Athlete Profiling: The Interview as Your First Screening Tool

Before you touch, before you test, before you load – you ask. The interview is not small talk. It is a critical first step that shapes every decision that follows.

Introduction: Why the Interview Is the Critical First Step

Athlete screening, as established in the previous article, is a multi-layered process. It begins with the interview, which provides the first layer of understanding about the athlete — before any observation, structural testing, or movement analysis takes place.

Before going further, a short example from my personal experience: about 10 years ago, I worked as a strength and conditioning coach with women’s basketball team “Dynamo” Kursk — one of the two highest-budget clubs in women’s basketball at the time — composed of top WNBA and national team players, yet knee injuries were a constant issue, with multiple athletes returning from ACL reconstruction and several with meniscus problems. The moment I took over that season, it was clear there was no room for error — player contracts were worth hundreds of thousands, often over a million dollars, meaning every injury carried major financial consequences for the club and, realistically, for my position as well. In that context, due to the existing injury profile and limited margin for mistakes, the screening and evaluation process effectively started before any physical testing — through structured interviews and questionnaires, which helped identify patterns in pain, swelling, instability, and load tolerance that would not be visible in a single testing session, and allowed more precise direction of both assessment and training periodization. That season, we won the Women’s EuroLeague undefeated — but more importantly, without a single injury, saving the club over 1.5 million dollars compared to the previous season. The takeaway is simple: a well-conducted interview is not a formality — it’s a performance and risk-management tool.

The interview captures what no test can directly measure: subjective experience, symptom behavior, and the athlete’s interaction with training load over time. It provides insight into the athlete’s internal perception and symptom awareness, as well as the specific situations they identify as problematic, often beyond what can be captured during testing.

Despite this, the interview is often underestimated or reduced to small talk or random questions that touch on individual issues without building a complete picture. A properly conducted interview, however, is a structured, purpose-driven process that extracts meaningful information, establishes context for interpretation, and forms the foundation for all subsequent assessment and decision-making.

In the context of injury prevention and performance, this is essential. It allows the practitioner to identify patterns related to pain, swelling, instability, and load tolerance — factors that are often invisible during a single testing session, yet critically important for decision-making.

In the previous article, we established that knee screening is risk mapping, not clearance. The interview plays an &nbsp essential starting role in that process, because it provides answers to questions that cannot be reliably obtained through physical testing alone. Neither ligament stability tests nor functional performance assessments can fully capture how the knee behaves across different contexts — during training, after repeated loading, or in specific sport situations.

Interview is particularly relevant in cases of subclinical injury. In athletic populations, partial anterior cruciate ligament (ACL) injuries may not always be detected through standard clinical tests, and these tests can basically be negative even when the injury exists, especially when performed by practitioners without extensive experience. As a result, structural compromise may exist despite apparently normal findings. Evidence suggests that the sensitivity of these tests can be reduced in partial tears and is highly dependent on examiner experience and patient presentation (Benjaminse et al., 2006; van Eck et al., 2013).

The interview helps bridge this gap. Athletes can report sensations and patterns that are otherwise difficult to detect — such as pain occurring only during deceleration or landing, a feeling of “giving way” in specific cutting movements, or swelling that develops hours after training rather than being present during evaluation. An athlete may present with no visible swelling at the time of assessment, yet consistently report post-training effusion, indicating a load tolerance issue that would be missed without proper questioning.

For these reasons, the interview is not a preliminary formality, but a structured and essential component of knee screening. It provides context to all subsequent findings, reduces the risk of misinterpretation, and allows for more precise and individualized decision-making in both training and injury prevention. At the time of writing, I am also in talks with one of the basketball national teams regarding a potential role as Head of Physical Preparation and Rehabilitation for the upcoming European Basketball Championship. In such high-performance environments, time constraints often dictate the assessment strategy — ideally, individual interviews would be conducted with each athlete, but when time is limited, structured questionnaires may serve as an initial filter. This creates a practical dilemma: which approach should be prioritized when both time and precision matter?

In the following sections, I address this directly — outlining why I prefer one over the other, while also presenting the advantages and limitations of both approaches. Additionally, the aim of this article is to provide coaches and physiotherapists with highly practical, immediately applicable guidelines — including structured tables and frameworks that can be directly implemented in everyday practice.

