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Home-Based Sports PT “Fellowship”

The following is a list of resources for sports/performance-minded physical therapists seeking to enhance athlete preparation beyond the requisite foundation they obtain in entry level programs. It assumes the adequate base in anatomy, biomechanics, physiology, and rehabilitation protocols entry level programs provide. To avoid redundancy, therefore, none of the resources below explicitly addresses these topics. The purpose of medical school is not to produce orthopedic surgeons per se. Similarly, DPT programs seek to produce generalists, not sports specialists, and to satisfy regulatory requirements from governing bodies. That additional training is required to produce competent sports specialists is not an indictment on programs whose objective is to produce generalists fit for licensure.

Formal fellowships are more focused but they too can be subject to the internal politics and regulatory pressures inherent in larger, highly centralized organizations. Whether or not to pursue a formal fellowship is a personal decision contingent upon many variables. Formal fellowships do make sense for many professionals. The intent here is to provide a decentralized, opportunity-cost friendly alternative to a formal program. As clinical instructors and business owners looking to continually grow our practice, we have skin in the game here. Ultimately, we care less about formal credentials and multiple choice test scores than the ability to apply and communicate knowledge to patients and athletes.

“Return to sport” is a popular buzzword these days. It’s not that mystical a concept, however, if one considers what it takes to be prepared for sport in the first place. Entry level physical therapy programs necessarily emphasize restoration of “normal” function more than sport preparation. Consequently, many of the resources below were produced by coaches or professionals from non-clinical disciplines. “Return to sport” is just normal preparation with a few additional constraints, typically on the front end of the preparatory process.

These resources help provide greater clarity about the ultimate destination so clinicians don’t stall at the midway point (e.g. “normal” function). To be clear, consuming these resources doesn’t ensure competency. The information contained therein needs to be applied, implemented, and coached. The only way to get better at coaching is to do it.  Getting “certified” via a written exam is strictly an entry point. Consider experimenting on yourself, on friends, or on healthy athletes in low pressure, low downside settings. Write programs for people with unique athletic goals. Work on your own running mechanics. Offer the same service to fellow students and colleagues. You will fail and make mistakes; just mitigate the potential for harm and don’t compromise safety. Seek mentorship if needed. Trial and error beats design. The apprenticeship model beats powerpoint. Lastly, this list will continually be refined (not lengthened) over time as we encounter additional references. The resources need not be completed in order. In fact, they shouldn’t be. Enjoy the journey with as little structure as required to achieve your objectives. It’s more fun and informative that way.

Critical Thinking/Complexity

We need to be able to zoom out before we can zoom in. These works provide a critical lens through which micro level training and rehabilitation resources may be filtered. Information is more abundant than ever so it’s never been more important to differentiate signal from noise. This section blends philosophy, risk management, basic science, heuristics, and ethics to establish a robust framework that may be employed to evaluate multi-disciplinary problems.

Antifragile by Nassim Taleb. Antifragile is about how to navigate a world we will never truly understand. Antifragility is the essence of sound training and rehabilitation. It’s fundamentally about how systems gain from disorder.  Fragility is more pervasive where there are gross asymmetries in risk. These asymmetries are everywhere- in the health care system, in athletic development programs, education, economics, foreign policy, etc.

Skin In The Game by Nassim Taleb. On a cursory level, Skin In The Game is about incentives but on a deeper level it provides an ethical framework for assessing complex domains.  We are constantly indoctrinated with virtue signaling about things like “evidence”, “rationality”, and “reason” as if there is a clear arbiter of these constructs. These constructs are contingent upon foundational values or assumptions; assumptions that are seldom questioned, however. Ethics and values help us determine why a question is important to ask in the first place. Skin in the game strips complex systems of unnecessary complication to ask better questions. As Taleb says, “It’s easier to macro BS than micro BS.” Decentralizing clinical education is the primary motivation for this list.

Risk Savvy by Gird Gigerenzer. Medicine, physical preparation, and pretty much any important policy discussion involve cost/benefit analyses and risk management. The adaptation process requires a necessary degree of risk to sufficiently stress the body. Too little or too much and the response is insufficient or maladaptive. Here, Gigerenzer deconstructs complicated risk mitigation and statistical models with simple heuristics much better suited to the “real world”.

What Do Economists Actually Know by Russ Roberts. This article transcends economics, but uses economics as a lens for the evaluation of the predictive limitations of data and mathematical modeling. It’s a call for intellectual humility, and a refreshing one at that. Roberts’ podcast, “EconTalk,” analyzes the most pertinent political, social, and ethical questions of our time without presuming to know the answers.

