Defining adaptive sports and teen-athlete PT programs

Written for pediatric physical therapy practices, and for occupational therapists when adaptive equipment or daily tasks are the goal: define adaptive sports and teen-athlete programs as two services, each with its own population, goals, measures, setting, staffing, payment route and consent, and keep skilled therapy separate from cash-pay training.

Adult adaptive sports and adult athletes are a different service with other referrers and payers, covered in the adult PT growth guide; speech-language pathology is outside this guide. Teaching leagues and coaches is covered in the sports leagues guide, and surgeons’ referrals in the orthopedic and sports-medicine guide; this guide defines the programs a practice runs itself.

What are adaptive sports and teen-athlete PT programs?

They are two services that share a gym and little else. An adaptive sports program helps a child or teen with a disability take up, and keep playing, a sport or active recreation they choose; a teen-athlete program aims to lower injury risk in adolescents who already play, and to plan the return after an injury. The AAP’s clinical report finds that physical activity, including adaptive or therapeutic sports and recreation, promotes inclusion, minimizes deconditioning and optimizes physical functioning in children with disabilities.⁠¹

Describe each program as one or the other, never as a blend nobody has named. A partnership with a league or an adaptive sport organization does not make every athlete a patient: a child enters therapy through an evaluation the family agrees to, not through a roster.

Which decisions define an adaptive sports or athlete program?

Eight, each settled in writing before the program is announced:

The specialty guide covers the earlier question of whether a team is ready to offer a new service at all.

Who does an adaptive sports program for children serve?

Children and teens with disabilities who want to take part in a sport or active recreation, at the level they choose. The AAP reports that these children face barriers to participation and have lower fitness and participation rates than their peers, and that pediatricians and caregivers may overestimate the risks or overlook the benefits.⁠¹ Some want the challenge of competition and others prefer recreation for enjoyment, the report notes, so the first intake question is what the child wants to do, not what a diagnosis suggests.⁠¹

APTA Pediatrics’ 2012 fact sheet describes the PT’s part: instructing community fitness providers on how to include children with disabilities in active recreation and sports, and assisting with the design, implementation and measurement of those programs.⁠¹² Teaching a partner’s coaches is education; an evaluated child’s individual goals are therapy.

What does the AAP advise before a child with a disability starts a sport?

A preparticipation evaluation covering health status, functional capacity, the child’s preferences, the programs available and safety precautions, which may happen over time rather than in one office visit, with input from a team that includes physicians, coaches, school nurses, adaptive recreation specialists and physical and occupational therapists.⁠¹ Health care providers can also write physical activity prescriptions based on the child’s preferred activities, functional status, need for adaptation and the opportunities in the community.⁠¹

• Ask for the physician’s precautions before the first session, and keep them where every staff member at the venue can see them.
• Offer the PT’s findings to the physician, with the family’s permission, as input to that evaluation, not as clearance to play.
• Keep a current list of local programs, so a physical activity prescription has somewhere to go.

Where do Move United and Special Olympics fit with a PT program?

They run the sport; the practice supports participation. Move United describes itself as the national leader in community adaptive sports and an official affiliate of the U.S. Olympic & Paralympic Committee, with a mission to provide opportunities for individuals with disabilities to develop independence, confidence and fitness through community sports.⁠^13,14 It offers more than 70 sports and encourages athletes to sample several until at least age 12.⁠¹⁵ Special Olympics offers 30-plus Olympic-style sports for people with intellectual disabilities, and its Young Athletes play program serves children with and without intellectual disabilities aged 2 to 7.⁠¹⁶

Describe a partner only in its own words, and check what a local chapter or member organization runs before naming it to families. The partner’s coaching, competition and eligibility rules stay the partner’s.

Who decides an athlete’s classification in Para sport?

Each sport’s classification panel, never the practice. The International Paralympic Committee states that classification is sport specific, that every international federation must run a classification system complying with the IPC Classification Code, and that classifiers are certified as officials by the federation governing the sport.⁠⁹ Athletes supply diagnostic information, and the IPC points them first to their National Paralympic Committee or national federation.⁠⁹ A PT can explain the process and send records the family asks for. The IPC lists physiotherapists among the occupations found in physical impairment classification, but international classifiers are trained and certified by the sport’s federation, so it is a role inside the sport, not a clinic service.⁠⁹

When should an occupational therapist join an adaptive sports program?

When the goal is a daily-living task around the sport, or equipment that makes daily tasks easier. AOTA lists activities of daily living such as bathing, dressing and eating, and adaptive equipment that makes daily tasks easier, among what occupational therapy makes recommendations for, in settings that include community centers.⁠¹⁷ Its practice framework counts play, leisure and social participation among the occupations OT addresses.⁠¹⁸ Changing for the pool without help or eating at an all-day tournament are OT goals; the movement skills of the sport are the PT’s focus here.

