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Strength Training Post ACL Injury with Strength Coach Nick B…

Strength Training Post ACL Injury with Strength Coach Nick B…

November 25, 2022

podcast

SPEAKERS: Brett Scott

Brett Scott  00:00

All right, Nick, thanks for coming on today. And as we discussed beforehand, we’re going to talk a little bit today about training for ACLs. And getting back from an ACL injury. And I know you guys have quite a unique program there at the training room. So I wanted to talk about that, and how that, how that goes down, and what that can look like, and what training should look like for someone coming out of an ACL tear and trying to get back to sport. And so you know, my biggest issue in this industry is people do PT a lot of times, and they do PT, it gets them to a certain level. And then there’s a big disconnect between the physical therapist, the coach, and we’re left off with a level like maybe 60%. And sometimes trainers don’t know the actual level someone’s out or what to expect. So it’s really great that you’ve become well versed acknowledged as a strength coach in the AC ACL field, because we need more people like that, that can take someone from A to B without any any issues or obstacles or, or setbacks in the process from a coach or trainer making a bad decision. So, Nick, thanks for coming on today. And where you want to start with this?

01:24

Yes, I think it’s I think it’s really interesting. And we are, we’re actually attached to a PT clinic. So I have the luxury of being able to speak to the therapist because I can literally walk across the hall and bug them until I get the answers, I need to provide the experience and the training that the athlete or individual needs coming off of their rehab. So I think that’s a unique experience that I get that not all people have, they don’t have that line of communication. So I think right away, like that’s a huge thing that I get to use to make these athletes experiences better.

Brett Scott  02:09

Yeah, and how did you get into having this niche in the ACL rehab field as a coach.

02:15

So I didn’t, I didn’t necessarily have an ACL injury myself, but one of the PTS that I work with his, his graduate stuff was heavy on the ACL, PCL, just knee in general. And he wanted to become a business that specializes in that. And we’d really want to be the gold standard of training, not just rehab. So he came to me and was like, hey, I really want you to work on this and take ownership of what the training process for an ACL rehab is like. So when we’re finished with PT, and transferring, and making sure these guys have full range of motion, no pain, that they’re in the best spot to not only get back to doing what they love, but also be at a higher level than they were previously.

Brett Scott  03:20

Yeah, for sure. And so at what point in the training process do you or the rehab process, you usually start working with individuals.

03:30

So we get people all over the place, which is a little bit fun, from my perspective, because I get to not just be so cut and dry with what I’m doing with them. But testing is a big part of our program. We use, we use hop tests, we use jump test, we use some dynamometer joints, specific angle tests, just to identify some key physical attributes that we’re looking at. So I take these numbers, and I really use them to identify what physical skills do I need to improve so the athletes are better. So we get, I would say 80 90% quad graphs. So oftentimes, knee extension symmetry is very poor. So our big goal right off the bat is how do we go about improving that number? And I would say that number ranges anywhere from 60 to 80%. symmetry.

Brett Scott  04:40

Yep. And what are the biggest key attributes someone should look like? So for people that don’t have someone like you in their pocket to go to and use, what things should someone look for in a coach, when they’re Coming back from an ACL tear, and they’ve likely had a repair. And how do they make sure they’re, they’re in the right place with the right coach? doing the right things? Or what things should they look for as red flags as well.

05:17

I think something that’s really important from somebody who’s going to be rehabbing you is then wanting to know more. I think, what makes our program so successful is the information we have. And the knowledge we have. Like, if I didn’t know where they were in their rehab process, I would just be guessing. And I think if you are a trainer, and you’re guessing what they need to do, then you could be a great trainer. But if you don’t really know what you need to work on, I think you’re going to be in trouble. So I think working with someone who’s going to try to find answers to put you in the best situation is probably one of the most valuable things you get from somebody who’s going to be training you to get back to your sport.

