WEBVTT - Athletes Authority ON AIR | Ep. 186 "Optimising Athlete Recovery" 0:00:03.920 --> 0:00:05.040 Okay, welcome back. 0:00:05.040 --> 0:00:08.280 We're at episode one and eighty six of Athletes Authority 0:00:08.360 --> 0:00:11.119 on it and Jesus Christ is some nerves going on 0:00:11.200 --> 0:00:14.720 in here. We have managed to squeeze all three physios 0:00:14.720 --> 0:00:16.439 into this room today for a bit of a physio 0:00:16.520 --> 0:00:17.160 round table. 0:00:18.160 --> 0:00:20.599 They're not all best at talking or discussing. 0:00:20.640 --> 0:00:22.720 We've got a couple of Irish, a couple of English 0:00:23.120 --> 0:00:26.520 and it's certainly. 0:00:26.200 --> 0:00:27.200 Going to be an interesting one. 0:00:27.280 --> 0:00:30.040 But guys, it's a bit of a round Let's have 0:00:30.120 --> 0:00:34.120 a very quick intro because nobody listens to podcasts for intros, 0:00:34.120 --> 0:00:35.840 so just so people know who's actually in the room. 0:00:36.200 --> 0:00:38.559 Joe, do you want to kick off? Mate? One sentence? 0:00:38.880 --> 0:00:43.600 One sentence. So I'm Joe. I'm from England. I worked 0:00:43.640 --> 0:00:46.320 in the NHS for around five years. I also worked 0:00:46.360 --> 0:00:51.720 in Elite codmy spot with Barnes the Football Club, and 0:00:51.760 --> 0:00:56.320 then sort of I find myself here in Australia Athletes Authority. 0:00:56.360 --> 0:00:58.080 Good to have you, Johnny. 0:00:58.720 --> 0:00:59.800 John from Ireland. 0:01:00.120 --> 0:01:02.320 I started out as an intern here and I've just 0:01:02.440 --> 0:01:06.120 worked my way up through intern rehab coach and then 0:01:06.640 --> 0:01:08.800 I got my registration could jump on as a physio 0:01:08.840 --> 0:01:09.520 here with the guys. 0:01:09.760 --> 0:01:11.520 Yeah, one of the one of the many interns that 0:01:11.560 --> 0:01:14.319 we continue to hire. Good to say and ahead of 0:01:14.400 --> 0:01:15.640 rehab the big man Kailin. 0:01:16.680 --> 0:01:20.000 Yeah, I'm Kitalen. I'm also Irish, but more importantly from Cork. 0:01:20.120 --> 0:01:22.119 So if you're Irish and you're listening, you'd probably get 0:01:22.120 --> 0:01:26.080 that one. Worked back home at the Sports Surgery Clinic 0:01:26.200 --> 0:01:28.960 for just over three years as an intern through a 0:01:29.040 --> 0:01:32.200 rotage physio to have seene in physio. Was also working 0:01:32.280 --> 0:01:35.199 with some elite Gaelic football on the side with Cavin 0:01:35.400 --> 0:01:38.199 and in the last kind of year and three months 0:01:38.200 --> 0:01:43.000 obviously have filmed myself also in the eastern suburbs of Sydney, 0:01:43.400 --> 0:01:44.960 currently working here now at a minute. 0:01:45.000 --> 0:01:46.960 So yeah, it's been it's been great. 0:01:46.720 --> 0:01:47.920 All right, So I can I'll get some of the 0:01:47.960 --> 0:01:49.760 trains like that, Joe, can you translate that? 0:01:50.120 --> 0:01:50.800 I can't help you. 0:01:51.200 --> 0:01:51.800 He's a tough one. 0:01:51.840 --> 0:01:54.040 He's a tough one. So we put a few questions. 0:01:54.080 --> 0:01:55.600 He has a few things you want to go through today. 0:01:55.960 --> 0:01:58.320 Obviously having all physios in the in the room is 0:01:58.560 --> 0:02:00.720 he's certainly a powerful thing to have for too and 0:02:00.720 --> 0:02:03.240 frow discussions. We have it on the daily here. You 0:02:03.240 --> 0:02:06.000 guys obviously work very closely together in the same room, 0:02:06.200 --> 0:02:10.280 with similar plints across athletes, across sam s and cs. 0:02:10.320 --> 0:02:14.480 So understanding the entirety of the program is powerful and 0:02:14.520 --> 0:02:15.440 that's exactly. 0:02:15.080 --> 0:02:17.240 What we try and spreach to our athletes to get 0:02:17.240 --> 0:02:17.720 them better. 