Why Do We Fear More As We Grow Older

I am writing this blog having just watched my 20 month old son Blake repeatedly run head first into the kitchen cupboards over and over again!!!

I'm watching him thinking...

1. What are you doing?
2. Doesn't that hurt?
3. If it does hurt WHY do you keep doing it?

To be fair it doesn't seem to bother him. He actually finds it quite humorous and will often laugh and giggle following his kamikaze style feats.

The same is said when he jumps of the sofa or throws himself around head first on his bouncy castle we have in the garden (weather permitting!!)

All that aside it got me thinking as to WHY he doesn't fear the above.

Also I started to think about myself and my friends/family and asked the question;

WHY is as we get older we FEAR more?

Why is it the thought of doing a bungee jump or sky-dive is so much more daunting in our 30's or 40's than it would of been in our late teens & 20's?

Whilst I don't really have a definitive answer for the above questions I think it does throw up some interesting thoughts and in turn I think we can learn a lot about FEAR setting and the impact it has on our intentions.

MOST OF THE THINGS WE WANT TO DO, BUT DON'T DO, ARE THE RESULT FEAR SETTING

Be that a job you didn't go for because it 'wasn't the right time' or because 'you wouldn't of got it anyways' or the reason you decided NOT to run a 10k race or get in better shape.

Above all else we are usually afraid of failure. The uncertainty of not being successful can be fearful and that is why most of will choose unhappiness over uncertainty.

Why push the boat out to do something when there's a chance it'll fail anyways?

This fear setting can be extremely dangerous and stifle us in our progressions, whether those are academic, professional or anything else for that matter.

The biggest problem with fear setting is that it stops us taking action.

Too often we stop to think, weight up or options and talk ourselves into NOT doing something.

Usually the the uncertainty of what may or may not happen is too big and we are reluctant to take action.

Fear setting itself is a process we however can use to our advantage. 

Ill talk about HOW to use Fear Setting in my next blog, but, in the meantime I'm going to try be more like my son Blake.

Whilst I'm going to stop short of running into the kitchen cupboards and jumping of the sofa head first I'm going to make a conscious effort to sometimes take action first then worry about the consequences afterwards.

It'd also be great to hear about your stories and experiences with fear setting.

In the past have you NOT pursued something you would like to do because of fear?

Has fear setting prevented you progressing in your career or elsewhere in your life?

Let me know andy@rehabroom.co.uk

Thanks for reading 

AB

Is the Setting Of Therapy Affecting Our Results?

One big factor that can be important to consider when we want to make improvements with the athletes and clients we work with is WHERE they do this work.

For me, an example just last week brought this to light.

For the last weeks I have been working with an elite rugby player who had been struggling with some pubic overload symptoms.

As part of his intervention his rehab included a combination of some positioning, breathing and isometric exercises. This went alongside his other training modifications and loading management plan.  

We made some fantastic improvements, and progressed accordingly over the next couple of days, during which time he missed no training or games.

We got through our last game with no issues.

So all good?

Not quite………….

Following this game the players were given a few days off as we had no fixture the following week.

I spoke to the player before this break and instructed him to complete some of the above exercises during his time away.

But when he came back in he was AWFUL!!!

His symptoms had worsened even though he hadn’t done anything.

You’d have thought he had played a game the night before not just had 4 days off!!!

My initial thought was ‘Has he been doing what I told him?’

However, when questioned the player was adamant he had continued with his home exercise programme and having a good relationship and trust with this athlete I genuinely believed him.

We ran through the same exercises in my treatment room and we were able to clear his symptoms pretty quickly.

So nothing too major.

On the face of it, not really.

But, this got me thinking.

Why was it that he came back worse? Even when he had been doing his exercises…..

     o   Was he doing them wrong?

     o   Was he doing something else (activity, training etc) that might have contributed to his symptoms getting worse?

     o   Was he lying to me and had not done his exercises at all?

In fact it was none of the above.

I did some digging and pinned down that it was actually WHERE he was trying to do his rehab exercises was the issue.

Let me explain......

A big component of his rehab was trying to dampen his sympathetic nervous system whilst trying to reduce the amount of work certain structures were doing (for him this included his anterior plate; anterior adductors, rectus abdominalis and hip flexors).

Although he had time off he actually had less opportunity to do his rehab.

You would think he had more than ample time for his rehab given he wasn’t in training, but instead his days were filled looking after his kids!!!!

Image (express.co.uk)

Time spent racing around making food, tidying up and keeping his kids entertained filled most of his days off.

When he did have any respite and opportunity to do his rehab, he got in position all ready to go, usually to be confronted with his kids fighting or one of them jumping all over him.

For him the setting of his rehab was very important given the aim to promote parasympathetic activity, allow him to ‘rest & digest,’ reduce his heart rate, breathing rate and to some degree RELAX.

In hindsight this was never going to happen with a house full of kids!!!

He made every effort to do his rehab.

But he was just doing in the WRONG PLACE.

For him its easy at training, as he doesn’t have the above distractions to deal with.

For him this type of rehab at home wasn’t feasible and as such wasn’t able to do it effectively.

Is it any wonder then that he came back after his time off with more symptoms than when he left?

If you consider the above, not at all.

What I have learnt from this is that I must always consider the environment my athletes or clients will be doing their interventions.

Depending on our intended outcomes and goals the setting of therapy can have a big contribution to actual results.

This is something that has been flagged up as something that I need to really need to consider when I am giving athletes and clients home exercise programmes.

Otherwise I might just be wasting my own and my athletes and clients time and effort.


Thanks for reading

AB

What We Can All Learn From Michael Jordan

Without question Michael Jordan is one of the all-time basketball greats.

But, he wasn’t always great.

He was cut from his high school varsity team.

Then he wasn’t recruited by North Carolina State college, the college he wanted to play for.

Then, he wasn’t drafted by the first two NBA teams that could have picked him.

What were these coaches thinking?

He would go on to be one of the all time greats in basketball. So why didn’t they sign him up.

Image: playbuzz.com

What we don’t hear about is the amount of work that MJ put into his game to go from a high school player not able to make the team to NBA All-Star .

Following being cut from the high school varsity team he started leaving home at 6 am to practice, by himself, before school.

Later at college he consistently worked on the weaker points of his game, his ball handling and defence.

After his college team lost their last game of the season, MJ stayed for hours after that game practicing.

Whilst the rest of the team had left, he has training ready for the NEXT SEASON!!!

This continued throughout his professional career and is likely why his peers and coaches labeledl with as the 'ultimate professional.'

When we think of Michael, we think of MICHAEL JORDAN, the multiple NBA winner, MVP, Olympic Gold Medallist etc etc.

We don’t think of the young Michael Jordan, getting knocked back from the high school, college & even some NBA teams.

But if we acknowledge the amount of time, effort and hard work MJ put in, are we really surprised he did as well as he did?

Whilst we might correlate his physical prowness to his basketball ability, without his MINDSET to consitantly improve and better his game, who knows where he might be now.

As MJ said himself….

‘The mental toughness and the heart are a lot stronger than some of the physical advantages you might have. I’ve always said that and I’ve always believed that.’

We like to think the most successful people are some sort of superhero.

We like to think these people have some sort of ‘innate talent,’ that they have been born and blessed with.

Whether they are from sport, the business world or any other domain this doesn’t really matter.

What we don’t see them as is ordinary folk that have worked hard to make themselves extraordinary.

That’s because we seem to value natural ‘talent’ over ‘earned ability.’


Is this because its easier to assume someone is great at something because they were born great, rather than becoming great because of hard-work? 


If we really delve into the stories of the most successful people many of them have stories like Michael Jordan.

Stories of disappointment, rejection and failure. Usually followed by determination, hard work and subsequent success.

Maybe they just used better strategies and/or just worked harder than us to overcome these difficulties.

No one is born successful, not even Michael Jordan.....

I think we can all learn a thing or two from successful people like MJ.

Thanks for reading

AB

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Invest In Yourself: Otherwise You Might Get Left Behind!!


I have revamped this blog, having initially wrote something similar last year, although this time around I'm coming at it at a different angle.

The reason I have rewrote this blog stems from a conversation I was having this week via email with a soon to be graduated physiotherapist with a desire to work in professional sport.

She contacted me approximately 6 months prior and we put some strategies in place to help her pursue her dream of working within professional sport.

In short, she asked my advice regarding what she needed to do to set herself apart from other people. The same people that would be competing for the same sports jobs upon graduation.

She contacted me this week inquiring any possible job opportunities I was able to offer or was aware of elsewhere at other sports clubs. 

I gave her a couple of leads and also asked how she had gone since our last interaction 6 months prior. 

I had made contact with some clubs (both amateur and semi-professional) to help her gain some experience given her intended career path. 

It was therefore very disappointing to hear that she had done pretty much NOTHING!!!!!

And then has the cheek to ask for a job!!!!

Needless to say she wouldn't be the first person on the top of my potential employee list.....

She listed a few excuses..... No time, holidays, exams & study.

That said, we are all busy.

I'm sat writing this blog at 8 pm on Friday night, a rare night off work, following a 2 hour struggle with my 18 month old son to feed, bath and put him to bed!!!!

And i've still got to empty the dishwasher and the washing machine!!!!

We are all busy!!!!

But failure to want to invest in yourself to help you achieve your intended goals is a big no no.

Remember.......The biggest investment you will ever make is yourself. 

So, this blog will hopefully help you out..........

Below are 3 simple tips to help you invest time in yourself and to help you on your way to success.

#1 Make Time

A lack of time is not a reason not to get things done. Many of us complain about not having time to pursue the things we want to, the things we enjoy most. But you can make time for those things. Whether its spending more time studying, more time exercising or more time with your family and friends, it doesn’t matter.

A lack of time is just a lack of priority…….

Image (wikipedia)

Let me give you an example to explain. If you were doing some DIY at your house and you stuck a nail through a water pipe. Water is spurting everywhere but you can stop it by wrapping your hand around the pipe. If you remove your hand, the house is going to flood, destroying your home and all its possessions. You might have a million and one things to do that day but you aren’t going to let go of that pipe are you? This is because now, stopping your house flooding is of paramount priority. You find the time to do it and put less important tasks aside. If you had to spend the next 24 hours with your hand wrapped around that water pipe waiting for help I’m sure you’d find a way to do it.

This is obviously an extreme example but highlights an important point. We often don’t accomplish what we set out to do because we don’t have time. But the reason we don’t have time is that we don’t prioritise well. This leads well onto tip #2.

