Speaker 1: Okay, welcome back.
Speaker 2: We're at episode one and eighty six of Athletes Authority
Speaker 2: on it and Jesus Christ is some nerves going on
Speaker 2: in here. We have managed to squeeze all three physios
Speaker 2: into this room today for a bit of a physio
Speaker 2: round table.
Speaker 1: They're not all best at talking or discussing.
Speaker 2: We've got a couple of Irish, a couple of English
Speaker 2: and it's certainly.
Speaker 1: Going to be an interesting one.
Speaker 2: But guys, it's a bit of a round Let's have
Speaker 2: a very quick intro because nobody listens to podcasts for intros,
Speaker 2: so just so people know who's actually in the room.
Speaker 3: Joe, do you want to kick off? Mate? One sentence?
Speaker 4: One sentence. So I'm Joe. I'm from England. I worked
Speaker 4: in the NHS for around five years. I also worked
Speaker 4: in Elite codmy spot with Barnes the Football Club, and
Speaker 4: then sort of I find myself here in Australia Athletes Authority.
Speaker 1: Good to have you, Johnny.
Speaker 3: John from Ireland.
Speaker 5: I started out as an intern here and I've just
Speaker 5: worked my way up through intern rehab coach and then
Speaker 5: I got my registration could jump on as a physio
Speaker 5: here with the guys.
Speaker 2: Yeah, one of the one of the many interns that
Speaker 2: we continue to hire. Good to say and ahead of
Speaker 2: rehab the big man Kailin.
Speaker 6: Yeah, I'm Kitalen. I'm also Irish, but more importantly from Cork.
Speaker 6: So if you're Irish and you're listening, you'd probably get
Speaker 6: that one. Worked back home at the Sports Surgery Clinic
Speaker 6: for just over three years as an intern through a
Speaker 6: rotage physio to have seene in physio. Was also working
Speaker 6: with some elite Gaelic football on the side with Cavin
Speaker 6: and in the last kind of year and three months
Speaker 6: obviously have filmed myself also in the eastern suburbs of Sydney,
Speaker 6: currently working here now at a minute.
Speaker 3: So yeah, it's been it's been great.
Speaker 2: All right, So I can I'll get some of the
Speaker 2: trains like that, Joe, can you translate that?
Speaker 3: I can't help you.
Speaker 1: He's a tough one.
Speaker 2: He's a tough one. So we put a few questions.
Speaker 2: He has a few things you want to go through today.
Speaker 2: Obviously having all physios in the in the room is
Speaker 2: he's certainly a powerful thing to have for too and
Speaker 2: frow discussions. We have it on the daily here. You
Speaker 2: guys obviously work very closely together in the same room,
Speaker 2: with similar plints across athletes, across sam s and cs.
Speaker 2: So understanding the entirety of the program is powerful and
Speaker 2: that's exactly.
Speaker 1: What we try and spreach to our athletes to get
Speaker 1: them better.
Speaker 2: But maybe we start with you, mate, to kick off,
Speaker 2: have a little bit of a discussion around, especially with
Speaker 2: some of the questions that we've had, a lot of
Speaker 2: them have been relationships with SNCs. What's your pet peeve
Speaker 2: with an S ANDC? What's the most the thing you
Speaker 2: love most about secs? All this type of stuff. So
Speaker 2: instead of going through each individual question about straight finditioning coaches,
Speaker 2: let's maybe attack it from a bit of a broader spectrum.
Speaker 2: How are you going here working with sencs? How have
Speaker 2: you gone over in Ireland? Sort of very simple. What's
Speaker 2: the importance of working together and making sure that it
Speaker 2: is a joint approach? Too many people these days they
Speaker 2: talk about silos, they talk about working together. I'm going
Speaker 2: to go on a round here, but there's even a
Speaker 2: certain view your clinic in Sydney that promotes the togetherness
Speaker 2: of sencs and physias would steal the physias. We'll go
Speaker 2: that's an Es sency thing and I just palm it
Speaker 2: off with little understanding. Talk to us a little bit
Speaker 2: about what an actual combined approach looks like and what
Speaker 2: the importance is.
Speaker 6: Yeah, so, look, we're obviously very lucky here in one
Speaker 6: sense to be able to work so closely with the with.
Speaker 3: The sen c's.
Speaker 6: Obviously a lot of our performance athletes will check in
Speaker 6: every now and then for different things, and these are
Speaker 6: your classic in season niggers. You know, your drying pain,
Speaker 6: reactive tender operties and things like that. Often with us
Speaker 6: it's just checking in maybe to see where the deficits
Speaker 6: are with the S and C program in general, because
Speaker 6: it's more well rounded and you're trying to take all
Speaker 6: the boxes there. Oftentimes the smaller muscle groups are the
Speaker 6: important things that we would obviously check.
Speaker 3: Regularly can be missed.
Speaker 6: So for us, really it's just a bit of fine tuning,
Speaker 6: maybe a bit of additional work in their resilience block
Speaker 6: or like an A two option that you can just
Speaker 6: tidy something up nicely and then managing training load there
Speaker 6: is usually kind of key.
Speaker 3: With us.
Speaker 6: I think it's vital important to have an MDT approach,
Speaker 6: and I suppose most teams or medical teams in pro
Speaker 6: sport that are operating the best start of ones where
Speaker 6: it's really really unified from the start, regardless of the injury,
Speaker 6: there's always upper body KPIs to hit as soon as
Speaker 6: you can get the offeet conditioning in, how can we
Speaker 6: get you as good as possible there to make that
Speaker 6: kind of transition as seamless as possible. And then often
Speaker 6: one of the things that's often spoken about is how
Speaker 6: physios tend to underload and maybe undershoot the market time.
Speaker 6: So I think like having a balance of boat is
Speaker 6: key for any kind of successful rehab.
Speaker 5: Really heap peeves with essencies. I guess it depends.
Speaker 6: Oftentimes it can be something's not flagged early enough proceed
Speaker 6: down a couple of weeks of for an example, at
Speaker 6: time that's just smashed to the eyes us for a
Speaker 6: few few weeks, and you know, the pteller tendon might
Speaker 6: necessarily be the culprit, that might be the victim, and
Speaker 6: there's other things that we need to be tiding up
Speaker 6: there to look at to try and assist and getting
Speaker 6: that better to the point then where it probably needs
Speaker 6: a further offload to get it better. So I suppose
Speaker 6: that'll be one thing, maybe proceeding ahead modifying training as
Speaker 6: much as they can without just like getting a check
Speaker 6: the sooner you can assess it, the sooner you can
Speaker 6: get a planning place, I suppose, and try and get
Speaker 6: that athlete back paying free and performing at as best
Speaker 6: as they would like.
Speaker 3: So supposed to be a couple of things for our
Speaker 3: long term real athletes.
Speaker 6: Then I feel like we're very lucky that when we
Speaker 6: do get to that mid to end stage because our
Speaker 6: field rehab sessions and our performance i e.
Speaker 3: Speed sessions run closely together.
Speaker 6: So we get an athlete to the point where they're
Speaker 6: in that transition phase and maybe with us they've ticked
Speaker 6: the key boxes and rehab i e. You know, max velocity, exposure,
Speaker 6: change the direction, react to change direction at the high level,
Speaker 6: and they've ticked all the rehab boxes per se. We
Speaker 6: can then kind of get them to transition across where
Speaker 6: we get an SNC's on it from a performance point
Speaker 6: of view, and they can often then hone in on
Speaker 6: the final details. I think obviously one of the big
Speaker 6: things we're all seeing at the minute on socials is
Speaker 6: the whole kind of movement matters and you know how
Speaker 6: different movement strategies and different running strategies load joints in
Speaker 6: different ways. So I feel like from an SNC's point
Speaker 6: of view, they will go come at it from a
Speaker 6: purely a performance point of view, how can we get
Speaker 6: you more efficient?
Speaker 3: How can we get you faster?
Speaker 6: And then we can hone in maybe on the strategies
Speaker 6: from Maria point of view, So like that that's key
Speaker 6: to me in any success that REH haven't And that's
Speaker 6: one of the things I actually love the most about
Speaker 6: how we work together here for sure, great good summary.
Speaker 3: Nia.
Speaker 2: We've had a fair amount of questions around specific injuries. Yeah,
Speaker 2: the typical how do I fix a hamstring? How do
Speaker 2: I fix plant? To fashiou? All these type of things.
Speaker 2: So I'm going to throw it to the group and
Speaker 2: if you're on't and I'm just going to start picking
Speaker 2: on you've got tendons is going to be a big one,
Speaker 2: and it is. You mentioned it before. We've talked about
Speaker 2: a little bit around the culprit or the victim, and
Speaker 2: I think it's important to sort of differentiate that, So
Speaker 2: I'd love a little bit of a chat around that.
Speaker 2: But then what are we seeing here from a ten
Speaker 2: and opathy standpoint, what are the go to initial solutions
Speaker 2: you guys are looking at and seeing. And also the
Speaker 2: biggest takeaway I think for a lot of listeners is
Speaker 2: the range of athletes we have from eleven year old
Speaker 2: female soccer players all the way through to fifty five
Speaker 2: year old masters level rowers.
Speaker 3: So we see a lot of different things.
Speaker 2: We see the phase of stress fractures that occur in
Speaker 2: our youth athlete across to then tendons flaring up at
Speaker 2: different ages and carves at different ages.
Speaker 1: But let's focus on tendons for a little bit.
Speaker 2: Hit me with a couple of things that you guys
Speaker 2: are starting to see from a trend standpoint, but also
Speaker 2: some of the solutions that you guys are working with
Speaker 2: and have had some really good success with.
Speaker 4: I think, first of all, it depends on what tendon
Speaker 4: we're looking at. More commonly, I think what we see
Speaker 4: here will be a pteal, a tendon or achilles tendonoposy.
Speaker 4: Now it's understanding the tendon and what's what their role is.
Speaker 4: So with an achilles tenderopathy, probably looking that's going to
Speaker 4: be a little bit stiffer. So if if you've got
Speaker 4: a tenderopathy in the Achilles, you probably find that it's
Speaker 4: it's actually gonna going to lose some of that stiffness.
Speaker 4: Probably the opposite with the tele attendon, so the way
Speaker 4: that you're going to load it. So for for Achilles,
Speaker 4: for example, I would do a lot of eccentric loading,
Speaker 4: whereas with the teletonopathy, especially if it's a lot more
Speaker 4: flared up if we're looking at long isometric holds.
Speaker 3: Yeah, I don't know about you.
Speaker 5: You guys are you Yeah, I'd be similar like I
Speaker 5: would have because I'm still pretty early in my career.
Speaker 5: I would have just picked up a lot of stuff
Speaker 5: from Kalen across the table here. I've noticed it a
Speaker 5: bit more with our AFL players just because on that
Speaker 5: hard ground on an artificial turf as well, and they're
Speaker 5: just ks through their load through their legs.
Speaker 2: Context say, we have one of the few IFL teams
Speaker 2: in Australia that plays on AstroTurf, So yep, we do
Speaker 2: deal with IFL boys coming off.
Speaker 3: You use a G three is that what you guys
Speaker 3: call it in the UK? G G five whatever it is.
Speaker 5: Yeah, but yeah, like we see a lot of it
Speaker 5: and for them it's they go through so much loads,
Speaker 5: so it's nearly just stripping them back a bit while,
Speaker 5: like Joe said, bringing in like your heavy solow isometrics
Speaker 5: or your isometric hold, whether that be like on a
Speaker 5: smith machine or a safety bar.
Speaker 3: Or something like that.
Speaker 5: But usually it comes down to load because they're in
Speaker 5: that pre season stage where they're trying to ramp everything up.
Speaker 5: They might be doing beach sessions because coaches love beach sessions,
Speaker 5: so that's a whole different beast altogether. Then if you
Speaker 5: think of like a pateell Er ten and you can
Speaker 5: then go pretty simple sixty degree isometric holes or like
Speaker 5: a wall set I think is a pretty handy one,
Speaker 5: and then just tying it back into the question with
Speaker 5: the S and c's, you'll always want to have them
Speaker 5: in the loop and then make sure that that's done
Speaker 5: religiously like every day. That's probably my pet peeves like
Speaker 5: you'll put something in communicate with them and then it
Speaker 5: might get missed a couple of weeks down the track,
Speaker 5: and then the athlete is wondering.
Speaker 3: Otherwise.
Speaker 5: My tends still a bit grumbly, But yeah, I think
Speaker 5: management preseason key for us at the minute. And yeah,
Speaker 5: I would have learned most of my stuff from this
Speaker 5: man sitting across the table from me, so I'm sure
Speaker 5: he has some tidbits of information that we might have missed.
Speaker 3: Yeah, where do I start?
Speaker 6: I suppose I would always see when you get attendant
Speaker 6: at them for the first time. It's almost like you're
Speaker 6: doing her a bit of a detective work at the
Speaker 6: start to try and find out.
Speaker 3: Okay, firstly, what's changed.
Speaker 6: So whether it achilles teller, tending, whatever it is, proximal
Speaker 6: HAMI has training load ramped up? Is this person consistently
Speaker 6: loading in the gym all those kind of I suppose
Speaker 6: weekly volume factors as to where we think potentially the
Speaker 6: overload hight it came from. You also then can't forget
Speaker 6: your differentials, so I suppose different autoimmune diseases can present
Speaker 6: with tending pain.
Speaker 3: So you always have your your medical hat on there.
Speaker 6: You know, is this definitely something that's boy mechanical and
Speaker 6: that might be something maybe that a couple of weeks
Speaker 6: down the line isn't responding to typical treatment like your
Speaker 6: asymmetrics and your training offload, but also like your clinical
Speaker 6: history to evaluate any other history of kind of systemic
Speaker 6: or autoimmune factors. I suppose it depends then how irritable
Speaker 6: they are in the session. So for example, for like
Speaker 6: ep teller tendonopotly we'd look at single egg squat, single
Speaker 6: egg hop. Sometimes for those kind of milder ones when
Speaker 6: you go really overtow on a decline board, how orable
Speaker 6: is it turning? There some palpation, and the key bits
Speaker 6: and those kinds of initial sessions are if we take
Speaker 6: them through some progressive isometric loading, like can we actually
Speaker 6: settle down the tendon in session? So then when we
Speaker 6: do our test retest, we get an idea of maybe, okay,
Speaker 6: is this actually a tendon causing the pain because it
Speaker 6: would respond like how we would expect the tend to respond.
Speaker 6: And then we can kind of gauge off that basically
Speaker 6: how much we need to offload the person in the week.
Speaker 6: Because it's often in season, people don't want to stop training,
Speaker 6: so it's often like a fine line between how much
Speaker 6: can we strip it back to still allow them to do,
Speaker 6: you know, some amount of training without continually flaring it up,
Speaker 6: throw the kitchen sink at it from aniceymmetric point of view,
Speaker 6: to try and set it down. But I think the
Speaker 6: key thing with them off. Then again it comes back.
Speaker 6: Though we just spoke about victim or the culprit. We
Speaker 6: see it all the time with teller tendon operties like
Speaker 6: really reach through the lateral hip on that side, maybe
Speaker 6: some foot nine coal reactive strength deficits or calve strength deficits.
Speaker 3: So it's kind of leading to an overload of the
Speaker 3: teller tendon.
Speaker 6: But if you actually settle down the piteler tendon and
Speaker 6: tested the quad strength, it actually might be symmetrical. So
Speaker 6: oftentimes it's like stripping it back, taking that detective approach
Speaker 6: and not just having a very narrow rehab focus of okay,
Speaker 6: it's just the sore tendon.
Speaker 3: It's kind of trying to fill the bigger picture.
Speaker 6: So for us, typical strategies we would do would be
Speaker 6: we would reduce their velocity block in the gym, We
Speaker 6: might take out a lot of the new dominant loading
Speaker 6: to help tend and settle down, focus more maybe on
Speaker 6: inter range stuff shortened contractions, and then as John said,
Speaker 6: I suppose isometrics at mid range if you take a
Speaker 6: pteller tendon for example, like Jill Cook has lots of
Speaker 6: work on different things heating with the iceometrics too, as
Speaker 6: we want to try and make sure that they're heavy.
Speaker 6: Too often we see go on to the gym five
Speaker 6: kilos on the like extension in the mid range, you
Speaker 6: could probably hold it for two days. So it's just
Speaker 6: a case of making sure that the isometrics are those correctly,
Speaker 6: and I think for the tendons that in session test
Speaker 6: retests will give you a lot of clues as to
Speaker 6: maybe how you need to manage it going forward. But again,
Speaker 6: as Joe alluded to, there contendings have different functions, but
Speaker 6: there's so much evidence on like you know, how attending
Speaker 6: is in that kind of disrepair phase, how true loading
Speaker 6: and progressive loading, heavy slow resistance over time, you know,
Speaker 6: you can actually rearrange the college an organization to look
Speaker 6: healthier again. So for your athletes, having your analogies I
Speaker 6: think are always really useful ways to like get them
Speaker 6: to relate to because they just want to play their sore.
Speaker 6: You know, we're very lucky that we've got a lot
Speaker 6: of highly motivated athletes, so oftentimes like they don't want
Speaker 6: to strip things back and we're always trying to. You
Speaker 6: don't want to be the bad guys, so you're obviously
Speaker 6: often playing good cop bad cop the choice, meet them
Speaker 6: in the middle somewhere and keep everybody in all parties
Speaker 6: happy while continuing to see improvement. But then sometimes obviously
Speaker 6: it's it's too irritable, and it does require a.
Speaker 3: Brief offload from all of your like big impact.
Speaker 6: Loading activities or stretch shortening cycle activities, just to let it,
Speaker 6: let it cam and settle and then start to rebuild.
