Medical model or performance 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 medical staffing 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.
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Vern Gambetta
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