In 1997 I published a book titled ‘Winning and Losing’, aiming to share the lessons of my prior two decades of professional experiences. One of those was that I felt physical preparation coaches should be more focused on injury prevention and rehabilitation, not just performance enhancement.  Additionally, the 1990s strength coaching focus was on how much you could lift in compound lifts such as the power and Olympic lifts, which was in itself leading to more injuries as not everyone was ready to go heavy in compound strength exercises, as was the dominant paradigm of that decade.[1]

There is no reason why a strength and conditioning coach should not be contributing to injury prevention/rehabilitation.[2]

Nearly 30 years later I back what I said. What I didn’t anticipate was the direction that would be taken, and I don’t support aspects of this approach. A statement in my 1999 book ‘Understanding Plyometrics’ sums it up.

The standard reaction to a new idea is over-reaction in the short-term and an under‐reaction in the long term. [3]

Tracking the changes in industry response to injury prevention and rehabilitation

Having been involved in the era of no interest/focus on injury prevention/rehabilitations through to now, I have had the opportunity to track the changes.

Firstly, from a broader professional ‘strength and conditioning’ role perspective, one of the major shifts has seen sporting team employ individuals whose work sits between the physical therapist and the physical preparation coach. In speaking with a sport coach in South Africa recently, I was given an insight into how South Africa potentially leads the way in this area. Irrespective of the value of this role, at least one can see the intention to transition between various professional services.

Secondly from the second-tier ‘personal trainer’ market, one that since its inception around 1990 has been fixated on trend following, there has been a post 2010 demand for them to be able to ‘fix imbalances’ and injuries.  This is replacing the dominant focus of the first decade this century where everyone was a ‘fat loss expert’. Now they are clamouring to be an injury rehab specialist.

It has been, hands down the most dominant question I have been asked by personal trainers during the last five years.

Here’s a major challenge for me. Who contributed to the injury epidemic? Those who physically train others. Who is going to, apparently, solve this with their ‘rehab knowledge and skills’? The same group.  So we are going to solve this societys injury problems withj the same ‘professionals, with the same thinking, and in the same environment in and by which the injuries occurred in the first place?

I suggest not.

My hope is that some will see the light in this oxymoron, and choose to master injury prevention before they pick the low hanging fruit of the situation they contributed to.

Of course, that is a tough ask, and I am under no illusion that my sentiments will put the brakes on the trend to be the injury rehab hero.  A client base conditioned by marketing -combined with the average person’s desire for instant gratification – is going to have its wants (note, not needs) met by a profession that essentially trend chasers.

Secondly, on a more micro-level, I have been able to observe the response to a specific artifact I published in 2000, before the shift in focus to include injury prevention and rehabilitation.  It was a video series titled Injury Prevention and Rehabilitation.

Ambulance chasing

The almost immediate effect I witnessed on those who ordered this educational video was a significant shift to what it referred to as an ‘ambulance chasing’ in many industries. They have a powerful new toy that would give them more clients and they became consumed with this.  To the point where these individuals would market:

‘Hey, do you have an injury? Contact me and I will fix it’.

You have probably seen similar billboards on the side of a highway or similar, where a pro bono motor vehicle or workplace accident attorney is inviting ‘victims’ to contact them.

My concerns

What don’t I like about this?

1. Injury prevention/rehabilitation should be a holistic part of what you do as a physical preparation coach, not the leading focus of your service (unless you are a physical therapist)

My interpretation of a physical preparation coach’s role is to physically prepare individuals, not to offer or lead with injury prevention, offering ‘treatment’, or claiming they can ‘fix’ injuries in individuals they have not met yet. If an injury issue arises in the broader services, approach pathways should be considered – and these pathways should include a multi-disciplinary approach.

2. How can the injury problem be solved by the same professionals that created them?

As I stated above, in my opinion, the exponential increase in injury rates and severity is in large part caused by the physical preparation training provided.  I understand that this is just my opinion. However, if there is validity in this perspective, under what circumstance can the conditions that caused the injury be resolved by the same person, in the same environment and or the same conditions? To think that this is a viable option is one of the great mysteries to me.  I do not support an injury rehabilitation skill claim by a physical preparation coach until they have demonstrated their competence in injury prevention.

3. If you want to focus on injury rehabilitation, become a physical therapist.

Now if a physical preparation coach is so attracted to injury rehabilitation, I suggest they complete appropriate professional development courses (e.g. a degree in physical therapy) and become a physical therapist. At least then you may have some appropriate professional indemnity insurance.   I know many individuals who have graduated with sports science degrees and then also completed physical therapy degrees when they realized they were more attracted to rehabilitation. To their credit, they have sought the approach of professional development for their chosen path.

At least then you will be working ‘in your lane’, have an industry body to support you, be able to get professional insurance covering your services, and are more likely to survive being judged in the light of a court-house should that occur.

4. Who is being served by a physical prep coach chasing injured clients? The needs of the physical prep coach to gain clients and significance, or the clients?

I understand that there is a massive demand for injury rehabilitation. I also know there are some relatively powerful yet simple methods to address basic injuries, some of which I outlined in my 2000 video series.  However, I question the motivation of a physical coach when it is apparent that they are short of clients and seeking significance.  Absolutely in today’s market, it is low-hanging fruit, and you can pay your car lease payments and gym rent by this path.