Brett Scott  06:09

Yeah. And I’ll add to that, too. So for people that are experiencing or have experienced, or have maybe have a child that has experienced an ACL tear, and they finished PT, and they’re off to a coach, I think testing is the biggest thing. And you need to find a coach that knows how to do that and do it well. A lot of times in the fitness industry, we go to a commercial gym, and some trainer might be like, Yeah, I can help you with your ACL tear and get you stronger. But really take a good look at what the assessment looks like of, you know, are they just doing a traditional fitness assessment that might have some cardiac markers you’re doing? How many pushups can you can do? How many squats do a box you can do? But I was specifically looking at the leg? Are we looking at like, like you said, Nick, are we looking at jump asymmetry? left versus right, are we looking at quad strength, left versus right versus hamstring strength? In those ratios? They’re even just gait running, stability is there valgus on one side versus the other? What does our hip strength look like? These are all things that a coach should be doing and looking at, to make sure that we do have the right markers to go after the right pieces in training.

07:34

For sure. And even the stuff that we do tests like I’m not saying it’s the perfect test. But inside of our system, Hey, it works, we can identify those asymmetries that we need to work on. One of the biggest things that I notice is, especially in our dynamometer tests, is the rate at which people produce force inside of certain joint angles. So we look at like 30 degrees, knee flexion, 60, and 90, just a seated knee extension test. And our our test is six seconds long, where it’s just max output. And the biggest thing that I noticed across the rehab process is the time it takes to produce that next output, especially on that involved side. And it’s always pushing that five, five and a half, almost six second mark to reach that top output. And if it’s taking us that long to do anything in sports like that, that’s a red flag.

08:40

That’s, that’s, that’s very slow in sports. Yeah. You will be behind the ball very quickly.

08:49

And sometimes that’s a confidence thing. Sometimes it’s a physical thing. But like we could kick out 100% symmetry, but if the power and the speed isn’t behind it, then that’s still not symmetry symmetrical, although the Numbers says it is.

Brett Scott  09:05

Yeah. And so for someone that has is lacking this rate of force development, and a test like that, we still don’t know, is this confidence neurologically? Or is this something maybe neurophysiological II that could be going on with the tissue? So once we discover that, we still might have a similar training process going ahead? It might just be a couple of different talk tracks, if you will. But for someone like that, what should we be doing with them in the training process?

09:40

Yeah, so somebody that demonstrates that lower power output to me, just off those tests, something that I really liked to do with them are those extrinsic extrinsic plyometrics I’m at least to like build the elasticity, the speed of which they can start to contract again. And so we have verta Max, sometimes we do band assisted jumps. Sometimes it’s just quick hops for distance, sometimes it’s side to side hops, but we’re really just starting to trigger that faster response. And as we start to tolerate that quickness, then, hey, let’s start to add some intensity to it will fall off a box to our jumps will go, way to death drop to release in jump, well maybe give you some assistance with a band or bungee and add a little bit intense intensity to it. So I think we always start with the gradual approach of, hey, let’s add some speed. What kind of results so we get? Did it improve? If it is improving, then okay, we can start to ramp up intensity, continue to drive it. And then maybe that wasn’t, maybe the speed wasn’t the problem if we retest and then we kind of re analyze and attack a different attribute that can start to affect those numbers positively.

Brett Scott  11:12

Yeah, for sure. And one thing, looking at these things in a symmetries, and getting back to some goal of symmetrical, do you guys find that some people can get back to like 100, you know, within 5%, normal, compared to their baseline like that has not been injured, with things like single leg jump, height, reaction time, everything else.

11:41

So I find that to be one of the most interesting things ever. Because you’ll get people who within six weeks, we’ll go from 75% symmetry on everything to 90%. And you’re like, all I did was give you a periodized training plan that focus on strength, we started to jump more than you were, and you made these huge jumps in progress that every athlete wish they got. And then you get the and then you get the person who doesn’t respond to anything will feel like they’re training for three months making 2% gains. And it’s just a grind to see the change that some people get in weeks.

Brett Scott  12:37

Do you find a difference there in maybe personality types are mindsets of these individuals that are making different rates of progress? Or, or some commonality you can see above between the different groups.

