I was recently asked a question that has stayed with me.
Which is more important in your work: your assessment skills or your manual therapy skills?
My answer was simple.
They're equally important.
I can't effectively treat something I haven't properly assessed. Rubbing tissue for the sake of rubbing tissue, without understanding what I'm trying to accomplish, isn't reconditioning.
But if I can identify a problem and don't have the practical skills to address it, that's a limitation too.
And if I can produce a change with my hands but can't help the athlete access and maintain that change through movement and loading, I haven't finished the job.
For me, those abilities are inseparable.
That conversation brought me back to a concern I've had about the direction of our industry for some time.
As professional sport becomes increasingly sophisticated, are we placing the same value on developing practical skills as we are on accumulating credentials, collecting data and introducing new technology?
The growing sophistication of professional sport
I've been fortunate to spend more than 20 years working in and around professional sport.
During that time, the resources available to practitioners have changed considerably.
We have access to technologies and information that would have been difficult to imagine when I started my career.
Force plates, motion analysis, GPS, wearable technology, advanced imaging and increasingly sophisticated ways of monitoring training loads and physical performance.
I'm interested in all of it.
I want access to good information. I want to understand what research is telling us. I want objective measures that can help me identify limitations, monitor progress and make better decisions.
But I've also become concerned that we're beginning to confuse the ability to collect and interpret information with the ability to recondition an athlete.
They're related, but they're not the same thing.
A force plate might identify an asymmetry.
Motion analysis might demonstrate an altered movement strategy.
Strength testing might show reduced force production.
All useful information.
But then what?
Why is the athlete producing less force?
What happens when you change their position?
Is the limitation related to strength, pain, mobility, coordination, tissue tolerance or something else?
What does their previous injury history tell you?
And can you actually intervene in a way that helps the athlete?
A spreadsheet may help organize the information.
It cannot replace the practitioner standing in front of the athlete.
What do we mean by assessment?
When I talk about assessment, I'm not simply referring to completing an orthopedic examination, measuring range of motion or running an athlete through a battery of performance tests.
Those things have their place.
I'm talking about developing an understanding of how this particular individual is functioning.
What happened before the injury?
What changed because of it?
What movement strategies are they using?
Where have they lost capacity?
What are they avoiding?
What happens when we change the demands?
And how does their body respond when we intervene?
My background in athletic therapy, strength and conditioning and manual osteopathy has shaped the way I approach those questions.
I want to observe the athlete moving.
I want to assess their strength and physical capacity.
And I want to use my hands.
Not because palpation gives me some magical ability to know everything happening beneath the skin. It doesn't.
But hands-on assessment provides another opportunity to interact with the individual, examine their presentation and develop a working hypothesis.
That hypothesis should then be tested against what we observe, what the athlete reports and how they respond.
The objective isn't to prove that my first explanation was correct.
It's to understand the person well enough to make a useful decision about what to do next.
Manual therapy is more than a treatment technique
I sometimes wonder whether part of the movement away from manual therapy comes from how narrowly we've come to define it.
Manual therapy is often discussed as though it means rubbing a sore muscle, applying a treatment technique or providing temporary symptom relief.
And if that's all we're doing, I understand the criticism.
I've never believed that applying a technique simply because an athlete has pain in a particular location is sufficient.
But that isn't how I view hands-on work.
For me, manual therapy is part of an ongoing process of assessment, intervention and reassessment.
I identify something that may be contributing to the athlete's presentation.
I use an appropriate intervention.
Then I reassess.
My first question is often whether their movement has changed.
Passively? Actively? Both? Or not at all?
Can they access a position they couldn't access before?
Can they produce force differently?
Does that change remain when we introduce movement and loading?
Sometimes the intervention is useful.
Sometimes it isn't.
Both responses give me information, although neither necessarily proves the underlying cause of the problem.
The important part is what I do with that information.
And this is where experience and practical skill become so important.
It's one thing to know a manual therapy technique.
It's another to know when to use it, when not to use it, what you're trying to accomplish and how to integrate the response into the athlete's reconditioning.
The treatment table is not the finish line
I don't believe manual therapy should be the centre of every reconditioning session.
Sometimes the athlete doesn't need my hands at all.
Sometimes the most useful intervention is a change in loading, an adjustment to an exercise, a different movement strategy or simply allowing more time for adaptation.
But when hands-on treatment is indicated, I want to have the skills to provide it.
And I want to connect whatever happens on the treatment table to what the athlete needs to do next.
If I can help an athlete access more hip mobility, for example, what happens when they stand up?