Equipment belongs to both disciplines: FSBPT’s model practice act lists among PT interventions the “prescription application and, as appropriate, fabrication” of assistive, adaptive, orthotic, prosthetic, protective and supportive devices and equipment.⁠⁶ Match the clinician to the task and your state’s act.

What do schools owe students with disabilities in athletics?

Equal opportunity, under a federal rule that binds the school, not your practice. Under the Section 504 regulations, a school receiving federal funds that operates or sponsors interscholastic, club or intramural athletics must give qualified students with disabilities an equal opportunity to participate.⁠¹⁹ A private program sits alongside school sports, and a covered practice’s letter to a school needs the parent’s written authorization, since the Privacy Rule requires one for disclosures outside treatment, payment, operations and other permitted uses.⁠²⁰ The IEP teams guide covers working with schools.

What does a teen-athlete injury prevention program include?

Three parts: a neuromuscular warm-up with trial evidence behind it, training-load habits from the AAP’s reports, and a planned route back after an injury. In these trials the warm-up was a team routine: clubs were randomized, and in the 11+ Kids trial teams replaced their usual warm-up with the program.⁠^21,22 So the PT teaches coaches, checks technique and adapts the routine to the sport, with individual work only after an evaluation.

How strong is the evidence for FIFA 11+ and similar warm-ups?

Strongest in soccer, and only as strong as each study:

Dose and adherence matter: the 11+ revised the FIFA 11 after a trial limited by low compliance, and the 11+ Kids authors advise at least one session a week, with two recommended.⁠^21,22 Emery and colleagues call lack of uptake and ongoing maintenance a concern.⁠²³ Plan how a team keeps the warm-up going after the PT leaves, and never quote a trial’s reduction as what your program delivers.

What do the AAP’s overuse and specialization reports advise?

Balance training load with recovery, and be wary of specializing early. The AAP’s 2024 report says properly implemented progressive training brings broad physiologic benefits, but imbalances of load and recovery can lead to overtraining syndrome, with decreased performance and increased injury and illness risk, and it counts burnout among the primary reasons young athletes drop out of sport.⁠²⁵ Its 2016 report adds that specializing too early may bring physical and psychological harm, and that training intensively carries risk for specialized and multi-sport athletes alike.⁠²⁶ In a program, that means an intake asking about every team and season, blocks that rise gradually with rest built in, and a hold when pain appears; the sports leagues guide has the AAP’s figures for families and concussion education.

How does return to sport fit a teen-athlete program?

As skilled care after an injury, inside a plan of care, with the clearance decision left where it belongs. A 2016 consensus statement from sports physical therapists meeting in Bern treats return to sport as a continuum running in parallel with rehabilitation, with decisions made by clinicians, athletes and coaches, ideally together, and notes that evidence to support those decisions is scarce.⁠²⁷ Report test results with your interpretation, do not sell a return date, and agree early who signs any participation form; the orthopedic and sports-medicine guide covers reports to the surgeon.

Where does skilled physical therapy end and a wellness program begin?

At the evaluation of an identified condition. Skilled physical therapy starts with an evaluation, follows a written plan of care with measurable goals and is billed when a payer’s medical-necessity rules are met; a wellness or performance program serves people with no condition under treatment and is paid privately. Aetna’s commercial policy shows one payer’s line: PT is medically necessary to significantly improve, develop or restore functions lost or impaired by disease, injury or surgery, under an ongoing written plan of care, and not medically necessary for asymptomatic people or people without an identifiable clinical condition.⁠³ It asks for specific, quantitative and objective goals, an estimate of when they are reached, and the frequency and duration of treatment.⁠³

Sports goals meet a further limit: the same policy does not cover sports rehabilitation aimed at improving beyond normal ability to perform daily activities, because it is not considered treatment of disease.⁠³ Aetna’s policies help administer benefits and are not offers of coverage, and other plans write their own rules, so read each plan’s policy before telling a family what is covered.⁠³

Is a cash-pay wellness program within a physical therapist’s scope?

Within the profession’s scope, yes; within your license, it depends on your state. APTA’s House of Delegates holds that physical therapists, though experts in rehabilitation and habilitation, also have the expertise to help people improve overall health and avoid preventable conditions, through education and direct intervention, including physical activity and injury prevention programs.⁠⁵ FSBPT’s model practice act includes in PT practice reducing the risk of injury and promoting fitness, health and wellness in all ages, and its commentary uses the word client for settings such as health clubs and wellness centers.⁠⁶

The model is not the law: FSBPT offers it as a resource and says legislative language varies from jurisdiction to jurisdiction, and APTA explains that a PT’s legal scope is set by the state practice act and its rules.⁠^7,29 Ask your board in writing whether a cash-pay training session is the practice of physical therapy in your state; if it is, document and supervise it as physical therapy.

