Building a Culture of Collaboration
The Role of NBA Physical Therapists in Integrated Performance Teams
David Clancy MSc, BSc, HC
In the fast-paced, high-stakes world of the NBA, success on the court depends on much more than just raw talent and athleticism. Behind every highlight reel, there exists an intricate web of professionals dedicated to optimizing player care, performance and longevity.
At the heart of this system are physical therapists (PTs; known as physiotherapists in Europe), who spend a lot of time with the players, be that in terms of injury prevention, or rehabilitation. They also play a pivotal role in fostering collaboration within integrated sports performance teams across the league.
This article unpacks how NBA PTs serve as linchpins in the orchestration of high-performance ecosystems for each team.
The shift towards integration in sports performance
Over the past two decades, the NBA has undergone a seismic shift in its approach to player health, care and performance. The emergence of integrated performance teams, comprising physical therapists, athletic trainers, strength and conditioning coaches, performance nutritionists, sports psychologists, and sports scientists, reflects a growing recognition of the interconnectedness of disciplines.
This paradigm shift aligns with the concept of ‘marginal gains’, where small, incremental improvements across multiple domains compound to yield significant results. Kudos to Sir David Brailsford from the ‘Team Sky’ days in elite cycling and the Tour de France, for bringing this concept to the forefront of performance in sport (the team used to bring the cyclists pillows on ‘away trips’ to help improve sleep and circadian rhythm setting, pretty much a relatively common practice now). Every 1% adds up. It’s how one approaches the small bits that speaks volumes about the big bits. For NBA franchises, the integration of these different skillsets and disciplines means not just preventing injuries - but optimizing recovery strategies, performance systems, and mental resilience programs.
In this model, the PT occupies a unique position. Their role extends beyond rehabilitation; they act as a ‘bridge’ between medical care, and performance optimization. They often serve as the connective tissue (pun intended) that aligns the goals of diverse professionals within the team, and front office. More often than not, they can ‘speak the language’ of each discipline due to their backgrounds.
Evidence-based practice (EBP)
For PTs to effectively lead in these environments, credibility is paramount. EBP is the bedrock upon which this credibility and reputation is built…for coaches, front office staff, and the athletes. By integrating rigorous, clinical expertise, the best available research, and patient values, PTs ensure that their interventions are both effective, and contextually relevant for the game of elite basketball.
For example, consider the management of patellar tendinopathy, a common condition in any basketball player, not just the NBA player. An evidence-based approach might include the Alfredson protocol for eccentric loading. Perhaps there will be influence from Keith Baar’s work from the University of California Davis, on the nuances between tendon stiffness and laxity. This could be supplemented by isometric exercises from the ‘school’ of LaTrobe University, and work by world-leading tendon researcher Dr Ebonie Rio, to modulate pain and improve neuromuscular function.
However, bearing in mind all these insightful inputs, PTs must also consider the player’s training load, biomechanical factors, and emotional/ psychological readiness. This is a complex task; humans are complex creatures. Therefore, this is one that necessitates connection and collaboration with other backroom team members across sports medicine and the performance sciences.
This ability to navigate complexity, guided, and informed by data and research, positions PTs as trusted voices in intense decision-making processes.
Interdisciplinarity: the art and science of collaboration
The concept of interdisciplinarity hinges on the seamless integration of expertise from multiple fields. In an NBA context, this might involve aligning a strength coach’s focus on hypertrophy and muscle gains, with a performance nutritionist’s emphasis on fueling, with a psychologist’s strategies for building grit.
PTs are positioned in teams well placed to mediate these intersections. Their training spans clinical anatomy, physiology, biomechanics, pain science, and psychology, enabling them to understand and translate the priorities of various stakeholders of an NBA team. By fostering a shared language, ethos and vision, PTs help to break down silos, nurture trust - and cultivate a culture of mutual respect.
The benefits of this approach are evident in injury prevention strategies. For instance, the implementation of a load management protocol for an irritable tendon requires input from multiple disciplines, across domains:
Sports scientists provide data on player workloads, exposures and recovery metrics.
