As a powerlifter (and hopefully soon to be CSCS) who works in the health & fitness industry I cringe whenever I see powerlifters & strength coaches asking other powerlifters and coaches for injury & rehab advice. Your coach may be great at preparing you for the platform but unless they went to PT/Chiro/RMT/ATC school and have a solid understanding of pain science & the evidence they likely aren’t the people you should be seeing.
That said I see a lot of powerlifters, strength coaches, and athletes in general who are reluctant to see a rehab professional as they may doubt the professional’s ability. In addition some (not all) rehab professionals aren’t very knowledgeable when it comes to weight training or athletics. This can make it difficult to find a good professional to work with.
The purpose of this article is to provide a (non-exhaustive) list of things to look for in a rehab professional.
1) They don’t run you through an assembly line
I understand that I will piss a few people off by saying this but <30 minute assessment times & 10 minute (or less) treatment times for patients are ridiculous. These bookings, in most (but not all) cases, fail to provide adequate time to adequately assess, reassess & treat patients.
Bottom line – you should be looking at clinics that provide 40-60 minutes per assessment and at least 15-20 minutes per visit.
2) They understand pain science and the biopsychosocial model
Many rehab professionals are educated in the postural-structural-biomechanical model of thinking. This model basically claims that all pain is due to postural, structural, and biomechanical faults. The problem with this theory is two fold.
First of all many of the “biomechanical” faults that therapists & chiros cite (e.g. trigger points, joints being out of place, upslips/downslips/rotated innominates, hypermobile/hypomobile segments) either can’t be reliably assessed and/or don’t correlate well with pain.
Secondly, through decades of research, we know that pain is more complex and can be influenced by biological, psychological, and sociological factors.
Bottom line – if you ask your therapist about the biopsychosocial model & pain science they should be able to give you a half decent answer as to what they are.
3) They should understand lifting and athletics
If you’re not an athlete or someone who lifts weights feel free to skip this part.
One of the gripes I hear about PTs & chiros from strength coaches, trainers and lifters is that many of them don’t understand lifting weights or athletics and are overly cautious with their restrictions. You hear this all the time. “Don’t squat it’s bad for your knees.” “Don’t deadlift it’s bad for your back.” “Use light weight and do lots of reps.” “You’ll never run again.” The list goes on and on.
Now I will be the first to say that certain injuries and certain medical conditions can make certain exercises unsafe. But working with a rehab professional who understands how to train effectively & safely and also understands athletics will give you the most bang for your buck.
Side note: Your therapist may not have done every single sport or activity that you do but they should at least understand the general demands of each activity.
4) They should give you a thorough assessment & ask you about your general health, not just your aches & pains
One major concern I have with some (again not all) rehab professionals is when they start doing manual therapy and other techniques without giving you a thorough assessment and asking about your medical history to rule out red flags.
Some medical conditions – such as cancer, rheumatoid arthritis, osteoporosis, and others can make manual therapy techniques (and certain modalities) unsafe. As such your PT/chiro/RMT/ATC whoever should be asking you about your general health & ruling out red flags to make sure treatments can be done safely.
Side note: Sometimes as a patient you may have to do things you don’t like – such as taking a temporary break from training, modifying your training volume, and/or doing rehab exercises to help get better. But, at the end of the day you should be able to ask your therapist “how is this helping me achieve my goals?”
5) They should be good at communication
“People don’t care how much you know until they know how much you care.” – Attributed to many people
Communication is key. As a patient you should feel like your story is being listened to and that your therapist is working towards your needs & goals. I’ve heard it said, both in PT and doctor’s clinics, that patients have less than 15-23 seconds to speak before they get interrupted. In my practice I open (almost) every assessment with “tell me your story” and let them have the floor. I found this gave me more useful information and insight into their condition than anything else did. As Peter O’Sullivan said “you won’t remember tick boxes but you’ll never forget a patient’s story.”
6) They should be evidence based & value continuing education
This is a no-brainer. If your therapist doesn’t value continuing education and making themselves better chances are he/she is more likely in it for the money than to help you.
7) They shouldn’t make you dependent on passive treatments
I’m sure I’ll also get some flack for this one but here goes….
Patients like passive treatments (e.g. modalities, manual therapy). The patients don’t have to do anything and they provide a short term (often placebo) benefit. While the odd modality is supported for the odd condition and manual therapy does have a place – if a therapist doesn’t give you some active methods to manage your pain (be it exercise, education, or both) that is problematic.
Side note: during my time in clinical practice I had times where I had to solely passive treat certain patients as they were in such pain they couldn’t tolerate much (if any) volume of exercise. But I made it known to the patients that this was a temporary thing.
I hope this article gives you some insight for choosing a therapist. If you have trouble finding a therapist email me at firstname.lastname@example.org and I’ll see what I can do. Tune in next week for “What to look for in a fitness professional.”