Training methods and NFL injuries - paging our trainers/PTs

[Hapless Bills Fan]

I've been one who thinks Alex Guerrero and the TB12 method are complete bunk.  There's no question the guy has a sketchy past, including trying to pass himself off as a doctor and peddling "Supreme Greens" as a cure-all for terminal illnesses based on a supposed study of 200 patients that he later admitted, never existed.  I don't believe anyone needs to drink 100 oz of water a day, more isn't necessarily better. 

 

As a biochemist who once taught medical students, I can tell you that "alkaline water" is complete hokum: our bodies are exquisitely designed to maintain whatever pH they want, your stomach is has an extremely acid pH and plenty of cute little parietal cells that are ready to go to work any time day and night to keep it that way, and that the pH of your intestinal tract, the pH of your blood, and the pH of your cells are designed to be independently regulated.  Minerals are very good for ya, true, but they're good if you're getting them from food or even supplements - no need to buy "designer water".  Avoiding sugar, white flour, salt, and caffeine sounds like good dietary advice, but possibly not for the reasons specified and I gotta look into this dairy, tomatoes, mushrooms, and and peppers thing - really?

 

Then I came upon this article, by a recreational rock-climber who used Guerrero in his personal rehab.  And it shocked me a bit - positively towards Guererro and questioning what is done by other trainers and teams?

 

The author suffered a debilitating heel fracture, one that is hard to heal due to poor blood flow supplying part of the bone. My surgeon warned me that I shouldn’t expect to perform at the athletic level “to which I had become accustomed.”   It was pinned together and he was advised to keep weight off his heel for 3 months. 

 

“Is it safe?” I ask Guerrero, 51, whom I met through a mutual friend. “I’m not actually supposed to be bearing any weight.”

He pauses, giving me his undivided attention. “It’s completely understandable that your surgeon’s number one goal is to protect his surgery site,” he explains. “He doesn’t care if you ever run again. He doesn’t care if you want to climb Mount Everest. But here’s the thing about rest: It makes you feel better, but it doesn’t make you get better.”  The author describes how Guerrero gets him walking 5 weeks post surgery: " Guerrero leads me to a machine that looks like a treadmill covered in a small greenhouse. “It’s an antigravity treadmill,” he explains. “It’s time to start retraining your neuro-patterns.” He straps me into the apparatus and begins pressing buttons until the greenhouse fills with air and I’m floating above the treadmill, bearing just 10 percent of my body weight."

 

I thought it was actually a fairly well established principle with PT and physical trainers these days, that a controlled, rapid return to physical activity using water or air to minimize weight bearing and maintaining as much ROM as possible, is beneficial to recovery.  There have been many sagas of endurance athletes who persist with conditions that would be regarded as requiring rest - severe shin splints, for example - and who continue doing what they do nevertheless and wind up with as good or better recovery than patients who adhere to rest.  They suffer a lot, but it endorses the conclusion that controlled early activity is beneficial to recovery. 

 

I would have thought bouyancy tanks (for injuries without open wounds) and zero-gravity treadmills would be standard and non-controversial additions to professional athletes recovery these days.   Am I wrong?

Next thing: Guerrero's focus on conditioning for injury avoidance, focusing on flexibility and creating long, "pliable" muscles:

"In 1996, he opened a rehabilitation practice in L.A. and began working with track athletes. After noticing runner after runner suffering from the same recurring hamstring injury, Guerrero decided to watch how they trained, hoping to gain insight into why they were so vulnerable. What he learned became the foundation of his philosophy.  “I realized that what they were doing in the gym and what they were doing on the track were worlds apart,” he says, pointing to gym routines with heavy weights that create short, tear-prone muscle fibers built for quick bursts. “You can’t do weighted squats one day and then the next expect to be fast and nimble in the other direction.” This marked the beginning of Guerrero’s obsession with conditioning to avoid injury,"

 

You won’t find anyone at TB12 lifting weights in a way that feels “nonfunctional” to Guerrero. Instead, his athletes train at high intensity using resistance bands and body-weight exercises — single-leg box jumps, lateral band walks, shoulder resistance-band circuits, and virtually every plank variation

 

On my bookshelf, I have an out-of-print book called "Total Body Training" by Richard Dominguez MD and Robert Gadja, which describes the use of bands, box jumps, and other gizmos focused on training the core and bunches of small stabilizer muscles that are missed by conventional weight training with free weights or machines. 

