Scott Webb (Host): Whether you're a professional athlete or a weekend warrior, ACL injuries, concussions, and other injuries may require physical therapy and a multidisciplinary team to help you to recover mentally and physically. And I'm joined today by Chris Poirier and Steve Bosjlie, both of whom are Physical Therapists with Emerson Center for Sports Medicine and Performance. And they're here today to talk about Emerson's programs and protocols and how they can help athletes return to play.

 This is the Health Works Here Podcast from Emerson Health. I'm Scott Webb

So I want to thank you both for joining me today. I have a daughter who plays sports. She plays basketball and softball, and I worry about injuries, concussions, ACL, and all the things we're going to talk about today, so great to have your expertise today.

Chris, I'm going to start with you. Maybe you could share a bit about Emerson's SMP program.

Chris Poirier, PT, DPT, OCS, CSCS: At the SMP program we have a really large variance in what we consider to be athletes. We have high schoolers, adolescents, college athletes. This can be recreational, higher intensity, sometimes we even have elite or professional or semi pro athletes as well. And then we also like to consider the aging athlete.

 So regardless of age, there's a really wide spectrum of what it means to be an athlete here. Overall, our philosophy here at our clinic and program is, you know, we have a really impressive gym, but we really prioritize loading and exercise progression. So, squatting, using dumbbells, using our implements, sleds, all the other stuff we have here, as well as a lot of other technology.

You know, we have apps, but we try to have a really welcoming and exciting environment for athletes of all abilities.

Steve Bosjlie, PT, DPT, CSCS: Yeah, I think Chris hit the nail on the head there. I think for us, we have a really good array of equipment here that we can really assess a lot of what's going on with our athletes, how to get them to where they want to be. And we use this equipment independently, but also with our expertise to get the athletes where they want to be.

And like Chris mentioned, it's a pretty wide array. So, we kind of have a pretty broad spectrum of what it means to be an athlete for us. We've had people from weekend warriors to firefighter, police force, pickleball, pretty much everywhere you could go, team sports. So we really like to build people up for what they're trying to get back to.

Host: Yeah, it sounds awesome. And pickleball has just taken the country by storm, of course. So I'm sure there's lots of folks trying to either avoid pickleball injuries or deal with pickleball injuries. And then everybody else that you mentioned as well. And Steve, I know that getting athletes back into their game is the end goal, so to speak, pun intended, of course. Can you talk about the return to play programs and why they're so important?

Steve Bosjlie, PT, DPT, CSCS: Yeah, I think it's just good to have a standardized program that you can fall back on that. You know, you're consistently assessing athletes where they're at and giving them the best information available for whether they're ready or not to get back on the field. Any injury, no matter how you look at it, is going to come with a mental and physical rehab that they're working through. And the last thing an athlete wants to do is go through it again. So for us, we want to make sure they're as ready as they can. So for us, we really work a lot with particularly ACL and concussion with a standardized return to play program. So, our ACL return to play program is pretty staged. We have certain metrics that we measure to assess your readiness.

We feel confident about these metrics to paint a clear picture for you being ready, but it can be individualized based and taken into account based on different weights of importance there. But the reason why they're so important for us, especially on the ACL side of things is as we keep looking further in the research, continues to suggest that if you're returning sooner than nine months post your ACL surgery, you're at a seven times increased risk of re-injury. So, we just want to make sure that we're working through as many things as we can to minimize that risk.

Chris Poirier, PT, DPT, OCS, CSCS: Yeah, I agree with everything Steve said so far. Using that staged criteria, to kind of make decisions for rehab and helping people navigate that return to play process. With ACLs, we're really looking at our return to play program for patients that are six months post-op or later. Again, this is later in the rehab, but still kind of early when you think about the full spectrum of like truly getting back and being at a hundred percent on the field.

 And we like to use a lot of that technology and program we design because if you're not testing, you're guessing, and that helps us make clear decisions to navigate it all. And just like the ACL, we carry that through for our return to play and our return to duty test for concussion.

So, overview on that is we'll have prepubescent adolescents, high school or college athletes and recreational athletes and we stage that particular concussion return to play progression depending on their level of sport. And this again hits different metrics relevant to concussions, so exertional or neck pain or some ocular tasks, but you have to be symptom free for two weeks in order to get that assessment completed with us.

And then the return to duty is more for our tactical athletes. So police, fire, military, EMS, maybe or even construction. So that higher level athlete that really has heavy demands, we can stage it up even more. So both tests, or return to play metrics, we will make sure it's appropriate and graded for who's in front of us.

