Dr. Nicole Canning, PT, DPT is our first featured professional on #NotYourAveragePhysio. She was a classmate of mine while at Emory University and is also the author of the blog: inthegamept.wordpress.com. Check it out! Dr. Canning is also a former NCAA D1 soccer player at St. Johns University in Queens, NY, and is also a soccer coach with experience in strength and conditioning as well. Recently I’ve had the opportunity to catch up with her and pick her brain a little:
JC: Where do you currently work and what population do you treat?
NC: I currently work at Competitive Athlete Training Zone (CATZ) Physical Therapy Institute in Pasadena. Since we are also attached to a Sports Performance Center, I see mostly youth, high school, and collegiate athletes, as well as active adults. I also see a small mix of general orthopedic cases.
JC:What are your top treatment philosophies when treating athletes?
NC: My main priority is getting the athletes I treat back onto their respective field/court as safely and quickly as possible, making them a better athlete in the process, and preventing future injury. My two biggest philosophies are promoting efficient movement, and education.
At CATZ, we draw primarily from the Gray Institute and the philosophy of Applied Functional Science. Essentially in this philosophy, movement in all three planes (sagittal, frontal, and transverse) is addressed, with respect to ground reaction forces, center of mass, gravity, momentum, reaction, and relevance, in order to enhance functional movement. For example, when I am working with an athlete, I need to know what movements are specific to his/her sport, what internal and external drivers of movement are utilized, what types of movement do they need to be able to react to, etc. I then look at how they are currently moving and performing these tasks, figure out where the dysfunction is occurring, and then address those impairments in a sport-specific, movement-based, and meaningful way for each individual.
I also like to draw from the Strength and Conditioning world when prescribing exercises for my athletes. Since many of these athletes are currently working, have worked, or will eventually work with a Strength and Conditioning Coach, I believe it is helpful to incorporate those principles as well, and tie it in with whatever pathology or impairments a given individual presents with. I also think it’s important to understand periodization when working with athletes, especially with college athletes. It’s imperative to understand how you need to challenge them differently based on what point of their season (or off-season) they’re in. The Strength and Conditioning world has also helped me in my prescription of exercise dosage. There are different rep and set variables to work with based on what you are trying to achieve. I don’t think I can truly do my job to the best of my ability unless I incorporate essential Strength and Conditioning principles.
Another philosophy I tend to get on my soap box about is the mental/emotional aspect of treating athletes. Competitive athletes possess a very different mentality than the general population. They will over train, play through pain, and do whatever they feel they need to do in order to stay at the top of their game. It’s crucial to understand that in order to help it work for the patient and their rehabilitation rather than working against them.
Finally, the most important thing I do for my patients is education! My goal is to never see my patients again (as a patient) once they have returned to their sport. I educate them on how to maintain ideal movement, how to prevent future injuries, and how to listen to and respect their bodies when they need rest.
JC: What are your clinical interests?
NC: Although I love treating any and all athletes, my main clinical interest is in treating conditions of the lower extremity. I particularly enjoy treating patients with ACL injury because I can take the athlete and basically build them back up from scratch. Aside from gaining range of motion and improving strength and neuromuscular control, I can also take a look at what impairments may have put them at risk of that ACL tear in the first place, and then address those risk factors to decrease the risk of re-injury, or injury to the contralateral side. With patients with ACL injury, you get to literally teach them how to walk, climb stairs, squat, run, jump again. What better way to address dysfunctional movement and inefficient movement patterns and teach the athlete ideal movement instead?
JC: How has your background as an NCAA D1 soccer player helped you in treating athletes?
NC: The ways in which my background as an NCAA D1 soccer player helps me treat athletes are countless! Probably the biggest aspect it helps me with is the mental/emotional facet of treating athletes. Not only do I have insight into the mental and emotional roller coaster that goes along with being a competitive athlete (especially one sidelined with an injury), but I feel that it also helps my patients to connect with me and feel more comfortable when they learn that I was once in their shoes and, to some extent, can understand what they’re going through. This helps me understand when I can push them a little harder, and when I need to back off a bit and allow them to experience success. I think generally, there’s a high level of mutual respect and understanding between my patients and me, and when a patient truly believes that you’re the Physical Therapist who’s going to get them better, and help them become a better athlete, then you’ve already won half the battle.
JC: I know you conducted research, and presented a platform talk at CSM 2015, on implementation of ACL injury prevention programs, can you tell me a little more about that project?
NC: Yes, as a female soccer player, I have always been interested in ACL Injuries. Also, aside from being a Physical Therapist, I have been coaching youth soccer for nearly 10 years now. While I was in PT school, I noticed that many of the research articles I read had great ways of helping to identify and reduce risk factors for ACL tears. Actually, considering how common ACL tears are among female soccer players, I was surprised at how much research I was finding on the topic, especially in the past 5-10 years. This made me wonder how there could be so much research on preventing ACL injuries, and yet the number of ACL injuries per year kept increasing. I realized that there is a huge gap between clinical research and its actual implementation into the population it addresses. I also realized that Physical Therapists, Orthopedic Surgeons, Professional and Collegiate Strength and Conditioning Coaches and ATC’s all have access to this information, but by the time an athlete gets to any of these people, it is often too late. This information is staying at the collegiate and professional levels and has no way of being accessed by youth athletes. I find this to be extremely surprising and important because nearly every researcher, MD, PT, ATC, Coach, S&C Coach will tell you that this stuff needs to be introduced and implemented while the athlete is still developing and growing. I decided to delve a little more deeply into where this breakdown of information was occurring, why it wasn’t being implemented, and how to bridge that gap between clinician/researcher and youth soccer player so that the research can be utilized in a meaningful way.
Thank you to Dr. Nicole Canning PT, DPT for taking the time to chat. Hope you all enjoyed this new segment!