Pełna transkrypcja odcinka [Physio Discussed] Inside the world of elite sports physio with Matt Cameron and Keiran Cleary

you know your your family and social life because you know you're not you can't take up every invitation to go to weddings or dinners or christenings or whatever. 00:04:33.759 --> 00:04:36.879 So, you know, there's there's some downside to the glamour. 00:04:37.199 --> 00:04:37.759 Absolutely. 00:04:38.000 --> 00:04:44.000 It sounds like you probably frame it more on-season, off-season rather than Monday to Friday and then the weekends. 00:04:44.240 --> 00:04:49.839 I think that's true, but you know, I don't know what Kieran finds, but I mean the the off-season is only very short. 00:04:50.000 --> 00:05:02.879 And so the pre-season period is often busier than in-season period, you know, the the training is longer and days are longer, and you know, so the the time commitments sometimes even greater, even though you don't have your Saturdays or Sundays occupied. 00:05:03.120 --> 00:05:11.519 Yeah, I think I'm I'm I'm finding probably the similar thing is that the you know, I think if I looked at my last week into our first round, I was at work every day. 00:05:11.759 --> 00:05:13.199 I was there Sunday, I'm there. 00:05:13.279 --> 00:05:17.920 If I looked in our runnings, we're going next Sunday I'll be there every day between now and then and the and the following week. 00:05:18.000 --> 00:05:21.120 So you're probably racking up yeah 14 to 15 days in a row. 00:05:21.199 --> 00:05:26.480 But you're probably not, I'm probably not thinking about that because I think if you get the environment you're in, you enjoy it and you're enjoying what you do. 00:05:26.560 --> 00:05:29.360 I feel that it's sort of just what I do, and we've always done. 00:05:29.439 --> 00:05:39.199 So it's probably uh you don't think twice about it, but if you wrote it down and you looked at it, you go and compared it to a nine to five Monday to Friday, and you'd go, holy duly, that's madness, perhaps. 00:05:39.519 --> 00:05:40.240 For sure. 00:05:40.480 --> 00:05:52.319 So I I'm curious, looking back at both of your own journeys in elite sport, what were the pivotal decisions or experiences that you found actually opened the doors and what helped you stay there? 00:05:52.480 --> 00:05:54.240 Kieran, we might go with you. 00:05:54.639 --> 00:06:06.160 Yeah, look for me, it was I remember looking at Matt, it was at the Swans at the time when I was sort of coming out of uni and working my way through and he'd had a career there that was already, you know, well established and there for a long time. 00:06:06.240 --> 00:06:13.199 So looking up to someone like him and saying, you know, how how possibly could I get a role like that, you know, even for one or two years? 00:06:13.279 --> 00:06:16.000 And if I'm honest there is an element of right place, right time. 00:06:16.160 --> 00:07:07.839 And so I remember I got a job at a big sports clinic in Sydney and I started working with a suburban rugby club, and then I was at work one night, and one of the physios that work me said, Oh, you know, Sydney Uni rugby is looking for a physio, so maybe Andrew want to talk to the coach, and then you know, I get that role, and then Sydney Union Rugby is a great club at that time, and so we were very successful, and so I talked to the Waratars, I get a role with them, and then you know, Michael Checker takes over the coaches at Waratars, and we win our first title, and he becomes the national coach, so I get to opportunity to go work for Australia, and so I guess it's there's a lot of hard work and and there's a lot of time put in, and there's a lot of hours put in and a lot of sacrifices, but the reality is at times there's there's uh you know, you turn up at the right place at the right time with the right people around you and the team is successful, then that's that's a big part of it as well, obviously building the skill set and developing clinical clinical acumen, I guess. 00:07:08.079 --> 00:07:17.199 I suppose the key there is that with the right place, right time, it's about being present, prepared, and actually taking action when luck or timing aligns as well. 00:07:17.680 --> 00:07:24.560 It's taking the opportunity and it's it's also, I guess, finding a way that the environment you walk into in different teams is different every year. 00:07:24.639 --> 00:07:31.360 So it's finding a way of making that work for you and making sure that you're right for it and that environment and culture is right right for you. 00:07:31.600 --> 00:07:32.160 Absolutely. 00:07:32.319 --> 00:07:34.160 Well, what about your experiences, Matt? 00:07:34.560 --> 00:07:37.120 Probably certainly in the case of right place, right time. 00:07:37.279 --> 00:07:54.639 I mean, I I was lucky enough to land a job with a with someone who I'd work uh studied with, and so was was kind of like a friend, colleague, and working with him in his clinical environment, and that involved doing swans on Sunday and Gordon Rugby on the Saturday. 00:07:54.800 --> 00:08:02.160 You know, I was working clinic from Monday to Friday into Saturday and Sunday, and then things just grew from there. 00:08:02.240 --> 00:08:05.439 You know, just an opportunity came along to be more involved with the swans. 00:08:05.600 --> 00:08:12.319 And, you know, I mean, I think if you're always, you know, you never want to shut a door, you're always trying to keep relationships with people. 00:08:12.399 --> 00:08:22.879 You know, sometimes things can be quite serious in sport and the stakes feel high, but it doesn't mean that, you know, the the personal stakes or things that are personal, you know, get should get discarded. 00:08:22.959 --> 00:08:28.079 And so I think it's important you have, you know, try to develop good relationships and connections with people. 00:08:28.160 --> 00:08:40.879 And then, you know, then I think things then can take care of themselves, you know, providing you you're up to it clinically and you've got your personal skills developed as well, then you know, you can take

