Athletes Authority ON AIRAthletes Authority ON AIR | Ep. 186 "Optimising Athlete Recovery"
In this episode, Lachlan sits down with our expert physio team—Kalen, Head of Rehab, John and Joe, Senior Physiotherapists—to dive into the crucial role recovery plays in athlete performance.
They answer the questions submitted around key recovery strategies, injury prevention, 'prehab', and the power of collaboration between coaches and physiotherapists to enhance outcomes.
Whether you're an athlete, coach or physio, this episode is packed with insights to help you optimise your training and rehab processes.
Okay, welcome back.
We're at episode one and eighty six of Athletes Authority on it and Jesus Christ is some nerves going on in here. We have managed to squeeze all three physios into this room today for a bit of a physio round table.
They're not all best at talking or discussing.
We've got a couple of Irish, a couple of English and it's certainly.
Going to be an interesting one.
But guys, it's a bit of a round Let's have a very quick intro because nobody listens to podcasts for intros, so just so people know who's actually in the room.
Joe, do you want to kick off? Mate? One sentence?
One sentence. So I'm Joe. I'm from England. I worked in the NHS for around five years. I also worked in Elite codmy spot with Barnes the Football Club, and then sort of I find myself here in Australia Athletes Authority.
Good to have you, Johnny.
John from Ireland.
I started out as an intern here and I've just worked my way up through intern rehab coach and then I got my registration could jump on as a physio here with the guys.
Yeah, one of the one of the many interns that we continue to hire. Good to say and ahead of rehab the big man Kailin.
Yeah, I'm Kitalen. I'm also Irish, but more importantly from Cork. So if you're Irish and you're listening, you'd probably get that one. Worked back home at the Sports Surgery Clinic for just over three years as an intern through a rotage physio to have seene in physio. Was also working with some elite Gaelic football on the side with Cavin and in the last kind of year and three months obviously have filmed myself also in the eastern suburbs of Sydney, currently working here now at a minute.
So yeah, it's been it's been great.
All right, So I can I'll get some of the trains like that, Joe, can you translate that?
I can't help you.
He's a tough one.
He's a tough one. So we put a few questions. He has a few things you want to go through today. Obviously having all physios in the in the room is he's certainly a powerful thing to have for too and frow discussions. We have it on the daily here. You guys obviously work very closely together in the same room, with similar plints across athletes, across sam s and cs. So understanding the entirety of the program is powerful and that's exactly.
What we try and spreach to our athletes to get them better.
But maybe we start with you, mate, to kick off, have a little bit of a discussion around, especially with some of the questions that we've had, a lot of them have been relationships with SNCs. What's your pet peeve with an S ANDC? What's the most the thing you love most about secs? All this type of stuff. So instead of going through each individual question about straight finditioning coaches, let's maybe attack it from a bit of a broader spectrum. How are you going here working with sencs? How have you gone over in Ireland? Sort of very simple. What's the importance of working together and making sure that it is a joint approach? Too many people these days they talk about silos, they talk about working together. I'm going to go on a round here, but there's even a certain view your clinic in Sydney that promotes the togetherness of sencs and physias would steal the physias. We'll go that's an Es sency thing and I just palm it off with little understanding. Talk to us a little bit about what an actual combined approach looks like and what the importance is.
Yeah, so, look, we're obviously very lucky here in one sense to be able to work so closely with the with.
The sen c's.
Obviously a lot of our performance athletes will check in every now and then for different things, and these are your classic in season niggers. You know, your drying pain, reactive tender operties and things like that. Often with us it's just checking in maybe to see where the deficits are with the S and C program in general, because it's more well rounded and you're trying to take all the boxes there. Oftentimes the smaller muscle groups are the important things that we would obviously check.
Regularly can be missed.
So for us, really it's just a bit of fine tuning, maybe a bit of additional work in their resilience block or like an A two option that you can just tidy something up nicely and then managing training load there is usually kind of key.
With us.
I think it's vital important to have an MDT approach, and I suppose most teams or medical teams in pro sport that are operating the best start of ones where it's really really unified from the start, regardless of the injury, there's always upper body KPIs to hit as soon as you can get the offeet conditioning in, how can we get you as good as possible there to make that kind of transition as seamless as possible. And then often one of the things that's often spoken about is how physios tend to underload and maybe undershoot the market time. So I think like having a balance of boat is key for any kind of successful rehab.
Really heap peeves with essencies. I guess it depends.
Oftentimes it can be something's not flagged early enough proceed down a couple of weeks of for an example, at time that's just smashed to the eyes us for a few few weeks, and you know, the pteller tendon might necessarily be the culprit, that might be the victim, and there's other things that we need to be tiding up there to look at to try and assist and getting that better to the point then where it probably needs a further offload to get it better. So I suppose that'll be one thing, maybe proceeding ahead modifying training as much as they can without just like getting a check the sooner you can assess it, the sooner you can get a planning place, I suppose, and try and get that athlete back paying free and performing at as best as they would like.
So supposed to be a couple of things for our long term real athletes.
Then I feel like we're very lucky that when we do get to that mid to end stage because our field rehab sessions and our performance i e.
Speed sessions run closely together.
So we get an athlete to the point where they're in that transition phase and maybe with us they've ticked the key boxes and rehab i e. You know, max velocity, exposure, change the direction, react to change direction at the high level, and they've ticked all the rehab boxes per se. We can then kind of get them to transition across where we get an SNC's on it from a performance point of view, and they can often then hone in on the final details. I think obviously one of the big things we're all seeing at the minute on socials is the whole kind of movement matters and you know how different movement strategies and different running strategies load joints in different ways. So I feel like from an SNC's point of view, they will go come at it from a purely a performance point of view, how can we get you more efficient?
How can we get you faster?
And then we can hone in maybe on the strategies from Maria point of view, So like that that's key to me in any success that REH haven't And that's one of the things I actually love the most about how we work together here for sure, great good summary.
Nia.
