Inside Redskins Park: The Training Room

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Whenever there’s an injury, I get emails asking why the trainers did this, or didn’t do that, or if they’re doing this other thing. The training room is one of the most closed, private places in Redskins Park — it’s where a lot of players go if they want to be sure the media can’t get to them — and, as a result, it’s one that tends to intrigue fans.

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I was able to talk to Director of Rehabilitation Larry Hess (that’s him above right) and new Physical Therapist/Assistant Athletic Trainer Elliott Jermyn (above left) for awhile about Jason Taylor’s calf, the differences between knee sprains, and what it is, exactly, they do. Along the way, I got some pictures of the training room, and both Hess and Jermyn agreed to answer some questions from you guys.

So if you’ve emailed in the past with questions for the training staff (that aren’t covered below), or you just want to take the opportunity now, send your questions to me. I can’t promise they’ll answer everything, but I’ll do my best.

All right. Start by taking us through your regular daily routine.

Elliott Jermyn: On a regular practice day, we get here early, at about 6:45 or so. We have treatments from about 7:00 until when team meetings start at about 9:00. For that we have people who are arranged into groups to come in, so not everybody’s here at the same time.


Treatment in the morning, get ready for the walkthrough practice afterward. We go out at about 11:15. Usually one of us stays up here if there’s someone who needs to rehab, but if not we both go out.

We come back in for lunch. Between the walkthrough practice and the afternoon session, guys are coming back in to continue with their rehabilitation, either if they haven’t done it in the morning, or the beginning of the second round of rehab for the day.

After practice, we finish up some rehab while they’re in meetings, write up our notes, and get ready to do it all again the next day. It’s like groundhog day.

Larry Hess: I think our day really starts the night before. Right now, it’s five o’clock and we’ve just finished our rehab plans for tomorrow. One of the biggest challenges we face is that when we start 7:00 treatments, we have two hours to see all our hurt guys and get a good feel for what they can and can’t do and progress their rehab plans based on that.

One of the questions I hear from a lot of people is how we do that. Even professionals that are physical therapists in a clinic, they see one or two patients per hour. We’re seeing twenty guys, about fourteen to sixteen rehab plans, and we’re seeing sixteen of those guys in two hours plus whatever little bumps and bruises come in.

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How do you do that, then?

L: It’s teamwork. It’s communication not only between us physical therapists, but all the other guys out there – athletic trainer John Burrell, Eric Steward, and even our intern, plus Bubba Tyer – we all need to communicate and be on the same page. So if I leave the room or Elliott leaves the room, we know exactly where to pick up and take over on a guy.

When you say you start the day with treatments, what does that include?

E: It depends on what it is.

L: Well, it’s everything.

E: Yeah, but it depends on what the injury is, is what I’m saying. Some guys, toward the very beginning of the rehab spectrum or the end of the rehab spectrum are fairly easy – maybe just ultrasound or electric stimulation or ice and some very gentle exercises.

Most of the people that we see, because all of us tend to do a lot of manual therapy, that’s what we base our system on: finding what the structural fault is within the skeleton and trying to correct that through manual techniques and then following that up with the other modalities I mentioned.

L: I think one of the biggest philosophies behind rehab is really getting back the function. We don’t just want a guy laying in here; we understand that we have to put our hands on them and correct some things that we see. We like to get them going functionally and doing sports related activities – what they need to do when they get back on the field.

So that’s the way we manage our patients. We spend ten to fifteen minutes with a guy doing our manual work on them, but then we just supervise their exercises while we’re working on the next guy as well.

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Is most of your work post-injury only, or are you involved with prevention as well?

E: Well, we get a lot of people in here. Like Larry said, if we have twenty guys in here, it can get very busy, but ideally you get these guys doing some stuff on their own. Maybe take a session or two to teach them some simple exercises they can be doing by themselves, and they can incorporate that into their program.