 

Again,  I would have thought the techniques and equipment described in this 35 year old book would have been SOP for professional athletes these days.  Every time I visit a physical therapist post-injury, the PT professors at our local med school, they poke and prod me and invariably identify some minor muscle I've never heard of which they claim has "gone on vacation" and must be strengthened by obscure exercises they give me, which when done religiously, do in fact improve my life in short order - but without need for bruising massage or alkaline water.

 

Are pro teams really not doing these types of training with their athletes and as part of rehab?

 

The guy's punch-line:

At my 10-week checkup, I was terrified of showing him how I’d already been walking. His reaction to my mobility was one of disbelief. “In my 25 years of practicing medicine, I have never seen someone recover from a calcaneus injury this quickly,” he said. Squinting at the X-rays on his computer screen, he asked about Guerrero  (he later returns to successful climbing)

 

OK, anyone who read this far and fancies themself as a trainer, PT, pro or recreational athlete - GO! let's hear your views.

 

 

 

 

 

 

 

 

 

[thebandit27]

It's my opinion that only so much can be done with physiology; the big difference maker is the neurological side.  Any injury is going to cause neurological compensation patterns that the body will not voluntarily remove in the long-term. The trainers/physios that can effectively remedy the neurological compensation patterns are the ones that can do the most to prevent injury and speed along rehab.

[H2o]

4 minutes ago, thebandit27 said:

It's my opinion that only so much can be done with physiology; the big difference maker is the neurological side.  Any injury is going to cause neurological compensation patterns that the body will not voluntarily remove in the long-term. The trainers/physios that can effectively remedy the neurological compensation patterns are the ones that can do the most to prevent injury and speed along rehab.

Nice insight brother.

 

The mental aspect is huge in a lot of instances. Trusting the previously injured body part to perform in the same manner it did prior. That's why you hear about a lot of players having to get past the "mental hurdles" before things proceed any further or before they feel comfortable. Taking that first hit after a torn or broken whatever, being able to throw without any residual pain, those types of things. It's what makes me even more skeptical of Andrew Luck. 

[thebandit27]

6 minutes ago, H2o said:

Nice insight brother.

 

The mental aspect is huge in a lot of instances. Trusting the previously injured body part to perform in the same manner it did prior. That's why you hear about a lot of players having to get past the "mental hurdles" before things proceed any further or before they feel comfortable. Taking that first hit after a torn or broken whatever, being able to throw without any residual pain, those types of things. It's what makes me even more skeptical of Andrew Luck. 

 

Mental aspect is important, but I was actually referring to the automatic nervous system's effect on involuntary muscle compensation.

 

For example: you twist an ankle when you're 18 years old.  It hurts, so you limp (involuntarily).  Your brain knows that this hurts, so it slows down and/or changes the way that muscles fire so that it doesn't hurt when you move.  Eventually, the injury heals and it doesn't hurt to move anymore.  Do your movement patterns return to pre-injury form?  Not unless your brain sees some problem with the way they're currently acting.

 

Now, imagine 5 years down the road.  You're 23 and carrying an additional 20-30 lbs.  After 5 years of imperfect movement patterns causing forces to be transferred to muscle/soft tissue where they can't be handled properly, you move the wrong way at the wrong time and tear an ACL.  Was the ACL the problem, or was the compensation established 5 years prior--which caused too much force to be placed on the ACL, which isn't designed to handle that load--the problem?

 

IMO, the best trainers and physios are the ones that can identify and eliminate those patterns most effectively.

[Over 29 years of fanhood]

I understand in China, doctors are paid by how healthy they keep their patients- not how often their patients visit or the quantity of procedures/surgeries they execute. 

 

Could you imagine how that might change the behavior American medical system ? 

 

Me I very much belive there could be something to this TB12 thing...  and I hope it ends up generating enough money that mainstream medicine can no longer ignore or merely dabble in the nutrition and nonsurgical invervention paths of treatment.

 

[Malazan]

I'm sure the pro trainers have no idea what they're doing.

[4BillsintheBurgh]

2 hours ago, Hapless Bills Fan said:

Next thing: Guerrero's focus on conditioning for injury avoidance, focusing on flexibility and creating long, "pliable" muscles:

"In 1996, he opened a rehabilitation practice in L.A. and began working with track athletes. After noticing runner after runner suffering from the same recurring hamstring injury, Guerrero decided to watch how they trained, hoping to gain insight into why they were so vulnerable. What he learned became the foundation of his philosophy.  “I realized that what they were doing in the gym and what they were doing on the track were worlds apart,” he says, pointing to gym routines with heavy weights that create short, tear-prone muscle fibers built for quick bursts. “You can’t do weighted squats one day and then the next expect to be fast and nimble in the other direction.” This marked the beginning of Guerrero’s obsession with conditioning to avoid injury,"

Sorry, this is just hilarious to me. The basis of his philosophy is that squats building short twitch muscles were an issue? How about over training your quads causes a muscle imbalance which makes your hamstring susceptible to tearing? Or over training your calves causes your achilles to tear?

I guess it's good stuff if you can sell it.

[Hapless Bills Fan]

4 hours ago, thebandit27 said:

 

Mental aspect is important, but I was actually referring to the automatic nervous system's effect on involuntary muscle compensation.

 

For example: you twist an ankle when you're 18 years old.  It hurts, so you limp (involuntarily).  Your brain knows that this hurts, so it slows down and/or changes the way that muscles fire so that it doesn't hurt when you move.  Eventually, the injury heals and it doesn't hurt to move anymore.  Do your movement patterns return to pre-injury form?  Not unless your brain sees some problem with the way they're currently acting.

 

Now, imagine 5 years down the road.  You're 23 and carrying an additional 20-30 lbs.  After 5 years of imperfect movement patterns causing forces to be transferred to muscle/soft tissue where they can't be handled properly, you move the wrong way at the wrong time and tear an ACL.  Was the ACL the problem, or was the compensation established 5 years prior--which caused too much force to be placed on the ACL, which isn't designed to handle that load--the problem?

 

IMO, the best trainers and physios are the ones that can identify and eliminate those patterns most effectively.

 

So this is actually very aligned with what Gurrerro was telling the author of the Men's Journal article I linked, and also with the techniques they were described to be using:

Guerrero explains that when I fell, my brain noticed. Instantly, new neural pathways were created, sending signals to my body that my heel was now out of commission. Using my heel, even in a small way, starts to re­program those pathways. It challenges my body to keep my muscles supple, to reduce the swelling, and increase my range of motion.

“The faster I can change the way in which your brain thinks about this injury, the quicker you will recover,” he says, “and the more successfully.”

and

" In almost every session (they cost $200 a pop), I was analyzed on a series of machines that checked my load distribution and biomechanical efficiency. "

 

Also this article from a different guy who used his services: "When I went to see Guerrero, he put me on a treadmill that measured my stride length with each leg, the pressure with which I pushed off of each foot and the length of time each foot spent on the ground during a stride. He had me watch the monitor until I got my left and right steps synced up."

 

If you think that kind of thing is important, Bandit, maybe he's less of a charlatan (at least in some aspects) than I thought

[thebandit27]

39 minutes ago, Hapless Bills Fan said:

 

So this is actually very aligned with what Gurrerro was telling the author of the Men's Journal article I linked, and also with the techniques they were described to be using:

Guerrero explains that when I fell, my brain noticed. Instantly, new neural pathways were created, sending signals to my body that my heel was now out of commission. Using my heel, even in a small way, starts to re­program those pathways. It challenges my body to keep my muscles supple, to reduce the swelling, and increase my range of motion.

“The faster I can change the way in which your brain thinks about this injury, the quicker you will recover,” he says, “and the more successfully.”

and

" In almost every session (they cost $200 a pop), I was analyzed on a series of machines that checked my load distribution and biomechanical efficiency. "

 

Also this article from a different guy who used his services: "When I went to see Guerrero, he put me on a treadmill that measured my stride length with each leg, the pressure with which I pushed off of each foot and the length of time each foot spent on the ground during a stride. He had me watch the monitor until I got my left and right steps synced up."

 

If you think that kind of thing is important, Bandit, maybe he's less of a charlatan (at least in some aspects) than I thought

 

I am absolutely a fan of neural kinetic therapy...it was the key in alleviating 20+ years of back pain from when I fractured 3 vertebrae playing hockey when I was 15.

 

So as far as the neurological approach to physical medicine, I'll back its inclusion.

 

I don't know enough of the details about his holistic approach to opine one way or another on that side though. In general I've found most holistic nutritional approaches to be decent on the surface, though often rooted in pseudoscience.

[3rdand12]

45 minutes ago, thebandit27 said:

 

I am absolutely a fan of neural kinetic therapy...it was the key in alleviating 20+ years of back pain from when I fractured 3 vertebrae playing hockey when I was 15.

 

So as far as the neurological approach to physical medicine, I'll back its inclusion.

 

I don't know enough of the details about his holistic approach to opine one way or another on that side though. In general I've found most holistic nutritional approaches to be decent on the surface, though often rooted in pseudoscience.

As i may have mentioned once or twice or too often. My 3 daughters are healers of some sort. licensed or yet to be licensed.