We've had a fair amount of questions around specific injuries. Yeah, the typical how do I fix a hamstring? How do I fix plant? To fashiou? All these type of things. So I'm going to throw it to the group and if you're on't and I'm just going to start picking on you've got tendons is going to be a big one, and it is. You mentioned it before. We've talked about a little bit around the culprit or the victim, and I think it's important to sort of differentiate that, So I'd love a little bit of a chat around that. But then what are we seeing here from a ten and opathy standpoint, what are the go to initial solutions you guys are looking at and seeing. And also the biggest takeaway I think for a lot of listeners is the range of athletes we have from eleven year old female soccer players all the way through to fifty five year old masters level rowers.
So we see a lot of different things.
We see the phase of stress fractures that occur in our youth athlete across to then tendons flaring up at different ages and carves at different ages.
But let's focus on tendons for a little bit.
Hit me with a couple of things that you guys are starting to see from a trend standpoint, but also some of the solutions that you guys are working with and have had some really good success with.
I think, first of all, it depends on what tendon we're looking at. More commonly, I think what we see here will be a pteal, a tendon or achilles tendonoposy. Now it's understanding the tendon and what's what their role is. So with an achilles tenderopathy, probably looking that's going to be a little bit stiffer. So if if you've got a tenderopathy in the Achilles, you probably find that it's it's actually gonna going to lose some of that stiffness. Probably the opposite with the tele attendon, so the way that you're going to load it. So for for Achilles, for example, I would do a lot of eccentric loading, whereas with the teletonopathy, especially if it's a lot more flared up if we're looking at long isometric holds.
Yeah, I don't know about you.
You guys are you Yeah, I'd be similar like I would have because I'm still pretty early in my career. I would have just picked up a lot of stuff from Kalen across the table here. I've noticed it a bit more with our AFL players just because on that hard ground on an artificial turf as well, and they're just ks through their load through their legs.
Context say, we have one of the few IFL teams in Australia that plays on AstroTurf, So yep, we do deal with IFL boys coming off.
You use a G three is that what you guys call it in the UK? G G five whatever it is.
Yeah, but yeah, like we see a lot of it and for them it's they go through so much loads, so it's nearly just stripping them back a bit while, like Joe said, bringing in like your heavy solow isometrics or your isometric hold, whether that be like on a smith machine or a safety bar.
Or something like that.
But usually it comes down to load because they're in that pre season stage where they're trying to ramp everything up. They might be doing beach sessions because coaches love beach sessions, so that's a whole different beast altogether. Then if you think of like a pateell Er ten and you can then go pretty simple sixty degree isometric holes or like a wall set I think is a pretty handy one, and then just tying it back into the question with the S and c's, you'll always want to have them in the loop and then make sure that that's done religiously like every day. That's probably my pet peeves like you'll put something in communicate with them and then it might get missed a couple of weeks down the track, and then the athlete is wondering.
Otherwise.
My tends still a bit grumbly, But yeah, I think management preseason key for us at the minute. And yeah, I would have learned most of my stuff from this man sitting across the table from me, so I'm sure he has some tidbits of information that we might have missed.
Yeah, where do I start?
I suppose I would always see when you get attendant at them for the first time. It's almost like you're doing her a bit of a detective work at the start to try and find out.
Okay, firstly, what's changed.
So whether it achilles teller, tending, whatever it is, proximal HAMI has training load ramped up? Is this person consistently loading in the gym all those kind of I suppose weekly volume factors as to where we think potentially the overload hight it came from. You also then can't forget your differentials, so I suppose different autoimmune diseases can present with tending pain.
So you always have your your medical hat on there.
You know, is this definitely something that's boy mechanical and that might be something maybe that a couple of weeks down the line isn't responding to typical treatment like your asymmetrics and your training offload, but also like your clinical history to evaluate any other history of kind of systemic or autoimmune factors. I suppose it depends then how irritable they are in the session. So for example, for like ep teller tendonopotly we'd look at single egg squat, single egg hop. Sometimes for those kind of milder ones when you go really overtow on a decline board, how orable is it turning? There some palpation, and the key bits and those kinds of initial sessions are if we take them through some progressive isometric loading, like can we actually settle down the tendon in session? So then when we do our test retest, we get an idea of maybe, okay, is this actually a tendon causing the pain because it would respond like how we would expect the tend to respond. And then we can kind of gauge off that basically how much we need to offload the person in the week. Because it's often in season, people don't want to stop training, so it's often like a fine line between how much can we strip it back to still allow them to do, you know, some amount of training without continually flaring it up, throw the kitchen sink at it from aniceymmetric point of view, to try and set it down. But I think the key thing with them off. Then again it comes back. Though we just spoke about victim or the culprit. We see it all the time with teller tendon operties like really reach through the lateral hip on that side, maybe some foot nine coal reactive strength deficits or calve strength deficits.
So it's kind of leading to an overload of the teller tendon.
But if you actually settle down the piteler tendon and tested the quad strength, it actually might be symmetrical. So oftentimes it's like stripping it back, taking that detective approach and not just having a very narrow rehab focus of okay, it's just the sore tendon.
It's kind of trying to fill the bigger picture.
So for us, typical strategies we would do would be we would reduce their velocity block in the gym, We might take out a lot of the new dominant loading to help tend and settle down, focus more maybe on inter range stuff shortened contractions, and then as John said, I suppose isometrics at mid range if you take a pteller tendon for example, like Jill Cook has lots of work on different things heating with the iceometrics too, as we want to try and make sure that they're heavy. Too often we see go on to the gym five kilos on the like extension in the mid range, you could probably hold it for two days. So it's just a case of making sure that the isometrics are those correctly, and I think for the tendons that in session test retests will give you a lot of clues as to maybe how you need to manage it going forward. But again, as Joe alluded to, there contendings have different functions, but there's so much evidence on like you know, how attending is in that kind of disrepair phase, how true loading and progressive loading, heavy slow resistance over time, you know, you can actually rearrange the college an organization to look healthier again. So for your athletes, having your analogies I think are always really useful ways to like get them to relate to because they just want to play their sore. You know, we're very lucky that we've got a lot of highly motivated athletes, so oftentimes like they don't want to strip things back and we're always trying to. You don't want to be the bad guys, so you're obviously often playing good cop bad cop the choice, meet them in the middle somewhere and keep everybody in all parties happy while continuing to see improvement. But then sometimes obviously it's it's too irritable, and it does require a.