Speaker 2: Well, I think previously, I think five years ago, is
Speaker 2: to do the classic I so introducts. You do three
Speaker 2: sets of thirty seconds and you'd expect some results after
Speaker 2: a few weeks, and I think, you know, as you
Speaker 2: get older, you start to realize, well, fuck, you know what,
Speaker 2: it actually takes a while for tendants to respond. And
Speaker 2: I think even my stuff i've started to create, most
Speaker 2: of any athlete that I work with or usually get
Speaker 2: five sets of about forty seconds, and there's an absolute
Speaker 2: stark difference. And I still see a lot of people
Speaker 2: do short, little iso hole pramp and then expect it
Speaker 2: to be better. What's your starting once you go to
Speaker 2: how do you sort of build someone into it? I
Speaker 2: know it's an open question because it depends where they're at.
Speaker 2: Meet them where they're at. But what sort of your
Speaker 2: base protocol that you look at for someone presenting with
Speaker 2: a tendon where you kind of like, we'll just get
Speaker 2: this under control.
Speaker 3: Yeah, And like often I think it's just best to
Speaker 3: keep it simples.
Speaker 5: Like, for example, if someone is like rosstly really weak,
Speaker 5: like you see it a last where you have just
Speaker 5: hear me some athletes who just throw all leaves I've
Speaker 5: got to wear with minimum gym lauding, have holy training
Speaker 5: lads and just seem to be able to tighter around it.
Speaker 5: Because again, everybody is different to certain so your entry
Speaker 5: level for them you've got a really weak calf, like
Speaker 5: just holding body weight for thirty forty seconds might give
Speaker 5: them a similar stimulus to someone who's obviously stronger and
Speaker 5: can tolerate more. From a tendon level, I think a
Speaker 5: lot of the research alludes to has to be over
Speaker 5: kind of seventy eighty percent of the maximum voluntary contraction
Speaker 5: of the muscle has to be slow and controlled for
Speaker 5: to really actually.
Speaker 6: Stimulate any sort of tending adaptation at all. So that
Speaker 6: would be one factor. Irritability is another, Like give me
Speaker 6: somebody with you know, six months of telor tending pain
Speaker 6: and get them through a heavy wall set like it's
Speaker 6: going to be very uncomfortable. So you're always looking for
Speaker 6: like your way, and I find often and that way
Speaker 6: and could be maybe you just start with some inner
Speaker 6: range y symmetric loading. If we just take the teller
Speaker 6: tendon for an example, you know, see how respond to that.
Speaker 6: You have your couple of test free test markers. Okay,
Speaker 6: Oftentimes when you load it at any level, it's going
Speaker 6: to change and feel a bit better, and you can
Speaker 6: start to maybe as the tending warms up to the session,
Speaker 6: build into just some I suppose greater degree or work
Speaker 6: through some more range of motion with it, and it
Speaker 6: can be like right, you know you do your ametrics
Speaker 6: in the world up, you have to you know, bring
Speaker 6: your single like squad paying down to a certain level
Speaker 6: before you can proceed what you're loading. And the key
Speaker 6: thing then with that too in the early stages is
Speaker 6: like we have to be monitoring twenty four hour forty
Speaker 6: eight hour symptom response because we know once they warm
Speaker 6: up they often feel good. But if they're waking up
Speaker 6: the following day with worse tending pain that's taking longer
Speaker 6: to settle, then chances that we might be doing more
Speaker 6: harm than good in the gym, So we have to
Speaker 6: bring it back to a level where we're starting to
Speaker 6: see improvement.
Speaker 3: Week to week. You know, one bad day.
Speaker 6: Out of six comparison to previously three bad days out
Speaker 6: of six is actually improvement. And that comes down to
Speaker 6: our education of like telling people that like, the way
Speaker 6: this works is like you're not just going to wake
Speaker 6: up no pain, Like you're going to slowly but surely,
Speaker 6: over the next couple of months start to see your
Speaker 6: irritability and severity of your pain damping down until we
Speaker 6: get you to a point where it's better. That's when
Speaker 6: we can probably really actually get an accurate test of
Speaker 6: your quad strength where the gaps are if it is
Speaker 6: a weak quad for example, but in the other In
Speaker 6: the meantime, in that early stage that we have, we've
Speaker 6: also been tiding up latter hip strength, hiplexus strength, half strength,
Speaker 6: because when we do get to that stage when we
Speaker 6: have a look at and buying mechanically, you know, oftentimes
Speaker 6: when you've got the gaps there, you see the same
Speaker 6: patterns poor petally control the midstands and it just maybe
Speaker 6: has like a knock on effect down the chain where
Speaker 6: they're just going to shift to load elsewhere.
Speaker 5: So by that point we're hoping that we have all
Speaker 5: other bases ticked versus then back to their question, Sorry,
Speaker 5: locks tangent, they're small, but when you've an entry level
Speaker 5: for like a strong or decent that late, then like
Speaker 5: I would look to try and get them as as
Speaker 5: heavy as possible. Short their bouts. You know, one set
Speaker 5: of six two sets six ten second holes quite heavy.
Speaker 5: Then you can kind of strip that back a bit
Speaker 5: if that's a bit there, but you can go for
Speaker 5: twenty seconds.
Speaker 3: There's obviously lots.
Speaker 6: Of again stuff on the Socialist these days about your
Speaker 6: different types of symmetrics, overcoming yielding, et cetera. But I
Speaker 6: think by and large it's the more down to how
Speaker 6: hard the tending is working and contracting and the load
Speaker 6: over time that's going to make that busy logical change,
Speaker 6: which is you know what we're chasing.
Speaker 3: So that's kind of how you approach it.
Speaker 4: Yeah, I think I think you touched on education there,
Speaker 4: which I think is a massive part of it, putting
Speaker 4: a bit of a ones on the on the athlete
Speaker 4: to take a little bit of control of how they're
Speaker 4: feeling as well. So something I've been kind of pushing
Speaker 4: a lot recently is I I've just been putting a
Speaker 4: questionnaire in the morning, how stiff is it? How painful
Speaker 4: is it do a single squad? How painful is it
Speaker 4: after after they've played sport. You'd expect probably going to
Speaker 4: be a bit of a spike in that, and then
Speaker 4: it's just finding a pattern of what's happening throughout the week,
Speaker 4: when where the points where we can get in can
Speaker 4: when can we load a little bit more? When it's
Speaker 4: when is it a little bit less painful? So I
Speaker 4: think educating athlete around that as well, so they know
Speaker 4: when to push and we went hold a little bit
Speaker 4: as well. It's not saying if it's painful, don't do anything,
Speaker 4: but it's definitely if it's really irritable, then you're unlikely
Speaker 4: going to push the need a little bit bit more.
Speaker 3: So I think it's it's choosing your battles with that.
Speaker 4: So that's something that I think has been working quite
Speaker 4: well in terms of just monitoring how they had across
Speaker 4: the week and picking up any patterns, because you know,
Speaker 4: it's like if you see somebody once or twice a
Speaker 4: week and you ask them what's happened there last week,
Speaker 4: and they forget little, a little bits what's happened over
Speaker 4: the week. So just having that actual touch point they've
Speaker 4: got to do daily, I think obviously it's fresh in
Speaker 4: the mind then rather than thinking back to what happened
Speaker 4: a few days ago, because we know we're all easy.
Speaker 2: I think you're probably the first three months of any
Speaker 2: general ten and stuff is you actually probably don't get
Speaker 2: any less pain, but you're doing five times the amount,
Speaker 2: like the amount of athletes that will calm, they'll present
Speaker 2: with pain, they can't do anything.
Speaker 3: You start to build them have been three months of
Speaker 3: the like.
Speaker 2: I still get a bit of it's like, yeah, but
Speaker 2: you're actually actually squat box one one hundred and fifty
Speaker 2: kilos now and you're pulling up with the sign paint.
Speaker 2: So sometimes that type of win is bigger than anything
Speaker 2: because at the end of the day, tech so long
Speaker 2: actually clear out some of that Pine and that Paine response.
Speaker 2: But if we're actually got them still playing, doing training
Speaker 2: and performing, then to fucking big win, big win.
Speaker 1: That's it.
Speaker 6: And I think that comes back to your education, to
Speaker 6: being able to showcase that because I see it all
Speaker 6: the time. People just get so fixated like you could
Speaker 6: have a chronic tendon and we know prognostically one of
Speaker 6: the best factors if is if you've had tendon pain
Speaker 6: for three months only going to take three months to
Speaker 6: set it down and get better, or you know, based
Speaker 6: on researching different timelines, but like educating people explaining that
Speaker 6: that's going to happen. I think that comes in your
Speaker 6: initial assessment or your initial meeting, like this is exactly
Speaker 6: how this is going to play out, and if you
Speaker 6: do that really well, then you don't set yourself up
Speaker 6: for failure. Whereas if you're there and you're like, this
Speaker 6: is you know this is going to be oftentimes maybe
Speaker 6: we don't. We're not as clear about how the path's
Speaker 6: going to be. That it's not going to be as
Speaker 6: clear cut path that you wake up in the morning with.
