Breaking the Cycle of Pain through Movement Coaching
The common story of pain
Are you ready for a story that will challenge your perception of traditional methods around dealing with injured athletes?
Before we begin, let me make one thing clear: we understand that there are those in the industry (therapists, strength and conditioning coaches and court coaches) who do things differently and also get great results by pushing the boundaries of what is considered conventional.
The story begins with an athlete whom we'll call Taylor. At some point in Taylor's career, they start to feel shoulder pain (as many volleyball athlete’s do). Taylor's first step after experiencing pain is typically to wait a few days or weeks to see if the pain goes away on its own. When it doesn't, they go see a physical therapist. The therapy session usually lasts 15-20 minutes and looks like this:
Athletes tell the therapist where they're experiencing the pain.
The therapist does a quick background check on the athlete to figure out past issues and other relevant health concerns.
Then the therapist performs a couple of quick assessments.
These assessments lead them to perform some form of soft tissue or manipulation to the affected area (in Taylor's case, the shoulder area).
Taylor tends to leave the session with less pain.
Sometimes the therapist prescribes a couple of generic exercises for Taylor's shoulder, usually including some form of band rotations and scapular retractions.
Having seen a therapist and experiencing some pain relief, Taylor continues to work out, doing their team training program. A common strength and conditioning mantra is "do no harm." Meaning, avoiding exercises that cause pain to the injured area. So now, Taylor has stopped doing most upper body exercises due to discomfort in the shoulder and continues to do the low-intensity generic banded shoulder rotations and scapular retractions prescribed by their therapist.
On-court, Taylor's coach knows about the pain and helps them manage it by reducing their attacking volume. This is a very thoughtful and common step, but unless the injury is purely due to over use of the injured area, this will only ever help Taylor manage pain. However, in almost every case we've seen where capacity is a problem, there is a co-existing movement quality or mechanical issue directly connected to the pain.
After receiving weekly therapy, Taylor continues to play, often still feeling pain. Taylor is in "survival mode." They are doing enough to keep their shoulder pain managed, but usually not enough to get rid of it for good. They are in limbo, feeling fine for a period of time before the pain flares back up. Unfortunately, this cycle may continue throughout their whole career.
The Opportunities
We believe this common story has some crucial missed opportunities.
The first opportunity in this situation exists in the follow-up to Taylor’s therapy appointments. Therapists treatment prioritizes “putting out the fire” which to us means they are using strategies to create some immediate pain relief. This is an important step in Taylor’s progress towards becoming pain free but it is only step 1 of many.
Therapists often don’t have time to address the root cause of why this pain exists in the shoulder. Commonly, therapists also exist in a space where they rarely see athletes when they’re feeling healthy and are constantly putting out fires rather than addressing the cause of pain.
Many therapists recognize they may not have addressed the root of why this pain is happening but within their constraints (time and priorities) sometimes all they can do is hope they did enough to manage the athlete’s pain. These constraints they face often lead them to prescribing generic exercises under the belief that certain exercises “should” help.
This is where we have the first opportunity to break the cycle of pain. Instead of the typical band rotator cuff exercises that “should” work, we take our time assessing Taylor in a 1-on-1 setting with the goal of identifying the root cause of the pain. In our assessment we identify and analyze their movement quality on and off the court. We spend anywhere from 45-120 minutes with Taylor to determine our starting point. Then we give them customized exercises to change how they move so their body learns and gains strength in positions that will keep the shoulder pain free.
The second opportunity exists in what athletes do in their strength training program. Taylor’s strength coach often doesn’t have time to assess the root cause of why their shoulder pain persists because they are usually dealing with 10+ athletes per hour and up to 500+ athletes per week. Strength and conditioning (S&C) coaches commonly prioritize making athletes stronger and more powerful while much of the pain management is left to the therapists. Furthermore, most S&C coaches often don’t have an extensive background in assessing movement quality. They will take out exercises that cause pain and replace them with exercises that “should” be good for the shoulder such as wall slides and band pull-aparts. Therefore, they take exercises out of Taylor’s program and make space for generic “physio” movements and for exercises Taylor can currently complete without pain.
Ideally, the athlete will continue to work with their S&C coach on developing strength and power but also begin to implement the exercises prescribed by their movement coach in order to eliminate their movement limitations that are driving their pain.
We believe athletes deserve better than “do no harm” or “should” in the weight room. Therefore, we give athletes exercises based on individualized assessments in order to efficiently eliminate any limitations they have that could lead to pain. We work with the athlete and S&C coaches to fit our exercises into their training programs. Then when they’re doing better, we progressively challenge the area or pattern we are working on so they make pain a thing of the past.
The third opportunity exists on-court. The common step of managing load is an intelligent and thoughtful step. However, coaches often can’t stop everything they’re doing to identify if pain is a result of an athletes technique. They may also lack the knowledge and education of how arm swing technique can positively or negatively affect pain. They reduce load with the expectation that their athletes are getting the appropriate help away from the court to reduce pain. In Taylor’s case, they’re attacking less in practice and their arm swing technique is left unaddressed. Alike MANY volleyball players, they have an arm swing pattern that is conducive to producing shoulder and back pain.
If we identify in their assessment that their arm swing may be a driver of their pain, we intervene with their arm swing technique. We work with the coach and athlete to create technical changes necessary for a more efficient, pain free, and powerful arm swing.
So Who is to Blame?
As humans we are always looking for the scape goat. Is someone in this story not doing their job? is someone purposefully harming the athlete?
NO, of course not!
In our opinion, the blame is on us (and those who perform similar services to us) for not making this approach more well-known and common practice in athlete’s training programs. We want to help change the “common” approach that athletes and teams take so it looks more like this:
Athlete develops “overuse” shoulder pain.
Athlete seeks out their therapist and Movement Coach for help.
Therapist works on relieving pain as the Movement Coach works with the athlete to assess the root cause of why this pain exists.
In the weight room, the athlete continues to work on strength and power but also implements the exercises prescribed by their Movement Coach to eliminate their limitations that drive their pain.
On-court, the coach reduces some volume and simultaneously works with the Movement Coach to make the changes necessary to their arm swing technique.
The athlete is no longer in pain. They are set up with exercises in the weight room and on court techniques that will keep the pain from returning.
Cycle Broken.
What happens if this cycle doesn’t change?
When the common cycle of pain persists, the ending of this story is often a sad one. I’ve witnessed this story first hand with some extremely high level and successful athletes. Even towards the end of their careers, these athletes have never broken out of this cycle. When this happens they consistently play with pain, they are always taking ibuprofen, they start getting injections as their careers progress, and surgeries eventually become part of the discussion. They continue to put out fires with their therapists, do shoulder band rotation exercises, do no harm in the weight room and reduce volume on court. Problems continue to arise each season and the physical pain continues even when they have left their sport.
Please let me be clear, we do not believe we are better or more valuable than anyone else in the process. This cyclical story just needs to change. It’s become too “normal” and the results are not good enough. We are an essential piece of the puzzle that allows athletes like Taylor to get out of pain faster, perform at a higher level, and have the chance to achieve their wildest goals.
So if you’re a Taylor, or you know one - rest assured that there’s a way out of the pain cycle once and for all.
Interested in how we work with athletes to improve velocity,
jump higher and play pain free?