opportunity if you're prepared to work pretty hard. 00:08:41.120 --> 00:08:41.759 Absolutely. 00:08:42.000 --> 00:08:50.320 I actually had this question for far later, but it's probably a nice segue now, just in talking about skills that matter beyond clinical knowledge. 00:08:50.559 --> 00:08:58.240 What are the non-clinical skills that separates the physios who thrive in elite sport from those who perhaps find it a little bit more challenging? 00:08:58.639 --> 00:09:00.960 This is something I feel pretty strongly about. 00:09:01.120 --> 00:09:09.600 There is a vast majority of time spent doing things that you know we didn't clinically go through at university or in the master's level. 00:09:09.759 --> 00:09:12.559 And there's a whole variety of different skill sets. 00:09:12.720 --> 00:09:19.600 For example, we've always worked a lot with collecting information about patients and athletes or players. 00:09:19.759 --> 00:09:22.399 You actually do need some amount of computer skills. 00:09:22.480 --> 00:09:34.320 You need to be able to use Excel, you need to be able to use other applications, even more so now with technology that has entered into the gym with you know, testing or testing in the gym or the clinic. 00:09:34.399 --> 00:09:39.840 You know, you need to be able to integrate that sort of information and be able to make use of it. 00:09:40.080 --> 00:09:43.519 So they're sort of skills that are very unrelated to physio. 00:09:43.759 --> 00:09:49.120 However, one of the biggest tools in our kit bag is exercise prescription. 00:09:49.279 --> 00:09:50.799 I think none of us can survive. 00:09:50.960 --> 00:09:53.679 This is any physio anywhere, let alone it's bored. 00:09:53.759 --> 00:10:01.440 You can't survive unless you've got an ability to prescribe exercise or at least work really closely with SNC. 00:10:01.519 --> 00:10:17.039 You know, they they certainly know how to put a program together and you know they can come up with the sets and reps, but you know, we need to be able to decide what a player needs, what type of exercise they need to do in order to target certain muscles or certain functions. 00:10:17.200 --> 00:10:19.600 And, you know, that's 50% of what we do. 00:10:19.759 --> 00:10:24.080 I mean, they're the two off the top of my head that I know that that are skills that you can't get by without. 00:10:24.320 --> 00:10:29.679 So exercise prescription and adaptability to the technology that's availing itself. 00:10:29.919 --> 00:10:30.720 Yeah, great. 00:10:30.960 --> 00:10:32.159 What about you, Kieran? 00:10:32.480 --> 00:10:33.200 It's an interesting one. 00:10:33.279 --> 00:10:34.639 I thought a lot about this one. 00:10:34.879 --> 00:10:47.279 I often say that I reckon in a team environment where you're dealing with maybe a squad of 40, 40 players and M15 staff, almost like the physical staff, the exercise prescription is key to what you do. 00:10:47.360 --> 00:10:56.639 But that's almost the easy bit compared to dealing with some of the difficult personalities and dealing with some of the difficult players that you might have within your group. 00:10:56.799 --> 00:11:00.639 That skill set is involves maybe having a little bit of a thick skin. 00:11:00.799 --> 00:11:09.279 It's it involves being able to have a conversation and stand your ground with perhaps a coach who is trying to push a player to play when they couldn't or you think they shouldn't. 00:11:09.360 --> 00:11:20.960 And I think it's about as much as you can try to operate, well, the coaches I've worked with in the past, not in the grey and trying to operate in the black and the white, because the senior coaches that I know that are uh successful, the grey's a horrible place to be with them. 00:11:21.200 --> 00:11:22.240 Oh, can you play on the weekend? 00:11:22.320 --> 00:11:30.080 Well, he might be able to play if we maybe no that I like most of them, you'd rather have a yes or a no and you know, stick to conviction wrong or right. 00:11:30.240 --> 00:11:33.679 It's the the wishy-washy in the middle that I think they find difficult. 00:11:33.759 --> 00:11:38.480 So yeah, I think it's it's a real you're in an environment that is very, very blonde. 00:11:38.720 --> 00:11:57.200 You have so many different characters and personalities within that group, and it's the ability to find a way to get the best out of from a physic perspective, their different personalities and coaches and and maintain your sanity through all that and on on top of and look after yourself on top of all that is something that I I reckon's yeah, really important. 00:11:57.679 --> 00:12:03.360 Just to expand on that a little bit more, just around navigating high pressure environments. 00:12:03.440 --> 00:12:09.519 And it's sounding like obviously clinical reasoning is a crucial part of being able to strongly make a decision. 00:12:09.759 --> 00:12:17.759 How do you both clinically and ethically navigate the tension between athlete health and performance pressure, particularly when the stakes are high? 00:12:17.919 --> 00:12:19.759 Perhaps, Kieran, your thoughts. 00:12:20.320 --> 00:12:27.200 If we look at a decision regarding someone playing a match or not playing a match, every decision we make every day is around risk. 00:12:27.279 --> 00:12:31.200 So what are the short-term risks and what are the long-term risks to a player playing with his injury? 00:12:31.279 --> 00:12:44.080 So a player has a lateral ligament sprain of the ankle and it's just happened they've got a big fat, swollen ankle, and they play, they are likely, they might make it a bit more swollen or a bit more inflamed, but they're not probably going to have a long-term problem with that from that. 00:12:44.240 --> 00:12:46.159 With something like concussion, it's very simple. 00:12:46.320 --> 00:12:48.559 There is no, there's no wiggle room whatsoever. 00:12:48.720 --> 00:12:55.200 You follow protocols to the letter of the law, and it actually makes our