The Sports Gene by David Epstein. The title here is a misnomer. Genetics matter, but this is really a book about complexity and the timeless discussion about nature and nurture. Epstein deftly analyzes the biological, environmental, and cultural contributors to performance.

Robert Sapolsky’s “Human Behavioral Biology” Course. Free on YouTube, Sapolsky delivers a truly multidisciplinary and integrated educational experience. He cautions us about the limitations of thinking in “buckets.” Why Don’t Zebras Get Ulcers could just as easily be on this list, but this course is even more comprehensive and relevant to clinicians. It provides a thoughtful explanation about what it means to be human.

Seeking Wisdom: From Darwin To Munger by Peter Bevelin. Mladen Jovanovich (featured on this list multiple times) called this book “the secret weapon”.  We’ll leave it at that.

Health Care Systems

There is very little discussion about health care systems in formal clinical curricula. In practice, clinical treatment does not occur in a vacuum as it does in controlled trials. The system itself can have a greater influence on patient outcomes than “science” or any clinical tool. Perverse incentives and a dysfunctionally symbiotic relationship between health care providers, hospitals, insurance companies, and governmental regulatory bodies promotes overconsumption of services, lack of price transparency, and homogenization of care.

After The ACA by John Cochrane. This analysis of the Affordable Care Act (ACA) covers the pertinent history of health care policy in the United States and the conflation of health care with health insurance. The manner in which Cochrane critiques the ACA raises important questions about any health care policy regardless of one’s personal politics.

The Price We Pay by Marty Makary. Makary describes in incredible (often upsetting) detail how lack of price transparency in medicine creates a predatory system. His analysis highlights that there is no single villain in the healthcare system. It’s the system itself. He proposes simple policy changes to eliminate many of the most egregious aspects of this system.

Strength Training

There is more to strength training than the color of the theraband or the EMG activity of the muscle being employed. Strength is not necessarily any more important than other physical qualities but it can be foundational in developing speed, agility, and endurance, especially in a post operative situation.

Science and Practice of Strength Training by Vladimir Zatsiorksy and William Kraemer. Thoroughly covers physiological adaptations to strength training and parameters for targeting specific qualities. Zatsiorsky’s writing is generally more concrete and digestible than that of other Soviet sports science legends.

Science of Sports Training by Thomas Kurtz. A global discourse on training theory that covers all the major principles that guide sound programs. This book is a lot like Supertraining, but won’t leave you with as much of a brain hangover.

Periodization Paradigms In the 21st Century by John Kiely. Takes the mantra “all models are wrong but some are useful” and applies it to periodization theory. Kiely recognizes the contributions of training theorists from the past but refines their models to account for the current reality.

Strength Training Manual by Mladen Jovanovich. This book can just as easily fall under the critical thinking category as its content transcends sets and reps. While it does cover sets and reps, it’s one of the best books on problem solving and planning we’ve encountered.

Resilient Movement Foundations Course (coming soon in online format). Demonstrates how to apply the aforementioned resources to a sports rehabilitation setting throughout the continuum of care. It includes progressions for how to access and load athletic positions for different movement categories including hip flexion/internal rotation, hip extension, overhead, horizontal push/pull, transverse/frontal plane, jumps, and running.  Case studies from this resource can be found here and here.

Linear and Multi-Directional Speed

Strength training is important and often essential but athleticism isn’t manifested in the weight room outside of powerlifting, olympic lifting, and strongman. Running and multi-directional speed are crucial elements of most sports. Even the goal of strength training, therefore, should generally be to support, directly or through second order effects, the manner in which athleticism is displayed on the court or field via locomotive efforts. These resources cover how to run and change direction effectively and how to systematically teach and program said abilities. Hope is not a viable rehabilitation strategy. Sports physical therapists can’t assume that other people an athlete comes into contact with are going to properly address linear and multi-directional speed work. The content contained in this section is effectively what end stage rehabilitation should look like.

Complete Speed Training by Lee Taft. The simplest and best resource we’ve encountered on agility and non-linear speed training. Taft doesn’t do much verbal cueing to achieve his desired endstate. Instead, he manipulates the athlete’s surrounding environment so that the imposed constraints necessitate the desired solutions.

Applied Sprint Training by James Smith. The ability to accelerate, decelerate, and outrun the competition is more important in most sports than maximal strength. Smith presents acceleration and top speed mechanics and progressions, highly informative sample programs, and game-specific conditioning. He also explains why many commonly accepted practices and testing protocols actually hinder speed development. In other words, what not to do.

Ken Clark’s Instagram. Clark is a researcher and coach whose easy to follow infographics reinforce key sprinting positional concepts. His original research is highly informative as well.