Can they use it?
Can they control it?
Can they produce force through it?
Can they tolerate it under the demands of their sport?
If the answer is no, there's more work to do.
That's why I have difficulty separating manual therapy from movement assessment and strength and conditioning.
They inform one another.
The athlete doesn't experience their body as a collection of separate departments.
Why should we approach reconditioning that way?
A designation doesn't tell us the whole story
This is where I think professional sport needs to be thoughtful about how we define and recruit for reconditioning roles.
I have enormous respect for people who pursue advanced education and research.
We need researchers, PhDs, sport scientists, physical therapists, athletic therapists and strength and conditioning coaches.
Each discipline brings valuable knowledge to the table.
But a designation alone doesn't tell me what someone can do with an athlete.
A PhD doesn't automatically establish practical treatment skills.
A therapy qualification doesn't automatically establish the ability to rebuild high-level physical capacity.
A strength and conditioning certification doesn't automatically establish the clinical skills needed to assess and manage a complex injury presentation.
And completing a weekend manual therapy course doesn't make someone a skilled hands-on practitioner.
These are not criticisms of the professions.
They're reminders that the skills required for reconditioning have to be developed and demonstrated.
I've worked with highly educated people who were exceptional practitioners. I've also learned a great deal from experienced people whose formal qualifications didn't begin to capture what they were capable of doing.
The distinction isn't education versus experience.
It's whether the education and experience have developed the abilities the role actually requires.
What skills define a reconditioning specialist?
If I were evaluating someone for a reconditioning role, I'd want to understand how they think and what they can do.
Can they take a thorough injury history and recognize patterns worth investigating?
Can they assess movement and identify meaningful limitations or compensatory strategies?
Can they develop a working hypothesis rather than simply assign a protocol?
How extensive is their manual therapy toolbox?
Can they assess and work with more than the obvious musculoskeletal presentation?
Have they developed hands-on skills across different approaches, whether that's osteoarticular, myofascial, cranial, visceral or other areas of manual therapy within their professional scope?
More importantly, do they understand when those approaches may be useful, when they aren't, and how to evaluate the athlete's response?
If the only tool you have is a hammer, everything starts to look like a nail.
I don't expect every practitioner to use the same techniques I do. But I would want to understand the depth of their practical skills and whether they have enough options to adapt to the individual rather than repeatedly applying the same intervention to different problems.
Can they build strength, conditioning and physical capacity?
Can they understand the demands of the sport?
Can they recognize when their intervention isn't working and change direction?
Can they integrate information from the medical team, performance staff and athlete without losing sight of the individual?
And can they demonstrate those abilities in practice?
I would be far more interested in watching someone assess and work with an athlete than simply reviewing another list of qualifications.
Of course, education matters.
But so does mentorship.
So does time spent working directly with people.
So does making mistakes, reflecting on them and learning to recognize things you didn't know how to see earlier in your career.
Experience alone doesn't guarantee expertise either.
It depends on what you've done with that experience.
Reconditioning is an art
I know the word art can make some people uncomfortable in a profession increasingly focused on evidence and measurement.
But I don't see art and science as competing ideas.
Science helps inform what we know and what we should question.
Data helps us measure and monitor.
Education gives us a foundation.
Experience helps us recognize patterns, understand context and make decisions when the situation doesn't fit neatly into a textbook.
And practical skill allows us to act on those decisions.
The art is bringing those things together while working with a real person.
It's recognizing that the exercise you planned isn't producing the response you expected.
It's knowing when to use your hands and when to step away.
It's knowing when to challenge an athlete and when to change direction.
It's being willing to abandon your initial hypothesis because the athlete is telling you something different.
And it's understanding that two people with the same medical diagnosis may need entirely different approaches.
I don't believe we can reduce that process to a protocol, a treatment technique or a spreadsheet.
Where I hope the industry goes from here
As professional sport continues to evolve, I hope we become increasingly sophisticated in how we evaluate practitioners, not just athletes.
I hope we continue to invest in research, technology and education.
But I also hope we continue to value the practical abilities developed through years of working directly with people.
The ability to assess.
The ability to treat.
The ability to recognize movement strategies and lost capacity.
The ability to build that capacity back.
And the ability to bring all of those skills together for the individual standing in front of us.
After more than 20 years in and around professional sport, I still have plenty to learn.
That's part of what keeps this work interesting.
But one thing I believe more strongly now than when I started is that reconditioning cannot be defined by a designation alone.
It's not simply what you know. It's what you can recognize, what you can do, and how you bring those abilities together to help another person.