lives easier because we just go, well, that's what we do. 00:12:55.279 --> 00:13:00.559 I always look at probably worst case scenario, what's the worst thing that could happen to this player if we play them with this or train them with this? 00:13:00.639 --> 00:13:06.639 And if it becomes something that couldn't impact beyond the short term, it becomes a decision that that's easy. 00:13:06.720 --> 00:13:09.759 And the athlete's at the center of all we of all that we do. 00:13:09.919 --> 00:13:11.600 So I always go back to that. 00:13:11.679 --> 00:13:16.559 Is what, you know, the best interest of the team is one thing, but the best interest of the athlete is the number one. 00:13:16.960 --> 00:13:20.320 Want an easier way to improve your assessment and treatment skills? 00:13:20.559 --> 00:13:28.240 Introducing practicals, where you can watch video recordings showing exactly how top experts assess and treat a range of conditions. 00:13:28.399 --> 00:13:33.039 It's the fastest way to develop your practical skills and enhance your clinical reasoning. 00:13:33.200 --> 00:13:37.679 Treat your patients like the experts do with practicals by Physio Network. 00:13:37.840 --> 00:13:41.039 Click the link in the show notes to try it for free today. 00:13:41.519 --> 00:13:43.279 It's a really strong framework. 00:13:43.519 --> 00:13:44.639 What about you, Matt? 00:13:45.039 --> 00:13:52.799 We're as challenged ethically, really, as as we might think, because I think that often gets taken care of by the players themselves. 00:13:53.039 --> 00:14:08.559 They view scenarios where you know a player is going to put their interests in front of the team, you know, that that's the last thing they're going to do in order to set about playing, taking all risk and letting their team down if if if it didn't pay off. 00:14:08.799 --> 00:14:10.480 So that kind of takes care of itself. 00:14:10.720 --> 00:14:13.679 Equally, you know, coaches, coaches have a lot of ethics as well. 00:14:13.759 --> 00:14:17.200 I mean, they're they'll joke about how their job's on the line, which is true. 00:14:17.519 --> 00:14:24.240 They have very strong connections and relationships with their players because they've got to keep continuing working with them. 00:14:24.320 --> 00:14:31.519 So they're they're not about to put their own coaching interests in front of a player for the long term to the detriment of the long term. 00:14:31.600 --> 00:14:35.120 So, you know, everyone's pretty good at balancing all those concerns. 00:14:35.200 --> 00:14:37.600 And, you know, Karen talks about managing risk. 00:14:37.679 --> 00:14:39.360 I mean, that's exactly what we're doing. 00:14:39.440 --> 00:14:45.919 We're trying to manage risk and provide the player and the coach with the information and the assessment of that risk. 00:14:46.159 --> 00:14:57.200 And players can be a bit naive, you know, particularly younger players, but you know, coaches become pretty savvy and having a real ability to assess those kinds of risks short and long term. 00:14:57.360 --> 00:15:01.039 And the majority of players don't have a lot of regard for their long-term health. 00:15:01.279 --> 00:15:04.720 Perhaps there is some emergence of more considerations for their head. 00:15:04.799 --> 00:15:16.080 With concussion, you know, they are developing some foresight of what the future might look, so which is a very good thing, you know, but they very much disregard their, you know, musculoskeletal health for the future. 00:15:16.320 --> 00:15:26.799 Therefore, we just can provide some information for them and they're going to participate in the decision with them and the coach, usually finding the right position amongst both interests. 00:15:27.039 --> 00:15:37.039 Matt, I remember talking to a coach after we're having a beer one night with a colleague and we're talking about a coach from another team putting pressure on the medical staff that players to play. 00:15:37.120 --> 00:15:40.080 And this coach goes, Oh no, well, you know, I I don't do that. 00:15:40.159 --> 00:15:40.879 That's disgraceful. 00:15:40.960 --> 00:15:41.600 They do things like that. 00:15:41.679 --> 00:15:43.919 And you know, you have that moment where you've spit your beer out. 00:15:44.240 --> 00:15:45.600 What do you mean you don't put pressure on us? 00:15:45.840 --> 00:15:48.399 And he he said, No, I don't put pressure on you. 00:15:48.480 --> 00:15:52.559 I will perhaps question you more deeply when I feel there's not resolving your decision making. 00:15:52.639 --> 00:16:05.919 So if I feel that you're not yes or you're not no, I feel like you're maybe in the grow, then maybe I might question you more around your resistance for your decision because I feel that having worked with you for a some time, we can I can feel that by the way that you present. 