 But Two are quite holistic as using diet and exercise and meditations to heal and remain healthy.

 

I have 3 rather deteriorated disc and arthritis in my spine from serious injury untreated for some years.
 

The way my body compensated was nearly grotesque before i began any treatment. ( and my daughters were not yet as well educated and practiced as they are now )
Happened about 14 years ago.
I now stand up straight to my previous height pre injury.  and have almost full range of motion in my upper body.

 What is still amazing is how it messed up my walking . The gait ( ? ). Still have muscles that contract suddenly and remain over protective. i walk kinda goofy sometimes i feel.

Thank gosh i can work out a bit  and get some solid exercise in last 4 years. Stretching and yoga has  helped my muscle memories to overcome my neural  impulses to protect my natural actions.

I am not sure about this guy except that he seems to have been focused on healing and maintaining health. is he effective ? Tom Brady will always be our barometer as to whether he is a healer, or just working his angles.

Edited June 12, 2018 by 3rdand12

[oldmanfan]

6 hours ago, thebandit27 said:

 

Mental aspect is important, but I was actually referring to the automatic nervous system's effect on involuntary muscle compensation.

 

For example: you twist an ankle when you're 18 years old.  It hurts, so you limp (involuntarily).  Your brain knows that this hurts, so it slows down and/or changes the way that muscles fire so that it doesn't hurt when you move.  Eventually, the injury heals and it doesn't hurt to move anymore.  Do your movement patterns return to pre-injury form?  Not unless your brain sees some problem with the way they're currently acting.

 

Now, imagine 5 years down the road.  You're 23 and carrying an additional 20-30 lbs.  After 5 years of imperfect movement patterns causing forces to be transferred to muscle/soft tissue where they can't be handled properly, you move the wrong way at the wrong time and tear an ACL.  Was the ACL the problem, or was the compensation established 5 years prior--which caused too much force to be placed on the ACL, which isn't designed to handle that load--the problem?

 

IMO, the best trainers and physios are the ones that can identify and eliminate those patterns most effectively.

Interesting.  You know strictly speaking that your autonomic nervous system does not innervate skeletal muscle, but does innervate vascular supply to those muscles.  And there is certainly evidence for neural plasticity with peripheral and central motor neurons that likely accounts for the changes you describe,

[Hapless Bills Fan]

3 hours ago, Over 29 years of fanhood said:

I understand in China, doctors are paid by how healthy they keep their patients- not how often their patients visit or the quantity of procedures/surgeries they execute. 

 

Could you imagine how that might change the behavior American medical system ? 

 

Me I very much belive there could be something to this TB12 thing...  and I hope it ends up generating enough money that mainstream medicine can no longer ignore or merely dabble in the nutrition and nonsurgical invervention paths of treatment.

 

 

I dunno about China.  Doesn't jibe with what the various Chinese folks I've worked with have told me nor my kid's three Chinese good friends.  But there is a parallel "Western medicine" and "traditional medicine" path, with some cross-talk, and most people (according to them) use both. 

 

I'm just wondering how much time and effort most teams actually put into the sort of assessment and retraining that the articles I linked describe.  The system described in "Slow Getting Up" - Nate Jackson's book about life in the NFL - did NOT sound as though it included much in the way of such assessment, at least for the "lower eschelon" players

[Xwnyer]

14 hours ago, jeremy2020 said:

I'm sure the pro trainers have no idea what they're doing.

Bud only knew one treatment process ice, stem and rest.  A lot has changed in the last 5 years in PT

Edited June 12, 2018 by Xwnyer

[Mango]

15 hours ago, jeremy2020 said:

I'm sure the pro trainers have no idea what they're doing.

 

 

This is much more true than you think. There is little stream lined practice or education in physiology in the USA. Many trainers are not well versed in the specific sports they work in. There are more bad physiologists in America than there are good ones. 

[Rochesterfan]

I think a lot like coaching - training tends to lag behind because people do what they have always done.

 

When TO broke his leg and started using hyperbaric chamber and that was like witchcraft at the time even though it was used to aid recovery outside the NFL.  Suddenly NFL teams like the Cowboys were investing in that.

 

It would not surprise me if TB12 has some great ideas, but it has also been shown to be full of crap before.  I think he mixes some fresh ideas with some risky alternatives and for some people that works and for others it does not.

 

I also think he is way ahead what NFL teams are doing and things like yoga on their days off would help the players more than some of the excessive lifting, but much like ballet in the 80’s - even though that helps balance - it is not manly enough for these players.

