This article was written by BHP provider Kathleen Ryan-Ceisel, PT MHS
Performance is not defined by a singular point in time, but as an evolution of the body’s adaptation to forces. These forces exist both within and outside the body. In working with youth, high school, and collegiate athletes, many physical therapists and healthcare professionals struggle with how to effectively sell and promote performance therapy in a manner that does not compete or intimidate coaches (either strength or conditioning coaches or sport/position specific coaches). Many coaches are unaware how physical therapists can help athletes who are NOT injured.
The concept and hierarchy of performance is analogous to looking at a tree. The leaves at the top of the tree represent sport specific skills (hitting/pitching/catching, etc.). The smaller branches correspond to the components of power, agility, quickness, balance, speed, strength, endurance, coordination, and flexibility. While these smaller branches are separate structures, they are closely interconnected to one another. The smaller branches feed into the medium sized branches, constructing the framework of movement. The scope of movement encompasses both the quality and quantity of movement, but also how dysfunction works within the system. It’s important to realize we all have areas of dysfunction; not all the branches on a tree are straight or all the leaves are full and symmetrical.
Movement breaks down into the larger branches, which represents function, form, and structure. Coaches work more on the function side of the tree; what you can see, touch, and manipulate. Physical therapists and other health care professionals work on the structural side of the tree. Structure tends to be more complicated, multifaceted, and not as easily observed. However, where coaches, physical therapists, and health care professionals work together is in the branch of form.
The form branch offers us different perspectives to the concept of performance. A recent example of this occurred while I was observing a coach cueing his baseball pitcher “to close his glove side” and “stride out longer.” What I saw was the same player with areas of movement dysfunction - rounded shoulders, increased thoracic kyphosis, and poor hip mobility. He could not stay closed effectively nor stride out longer because his structures would not (and could not) support his form. Two differing viewpoints on the same movement, neither incorrect.
The large branches of structure, form, and function come together to shape the trunk of the tree. The trunk must provide a solid base of support for all the branches and serve as a conduit for the root system. It has to be able to lengthen and expand with growth and development, but continue to remain strong and straight.
The underground network of the root system supports our tree and can directly affect all structures above it. This complex, multi-dimensional root system contains numerous divisions, all of which have different functions that contribute AND influence performance. These factors can be intrinsic (mobility, stability, joint mechanics, soft tissue, anatomy, biomechanics) or extrinsic (coaching style, sleep, nutrition, motivation, etc.). Physical therapists and other healthcare providers offer valuable insight in how those intrinsic components are dynamically related to one another.
Performance will decline or fail when pain, numbness and tingling, discomfort, soreness, and/or compensation appear. This can happen locally and/or globally to one or more roots. An “infected” root can shut down one or several roots, its corresponding branches and leaves, and even neighboring areas. It can happen quickly as with an injury/trauma or show up later in the season with overuse/compensation/weakness. Treatment and intervention must occur quickly, or performance will continue to suffer.
Our tree, like our athlete, will continue to grow and change over time. Yet, rarely do we have the WHOLE view of our tree (or athlete). Think about the Christmas tree that has a thin or bare spot and then “covering it up” by turning it to the corner. Performance therapy not only helps us to identify problem areas, but to develop a plan to address them while optimizing performance. The goal of a performance program is to build a better athlete by correcting imbalances, improving capacity while decreasing risk of injury.