Leaders™: Rehabilitation Programs and Performance Enhancement in College Sport

Leaders™: Stacy Carone of UMBC and Mitch Hauschildt of Missouri State outline the importance of clarity, trust, and building those working relationships.

“I came here to support our injury mitigation efforts, but most importantly, we’ve tried to enact a cultural change and give our student-athletes a safe space where they can trust in our sports medicine and sports performance staff.”

Stacy Carone, the Associate Director for Sports Medicine at the University of Maryland, Baltimore County [UMBC], is discussing rehabilitation and performance enhancement at her school, where she has worked since 2018. “They can trust that what we’re doing is not only helping move better and feel better but helping them win conference championships,” she tells the Leaders Performance Institute via FaceTime as we delve into her tried and trusted methods.

Also on the conversational agenda is Sparta Science, the software company with the largest athlete movement database that provides an objective full body assessment of strength, flexibility, and proprioception and a reliable injury risk analysis utilizing core machine learning. “We actually start with Sparta on day one,” says Carone. “Our student-athletes do a Sparta scan as part of their pre-participation physical.”

It is a similar story later in the day when the Leaders Performance Institute jumps on Zoom to connect with Mitchell Hauschildt, the Prevention, Rehabilitation and Physical Performance Coordinator at Missouri State. “We settled on Sparta because I felt that force plates were able to give me something that I couldn’t otherwise see,” he says.

In their efforts to provide exceptional rehab and performance support, Carone and Hauschildt both explain how they work to provide information that promotes performance conversations and delivers fresh insights that earn the trust of athletes and coaches alike.

A streamlined process

Injury prevention has been transformed since Hauschildt arrived at Missouri State in 2006. “I was hired to start to prevent injuries,” he said. “This was a time before anyone could afford to implement force plates on any kind of scale. I came in with an evaluation process that included a functional movement screen. It included a full biomechanical evaluation, a lumber-pelvic evaluation, and then a hop and stop test that looks at single-leg broad jump single-leg landing. We used that process for ten years, and it worked really well for us. We saw a huge reduction in our injuries and our spending – the administration loved it because we didn’t spend anywhere near as much money as we were previously on treating injuries. Our athletic department has been forward-focused on injury prevention for a long time now.”

Four years ago, Hauschildt replaced Missouri State’s hop and stop test with force plates. “We decided to look at force plates because it gave me some data and information I couldn’t get in other places,” he says. “We started using Sparta as a substitute for that hop and stop test we were doing previously; we looked at a single-leg broad jump and single-leg deceleration. It streamlined our injury-prevention process, so our screens are a lot faster now, and I do feel like we’ve got more data and different data.”

Central to that streamlined process is the instant feedback that force plates provide. “Our athletes like it because it gives them instant feedback, and they can see if they’re improving or not improving. I use the jump scan to monitor results and also look at athlete clearance. For example, I’ve got a young woman right now who is a freshman but, in high school, had torn her Achilles tendon and we have not cleared her for full return to track and, just two days ago, I put her on the Sparta force plate to see what she looks like because that way we can use that as part of our return-to-play criteria. If any of our parameters, load, explode, or drive is not where we want them, then it refocuses where I want to go with our return-to-play rehab.”

Hauschildt says that the interest in the data can vary from one student-athlete to another, but the numbers always provide a conversation starter. “Some of these other nuanced exercises we’re doing to keep them healthy and, in the field, they don’t always understand and see that, so it gives us a nice talking point where we can say, ‘hey, remember your Sparta MSK [musculoskeletal] score is at 38? Here’s why we’re doing those things to make sure that we cover all of that and do the right things to improve that score’. It’s an easy platform, easy to digest, and gives me a lot of talking points that I can take my athletes through so that they can fully understand why we’re doing what we’re doing.” MSK Health provides a concrete deliverable of an individual’s relative risk of musculoskeletal injury compared to the average person, making the metric both meaningful and easy to understand.

The scope for personalization appeals to the student-athlete. “It makes all the difference in the world because they’re valued, and they’re seen, they’re heard, and they see the personal gains that come out of it,” says Carone, who describes injury mitigation as her “professional hobby.” She also emphasizes the importance of the subjective input from student-athletes themselves, such as any soreness they might be feeling, as a complement to the data collected from objective sources.

“The backbone of everything that I do is data-driven because there are so many moving pieces to our performance and our training, and really just trying to take the subjective piece and give it a voice and amplify its value through data metrics, numbers, and science. It gives that student-athlete subjective input a strong voice; it isn’t just saying, ‘this person is sore today; let’s shut them down.’ It allows our coaches, our student-athletes, our sports performance staff, our sports medicine staff all to speak the same language, using that technology to unite the people and get those student-athletes as ready to compete as we can.”

Focusing on the 10%

For seasoned practitioners, does force plate data tend to confirm intuitions or challenge thinking? “I think there probably is a balance, but I would say more times than not it confirms what we see,” says Hauschildt, “but let’s say – and I’m just pulling this number out of thin air – if the 90% is right, the 10% is always concerning: those are the people we always have blinders to because we think that what we’re seeing is reality, but the truth is there’s probably something underlying. Those outliers where we think we know what’s happening and they surprise us: those are the ones that probably need the most attention.

“Most of the time, it confirms what we’re seeing, but that doesn’t mean we shouldn’t use it because that small percentage that’s conflicting what we’re seeing, that tells me really relevant and valuable data about those people. The reality is that, as a rehab guy, I spend the vast majority of my time on a small percentage of our population because those are the ones who have been hurt with significant injuries or get hurt over and over again. Those are the people we’re always trying to fix. The 90% are healthy all the time, that’s great it gives us good data, but that 10% give us good data on the people that tend to occupy a lot of our resources.”

Carone concurs. “I think it does both, especially as you start using the program for the first time. You start to learn a lot. My biggest thing with Sparta is that I feel as if I have another staff member. This was new to most at UMBC, and knowing that my staff at any point in time could pick up the phone and reach out to Sparta and get some help and insight around the data was important.

“I think at the beginning we learned a lot of things about our student-athletes that we weren’t seeing because it was new for us; we learn, and we grow from it. Now, it’s like: ‘I’ve seen this before, I’ve fixed this before, but let me get a quick Sparta scan on them and see if my hunch is correct.’ So I think it’s a beautiful balance of both.”

Developing trust

Ultimately, as Carone says, a modality’s success depends on the relationship between athlete, coach, and performance staff. “Everything that we do as sports scientists and coaches is about the people. I think if we take the time to humbly form those connections and those relationships, it makes it so much easier. Putting the people first, listening to the coaches, and making sure they understand that this is a partnership.”

When student-athletes feel that they are being looked after, they can be empowered in their own recovery and rehab. “I don’t think it’s possible without trust,” says Carone. “We have our student-athletes four hours a day – there are 20 hours out of the day where I rely on them to take care of themselves, to eat, to rest, to hydrate, to do some extra mobility or whatever they need. Their buy-in is everything. I tell my team all the time, ‘you guys are the rock stars here, I just write protocols, show you the data, show you the science, but you’re the ones executing it.’”

She recalls the example of the men’s lacrosse program at UMBC, with whom she serves as Athletic Trainer. At one point, the program was, as she describes, “a mess” that required her direct attention. “Their injury report lit up like a Christmas tree; it was the most color-coded injury report I’d seen and not the colors I wanted to be showing a coach.

“It was a new coaching staff, and I knew I couldn’t come in and say, ‘we need to buy this, and we need to do that,’ I needed to join their circle, gain their trust, and then maybe start introducing data. So, we started slowly, and I recognized that lacrosse is primarily an anaerobic sport, so did I really need to force purchasing heart rate monitors for them? Probably not. It’d be great to have, but maybe there’s a different way I can begin to track them. So I started to pepper in some of the easy things for them; the acute to chronic workload, the team’s perceived exertion; just the ‘gritty stuff,’ as we like to call it. It’s the stuff that was free, and we had to work a little harder to do it, but we did it. We turned a 1-6 season into a conference-winning season and went on to the NCAA Championship that year, which was one of the first times in program history.”

Hauschildt speaks with similar pride in his rehabilitation work with a female soccer player who had torn her ACL in her senior year of high school and again in her senior year of college. He says: “One of our surgeons said, ‘shut it down, let’s have surgery.’ I then went to one of our other orthopedic surgeons, and I said, ‘give me a shot, let’s see if I can rehab her, and we’ll see what happens.’ He reluctantly gave me his blessing, and she and I went to work. I think we did rehab three hours a day, six days a week, for close to a month, and we ended up returning her. She played the last five matches, had a goal and an assist, and, in her very last match on her GPS system, she hit 19mph, which was the fastest athlete on the pitch that day. She did all of that without an ACL. It was a fun story, and after the season, we fixed her ACL. I couldn’t have done that with everybody, but she was the right type of kid, and we threw everything at her that we could, and she responded really well.”

Both Missouri State and UMBC saw their competitions largely suspended during the fall, and both schools are looking towards spring seasons that will be both challenging and exciting. “I think we’ve learned more than ever how to adapt and how to be resilient. We thought we understood that in 2019 but 2020 has taught us a whole other level,” says Hauschildt.

Carone cites her team’s ability to pivot as a crucial element with 2021 approaching. “We had that ability to reinvent ourselves, and that’s why we’re still here; that ability to squeeze as much lemonade out of these lemons as possible as we could. It goes back to the way we lead as people. I’m a big leadership and culture nerd, so I spend a lot of my time and efforts focused on how I create this high-performance team of sports medicine and sports performance professionals.

“It starts with leading the people with empathy, to making them feel safe, trusted, and empowered.”

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