Podcast #111: Blending Rehab & Performance with Dr. Andy McDonald


“Rehab is a shared space”

“How do we plan rehab?.. how do we reverse engineer?”

The coactives: technical, physical, ecological (logistics), holistic (health and wellness, external (support from outside the rehab)

“A lot of coaches and clinical out there, when they design a rehab program, they make it look like a rehab program… they pick their methodology first rather than identifying what the end goal is, the adaptations, the outputs, the KPIs they’re trying to strive for and then identifying how you get there.”

“If you’re really clear on what you’re trying to achieve, how you get there is quite simple.”

“If you start picking your methods first, you’ll create a rehab program that includes lots of things… but because you’re doing so much volume and so much variety, they’re probably getting under-dosed.”

“Time is a great healer… if you’ve been doing something for long enough, maybe they start to feel better pain-wise.”

“Nobody owns rehab… clinicians learn in-depth anatomy, physiology, neuroscience, diagnostics, differential diagnosis… but what they’re not looking at is what does high performance or high level function look like?”

“S&C is kind of the opposite of that. You’re not learning how to manage an acute muscle injury on the table, but you’re learning how do you get someone stronger, fitter, faster.”

“There’s no way you can plan a rehab effectively at the beginning if you don’t know what the end looks like.”

Rehab: “Not just physios early, S&Cs late. You need both throughout.”

“What doesn’t help is, a physio can go and do their accreditation badge in S&C and then call themself a strength and conditioning coach… a S&C coach can’t go and do a quick exam in 4 hours and call themself a physical therapist… one can slightly badge collect the other.”

“The way you’re trained to be a clinician is for every population and then after you qualify, you pick the niche you’re going to work in… so then when you work in a rehab setting with athletes… once you get to the late stage where you’re really trying to load athletes up, that just really lends itself to S&C coaches because it’s their bread and butter.”

“You might find that the physio is brilliant acutely and they can get the car started but the S&C coach probably knows where the car is going.”

“If you look at someone’s ACL rehab at 5-months, it doesn’t look that different to somebody else’s leg strength training session that’s not injured.”

“Good rehab looks a lot like good S&C.”

“The loading for the tendinopathy is often the cause, the problem, and the remedy.”

Achilles: “Is this a stone in your shoe or is this a hot plate?”

“I think you get 80% of what you probably need information-wise from a good subjective.”

“Psychosocially, if you got someone who is a bit weary around loading, BFR is a really nice tool because you can get them working really hard in a painful area.”

Flare ups of pain: “The biggest risk factor for having any injury is probably having it before… even if you have a good rehab, it’s still statistically just more likely to happen.”

“If you’ve got this plantaris-driven Achilles, you can probably still be quite aggressive on things like a seated calf raise… you’re not getting that same level of compression and irritation (versus standing).”

“I don’t rehab a paratenon that differently… you’re still gonna use a full array of calf/Achilles landing.”

“If someone’s got bony or osseous changes at the patella (and they’ve got PT), they’ll very often be the athlete that gets more irritation when they load through more knee flexion… maybe just limit knee flexion (in some exercises).”

“The key things with tendons is, you have to find a loading start line and meet the athlete where they’re at in that current moment.”

“You need to pogressively load the tendon beyond its habitual state, you need to create strain in the tendon to influence adaptation. If you’re doing sub maximal loads, you’re not achieving that.”

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