[Physio Discussed] Injury prevention: what actually works? with Adam Loiacono and Dr Nicol Van Dyk

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Welcome to Physio Discussed, the podcast where we explore the conversations shaping modern physiotherapy, sports performance, and rehabilitation.
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Today's episode is centered around one of the biggest topics in elite sport and sports medicine: injury prevention.
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But rather focusing on the simple protocols or checklist style approaches, this conversation really explores the complexity, uncertainty, and realities of working in high performance environments.
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Joining me are Adam Loyacano and Nicole van Dijk.
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Adam is a sports physiotherapist and performance practitioner with extensive experience working in elite sport, particularly around rehabilitation, return to performance, and integrating rehab into real-world sporting environments.
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Nicole is an internationally recognized sports physiotherapist and researcher whose work has helped shape modern thinking around hamstring injuries, injury risk, and return to play in elite athletes.
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Throughout this episode, we discussed why injuries like hamstring strains continue to persist despite decades of research, and whether injury prevention has become overly reductionist, and how difficult it is to predict injury risk in chaotic sporting environments.
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We also explore the limitations and the pros of screening, the challenge of recreating true sporting demands during rehabilitation, and the balance between objective data, athlete feedback, and coaching context when making return-to-play decisions.
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A big theme running through this conversation is the research and real-world practice, including why many previous prevention strategies struggle to create meaningful changes at population level and what clinicians should actually prioritize both in elite sport and everyday clinical settings.
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This ended up being a really honest and thought-provoking discussion around uncertainty, complexity, and what meaningful injury prevention might actually look like in modern sport.
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You're gonna love this one, there's loads to take away.
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I advise you to grab a pen and paper and a cup of your favourite hot drink and join us in this fabulous discussion.
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I'm James Armstrong and this is Physio Disgust.
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Adam, Nicole, it is great to have you onto the Physio Disgust podcast.
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Today we're gonna be talking about a very broad topic of injury prevention.
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We're gonna get stuck right into that today.
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I'm sure listeners come across this an awful lot.
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Nicole, I'm gonna come to you.
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We were talking just off air for want for a better word, before we started recording about that term, injury prevention.
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So can we zoom out a little bit before we start delving into the nitty-gritty of injuries and whether or not we can prevent them?
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What do you what are we thinking about that term injury prevention?
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If we zoomed out and think about prevention as a whole.
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So what do we mean when we talk about prevention and healthcare?
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In a general sense, we usually talk about removing exposure, right?
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Like that's what we do.
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So we don't we we tell everybody to stop smoking, everybody wears a mask, everybody gets the vaccine.
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So we're trying to remove that exposure to the potential agent that causes the disease, the condition, or you know, the injury.
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But in sport and exercise, we really don't can't do that.
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You know, it's tied to that exposure.
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So we can't tell everybody to stop smoking.
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We're trying to figure out exactly how many cigarettes can you smoke before you tear a hamstring, right?
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That's a very different world we live in.
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So I think we really have to get away from that idea that you know prevention is somehow this like this hill we need to get to.
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I think injuries are just part of sports, you know, and like we need to accept that in a very real way, and that we need to build, and physiotherapists are fantastically placed to work across that whole spectrum.
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You know, if we think about primary prevention, secondary prevention, and tertiary prevention, so we can even break that up into everybody gets something, we're screening for a specific intervention or tertiary prevention, as in rehab and return to play, and the ability to prevent reinjuries or other or subsequent injuries.
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So I really do think we've reframed that narrative.
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And a lot of that has to do with management.
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So, you know, if we think about the old Van Mechelen model, everybody's seen it, the risk of injury sequence.
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That's really a research model.
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But what we're trying to do is understand those elements into those programs that will help athletes be robust, be resilient, and able to handle the stress or the load that's placed upon them.
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And that's really, I think, a better place for us to try and get to.
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I mean, if you think about hamstring injuries, right?
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So I did a bit of math and um we look after the United Rugby Championship injury surveillance.
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And just at our data from last season, the odds of an hamstring injury is about two to 23.
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Right.
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So for every two times it happens, there's about 23 times it won't.
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That's pretty low odds.
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They don't actually happen that often, even, you know, but it's in our mind, it's in our space, and we need to try to like reframe that, I think, a little bit in something we have to manage, athletes we have to build and make resilient, and then deal with it when it happens.
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Boom was talking at sort of uh creating a fear avoidance of injury rather than actually accepting that it's part and parcel of challenging bodies to compete at that highest level and how to become resilient and manage those injuries.
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Yeah, uh indeed.
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You know, I think I'm not saying we should just not we should just accept the status quo, but I do think there is a level of that's actually been proven to be quite successful.
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Hamstring injuries is a great example in a way, right?
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Because people kind of know, and if you've lived through the last two decades, it's the most common injury we see almost across all track and field-based sports.
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Now, it wasn't always, you know, like what would you know what do you want to guess what the most common injury was before hamstrings about two decades ago?
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Uh I won't keep you in suspense, right?
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Ankle sprains.
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I was gonna say ankles.
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I was gonna say ankles.
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Yeah, because like if you're old enough like me, you'll remember that ankle sprains was a big deal, and we had the real trouble.
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And then what happened, right?
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Conditions got better, pitches got better, equipment got better, and we and you know, like to give ourselves a little credit, we actually did a pretty good job in terms of prevention, rehab, and protective interventions.
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So, you know, I'm not sure if the same will happen for hamstrings or not, but I do think that we kind of forget that as the support is now, the demands on players is just enormous.
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You know, like if football is a great example, the amount of football an elite player plays now.
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Now, the funny thing about that is in the 70s it was about the same, but it didn't play every match at the same intensity that they do now.
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You know, like now it's and we demanded of them.
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So there's a real push in terms of player load, player welfare.
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Fifth pro has really been very like an active voice in trying to say, hey guys, we need to just think about this, and I think that is probably where we'll see the greatest effect.
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Absolutely.
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Adam, and from your point of view, you know, working in elite performance environments, do you think sometimes we're trying to solve injuries or prevent them?
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And an actual fact when reality in sports far more chaotic and context-driven?
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I agree with Nicole here that they're just a part of sport.
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And the other thing that Nicole talked about, like going from the 70s to now, like across a lot of different sports, you know, I think back from like the 2010s to 2020s and European football to then even the NBA over the last seven, eight years, just the intensity of play has gone up.
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Yet have we really changed or upgraded how we approach the prevention or management of injuries?
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And then also the match congestion of NBA and NHL here in the United States used to be the epitome of that playing on average three to four games every seven days.
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But now with the multiple fixtures, the multiple tournaments, the I mean, this year being a World Cup year, I mean, your best players in the world are going to play 18 months straight with no real offseason.
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And so you think about not only is it intensity, it's volume, there's just a lot of things in elite sport that no matter how good your programming is, you're just fighting an uphill battle.
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And that's part of like the business and entertainment aspects that come in elite sport that, you know, people try to make money, they want to get paid more.
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So if you want to get paid more, you gotta play more games, right?
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But you it is much more, to your point, chaotic and nuanced than just saying, hey, hamstring injuries are number one most common injury in elite football, elite soccer.
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You know, here's this program, and you're not gonna get hurt.
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It's just not that simple.
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I wish it was.
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But it's just very complex and chaotic.
