I wrote this piece in response to some discourse I was tagged in around OTâs role in sports medicine and supporting high performance athletes.
The reflection is specifically in response to this three-part LinkedIn series:
Part 1: What OT Adds to Sports MedicineRead the original post on LinkedIn
Part 2: Collaboration and Professional RolesRead the original post on LinkedIn
Part 3: Advocacy, Scope, and the FutureRead the original post on LinkedIn
Much of the discourse in the comments was centered on concerns of overlap with athletic trainers and presumptions that what OT is offering would be essentially duplicative and disrespectful to more traditionally prominent members of the sports medicine ecosystem.
I had to modify my response on LinkedIn to match their character limit, so I thought I would publish the full response here. It covers content that feels relevant to much of the endless discourse that is largely driven by shorthand misinformation, presumptions, and various insecurities that get stirred when our focus is on eliminating rather than expanding possibilities for care and innovation.
Why occupational science literacy matters
A big part of why I am a proponent of increased occupational science literacy for OTPs worldwide is to encourage us to use our own distinct lens and concepts when communicating about the innovations, roots, and foundations of our practice so we can get out of this trap of being reduced to limited paradigms and understandings of other professions in bad faith.
First, we tend to be undermined for possibly not having the same competencies as another discipline or profession. Then, when we reveal that we do have the same competencies, or we catch up, we are framed as essentially duplicative or redundant and not unique.
This is why communicating about our identity and skills from our own foundations and core terminology, including our cosmological, philosophical, epistemic, and emerging practice developments, on our own terms, alongside the formal policy developments that have shaped our practice from the beginning, is so important.
Especially if we do so with pride in our unique integrative foundations rather than shame or presumed incompetence, very often this pattern is deeply rooted in the internalization of structural sexism and misogyny as it relates to female-dominated health care professions and integrated care approaches overall.
OTPs need to start recognizing that when we are met with such suspicion and accusation, it can actually be a sign of our strength and competence as a threat rather than a sign of our own incompetence or need to prove or defend ourselves where we typically already currently belong.
We keep de-skilling each other
Itâs so interesting how often in this type of discourse we default to pigeonholing and limiting all skilled providers to the bare minimum of responsibilities in institutional settings.
For example, often between OT and PT the discourse can reduce both professions down to upper extremity versus lower extremity, even though we all know both disciplines in the real world are full-body therapists.
With the discourse around athletic trainers, it seems like weâre reducing all professions to the most basic elements of those responsibilities, rather than exploring nuanced conversations about strengths, weaknesses, opportunities, gaps, and intersections that could lead to more comprehensive care.
Unlike competitive athletics, health and human services are not competitive sports.
When providers compete, our clients are always the ones who lose out on comprehensive care.
I also think this pattern of discourse has consequences beyond any single profession. When we continually reduce skilled professions to their bare foundations and then treat overlap at that level as evidence of duplication, we can inadvertently create conditions that discourage innovation and advancement across health and human services.
The bare foundations are the floor of professional capacity, not necessarily the ceiling.
If we treat the floor as the ceiling, then every advancement into an emerging specialty, every new application of foundational knowledge, and every development in professional reasoning has to first defend itself against the existence of something another profession already does.
That creates a very different condition for professional development than asking what becomes possible when skilled professionals build beyond their foundations.
Overlap is not duplication
Overlap between providers is not new and never has been new. Itâs actually essential to communication and efficiency for there to be essential overlap.
One profession having a specific body area or modality in their scope does not mean that it is somehow unlawful or an automatic restriction or duplication for another provider to be skilled and competent in those areas. It simply means more than one profession has core competencies to perform a specific function.
It means there are options rather than a basis for exclusion.
For example, just about everyone in the hospital performs vitals, and we want it that way, to optimize saving everyoneâs lives.
The issue, then, is not simply whether competencies overlap. The more important question is what happens beyond those foundations.
Nearly every skilled profession has foundational competencies that overlap with other professions. Those foundations establish what a profession is capable of doing. They do not necessarily define everything that profession can become.
The floor is not the ceiling.
This is also why I think it is important to distinguish overlapping competencies from professional identity.
AOTAâs scope statement describes OT as a dynamic and evolving profession responsive to consumer and societal needs, system changes, and emerging knowledge and research. Its scope is organized around the domain and process of occupational therapy rather than around a single body region or a fixed list of procedures.
Professional differentiation can therefore exist even when foundational services overlap.
It can emerge through what a profession has developed beyond the foundation: its theories, epistemics, cosmology, professional reasoning, specialized knowledge, emerging practices, methods, populations, contexts, and approaches to delivering services.