#2 Get Rid, Get Better or Delegate

How you spend your time is of primary importance. If you list all the tasks you complete daily, to include your work, family and social lives, I reckon a large proportion of these could be either omitted or delegated.

Get Rid…

Firstly, we want to invest in ourselves, so any tasks that don’t help us improve and get us to where we need to be, omit if possible.

Other tasks that we have no intention of getting better at we should also omit.

Get Better….

Once we have prioritised what tasks are important, these tasks are what we should be prioritising our time with. Having brushed the things we don’t feel we want to develop we can spend additional time in those tasks we do. I wrote another blog recently about the importance of maximising our strengths. Improving our weaknesses is not always the go, mainly given our weaknesses are often tasks we don’t enjoy and thus don’t want to engage with. Pick things we enjoy not those we don’t.

Delegate……

Regardless of what task we are talking about, cleaning to laundry, home or work tasks, we could probably get others to help us out. Think about your workplace for example. Do you complete tasks on behalf of others that are not part of your job resume? If your answer is YES to this question then firstly, ask yourself why?

Should and could these tasks be completed by others?

Who is the best person to complete that specific task?

By assigning job roles and delegating tasks we should all have easier ride, both at work and home.

#3 Set Goals & Get Going Straight Away

This ties in well with tip #1. Goals setting is often some sort of long lived fantasy where we make a plan about where we want to be in 3, 5 or 10 years’ time. Whilst there might be value in doing this I think this prevents us from making change in the short term. We do need over-riding long term goals but what is more important is what we can do NOW, in the short term, to help us on our path to whatever aspiration that might be.

(image -chrissie-webber)

I use the process of breaking tasks down into smaller chunks, making tasks more manageable, especially in relation to time. It also increases the chances that I will adhere and complete these tasks. Therefore, I break tasks up and spread them over three days;  

Today
Tomorrow
Day After

Here’s an example that I have completed previously; 

I’m really into my coffee I was looking at improving my coffee making skills to make café style drinks at home. To ensure I got it done, I broke the task of finding somewhere to upskill my coffee skills like so;

Today: Search local barista course (within 15 miles)
Tomorrow: Shortlist 3 and research
Day After: Book best barista course
I will set a limit of 15 minutes per task per day.

As a result I am know a master coffee barista (well not quite)…….

Summary

The biggest investment we will make is ourselves. The biggest constraint to getting better at what we do and in doing the things we want to do, is TIME. Making more time is not difficult. Time is a matter of priority. Get rid and delegate the tasks that don’t interest us so we can spend more time in the tasks we do. Set goals for NOW…..what am I going to do tomorrow? The day after? The day after that?

Worry less about the bigger picture, focus upon the smaller bits and these will generally lead you to the bigger things.  Get rolling NOW to achieve success in whatever domain you want succeed.

Thanks for reading

AB
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Why We Don’t Have All The Answers

I recently wrote a similar post to my email subscribers explaining why we don’t have all the answers and how appropriate management of the athletes we work with means that this necessarily isn’t an issue.

I do reserve a selection of content for my email subscribers, so if you enjoy this sort of content be sure to sign up for my email list below this blog post.

So……Why Don’t We Have All The Answers? 

Firstly to set the scene.........

Whilst working at the top level in any domain sometimes we are expected to have all the answers. Sport is no different.

Unfortunately, we don't.

Anyone that tells you they do have all the answers are either;

1. Deluded and/or

2. Up their own arse

I certainly don't think I have all the answers.

Working with both athletes in elite sport and private patients from all walks of lives is challenging.

Whilst the end goal of an elite athlete and a weekend warrior might differ and the route we take to get them their will be individual to their needs there are common themes.

One of these themes is knowing your own role and how this fits in with that persons management.

Working as a physiotherapist I have to acknowledge that I don't have all the answers and sometimes I require the HELP of others to ensure the individuals I am looking after, whether its an international rugby player or a middle aged full time mum, to ensure they get the best care possible.

This might mean referring and taking such an individual to see a specialist or another professional that might have a different skills set to myself.

The end goal is always the same, to get long lasting athlete/patient outcomes, but how we get there for each individual may differ.

It might also be neccessary to use the help of other professionals to get to that end point. 

Some might think this shows weakness.

Some might think this highlights a lack of skill or expertise or this could indeed undermine your own position in your role working with an athlete or patient.

I disagree.

I think it shows humility. I think it shows understanding and the realisation that none of us know everything.

Nobody has all the answers. We shouldn't be expected to know all the answers either.

Asking for help is not weak.

For me its plain smart. 

Don't feel the pressure to know everything, because you never will.......

Hope you enjoyed reading this post.

AB

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Mental Health Awareness
Are You Giving Athletes What THEY Want?

To mark Mental Health Awareness Week this post makes reference to this and emphasises how a global approach to athlete health and well-being is key to any management plan.

Working with athletes brings its challenges least of all when a player is out injured for a considerable amount of time.

Many thoughts and emotions will run through an athletes head;

‘Will I get back playing?’

‘Will I have the same speed, footwork, strength and fitness that I had pre-injury?’

‘Is this something that is going to continue to plague me during the rest of my career?
 
Obviously, each injury is different and the severity and length of management will have a large impact on possible thoughts that an athlete might contend with.

A player out for 4-6 weeks is less likely to have the above thoughts compared with a player out for 9-12 months with a complex multi-structure injury for obvious reasons.

Either way, it is important that we first acknowledge that players have and do have anxieties following injury and secondly, that we put interventions in place to ensure these issues don’t impede the physical side of recovery from injury.

The big thing for me is finding out what players are worried about. 

This largely comes from being able to communicate well with your athletes and have a good understanding and rapport so that they are willing to divulge what anxieties and apprehensions they may have.

If you can get to the bottom of what concerns athletes then you can put interventions in place. Without such information, we are just guessing......

Making assumptions that all long term injured athletes will have mental health issues is firstly not true and secondly, such assumptions will likely lead to generic interventions that are unlikely to find and manage the true stressor(s) for each individual athlete.

Remember that such stressors might not be just anxieties related to their physical being and can and are often related to psychological well-being.

These could include anxieties relating to their home life, relationships, contract negotiations or indeed any other aspect of their lives.
   
Putting interventions in place is key – but these cant be generic.

We need to find out what each individual wants and why they want it.

As a practitioner working with these athletes we will often find the athletes needs and wants align very closely with our intervention goals...... often they are the exact same. 

Giving the athletes some of what THEY want, will help ensure buy in to your interventions. 

If your goals and your athletes goals differ, it is often just a case of educating as to why you want to achieve those goals and how they relate to getting your athlete to the end goal.  

Both athletes and practitioners alike want to build fit, skillful and robust athletes.

As an example we might talk about robustness in terms of training or match availability where as an athlete might talk in terms of being fit come the business end of the season. 

In effect the above are each of the same, but unless we connect the dots and establish the link between the two in the eyes of our athletes then our interventions may fail.

To summarise, firstly we need to identify individual athletes issues, making sure to account for both physical and psychological factors. Secondly, we need to put interventions in place that reflects that individual's issues and to maximise buy in, ensuring our interventions align closely with the needs and wants of our athletes. 

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How To Manage An MCL Knee Injury: Part One

Following a recent discussion I had on an online forum I have put together a blog post regarding my thoughts on the management of Medial Collateral Ligament (MCL) injuries.  I have split the post in two; this part will focus upon early immobilisation and management with part two in the series focusing more on the later stage rehab.

How To Immobilise

There are no definitive protocols on how long to brace an MCL injury for. What is agreed however is that bracing is effective to prevent further injury and to allow the MCL to repair.

Due to the close proximity of the MCL and the medial portion of the meniscus it is key to rule out a meniscal tear either clinically and/or through relevant imaging (MRI). Clinically this can be difficult, especially acutely as often the subject may not allow testing due to apprehension and/or pain. It is also important to rule out any other injury such as ACL and/or chondral injury which would result in a different management path.


Assuming we are dealing with an isolated MCL injury of grade 2/3 isolated MCL my bracing plan would look like this:

1. Braced locked at 30 degrees for 7 days (Phase 1)
2. Braced locked between 30- 60 degrees flexion for 7 days (Phase 2)
3. Brace locked between 0-90 degrees flexion for 7 days (Phase 3)
Beyond the bracing protocol subsequent rehab and return to sport will occur (Phase 4)

This is bracing plan is significantly shorter than more traditional orthopeadic guidelines which would generally look at around 2 weeks per setting, a total of 6 weeks in the brace. Whilst only bracing for half this time (3 weeks) I have found that this is sufficient to allow adequate tissue healing and subsequent return to multi-directional and contact sport between 5-7 weeks.

This is given that athletes are compliant with the bracing protocol. It is imperative that the brace is worn always including sleep to ensure repair is maximised. The brace should only be removed for physiotherapy treatment (propping the limb to mimic the bracing position) and showering.

Also remember that any timescale would commence once the brace has been applied and not when the injury occurred. i.e. if two weeks have elapsed since diagnosis you must still commence from #1. Early MCL diagnosis is key. Those that have been left and not braced immediately often have a much longer prognosis and in some tissue integrity in the long term isn’t great even after a significant bracing period. 

My Own MCL Story

I was unfortunate enough to suffer a high grade 2 isolated MCL tear in August 2015 playing rugby. It followed a classic mechanism of a fixed foot with a tackle forcing my knee into valgus. I followed the above bracing protocol and with the associated rehab and was back multidirectional running 4 weeks to the date of injury and available to play at 6 weeks.  
I pushed my rehab hard. This was for two reasons. 

Firstly, I work in professional sport and as part of my role I am required to run on the field of play to assess and treat players when needed. Within the sport I work, rugby league, as medical staff we have open access to the field of play and as a result often do a fair amount of running on/off the field. The other year I wore a GPS unit over three games and covered between 3 and 4.5 km over those fixtures!!! The night prior to my injury we had won our semi-final taking us to the Challenge Cup Final at the infamous Wembley Stadium. The only problem was that game was in in four weeks time!!!!!. Whilst in the brace the assistant physiotherapist took over my on field duties but I wanted to do everything possible to get back for this game. 

Secondly, whilst I had experienced plenty of previous rehabilitation programmes for the athletes I have worked with following MCL injury I wanted to see how far I could push myself and if I could learn anything new regarding the management of this type of injury. In essence, I was my own MCL guinea pig!!!!!