0:02:18.240 --> 0:02:21.079 But maybe we start with you, mate, to kick off, 0:02:21.200 --> 0:02:24.079 have a little bit of a discussion around, especially with 0:02:24.120 --> 0:02:25.359 some of the questions that we've had, a lot of 0:02:25.400 --> 0:02:29.120 them have been relationships with SNCs. What's your pet peeve 0:02:29.160 --> 0:02:31.160 with an S ANDC? What's the most the thing you 0:02:31.200 --> 0:02:33.400 love most about secs? All this type of stuff. So 0:02:34.040 --> 0:02:37.400 instead of going through each individual question about straight finditioning coaches, 0:02:37.480 --> 0:02:39.840 let's maybe attack it from a bit of a broader spectrum. 0:02:40.400 --> 0:02:42.920 How are you going here working with sencs? How have 0:02:42.960 --> 0:02:46.360 you gone over in Ireland? Sort of very simple. What's 0:02:46.800 --> 0:02:50.120 the importance of working together and making sure that it 0:02:50.160 --> 0:02:54.000 is a joint approach? Too many people these days they 0:02:54.040 --> 0:02:57.440 talk about silos, they talk about working together. I'm going 0:02:57.480 --> 0:02:59.320 to go on a round here, but there's even a 0:02:59.320 --> 0:03:04.680 certain view your clinic in Sydney that promotes the togetherness 0:03:04.680 --> 0:03:08.040 of sencs and physias would steal the physias. We'll go 0:03:08.160 --> 0:03:10.520 that's an Es sency thing and I just palm it 0:03:10.560 --> 0:03:13.240 off with little understanding. Talk to us a little bit 0:03:13.280 --> 0:03:17.200 about what an actual combined approach looks like and what 0:03:17.240 --> 0:03:17.920 the importance is. 0:03:18.480 --> 0:03:21.040 Yeah, so, look, we're obviously very lucky here in one 0:03:21.080 --> 0:03:23.840 sense to be able to work so closely with the with. 0:03:23.760 --> 0:03:24.480 The sen c's. 0:03:25.000 --> 0:03:28.400 Obviously a lot of our performance athletes will check in 0:03:28.440 --> 0:03:30.480 every now and then for different things, and these are 0:03:30.520 --> 0:03:34.840 your classic in season niggers. You know, your drying pain, 0:03:35.440 --> 0:03:40.040 reactive tender operties and things like that. Often with us 0:03:40.120 --> 0:03:42.640 it's just checking in maybe to see where the deficits 0:03:42.680 --> 0:03:45.400 are with the S and C program in general, because 0:03:45.400 --> 0:03:47.640 it's more well rounded and you're trying to take all 0:03:47.640 --> 0:03:51.040 the boxes there. Oftentimes the smaller muscle groups are the 0:03:51.080 --> 0:03:53.160 important things that we would obviously check. 0:03:53.040 --> 0:03:54.320 Regularly can be missed. 0:03:55.720 --> 0:03:58.440 So for us, really it's just a bit of fine tuning, 0:03:58.880 --> 0:04:01.280 maybe a bit of additional work in their resilience block 0:04:01.440 --> 0:04:03.320 or like an A two option that you can just 0:04:03.600 --> 0:04:06.640 tidy something up nicely and then managing training load there 0:04:06.720 --> 0:04:07.839 is usually kind of key. 0:04:07.880 --> 0:04:08.280 With us. 0:04:09.720 --> 0:04:12.200 I think it's vital important to have an MDT approach, 0:04:12.200 --> 0:04:15.120 and I suppose most teams or medical teams in pro 0:04:15.200 --> 0:04:17.200 sport that are operating the best start of ones where 0:04:17.240 --> 0:04:21.479 it's really really unified from the start, regardless of the injury, 0:04:21.600 --> 0:04:24.680 there's always upper body KPIs to hit as soon as 0:04:24.720 --> 0:04:26.720 you can get the offeet conditioning in, how can we 0:04:27.360 --> 0:04:29.120 get you as good as possible there to make that 0:04:29.200 --> 0:04:33.520 kind of transition as seamless as possible. And then often 0:04:34.000 --> 0:04:36.720 one of the things that's often spoken about is how 0:04:37.080 --> 0:04:41.400 physios tend to underload and maybe undershoot the market time. 0:04:41.520 --> 0:04:44.080 So I think like having a balance of boat is 0:04:44.480 --> 0:04:46.440 key for any kind of successful rehab. 