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And, you know, there's an interesting perspective like on hamstring, too, is like some heard some people in the sprint and trap community talk about how hamstring injuries are also a neurological injury, right?
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You think about the demands on a hamstring, crossing the hip, crossing the knee, an elite athlete having to be exposed to the high velocities of sprinting.
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And then you layer that with fatigue or match congestion.
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Now all of a sudden, was it really a structural biomechanical issue, or was it really that split second neurologic input?
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And all of a sudden, like that just happened to be the thing that gave.
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So we're almost oversimplifying it by using an anatomical point to blame for injury in some respects.
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Yeah.
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I mean, I've come to appreciate, you know, when you're dealing with professional athletes or elite level athletes, they almost all have something that goes when they're under stress or load.
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You know, and some sports have it more consistent across a certain tissue type, right?
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In basketball players, maybe it's tendonopathies, in soccer players, maybe it's hamstrings or calves, in hockey players, it's growing, in baseball players, it's an elbow, right?
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Like just the tissue that gets exposed the most when fatigue sets in or load sets in, that's the tissue, that's the signal, that's the thing we want to point to and say, yep, that's what's wrong.
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When in actuality, it's a much more complex puzzle.
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Not something it can't be solved or can't be managed, but the myopic viewpoint of an anatomical structure being, yep, that's what we have to fix.
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You can have success approaching it that way, albeit it may in the end be incomplete at best.
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I suppose it links really nicely back to what Nicole said about where we looked at the word prevention in healthcare, where we try to then limit exposure.
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Well, what we've already got out of our chat today so far is that in actual fact we're seeing the opposite happening.
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We're seeing more exposure, more intense exposure.
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And then to try and limit the injury, we're looking at a far more, far more complex approach to injury reduction management, or whatever, whatever we're we're calling it.
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It's a really broad thing we're looking at rather than just a tissue that we're gonna focus on.
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If I jump back in there just for a second, I mean, uh, you know, like the problem is the solution, right?
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So we you need to train, you need to run fast.
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And so to run fast, you need to run.
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So what do we do?
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We make athletes stronger and faster.
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And guess what they do?
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They run faster, they push harder.
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They're not going to stay at the same level.
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Their performance goes up, but with that, the risk goes up.
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And that's really what we're doing.
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It's a risk management program.
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So for young practitioners and any practitioner worth their salt, I mean, Adam and I will have bitten our like really like teeth many times.
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Like, just like please get through this next session, because then I know you'll get through the game.
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And you know, that's kind of where I think a lot of that lands is you just kind of have to accept the risk, mitigate against it as as well as you can.
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But then, and then maybe we'll get back to this, but it's really about the person.
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So we're yet to get there, but a poor night's sleep and a bad slice of pizza will probably tear your hamstring way more often than a 5% reduction in your eccentric strength.
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So, you know, it's that holistic view, and we're reductionists because it's easy.
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You know, Martin Boucher is on this crusade that we should stop looking or like hang our hats on our high-speed running exposure.
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He's not wrong in many ways, right?
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It's just easy to look at GPS because it was the technology that got there first, and it's the thing that's easy to gauge.
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Now, I'm not saying we throw it out, that's it's not an either-or situation either.
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Also, it's definite incorporating these different components.
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And man, I don't know how to do that, like other than looking at the individual in front of you.
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And again, you know, I think physios are pretty phenomenal at exactly that.
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It's much more complicated in the team sports versus an individual sport because there's so much, there's so much more that goes into that chaos on the field, right?
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Like basketball is 10 players playing in the smaller space, soccer is 22 playing in a larger space, you know, style of play, tactical decisions, individual differences, right?
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It's it's we love to solve problems, like the Nintendox Physios and healthcare practitioners, great.
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We love to solve problems, create solutions.
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The reality is, you know, the N equal one rings true so much in risk management and quote unquote injury prevention.
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And it's so hard to replicate some of these programmings across different athletes because you can have everyone do the same program and some get hurt, some don't.
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And then they do the same program next year, and the ones that got hurt did it, or the ones that didn't.
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And it's hard to say which one is with Nicole's point, like that slice of a pizza and that that sleep, you know, not to say we need to stop doing what we're doing, but elite sport and team sports really is difficult to pinpoint exactly what was the thing that led to an injury, and it's just understanding what are the general principles and qualities that we know are beneficial for athletes to help reduce that risk, whether that's high-speed running exposure or densities of high-intensity efforts, or it is absolute strength, or it is metrics on force plates or isokinetic, right?
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There are things that the rehab space has figured out for return to play.
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Take those principles, apply it to a healthy athlete, and then at best, you try to manage everything else.
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Well no, accepting that injuries are going to happen.
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And hopefully they don't happen all at once.
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But more than not, you know, a team will get put through the ringer at some point during the season.
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Absolutely.
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So I suppose what really quite good to get into now is maybe contradictory to what we've said already, but what can we do?
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So, what is there out there that we can not necessarily hang our hat on, but start leaning towards that that might help us mitigate some of those risks?
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We've said that actually we need to manage them, accept them as part and parcel of elite sport, and I think as general recreational sport as well.
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But what can we do to try and support athletes to mitigate, reduce the more the chances of injury that can be avoided?
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If that makes sense.
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You know, like to to to first kind of lean into those different narratives, right?
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So there's me, there's we, and there's the, right?
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If I can put it like that.
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So there's my story.
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So it's we we've appreciated, I think we need to get back to case studies, man.
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Like we don't publish them anymore.
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They're so useful, right?
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To compare against.
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And then we have so much data now on the individual that we can build a profile.
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I'm lucky enough to be part of a longevity platform called Cascade Health, and we have elite athletes on our profile too, where we're really trying to build this holistic picture, but of you, right?
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Of the person.
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And so that's a really important part.
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If you have the ability and the resources and the data and the tech, you know, there's some real value in understanding the patterns and trends associated with a person.
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You know, what are the habits?
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What are the things we can look out for?
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And then you have to figure out what to pay attention to, right?
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Like, what is the things to pay attention to?
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That's hard.
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And in the whoop kind of like wearable world we live in now, sometimes there is a lot of noise, right?
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And we we need to understand that better.
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Um, but certainly that helps.
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And then I think at the Wii level, so if you if you don't have that, but you have a team and you could even if you're looking at their exposure as a whole, you know, like that's helpful.
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And understanding where are we really pushing, where are we pulling back, why are there these gaps?
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Can we make something around a team effort in terms of exposure, even as a very simple metric, right?
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That we know is helpful, and maybe we have comparisons for that.
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And then maybe at the the the level, I maybe I've switched them around, but I'll inter I'll intertwine them.
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It's like we know that uh Nordics work, man, just do them.
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You know, like everybody has to do Nordics, and they don't just work to prevent injuries.
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We have fantastic work from Denmark and Germany.
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They make you stronger, they make you faster, they help your performance, right?
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And so does a lot of those exercises.
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And that should be our focus, right?
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We're gonna make you faster, stronger, we're gonna protect your ability to participate, whether you're elite or not, in the sport you love.
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And that's why we're doing these exercises baked into your program, not as this standalone feature, you know, that you do at the end of a session or you know, nobody wants to do that.
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I don't do that.
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Do you guys run?
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Hopefully, we have some runners on the podcast.
