1) This is an evolving hypothesis and will likely be modified dozens of times.
2) This thought process relates to physical preparation and athlete performance and not to pain and/or injury.
3) The possibility that I am overthinking this greatly exists.
Stimulated by ongoing dialogue between a friend-colleague and myself, the need for categorization and classification of manual inputs became apparent. The context of discussion was the "periodization of manual inputs" in the training environment. I've stated previously that every interaction we have with, and every intervention we give to, each athlete is considered a stressor that results in adaptation either positive or negative. It is important to “pick our battles” and intervene where we think is necessary rather than all the time. Thus, the culmination of what's contained below.
To me, manual inputs - or manual therapy - can be categorized into four main groupings. The classification (the identity) of these categories aren't so much important, however their role and the timing in which each are implemented within the training environment are. Therefore, the emphasis is not in the naming, or classification, of each category but in each grouping's contents and where, when and why they are utilized.
The four categories are as follows: Performance, Intensive, Extensive, and Restoration.
The main objective of "performance" here is mechanical efficiency. This is the category of manual therapy that we typically see directly in the training environment. In athletics, it is often called "trackside therapy" but is also commonly seen in other individual sports such as gymnastics, weightlifting and swimming amongst others. The main intent here is to prepare the athlete prior to and during training in order to optimize their "afferent-ability", or, their ability to receive and absorb the training stimulus presented to them. Interventions here are minimal and only what is deemed necessary for the training session of that day.
The main objective of "intensive" is normalization. Although this category of manual therapy can also be performed directly in the training environment it is typically performed in clinical settings and therapy rooms. Should "intensive" be performed at the training environment, then it is done so at the conclusion of the training session. The intent of this category of manual therapy is tissue normalization and includes, but is not limited to, articular, neural and myofascial tissue. Although the normal adaption process of the organism should be minimally interfered with, the importance of preparation for subsequent training sessions is paramount. Manual inputs within this category are generally local and as described by its classification, intensive.
The main objective of "extensive" is dynamics. This category of manual therapy is also performed in clinical settings and therapy rooms but it is also not uncommon to see such therapy performed in both athletes' hotel and living rooms. Fluid dynamics is the intent here and encompasses a great number of the bodily systems. Systems considered in both osteopathy and massage therapy are commonly considered but it should be noted that articular, myofascial and neurodynamic systems are fluid as well. Because the intensity of inputs here may be significant and extensive, as its classification suggests, caution should be taken with its timing and proximity to intensive training sessions.
The main objective of "restoration" is allostasis. This final category is almost certainly always performed outside of the immediate training environment and typically in a quiet area such as treatment rooms. As its classification states, the intent here is to aid restoration to a "state" that is most ideal for the athlete in his/her given training program or competitive schedule at the given time. Typically implemented during off-days, these inputs are often complemented with other interventions both actively (meditation/yoga) and passively (sensory deprivation).
So where does this all fit in and why?
Discussed on a recent online meeting hosted by ALTIS personnel was the comparison between individual and team sports as it pertains to performance therapy. What has recently seemed necessary too me and evident in this discussion was the need for a classification and categorization of manual inputs in order to assist in delineating the where, when and why of intervention. The "periodization of manual therapy" if you will. While I have intentionally omitted the specific methods utilized within each intervention, it is my opinion that this categorization assists in strategic planning especially when athlete to staff ratios are greater and manual interventions within technical and tactical practices are next to impossible. Additionally, team sporting environments are typically in-season. Therefore, minimal use of the "performance" category of manual therapy in team sports is likely other than pre-training/competition and is undoubtedly contingent on therapist availability. Typically then, "intensive" and "extensive" inputs are most commonly performed, and dependant on the competition schedule. Still, time is often limited and thus, "restoration" sessions are often reserved for athlete off-days.
Finally, the difference(s) between "clinical therapy" and "performance therapy" are often discussed and so again, the importance of such categorization and classification of manual therapies. Whereby the objective of performance therapy would be to optimize mechanical efficiency and to use Dan Pfaff's words, "nudge" the athlete into a better state of adaptability, this dynamic and relatively instantaneous process would rarely apply in a clinical setting. Rarely are training loads administered in such settings, at least those sufficient enough to elicit significant performance-related physical adaptation, and so therapeutic inputs would fall under the other three categories. That said, an understanding of each category is no less important particularly as it pertains to the downstream effects of each. And so, equally important is the knowledge of where an athlete is within their training program and/or competition schedule because as the mentalist Tony Corinda stated, "Good timing is invisible. Bad timing sticks out a mile."