Sports Medicine: Behind the Sport Scenes

Sports Physiotherapy

Have you ever wondered what happens behind the Sports scenes in terms of athlete preparation during pre season to in season? Here is a preview in the sports medicine perspective.

Our role as Sports Physiotherapists involve in the prevention and management of injuries resulting from sport and exercise participation at all ages and at all levels of ability. Our specialization provides evidence-based advice on safe participation in sport and exercise. Furthermore, we 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.

The Key Roles of Sports Physiotherapists

1.Injury treatment

2.Injury prevention

3.Rehabilitation

4.Performance enhancement

These are some of the Competencies and Standards that are related to the various overlapping roles that the sports and exercise physiotherapist fulfill

The various roles and competencies can be 

1. Manager of the client/patient  

     a) Injury Prevention

Sports and exercise physiotherapists assess the risk of injury associated with the 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

b)                 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

c)                  Rehabilitation

Sports and exercise physiotherapists utilize 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 aim for a safe return to the athlete's optimal level of performance in their specific sport or physical activity

d)                 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 optimize performance in a specific sport, within a multidisciplinary team approach

e)                  Advisor   

i.         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 of them to provide evidence-based advice regarding the optimal activity or sport for a specific individual as well as advice on the ways to minimize risk of injury and promote health.

ii.         Promotion of Fair Play and Anti-Doping Practices

Sports and exercise physiotherapists participate and promote safe, professional and ethical sporting practices. They strongly advocate for fair play and their duty of care for the athlete. They adhere to the International Sports Physiotherapy Code of Conduct on Doping.

f) Professional Leader

ü 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

ü 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.

g)                 Innovator

i.         Research Involvement

Sports and exercise physiotherapists are informed and evaluate their practice in relation to new information. They identify questions for further study and are invested and involved in research that addresses these questions at various levels.

ii.         Dissemination of Best Practice

Sports and exercise physiotherapists disseminate new 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, meetings as well as published material such as reports, journals promotional documents, newsletters and the internet

iii.         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.

Key Skills of the ports Physiotherapists

For the sports physiotherapist to be able to carefully perform the above roles, he or she should be able to have key skills in the following sports physiotherapy areas of expertise

·       Manual Therapy (Mobilization)

·       Sports Rehabilitation

·       Exercise Prescription

·       Sports Massage

·       Manipulation

·       Exercise prescription

·       Dry Needling/Acupuncture

·       Strapping and Taping

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 lone 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 practiced by multidisciplinary team of professionals. Each of these professionals have a certain set of specialized skills to provide optimal care for the athlete, but also to improve the knowledge and skills of their colleagues.

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 sport teams or at major events such as the Olympic games the sports medicine team may consist of  

·       Family physician

·       Physiotherapist

·       Sports physician

·       Massage therapist

·       Athletic trainer

·       Orthopedic surgeon

·       Radiologist

·       Podiatrist

·       Psychologist

·       Dietitian/nutritionist

·       Exercise physiologist

·       Coach

·       Fitness advisor

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 the 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.

The coach, the athlete and the physiotherapist

The sports physiotherapist needs to have a good relationship with the athlete. There needs to the 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 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 maximize and improve the performance and health of the athlete.

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  

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 physiotherapists 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

"Love thy sport" Take Home

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

If a sports physiotherapist understands the demands and technical aspects of a sport, this will improve their ability to recognize possible causes of injury and facilitate the development of sports specific rehabilitation programs.

The athlete will have confidence in the sports physiotherapist.

For those who are interested in becoming sports physiotherapists

Here is how to become one:

www.sportsinjuryclinic.net. How to become a Sports Physiotherapist. Available from: 

https://www.youtube.com/watch?v=taXSXxYHX9c 

References

1.    Sports and Exercise Physiotherapy New Zealand. What is Sports and Exercise Physiotherapy. Available from https://sportsphysiotherapy.org.nz/what-is-sports-physiotherapy/. (accessed 13 September 2019).

2.   Ashton H. Sports physiotherapy advancing in New Zealand. Br J Sports Med. 2015 Jul;49(14):903.

3.   International Federation of Sports Physical Therapists. Available from https://ifspt.org/. (accessed 13 September 2019)

4.   Bulley C, Donaghy M, Coppoolse R, Bizzini M, van Cingel R, DeCarlo M, Dekker L, Grant M, Meeusen R, Phillips N, & Risberg M.Sports Physiotherapy Competencies and Standards.2004. SportsPhysiotherapy For All Project. [online] Available at: www.SportsPhysiotherapyForAll.org/publications/

5.   Grant ME, Steffen K, Glasgow P, Phillips N, Booth L, Galligan M. The role of sports physiotherapy at the London 2012 Olympic Games. Br J Sports Med. 2014 Jan;48(1):63-70.

6.   Lifshitz L. A sport physiotherapist as medical director: taking a leadership role. J Orthop Sports Phys Ther. 2012 Sep;42(9):748-9.

7.   Woods A, Woods CB. An exploration of the perspectives of elite Irish rowers on the role of the sports physiotherapist. Phys Ther Sport. 2012 Feb;13(1):16-21.

8.   Brukner P, Khan K & colleagues. Clinical Sports Medicine. 3rd ed. Sydney. McGraw-Hill. 2007.

9.   Magee DJ, Zachazewski JE, Quillen WS, Manske RC. Chapter 1: Role of Sports Medicine Team , Athletic and Sport Issues in Musculoskeletal Rehabilitation. Elsevier Health Sciences; 2010

10. ww.sportsinjuryclinic.net. How to become a Sports Physiotherapist. Available from: https://www.youtube.com/watch?v=taXSXxYHX9c [last accessed 16 September 2019]

11. www.sportsinjuryclinic.net. The Benefits of being a Sports Physiotherapist. Available from: https://www.youtube.com/watch?v=UoDti5VSOWY&t=1s [last accessed 16 September 2019]