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I bet you 99% of people don't stretch before they run.
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I don't.
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And I know, I know I wish I should, but I couldn't be bothered preventing something that hasn't happened.
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Right?
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And that's I think we have to understand that our athletes feel the same way.
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So if we program it for performance, for participation, for protection, potentially, I think we're in a way better space.
00:17:24.799 --> 00:17:28.559
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00:17:50.000 --> 00:17:54.559
It's funny you say, like, if you know how do you implement something that hasn't happened yet.
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I often find some of the athletes that have the highest compliance and best participation in a weight room or in a performance program are ones that have endured some type of surgery because they understand what it took to get them back.
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And then they had an appreciation for every little detail that they had to undergo.
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I mean, I'm working with a female soccer player right now, she's on her second knee surgery, and she is an absolute rock star.
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She knows exactly what to expect.
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She's like, Yep, I know this is gonna suck.
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I have to do this, but she's so much better, having unfortunately had to endure it before.
00:18:32.720 --> 00:18:41.359
But you get an athlete that's never endured something like that before, or an athlete that you're trying to get compliance in the weight room to work on these things that are beneficial, like you said, like the Nordics.
00:18:41.440 --> 00:18:45.119
But until they, you know, that's life's greatest teacher, failure, right?
00:18:45.279 --> 00:18:52.559
Until you fail, until you I hate to use the word sufferers, you know, endure some level of trauma.
00:18:52.880 --> 00:18:57.759
It's hard to emotionally invest into something if you've never felt it or understood it before.
00:18:58.000 --> 00:19:03.039
And so I'm glad I'm as soon as you said that, I said, man, I gotta call this out because I see it day in and day out.
00:19:03.279 --> 00:19:10.400
Some of the best performers in the weight room and participation are those that have just unfortunately had to endure some struggle beforehand.
00:19:10.640 --> 00:19:23.359
And that bleeds right into an appreciation for understanding, hey, I need to hit these benchmarks in my prevention program, not as the means of it's the holy grail.
00:19:23.519 --> 00:19:26.079
If I do this one thing, I'm never gonna get hurt.
00:19:26.400 --> 00:19:32.319
But if I hit these minimum standards, it's almost like from a, you know, you send your car to the mechanic.
00:19:32.559 --> 00:19:40.960
Like you know they're gonna go through that 100, 200 point checklist just to make sure every individual part is where it needs to be.
00:19:41.359 --> 00:19:43.200
That's not saying you're not gonna get in a car accident.
00:19:43.279 --> 00:19:46.799
That's not saying something's gonna break down, but they're reducing your risk of something happening.
00:19:47.039 --> 00:19:47.759
Same thing for us.
00:19:47.839 --> 00:19:58.559
Like if you there is value in that mechanistic myopic view of okay, Nordics are only for hamstrings, but they also can translate to sprinting, they can translate to performance.
00:19:58.880 --> 00:20:06.559
Not saying if you do Nordics, you don't, you're not gonna not get a hamstring injury, but more likely than not, yeah, probably gonna reduce your risk.
00:20:06.799 --> 00:20:29.440
And so from a practical side, my viewpoint, having lived in both the rehab and performance world, you have to have an appreciation that there are minimum standards of strength, range of motion, power, tendon stiffness that should be majority of athletes hitting, regardless of sport, you know, almost like that general physical preparation, if you will.
00:20:29.519 --> 00:20:42.640
And I love the boom of longevity and some of these influencers talking about VOT Max and Nexa scans and grip strength or relative body mass list lifted on a squat, right?
00:20:42.720 --> 00:21:01.039
It's all super important if you pull back that and say, hey, if this is good for everybody to be quote unquote healthy and live longer, shouldn't we kind of take the same perspective and say, regardless of sort, regardless of who you are, like these are the things that we know just help improve your overall health span?
00:21:01.279 --> 00:21:09.359
I would imagine, and I'm led to believe the same is true for performance, probably just at a higher level, if you will, or a higher standard.
00:21:09.599 --> 00:21:18.400
And that's how I've approached this idea of injury prevention and risk mitigation and say, listen, there's I gotta check the boxes, I gotta make sure these baselines are here.
00:21:18.559 --> 00:21:25.359
And I know even if we hit all of these, there's still that integration piece that could lead to an injury.
00:21:25.440 --> 00:21:27.920
Like, is the driver half asleep today?
00:21:28.160 --> 00:21:30.400
Was there someone else on the road not paying attention?
00:21:30.559 --> 00:21:33.759
Was there a banana peel around on the corner like Mario Kart?
00:21:33.839 --> 00:21:34.160
I don't know.
00:21:34.240 --> 00:21:43.200
But there's those things that that could potentially just throw a wrench in the system and really cause that injury, no matter how much you know you invest into preventing or managing it.
00:21:43.440 --> 00:21:45.200
Yeah, and just to counterbalance that, right?
00:21:45.279 --> 00:21:47.519
Sorry, James, like we're going, we're riffing here, right?
00:21:47.599 --> 00:21:51.599
But like, I mean, I think we want to give a shout out to structured programs from the part.
00:21:51.680 --> 00:21:59.839
Like the FIFA 11 Plus, right, works incredibly well at an amateur youth level because there's no structure there or people are resource poor.
00:22:00.480 --> 00:22:06.240
So it's a wonderful warm-up program that we now have pretty good, you know, lab results.
00:22:06.400 --> 00:22:07.279
And it works.
00:22:07.440 --> 00:22:12.079
You know, there's others like that, I think that rugby and other sports have experimented with.
00:22:12.480 --> 00:22:16.319
So I want to give a shout-out to that because I think there is value in those structured programs.
00:22:16.400 --> 00:22:26.480
And if we look at like some of the Olympic work, there's an over like in the last two, maybe three decades, there's about a 50% drop in injuries overall, right?
00:22:26.720 --> 00:22:35.200
Like if you look at the UEFA data and the elite club study in Europe and in soccer or football, there's a around a 50% drop in incidence.
00:22:35.359 --> 00:22:37.440
Hamstrings have kind of stayed the same.
00:22:37.519 --> 00:22:40.079
And so proportionally they've got a bigger share of the pie now.
00:22:40.160 --> 00:22:42.400
And people kind of like tag onto that headline.
00:22:42.640 --> 00:22:55.920
But we've overall, so I think you know, like there is we're not saying that we are not successful, and it's holding that tension between that risk mitigation piece and then managing this stuff when it happens that I think is really important.
00:22:56.079 --> 00:23:01.680
So I just I think it's important you just mentioned that in the wonderful work that a ton of really amazing people have done.
00:23:01.920 --> 00:23:02.640
Yeah, definitely.
00:23:02.720 --> 00:23:05.440
And so it's we it we are seeing reductions.
00:23:05.519 --> 00:23:22.319
That's an interesting stats there, Nicole, that you've mentioned there, that actually overall that we're seeing a good reduction in injuries, but actually hamstrings are staying the same, therefore they appear to be that greater problem, as it were, and a solution needing to fix.
00:23:22.559 --> 00:23:25.519
I'd like to go back a couple of bits there, Adam, that you talked about.
00:23:25.599 --> 00:23:47.119
I thought that linked really nicely into when an athlete's previously been injured and had to go through that hard, arduous rehab that is often needed to return them to play, that they then have that understanding and then tend to be better at understanding and engaging in quote unquote the the injury prevention side of things.
