The Role of the Sports Physiotherapist

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk, Kim Jackson, Jess Bell and Tarina van der Stockt  

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 defines 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 standards are 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.

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." 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. 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%).

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. Another benefit is the great amount of time that sports physiotherapists spend working directly with the athletes.

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

However, 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.

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 Sport 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 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 maximise 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.

Thoughts and advice

"Love thy sport"

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:

1. If a sports physiotherapist understands the demands and technical aspects of a sport, this will improve their ability to recognise possible causes of injury and facilitate the development of sports specific rehabilitation programs.
2. The athlete will have confidence in the sports physiotherapist.

One of the best ways to learn about a sport and understand it is to attend both training and competition or to even participate in the sport. Being on site during training sessions and competition, not only to aid with injuries, but also to develop to a good understanding of the sport will help with this.

References