Bridging the Gap: The Transition from Active to Passive Care

Bridging the Gap: The Transition from Passive to Active Care

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Guest Contributor: Tom Teter, DC (developer of Rehab to Fitness)

When working with athletic populations one of the primary challenges in clinical practice is transitioning patients from passive to active care. At times we seem to aim our focus in the wrong direction, choosing to rely solely on the reduction of pain rather than instead the restoration of function as our metric for success. Even in our attempts to restore function, we often fall short by not considering the true nature of function for the athletes under our care. It is often our shortcoming in bridging the gap from rehabilitation into a structured fitness program that becomes a risk factor for reoccurrence of injury and lack of optimal performance.

Although everyone has slightly different variations of their goals when working with patients, there are some extremely consistent ideas that guide clinical practice.

The goals of patient care should be:

  1. Reduce pain
  2. Remove activity intolerances
  3. Restore function
  4. Improve capacity
  5. Prevent reoccurrence of injury

The primary focus of our interventions should be to restore function in order to remove activity intolerances. The patients activity intolerance is the posture, movement, or activity that the patient would like to be able to perform, but cannot due to their primary complaint.

Our goal as clinicians should be to create a plan to bridge the gap between the patients current movement competency, and their desired physiological capacity.

This is the definition of true function, and is directly related to the patients current capacity or fitness.

In order to accomplish the task of full functional restoration we may at times need to surround ourselves with an integrated support team of professionals with the athlete’s primary goals being the focus. Although clinicians may have the education and experience to see this process through from start to finish, too often due to time and/or financial constraints they may need to delegate portions of the workload to other providers. In my opinion we should always start with the end goal in mind (activity restoration), and then build our plan backwards to the treatment table in order to ensure that all the proper steps have been met along the way.

It could be argued that a large portion of the athletic injuries we see in clinical practice are due to decreased functional capacity. This means that the athlete has performed an activity to which they are not accustomed, or lack the physical resiliency to perform said activity at the required volume or intensities. Due to this lack of capacity, the biological system becomes stressed past its physiological tolerance, and thus the tissue becomes injured. If one of our primary goals as clinicians is to restore function in order to improve capacity, shouldn’t it be our responsibility to create a plan in order to do both with our athletic clients.

In order to effectively bridge the gap between rehabilitation into fitness we need to perform the following tasks to create an effective treatment plan:

  1. Determine activity intolerance: This is the movement or activity that they patient needs to be able to do to perform their sport but can’t because of pain or injury. This is what they want to do or their goal.
  2. Determine desired capacity: This is the exact physical requirements that the patient needs to be able to do in order to perform the activity to which they are intolerant. This is what they need to be able to do.
  3. Determine current competency: This is done during the evaluation process and determines what painless dysfunction that needs to be restored. This is what they can or cannot do right now.
  4. Create a plan: This is the point at which you have to reconcile rehabilitation and fitness. You must first determine what painless dysfunction that you are treating during rehab. Then you need to determine what physiological capacities you can load in order to maintain the fitness that the patient currently has, or systematically improve their fitness back to their original state before the injury. This is where everything comes together.

In order to perform this process effectively we must have a firm understanding of the physiological principles related to fitness, and a systematic process that allows us to efficiently load the patterns of fundamental movement.

If we shift our focus from the reduction of pain to the total restoration of function and capacity, then we will be able to be the preferred providers for working with the rehabilitation of injured athletes. If we constantly keep the athlete’s goals at the center of the process, we will not only provide the highest quality care, but also be able to raise the bar for our profession one treatment plan at a time.

Dr. Tom Teter is the owner of Engineering Athletes, a manual therapy and performance enhancement clinic that focuses on integrating movement-based rehabilitation and functional performance training. With more than 15 years of experience in strength and conditioning and clinical practice, Dr. Teter has treated and trained thousands of athletes at all levels of skill and ability. Dr. Teter holds a Bachelors degree in Exercise Science from Missouri State University, as well as a Doctorate in Chiropractic from Cleveland Chiropractic College. With his extensive experience in rehabilitation, Dr. Teter hold numerous certifications within the industry that have helped him develop injury prevention training protocols that assist his clients in reaching their peak physical potential.

In 2019, Dr. Teter developed the Rehab to Fitness training course that teaches practitioners the fundamentals of fitness programming for patients at all levels of skill and ability–with emphasis on patients newly discharged from rehab care. Click here learn more about Rehab to Fitness and upcoming course dates.