Bridging the Gap Between Physical Therapy and Strength and Conditioning
Today’s guest post is by Andrew Millett, a close friend and a skilled physical therapist outside of Boston. The phrase “bridging the gap” often comes up when people talk about physical therapy and strength and conditioning. There’s no doubt the two fields blend to help patients and athletes achieve the best results. But in a time when more trainers act like therapists (and vice versa), it’s important to recognize that while it’s good to work in both areas, there is a real distinction and we should respect it.
In the fields of strength and conditioning, human performance, and physical therapy, we interact with people every day. We learn about their families, jobs, goals, and what they want from training or rehab. Most people in these fields didn’t enter their work for the money. That doesn’t mean these careers can’t be rewarding financially, but it does mean we share a common bond: the desire to help people. Whether you’re a physical therapist helping someone reduce pain and return to what they love, or a personal trainer helping someone lose weight, most of us want to help.
When we see a client who is in pain or has a movement dysfunction, most of us want to help them get out of pain, even if we aren’t healthcare practitioners. Personal trainers and strength coaches can assess and correct movement, and there are several approaches that train this skill, such as the Functional Movement Screen (FMS), Selective Functional Movement Assessment (SFMA), and Functional Range Conditioning (FRC). These tools help trainers tailor programming to how a client presents.
Often a trainer notices a movement fault they’d like to fix to help the client succeed. There’s nothing wrong with wanting more for your client and helping them reach their goals. If you detect a movement limitation—like reduced joint mobility or range of motion—use the tools you have to try to address it. Tools such as a foam roller, lacrosse ball, or other self‑myofascial release devices can help improve soft tissue flexibility that may be limiting movement.
Self‑myofascial release can improve movement quality and reduce pain. By using these methods, you’re taking steps to help your client to the best of your abilities. If employing a tool helps someone move or feel better, that’s great. If it doesn’t, remember what Charlie Weingroff says: “4th and 10, you have to punt.” In his DVD Training = Rehab, he explains that if a client has a mobility limitation and isn’t improving, you should refer them to another provider, such as a physical therapist, sports chiropractor, or massage therapist.
If someone has pain, punt them. According to FMS, if a client shows pain during the test, the evaluation ends and they should be referred to a healthcare practitioner. Referring a client with pain to a healthcare professional would likely free up your time, but most clients have some ache or pain to deal with. Punting doesn’t mean you have to drop the client. You can continue training them in a multidisciplinary approach, without making their pain or dysfunction worse while they receive treatment.
Don’t try to be a jack of all trades and a master of none. Don’t be the trainer who also tries to treat pain or soft tissue problems with manual therapy. Know what you’re good at and where someone else may do it better. If a client shows up and I know another clinician who is better at a given task, I’ll have them continue care with that clinician. Keep manual therapy to the physical therapists, sports chiropractors, and others who have extensive training in these techniques.
By building a network of local PTs and chiropractors, you can refer clients to the right person when needed. Your client will appreciate your humility in pointing them toward the best care. Even if the physical therapist reduces their pain, they’ll remember that you had their best interests at heart.
Think of your client’s needs first, not your ego.
Now, just because I’m a physical therapist doesn’t mean I’m against personal trainers. I have a background in both PT and strength and conditioning, and I see myself as a hybrid who bridges rehab and strength work. I know I’m not the best trainer out there, but I’m confident in starting the programming process and teaching clients how to squat, deadlift, lunge, carry, push, and pull.
Eventually there comes a time when a trainer or strength coach can take over and continue the process. My goal for clients when they finish with me is that they have a solid foundation of the basic movements so they can safely progress toward their health and fitness goals.
If you’re a physical therapist or sports chiropractor and you lack confidence in teaching basic movements or programming, leave that to the strength and conditioning or personal training professionals. The message goes both ways: just as we encourage trainers not to be “bridge-gappy,” the same goes for physical therapists. The main point isn’t to bash either side of the health and performance spectrum. It’s about coexisting and building connections across healthcare and performance disciplines so we can best serve the client or patient.