Speaker 6: Not then that you're going to have one flare up,
Speaker 6: probably in the rehabit at some point we're going to
Speaker 6: lose control somewhere along the lane.
Speaker 3: That's part of the process. It'll probably cam down quicker.
Speaker 5: As you said, luck you're doing more and then over
Speaker 5: time we can hopefully start to get the tend and
Speaker 5: healthy again and reduce the band completely.
Speaker 2: So we're talking post pain Now, one of our questions
Speaker 2: we had was about prehab. Now I actually hate that term,
Speaker 2: but anyway, that's just semantics around hamstring and ankle. Johnny,
Speaker 2: I'm going to pinion first up, what is your opinion
Speaker 2: of the concept of prehab. Is it something that should
Speaker 2: be a part of people's program. Should we be actively
Speaker 2: targeting individual muscle groups, joints and saying, well, we better
Speaker 2: add in extra work if they're already healthy. Give me
Speaker 2: a bit of conceptual discussion, and then we'll delve into
Speaker 2: a couple more questions about it.
Speaker 3: Are we talking ankle or hamstring or anything.
Speaker 2: The general concept of well, less you believe in hamstring
Speaker 2: prehab and not ankle prehab?
Speaker 5: You tell me, now, I would say, like it comes
Speaker 5: down to, obviously your initial assessment what they're in for,
Speaker 5: what you can find, whether it's like lateral hip, calf,
Speaker 5: ankle like, whether it's a range thing, muscle strength thing capacity.
Speaker 5: You're obviously then looking at, okay, what is if there's
Speaker 5: any asymmetry, if there's anything you need to tidy up.
Speaker 5: I think prehab is like this fancy buzzword that everyone
Speaker 5: likes to use, but you could just have it in
Speaker 5: as like we put it in as a prep block,
Speaker 5: it's less like a rehabby connotation if people think of
Speaker 5: it that way. Same thing if you have a grumbly
Speaker 5: tend and you'll have a prep block. I think it's
Speaker 5: in our kind of realm. It's pretty important because there's
Speaker 5: always stuff that we're probably trying to tidy up, like
Speaker 5: an angry tendon, like someone who has just rolled their
Speaker 5: ankle and now has a pretty poor range or just
Speaker 5: pretty poor calf. We'll say nique on their cafe. As
Speaker 5: you're kind of trying to tidy this stuff up. Doesn't
Speaker 5: necessarily stop them doing what they're doing, but can we
Speaker 5: make them more efficient in their movement? Can we make
Speaker 5: them stronger in little things that they probably don't think about? Yeah,
Speaker 5: one hundred percent. I think it has a place, whether
Speaker 5: you put it as a prep block, as like that's
Speaker 5: their main focus. Like with our acls, we'll have prep
Speaker 5: block might be a big focus if like they have
Speaker 5: a quad deficit, or you can like shoot it in
Speaker 5: at the end. In what we do is sometimes like
Speaker 5: a resilience block, whether it's at the start or at
Speaker 5: the end. I think it's pretty important just because there
Speaker 5: probably is a couple of things we want to tidy up.
Speaker 5: With most of our athletes, I don't think anyone's perfect.
Speaker 5: We can always make them a little bit better. That's
Speaker 5: the way I would think about it. I think there's
Speaker 5: always a place for it. Yep, when it starts to
Speaker 5: get to probably a third of your session, then maybe
Speaker 5: it's a bit long.
Speaker 2: Only then well, if you're thinking about classics, because like
Speaker 2: you want to have.
Speaker 5: A couple of good, solid prep blocks, and even then
Speaker 5: with that, people tend to will just undershoot them, and
Speaker 5: I'm like, oh, it's just a bit of an extended
Speaker 5: warm up versus you're actually trying to make some pretty
Speaker 5: meaningful change with those exercises.
Speaker 3: I think that's probably one thing that.
Speaker 5: We as a physio probably pro fashion need to be
Speaker 5: better as educating with a prep or rehab block, to
Speaker 5: just do it pretty well and do it as heavy
Speaker 5: as you can, like if that's what we're looking for,
Speaker 5: or to as good of an extent as if it
Speaker 5: was your air block or that kind of thing.
Speaker 2: My biggest issue is that with the questions I suppose
Speaker 2: when people ask what's the best for hamstring, best for ankle,
Speaker 2: and I think what you just said a meaningful change
Speaker 2: if if it's hamstring, are we going for strength, We're
Speaker 2: going for range A, We're going for capacity?
Speaker 1: Are we going for position?
Speaker 2: Like, there's a number of things that we can chase,
Speaker 2: and I think that's where when people sort of start
Speaker 2: talking about or these are my top five hamstring exercise
Speaker 2: or top five ankle exercise. And to be honest, you know,
Speaker 2: back to the discussion you had around you know, sort
Speaker 2: of movement matters. I think there's a lot of over
Speaker 2: the years people talk about, oh, Nordics are great, nods shit,
Speaker 2: And it's just like this continue obsession with like if
Speaker 2: you choose to do one thing, then therefore you choose
Speaker 2: that over other things is just an absolute ridiculous conception.
Speaker 2: And if people are coaching or being a physio like that,
Speaker 2: then that's a whole other issue. And I think that's
Speaker 2: where being specific and understanding what your chase, what you
Speaker 2: need to change. The concept of resilience I love of
Speaker 2: Obviously that's something a part of our programming. We'll always
Speaker 2: look to what we need to target, but typically that's
Speaker 2: a kind of a catch all is that resilience block
Speaker 2: allows our coaches to go, Okay, do I need to
Speaker 2: add resilience. Has this individual had a history of hamstrings?
Speaker 2: If they haven't, do they play a sport that puts
Speaker 2: some risk at hand strings? If it is, then does
Speaker 2: their program currently have enough hamstring And if it does, great,
Speaker 2: But if we feel like we're lacking something in a
Speaker 2: block at some stage, then we can start to layer
Speaker 2: it in. But I think being specific about it is
Speaker 2: the key aspect, and that's where it's almost impossible to
Speaker 2: answer what is the best hamstring prehab or the best
Speaker 2: ankle prehab. It really comes back to what the individual
Speaker 2: needs at the time and what's been identified.
Speaker 6: Yeah, and I couldn't agree more. And I wouldn't think
Speaker 6: of it as what's the best exercise? Think about it
Speaker 6: as like what's the outcome you're looking for. So I'm
Speaker 6: a big fan of prep and pre have whatever you
Speaker 6: want to call it for a number of reasons, like
Speaker 6: if you take your chronic presentations again. Athletic grind pain
Speaker 6: is something I have a lot of experience in treating.
Speaker 6: It just gets so much inhibition in around the hip
Speaker 6: joint itself, So inhibition is probably going to drive loss
Speaker 6: of range. You know, when they do go into the
Speaker 6: warmp then they don't feel good, they probably haven't fully
Speaker 6: and again I don't like the word activate, but it's
Speaker 6: it's a big word. But like they probably haven't recruited
Speaker 6: those muscles around the hip well enough before they start
Speaker 6: the session, and the session maybe the warm up from
Speaker 6: ES and C isn't going to obviously be specific enough
Speaker 6: to really tailor for their needs.
Speaker 3: So it's a massive thing. They'll feel great after it.
Speaker 5: They'll get instantaneous range change, which we know is a
Speaker 5: big factor in something like athletic grind pain. If you're
Speaker 5: stiffened in a rotation range, you're going to load through
Speaker 5: the pubic symcomore, You're going to load you the anti
Speaker 5: hit more so, it's vital for stuff like that. It's
Speaker 5: also a really smart way to microse smaller strength work,
Speaker 5: if you want to call it across the week for example.
Speaker 5: Again I'm just going to use it like a grind
Speaker 5: pain as an example, but you know the typical places
Speaker 5: that we see there week maybe through the abs hip
Speaker 5: flex or lateral hip in all these specific ranges and positions,
Speaker 5: and when they get to the point when they're quite good,
Speaker 5: most people kind of fall off the wagon with that
Speaker 5: type of stuff. So rather than having it all in
Speaker 5: the gym program, maybe where we can focus on the
Speaker 5: bigger rocks. If they're doing like two sets of each
Speaker 5: exercise free training three times a week, then across the
Speaker 5: week we're actually accumulating a nice bit of additional volume
Speaker 5: in those smaller muscles around the hip. So it's actually
Speaker 5: a really smart way to get some lower level strengthy
Speaker 5: capacity stuff in.
Speaker 3: It's not going to fatigue them massively. They're going to
Speaker 3: feel better after it.
Speaker 6: And then the other one obviously, if you take an ankle,
Speaker 6: if we can get an instantaneous improvement and need the
Speaker 6: wall range and someone has any nic Achilles standing operator
Speaker 6: to post end and operate, or history is stress bone
Speaker 6: stress injuries, then that's a very quick win for us
Speaker 6: if we can get two three centimeters and ultimately for
Speaker 6: us the videos like the way I think of it
Speaker 6: as like I always want to keep everybody out in
Speaker 6: the field in any means possible.
