So you play a sport or prefer a certain activity but you have pain?
Very often, pain with movement is related to acute injury or repetitive trauma in a movement picture that isn't operating with the best mechanics or structural balance. ‘Movement patterns’ is a phrase that is flying out of the mouths of movement pros everywhere. You will hear strength coaches, personal trainers, athletic trainers and physical therapists use it. What you have to understand is that a physical therapist is the only pro who can watch someone move, understand the pattern and address the deficient pieces.
These patterns are based in neuroscience, primitive reflexes, and some very specific anatomy that no other pro is trained in to this combined detail. A strength and conditioning pro talking about these pieces of the movement puzzle is like a busboy trying to bake the perfect souffle; it might work out in the end but not after a LOT of trial and error. It's best left to the right professional.
Who's in your pit crew?
While the majority of us may not be competing at the highest levels, lots of smart folks are becoming aware that you don't have to be paid to play in order for you to have the team of pros that will keep you moving well and having fun.
In the past, these people might seek the help of their local PT Mill physical therapist. This is a good start. That physical therapist is going to be able to diagnose the cause of pain with great accuracy and then develop a plan to decrease it both acutely (right now) and for good. Problem is that the 'Mill' physical therapist isn't really equipped to take their clients much further than just "good enough". There are lots of reasons for this which we've chronicled in previous posts.
What if you want to get better than "good enough"?
Some people turn to their exercise pro. Strength coaches and personal trainers are great resources. Their skills in exercise technique, safety and effectiveness are excellent. Problem here is that they are not trained in any way to handle a client when pain creeps in. Some people think to themselves, “I’m not moving the way I want I move, I’ll just go see my personal trainer and I will become a better mover by becoming more fit.” We in physical therapy have a phrase for that – "adding fitness on top of dysfunction". It's a common problem and the one's who are the most blind to it are the trainers and coaches themselves! The best your strength coach can do is avoid the painful movement and design programming 'around the problem'.
Each of these strategies will help you deal with your pain but neither of them alone is the way to your highest movement efficiency and lowest pain possible. The power of a performance-minded, HYBRID physical therapist AND strength pro is unmatched in this niche of recreational and professional performance. The ability to directly address pain right when it's happening and then design and implement the plan that will knock it out for good is the most powerful skill set around. And now, you can have this high level treatment approach too! There are lots of HYBRID physical therapist/strength coaches out there. Problem is they are too quiet! That and they're too busy! These pros are highly trained, highly sought after and have the most profound impact on people's lives that most just let their work speak for them.
Your right hand man (or woman) should be a hybrid NEW BREED physical therapist. We will most efficiently pick out the areas of poor function, address them and then systematically reinsert them into the overall high level movement pattern they belong to. Even if you're not complaining of acute pain, we can help you work to keep it that way. With this approach, if something does occur, we can pinpoint why and what we should do to correct it immediately.
How are hybrid physical therapists/strength coaches changing the field of physical medicine?
In a perfect PT world, clients would have their hybrid physical therapist at top of mind for all movement related pain and to constantly be looking for ways to make them maximally efficient and powerful movers. Clients see us, similarly to how they see their dentist. You have your check-up set once every couple months. If everything checks out, we schedule another check-up 3-4 months out. But if the client is in pain or during a check-up we find a movement issue we address it with a few treatments and have that client back on their way. It all comes down to the way physical therapists assess MOVEMENT– even people without pain may have room for improvement. When we say, “all the way well”, we mean the solid foundation for an overall improved quality of life.
These patterns are based in neuroscience, primitive reflexes, and some very specific anatomy that no other pro is trained in to this combined detail. A strength and conditioning pro talking about these pieces of the movement puzzle is like a busboy trying to bake the perfect souffle; it might work out in the end but not after a LOT of trial and error. It's best left to the right professional.
Who's in your pit crew?
While the majority of us may not be competing at the highest levels, lots of smart folks are becoming aware that you don't have to be paid to play in order for you to have the team of pros that will keep you moving well and having fun.
In the past, these people might seek the help of their local PT Mill physical therapist. This is a good start. That physical therapist is going to be able to diagnose the cause of pain with great accuracy and then develop a plan to decrease it both acutely (right now) and for good. Problem is that the 'Mill' physical therapist isn't really equipped to take their clients much further than just "good enough". There are lots of reasons for this which we've chronicled in previous posts.
What if you want to get better than "good enough"?
Some people turn to their exercise pro. Strength coaches and personal trainers are great resources. Their skills in exercise technique, safety and effectiveness are excellent. Problem here is that they are not trained in any way to handle a client when pain creeps in. Some people think to themselves, “I’m not moving the way I want I move, I’ll just go see my personal trainer and I will become a better mover by becoming more fit.” We in physical therapy have a phrase for that – "adding fitness on top of dysfunction". It's a common problem and the one's who are the most blind to it are the trainers and coaches themselves! The best your strength coach can do is avoid the painful movement and design programming 'around the problem'.
Each of these strategies will help you deal with your pain but neither of them alone is the way to your highest movement efficiency and lowest pain possible. The power of a performance-minded, HYBRID physical therapist AND strength pro is unmatched in this niche of recreational and professional performance. The ability to directly address pain right when it's happening and then design and implement the plan that will knock it out for good is the most powerful skill set around. And now, you can have this high level treatment approach too! There are lots of HYBRID physical therapist/strength coaches out there. Problem is they are too quiet! That and they're too busy! These pros are highly trained, highly sought after and have the most profound impact on people's lives that most just let their work speak for them.
Your right hand man (or woman) should be a hybrid NEW BREED physical therapist. We will most efficiently pick out the areas of poor function, address them and then systematically reinsert them into the overall high level movement pattern they belong to. Even if you're not complaining of acute pain, we can help you work to keep it that way. With this approach, if something does occur, we can pinpoint why and what we should do to correct it immediately.
How are hybrid physical therapists/strength coaches changing the field of physical medicine?
In a perfect PT world, clients would have their hybrid physical therapist at top of mind for all movement related pain and to constantly be looking for ways to make them maximally efficient and powerful movers. Clients see us, similarly to how they see their dentist. You have your check-up set once every couple months. If everything checks out, we schedule another check-up 3-4 months out. But if the client is in pain or during a check-up we find a movement issue we address it with a few treatments and have that client back on their way. It all comes down to the way physical therapists assess MOVEMENT– even people without pain may have room for improvement. When we say, “all the way well”, we mean the solid foundation for an overall improved quality of life.
What’s the danger in throwing some endurance and strength at
a faulty system? Further dysfunction. Simple example: If you had 50% strength in one hip, and do a normal back
squat, you use one side more than the other and build strength in an
asymmetrical manner. This widens the disparity between the sides and leads to greater compensatory movement and imbalance; the type which your trainer will never understand so don't bother trying to explain it to them. Now, if that trainer decided to go and become educated as a physical therapist, they would soon see the error in their approach. It's novice level physical medicine thinking. I'm not going to give my plumber a hard time for giving me incorrect info about an electrical problem I have, so it's not fair to blame a trainer for a physical medicine mistake as they've never been educated about it.
Start sharing posts like this. Write your own. Connect with mentors and like minded physical therapy friends and have these conversations with your colleagues. If you're not incorporating some formal training of performance, physical strength, flexibility, or power movement, progression you aren’t what's best for your field or your clients.
Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.
Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races. He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at cjberio@sparkphysio.com
