Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York
During the past few years I have presented at many Physical Therapy and Strength and Conditioning/Athletic Performance Enhancement conferences as well as attended many of these same conferences as well. I have also visited and consulted with a number of University and Professional teams and during these experiences I have discovered an inordinate number of technical products available for both the Rehabilitation and Performance Enhancement Professional. Technology, when affordable, may be a very positive additive to any Professional’s “toolbox” as I am presently writing this commentary on my computer, not by candlelight and quill pen. Technology also appears, in certain environments, to eventually materialize to dictate the program design thus a question that arises is should technology dictate or simply assist in our vocation as professionals?
In the professional field of Orthopaedic and Sports Medicine the development of the arthroscope and arthroscopic techniques has assisted to achieve great advancements in surgical techniques and abilities. Does arthroscopy dictate the type of surgery required or does the orthopaedic surgeon determine the type of surgery necessary for specific orthopaedic pathologies and determine if arthroscopy is the vehicle for the execution of that surgery? Certainly arthroscopy enhances the surgical procedure options available to the physician however; it is the knowledge and skill of the surgeon that will determine (a) the pathology that is presented and (b) the best surgical technique to resolve the pathology.
Advancements have also been made in the pharmaceutical industry and one may ask is the same medication prescribed for all medical conditions or is it the physician who determines the medication that is best suited for the medical condition presented? Wouldn’t the content of this commentary be exactly the same if written by candlelight and quill pen, as it would simply require a greater period of time to complete?
Should these viewpoints be any different in the Rehabilitation and Strength and Conditioning (S&C) Professions? Should the methods utilized for the successes of the past be ignored? Should the proven principles and validated scientific evidence be ignored? As an example during my experiences of practice in these two related Professional fields has demonstrated when rehabilitating knee pathology, regardless of the type of knee pathology, those individuals with the strongest quadriceps musculature have demonstrated the best return to play outcomes. Many reading this commentary are likely familiar with the term “Quadriceps Dominance” as this condition is certainly present in a number of individuals. However, two thoughts that come to mind with this subject matter are:
(a) Are we not naturally quadriceps dominant as we are born with 4 quadriceps muscles, 5 if you include the VMO and 3 hamstring muscles?
(b) Is the individual that presents with “quadriceps dominance” really quad dominant or are they actually posterior chain deficient?
In the case of quad dominance are we actually to allow the quads to become weaker or are we to improve the physical quality of the posterior chain to eventually achieve an appropriate ratio of these muscle groups for athletic performance? Should technology assist in this determination or dictate this determination? Will resolving this condition be based on the experience and talent of the rehabilitation professional or strictly via the use of technology?
The S&C Profession has also been introduced to a number of up-to-date technical interventions. Many of these innovations make convincing claims regarding the prevention of injury and the enhancement of athletic performance. If these statements are true are these innovations the determinate of these results or is it the implementation of the appropriate program designed by the S&C Professional that determines these successful outcomes? If the latter plays the greater role in such claims then should technology determine the program design or be considered a tool to measure the results of the program design implemented?
When utilizing various technological instrumentation to record an athlete’s running mileage, in the case of the athlete who demonstrates excessive fatigue, is this a result of (a) excessive prescribed running mileage or (b) the prescribed mileage is appropriate and the athlete in question is not in the suitable physical condition to complete the prescribed running mileage efficiently? Thus is the prescribed running mileage excessive or is the program design insufficient to result in the athlete’s onset of excessive fatigue? Who determines this conclusion the technology or the S&C Professional? NFL Hall of Fame Coach Bill Parcells did not have the present day technology available to him. Coach Parcells knew the “physical requirements of the game” so to speak. His “technology” was to watch his fittest players at practice and when they appeared fatigued he would make the appropriate adjustments knowing the rest of his team were likely fatigued as well. This is a simple example of his superior coaching instincts and abilities which resulted in a Hall of Fame career and two NFL World Championships.
Three of my good friends and S&C mentors, Al Miller, Al Vermeil, and Johnny Parker are all well noted Hall of Fame S&C Professionals. They have 15 NFL and NBA Professional Championships and 10 NFL and NBA World Championships between them. Many of their championships occurred at a time where technology was limited and the terms and ideologies such as “pre-habilitation” and “correction” did not exist. These coaches focused on the fundamentals of training, their knowledge and coaching experience to enhance their athlete’s performance. Their program design and repeated performance of the prescribed exercises over time not only enhanced the physical qualities of strength, power and speed, but the athlete’s overall mobility and work capacity as well. These coaches will tell you that they had the talented athletes (i.e. the horses in the race) to win championships, however, their athlete’s also had the capability to compete day in and day out as their teams consistently had the lowest injury rates in their respected leagues. These coaches employed nothing fancy, no advanced technology, no special testing, screening, or “corrections” just the application of prescribed organized and appropriate programming, hard work, knowledge and good coaching. Based on their experiences these Hall of Fame coaches as well as many of the present day S&C coaches with whom I associate all agree if the athlete has the appropriate level of skill and athleticism, they will be successful if the following are achieved:
1. Enhance the athlete’s mobility and work capacity
2. Enhance the athlete’s strength, power, and speed
3. Ensure the athlete receives proper nutrition at each meal and eats regularly
4. Ensure the athlete achieves the appropriate amount of sleep
5. Implementation of a physical recovery strategy
Present day technology will continue to improve and new technology will continue to be introduced in many professional fields of practice. These technological advancements may certainly benefit the utilizing professional yet these technologies will also continue to “come and go” as well. The Rehabilitation and S&C Professional should consider the best present day technology available to provide them with the information necessary to reinforce or demonstrate deficiencies in their program design. As Professionals we have achieved hands on skills, knowledge, and experiences that contribute to the overall structure of the program design as most technology provides information on a limited portion of that program design. Technology can be very useful and beneficial when utilized applicably and in the appropriate setting, however the ability to actually rehabilitate and/or coach an athlete is a talent that cannot and should not ever be replaced. Technology will come and go and advancements will surely continue in the years to come, but the individual Professional will remain for the duration of a career. Should technology dictate or assist in the development of the athlete’s rehabilitation and/or S&C program design? This is a critical decision that will place the advantage with either the Professional or their competition.
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Robert Panariello MS, PT, ATC, CSCS
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