The following post was written by Paul Mitalski. Paul is not a physical therapist, but has vision for the where the profession of physical therapy can go in the realm of sports and athletics. The introduction was written by Matt Sremba, PT, DPT. Matt is a physical therapist. He is passionate about the profession of physical therapy and critically thinking about what we are doing, why we are doing it, and how we can do it better. Matt introduced me to Paul, and the three of us have discussed specifically the physical therapists role in athletics. What are your thoughts?


The evolution of the physical therapy profession is something that has always intrigued me. It is continually looking for new models of growth, practice, and education as seen in the recent progression towards the year long clinical model, the Innovation Summit by the APTA, and of course many discussions by passionate PTs on twitter and blogs like this to name a few. While spending the day at Dr. Christopher Powers’ Movement Performance Institute, I had the chance to meet with Paul Mitalski. Since that time, Paul and I have discussed many areas of Physical Therapy and I believe he brings an interesting angle to these topics as he is not a PT, however has worked closely with them for many years.  We look forward to discussing his innovative model and vision for the role of physical therapists in the management of athletes.

Matt Sremba PT, DPT


Before I present a snippet of my vision of the future of performance training and wellness (PTW) and the role I believe physical therapists should embrace, I will briefly describe how I got here. In short, I am the CEO of Conatus Athletics and I am not a physical therapist.  I am a computer programmer/software engineer/consultant by trade and mathematician. I led the development of three unique entities; the first and only complete mathematical model of the kinematics/kinetics of basketball, the first general methodology for performance training based on engineering principles, and a complete hierarchical “System” to implement the previously mentioned methodology. The last entity, the “System”, will be the primary focus of this blog post and I will discuss  the unique role of a Physical Therapist. My “System” is now a new business venture. My company, Conatus Athletics, is an education company and a training company. I lease space at the Movement Performance Institute in Los Angeles CA. and currently train professional athletes, however, our priority is developing and delivering  curricula based on science, engineering, and our system. My training “System” wasn’t intended to be a business nor was it created with the input of the sports performance world or fitness industry. I developed it in the late 1990s to prevent injuries in basketball and it is based upon mathematics, science, engineering, with refinement and guidance from physical therapists.

The Conatus Athletics System was designed to be a complete systematic process for managing all aspects of an athletes training and rehabilitation with clearly defined roles and responsibilities for all individuals. The role of the Physical Therapist in the Conatus Athletics System is unique. Here are some of the components, which help define the role of our therapists in our “System”.

COMPONENT 1. Therapists manage and oversee ALL therapy and training as well as related care extenders

We believe in a hierarchical model in which a MD and PT are peers and collaborate at the top of extender clinicians made up of PT’s, strength coaches, ATC’s, interns and residents to oversee and treat athletes. The MD and the PT both act as attendings as in a hospital setting, and must oversee all other clinicians. PT’s must contribute to the performance training program and must be present for all training including court, field, weight room, etc. This role is necessary due to our belief that athletes are NEVER “healthy” and always have musculoskeletal issues and require real time feedback during performance training. PT’s oversee the training regimen but do not execute it. Extenders are used for that role. The role of the Therapist in observing training regimens is to diagnose potential problems or future injuries and monitor return to activity.

COMPONENT 2. Therapists “Own” Musculoskeletal Problems

Physical Therapists are in charge of all musculoskeletal Problems and must establish treatment plans while altering training to allow continued performance training. We expect true collaboration between exercise physiologists, MDs, and strength coaches, and engineers. Although we believe in performance improvement, the health of the athlete is the highest priority. Therefore our conclusion is the Physical Therapist must “own” the training regimen.  This component also defines relationship/collaboration with Physicians in the training environment. In short, the therapists own the diagnosis of Musculoskeletal Disorders. MD and therapist must consistently communicate because some pathology requires both skill sets. The MD is not trained to “prescribe” a treatment plan (rehab) or manage the performance training. At the same time PTs should not try to be MDs and prescribe medications, etc. either. PT’s focus on mechanical problems.

Therapist Roles

1. Final approval of all Performance Training
2. “Veto” power over individual units in training regimen
3. Adjust individual units (exercises), add and replace units (exercises)
4. Defend his/her decisions to other professionals with rational explanations
5. Insure  team members are also to be able to defend the decisions related to training

Constant mentoring and explanations from the therapist is required…Team members WILL question the decisions made by the therapist. The culture is one of skepticism and constructive criticism. The therapist must take ownership and responsibility for management.

“Owning” a problem or issue is a part of Leadership training (google it). I have yet to meet non military trained therapist who understand this leadership topic. I suspect there are many natural leaders among the therapist ranks and I look forward to recruiting them into my happy company : ) I still feel this is a missing aspect of therapy curriculum. It is non negotiable in my System.

I would like to summarize.  I concluded that physical therapists should manage and lead performance training.  I am completely dismayed that physical therapists do not seem to want this role.   My system requires therapists to lead, manage, collaborate with other professionals (MD, Scientists, Engineers), defend their decisions, accept criticism, and  collaborate with other therapists for diagnosis and treatment. At the same time I hear therapists tell me they want these responsibilities, they resist embracing them and the sometimes difficult steps necessary to raising the standards in their profession.

Are there physical therapists out there who want this role?
Are physical therapists ready for this role?
Are the physical therapy curricula preparing students for this role?
Are you interested in the challenging steps necessary to make this system become the standard?


Paul Mitalski
Paul is the CEO of Conatus Athletics.  He has a B.S. in Mathematics, a M.S. in Computer Science, and is currently pursuing a M.S. in Engineering with a concentration in Biomedical Engineering.  He worked as a consultant for over 10 years and now is an entrepreneur focused on promoting Mathematics, Science, and Engineering in performance training and therapy.

Matt Sremba PT, DPT
Matt is a graduate of University of Colorado Doctor of Physical Therapy program in 2009. His clinical experience is in orthopedics/private practice and in the neuro rehabilitation hospital setting. His current interests include sports, orthopaedics, and manual therapy. He currently practices in Orange, CA where he is also trying to surf some waves.