Physical therapy can span a wide spectrum, ranging from injury rehabilitation, to injury prevention, and even performance enhancement. To truly help people get the most out of their bodies, we need to focus on all three of those.
But many of us don’t, and if you’re one of them, I think you may be really missing the boat.
I’m not completely sure why this happens, but if I had to guess, I think there may be two main thoughts holding us back:
- The vast majority of the physical therapy profession is focused on injury rehabilitation, this includes both our college curriculums and most workplace settings, which is really limiting our potential to help people maximize their function and performance.
- We spend the majority of time focusing on “function” and not “performance.”
Perhaps this is just terminology, but I know when I was in school and early in my career, “function” was people’s activities of daily living, and “performance” was sports. Would you agree? That was my perception at least.
I couldn’t disagree with these definitions more. Here is how I would define them now:
- Function is an activity. Sure, this could include things like bathing and getting dressed, but I would also say running, jumping, throwing, and just playing a sport, in general, is also a function.
- Performance is how well you perform that function.
Performance is not something that only athletes do. We all need to perform at whatever function we want with our bodies. This is probably the most important concept to understand, and one of the main things that people have said have helped them most after going through my Champion Performance Specialist course.
The Need for a Shift Towards Performance Physical Therapy
Here’s what I suspect is the most common vision of the performance spectrum to most physical therapists. At any point in time, you have your baseline. Most people then focus on either restoring or enhancing performance based on that baseline.
We sit back and wait for someone to get injured, then help them restore themselves back to baseline.
Well, what if their baseline was part of the reason why they got injured in the first place?
If we just focus on restoring their function back to their baseline, we’re completely missing the boat on helping them optimize and enhance their performance.
I can’t help but think that this is one of the reasons why so many people have recurring injuries, chronic pain, and failed surgeries. Restoring people back to their baseline isn’t enough, we need to build their capacity and enhance their baseline.
As we all know, many things can predispose a person to injury, including weakness, mobility concerns, and imbalances.
There has been a recent uptick in criticism on social media that too many physical therapy interventions are either ineffective, transient in nature, or both. Rightfully so.
But maybe it’s not the physical therapy treatments that are the concern, but rather the overall strategy? Maybe we are focusing too much on just restoring function, and not enough on optimizing and enhancing performance?
If you have limited shoulder range of motion overhead, and you have pain in your shoulder every time you overhead press in the gym, then we can do a great job reducing that pain with physical therapy. But don’t you think that pain will likely just come back when they get back to overhead pressing? We reduced their pain, restored them to their previous baseline (which wasn’t optimal), but we didn’t optimize their mobility.
Their long term outlook can’t be great, right?
The Goal of Performance Physical Therapy
The goal of performance physical therapy is to raise the capacity of the body, not just restore their function. If you haven’t seen it yet, you should watch our podcast episode discussing our vision of performance based physical therapy.
It’s not enough to simply try to restore someone to their previous baseline. That’s “traditional” physical therapy if you ask me. Performance physical therapy not only restores function, but also works on optimizing and enhancing performance. That’s the key difference to me.
If you add optimizing performance to the spectrum, it could look like this:
But I still don’t think that’s enough, we can do better.
If you are working on restoring or enhancing performance, you should also be working on optimizing performance. Realistically, there is an overlap between these concepts.
This changes our focus in a couple of ways:
- It shows that these concepts all overlap. We can restore and optimize performance, and we can optimize and enhance their performance. Thinking of them as independent factors, is not ideal
- It shifts our thought process from retrospective, to prospective. When you know the endpoint isn’t just to simply restore their baseline, but also to optimize and hopefully even enhance their performance, it changes your entire outlook on the injury rehabilitation process from day 1.
Our Profession Needs Performance Physical Therapy
I have good news for you.
Physical therapists are really good at diagnosis and treating injuries. All of the assessment and diagnostic skills that allow physical therapists to evaluate and treat an injury can easily be adapted to also assess someone’s function and level of performance.
Think about it, what’s the difference between an evaluation of someone with an injury and someone that is healthy that wants to enhance their performance?
Special tests. That’s kinda it, right?
Special tests were designed to help diagnose a specific injury. If this special test, or cluster of tests, is positive, then you may have this injury.
But everything else other than special tests essentially evaluate someone’s level of function, right? Strength, mobility, balance, movement. These are all things that we can evaluate to help develop a complete performance therapy and training program for a person. We can then work on optimizing and enhancing each of those qualities.
How do you blend all this together? Treat the injury and optimize the body.
All it takes is a shift in your perspective.
How Do You Get Started?
If you’re interested in learning more about my approach to performance physical therapy, you should check out my free Introduction to Performance Therapy and Training online course.
When we started our facility at Champion PT and Performance, one of our biggest goals was to develop a simple system for our physical therapists and strength coaches to help people move and perform better.
My Introduction to Performance Therapy and Training program will teach you our 4-step system at Champion to assure you have everything you need to start helping people move and perform better.