However, if you were good at what you are doing – training individuals using long-term planning and results – you would not have the time to do what essentially is a separate higher education degree – and be the ‘physical therapist’.

I suggest the needs of the client should come first, not the needs of the service provider.

5. The human body and injuries are very complex – are you really the person to ‘treat’ them? Instead of a professionally trained physical therapist?

A lesson I am continuously reminded of as the decades pass is how complex the human body is. I continue to get lessons and learn about the body and injury.  I appreciate the support and guidance I receive from professionals I collaborate with to seek solutions and answers to injuries including but not limited to doctors, surgeons, radiologists, physical therapists, chiropractors, and orthotists.   I don’t know too many physical preparation coaches who have this level of knowledge of the human body. One was our late KSI graduate coach Mike Pimentel. Note Mike was a university-qualified Athletic Trainer with years of clinical experience before training and converting to become a full-time physical preparation coach. ,

Other than Mike Pimentel I have not met – in my 45-year professional journey to date – anyone else who is a competent, successful and in-demand physical preparation coach – who leads with or dominates in their service focus on attracting and ‘healing’ injured clients. They may be out there, but we have not crossed paths.

If you want to be a physical therapist, do the right thing by clients and get appropriate higher-level education and training..

My response to these ambulance chasers

Within a few years of releasing the video series Injury Prevention and Rehabilitation I made it very clear to the coaches in the KSI Coaching Program who had been side-tracked by the shiny new object of being a healer that they were not using the information I provided in the manner intended, and encouraged them to become a physical therapist if that was their primary interest. This seemed to work at the time.

When I realized this message was not getting through to those who were not in the KSI Coaching Program, I made the video series available exclusively to KSI Coaches.

When I realized this was not working, and that there were still individuals mistreating the information, I restricted its sale to those at a minimum of L2 in the KSI Coaching Program.  Unfortunately, that still failed to solve what I saw to be a mistreatment of the intent of the information, and have since raised the pre-qualification to L4 and now L6 respectively.

What I was looking for is at what level of learning is it apparent that individuals will respect the intent. A major conclusion I have reached is that until a physical preparation coach can demonstrate that they can provide services that prevent injuries, they have no place in claiming or offering services that ‘rehabilitate’ injuries.

I understand that with the exponential growth in injuries, the new ‘black’ (the new go-to) in physical preparation is the desire to be able to ‘fix injuries’. It’s replaced the hottest trend in the physical preparation world between 2000 and 2010 to be a ‘fat-loss expert’.

But who is this desire to be in the pathway of profit from injuries serving?

I suggest the service provider more than the client, which will mean another failure to solve the rapidly growing injury trend.

And I do not support that.

Solutions

Addressing significant and or chronic injuries is most likely going to need a multi-disciplinary approach. If you are seeking these services, I encourage you to consider some of the issues raised in this article when selecting your service provider.

Even our high-level coaches – Level 8 and above – recognise when they are out of their depth.  In fact, in our most recent high-level camp, we held a meeting with a 40-year physiotherapist to allow our coaches to discuss best practices when working with aligned professionals.

Let me be very clear – due to the level of competence I believe needed before seeking to develop competence in injury rehabilitation (as opposed to prevention) we do not teach rehabilitation until L8 of 10 levels in the KSI Coaching Program.  Now I understand that this statement alone will preclude many from starting the KSI Coaching Program – when Joe Bloggs down the road claims he can teach PTs how to be physical therapists in a short course.

But that’s the way we roll.  The most important aspect of our service is what’s best for the client. Or as our slogan says ‘Where the athlete comes first’

If, as an end user, you do have injury concerns and want a physical preparation coach who is highly trained in the KSI, whose values align with those in this article, and who embraces the client’s needs first, I encourage you to seek out current L8 and above KSI coaches.

I appreciate there are relatively few current high-level KSI coaches, however, if you do have the opportunity to work with one, you will experience that current high-level KSI Coaches are trained in the KSI approach to injury prevention and rehabilitation. You will not see them soliciting injured people to contact them, nor will you see them offering to ‘fix’ injuries out of context.

Conclusion

During the last five decades, I have created a holistic approach to helping people with needs in physical preparation. This work has been at the forefront. For the last three decades, I have been sharing with physical preparation coaches what I have learnt through the KSI Coaching Program.

The ongoing challenge I have faced is encouraging these ‘students’ to hold the interests of the client first, rather than their own needs for significance and clients.

So what’s it going to be? Coach, trainer or ambulance chaser?

—-

PS. As a matter of reflection, there was another sentence or two in the same paragraph that appeared in my 1997 book that appears to have been selectively ignored by ambulance chasers:

As with all aspects of training, I never make a big deal about what I can do. I try to take a low profile. This is very important when you are taking a big step outside your boundaries, into another’s field of expertise, such as injury prevention and rehabilitation.

References

[1] At least until I began publishing my ‘different’ approach e.g. The Limping Programs published on T-mag (as it was known then) from 1999 were disruptive to these values.  You can find these programs and the rationale behind them in the Get Buffed!™ educational range.

[2] King, I., 1997, Winning and Losing

[3] King, I., 1999, Understanding Plyometrics – A Guide for Athletes and Coaches