Is there a blurring of scopes of practice between physiotherapists and strength and conditioning (S&C) coaches? When I look at Instagram and some of the big physiotherapist influencers, a lot of the material I am seeing are exercises for non-injured muscle. Does it matter? Not really. I’ve never been patch protective. Do physios need to know more about S&C and exercise prescription for performance and do S&C coaches need to know more about exercise prescription for rehab and return to play? In most cases, hell yeah! In fact, when we work together closely in return to activity-work-training-play, client/athlete outcomes are optimised (see Figure 1).
Another area that I think there should be a natural synergy between physiotherapists and S&C coaches is with injury resistance. I use the term injury resistance as it is impossible to prevent injury and also it helps me understand that I am trying to develop tissue resistance and resilience. When nuanced knowledge around injury aetiology and causes of movement dysfunction merge with understanding around the multifaceted nature of performance and the many training principles underlying performance enhancement, once more the client/athlete outcomes in terms of remaining injury free are more likely optimised.
So given this information, what really matters in terms of strength and conditioning knowledge that physiotherapists need to know? You will see that some believe it to be about periodisation, specificity, overload, progression, sets, reps, etc., I believe it to be more fundamental than that and if I could give physiotherapists any gifts of knowledge to enhance understanding and practice around the strengthening of muscle, I would take two foci initially: 1) a tissue perspective; and, 2) a mechanical loading perspective. In this blog post I’d like to unpack tissue perspective a little more...
A model that has really shaped my strength and conditioning practice and I have taught to physiotherapists and strength and conditioning coaches alike is shown in Figure 2. It is called the three-component model and it reminds you that there are a lot of tissues that you need to be aware of that are responsible for force transmission and production. The CC stands for the contractile component, which is your muscle fibres and myofilaments. The SEC is your series elastic component, which refers to your tendon and aponeurosis. The PEC is the parallel elastic component, which includes connective tissues such as your mysial tissues e.g., endo-,peri- and epimysium. You can see all the different components in the picture of muscle – Figure 3.
All of these components have important parts to play in force expression depending on the type of contraction, velocity and amplitude of movement. You will note that the SEC and PEC are modelled as springs because they have very important parts to play in the storage and utilisation of elastic energy.
So why is this model so important? Well, most practitioners deal with the strengthening of muscle whether it be for rehab, return to play and/or performance in a very macro manner. Understanding that there are multiple places/tissues where force expression can be compromised, helps focus assessment and prescription. For example, take the two elastic components, the SEC (tendon) and PEC (mysial tissues), essentially collagenous in structure that vary markedly in density and regularity, and as such both have very different stress (force) and strain (length) properties. If you wanted to assess and/or strengthen these tissues, how would you go about it? Would you train them the same?
Understanding tissue contribution to function is a great place to start the S&C journey as the physio is trying to restore force production and transmission, whereas the S&C coaches foci is enhancement. Head to part two of this blog post for more on this topic.
If you want to develop your knowledge further in this area, check out my "Optimising Strength and Power - A Tissue Perspective" block course, designed for Physiotherapists.