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Tag Archive: GAIN2018

  1. 5 Tenets of Sports Injury Rehabilitation

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    Movement is the foundation of sports injury rehabilitation

    Dr Grace Golden gave an insightful presentation on returning to sporting activity at GAIN 2018. I liked her systematic approach which was well illustrated with video examples. She also had a large amount of creativity and fun involved in her rehabilitation sessions.

    Coaching the injured athlete

    sports injury rehabilitationGrace “coaches” the rehab sessions, which is different from the experiences of many athletes who are returning from injury. Grace understands the need for skill development and fun in the rehab process. She often works on the sidelines with teams and integrates the rehab with the sport training. This is very important for athlete morale (it also helps remind the coach that the athlete is still alive and kicking).

    Communicating between members of staff is also important. The rehabilitation world uses inconsistent language when working with injured athletes:

    • Return to activity.
    • Return to sport.
    • Return to play.
    • Return to competition.

    What are we trying to do? All of the above are different in intensity, but athletes are often told to “rest for 4 weeks” by a medical professional. There is a difference between graded exercise progressions and competing in a regional tournament.

    Tenet 1 Start simply

    Practise and evaluate locomotor skills in isolation.  This means training in single planes and one direction of movement at the start. Work on the fundamentals before athlete specific and specialised movements.

    Criterion based rehab” may be a better method than “timeline” based rehab. Grace uses the single leg squat (SLS) as one criterion.  One target is to do 70 sls in a 2 minute span, ideally with a 90degree knee angle, but 70-90 degrees is acceptable. The athlete rests for 2 minutes then repeats, building up to 3 sets total.

    This prepares the athlete for 2 minutes of running or jogging better than “rest”. Having objective criteria improves understanding between athletes, medical staff and coaches.

    Can your athletes do 70 single leg squats in 2 minutes when healthy? Are they fit to play now?

    Tenet 2 Common agility tests should not serve as the primary training stimulus or pathway to progression

    Whilst agility tests like the Illinois agility test, the 3 cone test, or the T-test may have a place in training, they are very simplistic. This means they are quickly learned and the stimulus is redundant after a few attempts.

    Better to think of a variety of exercises using different stimuli. This includes decision making in a controlled fashion.

    Tenet 3 The order we combine locomotor skills influences acceleration or deceleration exposure

    sports injury inhabilitation

    Deceleration is loading

    The injured body part is loaded more in deceleration activities than acceleration, Grace trains acceleration early or first and then adds deceleration.

    (See Damaging nature of decelerations)

    Tenet 4 Add discrete skills in transitions for directional and plane changes

    (as long as they have been trained previously).

    Grace broke this into 4 different phases:

    1. Continuous direction and continuous speed.
    2. Continuous direction and multiple planes.
    3. Multiple directions and multiple planes.
    4. Multiple directions and continuous planes (cutting progressions).

    Tenet 5 Be mindful of how what you are doing today is preparing the athlete for what they need later

    Or, “start with the end in mind”. The goal of rehabilitating injured sports people is very different from rehabilitating the normal population. Jogging on a treadmill pain free could be a successful outcome for Joe Public.  That is nowhere near enough for a field/court team sport person, so the rehab process needs to be structured along different lines.

    Summary

    I have barely touched the surface of Grace’s presentation on sports injury rehabilitation. Her presentation was rich with detailed examples of the exercises she uses. Most important for me was how she integrates the work with the coaching staff. It is all too easy to rehabilitate in a clinic room that doubles as a bunker.

    Further reading:

     

  2. Sports Science: Servant or Master?

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    Sport Science: Servant or Master?

    sports science

    Practical session at GAIN

    Last month I attended Vern Gambetta’s GAIN conference in Houston, Texas.  A great mix of practical sessions, seminars and informal idea sharing, it is my annual chance to take time out and immerse myself in learning.

    I shall be sharing some of the ideas and insights learnt this year. The act reviewing what happened and disseminating that into a hopefully useful blog post is part of my ongoing learning.

