Performance therapy is a term that has become more mainstream in the last decade. When I was in school, the term Sports Chiropractor was probably more common. I can only give this article the viewpoint from the lens of a chiropractor as I have not walked the road of other professions even though I interact with them frequently.
I've been an athlete my whole life and because I was a fairly good, I was able to make a National Team in the sport of bobsled. I had just graduated chiropractic school, so the first people I worked on were high level powerful folks. In my world, this was the norm. It took me almost a full year to get used to a more passive mindset in clients when I left to work in the private sector.
I've had the good fortune of working an Olympic Games, traveling the world with some really fast guys and taking part in big meets and events. I've been able to work with lots of different sports and teams and had some amazing memories from them.
This article isn't about getting to do that. Some of it was luck and some of it was knowing the right people, and some was the classic right place at the right time. Sure, if the door opened and you aren't that good, you don't get asked back. This article is about being good enough to get asked back.
Performance therapy by my definition, is therapy that perpetuates better performance. It can be on a spectrum. Hurt on the left. Increased performance on the right. Someone will present somewhere between those two points. While performance therapy can be used to overcome injury, it is by definition treating someone not injured and looking to make that session or that race optimal. I think the best work is done in a heavy training block and therapy is used to help recover and allow more training volume and better training sessions to happen. I stress that not injured doesn't mean optimal. Think of someone that is running well, but the lower back get sore after every sprint session. Perhaps the big toe doesn't have enough motion to allow full ROM on push off at high speeds so the athlete arches their back to compensate. Still training well, but not as fast as they could progress and are getting increased lumbar soreness.
First a few points to remember. This is my opinion. Ask someone else and they may disagree on everything I'm about to tell you. Don't ever get into the mindset that because someone works for someone or some team that they are amazing. Just like someone driving an expensive car doesn't mean they are rich. The outline I'm going to talk about is also not the path I took. Many of the courses and people I've met along the way, weren't around when I was in school or on my graduation. So in a way, even though I've taken these courses it wasn't my path. This should tell you there are many paths, but the following path is what I tell kids when they email me asking advice on how to become a performance therapist.
Get a huge base. You need a big base if your ever going to build a big pyramid. Your base is what your going to spend most of your time with and it will take up most of your treatment. All other things become less effective if you don't master the basics. How many times have we been told, master the basics, build a solid base, don't skip ahead. The best course hands down for building this base is the Functional Range Release (FR). You get very good at finding anatomy and feeling anatomy. Locating tension and then addressing tension and tone, also differentiating mechanical tension from neural. (This was one of my biggest mistakes on leaving school) If you develop this base well, you will be able to help a lot of people even if you never went any further with your training. I plan on taking one every year or so, until I feel like I'm not getting anything out of it. I'll bleed this one dry. Get good at knowing what structure you are feeling and if what you are feeling is normal.
Get good at loading the tissue.
Things get better when we load them. Things get worse when we load them wrong. Things don't improve very much or as quick if we don't load them at all. Become a master of understanding load. The best course is Functional Range Conditioning. You may think I'm biased, but it probably worked out this way for a reason. The FR originators understood that to get great results required load and the conditioning course was born. This course goes deep into that understanding. I mean deep. It made me go back and read histology and cell physiology and truly enjoy it. I will retake this course in the future.
Get good at Being Part of a Team.
A performance therapist should know about physical training. Understand strength and conditioning. You probably won't be the primary coach for that person or athlete, but to understand what exactly is happening during training is extremely important. The body adapts to training, understand how your therapy can be synergistic to that. Being able to have a competent conversation with the athlete and coach is so undervalued it's criminal. If you end up working in a team setting, this may be the difference in being asked back. Are you competent in being part of the triangle of performance, athlete, coach and therapist. The best course is being offered by ALTIS, another hands down. It's the only thing really like it that I know of. You get to experience the triangle in action. You can ask a therapist why they pulled an athlete after watching them in their warm up to treat X. Then see how that treatment changed the movement or drill. You can watch and learn as treatment, coaching and athletes response feed of each other and determine the daily dose of training.
