and fixed dynamometry. Demystify the research surrounding open kinetic chain exercises after ACL reconstruction and confidently integrate them into your protocols. Master the application of modern strength training principles for hypertrophy, strength, and power, including practical guidance on load prescription using Reps in Reserve and 1RM estimation.

Explore rehabilitation strategies including neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) training to accelerate recovery and overcome anabolic resistance. Gain valuable insights into addressing the cycle of inhibition and compensation to ensure comprehensive rehabilitation. Learn and apply clinical strengthening pearls and milestones to guide your patient’s journey back to activity and sport.

Elevate your practice and achieve superior patient outcomes! Enroll in Strength Fundamentals: Rehab Roadmap to Optimal Performance today and transform your approach to rehabilitation.

Objectives

Following the completion of this course, the participant will:

1. Recall the importance of isolated muscle strength testing for assessing specific deficits in rehabilitation.

2. Identify research findings regarding the safety of open kinetic chain exercises after ACLR, understanding that they result in lower ACL graft strain than walking.

3. Recognize that early postoperative quadriceps strength relates to long-term functional outcomes after ACL reconstruction.

4. Recall the recommended intensity ranges for muscle hypertrophy (60-80% of 1RM) and for strength and power (greater than 80% of 1RM) when applying progressive resistance training.

5. Understand that neuromuscular electric stimulation (NMES) during resistance training can result in greater gains in strength and muscle mass compared to resistance training alone.

6. Recognize that blood flow restriction (BFR) resistance exercise at 20%-30% 1RM can lead to increased hypertrophy and strength and may help overcome anabolic resistance.

7. Recall that the inability to achieve 90% LSI on an isometric quadriceps strength assessment has implications for future ACL injury risk.

8. Identify options for systematically and objectively testing strength, such as isokinetic testing and fixed dynamometry, recognizing isokinetic testing as the gold standard.

9. Recognize common isokinetic metrics such as peak torque, total work, and limb symmetry index (LSI), and their relevance in assessing strength deficits.

10. State potential benefits of isometric exercises, such as being safe, simple, effective, and having an analgesic effect, and their ability to improve strength at specific joint angles.

Ready to bridge the gap between fundamental abilities and peak functional performance?

Elevate your rehabilitation practice by mastering the principles of complex movement screening with Complex Movement: Rehab Roadmap to Optimal Performance! Following our foundational courses on range of motion and strength, this essential sixth installment equips you with the knowledge and practical insights to effectively screen and interpret complex movement patterns in your patients.

We discuss the critical role of movement pattern screening as a vital link between traditional rehabilitation and high-level activities. Understand the nuanced application of tools like the Functional Movement Screen (FMS), moving beyond the composite score to appreciate the significance of individual test results, especially zeros (pain) and ones (inability to perform the movement). Explore the research surrounding the FMS, including its reliability and its role in identifying injury risk when used as part of a multifactorial approach. Learn how lower FMS performance can indicate underlying limitations in range of motion and core function.

Discover how to use movement screening to guide safe and responsible loading, understanding which patterns can be loaded and which require intervention. Recognize that improving movement patterns can positively impact outcomes and potentially reduce the risk of future injury.

Objectives

Following the completion of this course, the participant will:

1. Recall the importance of testing and correcting complex movement patterns in rehabilitation and performance.

2. Identify the components of a movement pattern screening tool such as the Functional Movement Screen (FMS).

3. Recognize the scoring system used in the FMS, including scores of 3, 2, 1, and 0, and their respective meanings.

4. Understand that individual FMS test scores, particularly zeros (pain) and ones (inability to perform), are more meaningful than the composite score.

5. Identify the moderate inter and intra-rater reliability of the FMS.

6. Recall that lower FMS performance can be indicative of underlying range of motion and core function deficits.

7. Recognize that FMS scores tend to be lower in individuals with injuries compared to healthy controls.

8. Understand that movement screening can help guide safe and responsible loading in rehabilitation.

9. Recall that the FMS can be used as part of a multi-factorial approach to identify injury risk.

10. Understand that pain with movement is a significant factor identified through movement screening.

Are you ready to understand dynamic balance for optimal rehabilitation and performance?

