New vision & role for the physical therapist in athlete management #sportsPT

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?

Introduction

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 which can be wagered on 홈카지노.

Matt Sremba PT, DPT
@MattSremba

Background

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.

48 Replies to “New vision & role for the physical therapist in athlete management #sportsPT”

  1. I would like to thank Paul and Matt for constructing this post as well as engaging me in some very thought provoking discussions. I hope this post creates some interesting discussion. I know both Paul and Matt are very interested in the PT’s experiences in various models as well as their thoughts on this proposal. Read, critique, discuss!

  2. 100% agree in that Physical Therapists are the correct owners of this area. We need to move beyond restorative care & into the arena of motivation & wellness. There is no other way. We have the unique skills & training to handle these issues & it is critical that we no longer view this role as adjunctive to our profession. Rather performance, motivation & wellness are core to our practice. We need to lead the way & show society how to overcome the current crop of ailments & preventable issues. The easiest way to advocate is with results. We have unique motor & performance assessment skills to advance our clients both elite & recreational.

    Brian Finch PT, CSCS
    “Get out there & treat your body like a rental car…”
    Twitter @AlpineAthlete \ @Blossomskis
    Blossomski.com – importer
    EpicSki.com – sports med moderator
    Exotic skis.com – test pilot
    SkiersEdge.com – Skier’s Edge National Team

  3. On twitter, people have mentioned that this model already exists in some sports programs.

    Secondly, some feel that this is a “direct assault” on athletic trainers position. And, that this is the role of athletic trainers. It has been said that a head athletic trainer has this role, and that if PT wants it they should become an ATC also.

    Eric Robertson mentioned sports residency/specialization is one of model of advancing knowledge and skill base.
    http://www.spts.org/education/sports-certified-specialist
    http://www.abpts.org/Certification/Sports/
    http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/About_Certification/SpecCertMinimumCriteria.pdf

  4. Summary (Cleaned up, expanded, and organized) from Twitter commentary):

    I disagree with this proposal at this time. There is enough friction between PT and AT professionals that this would completely push things over the edge. The roles discussed above directly cross into the existing role of the head athletic trainer. See: http://t.co/Xmh5Yevj

    For the APTA SCS credential to be comparable, the recommendations for on-field/acute care and athlete preparation and operations management experience need to become requirements because right now the entirety of the 2,000 hour requirement could be performed in outpatient sport clinic. Emergency care, acute and general triaging, day to day athlete preparation & management (in-particular multi-sport) is not something that can be learned out of a textbook or a weekend course. There are residency and fellowship programs offered which address these concerns, but they are not required for SCS credentialing. The experience gap needs to be filled in advance. To shove a great orthopedic specialist on the field or even in the athletic training room during preparation time with 10, 20, 30 athletes needing triaging, or “overseeing” other professionals doing these roles, it is just inappropriate for good quality patient care. Furthermore, this role is already been hard fought for and occupied by another profession for over 50 years. What does this say about our profession that we must now take it away in order to improve ourselves?

    Leonard Van Gelder, AT, ATC, CSCS, SPT
    http://www.dynamicprinciples.com
    Blog: http://dynamicprinciples.wordpress.com/
    Twitter: http://twitter.com/LeonardVnGelder
    Facebook: http://www.facebook.com/dynamicprinciples

    1. Leonard,
      Thanks for the comment, but at this time we are not discussing triage.
      Yes we are focused on changing the current models because we believe they do not work.
      Conatus Athletics does not agree with the current models and the roles within them.
      We are focused on moving PTs to top of a performance training model because it has been so successful for us.

      Adam Van Cleave
      Director of Performance Training
      Conatus Athletics

      1. Based on both “component 1 and 2”, you are claiming the entirety of athlete management, that includes triage since it includes management of what happens preparing for practice/events, what occurs during participation, and what happens after. You cannot state you are including or excluding anything at that point. As I provided in the link above, these and coordination of strength and conditioning staff are traditional roles of the head athletic trainer. It is excellent that you are having tremendous success with your program utilizing PTs as overseeing the program including performance component. There are PTs who are well prepared for this role, but most are not, and with the exception of certain fellowships and residencies, the SCS is not. The same success has been accomplished by many head athletic trainers for many years, coordination of team members and athletic program design is integrated both into the didactic and clinical experience of all current AT programs. Please recognize you are competing directly with an existing professions’ established role in this area.

        Leonard Van Gelder, AT, ATC, CSCS, SPT
        http://www.dynamicprinciples.com
        Blog: http://dynamicprinciples.wordpress.com/
        Twitter: http://twitter.com/LeonardVnGelder
        Facebook: http://www.facebook.com/dynamicprinciples

        1. With much respect…
          We do not believe athletic trainers should manage the athletes’ performance training.
          I’m sorry this may upset people but we are focused on the best possible solutions and the therapists have shown themselves to diagnose injuries the best and provide treatment plans the best. We firmly believe ALL athletes have injuries or disorders, therefore, the therapists should take the lead. Our system runs like a medical school, the therapists are the people who would lead in a clinical setting, therefore, they lead our system.

          As far as triage in our system… The individual who handles instances which require triage does not have to be the same person who manages the system. We are focused on this management role, not the triage role. Please stay on topic.

          This is a blog about the qualifications of the therapist and we firmly believe they should assume a NEW role at the top of the performance model. We believe there are challenging steps which need to be taken to accomplish our goal.

          You have clearly stated your opinion. Thanks.

          Based on our experience with therapists from USC and other schools in the United States, they are the best option for our system. We think therapists have a stronger foundation to manage the clinic in our system which is based on engineering principles and collaboration with scientists and other medical professionals.

