[Physio Discussed] Strength & conditioning in rehabilitation: key tips for clinicians with Dr Claire Minshull and Lachlan Wilmot

WEBVTT
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What is the best method of monitoring and measuring the rehabilitation of our clients?
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Strength versus rate of force development.
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Why does it matter and how do we assess it?
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We explore these questions and more today, and we're joined by two leaders in the space.
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Dr.
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Claire Minchul is a rehabilitation and conditioning specialist, researcher and visiting professor at Leeds Beckett University in the UK.
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Claire holds a PhD in neuromuscular performance rehabilitation science and has published over 30 papers primarily on strength and conditioning.
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Claire also runs Get Back to Sport, an education platform helping clinicians apply science in real-world practice.
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Loughlin Wilmot is the co-founder of Athletes Authority and brings a wealth of experience from elite sport and high performance environments.
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Known for his practical and progressive approach, Loughlin helps bridge the gap between rehab and performance, with a strong focus on structured loading, testing, and long-term outcomes.
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In this episode, we dive into how physios can take their rehab programming from good to great, with better testing, better planning, and a clearer understanding of the physical qualities that matter.
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So let's get into it.
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I think you're going to love today's episode.
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I'm Sarah Yule, and this is Physio Disgust.
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Welcome, Claire, and welcome Lochland.
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Thank you both for joining us tonight.
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I'm really excited to sink our teeth into this topic.
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I think it's a really important topic for the world of physios, osteos, kairos, all of our listeners.
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I appreciate it.
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Thank you for having us.
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Yeah, absolutely.
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Yeah, delighted.
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I should also say SNC coaches as well.
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So we'll we'll dive straight into it.
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My first question is what's the best method for monitoring and measuring the rehab of our clients?
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Well, that's a massive area.
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I don't think there's a single answer to that.
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I think for me, whenever I'm asked that type of question, it comes back to what is it that you're trying to change?
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And that is some of the basic, I suppose, principles of strength and conditioning, exercise training, rehabilitation, what indices of performance or what metrics are you trying to change?
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And then you can start to look for those tools or those metrics that you want to apply to judge progress.
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So I don't think there's a single uh way of being able to assess that.
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So it's it's multifactorial, isn't it?
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That's going to be, you know, if you're thinking about physical performance, where you can easily measure strength, or sometimes we can easily measure strength, and how accurately that's another question.
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You've got like kind of strength and you've got um some of the later kind of stage stuff, maybe power and stuff like that.
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Earlier on, maybe you're looking at range of motion, and and then there's also like the psychological component as well, isn't it?
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How is that athlete feeling?
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The kind of kinesophobia, that type of thing.
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So I think for me, the start point is establishing that hierarchy of importance.
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What type of things do you want to change, or what are all the things that you want to change, and kind of list them in a well, put them in a list and then put them in order.
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Like what are you gonna focus on first and foremost, then kind of using that periodization principle really, and then what you're gonna move on to.
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Then start to think about what are the tools that we've got in order to be able to measure progress andor success.
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From my perspective, it's spot on exactly what Claire said.
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It's such a a huge open clamshell of discussion that you could have, so to speak.
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But for me, it's the most consistent.
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At the end of the day, you can you can work in a very high-budgeted, high performance program.
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You can have you know, Humex, Cybex testing, you can you can have kinematic, you know, Vicon systems set up, and that's fantastic.
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But if that's what we do do with the gold standard, then yeah, 99% of people have no hope if that's the case.
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And and we know that's not the case because we we can have some fantastic outcomes from some very basic things.
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And you know, thanks to people like Vold that now have subscription like model technology, if anything, it's almost the other way.
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Yeah, people probably have too much access to technology and they don't actually know what they're looking at and they get confused and they feel that they have to keep up with the Joneses and do this and that.
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And I think as Claire kind of alluded to, let's just start at the beginning and at the end of the day, it's it's it's principles over anything.
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And if I'm taking rehab and you know, being an SSC coach, I I certainly dabble in, but don't lead that that early stage.
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But it's okay, well, if it's range of motion, that's that's the overarching principle, range of motion.
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How we measure that, you can do it with a video, an eyesight, a gyneometra, or you can you can do a 3D motion capture on everything if you want.
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We're still measuring the same thing, and I think that underpins everything we do.
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You know, we Claire mentioned power, and power's unbelievable, but you could do a a simple hop, uh a three-hop, and and requires nothing.
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Or, you know, you can get them on a humac and just get them unleashing, and you can get every data point, you can put them on a 3D capture camera and a force plate measuring every angle, and and you're still getting power, but you know, you're probably giving yourself more opportunity and more things to delve into.
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And um, I I've seen some of the greatest rehabs done with very little equipment, but just a very good practitioner that knows what they're looking at.
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And I think there's probably uh a slight bit of, and I know a lot of physios probably can relate to this, that I think we probably need to start a lot of your ventures without the technology to train your eyes a lot more before you get the technology.
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Coaches and physios that start with tech day one, they probably get a bit lazy, and I probably sound old saying that, but you do you get so used to looking at at data points that get spat out, you you're looking at iPads, you're not watching the person jump, you're letting it tell you things.
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And that's not to say that it's wrong.
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It's just probably to say that if you are ever in a field environment where you don't have the tech and stuff like that, you you probably don't have the coach's eye to be able to make decisions on the flyer as well as someone that potentially has done a lot more rehab without all the tech.
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So probably rambled there a bit, but I think at the end of the day, it's the principles of what you want to chase, as Claire said.
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And then depending on the environment you're you're in, I don't think there's a better or worse way.
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It's what's consistent, repeatable, what can you afford?
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Because if you can only do one HUMAC test, maybe it's not the best option.
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You're probably better to go back to some grassroots with things that you can repeat six or seven times throughout a rehab length.
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If I could just pick up on a point there, because I think it's current right now, which is on, and I agree violently with you.
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We've got so many devices available right now, and lots more now in the affordable range for individual um clinicians in clinics.
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And I think there's also maybe a feeling, a sense of I need this device because I need these numbers.
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And you know, my teaching has now opened up into the field of assessment and dynamometry and measurement science because I think it's now ready to be received.
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Because just because you have a number, it doesn't mean anything.
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You need to know how that number was generated, what's the measurement area associated with that, how often can you take that?
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Are you testing in exactly the same way each and every time?
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And if you're not, then that is redundant, that test is redundant.
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So we shouldn't be chasing the tech, we should be rolling it back to basic principles and thinking about what is it that I really need to change with this person, with these groups of individuals, with my patient populations.
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And then how can I best achieve that in terms of assessment, which may or may not include dynamometry, tens, hundreds of thousands of pounds worth of kids.
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Because everything that we do needs to be understood and properly delivered.
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So as a clinician, and to that point about being able to use your eyes and your yeah, inherently your clinical judgment and your experience, that's invaluable.
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That will be better than an objective test done poorly.
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So I think just to say that don't chase the tech because it's needed by ever, you know, we will feel the pressure to have it, by all means, and I'm I'm a great advocate to achieve object measures if they're done well.
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And let's learn how to use the tools because they can be fantastic in terms of giving you data.
