Chapter 2 is quite dense and broken down into two parts.
What you will read today is“Part 1”, which will talk about how we utilize the “biopsychosocial model” in determining needs of the athlete based on things such as genetics, personality, mindset, and maturity.
“Part 2” will provide details on specific parameters, tests, and metrics we are evaluating when conducting a movement screening.
Whether you are a longtime AW athlete, or someone who has just signed up for our program, we are assessing you daily in some capacity.
With our primary demographic being “youth athletes”, these kids are changing at such a rapid pace. Even if I have worked with an athlete for months prior, they could walk through the door next week and seem to have grown 2” and gained 10 pounds. This makes constant assessment crucial. It allows us to make adjustments to training at a very accurate rate in accordance with the athletes development.
During “PART 1” we will sit down with Dr. Brett Poniros, DC, CSCS to talk about how he has taken charge of our ever changing evaluation process. Dr. Poniros take it from here…
In 1977 George Engel coined the term “biopsychosocial” as it pertained to medicine and psychiatry1. This, in his mind, was an upgrade from the biomedical model that had been used for years prior. The biomedical model looked at each human as being broken in some way, and that the exam and treatment should be designed around finding and remedying that one abnormal physical finding. For example, a runner with a stress fracture in their foot. This model would treat by simply putting the foot in a boot and giving it time to rest (i.e. treating the symptoms).
The biopsychosocial model instead considered the whole person, including their mentality, outlook, support systems, belief systems, self-image, etc. Using our example of the broken foot, this both encompasses treating the structural issue of the broken bone (i.e. putting the foot in the boot), but also looking into other factors such as, what type of movement error may have caused the injury? Did this injury occur as a result of a rapid change in training demands? You can see how this model encompasses a much more holistic approach and gives the practitioner or coach a tremendous amount of information to base training around. While the biopsychosocial model has now become the supposed standard of care across a host of fields, at Athletes Warehouse we have embraced it both as our evaluation standard as well as our training standard.
What does this “Biopsychosocial” Model look like in terms of assessing the needs of the athlete?
If we break it down for what the word really means…
BIOLOGICAL TRAITS… PSYCHOLOGICAL STATE… SOCIAL CHARACTERISTICS
BIOLOGICAL TRAITS- What are your physical, genetic traits given to you that can determine how you may function as an athlete. This includes questions about previous participation in sport, height, weight, or body type. Other questions are in regards to your parent’s activity level or previous athletic experience. This can give us an idea about expectations, and what to expect with an athlete. We can find out more information on previous, and future growth spurts. In fact, we have found that by timing properly executed strength training during peak growth spurts we can dramatically change the gene expression of a young athlete. The term of this is “Peak Height Velocity” and this will be a chapter in itself to come. Finally, we can also hone in on genetic predisposition to injury tendencies.
When dealing with the injured athlete… if they came from a referral from a physical therapist or sports medicine practitioner, we look to gain as much information as possible in terms of the physiology of their injury. This includes the injury, the recovery time, the rehab they were prescribed, who did the rehab. You get the point. Communication with the referral doctor or professional is paramount to allowing us to understand exactly where the athlete is at in terms of their return to sport.
Psychological State- This starts from the very first interaction we have. Bluntly put, our professionals have found that training can be awkward and sometimes even anxiety filled for a youth athlete. Youth athletes usually have never had exposure to training, especially not training in front of someone they have never met. On top of that, we’re often performing movements which are designed for them to fail. Within the first few minutes of our eval, we try and have an idea about the general personality of the person that we are working with. After creating an open space for the athlete we can begin to pull out information in regards to their level of dedication to their sport, and their readiness to train. Is this person outgoing? Shy? Uncomfortable? Are they going to be somebody that needs to by pushed? Pulled Back? And all of this is noted and factored into our eval notes. The sooner that we can answer these questions, the sooner we can understand how to interact with that individual athlete.
When dealing with the injured athlete… Physical problems heal, especially in young people. A torn hamstring will eventually heal. It is what our body does best. However, what recent literature has brought to light is the importance of outlook in the presence of an injury, and the capability of pain mechanisms to become ingrained within the central nervous system2,3. When you are an athlete, sport can be a large part of your identity. When injury occurs, your identity gets called into question. The mind begins to question “how long will I be out”, “is this going to inhibit my future performance”, “am I ever going to be the same”, “is this season ending”, “is this career ending”? Injuries are traumatic and stir up real anxieties in many athletes. This is why we take extreme precautions when talking and interacting with our return to sport athletes (For more on this, here is the link to Coach Brett’s article “Words Matter” http://aw-blog.com/uncategorized/words-matter-why-coaches-have-a-unique-position-in-return-to-sport-after-injury-by-brett-poniros/).
Being that the psychological approach to physical rehab is ever changing, here are some recent findings…
-Inflammatory responses can be completely driven and perpetuated by the brain and negative thinking 4,5.
-Research is moving in the direction of exploring the relationship between the perception of pain and actual pain experienced.
-Professionals working with athletes are as much educators to young athletes as anything else. We can spur curiosity and ingenuity in them.
Social Characteristics: The final portion that we take into consideration is the athlete’s social background and tendencies. Above all else, this allows us to better relate to the athlete and to respect cultural or ideological values that they hold dear. Within minutes of meeting an athlete we attempt to start a “normal” conversation; gauging what their interests are, their level of comfort in a gym, their level of comfort around us, and their social support system. Do they use sports as a release? Do they use sports as a social gathering? Are they more comfortable training with a male or female coach? While brief, this information is so important to us setting up an environment for the individual to train in.
In the end, much of our initial evaluation has nothing to do with strength and conditioning. We are utilizing the biopsychosocial model to begin to formulate the environment in which we are going to be placing our athlete into. Rather than deciding what movements we are going to perform, we start by figuring out how we are going to interact and build a relationship with an athlete. By creating this environment first we begin to set the stage for an athlete to begin their pursuit of success in whatever it is they are looking to accomplish.
THINGS TO IMPLEMENT TODAY:
- If you have a younger athlete, provide them the opportunity to explore strength training during their peak growth periods.
- Start to ask your athletes what their parents’ athletic background is.
- Figure out the personality tendencies of each individual you train and adjust your interaction with them in accordance.
- While your biological potential is widely determined by your genetics, the right strength prescription can be the greatest factor in how they are expressed.
- Changing your outlook on your current state and of the world around you vastly impacts your performance and your recovery.
- Decide why you play sports and why you train. Once you answer this question, your focus towards what you really want out of sports becomes very accurate.
STILL TO COME IN CHAPTER 2 PART 2
In “PART 2” we will cover every detail in regards to how we conduct a movement assessment. Part 2 will go into more detail about how we begin to design programs and select exercises to meet the needs of each athlete.
1 Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.
2 Schlereth T, Birklein F. The sympathetic nervous system and pain. Neuromolecular medicine. 2008 Sep 1;10(3):141-7.
3 Cavanaugh JM. Neural mechanisms of lumbar pain. Spine. 1995 Aug;20(16):1804-9.
4 Rosenbloom BN, Khan S, McCartney C, Katz J. Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury. Journal of pain research. 2013;6:39.5 Holmes A, Williamson O, Hogg M, Arnold C, O’Donnell ML. Determinants of chronic pain 3 years after moderate or serious injury. Pain Medicine. 2013 Mar 1;14(3):336-44.