Saturday, March 14, 2009

Put down the barbell and slowly back away...

This may get me in a bit of trouble but here I go. Many colleagues have taken issue with my stance on the role of physical therapists in the realm of exercise as well as strength and conditioning.

My stance is simple and begins with a simple observation: Physical therapists are the undisputed experts of rehabilitation science. Rehabilitation is a sub field within the broader category of movement science and is accompanied by other sub fields such as biomechanics, exercise physiology, neuroscience, motor control, and the like…

As sole title holders of "World Champions" of rehabilitation, exercise physiologists and biomechanists cannot and should not declare themselves rehabilitation experts. This observation is plainly obvious to most physical therapists (just ask one). We are happy to share this with anyone who is willing to listen as well as some who aren't.

So why then do we in physical therapy get so befuddled when those specializing in exercise science question our role in prescribing exercise programs for athletes and otherwise healthy individuals?

A recent discussion on the RehabEdge forum took place in which we debated the merits of athletic trainers in treating a nonathletic population. Without getting into the specifics of the debate, it was generally agreed that physical therapists can’t hold a trainer’s jock (so to speak) in the assessment and management of an acute athletic injury. At the same time we argued that trainers can’t hang with a PT in the majority of rehabilitation settings. To put it succinctly, while there is some overlap in skill set, there is clearly only one professional best suited for the job. Of course, many therapists and trainers are duly credentialed in both fields….all bets are off for you!

We aren't bad...but there is better.

Physical therapists, like doctors and other health care professions, should feel a natural pull toward providing general activity guidelines for patients. In this regard our role in healthy movement should not be underestimated. However it will be difficult to press on and be great in rehabilitation if we are trying to be all things to all people. There is a professional best suited to provide exercise advice and leadership, and it is not us.

Now would be a good time for a wary reader to point out my arrogance in claiming to be both. This would be a fair criticism, but for better or worse, I have graduate degrees and extensive training in human performance and physical therapy. Like those credentialed in both athletic training and physical therapy, I hold titles in both sub fields. With that said, it is tough for me to be good at both. I’m probably a much better physical therapist right now than I am strength and conditioning specialist. That’s OK though…my patients probably would want it that way!

Want to be an expert? Here's how to earn it...

So here’s my official position and recommendations for physical therapists wanting to become exercise professionals:

· Physical therapists are not exercise specialists and should lay limited claim to human performance training unless specific criteria are met.

· The first criterion is achievement of an advanced certification from either the American College of Sports Medicine or the National Strength and Conditioning Association. Sorry to the pretendors that I carefully excluded from this list. These two organizations represent the highest standards of the profession and offer numerous opportunities for increasing knowledge of exercise science.

· The second criterion is a graduate (preferred) or undergraduate degree in exercise physiology or related curriculum. This will provide a solid and specific academic background in exercise science. You can attempt to tell me a physical therapy curriculum is sufficient to achieve this knowledge, but you would also be wrong.

· In the absence of meeting either of the above criteria, the physical therapist should spend at least 2-3 years working in a fitness and human performance setting with a seasoned conditioning specialist. I have a tough time with this one, but realize that it isn’t easy to achieve both of the above criteria. Trying to give a little here…

Bottom Line

If you believe my recommendations to be unreasonable I would challenge you to have a discussion on a specific issue pertaining to exercise science with someone who has met the above criteria. You may think you have sufficient knowledge and understanding of exercise physiology and human performance, but the conversation may cause you to think twice. I strongly encourage those in the rehabilitation profession to do what you do best. If you want to be considered an expert in physical therapy, you know where to go. If you goal is to hold expertise in exercise as well, please apply the same rigor to your standards as we expect from other professions.


The first podcast is currently “in production” and I hope to have it up and running soon faster than I expected. Thanks for visiting and I’m looking forward to talking to you soon. If you have a question or comment, please don’t hesitate to contact me and I’ll try to address it on the podcast. Take care.


  1. Woah... I can identify with what you are saying.. but...

    I have worked with and/or learned from many PT's who understand exercise because the under stand movement so intimently. And I have applied information from CSCS and ATC's that has helped me treat my patients.

    I think if we look just at academic training and one goes no farther then yes-There is a split.

    It is how you develop, educate yourself, and continue to apply your knowledge that dictates what area of practice that you excel. For example Performance enhancement is something of a niche wether you are a trainer, ATC, PT,etc. You must know the sport, exercise physiology, required movement patterns, specific exercise and additionally understand injury and healing.

  2. I can't disagree with you Amy. This is mainly a "If I ruled the world" post. There are many therapists out there who are really sharp with their understanding of movement as it applies to exercise.

    However having worked on both sides of the issue I can tell you that there is a pretty wide variation in aptitude when it comes to physical therapists and exercise. That being said I couldn't agree more with your comment about developing your individual abilities. These would simply be my guidelines based on the experiences I've had over the years. Thanks again for reading.

  3. Hey Rod. Nice post. I appreciate your knowledge on the subject and it is nice to hear a well balanced argument on the subject. Now let me ask a separate question. Do you think the groups are moving toward each other? Education and the certs offered by groups such as the NSCA such as the CSCS*D and other medical rehab specialist certs seem to indicate a change on the horizon Too spicy? What do you think?

    Would love to get your thoughts, as I am having a very healthy discussion on my blog about this topic and to get an opinion on the matter from someone with your experience would mean a great deal to me.

    Jamie Atlas of Fitness Insights