          We do NOT agree with traditional models. We think they are wrong. Furthermore, if they worked, we wouldn’t have clients (and we have clients).
          We just spent the weekend with a Division 1 basketball player who could not pass our return to sport protocol. This is his third ACL tear. His trainer cleared him to play. We have another professional athlete who has 5 ACL tears prior to coming to us. The focus for us is healing the athlete. Our hearts break when we receive these phone calls from all over the world. I’m sorry you disagree with us but we believe in this and that is why we wanted to blog about a “NEW” role for the therapist. We know there are challenging steps ahead including education. The best people for this role are therapists. We also continue to state this is a “NEW” role, therefore, it is obvious to us this implies change.

          Our focus is on the client and preventing injuries.

          We are NOT concerned with issues of territory or individuals focused on protecting their jobs.
          We are NOT interested in tangential personal arguments focused on these topics.

          We are interested in the steps necessary for therapists to run our system.
          We would like the therapy community to adopt our system (or portions of it) and begin to combat the problems in the current models.

          Adam Van Cleave
          Director Performance Training
          http://www.conatusathletics.com

  5. John Salva ‏@JsalvaPT
    @Dr_Ridge_DPT @sptsapta @ptthinktank great in theory but need specialized ed. Lot of PTs not familiar with conditioning

    John, thank you for the comment. We agree that there needs to be specialized education for therapists in our model. We believe change is necessary in the current models being practiced. We believe therapists are more suited for this role because of their association with universities, mandatory post graduate education and their licensure to diagnose injuries. We have outlined a detailed curricula required for this to happen and would be happy to discuss this (and are currently in discussions) with anyone.

    Moreover, I would like to note that this is not a theory for us, we currently integrate the therapy and training for athletes in the following: NFL, NBA, MLB, USA Track and Field, etc…

    Adam Van Cleave
    Director of Performance Training
    Conatus Athletics

  6. There are a couple of points made in Paul’s system that I believe that require a move away from the current model in place. The understanding that athletes are never healthy and are constantly requiring rehab and performance training together is not a novel idea but also one that I dont believe is integrated into current practice to the extent that Paul’s system does. There should be no separation of ‘rehab’ one day and ‘training’ the next. Another point that the athletes health trumps performance training is something that I believe is forgotten all to often. Athletes can not sacrifice minimal increases in performance for injuries. Too often the proper preventative measures are not being followed resulting in dramatic increases in injury, see below. Therefore I do believe that PTs should take this role. I agree with what has been previously mentioned that PTs will need training to complete this role but have the skill set and capacity to improve what is currently being performed in performance training.
    http://www.mikereinold.com/2012/08/the-prevention-of-overuse-injuries-in-youth-sports.html

  7. This is a progressive idea. As a recent grad I am always interested to hear and discuss the future of PT and opportunities for growth. I think that this model would take time to be accepted under our current medical model, especially with how the roles have been delineated for other providers like ATCs, PTAs etc. However just from the blog post it seems like it is more accepted in the world of professional sports. This is encouraging to see. I think PTs have a lot to offer the sports world, maybe more than what we are currently able to offer now due to our current roles. I am interested to see data about outcomes with this new system/model. Is there any available?

    1. Kirsten,
      Thanks for the comment. I am reaching out to Eric and I will put something together for you and others interested in outcomes.
      Thanks for your patience.

  8. I read the above article with interest. While I accept some of the points made above I am not convinced that the PT should be the one who manages and leads performance training. The continuum of care that is required for developing and maintaining the athletes physical attributes is broad and encompasses a number of specific niche roles. The article above chose to look at that of rehab and performance training. These two domains have a very significant amount of overlap but I do not see the argument being conclusive that the role of the performance coach is or should be subsumed by that of the PT. Both professionals should be the experts on both the area their profession focusses on as well as all the overlap between the two. This will lead to both of them doing very similar things a majority of the time. However the reason for doing so will be slightly different between the two professions.

    The entry level DPT is nowhere nearly exhaustive enough on performance enhancement to produce a gradate who would be able to step into this role. And it shouldn’t be. The goal of school is to produce someone who is at entry level for all aspects of PT. Even a sports residency would not prepare someone to take over the job of the performance director. The skill set that it takes to direct and manage the performance training side of things is exactly the skill set that the strength coach is required to have. While there are many similarities between the two professions I see this as areas of overlap between two distinct professions – not a redundancy. The strength coach is the best suited to direct the performance training aspects of a athlete/team. If a PT takes this role they are fulfilling two separate roles, that of strength coach and PT, not merely taking their rightful place as a PT. There are some excellent PT’s who are also great strength coaches (Think Rob Panirello) however this is the exception not the rule.

    That said some of the teams that do this best recognize that the areas of overlap are some of the most crucial and have all professions work together on those areas. Training and rehab share a large portion of common ground and it behooves us to be very well versed in these areas.

    1. Hello Scot,

      Thanks for reading and replying. I am going to try and address the questions you raised in the order in which you wrote them. Thanks again…

      You said . . . “I read the above article with interest. While I accept some of the points made above I am not convinced that the PT should be the one who manages and leads performance training. The continuum of care that is required for developing and maintaining the athletes physical attributes is broad and encompasses a number of specific niche roles.”

      The first question we felt needed to be addressed during the development of our system (in the late 90s) was … do we even need one person who will make a final decision on the contents of the training program (ie. individual exercises, amount of load, etc). Our conclusion (and you may disagree) was YES, for our system to run efficiently and have accountability, one person should make (or own) final decision. For example, a professional person (in our case a therapist) should own the final decision on whether or not the athlete is cleared to execute a specific exercise and is the athlete cleared to load that exercise. The therapist was our choice because they better understand the bio-mechanical risks with these movements, they better understand the consequences of subtle breakdowns in form for each individual athlete, they better understand medical history, they can slightly adjust the exercise to minimize risk, etc. If we had a dime for every time we received a call from a professional athlete in the off season who doesn’t want to train with the team because they are always in pain, we would buy a team. From a therapist, we later find out that a few of the exercises correlated with the athlete’s specific bio-mechanics are the root cause. The wrong choice of exercises is extremely detrimental to “performance training”.
      In our system the Physiologist, Structural Engineer, Mechanical Engineer, and Therapist all contribute to the exercise program. We are not excluding the opinion of the Physiologist, however, the buck stops with the guy/gal with the license to diagnose and as far as we know, that must be the therapist. We have found that this is not inhibiting to the Physiologist and in fact elevates the Physiologist’s awareness of injury. Please note, I am not a therapist, my undergraduate degree is in kinesiology.