00:16:06.000 --> 00:16:11.440 But all in all, I'm just doing it to to check your resolve or never question or or debate your final decision. 00:16:11.519 --> 00:16:18.879 So I uh that was an interesting insight from uh from a from a coach that I probably I probably wasn't expecting you know that that response from him. 00:16:19.039 --> 00:16:21.919 Yeah, and I I think coaches, they're generally all smart. 00:16:22.080 --> 00:16:23.759 They're the often the smarter players. 00:16:23.919 --> 00:16:30.159 They do apply pressure, but they're applying pressure on the decision-making process, you know, to make sure it's valid and thorough. 00:16:30.320 --> 00:16:36.080 And, you know, they do make you question some of the statements or assumptions, decisions you reach. 00:16:36.159 --> 00:16:42.639 And so, and you know, it's a great environment to work in that because you know, it's a great challenge to have someone who can challenge you on that. 00:16:42.720 --> 00:16:47.120 You know, when you think about the clinic, you're not all challenged over a lot of your decisions. 00:16:47.279 --> 00:16:50.960 You know, you you make you make some

decisions and you offer them to a client. 00:16:51.120 --> 00:16:55.679 But here you are in the situations we work in, we've got coaches who really keep us accountable. 00:16:56.000 --> 00:16:57.440 And I think that goes back to part of that. 00:16:57.519 --> 00:17:02.320 I'll talk about before about you know, maybe a soft skill set and the ability to stay resolute. 00:17:02.399 --> 00:17:14.160 And I think that that's often a difficult conversation and often something you just can stick to your guns and and back back your decision making, I reckon that allows you to maintain some longevity in this in this area. 00:17:14.480 --> 00:17:18.079 I think those are some great clinical pearls and non-clinical pearls. 00:17:18.160 --> 00:17:34.880 It's sounding like it really is that blend of strong clinical skills, the relationships, the communication, the way it's said and backing yourself as well, which probably leads into the next question somewhat, which is around the comparison between elite sport and private practice. 00:17:35.039 --> 00:17:45.279 So I'm curious, what has working in elite sport changed about the way you both assess and load and progress musculoskeletal injuries compared to in private practice? 00:17:45.519 --> 00:17:47.039 Kieran, I might get your thoughts. 00:17:47.440 --> 00:18:07.680 I haven't worked in private practice for a long time now, but the luxury of being able to see someone every day and progress an injury almost like you could do it by the hours of the day, you can change what you do from the morning to the afternoon, gives you a, I guess, a big picture view of where an injury looks, whether an injury sort of starts and where it ends. 00:18:08.000 --> 00:18:13.200 It also probably gives you, and this is not in a positive way, a bluntness around how to communicate. 00:18:13.279 --> 00:18:26.000 And potentially if I worked back into a practice, I would find it difficult to perhaps hold my tongue about if someone's going to sore back and perhaps need to do shift some kilos, then you would have to become more delicate that he delivered that. 00:18:26.160 --> 00:18:37.680 So in a negative way, I would find it more difficult to write drop back into that practice work and be able to maintain that level of appropriate communication with people in private clinic who only get to see once a week. 00:18:37.759 --> 00:18:46.559 So I would find it more difficult because you're finding instead of a half an hour every week to get everything you need to get the cross thing in that short period of time would be, in my mind, would would be difficult. 00:18:46.720 --> 00:18:48.240 I I haven't been there for a long time. 00:18:48.319 --> 00:18:50.240 So it would be very interesting. 00:18:50.559 --> 00:18:54.960 I had 20 years out of clinical practice completely. 00:18:55.359 --> 00:19:04.960 So when I when I came back in about five years ago, because I I do a small amount of clinical practice on top of what I do with the giants, coming

back into clinical practice. 00:19:05.039 --> 00:19:06.480 I mean, it was an eye-opener. 00:19:06.720 --> 00:19:08.319 There's positive and and negatives. 00:19:08.480 --> 00:19:21.039 I mean, I feel sorry for some of the older ladies that I first treated because, you know, I think I was whilst I knew I needed to be a little bit certainly a let a lot easier, you know, with my hands and the prescription of my treatment with my hands. 00:19:21.119 --> 00:19:23.599 I was way too aggressive with exercise. 00:19:23.759 --> 00:19:27.680 I didn't pull that back enough, and some of them certainly didn't have a good reaction. 00:19:27.839 --> 00:19:35.839 You know, there there's obviously some adjustments to make, but I think one thing that happens in sport is that you invariably have to find a solution with a player. 00:19:36.079 --> 00:19:40.319 You might have the answer, or if you don't have the answer, you've got to find the answer. 00:19:40.559 --> 00:19:46.640 So that could be ringing Kieran up and saying, you know, I know you had a player with a similar kind of injury. 00:19:46.799 --> 00:19:50.559 Have you got any ideas or thoughts on what I could do with what I'm doing is not working? 00:19:50.640 --> 00:19:51.440 What else have you got? 00:19:51.599 --> 00:19:58.480 You've got all these resources in your networks with sp easy access to specialists, imaging, trying new things. 00:19:58.559 --> 00:20:00.240 So you have to find a solution. 