The PT-Physio connection

For us as a physiotherapy practice, being based in a gym where we can work with our clients has always been important. We now have therapy rooms at Common Purpose, a personal training gym that opened the doors to its current premises in June 2022, and we’re delighted to have found a team we do indeed share a purpose and approach with.

Anjulie spoke to the gym’s co-founder Tiago Ribeiro about the benefit of having physios on site, and how personal trainers and physiotherapists can work together to improve their clients’ training journeys.

Anjulie: Tiago, what made you want to be a personal trainer?

Tiago: Growing up I was passionate about sports, so I did sports science at Brighton, right? And I was really lucky to work with a consultancy unit there, and through them I worked with the Lawn Tennis Association, for a couple of years, primarily in the long-term athletic development process for kids in their academy system. And our job was to ensure that there was a framework to help these young athletes peak in line with their biological maturation. So ensuring that they’re peaking to win not at age 11, but to become good pro athletes who have a long healthy career.

That was kind of my first foray into actual conditioning, but it was a really good one, because although I went to the gym a bit myself, it’s really, really hard to do a strength conditioning class with a dozen ten-year olds. And what it did teach me is the power of empathy and communication and the importance of finding and using the right language.

I was originally supposed to do a masters and continue working with the LTA, but then I just couldn’t afford to not get paid. So that was when I moved into PT. It was actually supposed to be just for a year to earn a bit of money so I could go back into my masters degree and back into the LTA. And what I found was I really, really loved it.

I did go back and do my masters, but I did it in physiology as opposed to strength conditioning, and I love the work I do as a personal trainer.

Anjulie: What are common things that you see in your clients where you suggest they see a physiotherapist?

Tiago: I think the most common things we see are a niggly shoulder or hip or knee. And the key for us is always asking: is it a one-time niggle or is it a recurring niggle? Because if it’s a recurring niggle, then you want to ask why? If it’s only slightly painful, does offloading it for a couple of weeks make a difference. Are you just we’re doing a little bit too much?

But the reality is there may be certain activities that people love and don’t want to stop doing even though they’re causing that niggle. Then, invariably the niggles start to progress and become a bit more of an issue. What we find really useful then is working with a physio before they actually get to an injury.

At the same time, I want to improve our clients’ health literacy. So as much as I’m teaching them how to get fitter and stronger, I’m also trying to get them to understand how to interpret some of these niggles. And working with a physio on this can be really, really useful, because the feedback might be you’re okay, you just need to tone it down. Other times it might be, we’ve caught something here, let’s do some preventative work. We also work with clients who may be recovering from an injury or accident, in which case it’s always great to be able to work with their physio.

Anjulie: So, what do you think are then the benefits of having in-house physios versus having to refer out?

Tiago: I think for us, a big a big influence on the way we think about physiotherapy, training and rehab is a fellow called Ben Cormack. His specialism is educating practitioners on managing chronic pain and creating confidence in people’s own movement. And being aware that achieving that is a bio-psycho-social process.

It’s really important that that the patient or the client feels there is a genuine human connection and rapport in the intervention. The intervention shouldn’t just be a bunch of exercises on a piece of paper, they need to be given by a physio who has taken the time to understand them as a person first, and then as a set of tissues that are connected by ligaments and tendons to skeletal tissues. And for us, working with in-house physios allows us to create an environment where the client can genuinely feel they’ve got a team around them. It’s so much more personal. And there’s lots of really good evidence showing the importance of that rapport in the success of an intervention. Having a little rapport with your PT or physio means you’re more likely to be given an intervention that you’ll actually do, as opposed to getting a 45-minute programme that needs to be done twice a day and completely disregards the fact that you’re a mother of four and you run a big fund, for example. And what we find really important is when we do work with other practitioners closely, we can give you not just a description of their training history but of their character too, and what they’re likely to respond to. We can create context around the person. For example, I’ve seen really strong athletic clients who are clearly capable of producing lots and lots of force, given rehabilitation processes that don’t reflect where they’ve come from.

Some people you can leave unsupervised, but other people like to feel like they’re being pushed, and we have to factor that in if the rehab process is going to work. And that something I sometimes say to clients: the training is the easy part. That’s the science. The challenge is how do I as a personal trainer create a regime that engages not just your tissues, but engages you? And for us, having physios in house allows us to contribute towards interventions that engage and help our clients.

Secondly, ultimately we’re both in the business of movement or restoring movement, and there’s the sheer practicality of me being able to take you out on the gym floor and literally show you the contexts and types of movements where this person feels pain. I can really create like a rich understanding for you as a physio by showing you. And I think when we’re in the business of movement, it’s quite hard to replicate that amount of information in an email.

Anjulie: Yes, and that works both ways. It makes our jobs as physios that much easier!

Tiago: Yeah. So to sum up from our side, number one, it’s much better for building rapport between client and practitioners. Number two, it fortifies the notion that there’s a support network and that they are part of an ecosystem. Three, they get a programme they’re more likely to engage with. And then four, I can actually just communicate with you that efficiently. And vice versa. We can create a fluid feedback loop where we’re all just always talking and conveying like lots of really valuable information and nothing’s falling by the wayside.

Anjulie: We love the focus and passion at Common Purpose, but what do you love about personal training?

Tiago: Although it’s really, really cool and fascinating to understand how you can add 1% to an elite athlete’s performance profile using these really sophisticated methods, I just found it even more amazing how you can transform someone’s life through the simplest of methods, with a bit of empathy and a bit of coaching and a bit of education.

And that to me was just so powerful. Like taking someone who could not sit and stand without pain to being able to squat their body weight. And the confidence that I gave my clients and how it allowed them to then enjoy their passions outside the gym, whether it be horse riding or just being comfortable to pick up their kids. I had an injury when I was growing up and it was quite an early insight for me into what it feels like to one day have your physicality taken away from you. I tore my MCL, had a grade three rupture, and damaged the cartilage in my knee, and I couldn’t run for about 9 months.

So if a person’s telling me they’ve not felt comfortable with their physicality for the last 10, 15 or 20 years, how transformative is it to get that back in later life when you feel like you might never have it back? Some of the most amazing things I hear now in my work are phrases like “I’m the fittest I’ve ever been, even though I’m like 55” or “I’m fitter now and I have more confidence in my physicality now than I did when I was 25.”

We’re just helping people do simple things but developing a behavioural framework where they do it well and they do it often.. And it’s actually quite simple, but it’s the simple things done well and consistently that are really, really powerful. And I think that’s one of the reasons why I fell in love with personal training and stayed in it.