No Days Off: NFL Physical Therapist Graeme Lauriston on Injury Prevention

Graeme Lauriston, the Physical Therapy Director of Pro Elite Sports at EXOS, has been doing this for a long time. Professional athletes will come to him with a problem. Tendonitis. Plantar fasciitis. A pinch in the shoulder. A sore back. Often, especially in football, they’ll have managed the injuries on their own, having never even thought about getting treatment. There is too much on the line, and they don’t want to lose their starting spot, lose their job, or get deactivated.

“The vast majority are dealing with nagging injuries on a regular basis,” says Lauriston, who’s been with EXOS for a year and a half.

That’s not a good thing for anyone. When you have an injury, your body automatically compensates. Says Lauriston, “You do set yourself up for further and more serious injuries.”

They come to EXOS, however, because it’s a one-stop site for everything. Lauriston works with both the NFL Combine and Vet programs, as well as The Trust, a service powered by the NFLPA that offers retired players the same training and nutritional services as the current players.

In an age where we’re still seeing athletes lose years of their careers to injury, what Lauriston does is imperative to everyone from the professional player to that high school kid just trying to earn a starting spot. I caught up with him to talk about how EXOS helps NFL players recover, how injury prevention has evolved, and the worst kinds of injuries that football players can go through.

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What are the most difficult injuries to come back from for football players?
Graeme Lauriston: The most difficult injuries to come back from are the recurrent hamstring strains or the recurrent plantar fasciitis, the recurrent low back pain. Those things become more challenging to deal with just because of a management system. When someone has a significant injury like an ACL tear or a hip surgery, the protocols are definite, strict, and tested on how long a player should be out and the exact steps they need to go through before they can return to play.

The recurring injuries are challenging because the biggest prediction of future injury is history of past injury. We need to push these guys in training because they only spend a limited time with us until they go back to their respective teams. We want to make sure they get the most out of training when they’re with us. A lot of time these guys come to us pretty beat up. We want to get them healthy enough so they can return to their teams at a healthy level versus continuing to grind them down and beat them up from a training standpoint. When you have an injury, it directly affects football and causes the athletes to compensate and sets them up to not perform at the level they need to be at.

With football being such a physical sport, you must have lots of guys with nagging injuries. Does that outlook change how you work with them?
GL: It does. At EXOS, we’re an open facility where the physical therapy area is directly connected to the gym, integrating performance training and rehab. Our physical therapists need to stay on the same page all the time as the performance coach, and vice versa because they need to understand exactly where they’re at from an injury and rehab standpoint. It’s also important for the therapist to understand what they’re doing in training and performance workouts. We gotta make sure we aren’t setting the athlete up for further failure but we also want to make sure they get the most strength and endurance gains while they’re with us.

We’ve prided ourselves on that seamless integration between rehab and performance because that’s the most important thing to get success out of these guys, and getting them to come back, especially in the offseason because they know we are a one-stop shop. They know our physical therapy will be here with our performance coaches, as well as our nutrition team so I think that’s something we probably do the best compared to some of the other areas or locations that pro football players would go to in the offseason.

What is something about injury prevention that most people don’t understand?
GL: Injury prevention is something that’s thrown around a lot and I think people don’t fully understand it. They might preach that they do injury prevention but don’t fully do it. When the athlete first comes to us, before they train, before they do anything, they get a functional movement screening. Basically it’s like taking your movement blood pressure. It’s giving us an overall snapshot. What are some areas that are deficient with this athlete? Are they coming in with pain already? If they’re not coming in with pain but have some of these deficient areas, we can put a plan in place to work on these areas before they become true injuries or issues. I think injury prevention needs to start with that. Even if a guy comes to us and has never had an injury in his life, he still gets a functional movement screening and our coaches still get a look at some of the injuries or deficiencies that athlete may have. That way we can proactively work on them to prevent injuries and get the most out of performance.

A lot of people are now blaming single-sport teenage stars for some of these injuries. What’s your stance on that?
GL: Yeah. I think that definitely plays into it. I think a level of cross training or playing different sports is important. When you’re growing up through the Little League stages, especially, and into adolescence, I think it’s important to not have the child do the same repetitive motion over and over again because that does build asymmetry. It does break down joints and tendons and ligaments and can set them up for failure in the future. That’s a very generalized statement but there are more and more professionals in the performance and rehab world that are coming out and making these statements.

Even earlier on, getting the children involved in other sports but also educating the parents on movement asymmetry and anything they can do with their children to help prevent some of these injuries are super important as well.

With football, what are some injuries that you see now that used to be career-enders that now players are coming back from?
GL: It wasn’t too long ago that a significant ACL tear or other ligament injuries associated with the ACL tear could be potentially career-ending. We’ve had so many of them now that it’s gotten to a point where the surgery and rehab have been fine-tuned to where it’s just x amount of months out. As long as you’re doing the right thing from a rehab standpoint and the surgery is what it should’ve been, they’re coming back quite easily with these.

Also the tibia fractures are one that NFL guys used to have and now they’re coming back from that. These significant hip tears where they need to go in and do microfracture, a lot of times those things were career-ending and they are becoming more and more common to come back from. It takes a little longer than what an ACL would take but it’s still not something that is career-threatening, unless it’s a player who is right at the end of his career. Those more significant knee and high surgeries used to be more serious.

If you were talking to a really good high school or college player, would there be any advice you’d give them to stay healthy and prevent injuries.
GL: Do your research, especially if you’ve had an injury. The number one predictor of future injury is past injury so if you have had a history of injury, try to do your research in the community of good rehab professionals that are functional therapists. I think that’s very important. There are a lot of professionals out there that take the cookie cutter approach. Do your research to find a good physician, find a good rehab professional. A physician that isn’t always going to go to surgery is the first option. There are definitely less invasive approaches that you can explore before jumping right to surgery. Sometimes you can’t help it, but this country has an epidemic of surgeries where a lot of them either aren’t necessary or we haven’t explored other less invasive procedures before jumping right to surgery.

So do your research with that, and when you’re doing a lot of your growing in your earlier childhood phases, I would suggest playing different sports and experiencing different movements so you’re not engrained into one specific movement over and over again because that will break down the joints. There’s an epidemic right now in the baseball world of Tommy John surgeries. That is an area getting a lot of attention in Little League and all the way up to the majors. We’ve seen a huge spike in the number of injuries in this area, and people as well known as Dr. James Andrews are talking about how a lot of these can be prevented by watching pitch counts, not overworking in one sport and letting them try other things, and also being open to looking at other parts of the body besides just the elbow when it comes to Tommy John.

I think all of those things are important. The other thing I’d say to kids out there is that you don’t have to be injured to get better. Going into a facility similar to EXOS that looks at the athlete as a whole and does preventative screening, movement screening, and tests can get a great way to find early deficiencies and work on those areas before they actually become legitimate and more serious injuries.

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