When does a teen-athlete client become a physical therapy patient?

When something needs evaluating. A client in a cash-pay speed block who reports knee pain stops progressing, and the PT offers an evaluation, with the family’s consent and a conversation about billing their plan. In the other direction, Aetna treats continued supervised PT as not medically necessary once therapeutic benefit is achieved or a home program could carry further gains.⁠³ Moving that athlete into a cash program is a new service the family chooses, explained before any charge: APTA’s code requires that patients and clients learn their financial obligations before charges are incurred.⁠²⁸ Check your network contracts on charging members first.

Does Medicaid cover physical therapy for adaptive sports goals?

It can, when therapy is medically necessary for the child’s condition, but never as recreation. Medicaid’s EPSDT benefit covers enrollees under 21, requires states to furnish all coverable, appropriate and medically necessary services needed to correct and ameliorate health conditions, and leaves each state to decide medical necessity case by case.⁠⁴ Document the condition, the functional limitation that affects the activity and a measurable goal; a recreational class open to any child is not that service. The credentialing guide covers enrolling with Medicaid and its plans.

What consent does a youth sports program need from families?

Written, informed consent from a parent for anything clinical, the teen’s own agreement, and separate permissions for photos and information sharing. APTA’s code requires ongoing informed consent after information that is understandable, honest and necessary for the patient, client or surrogate to decide.⁠²⁸ Under HIPAA a parent is usually the minor’s personal representative, HHS explains, though the Privacy Rule follows state law where it addresses a parent’s access to the child’s information.⁠³⁰

Cash pay does not change the privacy rules. A provider becomes a covered entity by sending health information electronically in a transaction HHS has set a standard for, and the Privacy Rule protects all individually identifiable health information it holds, in any form; using a client’s story or photo in promotion needs written authorization, which may not be made a condition of joining.⁠^20,31

• Program consent: what the program is, who leads it, whether it is therapy or training, its risks, and what happens when pain appears.
• The teen’s agreement: the athlete’s own goals, in the athlete’s words.
• Precautions: the physician’s precautions and emergency contacts, carried to every session.
• Information sharing: a signed authorization naming each coach, athletic trainer or school that may receive information; nothing goes to a coach without it.⁠²⁰
• Costs: fees and refunds before the first charge, and a good faith estimate where one is owed.⁠^28,32

Release forms, waivers and coverage for off-site sessions are questions for the practice’s liability insurer and counsel, asked in writing before the first session.

Who handles emergencies when a program runs on a field?

Whoever sponsors the session, under a written emergency action plan for that venue. NATA’s 2024 position statement holds organizations that sponsor athletic events responsible for a written plan covering all sponsored activities, conditioning and skills sessions included, specific to each venue and sport.⁠⁸ It recommends an AED on site or retrievable within 3 minutes at every sport venue, rehearsal at least once a year, and not relying only on health care team members to carry the plan out.⁠⁸

When the practice runs its own session in a park or rented gym, it writes the plan: who calls emergency services, where the AED is, how responders reach the field, and each athlete’s precautions. Inside a league or school event, the host’s plan and medical staff govern, and the agreement says so. Athletic trainers, in NATA’s description, give care under a physician’s direction or in collaboration with one, their services include emergent care, and they are licensed or otherwise regulated in every state and the District of Columbia.⁠³³

Covering games is a separate question. Sports board certification adds no rights or privileges, ABPTS says; the practice acts of the licensing state and of the venue’s state decide who may serve at athletic venues, and a PT may also need emergency medical responder or athletic trainer certification.⁠³⁴

Who should staff an adaptive sports or teen-athlete program?

A physical therapist who leads, documents and supervises, and every other role named for what it does. APTA’s code requires that duties a PT directs match each person’s credentials, competence and legal scope, and that assistants work under a PT’s direction and supervision; the state act and its rules set each person’s legal scope, so check their supervision terms before an assistant works a field session.⁠^7,28

Credentials help when they are real. ABPTS certifies pediatric specialists, whose specialty covers traumatic, developmental and systemic disorders that relate specifically to children, and reports 3,219 as of July 2026.⁠³⁶ A clinician without one describes their experience instead. When the therapy itself runs in a group, such as several children with similar goals on one court, the therapy groups guide covers group codes, consent and size.

Which goals and measures fit each type of program?

