Healthy Wealthy & Smart 492: Dr. Tracy Blake: Role of Physiotherapy in Sport
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tracy Blake on the show to discuss the evolving role of physical therapy in sport. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.
In this episode, we discuss:
-The preventative and reactionary roles of physical therapists in sport
-How to optimize the healthcare team’s strengths to amplify the organizational mission
-Equity and shifting power dynamics between the athlete and clinician
-COVID-19 and ethical considerations in sport
-And so much more!
Resources:
WCPT statement of diversity and inclusion
WCPT symposium on diversity and inclusion
2016 consensus on return to sport
Coin model of privilege and critical allyship
For more information on Tracy:
The only daughter of Trinidadian immigrants, Tracy Blake and her youngest brother were raised in the multi-cultural, multi-ethnic, multi-faith, working class Toronto (Canada) neighbourhood of Rexdale on the traditional territory of many nations, including the Mississaugas of the Credit, as well as the Anishinabeg, Chippewa, Haudenosaunee, and Wendat peoples. Sport was a power source of connection and vehicle for connection throughout Tracy’s upbringing. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.
Read the full transcript below:
Karen Litzy (00:01):
Hi Tracy, welcome to the podcast. I am happy to have you on. And I'm so excited to get to speak with you one on one. I heard you speak at WCPT in Geneva last year and I think I've told you this. It was one of my favorite sessions and we can talk a little bit about that session later. We'll probably sort of weave it in as we go along here, but it was a great session at WCPT and I'm really excited to have you on the podcast today to talk about the evolving role of physical therapy or physiotherapy in sport. So I'm just going to hand it off to you and if you can kind of let us know what that role kind of maybe where we were and how you see it evolving and how it has evolved up to this point.
Tracy Blake (00:53):
Yeah, so I think historically, physiotherapy or physical therapy, I'm Canadian, so I tend to use both. Historically in sport was seen as reactionary. So injury happens, enter physiotherapist from stage 1 right. And I think over time what has happened is that both from a clinician standpoint and an organization standpoint in sport there has been a change in perspective with an increasing level of focus on primary injury prevention. And so what that has meant is physiotherapists are not only responsible for there reactionary role, the rehabilitation, the remediation of injury, but also there has been a serious investment both in their time and an organization's resources around preventing injuries from occurring at all. I think the other part of this is that part of the evolution has been in the team around the team. So historically speaking, there may have been a physical therapist and athletic trainer, a doc, and that would sort of be the primary set of your team.
Tracy Blake (02:14):
Now, more and more organizations are having maybe multiple therapists, strength and conditioning, nutrition, dietician, sports psychology, other disciplines are involved in the team, which both alters the way in which we gather information, gather experience, the way we develop as practitioners, and also the way in which we engage in our role and in our competencies. Within a sport context. And I think that there's sort of three arcs in which I see physiotherapy in sport, which is consultant. So in a consultant role, you may not be actually involved with front-facing athlete care at all. You might be making recommendations or talking to ownership or be brought in special cases for example. As a concept, then you have external service providers. They might have more regular athlete contacts, but they're not embedded in the daily training environment, which is the third aspect. Each one of those rules has a role to play in today's modern sport, particularly as you get into more resource abundance levels, your high performance or Olympic level or professional level. But the arc of change for each of them is going to be different. The arc of evolution is different. And what that means for the practitioner and the profession will also be different.
Karen Litzy (03:47):
And so when we talk about those tiers, so let's say you sort of outlined consultant the external service provider and those people who are really embedded with the team on a day to day basis. And before we went on, you sort of use the example of the NBA example. So can you talk about that just to make that a little bit clearer?
Tracy Blake (04:10):
Yeah. So there was a time where like if you were, the internet still existed, but maybe like online rosters and Google's worth weren't quite as prevalent, I know, usage, but you wouldn't have been able to just go on and find a physical therapist listed on an NBA team. There might've been one a decade ago, maybe two. And now in today's days and times, every NBA team has at least one and sometimes multiple that are working in various specialties within physical therapy. And so I think that that is also something to consider it, right? So what exactly is your contribution to the team in the context of both your profession, which is a healthcare paradigm and your occupation, which is in a performance paradigm in your sector. And so how do you reconcile those two in a way that allows you to contribute and to be of service?
Tracy Blake (05:11):
And I think we were, I mentioned this to you as well, that I think that the only way to reconcile that in a way that is grounded and sustainable is to be really clear about what your specific mission is as a physical therapist. And then making sure that whatever role you're in, whatever tier you're in, in the incredibly fast paced moving world of physio and in the fast, fast moving world of sport that you're grounded to that regardless, it makes you more responsive and adoptive, particularly in these days and times where on top of the unpredictability of sports and the fast paced moving to sports, we now overlay a global pandemic into that. And so you lose your footing. It's real easy to lose your footing in sport these days. And so if you are not grounded in something that is separate from your job professionally, it is very easy to lose your way.
Karen Litzy (06:10):
And especially now that there is no sport happening. Correct. While we're in the midst of this global pandemic, there is no sport happening. And so I guess being very clear on what your mission is, does that then allow you to find other ways you can contribute to the team aside from direct we'll say patient care, athlete care or direct overview of strength and conditioning programs and things like that.
Tracy Blake (06:41):
Yeah. So, then the question becomes is how is a team still a team when they're not playing? So when the technical has been removed from you, what makes you a team? And then in that context, what is your role in maintaining that team in contributing to that team? So I think when we were at WCPT when I had mentioned the idea of what is your mission, I had told people to think about it and you're not allowed to use the words rehabilitation, remediation, illness or injury in whatever your mission statement is. The purpose of that at the time was that you were having conversations with people in sport who do not come from your health care background. So if you only use language that relates to health care remediatory way or inaction reactionary way, you're undervaluing what you do. And you also run the risk if that's not understood in the same way you intended.
Tracy Blake (07:52):
It turns out that that actually works out in this case as well because now we've taken all of the trappings or all of the preconceptions that come with our role have now been wiped away. Right. So what are you contributing to the team in this context? Are you, for example, as it's somebody who is usually in the daily training environment? Having a team that is sometimes centralized and sometimes decentralized. I made sure that I continue to talk to my team and do check-ins even when they're decentralized. So now we're decentralized longer than we would have been because the Olympics aren't happening. Right. But their communication with me isn't somehow new.
Karen Litzy (08:42):
Smart.
Tracy Blake (08:44):
So that's not everybody's option. But that is for me, a way in which the relationships we've had, we're not based on strictly what was on court in the team context. So therefore the relationships are able to be sustainable when an earth shifting history shifting thing is occurring.
Karen Litzy:
And, I have a question for you. What is your mission statement? Without using remediation, rehab, et cetera, et cetera.
Tracy Blake:
So my mission in sports specifically is the optimization of health function and performance, whatever your age, stage or field of play.
Karen Litzy:
Excellent. I love it when people are prepared. That was great. And I think it's very clear. I think that's very clear. It's short and sweet and to the point and people get an idea of what your mission is and what your function is within that team setting. And now let's talk about the team, but not so much the team that's on the court or on the field. But let's talk about the team around the team. So you had mentioned you've got maybe a couple of physical therapists the MD, the ATC, a sports psychologist, nutritionist, but let's talk about how the team around the team functions for the good of the team that's performing on the field, on the slope, on the court, et cetera.
Tracy Blake (10:15):
Yeah, I think that there is, so my circumstances were particularly interesting in my current situation with volleyball Canada in that I was brought in with the strength and conditioning coach halfway through a quad. Like going into Olympic qualifiers, which is highly unusual. Well we were very lucky was that we had our conversation right out of the gate and we were of a mind so to speak philosophically in this way. So we had our first conversation, I say lucky, I think our director of sports science, sports medicine and innovation would say that he planted this way cause he hired both of us. But we were lucky that we were philosophically aligned in both what we thought our jobs could be for the team in this setting and in this circumstance. And then turns out how we work together also worked quite well that way. So that becomes, I think one of the first things is what's your mission? Does it align with the people who you work with? That's the first thing. And then from that spot, how do you use your strengths of each of those team members to amplify what that organizational or team goal is.
Tracy Blake (11:33):
And then how can you also identify gaps in each other and fill those in. Because that's the thing, like people love to talk about their strengths. To a team and what they can contribute with their strengths. They're less comfortable, particularly in sports, particularly an environment that is bred on competition and winning. And there can only be one. It is much harder to feel comfortable with vulnerability and opening up something that feels like a gap or a weakness or an area that you're not as confident in and trust that somebody else will fill it without exploiting it. So I think both parts of those need to happen for a team to be both functional and that function to be sustainable for anyone for time.
Karen Litzy (12:20):
Yeah. And I think that's also where the learning happens, right? When you have that team of professionals around the team, I would think me as a physiotherapist or as a physical therapist can learn so much from those other partners.
Tracy Blake (12:38):
Yeah, I agree. And I'm a nerd. There's no getting around it. I love a learning moment. I love them all the time. I want to know everything. And so for me, I feed on that, but that is not everyone's experience. And so what I've had to learn is timing and approach and repetition. Frankly, being not just clear on my mission once, but clear on it over and over and over again. How do I express my mission in the big and small things that I do in a day so that I'm consistent and I'm transparent so that at no point somebody can be like, well you said that at the beginning but you did this and this and this. That was inconsistent with that. And so I want my own way. And so in those kinds of circumstances I'll be like, look, this is where I was coming from with this.
Tracy Blake (13:30):
This is why I thought it made sense. I went to a school where when I say school, like entry level physio training, was that a school where we didn't have traditional lectures? Very much. Almost everything was small group learning. And so I feel like that environment really fostered the way that I work in the team environment, in sport where everybody had the same questions. We all went off and found the information and key information, excuse me, and came back to it with our own whatever that information is plus our own experience and perspective layered in on it. And then you figured it out together what was useful, what was not.
Karen Litzy (14:13):
Nice. Well that's definitely set you up for being part of a team, that's for sure. And now let's talk about, so let me go back here. So we spoke about kind of the different tiers that may be a physiotherapist might be in how being part of the team is so important to understanding your mission, staying true to that. And I think being self aware enough to know that you're being true to that mission and that you can stand by it and back it up. And now let's talk about how does all of this that we just spoke about, what are the implications of that for athlete health and for support in sport?
Tracy Blake (14:52):
So for me, the cornerstone of every relationship but particularly in the context of sport is trust. I work in sport obviously, but I also work in acute inpatient healthcare. And I also worked in private practice for a long time and people often assume that my private practice life, my private practice, orthopedics and my sport life are the two that are most closely aligned. Okay. Particularly in recent years, I've corrected that. And then I actually think it's my hospital life in acute care and my sport life, particularly in high performance that are the most aligned and the reason why is the relationship building and the communication that they require. So when I'm working with an athlete, the way in which I can get the best out of that athlete is if they trust, but I'm working to the same goal they're working to.
Tracy Blake (15:58):
Now that does not mean that I don't care about health, right? Because sport is inherently a risky situation, right? There's a level of risk acceptance that you have to participate in them, particularly when the levels get higher. And I believe there was an article by Caroline bowling, it's a couple of years old now that actually talked about injury definition and asked high performance athletes, coaches and sport physios. And in that article, all injury was negative effect on performance. There's no mention of it risk, there's actually no mention of illness or injury. So if I can't have a conversation with you about what I think the injury is doing to affect your performance negatively, I'm only filling in half the picture. So I need you to trust me. And the way in which I garner that trust. The way in which I build that trust is making sure that you always know that I have your goal, which has performance in mind. And so I think that that component of the relationship is the cornerstone. What cannot be left out of it, however, is the role of equity and the power dynamics.