00:23:47.440 --> 00:23:50.400
That also then links Nicole into what you were saying about the you.
00:23:50.799 --> 00:24:00.640
So understanding the individual's needs for certain elements of conditioning and what they need to reduce their in incidence of injury, would you say?
00:24:00.880 --> 00:24:03.119
Yeah, but uh Carly McKay, Dr.
00:24:03.200 --> 00:24:06.079
Carly McKay from Calgary has written a great book.
00:24:06.160 --> 00:24:08.319
I don't think it's got a lot of tension, but it's actually pretty cool.
00:24:08.480 --> 00:24:30.000
The mental side of sports injuries, not the title, like I think we can argue about the title because it sounds like it's outside like of sports, but this idea that you know, if you build an understanding, a resilience, appreciation for, then you really are in a good sh in good shape to you know not only endure when injury happens, you know.
00:24:30.079 --> 00:24:34.960
Phil Glasgow, who's the head of performance support of the IRFU, that's a great way of saying it.
00:24:35.200 --> 00:24:38.000
Rehab is training in the presence of injury.
00:24:38.160 --> 00:24:41.279
I mean, that reframing is so helpful to athletes, right?
00:24:41.359 --> 00:24:46.319
It's like, oh, okay, we're still looking for a stimulus to drive an adaptation to get you back, right?
00:24:46.640 --> 00:24:50.000
We're looking for performance, you're looking for that extra bit of strength, speed, whatever.
00:24:50.160 --> 00:24:53.599
And when you're injured, you're looking for healing and good healing and recovery.
00:24:53.759 --> 00:25:02.319
And so I think that is a really important part of uh, as Adam said, that appreciation, how we build those narratives for athletes leaning into their context.
00:25:02.480 --> 00:25:03.519
Why are we doing this season?
00:25:03.680 --> 00:25:04.400
Do you need a contract?
00:25:04.480 --> 00:25:05.680
Do you want to press your folks?
00:25:05.839 --> 00:25:14.000
You know, you've just had a kid and you want to like make sure there's a like really understanding what's the motivator behind doing your re at five in the morning.
00:25:14.160 --> 00:25:15.279
I mean, that's a big part of this.
00:25:15.359 --> 00:25:19.599
And when once you tap into that, everything else is just a little bit easier.
00:25:19.759 --> 00:25:21.200
I think that is a big part of it.
00:25:21.440 --> 00:25:25.599
Not much more to add other than the the motivation side of it.
00:25:25.759 --> 00:25:35.359
I have found a great success in communicating and educating enough as to the why behind certain things or helping athletes connect.
00:25:35.440 --> 00:25:43.200
Like, hey, there's a reason why we're doing A, B, and C in a training program today, because it ties to what you're supposed to be doing on the field today or on the court.
00:25:43.519 --> 00:25:46.319
It's not coming from a place of I'm trying to tell you how smart I am.
00:25:46.480 --> 00:25:57.759
It's I've learned that when they can appreciate and connect the dots themselves, they're more barred in rather than just showing up and being told what to do and blindly executing something with no real understanding of it.
00:25:57.839 --> 00:26:02.319
Now, don't get me wrong, there are some athletes that prefer that they don't want to think they just trust you.
00:26:02.400 --> 00:26:03.839
That's there are those.
00:26:04.079 --> 00:26:14.720
But more often than not, you I have been able to have better intent, better effort, better quote unquote buy-in by just helping drip those breadcrumbs along, if you will.
00:26:14.880 --> 00:26:16.559
Say, like, this is the reason why.
00:26:16.640 --> 00:26:17.839
And here's where it's going.
00:26:18.000 --> 00:26:20.079
Maybe not today, but maybe you know in a couple of weeks.
00:26:20.240 --> 00:26:27.519
And then there's like, oh, okay, now I understand the importance of this exercise that I don't like to do, or hey, I hate doing, or I don't understand why this is like we have to do this.
00:26:27.599 --> 00:26:28.640
It's not related to my sport.
00:26:28.720 --> 00:26:30.559
Like, there's not a ball on my feet or a ball in my hand.
00:26:30.640 --> 00:26:31.279
Why am I doing this?
00:26:31.359 --> 00:26:32.240
Adam makes no sense.
00:26:32.319 --> 00:26:33.440
And it's like, oh, no, no, no.
00:26:33.599 --> 00:26:36.240
Let's tie it back to something that is meaningful to you.
00:26:36.400 --> 00:26:39.599
And like Nicole said, maybe it's something off the quarter, off the field, right?
00:26:39.680 --> 00:26:45.039
Like, there's all those little things that come down to the, if you will, the art versus science, right?
00:26:45.119 --> 00:26:45.519
You need both.
00:26:45.599 --> 00:26:47.119
You can't have one without the other.
00:26:47.440 --> 00:26:51.519
You also mentioned, Adam, you brought in the tub subject of return to play.
00:26:51.680 --> 00:26:55.519
I thought we can't have this podcast without talking about return to play.
00:26:55.599 --> 00:26:58.480
And to tee it up, we're also going to talk about screening later on as well.
00:26:58.559 --> 00:26:59.839
And we've got to have that in there.
00:27:00.000 --> 00:27:02.880
But return to play protocols, testing.
00:27:03.119 --> 00:27:04.720
What are your thoughts around that?
00:27:04.880 --> 00:27:12.400
How useful they are, and any tips, I suppose, for listeners on your advice on what you should or maybe not be doing.
00:27:12.720 --> 00:27:15.839
I liken this to, you know, everyone has it, everyone nowadays has a has a smartphone.
00:27:16.000 --> 00:27:18.079
You know, here in the United States, almost everyone has an iPhone.
00:27:18.160 --> 00:27:24.640
And so you get on you get on maps and you plug in your destination, you get anywhere from two to four routes to get there.
00:27:24.960 --> 00:27:26.319
Some are longer, some are shorter.
00:27:26.559 --> 00:27:31.200
Protocols and return to play plans are exactly that.
00:27:31.440 --> 00:27:36.960
They tell you where your starting conditions are, and they show you options to get you to the end.
00:27:37.359 --> 00:27:40.079
Now you can get on that drive and all of a sudden there's a car accident.
00:27:40.240 --> 00:27:41.759
Now you got to pivot and take a detour.
00:27:42.000 --> 00:27:45.119
Or there's actually not a wreck anymore, and it's actually faster.
00:27:45.200 --> 00:27:46.480
And so you can adapt.
00:27:46.799 --> 00:27:48.880
But the protocols are a starting point.
00:27:49.119 --> 00:27:54.160
They shouldn't be the holy grail or everything that you should be doing because to Nicole's point, you have to go to n equals one.
00:27:54.480 --> 00:27:59.759
And I'm a huge supporter of the idea like agile periodization or scrum project management, right?
00:27:59.839 --> 00:28:07.680
Like you're constantly embedding testing within your rehab, within your training plans, so that you're getting real-time feedback.
00:28:07.839 --> 00:28:18.079
I think this is what's great about the world of sports science and the performance community is they're constantly collecting data from on pitch or on court to help inform the coaches of, hey, that was too much, that was too hard.
00:28:18.160 --> 00:28:20.160
And you're like, they're making adjustments for the next day.