Individual goals for anyone in therapy, and program measures for the program. For a patient, write goals a payer can read: specific, quantitative and objective, with an estimate of when each is reached.⁠³ For the program, APTA Pediatrics suggests attendance records, records of adverse reactions or injuries, satisfaction questionnaires, and whether the program reached its goals for body structure and function, activity or participation.⁠¹²

Do not set a team’s injury count beside a trial’s figures: one season is not a trial, and a claim that the program reduced injuries needs the evidence the FTC expects behind health claims.⁠¹⁰

What goes in an adaptive sports or athlete program worksheet?

The decisions from the sections above, written once for each program. Leave a field empty until it is decided; a program with an empty field is not ready to announce.

How should a practice describe an athlete program to families?

With facts a family can check: the population, the content of a session, the lead clinician, the measures, the price and the limits. The FTC’s small-business guidance says advertising must be truthful and non-deceptive, that advertisers need evidence for their claims, and that health or safety claims usually need competent and reliable scientific evidence, which satisfied customers’ statements usually do not supply.⁠¹⁰ Under the FTC’s endorsement guides, one consumer’s account of a key result tends to be taken as typical of what buyers generally achieve.⁠¹¹ APTA’s code requires truthful and accurate information about services, with no misleading representation in any communication.⁠²⁸

What should a sample program description for families say?

Who it serves, how it starts, who leads it, how it is paid and what it does not do:

Use the same facts on the practice’s pediatric service pages. On DrSensory, a free directory families use to find occupational therapy, physical therapy and speech therapy clinics, a clinic’s paid listing can describe each program in a description the clinic writes, next to the ages, specialties and conditions it treats; the basic listing and claiming are free (claiming and optimizing a profile). DrSensory does not verify clinical quality, so list only programs the clinic runs now.

How should you price a cash-pay teen-athlete training block?

By the block, with the number of sessions, inclusions and refund terms stated. If your state treats the block as physical therapy, it is a health care service, and CMS explains that a provider usually must give a good faith estimate of expected charges to someone not using insurance who requests one, or who books at least 3 business days before the service.⁠³² One estimate may cover a recurring block when it sets out the expected timeframes, frequency and total number of sessions, and it may not reach past 12 months.⁠³⁷ Keep results out of the price; the insurance and fees guide covers explaining fees.

How does a practice set up both programs in one season?

By writing each definition before saying yes, as this hypothetical practice does.

The ages, payers and weeks are illustrations, not norms; the lesson is that each request was defined before anyone agreed to it, and neither became therapy until a family asked for an evaluation.

