Fitness is the path

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

This was my favorite slide from my recent presentation at the APTA’s Combined Sections Meeting (#APTACSM) with Brianna Battles, BS Kin, MS, CSCS, USAW.  Our topic: bridging the gap between rehab and fitness for female athletes. 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.
  1. 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.
  1. 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. Particularly if you can collaborate with great trainers in your area, like Bri. 

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

Wanna know more about how I train female athletes? Check out online courses here.

Don’t wanna miss a post? Sign up for my newsletter here

 

 

 

 

 

Related Post

10 thoughts on “Fitness is the path”

  1. Brenda says:

    Love this! Thank you!

    1. Julie Wiebe says:

      Thanks so much for the feedback! Julie

  2. Brenda says:

    Forgot to mention that I’m finding that running (short distances) actually seems to relieve my prolapse symptoms. Does that make sense? Thx!

    1. Julie Wiebe says:

      Yes, this happens with a lot of my athletes. I think there are a few possible reasons…one: we are meant for movement, not stiffness. If you are running you are breaking up static holds (abdominal grips/breath holds/stiff postures) that may be pressing down onto your prolapse. two: ultimately, we are striving for balance and running requires reciprocal balance of movers to pull it off….creates dynamic support. Says a lot about how we are designed to be stable. We have misinterpreted stable=stiff. Stiff/held/contracted postures can be rough on prolapses. three: you enjoy it. A little bit of joy goes a long way! Success is reinforcing. Just please listen to your symptoms and stay below your symptom threshold! Thanks for the question!

      1. Brenda says:

        Honestly, I was floored by how well my pelvic floor took to running so thank you so much for confirming this as I thought I was going a little crazy. My sense is that the shorter breath pattern forced my breath to recover more quickly so there was no time to hold onto that clenched pf inhale. Also realizing that with kegels, there seems to be this big emphasis out there on the lifting part with exhale and that it has to be a strong lift but that is not really the case, is it? I’m finding that the exhale/lift part is a non-issue for me as the lowering is where my challenge is. I’m almost there but it has taken about 2 weeks to really break my strong tendency to clench.

        1. Julie Wiebe says:

          Yes, learning to balance BOTH inhale and exhale is a critical piece of the puzzle! It is important for folks reading to understand that you have been able to create a balance, others may not find symptom relief when they run. Folks need to re-establish their balance, and may need to work towards running vs start there. But I agree with you allowing excursion is a part of dealing with impact in running. Thanks for weighing in! Julie

          1. Brenda says:

            Ah, balance! So helpful! Have been wondering for years why some ladies find that their incontinence improves with jumping on a trampoline. It seems so counterintuitive. For me, it made things (prolapse) worse but now my pelvic floor loves it. Still in awe. Also in awe at how much tension I still hold on inhale – it’s definitely a process (for some of us) to be mindful throughout the day of when we clench.

            Thank you again!

          2. Julie Wiebe says:

            Tension is OK, it just needs to be appropriate. Folks can go too far the other way too, and misinterpret the call to relax and allow give in the system as no tension. We can under recruit too! Balance! And please to those reading this thread, her path, may not be yours!! Not everyone responds like this! If you are having symptoms with running or any other impact activity, have someone take a look and sort out what is happening!! Thanks Brenda! Julie

  3. Clare says:

    I love this Julie. Nothing like a bit of logic and reason!

    1. Julie Wiebe says:

      Ha! Yes…it does seem reasonable :)! Julie

Leave a Reply

Your email address will not be published. Required fields are marked *

back to top