That Which Lies Ahead

This week marks the 18 year anniversary of my clinical practice, Smart Sport International. It is amazing how a milestone like this will prompt you to take a look in the rear view mirror to reflect on where you’ve been, pause to reflect on where you are, and look out the front window to see where you are going. A good car analogy never hurt anybody!

In January 2004, my vision of a seamless integration of physiotherapy and coaching was beckoning. I was approaching 16 years of clinical practice, having attained the highest level of training in Mechanical Diagnosis and Therapy six years earlier. I walked out of an outpatient physician-owned practice on a Friday afternoon and started in my own space on the following Monday. In retrospect, that vision - and its 18-year embodiment - has produced several innovations in clinical practice.

A cash-based practice integrating fitness, strength training, and coaching was virtually non-existent in 2004. That was at least a decade or more before those concepts became trendy. I built my clinical practice with a focus on self-care, integrating MDT in the assessment and treatment of the running athlete. One of the pillars of my practice would eventually be published in 2008 as “RunSmart: A Comprehensive Approach to Injury-Free Running”. This contained the first published reference to MDT in the context of the athlete. It was also a full 7 years in advance of the first “MDT and The Athlete” workshop in Copenhagen (of which I was a course developer and presenter).

Over those 18 years, I have found that if there is one limiting factor having the greatest impact on physical therapy and innovative models of delivery, it is the lack of direct access. The gatekeeper model is, in my humble opinion, an anti-trust violation in progress. Direct access involves a patient and physical therapist establishing a therapeutic relationship without the need for any form of permission slip during their course of care. In 2004, when I opened my practice there were just 15 states with direct access; now there are 18.

Frankly, the clinical world around me really hasn’t changed that much since I opened my practice in 2004.

I’ve come to learn that our career pathways evolve over time. I think that the challenge is to embrace those opportunities, even if they don’t specifically match our preconceived notions of what we think we are supposed to be doing or the path we think we are supposed to be on. The adventure I began 18 years ago has certainly had its ups and downs, but it has also prompted many iterations in my career that I’d never thought would happen. However, I don’t think I will ever fully stop treating patients.

I can now say that the next generation of Smart Sport International is going to appear in 2022. It will synthesize concepts I envisioned on these pages in the early days of my clinical practice, ideas that are now made feasible by technology and a deeper understanding of cognition, learning, and self-care.

It’s time to change the game - again.

It’s time to bring patient-centered care back to the patient - for real.

Is that an audacious claim? You are damn right it is.

Stay tuned and find out what lies ahead.

Photo credits: Allan Besselink

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