#103 - Rebuilding Better Athletes: The System Every Sports Clinician Needs with Dr. Tom Teter, Part 1

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Welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. In today's episode, we're diving deep into the missing link in sports chiropractic and rehab education with someone who's helping redefine how we think about clinical performance, Dr. Tom Teeter. Dr. Teeter brings a unique perspective, blending his background in strength and conditioning with years of hands-on clinical and teaching experience. After he noticed significant gaps between traditional clinical education and what's truly needed to serve athletes and active individuals, he developed a framework that bridges sports medicine and human performance, taking patients beyond injury recovery and into long-term performance enhancement. In this conversation, you'll hear how Dr. Teeter developed the Clinical Human Performance Practitioner model, what he sees as the biggest gaps in current sports med certifications, And how his algorithm-based approach is helping providers across disciplines work more collaboratively while also getting better outcomes for their patients. Whether you're new to the world of sports rehab or a seasoned provider looking to level up your approach, this episode is full of insights you can take straight into practice. Let's get into it.

So, Dr. Teeter, I think it would be really cool to first start off with a little bit of a look back at how all of this started. Obviously, you took a FACTOR course many, many years ago, met Dr. Riddle, and had some thoughts about some gaps that you were seeing in clinical education at the time. Is that, is that a kind of a fair segue into what that started out as?

Yeah, I think so. I think I took my first FACTOR course in 2015. And obviously since I've taken it 4 or 5 times now. So at the time I had a— I met Dr. Riddle and I had a really interesting conversation with him over lunch about— he works with high-level athletes. A large portion of my practice has always been high-level athletes. And just in striking up a conversation, we started talking about some of my experiences with some of the gaps that I tend to see between sports medicine and clinical practice and what happens in sports performance and skills training. And that was kind of the impetus for me at the time. I was a professor at a university and I was working with the university's athletic department. And a lot of this stuff that I put into the course was solutions that we had to have to the problems we were seeing in this university athletic department. And I think a lot of the information that's scattered throughout the course really comes from me having to try to come up with solutions to these really complex problems that we see in this divide that we have between sports medicine and sports performance.

Yeah, absolutely. And I guess a lot of that probably came from the background that you had prior to going to chiropractic school, correct? So you were already working in strength and conditioning and in fitness Way before you ever started in chiropractic school, is that correct?

I did my bachelor's degree in exercise science and then immediately got certified as a certified strength and conditioning specialist through the CSCS. And then at that time, I started working in private fitness and working with individual athletes and strength and conditioning. And then I just kept seeing over and over again that some of these people were really strong and relatively fit, but they kept getting injured over and over and over again. So it started making me try to figure out like, why are these people getting hurt? And so I kind of had to start looking for other information. And then I kind of had my own personal experience with chiropractic working out and had a really, really severe neck pain. Couldn't turn my head or move my head at all. And one of my friends and my colleagues suggested that I go see a chiropractor, which I had no experience with at the time. And I was convinced to go. And I went into this gentleman's office. And I was at a pretty extreme amount of pain. And when I left, I was almost virtually pain-free in one visit. And I was like, I have no idea what wizard magic this guy did, but I really want to look into this because there's got to be something to what just happened to me. And so that was kind of my impetus to start looking into chiropractic as a profession.

Absolutely.

And I think it's so interesting throughout the years, like, I've spoken to so many students, so many docs who always have that story, right? Like, usually it's something personally that happens to you. Sometimes you encounter Or something and you're like, okay, I have to do something about this injury. And then having an experience that's positive with a chiropractor kind of sets them on a course. And I'd imagine it's the same for many other professions as well. I know I've spoken to a number of physical therapists that are in that same position or athletic trainers who had a really incredible athletic trainer that worked with them when they were an athlete, that, that kind of carried over. So going back to some of the injuries that you were seeing time and time again with athletes, What do you feel like is kind of at the root of a lot of that? Is it more that there's a lack of understanding from an athlete or from a fitness enthusiast, I guess I should say, perspective of they're just not understanding how they need to prepare to do whatever it is they're doing? Do you think some of the TikTok culture of these crazy videos of people lifting ridiculous things or doing these tricks in the gym has contributed to that? Where do you think all of that kind of stems from?