Brief offload from all of your like big impact.
Loading activities or stretch shortening cycle activities, just to let it, let it cam and settle and then start to rebuild.
Well, I think previously, I think five years ago, is to do the classic I so introducts. You do three sets of thirty seconds and you'd expect some results after a few weeks, and I think, you know, as you get older, you start to realize, well, fuck, you know what, it actually takes a while for tendants to respond. And I think even my stuff i've started to create, most of any athlete that I work with or usually get five sets of about forty seconds, and there's an absolute stark difference. And I still see a lot of people do short, little iso hole pramp and then expect it to be better. What's your starting once you go to how do you sort of build someone into it? I know it's an open question because it depends where they're at. Meet them where they're at. But what sort of your base protocol that you look at for someone presenting with a tendon where you kind of like, we'll just get this under control.
Yeah, And like often I think it's just best to keep it simples.
Like, for example, if someone is like rosstly really weak, like you see it a last where you have just hear me some athletes who just throw all leaves I've got to wear with minimum gym lauding, have holy training lads and just seem to be able to tighter around it. Because again, everybody is different to certain so your entry level for them you've got a really weak calf, like just holding body weight for thirty forty seconds might give them a similar stimulus to someone who's obviously stronger and can tolerate more. From a tendon level, I think a lot of the research alludes to has to be over kind of seventy eighty percent of the maximum voluntary contraction of the muscle has to be slow and controlled for to really actually.
Stimulate any sort of tending adaptation at all. So that would be one factor. Irritability is another, Like give me somebody with you know, six months of telor tending pain and get them through a heavy wall set like it's going to be very uncomfortable. So you're always looking for like your way, and I find often and that way and could be maybe you just start with some inner range y symmetric loading. If we just take the teller tendon for an example, you know, see how respond to that. You have your couple of test free test markers. Okay, Oftentimes when you load it at any level, it's going to change and feel a bit better, and you can start to maybe as the tending warms up to the session, build into just some I suppose greater degree or work through some more range of motion with it, and it can be like right, you know you do your ametrics in the world up, you have to you know, bring your single like squad paying down to a certain level before you can proceed what you're loading. And the key thing then with that too in the early stages is like we have to be monitoring twenty four hour forty eight hour symptom response because we know once they warm up they often feel good. But if they're waking up the following day with worse tending pain that's taking longer to settle, then chances that we might be doing more harm than good in the gym, So we have to bring it back to a level where we're starting to see improvement.
Week to week. You know, one bad day.
Out of six comparison to previously three bad days out of six is actually improvement. And that comes down to our education of like telling people that like, the way this works is like you're not just going to wake up no pain, Like you're going to slowly but surely, over the next couple of months start to see your irritability and severity of your pain damping down until we get you to a point where it's better. That's when we can probably really actually get an accurate test of your quad strength where the gaps are if it is a weak quad for example, but in the other In the meantime, in that early stage that we have, we've also been tiding up latter hip strength, hiplexus strength, half strength, because when we do get to that stage when we have a look at and buying mechanically, you know, oftentimes when you've got the gaps there, you see the same patterns poor petally control the midstands and it just maybe has like a knock on effect down the chain where they're just going to shift to load elsewhere.
So by that point we're hoping that we have all other bases ticked versus then back to their question, Sorry, locks tangent, they're small, but when you've an entry level for like a strong or decent that late, then like I would look to try and get them as as heavy as possible. Short their bouts. You know, one set of six two sets six ten second holes quite heavy. Then you can kind of strip that back a bit if that's a bit there, but you can go for twenty seconds.
There's obviously lots.
Of again stuff on the Socialist these days about your different types of symmetrics, overcoming yielding, et cetera. But I think by and large it's the more down to how hard the tending is working and contracting and the load over time that's going to make that busy logical change, which is you know what we're chasing.
So that's kind of how you approach it.
Yeah, I think I think you touched on education there, which I think is a massive part of it, putting a bit of a ones on the on the athlete to take a little bit of control of how they're feeling as well. So something I've been kind of pushing a lot recently is I I've just been putting a questionnaire in the morning, how stiff is it? How painful is it do a single squad? How painful is it after after they've played sport. You'd expect probably going to be a bit of a spike in that, and then it's just finding a pattern of what's happening throughout the week, when where the points where we can get in can when can we load a little bit more? When it's when is it a little bit less painful? So I think educating athlete around that as well, so they know when to push and we went hold a little bit as well. It's not saying if it's painful, don't do anything, but it's definitely if it's really irritable, then you're unlikely going to push the need a little bit bit more.
So I think it's it's choosing your battles with that.
So that's something that I think has been working quite well in terms of just monitoring how they had across the week and picking up any patterns, because you know, it's like if you see somebody once or twice a week and you ask them what's happened there last week, and they forget little, a little bits what's happened over the week. So just having that actual touch point they've got to do daily, I think obviously it's fresh in the mind then rather than thinking back to what happened a few days ago, because we know we're all easy.
I think you're probably the first three months of any general ten and stuff is you actually probably don't get any less pain, but you're doing five times the amount, like the amount of athletes that will calm, they'll present with pain, they can't do anything.
You start to build them have been three months of the like.
I still get a bit of it's like, yeah, but you're actually actually squat box one one hundred and fifty kilos now and you're pulling up with the sign paint. So sometimes that type of win is bigger than anything because at the end of the day, tech so long actually clear out some of that Pine and that Paine response. But if we're actually got them still playing, doing training and performing, then to fucking big win, big win.
That's it.
And I think that comes back to your education, to being able to showcase that because I see it all the time. People just get so fixated like you could have a chronic tendon and we know prognostically one of the best factors if is if you've had tendon pain for three months only going to take three months to set it down and get better, or you know, based on researching different timelines, but like educating people explaining that that's going to happen. I think that comes in your initial assessment or your initial meeting, like this is exactly how this is going to play out, and if you do that really well, then you don't set yourself up for failure. Whereas if you're there and you're like, this is you know this is going to be oftentimes maybe we don't. We're not as clear about how the path's going to be. That it's not going to be as clear cut path that you wake up in the morning with. Not then that you're going to have one flare up, probably in the rehabit at some point we're going to lose control somewhere along the lane.