Speaker 5: And then you're honest, they play a court, Yeah, exactly,
Speaker 5: that's the clear card. But by and large, we just
Speaker 5: want everybody to be doing what they love. And you
Speaker 5: know there's often discussions around different things, but if we
Speaker 5: can get quick wins like that pre training that you
Speaker 5: know it's less likely to flare or makes them feel
Speaker 5: good enough to train that they're just comforts at a
Speaker 5: minimum level. Then like absolutely, I think that's a nice
Speaker 5: win for us or quick low hanging fruit.
Speaker 3: Love it.
Speaker 2: Now we've put it out to the eighth, A few
Speaker 2: people have got some questions in so it would be
Speaker 2: remissive me not to address some of these questions. Some
Speaker 2: just freaking ridiculous. So forgive me if I skip across
Speaker 2: some here and there, but one one I do like you,
Speaker 2: I'll get an answer from all three of you. But
Speaker 2: what makes an SNC coach easier to work with or alongside?
Speaker 2: So any I think any particular skills or traits so
Speaker 2: you don't need to ramble too much, but what are
Speaker 2: sort of some of the key things that you go
Speaker 2: you know what this is made an ESNC coach easier
Speaker 2: to work with versus Jesus crosses and not me.
Speaker 6: Communication skills is like for me, the biggest one like
Speaker 6: the more like over communicate and under communicated. Even if
Speaker 6: you feel like it's something small, like you'd rather hear
Speaker 6: about it, that's a nigger, then you can address it
Speaker 6: and say it's not in crack on then kind of
Speaker 6: like proceed ahead, being like, oh, I thought it was
Speaker 6: a teller tendon. You know, we've been putting all these
Speaker 6: isometrics in and potentially sometimes doing harm and good if
Speaker 6: it's not prescribed or whatever.
Speaker 5: So I think like just the collaboration and the communication
Speaker 5: is to keep it for me because then you can
Speaker 5: make changes on the fly and vice versa for physios
Speaker 5: like i'd always chat with the sency let's have a
Speaker 5: look at my program. What do you think particularly that
Speaker 5: mid to end stage and missing editing here? Could we
Speaker 5: be doing more from a performance point of view? How
Speaker 5: can I just make this person better in general?
Speaker 6: Where I've probably gotten very rehab focused and specific and
Speaker 6: would be probably do you think.
Speaker 3: Just to translate lads in Irish means women or men?
Speaker 1: Yes, boys, I.
Speaker 3: Don't to echo, well, I do want to echo what
Speaker 3: Kalyn says.
Speaker 4: Really what collaboration I think is understanding your I think
Speaker 4: it's understanding your role as well as the other persons
Speaker 4: and then how we can bridge that gap. Of course,
Speaker 4: I definitely don't claim to know everything about SNC, just
Speaker 4: as a SCY coach claim to know everything about physio.
Speaker 4: But definitely some gray areas which I think is always
Speaker 4: better to collaborate on, especially like return to return to
Speaker 4: playmarks and things like that, and how can we squeeze
Speaker 4: a little bit more out of out of the athlete?
Speaker 4: And it's having that without those discussions like better to
Speaker 4: say more than than than not enough and then.
Speaker 3: You should never assume.
Speaker 1: Yeah, assumptions, mate, Johnny, anything to add to it.
Speaker 5: I'm trying to think, like I would say, more of
Speaker 5: just curious as well of why this has come up,
Speaker 5: Like what part of whether it's our loading or they're
Speaker 5: loading that.
Speaker 3: Has kind of caused the issue.
Speaker 5: We'll say if it's like a field sport athlete, like
Speaker 5: is it something that we can change in the gym?
Speaker 3: Is it something that we need change on the field.
Speaker 3: That kind of problem solving together kind of thing. I
Speaker 3: enjoy that.
Speaker 5: Like with our like North Shore Bombers, we have Sam
Speaker 5: z as head of performance, so it's a very good
Speaker 5: kind of team around that and Joe beside me as well,
Speaker 5: so sorry Joe. So we're always trying to from the
Speaker 5: S and C side of things, So we're always trying
Speaker 5: to like collaborate and just problem solved as a group.
Speaker 5: I think that's super important and we're pretty lucky in
Speaker 5: this facility here to have that across the board.
Speaker 4: Yeah, it's interesting that people automatically assume that there's like
Speaker 4: the should be issues between the two when not.
Speaker 3: So the use of the mentality used to be and
Speaker 3: says break them and phusiastics them. That's what I used
Speaker 3: to be.
Speaker 2: And I agree that's think that any any high performing
Speaker 2: system or setup usually have a very collaborative setup like that.
Speaker 2: But there are still places that surprise me that I
Speaker 2: hear of and in discussions where you just you just
Speaker 2: have you only need one differing principle or mentality and
Speaker 2: it starts to build.
Speaker 3: So when a physio and ne SSC just have a
Speaker 3: differing mentality on something.
Speaker 2: And I've also seen scenarios where skills coaches build that,
Speaker 2: where skills coaches start going on, bloody physios keeps topping on,
Speaker 2: bloody smcs do this, and then you witness the physio
Speaker 2: or the SNC then side with the skills coach and
Speaker 2: because they don't want to be off side of them,
Speaker 2: and you get these little things just building these little silos,
Speaker 2: and it's shocking.
Speaker 3: It's not a way to be. No, I think I
Speaker 3: can go either way as well.
Speaker 4: I think sometimes like some I see, coaches might see
Speaker 4: someont of pain and really kind of alert to that,
Speaker 4: and really it's a lot of them on the flip
Speaker 4: sides from people will continue to push them.
Speaker 2: It comes under Yeah, to be honest, I actually think
Speaker 2: a lot of younger S and CEA coaches that are
Speaker 2: coming through these days that are probably a little bit
Speaker 2: more indoctrinated around a terrible term but the evidence based
Speaker 2: scientific type lifting. They're probably more conservative and stuff like
Speaker 2: that because they're probably more fearful versus your traditional S
Speaker 2: and C coach.
Speaker 3: It's like, nah, we'll just keep pushing them.
Speaker 2: But you're right, the more knowledgeable you are, I think,
Speaker 2: the easier you'll find it to push athletes, especially when
Speaker 2: they're in pain. You know what red flag pain is
Speaker 2: versus orange flag versus white flag pain, where you can
Speaker 2: let's keep going, let's keep pushing, which is fair difference.
Speaker 2: But could you other questions because we get we do
Speaker 2: get sidetracked, but a little bit of a really raw
Speaker 2: physio we chat here, but how do you build a
Speaker 2: rehab network across surgeons and GPS so and you've got
Speaker 2: you preach this all the time, I may you want
Speaker 2: and done them?
Speaker 6: Yeah, I suppose For me back home, I was just
Speaker 6: lucky enough to work in probably the artopedic Center of
Speaker 6: Excellence in Ireland for pretty much everything, as well as
Speaker 6: working very closely with some brilliant sports made consultants.
Speaker 3: So naturally that's kind of read a bit of a network.
Speaker 6: I feel like if you're kind of I suppose starting off,
Speaker 6: you probably need to try and establish some sort of
Speaker 6: point of difference because I know a lot of these
Speaker 6: are very busy people, probably getting lots and lots of
Speaker 6: different you know, excellent emails and messages about people trying
Speaker 6: to collaborate with them, and oftentimes they're obviously going to
Speaker 6: have their own people at this stage. I think in
Speaker 6: general what's often underappreciated what I've noticed in Australia is
Speaker 6: that kind of physiosports mad consultant relationship quite and large.
Speaker 6: If you if you're referring athletes are patients to sports
Speaker 6: made consulting there a surgeon, generally they're quite good to
Speaker 6: write back detailed letters around managing plans and like they're
Speaker 6: all very open and very collaborative people in general, you know,
Speaker 6: reaching out to them chining them over the phone. You know,
Speaker 6: for us, we're very very lucky that we kind of
Speaker 6: see a lot of the same presentation, so we would
Speaker 6: refer like a lot of bone stress injuries, and we
Speaker 6: obviously have surgeon.
Speaker 3: Ties as well.
Speaker 5: But I think it is literally just if you can
Speaker 5: get to that position where you're referring them a lot
Speaker 5: of patients and they see that you're writing back detailed
Speaker 5: letters and you know what you're talking about. You know,
Speaker 5: oftentimes it's going to be easier to build a bit
Speaker 5: of a network, but it is for sure a very
Speaker 5: hearting to do when there's lots of established long term surgeons.
Speaker 5: But like reach out, ask for shadowing opportunities. Same with
Speaker 5: like most most sports teams, like, they're often very open
Speaker 5: to it despite what you might think, and if you
Speaker 5: don't ask, you're never going to find out. So sometimes
Speaker 5: you do have to, you know, even though you might
Speaker 5: want to just point the bullet, try it. And you know,
Speaker 5: these people are very open minded as well. They love learning,
Speaker 5: they love new ideas, new facilities.