0:04:46.560 --> 0:04:51.719 Really heap peeves with essencies. I guess it depends. 0:04:51.839 --> 0:04:56.240 Oftentimes it can be something's not flagged early enough proceed 0:04:56.279 --> 0:04:59.119 down a couple of weeks of for an example, at 0:04:59.760 --> 0:05:02.640 time that's just smashed to the eyes us for a 0:05:02.680 --> 0:05:05.680 few few weeks, and you know, the pteller tendon might 0:05:05.839 --> 0:05:08.320 necessarily be the culprit, that might be the victim, and 0:05:08.320 --> 0:05:09.839 there's other things that we need to be tiding up 0:05:09.880 --> 0:05:12.200 there to look at to try and assist and getting 0:05:12.200 --> 0:05:14.760 that better to the point then where it probably needs 0:05:14.800 --> 0:05:17.080 a further offload to get it better. So I suppose 0:05:17.080 --> 0:05:22.120 that'll be one thing, maybe proceeding ahead modifying training as 0:05:22.200 --> 0:05:24.760 much as they can without just like getting a check 0:05:24.800 --> 0:05:26.760 the sooner you can assess it, the sooner you can 0:05:26.800 --> 0:05:29.599 get a planning place, I suppose, and try and get 0:05:29.600 --> 0:05:32.960 that athlete back paying free and performing at as best 0:05:33.000 --> 0:05:33.680 as they would like. 0:05:35.200 --> 0:05:38.560 So supposed to be a couple of things for our 0:05:38.560 --> 0:05:39.600 long term real athletes. 0:05:39.640 --> 0:05:41.400 Then I feel like we're very lucky that when we 0:05:41.440 --> 0:05:44.000 do get to that mid to end stage because our 0:05:44.040 --> 0:05:46.360 field rehab sessions and our performance i e. 0:05:46.560 --> 0:05:48.960 Speed sessions run closely together. 0:05:49.720 --> 0:05:52.039 So we get an athlete to the point where they're 0:05:52.080 --> 0:05:54.839 in that transition phase and maybe with us they've ticked 0:05:54.880 --> 0:05:58.760 the key boxes and rehab i e. You know, max velocity, exposure, 0:06:00.560 --> 0:06:02.880 change the direction, react to change direction at the high level, 0:06:03.040 --> 0:06:05.839 and they've ticked all the rehab boxes per se. We 0:06:05.920 --> 0:06:08.240 can then kind of get them to transition across where 0:06:08.240 --> 0:06:10.880 we get an SNC's on it from a performance point 0:06:10.920 --> 0:06:12.760 of view, and they can often then hone in on 0:06:12.800 --> 0:06:15.600 the final details. I think obviously one of the big 0:06:15.640 --> 0:06:18.160 things we're all seeing at the minute on socials is 0:06:18.480 --> 0:06:21.760 the whole kind of movement matters and you know how 0:06:21.839 --> 0:06:25.280 different movement strategies and different running strategies load joints in 0:06:25.320 --> 0:06:27.760 different ways. So I feel like from an SNC's point 0:06:27.760 --> 0:06:29.599 of view, they will go come at it from a 0:06:29.680 --> 0:06:32.040 purely a performance point of view, how can we get 0:06:32.080 --> 0:06:32.800 you more efficient? 0:06:32.880 --> 0:06:33.839 How can we get you faster? 0:06:33.880 --> 0:06:35.640 And then we can hone in maybe on the strategies 0:06:35.640 --> 0:06:38.320 from Maria point of view, So like that that's key 0:06:38.360 --> 0:06:40.480 to me in any success that REH haven't And that's 0:06:40.560 --> 0:06:42.440 one of the things I actually love the most about 0:06:42.920 --> 0:06:45.480 how we work together here for sure, great good summary. 0:06:45.560 --> 0:06:45.760 Nia. 0:06:46.279 --> 0:06:50.000 We've had a fair amount of questions around specific injuries. Yeah, 0:06:50.080 --> 0:06:52.600 the typical how do I fix a hamstring? How do 0:06:52.640 --> 0:06:55.080 I fix plant? To fashiou? All these type of things. 