That's a really loaded question. I can say what I generally like to describe in something like this is I generally think people are underprepared for what they're trying to do, and then they're grossly overstimulated, and those are kind of a recipe for disaster.

Hmm.

And I, from my experience across the board, and not in every case, but in the majority of non-contact musculoskeletal injuries that I would see, it was people that set a goal to do X and started training for X, but their preparation was here, and all of a sudden they're doing way too much load and they start to accumulate a lot of stress and they become injured in some way. So it's usually they're underprepared for their activity and overstimulated. And I think as far as the social media culture, I think what ends up happening a lot of times is the influencers— and I'm going to use that word in air quotes— but the influencers put their hardest, most advanced versions of exercise on because it's what gets clicks. And what people don't understand is there were probably 10 steps that a person would have to take to be able to earn the right to do that exercise. To do all that. And so when people see that, they start doing it, and it's like, now you were underprepared to do progression 10. Why don't we go back and start at number 1? So social media culture definitely doesn't help it. Particularly what we're seeing right now with just a lot of ridiculous things online. However, I think there's also just a lot of misinformation about human performance in general. And I think part of our jobs as clinicians and sports chiropractors, performance chiropractors, whatever you want to call yourself, is to dispel some of those myths. So we're actually giving real information instead of what people are putting out on social media.

Yeah, no, absolutely. So you mentioned overstimulated. What do you, what do you mean by that? Like being overstimulated when it comes to trying to do some of these lifts or whatever type of workout they're doing.

As an example, let's say someone has a capacity to run a 5— like 3 miles. This is an example, right? And in one instance, maybe they run 7 miles, right? Which is over double what their capacity is. So they're, they're doing too much load, which is a form of overstimulation. In this case, Maybe someone has the capacity to do 3 miles, but at the same time, they've not gone through all the appropriate physical preparation for the 7 miles. And that's where those 2 parts meet. They're underprepared, their tissues are not ready to do that, and they're being overstimulated. They're overtraining. And that is just— it's just a recipe for disaster. And I know I've seen it so many times. I know Dr. Riddle would probably say the same thing, that this is where people get hurt, is they're doing— They're not ready to do the task that we're asking them to do, or that they're asking themselves to do, and then they're just doing too much.

Yeah, so I'd imagine that's where a lot of chiropractors, physical therapists, healthcare providers, even especially athletic trainers on the sideline, that's where they usually enter the scene, right? So if we're talking about a movie, so to speak, they enter the scene after that patient has already Overdone it. They've already hurt themselves in some way. They've sprained it, they've strained it, they've torn a muscle, they've gotten in a bad way, and then they come to visit their healthcare provider. You all typically in a normal office setting will obviously do an exam, assess what's going on, make a diagnosis, come up with a treatment plan. And in a perfect world, you go through with their treatment plan, they progress as you expected, and then they've reached MMI or maximum medical improvement, and then like a baby bird, you set them free and say, okay, awesome, don't do that again, I'll see you next time. And I feel like that's not what you want, but that oftentimes is what happens, right? They get out of pain, they get back to where they were previous to the injury, and then you let them go. And then inevitably, sometimes those same people come back in with that same recurring injury or something similar to it. So I, I feel like the profession as a whole has always, or at least from conversations I've had, you get to a place where it's like, what's next? Like, how else can I serve this patient? How else can I help them so that not only do I just get them back to where they were before, but I put them back out better than they were when they walked in my door? And not only necessarily set them free until they hurt themselves again, but become a part of their plan for how to improve themselves from a physical standpoint. So it sounds like that's kind of how you've approached things in your own practice.

