I was asked to comment on a thought provoking blog post on MyPhyscialTherapySpace.com.  There is ongoing discussion with respect to the exact role a therapist should play in the continuum of care for patients.  I enjoyed reading the posts on there and I have posted my reply on my blog for you to see (not to mention the fact the blog site would not let me post my entire repsonse in a single comment).  To read the original post click the link below:


Now my comments…….

I would say as a cash based practitioner currently living in the sports performance and post-rehab fitness realm (I own a fitness training facility), I would say that many of my therapy colleagues do not truly understand how to push and/or fully rehabilitate people to a high enough level that meets the pre-injury functional capacity.

I often see referrals that have already failed traditional rehab or are getting inadequate therapy.  Why?  In many cases, PT’s are following basic protocols, not supervising exercise progression closely enough, moving too slowly or in some cases (ACL rehab) moving too fast.  I also find clinicians are often hesitant or perhaps unwilling to change treatment progressions within the sessions, reps or sets even if the client’s response to the stimulus indicates such a change.



I tend to agree that therapists possess the necessary knowledge and skill set to alleviate musculoskeletal problems through treatment, but yet they tend to stop as symptoms subside or are alleviated.  I think we are drilled in school that once we alleviate pain, we have often done most of our job.  I think we can partly blame insurance companies/managed care for this, but I also agree with an earlier post that asserted that therapists may simply not be great at the fitness side of things.  Due to a lack of knowledge here, the early discharge or basic HEP becomes the norm.

Admittedly, I spent years studying/observing with ATC’s and other respected authorities in the S & C realm before I had a better handle on training.  Working with youth to pro athletes has also helped me see what it takes to do full functional progressions  and challenge the human body enough to get the desired results without exposing it to injury risk.  This is a fine line indeed.

I also think therapists often unfairly assume they know so much more about exercise than trainers and this is simply not true in many cases.  There needs to be a proper integration between the fields to restore most people to full function, especially when they seek a higher level of function.

What is the answer?  I suggest finding your niche and working to be the best within it.  Therapists really need to lead in the rehab realm and then be able to hand off patients to qualified strength coaches or trainers once the rehab process indicates it is time.  I have been on both sides of this equation and currently get many referrals from PT’s who know their patients are ready for the next step.

In reality, insurance companies are just not willing to pay for return to play training, so finding and working with qualified fitness pros will only make your outcomes even better and hopefully reduce the risk for a future injury too.  We have much work to do in both the rehab and fitness world, and learning how to utilize the best from both worlds to ideally suit the needs and demands of each individual client is the way to go.

In the end, I believe PTs should focus on rehab unless your role specifically takes you into the sports training or fitness world, as it is really hard to be a master of both and the trainers/strength coaches need the direction of the PT to complete effective post rehab and return to play training.  Deepening your knowledge and application of exercise at a higher level will only help to facilitate and improve this collaboration moving forward.