0:06:55.080 --> 0:06:57.400 So I'm going to throw it to the group and 0:06:57.520 --> 0:06:59.159 if you're on't and I'm just going to start picking 0:06:59.160 --> 0:07:02.119 on you've got tendons is going to be a big one, 0:07:02.200 --> 0:07:06.200 and it is. You mentioned it before. We've talked about 0:07:06.240 --> 0:07:09.960 a little bit around the culprit or the victim, and 0:07:10.400 --> 0:07:12.760 I think it's important to sort of differentiate that, So 0:07:12.760 --> 0:07:14.200 I'd love a little bit of a chat around that. 0:07:14.280 --> 0:07:17.320 But then what are we seeing here from a ten 0:07:17.400 --> 0:07:22.880 and opathy standpoint, what are the go to initial solutions 0:07:22.880 --> 0:07:26.120 you guys are looking at and seeing. And also the 0:07:26.160 --> 0:07:28.080 biggest takeaway I think for a lot of listeners is 0:07:28.400 --> 0:07:32.480 the range of athletes we have from eleven year old 0:07:32.520 --> 0:07:35.040 female soccer players all the way through to fifty five 0:07:35.120 --> 0:07:37.280 year old masters level rowers. 0:07:37.840 --> 0:07:39.119 So we see a lot of different things. 0:07:39.160 --> 0:07:42.760 We see the phase of stress fractures that occur in 0:07:43.200 --> 0:07:45.920 our youth athlete across to then tendons flaring up at 0:07:45.960 --> 0:07:48.640 different ages and carves at different ages. 0:07:48.680 --> 0:07:51.000 But let's focus on tendons for a little bit. 0:07:51.720 --> 0:07:53.840 Hit me with a couple of things that you guys 0:07:53.880 --> 0:07:56.200 are starting to see from a trend standpoint, but also 0:07:56.640 --> 0:07:58.520 some of the solutions that you guys are working with 0:07:58.680 --> 0:08:00.160 and have had some really good success with. 0:08:01.680 --> 0:08:04.480 I think, first of all, it depends on what tendon 0:08:04.480 --> 0:08:08.080 we're looking at. More commonly, I think what we see 0:08:08.080 --> 0:08:10.920 here will be a pteal, a tendon or achilles tendonoposy. 0:08:13.000 --> 0:08:18.360 Now it's understanding the tendon and what's what their role is. 0:08:18.360 --> 0:08:22.400 So with an achilles tenderopathy, probably looking that's going to 0:08:22.400 --> 0:08:26.080 be a little bit stiffer. So if if you've got 0:08:26.160 --> 0:08:28.880 a tenderopathy in the Achilles, you probably find that it's 0:08:28.920 --> 0:08:32.040 it's actually gonna going to lose some of that stiffness. 0:08:32.360 --> 0:08:38.120 Probably the opposite with the tele attendon, so the way 0:08:38.120 --> 0:08:41.440 that you're going to load it. So for for Achilles, 0:08:41.480 --> 0:08:45.000 for example, I would do a lot of eccentric loading, 0:08:46.559 --> 0:08:50.439 whereas with the teletonopathy, especially if it's a lot more 0:08:50.480 --> 0:08:53.240 flared up if we're looking at long isometric holds. 0:08:55.480 --> 0:08:56.440 Yeah, I don't know about you. 0:08:56.920 --> 0:08:59.599 You guys are you Yeah, I'd be similar like I 0:08:59.600 --> 0:09:02.160 would have because I'm still pretty early in my career. 0:09:02.160 --> 0:09:03.679 I would have just picked up a lot of stuff 0:09:03.679 --> 0:09:07.320 from Kalen across the table here. I've noticed it a 0:09:07.360 --> 0:09:10.000 bit more with our AFL players just because on that 0:09:10.080 --> 0:09:13.240 hard ground on an artificial turf as well, and they're 0:09:13.280 --> 0:09:15.520 just ks through their load through their legs. 0:09:16.080 --> 0:09:18.800 Context say, we have one of the few IFL teams 0:09:18.800 --> 0:09:23.280 in Australia that plays on AstroTurf, So yep, we do 0:09:23.480 --> 0:09:25.080 deal with IFL boys coming off. 0:09:25.200 --> 0:09:27.600 You use a G three is that what you guys 0:09:27.640 --> 0:09:30.199 call it in the UK? G G five whatever it is. 0:09:30.360 --> 0:09:32.520 Yeah, but yeah, like we see a lot of it 0:09:32.679 --> 0:09:35.440 and for them it's they go through so much loads, 0:09:35.440 --> 0:09:37.240 so it's nearly just stripping them back a bit while, 0:09:37.960 --> 0:09:41.800 like Joe said, bringing in like your heavy solow isometrics 0:09:41.920 --> 0:09:43.760 or your isometric hold, whether that be like on a 0:09:43.800 --> 0:09:46.160 smith machine or a safety bar. 0:09:46.160 --> 0:09:46.800 Or something like that. 0:09:48.480 --> 0:09:51.880 But usually it comes down to load because they're in 0:09:51.960 --> 0:09:54.280 that pre season stage where they're trying to ramp everything up. 0:09:54.760 --> 0:09:57.840 They might be doing beach sessions because coaches love beach sessions, 0:09:58.000 --> 0:10:01.120 so that's a whole different beast altogether. Then if you 0:10:01.240 --> 0:10:02.880 think of like a pateell Er ten and you can 0:10:02.960 --> 0:10:07.800 then go pretty simple sixty degree isometric holes or like 0:10:07.880 --> 0:10:09.839 a wall set I think is a pretty handy one, 0:10:10.280 --> 0:10:13.199 and then just tying it back into the question with 0:10:13.240 --> 0:10:15.840 the S and c's, you'll always want to have them 0:10:15.880 --> 0:10:19.280 in the loop and then make sure that that's done 0:10:19.400 --> 0:10:22.160 religiously like every day. That's probably my pet peeves like 0:10:22.240 --> 0:10:26.240 you'll put something in communicate with them and then it 0:10:26.320 --> 0:10:28.040 might get missed a couple of weeks down the track, 0:10:28.080 --> 0:10:29.520 and then the athlete is wondering. 0:10:29.559 --> 0:10:29.920 Otherwise. 0:10:29.960 --> 0:10:33.120 My tends still a bit grumbly, But yeah, I think 0:10:33.800 --> 0:10:38.440 management preseason key for us at the minute. And yeah, 0:10:38.440 --> 0:10:40.319 I would have learned most of my stuff from this 0:10:40.480 --> 0:10:42.199 man sitting across the table from me, so I'm sure 0:10:42.240 --> 0:10:45.160 he has some tidbits of information that we might have missed. 0:10:47.200 --> 0:10:48.440 Yeah, where do I start? 0:10:48.640 --> 0:10:52.280 I suppose I would always see when you get attendant 0:10:52.280 --> 0:10:54.199 at them for the first time. It's almost like you're 0:10:54.200 --> 0:10:56.120 doing her a bit of a detective work at the 0:10:56.200 --> 0:10:57.400 start to try and find out. 0:10:57.400 --> 0:10:58.920 Okay, firstly, what's changed. 0:10:59.000 --> 0:11:03.040 So whether it achilles teller, tending, whatever it is, proximal 0:11:03.080 --> 0:11:07.760 HAMI has training load ramped up? Is this person consistently 0:11:07.800 --> 0:11:11.360 loading in the gym all those kind of I suppose 0:11:13.600 --> 0:11:16.240 weekly volume factors as to where we think potentially the 0:11:16.280 --> 0:11:20.000 overload hight it came from. You also then can't forget 0:11:20.040 --> 0:11:24.480 your differentials, so I suppose different autoimmune diseases can present 0:11:24.640 --> 0:11:26.080 with tending pain. 0:11:26.240 --> 0:11:28.400 So you always have your your medical hat on there. 0:11:28.600 --> 0:11:30.959 You know, is this definitely something that's boy mechanical and 0:11:31.040 --> 0:11:33.120 that might be something maybe that a couple of weeks 0:11:33.160 --> 0:11:36.320 down the line isn't responding to typical treatment like your 0:11:36.360 --> 0:11:39.040 asymmetrics and your training offload, but also like your clinical 0:11:39.120 --> 0:11:42.360 history to evaluate any other history of kind of systemic 0:11:42.440 --> 0:11:47.560 or autoimmune factors. I suppose it depends then how irritable 0:11:47.559 --> 0:11:50.319 they are in the session. So for example, for like 0:11:50.400 --> 0:11:54.319 ep teller tendonopotly we'd look at single egg squat, single 0:11:54.360 --> 0:11:57.559 egg hop. Sometimes for those kind of milder ones when 0:11:57.600 --> 0:12:00.280 you go really overtow on a decline board, how orable 0:12:00.400 --> 0:12:04.240 is it turning? There some palpation, and the key bits 0:12:04.240 --> 0:12:06.439 and those kinds of initial sessions are if we take 0:12:06.520 --> 0:12:09.760 them through some progressive isometric loading, like can we actually 0:12:09.840 --> 0:12:12.160 settle down the tendon in session? So then when we 0:12:12.240 --> 0:12:14.480 do our test retest, we get an idea of maybe, okay, 0:12:14.679 --> 0:12:16.679 is this actually a tendon causing the pain because it 0:12:16.720 --> 0:12:19.160 would respond like how we would expect the tend to respond. 