05 Dec So you want to be a Sports Physical Therapist?
If you’re looking to pursue a career to become a sports physical therapist, welcome. If you’re a veteran of the game who has been in team sports for years, forgive me should my limited 5 years of experience come up short in trying to capture such an interesting culture. And finally, if you’re not in sports medicine and just interested in learning a bit more “behind the scenes,” you may find some interest here too. Regardless, I hope you enjoy.
Hard to imagine, but I’ve been a sports physical therapist for 5 years now. During this time, I’ve worked with a multitude of mentors who collectively assigned me hundreds of different articles, publications and various physical therapy pieces to read. While I remember many, one piece always stuck with me in particular; it was assigned to me by a mentor on the very first day of the most influential clinical internship I completed while in physical therapy school. It was published on the blog of Adam Meakins, also known as the “The Sports Physio.” Written by the High Performance Director of the 2014 Great British Bobsled Team, “So you want to be a Sports Physio…” provides a hard dose of reality behind the business that is sports medicine. (Apologies for the profanities ahead of time if you give it a read!)
Later in sports physical therapy residency, it was one of the first pieces assigned to me to read again. While it did resonate to some degree at the time, I didn’t fully digest or relate to the deeper themes and difficulties of the article until I found myself working at the division 1 level, and later on, the olympic & paralympic level. As I progress deeper into my career, I find myself recalling this piece more and more — when my ego goes unchecked, and the perspectives and opinions that I hold on sports physical therapy begins to blur, this piece centers me. Very often do I give it a re-read, and even more often do I assign it to students, residents and fellows. That being said, in recent months, I’ve had the urge to write my own version. Not to discredit or detract from the deep truths in the original by Gary Anderson, but rather to pay homage to the original piece, and more importantly, provide new graduate physical therapists some hard truths if looking to enter the sports world. Naturally, I couldn’t give it the same title (physiotherapist is the term used in almost every other developed country including Great Britain), so I used “physical therapist,” which is the American equivalent to describe the profession.
Just don’t get yelled at
It was my second day on the job of a very prominent division 1 basketball team. After a few years of grinding, it finally felt like I had “made it.” While only serving in a fellowship role, I was being included in the care of some of the most prolific developing athletes in the sport. These guys were genetic freaks, most of whom would go onto make millions following their collegiate careers. My first day had gone great: I sat on the sideline with the veteran sports medicine providers of the team, learning how to digest and interpret player load metrics captured by the GPS technology built into the ceiling of the indoor practice court. I was humbled to be allowed access to such an incredible opportunity. It was truly a privilege.
Despite my excitement, at the end of the day, my only goal was to not get yelled at. Intensities ran high at these practices, access was extremely limited and I was a brand new face that many didn’t recognize. Not to mention, the head coach was known to have a temper and hold extremely high standards. Wouldn’t you if you were argued to be one of the best coaches in history?
On my second day, I sat down at the same seat I had chose on my first. Staff were starting to trickle in slowly, and I patiently waited for the senior sports medicine staff to come join me. I did my mental checklist: my phone was on silent, I was out of the way and I was being as inconspicuous as humanely possible. Soon, the doors to the film room opened up, and the team poured out onto the court as guys began their dynamic warm-ups. None of the staff had joined me quite yet, so I quietly ran my mental checklist again: phone on silent, stay out of the way, don’t tick anyone off.
I suddenly felt a very ominous pressure with heavy energy over my shoulder.
[COACH] “Why are you sitting there? Who are you?”
[ME] “Hi coach.” I squeaked. “This is where I sat yesterday with sports medicine. I’m the new sports physical therapy fellow, we met a few days ago in the athletic training room.”
[COACH] “You can’t sit there. That’s where staff sits. Who told you that you could sit there?”
[ME] “Sorry sir. Let me move elsewhere.” I picked up my things, and found a very uncomfortable metal chair at the furthest end of the court that obviously no one else wanted. I would have sat in the parking lot if it would have meant this would end.
It didn’t. He followed me:
[COACH] “I just don’t understand what made you think you could sit there? What gave you the idea that was appropriate?”
[ME] “I’m very sorry coach. Is this a better spot?”
He grunted, turning his back to me as he angrily returned back to practice. Great. Exactly how I wanted this to go. I’d be remembered by my mentors as the worst fellow they’d ever hired. Finally entering the court, the head athletic trainer came and sat down next to me. He looked at his very visibly shaken fellow, laughed and replied: “Happens to the best of us Chris. Don’t worry about it.”
Best Warm-Up For Athletes
“It’s not pretty and it’s not about you”
You’ve completed 7 years of schooling and achieved your doctorate in physical therapy. You spent months in preparation to pass your physical therapy licensure exam. All your professors and mentors have taught you that you’d be leading the show, providing direct access care to your patients. You may have even been one of the few to complete a post-graduate residency or fellowship! You leave your years of formal education ready to take on the world: a healthy dose of confidence, chest out with pride and excited to serve your patients. But guess what? You land your dream job in high-level athletics and quickly find that no one cares.
