Defining Moment Life and Death in a Single Rep Helping a warrior gain the strength to serve. By Chris Kolba, PT, PhD, MHS | November 2017 Listen to 'Defining Moment' I've always been a big believer in the importance of physical strength in overall health. Time and research have shown that most people who physical therapists (PTs) see in the clinic need more strength than they have when they first arrive, if they're to recover optimally from injury and if they're to be best equipped to battle the aging process. My background involves training for many years in various forms of karate and in Krav Maga—a self-defense system developed by the Israeli defense and security forces that combines techniques from boxing, wrestling, aikido, karate, and ground-fighting. The strength, coordination, balance, and discipline I've derived from these pursuits has been invaluable in all facets of my life. I've also lifted weights since high school. Therefore, being able to combine strength training and combat drills with education and training as a PT is, for me, a match made in heaven. To be effective in their work, police officers and military personnel need both strength and the ability to fight—in defense of themselves and others. They are tasked with protecting the lives of all Americans, and they sometimes must put their own lives on the line to ensure the preservation of our safety and freedoms. If having the privilege to serve these valiant individuals as a PT didn't light my fire, I'm not sure what would! So, enter Larry. My experience with him defined why I do what I do. Larry was a police officer in a demanding urban environment who also was in the Air Force Reserves. He had developed knee pain that was steadily progressing. It was starting to limit his job activities and his workouts, especially running. He had learned he was being deployed to Afghanistan and would be assisting a Navy SEAL team in its missions there. He knew he needed help if he was to be up to the task. He saw his doctor, who found that Larry had a meniscal tear. Given the demands of his police work and the requirements of his upcoming deployment, he opted to have surgery immediately, then begin rehab. Larry's wife had been a colleague of mine. She was familiar with my experience and background, and she believed her husband would respond well to my style of rehab. She told Larry about me, and he agreed that we seemed like a good match. But I'd have only 4 months to help get him literally combat-ready. Talk about a no-pressure situation, right? Actually, there wasn't as much pressure as you'd think. Larry and I quickly found that we shared a passion for strength training and hard work. We had a rapport and a common purpose. We didn't so much sweat the timeline as savor the challenge and feel excited to get to work. I'd been fortunate up to that point in my career to have worked with a number of high-level athletes. Larry's mental toughness and capacity for work, however, were as strong, if not stronger, than I'd ever seen in any patient or client. This got me excited, because it allowed me not only to push the limits of strengthening beyond the subacute phase but also to incorporate my love of martial arts into Larry's rehab via various combat drills. This opportunity to bring it all together—my creativity, extensive background in strength training and combat-related techniques, and expertise as a PT—captured what most excites me about working in sports medicine. Larry and I worked together in perfect synergy, and within 3 weeks he had regained full motion. All of his swelling was gone, and he was walking normally and without pain. We moved on to weights—with squats, deadlifts, and leg presses—in addition to various balance and stability exercises on level and unstable surfaces. At about 7 weeks Larry was able to start jogging and jumping. We incorporated punching, kicking, and ground-fighting drills—ground-fighting is a form of wrestling that mimics hand-to-hand combat and takes place while the “combatants” are on the ground. We also did stair runs together, climbed over walls, and incorporated jumping and rolling drills. Larry's rapid progression brought home to me everything that excites me about working with both sports and tactical athletes. Larry's hard work, coupled with my appreciation of his willingness to pay the ultimate price for our country, inspired me to coin a phrase that started out as a deliberately over-the-top statement—sort of an in-joke—but became a mantra as Larry and I trained together: “1 more rep may mean the difference between life and death!” Obviously, I didn't mean that literally as we worked out in a gym. Still, I shouted it often to exhort Larry to push himself through an extra rep—mindful of the fact that every extra bit of strength might be meaningful in a real life-and-death situation in Afghanistan. I do a lot of “supersetting” with clients—following one exercise with an opposing one, such as following a series of pushups with a “pull”-type exercise. Larry fully embraced the challenge and always gave me that extra rep. The effect was that our mentality, work ethic, and dedication to workout goals meshed, bringing out the best in both of us. By the conclusion of our time together, not only was Larry combat-ready, he actually was in better shape than he had been prior to his injury. We both felt confident that he would have no physical difficulties during his tour in Afghanistan. And indeed he didn't. Larry successfully fulfilled his duties overseas and returned home safely from deployment. It gave me a great sense of satisfaction to know I'd facilitated his ability to serve and defend our country, and I'd perhaps even helped keep him a little safer through his conditioning and readiness. My work with him encapsulated what I love about being a PT.