PROFESSIONAL PRACTICE MULTIDISCIPLINARY TEAMS
The athlete’s relationships with other athletes, coaches, team doctors, physiotherapists, STTs, and other members of the support team are important components of the whole system. These relationships can have a profound effect on the mental, emotional and physical state of the athlete. They can affect the group dynamics of the sport setting and ultimately influence individual performances. Testimonials about the benefits of
soft tissue therapy from enthusiastic athletes and anecdotal evidence to support its use for training and competition are abundant. But explaining how massage and soft tissue therapy enhance athletic performance in scientific terms is a challenge. Although the question seems simple, the answer is as complex as the athletes who engage in the sports. Much of sports medicine has
developed empirically, and current practice often reflects practitioner experience rather than evidence from research findings (3). The lack of high- quality research literature is one reason for this. Following a detailed survey into four major sports medicine journals to examine the evidence base of sports medicine, Bleakley and colleagues reported a dearth of studies addressing diagnostic and treatment interventions in the literature (4). In support of these findings, Hoskins and Pollard carried out an exhaustive literature search into the management of hamstring injuries and concluded there was a distinct lack of high-quality research into methods of treatment and rehabilitation; as a result of these findings, an evidence base for injury management of hamstrings does not exist (5). Naylor suggests that, at times,
evidence alone may not be sufficient to guide actions (6). Therefore, interventions may need to be based on inference and clinical reasoning, with its reliance on experience, analogy and extrapolation, to traverse these grey zones of practice. This includes eliciting and respecting the preferences of patients.
Clark refers to clinical reasoning as
the organisation of thought processes, the prioritisation of intervention strategies, and the application of clinical
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PHYSIOTHERAPISTS, STTS, AND OTHER MEMBERS OF THE SUPPORT TEAM ARE IMPORTANT COMPONENTS OF THE WHOLE SYSTEM
skills in the evaluation, diagnosis and treatment of a patient’s problem (7). Kresge offered further explanation of the limitations of experimental research to account for the effectiveness of sports massage, being only one element of the many weapons in the STT’s and physiotherapist’s armoury (8): “It has been frequently noted that clinical results of massage are often more dramatic than experiments with massage would indicate. Massage, however, tends to have a cumulative effect that is not shown in short-term experiments. It is a science and art combining a variety of strokes in infinite ways to best suit individual situations, while scientific experiments must employ standardized, repeatable procedures.” Maybe a more qualitative approach
would be more suited. Cumulative effects over time, the uniqueness of each application of soft tissue techniques to a specific athlete, and the characteristic synergy of sports performance make it difficult to design and carry out valid experimental research showing a simple cause-and- effect relationship of soft tissue therapy to sports performance. However, there is a plethora of research on the techniques that we use everyday that are second nature to us, such as myofascial release, trigger point therapy, muscle energy techniques, neuromuscular techniques, deep transverse friction, soft tissue release and fascial manipulation technique, to name but a few. With integration difficult at the best of times, and with bias and often uneducated professional opinions, mixed with some ego and a touch of insecurity, what will happen to our team? Will the current sports medicine team hierarchies embrace the evolution of the disciplines and inspire their potential? Will roles diversify or will there be boxes that individuals must
remain in? What system is best, what integration is required, and how much autonomy will produce the most effective outcome – athlete injury prevention and performance? I relish being able to work with so many disciplines and expand my knowledge. The ever-increasing expansion is one of the aspects of soft tissue therapy that I love the most.
References 1. Hulme R, Cracknell D, Owen D. Learning in third spaces: developing trans-professional understanding through practitioner enquiry. Educational Action Research 2009;17:537–550
2. Thylefors IA, Persson OA, Hellström DB. Team types, perceived efficiency and team climate in Swedish cross professional teamwork. Journal of Interprofessional Care 2005;19:102–114 3. Bleakley C, MacAuley D. The quality of research in sports journals. British Journal of Sports Medicine 2002;36:124–125 4. Bleakley C, MacAuley D, McDonough S. Are sports medicine journals relevant and applicable to practitioners and athletes? British Journal of Sports Medicine 2004;38:541–548 5. Hoskins R, Pollard H. Hamstring injury management – part 2: treatment. Manual Therapy 2005;10:180–190 6. Naylor CD. Grey zones of clinical practice: some limits to evidence-based medicine. Lancet 1995;345:840–842 7. Clark N. Principles of injury rehabilitation. SportEX Medicine 2004;19:6–10 8. Kresge CA. Massage and sports. In: Appenzeller O, Atkinson R (eds) Sports medicine: Fitness, training, injuries, 2nd edn. Urban & Schwarzenberg 1983. ISBN 9780806701325.
THE AUTHOR
Paula Clayton is a senior soft tissue therapist. She has worked for the English Institute of Sport and UKA since 2003, travels extensively with UKA to senior camps
and competitions, and is now in her third Olympic cycle. Before that, she worked in English Premiership football for 4 years. As well as running a busy private practice, established in 1994, with her husband Rick, Paula is studying for an MSc in sports injuries.
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THE ATHLETE’S RELATIONSHIPS WITH OTHER ATHLETES, COACHES, TEAM DOCTORS,
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