Tracy Blake (17:23):
Physio is a health profession. Health professions historically are in a position of power or a position of privilege in the context of your practitioner patient relationship, right? If that's the situation already to start, how can you know that the person is giving you the accurate information if they're already in a position where the power is shifted out of their favor? So knowing that and understanding that concept, I've tried to be really intentional and again, really consistent in actively working to even the scales. I do that. Yeah. So I regularly consistently ask athletes, not just what they think, but I start with the part that they know the most about because as it turns out, I've never played professional volleyball, I've never played any sports at a high level, right? So if I start with the part that they know the most about the technical components of that, the way that training happens, the way practices are organized. If I start with what they know and ask questions about that, and then I work the way in which I build a program back from that, what I often say to people, not just athletes, but obviously this applies to athletes as well, is that I say I know bodies, you know your body and what we're trying to do is take what we know about those two things and put them together in a place that gets you to where you want to go.
Tracy Blake (19:02):
And anything that you think I'm doing that either doesn't make sense for that for you or that you think is working against that you need to tell me early and often. And so that's the framework. That's a conversation that's happening like right away. First day.
Karen Litzy (19:19):
Hmm.
Tracy Blake (19:19):
And then I give them opportunities to come back to that over and over. And not everyone communicates the same way. So you can't expect somebody to like just be like, you spit out five minutes of like clinical decision making information at them and they're going to be like, yeah, aha, Oh by the way, this, this, that and the third. Right. That's not going to be how it happens all the time. So making sure that people have time to think about it. Give time to reflect how the place to come back to you. Some athletes want to break it down into small bite size pieces. Some athletes want to be like, just fix it. I don't want to talk about it. And that's also my responsibility to make sure all of those different types of personalities, those people with different relationships with their bodies. How the power of the emboldened to be able to say what they need to say to meet their goal. And so that's what for me, that communication and relationship building part has to be the cornerstone because it's the only way we can get anything done with the kind of both the speed in which we need to get it done in the context of sport, but also in a sustained way. Because if someone keeps getting hurt, that is also not going to help anybody’s situation both from my job security or theirs.
Karen Litzy (20:34):
Right, right. Absolutely not. And so again, this kind of goes back to being part of the team. And so what I'm sensing is, and again, I feel like as therapists, we should all know this, but the team around the team also includes the team. You can't just have the team around the team making the discussions and these return to play decisions without involving the members of the team without involving that athlete.
Tracy Blake (20:48):
Correct. And one of the things that I found, like I'm saying a lot of these things to be clear, I'm saying them now and it sounds Zen, but I found out most of these things through failure to be clear of course a million times over. It has brought me to where I am having this conversation today, but I just wanted to be clear that I did not like walk out of entry-level physio with this knowledge on a smorgasbord. No, I know. Shocking. Shocking. What kind of program was this? You went to again, that didn't prepare you for high level sport athletes shawty is what it was. But the idea that the idea that an athlete, an essential part to their healthcare team still is radical for many and they see it, they see it.
Tracy Blake (22:03):
But what happens is when there actually requires an actual power shifts to make happen. Yeah. It's hard for people when it actually requires them to let go of some of their power if it requires them to acknowledge. There was a moment in the process of programming, in the process of delivery, in the process of recovery that they are not the expert in the room. It can be a blow, particularly people who've spent in our cases years getting to that point.
Karen Litzy:
Oh absolutely. And I think in several presentations I've seen in writings of Claire ardor and I feel like she goes through this which with such specificity and simplicity that it makes you think, well of course, kind of what you just said. Like for some people it's a radical view that the athlete should take this big part in their recovery and their return to sport or in their health. But when you listen to folks like you or like Claire, it's like, well yeah, it all of a sudden turns into a no brainer. So where do you think that disconnect is with those people who still considered a radical idea and the people who are on the other end who are like, well, of course they should be part of it.