Athlete Screening: Four Core Roles of the Structured Interview

For the strength and conditioning professional, the structured interview serves four non-negotiable functions:

Safety (Red Flag identification) – Detecting conditions that require medical referral before any loading occurs.

Examples:

• Athlete reports knee swelling after an injury, either developing rapidly within a few hours or gradually over the next 24–48 hours (even if swelling is not present at the time of assessment) → suspicion of intra-articular damage such as ACL rupture or meniscal injury → medical referral required before loading.
• Athlete describes true locking (inability to fully extend or flex the knee at any point after injury) → possible meniscal tear → immediate referral
• Athlete reports instability during basic daily activities (walking, stairs), not just during sport-specific movements → potential ligament insufficiency → do not load, refer
• Athlete reports recurrent swelling that appears after training sessions, even if the knee looks normal during assessment → possible intra-articular irritation or reduced load tolerance → requires further evaluation before progressing load

Load prescription – Understanding what aggravates and what alleviates symptoms to design intelligent periodization.

Examples:

• Pain occurs only during high-speed deceleration or cutting → reduce change-of-direction volume and introduce progressive deceleration drills
• Athlete reports pain during eccentric loading (landing, squatting) → modify intensity and implement controlled eccentric progression
• Athlete reports symptoms after consecutive training days → adjust frequency and introduce recovery spacing
• Pain-free during training but symptoms appear several hours later → indicates load accumulation issue → modify total weekly load

Baseline establishment – Creating a subjective reference against which future changes (improvement or deterioration) are measured.

Examples:

• Athlete reports pain 6/10 after training, no pain at rest → used as baseline for tracking progress
• Reports occasional giving-way during cutting (1–2 times per week) → monitor reduction over time
• Morning stiffness lasting 10–15 minutes → track as indicator of joint response to load
• Swelling appears after high-intensity sessions only → baseline for load tolerance capacity

Legal and professional protection – Documented evidence that you conducted a thorough pre-participation evaluation.Examples:

• Documented history of previous knee injury or surgery (ACL, meniscus, cartilage, collateral ligaments) with incomplete rehabilitation → justifies modified training approach
• Recorded presence of red flag symptoms prior to training → protects practitioner if referral is advised
• Written baseline of existing pain, swelling, giving-way, or instability → differentiates new injury from pre-existing condition
• Documentation of athlete-reported symptoms and recommendations given → supports professional accountability

Part 1: The Five-Domain Interview Structure

Domain I – Training Load and Exposure Context

Why this matters before asking about pain:Load is neither good nor bad. Load relative to tissue capacity determines adaptation versus injury. Without understanding exposure, you cannot interpret symptoms.

Essential Questions:

• “Describe your typical training week – sessions, duration, and type (strength, plyometric, technical, conditioning).”
• “What changed in the last 7–10 days? Volume? Intensity? Surface? Footwear?”
• “How many consecutive days of training have you completed before today?”
• “Have you traveled across time zones in the past two weeks?”

Clinical Reasoning:

Red Flag: Athlete reports inability to complete previously manageable sessions without severe fatigue or pain → consider relative energy deficiency (RED-S) or overtraining syndrome → medical referral.

Domain II – Pain Characterization (Structured Assessment Algorithm)

Why this matters:Pain location, timing, and behavior are diagnostic. Anterior knee pain with loading differs pathophysiologically from medial joint line pain with rotation.

Essential Questions (Branching Logic):

• “Do you have knee pain?”
  • No → proceed to Domain III
  • Yes → continue

• “Where exactly? Point with one finger.”
  • Anterior (patellar region)
  • Medial (joint line or MCL)
  • Lateral (joint line or LCL)
  • Posterior (popliteal fossa)
  • Diffuse / cannot localize

• “When does it occur?”
  • Only during specific activities (jumping, cutting, squatting)
  • After training (delayed onset)
  • During daily activities (stairs, walking)
  • At rest or night

• “What does it feel like?”
  • Sharp / stabbing
  • Dull ache
  • Burning
  • Grinding / crepitus with or without pain

Red Flag Decision Tree: