By Michael Sharp, Certified Athletic Trainer, Sports Performance SpecialistWhat is Athletic Training at The APC? The APC’s athletic trainers are a part of the rehabilitation team of The Athletic Performance Center in association with Raleigh Orthopaedic Rehabilitation Specialists. They assist with rehabilitative care to patients along with administering and progressing functional exercise programs as outlined in conjunction with our Physical Therapists. They also provide on site prevention, assessment, treatment, education and rehabilitation of athletic injuries to many area high schools athletic programs.
Jaime Holt, MPT, PT, CSCSThere are 30 professional teams in the National Hockey League, each carrying 22 players on the active roster. One of the most injured teams in the NHL was the 2007-2008 Carolina Hurricanes. Just two short years after winning the Stanley Cup, the Hurricanes had more than 300-man games missed in 2007-2008; the most by any NHL team in the past five seasons.
This meant there was plenty of work for the team's medical staff, which consists mainly of an orthopedic surgeon, head athletic trainer, assistant athletic trainer, massage therapist, chiropractor and physical therapist.
Pete Friesen is in his 11th season with the Hurricanes as the strength and conditioning coach and head athletic trainer. Pete is also a licensed physical therapist. His responsibilities are to prepare the players in preseason camp, manage acute on-ice and off-ice injuries, delegate services of other medical personnel, file injury reports with the NHL and report to management regarding player status.
Jason Bailey is the assistant athletic trainer for the Carolina Hurricanes and helps Pete with these daily responsibilities. In order for Pete and Jason to focus on readying the players for the 82-game regular season, they enlisted me in 2006 to rehabilitate the injured hockey players.
Getting Started
I graduated from East Carolina University with a degree in exercise physiology in 1995 and a master's of physical therapy in 1999. Currently, I am a sports performance physical therapist at the Athletic Performance Center, a 20,000 square-foot rehab and training facility in Raleigh, NC.
I am in my dream job right now. I have always wanted to work with a professional team but not do all the traveling. This is why I chose physical therapy and not athletic training. Dr. Marty Isbell, of Raleigh Orthopedic Clinic, was named the team orthopedist for the Hurricanes and wanted a physical therapist who he was familiar and comfortable with to get the injured players back on the ice. Dr. Isbell and I are familiar with each other's treatment and rehab ideas.
I have been fortunate enough to work with a great number of his post-operative patients and he has seen the work I do in getting them back to full function. When dealing with multimillion dollar athletes, this familiarity can mean the difference between getting a hockey player back on the ice in four weeks or eight weeks, and ultimately making the Stanley Cup playoffs.
The Hurricanes have arranged that I remain in Raleigh and treat the injured athletes who are not playing or traveling. It is critical for there to be open lines of communication between player, physical therapist, athletic trainers and orthopedic surgeon.
The head trainer is the gatekeeper. Pete makes the decision if and when a player gets involved in physical therapy. He can suggest that a player see me for his rehabilitation, but ultimately it is up to the player to decide where he wants to go. I have found that the guys in the locker room talk, and if a player has had a good experience at our clinic, he will tell the other guys and before you know it, most of the injured players end up coming in for treatment.
Benefits and Hard Work
Of course, there are pluses and minuses to being the physical therapist for the Carolina Hurricanes. It has been great marketing for our clinic to have the hockey players come in. They are extremely friendly and interact with the rest of our patients. We do a really good job of protecting their privacy but still have them feel like regular guys. It also gives me a chance to work with elite world-class athletes and have access to the games and practices.
One negative is that hockey is a business; you become friends with the players but at any moment they can be traded. There also is the media. One day, there can be a story stating how well a player rehabbed and how quickly he got back on the ice, and the next week there can be a story on how a player was not ready or is not as fast as he used to be. There is also pressure to get players back to form quicker than your average patient.
One of the hardest things is managing my schedule in the clinic. These guys have a very tight schedule as far as when they can come in for rehab. I have a full normal schedule in the clinic and then may get a call requesting that a player come in at a specific time. There is no way that I could do this without a great support staff.
Ice Hockey in the South?
