Medical model or perfromance model? What’s the difference? Is there a difference? Does it matter? There is a huge difference. The medical model has gained a strong foothold in North America over the last 15 years. It is a vertically integrated structure driven by doctors and usually administered by an ATC or sometimes a physical therapist. There are silos, where narrow specialization is encouraged. Leadership is this model is by command. Everything is over diagnosed. If the player has a hangnail, an MRI is ordered. Of course if you look hard enough for injuries or dysfunctions then surely you will find them. In the medical model it is almost as if people are going out of their way to justify their existence. The S&C coaches are low on the food chain. They are given strict guidelines as to what they may and may not do in regard to training the athletes, even down to being told to include specific exercises and exclude others. They have little input in prevention programs, those are dictated to them from the medical side. There is an emphasis on corrective exercise to the exclusion of training. Much of what is done is protocol driven. They have little or no input in rehabilitation and returning the athlete to the sport after injury. The emphasis here is on what can’t be done, limitations, exclusion and panic reactions.
The performance model is just that, it is a model driven by performance. The focus is on what the athlete can do, on training and preparation for the game. It is a model that is proactive, based on abilities not disabilities, it takes into consideration the big picture connections and provides a broad spectrum of care. The performance director is crucial. That person needs to have great communication skills, and be a consummate generalist in order to connect all elements that comprise performance. The performance director coordinates and facilitates in a horizontal structure where everyone has clear roles and responsibilities but is encouraged to interact with others outside their area of expertise. Everything is criteria based, with baselines established through a specific physical competency assessment that fits the sport. The premium is on cooperation and communication. It is clearly coach driven. It is a model that is robust and dynamic based on accountability for performance of the player in competitive arena. The team is designed to optimize performance, injury prevention is transparent, but a stated objective. If there is an injury the whole team is involved in the process of returning the athlete to full participation from day one.
It does matter which model you choose. Look at where we are in the US. We have adopted the medical model and injuries are off the chart. The medical model results in everyone walking on eggshells, waiting for the next injury to happen and then pointing fingers to place blame when injuries do occur. We need to take a close look at the whole structure. I have a strong bias toward the performance model. I have seen it work. It optimizes the athlete’s abilities and significantly reduces injuries. It empowers everyone in the performance team because they all have a voice and a role in what occurs. It is not a power grab or who is in control; rather it is about producing results. Performance depends on a viable functional team behind the team with everyone on the same page. Bottom line that is what the performance model is all about.
Paul A. Davis
Vern-
While I agree with you about the need to return to a performance model, I think we should ask why the medical model has taken hold. And to what degree is the medical model the norm at various levels of sport (clearly it seems to have a stranglehold on professional sport)? At the amateur level (HS and below) I think one reason for the prevalence of the medical model is the epidemic of overtraining, or perhaps to be more specific, overplaying. Too many HS and below athletes play waaayyy too many games, and do very little actual training. The result is a litany of injuries. I see waaayyy too many coaches at this level who have very little – if any – knowledge of training needs and methods. There are too many Phil Jackson, Bill Belichick, Tony LaRussa, Scotty Bowman’s, etc. wannabee’s who don’t spend the time developing athletes but want to micromanage games (and young athletes) in order to get the next win.
rjbrissette@hotmail.com
Then why if you know they are not working would you target the established Medical Model to sign on with you in the GAIN Network. There are some phenomenal Medical Models that do a better job than the Performance hands down. I would love to see the Medical Models that are issuing MRI’s for a hang nail. I think we all need to be a bit more professional and really think about what we say and who are audience is, you have a lot of folloers that work in a Medical Model that truely embrace your opinions, but when hear comments as the above they are turned off.
Kevin
I think both models have benefits as I have worked with both settings. I think part of the issue is that the exercises used have to reflect the sport the athlete is participating in to get the best results. there is not a cookbook of exercises that you follow for every athlete regardless of sports. The structure of the model to meet the needs of the sport will get you the best result.
Will Kirousis
Interesting comments. I feel the medical model has taken hold as a result of “our” own desire to appear smarter within the profession, and for the medically centered trickle down caused by liability. A coach may know X or Y to be true, but if the doc says Z… the coach may feel compelled to go that way to avoid potential legal trouble.
I think new coaches, in a desire to appear smarter, and like their skill set and information has value, err to the medical model because it appears more “impressive”.
This is an area that coule create excellent debate for sure.
Emory Latta
What I largely see in dealing with diagnosis and rehab of my injured athletes is the ‘medical model’. At the high school level I am not treated as a professional even though I have coaching and conditioning certifications because I do not hold a medical degree or license.
What we encounter is single joint ROM and/or strength tests prescribed that must be completed to the ATC or PT’s satisfaction or the athlete is not certified to return to play. Period.
Blame is almost always on training (especially if it involves resistence training). Rarely is over-competition or year-round specialization mentioned. Rehab usually consists of joint-specific ROM movements only – rarely are any multi-joint athletic enhancement drills and programs suggested. I had one kid come back from ‘rehab’ with a football release that said ‘offense only, no defense’. We thought it was a joke but it was actually written out by the ATC and signed by the orthopedic doctor. Unreal!