      EACH AND EVERY professional involved in those decisions must defend their position to the others, however, if the athlete gets hurt… the therapist is accountable. Maybe we have wrongly communicated “management”. We apologize for this. Also, just for clarity, we usually say “physiologist” instead of “strength coach”.

      You said “The article above chose to look at that of rehab and performance training. These two domains have a very significant amount of overlap but I do not see the argument being conclusive that the role of the performance coach is or should be subsumed by that of the PT. Both professionals should be the experts on both the area their profession focuses on as well as all the overlap between the two. This will lead to both of them doing very similar things a majority of the time. However the reason for doing so will be slightly different between the two professions.”

      We do not believe there are two domains. We view all athletes the same (from 8th grade to professional, whether post-op or cleared for all activities). They need to improve! It is true we think different and our system was developed in isolation with no influence from other models. In our system, injury prevention happens everyday in performance training because the therapist is watching the performance training. The execution of the performance training is done with multiple disciplines present. We see no reason for the division and this is why we claim, we are the only truly integrated system. We concluded a truly integrated system has medical professionals (DPTs and MDs) at the top. We want to avoid injuries by allowing the therapist to aggressively be involved with the client’s exercise program.
      We continue to ask the performance training world… How can we allow strength coaches to train athletes in isolation without the education to identify precursors to the very injuries we are trying to prevent?

      You said “The entry level DPT is nowhere nearly exhaustive enough on performance enhancement to produce a graduate who would be able to step into this role. And it shouldn’t be.”

      In fact, some experienced DPTs aren’t ready for this role, but we firmly believe they are the only choice and their profession can adjust to produce some great leaders who can change the direction of this industry. They can play a key role in reducing injuries. We are here on a therapy blog asking therapists if they are interested in what we are saying.

      You said “The goal of school is to produce someone who is at entry level for all aspects of PT. Even a sports residency would not prepare someone to take over the job of the performance director.”

      We still feel that the DPTs can assume this role. We have executed this model and found the confident secure physiologist is not threatened by a mature DPT. I have personally executed our system with Olympians and the therapist leading was a faculty member at your university. I did not have any problems, nor did I feel constrained. I would like to restate our model was based the medical field and remember…collaboration is second nature for a quality physician.

      You said “The skill set that it takes to direct and manage the performance training side of things is exactly the skill set that the strength coach is required to have. While there are many similarities between the two professions I see this as areas of overlap between two distinct professions – not a redundancy. The strength coach is the best suited to direct the performance training aspects of an athlete/team.”

      Can you please list the specific skills that you feel a DPT lacks in order to accomplish the two components we listed in the original post?
      We feel people will conclude we are correct.
      We have found diagnosing injury to be the cornerstone of performance training. We have found leadership and management training can provide skills needed for the therapist to assume this role. We have found the physiologists still have a fulfilling role trying to improve athleticism and endurance while developing a true understanding that the highest priority is to not harm the athlete and to increase the longevity of the athlete’s career.

      Adam Van Cleave
      Director of Performance Training
      http://www.conatusathletics.com

  9. I fully support the model presented, as I support all initiatives that work to maximize the potential of a physical therapist education. Having worked in a variety of settings and roles including military physical therapy, cycling coaching, and academia, as well as consulting with a variety of professional athletes/programs has given me some perspective on the state of sports and athlete health. From my experiences, it’s clear that the current models in place leave room for improvement. In fact, I’ve visited very elite programs where both the strength training and rehab was consistent with what I would call, “crap.” There are good programs scattered, sure, but overall we can do better.

    The physical therapist with advanced training (no one is purporting this to be an entry-level thing and conversation regarding that is unnecessary) is an individual who not only has doctoral level training in rehabilitation, but advanced training in physiology, exercise physiology, diagnosis, and more. No one else in the scope of athletic performance management has the scope or unique vantage point that a physical therapist brings to the table. They can bridge the gap between medical expertise and sports performance/strength coaching. They can appreciate the nuances of tissue response to stress that goes well beyond the understanding any other profession as a whole brings to the table. Beyond the specific disciplines studied, the physical therapist brings the subtleties that comes from doctoral educational study, AND the advanced setting-specific training that this role would require. You’re talking about a very skilled individual.

    This is a new model, so people fiercely defending the status quo will surely disagree. They will cite turf battles and the like. They will cite individually excellent strength coach examples and the AT’s will jump up and down and say they already do this. They don’t. Teams and athletes which embrace this concept, which is novel yet subtle, are likely to realize a greater degree of coordination of services and performance/health in the athlete than those that don’t.

    Besides, even if the current system was working well, isn’t the concept of performance distilled from the desire to find ways to make it better? Arguments based in “this is the way we’ve always done it for 50 years,” are not logically sound if one purports to be rooted in the realm of human performance.

  10. “These two domains have a very significant amount of overlap but I do not see the argument being conclusive that the role of the performance coach is or should be subsumed by that of the PT. Both professionals should be the experts on both the area their profession focusses on as well as all the overlap between the two.”

    Scot, in the model proposed, as I understand it, the PT is NOT replacing the strength and conditioning specialist/coach he is merely managing/supervising the entire team and care of the athlete. Thus, the PT may not make or even deliver the strength and conditioning content. BUT, the PT will know what the content is and approve/modify based on the athlete’s current needs.

