Defining 'Performance Therapy'

This post was prompted by a discourse that occurred on social media. Vern Gambetta, a well-known author and coach who has consulted with many sports, responded to a Twitter post by asking 'What is performance therapy?', and his follow up question was 'Why?'. Clearly these are important questions, which I will do my best to provide definitive answers to here.

To define 'performance therapy' it is a useful to provide an illustrative example of an environment where performance therapy is a part of everyday practice. My previous blog post on Altis described such an example. Performance therapy is a cornerstone of the Altis approach; treatment tables and therapists are a permanent fixture on track side at every session, and the treatment rooms at the strength training facility are similarly fully staffed each afternoon. But what are the defining characteristics that separate this practice from what occurs elsewhere? What is the essence of what makes it 'performance therapy'?

I truly believe that mechanical efficiency can be affected daily by therapy inputs. Treat athletes like F1 race cars.
— Dan Pfaff

My original attempt at answering Vern's question within the 140 character limit was '...essentially directed track-side therapy'. This brings us onto the two key defining elements of performance therapy. The first is that it is directed (in the case of Altis by coaches who possess a highly developed eye for movement and the ability to detect normal vs aberrant function). The second critical feature is the immediacy and ready availability of therapy, both prior to and during practice and/or competition.

Remove the restriction to more optimal movement - don’t try to exercise your way out of ‘dysfunction’
— Stuart McMillan


In the training environment what makes it 'performance therapy' is the capacity for appropriate treatment delivered in a timely manner to positively influence the athlete's ability to perform the training prescribed on any given day. In this way the therapy delivered can have a significant impact on the quality of training performed over the course of a training block. In turn this makes therapy a key factor that directly and positively influences progression and training outcomes over time. This exemplifies that timely therapy intervention can have a direct effect on training input, the training outcomes that result, and ultimately the athlete's performance capacity and capability. 

Where this expertise is available, therapy can similarly play a highly complementary and potentially decisive role during competition. In this context, directed, timely and appropriate treatment intervention can have a direct and highly positive effect on performance in competition. For instance, relieving restriction and associated inhibition can positively impact upon the athlete's ability to function and their readiness to perform. Again, this describes the potential for a direct link between the application of therapy and performance.

Returning to the 'directed' aspect of performance therapy, the monitoring process that prompts and informs treatment intervention is incumbent not only on the coach but also the athlete themselves.

What is your ideal monitoring system? Coaches that pay attention”
— Dan Pfaff


And here we turn once more to Altis to provide a practical example of how this daily monitoring can be achieved. The warm up protocol performed by each squad is carefully devised to not only prepare the athlete to train and rehearse specific movement patterns, but more than this the exercises that comprise the dynamic warm up are carefully chosen to screen for areas of restriction and associated movement compensations. The coaches themselves not only actively observe the warm up each day, but also have a critical eye on their athletes for any other telltale signs from their posture, gait patterns or general demeanour from the moment they arrive at training.

Constant critical observation of movement is an active skill
— Stuart McMillan

But clearly the most sensitive detection system for any areas of restriction or altered function on a day-to-day basis is the athlete themselves. There should necessarily be an onus on the athlete to take responsibility for this. This is also a long term process to educate the athlete and develop their body awareness so that they are more attuned to their own posture and movement. Effectively the objective over time is to increase the sensitivity and specificity of the athlete's own self detection system.

Finally the success of the performance therapy approach is ultimately dependent upon the practitioner. Clearly a necessary first step is for the practitioner to be able (and willing) to move beyond the confines of the clinic or treatment room and station themselves in the training environment to observe and to treat athletes. Part of this exposure to the training environment is to gain critical insight into not only athletic movement but also the nuances of movement for the sport. 

Embracing a model where therapists spend time observing athletes in sporting movements is critical
— Gerry Ramogida

The availability of the practitioner at daily training is critical to ensure timely intervention. As mentioned previously, this is a key point of difference with the performance therapy approach. Whilst I dislike buzz words, performance therapy is by its nature 'pro-active'. Specifically, the intention is to preempt issues so that treatment is provided at the earliest opportunity before a 'minor' complaint or 'niggle' (restriction or altered function) leads to an injury episode. 

Similarly, when assessing the athlete, the focus of the practitioner must shift from solely treating the complaint to establishing and addressing the root cause.  Clearly the affected area must be treated, but the practitioner must also discern symptoms versus cause, and take appropriate measures to address both primary and secondary factors. Essentially, the role of the performance therapist is detective and 'fixer' in a preemptive manner, rather than merely a fire fighter tackling each blaze in a reactive fashion.

Don’t just focus on symptomatic area. Don’t just focus on likely cause. Always think ‘what else, where else’.
— Dan Pfaff

So there it is, the essence of 'performance therapy' and the points of difference that define it. In rather more than 140 characters...

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