Coaches adjust practice intensity and minutes.
Nutritionists ensure optimal energy availability and dietary requirements.
Psychologists address stressors that may impact recovery and prime the athlete's mindset.
The PT acts as the integrator, synthesizing these inputs into actionable strategies tailored to individual players’ needs.
Successful collaboration requires clarity of thought and the ability to see and combine diverse perspectives. Physical therapists often leverage first-principles thinking, a mental model that strips challenges down to their core elements. By asking 'What is true?' and 'What must be true for this approach to succeed?' PTs align the varied priorities of the Head Coach, nutritionists, and psychologists into cohesive, actionable approaches. This ability to think clearly and coherently amid complexity builds trust and helps drive results on the court.
Cohesion and trust
"Trust is built in very small moments, and it is those moments that create the foundation for strong teams” - Brené Brown (Researcher and author of ‘Dare to Lead’, renowned for topics such as vulnerability, emotional intelligence and leadership)
Trust within a team is rarely built through grand gestures; instead, it thrives on micro-interactions. Think of this as the 'emotional bank account', as Professor Damian Hughes coined the phrase…a reservoir of goodwill accumulated through consistent acts of support and integrity. For NBA PTs, every interaction with a player, from checking in on their mental state to adjusting a rehab protocol to address specific concerns, is a deposit into this account. Over time, these deposits create an environment where players and staff feel psychologically safe to express vulnerability, ‘open up’ - and make collective decisions, without a sense of fear or anxiety.
In his work on team-work index and cohesion at Gain Line Analytics, former Australian Wallaby rugby player Ben Darwin emphasizes the importance of trust, shared purpose, and this ‘psychological safety’ (originally from work by Dr Amy Edmondson, Professor of Leadership at Harvard Business School) in achieving collective success. For NBA performance teams, these principles are not just ideals but necessities.
PTs often find themselves at the center of trust-building efforts. Their consistent, hands-on work with players provides opportunities to foster relationships that extend beyond the treatment table. These connections are vital in creating an environment where players feel supported, listened to and valued. This is only reinforced from research by McKinsey & Company into organizational dynamics; teams with high levels of psychological safety are 12 times more likely to achieve their targeted performance objectives.
Moreover, PTs can model collaborative behavior for the broader team. By openly seeking input, acknowledging the expertise of others, across disciplines - and prioritizing the wellbeing of players over personal agendas, they set a standard for interdependence and shared accountability.
Case study: navigating high-stakes decisions
Consider a hypothetical scenario involving a star player recovering from a ‘high ankle sprain’.
The stakes are high. The playoffs are two weeks away, and the team’s playoff hopes hinge on the player’s availability.
‘The best ability is player availability’, said Bill ‘The Big Tuna’ Parcells, the legendary former football coach who’s now a member of the Pro Football Hall of Fame.
This is what is going on behind the scenes.
The Head Coach wants the player back asap, obviously.
The Head Strength Coach is focused on rebuilding muscle strength and power.
The Lead Sports Scientist is monitoring workload data to mitigate re-injury risk.
The Player feels pressure from fans and teammates to return to play.
The PT, grounded in EBP, armed with interdisciplinary insights, must navigate these competing demands. Faced with competing demands in pressure-cooker scenarios, one must rely on mental clarity, cultural alignment and buy-in - but also the best interests for player care. Through transparent communication and collaborative planning, they can:
Educate stakeholders on the biological healing timeline and the risks of premature return.
Coordinate efforts to ensure that rehab exercises, conditioning drills, and recovery modalities align.
Empower the player by involving them in decision-making processes and addressing their concerns.
The outcome, whether the player returns for the playoffs in time, or prioritizes long-term health, reflects the team behind the team’s ability to work cohesively under pressure. Research from consulting firms like Gartner often speak about how teams that can align quickly on priorities and adapt to changing circumstances deliver significantly better outcomes, such as real-time adjustments during a player’s recovery process. As we know, this ability to be agile and pivot while maintaining a clear focus on long-term goals is a hallmark of high performing teams.