    As Paul outlined, this is a collaborative, team model. ATC’s still exist, strength and conditioning specialists/coaches still exist.

    I totally agree, physical therapy does not adequately prepare a new graduate to step into this role. This is why a robust education model for this system is also needed. This may involve residency/fellowship type set up as well as advanced training in strength/conditioning.

    Why is the profession as a whole resistant to new models that require advanced training and new roles?

    It appears Paul is not asking PT’s to replace anyone, but step up into a leadership and management role of the athlete. The PT is uniquely positioned to understand the overalp of rehab>training>performance, examine/evaluate/medical screen athletes complaints, recommend modifications/additions/rehab, and interface intelligently/appropriate with ALL parts of the team from the strength and conditioning coach to the team physician.

    It appears we have identified an educational gap that also needs to be filled for this model to be successful? Does this need to be addressed in entry-level education or in post-professional residency/fellowship models.

    Just because ALL PT’s aren’t qualified to do it, does not mean PT’s should NOT do it. The same is true of evaluating/treating patients in an intensive care unit who require mechanical ventilation and other life support. This is NOT an entry level skill, but it absolutely is a role PT’s must (and have) fulfill(ed). Similarly, others including nurses, respiratory therapists, and physicians are still involved in this patient’s care. But, there is a team approach with recognition of each professionals expertise and knowledge base.

    Strength coaches will still be designing program and training athletes.
    ATC’s will still be triaging acute injuries and providing game/practice service.
    PT’s will still be evaluating/treating patients.

    But, all will work as a team unit with a PT as a leader and manager. As proposed this appears to provide assessment of real and potential problems while not just addressing the symptomatic athlete, but also how/why they are training. Further, given the athlete’s history and sport known risk reduction principles can be incorporated. An ATC or strength coach can no adequately address this issues at a systematic level.

  11. Eric summarized better than I:

    “No one else in the scope of athletic performance management has the scope or unique vantage point that a physical therapist brings to the table. They can bridge the gap between medical expertise and sports performance/strength coaching. They can appreciate the nuances of tissue response to stress that goes well beyond the understanding any other profession as a whole brings to the table. Beyond the specific disciplines studied, the physical therapist brings the subtleties that comes from doctoral educational study, AND the advanced setting-specific training that this role would require. You’re talking about a very skilled individual.”

  12. I applaud Matt Sremba and Paul Mitalski’s efforts to create a “system” for performance training based on engineering principles.

    I hope these comments are not merely semantics because I definitely think our American health care system needs more “system”.

    However, Components #1 and #2 seem to rely on concepts that appear to be rapidly changing, outmoded or dangerous.

    Component #1: A hierarchical model that grants the physician the only unlimited license in healthcare. Every other professional works under the physician regardless of training, experience or results. Nonsense.

    If you believe this model will survive another 20 years then you also believe America has a physician shortage. It doesn’t. Nurses, PTs, pharmacists, PAs and others are taking over roles once filled exclusively by physicians.

    Healthcare is flattening and decision-making is being dispersed from the physician towards other professionals and from them to the most logical and efficient decision-maker economic theory suggests: the patient.

    Component #2: Therapists “own” musculoskeletal injuries but “should not try to be physicians”.

    Again, the patient is the final arbiter for who to see for their problem. A truly efficient value chain has multiple entry and price points for patients to access musculoskeletal care. Maybe I don’t need a full-on PT eval and treatment for $120. Maybe a $50 massage will fix what ails me. Let the patient decide.

    Within the current system, hospitals are rapidly pushing the limits of state scope of practice by putting nurses, PAs and others in traditional physician roles. Hospitals are probably doing more than risk-averse state professional associations to push scope of practice.

    Retail health care is also pushing scope of practice. Companies such as CVS, WalMart and Walgreens are aggressively building a multi-tiered value chain that allows consumers to decide at what price point they want to enter the health care system. $10 flu shot, anyone?

    Finally, within Medicare the move towards value-based purchasing means health care systems will only make money if we all keep patients OUT of hospitals. That means pushing high-volume musculoskeletal injuries to physical therapists and away from x-ray happy primary care docs.

    That means physical therapists will have to “steal” skills from physicians such as diagnosing long bone fractures without x-rays, recognizing pneumonia in the community and fixing the big divers of healthcare cost like obesity, HTN and smoking.

    I realize my comments may not be exactly relevant to your sports performance system but I think some of the factors on which you predicate your business plan are changing quickly.

    Thanks again for striving to create a better system in America.

    Tim Richardson, PT
    http://www.PhysicalTherapyDiagnosis.com

    1. Hello Tim,
      Thanks for the “applause”. We are only going to reply to topics related to this blog.
      You said “Component #1: A hierarchical model that grants the physician the only unlimited license in healthcare. Every other professional works under the physician regardless of training, experience or results. Nonsense.”
      We are not saying this nor have we ever said this. We are elevating the Therapists to equal status with MDs for performance training systems. Musculoskeletal issues go to Therapists. Other issues require collaboration, such as pain (let’s not blog about pain right now :). We have no antagonistic behavior from either MD or Therapist to report. In fact, we are moving toward Therapists training MDs in specific areas. MDs are very interested in learning techniques for diagnosing musculoskeletal issues and Therapists are very interested in learning which symptoms require an MD. Both learn, win win.
      You said “Healthcare is flattening and decision-making is being dispersed from the physician towards other professionals and from them to the most logical and efficient decision-maker economic theory suggests: the patient.”
      Yes, we believe in an extender model, but a medical professional is always in charge and accountable in our system. The patient will seek help or in our case…the client will seek training.
      you said “Component #2: Therapists “own” musculoskeletal injuries but “should not try to be physicians”. Again, the patient is the final arbiter for who to see for their problem.”
      Sure, the patient could go to the strength coach if they have a rash, but we are trying to allow the best qualified to handle the issues that arise in performance training. There are clear roles for both MDs and Therapists in our system and areas of collaboration. We FIRMLY believe Physicians and Therapists together is a powerful team. That team combined with rigid science and engineering principles, provides a complete performance training model.