Speaker 6: I think one gap that I would see then from
Speaker 6: the sports about and certain so things is a lot
Speaker 6: of them don't have I suppose facilities where they'd send
Speaker 6: for testing, et cetera. So it's kind of the follow
Speaker 6: up care in their in their plans, you know, having
Speaker 6: a battery of test to clear to return to playing
Speaker 6: different things. That's maybe an area where different clinics might
Speaker 6: try and go with your niche a point the difference.
Speaker 6: But yeah, look, it's it's definitely a working process for
Speaker 6: most practices.
Speaker 3: They'd imagine, I think, yeah, being good at what you do.
Speaker 2: So they're obviously not going to refer to someone as
Speaker 2: an idiot or they the way you word things, the
Speaker 2: way you talk to them.
Speaker 3: Obviously you've got to be good at what you do.
Speaker 2: But I think the otherwise is consistency, and as you said,
Speaker 2: you know their eager learners. We've had a couple of
Speaker 2: people we've actually invited, surgeons we've worked with that we've
Speaker 2: invited and free of charge, they have come and presented
Speaker 2: to us on their surgery or what they do and
Speaker 2: stuff like that.
Speaker 1: And it's great for your staff, it's great for them.
Speaker 1: It's a really good connection.
Speaker 2: And to be honest, some of the vision that surgeons
Speaker 2: have in their presentations is second to none. It's absolutely
Speaker 2: cracking to watch some of the surgical vision that they
Speaker 2: have and to get an understanding I think especially for
Speaker 2: our S ANDC staff, probably more than the physios, because
Speaker 2: you guys will organically and naturally gravitate towards that. You'll
Speaker 2: go to surgeries. You'll see that. I think a lot
Speaker 2: of SNCs. I know when I was young SNC I
Speaker 2: pictured tendons is what you'd see in the colored books
Speaker 2: that you watch, the little red things that sit there,
Speaker 2: and when you actually see them functioning, being cut through,
Speaker 2: being reattached, you understand the trauma that the bone will
Speaker 2: go through in certain things. It sounds stupid, but I
Speaker 2: think the visualization of that's very powerful. When you're working
Speaker 2: with an athlete and you're pushing them, you're like, you
Speaker 2: know exactly what that bone plug look like, and it's like,
Speaker 2: I don't know if it's going to be able to
Speaker 2: withstand this type of stuff this early on. And it's
Speaker 2: a little thing. But to your point, all they're going
Speaker 2: to say is no. It's amazing how many are open
Speaker 2: to coming to present to talk to connects. Definitely, I
Speaker 2: think reach.
Speaker 4: Out and I think they like to hear about how
Speaker 4: their their athletes do it as well.
Speaker 1: Like he goes, I want to say, well, yeah, Kevin.
Speaker 4: Says, like right, make make sure it's not writing war
Speaker 4: and peace, but know what they're doing, because I think
Speaker 4: that just opens up a chain of actual communication. Customer
Speaker 4: might not even know you exist for a start.
Speaker 1: The first connection, isn't it.
Speaker 2: If you're working as a physios an SNC and any
Speaker 2: any facility, you will eventually get someone that is under
Speaker 2: a surgeon for whatever reason. So as soon as you
Speaker 2: do reach out to that surge and give them information,
Speaker 2: I think that that feedback is going to be very powerful.
Speaker 3: Showing willingness to learn.
Speaker 4: Like if most surgeons I've worked with a really keen
Speaker 4: on education and just love teaching other people. So if
Speaker 4: you're showing a willingness to kind of learn from them
Speaker 4: as well, I think else.
Speaker 3: Yeah, well Dan Joseph that yeah, there you go.
Speaker 1: Yeah. Other one.
Speaker 2: Now, this is an interesting one because I do I
Speaker 2: think there's people want need to side of the fence here.
Speaker 2: But the question is how important is it to train
Speaker 2: your uninjured leg whilst doing rehab for your injured leg.
Speaker 1: So yeah, Johnny's had a bit of a smirk.
Speaker 5: It's important. It's an interesting question because I know if
Speaker 5: we've submitted it, I would say it's so important. Yeah,
Speaker 5: Like you want to think you're training them differently. That
Speaker 5: doesn't mean you're not training them. They obviously can We'll
Speaker 5: say withstand different loading and maybe different ranges, but like
Speaker 5: you can't forget any contralateral injury or contralateral limbs. Sorry,
Speaker 5: Like for example, whether it's an ACL, you're still gonna
Speaker 5: you might be in one phase with your injured leg,
Speaker 5: like our load introduction phase or like immediately post off.
Speaker 5: You can probably do a lot on your own injured side.
Speaker 5: Whether or not this cross education is is a thing
Speaker 5: like research. Some as it is, some says it isn't.
Speaker 5: It's so important, Like you don't want to reduce your
Speaker 5: target that you're kind of aiming form. If we're thinking
Speaker 5: of like symmetry, you don't want your quote unquote good
Speaker 5: side to decrease and then get a false sense of
Speaker 5: symmetry if you're only training your injured side. So I
Speaker 5: think it's so important, Like you can't load it probably enough,
Speaker 5: especially because you won't have as much residual fatigue from
Speaker 5: just doing the other side. And then you're thinking of
Speaker 5: like upper body as well, So like whether it's the
Speaker 5: other limb upper body. I think you have so many
Speaker 5: opportunities to get a good dose of stimulus to an
Speaker 5: uninjured side while your maybe your injured side is going
Speaker 5: through some more lower load exercises. That's the way I
Speaker 5: would kind of look at it.
Speaker 2: Lock it, Dang, you sort of pipped up a bit there,
Speaker 2: might we bet as I say, yeah, so you fund
Speaker 2: Obviously cross training is one.
Speaker 3: General adaptations to resistance training is another.
Speaker 6: Like there's there's lots of great physiological benefits on the
Speaker 6: other side, and like it kind of begs a bit
Speaker 6: of a different question that we've discussed lately around like
Speaker 6: you know, lots of people's protocols is like within ten
Speaker 6: percent limb symmetry inext but like across every muscle group joined,
Speaker 6: whether it be strength or power testing.
Speaker 5: At this point, like we know what the norms are,
Speaker 5: what's good where you need to be apt to do
Speaker 5: what you need to do.
Speaker 6: So if you've got you know, one side that's exceptionally
Speaker 6: strong and your operated side is very strong, then I
Speaker 6: don't see that as a bad thing. It's only going
Speaker 6: to probably improve performance down the line. So absolutely, like
Speaker 6: try and get the other side as good as possible. Now,
Speaker 6: what you do see sometimes is that obviously in rehabit
Speaker 6: and we're targeting a muscle group, like the volume and
Speaker 6: inten today across the week would be much higher. So
Speaker 6: for example, if we're doing lots of unilatterer work, like
Speaker 6: you could be hitting your quad fifteen to twenty sets
Speaker 6: a week, you do that. On the other side as well,
Speaker 6: You're going to have two sides that you find are
Speaker 6: up and chasing. So I would tend to maybe just
Speaker 6: even half the volume of the good side, like bring
Speaker 6: it down to even if you do ten to twelve
Speaker 6: sets in that side across the week, You're still.
Speaker 5: Going to improve at a pretty good rate. And it
Speaker 5: just makes the sessions about character for them as well.
Speaker 5: Map as a rare shore four is to two or
Speaker 5: tree is to onorn off and as an EWE.
Speaker 2: Two, I'll add more to I typically will target far
Speaker 2: greater intensity on the uninjured side. I'm not going to
Speaker 2: throw any evidence of this is set my own anecdotal evidence,
Speaker 2: but I do feel that the central nervous system is
Speaker 2: a thing, and I feel even peripheral adaptation can help
Speaker 2: that central nervous system. So I find if I'm if
Speaker 2: I'm working with someone that is completely hamped on one
Speaker 2: side early stage or even tend and pain or anything
Speaker 2: upping the weight, lowering the rep range and having a
Speaker 2: real intensity focus on the good side, I find keeps
Speaker 2: a really good neurological adaptation, and I'm putting it there.
Speaker 1: That is my own anecdotal. There is no strong evidence
Speaker 1: for that.
Speaker 2: But in the same fashion where we look at a
Speaker 2: bit of research around things like bench press throws and
Speaker 2: stuff that stimulate a really good central nervous system adaptation,
Speaker 2: even though it's upper body, it still exists with that
Speaker 2: that contralateral side of just targeting a little bit more
Speaker 2: neurological function. Thanks man, I'm glad you agree with that.
Speaker 2: That's my support exactly. Now there's a couple of probably
Speaker 2: two more main questions. One I really like because there's
Speaker 2: something that we value quite a bit here. Now they
Speaker 2: use the word clinic. I'm anti physio for that, so
Speaker 2: we just like performance center. Even though certain someone started
Speaker 2: to refer to upstairs.
Speaker 3: As the clinic. I don't know if I'm on board
Speaker 3: with that one. I'm looking at them. Yeah, was it
Speaker 3: you or was it you? I think it is.
Speaker 2: How do you make sure everyone in the clinic works
Speaker 2: in the same way in rehab, so as in, how
Speaker 2: is everyone aligned?
