Physiotherapists are an intriguing breed. Part medical...part physical development?
Over the years I’ve found it a common thing to hear a strength & conditioning coaches bemoan physiotherapists…"f%^king physio stopped me doing deadlifts with so & so"...and to be fair visa versa. The axiom "you f&*k'em...we fix'em" is often thrown about by the braver physio souls. I must say as I’ve “matured” in the professional team environment I think both schools of thought are correct at different times. The challenge is knowing which time is which!
Are physios really a full-time necessity in professional team sport? Should they be banned from the weights room and the field?
I can hear the physio community bracing for battle and defense of their hard fought professional integrity.
Answers to these clearly inflammatory questions really come down to individual management styles and the philosophical perspective of the person setting up the medical / physical performance team. As I have sat in the very position described, I think I am well versed to offer thoughts on how I see the integration of the modern sports physiotherapist and S&C departments.
As a department lead my background is firmly as an S&C coach. However, for better or worse, the 14 years I spent preparing, and more importantly, traveling with international rugby teams has given me a unique experience and insights when it comes to physiotherapists. For most of the aforementioned time I worked in environments, particularly when travelling, where there was one doctor, one physio and one S&C coach. Working on tours that lasted for anything up to 8 weeks, you become exposed to a far more detailed experience when working with just two other people when it comes to the players physical preparation and well being.
In my rugby tenure I was privileged to work with a number of physios who not only possessed fantastic individual skills, but where also sufficiently open in their thinking to provide an almost seamless service provision with me in terms of overall physical preparation. The end result of working with these people was that I was able to receive what I would call an “operational” education in how physiotherapists think and what their skill sets can achieve. As I am a naturally inquisitive beast, my curiosity lead me to developing a very functional set of skills from these physios, based around massage techniques, muscle tone assessments, trigger point and fascia releases. In the early years of touring I was often the team masseuse, so these skills became well honed in a relatively short period of time.
As I have progressed in my career I have found this set of skill invaluable. Firstly, as a coach I have improved out of sight because of the insights my hands-on skills afford me. Elite track and field coaches such as Charlie Francis and Dan Pfaff have presented widely on their interactions with athletes at the highest level, and their views on the need for individualized provision of specific soft tissue work in order to achieve the most out of their athletes. Secondly, now as a department lead, I am sufficiently well versed to engage my physiotherapy staff about specific elements of treatment for individual athletes, how it relates to what is required, and also, almost more importantly to have a more detailed appreciation of their perspective on any given situation. Probably something I wasn’t quite as good at as a younger coach.
Like any profession there are good and bad physios. Often a bad physio is not necessarily the one which graduated last in his class, or the one for whom IQ is not a strong suite. In my view a "bad" physio is typically one who is categorically dogmatic in their views and cannot see the “Forrest through the tress” i.e. their role within the physical performance team. Funnily enough the same can be said of S&C coaches…too dogmatic and they become a liability.
Personally, I can’t deal with S&C coaches who think they are “hard men” nor physios who won’t let their “little charges” out of their sight.
Here’s how I see physios operationally;
Phase One Rehabilitation (acute treatment) - core skill set.
Phase Two Rehabilitation (return to function)…again core skill set.
Phase Three Rehabilitation (return to performance)…the right physio can provide objective oversight with respect to specific overload of the injury and associated structures. Th wrong physio...too much meddling...hit the ejection button! In my structure, Return to Performance is operationally the responsibility of the S&C department.
Monitoring - a key component of my monitoring model…their hands-on skills afford me insights that the players often overlook.
Recovery - assisting athletes regain ROM post training and games is central to time sensitive recovery. This is at its most pertinent when training “two-a-day” sessions where the ability to back up and function in the second session is critical. Specific joint/segment mobilization - I get the FMS/Supple Leopard philosophy (both great) but if given the choice why would I spend time attempting to replicate the mobilization techniques that physios are specifically skilled to execute, can do in half the time and double the results? Clearly this becomes a labor issue across a 45 man squad. As a wise man once told me “all players on a team are equal…some are just more equal than others”. Get your resources aimed at the guys who produce the results!
In-Session Management - in specific circumstances I have used physios on the training track to great effect, in much the same manner as described by esteemed Coaches Francis and Pfaff. However, these circumstances are rare within a professional football environments, and if implemented poorly can result in a dependency culture that will fail to produce under any physical duress. That said, the hands on skills of a "non-babying" physio can greatly assist with minor adjustments to get a player back out on the track or alternatively assist making a balanced call with respect to removing a player from training.
Maintenance - In football environments there are always injuries new and old to attend to. However, the implementation of and compliance to a sound musculo-skeletal maintenance program is critical to avoiding preventable injuries.
Tip for those aspiring to run High Performance programs - in my view, you must understand what each member of your staff is technically and personally capable of. The combination of the two is powerful and not to be underestimated. From there it is like playing chess, moving your pieces around the board tactically, in the context of an overarching strategic plan, to achieve the desired outcome. The challenge is making sure your staff is comprised of powerful pieces (castle, bishop, knight) not simply (pawns). That said, if you know chess, a pawn can be very effective when used well.
So, to answer the question...YES Physiotherapists and S&C coaches can and MUST integrate in order to provide a holistic program. Unquestionably, the effectiveness of this relationship lies with the individuals themselves and the departmental philosophy in which they exist. Physios and S&C coaches come from different perspectives and the key to working well in a team is gaining insight and empathy into the mindset, philosophies and skill-set of your the staff you work with.
PS - Do I let physios in the gym? Only the ones who come in to train!
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