Sources

1. Carbone PS, Smith PJ, Lewis C, LeBlanc C. Promoting the Participation of Children and Adolescents With Disabilities in Sports, Recreation, and Physical Activity (AAP clinical report, Pediatrics 2021;148(6):e2021054664; DOI 10.1542/peds.2021-054664; PMID 34851421; abstract as indexed by Europe PMC). Checked October 23, 2026.
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   “The participation of CWD in physical activity, including adaptive or therapeutic sports and recreation, promotes inclusion, minimizes deconditioning, optimizes physical functioning, improves mental health as well as academic achievement, and enhances overall well-being.”; “Despite these benefits, CWD face barriers to participation and have lower levels of fitness, reduced rates of participation, and a higher prevalence of overweight and obesity compared with typically developing peers.”; “Pediatricians and caregivers may overestimate the risks or overlook the benefits of physical activity in CWD, which further limits participation.”; “Preparticipation evaluations often include assessment of health status, functional capacity, individual activity preferences, availability of appropriate programs, and safety precautions.”; “the preparticipation evaluation for CWD may not occur in the context of a single office visit but rather over a period of time with input from the child’s multidisciplinary team (physicians, coaches, physical education teachers, school nurses, adaptive recreation specialists, physical and occupational therapists, and others).”; “Some CWD may desire to participate in organized sports to experience the challenge of competition, and others may prefer recreational activities for enjoyment.”; “Health care providers can create "physical activity prescriptions" for CWD on the basis of the child’s preferred activities, functional status, need for adaptation of the activity and the recreational opportunities available in the community.”.
2. Thorborg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes (British Journal of Sports Medicine 2017;51(7):562–571; DOI 10.1136/bjsports-2016-097066; PMID 28087568; abstract as indexed by Europe PMC). Checked October 23, 2026.
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   “6 cluster-randomised controlled trials had assessed the effect of FIFA injury prevention programmes compared with controls on the overall football injury incidence in recreational/subelite football.”; “when pooling the 4 studies applying the FIFA 11+ prevention programme, a reduction in the overall injury risk ratio (incidence rate ratio (IRR) 0.61; 95% CI 0.48 to 0.77, p<0.001) was present in favour of the FIFA 11+ prevention programme.”; “No reduction was present when pooling the 2 studies including the FIFA 11 prevention programme (IRR 0.99; 95% CI 0.80 to 1.23, p=0.940).”; “the FIFA 11+ prevention programme which has a substantial injury-preventing effect by reducing football injuries by 39%, whereas a preventive effect of the FIFA 11 prevention programme could not be documented.”.
3. Aetna. Physical Therapy (Medical Clinical Policy Bulletin 0325, a commercial plan’s policy). Checked October 23, 2026.
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   “Aetna considers physical therapy (PT) medically necessary to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure, and all of the following criteria are met:”; “PT must be provided in accordance with an ongoing, written plan of care.”; “Physical therapy in asymptomatic persons or in persons without an identifiable clinical condition is considered not medically necessary.”; “Once therapeutic benefit has been achieved, or a home exercise program could be used for further gains, continuing supervised physical therapy is not considered medically necessary.”; “Sports rehabilitation refers to continued treatment for sports related injuries in an effort to improve above and beyond normal ability to perform activities of daily living (ADLs). Sports-related rehabilitation or other similar avocational activities is not covered because it is not considered treatment of disease.”; “A reasonable estimate of when the goals will be reached;”; “Long-term and short-term goals that are specific, quantitative and objective;”; “The frequency and duration of treatment; and”; “Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice.”.
4. Centers for Medicare & Medicaid Services, Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefit page). Checked October 23, 2026.
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   “The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “States are required to furnish all 1905(a) Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines.”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”.
5. American Physical Therapy Association, House of Delegates. Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability (position HOD P06-19-27-12, last updated September 20, 2019, PDF). Checked October 23, 2026.
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   “although physical therapists are experts in rehabilitation and habilitation, they also have the expertise and the opportunity to help individuals and populations improve overall health and avoid preventable health conditions.”; “Physical therapists’ roles may include education, direct intervention, research, advocacy, and collaborative consultation.”; “Apply the best available evidence in selecting and prescribing exercise for individuals, and planning physical activity and injury prevention programs for individuals and communities”; “Function as a member of an interprofessional team of health providers, wellness and fitness providers, community health workers, public health providers, and other diverse professionals”.
6. Federation of State Boards of Physical Therapy. The Model Practice Act for Physical Therapy: A Tool for Public Protection and Legislative Change (seventh edition, revised 2022, PDF; definition of the practice of physical therapy and commentary). Checked October 23, 2026.
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   “Reducing the risk of injury, impairment, functional limitation, and disability, including performance of participation-focused physical examinations and the promotion and maintenance of fitness, health, and wellness in populations of all ages.”; “prescription application and, as appropriate, fabrication of assistive, adaptive, orthotic, prosthetic, protective and supportive devices and equipment.”; “in some of these settings (e.g. health clubs, wellness centers), the term "client" is more representative of the person the licensee [certificate holder] is treating.”.
7. American Physical Therapy Association. Scope of Practice (APTA practice page). Checked October 23, 2026.