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But that shouldn't be the thing.
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It should be what is it that we want to change?
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How can we seek to evaluate that?
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What uh experience do I have?
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What time am I able to invest to learn how to use these tools, techniques, etc.?
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And again, back to affordability.
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So a little bit of extra, I guess, points on that.
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I think those are fantastic points.
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And it probably goes all the way back to your original opening line, Claire, which was about intentionality.
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I think we we care about what we measure and how much we're measuring, but are we actually measuring exactly what we care about?
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And just on that, I'm curious because I've noticed we have all of this capacity to measure with Vald and do all of the strength tests.
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Do you feel like we, because we have that ability, do you think we're measuring at the right time frames after actually allowing a rehab program to have a proper effect before we measure again?
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The critical thing that we really, really want to get that is almost impossible to get is pre-injury data and when that person was flying.
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So we've established a baseline and we've got a marker that we can aim to get back to or exceed.
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And that's always going to exist.
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So that means the earlier we can test, the better.
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The caveat being quality data capture, standardized test, done well, and we know what we're assessing.
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So the earliest point that we can obtain quality data enables then some sort of comparison.
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And I'm not saying it's the thing that we should be aimed for, but it gives just you start to build that picture.
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As Lackie was saying before, the number of tests then you can obtain, you start to build a profile and an understanding and a and uh, I suppose a picture of how that individual started out and is progressing.
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So, you know, a single test in a moment of time, even if you're doing like an interlim symmetry test, ratio data doesn't really tell us anything because we lose sight of absolute performance and performance change.
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So a single test in one moment of time might give us a little bit of information that might feed in a little bit to our clinical decision-making rehab pathways, whether you're returning to play or not.
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But we need more than a single assessment and we need to start think about assessing over time.
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And there's many ways you you can do that commensurate with your rehabilitation programming to the start prior to surgery.
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If there is a surgery, as soon as you see somebody following uh if they're injured, and then if they're in pain or if it's inappropriate to have load heavily the naively injured tissue, then you know you need to rethink that a little bit.
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Maybe you can get a measure of the non-injured affected side, etc.
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Again, coming back to that profile of that person and the time frame of rehab and recovery.
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From a performance standpoint, and applied to rehab as well, but there's two and a half reasons why you test.
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One, to influence your program, two, to store data in your back pocket because you know someday they're going to get injured and you're going to use it.
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So in our in our facility, we have both performance and rehab, and all of our performance athletes, as good as we claim we are, they'll eventually get something.
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We hope it's little, but they'll eventually get something.
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And the history of data that we have to be able to look back on to guide their return to play and performance is second to none.
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And we really value that.
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As Claire said, it's so hard.
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You usually get them when they're injured.
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You wish you could go back and get it.
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So we kind of, you know, go back in the future and make sure we do collect it.
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And the half reason is if they've got a combine test or their sport demands something.
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And sometimes you're just handcuffed and you've got to get them good at that lap that lift because that's what they're going to be judged on.
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But the caveat to all of that is if you can't repeat it, then does it come back to the gold standard?
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If I'm running a team and I have all these amazing technology options that I can use and we can do all these tests, but it doesn't really influence my program.
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Plus, I can't even repeat the thing because it took me two days worth to try and get through all 50 athletes in these tests.
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Well, I can't repeat it.
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So it's like, well, the there's really like very few reasons why I would do a test that I can't repeat.
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And I think that's very similar to the rehab space.
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The tests you're picking, with the exception of some range of motion ones and sort of clearance stuff, you kind of want this tracked over time because you want to be able to establish that your program is influencing this outcome.
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And we used it for entry exit criteria, whatever you want to refer to it as.
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And then you test it again, it's closer and closer.
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And then, yes, you can layer in some later stage tests as you go.
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But yeah, as I said, apart from a couple of early stage range of motion things that I might tick off, very few tests will I ever only test once.
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You've got to have the capacity to do it multiple times.
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And and I think that guides what tests you use because you can't use 27 because you can't repeat 27.
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You know, when you have these type of filters, I feel like you you ultimately get handcuffed.
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It's the same as when you're told, you know, this athlete can train twice a week for 40 minutes.
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Well, guess what?
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My choice of options is now handcuffed, and that happens more often than not.
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And it's uh the same in the rehab space.
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You you've only got a finite amount of tests or time or whatever it might be.
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So the the best practitioners get the best bang for your buck options, and they don't they don't convolute everything with a a thousand different things and they test once or twice.
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Yeah, it sounds cool, but doesn't really apply very well.
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I think that's a really, really important point there.
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You just said that the best practitioner will give you the best bang for your buck.
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And that's something I'm really passionate about trying to help clinicians, rehab professionals understand and tool them with that knowledge.
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Because, as you said before, if there's a gold standard that involves tens, hundred thousand pounds or dollars worth of a kit, then you haven't got, you know, everybody doesn't have that ability.
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But if you understand, for example, how to develop a repeatable, reliable test of a particular element of performance that you understand the level of measurement error.
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And measuring an individual is very different to measuring a group of people.
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So we need even higher levels of measurement precision.
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If you are understand all of that and you can do that, then you can generate your own tests within your own clinic using your own facilities rather than strive for something that's never going to be achievable.
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And the value of that is is tremendous because everybody sits in different settings.
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And it's to have that knowledge and those skills than to develop something that's meaningful for your setting.
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I've always liked the saying to the beginner, there are many options, to the master, there are few.
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And it fits very perfectly in our world because yeah, the older you get, the more programs you do, the more you realize you go back to the same stuff.
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Fantastic points.
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I feel like my my saying on that is more is not always more.
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And it's the art of subtraction that we have to learn, isn't it?
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What do we remove to distill it into something really potent?
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Especially with social media and everything.
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I think there's more than enough out there.
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Dear God.
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Yeah, that and people jump like I thought I jumped around when I was young at a personal trainer, went to a different conference every weekend, and you learn something new and you change everything.
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That's just a part of growing up.
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But now it's like every day there's a whole new method or concept that gets launched out there of people are just they're just swamped in what to do.
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So I think it's more important than ever.
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Absolutely.
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Well, I suppose on that and just tying off this question, but what are your both of your thoughts on the best piece of equipment for S and C in a physio clinic?
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Space, turf?
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It's gonna be an annoying answer for me, but I I think describe athlete's authority.
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Yeah, well, look, and that's not a great description because we're we're very privileged and very lucky to have uh a lot, a lot of tech and a lot of space.
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And I say this all the time that we were a performance facility first, turned rehab, which means we already had a lot of space and a lot of equipment.
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So many rehab spaces are clinics, turned more performance-oriented rehabs.
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So they're usually in smaller spaces, so I can't just add stuff.
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We were the other way around.
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You know, we already had the size, so we just had to find spaces for plits.
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But if I was in a rehab space and I had to find technology, so to speak, I'll try and yeah, separate these.
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But first and foremost, I think having a space or an environment that you can do athletic-based testing where it might be a three-hop for distance, these type of things are I would much prefer space over any piece of tech.
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So these type of things are far more in line with what I would do.