00:20:00.480 --> 00:20:05.279 Whereas in clinical practice, I mean, if if you haven't found the solution, they probably don't come back. 00:20:05.440 --> 00:20:07.119 And so you kind of miss out on that. 00:20:07.279 --> 00:20:11.759 You know, if they're very loyal, you'll be able to pursue and find the solution. 00:20:11.920 --> 00:20:16.799 And so that's a skill you end up having when you work with sport, is that you do know how to find a solution. 00:20:16.960 --> 00:20:20.240 I think you can transfer that with clients and you can say, like, I know this is going to work. 00:20:20.400 --> 00:20:21.839 I'm pretty sure this is going to work for you. 00:20:22.000 --> 00:20:23.039 This is what we need to do. 00:20:23.119 --> 00:20:26.400 And you, you know, you've got a conviction about what you can bring. 00:20:26.559 --> 00:20:35.839 And as long as you temper it enough and adapt it so that you don't, you know, over-prescribe or or too heavy, you know, then you're able to bring that knowledge with you. 00:20:36.079 --> 00:20:49.599 But equally, the positives the other way is that you're seeing a really wide spectrum of injuries, which we have a fairly narrow band compared to what you'd face in private practice in sport. 00:20:49.680 --> 00:21:04.079 There's obviously a lot of variety within what we see, but it's really good for your clinical reasoning skills to be able to practice learning new things with totally different conditions, and then you can bring that to your work with your applet. 00:21:04.480 --> 00:21:08.160 And I'm curious, Matt, probably one for you, just on that. 00:21:08.319 --> 00:21:18.880 Did you find or are you finding your ability to give time frames in the population that's doesn't have the resources perhaps and doesn't have that athletic baseline? 00:21:19.039 --> 00:21:24.079 Do you find you're modifying your time frames of recovery around other parameters? 00:21:24.559 --> 00:21:25.039 A little. 00:21:25.200 --> 00:21:35.839 A little because, you know, perhaps they won't be as, you know, their adherence to exercise or the ability to monitor them as they're training or rehabilitating. 00:21:36.000 --> 00:21:37.440 So I think as long as you temper that. 00:21:37.519 --> 00:21:46.480 But I mean, mother nature is mother nature, so you will have a good sense, a good feel for how long something needs before it's it's ready to take another step. 00:21:46.640 --> 00:21:49.440 And I think that doesn't necessarily vary with healing. 00:21:49.920 --> 00:21:50.640 Apart from age. 00:21:50.720 --> 00:21:54.720 I mean, I think you know, obviously you've got to take that into account for uh for older clients. 00:21:55.119 --> 00:21:59.680 But certainly when you're dealing with the repair process, you know, you you can estimate that pretty. 00:22:00.160 --> 00:22:00.960 Well for sure. 00:22:01.359 --> 00:22:09.920 You can't have a beat biology, you know, and it's uh age dependent, yes, but at the end of the day, it's the healing is the healing and it's it is what it is almost. 00:22:10.160 --> 00:22:13.599 I think that's a really important point on that as well. 00:22:13.759 --> 00:22:20.480 That goes back to what both of you have said, which is around that clinical reasoning and having really sound clinical reasoning. 00:22:20.799 --> 00:22:27.599 I I often say to our young physios as well, like we do have a lot of resources and it's really important if you don't know, you ask someone else. 00:22:27.680 --> 00:22:35.440 So as Matt said, if I I might we had injury that came up today that I our doctor who's many, many years experienced, said, I've never seen this before. 00:22:35.599 --> 00:22:48.960 So we will go and we will ask questions of Matt and other colleagues and just try and find an experience that someone else has said, Oh, you know, we had that, you know, so well, I never like it when our experienced doctor says I've never seen this before because it's yeah, it makes for a challenging case. 00:22:49.359 --> 00:22:56.079 Well, I think that's a nice segue into the next question, which is around those clinical or professional experiences. 00:22:56.240 --> 00:23:02.880 So I'm curious, what has been one of the most challenging situations you've faced in elite sport, either clinically or professionally? 00:23:02.960 --> 00:23:04.799 And what did it teach you, Kieran? 00:23:04.880 --> 00:23:05.839 Perhaps you first. 00:23:06.240 --> 00:23:20.880 There's another example where we had a reading of a hamstring and a coach blamed us for many

years ago for the for the team's loss because you know the star player had really had injured his hamstring in the week of the game, and it was all our fault that you know that he didn't play and we got beat. 00:23:20.960 --> 00:23:41.759 But the the most difficult situation uh that I was professionally in was ironically at Brookvale Oval, and it was it was a rehab running session on the day that they announced the World Cup s final of 2023, and it was with Michael Hooper, who was the incumbent captain, and I knew that he wasn't going to be named into the team that afternoon. 00:23:41.920 --> 00:23:43.920 And he'd been the captain for many years. 00:23:44.000 --> 00:23:50.319 He played 100 tests, he was, I guess, wasn't expected to be there, and I was aware he wasn't going to be going to be selected. 00:23:50.480 --> 00:23:54.319 And we finished our running session on Brook Vellana, which is which is where I go every day now. 00:23:54.480 --> 00:23:58.160 And he said, I shook his hand and we were in camp the next day and said, I'll see you. 00:23:58.240 --> 00:23:59.279 He said, I'll see you tomorrow. 00:23:59.359 --> 00:24:04.240 Hopefully, it wasn't my place to to convey to him that I wasn't going to see him tomorrow. 00:24:04.319 --> 00:24:05.200 And I shook his hand. 00:24:05.359 --> 00:24:07.839 I I don't think I looked him, I couldn't look him in the eye. 00:24:07.920 --> 00:24:09.119 And uh I think I nodded. 00:24:09.200 --> 00:24:11.759 And yeah, it was it was not my place. 00:24:11.920 --> 00:24:14.079 I wasn't the person to convey that information to him. 00:24:14.160 --> 00:24:19.920 But for someone that I'd known for a long time and worked with for more than a decade, it was a really difficult moment. 00:24:20.319 --> 00:24:27.920 And looking back at it, I I would do the same thing again, but it was a situation that that I'll never forget because it I knew what it meant to him to not be there. 00:24:28.079 --> 00:24:34.319 I knew the work that he put in, I knew the sacrifices he's made, and the decision was made, and that's a decision that does know it is what it is. 00:24:34.400 --> 00:24:38.799 But knowing him personally and having worked so closely with your many years, uh was a tough one. 00:24:39.200 --> 00:24:42.480 Want an easy way to improve your assessment and treatment skills? 00:24:42.720 --> 00:24:50.480 Introducing practicals, where you can watch video recordings showing exactly how top experts assess and treat a range of conditions. 00:24:50.640 --> 00:24:55.440 It's the fastest way to develop your practical skills and enhance your clinical reasoning. 00:24:55.759 --> 00:25:00.400 Treat your patients like the experts do with practicals by Physio Network. 00:25:00.559 --> 00:25:03.920 Click the link in the show notes to try it for free today. 00:25:04.319 --> 00:25:07.279 It highlights your integrity, no doubt. 00:25:07.680 --> 00:25:08.559 Yeah, it does. 00:25:08.720 --> 00:25:14.880 If you look at Team First, then no, I

always look at things like that around it's not my story to tell him that. 00:25:14.960 --> 00:25:24.319 And so if it's not my story to tell, even though you know I wanted to say him and and not the others, so just say nod my head and and not look in now, it it wasn't up to me to do that. 00:25:24.480 --> 00:25:30.640 It's not all uh trophies and trophies with losses and it's sometimes a bit more personal than that. 00:25:31.039 --> 00:25:31.839 Absolutely. 00:25:32.079 --> 00:25:33.519 Matt, what about you? 00:25:34.160 --> 00:25:41.200 When you actually think about it, there's quite a lot of sad stories, I suppose, that relate to some of the players you deal with. 00:25:41.279 --> 00:25:59.680 I mean, whether they be clinical problems or selection related issues, and when they inter intersect, you know, we're working for the team, and so you know, we we get to move on pretty quickly, whereas, you know, the player just goes back they go back to their own world and their own bubble and do need to deal with it. 00:25:59.759 --> 00:26:13.359 But you know, one of the most difficult clinical cases I've had to deal with is a former Swans player who who's been very public about his story, but he had an ACL rupture and reconstruction that had a really bad clinical outcome. 00:26:13.440 --> 00:26:24.799 You know, he got sort of halfway through his rehabilitation and was, you know, having some difficulties and like like plenty of ACL rehab journeys sometimes, you know, they would run into a little bit of trouble. 00:26:24.880 --> 00:26:46.240 And we had had cause to re-scan him, and you know, his his graph wasn't taking, and he went on to have this persistent fusion that ultimately was really low-grade infection, you know, that set him stone, set him to trail this need for a rec redo of the reconstruction and then a ongoing failure on multiple accounts after that. 00:26:46.319 --> 00:26:52.720 You know, he ended up being out for four years trying to get on top of his reconstruction. 00:26:52.960 --> 00:26:57.759 And he eventually did do that, got back to play, got back to play at the elite level. 00:26:58.079 --> 00:27:02.720 And then in his in his next game at the elite level, he did his other knee. 00:27:02.880 --> 00:27:08.400 So it was such it was such a horrendous clinical story, and that's his career. 00:27:08.640 --> 00:27:12.880 You know, that was totally his career was consumed by this clinical case. 00:27:13.039 --> 00:27:20.640 And you know, there were there were obviously circumstances in which we could control, but there were many circumstances which we couldn't. 00:27:20.799 --> 00:27:39.359 And you know, it's a really sad situation when someone has to go through that, but he's still kicking along and he he's got a good he's got a great story to tell, and you know, he's an amazing character, so he's able to he's able to use all those experiences, you know, for his own his own gain, but it's still a bad clinical outcome. 00:27:39.680 --> 00:27:40.319 Absolutely. 00:27:40.480 --> 00:27:46.000 And I suppose it's also that intersection of it's it's sport and someone's career as well. 00:27:46.079 --> 00:27:50.000 That's there's large ramifications in many aspects. 00:27:50.400 --> 00:27:59.920 There is, but you work in clinic and there's plenty of people that you know they don't have a good outcome from whatever condition they have, and you know, they they have to get on with life. 00:28:00.240 --> 00:28:04.240 You know, they they may not be not be able to do some of the things that they really want to do. 00:28:04.319 --> 00:28:06.960 They have to change their lifestyle or their sport, you know. 00:28:07.039 --> 00:28:09.279 So in the end, it's not uncommon. 00:28:09.680 --> 00:28:10.400 Absolutely. 