I grew up in the south in Hickory, NC, and admit that I cannot ice skate. In order for me to better help the players, I had to familiarize myself with the sport of hockey and common injuries such as groin pulls, hip flexor strains, SI dysfunctions, ankle sprains, ACL tears, shoulder dislocations, concussions and hematomas, to name a few.
I also had to learn the rules of hockey pretty quick. The players were great in educating me and I also did a lot of research. For example, it was important to study skating mechanics to understand better why groin injuries occur and how to treat them. I also learned that the average shift on the ice is 45 seconds, so it is critical to train with quick bursts and recovery.
Hockey is a brutal sport with 82 regular season games. The average NHL player is 6 foot 1 inches in height and weighs 210 pounds. At any time, there are 10 bodies flying around the ice trying to get the puck and hit a player. It is important for the players to have their heads on a swivel to avoid injuries.
Major Injury, Major Opportunity
Part of the 300-plus games missed in 2007-2008 season occurred because Hurricanes' captain Rod Brind'amour tore his left ACL on Feb. 14, 2008. Two days later he began rehab at the Athletic Performance Center.
I had heard about Rod's work ethic and was told that I would not find a harder-working athlete in the country. This was true, but it was my job to convince Rod to train smarter, not necessarily harder. Rod was in his 19th season in the NHL, had won the Frank J. Selke trophy in both 2005 and 2006 as the league's top defensive forward but had never really been injured before.
First I had to gain Rod's trust, and then I had to train him differently than he was used to. Rod stands 6-foot-1 and weighs 205 pounds with about 5 percent body fat; flexibility was not a word he was familiar with! Rod quickly began doing dynamic flexibility exercises, used the massage therapist and even started taking Pilates two times a week. I admit that I had to go deep into my "box of tricks" to keep the weeks of rehab interesting.
Rod was ready to return to play just 13 weeks after tearing his ACL, but unfortunately,the Hurricanes just missed making the playoffs. Brind'amour said he so enjoyed his rehab at the Athletic Performance Center that he continued to train three times a week during the offseason to continue work on quickness and flexibility. Halfway into the 2008-2009 season, Rod is third on the team in points and became just the 4th active player in the NHL to register 700 career assists and 400 career goals.
Getting In
I admit that I was fortunate to be at the right place at the right time, but also want to point out that you have to make your opportunities. There are long hours, extra work on the weekends and evenings, but it can pay off. I suggest that physical therapists who are interested in working with an NHL team should volunteer their services. A lot of times, head trainers can use some help for preseason physicals and testing or even as a game-day assistant in the locker room. Either way, it has been extremely beneficial for both the Hurricanes and myself professionally to have a physical therapist, if not on the ice, then close enough to it to get the players back to making another run at the Stanley Cup.
Jaime Holt is the physical therapy consultant for the NHL's Carolina Hurricanes. He has a BS in exercise physiology, a master's degree in adapted physical education and his MPT in physical therapy. He is a sports performance PT at Athletic Performance Center, Raleigh Orthopedic Clinic in Raleigh, NC.
Core stability is a key component to high level athletics and is required to maximize speed, power, jumping ability, and strength. I often refer to the kinetic chain when discussing the importance of core training. Think of the body as a metal link chain. If force is applied to the chain and there is one link weaker than the rest of the chain then the overall strength of said chain is limited to the ability of the weakest link. Practical application of this would be an example of a person training with a Leg Press machine who can lift much more force than they can Back Squat. This is because they are limited by the strength of their core. Even the most well trained athletes will still have this limitation, but it can be drastically reduced. The overall functionality of a Back Squat is much better than a Leg Press because of this kinetic chain concept since it is a superior parallel to actual sport situations.
One of the exercises we use to improve core stability is called a Plank. To properly perform a Plank you will start by lying on the ground face down with your forearms flat to the ground in a rested position (hips and knees on the ground). Then you will lift your hips and knees to straighten out your body from your heels to your head. You will need to focus on stability in the ankles, knees, hips, core and neck. While holding this position, try to keep your belly-button tight and engaged while also maintaining a smooth rhythm to your breathing. Finally, keep your shoulders and hips parallel to the floor (no rotating). There are several ways to increase difficulty: try holding for longer time, lifting one arm, one leg, or opposite arm/leg at a time, or place your forearms or feet on an unstable surface like a Stability Ball.