Sure, the review panel that hired you respected your accomplishments enough to bring you on board. But once onboarded, and in the thick of a long training camp, those accomplishments mean so very little. Look around you: everyone on the sports medicine team is at the top of their game. Each member has clawed tooth and nail to make it here, just like you, and suddenly no one cares that you’re a doctor of physical therapy. If it hasn’t gone unsaid yet, no one is going to call you “doctor” here either. “What? I earned that title!”
Tough break. You haven’t earned anything here yet.
Your differential diagnosis skills will surely be tested as you’re unloading your 7th crate of a sports drink into the refrigerator. You’ll certainly be mentally stimulated as you wait in the athletic training room for the guys to get out of film. (Sorry that they’ve gone over 45 minutes already.) Athletes will ask you for generic, hour-long “rub-downs,” knowing you’ll be more likely to say yes than veteran staff. But don’t worry: you’ll very much be “leading the show” when there was 3 very well qualified orthopedic surgery fellows and 2 attending physicians at every game. “But I’m a doctor of physical therapy!” Again, no one cares. It’s not pretty, and it’s not about you.
You’re a member of the sports medicine team now, and unchecked egos will create friction quickly. The seasoned athletic trainers will make your emergency medical response skills look slow and clumsy. The veteran physical therapists will have well-established trust with players (many of which don’t seem to trust or seek your manual therapy skills initially). If there’s a chiropractor with the team, they’ll take nearly all the manipulations. And the heavy differential diagnosis following a trauma injury? That’s going to be the orthopedic surgery and primary care physicians. This isn’t at all what physical therapy school made the world seem like.
At least the lifestyle is clutch right? Well, it depends on what you’re seeking. Frequent travels are fun at first, but they sure are a lot of work. You will enjoy police escorts, charter bus rides and charter flights. You’ll feel especially important as road blocks are pulled aside for the team buses and you fly through intersections blocked off by police. You will experience a small fraction of what the athletes do as fans gawk and celebrate the team’s arrival, sometimes looking through your bus window, mistaking you as someone who will contribute athletically to the team’s success. (Enjoy this — it is admittedly kinda fun.)
But remember, players will be resting on the airplane while you, coaching staff and support personnel unload luggage on the tarmac in the pouring rain. You’ll learn how to set up mobile athletic training rooms in random hotel rooms, basements and some really lousy stadium facilities for visiting teams. The bye-week is spent rehabbing players, trying to play catch up and get ahead of the competition. Mandatory injury check-ins on the weekend limit the opportunity to catch your breath and find personal time to decompress.
Yes, your social circle will be jealous of the team swag you get. You’ll find brief moments of elation when your friends and family compliment you on how cool your job is. But unfortunately, you don’t get to see much of them during the season. You find it hard to translate the many sacrifices required to earn that gear. Regardless, people will still ask you to “hook them up.” People that you don’t even consider a friend, let alone an acquaintance, will ask for tickets and autographs. You’ll be annoyed.
Finding your lane
But as you grind your way throughout the season, you’ll start to learn through trial and error. You’ll develop a small cohort of athletes that come almost exclusively to you for treatment. You start to earn the trust of your co-workers, earning yourself lead on some long-term rehabs. You find that your function with the team truly is important. The physicians are so relieved to find their post-op patients are thriving under your care. The athletic trainers deeply appreciate that you serve in a supplementary role in emergency medical situations. Your extra set of hands, awareness and skillset proves invaluable with things really hit the fan. Your daily and weekly updates to the coaching staff and family of injured players significantly decreases the anxiety and worries of loved ones. Sure, there will be pressure to return guys/girls as quickly as possible, but you’ll find your voice and confidence with the help of your sports medicine partners in how to best push the envelope (safely), establishing the highest levels of care and providing your athletes with every opportunity to succeed.
If you’re unlucky
If you’re unlucky, you’ll experience multiple losses in a row. The energy of training facilities, practices and the athletic training rooms will feel flat. Athletes will be grumpy, short-tempered and uninterested in that new program you spent an hour writing up for them. Coaches will snap, practices will carry an energy of irritation. You’ll ride the waves, playing your cards carefully and close to your chest. You’ll be selective of what you say, when you say it and who you say it to. Now is not a time to rock the boat, but it is a time to strive for excellence. You’ll be sure that your responsibilities are dialed in. There isn’t any place for poor communication or shoddy care during times like these.
Coaches you liked will be fired or find new jobs. Players you connected with will be traded, enter the trading portal or leave for another opportunity. You may or may not actually stay in touch, although y’all will say you will. “Cleaning house” may occur if recurrent failures happen. In fact, you might get caught up in this too.
To be honest, this has nothing to do with “luck.” You will experience much of this in your career in high level sports.
