Azita Nejaddehghan is a performance specialist for the St. Louis Cardinals organization. She completed her doctorate in physical therapy (DPT) at Shenandoah University. Azita’s passion, which stems from her experiences in both physical therapy and strength and conditioning, lies in bridging the gap between these two domains to optimize the holistic approach to athlete performance. Previously, Azita has held roles with Louisiana Tech Football and University of Maryland Football under Coaches Kurt Hester and Ryan Davis, respectively.
Freelap USA: You’re a rehabilitation performance specialist trying to bridge the gap between performance and rehabilitation with an approach that is evidence-based, athlete-centered, multidisciplinary, and collaborative. What does that mean to you, and can you explain it with an example?
Azita Nejaddehghan: The integration of evidence-based, athlete-centered, collaborative care centers around the intention to provide the highest quality of care for an athlete. The fundamental component of athlete-centered care is the increasingly important emphasis on a biopsychosocial model of care rather than the fragmented, biomedical model of the past. This, in combination with the emotional and intellectual capacity to display compassion to the individual in front of us, allows for a course of care in which the athlete becomes the center of the framework and an active participant, rather than simply a recipient of coaching or physical therapy.
Athlete-centered care puts the athlete at the center of the framework as an active participant rather than simply a recipient of coaching or physical therapy, says @azitanej. Share on XIf we act in the best interest of the athlete, it means that we set aside our egos and collaborate with our fellow professionals and surrounding team members to address matters related to the athlete that may be outside of our own expertise. Evidence-based care then involves the conscientious and judicious integration of research and evidence to assist in decision-making, once again with the goal of maximizing athlete well-being and performance.
An example would be the long-term, postoperative care of an athlete, be it a UCL or ACL reconstruction. As opposed to a fragmented, biomedical approach to treatment, the practitioner should strive to integrate recent evidence, consideration of the athlete’s biopsychosocial factors, and an interdisciplinary approach (medical, athletic performance, performance science, mental wellness), all in conjunction with the athlete acting as an active participant in the planning of their long-term development.
Freelap USA: What are the gaps between performance training and rehabilitation, and why do you think they exist? What needs to be done in the field of strength and conditioning to bridge this gap?
Azita Nejaddehghan: In a sense, performance training and rehabilitation should be considered one and the same. Although the education and training, daily responsibilities, and skill sets may differ, the intent is identical. Human performance is human performance. On the end of physiotherapy, much of the gap resides in the knowledge and understanding of strength and conditioning principles—mainly progressive overload, exercise selection, and programming as a whole. That being said, here is what both professions can do:
- Leave your ego at the door.
- Identify and acknowledge the skill set of the practitioner across from you.
- Practice interdisciplinary communication and care.
Specifically, coaches can reach out to their physical therapist if their team employs one (or to any physical therapist through social media) in an attempt to seek an understanding of information that may benefit them in their own programming. A practical example of this would be when a strength and conditioning coach is placed in charge of an athlete’s return to play programming while there still may be biopsychosocial impairments lingering from an injury. This instance is a perfect situation in which a coach can follow the three steps above to provide a higher quality of care.
For both practitioners, the key would be to not allow themselves to get overwhelmed by the plethora of knowledge and information the other profession offers; simply focus on obtaining an understanding of the fundamental and basic principles.
Freelap USA: Professional athletes often deal with a variety of different overuse injuries, like jumper’s knee, Achilles tendinitis, and tennis elbow. What are your rehab principles and how do you adjust and monitor their load, especially in season?
Azita Nejaddehghan: My first suggestion here for practitioners is to gain a deeper understanding of the existing models behind tendon pathology (see the work of Dr. Jill Cook). In terms of reconditioning, generally my guardrails here will be to progress from protecting the injured tissue to facilitating a restorative process and ultimately to restoring qualities of both the target tissue and the system as a whole through progressive overload.
It is important to note that the initial “rest” phase is no longer one of complete immobilization, ice, and compression—rather, it involves temporary deduction of the primary stressor. Once irritability has decreased, mechanical load is applied in a gradual fashion to induce change in desired qualities and increase capacity. It is important to note that although they are influential, pain and pathology should not drive the reconditioning process when the ultimate goal is to restore function and prior performance level.
Loading schematics should be all-inclusive, not polarized to one contraction type, speed, intensity, angle, etc., and aim to systematically address qualities of capacity, competency, loading rate, tendon compliance, and tendon stiffness as appropriate. The key word here is “systematic”—practitioners should be guided by sound principles in the reconditioning process in order to maximize return to performance probability and success. Additionally, understand that tendon pathology is not strictly musculoskeletal, as neuroplastic changes are noted as well.
In-season strategies will largely depend on the situation—the athlete, irritability level, time left in the season, potential for a post-season, and the team’s need for that player’s availability, among many other factors. Speaking generally, the initial response will still likely be to reduce the primary stressor stimulus, often uncovered when speaking to the athlete, and progressively reapplying load to restore tolerance and capacity.
For me personally, this may look different in-season through the use of contraction types that are largely considered less fatiguing, decreased volume (even strong emphasis on minimum effective dose in-season), and understanding that the goal in-season is player availability and optimal readiness. To wrap it up, I have to say it again—do not just direct your efforts to a pathological tissue, treat and train the entire system!
Freelap USA: Before working in baseball, you gained valuable experiences in college football. What do you think is currently the main challenge for rehabilitation specialists in the college setting?
Azita Nejaddehghan: A broken system. This may come off as an unfairly forthright statement, but I believe it to be the truth. Our fellow athletic training teams tend to be understaffed, overworked, and underpaid. Meanwhile, most collegiate programs do not employ a full-time, in-house physical therapist for their team.
How can we provide the highest-quality athlete-centered care in this framework? How is this sustainable for the rehabilitation team? How is this the best we can do? The main challenge in the collegiate setting is the lack of resources and staffing provided to assemble a well-rounded, adequately staffed, interdisciplinary performance team.
Freelap USA: You were part of this year’s NFL Women’s Forum. Would you share some of your experiences from this forum? What perspectives do you see for female performance coaches in the NFL?
Azita Nejaddehghan: My main takeaways from this phenomenal experience were the lessons I learned from the NFL general managers, head coaches, and owners who were gracious enough to lend their time to a program committed to forward progress. The lessons I learned included the importance of staying curious, being present where your feet are, and betting on yourself.
I feel adamantly that the emphasis shouldn't be on our gender. The focus should be on the systematic and societal barriers that we face as coaches, says @azitanej. Share on XTruthfully, I don’t know if female performance coaches will bring any perspective other than that of who we are, performance coaches. I feel adamantly that the emphasis shouldn’t be on our gender. The focus should be placed on the systematic and societal barriers that we face as coaches. The bottom line—there are highly qualified, talented, and intelligent coaches who are not afforded the same opportunities or exposure as their male counterparts despite being equally, if not superiorly, qualified.
Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF
