Young Guns

I just wanted to say congratulations to a few former students of mine who recently earned their licenses. They graduated from UTMB back in December and are all gainfully employed! I was very fortunate to have them as students and am now privileged to call them colleagues. Congratulations and best of luck to Anne, Andrew, and Ryan. I'm very proud of you all and wish you all the best.

Rod

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.

P.S.

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.

Class Dismissed...

Just got back from Lubbock and feel like a charged capacitor...

There are so many thoughts and ideas running through my brain that it will be a true test for me to sit still long enough to articulate them. Fortunately my wife, blog, colleagues, and my upcoming podcasts will give me a nice steady discharge of this energy as opposed to blowing all at once!

The origin of my excitement is my experience at a recent contact session for my Sc.D. program at Texas Tech. The title of the course is "Motor Control in Orthopedics" and is basically part two of last semester's "Neuroscience in Orthopedics" course. The weekend began with a review of the motor control principles we independently studied over the last eight weeks. Information processing, attention and memory, peripheral and central contributions to movement, motor learning and practice...these were all reviewed and discussed with our course (and program) director Phil Sizer.

The second component of the course jumped over into practical application where we discussed issues pertaining to motor control and syndromes of the cervical and lumbar spines, shoulder, knee, and ankle. The vast majority of slides and resultant discussion stemmed from the peer-reviewed works of people like Hodges, O'Sullivan, Powers, Hewett, Falla, Jull, Flynn, Childs, and many MANY others. From this standpoint, the information presented was a good representation of the state of motor control as it pertains to our profession.

This information was juxtaposed with Phil's infectious passion for the material and synthesis. The result was the generation of great (raw...but great) ideas regarding management from my fellow classmates. I have to say from this perspective it was very inspirational. I will admit my threshold to excitation is a bit on the low end at times, so take that for what it's worth...

NOW. There were a few occasions on day two where I seemed to scratch my head. As positive as I am about the course, I have some questions/concerns about our integration of these topics. Predictably my concerns pertain to things like the relevance of feedforward TrA activation, hip weakness in anterior knee pain, etc...

• What is the relationship between lumbar muscle dysfunction and LBP? We know the relationships are there, but identification is not sufficient to place them in proper perspective. Despite our eagerness to dive into and "treat" these areas with various activity programs such as "core training", a stricter adherence to principles of motor control may cause us to rethink our current approaches. (more on this soon!)



• What are the relationships between hip muscle strength and anterior knee pain? We often see measurable decreases in hip capability in the presence of knee dysfunction. However this observational statement is only the beginning. Is this relationship causal or simply correlative? If it is causal, are we confident which came first? The answers have not been clearly defined and have profound implications for evaluation and management.
  

I believe the answers will become clearer as we begin to integrate clinical observations (weak hip abductors, functional instability, etc...) with our emerging understanding of neuroscience and motor control. Over the next several weeks, I hope to present examples and arguments in favor of integrating these fields of movement science and the evolution of understanding that they can bring. I am excited to share this with you and look forward to your questions and comments!