    Today I start with Peter Weyand’s second seminar which was a great overview of the scientific process and how things stand in this millennium.

    Sorting Sport Science in the Digital Era

    In the last millennium there was little or no information available to sports coaches. Peter said that much or most of what is available now is “shaky”.

    Here are his 5 “Drivers of Disinformation”:

    1. Proliferation of Information Outlets (Instagram, Facebook, YouTube, Podcasts and Twitter).
    2. Volume of data and literature being produced (wearables and new technology).
    3. Poor quality research training.
    4. Pressure to publish (anything).
    5. Self-Promotion (Not all bad, helps share ideas, but often results in self-citations).

    This results in “literature pollution” and disinformation.  Peter said that “laziness is the default intellectual condition”.

    It is hard to filter what is good or useful in this age. In fact, “Computers don’t reduce work, they create more of it” (Peter Taylor, 1994).

    So how can busy sports coaches develop a filter and understand what will work best for their teams and athletes?

    The Scientific Method

    Two years ago I was asked to present a CPD event to physiotherapists in Exeter. I gave my thoughts and observations on using motor skills learning in rehabilitation so that patients are working towards useful (and interesting) outcomes. At the end, one physio asked “Yes, but what about the science?”

    The science”? As if there is one thing that is all encompassing, this from a person with a science based degree showed a lack of understanding of the scientific process. Many coaches have no formal scientific background, but can still follow the scientific method.

    Peter laid it out very well, and these principles will help you as a coach develop a filter.

    1. Get an idea or question.
    2. Make observations.
    3. Analyse observations.
    4. Idea supported: Yes/No?

    Peter suggested that good researchers ask good questions and then look to first principles for answers.

    Step 1: The research question must be good.

    Step 2: The hypothesis must be testable. The design of the study must yield data that will “get out of the noise”.

    Step 3: Analyse the observations in the right way. Peter used several examples to illustrate what works/ doesn’t work.

    Step 4: Proving and disproving: how well does data support the idea?

    An interesting point was that an idea can never be proven true! Instead, the scientific method can only disprove. It only takes one outlier or piece of data to disprove a theory: the exception.

    For example, Peter was studying sprinters in action and a common hypothesis was that symmetry between limbs was needed. One sprinter had a big asymmetry and yet was very fast. This one individual therefore disproved the symmetry hypothesis. Other factors must be important in sprinting.

    Degrees of Uncertainty

    In the past I have often got confused about what is presented as “research” compared to “theories”. This is especially true in ideas like Long Term Athlete Development (LTAD), where many papers are published stating that this latest version is the definitive answer.

    Peter helped me understand better the hierarchical language of degrees of certainty.

    1: Hypothesis (an idea).

    2: Model (LTAD is an example).

    3: Mechanism.

    4: Law (Gravity). Hard to argue with this.

    (Peter may yet to have dealt with “Mum Chat” or “Bloke down the pub” which trumps all of the above! No matter what I do to try and help educate parents, they prefer to listen to their friends).

    Conclusions

    This presentation really helped me understand the scientific method (much more so than a whole module of “research methods” at Brunel University whilst studying for my MSc).

    If you cannot explain the conclusion in 1-2 sentences, you will never reach a general audience”.  I would add that if you cannot explain the conclusion succinctly, you may be unclear yourself as to what is happening.

    scientific method

    Isaac Newton

    Peter used Isaac Newton as an example of making a big subject very simple. Newton expressed his 3 laws in simple terms and then came up with a very simple equation F=Ma.

    When doing research (that includes looking at your own teams) it is important to “Get the big stuff and keep moving” (so much for “marginal gains”). Find out what matters most and look at that.

    When reading research “It’s critical to be critical”.

    Check the scientific method of the paper:

    1: Is the idea supported Yes/ No and does it have a value?

    2: Is it testable?

    This will then help you decide whether to try and implement some of the ideas into your own practice.

    Peter’s whole talk was illustrated with examples of his research and that of his colleagues. I was impressed with the detail he goes into, how much work and effort is required and also how he explained it.

    Brilliant.

    Further Reading: