Friday, May 11, 2018

Thoughts on The Art of Programming

I think the art of programming --- the selection, order, dosing and progression of movements --- is becoming a lost art. It seems to be more of a "plug and play" kind of activity rather than a craft.

A good program, and the process of implementing that program, will be much more than the sum of its exercises.

The use of software makes it easy to copy and paste.  Software makes every workout look basically the same. We pick from the list put the "power" exercises here, the "strength" exercises here and the "plyo" exercises here.

Is this activity inherently different than writing --shaping--- a workout on a blank piece of paper or even white board? Are the relationships of the movements within a workout and among the various other days of the workout plan easily comprehended?

The use of phones and tablets to display exercises means they are more likely to be displayed one at a time, possibly losing context of how they are connected to other exercises. It's hard to zoom out and see the big picture of the structure of an entire session.

If there are videos next to the exercise name, athletes are not forced to remember the movement, to comprehend the text and process it's relationship to the movement. There is no need to remember and learn --- to develop the knowledge, skills and behaviors associated with learning to train.

We want athletes to learn and embrace the process, not just to do the stuff. Just as we want coaches and clinicians to learn the process.

In physical therapy, the art of programming is barely even taught. It is my observation that exercise prescription is no longer a valued skill for the therapist. It's more about evaluations, procedures and maybe manual therapy treatments. Delegate exercises to the extenders.

One of the recent student therapists at US Ski & Snowboard told me his therapeutic exercise class in school was online and the students were expected to complete it independently. His only formal experience with programming exercise was during his clinical experiences.


Terrifying.

I thought the whole point of being a physical therapist was to be an expert in human movement and to use movement to improve function. Isn't dosing exercise the very heart of physical therapy? Or has that changed now that all new therapists are doctors of physical therapy?

A few years ago I attended a continuing education course taught by two prominent orthopedic PTs. I was psyched to spend two days focusing on the athletic knee and shoulder. How did the best in the field program for their patients? I never really found out.

They spent the majority of the course describing, discussing and reviewing the various surgical procedures and gave a cursory overview of the actual therapy afterward.

Well, you know, we do focus on range of motion, then we do the strength work and then by week x we are back to plyos or throwing. There was no in-depth discussion of exercise selection and progression --- with a particularly glaring lack of focus on building basic strength.

Cue Mark Rippetoe.

I was devastated. Livid. The therapists were more interested in talking surgical procedures than they were about the details of the rehabilitation. No deep dive or reflection on programming and progressions. No concern about the how and why of what of the movements they prescribed.

I think it is a noble calling to use movement to create health and performance. 

We must do better, as coaches and as clinicians. Our athletes and patients deserve it. We must value the process of exercise selection, instruction and progression. We must value the process and act of programming.








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