0:12:19.760 --> 0:12:21.680 And then we can kind of gauge off that basically 0:12:22.080 --> 0:12:23.920 how much we need to offload the person in the week. 0:12:23.960 --> 0:12:26.800 Because it's often in season, people don't want to stop training, 0:12:26.920 --> 0:12:29.920 so it's often like a fine line between how much 0:12:29.960 --> 0:12:31.599 can we strip it back to still allow them to do, 0:12:32.040 --> 0:12:35.120 you know, some amount of training without continually flaring it up, 0:12:35.720 --> 0:12:38.640 throw the kitchen sink at it from aniceymmetric point of view, 0:12:39.679 --> 0:12:41.120 to try and set it down. But I think the 0:12:41.200 --> 0:12:42.839 key thing with them off. Then again it comes back. 0:12:42.840 --> 0:12:45.400 Though we just spoke about victim or the culprit. We 0:12:45.480 --> 0:12:48.360 see it all the time with teller tendon operties like 0:12:48.520 --> 0:12:51.080 really reach through the lateral hip on that side, maybe 0:12:51.160 --> 0:12:54.360 some foot nine coal reactive strength deficits or calve strength deficits. 0:12:54.679 --> 0:12:56.559 So it's kind of leading to an overload of the 0:12:56.720 --> 0:12:57.319 teller tendon. 0:12:57.360 --> 0:12:59.559 But if you actually settle down the piteler tendon and 0:12:59.640 --> 0:13:02.160 tested the quad strength, it actually might be symmetrical. So 0:13:02.640 --> 0:13:06.800 oftentimes it's like stripping it back, taking that detective approach 0:13:06.920 --> 0:13:09.720 and not just having a very narrow rehab focus of okay, 0:13:09.760 --> 0:13:11.000 it's just the sore tendon. 0:13:11.320 --> 0:13:13.000 It's kind of trying to fill the bigger picture. 0:13:13.080 --> 0:13:15.120 So for us, typical strategies we would do would be 0:13:15.480 --> 0:13:18.000 we would reduce their velocity block in the gym, We 0:13:18.120 --> 0:13:20.160 might take out a lot of the new dominant loading 0:13:21.360 --> 0:13:23.920 to help tend and settle down, focus more maybe on 0:13:24.480 --> 0:13:27.760 inter range stuff shortened contractions, and then as John said, 0:13:28.120 --> 0:13:30.760 I suppose isometrics at mid range if you take a 0:13:30.800 --> 0:13:33.640 pteller tendon for example, like Jill Cook has lots of 0:13:33.720 --> 0:13:36.840 work on different things heating with the iceometrics too, as 0:13:36.840 --> 0:13:39.000 we want to try and make sure that they're heavy. 0:13:39.520 --> 0:13:41.920 Too often we see go on to the gym five 0:13:42.000 --> 0:13:43.599 kilos on the like extension in the mid range, you 0:13:43.600 --> 0:13:45.719 could probably hold it for two days. So it's just 0:13:45.800 --> 0:13:48.640 a case of making sure that the isometrics are those correctly, 0:13:49.440 --> 0:13:52.200 and I think for the tendons that in session test 0:13:52.280 --> 0:13:54.520 retests will give you a lot of clues as to 0:13:54.880 --> 0:13:57.840 maybe how you need to manage it going forward. But again, 0:13:58.000 --> 0:14:03.480 as Joe alluded to, there contendings have different functions, but 0:14:03.559 --> 0:14:06.680 there's so much evidence on like you know, how attending 0:14:06.800 --> 0:14:10.720 is in that kind of disrepair phase, how true loading 0:14:10.800 --> 0:14:13.480 and progressive loading, heavy slow resistance over time, you know, 0:14:13.600 --> 0:14:16.400 you can actually rearrange the college an organization to look 0:14:16.480 --> 0:14:20.080 healthier again. So for your athletes, having your analogies I 0:14:20.120 --> 0:14:22.720 think are always really useful ways to like get them 0:14:22.760 --> 