Host: It's amazing how far some of these things have come since I was a kid, you know, when it came to concussions protocol, so to speak, if that was even a word that was associated with that when I was a kid, it was, you got your bell rung, you got to shake the cobwebs out, rub some dirt on it, all those things, those sports cliches, so great to hear how far it's come.

And Steve, I know returning an athlete to sport, after ACL or concussion really takes a team, a multidisciplinary team. Maybe you could talk about the ways that you collaborate with the athlete's physician, surgeon, coaches, and other members of the team.

Steve Bosjlie, PT, DPT, CSCS: Yeah, that's a great point. It's one we really stress a lot here at Emerson. I think it's really important for us from a healthcare standpoint to also make sure that the athlete doesn't feel like they're in this alone. We typically provide a lot of the testing results to the surgical MDs throughout the rehab, but especially on a return to play day, where we're assessing if they're ready to go back on the field. We've had really good feedback as well from some of the surgeons in this area regarding what we're doing to test and having that kind of meet a lot of their criteria as well. But on the side as well, Chris and I and a lot of our other clinicians here will commonly set up email or phone calls with coaches regarding expectations and progressions of getting back to playing, including minutes on the field or on the court.

 We found that coaches really appreciate this as well, and it helps to give the athletes a little more control over the process and getting comfortable where it's not like the cord is cut and they are cleared to play and not knowing where to start. So that's been a really big key thing for us as well.

Chris Poirier, PT, DPT, OCS, CSCS: Yeah. Our job as the PTs too, is we're here to advocate for the patient. Obviously, if they're safe to do so, but we're really trying to pull in what the athlete wants to do, what they're capable of, and then kind of talking with the other people, whether that's, Steve said, the actual coach, strength coaches, surgeons, really anyone, we're the kind of go to to summarize that information.

Host: Yeah. And Chris, I want to have you talk about the return to play program, like what it's like. Maybe you could take us through what an athlete really experiences.

Chris Poirier, PT, DPT, OCS, CSCS: Definitely. So with both return to play or return to duties, you're going to be ready to work out. So it's, they're both particularly challenging tests and the reason for that is because we want patients to feel like they're ready. So with our ACL return to play program, you know, broadly, you're going to come in, you're going to get warmed up, we'll take you do some specific movements to kind of gauge where you're at, but also get prepared for the test.

And we'll gather some metrics on things like maybe range of motion, some muscle bulk, and some other things we use with our technology. And then we'll move on to things like assessing your strength of different muscle groups and comparing it to side to side, as well as some other normative data.

Maybe how fast you can do certain metrics, how far, some jump testing. And again, since it's all staged, you have to meet criteria to kind of keep moving through the tests. And basically at the end of the test, it's something more sport based, so we do change of direction, endurance, and some larger movements for sport, but that's really dependent on what sport you're going back to.

Steve Bosjlie, PT, DPT, CSCS: Yeah, I think Chris gave a great overview here with what we're specifically looking for. Especially with the athletes that have been coming to us in PT, they've likely already tested a good portion of these movements in their sessions to some capacity, so they're pretty familiar with what they should be doing in them and our expectations of them.

And like Chris just mentioned, there's definitely certain components of the testing that's weighted higher than others depending on sport. But we do take everyone individually into account based off of their healing timelines, what their position is of their sport, and anything else that may make their rehab process and return different than the next patient.

Chris Poirier, PT, DPT, OCS, CSCS: And then when we talk about concussion, that program looks fairly similar, you know, there's a warm up period, we work through some typical things like some endurance, some aerobic testing, anaerobic testing, and then a circuit that we designed. And again, like, we can plug and play with things. So if, you know, you play basketball or you're a baseball player; those are two completely different sports. So sometimes we'll switch out what we're doing to make it more applicable. And then, when we do our return to duty test, it's a very similar setup again, so progressive challenge, but we also have our bits machine, it's like a large monitor, I think it's about like 6 by 4 feet.

 We can do some visual fixation and tracking exercises that's specific to the tactical population, when they're under like high stress, so we kind of fit it in at a crucial point. So that's another cool piece of technology, but, again, everything is really to just meet some of the demands that people will come across in their sport or job.

Host: Yeah, and Steve, you know, I know that there's a mental and physical sides to this, and some athletes just may not be ready to return, even though, you know, it seems like they might be, or maybe they're behind schedule, whatever it might be, maybe you could just talk about that. What if an athlete's just not ready to return?

Steve Bosjlie, PT, DPT, CSCS: Yeah, these are definitely tough and honest conversations we oftentimes have to have here in PT, as well as just the whole team, including surgeons. But we try to be as open and honest with them as we can and phrase it more in the terms of a readiness and risk management for performance rather than a punishment.