00:28:10.720 --> 00:28:19.680 Well that we had we had a player that had a brake perplexus rupture overseas, and sorry, I remember he he enters in the game of footy and he'd been someone I'd known for a long time. 00:28:19.759 --> 00:28:22.319 Um when I first saw him when he came back, that happened overseas. 00:28:22.480 --> 00:28:43.599 He came back maybe six months after it had happened, just seeing that you know one arm thing was paralyzing one arm and he was obviously you know lost a little weight and and he's gone from the you know active one of the world's leading social centres to to the the guy, and I'd only teach him as a young age, just see him in front of you and you know his life's changed so much in an instance, it's it all rings home. 00:28:43.759 --> 00:28:51.359 I think one, how lucky are we able to do what we are and have the opportunity and enjoy the moments of that because it can come crashing down pretty quickly. 00:28:51.519 --> 00:29:03.359 So it was a a sombre moment, but at the same time, it probably was thinking, well, just do it, you know, look around, look at the environment and look at the opportunities you have and and make the most of those because we're a bit different to apply, but it can finish quickly. 00:29:03.599 --> 00:29:05.519 Yeah, gosh, absolutely. 00:29:05.839 --> 00:29:10.640 On that as well, this is probably a more uplifting question as well. 00:29:10.720 --> 00:29:15.200 But what are the moments that remind you why working in elite sport is so special? 00:29:15.359 --> 00:29:17.039 Kieran, perhaps your thoughts. 00:29:17.359 --> 00:29:25.279 I hope that I'm the only bloke from Aruba that's met both Prince William and Prince Harry, but that's uh that's not high on my list of uh achievements. 00:29:25.359 --> 00:29:29.119 It's it's more we had our first game with Many on Saturday night. 00:29:29.200 --> 00:29:42.559 And I try and as I've got a little bit older, just take it, take in a moment like first game of the year, perhaps study, and take a moment to look around and understand that you'll never be at there on that night with that playing group, with that staff group ever again. 00:29:42.640 --> 00:29:43.119 There's that. 00:29:43.200 -->

00:29:48.960 And I know as I get a bit older, just maybe realising and and acknowledging how how how fortunate you are. 00:29:49.119 --> 00:29:51.119 And you know, I always wanted to play sport. 00:29:51.279 --> 00:29:58.559 I mean, I'd love to have been a professional sportsman, but physically perhaps wasn't shifted with anywhere near enough uh qualities to even to even consider it. 00:29:58.640 --> 00:29:59.839 So it's a great way. 00:30:00.000 --> 00:30:03.279 This this profession is a great way to be able to experience all of that. 00:30:03.440 --> 00:30:09.519 Um we went super rugby with the Warrior Tars in 2014, we lost the World Cup final, rugby World Cup final in 2015. 00:30:09.599 --> 00:30:21.839 But if I look at one moment of that, it was it was a player who'd had Nikildi's problem and had had to move on from another team, and we gave him the opportunity, and he'd been to Sweden to see you know the the world's leading attendant and expert over there. 00:30:21.920 --> 00:30:27.440 And after we won the final, in the room, and he thanked he thanked me for my work with him for getting back there. 00:30:27.680 --> 00:30:41.599 Now it was all him, but it was nice to hear that acknowledgement of and tomorrow, Dad, where again you back and you know be grateful for for having the opportunity, acknowledging the the work and the the sacrifices we've made as well. 00:30:41.920 --> 00:30:42.799 Absolutely. 00:30:42.960 --> 00:30:51.119 It's a wonderful thing to be a part of someone's rehab journey and and share in on all of those achievements and goals. 00:30:51.359 --> 00:30:51.680 Definitely. 00:30:51.759 --> 00:30:57.519 And I look, we I'm not a we're a small part of that, but it it's often you don't often get told you're doing a good job in what we do. 00:30:57.599 --> 00:30:58.480 We deliver bad news. 00:30:58.559 --> 00:31:02.880 So if I guess the co-keep on this is when Blake looked at his face, says, Come and tell me something I don't want to hear. 00:31:03.200 --> 00:31:08.000 It's actually good because you you like to sort of work in work in the background and get your work done. 00:31:08.079 --> 00:31:15.039 But it is still nice to hear that because it feels like for me, oh they used to play the Star Wars music in Darth Vade or the bad news. 00:31:15.279 --> 00:31:19.839 I'm gonna walk into the meetings at top, so it's it's nice to it's nice to have some positive feedback. 00:31:20.079 --> 00:31:22.720 Yeah, I don't think coaches like when your number comes up on the phone. 00:31:22.960 --> 00:31:23.599 No, definitely. 00:31:24.480 --> 00:31:26.960 So it's usually you're not ringing them with good news. 00:31:27.119 --> 00:31:29.519 Well, you know, occasionally you are, but not generally not. 00:31:29.680 --> 00:31:35.440 One of the biggest things is we're, you know, we're part of a number of different teams, you know, we're part of the organization. 00:31:35.599 --> 00:31:42.240 And when the organisation wins, it's a great feeling to be