0:14:25.720 to relate to because they just want to play their sore. 0:14:26.400 --> 0:14:28.760 You know, we're very lucky that we've got a lot 0:14:28.800 --> 0:14:31.600 of highly motivated athletes, so oftentimes like they don't want 0:14:31.600 --> 0:14:33.760 to strip things back and we're always trying to. You 0:14:33.800 --> 0:14:35.760 don't want to be the bad guys, so you're obviously 0:14:35.880 --> 0:14:38.480 often playing good cop bad cop the choice, meet them 0:14:38.520 --> 0:14:41.240 in the middle somewhere and keep everybody in all parties 0:14:41.280 --> 0:14:44.440 happy while continuing to see improvement. But then sometimes obviously 0:14:44.520 --> 0:14:46.880 it's it's too irritable, and it does require a. 0:14:48.480 --> 0:14:52.680 Brief offload from all of your like big impact. 0:14:52.360 --> 0:14:55.560 Loading activities or stretch shortening cycle activities, just to let it, 0:14:55.880 --> 0:14:58.040 let it cam and settle and then start to rebuild. 0:14:58.280 --> 0:15:00.760 Well, I think previously, I think five years ago, is 0:15:00.800 --> 0:15:03.600 to do the classic I so introducts. You do three 0:15:03.680 --> 0:15:07.280 sets of thirty seconds and you'd expect some results after 0:15:07.320 --> 0:15:08.760 a few weeks, and I think, you know, as you 0:15:08.760 --> 0:15:10.840 get older, you start to realize, well, fuck, you know what, 0:15:10.960 --> 0:15:13.080 it actually takes a while for tendants to respond. And 0:15:13.240 --> 0:15:15.720 I think even my stuff i've started to create, most 0:15:15.760 --> 0:15:17.640 of any athlete that I work with or usually get 0:15:17.720 --> 0:15:21.200 five sets of about forty seconds, and there's an absolute 0:15:21.280 --> 0:15:23.040 stark difference. And I still see a lot of people 0:15:23.120 --> 0:15:26.320 do short, little iso hole pramp and then expect it 0:15:26.360 --> 0:15:29.520 to be better. What's your starting once you go to 0:15:29.760 --> 0:15:31.200 how do you sort of build someone into it? I 0:15:31.280 --> 0:15:33.600 know it's an open question because it depends where they're at. 0:15:33.720 --> 0:15:37.000 Meet them where they're at. But what sort of your 0:15:37.000 --> 0:15:39.400 base protocol that you look at for someone presenting with 0:15:39.480 --> 0:15:41.200 a tendon where you kind of like, we'll just get 0:15:41.240 --> 0:15:41.880 this under control. 0:15:42.320 --> 0:15:44.160 Yeah, And like often I think it's just best to 0:15:44.240 --> 0:15:45.160 keep it simples. 0:15:45.240 --> 0:15:48.360 Like, for example, if someone is like rosstly really weak, 0:15:48.920 --> 0:15:51.000 like you see it a last where you have just 0:15:51.400 --> 0:15:53.400 hear me some athletes who just throw all leaves I've 0:15:53.400 --> 0:15:56.400 got to wear with minimum gym lauding, have holy training 0:15:56.480 --> 0:15:58.000 lads and just seem to be able to tighter around it. 0:15:58.040 --> 0:16:01.160 Because again, everybody is different to certain so your entry 0:16:01.240 --> 0:16:03.680 level for them you've got a really weak calf, like 0:16:03.880 --> 0:16:07.360 just holding body weight for thirty forty seconds might give 0:16:07.400 --> 0:16:09.880 them a similar stimulus to someone who's obviously stronger and 0:16:09.920 --> 0:16:12.520 can tolerate more. From a tendon level, I think a 0:16:12.600 --> 0:16:14.960 lot of the research alludes to has to be over 0:16:15.040 --> 0:16:17.760 kind of seventy eighty percent of the maximum voluntary contraction 0:16:17.840 --> 0:16:20.040 of the muscle has to be slow and controlled for 0:16:20.240 --> 0:16:21.320 to really actually. 