We kind of then lay out a program and a framework for them to reach the criteria based on what they might be lacking, whether it is physical or mental, and keep the parents and coaches in the loop if appropriate. At times this could include very specific gym based programs, to help shore up their physical attributes.

 And then just helping to dive into open, honest conversations of what they're having difficulty with on the mental side of things. Whether that is nerves to play or involving other healthcare providers there as well. We do assess that through some, what we call outcome measures where they're essentially these open surveys in terms of how confident an athlete may feel doing X, Y, and Z. So it helps to lay out a good portion of where they need help in that regard. And then we tend to go from there.

Chris Poirier, PT, DPT, OCS, CSCS: Steve summarized that perfectly where we're having the metrics to track physical and mental readiness. But again, as Steve mentioned, we're here to lay out information and talk about risks rather than purely saying you're passing or failing and making people feel bad. We're here to just say, this is what we see and this is what we could recommend that we should be working on to mitigate any sort of risk.

 But again, it really just depends, case by case scenario, but we're here to give them whether they need the actual space and equipment or just an approach and supportive environment to get back to their sport.

Host: Sure. I want to have you both take up this next one. Maybe we do it sort of rapid fire, but to both of you, and I'll start with you, Chris, what are your best tips for athletes to avoid injuries?

Chris Poirier, PT, DPT, OCS, CSCS: I think a low hanging fruit and a nice easy one would definitely be to be in the weight room. People think about the weight room that maybe it's not like the field sport or the sport they're in, but think of the weight room as it's the supplement to your sport. It's here to keep your tissues and your body healthy and strong.

It'll give you bigger capacities to be better at your sport and it'll help you be a better athlete for longer. So it's never too late or too early to begin that weight training. So getting in the gym is definitely something I would recommend.

Steve Bosjlie, PT, DPT, CSCS: Yeah, I'll echo what Chris is saying there. I think the weight room is definitely the biggest importance. I think athletes often neglect this with their busy sports schedules where combining practice and games is taking up most of their week, but we typically see athletes are losing strength in their season because of the lack of lifting and lifting on the heavier side.

So we actually want our athletes to be as strong as they can in the season to help withstand the demands of the season and the sport. So, and this can usually be accomplished in less frequency than people think. Good high intensity sessions with higher weight and lower volume at about one to two times a week of frequency should be enough to keep them at a good standpoint there.

Host: Yeah, let's finish up today. This has been a good stuff, really educational. To finish up here, Steve, I'll start with you, but your best tips, we touched on the mental side of things and how that's an important part of the recovery process for athletes, be it ACL, concussion, or other things, pickleball injuries, whatever it might be. What are some of your best tips for athletes to stay strong mentally during recovery.

Steve Bosjlie, PT, DPT, CSCS: Yeah, Scott, you bring up a great point there. I think the mental aspect is just as important if not more so than the physical aspect, right? So we really stress to try to just control what you can control and just stay present with where you are in your rehab process because unfortunately we can't rush time, but it's going to go by quicker when you're more invested in what you're doing.

We also just try to encourage athletes to, whether it's a new hobby to pick up or something else they like to do, to try to invest some time and growth into that because oftentimes our athletes are placing their identity in the sport they play, and they're not really accustomed to the sudden openness of schedule and time. So trying to see this as a blessing to explore new things rather than a detriment of what you can't do.

Chris Poirier, PT, DPT, OCS, CSCS: I think it's also important too, with that patience of controlling what you can control is just taking it one day at a time, which is easier said than done. So looking at your progress over the long run rather than comparing every moment, just take, all right, how did I do this week? How did I do this day? And let's just take it for what it is as it's just one point in my whole journey here. And I think athletes need to have some compassion and patience for themselves. They're not going to be able to rush this or will this away. It's not their fault. It's just the situation we're dealing with.

And, we like to try to keep them with the team. Doesn't mean just cause you're injured and you can't be out there playing the sport that we can't get you in there. So, you know, maybe we're just keeping you rehabbing at practice and giving you some other recommendations, but we still want them to feel like an athlete during their rehab.

Host: Yeah, that's perfect. That's been my experience, both when I played sports and both of my kids. It's just through this journey, as you say, is such a perfect word. But through this journey is about keeping them with their team as much as possible and being a part of the team as much as possible. I think that helped them physically a little bit, but definitely the mental side that we're talking about here, just keeping their spirits up, getting them excited about the return to play and all of that. So I just want to thank you both and you both stay well.

Chris Poirier, PT, DPT, OCS, CSCS: Thanks.

Steve Bosjlie, PT, DPT, CSCS: Yeah, thank you so much.

Host: And for more information, visit emersonhealth.org/sports. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify or wherever podcasts can be heard.