Are We Functional Performance Experts?

Are we really functional performance experts? We recently returned from a weekend course on some new fun exercise equipment. The majority of attendees were not physical therapists, but personal trainers, fitness instructors, and folks who describe themselves as “medical exercise specialists” even though the course was advertised for rehab professionals.

But many of them were quite good at observing and assessing movement patterns. And this made us think. As the fitness industry evolves and looks to mimic the medical model, what is our role as physical therapists? Are we truly the functional performance experts?

Functional performance experts. What could that mean? Physical therapists have long belonged to the medical team, but have lived on the periphery of the fitness industry.

Function and exercise has been around for years, but medicine is finally recognizing its importance. There is a leadership vacuum in this space, and others are rushing to fill it. We must be there as the practitioner of choice for this segment of medicine and beyond.

We must dedicate ourselves to being the best at this. Currently, others may be performing this function better than we are. We must show our colleagues on the medical team and our payers that we can be the gatekeepers of good physical health.

We are not personal trainers. Yes, we can do some of the things trainers do, but we are medically trained biomechanical experts. We have studies that date back decades with information that is extremely relevant to human performance.

A wonderful example of this is the work of Nuzik et al. in 1986 on the sit-to-stand movement pattern.1 This study has so much clinical content that can be used every day in the clinic for young and old. We would like to expand on this study as an example of how physical therapists can use evidence-based literature in a way none of our ancillary peers can.

To begin, sit back in your chair, and without letting your back leave complete vertical, try to get up from the chair. Not easy. What did your trunk want to do? Flex, right? The first 35% of the sit-to-stand movement pattern is flexion, and the last 65% is extension.

In this article, the authors describe the movement pattern and provide range-of-motion norms in each joint of the lower body and trunk as a person performs the sit-to-stand maneuver. Do you know how much hip flexion you need to initiate this activity? Guess.

You need 110 degrees. You also need 110 degrees in the knees, and 10 degrees in the ankle.

These researchers also discuss momentum and the momentum transfer. There is so much information here that we can use with patients who can’t get out of a chair. They may lack the range, motor control, and strength, but because we are biomechanical experts, we can see the problem and help fix the appropriate deficit for each person.

However, unless we take time to learn these biomechanical models, we may have difficulty differentiating our role from others who are non-licensed “movement specialists.”

We must use the information on all aspects of all functional movement patterns, put that information into the setting of medical care, and show teams and payers what we know and how we can help their patients. We also must sell ourselves as preventive and maintenance experts for the rest of the populace to improve quality of life and decrease costs.

So how is that different than what we’re doing now? We are doing it from a position of strength, research and knowledge. We are peers, not subordinates, with the entire medical team. We are doctors of physical therapy and we have the medical evidence to support our work.

We use our information to determine care needs through standard, validated tests of function, and we prescribe and monitor programs from prevention through the medical milieu to maintenance. When someone has a relapse, they come to us. Or, as in Finland, they get two free weeks at rehabilitation centers (which look a lot like our spas) that are overseen by therapists to keep the populace in top shape. What a wonderful opportunity to for therapists to claim and really master what is our domain.

Attached to this article is a diagram from the work of Nuzik et al. We hope therapists will use this card as physicians use the Beers Pocket Card created by the American Geriatric Society for potentially inappropriate medication use in older adults.

Using our knowledge to evaluate, treat, create and manage functional deficits as functional performance experts will truly reinforce our role in this area. The columns that will follow will address all the aspects of function for our older population.

We are sad to see Dr. Keiba Shaw leave the column. We would like to thank her for her wonderful contributions and wish her the best. Dr. Jason Dring will be co-authoring this column from now into the future. We welcome him and his creative and thoughtful ideas and articles.


Nuzik S, Lamb R, VanSant A, Hirt S. “Sit-to-Stand Movement Pattern.” Physical Therapy 66(11), Nov. 1986.