Some of the guys take to it and have been doing from training camp on, some guys once they feel like their pain isn’t there anymore, they kinda stop. But we keep on them, because preventative maintenance is a huge thing. And there are a lot of guys who come in here and go right to their exercises and get them squared away.

L: It definitely starts prior to injury. We communicate with the strength and conditioning coaches as well and we’re actively involved in helping them design their program – we give our input on what we see and hear, so they can design exercises on their end to prevent some of the problems that we’re seeing, so that all starts in the off-season conditioning program.

I get a lot of emails about hamstring injuries — they’re preventable, they shouldn’t linger so long, and so on. For awhile, the Skins seemed to have a lot of them, though. So, I guess, what’s the deal there.

L: It’s interesting – we researched this, because, yeah, we had problems in the past. We sat down, all of the athletic training staff and the strength and conditioning coaches too, just rtying to look at some of the factors, saying “What’s going on? Can we pinpoint one thing that’s causing this?” And the answer is, no, you can’t.

If there was an easy answer, there wouldn’t be any hamstring strains in the NFL. Everybody is plagued by a hamstring strain during the football season. What we came up with is, you know, it could be muscle imbalances, if you’re talking about issues of strength and flexibility with a person. So we developed screening techniques to screen all our players.
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It could be overuse. If you have a guy that’s injured in a game, say a wide receiver, now you’re down a receiver in practice. And they’re running the same number of reps so now it could be a little bit of overuse on the other receivers and one them could pull up.

It could be a hydration issue, it could be muscle cramps … there are so many different factors. So we think we’ve done our part in what we can do: pre-screening the players, adding another physical therapist so we could get more hands-on with the players and do our manual therapy techniques when we recognize problems with the screening, and then preventive exercises across the board.

E: But the bottom line is, they’re playing a collision sport and the average person might not realize what that means. It’s professional football.

L: With that said, we understand that we’re going to have injuries and we’re going to have hamstring strains. The question is what can we do to minimize the number we get, and what can we do to minimize the time lost when we get them.

E: One of the things that was strange coming from a clinic, is that there if somebody comes in with a hamstring strain, it could be eight to ten weeks before he’s jogging on a treadmill. Here, we don’t have that luxury. We just don’t have that kind of time.

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How tight are you with the coaching staff? You’re screening guys, you know a lot about work ethic that they may or may not see – do you share that with them, and with player personnel in regular meetings or anything like that?

L: Most of the time on our end during the season, most of the communication with the coaching staff is in the form of a daily injury report that Bubba Tyer takes up to them. At the end of the year and during the offseason, we try to give an update on all the guys across the board, but right now it’s just injury reports and how guys are progressing and recovering from injuries.

Obviously, there’s a level of gamesmanship in the injury report. There’s internal info, there’s public info, and so on. How much more do you guys know than what the general public does, or even than people upstairs in PR or wherever?

L: We don’t try to get too technical and medical in the internal injury report, because we know it’s going to coaches and PR and people like that. We try to stick to a level of summary – “this guy’s jogging today” or whatever. But if you look at our notes, it’s going to say, “This guy’s strength is a 4.5 on manual resistance, his range of motion has increased by 90 degrees, he’s asymptomatic,” things like that. When I design the injury report to send upstairs, it’s basically just an overview to say if a guy’s progressing or not progressing.

But, say a guy like Clinton Portis prior to the Dallas game: did you guys have a really good idea of if he was going to play or not during that whole week?

E: I think we probably had a decent idea.

L: We never rule a guy out too early, unless it’s a fracture or something where the doctor just says “No way.” We’ll take it down to the last day if we have to.

Clinton had a second-degree MCL sprain, which is what knocked Tomlinson out of the playoffs last year. Why couldn’t we just assume that meant Portis would be out just as long?

E: By definition, if you look in a book, there’ll be a book definition of a grade 2 sprain of a ligament. But if the MRI, which gives you that grade 2 MCL sprain, doesn’t match the clinical presentation and what you feel physically, then that grade is just a book definition. It’s what he can do functionally, what his range of motion is, what his strength is, what his pain tolerance is … so there’s a lot of factors that go into it.