Decision making in these kinds of contexts would benefit from the ‘OODA loop’ – observe, orient, decide, act. This model, developed by United States Air Force Colonel John Boyd was applied to the combat operations process, often at the operational level during military campaigns. By observing injury data, orienting themselves to the teams immediate and long-term goals, and making evidence-informed decisions, PTs ensure a structured approach to decide and execute – act on.
The role of culture
In his book ‘Legacy’, James Kerr highlights the importance of culture in sustained excellence for the all-conquering All Blacks. Similarly, Sam Walker’s ‘The Captain Class’, underscores the role of leadership in shaping team dynamics and what makes successful teams flourish. Both perspectives are instructive for NBA performance teams and the team behind the team in this world.
PTs contribute to culture in several ways:
Leadership by example: Modeling professionalism, adaptability, and empathy.
Storytelling: Sharing science-backed success stories to inspire confidence and acceptance.
Rituals and routines: Establishing consistent practices, such as pre-game mobility sessions or post-game recovery protocols, that reinforce team values and work philosophies.
These cultural elements create a sense of continuity and purpose that transcends individual roles.
Practical takeaways for NBA PTs
Prioritize Relationships: Build trust with players and colleagues through consistent, empathetic communication. Lean in, ask questions, and stay curious that little bit longer. If you can create relationships where the athlete wants to ‘pour out’ what they feel, rather than you always having to ‘pour in’ advice and suggestions, then you are ‘winning’.
Think Tim Duncan: Stay grounded in EBP, while remaining open to innovation and creativity. Master those fundamentals! The score will take care of itself, as Bill Walsh said.
Embrace Interdisciplinarity: Seek first to understand, then be understood as Stephen Covey from ‘7 Habits’ wrote. Actively seek to digest and integrate the perspectives of other disciplines in the sports medicine and performance department. Ask questions from the other members of the team behind the team. Learn about what makes them tick, their challenges, strengths, their core skills, etc. This will only help with player care and performance.
Champion Cohesion: Foster an environment of psychological safety and belonging, where diverse voices are valued to ‘add strings to the bow’. As Ray Dalio, investor and hedge fund manager, says, 1+1=3
Lead with Purpose: Use your unique position to align the team around a shared vision for player health and performance.
Looking ahead: the evolving role of PTs in 2025, and beyond
As the NBA continues to push the boundaries of human performance and innovation in data, tech and emergent methodologies, the role of physical therapists will only grow in complexity, need and importance. Cutting edge technologies, from wearables to AI-driven injury prediction systems, will provide new tools for optimizing outcomes.
However, the core principles of collaboration, trust, and evidence-based, scientifically grounded care will remain unchanged, and critical. As Seth Godin of ‘Purple Cow’ proclaims, soft skills are real skills that make a difference. It’s this understanding of the human element, that there is more to the profession than just the technical and clinical stuff, that is central to how PTs think, behave and operate in a team environment.
By embracing their role as integrators, advisors and leaders, NBA PTs have the potential to shape not only the careers of individual players but the future of the NBA itself.
In the words of Malcolm Gladwell, it is often the “outliers” who redefine the game…and in this case, the outlier may very well be the humble, yet indispensable PT.
About The Author
David Clancy MSc, BSc, HC
Higher Certificate in Science in Physiology and Health Science, BSc Physiotherapy, MSc Sports Medicine, Assoc. Prof., MISCP, CORU
CEO The Nxt Level Group
Editor/ Author of Essential Skills for Physiotherapists: A Personal and Professional Development Framework
David has been in the field of sports medicine, physiotherapy and performance support for over 15 years. A Physiotherapy background and MSc in Sports and Exercise Medicine paved the way into high performance sport, private practice - and Isokinetic Medical Group in Harley Street, London. He was a consultant support for Europe-based players regarding Medical Care and Performance Services for the Brooklyn Nets and the San Antonio Spurs of the NBA. Currently, David directs The Nxt Level Group, which is a consulting firm providing organizational design advisory, and recruitment and headhunting search processes. He also provides learning and development support to several pro sports teams.