      Maybe in other blogs or offline we can discuss business plans and medical systems. Our business plan works and we are interested in scaling, therefore, we are testing to see if other therapists find interest in it.

      Conatus Athletics
      info@conatusathletics.com

  13. This is a great topic and one that I am very passionate about. While I respect and appreciate all the training and knowledge that a head athletic trainer possesses, I do believe this should be within the scope of a well qualified physical therapist. We are musculoskeletal EXPERTS. We are and should be thought of as experts in all aspects of this domain. While I concede that a general practitioner or recent grad is by no means at the same level as an ATC, I do believe this is an area appropriate for the right PTs. To clarify, the CSCS does not make you at the same level as a head strength and conditioning coach. The SCS does not make you at the same level as a head ATC. However, these credentials coupled with adequate experience and drive should be far and away better than an ATC/CSCS. This is where residency training and appropriate experience/mentoring come into play. Having this additional training and ‘on the job’ training should put these PTs in a supervisory role.

    No offense should be taken by this. I know many great ATCs and many of the best students in my class came from ATC programs in undergrad. That being said, I find it hard to believe that a rigorous sports residency program would not yield the same results. Many of these programs offer robust coverage of athletics (many of which at the professional or collegiate level) along with mentored time spent with EXPERTS in the sports medicine field. So, this additional training combined with a doctoral education should, at the very least, be at the same level as an ATC, no?

    Like Kyle mentioned, this is a supervisory role. This model does not and should not involve absorbing the responsibilities of the athletic trainer or strength coach. For someone to provide a supervisory role in this system, they MUST have adequate training in exercise programming/physiology, injury prevention, and rehabilitation… This sounds like a residency trained sports physical therapist to me.

    John Snyder, SPT, CSCS

    1. John,
      Thanks for the comments. Your statements illustrate what THIS blog is trying to communicate. As a side note, our system goes many steps further with science and engineering and maybe in a later blog we can go there. Back on topic… You’re right, we are not trying to replace anyone, however we are not concerned if someone gets replaced. We see a role for the therapist based on their education and training which minimizes the risk to our athletes. We ARE concerned about our athletes (all ages and all levels of competition). This blog was not intended to be a comparison between (PTs and ATCs) or (PTs and Strength Coaches).
      We believe there is a duty to minimize risk during training. Others may disagree. The strength coaches we know (at the VERY VERY VERY top of the industry) do not integrate injury prevention, however, EVERYONE says they do. Without a PT present during training, who is diagnosing and monitoring these athletes? Why not make it easy and have the therapists “own” these musculoskeletal issues? It works for us.
      Experience and certifications being equal…what specific academic training did a “strength coach” receive that qualifies them “more” than a PT/DPT?
      Almost all PTs acknowledge a role for a trained professional to perform triage (let’s not revisit ATCs in this blog).
      As a side note, we don’t consider the CSCS necessary. Feel free to reach out to us and we will contact you outside the blog. We want to avoid tangents but would love to talk with you about certifications.

      Adam Van Cleave
      Director of Performance Training
      http://www.conatusathletics.com

  14. Hi,

    I am a current undergrad who has been juggling the decision to pursue a DPT or a CSCS certification. If physical therapy and the sports world used this model I would become a DPT in a heartbeat. I agree with this model because I think prevention of injuries for elite athletes can be best assessed by a DPT. from my limited experience around ATC’s at my college they do not have the proper knowledge to handle the responsibilities as listed above but they do have the ability to follow a well laid out plan. I just wish physical therapists took on a more preventative role then purely a rehab role. Again I have limited experience and I’m young but these are just my opinions.

    Thanks,
    Sarah

    1. Do both Sarah! Acquire your CSCS in the final year of undergrad while applying to PT school. I took the ACSM route and acquired the HFS credential. I wish I had taken the CSCS! I will graduate with a DPT in may 2013 and am planning on sitting for the CSCS in April 2013. Save yourself the hassle of studying for CSCS while in PT school and do it now!

      1. While this is certainly a side bar in this conversation, I do have to say that I don’t place a lot of value in the CSCS. It’s open to many many people, with a low barrier to success. The information it tests is certainly good information, but I find as educational level rises, I see less and less of a need to pursue this. However, I’m also against alphabet soup of certifications as a whole, favoring several key designators instead. In response to Sarah, your comparing things that are not the same. There’s so much more to PT than the sports realm. Even if you work in sports.

  15. 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?
    1. Yes, I do!
    2. As a new grad no I will not be ready for this role which is why I am choosing to attend a sports PT residency so I will have the skills to assume this position.
    3. Entry level grads do not have the skill set to OWN Musculoskeletal disorders, however through continued mentorship I believe after one year in a Sports residency I will.
    4. Yes eventually I believe all graduating PTs will be required to complete a residency, however residency programs will have to grow exponentially in order for that to happen.

  16. The problem we are all seeing is across the board isn’t profession specific, they are individual specific. Failure to properly supervise/manage the provision of quality of care is the result of failure to draw on what research, current practice, and experience is out there to drawn on. To replace one discipline with another based on their academic background is only going to result with new individuals, with new titles, making the same or new mistakes. If someone is complacent in their position, that is their own doing, not the profession. No profession or academic program can make a professional, no amount of alphabet soup (guilty as charged) can make someone a professional, someone must choose to be a professional. Less than 10% of anything we learned in our professional academic programs will be used in the course of our career. Successful programs are overseen by professional who invested in self-guided learning, work and experience, not academic background. Truly the problem lies more in consistency of quality across multiple professions which work in the role of overseeing the sports medicine and performance team. If you want to solve the problem, look at developing a management/supervising program offering which involves multiple professions with a new standardizing body insure quality standards with rigorous experience and continuing education demands.

