Recently on April 16, 2020, Brandon Rearick and Kevin Carr of the team of “Movement as Medicine” hosted an exciting webinar in which 3 fitness/movement and rehabilitation experts, including Michael Mullin, the owner of Integrative Rehab Training, virtually gathered to discuss the integration and the connection between rehab and fitness.
The conversation starts with Brandon Rearick describing his early career interests and the direct friendship and professional relationship that was built with Kevin Carr. The moment that genuinely defined their chosen profession was in one of their earlier university classes when the professor described her recently published article that discussed how movement helps to manage or prevent type 2 diabetes. Essentially they named their brand “Movement as Medicine,” according to that article’s general principle.
Brandon and Kevin’s perspective in “Movement as Medicine” is to see rehabilitation from the eyes of functional strength coaches and manual therapists. Surely they are movement therapists – both individuals are highly trained professionals both in their educational level and clinical experience, and it seems that they only continue to improve. The list of titles and courses that they both acquired is long, but it is their eagerness to learn, understand, and improve which is most notable.
Michael Mullin is an experienced rehabilitation specialist and movement advocate. He specializes in treatment, rehabilitation, and movement assessment. Similar to Brandon and Kevin, Michael Mullin is extensively continuing to learn more skills and to acquire more professional knowledge. He has worked with athletes at all levels, from pro-elite to recreational, to improve functional mobility, and to integrate proper rehabilitation training programs.
One keyword that often comes up in conversation is the word relationship, and how to build such with all health professionals while working on the clients’ same goal: from the doctors – physical therapists- rehabilitation specialists – coaches- each should communicate and work within their scope of practice to provide the most optimal treatment possible.
The following each presents a few slides that sum up their work approach and general philosophy, and precisely how they define the connection between rehab and fitness.
Brandon Rearick’s slide showed two triangles positioned opposite to each other: one represents training (top) and the second rehab (bottom), and there is a spectrum that is shared and runs between both triangles.
Each individual’s physical level is somewhere on the training-rehab spectrum. A vertical line can be positioned according to functional ability, and that can allow for predicting and prescribing the required dose of balance between training or rehab focused practices. For example, for an individual who holds old injuries and presents with movement dysfunction can be prescribed to exercise 60% of the time on fitness elements and 40% of the time on rehab focused practices.
According to Brandon Rearick, there is no difference between rehab and fitness – “There are only regression and progression trainings.”
Physical therapy, occupational therapy, chiropractic, DNS, and FRC all provide and specialize in delivering slow progression training after significant regression has occurred. For instance, after a knee reconstruction surgery, the goal is first to control the pain and to gain minimal functional movement. Such training represents the lowest progression starting point.
On the other side of the spectrum, functional strength and conditioning coaches are more capable of delivering progression to the fitter ones. All are considered training, and depending where you fall on the spectrum would define the training regime (rehab or fitness-focused).
In the middle of the spectrum, the functional strength coaches can provide adequate knowledge on both rehab and fitness training. Such individuals are valuable professionals to the health system as they can bridge the gap between rehab and fitness and guide practice to individuals who are coping with particular chronic pain or previous mechanical injuries.
Such professionals can be defined as hybrid coaches who can implement both the field of rehab and fitness.
The slide presented discusses the role of trainers and coaches in promoting long term rehab processes and outcomes in injured clients. Many times, an injury can negatively affect the entire perspective of the individual dealing with it, which may result in giving up on the sport or training.
The coaches’ and trainers’ role is to shift the athlete’s attention away from the injury and to assist in developing other fitness qualities that do not necessarily harm or flare up the pain associated with the injury.
Aerobic, strength, movement quality, social support, and athlete’s self-efficacy are other fitness and performance characteristics that can be worked and improved while dealing with an injury.
An athlete recovering from a shoulder injury can still work on aerobic parameters and focus on improving movement quality or even strengthening the lower body area. Thus, during the recovery phase of the athlete, the coach can step up and get involved not only in the process of treating the injury but also in guiding the athletes to adopt proper and beneficial behaviors by working on other fitness systems.
Often, coaches or trainers try to fix all their athletes’ injuries, which can cause a discontinuation of training. A different approach to continue training during the rehab phase is suggested by acknowledging the deep connection that exists between all fitness variables and overall recovery, both physically and mentally. Hence, this integrated approach allows the athletes to develop a set of tools to get back to their regular training routine and to overcome the challenging phase of coping with an injury.
On his slide, an arrow pointing up is presented, demonstrating a continuous spectrum of physical capability. Limited- Rehab Training – Resistant Level are the 3 training states that express the progression of the spectrum of rehabilitation.
“Ha-bil-i-tate – to make fit or capable.” An adaptive mindset in which rehab experts or performance coaches involve fitness practices in the training regime to promote the healing processes and optimal recovery.
To facilitate such capable, tight, and constant communication is required. At first, a close and ongoing relationship with clients builds trust, which would be effective for the overall health and fitness progression regardless of the end outcomes. Also, it is important to develop a more profound recognition of the clients’ medical history and current treatments received by other medical providers.
Progression along this spectrum should be done through an objective evaluation of an individual’s current status; this can be achieved by constant physical assessments and assigning training programs that fit and consider the particular physical function conditions of the individual.
By adopting such practices, it creates an additional platform that supplements the rehab treatments—not replacing the rehab, but supplementing it and providing an extra discipline that also focuses on overall functionality and proper recovery.
Sharing knowledge and expertise between all the health and fitness professionals can be a beneficial process for optimal rehabilitation. Furthermore, working as a team to properly address the individuals’ injuries can promote healthy recovery.
Regarding the process of rehabilitation, the right approach to adopt is that there are no differences between rehab and fitness. All are considered training, and where the client stands on the spectrum would define the focus of the practice.
In the health system, we need more health and fitness professionals that understand the unique and complex characteristics of rehabilitation – a process that involves numerous cognitive and physical elements. Yet, with the right guidance, such a combination of fitness and rehabilitation can be optimized and adequately carried out.
In the other parts of the video, the coaches answer to the popular related questions and presented a case study.
Integrating Rehab and Fitness Webinar w/ Brendon Rearick, Kevin Carr, and Michael Mullin: