SCOPE OF PRACTICE ≠ QUALIFICATION

A regulated health professional, may have a broad legal scope of practice. That tells us what they are permitted to do legally. Interestingly, CHCPBC itself acknowledges that legal scope doesn't necessarily mean an individual should perform everything within that scope.

From the CHCPBC website:

“A regulation creates a legally enforceable rule, established by a governing agency such as the Ministry of Health.  ……a scope of practice statement that broadly describes what a profession may do.” You can read more here if you like.

Basically, a regulation does not automatically tell us what they are qualified and competent to do at a high level. Or, in other words, scope of practice does not mean competent. It can simply state: The professional is permitted to rehabilitate and improve physical function.

Late-stage return-to-sport after a major injury is a good example.

Once an athlete moves beyond restoring basic function, ROM and foundational strength, the problem changes.

Now we are talking about:

• high-force and high-velocity strength
• sprint mechanics
• acceleration and deceleration mechanics, exposure and prescription
• plyometric progressions and reactive strength
• change of direction and cutting progressions and technical models
• sport-specific conditioning
• workload progression
• objective performance testing (versus in-clinic ortho assessments)
• progressive exposure to the demands of simulated sport competition

Those are high-performance strength & conditioning competencies.

A physiotherapist can absolutely possess them. Some are exceptional in this area.

But a license to practice does not automatically confer expertise in high-performance S&C any more than an S&C coach's credentials make them an expert in the treatment of an injury.

The same principle applies to physicians, surgeons, kinesiologists, athletic therapists and strength coaches. Essentially,

Your profession establishes a scope.
Your education, training and experience establish your qualifications.
Your demonstrated & evidence of ability establishes your competence.

This is why I struggle with the idea that one profession should “own” the entire return-to-sport continuum. A team is the best approach.

An orthopaedic surgeon may be extraordinarily skilled at reconstructing an ACL. That does not inherently make the surgeon an expert in designing a 12-week cutting progression plan and teach it on field and demonstrate the movements.

A physiotherapist may be highly skilled in early and mid-stage rehabilitation. That does not inherently make them an expert in sprint mechanics, maximal strength development or return-to-performance programming.

And an S&C coach or Kinesiologist should not pretend expertise in surgical decision-making or clinical diagnosis simply because they work with injured athletes and an S&C is not allowed to do early stage exercise-based rehab.

Expertise has boundaries. And the best return-to-sport teams recognize them.

Surgeon.
Physiotherapist.
Sport medicine physician.
Kinesiologist or Strength & conditioning coach.
Sport coach.

Different expertise. Different responsibilities. Overlapping competencies.

The athlete does not need one professional trying to do everything.

The athlete needs the right professional doing the right job at the right stage. It’s best for the athlete.