As president of the International Federation of Sports Physical Therapy (IFSPT), Dr Luciana De Michelis Mendonça was invited to present her perspective on Sport & Exercise Medicine (SEM) in her home country Brazil.
Tell us more about yourself
I am a Sports Physical Therapist (SPT) working as a Professor at the Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM – Brazil) and a mother of an incredible 13-yo daughter. After having worked as an SPT for soccer and volleyball teams and within the Physical Therapy services at the 2016 Rio Olympics Games, I am focussing on research in the field of sports injury risk and prevention. Additionally, I am the current president of the International Federation of Sports Physical Therapy (IFSPT).
What is the path to becoming a Sports Physical Therapist in Brazil, and what are the main hurdles on this path?
In Brazil, to become an officially accredited SPT registered at the Federal Physiotherapy Council (COFFITO), you must fulfil several criteria.
First, following the Physical Therapy graduation, a minimum of two years of experience working with athletes (of any level) is required. Candidates must subscribe to a specific call released by SONAFE (the Brazilian National Society of Sports Physical Therapy) and COFFITO, then take an exam and have their CV evaluated. If approved by SONAFE, candidates can then be registered as SPT at COFFITO.
The main hurdle on this path is to define a fair process to be inclusive. The past SPT generation criticized, for instance, that its members had to follow the path mentioned above (exam included) to get registered.
Finally, it is worth mentioning that in Brazil, academic courses, which deliver specialization titles in SPT, are also available. While these courses are open to all physiotherapists, the delivered title is not equivalent to the above-mentioned official recognition as an SPT. This duality within the same country does lead to some confusion, even though SONAFE and COFFITO try to communicate clearly about this matter to inform Brazilian physiotherapists transparently.
How developed is collaborative work in SEM in Brazil?
Nowadays, I can say that the exchange between different disciplines is good. Physicians, strength conditioning coaches and SPT work together to improve athletes’ health, and they value a shared decision-making process.
In the nineties, the situation was quite different. Indeed, physicians had the final (or even full) word on any decision related to athletes’ care. A major change was observed after the Rio Olympics and Paralympic Games in 2016, where SPT gained recognition thanks to the amazing work it delivered. This, coupled with the accumulating scientific evidence that conservative therapy is at least as effective as surgery for many musculoskeletal conditions and the development of interdisciplinary return to play protocols, remodelled relationships between healthcare professionals in a more balanced and positive way.
Finally, the political activities of the SPT community also contribute to the observed positive development of interdisciplinary collaboration in SEM. For instance, SONAFE has been an IFSPT member since 2016, just before the Rio 2016 Games started. Since then, SONAFE’s relationship with medical organizations such as the Brazilian National Society of Orthopaedics and Traumatology (SBOT – Sociedade Brasileira de Ortopedia e Traumatologia), the Brazilian National Society of Sports Arthroscopy and Traumatology (SBRATE – Sociedade Brasileira de Artroscopia e Traumatologia do Esporte), the Brazilian National Society of Sports and Exercise Medicine (SBMEE – Sociedade Brasileira de Medicina do Exercício e do Esporte), the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the International Federation of Sports Medicine (FIMS) started to get closer.
Are exercise physiologists/scientists integrated into your healthcare system, and does health insurance cover their services?
Straight-forward answer: no.
We have physiologists and sports scientists (statisticians) working in the staff of the major Brazilian sports teams. Similar services are not offered in the standard health care system, unfortunately. Sports teams who cannot afford exercise physiologists or scientists usually seek to partner with academic institutions in the form of research projects.
I can say that soccer is the sport that has the biggest financial power in Brazil, probably followed by volleyball. However, the reality is that most sports in Brazil struggle to find sufficient financial support from the media, sponsors, and government.
What is done in Brazil to promote SEM among students and young professionals regarding research and clinical opportunities?
I can tell you what is done to promote SPT by SONAFE. SONAFE has a commission composed of academic leagues from different Brazilian universities (a league being made of undergraduate students supervised by a professor, all of them sharing a common interest), which offers online meetings targeting students with interest in SPT. During these meetings, possible actions to support and promote these students are discussed. I participated in one of these meetings and had the chance to exchange with students about my sports injury prevention research topic. Each time I participate in such events, I try to encourage students, particularly female students, to follow their dream of becoming an SPT.
In addition, some universities include SPT as an obligatory discipline during physiotherapy training. This luckily leads to increase opportunities for students to commit to research and open clinical opportunities during their time at university.
Finally, if you were Harry Potter, what would you change to SEM in Brazil?
I would change the prevalent mindset that clinicians are less valuable than researchers. Some SPT here in Brazil advocates that SONAFE should be made of clinicians only. They frequently attack members with a more academic profile. Therefore, if I had the power of Harry Potter, I would like to convince my colleagues that clinical practice and research go hand in hand towards developing the profession and eventually towards better healthcare.