If you’re lucky
If you’re lucky, you’ll enjoy the privilege of seeing athletes you’ve worked with accomplish their dreams and succeed. Medals, championships and wins. You’ll enjoy the quiet elation knowing that you helped them in their career. You’ll also recognize that their victory is not yours. You don’t deserve a public shout-out and you won’t be called on the podium for photographs. You’re a physical therapist, not a celebrity. Act your part. You are expendable; chances are the athlete is not. If you’re lucky, you’ll get a heart-felt thank you note, an Instagram shoutout or just the personal satisfaction that you were a small cog in the machine that helped support such excellence. But in good cynical fashion, sometimes you won’t be recognized at all.
You will get wrapped up in them. You will deeply identify with the philosophies of certain co-workers, coaches and support staff. Others, you will not. You’ll make lifelong friends, you’ll make enemies. You’ll encounter the silent treatment and passive-aggressiveness. You’ll witness occasional shouting matches (hopefully you’re never a participant or on the receiving end of these). People will likely criticize you behind you back, questioning your interventions. “He loads too much.” “She loads too little, too many passive interventions.” “That athlete doesn’t look far enough along for this stage of the game.” It’s bound to happen; at this level, everyone has an opinion. You’ll get better at focusing on your trade, staying in your lane and maintaining a distance from the relationships you define as neutral, or negative, in your professional life.
But you will not, I promise, avoid the politics completely.
You will not
You will not ask players for autographs. You will not ask players for things that advance your career. If you do, these are hard-earned over years. When done inappropriately, you will be labeled “green” by other staff. I promise you this: that image will stick to your back. You will not post photos of players rehabbing, lifting or focusing on any aspect of their health or performance. You will not talk poorly of your co-workers to an athlete you may be co-treating on. You will not offer your advice on how a player can play or perform better; you are a physical therapist, not a coach. Many players will lay on your plinth to receive your treatment, often times following a bad loss. You will not contribute to their dismay. You will likely not know the words to say, so you will choose them carefully. You will not be a distraction during practice or competition, even with the players you click with most. There is time for celebrations, jokes and conversation later. You will not detract from team philosophies or represent the team poorly. If you go out for drinks afterwards with co-workers to celebrate a success (you likely won’t, you’ll be focusing on tear-downs and pack-outs), you won’t wear team gear or cause a scene. There will likely be players on your team that attract negative press: this attention should never, ever, be on you. Sports medicine personnel in the news is rarely a good thing.
You will work your tail off and provide every opportunity for athletes to succeed under your care. You will create memories, many of them good, pushing “through the suck,” working 80 to 100 hour work weeks during the height of training camp. You will work weekends, holidays and bye-weeks. You will make friends, strengthened by the hours of bonding in the training room, on the road and on the sidelines. You will probably gain a few pounds — you’ll be eating the same food as the players most of the time, but expending about 1/10th the amount of calories they do. You’ll celebrate successes, feeling the glow of pride watching your long-term rehabs succeed. You’ll mourn losses, often watching athletes re-injure the 2nd, 3rd or even 4th times; despite every effort to keep them safe.
You will reflect on how lucky you are that “you made it.” Very few actually make it to this level of sport (that goes for both the athletes and the sports medicine personnel). You will do everything you can to take care of your mental and physical health, but you will sometimes fall short. You will sometimes feel like you’ve found your life-long career. You will sometimes contemplate quitting it. And sometimes — you will. Whether you spend 1 year in elite level sports or 15, you’ll leave with pride, stories and a sense of humor now garnished with some healthy cynicism and sarcasm.
But most importantly, you’ll leave athletes, and the team, better than when you first met them. And for those reasons, the sacrifices and mistakes were worth it.
“I don’t believe we’ve met?”
Weeks later following my first chew-out, I was walking down to the athletic training room from the training courts. As I descended the stairs and turned the corner, the stairwell door opened just as I was about to push it open. I staggered a bit, realizing it was coach. In a brief moment of awkwardness, we both took a step backwards to allow the other to pass through. “No please, after you,” he said with a warm smile. I thanked him as I walked through. As I did, he paused: “Hey, I don’t believe we’ve met?” he politely inquired, extending his hand to shake mine.
He had completely forgotten that we were formally introduced already. He had forgotten that I was the physical therapist that sat in the wrong seat at practice. And he had very obviously forgotten that he had already very clearly condemned my chair picking abilities.
I paused in disbelief, reintroducing myself. He didn’t remember that? I would literally never forget that chewing out. (Here I am, years later, writing about it.) No, he didn’t remember that. I was caught at the wrong place at the wrong time in the wrong chair. The hundreds of things on a coach’s mind were beyond me with my level of inexperience then. I truly thought my feelings were actually on the forefront of his conscious. They weren’t. My chewing out was purely reaction, subconscious and probably the sequelae of a very well-justified really bad mood related to something else. In reflection, I learned a ton that season about sports medicine, this moment solidifying a very important lesson that I read years earlier in that original blog post:
“It’s not pretty, and it’s not about you.”