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If I had no money constraints, probably something like an opto jump, but that is ridiculously expensive.
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But probably in this day and age, I'd probably be looking at something like a subscription model force plate.
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I think that's probably my my number one.
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So pretty inexpensive these days.
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Um, obviously, Vold are probably the most well known for their whole suite.
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And again, it's an easy suite to go with from a force frame and a like Nordboard.
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These things have been pretty commonly used.
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But yeah, I think a subscription modeled force plate would probably be my number one if I was there, forced to make a decision.
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You're on your desert island, you've got valves.
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Yeah.
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Well, that's my answer, right?
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My answer is so I I teach a lot of physios and and rehab professionals just kind of getting into this.
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What do I need?
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You need resistance, you need kit to generate an overload that's greater than that individual is accustomed to.
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Whatever that looks like, it can look really flashy, and you can spend loads on you know, kind of gym-based kits, and there's loads of different add-ons now that you can get with you know, kind of make it look even fancier.
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But the basics is it needs to be heavy enough to challenge the index that you want to you want to change.
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So, strength, we know we need to push really, really, really heavy just for a few repetitions, and to create that, certainly for the lower limb, can be quite, quite challenging.
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Um, we need some significant mass to do that.
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So some resistance kit is really important.
00:18:13.809 --> 00:18:24.449
And again, where I sit is can we introduce some of these principles that we're looking at when that athlete is less impaired, less in pain, or uh the tissue's more resilient?
00:18:24.609 --> 00:18:26.769
Can we look at some of those principles earlier on?
00:18:26.929 --> 00:18:32.449
So if we've got somebody who is blood compromised, does that mean we can't train strength with them?
00:18:32.689 --> 00:18:35.169
Well, no, it doesn't immediately.
00:18:35.409 --> 00:18:38.849
Let's think about that as a as a problem to solve.
00:18:39.009 --> 00:18:39.649
What can we do?
00:18:39.809 --> 00:18:41.329
Can we adapt exercise, etc.?
00:18:41.490 --> 00:18:45.409
But if we're talking about kit, thinking like blood flow restriction kit.
00:18:45.809 --> 00:18:48.529
It's not for everybody and but for the right patient.
00:18:48.769 --> 00:19:07.730
It can be a real pardon the pun, leg up to to get into doing some uh resistance base exercise, a much lower load that can instill some strength adaptation and hypertrophic changes much earlier on in the rehab pathway than if we didn't have that.
00:19:07.889 --> 00:19:09.730
And that's just one option that involves kids.
00:19:09.969 --> 00:19:11.649
We can do it in different different ways.
00:19:11.889 --> 00:19:14.289
Yeah, so that's just a couple couple of things from me.
00:19:14.529 --> 00:19:16.529
Resistance, definitely number one.
00:19:16.609 --> 00:19:26.289
And then are there some adjuncts that we could maybe um use to accelerate some of these outcomes or could do some of this stuff earlier on where individuals are load compromised?
00:19:26.369 --> 00:19:29.329
So that could include things like blood flow restriction.
00:19:29.569 --> 00:19:30.449
You bring up a good point.
00:19:30.849 --> 00:19:38.449
I think for anyone out there that either runs a clinic now or is looking to set something up, understand what your framework and system is first, and that will dictate what you get.
00:19:38.529 --> 00:20:02.129
Uh, as an example, we certainly pride ourselves on if an athlete comes in, injured, sore, pain, we will overload them somehow, somewhere, which means things like a leg extension, uh a hamstring curl machine, a leg press, pendulum squat, belt squat, all these things that are almost bodybuilding like, we prioritize because we know the amount of times that we can't do a lot of stuff with an athlete in season.
00:20:02.289 --> 00:20:05.889
They've just got to, you know, I hate saying it, but it's it's tick the box.
00:20:05.969 --> 00:20:06.449
Sometimes you do.
00:20:06.529 --> 00:20:08.529
You just got to keep some sort of stimulus in them.
00:20:08.689 --> 00:20:09.809
And machines are great.
00:20:09.969 --> 00:20:12.609
Yeah, so many people have these things against them, but they're brilliant.
00:20:12.769 --> 00:20:17.969
They isolate, they control, they overload, everything you want to do in a compromised athlete.
00:20:18.049 --> 00:20:29.889
Uh, so understanding your rehab process, looking at someone else and and what they have and what's shiny and what's new, if it doesn't actually align with how you rehab, then you get you're gonna hit a wall pretty quickly.
00:20:29.969 --> 00:20:44.129
So understand what do you prioritize in your rehab process and when, and make sure you've got it because you you don't want to be sending athletes or any type of patients that you're working with, even general pops, down the road to do stuff that that you kind of should be doing with them at your facility.
00:20:44.449 --> 00:20:45.569
Fantastic points.
00:20:45.649 --> 00:20:57.969
And I'm actually gonna use the repeated concept of overloading and underloading into the next question, which may be now a very lead-in question, but where do you think we go wrong with SNC in our rehab?
00:20:58.209 --> 00:21:03.649
I've got an issue with that with that because I never say anybody's doing anything wrong unless they're hurting somebody.
00:21:03.889 --> 00:21:10.769
I don't ever want to be gonna, I suppose, tarnished with being critical because it's incredibly difficult to work with humans.
00:21:10.929 --> 00:21:16.129
I'm kind of one and I know I'm difficult, and I'm actually rehabilitating at the moment.
00:21:16.289 --> 00:21:19.169
So my team I may be a little bit exasperated.
00:21:19.329 --> 00:21:36.369
So not only is it really difficult to work with individuals, then in this type of setting, you've got to know what's the best way physiologically changing indices of performance strength, but rate force development, power, what else, tissue compliance, blah, you know, all of these different things.
00:21:36.529 --> 00:21:41.809
So we need to know the best way to design exercise to do that, and know the dose response.
00:21:42.049 --> 00:21:48.209
Then those individuals are gonna be in some level of discomfort or have clinical restrictions.
00:21:48.369 --> 00:21:53.089
So then you need to go, can I still deliver this and solve that equation?
00:21:53.250 --> 00:21:55.809
And then you've got to go, that's an individual.
00:21:55.969 --> 00:21:57.169
Can I get them to buy in?
00:21:57.250 --> 00:22:02.689
Now, if you're working with athletes, usually it's a little bit easier than general populations, but not all the time.
00:22:03.009 --> 00:22:20.209
So, in terms of wrong, I think those individuals may have not had the right type of training or the had that level of understanding, or the there's a gap in knowledge that we can help to redeem, to fill commensurate with their own setting.
00:22:20.369 --> 00:22:29.490
And if there's anything that I know that can help people's rehabilitation practice, then it's absolutely my pleasure and blessing to be able to aid that.
00:22:29.809 --> 00:22:44.449
So I think there's ways in which we can improve, and I can improve, but in terms of wrong, and that's not to pick on you for the question, but it's often said within this arena and within loads on social media, and I just grates on me a little bit because it's a phenomenally difficult job.
00:22:44.769 --> 00:22:45.250
Yeah, yeah.
00:22:45.329 --> 00:22:48.289
Sometimes wrong does have the context that they're doing it on purpose, but you're right.
00:22:48.369 --> 00:23:02.929
It's very contextual, and I'll always anything I've done, do or say is always, and typically from the context of a team sport environment, it is a different environment to say your Olympic institute one-on-one environments or your general population clinic environments and things like that.
00:23:03.089 --> 00:23:31.490
But if I had to, if I had to put it on the spear type of thing, I I think the biggest misconception is probably a bit too harsh, but the biggest thing I see a lot of rehab go maybe a little bit too slow and blocked is people have this assumption that everything happens one step at a time, i.e., we return range, we should get pain free, we then load, then we load with range, and this type of almost just absolute beautiful unicorn type setup that never happens because of that.
00:23:31.649 --> 00:23:37.490
And in a team environment where a lot of people are very, very happy to say these days, you know, timelines are out the window.
00:23:37.569 --> 00:23:39.730
It's all about entry and exit criteria.
00:23:39.889 --> 00:23:41.250
And I'm all for that.
00:23:41.329 --> 00:23:45.409
But when you've got a head coach asking what game are they returning, guess what?
00:23:45.569 --> 00:23:47.490
Your timeline is straight back in there.
00:23:47.649 --> 00:23:48.289
It doesn't matter.
00:23:48.609 --> 00:23:53.409
You can't just be like, oh, well, we'll see if they get there quickly, or yeah, we'll just see how they go each phase.
00:23:53.569 --> 00:23:54.209
You can't do that.
00:23:54.289 --> 00:23:55.089
You've got to tell them.
00:23:55.250 --> 00:23:59.649
You may be able to pat it out and you'll still treat them with each phase and hopefully speed them up.
00:23:59.730 --> 00:24:01.730
But the timelines are a real thing, they exist.
00:24:01.809 --> 00:24:06.209
And whether they're an athlete that has a coach asking or they're asking, they want to know when they're back.
00:24:06.289 --> 00:24:12.609
And that's where a lot of the stuff that I've done in the rehab space is okay, well, it's still painful in this range.
00:24:12.769 --> 00:24:28.209
So we can chase heavier loads in this movement in this range, but we'll also change and chase range of motion with no load in this range, and then we'll try and put some ISOs or we might use some complex work or BFR and in this range with this.
00:24:28.289 --> 00:24:42.929
And there's always a handful of things that need to be done before you you technically load everything, but there's a lot that you can do when someone's still in pain and still doesn't have great range that is actually going to accelerate them at the back end once it returns.
00:24:43.009 --> 00:24:49.169
And I think the ability to work around pain a little bit more with good loading is probably missed a lot.
00:24:49.329 --> 00:24:53.250
People probably feel like I can't load anything until this is pain-free.
00:24:53.329 --> 00:25:01.809
And I think with the push of tendons and and the popularity of trying to return people with tendon pain and how we can load that is hopefully shifting that a little bit.
00:25:01.889 --> 00:25:07.009
I think a lot of people are getting far more comfortable to accept a little bit of pain and good load and stuff like that.
00:25:07.169 --> 00:25:10.049
And even in the calf space, you mentioned Claire about stimulus.
00:25:10.129 --> 00:25:15.889
Like I think every week it goes up by one body weight or something that you need to pump into the calf like you're protected.
00:25:15.969 --> 00:25:19.009
Like it's just getting almost out of reach for most people these days.
00:25:19.169 --> 00:25:20.449
But that's a perfect example.
00:25:20.529 --> 00:25:26.929
Like so many people now talk up to eight times, nine times body weight on a bloody Smith machine in a seated position that you've got to tolerate.
00:25:27.009 --> 00:25:28.209
Like that's a lot of weight.
00:25:28.449 --> 00:25:44.369
These type of things, I think, uh probably the more advanced side of it that I think potentially people that have worked in environments that don't need to get an athlete back on a day ready to perform, that often they probably haven't been forced to try and load outside the norm.
00:25:44.529 --> 00:26:15.869
And I think that's probably what's becoming more popular now, even in your just typical clinical settings.
00:26:15.949 --> 00:26:21.389
I think people are starting to understand that hang on, load, load is good when it's appropriately done.
00:26:21.549 --> 00:26:24.829
And we know that we can't accelerate it at the end.
00:26:24.989 --> 00:26:27.709
We have to have started doing something leading into that.
00:26:27.869 --> 00:26:30.589
And that's a very overarching sort of thing, I know.
00:26:30.669 --> 00:26:42.029
But um, that's probably the thing that I see is probably that the bigger gap at the moment, that people can probably load a lot of ranges, angles, joints, muscles earlier in a rehab space than then potentially they do.
00:26:42.269 --> 00:26:42.749
I agree.
00:26:42.829 --> 00:26:43.789
I agree entirely.
00:26:43.869 --> 00:26:44.989
And it's what I teach.
00:26:45.149 --> 00:26:48.829
The fundamentals of pretty much every course that I teach is all about this.
00:26:49.069 --> 00:26:50.509
Can you solve the equation?
00:26:50.749 --> 00:26:52.109
Can you change your range?
00:26:52.189 --> 00:26:58.749
And we've got evidence that suggests or clearly shows that, you know, isometric, for example, doing isometric training.
00:26:58.829 --> 00:27:08.989
Now, this isn't isometric 60-second holes, this is high load, go for maximal contraction at a particular joint angle, will give you a strength adaptation at that joint angle.
00:27:09.149 --> 00:27:14.589
Now, if you do it at long muscle lengths, you might actually get a transfer across to shorter muscle lengths as well.
00:27:14.829 --> 00:27:16.989
So, you know, there's loads of different ways.
00:27:17.069 --> 00:27:31.149
And if you understand a little bit the human physiology, some of the literature in this space, then you've got a multitude, maybe five different options without buying any kit to influence, for example, strength adaptation.
00:27:31.309 --> 00:27:40.429
And if you think about injuries, when injuries happen, we're rather than looking to perhaps recoup strength, we're looking to attenuate loss, certainly in that early phase.
00:27:40.669 --> 00:27:47.149
So if after all of the adaptations that you've thought of, you still can't do it, you can still train the opposite side.
00:27:47.309 --> 00:27:55.149
The cross-education effect is so powerful, and that means strength training one side for the benefit of the other that is not strength training.
00:27:55.309 --> 00:27:58.589
If you never heard it before, it sounds very weird, very profound.
00:27:58.749 --> 00:28:00.269
But human body is amazing.
00:28:00.349 --> 00:28:03.149
We've known about this since something like 1894.
00:28:03.309 --> 00:28:10.029
Well, not me personally, because I've been doing something else, but in healthy populations, it can generate a strength adaptation.
00:28:10.189 --> 00:28:14.429
In those injured populations, particularly at the early phase, it can attenuate loss.
00:28:14.509 --> 00:28:40.989
And we've done studies in this space, and just for a little bit of extra time, no extra money, a heavy load resistance training program on the non-affected side can attenuate the loss on the affected side, which again gives you ability to perhaps go a little quicker or have a better outcome at the end of that time point because you've got as far or as long or as much change to make in that time frame.