Early Treatment & Rehabilitation

During the earlier MCL injuries I managed I generally left them alone for the first week whilst locked at 30 degrees’ flexion. They would complete some open chain hip circuits but other than that I didn’t get them to do too much. My early management now is much different. 

From a treatment point of view I use instrument assisted soft tissue mobilisation (IASTM) for the MCL as early as possible. The theory on this modality isn’t robust by any means but I have found it great to dampen pain especially in the early days. This is particularly so with injuries at the femoral attachment which tend to be much more painful than tibial attachment site injuries. The difference in orientation of femoral MCL fibres (run more perpendicular at the MCL femoral insertion) is one possible reason for this. If an athlete can’t tolerate the pressure, ease back. If they are still very symptomatic with treatment consider dry needling. I have however found that actually being more aggressive with treatment early with those with more ‘painful’ MCL injuries actually helps to dampen their pain quicker compared with leaving them alone. This also seems to feed forward in that the less painful we can get the MCL (i.e. to palpate) the less pain they generally have when the range of motion in the brace is increased beyond the first week. 

As a general rule I aim to use IASTM at least three times per week for approx. 2-4 minutes running perpendicular to fibre direction of the MCL. Regarding the theory, a study in rats showed IASTM effective at significantly increasing MCL strength at 6 weeks following a grade 3 injury (dissection) compared with controls. No significant differences were found at 12 weeks between groups. This suggests early IASTM contributes towards early ligament stiffness and should complement the downregulation of pain also seen. 

During my own self experiment I also made use of neuro-muscular electrical stimulation. Particularly during the first week whilst the brace was fixed I used this up to three times daily (average 30 minutes per session) to allow some quad activation without movement. Great piece of kit and very useful for immobilised athletes if you can get access to it.  I continued to use this during ‘rest’ periods throughout the period whilst I was using the brace (Day 1-21).

Additionally, whilst locked in the brace I also used occlusion training. I would occlude my proximal thigh, so the cuff would sit just above the brace, for a total of 60 minutes per day. How this would work would differ depending what activities I was doing that day. Ideally, I would occlude whilst I was more active i.e. walking. I started at approx. 120mmHg but quite quickly I was able to increase this over the first week, finishing at around 200mmHg quite comfortably with activity.  

To  summarise the first week (Day 1-7);

Rule out other injury (ACL, meniscal, chondral)
Brace at 30 degrees flexion immediately
Open chain hip circuits to minimise hip/thigh atrophy and strength loss
Use instrument assisted treatments to downregulate pain
Neuro-muscular stimulation if possible
Consider occlusion training for low level activity

The biggest eye opener for me having an MCL injury myself was the how much I was able to do during that first week and also the impact that early treatment had once the brace settings were advanced. Using the occlusion, neuro-muscular stimulation and IASTM alongside more traditional open hip training provided a great start for what would continue in weeks 2-3 during gym based rehab.

Keep an eye out for part two which will run through the progressions of both treatment and rehab once the brace settings are advanced and then finally removed. 

Thanks for reading

AB
Walking on eggshells 
 
Seeing as its Easter I thought I would publish post with that in mind. To be fair the post has absolutely nothing to do with Easter as you will soon find out, but Happy Easter all the same. 
 
The term ‘walking on eggshells’ is a well known phrase. It usually refers to having to watch what you say or do around a certain person because anything might set him or her off. In this post I am not attempting to write about how to avoid conflict with people but write about how I would assume you or me would try and walk on eggshells, in a literal way.  
 
To set the scene, if you were to try walk over eggshells and not break them is an impossible task. However, to attempt you would most probably try and spread the weight of your body across the biggest area possible. i.e. spread your body-weight across as much as your feet area as possible. The same technique you might try to walk across a frozen lake, not that I am suggesting you try it! 
 
And that forms the basis for this post, weight transfer of the foot with activity. 
 
The ability to do so, transfer weight evenly in the feet, is largely the result of the ability to maintain a neutral foot position or ‘tripod stance.’  
 
A successful tripod stance position would involve equal distribution of weight between the three points of; 
 
  • Base 5th metatarsal 
  • Calcaneous 
  • Base 1st metatarsal 
 
If weight can be distributed evenly between these three points then the foot is likely to favour a 'neutral' foot position and in addition will provide a stable platform for movement. In addition, you might not fall through that ice! 
 
The picture below shows the correct tripod stance. 
 
Correct tripod position 

The ability to produce such a position is key as such a position provides a solid base for foot and ankle biomechanics. I think we have lost the focus in recent years as we have gone done the path of trying to fix the foot and other issues up the kinetic change by changing what we wear on our feet, whilst bypassing foot position itself. 
 
A lot has been made in recent years regarding footwear and in particular minimalist footwear and barefoot training. I think the reasons for opting for a particular footwear, to go barefoot or not isn’t the main issue. The question is with what footwear type or barefoot style stance will enable you to get into a neutral foot position or tripod stance.  
 
Getting that tripod stance is the key. As a result it doesn’t really matter what’s on your feet if anything as long as we maximise and make use of a good solid foot and ankle position.

When we then move we need the ability to transfer weight away from 'neutral' depending upon the intended movement task. The ability to move away, back towards/through a 'neutral' foot position is key for optimal force transfer through the foot during movement. Hence, whilst the ability to achieve a 'neutral' foot position is key, we also need the movement capability to move away from 'neutral' and return to 'neutral' is also as vitally as important. But that's a story for another day!!!
 
Spread weight evenly across your feet and have fun ‘walking on eggshells’!!!
 
Thanks for reading 
 
AB 
80:20 Rule 2.0

Following the great feedback I received on the previous blog post about the 80:20 Rule I have decided to expand upon this concept. So here it is……….

In the first installment, I spoke primarily about what the 80:20 rule is and how you could apply the principles of this rule to your advantage. If you missed it, scroll down the page and you’ll find it directly below.
 
Focus On What You Enjoy Not What You Want

Following on from the previous blog post you need to prioritise what you enjoy. Less emphasis probably needs to be placed on materialistic passions. In essence this is the 80:20 life. 

The 80:20 life will give you more time and enjoyment in the things you want to do the most. In addition, a further advantage of living by the 80:20 way is that you will likely see progress in other domains. For example, many people living the 80:20 way experience greater productivity and success at work. This could be considered the result of being able to appreciate the time allocated to ‘enjoyment’ activities so when they are at work productivity and even enjoyment of work activities will improve.

As it can be hard to identify the things we enjoy the most and thus the ones we want to prioritise, an easier way can be to start to eliminate your current activities you don't enjoy. Remove these activities first and you will be left with those activities you find most rewarding.

What We Give v What We Take

We are all good takers. Me and you are no different in that we enjoy consuming from others. Whether that's eating out, going out with friends, watching TV, exercising or playing sport, these are all activities in which we are consuming or taking the outputs of others. 

If all we ever do is consume i.e. take and never give, it can be hard to find longevity in the activities we find rewarding.
To live the 80:20 way is to find activities that you are maximally rewarding for you because they create output for others to enjoy. I love eating out and reading books but at present no one is yet to pay me for these activities. If I was to eat out everyday I suspect it would become less fulfilling as time went by. This is because I am just taking and not giving. By not giving and hence providing no output, I am creating no value. 

Only by considering the concept of producing output for other people can we expect to convert an activity we are passionate about into a sustainable income. We can all probably think of a situation whereby we have helped someone else achieve something and that process has given us great pride and fulfillment despite us not gaining direct reward for it. 

Its unlikely you will find such fulfillment by just being a taker. We need to give, as well as take, to find fulfillment in the activities we undertake. 

Summary

The 80:20 principle sounds great, eh? 

The best way to get started is to focus your efforts on the activites you enjoy most. Be creative and follow the activites that give you the most rewards. 

If you feel like your lacking direct and that your running a 20:80 ratio, your spending far too much time in activities, work or otherwise, that you don't enjoy. Running a 20:80 ratio will mean that by the time you get the time to potentially pursue those activities you enjoy the most you are likely too gassed to complete them. 

In short you need to flip this ratio on its head and spend a larger amount of time in activities you find rewarding. 

Whether that's writing blog posts, planning your next holiday  or learning to play an instrument, you need to find time for YOUR activities.  

Even if you have no strong intention of turning these passions into money making businesses they still serve as a good option. 

Look for the possibility of boosting your 80:20 ratio, increasing the time spent in rewarding activities whilst dropping any inefficiencies along the way. 

The biggest barrier to following a 80:20 life is fear. Falling away from those hard ingrained routines we have always followed. Maybe its fear of the unknown.

But what have we really got to be fearful about?

Spending more time doing what we enjoy the most and find the most rewarding doesn't sound that scary to me?

Flip your way of thinking and have a crack at using the 80:20 principle to your own circumstances.

Let me know what you think. 

Thanks for reading 

AB

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Anxiety & Getting Injured…….

One of my colleagues at work sent me a research paper the other day. This followed on from a conversation we had in the previous week in relation to players sustaining injuries following illness. We have started to gather some decent information that our players are at a much greater risk of injury; both contact and non-contact up to a month after illness.

In short, the study looked to determine pre-participation predictors of injury and illness before the 2015 International Association of Athletics Federations World Championships in Beijing. A total of 307 athletes completed a pre-participation health screen, whilst new injuries and illnesses that occurred at the championships were prospectively recorded. 

116 athletes (38.3%) reported an injury symptom during the month before the championships, while 40 athletes (13%) reported an illness symptom. 20 (6.5%) of the participating athletes sustained a health problem during the championships. Endurance athletes were almost 10-fold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI 1.20 to 81.31; p=0.033). Participants reporting a pre-participation gradual-onset injury symptom were three times more likely (OR, 3.09; 95% CI 1.08 to 8.79; p=0.035) and those reporting an illness symptom causing anxiety were five-fold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury.

Image: athleticsweekly.com

The link for this study can be found at the bottom of this page. 

Whilst this is to be expected given what we know about the what happens to the nervous system when we suffer illness we are looking at revising our return to training protocols for the elite athletes we work with following illness.

Similar to any physical injury i.e. muscle tear, fracture, tendonopathy, following injury we progressively load tissue using a logical and systematic approach to return our athletes to full health and enable them to return to the training and match-day field. 

Despite evidence regarding illness and its effects of physical performance there is little guidance out there as to how to integrate athletes back into training post illness. 

That said the biggest standout for me regarding this particular research paper is the evidenced link between heightened injury risk and psychosocial issues.

Those athletes reporting an illness symptom causing anxiety were fivefold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury.