[Ridgewaycynic2013]

Along the basic lines of this thread, was there not an internal controversy with the Bills over increased injuries when the front office switched either trainers or strength and conditioning coaches?  It might have been during the Marrone 'friends and family' era, but I cannot recall with any certainty.

[Hapless Bills Fan]

3 minutes ago, Ridgewaycynic2013 said:

Along the basic lines of this thread, was there not an internal controversy with the Bills over increased injuries when the front office switched either trainers or strength and conditioning coaches?  It might have been during the Marrone 'friends and family' era, but I cannot recall with any certainty.

 

Well before that - Rusty Jones left in 2004.  Many felt that the Bills level of readiness declined and their level of nagging injuries increased.

[SouthNYfan]

TB12 as a whole has a lot of little things that, when taken on their own, seem like hoodoo bs, but lots of little things can add up.

Let's also not forget the placebo effect on people, where sometimes, mentally thinking something works, can actually improve outcomes.

Guerrero throws 50 darts at a wall, some stick and some don't, and it's not the same dart for every person, but you can't really single out which work and which don't, it has to be taken as a whole.

 

All the concepts you listed make sense, I try to incorporate them in my patients as well.

Sometimes it's better to listen to the surgeon, sometimes it's better to push the person.

 

One thing to remember about athletes, especially pro level, is your goal is to get them back to full playing shape ASAP and prevent reinjury.

Many times they aren't concerned with long term impact of the injury and rehab in 25 years (such as the arthritic changes that happen when rushing back from an injury), look at Brandon Roy in the NBA, his knees gave out years earlier than they should have, most likely due to rushing back for the playoffs.

 

Low/zero g rehab helps early on, and can actually help strengthen the surgical repair, harden the bone, and prevent muscle wasting.

The problem is it's very expensive equipment (I'm talking 35-100k per treadmill vs 3-5k for a good rehab quality treadmill) and requires one on one supervision that many places can't afford that luxury.

[Hapless Bills Fan]

12 minutes ago, SouthNYfan said:

TB12 as a whole has a lot of little things that, when taken on their own, seem like hoodoo bs, but lots of little things can add up.

Let's also not forget the placebo effect on people, where sometimes, mentally thinking something works, can actually improve outcomes.

Guerrero throws 50 darts at a wall, some stick and some don't, and it's not the same dart for every person, but you can't really single out which work and which don't, it has to be taken as a whole.

 

All the concepts you listed make sense, I try to incorporate them in my patients as well.

Sometimes it's better to listen to the surgeon, sometimes it's better to push the person.

 

One thing to remember about athletes, especially pro level, is your goal is to get them back to full playing shape ASAP and prevent reinjury.

Many times they aren't concerned with long term impact of the injury and rehab in 25 years (such as the arthritic changes that happen when rushing back from an injury), look at Brandon Roy in the NBA, his knees gave out years earlier than they should have, most likely due to rushing back for the playoffs.

 

Low/zero g rehab helps early on, and can actually help strengthen the surgical repair, harden the bone, and prevent muscle wasting.

The problem is it's very expensive equipment (I'm talking 35-100k per treadmill vs 3-5k for a good rehab quality treadmill) and requires one on one supervision that many places can't afford that luxury.

 

I guess my question was more along the lines of, if one toured the Pats*** or the Bills training facilities, would one find a row of zero-g rehab treadmills for the use of recovering injuries?  Would one find the specialized gait analysis equipment (which I assume also needs 1:1 operation)?  Would one find all the resistance band setups and small muscle stabilizing stuff (are you familiar with that Total Body Training book)? 

 

Would the trainers have enough time to work 1:1 with each guy, perform a Spring assessment and customize a training plan?  Or after an injury, perform an in-depth muscle group analysis and identify which supporting muscles need strengthened?  It takes about an hour each time I've had this done.  90 guys, would need to have what, staff of 5? 10?

 

IOW are people going to Guerrerro in part because he's genuinely offering state-of-the-art training that they can't get at the team facilities? 

 

Given the scale of NFL operations and salaries, $100k treadmill to get your injured stars back on the field seems like chump change - Charles Clay for example, gets $281,250/game.  If a gait analysis setup and re-training plus a zero-gravity treadmill to rehab with would keep Benjamin and Clay on the field at higher efficiency, sounds worth it.

[Ridgewaycynic2013]

8 minutes ago, SouthNYfan said:

The problem is it's very expensive equipment (I'm talking 35-100k per treadmill vs 3-5k for a good rehab quality treadmill) and requires one on one supervision that many places can't afford that luxury.

Yes, but with what the Bills are now saving on not buying suits for Brandon and Whaley, and foosball tables for the players' lounge, it will be that much easier.