That's part of the process. It'll probably cam down quicker.
As you said, luck you're doing more and then over time we can hopefully start to get the tend and healthy again and reduce the band completely.
So we're talking post pain Now, one of our questions we had was about prehab. Now I actually hate that term, but anyway, that's just semantics around hamstring and ankle. Johnny, I'm going to pinion first up, what is your opinion of the concept of prehab. Is it something that should be a part of people's program. Should we be actively targeting individual muscle groups, joints and saying, well, we better add in extra work if they're already healthy. Give me a bit of conceptual discussion, and then we'll delve into a couple more questions about it.
Are we talking ankle or hamstring or anything.
The general concept of well, less you believe in hamstring prehab and not ankle prehab?
You tell me, now, I would say, like it comes down to, obviously your initial assessment what they're in for, what you can find, whether it's like lateral hip, calf, ankle like, whether it's a range thing, muscle strength thing capacity. You're obviously then looking at, okay, what is if there's any asymmetry, if there's anything you need to tidy up. I think prehab is like this fancy buzzword that everyone likes to use, but you could just have it in as like we put it in as a prep block, it's less like a rehabby connotation if people think of it that way. Same thing if you have a grumbly tend and you'll have a prep block. I think it's in our kind of realm. It's pretty important because there's always stuff that we're probably trying to tidy up, like an angry tendon, like someone who has just rolled their ankle and now has a pretty poor range or just pretty poor calf. We'll say nique on their cafe. As you're kind of trying to tidy this stuff up. Doesn't necessarily stop them doing what they're doing, but can we make them more efficient in their movement? Can we make them stronger in little things that they probably don't think about? Yeah, one hundred percent. I think it has a place, whether you put it as a prep block, as like that's their main focus. Like with our acls, we'll have prep block might be a big focus if like they have a quad deficit, or you can like shoot it in at the end. In what we do is sometimes like a resilience block, whether it's at the start or at the end. I think it's pretty important just because there probably is a couple of things we want to tidy up. With most of our athletes, I don't think anyone's perfect. We can always make them a little bit better. That's the way I would think about it. I think there's always a place for it. Yep, when it starts to get to probably a third of your session, then maybe it's a bit long.
Only then well, if you're thinking about classics, because like you want to have.
A couple of good, solid prep blocks, and even then with that, people tend to will just undershoot them, and I'm like, oh, it's just a bit of an extended warm up versus you're actually trying to make some pretty meaningful change with those exercises.
I think that's probably one thing that.
We as a physio probably pro fashion need to be better as educating with a prep or rehab block, to just do it pretty well and do it as heavy as you can, like if that's what we're looking for, or to as good of an extent as if it was your air block or that kind of thing.
My biggest issue is that with the questions I suppose when people ask what's the best for hamstring, best for ankle, and I think what you just said a meaningful change if if it's hamstring, are we going for strength, We're going for range A, We're going for capacity?
Are we going for position?
Like, there's a number of things that we can chase, and I think that's where when people sort of start talking about or these are my top five hamstring exercise or top five ankle exercise. And to be honest, you know, back to the discussion you had around you know, sort of movement matters. I think there's a lot of over the years people talk about, oh, Nordics are great, nods shit, And it's just like this continue obsession with like if you choose to do one thing, then therefore you choose that over other things is just an absolute ridiculous conception. And if people are coaching or being a physio like that, then that's a whole other issue. And I think that's where being specific and understanding what your chase, what you need to change. The concept of resilience I love of Obviously that's something a part of our programming. We'll always look to what we need to target, but typically that's a kind of a catch all is that resilience block allows our coaches to go, Okay, do I need to add resilience. Has this individual had a history of hamstrings? If they haven't, do they play a sport that puts some risk at hand strings? If it is, then does their program currently have enough hamstring And if it does, great, But if we feel like we're lacking something in a block at some stage, then we can start to layer it in. But I think being specific about it is the key aspect, and that's where it's almost impossible to answer what is the best hamstring prehab or the best ankle prehab. It really comes back to what the individual needs at the time and what's been identified.
Yeah, and I couldn't agree more. And I wouldn't think of it as what's the best exercise? Think about it as like what's the outcome you're looking for. So I'm a big fan of prep and pre have whatever you want to call it for a number of reasons, like if you take your chronic presentations again. Athletic grind pain is something I have a lot of experience in treating. It just gets so much inhibition in around the hip joint itself, So inhibition is probably going to drive loss of range. You know, when they do go into the warmp then they don't feel good, they probably haven't fully and again I don't like the word activate, but it's it's a big word. But like they probably haven't recruited those muscles around the hip well enough before they start the session, and the session maybe the warm up from ES and C isn't going to obviously be specific enough to really tailor for their needs.
So it's a massive thing. They'll feel great after it.
They'll get instantaneous range change, which we know is a big factor in something like athletic grind pain. If you're stiffened in a rotation range, you're going to load through the pubic symcomore, You're going to load you the anti hit more so, it's vital for stuff like that. It's also a really smart way to microse smaller strength work, if you want to call it across the week for example. Again I'm just going to use it like a grind pain as an example, but you know the typical places that we see there week maybe through the abs hip flex or lateral hip in all these specific ranges and positions, and when they get to the point when they're quite good, most people kind of fall off the wagon with that type of stuff. So rather than having it all in the gym program, maybe where we can focus on the bigger rocks. If they're doing like two sets of each exercise free training three times a week, then across the week we're actually accumulating a nice bit of additional volume in those smaller muscles around the hip. So it's actually a really smart way to get some lower level strengthy capacity stuff in.
It's not going to fatigue them massively. They're going to feel better after it.