Get good at Regression and Lateralization.
This is a term I learned from Charlie Weingroff. Regression is taking an exercise and making it available to that athlete that can't quite do it as prescribed. They lack hip mobility so you take a deadlift from the floor to a deadlift off blocks, this is an example of a regression. Lateralization is a side step. If you don't have dorsiflexion to get into a great squat position, substitute the squat for a trap bar. Still being able to train a heavy load with out putting the athlete at risk while working on getting them dorsiflexion. Charlies Training=Rehab series of DVD's are a tremendous resource.
Get good at Energy Systems.
Not understanding the impact that the physiology of the energy systems plays, is one of the biggest mistakes in therapy. Getting in great aerobic shape can help the healing response and position the athlete to have better tissue quality, less prone to colds and allow more training volume. Blood flow brings healing, build more ways for that blood to flow! I'm currently taking Joel Jamieson's Bioforce Conditioning Coach course. It's very good. His book is also a tremendous resource.
Get good at Nerve Flossing.
How to address neural tension or nerves that are causing the major course of dysfunction. Michael Shacklocks Neurodynamics course is amazing. 4 days of of insane amount of information. Great anatomy tie ins and superb blend of teaching and hands on. I will retake this course in the future.
Get good at Knowing What You Don't Know.
This category exists to understand when you need help. For me, this category is stuff I want to get better at, but am currently inefficient in to give guidance at an elite level. For example, the everyday person, I can give blood work advice on some basic stuff. Throw in an autoimmune problem, or fluctuating patterns that I'm not confident with, I'm not going to risk their health. Some of the systemic monitoring like HRV and omega wave and using technology like EMS are one of the pools I'm learning to swim in, but again, I don't feel confident in giving advice.
Get good at Waking Up.
I think this is a small percentage, and to be honest I'm still figuring out where it belongs in the big scheme of things. But I do think it belongs somewhere. I put the courses fascial manipulation and Reflex Performance Reset in these. I give RPR the nod, as it's like 1500 dollars cheaper. I think there is an appropriate time to "wake up" tissue, like post surgery or when body awareness is low. I currently am using it mostly in the untrained individual. I'm finding they have a hard time "feeling" a muscle work/contract. Even if it is! The body awareness is so poor that when you do exercises with them, they start biasing into what they can feel. RPR has allowed them to have better body awareness.
Get good at Competition
I think therapists should compete in something. I think you should understand what being at a start line, waiting for the whistle to blow, or waiting for the green light is like. What it feels like to know your ready to compete, to also know what it feels like to know your under prepared. To fully know the frustration of being hurt. To know what bonking is. To know what heat/cold feel like. To know the highs and lows of training. To know that most days are just showing up and putting in work and your therapy is a part of that. Nothing special, just a part of their day. You don't have to be good, but you have to work at something and put yourself out there. I think athletes appreciate when they know you may know a little about their world. It also helps from an esoteric level. If your at a big meet/event and you can feel the energy and nervousness that is around, it helps you give a more calming, positive presence in your treatment. If you have never felt the nerves yourself, you may get caught up in the situation and put out nervousness and feed forward that to your athlete. So join a lifting club, enter a 5k, register for a local cyclocross race and put yourself out there.
Get good at Reading
Every talented therapist I ever met has been a voracious reader. It's not just therapy books either. Although you should have some solid anatomy books. (I like Stecco's stuff) The bigger the library the more you start to see how things fit together or intertwine and overlap. I think this helps you start to recognize patterns and process information at a higher rate. The more that is in your understanding the faster you can start to process information. In a private clinic that might mean you get to see 3 people in an hour instead of 2. At the track it may mean you get to solve a potential problem in warm up instead of interrupting the practice. Figuring stuff out faster is important. Train your brain to learn and be creative. Read more and read from a broad spectrum. Variability is a good thing for joints, heart and your reading.
This is my recommended path when kids email me. Now I can just send them to this blog post instead of just listing some courses. Like I said, this was my opinion. I'm sure others would have other recommendations. If you are a therapist that works with sports or athletes, what course have you found instrumental in your learning?