00:28:41.149 --> 00:28:53.229
And even in non-athletic situations where you've got this, I need my athlete back on this date, for example, NHS, national health service practice in this country, you still have a time frame.
00:28:53.469 --> 00:28:56.589
You might only see somebody like two or three times.
00:28:56.829 --> 00:29:01.229
What's the biggest bang for your book that you can get uh in those sessions?
00:29:01.469 --> 00:29:04.589
How can you you can space them out if you've got the luxury of doing that?
00:29:04.669 --> 00:29:07.229
You might only get to see them in a six-week block.
00:29:07.389 --> 00:29:08.429
What changes can you make?
00:29:08.509 --> 00:29:10.189
What losses can you attenuate?
00:29:10.429 --> 00:29:17.149
The point about thinking about the environment as equation and maybe not going like he was saying linearly.
00:29:17.309 --> 00:29:19.069
We need to get eliminate pain.
00:29:19.149 --> 00:29:20.989
Now you think about I do a lot of work.
00:29:21.069 --> 00:29:24.589
My passion now is OA, osteoparthritis, particularly with a knee.
00:29:24.749 --> 00:29:28.189
Those individuals are in pain no matter what you've got to do with them, right?
00:29:28.349 --> 00:29:32.429
So if you're gonna wait for them to become pain-free, you're gonna have a pretty long wait.
00:29:32.589 --> 00:29:35.869
And they probably won't be very responsive when you start with them.
00:29:36.109 --> 00:29:48.589
You need to think about some of these challenges, and as a, I guess, as well, and a fear when you think about patients, individuals who are in pain or who have injuries, there is an inherent fear about I don't want to make them worse.
00:29:48.669 --> 00:29:50.909
So I understand completely where it comes from.
00:29:51.149 --> 00:29:55.709
Do no harm, don't want to get them worse, and particularly with older populations as well.
00:29:55.869 --> 00:30:03.949
But in actual fact, if you think about this as a physiologic problem to solve, how can we, for example, reinstate strength?
00:30:04.189 --> 00:30:09.309
Well, it's high loads, kind of low repetitions, ideally for an optimal prescription.
00:30:09.389 --> 00:30:14.109
But essentially, if they're doing nothing, any amount of loads to start with is going to challenge that.
00:30:14.509 --> 00:30:17.149
So we we do need to start to load these populations.
00:30:17.229 --> 00:30:19.069
Swimming's not really gonna do it, you know.
00:30:19.229 --> 00:30:32.669
Certainly if you look at Linda Beck's amazing work in the Lithmore trial and series beyond that, you're thinking about osteopenia, osteoporosis, what's going to solve or help remedy the kind of uh bone mineral density changes?
00:30:32.749 --> 00:30:34.349
Again, it's not low load.
00:30:34.509 --> 00:30:37.869
So we've got to fear, we don't want to load these people because they're fragile.
00:30:38.109 --> 00:30:42.749
But actually, if you look at it from a physiologic perspective, we need to load that tissue to cause it to adapt.
00:30:42.909 --> 00:30:53.629
So, how can I look at that situation and solve that equation such that it's clinically appropriate to do, but still I've got a chance to get some of these important stimuli in for the high load.
00:30:54.029 --> 00:30:57.469
If you look at it from that perspective, then it's pretty powerful.
00:30:57.949 --> 00:31:02.429
I feel like there's two things that people probably don't give enough credit for because they don't see it early on.
00:31:02.589 --> 00:31:13.949
It's only until the later stage of rehab that you can appreciate it is one, really good pre-surgery training to be able to go under the knife with very little swelling, good strength, good movement.
00:31:14.109 --> 00:31:18.669
You speak to any surgeon and they open up someone that's been training leading into it, it's like a dream.
00:31:18.909 --> 00:31:28.109
That and then loading early, because it's not like you necessarily, like if you get anterior knee pain in an ACL rehab, it's not like this eliminates it magically.
00:31:28.189 --> 00:31:31.549
It's not like it magically makes that first three months easy.
00:31:31.789 --> 00:31:36.829
But what it does do is it sets you up for the next block where you've already established this loading.
00:31:36.989 --> 00:31:40.669
We've just said you can't just throw 100 kilos on someone's back out of nowhere.
00:31:40.909 --> 00:31:48.589
But you can if they've been building up load for all this time and you don't actually get the monies back until after.
00:31:48.749 --> 00:31:54.589
So I've seen and heard a lot of people say, Oh, I did this, tried this, but I didn't really think it didn't really accelerate the rehab.
00:31:54.669 --> 00:31:57.629
Well, it doesn't accelerate the rehab, it's not like they suddenly go quicker.
00:31:57.789 --> 00:31:59.629
You still have to go through the same issues.
00:31:59.709 --> 00:32:01.789
You still get faced with random things that pop up.
00:32:01.869 --> 00:32:06.429
It's not like a magic vix, but just time and time again, I see in that that back end.
00:32:06.509 --> 00:32:12.269
Obviously, depending on the rehab, we use an ACL, it's probably the easiest one to uh extrapolate out over a longer time.
00:32:12.349 --> 00:32:23.389
But you know, that four, five, six month mark is where the money starts to come back because you're like, holy crap, like we're in this time where a lot of people are reintroducing stuff and we can actually really push someone, and it's a great feeling.
00:32:23.469 --> 00:32:28.189
And you get them back again, not necessarily super quicker, but in a far better environment.
00:32:28.349 --> 00:32:33.869
They they can actually return to performance and it's not just return pain-free, which there's a fair difference.
00:32:33.949 --> 00:32:35.389
And I think that's where you make your money.
00:32:35.549 --> 00:32:41.469
So um, anyone listening, don't be shy because you're like, oh, it hasn't magically sped up the first two phases.
00:32:41.709 --> 00:32:43.949
In my experience, you still suffer the same things.
00:32:44.109 --> 00:32:45.869
You still get random bouts of pain.
00:32:45.949 --> 00:32:49.789
They still get every now and then something just swells, and you're like, why the hell did it swell?
00:32:49.869 --> 00:32:59.229
Like, yeah, these things happen, but yeah, I feel like it breeds a far better, robust individual once they get into the harder stuff if they've been doing this type of loading earlier.
00:32:59.469 --> 00:33:00.989
I think those are fantastic points.
00:33:01.069 --> 00:33:02.829
So it's starting with the end in mind.
00:33:03.069 --> 00:33:24.589
And Claire, I think building onto your point, there's certainly what I'm hearing is the relevance to consider those, that physiological and anatomical knowledge in what tissue we're loading and how that feeds into the pain and performance picture, how chondral surfaces, how bone loads, how tendon loads, and how that might change our adaptations to the programming as we go.
00:33:24.909 --> 00:33:31.629
Well, I think, you know, if you think about the issues that you're faced with that would challenge your loading full stop.
00:33:32.029 --> 00:33:39.309
And if there's a clear clinical reason, absolutely, I'm not saying kind of ignore all your training and your clinical reasoning.
00:33:39.549 --> 00:33:45.389
But if there's a way in which you can, you know, joints love load, joints like loading.
