Performance vs. Medical

Hello everybody!

Today’s SOAP Note will be focused on the blend of the weight room and the athletic training room. I have previously talked about the role of the strength coach being focused on enhancing movement through force production compared to the sport coach who teaches skill. Then there is the athletic trainer/physical therapist who aim to restore mobility in injured athletes through the means of efficient movement. Today I hope to explore both the division and the deep connections between the weight room and the athletic training room. Please note, I do not personally believe all athletic trainers and strength coaches operate this way, nor am I speaking of any specific person. I am only analyzing the demands of each job in a general sense.

Let’s begin with the commonalities. Between the three departments of athlete development (medical, performance, and sport) there is really only one goal; to optimize athletic potential in an individual. For each department, that goal means something slightly different but in reality this is the only thing we all hope to accomplish. When the goal is centered on the athlete, it is easier to visualize how these three departments coexist and are mutually beneficial. In a previous article on the “3 Departments of Athlete Development” I described the athlete as the main vehicle and the coaches play specific roles in driving the vehicle. I believe this analogy to be an accurate depiction of how each department shares the same goal focused on the athlete. When our goals align and we can stay focused on them, and it becomes difficult for the three departments to clash with one another. If we just pick out the performance and medical (injury rehabilitation) departments, these two are both responsible for training the body. Medical mostly involves isolated rehab exercises usually with lighter load and higher tension, often targeting neurological gains(its all about the nerves). Performance training typically requires higher load and creates mostly muscular hypertrophy with some neurological gains. The overlap between the two should be seen as an opportunity for collaboration and maximum improvement rather than a cause of friction and divide.

The differences between the performance and medical departments are often more obvious and visible. Injuries will occur in the course of athlete development, this is both inevitable and frustrating. When an injury occurs in the weight room, the athletic trainer might blame the strength coach for mismanagement of the athlete during a lift. Or maybe the strength coach might blame the athletic trainer for clearing the athlete for lift too early in their return to play protocol. The athletic trainer must be seen as approachable to athletes so they feel comfortable revealing an injury to the AT, which, untreated could lead to further harm. The strength coach, by nature of the job, is meant to push the athletes both mentally and physically. When faced with a new stress, some athletes will engage a sympathetic fight or flight response and may want to avoid the workout in some way. This avoidance might manifest as “I can’t squat today, my knee is bothering me” despite no medical history of knee pain. Commonly in these scenarios, the strength coach will look to push the athlete to overcome this obstacle for the betterment of their mental and physical strength. However, sometimes the athlete is not offering a sympathetic response and they are in fact hurt. So on one end, you have the approachable athletic trainer who encourages discussion of any ailments. On the other end, there is the strength coach whose role is to push the athletes’ limits to new heights while also encouraging athletes to increase their work/stress load for better athletic performance. These elements of the performance and medical departments are at constant odds with each other.

My description of the similarities and differences probably reveals my bias in how I think things should operate. I am all in favor of more collaboration and mutually beneficial goals. I think the most ideal situation would involve a strength coach who can incorporate elements of rehab/movement efficiency into the team workouts and an athletic trainer who can utilize performance based training methods to enhance his or her rehab protocols. This is something I have tried to do in my own practice lately. Though I have not read his book, Cal Dietz pioneered triphasic training and I have tried to casually gather information on this subject. The basic gist of triphasic is breaking down the training into three (usually) two week long cycles; eccentric, isometric, concentric. In some of my rehab protocols, I have used this same model for exercise prescription. I am still early on in my experimentation so I don’t yet have any results to share. So far I do find this model helps me greatly in the organization of my protocols.

In my experience, I have worked with and noted many athletic trainers who also worked as a strength coach at their respective school or organization. These particular athletic trainers are also individuals whom I learned a great deal from and who were also incredibly effective at their job. Also, it seems to me that physical therapists (at least the ones I find online) have recently been pushing more into the sports performance world as a means of injury prevention. What are your thoughts on the blend of medical and performance? Do ATs and PTs need to shift more towards performance? Or do strength coaches need to shift more towards prevention? Do you have any other similarities or differences to share?

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Mark D.

@MarkDomATC