And then the other one obviously, if you take an ankle, if we can get an instantaneous improvement and need the wall range and someone has any nic Achilles standing operator to post end and operate, or history is stress bone stress injuries, then that's a very quick win for us if we can get two three centimeters and ultimately for us the videos like the way I think of it as like I always want to keep everybody out in the field in any means possible.
And then you're honest, they play a court, Yeah, exactly, that's the clear card. But by and large, we just want everybody to be doing what they love. And you know there's often discussions around different things, but if we can get quick wins like that pre training that you know it's less likely to flare or makes them feel good enough to train that they're just comforts at a minimum level. Then like absolutely, I think that's a nice win for us or quick low hanging fruit.
Love it.
Now we've put it out to the eighth, A few people have got some questions in so it would be remissive me not to address some of these questions. Some just freaking ridiculous. So forgive me if I skip across some here and there, but one one I do like you, I'll get an answer from all three of you. But what makes an SNC coach easier to work with or alongside? So any I think any particular skills or traits so you don't need to ramble too much, but what are sort of some of the key things that you go you know what this is made an ESNC coach easier to work with versus Jesus crosses and not me.
Communication skills is like for me, the biggest one like the more like over communicate and under communicated. Even if you feel like it's something small, like you'd rather hear about it, that's a nigger, then you can address it and say it's not in crack on then kind of like proceed ahead, being like, oh, I thought it was a teller tendon. You know, we've been putting all these isometrics in and potentially sometimes doing harm and good if it's not prescribed or whatever.
So I think like just the collaboration and the communication is to keep it for me because then you can make changes on the fly and vice versa for physios like i'd always chat with the sency let's have a look at my program. What do you think particularly that mid to end stage and missing editing here? Could we be doing more from a performance point of view? How can I just make this person better in general?
Where I've probably gotten very rehab focused and specific and would be probably do you think.
Just to translate lads in Irish means women or men?
Yes, boys, I.
Don't to echo, well, I do want to echo what Kalyn says.
Really what collaboration I think is understanding your I think it's understanding your role as well as the other persons and then how we can bridge that gap. Of course, I definitely don't claim to know everything about SNC, just as a SCY coach claim to know everything about physio. But definitely some gray areas which I think is always better to collaborate on, especially like return to return to playmarks and things like that, and how can we squeeze a little bit more out of out of the athlete? And it's having that without those discussions like better to say more than than than not enough and then.
You should never assume.
Yeah, assumptions, mate, Johnny, anything to add to it.
I'm trying to think, like I would say, more of just curious as well of why this has come up, Like what part of whether it's our loading or they're loading that.
Has kind of caused the issue.
We'll say if it's like a field sport athlete, like is it something that we can change in the gym?
Is it something that we need change on the field. That kind of problem solving together kind of thing. I enjoy that.
Like with our like North Shore Bombers, we have Sam z as head of performance, so it's a very good kind of team around that and Joe beside me as well, so sorry Joe. So we're always trying to from the S and C side of things, So we're always trying to like collaborate and just problem solved as a group. I think that's super important and we're pretty lucky in this facility here to have that across the board.
Yeah, it's interesting that people automatically assume that there's like the should be issues between the two when not.
So the use of the mentality used to be and says break them and phusiastics them. That's what I used to be.
And I agree that's think that any any high performing system or setup usually have a very collaborative setup like that. But there are still places that surprise me that I hear of and in discussions where you just you just have you only need one differing principle or mentality and it starts to build.
So when a physio and ne SSC just have a differing mentality on something.
And I've also seen scenarios where skills coaches build that, where skills coaches start going on, bloody physios keeps topping on, bloody smcs do this, and then you witness the physio or the SNC then side with the skills coach and because they don't want to be off side of them, and you get these little things just building these little silos, and it's shocking.
It's not a way to be. No, I think I can go either way as well.
I think sometimes like some I see, coaches might see someont of pain and really kind of alert to that, and really it's a lot of them on the flip sides from people will continue to push them.
It comes under Yeah, to be honest, I actually think a lot of younger S and CEA coaches that are coming through these days that are probably a little bit more indoctrinated around a terrible term but the evidence based scientific type lifting. They're probably more conservative and stuff like that because they're probably more fearful versus your traditional S and C coach.
It's like, nah, we'll just keep pushing them.
But you're right, the more knowledgeable you are, I think, the easier you'll find it to push athletes, especially when they're in pain. You know what red flag pain is versus orange flag versus white flag pain, where you can let's keep going, let's keep pushing, which is fair difference. But could you other questions because we get we do get sidetracked, but a little bit of a really raw physio we chat here, but how do you build a rehab network across surgeons and GPS so and you've got you preach this all the time, I may you want and done them?
Yeah, I suppose For me back home, I was just lucky enough to work in probably the artopedic Center of Excellence in Ireland for pretty much everything, as well as working very closely with some brilliant sports made consultants.
So naturally that's kind of read a bit of a network.
I feel like if you're kind of I suppose starting off, you probably need to try and establish some sort of point of difference because I know a lot of these are very busy people, probably getting lots and lots of different you know, excellent emails and messages about people trying to collaborate with them, and oftentimes they're obviously going to have their own people at this stage. I think in general what's often underappreciated what I've noticed in Australia is that kind of physiosports mad consultant relationship quite and large. If you if you're referring athletes are patients to sports made consulting there a surgeon, generally they're quite good to write back detailed letters around managing plans and like they're all very open and very collaborative people in general, you know, reaching out to them chining them over the phone. You know, for us, we're very very lucky that we kind of see a lot of the same presentation, so we would refer like a lot of bone stress injuries, and we obviously have surgeon.
Ties as well.
But I think it is literally just if you can get to that position where you're referring them a lot of patients and they see that you're writing back detailed letters and you know what you're talking about. You know, oftentimes it's going to be easier to build a bit of a network, but it is for sure a very hearting to do when there's lots of established long term surgeons. But like reach out, ask for shadowing opportunities. Same with like most most sports teams, like, they're often very open to it despite what you might think, and if you don't ask, you're never going to find out. So sometimes you do have to, you know, even though you might want to just point the bullet, try it. And you know, these people are very open minded as well. They love learning, they love new ideas, new facilities.
