Performance Teams and "Lanes"

“Stay in your lane,” said nobody any of us would like to work with.

 When it comes to medical and performance teams in sport, it is not always clear where the lanes are.  First, who decides where to draw the lanes? In medicine, the lanes are often guided by political and economic incentives, not necessarily by clinically meaningful criteria.  The “lane lines” are typically drawn by the party with the more powerful political lobby in anticipation of, or in response to, competition for market share.

Physician lobbies generally don’t want nurse practitioners to operate autonomous primary care clinics or physios to evaluate patients for musculoskeletal conditions without a referral.  Physios don’t want athletic trainers to do anything but acute, on field care or strength coaches to roll an athlete’s muscles with a stick (such an act constitutes “manual therapy”). Safety and concern for public well-being are usually cited as the primary reason for many professional distinctions but such claims are seldom backed by objective data.  Instead, rhetorical pleas and fear mongering lurk beneath the facade of safety advocacy. Outside of medicine, occupational regulations protect existing job holders from competition.  It is not a stretch to say that professional boundaries in medicine are influenced by more than just the potential for preventable harm.  Therefore, acknowledging that the lanes themselves are somewhat arbitrary is crucial for transparency to prevail in any medical and performance team.

In practice, the lane analogy isn’t very useful.  The roles between the various medical and performance providers aren’t like the lane lines that divide a highway.  Some professional redundancy and overlapping scope of responsibility is actually desirable to minimize the potential for error.  There’s no definitive boundary between rehabilitation and strength and conditioning or between strength and conditioning and technical/tactical preparation.  The boundaries are blurry and that’s actually a good thing with the right organizational dynamics and culture.

Only at the extreme end of the preparatory continuum are professional responsibilities clear.  Additionally, the positions that assume the greatest risk should be regulated the most strictly.  The barrier for entry into surgical professions is necessarily higher than for something like “manual therapy”.  I’m totally okay with a barber giving me a neck massage upon the completion of a haircut.  I don’t report him to the state medical board because he isn’t formally trained in manual therapy.  As far as I know, however, barbers aren’t doing surgeries as a side hustle so the free market provides some safeguard against egregiously unsafe practices.  Physios and massage therapists aren’t going after barbers because the neck massage in this scenario is incidental to the haircut and therefore not competition for market share; a concession that putting one’s hands on somebody without having completed 100+ hours of formal manual therapy training isn’t dangerous per se.  

Technical coaches should have little to no influence on a surgical decision.  Conversely surgeons shouldn’t be writing up the final play of a contested game.  Strength coaches probably shouldn’t be managing a surgically repaired joint within a few days of an operation.  These professional delineations are clear, just as the divider and shoulder on a highway are easily distinguishable.  The area where most of the driving occurs, however, is an overlapping sector of accountability which is why “stay in your lane” can be a problematic statement and reflective of a dysfunctional team.

Where there need to be lanes, those lanes should be clearly defined by the organization.  Where the lanes intersect, ego and lack of self-awareness compromise outcomes more than a particular person navigating through more than one lane.  Assuming everybody is operating under the law, knowledge and competence, not certifications and diplomas, should dictate who does what with an athlete and when a medical or performance staff member should “change lanes”.  A track and field or strength and conditioning coach might be more qualified than a physio to reintroduce running to a field sport athlete following an ACL surgery, as an example, assuming basic joint function has been restored.  A physio might be better able to identify a compensatory pattern or technique fault on the field than a sport coach or strength and conditioning coach.  No single profession has a monopoly on knowledge. (Mainly) seamless distinctions among providers and professional redundancy makes for a more adaptable, less fragile team.   Only at the extreme ends of the medical/performance continuum are the lanes apparent.  Most situations performance teams encounter aren’t akin to a surgical procedure where the personnel choice is obvious.  Embrace the grey by letting the “right” people operate under a “good” system without too many regulations or constraints.  Easier said than done...

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