It can also emerge through the way even some of the same foundational services are understood and integrated into a personâs actual occupational life.
Two professionals may provide something that looks similar on the surface while asking very different questions about the person, their environment, their goals, their occupations, their identity, their routines, and what meaningful participation looks like to them.
That is not necessarily duplication.
That is professional differentiation.
And those differences can be meaningful to clients.
A client may choose between qualified providers not simply because one profession possesses an activity that another profession is forbidden or unable to perform, but because of the way a practitioner understands their needs, the populations or contexts they specialize in, how they approach collaboration, how they conceptualize their goals, and how their services fit with the clientâs preferences and priorities.
Our clients are not choosing between completely separate universes of intervention.
They are choosing people, approaches, relationships, areas of expertise, and ways of understanding and responding to their needs.
The more generative question is therefore not simply whether another profession can perform the same foundational task.
It is what each profession has developed beyond the foundation and how that development creates additional possibilities for care.
OT has always been more than hands
Much of what distinguishes occupational therapy exists in what is often regarded as largely unseen realms in physical medicine. Our internal, subjective experiences of navigating changes in body, mind, spirit, and environment are rarely fully appreciated through physical medicine methodologies alone.
Occupational therapy emerged through the moral treatment and arts and crafts movements, advancing the right to engage in self-directed activity as restorative to body, mind, and spirit, and as foundational to human rights-affirming living for people wherever they live, work, and play.
Occupational therapy is the belief that engagement in self-directed, integrative activity can regenerate health, integrating body, mind, spirit, and especially hands, but never reducing occupation simply to hands, because every occupation requires a full body to execute.
This is where Elizabeth J. Yerxaâs work on occupational science becomes especially relevant.
In her 2000 article, Occupational Science: A Renaissance of Service to Humankind Through Knowledge, Yerxa argued that occupational science could help occupational therapy develop and define its own knowledge base and scope through scholarship. She centered the human as an occupational being whose relationship with occupation unfolds across development, environment, culture, learning, and agency.
That matters because our foundations are not simply historical ideas to preserve. They give us a way of knowing and reasoning that can continue to generate new possibilities for practice.
That is also why I am excited that our September Evolved Living Collaborative Journal Club is returning to Yerxaâs article. More than 25 years later, her questions give us an opportunity to consider what occupational science can still contribute to how we understand occupation, knowledge, and the future of occupational therapy.
Those foundations are still relevant, but they are also a starting point for what comes next.
đ September Journal Club
Saturday, September 26 at 1:00 PM Pacific
Our first Journal Club was moved from August to September so we could give ourselves more time to read and engage with the article.
This month we are returning to Elizabeth J. Yerxaâs 2000 article, Occupational Science: A Renaissance of Service to Humankind Through Knowledge.
Article Freely Available Here
More than 25 years later, Yerxaâs questions still give us plenty to think about. We will explore the emergence of occupational science, its relationship with occupational therapy, and what kinds of knowledge about occupation might continue to serve humanity.
Inside the Collaborative, you will find an article summary, reflective prompts, and additional resources to help you engage with the reading. You do not have to read every word of the original article to participate.
The Journal Club will be recorded for anyone who cannot attend live.
Join Evolved Living Collaborative Here
What could OT offer a high-performance athlete?
With any client receiving occupational therapy services, which could include a high performance athlete, our services are determined by their unique occupational profile and disruptions.
We receive the referral, either from a medical provider or, if not medically related, it could be pursued through a coaching model by a client themselves.
We develop an occupational profile looking at activities, engagement, and development at different stages of life.
Iâve characterized this as a personâs Pokemon card that looks at the ways in which occupational balance is experienced throughout days, weeks, months, years, and how routines can be optimized and adapted to accommodate different injuries and precautions, while still being able to have quality meaningful access and participation in oneâs daily and weekly routine.
This includes not just oneâs role as a high performance sport athlete, but also as a mother, father, student.
This is very consistent with the professionâs own contemporary description of practice. OTPF-4 defines occupational therapy as the therapeutic use of everyday life occupations with persons, groups, or populations to enhance or enable participation, emphasizing the transactional relationship among the client, their engagement in occupations, and context (AOTA, 2020).
And there is now emerging literature specifically supporting this way of thinking about athletes. A 2025 scoping review of occupational therapy in athletics and sports identified OT contributions across physical, emotional, and social rehabilitation, participation, recovery, performance, quality of life, and psychosocial well-being. The authors explicitly describe sport as a meaningful occupation associated with identity, mastery, and well-being (Bulan et al., 2025).