I think one gap that I would see then from the sports about and certain so things is a lot of them don't have I suppose facilities where they'd send for testing, et cetera. So it's kind of the follow up care in their in their plans, you know, having a battery of test to clear to return to playing different things. That's maybe an area where different clinics might try and go with your niche a point the difference. But yeah, look, it's it's definitely a working process for most practices.
They'd imagine, I think, yeah, being good at what you do.
So they're obviously not going to refer to someone as an idiot or they the way you word things, the way you talk to them.
Obviously you've got to be good at what you do.
But I think the otherwise is consistency, and as you said, you know their eager learners. We've had a couple of people we've actually invited, surgeons we've worked with that we've invited and free of charge, they have come and presented to us on their surgery or what they do and stuff like that.
And it's great for your staff, it's great for them. It's a really good connection.
And to be honest, some of the vision that surgeons have in their presentations is second to none. It's absolutely cracking to watch some of the surgical vision that they have and to get an understanding I think especially for our S ANDC staff, probably more than the physios, because you guys will organically and naturally gravitate towards that. You'll go to surgeries. You'll see that. I think a lot of SNCs. I know when I was young SNC I pictured tendons is what you'd see in the colored books that you watch, the little red things that sit there, and when you actually see them functioning, being cut through, being reattached, you understand the trauma that the bone will go through in certain things. It sounds stupid, but I think the visualization of that's very powerful. When you're working with an athlete and you're pushing them, you're like, you know exactly what that bone plug look like, and it's like, I don't know if it's going to be able to withstand this type of stuff this early on. And it's a little thing. But to your point, all they're going to say is no. It's amazing how many are open to coming to present to talk to connects. Definitely, I think reach.
Out and I think they like to hear about how their their athletes do it as well.
Like he goes, I want to say, well, yeah, Kevin.
Says, like right, make make sure it's not writing war and peace, but know what they're doing, because I think that just opens up a chain of actual communication. Customer might not even know you exist for a start.
The first connection, isn't it.
If you're working as a physios an SNC and any any facility, you will eventually get someone that is under a surgeon for whatever reason. So as soon as you do reach out to that surge and give them information, I think that that feedback is going to be very powerful.
Showing willingness to learn.
Like if most surgeons I've worked with a really keen on education and just love teaching other people. So if you're showing a willingness to kind of learn from them as well, I think else.
Yeah, well Dan Joseph that yeah, there you go.
Yeah. Other one.
Now, this is an interesting one because I do I think there's people want need to side of the fence here. But the question is how important is it to train your uninjured leg whilst doing rehab for your injured leg.
So yeah, Johnny's had a bit of a smirk.
It's important. It's an interesting question because I know if we've submitted it, I would say it's so important. Yeah, Like you want to think you're training them differently. That doesn't mean you're not training them. They obviously can We'll say withstand different loading and maybe different ranges, but like you can't forget any contralateral injury or contralateral limbs. Sorry, Like for example, whether it's an ACL, you're still gonna you might be in one phase with your injured leg, like our load introduction phase or like immediately post off. You can probably do a lot on your own injured side. Whether or not this cross education is is a thing like research. Some as it is, some says it isn't. It's so important, Like you don't want to reduce your target that you're kind of aiming form. If we're thinking of like symmetry, you don't want your quote unquote good side to decrease and then get a false sense of symmetry if you're only training your injured side. So I think it's so important, Like you can't load it probably enough, especially because you won't have as much residual fatigue from just doing the other side. And then you're thinking of like upper body as well, So like whether it's the other limb upper body. I think you have so many opportunities to get a good dose of stimulus to an uninjured side while your maybe your injured side is going through some more lower load exercises. That's the way I would kind of look at it.
Lock it, Dang, you sort of pipped up a bit there, might we bet as I say, yeah, so you fund Obviously cross training is one.
General adaptations to resistance training is another.
Like there's there's lots of great physiological benefits on the other side, and like it kind of begs a bit of a different question that we've discussed lately around like you know, lots of people's protocols is like within ten percent limb symmetry inext but like across every muscle group joined, whether it be strength or power testing.
At this point, like we know what the norms are, what's good where you need to be apt to do what you need to do.
So if you've got you know, one side that's exceptionally strong and your operated side is very strong, then I don't see that as a bad thing. It's only going to probably improve performance down the line. So absolutely, like try and get the other side as good as possible. Now, what you do see sometimes is that obviously in rehabit and we're targeting a muscle group, like the volume and inten today across the week would be much higher. So for example, if we're doing lots of unilatterer work, like you could be hitting your quad fifteen to twenty sets a week, you do that. On the other side as well, You're going to have two sides that you find are up and chasing. So I would tend to maybe just even half the volume of the good side, like bring it down to even if you do ten to twelve sets in that side across the week, You're still.
Going to improve at a pretty good rate. And it just makes the sessions about character for them as well. Map as a rare shore four is to two or tree is to onorn off and as an EWE.
Two, I'll add more to I typically will target far greater intensity on the uninjured side. I'm not going to throw any evidence of this is set my own anecdotal evidence, but I do feel that the central nervous system is a thing, and I feel even peripheral adaptation can help that central nervous system. So I find if I'm if I'm working with someone that is completely hamped on one side early stage or even tend and pain or anything upping the weight, lowering the rep range and having a real intensity focus on the good side, I find keeps a really good neurological adaptation, and I'm putting it there.
That is my own anecdotal. There is no strong evidence for that.
But in the same fashion where we look at a bit of research around things like bench press throws and stuff that stimulate a really good central nervous system adaptation, even though it's upper body, it still exists with that that contralateral side of just targeting a little bit more neurological function. Thanks man, I'm glad you agree with that. That's my support exactly. Now there's a couple of probably two more main questions. One I really like because there's something that we value quite a bit here. Now they use the word clinic. I'm anti physio for that, so we just like performance center. Even though certain someone started to refer to upstairs.
As the clinic. I don't know if I'm on board with that one. I'm looking at them. Yeah, was it you or was it you? I think it is.