Yeah, I think you just said everything for me. I think I want to take a couple of pieces of what you just said. Like, I think the first part is we have to redefine what we're classifying as what you said was maximum medical improvement, right? What typically happens— let me use an example. Someone sprains their ankle. Playing football or soccer, playing soccer, sprains their ankle, and the clinician comes in, works locally on the site. They do acute management, kinematics, and motor control. They get the ankle moving and being able to resist forces in multiple planes of motion. And typically, in most cases, that's where we would call maximum medical improvement. Like, it's, it's back to normal, the isolated structure and tissue, and so you're ready to go. And what I've often said is I think we need to change that definition of MMI to include now fitness, because the, the real problem with being underprepared is if we're letting our people go after motor control and maximum medical improvement, and they're that, that soccer player, they're not ready to play soccer yet. They've still got to accumulate strength globally and integrated patterns through those tissues. They still have to learn to sprint, jump, or throw, or produce rapid rate of force production. And then they ultimately have to rebuild their work capacity. So if we're letting people go from care at MMI, they've skipped half the puzzle and they're not— they're still underprepared with the physical qualities they need to complete in their terminal task in sport. I think that's what— that's the crux of the real problem is that we, number one, we tend to only look at like local isolated problems. Like, oh, the ankles hurt. We're going to correct the ankle, which is part of the solution. But we also have to think more globally, not only from a movement perspective, but from a sport and requisite perspective. Because if someone's— what I always think about is when I release someone from care, I think what's the end goal in mind, and I reverse engineer the whole process.

Mm-hmm.

So if I have a soccer player, the end process is soccer competition. And then I have to work backwards to where they are now, which is I sprained my ankle in an acute manner.

Right?

And so I have to come up with a plan that, that takes you all the way from being on the table all the way back to being on the turf and playing soccer. If we just stop at MMI, we've skipped half the puzzle, and this person's gonna be grossly underprepared for the tasks and the forces that are gonna be going through those tissues, and that's why they end up injured again.

Are you a clinician, trainer, or performance coach who's tired of seeing the gap between rehab and real performance care? Then let me introduce you to the Performance Practitioner, a free Substack newsletter created by Dr. Tom Teeter of Rehab to Fitness. In this newsletter, Dr. Teeter brings you into his system for bridging the divide between rehabilitation and fitness using structured, data-driven strategies to help athletes recover, perform, and stay resilient. Each week you'll get practical insights on things like integrating rehab and strength training, Smart loading strategies for recovery and performance, real-world case studies, and even myth-busting breakdowns of what's actually working in human performance. Whether you're managing injuries or optimizing your athletes, this is a must-read for providers who want to challenge outdated models and redefine their methods. Subscribe today at theperformancepractitioner.substack.com or visit the link in our show notes and start thinking more critically Practicing more intelligently and delivering better outcomes. Let's build better athletes together.

Yeah, no, I can absolutely see that. And I think that's what's so exciting about this thought process and possibly where there's kind of been that gap in clinical education, right? Like you have what students are learning in school, which is a lot. There's a lot of information crammed into a short time period and it really essentially helps you start at base level, at foundation of like, I am a healthcare provider. I have a license. I can do these things. But then I think going beyond that, a lot of people who are interested in working with athletes or people that are active look to sports-specific certifications like the CCSP program, which of course is a certification in sports practitioners for chiropractors, or the Diplomate in Sports. There's rehab certifications, obviously, and there are sports-type certifications, I think, in every discipline underneath the umbrella of physical medicine. Where do you feel like you've seen the biggest gap in what's being taught in sports med certifications like those? And obviously we're only going to speak to the ones we're familiar with versus what we've developed here with the clinical human performance practitioner. Like where's, where are we filling in that gap between the two? Yeah.