One of my colleagues is currently providing occupational therapy supports for neurodivergent medical students. In that work, theyâre looking at how to adapt and relate to assignments and routine organization that is specific to accommodate neurodivergent medical students, which could be analogous to high performance athletes.
I think the important point here is not that medical students and high performance athletes are interchangeable populations. It is that occupational therapy can look at how the demands of a personâs particular role interact with their cognitive, physical, emotional, environmental, and occupational needs.
That kind of occupational lens is relevant to high performance athletes because the role of the athlete is not simply the performance of a physical skill.
It exists within a network of routines, relationships, environments, expectations, recovery demands, identity, education or employment, family roles, sleep, leisure, and other occupations.
And we have direct research demonstrating why this broader occupational lens matters in sports. Douglas et al. (2024) found that high school athletes recovering from concussion experienced disruptions not only in sport, but also in ADLs, school performance, sleep, mental health, driving, social participation, and identity. The authors concluded that occupational therapists can assist with individualized treatment plans supporting athletesâ return to meaningful occupations.
The point is not that OT has to invent a completely different physical activity every time we work with someone.
The distinction may be in what we are trying to understand, what we are trying to support, how we are reasoning about the personâs occupations and context, and how we integrate foundational services into the larger occupational life of the client.
Tim Dionneâs work offers a useful example of this kind of occupationally grounded thinking. In The Neuroscience of Everyday Life: An Applied Guide for Health Sciences Students, Dionne contributed a chapter on ADHD and task completion that uses an everyday activity as the context for understanding how neurological differences affect participation. The book as a whole is explicitly organized around connecting neuroscience with peopleâs everyday activities and participation (Dionne, 2025).
Tim also writes What Counts, where he shares contemporary OT perspectives and applied reflections.
That kind of occupational lens is relevant to high performance athletes as well. The role of the athlete is not simply the performance of a physical skill. It exists within a network of routines, relationships, environments, expectations, recovery demands, identity, education or employment, family roles, sleep, leisure, and other occupations.
The distinct psychology of a high performance athlete and the requirements of their role, similar to the role that occupational therapists play in the high-performance athletics of our military, focus on optimizing sleep routines and creating customized habits and life hacks that are particular to those soldiers and their various nuanced roles.
Firefighters offer another example
I have seen this same occupational science-informed approach emerge in work with another population whose demands can be remarkably analogous to those of high performance athletes: municipal firefighters.
In 2023, I was involved in developing a capstone direction connected with the University of Washington that asked occupational therapy students to engage with community stakeholders and regional fire departments through an individual, micro, and mezzo lens informed by occupational science.
The purpose was not simply to identify biomechanical injuries and then develop biomechanical interventions for the individual firefighter.
The larger question was how occupational therapy could support wellness, recovery, and burnout prevention by examining the occupational ecology in which firefighting actually occurs.
A firefighterâs performance does not happen in isolation from the fire station, shift structure, staffing patterns, routines, physical spaces, social culture, recovery opportunities, sleep, or the way activities are organized throughout a shift.
A purely impairment-centered approach might identify the shoulder, back, knee, or other biomechanical problem affecting role performance and then treat the injured body part.
An occupational science-informed approach can ask a different set of questions:
What is happening in the environment that is contributing to this occupational disruption in the first place?
How are activities being organized?
What routines are making recovery easier or harder?
How are the physical spaces of the fire station supporting or constraining wellness occupations?
Where are there opportunities to reorganize activity, routines, environmental affordances, and social supports before an injury or burnout becomes an individual clinical problem?
This is where the individual, micro, and mezzo levels become particularly important. Instead of isolating services to the individual and their biomechanical impairments and client factors, OT can also examine the organization of occupations within the team, the fire station, and the broader work environment.
The University of Washingtonâs 2024 MOT capstone project, Sleep, Stress, and Shift Work: An Occupational Therapistâs Investigation into Firefighter Wellbeing and Culture, provides a concrete example of this emerging approach. The student team examined environmental, social, personal, and physical factors affecting firefightersâ occupational lives and identified intervention opportunities at individual, meso, and systemic levels. Their work included literature and media review, key informant interviews, six firefighter interviews, and two fire station visits. I was one of the community mentors for the project.
This is exactly the kind of work I mean when I talk about occupational science creating possibilities for OT that cannot be reduced to biomechanical treatment.
The project did not begin with the assumption that a standardized intervention already existed and simply needed to be delivered to firefighters. It engaged firefighters and community stakeholders in understanding the occupational ecology of their work and identifying where wellness and participation could be supported.
