Updated: Oct 20, 2019
Historically a physical therapist (PT) in the United States has been focused on the treatment of patients who desired to avoid surgery to correct a degenerative musculoskeletal condition, recovered from surgery, or rehabilitated from a traumatic injury. Most treatment scenarios centered around inpatient rehabilitation with a conservative plan that sometimes took months to complete. Eventually, the practice of physical therapy moved out into an outpatient setting and PTs began to pursue more independence as physical therapy professional practice evolved to applied doctoral training, and therapeutic results increasingly delivered improved function, reduced pain, and gave patients increased independence in daily living. In many states today, the physical therapist practices independently within a defined scope of primarily rehabilitative practice.
Technological Advancements in Precision Movement Measurement and Wearables
The independent practice of physical therapy continues to advance, aided by rapidly evolving technology that can collect biomechanical data in real-time via highly sensitive equipment and wearable technology. At the same time, there is also a growing demand from clients who wish to avoid becoming patients by engaging in rigorous injury prevention training. Intensive injury prevention training has, until recently, been the providence of elite athletes supported by national teams and professional organizations that could afford the required technology and professional expertise.
The cost of this technology has dropped to the point that physical therapy practitioners can afford to incorporate it into private practice. This is evidenced by the description of one local practice whose web site explains, "The PIM (precision in movement) system is a biomechanical-based approach centered around restoring and reinforcing your body’s movement systems. It is deeply rooted in the scientific study of human movement and the innovative integration of technology into practice (Precision in Movement/Performance Therapy Inc., 2019, para. 6).”
Precise movement analysis enables a comprehensive physiological approach supported by a technical diagnosis of movement. This data supports the physical therapist's identification of the most effective intervention. With this tool, skilled PTs can execute therapied that improve mobility, flexibility, and strength and increase neuromuscular capacity. With enhanced baseline physical capabilities, the physical therapist can help the client re-educate her movement patterns and optimize her sport-specific movements or activities. Here is where sport psychology interventions, grounded in motor learning and motor performance science, can be deployed to help the client accelerate the adoption of new movement patterns and retain optimized movements in the live sport setting. Examples of sport psychology interventions that can aid the re-education of movement include imagery, positive self-talk, relaxation, mindfulness, and goal setting. The benefits of these interventions to a physical therapist will be discussed next.
Visual Observation and Imagery
Schmidt & Lee (2013) describe the benefits of motor skill learning that accrues to an athlete by merely observing a teammate or other subject learning a movement in person or via pre-recorded video. Given the proliferation of video available from precision movement system recordings, physical therapists can use actual recordings of other athletes or of the client athlete learning a movement to supplement the motor skill adoption of that movement or activity. Additionally, group sessions may be valuable for physical therapy clients, especially for related groups of new learners who can benefit from watching teammates or other athletes learn.
The physical therapist can also utilize imagery to help the athlete replace an unwanted movement with a desirable one in mental practice before and after attempting to learn the movement physically. If the PT is uncomfortable at first utilizing imagery interventions, a qualified sport performance psychologist can join in the session or work with the physical therapist until he is comfortable with the mental performance technique.
Re-learning a movement to improve performance will likely be frustrating for an athlete at first attempt. Positive self-talk can help the athlete adopt a mindset that allows her to believe that the successful adoption of a new movement or activity is within her control and will come with focus and practice (Dosil, 2006). Positive self-talk will also be helpful in the live sport domain as the athlete attempts to utilize newly acquired movements in competition.
Perry, Ross, Weinstock, and Weaver (2017) found positive results in the performance of athletic tasks following a single short session of mindfulness training. Although the study was not explicitly related to movement skill development, the results are promising as to the potential outcomes in movement training performance, flow state, and stress reduction in athletes who receive mindfulness training. The results of Perry (2017) also indicate that a small investment in mindfulness skills could yield a significant improvement in athletes' performance.
Goal setting is a staple of psychological skills training, and it offers significant benefits to athletes. Physical therapists commonly utilize basic methods of goal setting to establish treatment or training milestones with clients. SPCs are trained in advanced goal setting psychological skills, and they can contribute to the process of and accountability to goals that clients wish to achieve in movement training Dosil (2006).
Establishing a Routine
Athletes in training or competition must establish consistent, intentional routines to prepare their minds and bodies for optimal performance. Routines are essential in the areas of athlete nutrition, sleeping patterns, and activity preparation to name only a few areas. Physical therapy movement training clients, who wish to perform at an elite level in their sport, can especially benefit from regimented routines to support their training Dosil (2006).