Well, I think you got to speak to 3 parts to what you just said. I think if we're talking about chiropractic education in general, when you're in school, they teach you how to be a healthcare provider, how to examine, diagnose, and treat musculoskeletal injuries. And in most places, it's typically through the form of manipulation. Now, some schools have now gotten into teaching soft tissue techniques like FACTOR, other various soft tissue techniques, but then at that point, They just really teach you how to pass the boards, which is really, really important, by the way, because you have to have a license to practice.

First step.

So it's the first step. Most students and young clinicians are then left to search out technique courses to help them try to fill in the gaps. But I think part of the problem is most of these students have never been shown what the gaps are in their process. And so they find different things that either they gravitate towards, techniques that other people do that they think look cool or trendy. And they really have no cohesive system to kind of put it all together. I think then if we're talking about where's the gaps in education, chiropractic school is just teaching you how to pass the boards. We have wonderful education in chiropractic with the CCSP, but from my experience and my knowledge and the people I've talked to, the CCSP is fantastic for teaching sideline work, behind-the-scenes event work. It really teaches you acute management and getting into the fundamentals of kinematics and even Some in motor control, but then you're left to take some of those motor control rehab courses like you just discussed on your own. What ends up happening if a young clinician passes the boards and then takes something like the CCSP, they are really, really good at the first 3 stages of care and rehab with acute management, kinematics, and motor control.

Mm-hmm.

But that's where it stops. And just like I just explained, we're talking about a spectrum of care and rehabilitation. That goes all the way through to performance and back to being able to play. And so we're still seeing like 50% of the puzzle being left out of education, and that's kind of the gap that we're trying to fill. We're not trying to replace traditional chiropractic education. We're not even trying to replace or compete with the CCSP because that's such a wonderful complement to the things that we're talking about. What we're trying to teach is taking those people And show him, here's the after stuff that you need to know to be able to work with high-level athletes or in really elite sporting environments. If you're going to— in my case, when I was working with an athletic department, I needed to have all of these things at my disposal because if we just stopped at motor control, we would see a lot of people continue to come into our offices with reinjuries. And so the gap that I think we're really trying to fill is the I always think of, like, what's next, or what's after, what's after the CCSP. This is what we're trying to teach you.

You mentioned too, like, that critical thinking is so important when it comes to what you do as a provider when that patient's in your office. And there's so much emphasis, I know, within healthcare education when it comes to that clinical decision-making and being able to know Not only what's going on with the patient, what needs to happen in order to help them achieve their goals. But it sounds like there has been that gap between the first goal, which may be, you know, I just don't want to hurt anymore and I want to be able to move like I used to, and what the real goal is if they are performing in some type of way. Could you speak a little bit to kind of that gap in critical thinking that exists right now from a clinical standpoint and how this helps fill that need?

Yeah, I think you said one thing that, that was really interesting I'd like to touch on, where it's like you, you have a certain— I think gen pop people particularly, they're like, look, I don't care about all the other stuff, I just want my knee not to hurt. So you're going to have people that maybe you do stop after motor control and that's all the person needs. But if you're working with recreational athletes or fitness-minded people, people who are really semi-professional, elite, or even professional athletes, like there's more to the puzzle than just stopping after motor control. And one of the things that I have found in the time with working in athletics is that I think we tend to miss organized framework in an operating system. And then we don't have a standard operating procedure or processes that we can use as a series of checks and balances to check our work to make sure we're not missing steps. And then we have a system that's reproducible across multiple practitioners. And so one of the things I'd like to show, if I can, And I know it's gonna be hard for some people to see, but this is the operational algorithm that we use to help with critical thinking in our course. And at the very top, when someone comes into my office or into an athletic training department, the first thing I want them— the provider to ask is, what can we do for you? It's a simple open-ended question, and we have 2 pathways. So this is the algorithm that we use to work with athletics and athletic environments. And so if someone says, I have pain, Mm-hmm. We automatically shift them over to the right of this equation, and we're gonna go through our process, which is called our clinical audit process, and that's our rehabilitation structure. If someone comes in and is like, I need to improve my 40 time, or I need to train for a marathon, it's non-painful, but they have a specific fitness-oriented task, we're gonna shift them over to the left, and this is gonna be people going through our fitness audit processes. So we have an organizational structure that tells you where to go in every step of the puzzle. And then we have a process for painful situations and non-painful situations. And when I worked with— the school I used to teach at, and we worked with the athletic department, we started setting this up. And it really created almost like a barrier for each person on the integrated support team. So everyone knew what their role was and what the next step in the process was. And so again, when we have someone that comes in on our algorithm, this is how we operate. On the right, it's for painful situations, and on the left, it's for non-painful or fitness-oriented situations. And then, like I said, we have 2 structured processes. If someone has pain, we're going to take them— what we hear is our clinical audit process, and it's essentially 5 steps. We have creating a patient profile that tells us who the patient is, And what they want to do. So I'm Kevin, I have knee pain, and I wanna run a marathon, right? Who the patient is, what they wanna do. Then we have to perform a needs analysis. Let's say, well, if you want to run a marathon, I need to know what physical qualities do you need specifically to run a marathon? So we do a needs analysis. So this tells us what they need to be able to do. Then we do our exam, right? And this is stuff you're taught in chiropractic school. We're gonna look for mechanical sensitivity, any contraindications, And then we're going to do a series of screens or assessment, whether it's looking at breathing, movement, etc. And then we might do some local palpation or biomechanical testing and come up with a diagnosis, right? Then we do our treatment plan. And in our course, the treatment plan is looking at the 6 stages of rehabilitation. Those stages are acute management, foundational kinematics, motor control— that's on the sports medicine side— and then we have functional integration. We have progressive kinetics and fundamental capacity, which is on the sports performance side. But it's all tied together, and I'll explain how that works in a minute. But once we have our treatment plan, we have a diagnosis, we've come up with a plan of action, and then at links throughout that process, we have activity restoration or discharge criteria to know, hey, are we done doing this stage, or is this person ready to go back to playing sport? And then on the other end of the spectrum, we have our fitness audit process, and it's very similar, but it's quite distinctly different. We want to create a client profile. Again, who is the— who is the client and what do they want to do? Needs analysis— what do they need to be able to do? We do an assessment of health, movement, or health, breathing, movement, and fitness. And then we come up with a training plan. So we know what you want to do, we know what you need to be able to do, here's what you can currently do, and how do we get you from point A to point B, which is your end goal? And then along the way of our training plan, Periodically, we're gonna check in for— to see if the things that we're doing in evaluation has been successful, and then we come up with another plan. So we have a general operating algorithm, which is the structural framework for how we go about doing our business, and then we now have a painful audit process with our clinical audit process and a fitness audit process, and that's how we essentially create a structural framework for critical thinking. We're not trying to take away the clinician's ability to think and input the creative things they do in their treatments. We're just trying to give it structure so that you're not missing any steps in the process, that it's reproducible across multiple practitioners. And so you can start to bring in other people in the process because you can't be everything to everybody.

I think that's huge. We've talked so many times with providers who work with elite-level athletes, who work with teams, who work with Any patient that really has a healthcare team involved in multiple providers. And the hard part is the turf war, right? Like it's understanding when you have multiple providers that have overlapping scopes, who's doing what, who's responsible for what piece, what is the thing that you have ownership of? Because of course, if no one on the team has ownership and is communicated with that, like, this is your piece, then no one has it, right? There's a lot of—

Right.

Pointing fingers back and forth. So have you found in your experience that having this framework has been a huge help when it comes to knowing how to work well in the sandbox with other providers?