How do you make sure everyone in the clinic works in the same way in rehab, so as in, how is everyone aligned?
Now, I'm going to start this.
Answer and then then hand it over to you guys, because if you can't tell, I'm a massive believer in having very structured phases of rehab, regardless of the injury. Now, I think from an S ANDC standpoint, I preach it quite a lot that when you have SNC's EPs, cairo's physios, even docs that all work amongst one individual in team sport, I found it really powerful.
But they have quite clear outcomes.
Each phase really guides and gauges everyone, even skills coaches as well. They understand that in their protection phase it's red, they kind of know they're not going to be doing much. They kind of know they're off feet conditioning obviously, sum it's lower limb, and everyone's really on the same page. Then you move into this sort of load introduction. Everyone knows what the general theme is and although.
It might be.
Oversimplifying it a little bit, I think it allows everyone to really be on the same page. So I'm going to answer with saying having a very clear phase and systems approach to rehab is really powerful. Even if there's going to be some gray areas with different injuries. It allows everyone to be on the same page because as an S and C coach, even a young SNC coach that's here, they know if someone's in protection phase, stay the hell away, like chat with them about their weekend. But you, as an SENC coach, especially a young SENC coach, you're not going to be making decisions on things in the same fashion. If they know their load intro and someone asks about an exercise, they kind of know what loading they're going to be doing. They know they're not going to be pushing it. They know to go for the smallest band instead of the medium band. All these little things that just govern someone's decision making when they kind of know the theme of that rehab and it means they don't necessarily need to know the graft type, they don't necessarily need to know the intricacies that say, the physio department will know. But it does allow everyone to be on a very similar page and also coach a very similar thing if the physio isn't with them all the time. Next part of it, Hanny over Carlyn, you want to take this. You're not in a little bit as well there, mate, how have you seen that works well here? That sort of keeps everyone on the same page, keeps everyone aligned, keeps everyone communicating the same message.
I think the weekly catch up is one thing that we do really so like there just has to be weekly communication of like where someone's at, if someone's had a flare up, Like it's everybody's business to know that. And as you said, lo, because the physios we aren't always on the floor all the time, we're only there sports throughout the week, it's likely going to be the SNC coach that is getting these queers in questions, so they need to be in the know about what the push, what the pull. So like the weekly comes is massive for all of us being on top of it there, and we're very lucky as well actually with you know, the systems we have in place, the different phases, it's quite obvious when someone is really putting the pedal down er, as I said, if they're in that interim phase where it's a bit less in terms.
Of a loading point of view.
But the last bit I think is like education, Like physios need to educate essencies, and essencies need to educate physios. The more essencies know about a given injury or given pathology, the better they're equipped then to help and manage when something comes up, Like I love more experience SENC coaches will be here, but like, oh look, so and so had.
This in the session. We didn't stop session.
We just pull it back a bit and give them some heavy hinge work instead of there Teler Tendem was sore for example, Like just being able to make those changes on the fly helps a lot as well create great trust from the athletes because they trust everybody and not just the physio that they see, which I think is really really important as well. So it's just making sure that everyone's in unison, like I know for RPD we were kind of doing every five weeks the physios would present in a case study and like extremely valuable and one of my I suppose bits of advice for any like spurring SNC coaches like you are so much more employable in the pro sector if you've got a rehab knowledge based because you're going to seamlessly transition into from performance points view, but also being able to work closely with the physio, like you just have another tool in your toolbox to utilize. So that would be a big thing for me would be like, you know, try and seek some experience with physios and learn what we do. And same for physios like going up skill in your sec go and learn how to program, how to load effectively. You know, do you actually understand the physiological changes that you're trying to make when you're rehabbing somebody, Because that's what the best rehabbers can do. They have their objective tests, this is what you need to go and do these any exercises to do it six weeks buying job done.
So that'll be my bit on that AA.
I think bringing it back to the quote unquote clinic we have up here, having and trying to have all the physios on the same page.
I think our consistent pd is is pretty good.
And having Kalen here, as I suppose someone who hasn't been in the AA system for a couple of years or hasn't come up through it will say, like myself, it's a different kind of assessment and different way of thinking. So getting that input for me has been like so helpful. And then building out processes of assessment and we'll say we'll go through currently we're going through the shoulder, just through the whole way from like objective the whole way through too, like rehab, making sure we're all kind of on the same page with Okay, what are we looking at, what are we looking for? I think then it makes it easier if we have any athlete, for example, one of us is sick, can go see someone else pretty seamlessly.
I think that's so important.
And then upskilling on the same kind of techniques is pretty good too, And like just having a process and making sure we're all on the same page. And then one thing that we've built out for the ACLS and what I've been kind of playing around with in the background for other like big long term injuries, is just frameworks. So at each of our stages, what are we trying to hit, Like what's our criteria to move to the next phase? That kind of stuff, whether it's like return to run or return to change the direction or even just return to normal loading, like making sure that okay, if I've done it that, then I run up by the other two boys to make sure we're all on the same page, because I think if we're all aiming for the same targets, then like I said, you can kind of jump between different people if something like that happens, or if someone is on field with someone else's athlete, it's like, okay, sweet, they're at this phase.
But that we're just all across the same process.
There's a bit of a kind of a consistent framework across our three three clinicians here, and.
I think we're quite fortunate that we all share pretty much similar views on most things as well, which means that we're in the same time, Like I think of things where whereas been like total disagreement generally we're kind of obviously asked healing.
Yeah, but that's why it's got you all from a similar part of the world.
Make sure we're all on so we can actually understand it.
Actually, when we heard this put in a like counter with the amount of times that either him or me says like yeah, wells.
Like it's having that willingness to.
To learn as well, I think, and not just assume that you know everything, like and that's why I think we have so many touch points across the week and we're probably back alm with questions, but the willingness for him to give us some advice as well, which is always beneficial. So I just have time for each other to be able to discuss anything that we might be questioning a little bit. But generally it runs quite smoothly in terms of how we're structured our week in terms of being those touch points. So generally all of us are across most athletes who are on the fore. Of course, obviously we have hours where we are on the floor, so I might have John's athlete on the far klons on the floor. So if you know that they maybe had a bad week with something in particular, it's just honing.