Tracy Blake (23:09):
Some of it is experience. And so what I mean by that is not just like length of time experience, but I found that when everything's going well, it's going well, right? There is no impetus to change. There is no disruptor that actually acts to give you a moment to or recalibrate as you need. And so when I say experience, I mean I've had instances where, to be honest, I wasn't sure if it was going well. I wasn't sure I was doing what I thought needed to be done and I was doing what felt right. Again, I was aligning with the mission that I had because I didn't have any real world context in this specific sport or circumstance that I might've been in. And then something goes wrong. And you realize in the aftermath of that, whether it's an illness, whether it's an injury, whether it's something off court altogether, right? Whether it's an abuse and harassment situation, whether it's a boundary situation, whether it's a patient confidentiality situation, right? You realize when those things go sideways, but that's whereyour power and your metal is tested professionally.
Tracy Blake (24:46):
And so I think that's one part of it. I think another part is there's ability to what they call it mission creep, right? Where over time you sort of like, this is what you think your mission is, but then you did a little of this and you do a little of this and the next thing you know, you're far away from where you started. And I think that a lot of people, I think they're in service to the mission one in sometimes they actually end up in service to the business model. And particularly in sport where the jobs or when I say sport, like high performance sport professional sport, where the jobs are few, where the jobs are highly competitive. I don't think I've ever applied for a sport job that had less than 75 applicants and upwards of several hundred in some cases.
Tracy Blake (25:43):
Wow. Everybody wants that gig. And so people can sometimes get led by the, or creeped away from their mission by the instinct to do what is necessary to stay in the position rather than what is necessary to optimize the health function and performance of their athlete. So having a situation where you've been tested and sometimes don't, aren't successful and mission creep. Those two things I think are maybe the biggest ways that aren't just related to like personality. Like those are that things can be trained or modify. Those are like the modifiable things I think.
Karen Litzy (26:44):
Great. And then, you know, we had said as we are recording this, we are in the middle of the global covid-19 pandemic. And so there is no sport going on. And so to the best of your ability, and we're not asking you to be a future teller here, but what do you think will happen to the role of physiotherapy in sport and the medical teams in sport?
Tracy Blake (27:28):
I don't know necessarily what will happen. What I hope happens is that all healthcare practitioners, but particularly physical therapists in our case because I'm biased in that direction that they recognize their role in contribution to population health in the context of sport. So public health in the context of sport, we often think of sports as a bubble and it is to a certain extent, but that bubble is manufactured. That means all parts of an athlete's existence are manufactured, right? All parts of what the athlete is provided with from a health perspective are manufactured. So have gaps are left in that it's up to you as the person who is actually in the sport context to identify and try to remedy and resolve. Right? It's deeply problematic for athletes to not have the same information that somebody who works in the public house. It's deeply problematic for athletes too, not have access to labor rights. It's deeply problematic for athletes to not have be informed and be given informed consent to participate in mass gatherings during a time of pandemic.
Tracy Blake (29:02):
And I also think there is a strong ethical quandary that comes with providing services, two events that fly in the face of public health recommendations during times like this. And I've been on record with this, I said this a couple of weeks ago, I posted about it on Twitter where there was a massive wrestling tournament happening and I thought to myself, it's wrestling, it's a combat sport. It can't happen. Like they literally would have no insurance if there was no medical covenant medical coverage provided. So if you didn't have medical coverage, the event couldn't happen. So how does medical coverage or physio coverage or what have you happen against public health recommendations? We can't continue to act in separation with each other. We need to view sports as part of population health. And then we need to make sure athletes and those in the sporting community are acting in accordance with the public health.
