If you want an awesome golf swing, a great squat, a long triple jump, or even an efficient gait, the component parts need to be working normally. You want these component instruments - joints muscles, nerves, etc. - to be functioning individually before you start to program or re-program patterns. The independent parts will improve as a unit when the swing or squat is practiced - and we don’t want to engrain abnormal unconscious patterns if we don't have to.
Take running as an example. If you’re lacking normal dorsiflexion that can affect how you run. Worse case scenario, that leads to injury at the ankle or somewhere else. Best case scenario, it doesn’t matter at all. Could your dorsiflexion normalize simply by running? Maybe. I am more exact, however; I investigate how to get a patient more dorsiflexion (there are many causes). There are so many moving parts when it comes to the symphony of running and I realize most people who run aren’t going to check all these things. But if your goal is performance and/or you’re interested in investing time and energy in perfecting your running, it behooves you to see to it that the individual parts work well. -- Laura
Simply put, therapy makes something that isn’t working, work again. Performance, on the other hand, makes something that already works, work better. There is overlap between the two realms, but it’s not as large as many seem to think. If you understand how to fix a torn muscle, you likely have a basic understanding of how to maximize performance of a normal muscle. Likewise, if you understand how to make a normal heart become more efficient, you’ll have modest knowledge of what happens when something goes wrong.
Having been a relatively high-level athlete myself, I am comfortable in the world of performance (fitness and sport performance). However, that is not my expertise. As I value expertise, I advise people within my area of expertise (orthopedic therapy) and refer people to other professionals for guidance in other fields.
Do you run a 9-minute mile and want to run a 6-minute mile in 3 months? Do you want to improve your vertical leap by 25% before next season? My role in these situations is to ensure no orthopedic problem is stopping you (which is an important step!). That it, things work well, they are just not conditioned for that higher level of performance. While I could certainly help in the performance realm, if you want the best, most efficient training plan, I am not your person.
Overlap most concretely occurs when a high-performing patient is nearing the end of therapy. My job is to restore a patient’s body to the patient’s individual normal. If her normal is playing professional soccer and I can get her only 75% of the way there (at which point her body is way above universal norms), that is the time for a performance specialist to take the lead to get her to 100%. -- Laura
When discussing athletic performance, we think of coaches, strength and conditioning specialists, trainers, and so on, but my role comprises the foundation. Power, balance, and mobility are certainly trainable, but if your body is not fully normal to begin with, training will only get you so far. If performance prowess is your goal, you need normal nerve conduction, nerve extensibility, strength, mobility, biomechanics, etc. first. (Having no symptoms doesn’t mean everything is functioning normally.)
Consider jumping. If there’s even a slight derangement (painful or not) in the lumbosacral spine, the electricity supplying necessary muscles can be impeded. Tiny malalignments in the foot, ankle, knee, hip, or spine joints can affect strength, mobility, balance, and movement patterns with jumping. Abnormalities with muscles or tendons themselves (rare) will also impact jumping.
My expertise is in ensuring people have normal physiology before they go train to make it exceptional. (There are, of course, some allowances.) Perhaps most importantly, I teach people how to self-assess and self-treat so they can always perform with optimized physiology. It takes only minutes. I believe that many “off” days are due to minor, transient joint malalignments - which can easily be self-detected and corrected if you learn how. --Laura
Learn more about the world of diagnosing and treating orthopedics here!