In on that a little bit as well, and a bit of a shameless plug if you are struggling with frameworks. Ac Mentorship is kicking off in two months ten Speak of Me first week of May is launching, so if interested reach out. It's been a very successful mentor ship, sold out every single one of them, so I'm sure it'll go quickly again.
But final question, because it is kind of the state of.
The industry and the evolution, a question around what is your opinion of online rehab? So it is funny because we actually have started some online rehab, so I thought it was quite appropriate question to finish on. But is it something I've sort of been opinionated online coaching, well, athletic performance coaching anyway, but with technology these days, it's certainly getting bigger. Obviously, you've worked with a couple of people online now, so I'm going to put it to you being the best situation considering you're doing it. How do you feel with it based off your experience and do you feel like you're getting as effective results?
And what's it likes a bit of a new venture for your Yeah, so I suppose the start off. Is it better than in person treatment coaching testing? Obviously not? Can it be doing extremely well in the circumstance absolutely for most like injuries particularly, I feel like, for example, if you're rehabing someone who's coming in at kind of the mid stage of an act of pause attending graft like, you often know where the gaps and strength are. Again, that's just true experience and seeing a lot of them, so you can prescribe a really well designed programm to tidy up and assist with some of those strength deficits. But the amount of technology that we have available at the minute, the different apps getting the the at lead or client to record themselves doing the exercise in the gym, you know, over zoom, assessments. They can be in endurance assessments, capacity assessments. Watching the move we can actually get so much useful information. And if it is for somebody that's in a different part of the world and wants access to clinician elsewhere, like there's I think it's only going to get bigger, to be honest, there's only going to go one direction. Obviously it's at a lesser cost as well, So someone who's re having a longer term injury and feel like they can't afford the necessarily pay for the in person one, it is definitely coming in probably a cheaper rate. And I think you can have extremely good outcomes with any online rehab for most things, if I'm being honest.
But is it better than in person? Absolutely not, I think everybody knows that. But like it's just.
Becoming more and more showcased by different practitioners and clinics. And you know, with the kind of video analysis we can now do and drum up reports for people sending us clips to them accelerating and and you know some max velocity work, like it can be really really effective and really useful. And I'm actually enjoying it because it's different challenges a practitioner, like when you're following up with somebody weekly and you know, getting better at asking the right questions rather sometimes in person, you just know what you're going to look for, but you just have to be really really clear when you're communicating to somebody, Okay, this is exactly what I need you to set up now at home.
Keep it simple.
And also that when you're reviewing some some footage of them in the gym and running, you know, how do I make it as easy as possible to get this point across to the person so that they can you know, elicit this change in their acceleration technique is pretty like obviously with this it's air like we're lucky and that we see all of our athletes like every week and they're like in person, so it's pretty easy, and like we see them on the gym or in the gym on the field. Like with an online rehab, surely there are like they might be a perfect candidate for online rehab, but it's more on us on them as well to provide you with the feedback, provide.
You with the videos, like how do you navigate that with them? If you have someone that's not pulling their weight.
I suppose on there, And it's a great question, like it takes two to tangle, so like if you're not willing to be able to do that, then they're just not to feel on area. It's probably the best way to think about it, but absolutely, like it's a commitment on your end to be setting up the camera right, making sure you're getting the right angles. Like you often say, okay, can you record your you know, spit squat in the gym, And then they come back and the camera's at an angle and you can't see what you need to see and you're kind of like, you know, like, hey, maybe that's not the best way to film it. But I suppose these are the real life challenges. Even though you would spell a lot of this stuff out, it doesn't necessarily always happen like you expected this. So yeah, it's just lots of communication even throughout the week, Like it's not just a weekly zoom call, Like you're talking to these people after every rehab session.
How did you pull up? What did you feel?
Did you feel that exercise in your quad? You know, Okay, I didn't, I felt it in my hip?
Can you show me?
Yeah, look, there's lots of trunk flection there. Maybe you need to fix that. So, yeah, there's lots of communication. Like it arguably, I know a lot We've talked about this before, but like it arguably makes the clinicians job harder. But I suppose you have the novelty of doing it remotely from anywhere. That's obviously pros for the athlete and for the clinician. But like if you can't see them every day and you can't test them it regularly, like it is obviously is a disadvantage, but like I think it can be if you're well structured and how you do it, you can easily navigate those things. And then look, you just have to get them testing in the next hour and facility somewhere local to them. So we need that, like we can't progress for it objective data. So I always would spell it out from the start, like you know, in six weeks time, eight weeks time, I want you to find the place I want you to do these tests. Nowadays, with technology being so available, like a large portion of physio clinics or gyms have all DEVLT case and can do the majority of the testimony it gets up. It's just becoming more and more accessible, and with all.
These apps coming out these days, you know cafres app and all these jump apps, like a ot of them can give you some useful quick information may not be overally as accurate, but like it's useful and keeps them motivated to see maybe that there's a bit of progress and that you know the planner is actually working for.
Them, no doubt. I feel like online is harder. Yeah, it is.
You gotta work a lot harder as a coach or as a physio because you don't have the organic there you are. Let me coach you live, let me fix you up. Instead of I've got to coach you. It's I've got to highlight things, I've got video things and send it to you. There's definitely more work involved, so kudos to anyone doing it. But if you are a physioclinic and a physio and you are interested in getting into your online space, it is certainly something that's getting bigger, and as Kalin is just alluded to, certainly something that we've been doing now and been doing really well and again a little bit harder for Calan, but it's certainly certainly been rewarding to be able to reach a few more people and push them through.
The rehab stages again to the other end.
Boyce appreciate it.
I know this is not the comfort zone of physios, so I appreciate you jumping on. Hopefully there's some great takeaways for everyone listening at home. But ultimately I think it's really good to get the physiocide into it. Our coaches don't shut up, so it's good to hear from.
The physio crew.
And we'll get you back on it very soon. But thank you, and hopefully everyone enjoyed it. Thank you, luck I
