Defining Moment A Lesson From the Line of Scrimmage Seeing the gridiron as a player in postprofessional education. By Elizabeth Lane, PT, DPT | March 2018 Listen to 'Defining Moment' It is the Western Conference championship game. The rivalry is fierce—think Army versus Navy or Auburn versus Alabama. We faced them twice during the regular season, winning both contests. They were intensely physical battles, however, leaving players on both teams tested and bruised. We're now on our fourth possession. We've struggled to keep the ball moving, because their defense has moved a linebacker into position to shut down our outside running game. Thus far that's been an effective strategy. After watching this defensive player throw us back for a 1-yard loss, however, a teammate and I devise a scheme to shift our blocking pattern. It's an adjustment that no coach ever taught us. Next play: Touchdown! Our running back sprints 40 yards to the end zone without ever feeling even the glancing hand of an opposing player. Why is this important? More pointedly—given that I'm writing this essay for PT in Motion—what the heck does it have to do with physical therapy? Empowerment. That's what it's all about. I play for the Salt Lake City-based Utah Falconz of the Independent Women's Football League. It's a full-tackle semipro circuit consisting of 19 teams from cities across the western United States. Our athletes come from all facets of life: We are career women, stay-at-home moms, wives, girlfriends, students. In addition to my "day job" as a physical therapist (PT), during parts of the spring and summer I'm a quarterback and wide receiver. The Falconz have experienced great success. We are the league's 2-time defending champions as we head into the 2018 season, which starts next month. A big reason is that our coach, a graduate of the Air Force Academy, empowers every player on the team. He has this saying: "Once you know what we're trying to do—once you 'get it'—we will be unstoppable." What that means is, we Falconz aren't simply told what to do, but why we are doing it. Which, in turn, influences the decisions we make—the way we approach each task. After we've mastered a task under ordinary circumstances, we are thrown into unfamiliar playmaking schemes. That's what gave us the ability, in that championship game, to adjust on the fly—to make a change that left our opponents helpless, propelled us toward victory, and led to what ultimately would become our second national championship. That same methodology has made the Falconz the most successful team in recent history in any American football league: We've lost just 1 game in those 4 seasons. There's a lesson there, I believe, for all PTs in how we can best help patients and clients achieve their full potential. In the health care world, empowerment improves self-efficacy—our confidence in our ability to perform a given task, and the patient's confidence in his or her ability to effect improvement. What's the engine of empowerment? Motivation. Why is this individual coming to you for treatment? The answer might seem obvious, but often it is not. I'll ask a patient, for example, "If you and I could get rid of your back pain, what activity would you want to do that you can't do now—or that you can't do as easily as you'd like?" That person's answer is vitally important. When an individual can see the link between what you're asking him or her to do and what he or she most wants to do, that person is going to, as my football coach says, "get it"—and adhere to the plan. Empowerment is key to "buy-in" when we push our patients to adopt healthy behaviors. Once they can see what success looks like, we can help establish the plan to get them there. Then, the next step is to place that patient in the driver's seat. Many patients won't initially feel in control of the situation. That's understandable. This requires us as PTs to provide patients with enough education and encouragement on the foundational steps of what we're asking them to do that they do feel empowered and in charge. We can, for example, show them a home exercise that immediately decreases their pain and/or improves their function. Then, we must challenge them—just as my football coach challenges my teammates and me. "How will you respond to a degree of increased pain while you're walking?" we might ask. In other words, we shouldn't suggest how we'd like them to respond. Their unprompted response will reveal a lot about how empowered they feel—and whether we still have work to do on that score. There's 1 other thing I want to note. Just as physical therapy can and should empower patients, it empowers me as a football player. Let me explain. I'm often asked whether I fear significant injury from playing such a physically punishing sport. The answer is no. First of all, many football injuries are noncontact. The most common of these is a torn anterior cruciate ligament, or ACL. Such injuries, I know because I am a PT, are less likely to occur given proper training and technique. Second, the same is true of contact injuries, such as concussion. My professional knowledge and expertise has influenced my own training program and those of a number of my teammates. A quote I love has been attributed to various people. I'm not sure who said it first. What I do know, though, is that it addresses the great things that can happen—in football, in physical therapy, and in life—when people are empowered: "Behind me is infinite power. Before me is endless possibility. Around me is boundless opportunity. Why should I fear?" I encourage you to think about those lines with each patient you see—or, depending on your avocation, the next blocking pattern you design. Elizabeth Lane, PT, DPT, is the director of orthopedic physical therapy residency at BenchMark Rehab Institute in Atlanta, Georgia, and a PhD candidate at the University of Utah in Salt Lake City. She is a board-certified clinical specialist in orthopaedic physical therapy.