For me this is obvious.

Injury of any type is the result of our bodies being unable to tolerate stress. When we reach failure point any tissue, be it bone, ligament, muscle, fascia etc, will break. This could manifest itself in a muscle tear, tendonopathy, bone fracture, ligament tear etc etc. 

What we often don’t consider is other stressors, non-physical stressors that contribute towards an athletes overall ‘stress’ level. Ultimately the more are athletes are ‘stressed’ via physical and non-physical parameters there more likely to break down. Obviously, recovery strategies or for a better term ‘de-stressing activities’ play a big part in this process, given what we know about physical stressors, recovery and the principle of supercompensation. In short, if we progressively load, we adapt, assuming adequate recovery is observed.

But, how often do we really observe and acknowledge the non-physical stressors that may have contributed towards an athletes injury?

In most environments, this happens very infrequently if ever!!!

If it does it’s usually reactive i.e. an athlete is injured, then we review why it has happened, then we discover some of these non-physical stressors have potentially contributed towards that athletes injury.

For an athlete these non-physical stressors could be financial, contract related, include player selection, issues with family or friends. 

We often forgot about athletes lives away from the training and match-day environment. 

We often forgot or fail to acknowledge the effect these stressors have on physical preparation and injury risk.

Rather than a reactive system, wouldn’t we be better at trying to screen and observe these stressors frequently, to pick up any possible issues that might predispose injury, to try prevent injury before it happens. A more proactive approach seems reasonable rather than reacting to injuries after they have occurred.

Like I say, as simple as this sounds, it doesn’t happen.

In the monitoring system, I have developed to monitor athlete’s physical and wellbeing status as part of their pre-training testing, we include psychosocial scoring. 

Without systems like these there is no way for us to regularly monitor psychological status. Without such a system by the time we find out about these other off-field issues athletes may have, its often too late, as often they have already contributed towards injury and/or reductions in performance.

Performance for me is the product of fitness minus fatigue.

Performance = Fitness – Fatigue

These non-physical stressors ultimately affect fatigue, in not allowing our nervous system to down-regulate. If we are always in a ‘fight or flight’ state and never in a ‘rest and digest’ state how can we expect to relax and recovery from physical exercise. As such our level of fatigue will be much greater and linking back to the equation above would result in a detriment in performance. So not only are de-stressing activities injury prevention based, they are also performance based. 

By failing to look out for stressors, not just the physical stressors, we are missing a big trick!!!

For the link to the study discussed above click here.

Hope you enjoyed reading this post,

AB

The 80:20 Rule & How You Can Use It To Your Advantage

In this blog post I am going to firstly explain what the 80:20 rule is and secondly, show you how to use this rule to your advantage. So, if you’re wondering what this rule is and how it could massively improve your life, please read on…….

What Is the 80:20 rule?

Firstly, although a statistic it hasn’t got a whole lot to do with maths.

The term originated from economics from a chap named Vilfredo Pareto, with the principle itself later made famous by management thinker Joseph M. Juran. 

Juran named the principle after Pareto, following the latter’s observation that 80% of income in Italy was received by 20% of the Italian population. Thus, referencing the 80:20 rule, assumptions are that most of the results in any situation are determined by a small number of causes.

This is not a new principle by any means and can be referenced in many publications, particularly in the business and lifestyle fields. I’ve read about it in both the 4 Hour Work Week (Tim Ferriss) and Living The 80:20 Way (Richard Koch).  

Looking at the 80:20 rule simplistically we can attain that 80 % of your outcomes come from 20 % of your inputs. 
On the flip side, the remainder 80 % of our inputs account for only 20% of your outcomes.

Before we move on, just take a minute to re-read the above two sentences. And ask yourself the following question;

Q. Which example is the most efficient?

Without question, I’m sure you all answered using the first ‘80 % of your outcomes come from 20 % of your inputs’. And you would be right. Less work (input) for more productivity (output) is the over-riding goal of any individual or organisation. 

So How Can You Apply The 80:20 Rule To Your Life

Firstly, you could be mistaken for thinking that you need to run a business of some description to benefit from the 80:20 rule. Sure, you can apply this principle to business management, but that’s not the end of its use and probably not its best use. 

The best use would be to use the 80:20 rule to your own personal benefit. The most important aspect of the 80:20 rule is the understanding that in your life there are certain activities you do (your 20%) that account for the majority (your 80%) of your enjoyment and outputs.

Whilst as mentioned you could apply the principles of the 80:20 rule to your working life, the greatest gains will be made by aiming to improve your overall happiness and the satisfaction gained in doing these chosen activities. 

To put this in context, if you were to describe your perfect day (think location, weather, food, people you’re with, what you’re doing) I’m guessing work doesn’t figure in that plan.It doesn’t in my perfect day. As much as I love my job, I’d much rather be jet-setting somewhere, family in toe, with the time and mobility to pursue activities of choice.
The above is an example of how a small percentage of activities (i.e. holidays) account for a large percentage of our happiness and ‘happy experiences.’ Hence why we attach value to such activities and the resulting happiness they bring.
Closer to home the 80:20 principle is everywhere. 

Just consider that you most probably spend most of your time with a small number of people within a much larger sample of ‘family and friends.’ The same small pocket of people are also those you make the most phone calls to, although you have numbers for dozens, even hundreds more.  Financially, like me you probably also spend the largest chunk of your money on a small number of things (mortgage, bills and groceries). 

When you start to think about your own life and break it down it’s easy to see the 80:20 rule in full effect. Firstly, you need to identify what your K(ey) H(appiness) I(ndicators) are. Once your KHI’s have been identified the aim of the game is to avoid wasting time on the 80% of activities that produce little satisfaction for you, concentrating instead on the 20%, those giving the greatest satisfaction.

My Examples

So, to give you some guidance I have some examples of how I’ve applied the 80:20 rule to my life to gain greater time and mobility in the activities I enjoy most whilst reducing time spent doing the time consuming tasks that are of little enjoyment. 

#1
As I write this blog post I’m happy, as writing content like this is something I really enjoy. That’s the whole reason I set up my website, www.rehabroom.co.uk, all those years ago. The time spent creating content via blogs like this, videos, podcasts etc. is time well spent as I really enjoy doing it. Secondly, by publishing such material means I can engage and interact with others, like you reading this blog. Thirdly, off the back of this sort of content I have been asked to present and lecture at numerous institutions and events, alongside some private writing work. Also various consultancy type work has also been attained, largely following my non-clinical work, like that on my website. This consultancy and lecture style work per hour, generates the most income for me.  Therefore, I get the most financial gain whilst doing the ‘work’ activity that gives me the most satisfaction.
#2
I hate some activities. These are my 80% inputs (time) that give me very little reward. One example is my accounting and bookkeeping that I complete as part of running my own business. This is something as you expect doesn’t give me much reward and as such is not high on my prime-time activity list. As such, I don’t do these activities anymore. To free up time and mobility, I have outsourced these activities to others. Whilst I pay for these services the savings in my time and mobility greatly outweigh the cost.  

Closing Thoughts

Hopefully, this blog has given you an insight into the principle of the 80:20 rule and how you can use it to enjoy more of the activities that give you the most satisfaction and minimise the time spent in those activities that you don’t. 

Most of you reading this will spend most their time in activities (mainly work) that they don’t really like, saving their passions for the weekend and other times outside of working hours. 

Applying the 80:20 rule to your life might help you turn this tide. 

There’s no reason you can’t be part of the small sample that live their passions day in and day out, with ever increasing time and mobility. 

Do more of what you like and less of what you don’t.

Find the 20% of inputs that give you 80% of your satisfaction.

Thanks for reading

AB

Images: Perfect Day (videohive.net); Blog writing (wordstream.com)
Pain: It’s NOT In Your Head

For many a particular activity and pain go hand in hand. Like a trip to the dentist always brings about those feelings of anxiety and fear associated with the impending intervention. And whilst you are just booked in for a routine appointment you still have the same level of apprehension as the last time you saw the dentist when he pulled several teeth out. Why do these feelings return even though you know that it’s just a routine check-up? 
Whilst there is plentiful research into pain and our perceptions of pain, the factors that influence and how it presents, I still feel we know only a small amount of information regarding pain science. Even within the medical domain, a domain we see and treat pain daily, I feel we often neglect most aspects of pain science during both assessment and rehabilitation strategies. In doing so we are missing the boat and as result our intended interventions prove suboptimal and this could account for why many people develop chronic pain and live their lives with pain and discomfort. First up, it’s important to get to grasp with what pain is……

What is Pain?

If you looked at the dictionary definition of pain it reads like this…..

“physical suffering or distress, as due to injury or illness” or 

“a distressing sensation in a particular part of the body” or

“ a mental or emotional suffering or torment.”

Labelling pain is difficult. How you or me might rate the same pain would most probably differ. In the world of medicine, we often use pain scales to allow those we work with in pain to score their current symptoms. Whilst these might be useful to help clinicians provide a baseline and gauge patient progression through treatment and rehabilitation interventions trying to classify pain is a minefield. Pain isn’t something that is easily labelled. Pain is exclusively subjective and as previously stated will differ widely from patient to patient. Therefore, trying to pigeon hole someone symptoms to a scale is very difficult. 

Pain is an experience and pain is a perception. This experience might be the result of actual tissue injury (e.g. result of inflammatory process which excites pain receptors) or could be the perception of potential symptoms (e.g. fear of potential injury/pain). Going back to the dentist example, this could explain why some of us fear certain experiences. Regardless of the impending intervention a trip for the dentist for some will always be an unpleasant experience as they perceive potential harm. But why?

Past Experiences and Perception

Central to perceived pain in both the present and future relates back to our past experiences. 
This provides an explanation as to why certain experiences continue to be unpleasant, like that trip to the dentist.  
In a study by a group German researchers (1) they found how preconceived notions of pain specifically affected a patient´s experience of pain. They found that past experiences with needle pricks, combined with information received before having an injection, greatly influenced each individual’s pain experience.

In the experiment, participants watched various video clips whilst receiving painful or painless electrical stimuli to their hand. The video clips included shots of a needle pricking a hand, a Q-tip touching a hand, and a hand standing alone. The screen showing these clips was placed above the participants own hand; therefore, giving the participants the experience that the video image was their own hand.

During the experiment the participant’s felt varying degrees of pain. This isn’t surprising given we perceive and rate pain individually. What was interesting however that was the clips showing needles pricking the hand, elicited pain levels far more intense and unpleasant than the Q-tip touching the hand and the hand standing alone. These individuals are relating back to previous experiences. The brain will remember the last time the body received a needle prick and the associated negative thoughts and emotions that accompanied it.  