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   “The scope of practice for physical therapists has three components: professional, jurisdictional, and personal.”; “The jurisdictional (i.e., legal) scope of practice is established by a state’s practice act governing the specific physical therapist’s license, and the rules adopted pursuant to that act.”; “Personal scope of practice consists of activities for which an individual physical therapist is educated and trained and their competence to perform.”.
8. Scarneo-Miller SE, Hosokawa Y, Drezner JA, et al. National Athletic Trainers’ Association Position Statement: Emergency Action Plan Development and Implementation in Sport (Journal of Athletic Training 2024;59(6):570–583; DOI 10.4085/1062-6050-0521.23; PDF on nata.org). Checked October 23, 2026.
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   “An emergency action plan (EAP) is a written document indicating the preparations and on-site emergency response for any type of catastrophic injury in the prehospital setting.”; “Institutions and organizations that sponsor athletic events have a responsibility to develop a written EAP for all sponsored activities (including in-season and out-of-season games, practices, conditioning, and skills sessions).”; “Institutions and organizations should develop EAPs specific to each venue and sport.”; “An AED should be on site or retrievable for use within 3 minutes at all sport venues.”; “The EAP should be rehearsed (ie, hands-on, scenario-based practice) at least annually”; “it is critical that athletic programs not rely solely on health care team members to develop and execute the EAP.”.
9. International Paralympic Committee. Classification (IPC classification page). Checked October 23, 2026.
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   “Classification is sport specific.”; “Every International Federation must therefore develop and implement a Classification System that complies with the IPC Classification Code and the International Standards.”; “an athlete will be requested to provide Diagnostic Information about their health condition as part of the Classification process.”; “Athletes are evaluated by Classifiers, who work in a group called a Classification Panel. Classifiers have the relevant qualifications and competencies, are knowledgeable in their sport, and certified as officials by the International Federation who govern the sport.”; “International Classifiers are trained and certified by a sport’s International Federation in one specific impairment group”; “the following occupations are often found amongst the three impairment groups:”; “Physical Impairment: Medical doctors, physiotherapists, and experts in the sport and biomechanics.”; “you can contact your National Paralympic Committee (NPC) or National Federation as a first step.”.
10. Federal Trade Commission. Advertising FAQ’s: A Guide for Small Business (FTC business guidance). Checked October 23, 2026.
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    “Advertising must be truthful and non-deceptive;”; “Advertisers must have evidence to back up their claims;”; “In most cases, ads that make health or safety claims must be supported by "competent and reliable scientific evidence"”; “Statements from satisfied customers usually are not sufficient to support a health or safety claim or any other claim that requires objective evaluation.”.
11. Electronic Code of Federal Regulations. 16 CFR 255.2, Consumer endorsements (FTC Guides Concerning the Use of Endorsements and Testimonials in Advertising). Checked October 23, 2026.
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    “An advertisement containing an endorsement relating the experience of one or more consumers on a central or key attribute of the product will likely be interpreted as representing that the endorser’s experience is representative of what consumers will generally achieve with the advertised product in actual, albeit variable, conditions of use.”.
12. APTA Pediatrics (Academy of Pediatric Physical Therapy of the American Physical Therapy Association). Fitness, Wellness, Health Promotion, and Prevention: The Role and Scope of Pediatric Physical Therapy (fact sheet, 2012, PDF; Table 4, “Physical Therapists Roles in Adapted Sports Programs and Consultation in the Community”). Checked October 23, 2026.
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    “defines scope of practice to include a role in prevention, health promotion, wellness, fitness and screening activities.”; “Instruct community fitness providers on how to include children with disabilities in active recreation and sports programs.”; “Assist with the design, implementation and measurement of active recreation and sports programs for children with disabilities.”; “Measures may be summative evaluations of participation in programs (e.g., attendance records, information on adverse reactions or injuries).”; “program effectiveness for attaining identified goals and objectives on body structure and function, activity, or participation”.
13. Move United. Move United (home page). “Move United is the national leader in community adaptive sports.”. Checked October 23, 2026.
14. Move United. Our Mission & Impact (about page). “Mission: To provide national leadership and opportunities for individuals with disabilities to develop independence, confidence, and fitness through participation in community sports—from competition to recreation to education.”; “Move United is an official Affiliate of the U.S. Olympic & Paralympic Committee”. Checked October 23, 2026.
15. Move United. Adaptive Sports (sports page). “With over 70 sports offered, Move United supports sports sampling and encourages athletes to participate in a multiple sports until at least 12 years of age.”. Checked October 23, 2026.
16. Special Olympics. Sports (Special Olympics program page). “Special Olympics offers 30-plus Olympic-style individual and team sports that provide meaningful training and competition opportunities for persons with intellectual disabilities.”; “Special Olympics Young Athletes is an early childhood play program for children with and without intellectual disabilities, ages 2 to 7 years old.”. Checked October 23, 2026.
17. American Occupational Therapy Association. What is occupational therapy? (AOTA page). Checked October 23, 2026.
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    “Occupational therapy can help you participate in life activities (occupations) and provide recommendations for:”; “Activities of daily living (such as bathing, dressing, and eating)”; “Adaptive equipment (such as shower chairs, or equipment to make daily tasks easier)”; “Occupational therapy services may be provided in a client’s home, community settings (e.g., community centers, shelters, free clinics), hospitals, nursing homes, outpatient clinics, primary care offices, schools, and many other locations.”.
18. American Occupational Therapy Association. Occupations and everyday activities (AOTA practice page). “The broad range of occupations is categorized in the Occupational Therapy Practice Framework (OTPF-4) as activities of daily living, instrumental activities of daily living, health management, rest and sleep, education, work, play, leisure, and social participation.”. Checked October 23, 2026.
19. Electronic Code of Federal Regulations. 34 CFR 104.37, Nonacademic services (Section 504 regulations of the Department of Education, up to date as of October 22, 2026). Checked October 23, 2026.
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    “In providing physical education courses and athletics and similar aid, benefits, or services to any of its students, a recipient to which this subpart applies may not discriminate on the basis of handicap. A recipient that offers physical education courses or that operates or sponsors interscholastic, club, or intramural athletics shall provide to qualified handicapped students an equal opportunity for participation.”.
20. U.S. Department of Health and Human Services, Office for Civil Rights. Summary of the HIPAA Privacy Rule (content last reviewed March 14, 2025). Checked October 23, 2026.
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    “The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral.”; “A covered entity must obtain the individual’s written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.”; “A covered entity may not condition treatment, payment, enrollment, or benefits eligibility on an individual granting an authorization, except in limited circumstances.”.
21. Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial (BMJ 2008;337:a2469; DOI 10.1136/bmj.a2469; PMID 19066253; PMC2600961; abstract and open-access full text as indexed by Europe PMC). Checked October 23, 2026.
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    “In a recent randomised controlled trial, we examined the effect of a structured training programme ("The 11")”; “We found no difference in the injury risk between the intervention group and control group, though the study was limited by low compliance among the intervention teams.”; “The revised programme ("The 11+") included key exercises and additional exercises to provide variation and progression.”; “We conducted a randomised controlled trial to examine the effect of the revised programme on rates of lower extremity injury in young female footballers.”; “Cluster randomised controlled trial with clubs as the unit of randomisation.”; “125 football clubs from the south, east, and middle of Norway”; “1892 female players aged 13-17”; “During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).”; “Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced.”.
22. Rössler R, Junge A, Bizzini M, et al. A Multinational Cluster Randomised Controlled Trial to Assess the Efficacy of ‘11+ Kids’: A Warm-Up Programme to Prevent Injuries in Children’s Football (Sports Medicine 2018;48(6):1493–1504; DOI 10.1007/s40279-017-0834-8; PMID 29273936; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “Children’s football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited.”; “The intervention group replaced their usual warm-up by ’11+ Kids’, while the control group warmed up as usual.”; “In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years.”; “The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86).”; “Injury incidence decreased with increasing compliance.”; “The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.”.
23. Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis (British Journal of Sports Medicine 2015;49(13):865–870; DOI 10.1136/bjsports-2015-094639; PMID 26084526; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “Of 2504 potentially relevant studies, 25 were included.”; “Meta-analysis revealed a combined preventative effect of neuromuscular training in reducing the risk of lower extremity injury (incidence rate ratio: IRR=0.64 (95% CI 0.49 to 0.84)).”; “Though not statistically significant, the point estimate suggests a protective effect of such programmes in reducing the risk of knee injury (IRR=0.74 (95% CI 0.51 to 1.07)).”; “Lack of uptake and ongoing maintenance of such programmes is an ongoing concern.”.
24. Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs (Journal of Orthopaedic Research 2018;36(10):2696–2708; DOI 10.1002/jor.24043; PMID 29737024; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “Eight meta-analyses met eligibility criteria. Six of the eight only included data for female athletes.”; “shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes.”; “There is insufficient data to make conclusions as to the effectiveness of ACL injury prevention programs in male athletes.”.
25. Brenner JS, Watson A; American Academy of Pediatrics Council on Sports Medicine and Fitness. Overuse Injuries, Overtraining, and Burnout in Young Athletes (AAP clinical report, Pediatrics 2024;153(2):e2023065129; DOI 10.1542/peds.2023-065129; PMID 38247370; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences.”; “extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk”; “Burnout represents one of the primary reasons for attrition in youth sports.”.
26. Brenner JS; American Academy of Pediatrics Council on Sports Medicine and Fitness. Sports Specialization and Intensive Training in Young Athletes (AAP clinical report, Pediatrics 2016;138(3):e20162148; DOI 10.1542/peds.2016-2148; PMID 27573090; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “When sports specialization occurs too early, detrimental effects may occur, both physically and psychologically.”; “Young athletes who train intensively, whether specialized or not, can also be at risk of adverse effects on the mind and body.”.
27. Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern (British Journal of Sports Medicine 2016;50(14):853–864; DOI 10.1136/bjsports-2016-096278; PMID 27226389; abstract as indexed by Europe PMC). Checked October 23, 2026.
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    “Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way.”; “Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation.”; “Research evidence to support return to sport decisions in clinical practice is scarce.”.
28. American Physical Therapy Association. Code of Ethics for the Physical Therapy Profession (Standards of Conduct, PDF dated 2026). Checked October 23, 2026.
