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What is a Sports and Exercise Physiotherapist?

Sports and Exercise Physiotherapists are involved in the prevention and management of injuries resulting from sport and exercise participation at all ages and at all levels of ability. These specialised physiotherapists provide evidence-based advice on safe participation in sport and exercise. Furthermore, they promote an active lifestyle to aid individuals in improving and maintaining their quality of life. Sports and Exercise Physiotherapists also play a huge role in helping athletes of all ages and all levels of ability to enhance their performance.[1] Grant et al. [2] summarises the role of the sports physiotherapist as follows: “The essential role of the sports physiotherapist is to provide treatment and rehabilitation of injuries and also to provide support for performance through injury prevention, maintenance and recovery interventions.”

hat do Sports and Exercise Physiotherapists do?

The New Zealand Sports Physiotherapy organisation defines a sports physiotherapist as:

“A recognized professional who demonstrates advanced competencies in the promotion of safe physical activity participation, provision of advice, and adaptation of rehabilitation and training interventions, for the purposes of preventing injury, restoring optimal function, and contributing to the enhancement of sports performance, in athletes of all ages and abilities, while ensuring a high standard of professional and ethical practice.”[1]

Sports and exercise physiotherapists work in a wide variety of settings. Many work with active recreational athletes in private practice or clinic settings. They can also be involved in social and club-level sports and attend training sessions. Sports and exercise physiotherapists often work in the elite athlete setting in competitive and professional sports, working, and travelling with elite individual athletes or teams, and integrating their services with other medical professionals, coaches, strength and conditioning personnel and other support staff. Sports and exercise physiotherapists are also actively involved within various sporting organisations to coordinate physiotherapy services, injury prevention, rehabilitation, and injury surveillance programmes.[1]

Sports and Exercise Physiotherapy Roles and Competency Areas

Ashton[4] outlines advanced competencies of the sports physiotherapist in the promotion of safe physical activity participation, provision of advice, adaptation of rehabilitation and training interventions, for the purposes of preventing injury, restoring optimal function, and contributing to the enhancement of sports performance, in athletes of all ages and abilities, while ensuring a high standard of professional and ethical practice. The role of the physiotherapist does vary and can depend on:

  • The sport they are involved in
  • Their specific role within the team
  • The performance level of the sport, local level or international, amateur or professional.

The International Federation of Sports Physical Therapy (IFSPT)[5] states that “sports physiotherapy is a growing specialisation in cultures that strive to promote an active lifestyle and athletic excellence”. The Sports Physiotherapy for All (SPA) describes “effective professional behaviour and the integration of specific knowledge, skills and attitudes for the context of practice as a sports physiotherapist.”[6] As part of the Sports Physiotherapy for All project, eleven competencies have been identified that is required for sports and exercise physiotherapists. Along with these competencies are a set of specific skills or standards that needs to be upheld. These competencies and standards[7] are related to the various overlapping roles that the sports and exercise physiotherapist fulfil. The various roles and competencies can be[7]:

  • Manager of the client/patient[7]
    • Injury prevention
      • Sports and exercise physiotherapists assess the risk of injury associated with participation in a specific sport or physical activity. They are equipped to inform and train athletes, coaches and other members of the multidisciplinary team in such a way that there is a reduction in occurrence and recurrence of specific injuries.
    • Acute intervention
      • Sports and exercise physiotherapists have the skills to respond appropriately to an acute injury or illness in various contexts, such as training or competition.
    • Rehabilitation
      • Sports and exercise physiotherapists utilise clinical reasoning and therapeutic skills to assess and diagnose sports-related injuries. Furthermore, they are skilled in designing, implementing, evaluating and modifying evidence-based interventions that allow for a safe return to the athlete’s optimal level of performance in their specific sport or physical activity.
    • Performance enhancement
      • Sports and exercise physiotherapists contribute to the enhancement of the athlete’s performance through evaluation of the athlete’s physical and performance-related profile and can advise or intervene to optimise performance in a specific sport, within a multidisciplinary team approach.
  • Advisor[7]
    • Promotion of a safe, active lifestyle
      • Sports and exercise physiotherapists are competent in working together with other professionals in the multidisciplinary team environment to promote safe participation in sports and physical activity for individuals of all abilities. It is expected that they provide evidence-based advice regarding the optimal activity or sport for a specific individual as well as advice on the ways to minimise the risk of injury and promote health.
    • Promotion of fair play and anti-doping practices
  • Professional leader[7]
    • Life-long learning
      • Sports and exercise physiotherapists maintain and improve their clinical standards by critical, reflective and evidence-based approaches to practice. They engage in a continual process of learning and teaching throughout their career and collaborate actively with other professionals.
    • Professionalism and management
      • Sports and exercise physiotherapists are competent in the management of time, resources and personnel. They achieve this in a professional, legal and ethical manner. They also promote and facilitate professional development and excellence.
  • Innovator[7]
    • Research involvement
      • Sports and exercise physiotherapists are informed and evaluate their practice in relation to latest information. They identify questions for further study and are invested and involved in research that addresses these questions at various levels.
    • Dissemination of best practice
      • Sports and exercise physiotherapists disseminate latest information and research to other professionals within the multidisciplinary team set-up through different media such as team communications, conferences, special interest groups, research collaborations, and meetings, as well as published material such as reports, journals promotional documents, newsletters, and the internet.
    • Extending practice through innovation
      • Sports and exercise physiotherapists encourage and promote the application and integration of new knowledge and innovation within the multidisciplinary team practice and decision-making processes. They also influence further research and innovation directions.

The full document on Sports Physiotherapy: Competencies and Standards[7] are available on the website of The International Federation of Sports Physical Therapists (IFSPT)[5].

Technical and Non-Technical Competencies

Ian Gatt, a sports physiotherapist with vast experience in professional and Olympic sports, divides competencies into two categories: Technical Competencies vs Non-Technical Competencies.[8]

 
Technical CompetenciesNon-Technical Competencies
Hard skills required to be effective in your work environment (acute trauma management, mobilisations or manipulations, soft tissue mobilisation, acupuncture, taping, rehabilitation, etc)Soft skills required to “fit” in your environment:

  • Personality
  • Ethos
  • Communication

These will influence athlete interaction and multidisciplinary team interactions and considerations.

Developing Sports Physiotherapy Expertise

Becoming an expert in sports can be developed through specialisation in sports physiotherapy as part of lifelong learning.[9] Tawiah et al.[10] characterises specialisation as “having in-depth knowledge, skills and competencies in a specific area of practice.” The International Federation of Sports Physiotherapy (IFSPT) has a specialist recognition process that involves certification by member organisations.

Developing sports physiotherapy expertise is a gradual process, usually starting with formal university education in physiotherapy, then specialising through clinical experience and informal learning.[11] Phillips and Paterson[12] developed a model of how a physiotherapist advances from novice to an expert in decision-making and the development of skills. This model categorises learning into[12][13]:

  • Technical (scientific and skill-based)
  • Creative (adapting decision-making and techniques to clinical situations)
  • Contextual (self-awareness and the ability to adapt behaviours within wider cultural and situational circumstances)

Read more on this here:

The Role of the Sports and Exercise Physiotherapist in International/Elite Sports

Physiotherapy has become an integral part of the sports medicine team and has a crucial role in the management of injuries during major international events.[14][15] At the London 2012 Olympic Games, physiotherapists formed the largest professional group working at the Olympic Games. The essential role of the sports physiotherapist in international and elite sports (and in all other levels of sport, for that matter) remains to provide treatment and rehabilitation of injuries and to provide performance support through injury prevention, maintenance and recovery interventions.[2]

The common perception of the role of the sports physiotherapist in supporting athletes during competition or major games seems to be that the physio is a “provider of treatment interventions related to specific injuries.”[2] From recent studies it is evident that sports physiotherapists are also playing a much bigger role in supporting uninjured athletes.[2] During the London 2012 Olympic Games, athletes attended physiotherapy services in the absence of injuries. A reasonable assumption for this may be that the physiotherapy sessions focused on maintaining physical function, as well as aiding in recovery, have a place in supporting athletic performance.[2] It was also evident that athletes required follow-up visits for the same condition/injury and that muscle injury were the most common. Furthermore, the non-injury related physiotherapy sessions/encounters reflected the need for maintenance of the musculoskeletal system, injury prevention strategies and assistance with recovery.[2]

According to Grant et al.,[2] sports physiotherapists working with international/elite athletes also face the challenge of the ongoing management of pre-existing conditions. Overuse injuries among athletes were identified as the most common reason to attend physiotherapy services (44%).[2]

It is evident that the role of the physiotherapist within the sphere of international sport, is vast and that the role goes beyond the treatment of injury and rehabilitation, to a much broader role which includes providing assistance with musculoskeletal maintenance and recovery as well as injury prevention strategies and supportive rehabilitation.[14]

Sports physiotherapists are also in a unique position to be able to take on leadership roles. The broadness of the sports physiotherapist skill set, which includes skills such as understanding acute care management, exercise and evidence-based approaches to injury prevention and treatment, as well as general strength and conditioning concepts, enables sports physiotherapists to oversee the healthcare of athletes in various sporting codes.[16] Another benefit is the great amount of time that sports physiotherapists spend working directly with the athletes.

Athletes’ Perspectives on the Role of the Sports and Exercise Physiotherapist

The role of the sports physiotherapist

“What does a sports physiotherapist do?”

Athletes have a clear, but sometimes limited, understanding of the role of the sports physiotherapist. They see the role of the sports physiotherapist as mainly injury-focused. In interviews with athletes on the role of the sports physiotherapist, the following four themes emerged[17]:

  • Injury treatment
  • Injury prevention
  • Rehabilitation
  • Performance enhancement

“What should a sports physiotherapist not do?”

  • Break medical confidentiality – this highlights the importance of trust between the athlete and the sports physiotherapist
  • Become complacent about their position – athletes expect their sports physiotherapist to engage in continual professional development and should be striving to better their abilities, just like athletes do.

Qualities of a sports physiotherapist

Athletes indicated that these qualities are important for sports physiotherapists to possess[17]:

  • Being professional
  • Good personal qualities
  • Being accessible
  • Good communication skills
  • Have an interest in the athletes that they are working with
  • Being open-minded with regards to athletes’ ideas regarding their management and the use of other practitioners

“A sports physiotherapist should be patient, persistent, have a high level of competency, know when to refer, understand the emotional and psychological demands of the sport and be a good communicator with athletes and coaching staff.”[17]

Qualities that athletes do not like to see in sports physiotherapists are:

  • Bad personal qualities
  • Being unapproachable
  • Not being a team player

Athletes’ expectations about physiotherapy in sports injury rehabilitation

Quartey et al.[18]conducted a cross-sectional qualitative study exploring athletes’ expectations about physiotherapy in sports injury rehabilitation. It was shown that athletes have high expectations of physiotherapy for sports injury rehabilitation and that the level of competition had a significant association with athletes’ expectations.[18] The different factors of athletes’ expectations investigated were[18]:

  • Acceptance
  • Motivation
  • Attractiveness
  • Responsibility
  • Directiveness
  • Empathy
  • Confrontation
  • Nurturance
  • Genuineness
  • Openness
  • Outcome

Athletes in this study showed high expectations for all of these factors. However, the most influencing factors that affected athletes’ expectations were: directivenessnurturance and genuineness.[18] These factors are linked to accurate expectations. Athletes expect a high level of professionalism from physiotherapists and furthermore expect physiotherapists to thoroughly explain their injury and outcomes of rehabilitation. Physiotherapists should provide clear direction on rehabilitation, but be nurturing and provide support throughout the rehabilitation process and always be genuine and honest.[8]

Achieving sporting success

“How does sports physiotherapy help you achieve your sporting goals?”

When athletes were asked this question, their response again mainly reflected on injury focus i.e.:[17]

  • Help to recover from injuries
  • Prevent injuries

However, there was also a change in perspective noted. Athletes acknowledged the role of the sports physiotherapist in preventing and managing injuries, but also placed emphasis on sports physiotherapists helping them to train for increased duration and intensity without becoming injured.

Physiotherapy treatment techniques

Athletes feel that the following treatment techniques are beneficial[17]:

However, this is also dependent on athletes’ exposure to the range of treatments. Athletes feel that the physiotherapist is the expert and they put their trust in the physiotherapist to resolve any injury issues that the athlete might have.[17]

The Sports Medicine Team

Now we have examined our role as a Sports Physiotherapist and the competencies required, how do we fit within the bigger Sports Medicine Team. This can vary across the type of sports environment you may be working in. In many cases working with your local sports teams, whether it is support at training or competition, you may be the only sports medicine professional working directly with the athlete and team. In this situation, you have to make decisions in relation to removal from the field, injury management and return to play independently. Working with National Teams and Professional Sports Teams can be quite different, in many cases, you may be just one sports medicine professional in a much larger team network providing services to the team. Sports Medicine is such a wide area and this lends itself to being practised by a multidisciplinary team of professionals. Each of these professionals has a certain set of specialised skills to provide optimal care for the athlete, but also to improve the knowledge and skills of their colleagues.[19][20]

The most appropriate sports medicine team depends on the setting. As mentioned working with your local sports club the sports medicine team may consist of a family physician or physiotherapist alone. In professional sports teams or at major events such as the Olympic games the sports medicine team may consist of:[20]

  • Family physician
  • Physiotherapist
  • Sports physician
  • Massage therapist
  • Athletic trainer
  • Orthopaedic surgeon
  • Radiologist
  • Podiatrist
  • Psychologist
  • Dietitian/nutritionist
  • Exercise physiologist
  • Coach
  • Fitness advisor
  • Sports scientist
  • Biokinetics

The sports medicine model

The traditional medical model has a physician as the primary contact practitioner with subsequent referral to other medical and paramedical practitioners. The sports medicine model differs from this. The athlete’s primary contact may be with a physician, but it can also be with the trainer, the physiotherapist or the massage therapist. Athletes prefer to see the practitioner that they have the best relationship with or the one that they are used to seeing the most. This makes it important that all members of the multidisciplinary sports medicine team are aware of their own strengths and limitations, and also be aware of the skills of the other members and refer to them in order to provide the athlete with the best possible management.[19]Always remember that the management and rehabilitation is athlete-centred.

The coach, the athlete and the physiotherapist

The sports physiotherapist needs to have a good relationship with the athlete. There needs to be a feeling of mutual trust and confidence. This implies that the athlete will feel that he/she can confide in the physio and the physio will feel that the athlete will comply with the advice given.

The coach is responsible for the athlete’s training and performance and it is vital to involve the coach in the medical decision-making process. It is, unfortunately, the case that some coaches have a distrust of healthcare professionals in sport and they sometimes have the opinion, rightly or wrongly, that the main role of the health care professional is to keep the athlete from training or competing. It is important for coaches to understand that the sports physiotherapist also aims to maximise and improve the performance and health of the athlete.[19]

Getting the coach involved in the decision-making process and also explaining the rationale behind recommendations will actually also increase athlete compliance. The coach can be a valuable asset in supervising the recommended treatment or rehabilitation program, and discussions with the coach may help determine possible causes for an injury.[19]

Having a good relationship between the coach and sports physiotherapist is a win-win situation for everyone. The coach will have a better and clearer understanding of what the sports physiotherapist does and this can lead to seeking help for minor problems, which in turn can lead to injury prevention. The sports physiotherapist can learn from the coach and have a better understanding of the demands of the sport and this can aid in the institution of injury prevention measures.[19]

The Fun of Working in Sports

Why do sports physiotherapists enjoy working in sports? Some reasons may include[8]:

  • Flexibility
    • Mode: contractor/part-time/full-time
    • Level: elite/sub-elite
      • Olympic/professional/amateur/schools
    • Numbers: individual athletes/teams/squads
    • Environment: indoor/outdoor/extreme sports
    • Types: combat/racing/ball/water/athletic/target/extreme
    • Location: centralised vs multiple sites vs remote (satellite)
    • Funding: remuneration/resources
    • Collaboration: internal/external stake holders and multidisciplinary team
    • Professional development plan: how to get there and keep on progressing
  • Diversity
    • The different roles a sports physiotherapist can fulfil:
      • Pitchside assessment and management
      • Treatment and rehabilitation
      • Screening
      • Objective testing e.g. isokinetic machines
  • Success
    • Being part of the team’s or athlete’s success

Although being a sports physiotherapist seems glamorous, one still needs to be cautious about your goals and achievements. Also, have realistic expectations about the different environments you would need to work in, the long hours and the available facilities that you will encounter.[8]

Thoughts and advice

Final Thoughts

Some final thoughts to bear in mind on your road to becoming a sports physiotherapist[8]:

  • As a sports physiotherapist always consider the two elements of athlete health and performance enhancement
  • Consider the rewards as well as the challenges of being a sports physiotherapist
  • Keep in mind the technical and non-technical competencies required to make a difference
  • Have a clear vision and mission on how to become a sports physiotherapist or how to become an even better one

“Love thy sport”

It is essential to know and love the sport that you are involved with if you want to be a successful sports physiotherapist. Furthermore, it is essential to be an advocate for physical activity. Sports physiotherapists need to understand the importance of the sport to the athlete, as well as the physical (training and technique) and psychological demands of the sport. Having a good understanding of a sport and exercise provides two important advantages[19]:

  1. If a sports physiotherapist understands the demands and technical aspects of a sport, this will improve their ability to recognise possible causes of injury and facilitate the development of sports-specific rehabilitation programmes.
  2. The athlete will have confidence in the sports physiotherapist.

One of the best ways to learn about a sport and understand it is to attend both training and competition or to even participate in the sport. Being on site during training sessions and competition, not only to aid with injuries but also to develop a good understanding of the sport will help with this.

Source Credit: https://www.physio-pedia.com/The_Role_of_the_Sports_Physiotherapist

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Thomas Bloem
Thomas Bloem

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