Who owns the rehabilitation domain?

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Who owns the rehabilitation domain? While this could be construed as a question likely to lead to significant heated debate, my aim in exploring this issue is simply to look at some of the recent and potential changes in this area. Rehabilitation, within the context of the physical therapies, usually refers to a process of reducing or overcoming deficits following injury or illness with an aim of gaining optimal physical and mental ability. It is likely that if we asked several professional groups (e.g., physical therapists, athletic trainers, sport and exercise scientists, sports physicians, osteopaths, chiropractors), they would all say that they play a major role in rehabilitation. While some of these professions have their beginnings grounded in a rehabilitation focus (e.g., physical therapists), others such as sport and exercise scientists (or exercise physiologists as many in this discipline are now referring to themselves) are in the relatively early stages of gaining recognition in the rehabilitation arena.

The reasonable conclusion to the question posed in this editorial is likely that all of the above-mentioned professions and disciplines have some input into rehabilitation. With some groups, however, making significant recent pushes into this area, it is worth looking at the impact this may have. I will use a recent Australian example to illustrate my point. I recently returned to Australia after 7 years in a New Zealand academic environment. One noticeable professional change that struck me on my return was the move made by the sport and exercise science discipline into the rehabilitation domain. This shift was likely predictable given the large number of graduates from such programs around the world, and the relative size of the employment market in the area of sport performance, let alone elite sport performance (where most wide-eyed sport and exercise science university entrants eventually want to work). In Australia, the Australian Association for Exercise and Sport Science lobbied the national government over a long period and succeeded in achieving status that allows accredited individuals to claim government health rebates for rehabilitation services. The rehabilitation services offered by many of these individuals include those for musculoskeletal and cardiorespiratory conditions, as well as rehabilitation for many (often complex) neurological conditions. At the same time as congratulating this organisation for their lobbying work around rehabilitation services, I would like to pose the challenges that such a shift places on training of such individuals, and on other professions. When we are working with people with complex conditions it is important to have a robust knowledge of the pathology of the condition, and how that pathology will interact with the various rehabilitation modalities used. Sport and exercise science graduates will need to ensure that their knowledge of these interactions is at a high level to meet both efficacy and safety criteria. This is especially true when working in areas of cardiorespiratory and neurological conditions. Another challenge faced by this shift in discipline focus is the applied or “clinical” training that is required to ensure that graduates are competent in the areas in which they will be working. With most countries around the world facing difficulties in finding enough clinical training opportunities for their students in programs such as physical therapy, the addition of requirements for exercise physiologists to pursue such training will only add to the challenge. Will this ultimately mean that students will have less access to clinical training in real-world environments? Will this impact on their competencies on entering their professions? These questions all need to be carefully considered when examining the preparedness of graduates to enter the rehabilitation domain of health care.

This issue of Physical Therapy in Sport includes several original research papers as well as a masterclass paper. The lead paper by Kinney and colleagues from Grand Valley State University in the US investigates trapezius muscle activation patterns during a range of specific and commonly used therapeutic exercises. The authors concluded that training at 90° horizontal abduction provides maximal activation, and suggested that training at multiple horizontal abduction angles was not necessary. The next paper by Webster and colleagues from La Trobe University, Australia reports on the development of a scale to measure the psychological impact of returning to sport after anterior cruciate ligament reconstruction surgery. While many clinicians will anecdotally suggest that returning to sport after such injury and surgery is influenced by psychological factors, the scale developed by Webster and her team can help in identifying athletes who may find return to sport difficult. Gabriel and his team from the University of Trás-os-Montes & Alto Douro (Portugal), the Technical University of Lisbon, and Virginia Polytechnic Institute & State University examined gender differences in dynamic joint stiffness of the ankle during walking. They concluded that the gender differences identified are useful in designing training programs that use contractile components to produce mechanical energy through the ankle. This issue includes two papers on the sport of cricket. While some of our readership from North America and Europe may not be all that familiar with cricket (and understandably so, given that it is a game that can be played over 5 days and end in a draw!), the topics can be viewed from a broader perspective. Dennis and colleagues from Australia examined the reliability of a range of musculoskeletal screening tests commonly used in cricket. Their findings can help inform screening programs across many sports. The second cricket paper reports on the impact of shoulder injuries on professional cricket players in England and Wales. The authors found that 23 per cent of those surveyed sustained shoulder injuries during a season, and that most played on despite their injuries and the impact it had on their performance. This issue concludes with a masterclass paper by Mottram and Comerford in the UK that explores musculoskeletal assessment and retraining from a new perspective that attempts to address multiple muscle interactions in functional tasks.

I hope you enjoy this first issue in our ninth volume of Physical Therapy in Sport. We have endeavoured to adhere to our original intent of providing a healthy balance of papers that have a strong practical focus, and will be of interest to be practitioners and researchers alike.