Great Staff. Wrong Structure. Why Sequential Rehab Fails Elite Teams.

The traditional rehabilitation model in elite sport is not the product of poor intentions. It reflects a historically reasonable response to professional specialisation — physiotherapy owns the acute phase, S&C assumes loading when the athlete is cleared, coaching receives a conditionally fit player. Each discipline does its work competently. But as Lindsay Bull and Martin Buchheit argue in a 2026 paper published in Sport Performance and Science Reports, the architecture of sequential handover generates structural problems that are independent of individual practitioner quality.

Their proposed alternative — the Integrated Rehabilitation Continuum — is built on three interdependent principles.

Collegiality

Collegiality, as Bull and Buchheit define it, is not professional courtesy. It is the condition in which practitioners from different disciplines hold each other's expertise as genuinely relevant to their own clinical reasoning — not as a formality observed at transition meetings, but as a daily operational reality.

This does not emerge from goodwill alone. The authors draw on research by King et al. (2024) to argue that psychological safety is the foundational condition for collaborative behaviour. Without it, even practitioners who value integration default to protecting their professional domain.

The physiotherapist who changes a loading decision because of what the S&C coach observed in the gym that morning. The S&C coach who adjusts a programme because the physiotherapist flagged a tissue response the objective metrics did not capture. That is collegiality in practice — information flowing both ways, in real time, informing decisions.

Alignment

Alignment refers to the shared articulation of goals, timelines, and progression criteria across all disciplines from day one. In the sequential model, goal-setting is largely staged — each discipline sets its own targets, in its own language, toward its own definition of ready.

The consequence, as a 2023 survey of 85 elite practitioners across the world's top professional football leagues found, is substantial variation in how diagnostic information is shared and how progression decisions are made.

Bull and Buchheit argue that all disciplines must agree on the destination, negotiate the key milestones, and establish shared metrics for progression — delivered as one message, one shared voice. Not compared at handover points. Agreed before the process begins.

Concurrent Engagement

Concurrent engagement is the structural consequence of the first two principles made operational. All disciplines present and contributing from day one — not at full weight throughout, but never absent. Proportional contribution shifts as rehabilitation progresses. Presence does not.

The sequential model assumes that staged responsibility produces cleaner accountability. In practice, it produces gaps. The athlete who moves from physiotherapy to S&C carries information that was never formally transferred. The coach who receives a cleared player has had no involvement in what cleared actually means for that individual.

Concurrent engagement resolves this not by dissolving professional boundaries, but by ensuring no discipline ever fully leaves the room.

What This Requires in Practice

Collegiality, alignment, and concurrent engagement are not abstractions. They are operational commitments that change the daily texture of how practitioners communicate, how decisions are made, and how athletes experience the rehabilitation process.

They also require infrastructure. Shared decision-making across disciplines depends on shared information — a single record where plans, criteria, and progression benchmarks are visible to everyone with a role in the athlete's care. Without that, alignment has to be rebuilt manually every day. Concurrent engagement becomes a meeting cadence rather than a structural feature. And collegiality, however genuine, operates on incomplete information.

Gameplan is built for exactly this. One shared platform where physio, S&C, and medical work from the same athlete record, the same plan, and the same return-to-play criteria in real time. The infrastructure that makes the Integrated Rehabilitation Continuum operationally possible — not just philosophically sound.

Bull L, Buchheit M. The Handover Hangover: Sequential vs. Concurrent Return to Performance Models in Elite Sport. Sport Perform Sci Rep. 2026;304:v1. Read the full paper here.