If You’re An Athlete, Physical Therapy Needs to be Customized for Your Sport

At Resilience RX, we primarily see athletes and active individuals. Because we are out-of-network with insurance, some of those individuals choose to forgo seeing us first. Instead, they opt to see an in-network physical therapist to save money.

This may make sense from an immediate financial perspective, but it only works if you get a stellar in-network physical therapist. Most in-network physical therapy clinics are not set up to adequately address athlete needs. And, most in-network physical therapy clinics do not work with athletes regularly. Because of this, a lot of issues that could and should be prevented are missed.

When this happens, we often find ourselves getting a phone call from the frustrated individual who “did all the right things”. They followed their physical therapist’s instructions, but they didn’t get the results they wanted.

Where We Come In

I (Dr. Sarah) used to be politically correct when I was asked by people who had surgery “What do you recommend I do?” Typically the answer would look like “Well you can save money and go in-network first and then come here if you don’t get the results you want.”

After the past few years of consistently seeing people not get the results they want from in-network clinics, I’ve changed from being politically correct to being honest. Now, my answer is “If you want results and you want to get back to doing what you want as fast as you can while progressing safely, work with us the whole time. You may pay more for it, but you’ll also get the result you want.”

I won’t deny it’s a ballsy statement. But, we’ve had a consistent stream of clients who don’t get results in an in-network clinic come to see us and get results. With the data to back us, it no longer feels like bragging. It’s simply stating what we’ve been able to accomplish.


Over the past years, there’s been a handful of examples that both Dr. Emily and myself have treated and seen this happen with. I picked three examples to highlight. We’ll cover what their injury is, what went wrong in the in-network clinic, how we figured out what was wrong, and where they are at now.

Athlete #1 – A Softball Player

In January, I saw a youth softball player who had shoulder pain with throwing. She went to multiple months of in-network physical therapy with little to no progress. With her school season coming up and her mom nervous about her playing through fairly significant pain for another year, she brought her daughter in.

At the first visit, we did a strength and mobility assessment. She passed the mobility assessment with flying colors. Her strength was okay, but her strength ratios were off. The muscles that she used to throw were significantly weaker than the muscles that opposed throwing. This was what was causing her pain.

Upon discussing what she did at the in-network clinic, we found out that she had been primarily doing stretching and some strengthening. However, the muscles that she was strengthening had nothing to do with throwing. They were simply general shoulder strengthening exercises; nothing was sport-specific.


We immediately started strengthening her relatively weak muscles that she uses to throw and did some hands-on techniques. Her pain went away after a month and has not come back. She’s still happily playing softball.

Ironically, seeing us was less expensive for her mom than taking her daughter to an in-network clinic. They had no physical therapy coverage, so all visits were 100% out of pocket. This means they were paying anywhere from $300-600 per visit!

Athlete #2 – Biceps Relocation Surgery

Last April, a client came in complaining of shoulder pain after having a biceps relocation surgery. His shoulder pain was different from his pre-surgical pain. It was a new feeling that had developed during the rehab process.

At his first visit, we learned that because his original source of pain was gone, he was given the green light to progress through rehab. The problem the surgeon was supposed to fix had been solved, so everything was good. But – things weren’t good.

He couldn’t do normal life things without experiencing pain. CrossFitting – the one thing he loved to do and used to destress – was incredibly frustrating and made his shoulder hurt even more.


Our examination showed that the initial problem (biceps pain) was indeed gone. However, he had developed a rotator cuff injury through the rehab process. Despite a steady increase in pain, the therapist he worked with did nothing about it since it wasn’t related to his original complaint. She said post-surgical discomfort was normal and it would probably go away with time.

However, if something is steadily worsening in discomfort and progressively limiting in function, it needs to be addressed. The odds of it spontaneously going away are pretty slim. On day one, we did some hands-on treatment and he left with an immediate improvement. We also gave him some initial strengthening exercises he could start to work through on his own.

Fast-forward four months and his pain was gone. He was back to CrossFitting without shoulder pain and doing what made him happy. Our solution was simple – look at things with a holistic approach. Rehab is more than focusing on the one thing the rehab order was for.

Athlete #3 – Tendon Repair Surgery

About a year ago, a lifter came to me after his quad tendon had been repaired. He had gone through 6 months of physical therapy at an in-network clinic and made limited progress. However, he was still struggling to be able to strengthen his quad. For some reason, the muscle simply wasn’t kicking on.

During our examination, we confirmed this finding. His quad wasn’t working the way it should. We moved from individual measurements (specific muscle strength testing) to qualitative measurements. Immediately upon watching him do a squat, we found our answer.


This individual was so strong that he was using his glute to complete all the multi-joint strengthening exercises instead of his quad. When we dug into this more, we found out that his glute muscles on that side were consistently sore after his previous physical therapy visits, but his quad never was.

Based on this information, we started isolated muscle strengthening of his quad. For the first time in 6 months after his surgery, he was able to feel muscle soreness in his quad. We also used dry needling combined with electrical stimulation to help his quad re-learn how to activate so he could use it instead of just his glutes during multi-joint movements.

After doing specific strengthening for a couple months, his quad started to significantly increase in size and was almost the size of his uninjured leg. I have not forgotten what he told me after his third visit – “We accomplished more in 3 visits than I did in 6 months of physical therapy at [insert clinic name that we’re leaving out for obvious reasons]”.

And that statement made me think. How much was his time worth? Where would he be if this was caught in the first week or two after surgery? Would he still be struggling or would he already be back to lifting the way he wanted to? These are questions we’ll never have the answers to, but situations like this have made me much more bold in my recommendations of where people should go for physical therapy.

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