Strength coaches are not physical therapists and that is a good thing
Unpopular Opinion – Sometimes lighthearted and sometimes serious commentary on issues surrounding strength training, physical fitness, and culture.
Strength coaches are not physical therapists, which can be to the benefit of the client. Of similar vein, many strength coaches have begun to blur the lines and practice as poorly educated physical therapists, much to the harm of the client. This article will explore my issues with the practice of physical therapy and conversely my issues with strength coaches acting as pseudo physical therapists.
The profession of physical therapy traditionally works with injured and ill persons for the purposes of restoring baseline function and reducing pain. While there are individuals out there that are highly educated and incredibly effective, the majority of physical therapists are woefully inadequate at performing the task. There ineffectiveness is multi-factorial.
My primary concern is the complete disregard for the importance of strength and strength endurance in a rehabilitation setting. One of the main issues with injury is a loss of functionality of the given tissue that is injured. In a sense the tissue is weak, creating disability. The logical modality of treatment would be to give the tissue an appropriate challenge in a manner consistent with its function. Upon successful completion and recovery from the stress, a slightly greater challenge must be applied to cause further adaptation. Instead what I typically witness is the application of a variety of novel exercises with isolated load to the injured tissue. Once the client has achieved a satisfactory movement pattern a different stimulus is added. Once the client can perform a checklist of movements they are “cured.”
In this manner physical therapy is crossfit ultra-light. Since motor learning is a quick process, constantly varying movements makes clients feel like they are making rapid progress. However, any real progress made is mostly by chance or simply a factor of time. Instead focus on a small subset of movements pertinent to the function of the tissue and apply progressive overload.
What is the physical therapist to do once the client is moving without pain or disability? Typically discharge. Essentially the client is being discharged in a state of health similar or worse than before the injury occurred. The client may very well have some additional knowledge of movement prevention strategies but without an additional resilience. This is where the strength coach shines. Once the tissue can manage load, a strength coach can guide the client in gaining strength and strength endurance. With increased strength comes injury resilience and greater function then before the injury.