What gives us the right? A guest blog by David Poulter

I often get requests from therapists wanting to guest blog, and I tend to ignore or delete them due to stupid ideas or crappy content. However, when I got this from David Poutler I didn’t do either. Firstly because ‘Poults’ is a legend in our physio community for ruffling the feathers of the dark lords of this profession now and then. Also because Poults has been around the block a few times and knows a thing or two about physio having worked with Robin McKenzie himself and done various jobs and roles throughout the years. He has also competed at, and worked with many elite level sports, is a father and grandfather, as well as a social media whirlwind. He currently lives and works in Twin Cities, Minnesota, USA, and without further ado, take it away Poults…

What gives us the right to advise an athlete on what to do? Credentials or Credibility?

I recently added two new items to my bucket list. First present a TED talk. Second author a guest blog on “The Sports Physio”. Now admittedly I haven’t been asked to do either, but my motto has always been if you wait to be asked, you might be waiting a long time. So if you are reading this then my bucket list has one less item, and who knows the people at TED might read this as well.

So, the thought for this article came about after watching Adam’s recent rant on Facebook live. He posed the question: Are most physios (PTs) qualified to give training advice to athletes? (I think he was talking about elite or high level athletes, and I’m being kind when I say that he said in no uncertain terms that the vast majority of PTs were not qualified). It brought up some thoughts I had previously had regarding the question: Are the vast majority of PTs even qualified to give treatment advice let alone training advice to athletes, especially at the elite level?

So what does it take to be able to give advice and treatment to athletes at the elite and not so elite level?

For those of you that follow me on twitter, you will be familiar with my constant use of Ethos, Pathos Logos.

Ethos: Gain trust

Pathos: Seek to understand

Logos: Then be understood

I propose that each of these three elements is essential in advising and treating the elite and not so elite athletes. Ethos, how do you gain an athlete’s trust?  Pathos, how do you seek to understand them, especially when injured? Do you understand the effect injury has on their mental state, ability to train and to compete?  And, Logos, how do you explain the management / treatment plan to them?

My answer is simple; you probably have to have walked, run, cycled, thrown or swum in their shoes. (Or Wellies in the case of Damian Thacker). Have you personally experienced anything close to what the elite athlete goes through in training and competition?

There is an old saying “If you talk the talk can you walk the walk?” (Simply put: Do you practice what you preach?) In this case I’m suggesting you have to have “walked the walk to be able to talk the talk and then walk your talk.” (Sounded better in my head)

walk-the-walk

On a personal note I have always valued the understanding I have gained from competing in sport throughout my teens and adult years. I have suffered through long hours of training in swimming running and cycling. I have had my share of injuries, which have often required adjusting my training, competition goals and expectations. I understand that being told to rest is the last thing in the world an athlete wants to hear and that athletes may go through similar stages to grieving when injured.

I suspect that some of you are probably thinking that you don’t have to have experienced what the athlete is going through in order to provide advice or treat them effectively. So why am I emphasizing the need to have experienced what they experience?

The answer is “Credibility.” The ability to say to an athlete…

“I understand what you are going through; I have been through the training and suffering myself”

“I understand that rest, is a dirty word and that you want strategies and advice that will keep you in training and competition.”

“I understand that being injured feels like the end of the world, especially at this point in time.”

“I understand that being injured is disappointing and difficult to cope with at times.”

Having experienced the training, the disappointment of injury and the drive to compete allows you to understand most of the athletes who will consult with you. It gives you credibility and allows you to gain the athletes trust. (Ethos). It allows you to understand where the athlete is coming from, and why they may behave differently than your other patients. (Pathos)

A sidebar: (In a Shakespeare play this is where I talk to the audience directly, it’s a Brit thing, plus this is the Logos section)

Experience has taught me to always put the emphasis on asking athletes what they want from the session. What concerns, hopes, needs and most of all, what their expectations of me and any therapy/treatment might be?

When consulting with an athlete I try not to offer my opinion; instead I offer informed advice and direction. Direction may involve referring them to an appropriate MD or more experienced PT, who is more familiar with their sport. (I have never played baseball or pitched, so often refer athletes out to US trained PTs who specialise in this.) I am also lucky to have developed a network of Sports MDs and surgeons who still compete in Triathlon at a high level, run marathons, or were college athletes themselves. This allows me to refer my athletes on with confidence, knowing that they will receive the same understanding and care.

I am happy in the thought that, most, if not all of the athletes who have sat in front of me have trusted me; I feel I have understood the vast majority of them. And, after listening and consulting with them, have come up with a management plan to keep them training, playing and competing.

I want to stress that I may suggest modifications to their training whilst injured, but I do not feel I am qualified to offer training or performance advice to elite level athletes. (Echoing Adam’s message in his Facebook post)

What works for me personally in my own training (which is usually “unconventional wisdom” based training) may not work for them? Training is the purview of their coach, who I will often consult, with the athlete’s permission. This allows the athlete, the coach and I to be on the same page moving forward.

End of sidebar. (Logos done, you can understand where I’m coming from, hopefully)

In summary having walked a mile in an athlete’s shoes it allows you to gain their trust, and to understand them. It allows you to offer advice, implement treatment programs, and keep them training and hopefully competing as they recover.  As PTs we may have the credentials to see all, but do we have the credibility needed to gain trust and understanding in the elite and not so elite athlete?

 

Thanks for reading.

David Poulter PT

Former competitive swimmer, runner, triathlete. Current endurance cyclist

(Disclosure: I was fortunate (or unfortunate depending on your perspective) to have grown up in a household with a two time Olympian and Commonwealth games medalist)

Follow me on Twitter @Retlouping

3 thoughts on “What gives us the right? A guest blog by David Poulter

  1. Thanks Adam and David. As the important messages contained therein are applicable to all health professionals who engage with people experiencing persistent pain, I have taken the liberty of sharing the article with a wider audience.

  2. Dear David
    Nice to see you on a guest blog. I know you often have a lot of clever ideas in the world of physiotherapy, thanks for that!
    Your argument in this blog, about you have to be an athlete to treat and help an athlete is my opinion hopeless at best and harming at worst.
    Firstly, if your argument should hold then you can´t be an obstetrician if you haven´t had a child by your self or as a doctor you can´t treat or help a patient with fx cancer if you haven´t been very ill yourself. Simply in your words, because you have not walked in the patients footstep.
    Secondly its a harmfull approach before hand to say who are able to help and who are not. Simply because no one knows.
    In my opinion there is a much better way to know, who is able to treat, help or give advice to an athlete or any other patient. That is something all therapist could learn from.
    1) You have to measure the therapist and patients alliance every visit ( then you know if you have credibility)
    2) Measure the patients “well being” every visit or at least every week. Then you have a chance to ask quistions in areas where the scores are low. You can see if your helping the patients. If there is no progress over a few visits and the scores are low, chance are low that you can help and you are in risk of giving the patients more problems if you do not changes you treatment or advice. (best choice is most often to change the therapist)
    3) Make massures of patient specific functions goals, again to see if you help or not.

    Kind regards Steen PT

  3. Hi David,

    Would you mind elaborate further on “When consulting with an athlete I try not to offer my opinion; instead I offer informed advice and direction. ”

    Sincerely,
    Antony PT

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