    Leonard Van Gelder, AT, ATC, CSCS, SPT
    http://www.dynamicprinciples.com
    Blog: http://dynamicprinciples.wordpress.com/
    Twitter: http://twitter.com/LeonardVnGelder
    Facebook: http://www.facebook.com/dynamicprinciples

    1. Leonard, I must say through your comments on Twitter and here on the blog it seems like you don’t place a high value on the physical therapy education you are undertaking. That’s concerning on many levels. Further, as someone who has practiced at a high level as a physical therapist for a number of years, I adamantly disagree that one uses less than 10% of their academic education. I encourage you to do some self reflection about this.

    2. Excellent point Leonard! The system suggested is not flawed and clearly works, but it all depends on people, replacing the head AT with a head PT is not the answer, finding the right person is key. There are both good and bad programs with ATCs at the helm as there are good and bad clinics with PTs running the show. This immense task of inter-personal communication and leadership is not magically going to be done better by someone with a different set of letters. If the best person happens to be a PT or an AT why does it matter? As everyone has already pointed out no PT or AT is ready for this kind of position out of their educational program, this is a leadership role and will require the right person, with the right set of experiences, training and perhaps most importantly intrinsic qualities to pull off effectively. If a PT happens to be more likely to do this so be it, but the best salesman in business does not equate with the best manager, just because the PT may a broader rehabilitation education does not mean they are automatically more qualified for this model. By that logic MDs should be excellent leaders! They have the most medical training of all!?! One does not equate the other….

  17. Hi Leonard,

    Thanks for your insight. I would like to respond. I don’t think Paul is trying to attach any one profession, get rid of any positions, nor take over previously established roles. In fact, quite the opposite. He pursues an effective, improved system that maximizes the knowledge, potential, and skills of each role/professional individually as well as collectively through collaboration.

    “To replace one discipline with another based on their academic background is only going to result with new individuals, with new titles, making the same or new mistakes.”

    Again, this model is not proposing that any discipline or position is replaced. ATC’s still exits, strength/conditioning coaches still exist, treating PT’s still exist, team/ortho physicians still exist.

    This is the creation of a whole new position within the realm of sports performance and athletics. The details of this new role and position are distinctly different from that of a head athletic trainer, and also meant/able to function outside the realm of a formal athletic program (think private business entity, club teams).

    “If someone is complacent in their position, that is their own doing, not the profession. No profession or academic program can make a professional, no amount of alphabet soup (guilty as charged) can make someone a professional, someone must choose to be a professional. “

    I couldn’t agree more. True in every profession. There are fantastic janitors and horrendous neurosurgeons. That doesn’t invalidate the process of education, the role of new delivery models, and the qualifications/training generally of certain professions/certifications.

    “Less than 10% of anything we learned in our professional academic programs will be used in the course of our career.”

    To be frank, what data or line of reasoning is this based upon? It is impossible to lay a concrete number or claim on such an idea. How would we even measure this? No one will argue that some, or even much (depending on your perspective), that is learned, taught, and required in school appears to hold little real world application. This is likely a separate issue (what is applicable from school), but I think a lot of information learned didactically is (or should be) to build proper thought processes, background, knowledge, and context for professional practice. I don’t often model or calculate moment arms or other biomechanical measures, but the knowledge of that process does serve some utility to my practice.

    “Successful programs are overseen by professional who invested in self-guided learning, work and experience, not academic background. Truly the problem lies more in consistency of quality across multiple professions which work in the role of overseeing the sports medicine and performance team.”

    Agreed, program success will be contingent on the individual and individuals will vary. Yes consistently, communication, and proper COLLABORATION between professions is an absolute must, need to break down silos (applies to all of healthcare). Need to progress to trans-disciplinary care instead of individuals working on separate issues and goals. But, a new model with new positions can address these problems. Consistently BETWEEN professions is not going to be solved without fundamentally changing the system and how these professionals interact/communicate. This can mean role change and evolution.

    “Truly the problem lies more in consistency of quality across multiple professions which work in the role of overseeing the sports medicine and performance team. If you want to solve the problem, look at developing a management/supervising program offering which involves multiple professions with a new standardizing body insure quality standards with rigorous experience and continuing education demands.”

    The proposed system above is doing just that, but without the creation of a new profession or standardizing body. Another standardizing body is exactly what is NOT needed.

    Paul’s proposed system is the development of a new model to address those concerns. A new program which involves the interaction and collaboration of variety of professions/roles at multiple levels of education (between/within) ranging strength coach to ortho physician.

  18. I’m second year PT student at MCV. My pursuit of DPT came about from valuable experience and some frustration when I worked as a personal trainer/strength & conditioning coach/crossfit instructor. My knowledge about improvement of performance via quality movement, proper progression and periodization was useful for many individuals. However, there were also many clients whose conditions/injured body parts limited performance. I knew enough (common sense & experience, no certifications for this) how to improve one’s fitness level without aggravating these special conditions, but I didn’t know how to improve them & truly optimize performance. That’s why I’m in school. My goal is to be able to safely and effectively maximize ANYONE’S functional capacity to the optimum level regardless of health status. Please offer opportunities for clinical rotations. Good luck & thank you for advancing our underutilized skill set.

  19. An interesting perspective that is perhaps relevant more to the US than elsewhere given the professional role issue. Certainly I would agree that having a (suitably trained/knowledgable) physiotherapist within the MDT is invaluable and there is no reason, other than political, as to why they should not lead the team given the width and breadth of knowledge they bring.

