Tom Broback is a physical therapist and strength and conditioning specialist in Minneapolis, Minnesota. A lifelong athlete, Tom continues to develop his passion for and knowledge of sports performance through a dedicated effort of research, commitment, and experimentation. Tom helps high school coaches keep their athletes happy and healthy through the power of exercise and education.
Freelap USA: Knee pain is one of the most common reasons for high school kids to miss out on games and training. Why do you believe there is so much knee pain, and how can we combat it?
Tom Broback: Knee pain is multifactorial, like most joint pain issues are. When I first started my career, I would spend so much time trying to figure out the cause. Are people sitting too much? But not all inactive people have knee pain. Are people not working out enough? But not all people who don’t work out have knee pain. Do we need better shoes? The list goes on and on.
To answer the question, I do think our movement variability on a given day is quite limited, and this can be a precursor to pain when we try to do activities that are too intense or too frequent. Very often, I will ask a high school athlete to do a single leg squat or a hip hinge, and they will struggle with the technique of this movement, even without a high external load.
Find movement options that work on profound deficiencies. Tight hips? Get motion back. Weak quads? Work on squats, lunges, step-ups. Stiff ankles? Change shoe wear, says @TomBroback. Share on XSo, what are some solutions? Find movement options that work on profound deficiencies. Tight hips? Get motion back. Weak quads? Work on squats, lunges, step-ups. Stiff ankles? Change shoe wear. Focusing on solutions gives an athlete more control on the path going forward. Any athlete who doesn’t know what they need to work on should find a qualified coach or therapist who can help guide them in the process.
Freelap USA: Coaches are often put into positions to handle non-traumatic acute injuries. What advice would you give coaches on how to generally navigate the process?
Tom Broback: Coaches are incredible human beings. The amount of stress, pressure, problems, and opportunities the typical high school coach must combat on a daily basis is mind-boggling. I am so proud of coaches who strive to do the best for their athletes. My new philosophy on problem-solving is this: Are you the best person to help this athlete with their problem? If yes, help. If no, refer them to someone who can give them the best help.
Some simple solutions for coaches who see lingering issues with their athletes:
- Audit the warm-up. Is it properly preparing the athlete for their workout or practice?
- Track notable spikes upward and downward in activity. Are athletes shutting down too quickly or ramping up at an unreasonable rate?
- Check the buckets. I love the bucket analogy for sports performance. Strength, speed, mobility, conditioning. Which buckets are too full, and which are too empty?
- Connect. There are amazing coaches and therapists out there who spend all day trying to find ways for athletes to stay healthy and be happy. Connect with them to get simple answers to complex solutions.
Freelap USA: The old RICE method (Rest, Ice, Compressions, Elevation) is something of the past but many coaches still use it. What is a better strategy to use, in your opinion?
Tom Broback: There are three:
Option 1: Activity modification. Many reasons we use the RICE method revolve around swelling. Swelling, in the simplest idea, comes from doing too much activity for what an athlete’s body is prepared to handle. The athlete can either increase the robustness of their system (get stronger, improve movement patterns, etc.) or decrease the activity demands. A combination is usually best for keeping athletes as active as possible while improving their sports performance capabilities.
Option 2: Soft tissue work. Another reason for the RICE method is to help with pain and soreness. There are options with better risk:reward ratios than an ice pack. Taking time to use a foam roller before a workout, getting a professional massage, or rolling on a lacrosse ball at night are all ways an athlete can get soft tissue work in to help with aches and pains.
Option 3: Non-fatiguing electrical stimulation. I still don’t know why this isn’t taught in PT school as the premier way to handle a swollen ankle. Non-fatiguing electrical stimulation allows muscle contractions to pump the fluid out of the joint and circulate it throughout the lymphatic symptom. The benefit is it won’t tire out the muscle (e.g., using it on the calf with a sprained ankle). There are many options on the market for this, and it is a game-changer in recovery for athletes in 2022.
Freelap USA: How do you utilize isometrics in therapy? Where do you believe they are most effective and appropriate?
Tom Broback: Although they are not new by any means, I have recently started to use isometrics more often in therapy with patients. There is some great research from Jill Cook on isometric effects on tendon rehab, especially patellar tendinopathy. I like using isometrics early on in PT, as they are easy for patients to replicate at home in their exercise program.
The inclusion of isometrics has been the single biggest advantage in my shoulder rehab philosophy and has dramatically improved outcomes with patients with acute and chronic shoulder pain. Share on XIn my own practice, my mentor shared with me his inclusion of isometrics for rotator cuff dysfunction. This incorporation has been the single biggest advantage I have found in my shoulder rehab philosophy and has dramatically improved my outcomes with patients with acute and chronic shoulder pain. Even nonoperative shoulder pain can take months to resolve, so this series of exercises has been tremendously helpful.
I think isometrics are a great way to introduce someone newer to the weight room to handling their body and external weight in space. Owning a squat position, a lunge hold, or a push-up position are amazing neuro-cognitive skills athletes can ingrain for the rest of their athletic career and life.
Freelap USA: Do you use blood-flow restriction training in rehab? If so, when do you use it? What makes it effective?
Tom Broback: Yes. Blood flow restriction (BFR) training is a staple in rehab programs, especially for lower-extremity rehab after a surgery like an ACL reconstruction. BFR allows a patient to get the correct intensity of an exercise for the muscle with the limitations presented after surgery. We can’t put a football player in the squat rack the week after a meniscus repair, so BFR comes into play. BFR alters the amount of blood flow going down to the leg and prevents it from returning to the body. This pooling effect of blood changes the environment of the leg and forces the muscle to work harder and adapt.
Some common exercises I use initially are straight leg raises, quad sets, and knee extensions. Once an athlete progresses, I also use it in standing exercises like step-ups, squats, and lunges. I have found BFR to be beneficial in decreasing anterior knee pain, so this would be another positive for its application in PT.
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