Strength and Conditioning in the NHS

Many of you will know that I work multiple roles within the field of S&C. I have already spoken about my work within Rugby League, and I hope you know that I offer a S&C coaching on a 1-2-1 basis with private clients of all ages and abilities. My main role is using my skills within a Physiotherapy outpatients department to help rehabilitate people with a wide range of people.

When people think of rehabilitation they often jump straight to physiotherapists. With a traditional physiotherapy only approach, patients are diagnosed, treated and rehabilitated by physiotherapists. With complex injuries such as ACL or Achilles tendon ruptures this rehabilitation can take many sessions over a long period of time.

Once the initial phase of injury has settled down, pain has (mostly) subsided and the patient is fully weight bearing, treatment moves on. At this point of rehabilitation many of the treatments involve improving strength lost through the injury itself or the period of being immobile. Many injuries have a lack of appropriate strength and conditioning as a root cause. Some ACL patients are able to get strong enough that they don't need surgery to return to running or cycling.

As a Strength and Conditioning coach my process is the same in every case:

1. Assess current abilities

2. Understand where the person needs to be

3. Make a plan to get there

This process remains the same no matter whether a professional athlete looking to improve their game or a patient needs to be able to climb down stairs after a knee replacement. Key considerations include

1. Availability of equipment

2. Level of exercise the person can recover from

3. Appropriate amount of load

The key reason for using S&C coaches alongside physiotherapists is that we have different skill sets. Initial assessments are always physiotherapist led, their training allows them to diagnose and treat early stage acute and chronic injuries. Once a patient gets to the point where they need to strengthen a joint or return to sport specific movements such as running they get the option of a referral to strength and conditioning. The benefit for the patient is we are trained to maximise the rate of improvement. This means we get people back to sport or day to day normality quickly. It also frees up the physiotherapy team to see more patients who need diagnosing and early stage treatment.

The key is team work, S&C coaches and physiotherapists working together has been common in sport for years. In sport I work with a full squad of players, This skill set allows a small group training approach for late stage rehabilitation. For example; the department I work in offers an advanced stage ACL rehabilitation session for people looking to return to sport. By working in a small group, patients are able to recreate the environment within a team sport and train as a team. It also allows patients to see a coach and physio each week as opposed to each month.

The role of an S&C coach within an NHS Physiotherapy department is a relatively recent idea. The overwhelming majority of NHS trusts do not currently offer this service. That is why I consider it an important part of my role to highlight the potential benefits for both the NHS and patients. Hopefully this role will become more common in the future with the healthcare sector learning from professional sport.