Are S&C Coaches Or Physiotherapists The Real Exercise Professionals?

This week's post is on an article I read in the blog from the British Journal of Sports Medicine where the author asked whether physiotherapists or strength and conditioning (S&C) coaches are the real pros when it comes to prescribing rehabilitation exercises and getting patients/ athletes to return to sport (RTS).

The author compared physiotherapists and strength and conditioning (S&C) coaches working with athletic populations (in the UK). His view was that the physiotherapist has always been the decision maker or 'top dog' when it comes to managing the injured athlete or any patient that needed exercise to rehabilitate or improve physical function. 

He feels that the physiotherapy profession has not kept up to date with professional developments in exercise science and S&C, even falling behind and out of step in some aspects. This is despite the fact that there has been an increase in demand by physiotherapists in the UK for weekend courses in S&C training to fill in gaps in expertise and knowledge. 

The author thinks these short 2 day courses is "really an insult to those S&C professionals that have devoted time, effort and financial resources to their expertise" as they have studied exercise science, S&C at undergraduate level and gone on to postgraduate study and even advanced professional accreditation to work.

He also feels that the undergraduate training program for physiotherapists in the UK does not provide enough basic grounding in exercise prescription and training science despite claims by the physiotherapy profession that they have a firm grounding in basic clinical sciences so they can circumvent the need for extensive training in S&C.

This has then led to a deficit in rehabilitating athletic populations such that it even slows an athlete's full RTS. The athlete is usually handed to the S&C team or left to their own devices. He concludes that rehabilitation of recreational and professional athletes must be recognized as an advanced practiced skill requiring specialist training. If these gaps/ deficits in both under and post graduate training are not addressed, then physiotherapists will be relegated to technicians in the restoration of the patient/ athlete.

My thoughts? I used to work at the *Singapore Sports Council in the Sports Medicine department (the current Singapore Institute of Sport). The doctors, physiotherapists, S&C coaches and other sports science staff (nutrition, biomechanics, psychology) all have degrees and/ or postgraduate qualifications and definitely had a good working relationship. We had a weekly case discussion where the athletes who were not progressing well after injury were brought up and analyzed.

Other than that sort of setting and perhaps in the Singapore Sports School and Football Association of Singapore, I think that physiotherapists in  hospitals and private practices that treat sporting populations may differ in their ability to enable these patients to RTS. It boils down to the interest and exposure of each physiotherapist. Whether they had any previous sports/ athletic background, how interested they are in sports, and most importantly, their tenacity to want to better themselves. 

There will be S&C coaches, sports and functional trainers, CrossFit coaches and personal trainers who, with their interests and commitment to improve themselves, will be superior to some physiotherapists with regard to rehabilitation and returning patients to sport. Likewise, there will be physiotherapists who can more than hold their own. 

It is, ultimately, up to each individual in their respective line of work to keep themselves up to date, to keep improving to help athletes recover better and faster. And also to recognize when they aren't the best person to return an athlete to sport and refer them out to someone who is.

Here's another sugggestion for physiotherapists not working in those sort of sports settings. If, most if not all undergraduate physiotherapy courses does not provide enough basic grounding in exercise prescription (like the author writes), then perhaps we, as physiotherapists should be doing what we are trained best at. To use our hands! All the manual assessing, mobilizations, manipulations etc, that other heatlhcare professionals can't do. Why are we not doing more of what we are best trained for?

Instead of giving patients exercises to do during treatment sessions, physiotherapists should be doing things that the patients cannot do themselves. Now, the robots or other healthcare professionals cannot replace that type of physiotherapist.

Reference

Blog article from British Journal of Sports Medicine, published on May 2, 2021.

* Thanks to my former colleagues and former S&C coaches Todd Vladich and James Wong (also multiple SEA Games gold medalist and discus throw record holder), whom guided my S&C program when I was still competing. James, a few other colleagues and I used to train at the old KATC gym at the old National Stadium 3 mornings a week at 7:30 am before we started work when we were not traveling or competing. We did this year round, especially in the off season. Those sessions and attending a Level 1 Australian Weightlifting Federation course while working there definitely made me competent at getting patients to return to sport quickly and most importantly, safely.

Does Weight Training Stunt Growth In Young Adolescent Kids?

14 yo Miles with Dad Ving Henson at The Pit

I remember clearly being told by my teammates as a young runner at twelve that I should never do weights as it would stop me from growing taller.

This misconception about weight training often comes from fellow teammates, well meaning parents, physical education teachers and even some coaches. Actually, the sport your child participates in (sprinting, jumping or contact sports) will generate greater forces than training in the weight room.

This widely held belief that weight training especially when performed during puberty/ adolescence stunts growth still persist in the present day. Due to this, young athletes and children should only perform body weight exercises and not do any training with barbells, kettlebells or even dumbbells.

Fret not if you're a parent or teacher of a young athlete. There is simply no evidence to support this belief at all. Many studies have looked into this topic and found that weight training has no negative impact on skeletal growth. It will not stunt growth.

Actually, studies show consistent findings that young subjects have increased strength, speed and power, while losing weight, gaining muscle and stronger bones. There is also a reduction in injury rates. Good news for parents if your child keeps getting injured. This is especially true even when the young subjects have not reached puberty.

So it makes very little sense from a bone stress point of view if you stop your child from going to the gym but allow them to participate in sports.

So how soon can your child start weight training? We do not have any suggestions from any local authority but the Australian Strength and Conditioning Association suggest that a child can start weight training at six years old. As long as he/she can follow clear instructions and understand the dangers when training.

If you do send your child/ athlete for weight training, make sure the learn the correct techniques by a good strength coach who has experience working with young athletes. Remember, don't force the young athletes if they are not keen.


References

Barbieri D and Zaccagni L (2013). Strength Training For Children And Adolescents: Benefits And Risks. Collegium Antropologicum. 37(2): 219-225.

Faigenbaum AD and Meyer GD (2010). Resistance Training Among Young Athletes: Safety, Efficacy And Injury Prevention Effects. BJSM. 44(1): 56-63.

Falk D and Dotard R (2019). Strength Training In Children. Harefuah. 158(8): 515-519.

After seeing 14 yo Miles training above, my 9 yo was inspired to do the same