    I do however have significant reservation over these two statements within this article,

    due to our belief that athletes are NEVER “healthy” and always have musculoskeletal issues and require real time feedback during performance training

    and

    We firmly believe ALL athletes have injuries or disorders, therefore, the therapists should take the lead

    I think this can reflect an overly mechanical perspective with an underlying assumption of mechanical perfection that does not exist. It is also self fulfilling and risks medicalising the athlete unnecessarily – what is the psychological impact of being continually told, implicitly or otherwise that there is something wrong with you? Does that increase or reduce the risk of “injury” – does it sensitise the athlete unnecessarily? The overuse of a biomechanical model with inadequate understanding of the very great range of factors that contribute to the individual experience of injury and pain may not be appropriate. While it is endemic to the athletic world to view the body as a machine to be honed it is in fact a less than accurate perspective. I would also express some concern how his feeds into the wider perceptions of the medical professions such as physiotherapy and the impact of general perceptions about health and wellbeing, that however is outside the remit of this article.

    regards

    ANdy

  20. ANDY,
    Thanks for your comments.

    you said “An interesting perspective that is perhaps relevant more to the US than elsewhere given the professional role issue.”
    -With respect, we have athletes and clients from all over the world and we are asked to consult with teams from all over the world. Our competitors actually do consult worldwide by implementing the model we disagree with and their poor results are evident.

    you said “I think this can reflect an overly mechanical perspective with an underlying assumption of mechanical perfection that does not exist.”
    -Please define “overly mechanical perspective”. We have no idea what you mean? Mechanics play an integral role in sports. We are not advocating ignoring chemical or physiological issues. This blog is focused on therapists taking a leadership role which includes mechanics and other disciplines.
    We have no assumption of “mechanical perfection” nor have we said this. If you are suggesting we not strive to improve our athletes and we ignore any recognizable mechanical imperfections, than we respectively and completely disagree with your vision. Moreover, we feel therapists have a better trained eye to recognized mechanical imperfections and we are firmly standing by our vision that this is a positive attribute. By stating we want therapists to identify mechanical issues does not mean we don’t want therapists or other professionals to identify non classical mechanical issues (such as, pain not directly related to musculoskeletal disorders). We want to identify all problems and allow our therapists to have as much information available to them with diagnosing the athletes. The point is…let the therapists lead from the beginning.

    you said “It is also self fulfilling and risks medicalising the athlete unnecessarily”
    – What is “self fulfilling”? Do you have athletes without mechanical issues? Please contact us and we would like to see the methods you are using. We are always open to new ideas.
    Our clients have lower injury rates than our competitors, therefore, we lower the risk for “medicalising” the client. We stand by our system, the therapists see the issues earlier and before the client has a catastrophic failure.

    you said “what is the psychological impact of being continually told, implicitly or otherwise that there is something wrong with you? Does that increase or reduce the risk of “injury” – does it sensitise the athlete unnecessarily?”
    – We can’t answer your question because we don’t continually tell our athletes they have something wrong. If a therapist diagnoses them with a problem, they are notified. We are concerned you may have read a different article or have a separate agenda. The nature of training is to improve, therefore, we have a duty to thoroughly evaluate the athlete and identify problems. In our proposed system, a qualified professional is constantly evaluating the athlete.
    you said “The overuse of a bio-mechanical model with inadequate understanding of the very great range of factors that contribute to the individual experience of injury and pain may not be appropriate. While it is endemic to the athletic world to view the body as a machine to be honed it is in fact a less than accurate perspective.”
    – Do you not view the human body as a machine? For the purposes of performance training, we do. Our approach is based on science. To the best of our knowledge, electrical signals, chemistry, physiology, classical mechanics, etc are all under the umbrella of science and make up the human machine. In some respects the human is more complicated, but as scientists we love collaboration with all disciplines. If you are advocating we discuss philosophy or religious views of the human, although we enjoy those topics, we feel they are more appropriate in a different blog post.

    Conatus Athletics

    1. Thank you for your reply and apologies for being so tardy to respond.
      I must confess to be somewhat confused.

      You clearly state in the article,

      “This role is necessary due to our belief that athletes are NEVER “healthy” and always have musculoskeletal issues ”

      and subsequently in Adam’s reply to another post,

      “We firmly believe ALL athletes have injuries or disorders, therefore, the therapists should take the lead”

      Those are clearly in this article not in another and do not reflect a hidden agenda by me. Indeed you further suggest I am entering the realm of either religion or philosophy – perhaps you could clarify which realm these statements fall into given both are prepositioned by “belief” and “believe”? I also remain curious as to how you can hold these perspectives on one hand but then state in your reply that you do not tell the athletes they are injured. This would imply that you believe the above but do not communicate it further? That aside I was trying to pursue how you arrive at to such strong positions and my reference to biomechanics was an effort to grasp how you got there. Your reply provides little to no clarity on the matter although it did invite speculation.
      I realise that the object of this article was to raise issues of leadership and that is to be lauded but it does it not also mean you should explain how you arrive at some of your positions particularly when stated in such absolute terms?

      ANdy

  21. What a great topic. I commend Conatus Athletics on their desire to improve our current system of treating athletes. One, the collaborative component is a key factor as our knowledge of the human body and rehabilitation sciences grows exponentially. As experts on movement disorders, physical therapists are appropriately trained to take the leadership roles. I see sports PTs wanting and taking this role. I am curious if you see this model translating into other aspects of PT. Many PTs are afraid of this role. Second, as we saw PT move to a clinical doctoring profession, I suspect other similar professions may move that direction as well. How do you see your system evolving if these changes occur? Lastly, I am also curious about your outcomes. You have made some bold claims about the success of your system. The authors of this blog have advocated transparency and openness in research (http://ptthinktank.com/2012/03/18/publishing-in-science-are-industry-standards-serving-researchers-clinicians-and-science/). Are you willing to share your results and outcomes with us?
    I appreciate the work you and your colleagues are doing to advance human performance.

