If you are looking for physical therapy with the ultimate goal of returning to sport, you don’t have to look too far to find multiple clinics claiming to offer sports physical therapy services. But what does that mean? And is that individual or clinic adequately skilled to offer that service? I will let you make your own decisions after reading the next few paragraphs.
Firstly, lets define who can offer sports physical therapy services or call themselves a sports physical therapist? The answer is any physical therapist who wants too! And for a physical therapist why wouldn’t you make that claim to work with on average a younger demographic who is motivated to put the work in. The next question is…. have they had experience of working directly with sports teams or high-level individuals? And the answer again is probably the majority haven’t. So where does that leave us? To credit the physical therapy population, they are generally very studious and are keen to seek extra qualifications in their chosen field, so you may find a PT who has gone the extra yards and achieved some qualifications and does deserve respect. But that is certainly not all PTs. My major issue here is not the individual, but how the profession is structured and the speed of development of mainstream sports physical therapy over the last few decades.
In my lifetime and as a graduate of sports science, I can appreciate how far sports science has come over the last few decades, and how it continues to influence how we train and recover in relation to our sports. This has cascaded though the general population with the use of wearable technologies. And while I look to sports scientists among other professions to better myself, I often look back at my profession in amazement of how far behind we are in certain elements of our practice. As I said before, we have some incredibly skilled PTs who are pushing the boundaries in the niches of their various fields, and the top sports physical therapists are doing incredible work. But if we take the middle 80% of our profession which are the PTs you will most likely visiting, we are falling behind the minimum standards we should be delivering.
Allow me to present my case……..
If you are a multi-directional athlete, for example a soccer player, you are running 8-15k a game making multiple sprints, cuts, and putting forces through the body of anywhere from 2-6 times our body weight at 10/10 effort. If you were looking to return to soccer from injury, what might be the standard tests a PT may complete to determine your state of readiness to return? These would likely be a manual muscle tests where a PT pulls on a limb and asks you to resist and then decides if you are strong enough to return to sport. They would likely also conduct a few hop tests to determine your ability to act dynamically on the affected limb. But would you trust the same level of detail on any other element of your life that may cause you pain or injury? In sport, it is often milliseconds and inches that define success and failure, what we should be doing as PTs is working and testing athletes to the highest demands of their sports, as it is at those levels that success and failure will be determined. We should be incorporating technologies such as force plates, that not only accurately measure fractional differences in forces being produced at maximal effort, but also the timings of that force being produced. For example, you might be stronger for attending physical therapy, but have you completed the right exercises so you can produce that force and make adjustments within a few milliseconds to react to unexpected external loads on the field? Most sports physical therapy clinics won’t be able to answer that question comprehensively. Also where is the on-field fitness component to physical therapy? Getting the athlete up to match fitness should be an essential part of sports PT. Your tissue’s ability to demonstrate a ‘good’ hop test will look very different after 60 minutes of playing if you haven’t explored those intensities of play since your injury. These issues are just the tip of the iceberg when we look at managing the athlete back to sport. From my experiences working in sport, a significant portion of the rehab takes place on the field, allowing the athlete’s tissue to experience sport specific stresses which no level of gym lifting will match.
Probably my biggest compliant is that the majority of sports physical therapy operates as a business! High volume of patients and no time to get into the details before the next client arrives. And I sympathize with talented sports PTs who just do not have the facilities or the time to deliver quality content because they are stuck in 300 sq ft gym with just a few weights and a maximum of 20-30 minutes of quality time once all administrative responsibilities are completed. How can you possibly assess, test, interpretate finding and plan for that athlete’s progression at the highest level possible? Imagine your body is a high-performance car, would you trust a mechanic that pulls on a few parts, revs the engine a few times and then says you’re good to go? Or a mechanic that uses advanced technologies to explore all the nuances of the car’s technology, before taking it out on a track to determine performance during and after high-performance tasks?
As physical therapists the technology exists for us to better ourselves and give the athlete the service they deserve. As a client we need to ask questions about the service we are getting and find someone who is performing at the forefront of their profession.