Sunday, June 12, 2016

Knee injuries - How can you hope to solve the problem using the stimulus that caused the problem?

As a student of sports training and competition I took up the opportunity to watch the exercise selection from the waiting room at the physical therapists. I was surprised at the amount of quad exercises used over the weeks of my observing.

Later as I lay on a table in the therapy clinic I listened to a young male client answer the question from this physical therapist.

Therapist: Okay what have we done so far?
Patient: Squats.
My mind: That’s one.
Patient: Wall squats.
My mind: That’s two
Patient: Lunges.
My mind: That’s three.
Patient: Walking lunges.
My mind: That’s four.
Patient: Step ups.
My mind: That’s five.

So far, the workout was 100% quad. I shook my head and said a prayer for the patient. Now to be fair I did see one non-quad exercise being done later. But the first five and the overwhelming majority of exercises being used in the rehab program for what I believe was an ACL surgery patient were quad exercises.

I found this ironic, because it was this very profession some 30 years ago that brought me attention to the risks of ‘quad dominance’ in muscle balance and its relationship with gait and joint integrity. And here I was, some three decades later, and they were creating that exact same condition.

I took this quad dominant concern, along with my own observations, quite seriously and spend a decade or so developing and refining before publishing a concept I called ‘Lines of Movement’ in 1998. You might not recognize the concept title I gave it but you will recognize the terminology by virtue of the prolific unreferenced and uncredited publishing by people who knew better.

In relation to the lower body, I developed the concept to ‘hip dominant’ exercises to counter the concern I learnt from my therapist colleagues about ‘quad dominance’. Now, nearly 20 years after I first published this concept, my theories about the risks of quad dominance have become greater and clearer. I rank the muscle imbalance presented by quad dominant training as one of the highest correlates with ACL ruptures and similar.

If I am track, then the question can be asked:

How can you hope to solve the problem (ACL rupture risk) using the same stimulus that contributed to the problem?

Now I understand that there are many reasons why most will disregard this message. Firstly, and most importantly, because the majority of ‘performance’, ‘injury prevention’ and ‘injury rehab’ strength training does just this – create quad dominance. And to accept this and change would take the emotional intelligence to conclude one is off track and needs to redirection one’s training programs. That’s the biggest reason the message will be ignored.

I understand this. I understand others are waiting for ‘evidence’. I say look at the changing injury landscape. This injury was extremely rare in the 1980s, and even after the surgery became available there was not an instant increase in ACL incidence – so the low incidence was not because the surgery was not available. It was just a rare injury. It is not any more. So what changed? Why are so many athletes suffering from this injury now? But this would take again a degree of commitment to excellence and a detachment from ego that few are committed to.

Evidence is, I suggest, another way of saying I will only do it when I see most others doing it, and when I am doing what most others are doing, I feel ‘right’ and ‘safe’.

What I do say is this – not withstanding the frequent medical claims I here quoted by patients all too often about how their graft will be stronger than the one their Maker gave them - 50% of all ACL patients will have repeat knee surgery, and 100% will have premature degenerative changes such as osteoarthritis. I would not wish this on anyone. If it was your child would you want this?

So while the masses wait the quarter to full century it may take for the ‘evidence’ to ‘allow’ them to take note of my conclusions, another generation or more will suffer from life changing injury and surgery such as the ACL.

It does not have to be this way for you and those in your care, however that is up to you.

Wednesday, June 1, 2016

Throwing the players under the bus – a strategy for failing as a coach

The first game of the season showed promise with the team winning the first half easily, and then holding on for the second half to win the game. By the second game this pattern of decline in dominance as the game went on became worse, and the team lost the second half.

I had fears of what was to follow, and my fears were amplified when the field announcer stated the final score and congratulated the visiting team for winning the second half. It was just the announcer looking to give a positive to the losing team, but he had inadvertently drove the nail further into the coffin of his own team.

As I feared, the coach told the team in the post-game talk that they were not fit enough. This code for something’s not working, I’ve got no idea what, but it must be your fault and the easiest blame strategy is ‘you are not fit enough’.

Predictably they trained the team harder in non-specific conditioning work as well as rugby drills during the following week. During the next game the team were the flattest they had been, with limited on-field talk. They almost lost the first half, and ended up drawing the game. This outcome was exacerbated by the fact that the opponent on this day had not won a game in the season to date. Of course, it’s unlikely that anyone took into account that they had played and lost to the competitions top teams.

So what do you do next after blaming fitness? The post-game coach’s speech focused on the lack of intensity, telling the players they needed to play and train with more intensity. I am not sure how you naturally bring more intensity when you are more tired than you needed to be, but that’s the way this scenario played out.

During the week, as you can expect, the team were trained in a way that resulted in the coach happily stating that they had brought more ‘intensity’ to training, inferring this would serve them well in the upcoming game.

In the upcoming game the team lost for the first time, failing to score a single try, and conceding nearly half a century of points.

So what do you do now that you have gone down the path of throwing the players under the bus? You start dropping players. So about 55% of the way through the season players are relegated, with the ensuing drop in personal confidence you can expect from players dropped without knowing why.

How did this work? The next game resulted in a score against that exceeded half a century. Now it was against the second strongest team in the competition, but the fact this team scored as many points as they did against a lowest rank team (a team that the losing team had easily beaten) suggested that the outcome was unnecessarily out of context to the losing teams potential.

So where do you go now? Shuffle players around, playing them out of the position you had them in for most of the season? Basically you run out of options.

Few would disagree that athletes benefit positively from people believing in them, especially their significant others. And who more significant than their coach? On the flip side, again few would disagree that negative impacts potentially result when a coach directly or indirectly tells the athlete they are lazy, don’t try hard enough, are not intense or focused enough, or are not good enough to play at that level.

The challenge with any coach who fails to interpret the cause of their outcomes is further failure. However this failure is magnified in it’s consequence in the team culture where the coach takes the path of throwing the players under the bus.

Whenever I hear a coach who by words or actions blames his players, I see a lesser future for the coach. To put it bluntly it’s a path to failure. This applies no matter what level it is occurring at, bet it the national team or a local kids team.

I have had the fortune of working with coaches who have the strength to deflect the pressure on their team. The long serving Queensland rugby union coach John Connolly was one of these. I was impressed with his choice to absorb the pressure and not throw the players under the bus. However these coaches are the overwhelmingly minority. From my experience, I have observed the majority of coaches blame the players, failing to understand that firstly what goes on is a product of their leadership, and that the act of blaming the players is in the short term the kiss of death to their team’s culture and in the long term the kiss of death to their coaching career success.

Few coaches develop their coaching abilities to the level of being able to consistently and successfully interpret the cause of their wining or losing, and I accept this. However my suggestion that even in the absence of this high level ability, coaches could benefit from avoiding the popular habit of throwing the players under the bus.

NB. The above is fictional story to illustrate the message.