The increased pain scores observed in the study also matched to increases in autonomic nervous system activity. Those perceiving more pain (those exposed to the needle images) showed increased pupil dilation responses, indicating heightened nervous system activity, the body’s fight or flight response.  

The study also found that the participant’s expectations affected each participant’s pain response. Before the experiment started, the participants were told that either the needles or the Q-tips were more related to painful electrical stimulation than non-painful electric stimulation. As a result, the images shown to participant’s that highlighted pain (i.e. images related to needles), proved to produce higher levels of self-reported pain than clips less associated with pain. This proves that the participant’s expectations or perception of a particular painful experience directly influences the intensity of the pain participants felt during the trial.
So it would seem clear that past experiences influence perception which plays an important role in pain provocation. 
What is causing pain?

Basic pain science tells us that pain is the brain’s way of telling us something is wrong. Pain can be the direct outcome of tissue damage, if you cut your finger, it hurts. However, pain is not always a good indicator of tissue damage. Pain can be the result of the brain telling us we are under threat when the brain perceives possible tissue damage. The brain may perceive a threat even when there is none. In the same way it may ignore a threat even when the threat is very real. Think of the stories you may have heard about an injured soldier in battle, who is able to keep fighting despite catastrophic injuries and at that time felt no pain. Or the sport star that discovers he has broken his ankle long after the game has finished, having played the majority of the game with this injury. In both these situations, there is clearly tissue damage, but how the brain perceives, or doesn’t perceive pain results in no pain being felt at that particular time point. 

Past pain experiences, anxiety and emotion, which may run independently from the diagnosis, will all influence our perception of pain. There is no straightforward relationship between tissue damage and pain. Therefore, trying to classify pain and trying to control pain given the complexities of its origin (tissue damage and/or perception) is very difficult. 
Does the brain get it wrong? I believe it doesn’t. But is in fact doing something very clever, using all the information it receives to make a decision on how to protect (pain) or not protect (no pain) the system at that particular time point. In the case of the soldier above the brain is able to override pain coming from his catastrophic injuries to allow him to continue to fight, as it might be a matter of life or death. 
Chronic Pain Patterns

Those individuals that have persistent or chronic pain are inevitably going to have altered pain control mechanisms via both the central and peripheral nervous systems. With chronic pain the nervous system becomes increasingly sensitised. This means the relationship between pain and actual tissue injury becomes weaker and also less predictable. It could be said for these individual’s pain is not actually a symptom of another disorder; pain is the disorder. This definitely doesn’t mean that the pain isn’t real. We need to remember that all pain is created by the brain. Pain equally is not weakness leaving the body as many lead us to believe. Pain production is part of the body’s highly complex protective mechanism. The body craves homestatsis. The brain uses every piece of information at its disposal to keep us functioning as close to neutral as possible. Pain is a way of telling us something is wrong, but pain messages can be dampened depending upon the needs of the body at that particular time point.

The brain and pain science is a highly complex relationship still in its infancy. The more knowledge we attain about this relationship the more we will be able to learn about pain provocation and pain management. Until then we need to make efforts to acknowledge pain, both actual tissue damage and perceptions of actual or potential tissue damage. Failure to do so will likely make our interventions less effective and for many lead to the continued presence of daily pain and increased apprehension of certain future activities. 

Pain is just an output the brain. This doesn’t mean that it originates in the brain. Past experiences and our individual perceptions of pain contribute to what we feel.

So just remember, pain is NOT in your head.

Hope you enjoyed reading

A B

1 Pain study: Viewing a needle pricking a hand that you perceive as yours enhances unpleasantness of pain,” by M. Höfle, M. Hauck, A.K. Engel, and D. Senkowski in PAIN, Volume 153, Issue 5 (May 2012). 
Dentist image by hubpages (online)
Needle image by doctorshangout (online)
Pain image by Steven Depolo (online)
Soldier image by Pinterest (online)

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If All You Have Is A Hammer Then Everything Else Is A Nail

This concept is known as the law of the instrument, It initially is thought to stem from Maslow's hammer (or gavel), or a golden hammer, which relates to 'an over-reliance on a familiar tool.' This was expanded by Abraham Maslow in 1966 who said,

"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail."

This hammer and nail metaphor is often used to describe 'narrow-mindedness' and is frequently used within the medical profession, usually as a criticism.

It generally refers to the use of techniques (treatment/rehab) that the intervening professional is familiar with as opposed to the use other techniques that in some cases might be more appropriate.

This concept extends further and into other professions e.g. if you take your car to see a mechanic that specialises in gear-box transmissions, you are more likely to have a new transmission put in than to have the actual problem fixed.  

Thus, this concept of the handling of unfamiliar problems using old techniques of possible questionable effectiveness as opposed to formulating new and better techniques gives the connotation of narrow-mindedness.

But does this matter?

I don't think it does.

However, it does matter as to the competency and confidence in the use of the hammer in the first place. 

Lets explain this a little........

A healthcare professional might have been under every course under the sun. Relating to the above model this professional not only has a hammer, but a handsaw, a drill, a crowbar and so on and so on.......But that doesn't make them better than another professional that has half the number of tools, or even the professional that just has a hammer.

What is of most importance is how these tools (the skills of the professional) are managed.

This stems from each professionals system.

The system that professional uses to diagnosis and the resulting system of treatment and intervention.  

Without a logical and structured system you are just guessing. Having a system not only ensures a correct diagnosis but gives you the information required to plan the correct treatment plan and interventions.

Without a system we will probably always fall back to old ways.

Using certain 'go to' exercises or treatment techniques just because these worked with previous athletes/patients who complained of similar symptoms. 

But are these the correct exercises or treatment techniques for the athlete or patient on the treatment table right now?

Even with a full toolbox of tools, without a system we will probably always fall back to using just the hammer.

As healthcare professionals or any other domain for that matter we don't need every tool at our disposal.

The ability to use different tools (skills) might help but also becoming more proficient at using our existing skills (i.e. the hammer) might be of similar or even better use.

Hope you enjoyed reading this post.

AB

Why Barack Obama Is Like A Physio In Sport

You will have likely have seen the photos this week of Barack Obama sunning himself on holiday and having the time of his life. The photo shows him alongside Sir Richard Branson, in the British Virgin Islands, following the completion of his term as the president of the United States. 
Image (marieclaire.co.uk)

So given the title of this post, you might be thinking why I, a physio working in elite sport am likening myself to the former president of the United States. 

You could replace myself with any other professional working within elite sport, from physiotherapists to coaches, strength and conditioning staff to nutritionists, but why?

Having just completed an 8 year term in office, Barack and his family are enjoying their first proper holiday during that period.

Reading this story and seeing the images above got me thinking about a good friend and former colleague and a conversation we had late last year.

He stated that in the Summer he went on his first proper holiday, in just short of 8 years. During those past 8 years he had worked within professional sport a variety of different clubs.  

Probably the biggest drawback of working in professional sport is the impact it has on your social life, including holiday time. 

Ultimately you need to take your holidays during the off-season period. Personally for me this isn't great given my wife is a teacher and our holidays don't really cross over.

As such we are usually restricted to a sole week's holiday per year.

Don't get me wrong, I'm not complaining.

I have chosen this area of work and working at the top level of professional sport is fantastic and I wouldn't give it up.

On the flip side, an extra weeks holiday here or there wouldn't go a miss either.

Fair play to Barack.

I think we could all agree that he definitely deserves his holiday.

Thanks for reading 

Andy

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Why Do Physiotherapists Not Know What Physiotherapy Is?

Working as physiotherapist in both professional sport and private practice it amazes me that many of those we see don't actually know what physiotherapy is. This is particularly so for private patients who sometimes have no real idea of what we do as a profession and what we might be able to do to help them out, whatever their problem. 

Is this a surprise?

Well probably not given that physiotherapists themselves have differing opinions and thoughts about the definition and purpose of physiotherapy. As a test of this I myself wrote a one sentence definition of physiotherapy whilst also asking several of my colleagues to do the same. Here's the results........

Physiotherapy is......

' Diagnosis, treatment and management of a problem, with progressive restoration of function to the desired level '

' Identification of injury and management of pain, with follow up restoration of movement, strength and athletic tasks '

' The maintenance of a healthy functional body equipped to perform '

' Restoring and optimising movement and pain perception through active rehabilitation, applications of pain science and patient education to promote independence '

' An integrated approach taken with the aim of providing an environment for multifaceted systems to function optimally '

' An umbrella term for the maintenance or restoration of optimal human function and relative homeostatic state '

As you can see yourself these definitions differ. This is interesting as these definitions are from 'physiotherapists,' who trained under the same system and curriculum and are all currently working within the same setting (professional sport). The mention of terms such as 'function' 'pain' 'restoration' and 'injury' or terms similar to these are replicated throughout the definitions listed above. This implies similarities in the way we view physiotherapy. However, as I read each and every definition, I read physiotherapy to be something different in each example. Not that i disagree with any of the above definitions, complete the opposite.  Each has a different spin on what is a very varied and multi-factorial profession. But if we differ as professionals as to what physiotherapy is, how can we expect our patients to make sense of this and decide whether physiotherapy might be for them. 

I myself and some of my colleagues that came up with the above definitions found it quite difficult when asked to write a definition of physiotherapy. This might be considered surprising given we are 'physiotherapists.'

What is also interesting is that these definitions again differ from what the Chartered Society of Physiotherapy, the body all Chartered Physiotherapists are registered with, define physiotherapy as;

' Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability' 

Does This Really Matter?

In short, I don't think it matters if physiotherapists differ in what we think our profession is and what the service of physiotherapy offers our patients. Physiotherapists will differ greatly in the ways and means they diagnosis, treat, rehabilitate and manage similar presentations. Is one method better than another? Probably not, assuming they both get to the same end point in the same time period. I actually think autonomy and the ability for us to be different to one another, to develop our own approach is one of the things that makes working in this profession so good. 

However, I do think it is a massive problem that those we see daily, our patients, don't know what we are and the services we can offer. I'm not suggesting we need a standardised definition of what physiotherapy from a central body that we must all use and acknowledge. Given the differences in approaches discussed above I think this would be both unsuitable and undesirable. 

But there is an issue in that many of our 'potential patients' don't access our services largely because they are unclear about what it is we actually can provide them. 

Should we be surprised then why someone in pain wouldn't seek our assistance in the aim of becoming pain-free and improving function? We question why these people choose massage therapy, osteopathy, chiropractic care or other remedial therapies over physiotherapy. 

The reason they are doing this is not because they perceive these therapies better than physiotherapy.

I honestly believe its because they don't know what physiotherapy is

In turn, they cannot make an informed judgement as to how physiotherapy will be beneficial to them.

Less uncertainty surrounds the other professions listed above. Everyone has a grasp of what a massage therapy session would entail or that they would go and visit a chiropractor should they have neck or back pain and wanted it manipulating.  

As physiotherapists we are missing the boat.

We need to be better salespersons as to what we offer and how we can help our patients. The beauty of our professions is that we all so different in the way we approach physiotherapy. But this might also be our biggest flaw, as we don't deliver this information well, particularly to 'potential patients.' 

Maybe we need to explain better what physiotherapy is.......

Maybe we just need to be more transparent as to the services we offer.......

Maybe we just need to educate our patients better........

Thanks for reading 

AB

Why Injury Prevention Programmes DON'T Work

The title of this article is slightly misleading as you will find as you read through the text.

The aim of this article is not to dismiss injury prevention, quite the opposite in fact. Injury prevention methods do work providing they address what that individual athlete or client needs. On the flip slide, ‘one size fits all’ ‘generic’ injury prevention programmes do not work and are very poor at reducing actual injury incidence.

image: soccer-training info

Continue reading to find out the back story and how I have come to this conclusion…..

I recently completed my MSc in Sport and Exercise Biomechanics at Leeds Beckett University. I studied part time over two years and feel the degree has improved my practice greatly in the professional sports setting. Being able to apply biomechanical principles to my work as physiotherapist within sport is a relatively niche skill-set and has aided in particular the robustness of my return to play methods for injured players. Quite often we rely, even at the top level, on unreliable and invalid testing procedures as part of our return to play criteria and as part of the return to play decision making process. Having the skills and ability to use EMG, high speed video and force plate data, amongst other testing, ensures I know my players are where they need to be prior to return to training and match-play.

Image: motionxcellence

The degree itself was particularly challenging. The content and depth of study was what you would expect from a Masters level programme. Finding the time to study alongside working full time in sport, running my own private practice and still trying to have some kind of family and social life was difficult to say the least. The birth of my son mid-way through my Masters and bang in the middle of some of my assessments also didn’t help!!!!! Nothing like trying to study off the back of a broken night’s sleep!!!

As part of my MSc I conducted a systematic review of lower limb injury prevention programmes in male team sport athletes. Trawling through the literature I found;

  • Overall very limited number of studies

  • Lack of injury prevention studies in males

  • Mostly using amateur athletes

  • ACL/hamstring bias

  • Football bias

In summary, I found that these generic injury prevention programmes; such as FIFA 11/11+ do not significantly reduce injury rates. 

The only studies that showed any positive findings were some of the hamstring injury prevention programmes. The main reason that was postulated as to why these programmes were effective at reducing injury is because athletes got stronger as unlike programmes like the FIFA 11 they included sufficient, progressive strength training. 

All in all this review enabled me to confirm my pre-existing thoughts regarding injury prevention..... 

Generic programmes do not work. Throwing everything but the kitchen sink at something or someone and hoping it sticks will not reduce injury incidence. 

So What Is Injury Prevention?

Injury prevention programming is individual to each athlete. Common patterns might be seen between team sport athletes but that is largely due to them completing the same testing battery and also being required to complete similar movement patterns/training stimulus's/training schedules within that same sport. 

I don't think we need to programme specific 'injury prevention' work into our athletes. A well rounded, progressive and periodised training plan, with takes into account how each individual moves (mobility, stability), their past medical history and current health, alongside their training history and level, can be sufficient. 

To make athletes robust we need them to move well and to be able to tolerate load. Specifically, they need to be able to tolerate load specific to their sport and common movements i.e. training prepare athletes for the sporting actions they are required to complete, at the intensity, duration and frequency they will be required. 

As such, providing these factors are covered within training i.e. gym and field/skills/training sessions do we need additional 'injury prevention' programming? 

I don't think we do.........

Prehab or not Prehab? 

That is the question..... I run and advocate physio led prehab/movement sessions as part of my current role within sport. The main rationale for this is not injury prevention. It is to prepare the body and brain for the intended and upcoming session(s).  I'd almost describe it as an extension of the warm up. In a group setting players will conduct the same drills and movements, but this is in additional to their own individual corrective exercise plan. The individualised content does have a rationale to reduce injury as will aim to work on any movement deficiencies or energy leaks that might predispose that player to injury.

Within a prehab session pre-gym, the content of the gym session will inform the content of the prehab session. If a deadlift or RDL pattern was programmed in the gym prehab content might look at some hip mobility, into some hip hinge retraining and cueing. The aim being that this will carry into the session, allowing players to move well in the gym, avoid poor form and maximise the intended gains of that training lift and gym session as a whole. By improving how players move this will likely reduce injury incidence, both in the gym and in other settings, but this is not the main rationale for prehab.

To round up, generic injury prevention programmes aren't worth the paper their written on. Individualisation of training is the way to go; athletes should have individual programmed correctives based on what they need to improve, which is then reinforced with a good gym programming.

Thanks for reading

AB
Are you a GIVER or a TAKER?

That is the big question. Are you a giver or a taker? Or are you something else? Lets find out………

So, which one are you?

Are you the one that always helps others out, like your colleagues at work, or are you the one that takes what you can from all of those around you to maximise personal gain?
Some of us will probably not lean towards one side or the other. I guess we would all like to think we are more of a giver than a taker, but are we?
Image: slideshare.net

Within the business world recent evidence has suggested that although takers tend to be more successful financially the givers are generally in a better position to advance their careers and also sustain greater longevity once they reach the top of their field. So, within the business world if you’re after a quick buck, take from those around you, get them to do the hard yards and you’ll reap the benefits, at least in the short term. If you’re after long lasting success and longevity your better being a giver. You might not reap the benefits as quickly but you should expect a more sustainable and longer stay at the top once you get there.

Although this relates to the business world, I think there is carryover into any domain of work, including sport. 
Working as a physiotherapist at the highest level of sport brings its challenges. One vitally important concept that needs to be developed and is imperative to the success working in elite sport is the athlete-therapist relationship. A poor relationship between the athlete and therapist will likely lead to poor treatment, rehab and performance outcomes. The flip side being a strong relationship should lead to good treatment, rehab and performance outcomes.  

In many respects, therapists tend to have close and strong relationships with athletes and I believe it boils down to one main aspect. That is that athletes believe we have their best interests at heart. When we are assessing, treating and rehabilitating these athletes we devise a plan based on the best interests of that particular athlete at that particular time. This is a strong example of being a ‘giver.’ When athletes see this behavior consistently they put trust in us and we are able to build a stronger relationships, largely because they appreciate our ‘giving’ approach. Should they think we are driven by other things or have different motives, aside from their best interests, then they wouldn’t trust and ‘buy in’ to what we do and say. As a result, we would expect the athlete-therapist relationship to be much weaker. In turn, we would expect non-adherence to rehab and poor clinical and performance outcomes as a result.  
The giver-taker relationship is probably a little more complex than discussed above. Its likely at times we might be more of a giver or more of a taker. This might depend upon the person, situation or intended outcome expected.  
If you don’t feel that you fit into either category i.e. your neither predominately a giver or a taker, maybe your not. You could actually be a MATCHER……..

Psychologist Adam Grant has done extensive research into personality profiling and was the one to come up with the concept of classifying the working world into givers, takers or matchers. 
Givers generally find out ways to be helpful and give to others. Takers are the flip side and focus on extracting as much as possible from others. Matchers play “tit for tat”—they reciprocate and expect reciprocity and as such fall somewhere between the two. 

But as discussed there are situations when we act differently and everyone—even givers—can operate like takers.
Despite these situational changes I believe that we all have a dominant type i.e. we are predominately a giver, taker or a matcher. We can change and adapt. Our goals and motives will be the primary driver behind which style we predominately adopt. 

The work of Grant suggests that givers and matchers run of becoming takers when they disregard their actions and the consequence these actions have on other people. 

In life we often feel the need to pigeon hole ourselves into one category or another. Are you a giver, taker or matcher? Does it really matter? All we do know is that people will generally adopt one style more than another. The important factor is highlighting the driver behind which style they choose to adopt. The goals motives of someone will likely be the deciding factor as to which style is most dominant. Can we change? Sure, we can change our style, but such changes are the likely consequence of a change in motive. 

So, going back to the initial question; Are you a giver, taker or indeed a matcher? 
It all depends on what your intended goals and motives are………..

Thanks for reading

AB

Don’t Make a New Year’s Resolution!!!

In the wake of Christmas and in preparation for 2017 many of us may be considering making New Year’s resolutions. I’m personally not a fan of resolutions and this short blog will explain why.

#1 Why Wait?

Firstly, I can’t grasp why we must wait until a certain time point i.e. 1st January to elicit change. The same way every new diet or exercise regime must start on a Monday. If you feel change is needed why not start straight away? There is no need to wait. Don’t wait for a common timepoint, you don’t need to. Whatever your goal, be it diet, exercise, work and/or relationships, you can start to make change right away. 

NY resolution (politicsinpoverty)

#2 Resolutions are too broad

Secondly, most resolutions are too broad.

‘In 2017 I want to be healthier’ or

‘I want to complete a 10k race’

Both the examples above are flawed. The first ‘resolution’ is non-specific. Firstly, what is healthier? This will be highly individual and each person’s starting and end points must be considered if we are realistically going to use goal setting appropriately.

Two different people might use body fat % as a goal, both wanting to drop 10% from their starting weight. Person A is 200kg and person B 100kg, representing a 20kg and 10kg weight reduction goal respectively. If after 6 months both had achieved their goal you would consider both to have been successful. If you looked at absolute numbers person A dropping 20kg has lost ‘more weight’ than the 10kg lost by person B. But considering it as a percentage of initial bodyweight (10%) they have lost the same. Furthermore, person A is still 180kg, probably not that ‘healthy.’

The 10k ‘resolution’ again lacks specificity. Completing a 10k? Does this mean walking, running or are we aiming for a sub 40-minute time? Three very different scenarios and goals. Broadly someone walking a 10k in three hours has completed their goal and completed their ‘resolution’ but is this really a big achievement. Again, we need to consider each individuals starting point. Just completing a 10k race might be a massive achievement for one person, maybe they’ve overcome illness or injury for example.

