Nadine Waeghe, MPT, ATC, is the owner of Elevate Performance and Physical Therapy located in Redwood City, CA. Elevate Performance offers comprehensive sport science services whether the athlete needs a complete bio-mechanical analysis or rehabilitation of an injury.
Nadine has expertise in bio-mechanics, equipment analysis, manual therapy and therapeutic taping. These specialties have allowed her to vary her work experience across a broad spectrum of clientele. Nadine has provided sports medicine services for athletes at high schools, NCAA Division I,II & III colleges, the U.S. Olympic Training Center, Special Olympics and for seven years worked on tour with the Women's Tennis Association (WTA). Beyond sports Nadine has outpatient orthopedic clinical and inpatient spinal cord injury rehabilitation experiences.
Examiner: You worked on tour for the WTA for seven plus years helping all levels of professional players. Are there experiences you encountered along the way working with WTA players that make your physical therapy practice unique?
NW: As a health care practitioner working on the WTA tour brought me an opportunity to work with some of the best sport science and medicine professionals in the world. Collaboration with this amazing team of experts really helped me become more comprehensive in my approach to every person that I work with. As a primary health care provider working on the WTA I was responsible for coordinating all aspects of health care for the athlete. WTA players are on the road and can’t just go to one single doctors office. Health care providers on the tour are players primary contact for health services. I helped coordinate all disciplines of care for that athlete from a distance.
Working with various specialists from different areas taught me to be more thorough in my evaluation and to differentiate diagnosis, as well as treatment options available to help the individual. Working in this capacity gave me knowledge as well as confidence in my own skills to really question what is right for the athlete. It also allowed me to kind of push the traditional or current health care system to look at other options to fully service the athlete. In my own practice I think my assessment perspective is a little more broad than other physical therapy practices.
My specialty is bio-mechanics and I didn’t grow up playing tennis. On tour I learned a lot about tennis mechanics which sharpened my skills in all areas of bio-mechanics because tennis is so technical. Combining my bio-mechanics knowledge with current technologies and the ability to do video analysis also allows me to provide a unique service to the clients I serve.
Examiner: Describe a Functional Movement Screen (FMS) test and how this tool helps you assess the risk for injury.
NW: The FMS is basically an assessment tool that is used to provide a simple way of quantifying and qualifying fundamental human movement. The human body is specifically designed to do movement and tasks that makes us different from other animals. The FMS is an easy way to help identify imbalances, weaknesses or joint restrictions, anything that is a little off in the body that may effect the efficiency of those basic movements. If those low level movements are inefficient then the ability of an athlete to perform a more complex or higher level movement is diminished and can increase an athletes risk for injury. FMS helps identify those issues and then the athlete is able to address them through a corrective exercise program usually guided by a professional physical therapist, athletic trainer or strength coach.
Examiner: Through the years I’ve sprained my ankle several times. I have been told that a weak glute may be involved in these sprains. Personally I think my glutes are just fine but, is this part of a FMS test?
NW: The FMS doesn’t get that specific. It really looks closely at seven fundamental movements for example, like a squat, a lunge, a step, core stability with anterior, posterior movement, or rotational movement. The test is designed to look at how the body performs in these simple movements to evaluate whether the athlete can do these tasks or not. The FMS is not going to identify whether or not you have a weak glute or whatever. That’s where the practitioner interprets the results and identifies your imbalances. For instance I may say to a client, “There are three areas of weakness I found and are probably related to this issue.” Then I would go on to provide a more detailed evaluation of the biomechanical link between the imbalances and the injury, or a past injury that may be affecting full function.
After the FMS, step two, is called the Selective Function Movement Assessment
(SFMA). After an athlete completes the FMS the practitioner figures out where the imbalances or weakness are originating from and performs a few other specific tests which help identify specific joint or muscles that might be contributing to the weakness in the body. From there the imbalance is treated.
Examiner: What are some standard errors social/recreational athletes make that are a set up for injury that can be prevented fairly easily?
NW: Three common mistakes that I see happen or hear about happening when people describe to me their routine are and this is in no particular order:
1) Either inappropriate, inadequate or complete lack of a warm down after a work-out, or
competition. After physical activity not stretching or partaking in recovery activities that can help the athlete in their next performance. Therefore the athlete has increased risk of injury going into the next performance.
2) Core postural adjustment and core postural awareness or just lack of focus on posture in general while performing any kind of sport or fitness activity. Athletes can have inefficient movement because their body isn’t in proper position.
3) Inadequate hydration or nutrition which directly affects flexibility, mobility, power and endurance. If an athlete isn’t properly hydrated or fueled he/she risks running out of energy which impedes having the resources to get where they need to during their activity.