00:28:20.319 --> 00:28:26.400
Well, the rehab and physio space can do the same thing rather than saying, hey, here's your four-week block, and we're not going to look at anything until four weeks later.
00:28:26.480 --> 00:28:32.400
It's like, no, can you embed a little bit to kind of give you that understanding of your progress?
00:28:32.559 --> 00:28:41.759
So then you know within you can kind of maybe take, you know, a little detour around this back road, or maybe you can bypass this person on the left-hand side and go a little bit faster.
00:28:42.000 --> 00:28:46.480
And so it's a it's this combination of you need those protocols to start somewhere.
00:28:46.640 --> 00:28:52.000
And like to Nico's point, there's been a lot of great people that have helped write a lot of those protocols.
00:28:52.160 --> 00:29:03.519
And then to the N equals one, well, once you get rock and roll and you're two, four, six weeks in, like that protocol got you where you need it to, but now you have to individualize it based on what you're seeing in real time.
00:29:03.680 --> 00:29:18.880
And then you maybe can go faster, maybe you can go slower, but it all comes down to your ability to constantly evaluate within sessions and between sessions, not just these simple benchmarks of every two, four, or six weeks.
00:29:19.039 --> 00:29:22.720
It's how can you make those micro adjustments along the way?
00:29:22.880 --> 00:29:26.880
And I'll put the disclaimer and say, I know that's challenging in the private space.
00:29:27.039 --> 00:29:32.160
I know it's a lot more pragmatic in the team environment when you have multiple touch points.
00:29:32.240 --> 00:29:42.720
But if you're in the private space and in a clinic or in not a team environment, can you leverage some of your exercises as just check-in points?
00:29:42.880 --> 00:29:46.640
Like I'm gonna look at this particular set as a means of how are we doing?
00:29:46.799 --> 00:29:53.759
Or I'm going to embed a force plate testing as part of our program today, just to hey, let's just see how you're doing.
00:29:53.839 --> 00:29:58.480
Let's just see where we're at, rather than only looking at a snapshot on one particular time.
00:29:58.720 --> 00:30:01.119
And Matt, we used to get that question all the time, right?
00:30:01.200 --> 00:30:03.599
Like, what's your criteria for return to play?
00:30:03.759 --> 00:30:07.039
It's like, well, you know, at the end of our react, we do this.
00:30:07.200 --> 00:30:10.559
They've usually done a period of sports-specific training by then.
00:30:10.640 --> 00:30:14.799
And then in stage three, we do this, in stage two, we do this, in stage one, it's this.
00:30:14.880 --> 00:30:16.480
And you earn the right to progress.
00:30:16.640 --> 00:30:23.039
A lot of these criteria now have adapted that criteria-based progression, which I think is the way to go with respect to biological healing.
00:30:23.119 --> 00:30:30.960
I mean, it's a great Arsen Wenger quite maybe a good thing to name Arsen Wenger after Arsenal won the Premier League thanks to um to Man City draw last night.
00:30:31.039 --> 00:30:36.640
But you know, he was asked about all this recovery innovation and like ice baths and beat reduce and whatever.
00:30:36.720 --> 00:30:40.319
And he was like, if you have a muscle injury, it takes 23 days.
00:30:40.480 --> 00:30:42.559
It took 23 days 30 years ago.
00:30:42.799 --> 00:30:44.079
So there's that, right?
00:30:44.160 --> 00:30:47.440
There's a biological healing process we will never get away from.
00:30:47.599 --> 00:30:53.920
But we are optimizing rehab by having these criteria-based progressions and treating the person clinically in front of you, right?
00:30:54.000 --> 00:30:55.519
So that's absolutely crucial.
00:30:55.759 --> 00:31:00.799
And then I then I think the the key pieces that Adam alludes to there too is getting back to your performance, right?
00:31:00.960 --> 00:31:03.119
We know now that I can get you back to playing.
00:31:03.279 --> 00:31:05.279
That doesn't mean you're back where you were.
00:31:05.440 --> 00:31:07.039
And so how do I get you back there?
00:31:07.119 --> 00:31:09.680
And a lot of that is not maybe just strength-based.
00:31:09.759 --> 00:31:14.000
I mean, that there is lots of the mental side of sport that comes into that too.
00:31:14.079 --> 00:31:15.759
And there's a story building around that.
00:31:15.839 --> 00:31:28.000
But yeah, I think it's absolutely crucial that we look beyond single muscle, single metric, single measure, and that we build all those components as much as you can into that return to performance piece.
00:31:28.079 --> 00:31:32.319
And I again, like we're talking about elite athletes, it's true for everybody, right?
00:31:32.559 --> 00:31:36.799
So, and we all like you know, we all have that data now to kind of lean into.
00:31:36.880 --> 00:31:44.000
So if you're running your own private practice somewhere and you have athletes at your practice, like get their Strava profiles, check what they did before they got injured.
00:31:44.160 --> 00:31:47.599
Strava's actually added a physio section to their workflow now.
00:31:47.680 --> 00:31:50.000
So you can load your rehab sessions on the platform.
00:31:50.079 --> 00:31:51.279
I mean, how great is that?
00:31:51.440 --> 00:32:00.160
So I think there's a lot of advantages we can take when we're planning out that journey, as Adam said, through for the athletes up to where they need to be.
00:32:00.400 --> 00:32:14.640
And then I think, really importantly, beyond that, like some fantastic, just genius work from Michael Kiar and Abigail Mackey in Denmark showing that at 30 days post-muscle injury, the cells are still active on the membrane, right?
00:32:14.720 --> 00:32:17.359
Like there's still healing processes happening.
00:32:17.519 --> 00:32:20.000
Most of our hamstring injuries are back by then.
00:32:20.160 --> 00:32:22.640
So our job isn't done when they go back.
00:32:22.799 --> 00:32:32.799
Our job is to make sure that when they go back, they go back and they keep whatever they need, and then they build into those routines, those habits, hopefully healthy habits to maintain that.
00:32:32.880 --> 00:32:35.759
And they're way more willing to participate in that in the future.
00:32:36.000 --> 00:32:37.119
I'm gonna ask a question now.
00:32:37.440 --> 00:32:47.440
This is something personal, but it often comes up into my mind and a question I have around when you often hear that the greatest risk of a particular injury is having that injury before.
00:32:47.920 --> 00:33:01.680
Do you sometimes think or ever think that statistic is there because that return to performance hasn't actually been put into place and they've been returned to play, and then, like you said, there, they've just been left to carry on.
00:33:01.759 --> 00:33:03.680
And maybe it wasn't quite finished.
00:33:03.839 --> 00:33:04.559
But no, you're right.
00:33:04.640 --> 00:33:06.960
Like, I mean, I think there's a caveat to that, right?
00:33:07.119 --> 00:33:08.079
So we've seen it twice.
00:33:08.319 --> 00:33:18.720
When I was in Qatar and my work was on risk factors for hamstring injuries in football, in our first paper, around four seasons, previous injury risk factor, significant result, boom.
00:33:19.039 --> 00:33:21.200
Second paper, two seasons gone.
00:33:21.359 --> 00:33:24.480
No, no previous injury risk factor, no, no significant finding.
00:33:24.799 --> 00:33:26.319
Like, where did this go?