  22. You have over and over again degraded the athletic training profession. You talk about the “medical professionals” as you only list PTs and MDs. Guess what– Athletic Trainers are LICENSED HEALTHCARE PROFESSIONALS in most states.

    Your argument holds no credibility because you cannot recognize something that simple.

    1. Mike,

      Thank you for your participation here. I am sorry you believe this post degrades athletic trainers. Please provide some instances where this done? I don’t see explicit examples. No one here is trying to degrade or insult athletic trainers nor their training and skill. The discussion is around an innovative model of athlete management specifically in performance training and also more generally. This is not an attack on ATCs or their current role in athletics. Athletic trainers play a vital role. Paul plus others have acknowledged such multiple times, and in fact are not proposing a change in that role.

      Besides the perceived attack on athletic trainers, do you have any critiques or insights you can provide on the model and system proposed??

  23. “No one else in the scope of athletic performance management has the scope or unique vantage point that a physical therapist brings to the table. They can bridge the gap between medical expertise and sports performance/strength coaching.”

    “We are not excluding the opinion of the Physiologist, however, the buck stops with the guy/gal with the license to diagnose and as far as we know, that must be the therapist.”

    Both of which the Certified Athletic Trainer is MORE THAN QUALIFIED to do. Not just “the therapist.”

    “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.”

    If you honestly believe the PT is at the same level as a physician and everybody else is underneath those two, then you’re mistaken.

    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.”

    In this component, the Certified Athletic Trainer is not even included!

    And actually this system is in use around the nation already. Clinics owned by PTs use athletic trainers as revenue sources through high school outreach. Many of them simply require the athletic trainer to refer patients back to physical therapy where a physical therapist or a physical therapy assistant rehabs this individual often without understanding athletic performance. In this environment, the PT runs the show and instructs the PTA and the athletic trainer (in role of “untrained staff”) on what to do.

  24. I truly believe that a good sports medicine team includes the strength and conditioning specialists, the athletic trainers, the physical therapists, and an assortment of physicians. Working together, these professionals provide the best care for the athlete.

    What has many athletic trainers upset is that many PTs dismiss our abilities and knowledge. And those that believe PTs should be “in charge” of the athletic trainer. That’s simply wrong.

  25. Mike,

    We explicitly stated there would be challenging steps ahead for Physical Therapists to take on this role/model and scale it. We have looked at this role for more than a decade and the Physical Therapists we have recently spoken with recognize a need for curricula changes and residency / fellowship programs. We fully understand the difference between the MD and the PT , however, this is not the focus of this blog. Furthermore, this blog is in the context of performance training, not the ER, ICU, etc. It has been our experience that a group of collaborating Physical Therapists will correctly diagnose and set treatment for musculo-skeletal problems better. We have found a large number of Physical Therapists are (some are not) sincerely interested in improving and elevating their role in performance training.
    As far as the argument holding credibility and this model is already in use, we will be reaching out to you on your personal email and inviting you to come visit.
    We are not interested in turf battles between professionals.

    Thanks
    Conatus Athletics

  26. Good luck with your idea and clinic. I understand you are trying to elevate the profession of physical therapy in the realm of musculoskeletal disorders, and being a physical therapist and owning a private practice, I have the belief that we are ‘experts’ in this area. However, there are other professionals that can be included in this list of experts, including but not limited to PM&R physicians, Sports Medicine fellow trained physicians, ATCs. And I agree that a multidiscipline approach is needed for rehab and performance. And through quality care and building trusting relationships I have built a network of physicians, ATC, strength/conditioning coaches, personal trainers, etc that have respect for what I do, and I have mutual respect for what they do. I am sure this is the same relationships you have within your company. But stating that the PTs should have final say on an athlete’s program is quite limiting considering these other professionals may have evidence based beliefs that differ from the evidence based beliefs the PT has. In my offices we treat athletes at all levels, and sometimes the team physician leaves the return to sport date for us (the physical therapist) to decide and other times the ATC decides and other times the physician has justification for a return date. And I am sure you take all these professionals opinions into consideration and allow the PT to make the final decision. The possible factor that will be limiting this model from being ‘the gold standard’ is the political aspect. The blogs you are posting are sounding ‘ego-centric’ by naming the PT as the most knowing and this may not and probably will not sit well with the AMA. And the AMA has a lot more money than the APTA. For this to be more accepted by more disciplines maybe a board of musculoskeletal experts will be a better model than a ‘dictatorship’ of anyone discipline having the final say.

  27. As a former and soon to be again ATC I would echo Mike Hopper’s comments…
    You may not intend to disregard the ATC profession but it is in there.
    As Mike noted from the sections of this blog post and comments that follow you continually leave the ATC out of the list of allied health care professionals that are accredited to work with the treatment of orthopedic injuries and rehabilitation.

    And yes this does throw us back to the lawsuit between the NATA and APTA over scope of practice – which the APTA settled out of court:
    http://www.nata.org/NR092509

    I work closely with Gray Cook, Dr. Kyle Keisel, Dr. Phil Pliskey, Dr. Rob Butler and many other PTs without “turf battles” because of shared respect for both professions.

    ATCs, PTs should work together

  28. I agree with many comments suggesting that relevant experience with athletics is vital, regardless of profession. Further, I strongly support the idea of the physical therapist as the musculoskeletal diagnostician, in particular for potential of overuse injury and acute injury related to predisposing risk factors. I think the key point is not relying on making a diagnosis after pain or injury has occurred. A monkey can point to a spot on the body that hurts and give it a name (i.e. achilles tendinosis, “runner’s knee,” ITB syndrome) That doesn’t tell you a damn thing about how to go about treating it. The language of how we define injury needs to change from pathoanatomy to movement based dysfunction in order to understand how to treat/prevent. I believe physical therapists are most well equipped as a whole profession to do this. The type of people needed in this role are those who want to understand “why” in order to become the upstreamists (prevention-based) experts in this model.

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