Speaker 1: Now, I'm going to start this.
Speaker 2: Answer and then then hand it over to you guys,
Speaker 2: because if you can't tell, I'm a massive believer in
Speaker 2: having very structured phases of rehab, regardless of the injury. Now,
Speaker 2: I think from an S ANDC standpoint, I preach it
Speaker 2: quite a lot that when you have SNC's EPs, cairo's physios,
Speaker 2: even docs that all work amongst one individual in team sport,
Speaker 2: I found it really powerful.
Speaker 1: But they have quite clear outcomes.
Speaker 2: Each phase really guides and gauges everyone, even skills coaches
Speaker 2: as well. They understand that in their protection phase it's red,
Speaker 2: they kind of know they're not going to be doing much.
Speaker 2: They kind of know they're off feet conditioning obviously, sum
Speaker 2: it's lower limb, and everyone's really on the same page.
Speaker 2: Then you move into this sort of load introduction. Everyone
Speaker 2: knows what the general theme is and although.
Speaker 1: It might be.
Speaker 2: Oversimplifying it a little bit, I think it allows everyone
Speaker 2: to really be on the same page. So I'm going
Speaker 2: to answer with saying having a very clear phase and
Speaker 2: systems approach to rehab is really powerful. Even if there's
Speaker 2: going to be some gray areas with different injuries. It
Speaker 2: allows everyone to be on the same page because as
Speaker 2: an S and C coach, even a young SNC coach
Speaker 2: that's here, they know if someone's in protection phase, stay
Speaker 2: the hell away, like chat with them about their weekend.
Speaker 2: But you, as an SENC coach, especially a young SENC coach,
Speaker 2: you're not going to be making decisions on things in
Speaker 2: the same fashion. If they know their load intro and
Speaker 2: someone asks about an exercise, they kind of know what
Speaker 2: loading they're going to be doing. They know they're not
Speaker 2: going to be pushing it. They know to go for
Speaker 2: the smallest band instead of the medium band. All these
Speaker 2: little things that just govern someone's decision making when they
Speaker 2: kind of know the theme of that rehab and it
Speaker 2: means they don't necessarily need to know the graft type,
Speaker 2: they don't necessarily need to know the intricacies that say,
Speaker 2: the physio department will know. But it does allow everyone
Speaker 2: to be on a very similar page and also coach
Speaker 2: a very similar thing if the physio isn't with them
Speaker 2: all the time. Next part of it, Hanny over Carlyn,
Speaker 2: you want to take this. You're not in a little
Speaker 2: bit as well there, mate, how have you seen that
Speaker 2: works well here? That sort of keeps everyone on the
Speaker 2: same page, keeps everyone aligned, keeps everyone communicating the same message.
Speaker 5: I think the weekly catch up is one thing that
Speaker 5: we do really so like there just has to be
Speaker 5: weekly communication of like where someone's at, if someone's had
Speaker 5: a flare up, Like it's everybody's business to know that.
Speaker 5: And as you said, lo, because the physios we aren't
Speaker 5: always on the floor all the time, we're only there
Speaker 5: sports throughout the week, it's likely going to be the
Speaker 5: SNC coach that is getting these queers in questions, so
Speaker 5: they need to be in the know about what the push,
Speaker 5: what the pull. So like the weekly comes is massive
Speaker 5: for all of us being on top of it there,
Speaker 5: and we're very lucky as well actually with you know,
Speaker 5: the systems we have in place, the different phases, it's
Speaker 5: quite obvious when someone is really putting the pedal down er,
Speaker 5: as I said, if they're in that interim phase where
Speaker 5: it's a bit less in terms.
Speaker 3: Of a loading point of view.
Speaker 5: But the last bit I think is like education, Like
Speaker 5: physios need to educate essencies, and essencies need to educate physios.
Speaker 5: The more essencies know about a given injury or given pathology,
Speaker 5: the better they're equipped then to help and manage when
Speaker 5: something comes up, Like I love more experience SENC coaches
Speaker 5: will be here, but like, oh look, so and so had.
Speaker 3: This in the session. We didn't stop session.
Speaker 6: We just pull it back a bit and give them
Speaker 6: some heavy hinge work instead of there Teler Tendem was
Speaker 6: sore for example, Like just being able to make those
Speaker 6: changes on the fly helps a lot as well create
Speaker 6: great trust from the athletes because they trust everybody and
Speaker 6: not just the physio that they see, which I think
Speaker 6: is really really important as well. So it's just making
Speaker 6: sure that everyone's in unison, like I know for RPD
Speaker 6: we were kind of doing every five weeks the physios
Speaker 6: would present in a case study and like extremely valuable
Speaker 6: and one of my I suppose bits of advice for
Speaker 6: any like spurring SNC coaches like you are so much
Speaker 6: more employable in the pro sector if you've got a
Speaker 6: rehab knowledge based because you're going to seamlessly transition into
Speaker 6: from performance points view, but also being able to work
Speaker 6: closely with the physio, like you just have another tool
Speaker 6: in your toolbox to utilize. So that would be a
Speaker 6: big thing for me would be like, you know, try
Speaker 6: and seek some experience with physios and learn what we do.
Speaker 6: And same for physios like going up skill in your
Speaker 6: sec go and learn how to program, how to load effectively.
Speaker 6: You know, do you actually understand the physiological changes that
Speaker 6: you're trying to make when you're rehabbing somebody, Because that's
Speaker 6: what the best rehabbers can do. They have their objective tests,
Speaker 6: this is what you need to go and do these
Speaker 6: any exercises to do it six weeks buying job done.
Speaker 3: So that'll be my bit on that AA.
Speaker 5: I think bringing it back to the quote unquote clinic
Speaker 5: we have up here, having and trying to have all
Speaker 5: the physios on the same page.
Speaker 3: I think our consistent pd is is pretty good.
Speaker 5: And having Kalen here, as I suppose someone who hasn't
Speaker 5: been in the AA system for a couple of years
Speaker 5: or hasn't come up through it will say, like myself,
Speaker 5: it's a different kind of assessment and different way of thinking.
Speaker 5: So getting that input for me has been like so helpful.
Speaker 5: And then building out processes of assessment and we'll say
Speaker 5: we'll go through currently we're going through the shoulder, just
Speaker 5: through the whole way from like objective the whole way
Speaker 5: through too, like rehab, making sure we're all kind of
Speaker 5: on the same page with Okay, what are we looking at,
Speaker 5: what are we looking for? I think then it makes
Speaker 5: it easier if we have any athlete, for example, one
Speaker 5: of us is sick, can go see someone else pretty seamlessly.
Speaker 3: I think that's so important.
Speaker 5: And then upskilling on the same kind of techniques is
Speaker 5: pretty good too, And like just having a process and
Speaker 5: making sure we're all on the same page. And then
Speaker 5: one thing that we've built out for the ACLS and
Speaker 5: what I've been kind of playing around with in the
Speaker 5: background for other like big long term injuries, is just frameworks.
Speaker 5: So at each of our stages, what are we trying
Speaker 5: to hit, Like what's our criteria to move to the
Speaker 5: next phase? That kind of stuff, whether it's like return
Speaker 5: to run or return to change the direction or even
Speaker 5: just return to normal loading, like making sure that okay,
Speaker 5: if I've done it that, then I run up by
Speaker 5: the other two boys to make sure we're all on
Speaker 5: the same page, because I think if we're all aiming
Speaker 5: for the same targets, then like I said, you can
Speaker 5: kind of jump between different people if something like that happens,
Speaker 5: or if someone is on field with someone else's athlete,
Speaker 5: it's like, okay, sweet, they're at this phase.
Speaker 3: But that we're just all across the same process.
Speaker 5: There's a bit of a kind of a consistent framework
Speaker 5: across our three three clinicians here, and.
Speaker 4: I think we're quite fortunate that we all share pretty
Speaker 4: much similar views on most things as well, which means
Speaker 4: that we're in the same time, Like I think of
Speaker 4: things where whereas been like total disagreement generally we're kind
Speaker 4: of obviously asked healing.
Speaker 1: Yeah, but that's why it's got you all from a
Speaker 1: similar part of the world.
Speaker 3: Make sure we're all on so we can actually understand it.
Speaker 5: Actually, when we heard this put in a like counter
Speaker 5: with the amount of times that either him or me
Speaker 5: says like yeah, wells.
Speaker 3: Like it's having that willingness to.
Speaker 4: To learn as well, I think, and not just assume
Speaker 4: that you know everything, like and that's why I think
Speaker 4: we have so many touch points across the week and
Speaker 4: we're probably back alm with questions, but the willingness for
Speaker 4: him to give us some advice as well, which is
Speaker 4: always beneficial. So I just have time for each other
Speaker 4: to be able to discuss anything that we might be
Speaker 4: questioning a little bit. But generally it runs quite smoothly
Speaker 4: in terms of how we're structured our week in terms
Speaker 4: of being those touch points. So generally all of us
Speaker 4: are across most athletes who are on the fore. Of course,
Speaker 4: obviously we have hours where we are on the floor,
Speaker 4: so I might have John's athlete on the far klons
Speaker 4: on the floor. So if you know that they maybe
Speaker 4: had a bad week with something in particular, it's just honing.