part of an organization when you win the game, when you just win a single game. 00:31:42.400 --> 00:31:47.359 I think you have to respect that it's one game along the journey to try and win the whole competition. 00:31:47.440 --> 00:31:49.680 But you've got to you you're part of the the win. 00:31:49.839 --> 00:31:53.119 So you you enjoy the win with the whole organization. 00:31:53.359 --> 00:31:55.359 And so that's pretty easy because that's win-loss. 00:31:55.519 --> 00:32:04.559 It's really easy to be to recognize and get the reward, you know, top and short lived, because you know, it doesn't take long, but by the next day you're thinking about the next week. 00:32:04.720 --> 00:32:07.920 But then, you know, we'll have wins within our smaller team. 00:32:08.000 --> 00:32:14.319 So as as Kieran mentioned, you know, a player coming back, you know, they they might come back earlier than was expected. 00:32:14.400 --> 00:32:18.480 You know, that's a win, you know, and if you don't celebrate those, then you're missing an opportunity. 00:32:18.640 --> 00:32:22.559 You don't need to be told what you can tell your your colleagues, you know, that's a win for us. 00:32:22.720 --> 00:32:29.200 There's other run-of-the-mill things where being able to keep players playing continuously, that's a win as well. 00:32:29.359 --> 00:32:31.680 You know, it's not always about returning. 00:32:31.759 --> 00:32:35.839 But, you know, if you can get away with a week where no one got hurt, you know, then that's a win as well. 00:32:36.000 --> 00:32:38.319 So I think you've got to be able to you've got to find the wins. 00:32:38.400 --> 00:32:46.960 And, you know, then it comes down to with a player, you know, they they're gonna be setting goals and achievements, whether they're short, short-term rehab or long-term rehab, you know. 00:32:47.039 --> 00:32:56.319 And it's really rewarding working with someone long-term rehab when you when you achieve little milestones, you know, like the first run or the first training session or their first game, you know, even if it's in a lower grade. 00:32:56.400 --> 00:33:02.720 So I love celebrating the wins, whatever they are, because I don't have that many wins on the golf course or whatever myself. 00:33:02.799 --> 00:33:10.400 So Matt, uh one on that and one thing, I guess, from a more clinical perspective, is always trying somebody's out for a long period of time with ACL. 00:33:10.640 --> 00:33:12.400 I try and have a we set a return date. 00:33:12.559 --> 00:33:19.200 You know, you're gonna play round seven against whatever far advanced, and when you hit that date or you know, return sooner. 00:33:19.359 --> 00:33:22.240 But there's nothing I I really am big on. 00:33:22.559 --> 00:33:26.720 If a coach says still a player who's out for a long time when you're playing, and they go, oh no, I don't know. 00:33:26.960 --> 00:33:29.119 I I like them say I'm playing in this date. 00:33:29.200 --> 00:33:31.519 And yeah, if we don't

get there, we don't get there, right? 00:33:31.599 --> 00:33:36.000 But if they don't have a goal, as you said, you know, set up, then I find they can just sometimes drift. 00:33:36.079 --> 00:33:42.880 And I have in the past asked coaches to ask them when they're returning in front of me just to just to check on their clarity and their and where they're at. 00:33:43.119 --> 00:33:50.160 And it's a nice thing when you hit the goals and I said to you, they um often things don't go to plan, so it's it's also it's it's good when they do. 00:33:50.480 --> 00:34:06.960 That's actually another skill set that you probably brush over when you're undergraduate or you're recent a recent graduate is setting goals because pandemic being really, really important to guide your rehab yourself, setting goals with the player or the client. 00:34:07.200 --> 00:34:14.800 And it is like Kieran suggested, you can change them, but you you need to have them because you know they've they'll set themselves otherwise. 00:34:14.960 --> 00:34:17.840 If you don't set it with the player, they'll probably set one themselves. 00:34:18.000 --> 00:34:23.840 And they won't necessarily tell you, you know, I want to be playing by a certain time, I want to be training by here. 00:34:23.920 --> 00:34:26.480 So I think it's really, really important to set them. 00:34:26.639 --> 00:34:31.760 Otherwise, you know, you're just not harnessing the mo that motivation, which is so useful. 00:34:32.000 --> 00:34:45.679 That's when you enter that gray zone as well, if uh coach says to the play when you're playing, and then oh, you know, maybe I'm not sure, you know, maybe this day then again that that answers that sort of not black or white zone, so having a goal and not achieving it. 00:34:45.920 --> 00:34:49.280 I think goal of achieving it earlier is it's like everything in life. 00:34:49.360 --> 00:34:58.079 I think if you you need an outcome and you need something you're working towards, and if you're not working towards something concrete, or as concrete as we can be, then it's it's difficult to make things want to really good. 00:34:58.400 --> 00:35:03.039 Some really nice common themes that you've both threaded throughout today's podcast. 00:35:03.199 --> 00:35:05.440 So thank you for both for sharing. 00:35:05.760 --> 00:35:16.719 It sounds like working in elite sport can certainly look glamorous from the outside, but as today's conversation I think is highlighted really nicely, it requires more than just clinical skill. 00:35:16.880 --> 00:35:25.280 It's it demands goal setting and communication and leadership and that ability to make decisions when the pressure is at its highest. 00:35:25.440 --> 00:35:30.400 So a very big thank you to you both for sharing your insights and your experiences today. 00:35:30.480 --> 00:35:32.880 I think there's plenty of clinical gems from that. 00:35:33.199 --> 00:35:34.000 No problem, as well. 00:35:34.079 --> 00:35:35.199 Thank you for for having me. 00:35:35.360 --> 00:35:36.079 Yeah, thanks, Sarah. 00:35:36.159 --> 00:35:36.559 Thanks for the chat. 00:35:36.639 --> 00:35:39.199 And Kieran, good to good to chat with you.