0:16:21.080 --> 0:16:24.360 Stimulate any sort of tending adaptation at all. So that 0:16:24.400 --> 0:16:28.040 would be one factor. Irritability is another, Like give me 0:16:28.160 --> 0:16:30.880 somebody with you know, six months of telor tending pain 0:16:30.920 --> 0:16:32.640 and get them through a heavy wall set like it's 0:16:32.680 --> 0:16:35.640 going to be very uncomfortable. So you're always looking for 0:16:35.800 --> 0:16:38.760 like your way, and I find often and that way 0:16:38.800 --> 0:16:40.840 and could be maybe you just start with some inner 0:16:40.880 --> 0:16:42.880 range y symmetric loading. If we just take the teller 0:16:42.960 --> 0:16:47.480 tendon for an example, you know, see how respond to that. 0:16:47.760 --> 0:16:50.000 You have your couple of test free test markers. Okay, 0:16:50.120 --> 0:16:52.280 Oftentimes when you load it at any level, it's going 0:16:52.360 --> 0:16:54.160 to change and feel a bit better, and you can 0:16:54.200 --> 0:16:56.440 start to maybe as the tending warms up to the session, 0:16:56.840 --> 0:16:59.920 build into just some I suppose greater degree or work 0:17:00.160 --> 0:17:02.600 through some more range of motion with it, and it 0:17:02.640 --> 0:17:05.600 can be like right, you know you do your ametrics 0:17:05.640 --> 0:17:07.200 in the world up, you have to you know, bring 0:17:07.280 --> 0:17:09.760 your single like squad paying down to a certain level 0:17:09.800 --> 0:17:12.160 before you can proceed what you're loading. And the key 0:17:12.240 --> 0:17:14.000 thing then with that too in the early stages is 0:17:14.080 --> 0:17:17.000 like we have to be monitoring twenty four hour forty 0:17:17.000 --> 0:17:19.479 eight hour symptom response because we know once they warm 0:17:19.560 --> 0:17:21.480 up they often feel good. But if they're waking up 0:17:21.480 --> 0:17:24.240 the following day with worse tending pain that's taking longer 0:17:24.280 --> 0:17:26.320 to settle, then chances that we might be doing more 0:17:26.359 --> 0:17:27.960 harm than good in the gym, So we have to 0:17:28.480 --> 0:17:30.879 bring it back to a level where we're starting to 0:17:30.960 --> 0:17:32.280 see improvement. 0:17:33.840 --> 0:17:36.040 Week to week. You know, one bad day. 0:17:35.920 --> 0:17:39.199 Out of six comparison to previously three bad days out 0:17:39.240 --> 0:17:41.480 of six is actually improvement. And that comes down to 0:17:41.520 --> 0:17:44.360 our education of like telling people that like, the way 0:17:44.440 --> 0:17:46.000 this works is like you're not just going to wake 0:17:46.080 --> 0:17:48.520 up no pain, Like you're going to slowly but surely, 0:17:48.960 --> 0:17:51.239 over the next couple of months start to see your 0:17:51.280 --> 0:17:54.840 irritability and severity of your pain damping down until we 0:17:54.920 --> 0:17:57.120 get you to a point where it's better. That's when 0:17:57.160 --> 0:17:59.200 we can probably really actually get an accurate test of 0:17:59.200 --> 0:18:01.200 your quad strength where the gaps are if it is 0:18:01.240 --> 0:18:04.040 a weak quad for example, but in the other In 0:18:04.119 --> 0:18:05.920 the meantime, in that early stage that we have, we've 0:18:05.960 --> 0:18:10.240 also been tiding up latter hip strength, hiplexus strength, half strength, 0:18:10.320 --> 0:18:11.800 because when we do get to that stage when we 0:18:11.880 --> 0:18:15.040 have a look at and buying mechanically, you know, oftentimes 0:18:15.040 --> 0:18:16.680 when you've got the gaps there, you see the same 0:18:16.760 --> 0:18:20.800 patterns poor petally control the midstands and it just maybe 0:18:20.880 --> 0:18:22.640 has like a knock on effect down the chain where 0:18:22.640 --> 0:18:24.080 they're just going to shift to load elsewhere. 0:18:24.520 --> 0:18:26.159 So by that point we're hoping that we have all 0:18:26.240 --> 0:18:30.560 other bases ticked versus then back to their question, Sorry, 0:18:30.600 --> 0:18:33.280 locks tangent, they're small, but when you've an entry level 0:18:33.359 --> 0:18:35.920 for like a strong or decent that late, then like 0:18:36.040 --> 0:18:38.280