The moment I deadlifted over 225lbs, the hip impingement would come back.
When I was working my first job of as a Student Athletic Trainer back in 2012, things were easy, I was the front line for athletes when they got injured during play- I did sideline testing and deemed if the athlete was able to return to play. I made the necessary referrals, and ensured the safety action plan was in place. It was a check-list. But as my experience and knowledge expanded, the lines blurred. I became the Personal Trainer with a Bachelor in Kinesiology that “specialized in rehab”, and I am the Physiotherapist/ Certified Strength and Conditioning Specialist that does their patient’s programming for “load management”, as they get back to the gym.
As a Physiotherapist, where does my job end?
I’ve realized, there are no defined points of when Rehab ends and Performance training begins, and unfortunately most of the time there are no official hand-off from one professional to another. Unless you are a professional athlete, we often don’t have our own Strength and Conditioning Coach or Trainer to help us make the safe transition back to activity and sport.
Around 5 years ago I was struggling with re- occurring hip impingement. I would flare it up at the gym every time I deadlifted, and the pain would continue until for the next 3-4 days. I had strong manual physiotherapist at the time, who was able to mobilize my hip, ankle and ribs back in place, and I would always walk out of his clinic pain- free. He gave my stabilization exercises to help stop my ribs from shifting ( Thoracic Ring approach, for all you Physios out there) and even taught me how to mobilize my own ribs. He encouraged me to take it easy for two days post treatment, and with his therapeutic exercises, I was able to practice yoga pain-free and with more symmetry.
But, the moment I deadlifted over 245lbs, the hip impingement would come back. I lost confidence, and I became so scared to pull hard, because often the sharp pain in my hip was so intense, I ended up on the gym floor in agony.
This went on for about 8 months.
As a Physiotherapist now, I realize the gap. Being able to stabilize my bodyweight, was very different from stabilizing while deadlifting 245lbs off the floor. As the load got heavier my motor patterns broke down and I compensated. Because I always deadlifted switch-grip with my right hand on top, my pelvis would rotate to the right during my heavier lifts, and my left glute muscles were unable to fire optimally. In turn, my left hamstrings and adductor magnus took the grunt of the work. This poor motor pattern under significant load and fatigue made everything “pop out of place” and my left hip would get impinged.
Therapeutic exercises to target muscle imbalances, movement re-education, periodization of my training became critical in my recovery, and was what healed me in the end.
As a therapist, I am always looking for the DRIVER of your injury. If we do not address WHY your injury occurred, you will keep coming back, and likely with different injuries. In a more active population this often comes down to load management and poor motor patterns.
So where does my job end?
Similar to my experience with deadlifting, being able to do resistance band front raises without shoulder impingement is leaps away from safely barbell clean and pressing 135 lbs overhead.
Helping my patient restore their mobility in their ankle post immobilization in an air cast from a stress fracture, is just the beginning of addressing the true issue of poor programming during their plyometric training which lead to the stress fracture in the first place.
My job doesn’t stop the moment my patient’s are symptom- free, because most of the time they end up back on my treatment table. Empowering patients to move is the heart of Physiotherapy. Filling the gap between rehab and training is critical in ensuring patients do not re-injure themselves.
My job ends, when it can.
This is why I always appreciate the many years I worked as a Personal Trainer, Strength and Conditioning Specialist and Yoga Instructor. Our industry is changing, and I understand I cannot do everything for the patient/ athlete. Particularly at the elite level there are many contributors involved in the process. As there are more and more physiotherapists and professionals recognizing this gap, our roles are blurring.
The work of Physiotherapists, Strength and Conditioning Coaches, Massage Therapists, Chiropractors, Kinesiologists and Personal Trainers are overlapping.
Bridging this gap needs us all to work under a patient/ athlete centred model, and out egos and letters need to be left at the door. It’s accepting different professionals may be playing quarterback for this patient’s team at certain times - but we are all in it for the end game.