Unlock the critical elements of balance testing and training with Dynamic Balance: Rehab Roadmap to Optimal Performance! This comprehensive course will equip you with the understanding and practical application of dynamic balance testing and effective intervention strategies. You will learn to recognize the importance of evaluating balance at the limit of stability and how to utilize key tools like the Lower Quarter and Upper Quarter Y-Balance Tests to identify deficits and guide your rehabilitation programs.

Explore the intricacies of tri-planar dynamic balance testing using the Y-Balance Tests for both the lower and upper quarters. Demystify the scoring and interpretation of these tests, including the significance of asymmetry and composite scores, and understand the crucial role of population-specific norms. Gain insights into the reliability and validity of these assessments and their connection to injury risk and functional performance.

Master practical lower body balance interventions, starting with fundamental diaphragmatic breathing and progressing to dynamic balance exercises. Understand the specific requirements for successful balance, including range of motion, strength, stability, proprioception, and vestibular and visual function. Elevate your ability to integrate dynamic balance testing into your screening, rehabilitation, and return-to-sport protocols for superior patient outcomes.

Objectives

Following the completion of this course, the participant will:

1. Recognize the importance of testing dynamic balance at the limit of stability for a comprehensive testing of motor control.

2. Recall the asymmetry cut-off scores for the YBT-LQ: less than 4 cm for anterior reach and less than 6 cm for posteromedial and posterolateral reach directions.

3. Understand that YBT-LQ composite scores need to be compared to population-specific norms based on age, gender, and sport.

4. Recognize the YBT-LQ as a reliable and valid tool for detecting balance deficits and asymmetries.

5. Identify factors required for successful performance on the YBT-LQ, including foot, ankle, knee, hip, spine ROM, strength, stability, proprioception, vestibular, and visual function.

6. Understand that the YBT-LQ can be used in screening, to establish baselines in rehabilitation, to track progress, and as part of return-to-sport testing.

7. Recall the asymmetry cut-off score for the YBT-UQ: less than 4 cm in each reach direction.

8. Understand that the YBT-UQ composite score is also based on age, gender, and sport-specific cut points.

9. Recognize the YBT-UQ as a reliable measure that assesses a different construct of core and upper extremity function.

10. Identify key components of lower body balance interventions, such as diaphragmatic breathing and balance rotation progressions.

Are you ready to truly bridge the gap between injury recovery and peak athletic potential?

The journey from early rehabilitation to optimal performance is incomplete without mastering the art and science of jumping and plyometrics. Recognized as the foundation of prevention and performance, plyometric training is essential for return-to-running and safe return-to-sport protocols. This course provides you with the complete roadmap, ensuring your patients don't face the common clinical disconnect of being cleared for sport without having adequate explosive power.

You will learn to build a solid movement foundation using early strategies like the athletic base position and bilateral and unilateral snap downs, leading to improved outcomes and simplified cueing. Elevate your testing standards by moving beyond static assessments. Discover why the Single-Leg Vertical Hop Test is crucial for identifying performance deficits missed by traditional horizontal hopping, as it provides a better measure of knee function and quadriceps power. Critically, you will learn to abandon the outdated 90% Limb Symmetry Index (LSI) standard, understanding why athletes must achieve LSI scores above 95% and be compared to normative data to mitigate re-injury risk and restore function.

By integrating evidence-based plyometric and eccentric programs, which are proven to significantly reduce ACL injury risk by up to 67%, you will transform your rehabilitation practice into a high-level performance preparation system.

Objectives

Following the completion of this course, the participant will:

1. Recognize that plyometrics serve as the foundation of both performance and prevention programs.

2. Recall that a solid movement foundation, including range of motion and strength, is essential prior to initiating jumping and plyometrics.

3. Recall the ten criteria used to assess technique during the Tuck Jump Assessment.

4. Recognize that the Single-Leg Vertical Hop Test and Horizontal Hop Testing measure different aspects of power production.