12:54

So one of the biggest things is training level. I think people who have had some prior training experience, don’t see the improvement the same way people who really have never been loaded before in their life do. So the ones who are the ones who have and had that neurological response, hey, they don’t have the luxury of being fed load and seeing this huge change. Where, Hey, I’ve never touched a weight in my life. Now, I’m just doing some split squats. And my numbers are flying off the chart at a crazy percent increase. And well, I’m back to normal and I feel great.

Brett Scott  13:45

So So you’re saying that people that don’t have as high of a training experience with with strength training or strength conditioning, actually see better progress and the person that has been strength training?

13:58

I feel like I see that trend a lot. And the population we work with age 13 to age 18, oftentimes, and hey, the older high school girls, especially like they’ve started to lift weights a little bit traditionally. And they go a little bit longer, but are 1314 15 where they really don’t have it. They’re typically very quick to respond.

Brett Scott  14:27

That’s very interesting. I would, I wouldn’t think of that intuitively off the top of my head. So very interesting piece to think about there. And for your population, what is typically the end goal for a lot of them to get back to Is it is it sport, is it just training. You said most of them younger saw machine like sport?

14:52

Yeah, most of them really do get sport. We’ve had a couple who we have a couple older older ones were Hey, They jumped over a fence landed wrong. We’ve had some older like, women, volleyball players, some men’s softball, men’s soccer. So we do see a little bit on the older population. And I feel like those those people typically have like pretty rough recovery from range of motion, not necessarily the adaptation side, just more of the movement side of things. Where,

Brett Scott  15:32

yeah, I’m curious to think about that with what you’re saying about being or having less of a training age, and making more progress, because I still would assume that someone that came into the rehab process stronger. So someone that has been strength training, do you find that the person that maybe has does have a higher training age, gets a better long term outcome overall, versus someone that hasn’t trained doesn’t have good body awareness doesn’t really know how to, you know, use their body or put it in different positions, things like that.

16:07

I think it’s a little bit of a mixed bag. So some of the stronger, more athletic ones that I’ve dealt with, they are the ones who like crushed the tests, especially the Power Test, jumping, landing, control, but sometimes they’re most too strong for their own good. And maybe muscularly, they’re really strong, but tendon, ligaments don’t necessarily match the outputs that they create. So that typically puts them in a tough position, because they’ll be ready seven months. And I have to keep them here for a longer timeframe, because, hey, like, your body feels really good. But there’s a huge window of time where you still have to prep yourself and become more prepared. From the physical side, not necessarily just like the output side.

Brett Scott  17:21

Yeah, I’ve, I’ve seen that a lot with people have, we get to a point where it’s okay, just because you’re feeling good. And a lot of times, ACL tears don’t always have a lot of pain. And once we get through like the acute post op stuff, it kind of goes away, but we still have lingering effects of that from a physical quality of movement sides. So that’s kind of the hardest part. Sometimes it’s telling people like, No, you’re not ready to go back to skiing or sport yet, like you’re eight months out from surgery, you haven’t done enough single leg work yet you haven’t done enough flies, and you don’t have the capacity yet. It was like, Well, I want to go skiing, it’s like okay, well might not be your best idea since you hurt the skiing to just last year. So looking at that, and going a step further with this. On the the training side of things. A lot of people think that we get back to Plyometrics, jumping, landing and agility type work. And people think just doing some box jumps and being able to land on one leg. And doing some ladder drills or some some hurdles is the end of the road, and then they’re cleared for takeoff to go back to sport. What do you have to say about that?

18:41

So I feel like that’s a great way to warm up.

Brett Scott  18:47

I agree. The biggest thing we see in what the literature showing is there is a difference between like a I can’t think of the word off the top of my head right now, but more of a pre planned motor strategy. So when you’re looking at a set of hurdles, or a ladder, these are all things that are pre planned and pre programmed in your head where your your body can forecast where it’s needs to go, where it’s going to be, how it’s going to feel, etc, etc. But if we put you on a fields and say, Okay, go chase this ball and these 11 other people around that whole program goes out the window or that pre planned program goes out the window. And now we have to react to things very quickly.