Emerging Opportunities for a Data-Enabled Multi-disciplinary Team
Hamson-Utley, Martin, and Walters (2008) as cited in Kamphoff et al. (2010) pointed out that Athletic Trainers (ATs) and Physical Therapists share favorable impressions of the usefulness of psychological skills. Further, as their formal training increased in mental abilities, this appreciation increased. Kamphoff (2010) additionally proposed a more comprehensive education in psychological skills to prepare practitioners to incorporate them into treatment. However, few PTs receive such expanded knowledge. As a result, opportunities exist to include a Sports Psychology Consultant (SPC) in the treatment and performance training settings. SPCs can be added to a multi-disciplinary team or can be engaged to provide further professional education to members of an existing Physical Therapy practice.
Physical therapists can improve client movement skill acquisition and retention by making a professional educational investment or by adding an SPC to their practices. This service can be packaged with existing training or as a separate enhanced service for physical therapy clients who wish to improve their movement skills as has been described. Further, significant gains can accrue as a result of relatively small investments in mental training with athletes.
One of the essential facets of mental performance training is that mental skills be customized for each client’s unique needs. Psychological techniques can be delivered in many settings, and they do not require an investment in expensive equipment. All that is needed is a willing collaborative spirit and a well-trained, experienced Sport Performance Consultant. The Mental Side of Sports (MSP) recommends that any SPC meet the Association for Applied Sport Psychology designation as a Certified Mental Performance Consultant (CPMC) (Association for Applied Sport Psychology, 2019, para. 1).
New Laboratories – Beyond the Physical Therapy Gym
Physical Therapists can collaborate with Sport Psychology Consultants in several settings outside of the traditional physical therapy gym setting. Advances in portable and wearable technology are enabling diagnosis and monitoring of movement training on the field, on the court, and even in competition. There is also an endless opportunity to engage in research to demonstrate how the incorporation mental training into precision movement training can improve overall movement performance. This type of collaboration between the disciplines would contribute to the advancement of both fields.
Psychological skills training and precision movement training share another commonality that has yet to be discussed. Both can be incorporated to meet a wide range of clients’ needs from those who wish to move better to alleviate any pain or discomfort, to the weekend warriors who desire to improve in amateur competition, or to the elite athletes looking for the next competitive edge.
An exciting new era has arrived in athlete performance training. Physical therapists have at their disposal advanced technology that has become affordable for private practices to train clients in precision movement ability. Wearable technology and portable equipment have even extended the possibilities into the domain of live competition. A case has been presented that sport psychology skills can be incorporated into precision movement training to limit the time required for an athlete to acquire movement skills, and to improve her ability to retain those skills. Specifically, mental performance skills like visual observation and imagery, positive self-talk, mindfulness, goal setting, and establishment of routine can significantly enhance the effectiveness of precision movement training. The collaboration of sport and performance psychology and physical therapy offers benefits that can be customized for athletes of all levels of ability and status. A sport psychology partnership offers a physical therapist the opportunity to differentiate his precision movement training program from competitors, at a flexible and affordable investment, particularly when compared to the cost of precision movement technology.
For further information about how you can integrate mental skills with precision movement training please contact me at:
Owner and Mental Performance Consultant
The Mental Side of Performance
Cell: (817) 507-7389
Dosil, J. (2006). The Sport Psychologist’s Handbook: A Guide to Sport-specific Performance Enhancement. West Sussex, England: John Wiley & Sons, Ltd.
Find a Certified Mental Performance Consultant®. Association for Applied Sport Psychology. Retrieved from https://appliedsportpsych.org/certification/cmpc-directory/
Hamson-Utley J.J., Martin S., Walters J. (2008). Athletic Trainers’ and Physical Therapists’ Perceptions of the Effectiveness of Psychological Skills Within Sport Injury Rehabilitation Programs. Journal of Athletic Training, 43(3), 258-264.
Kamphoff, C.S., Hamson-Utley, J., Antoine, B., Knutson, R., Thomae, J., & Hoenig, C. (2010). Athletic Training Students' Perceptions of and Academic Preparation in the Use of Psychological Skills in Sport Injury Rehabilitation. Athletic Training Education Journal, 5(3), 109-116.
Our Approach. Precision in Movement/Performance Physical Therapy Inc. Retrieved from http://precisioninmovement.com/about/approach/
Perry, J. E., Ross, M., Weinstock, J., & Weaver, T. (2017). Efficacy of a Brief Mindfulness Intervention to Prevent Athletic Task Performance Deterioration: A Randomized Controlled Trial. Sport Psychologist, 31(4), 410–421. https://doi-org.proxy-library.ashford.edu/10.1123/tsp.2016-0130
Schmidt, R., & Lee, T. (2013). Motor Learning and Performance with Web Study Guide: From Principles to Application, 5th ed. Human Kinetics, Champaign, IL. ISBN 13: 978-1450443616; ASIN: B00GGV364Y