A vision of high performance sport

 

I recently embarked on a professional development tour of North America, sparked by the inevitable malaise that comes from years and years of working in pro sports. I love my job and my profession and am incredibly lucky and grateful to have worked where I have, but the long hours and short recovery time don’t always allow for that enthusiasm to be re-ignited, to go out and learn from others and see what the world looks like. So, when Oliver Finlay, the concierge of sport, offered me the opportunity of a lifetime to visit Vancouver, Seattle, Las Vegas and LA to see some of the best high performance operators in the world, I jumped at the chance. 

(Top row, left to right): Jeremy Sheppard & Elliot Canton; Andrew Small. (Middle row, left to right): Amy Arundale; Graham Betchart; Nick Pituk. (Bottom row, left to right): Scott Savor; Teena Murray; Per Lundstam.

 

This is a reflection of four key themes that I took from the meetings; Strategy, impact of change, ego and mental performance.

(Top row, left to right): Marc Cleary & Brian Moore; Nicole Surdyka. (Middle row, left to right): Lindsay Shaffer; Sean Muldoon. (Bottom row, left to right): Amber Rowel & Damian Roden; Patrick Ward.

Out of respect for those that provided their time, I would like to acknowledge each and every one of those that met with us but also provide some anonymity & confidentiality to how they operate and what they are working towards. So, for most parts this is a general reflection and synthesis of information. With the odd tip of the cap where appropriate to the exceptional individual work that is being done. So, my thanks go to:

• Jeremy Sheppard (Canadian Sports Institute)
• Elliot Canton (Canadian Sports Institute)
• Andrew Small (Milwaukee Bucks)
• Per Lundstam (Redbull)
• Teena Murray (Sacramento Kings)
• Graham Betchart (NBA mental skills coach)
• Scott Savor (NBA mental skills coach)
• Duncan French (UFC)
• Amy Arundale (Brooklyn Nets)
• Nick Pituck (Cirque du Soleil)
• Katie Perlsweig (Cirque du Soleil)
• Brian Moore (Orreco bioanalytics)
• Marc Cleary (Orreco bioanalytics)
• Nicole Surdyka
• Lindsay Shaffer (Headspace)
• Sean Muldoon (Seattle Sounders)
• Amber Rowell (Seattle Sounders
• Damian Roden (Seattle Sounders)
• Patrick Ward (Seattle Seahawks)
• Sam Ramsden (Seattle Seahawks) 
  

STRATEGY 

We met with a range of disciplines with a range of experience in their current roles; athletic trainers, strength coaches, physio’s, performance directors, mental skills coaches; Ranging from 1 year on the job to entering their 10th year. But we didn’t meet one person that wasn’t aware of their process, where they were going and what challenges they faced. 

The environments that had a tangible feeling of sustainability all had clear and concise visions. Strategies of where they are now and where they need to be. Sounds obvious right? But it’s an easy thing to say and a different thing to do. 

“Build it and they will come”

Graham gave a great analogy that serves this thought well; who will be more successful, the person who tries to chase after the rabbit or the person who plants a field of carrots and sits quietly? The standout environments for me that planted fields upon fields of carrots were the Canadian Sports Institute and Redbull. Because their population within extreme sports have lived a life ungoverned by rules, they are the rule breakers that don’t conform to structure. So applying a regiment schedule that you may see in American Football just wouldn’t work. In very different ways, both organisations planted the carrots and waited. And there was a comfort in this superficial lack of structure because underpinning it were clear objectives and a vision that sat on a level that was detached from the athletes. 

Away from working with the athletes, there were processes about building, developing and sustaining a performance team that again was underpinned by clear strategy and purposeful recruitment. Seattle Seahawks, under the wisdom of Sam Ramsden, stood out as one of the departments that had perhaps been on the longest journey and was now at a point that he was truly comfortable but still had a 3 year progression plan ahead of them. Consistently, performance directors spoke of the time that this took, between 5-7 years was the consensus to establish a harmonious and collaborative performance team. 

At the other end of the journey were practitioners finishing their first year in the job, reflecting on the change around them, the change they wanted to create and how their environment was coping with the change that came with their employment.

CHANGE

Nobody likes change. Unless you are Oliver Finlay and you are studying change management as your PhD. Whether you are trying to implement change or you are a product of the change, it comes with uncertainty and requires an ability to balance and gradually influence. It was interesting to see that everyone had a different approach to this. 

Some people were energised by the positive approach to change at their organisation, whereas others clearly demonstrated signs of “change fatigue” where year on year something operational or structural had occurred and was creating a demotivated approach to change

“what’s the point in getting on board with this when it will probably change again next year” (paraphrased quote amalgamated from a few different conversations). 