Altis Short Sprints Course. A masterclass in linear speed development with contributions from numerous elite level coaches. Despite the depth of the material, one need not be a competitive track and field coach to follow along.

Derek Hansen. Hansen makes the fundamentals of sprinting and running very easy to understand without watering down the quality of the content. His “Running Mechanics” course is a great resource for people who prefer a live experience to an online one. The advantage of the live course is you get to see how a highly qualified speed coach like Derek cues athletes in real time.

Tony Holler. Another coach with a tremendous wealth of knowledge and experience who doesn’t overcomplicate things. A self-proclaimed essentialist, Holler’s “Feed The Cats” program eliminates many of the common practices that hinder speed development while focusing on what actually matters.

Endurance and Conditioning

Strength, speed, and agility must be “extended” or repeated to conform to the demands of sport. This is another area where it is unlikely that another professional or coach is going to come to a physical therapist’s rescue outside of a professional or high level collegiate setting. Physical therapists need not be able to program for an elite level endurance athlete but they should understand conditioning well enough to feel comfortable programming endurance work for team sport athletes and the general population. Programming for conditioning can be overwhelming initially but it is ultimately about defining the needs of the sport or activity and supporting said demands with appropriate intensity-based work on the front end and volume-based work on the back end of the bioenergetic continuum. These resources explain how coaches from different sports program conditioning which helps elucidate key patterns and themes.

The Science of Running by Steve Magness. This book is really an applied exercise physiology text that delicately navigates the tightrope between the art and the science of coaching. It is replete with science, but you’ll complete it with a much greater appreciation for the art. It also reminds us that the goal of training is to improve performance, not necessarily to maximize physiological metrics like VO2 and lactate threshold. Magness provides actual programs for runners ranging from 800m distance to marathon.

Ultimate MMA Conditioning by Joel Jamieson. Another deceiving title (in a good way). Remember all the chemical reactions from the Kreb’s Cycle? Yeah, neither do we, because they don’t dictate what we actually do with athletes. Jamieson explores key bioenergetic principles without boring you with unnecessary details. More importantly, he demonstrates when and how various aspects of the bioenergetic continuum should be targeted during a training program.

HIIT Manual: High Intensity Interval Training and Agile Periodization by Mladen Jovanovich. Jovanovich makes this list twice because his writing is so comprehensive and sensical. This manual is not just about interval training but covers how to program conditioning using a range of intensity based on the needs of the sport or occupational endeavor.

Training For The New Alpinism: A Manual For The Climber As Athlete by Scott Johnston and Steve House. The authors are some of the most highly accomplished alpinists in the world, having completed first accents on technically demanding routes in mountains most of us only see in nature documentaries. They share their preparation schemes for their most physically and technically demanding multi-day expeditions which helps to reinforce endurance programming for more traditional sports. The personal anecdotes featured throughout the book are thrilling.

Leadership and Communication

Medicine involves dealing with and managing people. Leadership and communication skills are trainable. Even the best craftsmen will achieve inferior outcomes if they don’t appreciate how to manage people’s expectations and communicate clearly and with intent. Integrity and an ethical framework help guide any sustainable mission. Each of these books contains important commentary about defining personal and organizational values.

Extreme Ownership by Jocko Willink and Leif Babin. An outstanding account of personal and organizational accountability, standard operating procedures, systems development, humility, and transparency. This work represents a rare case in which the lessons from military special operations are articulated in a generalizable manner.

Conscious Coaching by Brett Bartholomew. Coaches and medical providers are leaders by virtue of their position. Bartholomew effectively captures the human side of coaching by detailing how to enhance communication to help make meaningful connections.

The Infinite Game by Simon Sinek. Most business and leadership books emphasize how to maximize concepts like “efficiency” or how to “optimize” various aspects of an organization. Sinek is more concerned with sustainable success or an infinite mindset that values organizational and personal integrity over simple metrics that can be gamed to support deceptive narratives. Sinek writes what is effectively an ethics book for organizations and businesses; it’s about “culture” without the pejorative signaling.

Pain Science Workbooks by Greg Lehman. A great resource for patients and clinicians. Pain science texts and discussion forums are often too esoteric, but Lehman demystifies pain education and nicely reconciles psychosocial considerations with biomechanics.

The Patient’s Brain by Fabrizio Benedetti. Bendetti describes the neurophysiology of doctor/patient interactions. The patient’s experience cannot be separated from the practice of medicine. While the placebo effect is often depicted in a derogatory manner, it is actually an essential and unavoidable aspect of patient care that we must understand to harness it ethically and effectively.