What is your role?
A large percentage of rehabilitation and fitness facilities in this country still lack the understanding that rehabilitation and performance can and should be included in an integrated sports medicine model of care. Charlie Weingroff noted in a recent article that the delay in adopting this integrative approach is less likely due to a lack of knowledge by physical therapists that performance and rehabilitation should be delivered in parallel and more likely they don’t know how to deliver them in parallel.
To most of you reading this article, this is likely not a secret or front page news. And it shouldn’t be a surprise if I say that physical therapists aren’t the only culprits in this. I would venture to guess that a fair amount of you who aren't on this antiquated bandwagon didn’t start your professional career with this mindset either (particularly the more seasoned veterans in the crowd).
Through immersion in educational opportunities outside of the classroom, and guidance from those around you, you have come to understand and truly believe that the success of the client and better outcomes is largely dependent on the level of care we provide. You recognize that rehabilitation and performance must be interdependent on one another, encompassing an integrative sports medicine approach – and as such, we have developed world-class facilities that are champions of this movement (we all know who they are so need to list names!)
As Movement Resilience has championed before, prioritizing the athlete or client with a sports medicine approach is, and should be, the way we begin to approach care.
The first step to recovery is admitting there is a problem!
There is a problem that Charlie didn’t directly mention but definitely implied in his article: the formal education we receive does not prepare undergraduate or graduate students to be a part of this model as well as it should and has the ability to do. If it did, practicing professionals would not have difficulty delivering rehabilitation and performance together and certainly be more at ease with their role in this continuum.
I can firmly state this because as a practicing physical therapist, I did not learn this during my formal training. I immersed myself just as you did in all types of educational materials outside of the classroom. It was a team effort, mutual work put in by myself and those I learned from.
And as a Lecturer of Exercise Physiology and Program Director, I can tell you academics is slow to adapt. Rehabilitation and performance are not integrated in educational curricula and are still considered independent of one another. While we all agree that there is a practical gap between rehabilitation and performance, it’s time we recognize that there is also an educational gap between rehabilitation and performance.
There, I said it. And I feel much better getting it off my chest. Phew. This might be blasphemous coming from a member of higher education, but if we (everyone in this industry in some capacity or another) want to see continued development of this model and qualified co-workers and colleagues, academics needs to be honest with itself. Over the past five to ten years, while the model of care has been shifting toward a more integrative approach, academics has been slow to adapt.
This is a consistent issue that I encounter when talking to program directors at other universities across the country. It isn’t just the program I work in. In fact, I believe our program does a better job than most, but we are not exempt from regular self-evaluation. Academics does a very good job at preparing students, undergraduate and graduate, to regurgitate didactic information. The challenge has been and always will be guiding students to make clinical decisions and applying concepts to a variety of clients or patients which is needed when providing care along a continuum.
So I have been asking a simple question for just over a year: why is it that academics currently does not present this integrative approach and more importantly, how can this realistically be changed? Or even better: would we see an increase in utilization of the integrative rehabilitation and performance approach if we exposed students to this earlier in their career?
And what if we were all in this "revolution" together...(yes that means YOU!)
Steps in the right direction for all of us!
Academics does not need to revamp entire curricula to make an impact. In fact, academic undergraduate and graduate programs are necessary to ensure students have the scientific foundation that is imperative for sound reasoning skills when working with clients and athletes. For the most part, basic certifications such as the CSCS and EP-C require knowledge of this material; because of this, academics, to an extent, have their hands tied in terms of “free time” to add major curricula changes.
But there are certainly ways in which academics can adapt and evolve to promote and encourage the adoption of the integrated model on a larger scale. And likewise, there are definitely ways in which those of us currently in the field can help. What I am proposing here is a team approach, similar to our model of care. Academics needs to make some changes and we are fitness professionals must step in to help fill the areas where academics lacks.
Here are some of the ideas, some revolutionary and most not, that we should all explore as potential avenues to provide students greater exposure and understanding of the medical fitness and integrative sports medicine model:
Academics
· Inter-professional education: this one is definitely geared more toward academics. Create directed study courses that emphasize or prioritize this model, including practitioners from all arenas of the fitness and health industries. Nurses working with clinical lab, nutrition working with public health, exercise physiologists working with biomedical engineers, and any mix thereof.
· Practicums: Branch away from the typical model of internships and find places that embrace this integrative model of care. We should want our students there to help prepare for the current job market. Boston Physical Therapy & Wellness is a prime example of a facility universities should look to partner with.
· Degree tracks: Academic programs should be creative in how they develop degree pathways and incorporate the skills necessary to be ready for the integrative sports medicine approach. Reevaluate, reassess, re-work, repeat.
· Guidance is paramount: higher education needs to help guide the student toward the area within the sports medicine continuum where they will be best suited to be successful and make the biggest impact. Not every student is made out for Physical Therapy school, but encourage them to embrace their passion and focus them on other areas.
Fitness Professionals
· Guest speakers: if you have an expertise that you feel students should understand, reach out to your local university and volunteer your time. Academic institutions would welcome these experience-rich practitioners with open arms as a creative way to expose students to topics. I regularly reach out to professionals and they are more than willing to drop a knowledge bomb or two.
· Seminars: reach out to local universities when you have seminars at your facility or are providing seminars in the area. Encourage students to become an active part of the professional environment early on. Universities should encourage seminars on campus and develop seminar series where at least one is held on campus to students for free or at a largely discounted rate.
· Practicums: If you work in the integrative model, reach out to your local universities and bring students in! Expose them to the model early and both fitness professionals and clients and athletes will be better off in the long run. But don’t do all the work – students need be an active participant. I highly recommend this article by Peter Dupuis of Cressey Sports Performance about whether or not your facility’s internship is a one way street.
Summary
Prioritizing the client or athlete through the integration of rehabilitation and performance is the new work environment for strength coaches, performance coaches, physical therapists, and the like. And it should be! I believe we must also prioritize the student by properly educating and preparing them to be an integral part. However, this is a team effort and we all have a part in this process. An educator’s mission should be to help students identify which portion of that sports medicine team they are best at and fitness professionals must be willing to spread their invaluable knowledge. Let’s do this together!
Originally posted on Movement Resilience on March 15, 2016