Lindsay Bull - The Handover Hangover: Sequential vs Concurrent Return to Performance Models in Elite Sport

 Episode 225: In this Gameplan episode — a collaboration between Gameplan & Inform Performance, Host Andy McDonald is joined by Consultant Physiotherapist Lindsay Bull.

Lindsay is an experienced sports physiotherapist and medical services leader working across elite professional sport and high-performance environments. His work centres on performance rehabilitation, return-to-sport decision making, and management of complex musculoskeletal injuries, particularly thigh muscle and hip/groin conditions across elite athletes. Lindsay's experience includes leading medical services within elite AFL programs across multiple programs, with responsibility for multidisciplinary team leadership, medical and rehabilitation strategy, and player availability outcomes.

In this episode, Lindsay unpacks his recent article collaboration with Martin Buchheit titled: The Handover Hangover: Sequential vs. Concurrent Return to Performance Models in Elite Sport.

Topics Discussed

• The villain in suboptimal rehab: siloed approaches
• Job security and its impact on collaboration
• Principles of collegiality, alignment & concurrent engagement
• Common misalignments in prognosis and expectations
• Practical tips for building a collaborative department
• The role of facility design and communication

Key Points

• Sequential vs Concurrent Rehabilitation Models in Elite Sport

  Elite sport rehabilitation has traditionally relied on sequential, siloed models in which practitioners manage distinct phases of recovery before handing the athlete to the next specialist. The most successful high-performance organisations instead employ a concurrent, integrated model in which all key disciplines — physiotherapy, strength and conditioning, coaching, and medical staff — are involved throughout the rehabilitation continuum from day one. This model is represented as a wedge-shaped framework, illustrating how involvement and leadership shifts between disciplines over time without ever fully withdrawing any stakeholder from the process.

• Siloed Practice Is an Integration Problem, Not an Expertise Problem

  Poor rehabilitation outcomes in elite sport are frequently attributed to deficits in practitioner expertise or technical knowledge. However, the primary issue is one of integration rather than competence. Most practitioners working in elite environments are highly skilled, yet outcomes remain suboptimal when departments operate in isolation. The core problem lies in how knowledge is coordinated, communicated, and applied collectively across disciplines, rather than in the quality of any individual practitioner's clinical decision-making. Recognising this distinction is essential to diagnosing and addressing underperformance within multidisciplinary departments.

• Job Security Undermines Psychological Safety and Progressive Decision-Making

  The precarious nature of employment in elite sport creates conditions that undermine collaborative and progressive practice. Practitioners who feel their positions are at risk may default to conservative decision-making — holding athletes back longer than is clinically optimal — in order to minimise the likelihood of re-injury and protect their roles. This conservatism is not a reflection of poor values but an adaptive response to unsafe organisational environments. Effective leadership is therefore critical in establishing the psychological safety that enables practitioners to make the correct decision rather than simply the most defensible one.

• Collegiality Requires Placing Genuine Value on Interdisciplinary Observations

  Collegiality within an integrated rehabilitation model extends well beyond simply working in the same building or attending joint meetings. It requires each discipline to place genuine value on the observations and clinical reasoning of their colleagues. A physiotherapist who actively engages with the S&C coach's assessment of an athlete's gym performance, or a coach who considers clinical findings when designing return-to-training progressions, demonstrates true collegiality. Creating this environment depends on psychological safety that allows practitioners to speak up, debate openly, and allow those contributions to genuinely influence decision-making across professional boundaries.

• Alignment Means All Stakeholders Are Solving the Same Well-Defined Problem

  Effective interdisciplinary rehabilitation requires all stakeholders to agree on one clearly defined problem from the outset. This means establishing consensus on the key physical qualities that need to be restored, the criteria that define successful return to performance, and the projected pathway to get there. While debate and discussion are encouraged behind closed doors, all practitioners must deliver a single, unified message to the athlete. Internal inconsistencies communicated to the athlete generate doubt, which can impair confidence and adherence, ultimately reducing the effectiveness of even an objectively sound rehabilitation plan.

• Prognosis Is the Most Common Source of Misalignment Across Disciplines

  Among all potential points of misalignment within a multidisciplinary rehabilitation team, prognosis consistently emerges as the most contentious. Coaching staff are frequently motivated to receive optimistic timelines driven by team performance requirements, while medical staff may provide more conservative estimates to account for biological healing timelines and re-injury risk. Compounding this tension is the important distinction between return to play and return to performance — an athlete may be medically cleared to compete before they have fully recovered the physical qualities necessary to perform at their pre-injury level, requiring nuanced and aligned communication to all stakeholders.

• Concurrent Engagement Requires All Key Stakeholders Involved from Day One

  Integrated rehabilitation models require the involvement of all key stakeholders from the first day of an injury, not just medical staff. Coaches can use the acute phase to develop the athlete's tactical and technical understanding by reviewing match footage. Strength and conditioning staff can address deficits in unaffected areas and underlying physical qualities. Medical staff manage the acute presentation and set risk parameters. This early involvement prevents surprises later in the process, reduces misaligned expectations, and ensures each discipline retains sufficient context to contribute meaningfully throughout the entire rehabilitation period, rather than being brought in only when their specific phase begins.

• Integrated Models Require Designated Case Managers to Preserve Accountability

  A potential pitfall of concurrent, collaborative rehabilitation models is the diffusion of responsibility — where broad involvement masks unclear ownership, resulting in an all-care, no-responsibility dynamic. To counter this, each athlete's rehabilitation must have a designated case manager responsible for coordinating all stakeholders, driving workflow, and ensuring appropriate progression through phases. In team sport environments, this role may sit with the physiotherapist, S&C coach, or high performance manager, depending on injury phase and organisational structure. Clear accountability at the individual level is essential to the effective functioning of any genuinely integrated rehabilitation model.

• Recruitment Should Prioritise Character, Values, and Diverse Sporting Background

  Building high-functioning interdisciplinary departments requires prioritising values, character, and cultural alignment during recruitment, not only technical proficiency. In elite sport, technical expertise among shortlisted candidates is typically strong — the differentiating factor is often how a practitioner integrates with a team, manages professional disagreement, and contributes to a collaborative culture. Diversity of sporting background is also valuable, as practitioners with experience across multiple sports are more likely to bring fresh perspectives and challenge entrenched thinking. Scenario-based interview questions and thorough reference checks are essential for assessing genuine collaborative behaviour beyond what rehearsed interview answers can reveal.

• Physical Layout and Shared Data Access Are Critical Enablers of Collaboration

  The physical design of performance facilities and the communication platforms used across departments have a significant and often underappreciated influence on collaborative behaviour. Open-plan environments, shared spaces between treatment areas and gymnasiums, and transparent sightlines between disciplines reduce barriers to spontaneous interaction and cross-disciplinary communication. Equally, shared digital access to athlete load monitoring data, rehabilitation notes, and planning tools ensures all stakeholders are working from the same information base. Restricted access to data — such as GPS metrics siloed within a single department — actively undermines the integration that concurrent and effective rehabilitation requires.

Sponsors

Gameplan Is a Rehab Management System providing Medical & Performance Departments with a centralised platform to plan, track & manage the return-to-play process inside a data rich environment. Gameplan provides one platform to connect the people, process and data during rehab.