That Escalated Quickly: Injury Red Flags That Should Be Tracked
By Dr. Chris Kersten, O2X Injury Prevention Specialist
As a DPT the fuel that drives us to doing our job to the best of our abilities is not only seeing our patient population show resiliency and rebound from an injury but to have a hand in preventing an onset of injury. Unfortunately, injury prevention research shows that primary prevention (preventing an injury that has not occurred,) is as predictable as flipping a coin. I have a saying in the clinic; “There’s more than one ingredient to bake a cake”. Just because you have a handful of flour doesn’t mean you’re going to whip up a culinary masterpiece. A recent analogy from Ben Cormack I heard really resonated regarding the injury causation phenomenon known as the “dry fire theory.” Sometimes a spark coupled with some dry timber, a large amount of pine needles and leaves, and a gale force wind can turn a spark into a full-blown issue. Below is a list, not exhaustive by any means, of red flags DPTs should keep their eyes open to avoid.
Large Spikes In Workloads
As a tactical physical therapist, we’re well versed to not only have an idea on strength and conditioning programming for operators but we’re also capable of writing programs for individuals. Workload is considered the amount of work (sets, reps, load, distance, etc.) performed over a given period. Typically, workload is divided into different modes (physical and mental; acute and chronic) which can be measured and therefore managed. A useful tool to help me measure workload is by dividing your acute workload (typically 7-day period) by chronic workload (typically over 28-day period). This is referred to as your acute to chronic workload ratio (ACWR). Research states that ACWR exceeding 1.3 is a risk factor for injury. Does this mean as soon as you hit an ACWR of 1.31 you’re facing impending doom?! Not necessarily. Does that mean that you’re “bulletproof” if your ACWR is 1.29? Not necessarily. To make physiological adaptations you must push the needle into uncomfortable domains, but pushing too hard too fast can be a red flag that DPTs should be mindful of.
Clearing Athletes To Full Duty With Gross Asymmetries
Physical impairment whether joint, tendon, muscle, or neurological can affect strength and range of motion. So much so that the involved side can have noticeable changes. Rehabilitative efforts address said asymmetries so individuals can return to their prior level of function. Typical rule of thumb is getting them at least 90% of their baseline levels or to their uninvolved side. Despite the athlete’s subjective reporting of them feeling ready to return to sport, active duty, etc. Certain objective markers must be met for the athlete to safely return to full duty without restrictions. Cutting corners in the rehab process without fully meeting objective goals sets the athlete up for lingering issues.
Warmups, Or Lack Thereof, That Don’t Task Much At Hand
As was mentioned before, injuries in nature aren’t always predictable. However, there are several warning signs that are obvious when you take a step back from the trees to appreciate the forest. An improper warm up checks this box. Despite the physical and mental rigors of being a tactical athlete, one of the leading causes of injuries in the military is (drumroll please) intramural sports. I’m not demonizing going out after work and playing slow pitch softball with your buddies. Not engaging in a warmup or sprinting prior to sprinting will lead to sprint related soft tissue injuries (hamstring strain, gastrocnemius tears, hip flexor strain, etc.)
A big check with our athletes before they take their respective playing field or occupation: is their warmup lining up with their vigorous physically demanding task they’re about ready to do? If not, make corrections to this potential pitfall.
Lack Of Implementing Task Specific Drills During The Rehab Process
As a DPT the key goal is to gather puzzle pieces from the past, present, and future to safely return them to their prior level of function so the patient can optimize to X.
This includes gathering job specific tasks of what this individual needs to do in the future and how close they’re currently able to do said task. For example, if your operator needs to sprint 100 yards with full kit and that task is never simulated during the rehab process it will lead to a level of uncertainty with your patient which could lead to apprehension and indecisiveness that makes that person more of a liability than an asset on their team, squad, or unit. 90% of the rehab process is having sound communication and a therapeutic alliance with your patient so everyone is on the same sheet of music. For myself I have no previous years of tactical experience. My tactical relevance relies heavily on understanding what my operator needs to do for his specific job and if his or her current injury is in jeopardy of hindering their ability to perform that job.
The Bottom Line
As much money as DPTs have spent on our education, one would think we would’ve gotten a crystal ball along with our diplomas but unfortunately that’s not the case (unless you graduated from Hogwarts Physical Therapy School, I’m not sure what their graduation ceremony is like). Our movement analysis, handheld dynamometer testing, and past medical history screening can give us a glimpse into one’s past but doesn’t clearly predict injury. However, there are some warning signs we need to keep an eye out for. Spikes in workload, improper warmups, and not accounting for the job demands are only a handful of things that can be a red flag for possible injuries. Of those 3 topics they can funnel down to sound communication and build rapport with your population.
About O2X Injury Prevention Specialist Chris Kersten:
Chris is an O2X Injury Prevention Specialist and board certified orthopedic clinical specialist with 9 total years of physical therapy experience. He spent four and a half of those years working with US Air Force Special Warfare. On a typical day with the Sandhogs Chris’ morning consists of performance-Based interventions in the form of blood flow restriction training and strength and conditioning programming for athletes in the rehab process. Afternoons consist of providing hands on manual therapy in the form of dry needling and spinal/joint manipulation therapies.
Originally from Kansas, Chris received his bachelor's degree at Louisiana Tech in 2010 while playing four years of collegiate baseball. After playing two years of professional baseball with the Cleveland Guardians, Chris followed his passion of human performance in the form of physical therapy, which he earned his doctorate from Southwest Baptist University in 2015. During his spare time Chris enjoys spending time with his wife Hillary, his son Griffey, and his black lab Angus. Chris’ hobbies are lifting weights, playing golf, hunting, and fishing.