Opinion: The Strength and Conditioning Coach & me
In the physio and S&C relationship there is only one winner or loser… the athlete.
The relationship between the strength and conditioning coach (S&C) and physiotherapist is one shrouded in controversy and endless muttering. We all hope to work with someone that is on our page, agrees with our principles and makes our job ‘easy’. Is this person out there or are we missing the mark? I have been fortunate to work with some truly remarkable S&C coaches who have not only been invaluable to the teams we were part of but improved my professional aptitude in ways no course or qualification can. The million-dollar question is how do we establish one of these relationships where growth is inevitable and the multi-disciplinary team (MDT) can succeed?
In my opinion, the relationship between a S&C coach and physiotherapist needs to be re-framed. Firstly, there needs to be a personal respect. Often, we are not able to choose the other team members in the MDT team, there is a famous saying that you can chose your friends, but you can’t choose your MDT . So how then do we avoid inevitable personality clashes and the endless ebb and flow on email? Personal respect outside of the working environment leads to the development of a fruitful relationship in where each professional can contribute to the best of their ability. Now don’t get me wrong, I am not saying that you must become best buddies (it does help though) but affording the other individual the respect they deserve helps to build trust between the two professions.
The way I see the relationship between the S&C coaches I work with and myself – we have the same qualification, one of us has specialised in the acute management and the other is a professional in conditioning, improving strength, and optimising performance. As two individuals on either end of the spectrum we need to allow for professional clinical independence in the respective extremes. However, there is a substantial demilitarised zone between these extremes where no sports professional dare tread due to fear of ‘stepping on someone’s toes.’ In my experience this is the zone where the teams I have worked in have done remarkably well. Instead of avoiding certain topics and just carrying on with our business, we developed combined strategies to push our teams forward. Instead of having one mind challenging a problem, we allowed all stakeholders to the round table. Coaches, captains, players, S&C coaches, physiotherapists and even administrative managers could be involved in the discussion. Yes – there are the experts in each facet but each one brings a unique perspective and experience to the discussion. At the end you a get a decision that might not be unanimous, but it is respected.
The greatest skill I have developed when working with other professions is emotional detachment from debate, criticism and questioning. Being able to remove your emotional connection with your profession and more so your personal emotional response to criticism is the greatest thing you can do. Remaining humble and understanding that our two professions are moving forward at a staggering pace is essential to developing a relationship that doesn’t push the professions apart, instead pulls the professions forward. It is the role of the S&C coach, in my mind, to question my clinical decisions, encourage me to find more efficient solutions and be critical of my management principles. It drives me to improve my practical skills and polish my theoretical principles. Sorry to say, but if you can’t support your practice with sound evidence, that’s likely probably due to you never being critical of your own actions. Every decision I make, I question. Not to create doubt or give myself a headache but to answer the question that is most fundamental in sports medicine, “Did I do the best for the athlete?”
On the other hand, it is the role of me as a physiotherapist to demand more from my S&C coach, improved monitoring of late stage rehab, appropriate loads throughout the stages of rehab, ensure athletes are safe and well-educated in gym etc. The list is as long or short as you want it to be. The same way I expect the S&C coach to encourage me to question my principles, I will do the same. Now, it should be said that this critical evaluation of each other is not done to belittle or expose but through discussions in a relaxed, nonformal settings (team meals are a great place) I have learned unmeasurable amounts of information on periodisation, conditioning, best and worst exercises (always question this one) etc. It’s free CPD. These discussions also allow you to get a true understanding of the person and the professional you work with. Getting to know the person behind the stopwatch or physiotherapy table allows the barriers to team development to be removed and true friendships are born.
Not only is being in a coherent MDT much greater for job satisfaction, it reduces injury risk and days off sport in a team setting. A study conducted by Tee et al (2018) demonstrated that managing the complex decisions within sport as an MDT leads to improved injury risk. This short video (Click here) provides a great summary of this paper. Successfully managing complex injuries requires us to cross disciplinary boundaries and interact proactively with each other.
Let go of your ego, humble yourself and be able to learn, unlearn, and relearn. The continuous process of professional development only happens when critical minds continue to challenge the current thinking. The S&C coach and physiotherapist are in the perfect position to do that. Debate, discuss, and develop interventions that improve your knowledge.
This endless game of Jenga between the two professions can lead to disaster or success, coherence or backstabbing. Imagine you played a game of Jenga where your goal was to get the tower as high as possible, instead of watching your competitor fail. You would still need to make risky moves as the tower gets higher but this time you and your partner would likely discuss which block to move. Which block would give him or her the best chance, and in doing so, give you the best chance when your turn comes around. Together with a shared vision, we accomplish more. With open communication, respect, and critical thinking we can accomplish the impossible. Very few times in my professional career have I experienced this feeling of complete coherence, each person giving themselves selflessly to the task. It is in these rare situations that my professional and personal development has been boosted most.
Tee, J.C., Bekker, S., Collins, R., Klingbiel, J., van Rooyen, I., van Wyk, D., Till, K., Jones, B. The efficacy of iterative “sequence of prevention” approach to injury prevention by a multidisciplinary team in professional rugby union. Journal of Science and Medicine in Sport.