L: Bubba’s been saying for years, “No two sprains are the same.” You can’t judge one person’s injury by someone else’s injury.

Speaking of Bubba, what is the hierarchy here?

L: Bubba Tyer is our director of sports medicine and he overlooks all of us. This year we have sort of a new design to the athletic training room where we have an athletic training department and a rehabilitation department. Now, there’s a tremendous amount of communication and we all work together, but Elliott and I are primarily in rehabilitation.

John and Eric focus more on the athletic training duties. Eric does more of the taping stuff, John does more of the administrative stuff, dealining with upstairs communication and everything.

I wouldn’t call it a ranking system, though, because we’re a team. Bubba’s god in here, though, with his 37 years, and Elliott’s our rookie, but we all work as one. We’re one voice and one team.

What do you guys do during games?

L: We’re glorified waterboys. No, I’m joking, but that’s what a lot of people seem to think. Pregame,there’s a lot of taping, a lot of stretching, a lot of our manual therapies, a lot of activation of muscles and lengthening of muscles. During the game, we are hydrating players, it’s true, but we’re also watching out for injury, and we’re working our same manual techniques on the sidelines.

When you see a guy getting getting down on the sideline, getting stretched out on the sideline with me or Elliott pushing on him, that goes into prevention mode, as we’re preventing the injuries that could happen.

And, of course, if a guy does go down, we get our best evaluation on him, if he can play or not play, and we communicate that with the coaches. But we’re constantly on the ball, watching for injuries and working to prevent them.

E: And it’s great, because more and more we have guys who will grab one of us and say, “Hey, this is starting to lock up a little bit,” and we’re able to get to that right away, before it becomes and injury.

So it’s not a bad thing, necessarily, when we that shot of the sidelines and one of you is bending a guy’s leg back or whatever?

L: Not at all. Could be preventative strategy, could be muscle activation, could be a lot of things.

And is that mostly what you do in practice as well?

L: Pretty much, yep.

What about the Jason Taylor injury? What was a freak injury like that like?

L: When people get hit in the shin, I warn all the players, “Hey, if you have any problems tonight, if your foot gets sore, you can’t feel it, you get numbness or tingling, you get excruciating pain … call me.”

I’ve said that to a hundred players and haven’t had one phone call until this one.

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But you’re prepated for sprains, strains, stuff like that. How often do you get weird injuries like that, and how are you prepared for that kind of stuff?

L: You have training across the board in everything, and you have to be prepared for everything. You’ll see those things, like you said, and then they come in series. We’ve had two nasty knee injuries this year, and it’s is the first time I’ve seen them. You hear about posterior lateral corner injuries, which is Philip Daniels and Johnny Baldwin. You don’t see those too often, and we’ve had two of them.

In the end, it’s basic principles.

E: Exactly. Like he said on the thing with Jason, you do the exact same thing every time. I was sitting there when I heard him say that to Jason, and you say that to every single person who is even close to being at risk, with the thought of ‘I will never have to deal with this.’

But the one time we did, the player had the right information, he called Larry and from there on, he was able to get the correct treatment and everything went from there.

Email me with your questions for Hess and Jermyn.

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8 Responses

  1. Great info. Thanks Matt.

  2. Wow, Matt, talk about interesting stuff from the inner sanctum!
    Thanks!

  3. Very important info.
    I learned alot from this blog entry……

    and I think the training staff has done a pretty great job keeping alot of guys able to gte back on the field.

  4. Terrific post Matt, very informative with terrific insight into a critical aspect of medicine, football and the Redskins organization.

  5. Nice post Matt, if you keep getting insight information like this you’ll be ready to be Vice President of Football Operations in no time.

  6. Great! Thank you for this entry.

  7. That is very cool to give us an inside look like that. Thanks you.

    I once worked with a guy who worked for the Broncos. He said it was the best job he ever had but he never saw his family.

  8. it was great to see inside of the locker room.

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