My major gripe with both is that because they lack specificity and detail they are easier to accomplish and hard to plan. If someone said;

‘I want to complete a 10k race in under 50 mins by the end of August’

now we are talking. We have a target time and the goal is time bound. We can look at the race calendar and target specific races in which we will attempt to break 50 minutes. We can also plan our training around these events accordingly. These factors will increase the likelihood of the target time of a 50 minute 10k happening whilst increasing adherence to a training programme.

This brings me on to my final point and incorporates my own goals, ‘not resolutions,’ for 2017.

Success (medical practice success)


#3 Goals don’t need to be new ones

New goals don’t need to be new. They can be a continuation of tasks, activities or routines we already complete. Too often we look at what we don’t already do, thinking it’s a magic fix for all the other things in our lives. This is not always the case. In my opinion, far too often in life we highlight our weaknesses and think that by addressing these we will become better in whatever that domain may be. We very rarely look at what we are good at and think….

‘I’m going to continue to be good at that’

We almost assume that because we are already good at that aspect of our lives that it needs limited attention and time. But what it we don’t make time for the development of these strengths? Will they become our weaknesses down the line? Maybe we are good at what we do largely because of these strengths, so surely, we shouldn’t dismiss them. Maybe we should highlight these strengths and make them even stronger. Furthermore, many of our strengths are often strong because they are tasks, activities, routines that we enjoy. This in itself will improve adherence to our ‘goals’ rather than focusing on a weakness that we don’t actually want to engage with in the first place.

If you asked my wife what I am rubbish at, number one on the list would be ironing. The main reason I am rubbish at it is because I hate doing it. It bores me to death. I have no intention to ever get good at it either. A simplistic view would be because I’m poor at ironing, I should do more of it, to get better. But why would I do that when it bores me to tears. As such my wife does all the ironing and I do different jobs within the house. Everything gets done and I never have to touch the iron!! Happy days!!!

My Goals for 2017

So, you’re probably wondering what my goals are for 2017. They are the same as 2016;

1.       Exercise everyday

2.       Allocate 30 minutes a day to learning

By exercising daily, this doesn’t mean I’m in the gym every day. I might go for a walk, take my sun swimming or doing some low level corrective exercise or breathing retraining. This could range from 15 min one day to three hours the next. Its very flexible and as such I can adapt my exercise habits around particular busy time periods.

Learning comes in many forms for me, but is usually reading. By allocating 30 minutes daily ensures that I do continue to learn. I greatly value the time I do sacrifice in the aim in making me better at what I do; both in my working domain and out of it.

Summary

I think that consistency is key. I will reflect on 2016, use this information to guide future study and progressions that I want to make along the way. My 2017 goals above, feel like a continuation of my lifestyle habits. They are not resolutions. These are both things I enjoy doing so I don’t find them difficult to attain. Equally, both are beneficial to me in development, both health related and knowledge based. Furthermore, when I complete these two tasks daily I feel like it’s a ‘win.’ Getting daily ‘wins’ feels more rewarding to me than maybe one or two larger ‘wins’ within a year. Usually these small wins will contribute to larger wins so I can go to bed happy that I’m heading in the right direction.

Strengthen your strengths not just your weaknesses. Our strengths are generally a result of things we enjoy doing. Keep doing what you enjoy doing. Don’t worry too much about your weaknesses.

Sets specific targets not wishy washy ‘resolutions’

Here’s to a prosperous and happy 2017 filled with accomplished goals and continued development in all aspects of our lives.

Happy New Year and thanks for reading,

AB

What Santa Can Teach Us About Our Work:Life Balance

Santa Claus has probably the best work:life balance out there. He works 1 day a year, then a steady 364 days to rest up and get ready for his next shift. He does have a tough day, but we’d all take that for the rest of the year off, wouldn’t we?
Santa is also very smart in several other ways. Firstly, he has outsourced most of his work. His team of Elves do all his dirty work up at the North Pole. Secondly, he has virtually no costs as he doesn’t purchase any of the presents that he delivers. And all this whilst also demanding that he is fed (mince pies) and watered (sherry) alongside feeding his reindeer (carrots). 

In summary, Santa has nailed the ultimate work:life balance. Whilst the above comments are quite jovial, we can take some important advice from Santa. Here’s how.

#1 Delegate

Like Santa with his army of Elves there are some tasks we complete that could be completed by others. Why would Santa flog himself working for weeks and weeks in the run up to Christmas in every grotto around the world when he can get others to do it for him?

During my early years as a head clinician working in professional sport, delegating tasks was something I struggled with. Not that I didn’t trust other staff that I was working with, I think on reflection it was my control freak side taking over. I think everyone has their own way of doing things, I certainly have. During those early times, I think I saw value in certain tasks and if I could physically find the time to do them myself I would. Additionally, I was still learning how to lead and manage others, previously I was the one being managed by some one senior to me, now I was the senior one!!!


An older more experienced me has realised through my own errors that this is not the way to do it. Delegation of tasks shares the workload; allowing myself and those I work with to have more time and allow us to do a better job in those prescribed tasks. More time allows more in depth work and in turn better task completion. 

Like Santa I have learnt the skills to delegate and get more work done, work is completed to a better standard and overall save everyone time. Less time working and more time to do what I want to do is obviously a good thing.

#2 Prioritise & Omit 

There are certain tasks we complete day to day that probably don’t even need completing in the first place. Working day to day as a physiotherapist there are several tasks that I must complete. For example, from a medico-legal standpoint I must complete my patient/player notes within 24 hours of the intervention. Additionally, I must plan my next working day, so I know who I need to see, when I am going to see them and what I am planning to do (i.e. treatment and rehab). These are my priorities. Beyond that many other tasks might not need completing right away. I used to make it habit to daily to clean my desk, empty my paper bin, check and restock my run-on box/bag amongst other things. Whilst these tasks do need completing, they don’t need completing daily. Doing them daily is not an efficient use of my time. Time that could be better spent on other activities. Activities that will improve me clinically for example, like reading a journal paper or doing some research on a particular pathology or subject to deepen my knowledge in that area. Emptying a bin isn’t going to make me better at my job, but spending some time studying might do. 


Over time I have become better and better at omitting tasks from my daily routine. I used to be a compulsive email reader. I have about 6 email accounts and get approx. 40-50 emails daily. Every hour or so I’d be checking my mail and reading through them, usually on my phone. I’d then get side tracked and end up trawling through my Facebook and Twitter feeds and before you know it 10-15 minutes has passed. To stop me doing this now, I will not check my emails after 5 pm. Sometimes it can be even earlier depending upon what time I finish work that day. The only real urgent emails that I may receive will be sent to my work email. 90% of these ‘urgent’ emails aren’t ever that urgent and can be picked up and responded to the next day. The other 10% if urgent, the sender will almost exclusively contact me another way i.e. text or a phone call. Therefore, it is not necessary for me to check my emails continuously throughout the evening, so I don’t. If I was expecting an important email, modern day technology allows us to set notifications from certain senders to ensure we don’t miss them. I occasionally use this feature. 

#3 Do what you enjoy!!!

Like Santa, do the best bits. Deliver the presents and get all the glory. Why would Santa want to do all the hard graft like the Elves? Like Santa you need to make time for the things you enjoy. This will be made easier by prioritising and omitting other tasks as per #2. 

I enjoy learning. I continuously strive to get better and better at what I do and value my time spent trying to achieve this. As such I ensure I complete 30 minutes of such practice daily. This usually comes in the form of reading. If for some reason, I don’t manage to complete 30 minutes learning in a day, that time will be made up another day. This rarely happens however. I value the importance of my learning and thus always find the time to do it. Do what you enjoy……. 

In summary, learning to delegate, prioritise and omit tasks will leave you more time to pursue the tasks and challenges you want to do, particularly those you enjoy the most. In doing so you can maximise your work efficiency and even get tasks done to a better standard in less time. In turn this could help improve your work:life balance for the better.

In 2017 lets be more like Santa.

Thanks for reading

AB

Images
Santa image (askideas.com)
Delegate (seapoint)
Time (Pinterest)
Free e-book '5 Steps to Get a Job in Professional Sport'

Working Within Sport: The Art of Collaboration

I recently sent out an email newsletter to RehabRoom mailing list subscribers regarding collaboration within a sporting setting and received quite a few questions about this topic. Therefore, I have decided to expand upon that email and write a blog post on this subject.

                                                                                   Setting the Scene

In many respects working within a professional sport setting is no different to working in any other environment. Number one being that most usually involve interaction with other people. Both on and off the field the best teams generally are the product of individuals working well together. This is true whether we are relating this to a professional sports team or any other industry.

As a physiotherapist I have my thoughts and opinions about the rugby department operation including coaching, strength and conditioning, sports science and nutrition. On the flip side those people will have an opinion on my physiotherapy practices and the medical department as whole and rightly so. In working within a professional sports setting for seven years one of the major lessons that I have learnt is that the ability to collaborate is key to a successful team; whether that's on the pitch or off it.

The ability to collaborate is something that’s not taught during our studies whether we are healthcare professionals, strength and conditioning coaches, skills coaches, nutritionists or any other type of professional. I remember being told about the MDT (multidisciplinary team) and the importance that different professionals work together to achieve a common goal. Whilst this is true, nobody ever talked about how to do this and why or how an effective MDT operates. Hopefully this blog will go towards addressing some part of that.

Don’t Avoid Conflict

‘Judge a man by his questions rather than his answers’

Voltaire

There will come a time when you might have a differing opinion to others. I often do and sometimes these opinions need to be voiced. Quite often, rather than throwing myself in the deep end straight away I will ask for clarity regarding a particular discussion point. For example, I might ask for clarity as to why a decision has been made e.g. scheduling, content in a gym or field session. Quite often this process offers explanation and as such their intervention having been explained is then no longer an issue. I now know and understand why that decision has been made and 99% of the time my initial difference of opinion is no longer so. Had I jumped straight down somebody’s throat questioning everything under the sun unnecessarily, this would of likely caused a degree of conflict. Continued conflict within a team environment is something we obviously want to avoid where possible. As indicated in the quote above the art of asking questions is very important and above all else will add clarity to any potential issues.

There are times however that you need to voice your opinion, which might be in direct conflict to another member of the team. If it needs to be said then you need to say it.