Examiner: Frequently athletes miss making a connection between nutrition, sport psychology and physical wellness. How do these fit into the bigger picture for you in your view of athletic fitness?
NW: I believe it comes down to sound mind, sound body and looking at three fundamental or innate functions of a human being. Those are breathing, eating and sleeping. We can’t survive without those three things. If any of these are not functioning at an optimal level the whole body is affected. If an athlete is functioning in a suboptimal range, for example, isn’t breathing properly, not getting enough sleep, or has inadequate nutrition, then their body tries to compensate for those deficiencies. This taxes the mind and requires the brain to work harder in an attempt to make up for the suboptimal functioning which can cause the brain to work at a more diminished capacity. When the brain is not functioning at it’s optimal level it can affect physical performance.
I also think it happens in the opposite way. If an athletes mind is not in the right space it can affect their choices to eat, sleep and breathe in a beneficial way. I think it’s all very much linked. When clients come in for an evaluation I ask questions about these three areas. I try to guide them to make sure that they are enhancing their optimal levels of performance by making sure they are getting enough sleep, breathing effectively and have an adequate diet, which helps them have a sounder focused mind.
Examiner: Basically you’re describing de-stressing the body.
NW: That’s exactly right. The ability to function at the optimal level requires a sound and focused state of mind. My discussion with clients always starts with, “What are your biggest stresses in your life?” From there looking at how those stressors affect the quality of their sleep, alters their diet or proper breathing. All of which affect performance.
Examiner: In your experience when a high school, collegiate or professional athlete incurs a serious injury how important is it for them to receive mental/emotional support? How does this support impact their recovery?
NW: The first thing to remember is that every athlete at any age is a human being first. Any human being when impacted by a serious injury can use some mental/emotional support. A life altering event like a major injury has a profound effect on a person moving into the future. From that day on everything is a little bit different because the person is altering the course they thought they were on. I think it’s really important for an athlete to be able to accept the change in their life that occurs at the time of an injury. For competitive athletes, whether high school, collegiate or professional, many of them identify themselves as being an athlete. They identify with their role on a team, or their position, and when injury removes them from competition or takes them away from their sport involvement it can create a bit of an identity crisis.
Some athletes can begin to have serious doubts or insecurities and may even become panicky about their future, who they are, what their future as an athlete is and can feel very lost. I think that having some mental/emotional support can really help them curb those feelings of hopelessness or frustration which can negatively impact their ability to recover their physical responsiveness. Whether having a friend or professional to support them and tell them it’s okay to have those feelings, that the feelings are normal and part of being a human being, can really help them get through the stages of recovery. It benefits their body as well as their mind and is a key component for complete recovery.
Examiner: What are favorite questions you like to hear from your clients regarding injury?
NW: One thing I love to hear is, “What can I do to recover faster?” The emphasis is on the letter “I.” What can “I” do to recover faster. The other is, “What do “I” need to do to prevent another injury from happening in the future?”
Examiner: Taking more responsibility for it.
Examiner: Are there any upcoming events at Elevate Performance & Physical Therapy for practitioners or the public?
NW: August, 16 & 17th we are holding a seminar for healthcare professionals presented by Lois Laynee, Ph.D. “Restoring Movement Through Breathing.” Details can be found on Elevate Performance & Physical Therapy Facebook page and restoringbreathing.com.
Sept. 5-7 FMS & SFMA Certification Course, is a course for healthcare professionals presented by Functional Movement Systems. Details can be found on Elevate Performance & Physical Therapy Facebook page and functionalmovement.com.
Sept. 20th,” Amputee Sport and Running Clinic.” This event is intended to give the participant the opportunity to return to or try out new sports and activities, including fitness routines, running etc. Age, experience and ability are not a factor. The clinic is free and open to everyone. Our goal is to promote mobility through sport and fitness. Details can be found on Elevate Performance & Physical Therapy and Prosthetic Solutions Facebook page.
Examiner: You’ve seen a lot of people with injuries over the years. Do you have any quotes, tips or stories that keep you motivated as a physical therapist?
NW: What motivates me is that there are always people that need help. There’s always another phone call or e-mail from someone that is looking for help. What I want for clients is for them to really understand the ways in which they can help themselves. My job is to help people discover the motivation and inspiration to help themselves. I can provide them the tools and point them in the right direction. One of my favorite quotes that goes along with my motivation is from Ralph Waldo Emerson, “What lies behind you and what lies in front of you, pales in comparison to what lies inside of you.”
Examiner: Nadine thank you for taking time from your very busy schedule to share your knowledge and thoughts.