And importantly, this does not mean OT needs to become the profession that treats every physical injury a firefighter experiences.
A firefighter with a biomechanical injury may appropriately benefit from physical therapy, medicine, athletic training, occupational therapy, or other specialized services.
The occupational therapy contribution can be understanding what that injury means within the personâs occupational life and what changes to routines, environments, roles, habits, recovery opportunities, and participation might support the person and the larger system.
Occupational therapyâs involvement in this population is still an emerging area. We do not necessarily need to wait five decades for a fully mature literature base before occupational therapists are allowed to recognize an emerging occupational need and begin responsibly developing, evaluating, and refining services.
We do need to distinguish between claiming that an intervention has been proven effective and responsibly engaging in program development, community-based inquiry, practice-based learning, and evaluation.
Those are not the same claim.
Occupational science gives us tools for asking questions about occupations in context while bodies of evidence are still developing.
We can begin with the occupation.
We can listen to the people who live it.
We can examine the environment in which it occurs.
We can identify disruptions and opportunities across individual, micro, mezzo, and macro levels.
We can collaborate with the professions that have complementary expertise.
And we can develop and evaluate responsive interventions without pretending that a standardized protocol from another population is automatically the best answer.
This is another example of what occupational science-informed OT can provide that is genuinely different from simply developing another biomechanical intervention for another biomechanical impairment.
And importantly, the differentiation does not depend on claiming that no other profession can address sleep, wellness, injury, performance, environment, or routines.
The differentiation can emerge from how OT brings these pieces together through its own occupational foundations, epistemics, professional reasoning, and developing practice.
That is what advancement can look like.
We do not need to define each other
I donât think any of us that are specialized clinicians are in a good position to accurately reflect at a high level any other credential that is not our own, to be able to say exactly what the precise differences are between different providers.
It is much more refined when we get to know each other and those who seek to be of support to these populations, to get to know each other as individuals and our individual zones of expertise and excellence.
We need to move beyond a scarcity mindset and allow all professions to advance beyond the bare minimum stereotypes or distinctions, because our clients benefit from access to as many choices as possible, as well as autonomy and agency in how they develop their personal care team.
Itâs not up to us to police or limit the progression of other providers.
Itâs on us to show up to the call and advance and innovate into new terrain that has not yet been touched.
I think this is also where our professional discourse can either facilitate or constrain advancement.
If every new contribution has to first establish that it is completely separate from every existing contribution, we create a system where overlap becomes something to eliminate rather than something to build from.
That is not how most skilled professions actually develop.
Advancement often happens at the intersections.
A profession develops new knowledge, new applications, new specialties, new methods, and new ways of delivering services from a foundation that may already overlap with other professions.
The existence of shared foundations can actually make interdisciplinary advancement possible.
The goal should therefore not be to eliminate overlap.
It should be to understand it well enough that we can recognize where our foundations intersect, where our professional developments differentiate, and where collaboration creates something none of us could provide alone.
Weâre not going to evolve into the future by constantly reproducing conditions of the past or blocking the developments of other providers, as has been the history of the United States healthcare system, which Iâve outlined in a workshop on the text Witches, Midwives, and Nurses in my online learning community.
Who gets to choose?
Itâs really not up to any of us as allied providers who our clients choose to work with.
Itâs up to our clients.
I think we will have much more productive discourse if we take on good faith learning from advanced clinicians and the clients that receive their services about how they can complement and enhance care rather than only seeing fear of duplication.
This does not mean that every provider should do everything, or that professional boundaries and legal scope do not matter. They do. AOTA explicitly notes that state law defines the scope of practice for OTs and OTAs and that practitioners must comply with applicable statutes and regulations.
The point is that professional boundaries are not the same thing as rigidly assigning every competency to only one profession.
Multidisciplinary care can contain overlapping knowledge and skills while still retaining meaningful differences in professional education, philosophy, reasoning, and purpose.
The existence of overlap is therefore not, by itself, evidence of duplication.
And this matters for client autonomy.
If multiple qualified professionals can provide a foundational service, that does not mean the client has no meaningful basis for choosing among them.
Their choice may be shaped by the practitionerâs specialization, professional lens, theoretical orientation, communication, relationship, experience with a particular population, approach to care, or ability to connect the service to the occupations and environments that matter most to them.
Sometimes the foundational service may even look similar.
The experience of receiving that service, the reasoning behind it, what it is connected to, and what the practitioner sees as possible beyond it may be very different.
That difference can be meaningful.