00:33:26.480 --> 00:33:27.759
Like, how is that possible?
00:33:28.079 --> 00:33:37.359
But at the same time, in this very controlled environment at the Qatar Stars League, almost everybody got rehab in our rehab uh randomized controlled trials.
00:33:37.519 --> 00:33:41.279
Whether you were in the intervention or the control group, you got a pretty good deal, right?
00:33:41.359 --> 00:33:43.519
Like you got a really good rehab program.
00:33:43.680 --> 00:33:51.519
We saw that in volleyball in Norway with Professor Roald Barr and his team as well, where ankle sprains as a previous injury risk factor just disappeared.
00:33:51.680 --> 00:33:57.839
So if you do a really good job in rehab, it's actually possible to mitigate that risk way down.
00:33:58.079 --> 00:34:02.480
You know, but but a part of that is when you return, now we don't always have control over that.
00:34:02.559 --> 00:34:06.880
Like sometimes there's loads of reasons, contextual reasons, why an athlete may take that risk.
00:34:07.119 --> 00:34:11.280
So communicating that, understanding that this is a risk, there is a higher chance.
00:34:11.519 --> 00:34:15.519
We've got to do this because it's the final, and you may never play again and let's go.
00:34:15.760 --> 00:34:16.320
Sure, right?
00:34:16.400 --> 00:34:17.679
Like who wouldn't do that?
00:34:18.000 --> 00:34:26.639
But at the same time, even beyond that, making sure that our athletes do get back to what they need or have that adaptation that they need.
00:34:26.800 --> 00:34:28.639
I mean, that's the other really big thing.
00:34:28.800 --> 00:34:31.360
Adam talked about it in the rehab part two, right?
00:34:31.440 --> 00:34:37.440
And I think it's true across Nikolai Bernstein's blacksmith experiment from the 1930s.
00:34:37.599 --> 00:34:41.920
So you looked at blacksmith and where they hit with their hammer, right, as they as they do the motion.
00:34:42.000 --> 00:34:48.400
And the the variability in their movement is insanely high, but they hit the same point every time, right?
00:34:48.719 --> 00:34:56.480
So that expert kind of level ability to build programs for our athletes that have loads of adaptability in them, but we're hitting what we need.
00:34:56.639 --> 00:34:59.440
I mean, that is the mark of a truly great process.
00:34:59.519 --> 00:35:00.719
And and that takes some time.
00:35:00.800 --> 00:35:07.840
I think you've got to admit that that takes time and experience to build, but boy oh boy, your athletes will thank you every time, right?
00:35:08.000 --> 00:35:09.679
It there's just so much value in that.
00:35:09.760 --> 00:35:14.719
And it's needed very often to have that adaptation and ability to adapt in the program.
00:35:14.960 --> 00:35:17.199
Yeah, I love the variability conversation there.
00:35:17.280 --> 00:35:28.960
I mean, nothing, I think nothing also supports that more than like the concept of early specialization in sport versus generalization uh and sport when it comes to you know who becomes world class in the end.
00:35:29.039 --> 00:35:33.360
Uh, I think you know, David, David Epstein has written about that in his book range quite extensively.
00:35:33.440 --> 00:35:36.239
There's been numerous studies and people looking into that.
00:35:36.320 --> 00:35:49.039
And so I think it just goes back again, you know, the blacksmith versus, you know, the blacksmith study versus early specialization, it just goes to show that rigidity within anything is not going to be beneficial.
00:35:49.199 --> 00:35:56.559
And that's where the variability in the motor learning, the programming, just the adaptation, it all just takes time.
00:35:56.800 --> 00:36:05.199
Um, and that's where this idea of return to play, return to performance, return to sport, choose your budget blur.
00:36:05.280 --> 00:36:12.559
I feel like everyone has a different, you know, dogma of which one should be used, or like, oh, return to sport is not the same as return to play or performance.
00:36:12.639 --> 00:36:19.199
At the end of the day, like you're what we're trying to do is just get you back to where you were at previously at minimum.
00:36:19.440 --> 00:36:25.360
And then depending on who you are, where you're at in your career, who you what you want out of your career, do you want to be better?
00:36:25.519 --> 00:36:27.360
Are you trying to be not have this happen again?
00:36:27.440 --> 00:36:29.280
Are you trying to just survive this season?
00:36:29.599 --> 00:36:31.199
It's not as clear-cut as we want it to be.
00:36:31.280 --> 00:36:39.599
And so I just share that perspective of yeah, that pie in the skies we all want everyone to be performing better than they were pre-injury.
00:36:39.920 --> 00:36:50.480
But sometimes the reality is just getting them back to on the field on the court to be able to do things that they need to as part of a professional job or as part of a personal goal.
00:36:50.639 --> 00:36:51.679
Sometimes that's good enough.
00:36:51.760 --> 00:36:56.320
And I think we have to be willing to accept that good enough is sometimes acceptable.
00:36:57.119 --> 00:37:00.719
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00:37:22.800 --> 00:37:26.000
I want to talk about screening because it's something that we hear about a lot.
00:37:26.239 --> 00:37:35.840
And in terms of a way to prevent teams getting more injuries or individuals becoming injured.
00:37:36.079 --> 00:37:39.039
What are your thoughts around how useful screening is?
00:37:39.119 --> 00:37:40.559
Is it as useful as some think?
00:37:40.960 --> 00:37:42.800
Can it be used in a good way?
00:37:42.880 --> 00:37:44.400
And do you think it's sometimes overused?
00:37:44.639 --> 00:37:45.599
Adam, let's start with you.
00:37:45.840 --> 00:37:46.480
We'll go on that.
00:37:47.039 --> 00:37:48.559
Absolutely, it's it's useful.
00:37:48.719 --> 00:37:51.119
How else are you gonna know if something's going awry?
00:37:51.360 --> 00:37:56.159
As I look I liken this to, you know, you go and get your routine physical from your physician, they look at the labs.
00:37:56.320 --> 00:37:58.320
They're not saying they're gonna change anything right away.
00:37:58.400 --> 00:38:00.880
They're just simply saying, well, let's take a look under the hood, see how you're doing.
00:38:00.960 --> 00:38:02.880
Let's, you know, do we need to intervene on anything?
00:38:03.119 --> 00:38:15.280
So the screens, I view them as just a way to let's have a formal assessment that's consistent, that we can measure against, that we can look for potential yellow flags.
00:38:15.360 --> 00:38:16.800
I wouldn't even call them red flags.
00:38:17.199 --> 00:38:20.719
And then you cross-reference that against some standard that you believe in.
00:38:20.960 --> 00:38:24.239
Now, there's a lot of standards out there that I feel are well established.
00:38:24.480 --> 00:38:26.639
If we think, you know, we've been talking about hamstrings a lot.
00:38:26.719 --> 00:38:39.920
So let's say part of your screening tool is lumbopelvic complex and hip internal, external rotation, straight leg raise, and then you're looking at Nordic, you know, eccentric strength on a Nordic, and we have our standards and thresholds.
00:38:40.079 --> 00:38:43.760
Well, if you are sufficient within those standards and thresholds, great.
00:38:43.840 --> 00:38:45.519
This isn't a priority for your program anymore.
00:38:45.679 --> 00:38:46.639
Let's go look somewhere else.