Speaker 2: In on that a little bit as well, and a
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Speaker 2: Ac Mentorship is kicking off in two months ten Speak
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Speaker 2: interested reach out. It's been a very successful mentor ship,
Speaker 2: sold out every single one of them, so I'm sure
Speaker 2: it'll go quickly again.
Speaker 1: But final question, because it is kind of the state of.
Speaker 2: The industry and the evolution, a question around what is
Speaker 2: your opinion of online rehab? So it is funny because
Speaker 2: we actually have started some online rehab, so I thought
Speaker 2: it was quite appropriate question to finish on. But is
Speaker 2: it something I've sort of been opinionated online coaching, well,
Speaker 2: athletic performance coaching anyway, but with technology these days, it's
Speaker 2: certainly getting bigger. Obviously, you've worked with a couple of
Speaker 2: people online now, so I'm going to put it to
Speaker 2: you being the best situation considering you're doing it. How
Speaker 2: do you feel with it based off your experience and
Speaker 2: do you feel like you're getting as effective results?
Speaker 5: And what's it likes a bit of a new venture
Speaker 5: for your Yeah, so I suppose the start off. Is
Speaker 5: it better than in person treatment coaching testing? Obviously not?
Speaker 5: Can it be doing extremely well in the circumstance absolutely
Speaker 5: for most like injuries particularly, I feel like, for example,
Speaker 5: if you're rehabing someone who's coming in at kind of
Speaker 5: the mid stage of an act of pause attending graft like,
Speaker 5: you often know where the gaps and strength are. Again,
Speaker 5: that's just true experience and seeing a lot of them,
Speaker 5: so you can prescribe a really well designed programm to
Speaker 5: tidy up and assist with some of those strength deficits.
Speaker 5: But the amount of technology that we have available at
Speaker 5: the minute, the different apps getting the the at lead
Speaker 5: or client to record themselves doing the exercise in the gym,
Speaker 5: you know, over zoom, assessments. They can be in endurance assessments,
Speaker 5: capacity assessments. Watching the move we can actually get so
Speaker 5: much useful information. And if it is for somebody that's
Speaker 5: in a different part of the world and wants access
Speaker 5: to clinician elsewhere, like there's I think it's only going
Speaker 5: to get bigger, to be honest, there's only going to
Speaker 5: go one direction. Obviously it's at a lesser cost as well,
Speaker 5: So someone who's re having a longer term injury and
Speaker 5: feel like they can't afford the necessarily pay for the
Speaker 5: in person one, it is definitely coming in probably a
Speaker 5: cheaper rate. And I think you can have extremely good
Speaker 5: outcomes with any online rehab for most things, if I'm
Speaker 5: being honest.
Speaker 3: But is it better than in person? Absolutely not, I
Speaker 3: think everybody knows that. But like it's just.
Speaker 6: Becoming more and more showcased by different practitioners and clinics.
Speaker 6: And you know, with the kind of video analysis we
Speaker 6: can now do and drum up reports for people sending
Speaker 6: us clips to them accelerating and and you know some
Speaker 6: max velocity work, like it can be really really effective
Speaker 6: and really useful. And I'm actually enjoying it because it's
Speaker 6: different challenges a practitioner, like when you're following up with
Speaker 6: somebody weekly and you know, getting better at asking the
Speaker 6: right questions rather sometimes in person, you just know what
Speaker 6: you're going to look for, but you just have to
Speaker 6: be really really clear when you're communicating to somebody, Okay,
Speaker 6: this is exactly what I need you to set up
Speaker 6: now at home.
Speaker 3: Keep it simple.
Speaker 6: And also that when you're reviewing some some footage of
Speaker 6: them in the gym and running, you know, how do
Speaker 6: I make it as easy as possible to get this
Speaker 6: point across to the person so that they can you know,
Speaker 6: elicit this change in their acceleration technique is pretty like
Speaker 6: obviously with this it's air like we're lucky and that
Speaker 6: we see all of our athletes like every week and
Speaker 6: they're like in person, so it's pretty easy, and like
Speaker 6: we see them on the gym or in the gym
Speaker 6: on the field. Like with an online rehab, surely there
Speaker 6: are like they might be a perfect candidate for online rehab,
Speaker 6: but it's more on us on them as well to
Speaker 6: provide you with the feedback, provide.
Speaker 5: You with the videos, like how do you navigate that
Speaker 5: with them? If you have someone that's not pulling their weight.
Speaker 6: I suppose on there, And it's a great question, like
Speaker 6: it takes two to tangle, so like if you're not
Speaker 6: willing to be able to do that, then they're just
Speaker 6: not to feel on area. It's probably the best way
Speaker 6: to think about it, but absolutely, like it's a commitment
Speaker 6: on your end to be setting up the camera right,
Speaker 6: making sure you're getting the right angles. Like you often say, okay,
Speaker 6: can you record your you know, spit squat in the gym,
Speaker 6: And then they come back and the camera's at an
Speaker 6: angle and you can't see what you need to see
Speaker 6: and you're kind of like, you know, like, hey, maybe
Speaker 6: that's not the best way to film it. But I
Speaker 6: suppose these are the real life challenges. Even though you
Speaker 6: would spell a lot of this stuff out, it doesn't
Speaker 6: necessarily always happen like you expected this. So yeah, it's
Speaker 6: just lots of communication even throughout the week, Like it's
Speaker 6: not just a weekly zoom call, Like you're talking to
Speaker 6: these people after every rehab session.
Speaker 3: How did you pull up? What did you feel?
Speaker 6: Did you feel that exercise in your quad? You know, Okay,
Speaker 6: I didn't, I felt it in my hip?
Speaker 3: Can you show me?
Speaker 6: Yeah, look, there's lots of trunk flection there. Maybe you
Speaker 6: need to fix that. So, yeah, there's lots of communication.
Speaker 6: Like it arguably, I know a lot We've talked about
Speaker 6: this before, but like it arguably makes the clinicians job harder.
Speaker 6: But I suppose you have the novelty of doing it
Speaker 6: remotely from anywhere. That's obviously pros for the athlete and
Speaker 6: for the clinician. But like if you can't see them
Speaker 6: every day and you can't test them it regularly, like
Speaker 6: it is obviously is a disadvantage, but like I think
Speaker 6: it can be if you're well structured and how you
Speaker 6: do it, you can easily navigate those things. And then look,
Speaker 6: you just have to get them testing in the next
Speaker 6: hour and facility somewhere local to them. So we need that,
Speaker 6: like we can't progress for it objective data. So I
Speaker 6: always would spell it out from the start, like you know,
Speaker 6: in six weeks time, eight weeks time, I want you
Speaker 6: to find the place I want you to do these tests. Nowadays,
Speaker 6: with technology being so available, like a large portion of
Speaker 6: physio clinics or gyms have all DEVLT case and can
Speaker 6: do the majority of the testimony it gets up. It's
Speaker 6: just becoming more and more accessible, and with all.
Speaker 5: These apps coming out these days, you know cafres app
Speaker 5: and all these jump apps, like a ot of them
Speaker 5: can give you some useful quick information may not be
Speaker 5: overally as accurate, but like it's useful and keeps them
Speaker 5: motivated to see maybe that there's a bit of progress
Speaker 5: and that you know the planner is actually working for.
Speaker 3: Them, no doubt. I feel like online is harder. Yeah,
Speaker 3: it is.
Speaker 2: You gotta work a lot harder as a coach or
Speaker 2: as a physio because you don't have the organic there
Speaker 2: you are. Let me coach you live, let me fix
Speaker 2: you up. Instead of I've got to coach you. It's
Speaker 2: I've got to highlight things, I've got video things and
Speaker 2: send it to you. There's definitely more work involved, so
Speaker 2: kudos to anyone doing it. But if you are a
Speaker 2: physioclinic and a physio and you are interested in getting
Speaker 2: into your online space, it is certainly something that's getting bigger,
Speaker 2: and as Kalin is just alluded to, certainly something that
Speaker 2: we've been doing now and been doing really well and
Speaker 2: again a little bit harder for Calan, but it's certainly
Speaker 2: certainly been rewarding to be able to reach a few
Speaker 2: more people and push them through.
Speaker 3: The rehab stages again to the other end.
Speaker 1: Boyce appreciate it.
Speaker 2: I know this is not the comfort zone of physios,
Speaker 2: so I appreciate you jumping on. Hopefully there's some great
Speaker 2: takeaways for everyone listening at home. But ultimately I think
Speaker 2: it's really good to get the physiocide into it. Our
Speaker 2: coaches don't shut up, so it's good to hear from.
Speaker 1: The physio crew.
Speaker 3: And we'll get you back on it very soon. But
Speaker 3: thank you, and hopefully everyone enjoyed it. Thank you, luck
Speaker 3: I