19:43

Yeah, so now our systems have to work together. And I think that’s a really good segue into how we transition our PT people who have just started to jog. really haven’t done any sprint work. and how we take them, implement them into our system and start to transition them into more sport like activities. So we talked about the warm up stuff, like, I think the depth drops, the box jumps, the ACE skips low intensity, but still provide some sort of impact, start to load start to create better positions, especially on the sport field. And the conversation that I have with my athletes a lot of times is we have to build breaks first. And then we’re gonna start to add speed and intensity to everything. Like one of the, one of the biggest things that we see, just with movement and landing strategies and braking strategies is this super knee forward, trunk upright, super reliant on the knee to decelerate the body. And we don’t necessarily want to change their strategy a ton. But I do want them to practice being this hybrid athlete of, hey, I’m in like, little bit of knee flexion, little bit of hip flexion, trunk stable motion that can make me or give me the ability to move in any direction pivot cut, and just have that ability to be quick in any direction that I need to move.

Brett Scott  21:43

How important do you think the hip hinge pattern is to a successful ACL rehab.

21:51

So what like worse, we also specialize in speed and speed, you really do need those positive Shin angles, which is deep knee flexion. So I understand the value of having that, that deep knee angle to create a lot of power and speed quickly. So when I’m taking these kids, I’m not I’m not trying to get rid of it, I don’t want to get rid of it, because it is super important to the athletic part of sport. But I don’t want to be I don’t want to be reliant or not be in a hybrid pattern of deceleration all the time. I want to start to rewire and be a little bit more, not not just be solely relying on one muscle group.

Brett Scott  22:52

Yeah, it’s something I see with a lot of the kids I do ACL rehab with is they come in, in their general patterns of I don’t know if this is just me finding this as bias, but maybe I’m looking for some validation here is that a lot of these kids tend to have the same movement strategies. And that is, with jumping in landing. Yes, some of them have, you know, a typical valgus type, jump where the knee might, the knees might cave in a little bit. But more than that, it’s they don’t know how to use their hips in in weight shift at all. And you see them land, like you said, they’re very upright, and it’s a very knee dominant, knee forward, high angle, Shin position, where it’s just everything is going through the knee, all the forces absorbed by the knee. And it just makes me go back and wonder like, what have you been doing on the field this whole time? Like, is this your go to movement strategy? That might not be biomechanically the best suited for the ACL? And Could these be prevented if these kids just learn some different movement strategies to begin with?

24:15

Yeah, and they don’t, they don’t really teach movement strategies. Like I, I teach kids how to sprint and I’m like, Alright, we got to take your last 14 years, throw it out the window. And then we have to re change how you neuromuscular li move. And I think the same thing goes into the speed work that we put inside of an ACL program. I think the biggest thing that we’re changing is just patterning. And we’re trying to make that subconscious. So you don’t have to think about how you slow down like I don’t want you thinking when you play. What I do need you to think when we’re doing these reps because if you tried to stop like that, and I was bodying you you’d be on the ground in seconds.

Brett Scott  25:03

Yeah, absolutely. That’s why I like, like for me, kettlebell swings are like an absolute, I need them in your program unless there’s some other contraindication. But later on in the rehab process like, we are going to be swinging a kettlebell, so that you learn how to rely not on just your knees, but use your hips and your ankles a little bit differently, too. So we’re not always just stressing the knee out, we have different movement options. And what’s awesome about the swing, is it really makes people learn the state of tension, and this aggressive muscle contraction, but then very quickly, you need to switch back and forth between that side of tension and relaxation. And just, you can see, once people start nailing the swing, a lot of other things within their athletic development can start to come around as well. And so I don’t know about you, but do you use the swing a lot in rehab?

26:04

I actually don’t. But more so because I would have to take time to teach people to hinge. And like, not that I’m opposed. But hey, like, my goal is the I do a lot for the jumping in the movement prep, and the schoolwork. And our program set up in a way where we have roughly like 45 minutes with people. So I’m dedicating 2025 minutes to sport specific speed work. And then I’m giving the other 20 minutes to closing the gap between symmetry, which is really quiet emphasis at that point. So in our actual program, we don’t hit a ton of hip extension work outside of our jumping and our sprint stuff.

Brett Scott  26:59

Would you though, so if your resources of time are a little bit different? Would you include something like a hip hinging work and in swinging into your program? Because, yeah, by the sounds of it, like that probably wouldn’t work. The swing probably isn’t where I would go either with those time constraints, but what are your overall thoughts on that?

27:20

I think, I think the I think the pattern is perfect for any kind of deceleration that we hit. So I decide when we talk about trunk angle, hip flexion, I think it’d be great. I’ve never even thought about using it. Because I didn’t want to take the time away, but especially the load absorption side and the position that you look for, I think it’d be a super applicable from the deceleration standpoint of movement.

Brett Scott  27:52

Yeah. And so that’s the other thing I want to talk about too, is deceleration I think a lot of people think I just need to get back to running fast. It’s like, well, hold on a second, you got hurt because you didn’t actually know how to slow down. And your shin went one way your femur went the other because the systems weren’t in line with one another. So what types of drills or activities should people be making sure they’re doing when it comes to building up the brakes? Because yeah, we don’t need Honda Civic brakes on like a semi we want semi brakes for semi?

28:30

Yeah, I want semi brakes for a Honda Civic. Yeah, exactly. Put it on a t shirt. So

Brett Scott  28:37

So what should we be doing there?

28:41

So I think strength is honestly a big contributor to this part of the training. I think if we’re taking someone who really has like raw, raw strength numbers that are not impressive, then our approach is a little bit different than someone who has super high outputs and may just be a symmetrical. So I traditionally start everyone with 510 and 15 yard details. And I transition the way that we decelerate so sometimes I’ll go even stand sometimes I’ll go single stance. And I’m really focusing a lot of the times on that involve side being the harder braking step. And it typically takes a lot of practice for athletes to start to build the confidence with that movement. But again, like I’m trying to teach pattern in position on top of that, so inside of our set of hey, we’re we’re beginning to learn how to slow down in this position I’m going to do I put that into a superset with depth drops off a box where our emphasis is, hey, knee flexion, hip flexion, I’m going to do medicine ball slams, single leg double leg hopping to slam where same emphasis is going to be going to be applied. So as long as my goal is to pay create this pattern, I’m going to reinforce it with things that are a little bit easier to perform. And always circle back to that sport specific skill that I want them to get better at.

Brett Scott  30:38

And kind of to wrap things up here to is the last bit of training, we we touched on the reactivity thing, what it, these are the things that are hard to do alone. And there’s some new training tools out there now that might be able to help some people with that. But what should people be doing on their own or doing with a coach to make sure they actually are ready for sport.

31:08

So I think the reactive side of movement I have talked about we had I had a talk with one of our therapists one time about possibly like giving athletes like an audio recording of, hey, this what you’re going to do, and you have to use this audio recording as needed and give multiple variations. So like they can play it out loud and do it for their sprint work. I think it’s something that we do is we in the same drill, where we’re doing our decelerations is we’ll go we’ll just use like call outs, we’ll go even numbers, odd numbers, we’ll have someone sprint forward, hey, even number stop, odd number re accelerate. So I think I think just the use of verbal, visual, external cues, like we do our groups inside of sessions, so two or three people can be in the session and 90% of the injured population we work with is ACLs. So when we get to a level that athletes are confident in themselves and can really perform at a level that we’re comfortable with, we have them compete against each other. So it could be we set two cones 10 yards apart, set each other up in the middle, and then it’s a chase. So person in front will stop take off person behind will chase athlete will break either way, and person behind just has to follow them. So I think just using somebody who’s at a very similar stage is super effective.

Brett Scott  33:00

Nice man, sorry, excuse my dog was just frantically running around here, one of our dogs. He’s losing his mind if you could hear him chirping over there. So I’m trying to settle him down here. But yeah, I mean, those are all definitely things that I think people should make sure they’re getting from a coach, I completely agree that that these are all things people should be getting from a coach, or a training program or strength and conditioning facility. Before going back to sport, we want to make sure not only are we confident in our movement to be able to perform these movements, but being able to react to them live. And kind of going back to the beginning to like we said like one of the biggest issues we tend to see in testing is this delayed rate of rate of force development with muscular testing. So if we have that, and then we bring that live on to the fields, then we can be in plus you check, we can be in big trouble on the field. Because if my quad isn’t firing fast enough to get my body to change direction, well, then there is a high likelihood my ACL might give again. And unfortunately, the statistics say that one out of every four ACL repairs, fails and needs three repair. So you know, I told someone just the other day that I was actually returning to skiing. And I made the analogy of like, you’re gonna go back to skiing you’re you’re seven months post up. We haven’t done any reactivity training yet. We’re not there yet in your rehab process, and you want to go skiing. He’s like, yep, that’s like one in four of these right here. He goes, Yeah, go. So if we were parachuting right now, and I said, pick up one of these backpacks and one of them one of the four isn’t going to open and you’re just gonna fall you’ll do it. It’s Sick? Well, when you put it that way, actually, maybe I want it so good. Yeah, it’s a very good analogy, it makes you think a little bit differently about it. And because having to go through that process, again, a is not going to be fun, B, it’s going to be harder. And C, we’re probably not gonna get the highest level outcome that we were trying to get, because we’ve just been set back. So so much now. And so, yeah, I think all these things are, are definitely pieces of the puzzle that need to be incorporated into the return to sport profile, as well as there are some psychological tests. So I have another podcast with Steph Allen, where we discussed the psychological profile of return to sport and there’s a lot of data to support, that there needs to be a confidence level with in the individual to be able to have the the emotional mental confidence to return to sport. So we want to make sure we have those, those factors, as well as not just physical, but do they feel like they can perform because if they don’t, their confidence lacking, they’re probably going to be slower, they might not be able to produce force as much just from a mental standpoint, and could potentially get hurt again. So want to make sure those things are all in line.

36:22

Yeah, I think we don’t have any particular psychological tests. But as you progress through the training process, I think you see it. The first time I ever asked someone to sprint, it’s like, Are you sure? Am I allowed to do that? And I’m like, yeah. And then I’m like, Alright, let’s do it faster. I’m like, let’s do it faster. Yeah, then, and then we’re going to be like, Alright, so I’m going to be spread further now. And over weeks and months, that confidence kind of kicks in, and they do something that they might have thought they’re never going to do again. And they’re like, oh, I can. I’m good for I feel good.

Brett Scott  37:11

Yeah, absolutely. And there are some some resources out there, I can try to find and send you for the psychological readiness testing for ACL. It might just be the pacl are or something. I’m not quite sure. Off the top of my head, but it’s somewhere in my, my folder at work. So Nick, where can people find you?

37:36

So our facilities name is TTR. Performance, you can find our website@trfp.com we work a lot with Acio, you can find myself Nick Barker 15 on Instagram, and v 15. On Twitter. Those are the two big ones I use. We don’t have a tick tock yet. Even though all the kids are telling me we should get one. My might be down the pipeline that we’ll see.

Brett Scott  38:03

We’ve started on it, but I have our marketing director doing it, but I don’t even know much about it. And for those of you that don’t know, we have a new clinic for barbell therapy in Barrington, New Jersey with my mentor Rebbes Antoon. And so Nick is not too far from from our clinic. And we plan to be working side by side with him of returning some some ACL and post op athletes to these guys for some training because it seems like they do some great work. And we’re happy to have personal trainers strength coaches in the South Jersey and Philly area that’s can fill in the gaps with coming from physical therapy. So if you guys are in the Philly area, and you’re looking for physical therapy, or training or anything related to your health and fitness, you have barbell therapy down there, as well as Nick Barker at the training room. So, Nick, thanks for joining us today. And we’ll definitely keep in touch and if you guys your listeners have any questions, feel free to reach out and we’ll do the best we can to answer your questions. Thanks for watching. Thanks for listening