Absolutely. It's, it's, it's the one thing that has saved me time and time again when working with integrated sporting environments. And I can give you an example, like the athletic department that I worked at, I was asked to help out and I was happy to when I was a professor. And the first thing I did was I had a meeting with the athletic director and one of the coaches that I was friendly with. I was like, just tell me, what, what do you guys currently do? And we'll talk a little bit later. And let me just flip through it since we're talking about it now. Sorry, because I think this will be helpful when I explain this here. There we go. So when you have a department or a sports team, there's 6 parts. There's 6 people that you need, right? You have management, which is the people at the top. This is athletic director. This is the general manager of a professional sports team. These are the people that motivate the team. Guide the direction of the team, and they make the big important decisions.

And the business—

That's— they're the business people, right? They make the decisions. Then you have medical. Medical is your athletic trainer, which is, I think, the most important point. I'm going to be frank, I think that the medical and athletic trainer is the single most important person on this team because they're the triage person who has first contact with the athlete in most situations, and they get to determine, is this an emergency where I need to send them to X Or can we push it down the road to movement and correct it that way? So then you have your general practice physician, your orthopedist, your psychologist, your nutritionist, et cetera. That's all under medical, and they're responsible for player health. Then we have movement. This is where we come in. Movement is either a chiropractor or a physical therapist. Now, typically, in most settings, we see that chiropractors are usually responsible for the kinematic part. going to make a joint or a tissue move better. And then usually in most settings, the physiotherapist or the physical therapist is responsible for the motor control side. If you're a really good clinician, you can do both. It's not saying that you have to have those people on your team, but this is how you play nice in the sandbox and you designate roles. And what I ended up doing at the school I was working at is I would do all the movement stuff, and we did have a part-time PT that would come in, and I was like, look, I'm gonna Work with you, and I'm going to do the kinematic part, and you're going to work on motor control, and then we're going to pass them off to the strength coach. But having this spectrum where everyone knows their role was immensely helpful. Then obviously after movement, you have your fitness staff. This is your strength and conditioning staff. They're responsible for improving the physical qualities of each athlete. And then you have skill, which is your head coach or your assistant coach, and they're responsible for teaching the techniques and tactics of sport. And then I think the unsung hero in some settings of this It's all tied together by sports science and monitoring. And monitoring or sports science, we're going to look at ways to manage load and promote recovery, right? So if you have an athletic department or a sporting environment, these are the 6 people you need on your— or the 6 categories of people you need on your integrated support team.

Mm-hmm.

And being able to use that algorithm, so knowing who tags in when and using this system of creating an integrated support team was immensely helpful in making sure that everyone knew their role. Everyone knew the other people's role on the team. And that it also essentially— there's always a turf war in general, but it doesn't have to be that way because there were many times where I would— the physical therapist did a few things better than me that I didn't even know how to do at the time. A great example would be something like dry needling. At the time, I didn't do any dry needling. So I would pass them off to the physical therapist, 'cause like, hey, I need you to come in and kneel this person for me. And then I'm gonna do my adjustment and I'm gonna pass them back to you to do his rehab exercises before we send them into the weight room. So it really just ties everything together, but I think it all starts with having that operational algorithm and then having those 2 processes, whether it's clinical audit process or your fitness audit process.

That wraps up part 1 of our conversation with Dr. Tom Teeter. I hope it sparks some fresh thinking about how we redefine recovery, performance, and what it really means to guide a patient from injury to optimization. His framework and approach offer something that oftentimes is missing from traditional sports education programs: structure, clarity, and a path to reproducible results in performance-driven care. If you'd like to go deeper into Dr. Teeter's system and learn how to apply it in your own practice, be sure to check out our Clinical Human Performance Practitioner Certification. This comprehensive program includes 12 courses and over 114 hours of content designed to help you bridge the gap between rehab and performance. You'll learn how to assess more effectively, build evidence-informed treatment and training plans, and work more collaboratively across integrated care teams. Enrollment is now open and you can get immediate access to start learning at your own pace. Simply visit the certifications tab at online.sports-seminars.com or visit the link in our show notes to learn more. And as always, if you enjoyed today's episode, please like, follow, and share The Factor Podcast with a colleague or friend. We'll see you next time.

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