Tracy Blake (30:11):
At the times demand as well. And I think the Rudy go bear situation was truly, genuinely shocking for a lot of people. They were unprepared at every level, not just sports medicine and sport physical therapy. And so what I hope lingers for people is that we think about emergency action plans a lot, right? We think about how we're going to get somebody off the court in the case of an emergent issue, Encore, how are we preparing them for life in that same context? How are we in preparing ourselves as professionals in that context? And I hope that those conversations, because it turns out you don't need to be in person for that.
Tracy Blake (31:01):
That people are reflecting on that now and that steps are being taken to improve both the gaps that are specific to the city, the situation with the pandemic now, but also how do we identify these things going forward. And I think some of that had already started to show its colors around issues of food insecurity, issues of education, issues of like the younger your players are coming in. Are you providing appropriate development? I went to you as a, you know, I went to the United nations last year for the sporting chance for him, which is around sport and human rights. And last year, 2019 was the year of the child. And so there had been a special rapport to report on the rights of the child and child exploitation and snails. There is an entire section dedicated to sport and how sport has been used as a vehicle for the exploitation of the child.
Tracy Blake (32:08):
And I think of things like that, like those are the kinds of gaps. But now that you know that these kinds of gaps exist now you know, you understand in a very real way and it's kind of, it's telling in some kind of ways that it needs to strike so personally close to people's wallets and they'll help. But now that we've had that touch, now that we've been exposed in this kind of way, can we continue to be proactive in the way we address other things going forward? That would be what I would hope to see.
Karen Litzy (32:40):
Well, and I think that's I feel like very doable hope. I don't think it's like a pie in the sky. Hope. I think all of those conversations can be had and hopefully can be had by everyone surrounding sports, not just the physiotherapist or just the medical team, but straight up to owners and players and everyone else in between. So Tracy, thank you so much for such a great conversation.
Tracy Blake (33:13):
Yeah, it's been great. And I think again, like physios are really well situated because you have physiotherapists who have really like have access to the player and have access to the coaching, the ownership, the administrative stakeholders. They're well situated to be able to bring these things to light on both sides and be involved in those conversations even if they don't have out right decision making power.
Karen Litzy (33:38):
Right. Absolutely.
Tracy Blake (33:39):
Yeah. Thanks for letting me out of the shadow.
Karen Litzy (33:42):
Oh, it was great. Thank you so much. And then before we sign off here, I have one more question that I ask everyone. And knowing what you know now and where you are in your life and in your career, what advice would you give to yourself as that fresh graduate, straight out of physiotherapy school?
Tracy Blake (34:04):
I would say that you need a mission early and you need to speak it into existence. It's not good enough to keep it in your head. You need to say it out loud to people and you need to get feedback from people and whether it's clear or not. And I also think that one of the things that I learned I was 36 almost 37 when I took my first dedicated health equity class and aye, it was a workshop. And in the beginning she said for some of you this will be new information and it was specifically targeted at health professionals, not just physio. And some of you would have learned this in, you know, your first year equity studies, first year gender studies kind of course. And after the weekend where I slept for basically three days because of all the information floating in my head, I was like, there are 18 year olds walking around with this in there. And so I think that if I could go back now, I'd be like, you need to start taking those courses early. You need to start embedding it into your thinking early. Maybe you'll be better at being intentional about how you use it earlier.
Karen Litzy (35:11):
Excellent, excellent advice. Now, where can people find you if they want to shoot you a question or they just want to say how great this episode was?
Tracy Blake (35:22):
So I'm active on the Twitter, so my Twitter handle is @TracyABlake. I am not as active on the on Instagram. My Instagram still private, but if you shoot me a message I usually find it anyway. So that also works. Same handle @TracyaBlake.
Karen Litzy (35:38):
Perfect. And just so everyone knows, we will have links to certainly to your Twitter at the show notes over at podcast.Healthywealthysmart.com. So Tracy, thank you so much. I really appreciate it. This is a great conversation. Thank you so much. This is quite the podcast debut. I appreciate it anytime and everyone, thanks so much for tuning in and listening. Have a great couple of days and stay healthy, wealthy, and smart.
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