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    “Physical therapists and physical therapist assistants shall obtain ongoing informed consent after providing information that is understandable, honest, and necessary to allow the patient or client or their surrogate to make informed decisions about participation in physical therapist services or research.”; “Physical therapists and physical therapist assistants shall not exceed their professional, jurisdictional, and personal scopes of practice and shall communicate with, collaborate with, or refer to a peer or other health care professionals when necessary.”; “Physical therapists and physical therapist assistants shall provide information about their services that is truthful and accurate and shall not make misleading representations in any forms of communication, including billing.”; “Physical therapists shall ensure that patients and clients are informed of their financial obligations prior to incurring charges so that shared decision-making can be incorporated into the treatment plan.”; “Physical therapists shall ensure that all duties directed to other physical therapy personnel are congruent with the credentials, qualifications, competencies, and legal scope of practice or scope of work of the individual.”; “Physical therapist assistants shall provide physical therapist services under the direction and supervision of a physical therapist”.
29. Federation of State Boards of Physical Therapy. Model Practice Act (FSBPT regulatory resources page). “The legislative language presented in the Model Practice Act is provided to state legislatures and members of the Federation of State Boards of Physical Therapy as a resource; actual legislative language will vary from jurisdiction to jurisdiction.”. Checked October 23, 2026.
30. U.S. Department of Health and Human Services, Office for Civil Rights. Personal Representatives (HIPAA Privacy Rule guidance, content last reviewed January 5, 2024). Checked October 23, 2026.
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    “In most cases under the Rule, a parent, guardian, or other person acting in loco parentis (collectively, "parent") is the personal representative of the minor child and can exercise the minor’s rights with respect to protected health information, because the parent usually has the authority to make health care decisions about his or her minor child.”; “the Privacy Rule defers to State or other applicable laws that expressly address the ability of the parent to obtain health information about the minor child.”.
31. U.S. Department of Health and Human Services, Office for Civil Rights. Covered Entities and Business Associates (HIPAA guidance, content last reviewed August 21, 2024). Checked October 23, 2026.
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    “...but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard.”; “If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.”.
32. Centers for Medicare & Medicaid Services. What is a good faith estimate? (No Surprises Act consumer guide, page last modified October 5, 2026). Checked October 23, 2026.
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    “Usually, if you aren’t using health insurance to pay for your care, your health care provider must give you a good faith estimate of expected charges if you request one or schedule services at least 3 business days in advance.”.
33. National Athletic Trainers’ Association. Athletic Training (NATA page). Checked October 23, 2026.
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    “Athletic trainers (ATs) are highly qualified, multi-skilled health care professionals who render service or treatment, under the direction of or in collaboration with a physician, in accordance with their education, training and the state’s statutes, rules and regulations.”; “services provided by athletic trainers include primary care, injury and illness prevention, wellness promotion and education, emergent care, examination and clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.”; “Athletic trainers are sometimes confused with personal trainers.”; “Athletic trainers are licensed or otherwise regulated in 50 states and the District of Columbia.”.
34. American Board of Physical Therapy Specialties (APTA Specialist Certification). Become a Board-Certified Sports Specialist in Physical Therapy (ABPTS page). Checked October 23, 2026.
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    “If you are board certified in sports physical therapy, you are permitted to practice only within the scope of your state physical therapy practice act. Board certification does not grant you any additional rights or privileges.”; “The state practice act dictates who is permitted to provide services at athletic venues, based on the state of licensure and the physical location of the venue.”; “you may be required to have additional certification as an emergency medical responder or certified athletic trainer.”.
35. National Strength and Conditioning Association. CSCS Certification: Certified Strength & Conditioning Specialist (NSCA certification page). Checked October 23, 2026.
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    “As a Certified Strength & Conditioning Specialist, you can work across diverse training environments, from educational institutions and professional teams to tactical, healthcare, or private sector facilities.”; “your emphasis centers on driving outcomes, reducing injury risk, and collaborating with the broader performance team.”.
36. American Board of Physical Therapy Specialties (APTA Specialist Certification). Become a Board-Certified Pediatric Specialist in Physical Therapy (ABPTS page). “The pediatric specialty area within the physical therapy profession includes treatment of traumatic, developmental, and systemic disorders that relate specifically to children.”; “As of July 2026, ABPTS has certified 3,219 pediatric specialists.”. Checked October 23, 2026.
37. Electronic Code of Federal Regulations. 45 CFR 149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals (regulation). Checked October 23, 2026.
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    “A convening provider or convening facility may issue a single good faith estimate for recurring primary items or services”; “the expected scope of the recurring primary items or services (such as timeframes, frequency, and total number of recurring items or services)”; “The scope of a good faith estimate for recurring primary items or services must not exceed 12 months.”.
38. American Physical Therapy Association. Levels of Patient Access to Physical Therapists Services in the U.S. (direct access by state, data current as of July 2025). “While all 50 states, the District of Columbia and the U.S. Virgin Islands, provide some form of direct access to physical therapist services, the specific provisions and limitations differ across jurisdictions.”. Checked October 23, 2026.
39. American Physical Therapy Association, ChoosePT. Physician Referral Not Needed: You Can See a Physical Therapist First (consumer page). “Certain insurance plans may still require a referral. Some states may limit the duration or type of treatment that can be provided without one.”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. Its worked example is hypothetical; state practice acts, payer policies, each sport’s own rules and the practice’s insurer govern what a program may offer.