And clients should have room to decide which approach is most consistent with their own preferences, priorities, and goals.
Why I keep coming back to Occupational Science
A big part of why I am a proponent of increased occupational science literacy for OTPs worldwide is because I believe we need to be able to communicate about our identity, skills, innovations, and possibilities from our own foundations.
If we only communicate about OT through the language and boundaries of other professions, we will continue getting caught in the same cycle.
We need to be able to articulate what occupational therapy brings to the table without first having to prove that we can do something another profession already does.
And we need to be able to recognize that overlap does not erase distinction.
Occupational science can help us better understand what exists beyond the foundational floor.
It gives us language to examine occupation not only as something we intervene in clinically, but as a field of inquiry involving human experience, meaning, identity, participation, environment, culture, systems, and the conditions that enable or constrain what people are able to do and become.
That matters because the future of professional practice cannot be built only by repeating the foundational services that already exist.
We need professions capable of developing.
We need practitioners capable of thinking beyond inherited categories.
We need epistemic flexibility that allows us to recognize knowledge emerging from practice, communities, lived experience, interdisciplinary collaboration, scholarship, and places that established systems may not yet have fully recognized.
And we need professional discourse that makes room for that development rather than treating every new possibility as a threat to someone elseâs territory.
Our clients are not territory.
Our professions do not have to be in competition for one profession to advance.
We can have different areas of expertise, overlapping competencies, distinct lenses, and collaborative relationships at the same time.
We can provide some of the same foundational services while developing very different ways of understanding and applying them.
We can develop emerging practices without pretending that the foundational professions that came before us have become irrelevant.
And we can allow clients to choose among qualified providers based on what is meaningful to them.
That is a much more interesting future to me than continually arguing about who is allowed to do what.
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Continue the conversation
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This is where I am making room for the longer conversations that do not fit inside a LinkedIn character limit, including conversations about Occupational Science, OT history, professional identity, policy, scope, interdisciplinary collaboration, and emerging practice.
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There are an abundance of free OS 101 resources and opportunities to engage through craft nights, journal club, daily discussion, and ongoing conversations about how we can expand our understanding and application of occupational therapy.
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I hope this longer version gives us more room to move beyond shorthand definitions, professional insecurity, and scarcity toward more nuanced conversations about what becomes possible when we allow skilled providers to develop, collaborate, specialize, and innovate.
References
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. doi:10.5014/ajot.2020.74S2001.
American Occupational Therapy Association. (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410020. doi:10.5014/ajot.2021.75S3005.
Bulan, P. M. P., Villalino, C. K., Gutierrez, M. S. Y., & Evardo, M. K. S. (2025). Occupational therapy in athletics and sports: A scoping review. American Journal of Occupational Therapy, 79(6), 7906205020. doi:10.5014/ajot.2025.051180.
Dionne, T. (2025). Peter wants to build a playhouse for his siblings and has ADHD: Neuroscience facilitates our understanding of task completion. In W. Dunn, T. J. Wolf, L. G. Richards, & D. M. Nilsen (Eds.), The neuroscience of everyday life: An applied guide for health sciences students. Routledge.
Dionne, T. (n.d.). What Counts. Substack.
Douglas, R., McConnell, C., Abbott, A., Bare, G., Cleave, S., Crum, T., Kirkpatrick, M. A., & Kuenzli, M. (2024). Occupational therapyâs role in return to occupations post-concussion in high school athletes. Physical & Occupational Therapy in Pediatrics, 44(4), 542â553. doi:10.1080/01942638.2023.2299033.
Kielhofner, G. (1982). A heritage of activity: Development of theory. American Journal of Occupational Therapy, 36(11), 723â730. doi:10.5014/ajot.36.11.723.
Neal, A. E. (2026). Addressing sleep health in the fire service: A sleep hygiene education program. University of Nevada, Las Vegas.
Oh, H.-J., Sim, C. S., Jang, T.-W., Ahn, Y. S., & Jeong, K. S. (2022). Association between sleep quality and type of shift work in Korean firefighters. Annals of Occupational and Environmental Medicine, 34, e27. doi:10.35371/aoem.2022.34.e27.
Schemm, R. L. (1994). Bridging conflicting ideologies: The origins of American and British occupational therapy. American Journal of Occupational Therapy, 48(11), 1082â1088. doi:10.5014/ajot.48.11.1082.
University of Washington Division of Occupational Therapy. (2024). Sleep, stress, and shift work: An occupational therapistâs investigation into firefighter wellbeing and culture [Graduate capstone poster].
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