Fitness isn’t just the goal, it’s the path.

This message, fitness as the path back to health and return to play, represents the treatment approach I have taken for 20+ years with all forms of athletes….pilates, yoga, running, gymnastics, ballet, weight training, etc. Whatever your game is…I can use your fitness of choice to help you heal your body (and brain).

This is not news to a sports medicine therapist, or shouldn’t be, but often this has not been our approach in orthopedic and pelvic health treatment rooms. Often as physical therapists we end up treating fitness related injuries or injuries that were made worse through fitness programs. So we set aside fitness as the goal the patient can return to when they are strong enough, dry enough, or symptom free enough (insert your own litmus test for return to play here). This protection mindset unintentionally communicates to our clients that fitness is dangerous, it is set-aside for when they are “better”. But if we never train them in the demand that they are preparing for….how will they ever be prepared. How does a heel slide prepare a weight trainer for loads? How does a kegel prepare a runner for impact?

Instead, I am advocating for a progression mindset that uses your client’s fitness of choice as the path back to freedom from symptoms.  When we do this we are capitalizing on the movement patterns, neuromuscular pathways, and physical language that their brain and body already speaks. And PS they LOVE it. They chose that type of fitness for a reason, it resonates with them. We can tap into their brain, body and heart simultaneously by using modified fitness activities, or broken down fitness components as their rehab. This keeps them motivated and working toward meeting their rehab and return to fitness goals. This also communicates with them that we get them, and we are listening! Meet them where they are and they will be more open to  modifications, and substitute activities if needed.  This is very different than just telling them “No” (no more Crossfit, no more running, no more planks). Let’s build them progressive strategies instead.

So how does this actually break down with the female athlete standing in front of you? Start by watching them move, run, lift, pose, etc.

1. Understand the demands. What is the demand that those fitness activities are putting on them that they cannot meet?  Are there speed, endurance, impact, or strength demands in the aggravating activity? Which activity or component of the activity is the bugger that creates symptoms? Rather than throw out all of their crossfit or yoga or running, is it one particular lift or pose? Or is it just running downhill, not uphill? Do symptoms (pelvic health, pain or performance) begin when things speed up? These are the clues to help you understand where they are not able to meet the demand, so you can build the program around those pieces of the puzzle.

2. Understand their strategy to meet the demand. In other words, is the demand the problem- too heavy? Too far? OR is it HOW they are trying to meet the demand, their strategy. A great example is the use of a high pressure strategy for a low load task, such as a female athlete who leaks during her Yoga or Pilates class. Are they using a breath holding strategy for each repetition? Or are they gripping their abs beyond what is required by the activity? That high intra-abdominal pressure strategy , coupled with overwhelming abdominal force from above is the problem and it is our place to intervene within their current fitness vs needing to eliminate the exercise itself.

3. Monitor and Modify to keep them below symptom threshold. Keep an eye out for symptoms and compensations in their fitness movements. Do they lose form under load? Do they have pain? Do they leak or feel pressure in their vagina? Do they over-grip abs or pelvic floor or glutes? Do they breath hold? Does their Linea Alba dome? Yes? Cue them, remind them, give them a chance to practice and correct. But if they can’t then time to modify. Change the demand-reduce load, range, speed, or reps to keep them under their symptom threshold. AND/OR change the strategy-more or less muscular force, form corrections, or breath/pressure mechanics.  If symptoms persist, try to substitute a similar activity from their fitness repertoire that doesn’t aggravate them or create a compensation.

Finally….an approach that uses fitness as the path will improve their compliance. Remember by speaking the language of neuromotor pathways and movement patterns that their brain, body and heart are already fluent in, they will be happy to engage in the program you create for them. It’s no longer boring rehab, it’s getting to continue what they love (modified as needed), with a community they enjoy. This helps them manage the emotions of an injury, and throws in some self-care to boot.  Fitness becomes their home program when you modify their 3 favorite moves for practice at the gym or at home. Eventually, fitness becomes their maintenance program,too. It’s win-win-win.

Fitness isn’t just the goal, or the reward for when your client is “better”. It’s the path to get them there. #letthemplay

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