00:33:45.629 --> 00:33:51.549
You take away a load, your tissues adapt in the same way that you would load them, except in the negative way.
00:33:51.709 --> 00:34:05.069
So we need it becomes proportionately more important as we age to introduce, if we're not already doing it, some sort of resistance training, some sort of heavy training, because our lives are becoming more and more sedentary.
00:34:05.149 --> 00:34:06.829
So we're not getting it in everyday life.
00:34:06.989 --> 00:34:15.789
I think, you know, if you even if you carry a shopping home, we want that to be easy, not to be your like farmer's carry of the day.
00:34:15.949 --> 00:34:19.069
What is it that's challenging your thoughts about loading?
00:34:19.150 --> 00:34:20.989
And then how can you you solve that?
00:34:21.069 --> 00:34:34.190
And then clearly, you know, if you're doing a tendonopathy rehab, it might be slightly different in terms of exercise selection than who's maybe a runner versus an older person who wants to be able to walk on unstable ground with OA with their dog.
00:34:34.429 --> 00:34:47.470
The exercise selections will be different commensurate with the the individual and their baseline status and with the, I suppose, a tissue that you're looking to engage and load, but the principles remain the same.
00:34:47.630 --> 00:34:51.070
So I say everybody is an athlete.
00:34:51.309 --> 00:34:58.990
Let's treat everybody with the same level of knowledge that we have about athletic elite performance to that general population.
00:34:59.150 --> 00:35:02.750
The principles are the same, it's just the way in which we deliver them.
00:35:02.909 --> 00:35:05.389
And if you think about yourself, how do you train yourself?
00:35:05.550 --> 00:35:06.750
Do you go to the gym, right?
00:35:06.909 --> 00:35:10.670
So if you go to the gym and do you strength train, how do you approach that?
00:35:10.829 --> 00:35:14.590
Now, if you go back into your clinic or your rehob environment, do you switch that?
00:35:14.750 --> 00:35:15.710
And if you do, why?
00:35:16.190 --> 00:35:26.670
If you know there's a better way to instill strength adaptation or rapidity of muscle force production, if you know there's a better way to do it, why are you almost withholding that from your patient?
00:35:26.829 --> 00:35:42.670
And I say that it's a little bit provocative, but if we take a step back from the thing that that causes the fear and the hesitancy and look at that objectively without emotion, is there a way we can work around that to do what I know is best?
00:35:43.150 --> 00:35:54.990
That's the empowerment, and that's what's going to be the start to improve maybe those touch points, the input-output equation with you, your patient, and the patient with those exercises now.
00:35:55.230 --> 00:36:03.550
Yeah, our old red head of rehab, Justin Richardson, used to always say a great Warren Buffett quote, which is that the best way to make money is to first not lose money.
00:36:03.789 --> 00:36:05.550
And it is very appropriate to rehab.
00:36:05.630 --> 00:36:10.110
The best way to get strong, powerful, progress is first of all, don't lose it.
00:36:10.269 --> 00:36:13.309
So whatever they've got at the time when they say just maintain to start.
00:36:13.389 --> 00:36:14.429
That's the first in the box.
00:36:14.510 --> 00:36:15.710
Make sure they don't go backwards.
00:36:16.030 --> 00:36:17.710
Fantastic advice from you both.
00:36:17.789 --> 00:36:18.510
I like it.
00:36:18.829 --> 00:36:28.030
Moving into the sort of the strength versus rate of force development, why does it matter and how do we assess it?
00:36:28.269 --> 00:36:33.550
Claire, I know you've done a fantastic post on it as well that I was reading the other day too.
00:36:33.710 --> 00:36:35.230
So if you're happy to answer.
00:36:35.550 --> 00:36:40.590
So rate of force development refers to the ability for us to produce force quickly.
00:36:40.670 --> 00:36:47.230
And if we're looking at assessing that through some of the amazing kit that Lackey's got, what we'd look at is the force time curve.
00:36:47.309 --> 00:36:51.789
So you say like a force production over time and then the removal of force.
00:36:51.949 --> 00:36:54.269
And it's the gradient of that force time curve.
00:36:54.429 --> 00:36:57.070
It's often used interchangeably with muscle power.
00:36:57.230 --> 00:36:59.949
These rate of force, RFD, and muscle power, same thing.
00:37:00.030 --> 00:37:10.670
They're not actually the same thing because muscle power, if you think about how you assess muscle power, it's usually with, you know, if we're thinking about a very simple test of power, a broad jump.
00:37:10.909 --> 00:37:11.230
Okay.
00:37:11.470 --> 00:37:20.110
So you could have very poor power, session one, session two, but in session two, you can go further because you've lost 20 pounds in weight.
00:37:20.349 --> 00:37:20.670
Okay.
00:37:21.150 --> 00:37:25.470
So the thing is we're looking to change the contractile properties of the musculature.
00:37:25.630 --> 00:37:33.869
And then again, coming back to basic physiology, that will translate, as long as you don't put on weight, into better power performance if we're measuring it in that way.
00:37:34.110 --> 00:37:39.150
The other thing to say, rate of force development is not just something that's important for athletic populations.
00:37:39.230 --> 00:37:44.670
It is super important in sprint speed, in vertical jump height, in rapid changes of direction.
00:37:44.829 --> 00:37:46.030
Of course, it absolutely is.
00:37:46.110 --> 00:37:47.150
But it's not only there.
00:37:47.230 --> 00:37:57.150
If you think about general populations and you think about injury incidents and you think about time course of injury incidence, you know, it takes less than half a second to fall over, right?
00:37:57.550 --> 00:38:00.190
So we need rapidity of muscle force production.
00:38:00.269 --> 00:38:19.789
If you're standing up out of a chair and you trip, and you know that that older person trips over their handbag tortoise partner, I don't know, whatever's there, you need a fast acceleration of that lower limb to help prevent the fall, but also then accommodate their mass as they plant the foot, which again is rapid muscle contraction.
00:38:20.349 --> 00:38:24.030
So it's first to say it's really, really important in in all populations.
00:38:24.110 --> 00:38:33.949
And there's data that show deficits and loss in OANEs, in phtalofemoral pain, as well as ACL, injured and rehabilitated populations.
00:38:34.190 --> 00:38:35.949
Maybe it's proportionally more important.
00:38:36.110 --> 00:38:46.510
But the way in which we um and Blackie probably can say some really great points on this, how you specifically train for that, it's you need a different approach to it.
00:38:46.750 --> 00:38:50.030
So you do something new with somebody, they'll get a multitude of adaptations.
00:38:50.190 --> 00:38:57.949
But thereafter, you need to start to get really specific if you want to change strength, you want to change rate of force development, the contract properties of the musculature.
00:38:58.190 --> 00:39:01.389
The key thing, and there there are different ways we can focus on this.
00:39:01.470 --> 00:39:07.869
If we want to go really granular, we can chop up that force time curve and think about the early phase, the first hundred milliseconds.
00:39:07.949 --> 00:39:10.429
And yes, we are talking in very small time frames.
00:39:10.829 --> 00:39:18.829
But if I told you that it takes less than half a second, maybe less than a third of a second to fall, then these small time frames are really, really important.
