should they have strength and conditioning training,read this on another site.
Whose job is it anyway?
It can be argued – and no doubt many physiotherapists will be thinking this – that this kind of exercise program-setting is surely the job of a professional strength and conditioning coach.
This is a fair comment – up to a point. It is the job of a physiotherapist to prescribe exercises and they therefore need to know what kinds of exercises should be done at which rehab points.
That is only possible if you understand properly how the movement and load will affect the injured structures.
Secondly, if they don’t understand these principles, how can we advise our coaching colleagues (whose primary purpose is to train healthy bodies, not injured or recovering ones)?
Thirdly, how many of you, as athletes, can afford to track down and work with a strength and conditioning coach, especially once you've already paid for your physiotherapy treatment?
Three key elements
Sean Fyfe states that three elements of strength training – exercise technique, progressive overload and specificity – are critical to the competent practice of physiotherapy.
“One of the lecturers on my recent course tells of how, as a tutor, he routinely encounters sports physiotherapists, many with more than 10 years’ experience, who cannot teach the performance of a basic squat. If they can’t teach a squat, it is doubtful they could teach someone to deadlift. So how, for example, have they been teaching their patients with lumbar disc injuries to brace their low backs in neutral?”
To take the point further,
“if they can’t teach a double-leg squat, they surely can’t teach a single-leg squat, so how have these physiotherapists been rehabilitating someone with patellofemoral dysfunction?”
Fyfe wasn't taught on his undergraduate course how to squat or how to deadlift correctly, which does seem to me a pretty incredible omission.
"Here’s something else that was barely touched on in my undergraduate studies. The overload principle is the underpinning principle of all training. Put simply, the body adapts in line with the demands placed on it. To achieve a positive training response and thus gain strength improvements, you must overload the relevant muscles. Too little effort and the client will fail to make strength gains. But too much overload at any point will cause injury, so it is necessary to prescribe a program of progressive overload, manipulating the weight, repetitions, sets, rest periods and speed of movement"
The other key principle common to effective training and physiotherapy is specificity, or SAID (specific adaptations to imposed demands). Again, put simply, the body adapts in a highly specific way to increased demands: the precise input will determine the precise adaptation.
Case Study - Sprinter vs Marathon Runner
To illustrate this, let’s look at how you might use a single-leg squat in the rehab of a sprinter versus a marathon runner, both recovering from patellar tendinitis. The aim of the single leg squat is
to improve strength and activation through gluteus maximus and gluteus medius
to improve quadriceps strength and activate vastus medialis (VMO)
to maintain neutral spine under load, and
to improve proprioception of the lower limb chain.
The exercise is functional for the sporting needs of both athletes, and will be working aspects of their lower limb chain that probably need improvement to prevent further tensile overload to the patellar tendon. But the 100m sprinter needs to do all of these things fast, with maximal contraction, for 10 to 11 seconds; while the marathon runner does them all sub-maximally and slower -- for more than two hours.
It is therefore no good prescribing exactly the same dose of this exercise to both athletes. The sprinter will need:
low repetitions
greater load to achieve maximal contraction
fast speed of movement, and
longer rest periods.
And the marathon runner needs quite the opposite.
The teaching of correct technique and the principles of overload and SAID should be at the forefront of a physiotherapist’s mind whenever prescribing an exercise program. Indeed, they should underpin the setting of all rehabilitation programs.
Whose job is it anyway?
It can be argued – and no doubt many physiotherapists will be thinking this – that this kind of exercise program-setting is surely the job of a professional strength and conditioning coach.
This is a fair comment – up to a point. It is the job of a physiotherapist to prescribe exercises and they therefore need to know what kinds of exercises should be done at which rehab points.
That is only possible if you understand properly how the movement and load will affect the injured structures.
Secondly, if they don’t understand these principles, how can we advise our coaching colleagues (whose primary purpose is to train healthy bodies, not injured or recovering ones)?
Thirdly, how many of you, as athletes, can afford to track down and work with a strength and conditioning coach, especially once you've already paid for your physiotherapy treatment?
Three key elements
Sean Fyfe states that three elements of strength training – exercise technique, progressive overload and specificity – are critical to the competent practice of physiotherapy.
“One of the lecturers on my recent course tells of how, as a tutor, he routinely encounters sports physiotherapists, many with more than 10 years’ experience, who cannot teach the performance of a basic squat. If they can’t teach a squat, it is doubtful they could teach someone to deadlift. So how, for example, have they been teaching their patients with lumbar disc injuries to brace their low backs in neutral?”
To take the point further,
“if they can’t teach a double-leg squat, they surely can’t teach a single-leg squat, so how have these physiotherapists been rehabilitating someone with patellofemoral dysfunction?”
Fyfe wasn't taught on his undergraduate course how to squat or how to deadlift correctly, which does seem to me a pretty incredible omission.
"Here’s something else that was barely touched on in my undergraduate studies. The overload principle is the underpinning principle of all training. Put simply, the body adapts in line with the demands placed on it. To achieve a positive training response and thus gain strength improvements, you must overload the relevant muscles. Too little effort and the client will fail to make strength gains. But too much overload at any point will cause injury, so it is necessary to prescribe a program of progressive overload, manipulating the weight, repetitions, sets, rest periods and speed of movement"
The other key principle common to effective training and physiotherapy is specificity, or SAID (specific adaptations to imposed demands). Again, put simply, the body adapts in a highly specific way to increased demands: the precise input will determine the precise adaptation.
Case Study - Sprinter vs Marathon Runner
To illustrate this, let’s look at how you might use a single-leg squat in the rehab of a sprinter versus a marathon runner, both recovering from patellar tendinitis. The aim of the single leg squat is
to improve strength and activation through gluteus maximus and gluteus medius
to improve quadriceps strength and activate vastus medialis (VMO)
to maintain neutral spine under load, and
to improve proprioception of the lower limb chain.
The exercise is functional for the sporting needs of both athletes, and will be working aspects of their lower limb chain that probably need improvement to prevent further tensile overload to the patellar tendon. But the 100m sprinter needs to do all of these things fast, with maximal contraction, for 10 to 11 seconds; while the marathon runner does them all sub-maximally and slower -- for more than two hours.
It is therefore no good prescribing exactly the same dose of this exercise to both athletes. The sprinter will need:
low repetitions
greater load to achieve maximal contraction
fast speed of movement, and
longer rest periods.
And the marathon runner needs quite the opposite.
The teaching of correct technique and the principles of overload and SAID should be at the forefront of a physiotherapist’s mind whenever prescribing an exercise program. Indeed, they should underpin the setting of all rehabilitation programs.