Maybe you have followed the steps above and asked for clarity regarding a potential issue but the answers you received don’t sit well with you. In these cases you must speak up. If you think these decisions are going to be of detriment to your players in any way you must voice your opinion. Even if this is outside your field of expertise i.e. a healthcare professional commenting on strength and conditioning and/or coaching. Equally, as a healthcare professional I would always welcome other professionals opinions on healthcare issues. Sometimes other professionals offer a different perspective to yourself and as such you can use this perspective to improve your own practice and interventions. In essence, you are using others knowledge and expertise to your advantage. 

Backroom staff enjoying a beer following victory in the 2012 Grand Final

How do I voice my concerns?

Firstly, you must be strong in your judgement that you have some substance behind your opinion. In today's day in age in professional sport where near everything is measured, using information such as GPS, screening or well-being data might be useful to substantiate your opinion. You need substance to validate your claim(s) and in turn make your argument stronger. 

Secondly, consider your surroundings. Certain personalities can become very defensive if questioned. Therefore, bringing up your potential issue might not be best suited within a departmental meeting. Maybe speaking in close quarters away from the group with certain individuals would have a greater affect. This could help to minimise a potential confrontation and ultimately your message and resultant recommendation(s) are more likely to be acted upon. As you build a relationship and rapport with those you work with you will attain how they work; how they like to receive information. This information is key to then allowing you to structure your message in the correct way. This extends to both the professional-athlete relationship as well as the professional-professional relationship.

Giver or receiver?

Within the sporting setting it is apparent that professionals will have differing opinions regarding a variety of topics. Is one person right and others wrong? Probably not. Probably they are just looking at the same issue from a different perspective.

From working in professional sport for a number of years I have learnt that you need to be both a giver and receiver of information. You will have differing opinions but you can still get to the same common goal with your athletes by using all members of the MDT. Quite often this approach will actually yield faster and better results. One member of the team might be more dominant during a certain period i.e. a physiotherapist will be the dominant professional during the time a player has an injury, but input from all the MDT is both warranted and needed. That is why you need to take on the opinions and information that other professionals give you. The ability to collate and utilise this information correctly mainly boils down to the art of collaboration.

Summary

Above all the ability to collaborate is key. Working in sport, many different disciplines will have differing opinions on a variety of different topics. Whatever these opinions the common goal is always the same;

To build athletic, robust and durable athletes that can execute skill well

 

How we get to that point may be open to opinion but what is clear is that collaborating as a team will allow all disciplines their input and if these inputs don't conflict one another we should be able to work towards this common goal.

Thanks for reading

Andy  

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Keeping Athletes Below the Injury Threshold


In any athletic population keeping players fit and healthy and in turn on the training and playing field is obviously highly desirable. Having the best players in the competition probably doesn’t account for too much if half the team are on the side-lines nursing injuries.

Probably the major flaw with injury prevention strategies globally is that they are not evidenced. The major reason for this is that we never know the injuries we don’t get. Therefore, it is difficult to determine whether injury prevention strategies actually reduce injury risk. Our knowledge of anatomy, mobility, stability and movement and subsequent flaws with such factors, indicate that improvements in the identified flaws will in theory decrease injury incidence, but are we sure? The only reason to really determine this would be to run grand scale longitudinal studies from athletic populations through the entire course off athletes careers, documenting what injury prevention strategies they had been exposed to; this would include the type of strategy, duration, reps, sets, load etc. Pretty much impossible!! The gold standard would be to take a sample of players, split the group, expose one group to injury prevention with the other group given no intervention, then compare the groups beside one another for any differences in injury incidence. To gain any weight this would again need to be conducted over a prolonged time period, ideally an athletes full career span, something again pretty much impossible. However, given our knowledge of the proposed benefits of injury prevention, withholding such interventions and potentially increasing injury incidence within the environments we work could almost be considered negligent. Hence, it’s not something we would want to pursue.

Despite this, I am a firm believer that employing the correct strategies do reduce injury incidence and as a result I run a comprehensive injury prevention plan throughout the course of the season with all the athletes I work with. This includes individual self-directed corrective exercises completed by the athletes themselves alongside group led prehabilitation type sessions that precede training (both gym and field based). 

What should be included within injury prevention strategies is open to debate. For each individual player I include corrective exercises based upon issues identified during screening i.e. postural and positioning, mobility, stability, movement or strength issues. I also think it is important that athletes themselves have input into such programs. Athletes, particularly more so experienced athletes, have an idea of what works for them and often have certain exercises patterns that they feel prepare them for training and games. As long as those patterns do not conflict with the correctives I have set then I don’t have any issues including athlete led correctives and have also found that with shared decision making adherence to such programs is increased. In addition, player education is massive regarding injury prevention and failure to get athlete ‘buy in’ will undermine any strategy to reduce injury incidence. Within a training setting it is likely that what players complete with regards to correctives whilst at the training ground will not be enough on its own. Athletes will need to spend time working on the above whilst at home and away from the training ground to maximise the potential benefits of such programmes.

 

Injury Threshold

Every tissue has a failure point; the point at which it cannot withstand the load placed upon it resulting in failure and in turn injury. This load may be an acute episode or chronic loading over a period of time. This applies to whether the tissue is bone, muscle, ligament, tendon, fascia, skin…….. with largely the amount of load and loading rate indicating the severity of injury.

The idea therefore is to reduce the incidence of injury by taking players as far away from the point at which tissues will break (threshold). The picture below gives an indication of injury risk and adaptive response to loading.

 Image from pponline.co.uk


Injury Prevention Strategies

I would broadly split injury prevention strategies into 5 sections; Repositioning, soft tissue, mobility, stability and movement. Correctives and/or group led interventions would follow this order i.e. repositioning into soft tissue into mobility and so on.


Repositioning

If athletes are in the incorrect position to start with any intervention beyond that point will add further dysfunction to the system. Are we likely to fully balance the system, probably not, but every attempt to balance the system should be sought.

My go to for repositioning are Postural Restoration Institute techniques, using both non-manual and manual where appropriate, although there are many other avenues that could be used.


90-90 Hip Lift with Hemi-bridge


 Image from posturalrestoration.com


Soft tissue

Following repositioning I would address any soft tissue limitations that may be apparent and that may impede any gains sought later in the program, particularly with regards to mobility and movement.


Mobility

Following on, any correctives regrading mobility would be addressed at this point. Mobility itself can be achieved via a vast array of ways and going into detail is an article in itself. The areas addressed would be those identified via screening and/or involve common athletic joint movements that would be necessary going into the intended training/game setting i.e. a pre gym session might differ from a pre field session.

 

½ Kneeling Stick Ankle Mobilisation



Stability

Following mobility any stability flaws would be addressed and be individual based per athlete and/or reflective of the intended session (gym or field based).

This could include for example scapula activation, serratus anterior and lower trap dominant exercises, prior to upper limb lifting.

 

Movement

Movement strategies employed would be directed given the intended movement demands of the intended session. Similar to previous therefore, a pre gym or pre field session would likely differ in content.

A pre field session might include a mobility based warm up followed by an activation circuit to reduce possible injury risk within that session whilst also preparing the system for the movement demands of the intended field session. Further applications to cater for specific movements i.e. deceleration retraining could be incorporated if the intended session was to include repeated deceleration tasks.

A pre gym session would likely include specific movements intended for those lifts included in the program. For example, if athletes had a deadlift variation programmed in their gym practice and retraining of the hip hinge could be incorporated as part of the pre gym session. This would in theory decrease the likelihood of obtaining an injury during the deadlift exercise itself, through an improper hip hinge strategy, whilst also increasing the quality of the movement and in turn the development of intended gains e.g. strength.

Hip Hinge



 Conclusion

In summary, despite a lack of evidence, spending time conducting ‘injury prevention strategies’ are seemingly advantageous in trying to reduce injury incidence by taking athletes away from tissue failure thresholds.  Failure to do this may result in a higher incidence of injury; something everyone would agree is not contusive to successful team performance.

Hope you have enjoyed reading. Any questions or comments please get in touch.

Andy Barker

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The Value of Isometric Training


The aim of this article is to highlight some of the issues and misuses of isometric training both within rehabilitation and strength and conditioning. Isometric training is a frequent used and evidenced as a valued form of resistance training. Yet in some cases isometric exercise is used without great thought of what the goals of the exercise are and how it integrates with movement. 

Isometric exercise is well evidenced particularly in tendinopathy patterns. Progressive loading of tendons via isometric exercise has great value to help manage symptoms and improve function alongside other methods of management.  Decline squats like the image below are an exercise example that might be used as part of patella tendon rehabilitation. 

Some other methods I use such as Postural Restoration Institute incorporate isometric exercise as part of their corrective exercises. The only other time I routinely use isometrics is when range of movement is restricted. For example, I currently have an athlete who is recovering from a quad tendon repair post rupture and at present is locked in a knee brace at 0 degrees. We have used isometric quad and hamstring exercises to load the respective muscles. Loading of the lower limb is difficult given the limited exercise choices available. In this case the use of isometrics is a safe way to load given the athletes current bracing restrictions.

That said, I don’t think isometrics have a place in mainstream training in healthy asymptomatic individuals.

Where In Range?

Understanding when an isometric muscle contraction occurs during movement provides the majority of my reasoning why isometrics have limited value in asymptomatic individuals. An isometric contraction should be at the midpoint between eccentric and concentric muscle activity. Using a squat as an example, the midpoint occurs in the bottom position, at the point there is no movement in either direction (descending or ascending). Thus, isometric contraction in a squat occurs at one point along the movement. It might account for 1% of the total range continuum, with the eccentric portion (49.5%) and the concentric portion (49.5%) accounting for the rest.

With this in mind, isometrics should only be conducted at the point an isometric contraction occurs during that movement.Holding at isometric squat at 90 degree knee flexion could therefore be applicable as for most this would be around the bottom point of a squat. But holding an isometric contraction at any other point along that range continuum doesn’t seem to add up.

Duration

In addition, isometric contractions in movement occur over a split second, therefore why are we holding isometric contractions for prolonged periods. Such exercises don’t equate to what occurs during normal movement. Unless you were training to set a world record in the plank, I don’t understand the reasoning for training such a movement. Where would you see an athlete during competition holding a static abdominal contraction for 60 seconds? Then why do we train such patterns?

I hope this article might stimulate some discussion regarding isometric training. Please put any comments or questions up in the discussion forum.

Muscles don’t work in isolation, and definitely don’t work at one particular point on the muscle contraction continuum for prolonged periods. 

Thanks for reading

AB

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