00:39:19.150 --> 00:39:24.429
So we can focus on that early phase and then latterly the late phase, and we can get into that if you want to.
00:39:24.670 --> 00:39:32.269
But the key difference between training strength and training rate of force development is the intent, the intent to be explosive.
00:39:32.590 --> 00:39:34.269
And that is the critical thing.
00:39:34.429 --> 00:39:57.869
Now you can play around with mass and load and resistance and exercise type, but there has to be that explosive intent to really focus on a maximal speed of muscle activation, which is different to if you think about strength training and strength-based training, you just need to lift the thing off the floor or push push the thing, and there's no real kind of time parameter that we're evoking here.
00:39:58.030 --> 00:40:08.829
The key thing, and indeed when you assess rate of force development as well, if you kind of get into that, it's the as fast as you can, and and the emphasis is placed on the speed of contraction.
00:40:09.389 --> 00:40:16.990
They are different, strength and rate of force development are different, both are important in many populations, and all populations actually.
00:40:17.150 --> 00:40:25.150
And the way to distinguish is strength is maximal force, rate of force development is rapidity of force of production.
00:40:25.470 --> 00:40:26.110
I agree with all.
00:40:26.269 --> 00:40:36.909
I have a small gripe with RFD as a whole, just because I think it's the Arkham's razor of the fact that it is amazing, but it's also the most sensitive and hardest thing to test.
00:40:37.150 --> 00:40:39.869
To actually put someone, it doesn't matter what you're doing.
00:40:39.949 --> 00:40:46.030
Let's take an IM like an isometric mid thigh pull on force plates, which again, 90% of physios don't use grip straps.
00:40:46.110 --> 00:40:47.150
So that's another recommendation.
00:40:47.230 --> 00:40:52.750
If you're doing an isometric mid thigh pull and you don't have a grip grip straps on, then you're just testing someone's grip strength.
00:40:52.909 --> 00:40:54.030
So always wear straps.
00:40:54.190 --> 00:41:04.190
Next part is to teach someone how to contract at the right time with the right intent to be able to measure accurate RFD is very tough.
00:41:04.429 --> 00:41:08.510
And it during a rehab process isn't probably the best time to teach someone.
00:41:08.670 --> 00:41:16.590
So this is where you you've got to quantify, qualify, probably as a better word, your individual you're working with and what's going to be the bang for their buck.
00:41:16.670 --> 00:41:18.190
Because RFD is very important.
00:41:18.349 --> 00:41:20.909
It's just getting an accurate measurement is the is the tough part.
00:41:21.150 --> 00:41:26.190
Me personally, I'm I'm a massive lover of impulse, which is to throw another word at everyone.
00:41:26.269 --> 00:41:31.389
But when working with with athletes, you want to get them more forceful, but you want to get them to do it quicker.
00:41:31.470 --> 00:41:33.389
And then they get more forceful, they get slower.
00:41:33.470 --> 00:41:36.190
And then you okay, we'll get them a little bit quicker with doing it, and then their force drops.
00:41:36.590 --> 00:41:44.030
It's just this ebb and flow that is the entire life of a strength editioning coach, robbing Peter to pay Paul and trying to give it back and trying to find that growth.
00:41:44.190 --> 00:41:56.429
And impulse is the best way to think about it of that area under the curve where we've actually made an entire change where you don't want someone super good at RFD, but have very low max force.
00:41:56.670 --> 00:42:01.550
Same as you don't want someone really good with max force, but then have, yeah, it takes four hours to get there.
00:42:01.710 --> 00:42:03.869
Now, obviously, positionally, it's different.
00:42:03.949 --> 00:42:05.550
You can certainly, it is weighted.
00:42:05.710 --> 00:42:08.269
You know, if you're working in rugby, it's a big prop forward.
00:42:08.429 --> 00:42:10.110
Doesn't matter if it takes them half an hour to get there.
00:42:10.190 --> 00:42:12.110
As long as they can get there, that's that's the key thing.
00:42:12.269 --> 00:42:24.429
Obviously, there's still arguments to say that it's important, but impulse for me describes the relationship of both of these actually improving, or at least one remaining and the other one getting better, because it means that we're actually chasing both.
00:42:24.510 --> 00:42:28.590
And the way you do that is, I don't want to say art form, but but it is.
00:42:28.670 --> 00:42:29.630
It Claire said it right.
00:42:29.869 --> 00:42:30.590
Everyone's human.
00:42:30.670 --> 00:42:41.150
So if we even completely remove ourselves from a rehab space, you're working with a very healthy high-end athlete, same sport, same background, same ethnicity, they respond differently.
00:42:41.309 --> 00:42:42.190
It's magic.
00:42:42.269 --> 00:42:43.789
It's everyone is very different.
00:42:43.949 --> 00:42:47.789
So you've got to have a lot of methods uh in the back to work out things.
00:42:47.869 --> 00:42:53.550
And and that's why our industry is flooded with all these different methods that like people aren't wrong.
00:42:53.630 --> 00:42:56.349
Like, people don't advertise this because they haven't gotten anyone better.
00:42:56.510 --> 00:42:57.550
Maybe there's one or two.
00:42:57.789 --> 00:43:00.909
But ultimately, everything's worked for someone somehow.
00:43:01.070 --> 00:43:12.269
It just depends how it's been applied and what their physiological response has been at that time they're loading, what what sport they're playing, but define adjustment of trying to get someone stronger, then you're kind of like, Well, you're strong enough.
00:43:12.429 --> 00:43:14.829
Now let's try and apply more force at a quicker rate.
00:43:14.990 --> 00:43:21.230
But then we start to look at contact time and say, Well, you spend four hours on the ground to do this, we need to get contact time quicker.
00:43:21.389 --> 00:43:25.070
But then if we go too quick with contact time, you're not putting enough force into the ground.
00:43:25.150 --> 00:43:29.550
And you know, there's a lot of different methods to trick the body into doing that and adjusting.
00:43:29.710 --> 00:43:33.070
But this is the nature of a return to performance.
00:43:33.230 --> 00:43:54.510
And I think if you're not having these discussions, then again, you're probably doing a return to play, you know, not return to performance, because this is the echelon of discussion, I think, at that end stage rehab that good rehab physios, as they they get more experience, want to start to have the discussions about, start to work out, okay, well, how do we improve their ability to apply force?
00:43:54.590 --> 00:43:56.750
But also now, how do we do it at a greater rate?
00:43:56.909 --> 00:43:58.829
And this comes back to what's the best tech?
00:43:58.909 --> 00:44:00.190
What should I have in my facility?
00:44:00.349 --> 00:44:02.750
Well, if that's what you value, then what are you going to use?
00:44:02.909 --> 00:44:07.470
Are we now looking at, say, a gym aware unit where you can measure the velocity of different movements?
00:44:07.710 --> 00:44:23.630
Is this where you're getting contact mats or opti jump where you're measuring contact time of plyometric options and whether or not you do need to load them up with a jump to slow down their contact time, but in turn put more force into the ground to then remove that and speed them up again?
