The Role of the Sports Physiotherapist

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Original Editor - Wanda van Niekerk

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What is a Sports and Exercise Physiotherapist?

Sports and Exercise Physiotherapists are involved in the prevention and management of injuries resulting from sport and exercise participation at all ages and at all levels of ability. These specialized physiotherapists provide evidence based advice on safe participation in sport and exercise. Furthermore, they 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 in helping athletes of all ages and all levels of ability to enhance their performance.

What do Sports and Exercise Physiotherapists do?

The New Zealand Sports Physiotherapy organisation define a sports physiotherapist as:

"A recognized professional who demonstrates advanced competencies in the promotion of safe physical activity participation, provision of advice, and adaptation of rehabilitation and training interventions, for the purposes of preventing injury, restoring optimal function, and contributing to the enhancement of sports performance, in athletes of all ages and abilities, while ensuring a high standard of professional and ethical practice."

Sports and Exercise Physiotherapists work in a wide variety of settings. Many work with active recreational athletes in private practice or clinic settings. They can also be involved in social and club level sports and attend training sessions. Sports and Exercise Physiotherapists often work in the elite athlete setting in competitive and professional sports, working and travelling with elite individual athletes or teams, and integrating their services with other medical professionals, coaches, strength and conditioning personnel and other support staff. Sports and Exercise Physiotherapists are also actively involved within various sporting organisations to coordinate physiotherapy services, injury prevention, rehabilitation and injury surveillance programs.

Sports and Exercise Physiotherapy Roles and Competency Areas

Ashton (2015) outlines advanced competencies of the sports physiotherapist in the promotion of safe physical activity participation, provision of advice, adaptation of rehabilitation and training interventions, for the purposes of preventing injury, restoring optimal function, and contributing to the enhancement of sports performance, in athletes of all ages and abilities, while ensuring a high standard of professional and ethical practice. What role the physiotherapist plays does vary depending on the sport they are involved in, their specific role within the team, the performance level of the sport, local level or international, amateur or professional.

The International Federation of Sports Physical Therapy (IFSPT) has identified 11 competencies that is required for Sports and Exercise Physiotherapists. Along with these competencies are a set of specific skills or standards that needs to be upheld. These competencies and standardsare related to the various overlapping roles that the Sports and Exercise Physiotherapist fulfill. The various roles and competencies can be:

• Manager of the client/patient
  • 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
  • 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
  • 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
  • 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

• Advisor
  • 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.
  • 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.
• Professional Leader
  • 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.
  • 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.
• Innovator
  • 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.
  • 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.
  • 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.

The full document on Sports Physiotherapy: Competencies and Standards are available on the website of The International Federation of Sports Physical Therapists (IFSPT).

The Role of the Sports and Exercise Physiotherapist in International/Elite Sports

Physiotherapy has become an integral part of the sports medicine team. At the London 2012 Olympic games physiotherapists formed the largest professional group working at the Olympic Games. The essential role of the sports physiotherapist in international and elite sports (and in all other levels of sport, for that matter) remains to provide treatment and rehabilitation of injuries and to provide performance support through injury prevention, maintenance and recovery interventions.(ref)

The common perception of the role of the sports physiotherapist in supporting athletes during competition or major games seems to be that the physio is a "provider of treatment interventions related to specific injuries" (ref) From recent studies it is evident that sports physios are also playing a much bigger role in supporting uninjured athletes. During the London 2012 Olympic Games, athletes attended physiotherapy services in the absence of injuries. A reasonable assumption for this may be that the physiotherapy sessions focused on maintaining physical function as well as aiding in recovery have a place in supporting athletic performance, (ref) It was also evident that athletes required follow-up visits for the same condition/injury and that muscle injuries were the most common. Furthermore, the non-injury related physiotherapy sessions/encounters reflected the need for maintenance of the musculoskeletal system, injury prevention strategies and assistance with recovery.

Sports physiotherapists working with international/elite athletes also face the challenge of the ongoing management of pre-existing conditions. Overuse injuries among athletes were identified as the most common reason to attend physiotherapy services (44%) ref.

It is evident that the role of the physiotherapist within the sphere of international sport, is vast and that the role goes beyond the treatment of injury to a much broader role which includes providing assistance with musculoskeletal maintenance and recovery as well as injury prevention strategies.

Sports physiotherapists are also in a unique position to be able to take on leadership roles. The breadth of the sports physiotherapist skill set, which includes skills such as understanding acute care management, exercise and evidence-based approaches to injury prevention and treatment, as well as general strength and conditioning concepts, enables sports physiotherapists to oversee the healthcare of athletes in various sporting codes. (ref)Another benefit is the great amount of time that sports physiotherapists spend working directly with the athletes.

Scope of Practice

As Schneiders (2015) highlights Sports physiotherapy can be a very a challenging area of clinical practice with demands being made of the physiotherapist to provide rapid injury resolution and clinical decisions on the sport field or court, under huge pressure from the athlete, coaching and management. Understanding your role, scope of practice and boundaries of ethical and moral behaviour in sport is a key part of your development as a Sports Physiotherapist. Read the following articles, which examine some of these key areas and highlight situations where the scope of practice was questioned.

Schneiders AG. Blood, sweat and tears – reclaiming the ethical high ground in sports physiotherapy . British journal of sports medicine. 2015 May 27

O’Neill, Lise-Ann. No way Jose Clinicians must have authority over patient care – The manager’s scope of practice does not cover medical decisions , British journal of sports medicine (2015)

Athlete's Perspectives on the Role of the Sports and Exercise Physiotherapist

The role of the sports physiotherapist

"What does a sports physiotherapist do?"

Athletes have a clear, but sometimes limited, understanding of the role of the sports physiotherapist. They see the role of the sports physiotherapist as mainly injury focused. In interviews with athletes on the role of the sports physiotherapist the following four themes emerged:

• Injury treatment
• Injury prevention
• Rehabilitation
• Performance enhancement

"What should a sports physiotherapist not do?"

• Break medical confidentiality - this highlights the importance of trust between the athlete and the sports physiotherapist
• Become complacent about their position - athletes expect their sports physiotherapist to practice continual professional development and should be striving to better their abilities, just like athletes do.

Qualities of a sports physiotherapist

Athletes indicated that these qualities are important for sports physiotherapists to possess:

• Being professional
• Good personal qualities
• Being accessible
• Good communication skills
• Have an interest in the athletes that they are working with
• Being open-minded with regards to athletes' ideas regarding their management and the use of other practitioners

"A sports physiotherapist should be patient, persistent, have a high level of competency, know when to refer, understand the emotional and psychological demands of the sport and be a good communicator with athletes and coaching staff."

Qualities that athletes do not like to see in sports physiotherapists are:

• Bad personal qualities
• Being unapproachable
• Not being a team player

Achieving sporting success

"How does sports physiotherapy help you achieve your sporting goals?"

When athletes were asked this question, their response again mainly reflected on injury focus i.e.

• Help to recover from injuries
• Prevent injuries

There was also a change in perspective noted. Athletes acknowledged the role of the sports physiotherapist in preventing and managing injuries but also placed emphasis on sports physiotherapists helping them to train for increased duration and intensity without becoming injured.

Physiotherapy treatment techniques

Athletes feel that the following treatment techniques are beneficial:

• Mobilisation
• Massage
• Manipulation
• Exercise prescription
• Acupuncture
• Taping

However, this is also dependent on athletes' exposure to the range of treatments. Athletes feel that the physiotherapist is the expert and they put their trust in the physiotherapist to resolve any injury issues that they athlete might have.

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