5. Identify the importance of performing both Limb Symmetry Index (LSI) calculations and comparison to normative values when analyzing hop testing results.

6. Recall that healthy, uninjured control groups typically demonstrate a Limb Symmetry Index near 100%.

7. Recall that exercise-based injury prevention programs are classified as Grade A evidence for reducing the risk of knee and anterior cruciate ligament (ACL) injuries.

8. Recall that beginner athletes should adhere to guidelines of 60 to 80 ground contacts per plyometric session, performed one to two times per week.

Are you tired of guessing when your patient is truly ready to run? Relying solely on the "10% rule" or subjective pain reports often leads to setbacks and reinjury. This course bridges the critical gap between rehabilitation and return-to-sport by providing a systematic, evidence-based framework for returning athletes to running safely.

You will learn to implement biometric guardrails using heart rate and cadence to govern progression, moving beyond the limitations of pain perception. We will cover the essential checklist criteria for initiating a running program, including the often-overlooked necessity of a progressive walking program. You will discover how to calculate the Maximum Aerobic Function to monitor biomechanical efficiency and prevent overuse,.

Furthermore, this course simplifies gait analysis with military researched the Run with CLASS (Cadence, Lean, Alignment, Soft landing, Strike) framework, allowing you to correct mechanics without expensive equipment. You will also learn to program "Gear Workouts" to vary motor patterns and prevent the overuse phenomena common in recreational and elite runners alike.

Objectives

Following the completion of this course, the participant will…

1. List the specific physical criteria, including range of motion, effusion status, and limb symmetry, required to initiate a return-to-running program.

2. Identify the duration and capacity of the walking program that must be completed prior to starting a running progression.

3. Recall the soreness guidelines used to determine if a patient should advance, maintain, or regress their running level.

4. Define the relationship between increased cadence and peak ground reaction forces during running.

5. Identify the target cadence threshold that is associated with reduced injury rates in runners.

6. Describe the calculation of the maximum aerobic heart rate and the necessary adjustments for injured populations.

7. List the five components of the "Run with CLASS" acronym used for gait education and retraining.

8. Recognize the purpose of "Gear Workouts" in promoting different neuromuscular patterns to prevent overuse injuries.

Are you treating agility as an afterthought?

Many rehabilitation professionals wait until the "Return to Participation" phase to address agility, often relying on generic cone drills that fail to prepare the athlete for the demands of sport. This delay frequently leads to running out of insurance visits, time, or patient interest before true performance is restored. The Systematic Agility: Rehab Roadmap to Optimal Performance course bridges this gap by redefining agility training as a process that begins on Day 1.

You will learn to distinguish between pre-programmed Change of Direction (COD) and true agility, which requires a reaction to a stimulus. This course provides a comprehensive framework, moving systematically from Basic Human Movement (gait re-education, wall drills) to Fundamental COD (linear, lateral, crossover mechanics), and finally to the Skill of Agility (perceptual-cognitive reaction).

You will gain access to specific testing protocols—including the 5-0-5, T-Test, and Illinois Agility Test—and learn to compare results against population norms rather than just the uninjured side. By integrating these strategies, you will build a complete rehabilitation roadmap that ensures your patients are robust, reactive, and ready for competition.

Objectives

Following the completion of this course, the participant will…

1. Define the difference between Change of Direction (COD) and Agility.

2. Identify the three levels of the systematic agility training pyramid: Basic Human Movement, Fundamental COD/Agility, and Skill Components.

3. List the three primary directional categories used for organizing agility drills: Linear, Lateral, and Crossover.

4. Recall that the foundation of agility training begins as soon as the patient demonstrates pain-free walking with a normal gait pattern.

5. Identify the specific goal of the "Skill of Agility" phase, which includes perceptual-cognitive abilities such as visual scanning and decision-making.

6. Recognize standard tests used to assess Change of Direction and Maneuverability, such as the 5-0-5, T-Test, and Illinois Agility Test.

7. Recall the normative data categories (Excellent to Poor) used to interpret the Illinois Agility Test results for males and females.