00:44:23.710 --> 00:44:29.949
And it is a four-day discussion on how you improve RFD impulse and max force.
00:44:30.110 --> 00:44:51.150
But it's probably the the biggest takeaway I can say is that one, they're all very important, and then the interrelationship of them is very important to decide what you prioritize in a lot of your high speed movements and your jump selection, whether you load it, whether you don't load it, what type of rep ranges you want to use and and how you want to track even the descent of velocity.
00:44:51.230 --> 00:44:57.070
You know, are you actually worrying about the load or are you just tracking how many reps above 1.1 meters a second?
00:44:57.150 --> 00:44:58.990
And once it drops, that's the set done.
00:44:59.070 --> 00:45:01.869
Like this is where we start to chase that higher end.
00:45:02.030 --> 00:45:14.909
And as Claire mentioned, like the funny thing is that this type of stuff's the most important for, I will, again, without offending, probably say the most basic of populations where it's just an older person who is starting to degrade.
00:45:14.990 --> 00:45:21.150
You know, you think high-end elite million dollar athlete with this type of stuff, but it's as important for the other age group.
00:45:21.230 --> 00:45:23.550
Because as Claire said, like when they fall, they fall hard.
00:45:23.630 --> 00:45:31.230
And the only way to stop yourself from falling is a rapid contraction of a muscle, a huge rate of force development to be able to stop you.
00:45:31.389 --> 00:45:38.349
And there's there's plenty of studies coming out, and plenty of EPs or exosphysiologists and physios that are working in the space that are chasing power.
00:45:38.429 --> 00:45:50.429
And it might be as simple as seated leg extension done at a higher rate, but at least it's starting to lend that gap of, well, actually, this power training per se is not the peak.
00:45:50.670 --> 00:45:56.030
This power training is actually sometimes the foundation of just human movement and making sure everyone's doing it.
00:45:56.269 --> 00:46:02.670
The elite athlete level, you're probably you know putting the magnifying glass on all the results a little bit closer.
00:46:02.829 --> 00:46:07.389
If you're a physio and you're not having the discussions, I think that's something that is certainly an area for development.
00:46:07.470 --> 00:46:07.710
Yeah.
00:46:08.110 --> 00:46:17.789
A really good illustration of how granular it can get and how important these things are when you've got the time, capacity, resources, and you're dealing with those really high-profile athletes.
00:46:18.110 --> 00:46:21.949
And, you know, I concur with with everything that that Lackey said.
00:46:22.190 --> 00:46:38.110
I think if I put myself in a clinician's shoes who might be feeling somewhat overwhelmed by this, I'd just like to roll it back and say there is relevance in this and don't worry about the volume of information that's just been imparted on you.
00:46:38.349 --> 00:46:39.230
Absolutely true.
00:46:39.309 --> 00:46:47.869
But in terms of measuring rate of force development, I'd say it's a futile exercise unless you're going to really practice and become experts at it and have the right type of equipment.
00:46:48.030 --> 00:46:52.429
I've written several measurement science papers on rate of force development.
00:46:52.510 --> 00:46:55.070
It's an inherently variable index.
00:46:55.150 --> 00:47:03.389
And that's due to you, it's due to your kit, and it's due to the individual being able to perform explosively, repeatedly, and habitually.
00:47:03.550 --> 00:47:08.269
But just because you might not be able to measure it, it doesn't mean you shouldn't necessarily train it.
00:47:08.429 --> 00:47:24.429
And the best way, again, illustrated really nicely, it does not have to be highly complex moves, potentiation complexes with X, Y, and Z and 70% of this and but think about strength as the fuel tank, the maximal force that that individual is able to generate.
00:47:24.670 --> 00:47:27.389
Then think about the ability to express that quickly.
00:47:27.470 --> 00:47:40.909
So if you move, once you've got somebody strong, then you could almost do exactly the same exercise, lower the weight to maybe something like 50% of what they were doing, 70% of what they're doing, just to make this simple and do it explosively.
00:47:40.990 --> 00:47:42.990
And explosively is the key, right?
00:47:43.070 --> 00:47:45.710
It's often called explosive strength in the literature as well, right?
00:47:45.789 --> 00:47:57.789
Of thought development, because it's been explosive and you can do it isometrically, you can do it in machines, you can do it kind of bodyweight stuff, you can do it in very complex ways, but it doesn't have to be complex.
00:47:57.949 --> 00:48:10.909
So we're now talking about power openia in the literature versus sarcopenia and power maybe having more or greater influence on quality of life, all cause mortality disease, like strength has.
00:48:11.070 --> 00:48:13.710
I'm not sure we're quite there yet, but it's certainly important.
00:48:13.869 --> 00:48:17.869
And if you're going to integrate it into your practice, I'd strongly encourage you to do.
00:48:18.110 --> 00:48:23.869
Just think about the movements, the exercise prescriptions that you're doing for strength, and just drop the road a little bit.
00:48:24.110 --> 00:48:28.429
As long as it's safe to do it explosively, and it can be, that's your starting point.
00:48:28.510 --> 00:48:34.510
It doesn't have to involve all the really important things that we're talking about before when you're dealing with high-level athletes.
00:48:34.590 --> 00:48:40.269
And clearly there's a really, really strong remit for all of this, and there's maybe a lot of money at stake as well.
00:48:40.429 --> 00:48:45.389
But if we're saying it's really important for general populations, that might be just a nice way to start out.
00:48:45.630 --> 00:48:45.949
100%.
00:48:46.190 --> 00:48:50.190
And to be honest, to that point, I'd even go further and say you don't actually need to be that strong.
00:48:50.429 --> 00:49:01.309
I think the concept of people needing to be really strong to do it is probably sometimes holds people back because we know, yeah, greater strength usually indicates greater coordination, they're better at it, usually get more out of it.
00:49:01.470 --> 00:49:05.550
But if you're a physio standing there trying to do that and not go, oh well, are they strong enough?
00:49:05.710 --> 00:49:06.510
Don't overthink it.
00:49:06.670 --> 00:49:16.829
As I said, if we go back to that leg extension example, if they've got enough plates that you can reduce it by a few plates and they can do it comfortably at speed and they look like they can control it, then that's a good start.
00:49:16.909 --> 00:49:20.110
Like don't overthink, oh, they're not strong enough yet and keep delaying.
00:49:20.269 --> 00:49:31.470
No doubt the stronger someone is, the better outcomes you can usually have with velocity work, but it's certainly not a door in my mind that just because they're not super strong, they can't start some things at velocity.
00:49:31.789 --> 00:49:38.190
I think there's some fantastic clinical gems and some really tangible takeaways from both of you there.
00:49:38.349 --> 00:49:54.990
So thank you very much, and a huge thank you to I suppose helping us explore all things S and C and rehab and performance and hopefully navigate it more confidently in the clinic and hopefully consider ways that we can optimize what we do with our patients.
00:49:55.070 --> 00:49:56.030
So thank you.
00:49:56.510 --> 00:49:57.550
Absolutely my pleasure.
00:49:57.710 --> 00:49:58.429
Thanks for having us.
00:49:58.670 --> 00:50:00.349
We'll go to chat when quick.