00:38:46.800 --> 00:38:58.400
And so that's how I look at screens as a means of I'm not using a screen to say I'm going to fit you into this box and say you have to have all of these key things and be within all of this.
00:38:58.559 --> 00:39:03.519
I think there's a bandwidth that we have to be willing to accept because it is an entire system.
00:39:03.599 --> 00:39:16.000
And usually, you know, body shapes, archetypes, positional demands, training age, training history, chronologically, all those things add this variability to allow bandwidth to exist.
00:39:16.079 --> 00:39:22.639
And we have to look at that and say, what's our tolerance to that bandwidth being smaller or larger?
00:39:22.800 --> 00:39:32.719
And then leaning into what we has been established from great practitioners, great researchers, great clinicians, as hey, this is what we believe the standard should be.
00:39:32.800 --> 00:39:37.440
You know, I think a great example of this is if you're in team sports as a baseball pitcher.
00:39:37.679 --> 00:39:40.239
If you're in track and field, it's a sprinter.
00:39:40.639 --> 00:39:48.960
We know there is an acceptable range of motion, biomechanics that are gonna be beneficial to both those activities.
00:39:49.280 --> 00:40:10.000
But when you consider baseball pitchers have a variety of different arm lengths, different heights, sprinters, you look at Usain Boltz, who is six foot plus, to say someone that's five foot six, five foot eight, they're gonna have different bandwidths within that screen, if you will, based on the skill they have to do.
00:40:10.400 --> 00:40:13.280
But we've established that acceptable bandwidth.
00:40:13.519 --> 00:40:20.800
And that's where I lean into how I look at screening tools, whether it's movement, performance, return to play.
00:40:20.880 --> 00:40:25.920
Like to me, that's how I implement and utilize those on a day-to-day basis.
00:40:26.239 --> 00:40:28.880
Yeah, I think the utility is the question, right?
00:40:29.039 --> 00:40:32.000
So for a long time, screening was kind of associated with prediction.
00:40:32.079 --> 00:40:36.880
And so we had programs like the FMS, it's really broad value, right?
00:40:36.960 --> 00:40:39.599
But at a broad level, like you can't dig into details there.
00:40:39.679 --> 00:40:43.920
It's not gonna give you more than at that overview, and it certainly won't predict.
00:40:44.000 --> 00:40:51.199
So we I think we've moved away from the idea that I'm gonna find the athlete that will get injured and then I'm gonna focus on him and he won't, right?
00:40:51.360 --> 00:40:53.679
By the way, that's the problem with this stuff for us, right?
00:40:53.760 --> 00:40:59.760
We can't go to the coach at the end of the season and I look at all these athletes, look at all these injuries that I prevented.
00:40:59.840 --> 00:41:01.199
You know, like I need a bonus.
00:41:01.360 --> 00:41:06.480
Like we only get the pressure when there's a lot of injuries in a team, like some of the premier clubs at the moment.
00:41:06.639 --> 00:41:10.320
But screening is valuable, certainly from the data that we've collected.
00:41:10.480 --> 00:41:24.719
You know, looking across our program when we when I was in Qatar at the Ask Law Sports Medicine and Orthopedic Hospital, so we can't predict who will get injured, but about one in every three players had a musculoskeletal issue we followed up on that wasn't reported before we did the screen.
00:41:24.880 --> 00:41:30.960
Now, some of it was really simple, a bit of advice, some of it was an additional test, some of that subclinical pathology.
00:41:31.119 --> 00:41:36.480
So screening is really valuable in that sense, detecting current issues, understanding where you are with what you have.
00:41:36.639 --> 00:41:39.599
So you had an ACL two years ago, a year ago, you had a HAMI.
00:41:40.000 --> 00:41:45.599
Where are we in that process and in that profile and understanding how you're doing overall, I think is really valuable.
00:41:45.760 --> 00:41:47.199
And all the other bits, right?
00:41:47.280 --> 00:41:55.280
Building those relationships with athletes, monitoring those trends and little signals within all the noise you know you have on a daily basis can be really, really valuable.
00:41:55.440 --> 00:42:00.159
So I think there is an enormous reason why we need to continue screening programs.
00:42:00.320 --> 00:42:04.079
And it's another way in which we can serve it, serve our communities, right?
00:42:04.320 --> 00:42:13.679
Outside of the elite environment and make sure we are providing them with ways in which they can lean into prevention in a way that's really meaningful.
00:42:13.840 --> 00:42:24.880
So I'm a big fan, and I think that's the key now is having these programs that are tailored to what your team, your situation, or your athlete may need and what they're trying to achieve.
00:42:25.199 --> 00:42:38.480
In sense you think that actually keeping track of where athletes are throughout the season, for instance, can that lead to us being able to potentially see where someone might become more prone to injury?
00:42:38.800 --> 00:42:39.519
Yes and no.
00:42:39.920 --> 00:42:49.039
Yes, in the sense that you can look at pattern recognition, and if I see these sets of variables, the last time I saw this, X happened.
00:42:49.280 --> 00:42:57.840
And I've been in situations where we've made decisions on player and say, you know what, A, B, and C last time was at this threshold, and something there was a negative outcome.
00:42:58.079 --> 00:43:01.599
And then I've been in the exact same situation, and A, B, and C was there.
00:43:01.760 --> 00:43:17.840
We had a negative outcome, but that didn't happen the second time through because it's so individualized and context specific that it does make it challenging to be able to say with absolute certainty like something is going to happen.
00:43:18.159 --> 00:43:28.480
But I think it comes back to everything we've talked about so far, is just the level of risk and tolerance around those decisions when you have that data.
00:43:28.719 --> 00:43:39.519
And the screening allows you to get that consistent data collection to then be able to over time speak with potentially more confidence in those situations.
00:43:39.760 --> 00:43:50.639
That's where we're leaning into when we consider the ability to manage within a season by just seeing it work and not work and not on anyone's fault or anyone did something wrong.
00:43:50.719 --> 00:43:51.920
It's just that's just what happened.
00:43:52.400 --> 00:43:56.559
If we look at a big medical screening program, so let's think about breast cancer, right?
00:43:56.719 --> 00:44:02.159
So mammograms as a screening tool is incredibly Incredibly effective to detect cancer.
00:44:02.320 --> 00:44:06.159
But the intervention for a positive mammogram is pretty heavy, right?
00:44:06.320 --> 00:44:08.719
You're potentially getting a mastectomy.
00:44:08.800 --> 00:44:15.119
Now we could cure breast cancer tomorrow if all 13-year-old girls got double bilateral total mastectomies.
00:44:15.360 --> 00:44:18.400
But that's a pretty horrible world to live in, and that would be a massive expense.
00:44:18.480 --> 00:44:20.159
I mean, we don't have the money to do that.
00:44:20.320 --> 00:44:22.320
So, but our what's our interventions?
00:44:22.480 --> 00:44:25.039
Our interventions are pretty simple, they're pretty cheap.
00:44:25.199 --> 00:44:28.400
You know, there's single-leg hops and naudic exercises and warmups.
00:44:28.559 --> 00:44:31.840
I mean, we really should lean into our interventions as a whole.
00:44:31.920 --> 00:44:37.199
So I'm not saying you need to do screening before you get an intervention, and not in our world, for sure or not.
