Sports physiotherapy as a profession is undergoing significant changes. The physiotherapist working solo in the basement of his or her home, or alongside a GP at the local practice, is gradually being replaced by larger clinics, incorporating a range of different health professionals.
The sports medicine team may include any of the following:
The work of all these professionals can become more efficient in a team set-up. A client’s hopes for speedy and full recovery from injury rely heavily on the prompt establishment of good injury management strategies. In a multi-disciplinary clinic athletes can easily be referred for further testing or treatment, and communication between the support team should be straightforward, cutting out delays and mixed messages.
The global scale of sports-injury research and knowledge is now so large that most physiotherapists opt to specialise. For sports physios, that involves an initial decision either to focus on a particular sport, or on a particular area of the body – although therapists who go the sport-specific route will usually acquire transferable in-depth knowledge about certain areas of the body. Thus a physio with an interest in swimming will more than likely be very competent in dealing with shoulder injuries.
It stands to reason, therefore, that a multi-skilled team containing several sports physios will enable athletes attending the clinic to be directed towards the therapist with the most relevant expertise.
While this sounds obvious, the reality is that athletes’ problems are often complex and multifactorial, a combination which considerably disadvantages any sole practitioner of any sport-related discipline. Quite simply, large clinics facilitate specialisation and cross-disciplinary analysis.
The case of Josie, a competitive hurdler suffering from medial foot pain, illustrates the interplay possible between the sports medicine team. Josie’s first contact is by telephone, when she asks to see Peter, a sports physio specialising in track and field.
Peter assesses her and decides to refer her to the clinic’s sports doctor, as he suspects a fracture of the navicular. A bone scan confirms the stress fracture and Josie gets a non-weight-bearing cast to wear for six weeks. Peter notes in his initial assessment that Josie overpronates when walking and jogging, as a result of a forefoot varus (flattened angle) which is more pronounced on the affected side.
Peter and the sports doctor both agree that this increase in pronation, along with Josie’s decreased calf range of movement, are predisposing factors. They decide that the podiatrist should take a look, as orthotics may be required. Janet the clinic podiatrist agrees, and prescribes Josie a light-weight orthotic to fit her spikes and a bulkier device for her runners. Josie also visits the massage therapist to increase her range of movement through her calves and other areas that Peter has noted as being restricted for a hurdler.
At 16 years old, Josie already has a long injury list to her name, and despite her keen ambition has not begun any strength and conditioning training. Through the encouragement of the staff at the clinic, and after discussion with her coach, she starts work while she is still non-weight-bearing, with the clinic’s strength and conditioning specialist.
Between them, the clinic’s team helped Josie overcome her injury quickly, addressed the underlying causes, and educated her on how best to remain injury free and improve her performance. Peter’s specialisation in track and field allowed him to assess past the injury and introduce Josie to services she previously did not understand the need for. Financially the clinic benefited by providing five different services to the client.
Injured athletes often struggle with motivation. They need positive influences to maintain a good work ethic. In large clinics athletes can interact with one another in the clinic gym area, share experiences and feed off each other, just as they would do in their regular regime with training partners. I believe younger and amateur athletes benefit the most from this livelier environment. Imagine the motivational value for a young injured person in rubbing shoulders with a famous athlete who is also at the clinic, working hard to regain full fitness. You can see the shift in their attitude almost instantly.
The most effective clinicians are those who enjoy their workplace. They are willing to go the extra step for their clients – and the athletes respond accordingly. It is all too easy when you are working solo to become flat and mentally drained, so the social benefits of large clinics can be really significant.
Professionally, you can stay mentally refreshed with new ideas and techniques; attend regular intra-clinic education sessions; benefit from organised seminars or practicals by invited experts. For younger, less experienced staff this is a great bonus. Indeed, newly qualified physios are not particularly well equipped to work in private practice and many become quickly disillusioned with the isolation and lack of learning. Poor knowledge of differential diagnosis, difficulty knowing when to refer for further testing, and unrealistic expectations for patient recovery are all sources of frustration and lack of confidence when trying to manage complex cases.
Larger clinics offer the opportunity for recent graduates to have mentors on hand for their questions, or to refer patients to a senior member of staff while still following the progress of the case. And they get a chance to become familiar at close hand with the work of other support professionals.
Another obvious advantage of large clinics is in their ability to provide a broad range of rehab equipment. The needs of physios and conditioning specialists vary, and you might find any or all of the following in a modern clinic gym area:
Frequently the ‘client’ will not be an individual but an entire sports team. To provide a service to a team can be demanding, as it invariably means spending time away from the clinic with the team and having to try and squeeze in many appointments for team members. The logistical issues are much easier to handle if colleagues can cover for you and give back-up for your client.
Are there any drawbacks to large multi-disciplinary clinics? A few. For the team to work effectively, each specialist must be able to recognise their own limitations and have sufficient understanding of and interest in the other disciplines to know when to refer to their fellow team members. (Peter being able to pinpoint the biomechanical faults and recognising the need for further assessment by a podiatrist is a perfect example.)
A real sense of teamwork is only possible if the clinicians share common goals and have a similar mindset in terms of management. Yet no two clinicians ever approach problems in exactly the same way, so it is essential that all team members are willing to think outside of their mental framework and view the opinions of others objectively. Interaction between two open-minded clinicians with common goals can only ever improve an individual’s skills and knowledge.
Personal care can raise issues, too. The management of an injured athlete can be a very personal experience. Athletes have to feel comfortable in their surroundings, and not just as though they are on a conveyor belt. Indeed, this matters not just from a customer relations viewpoint but in terms of rehab: how the athlete feels can play a major role in the outcome of their treatment. Larger clinics therefore need to take care to avoid their premises giving off a sterile, big-business feel.
And the flip side of sharing clients between professionals to enhance their care is that clients can get lost in the system. It is essential that one therapist always assumes responsibility for treatment direction and follow-up with each client.
Even more sensitive is the potential problem of competition for clients between the various therapists at the clinic. The clinic should draw up clear guidelines on this.
So while the advantages of large clinics are many and varied, the pitfalls come down in large part to human relationships, both between the different professionals and between the clinic and its clients. If these tricky aspects can be successfully managed, multi-disciplinary sports clinics should score highly for all concerned.