Monday, August 20, 2012

The Therapist - Trainer Divide

The Strength and Conditioning world has taken a turn for the better lately. There is more and more work being done by strength coaches that will help an athlete prevent injury or recover from an injury. Strength coaches are delving more and more into the world inhabited by Athletic Trainers (AT's) and Physical Therapists (PT's).

This has nothing to do with anything.
Currently, there are a few top-tier strength coaches that are doing quite well blending Strength and Conditioning and Pre/Re-hab work. Coaches like Eric CresseyMike Ranfone and Dean Somerset are more or less leading the way for this new "breed" of coach that understands the need to do more than just get hyooge and strong.

Athletic Trainers, I'm learning, are more and more open to new techniques and research. They are moving beyond taping, ice and e-stim as a way to keep athletes healthy. More and more they are paying attention to things like the Functional Movement Screen and the work of Dr. Stuart McGill. There are also many more Athletic Trainers who are picking up on the benefits of soft-tissue work; ART, Graston and Trigger Point Therapy (to name a few).

Now, we come to Physical Therapists. Because their card starts with "Dr." everybody assumes they know everything about everything. With a few notable exceptions like Dr. McGillMike Reinold and Kelly Starrett it is getting pretty hard to find a PT who will think outside of the box.

Maybe I notice it more because of the people that I work with (general population clients), but anytime a client/friend of mine goes to see a PT about something, they come back with the same damn treatment sheet. Everybody is given a pre-written print-out with a list of exercises and demonstrations on them. Then they go back into the office for some e-stim or ultrasound and they do the exercises with a PT. 6 weeks later, problem solved!

I doubt it.

What makes any health professional think that every similar case can be solved the same way? Can every ACL tear really be fixed with the same print out? Why is it that more PT's don't take a patient-by-patient approach? I have a sneaking suspicion it has to do with their connection to the health care/insurance system. Due to their fear of losing all the income generated by Doctor referrals, PT's are too nervous to try any new modalities.

A recent conversation between myself and a PT friend regarding an athlete of mine sparked these thoughts. This particular athlete puts in a ton of miles running every week, in addition to my weight training program. She had been having some general anterior knee pain post-run and asked us (individually) about it. My suggestion was to ice, tone down her mileage and lighten the load a bit during her knee-dominant lower-body exercises (squats, lunges, etc). The PT's suggestion? Stop squatting, or stop squatting with a full range of motion. Without ever having seen her squat (I taught her) he automatically assumed it was the squat causing the problem. He also did this without reading the plethora of recent research which shows that partial range of motion squats exert more stress on the anterior portion of the knee capsule than full range squats which increase capsular stabilization at end-range. While I feel that this friend is an exceptional PT, he still tends to follow the dogmatic principles of a traditional therapist.

Clearly, PT's are a necessity. They do lot's of good work that other health professionals can't do. I, by no means, intend to belittle their profession. But if you are an athlete, a weight lifter or an active individual and need to go see a PT please make sure you do your homework. They are not all cut from the same cloth, and you need to make sure yours has views that fall in line with your own goals.

Take care. Go lift some heavy shit!


  1. I know you wrote this a little while ago, but just catching up now, I have to comment. As an AT myself who leans strongly on the strength training side of therapy, I love what you've written here. I recently had a new student-athlete come to me with a chronic knee condition, and some notes and exercises he had gotten from a PT back home. Those exercises included some generic self stretching, and the most basic of "exercises", none of which seemed appropriate to me. After doing my own full eval, it was blatantly obvious that this particular athlete was lacking both VMO strength AND hip external rotator/glute strength, which was causing some serious postural defects and faulty movement patterns. The note form the PT included NOTHING of that type of finding from their eval. Frustrating to say the least,but at least I know he's in good hands now!

  2. Stephanie, this is exactly what I see far too much of. I certainly don't expect all physical therapists to be versed in strength and conditioning stuff, but it would be nice for them to take more of an individualized approach to treating people (both gen-pop and athletes).

    Good catch, and good luck!