00:44:37.360 --> 00:44:41.760
But screening adds that next level of understanding where I can intervene.
00:44:41.920 --> 00:44:42.960
How can I make you better?
00:44:43.119 --> 00:44:47.280
And again, tying that into you as a holistic performer, right?
00:44:47.440 --> 00:44:51.199
Like, where do we make sure that we're addressing everything we can?
00:44:51.440 --> 00:44:57.199
The other thing that I think we should also differentiate is overuse injuries versus index injuries or acute injuries.
00:44:57.360 --> 00:45:01.679
So Ben Clarsten and the folks at the OSDRC developed the overuse questionnaire.
00:45:01.760 --> 00:45:04.960
And you look at the data from Norway, it's not a perfect tool, right?
00:45:05.119 --> 00:45:08.079
But there's really good ways to then look at those trends.
00:45:08.159 --> 00:45:12.400
So when does your tendonopathy, like that you're dealing with and you're managing, become an issue?
00:45:12.559 --> 00:45:13.599
When is it painful?
00:45:13.760 --> 00:45:17.599
And when do you keep it like below the surface so you can actually do what you need to do?
00:45:17.760 --> 00:45:30.400
So there's also that that ability to look at chronic ongoing issues that athletes deal with from a monitoring perspective, even with something as simple as the OHCRC tool, that's really useful in terms of a screening program.
00:45:30.800 --> 00:45:31.840
Brilliant, brilliant.
00:45:32.079 --> 00:45:35.920
Right, we're coming in towards the end of our time now.
00:45:36.320 --> 00:45:44.639
So I thought it'd be really nice now to come to each of you to give some pearls of wisdom to the listeners now and to kind of sum up this.
00:45:45.199 --> 00:45:57.599
If you were to give listeners some real key takeaways in terms of uh their perspective of injury, we're gonna call it injury prevention, and things to take away into clinic.
00:45:57.760 --> 00:46:02.960
What would you say to newly qualified and experienced clinicians listening?
00:46:03.199 --> 00:46:04.239
Adam, we'll start with you.
00:46:04.559 --> 00:46:09.039
In terms of injury prevention, that sounds great.
00:46:09.599 --> 00:46:15.360
The reality is you're trying to manage a bunch of variables and lower their risk.
00:46:15.599 --> 00:46:50.800
So if the young clinician has to really understand who's in front of you and what the demands are once they're trying to get back to what they're doing, and reverse engineer that and understand what are the constituents or the parts that can help this person be successful, and then create your checklist of what am I going to evaluate these parts again to just determine if I feel confident that they that this part, this muscle, this joint, this range of motion, this movement is adequate enough where it's no longer a threat to injury.
00:46:51.039 --> 00:46:58.800
And then you you start to create your hierarchy of what's most important on a priority list for your athlete, for your individual.
00:46:58.960 --> 00:47:03.039
And then that helps you write that n equals one program.
00:47:03.280 --> 00:47:15.039
And if you have someone coming in for the first time and you don't have that longitudinal data, you don't know what to do with them, well, then you can lean on to the to the mass studies and the generalizations and these programs that we've come out with.
00:47:15.119 --> 00:47:17.039
Like, for example, the FIFA 11 Plus.
00:47:17.280 --> 00:47:18.960
Well, if you're a soccer player, what do we know?
00:47:19.119 --> 00:47:23.920
Probably need to do the Nordics, probably got to do some Copenhagens, probably got to work on some single-leg hops, right?
00:47:24.000 --> 00:47:25.199
And that just is the starting point.
00:47:25.280 --> 00:47:28.960
And then as you start to work with them and evaluate them more, you can refine it a little bit.
00:47:29.119 --> 00:47:47.280
So to summarize there, it's understand where you're going, break it down into digestible tasks or exercises or interventions, if you will, and then lean into the general data or the normative data.
00:47:47.360 --> 00:47:53.360
Excuse me, that was the word I was looking for, the normative data to help you start somewhere, and then you just refine it as you go.
00:47:53.599 --> 00:47:56.239
One of my favorite quotes, right, is from Mike Tyson.
00:47:56.320 --> 00:47:56.559
Right.
00:47:56.639 --> 00:47:59.360
So everybody's got a plan until they get punched in the face.
00:47:59.599 --> 00:48:00.719
I think that's so true.
00:48:00.800 --> 00:48:08.559
So when I think injury prevention, I'm thinking, how do I create robustness and resilience in the in this person that I'm helping, right?
00:48:08.719 --> 00:48:12.880
How do I make you able to take the punches and to get up when you get hit?
00:48:12.960 --> 00:48:13.199
Right.
00:48:13.280 --> 00:48:20.000
That's really, I think, where we should be putting that injury prevention frame into risk management and robustness.
00:48:20.239 --> 00:48:21.760
I really like the idea of that.
00:48:21.920 --> 00:48:28.320
So I'm going to encourage folks to really consider how they reframe their approach to injury prevention in that way.
00:48:28.559 --> 00:48:29.360
There's two things.
00:48:29.519 --> 00:48:31.519
It's still evidence-based practice, you know.
00:48:31.599 --> 00:48:33.440
So there's still those three components, right?
00:48:33.519 --> 00:48:35.440
There's the research, and we need more of it.
00:48:35.519 --> 00:48:37.679
And we need clinicians to drive that.
00:48:37.840 --> 00:48:49.360
The gap is that we're still waiting for people doing their master's or PhD, and I'm one of them, to finish their degrees before, like we need clinicians and clinics and teams to drive that, and it's happening.
00:48:49.599 --> 00:48:50.559
So that's the one thing.
00:48:50.719 --> 00:48:54.079
And then I think that there's your experience.
00:48:54.239 --> 00:49:02.000
Don't discount how valuable it is to do this on a day-to-day basis and lean into that intuition you build as a clinician.
00:49:02.239 --> 00:49:06.400
And then there's the player preference, it's the individual, it's the human in front of you.
00:49:06.480 --> 00:49:12.559
And make sure you're always attaching your program, your prevention, your implementation to that person and their needs.
00:49:12.719 --> 00:49:17.119
You know, and then I think complementary to that, or I want to plug my friend David Clancy.
00:49:17.360 --> 00:49:20.960
He's written this wonderful book called Essential Skills for Physiotherapists.
00:49:21.119 --> 00:49:34.639
And it's just absolutely about how we build those real skills, to use the Seth Godin term, in terms of interacting with patients, with players, with individuals, empathy, listening, wisdom, charisma.
00:49:34.800 --> 00:49:42.159
You know, those are the things that will help you absolutely excel in whatever you're doing as a physiotherapist, certainly injury prevention.
00:49:42.400 --> 00:49:43.199
Marvelous.
00:49:43.440 --> 00:49:47.039
Adam, Nicole, thank you so, so much for your time today.
00:49:47.199 --> 00:49:58.320
It's been a very broad subject, which I think we've really unpicked quite nicely today with some things that listeners can put into practice and certainly start thinking about in terms of that term injury prevention.
00:49:58.480 --> 00:50:00.480
Adam, Nicole, thank you so much.
00:50:00.559 --> 00:50:04.320
Um I'm sure we'll no doubt have you on the podcast again in the future.
00:50:04.559 --> 00:50:05.519
Thank you, Jeff.
00:50:05.920 --> 00:50:06.719
Thank you.