The introduction of new staff was a major component of this association with change. And it was interesting to hear how new staff are integrated at different organisations. Take Cirque du Soleil, an environment where every single person has a very different personality and background, from dance, gymnastics, trampoline to military, NFL or academia. As part of the circus family, each individual was celebrated for who they are, no one had to conform. Equally, we were told that a new member of staff is almost expected to know nothing, with a robust and consistent induction period to each show. 

At one end of the scale, we met people who agreed that their philosophy in year one of a new role was to sit and be quiet, to observe and speak when spoken to. To essentially use the year to “be accepted”. At the other end we met people with vast depths of experience that could identify early on where changes needed to occur and how to improve, picking that “low hanging fruit” but on reflection, felt that perhaps too much change at once had been detrimental. 

And this made me reflect on my experiences, having been a contractor that “fills in” or on a 1 year fixed term contract and how that compares to being part of a project on a permanent contract. Going into any role now, I would know what questions to ask of those above me. What are the expectations? Knowing it’s a short term contract means you know to do the quick fixes, but if its permanent, what do year one expectations look like compared to year 3? What changes are necessary and what can be a longer term project. I am forever grateful to a conversation I once had with Dr Ben Rosenblatt who outlined a matrix for change, looking to “traffic light” interventions and opportunities that:

1) would be immediately important

2) would be easy to implement 

3) had greatest magnitude of effect?

Outlining these things and revisiting them regularly helps you to gauge the need for change. Herein lies a thin line, and what side of that line you fall depends on ego.

EGO

An overriding message from the trip was “there is no room in performance departments for ego”.

What you implement, what you decide to change, who you decide to invest your energies in, can not be driven by ego. And here was the deepest level of reflection for me. I would like to think I am not known as having a massive ego, but when I spoke to people much wiser than I, I realised I did have one that perhaps was enough to influence my practice over the years. 

Another gem from Graham, as soon as you feel you have to justify your job, you are onto a loss. The athlete has reached this level without you and, more often than not, will remain there in spite of you. Supporting them doesn’t come from enforcing your beliefs on them, it also doesn’t come from running monitoring systems that serve a purpose to publish your data. The best organisations we visited again had a structure in place to safeguard this. Whether it was a layered approach to implementing a new monitoring system, robustly scrutinised at each level to ask “does this serve the athlete?” Or whether it was an end of season audit to review practice and ask “what have we done and why did we do it?” Both approaches served the purpose to ask, “Am I satisfying myself and my ego or does it benefit the program & the athlete.”

Now, this is a two sided relationship. To have that ability to sit and be patient, to not feel the need to prove your worth, to know where the low hanging fruit is with immediate impact whilst planning the longer term vision, it all requires support from above and around you. Again, those organisations stood out. The Seahawks, UFC under Duncan French, Canadian Sports Institute among many others, all had people at the helm who knew the happiness and development of their staff was crucial to the long term success of the organisation and their athletes. 

MENTAL PERFORMANCE

We all know sport is tough, rarely does it come with the glamour or success that we dreamed before entering the profession. Instead it is long hours, time away from family, missed weddings, flying visits to hotels and long delays in airport waiting rooms. It also has a lot more adversity than it has championship medals. I personally took great motivation from Pep Guardiola’s advice to John Stones: “In football, there are more mistakes than success and you lose more than you win” 

From a medical perspective, I think this can sometimes be overlooked. Its is easy to chase success; a successful rehab, a low re-injury rate, a correct diagnosis after initial assessment, even thinking outside of your department and focusing on team selection and competition results. But focusing on chasing success can mean you aren’t learning from the mistakes.

If the staff are feeling the pinch from the characteristics of sport listed above, or perhaps an injury that doesn’t go to plan, it can be compounded by the fact that the majority of interactions through the day have negative connotations; “I am in pain” “I can’t do this” “why does this hurt”…. no one sticks their head in the treatment room to tell how amazing they feel. 

If you don’t like hearing these questions then you shouldn’t be a health professional. But my point is, if the staff are looking after the players and absorbing or buffering their negativity, who is looking after the staff? 

This was a recurring question we asked of performance directors and of the mental skills coaches we met with. Headspace, in a move that just oozed with everything Headspace stands for, blocks out two 15 minute spaces in the day to ensure staff get some alone time. No meetings can be booked in these times, they are free to meditate and group meditations are encouraged, but equally they can just sit in a quiet room and breath for a small period of time in a busy day. This made me think about its application in sport. Why not? 15 minutes should be achievable, right?

Without having a rigid meditation structure like Headspace, there was acknowledgement of the need to decompress at UFC, where work can intensify over a period of weeks. Duncan made it clear that when the opportunity comes, he encourages staff to go down a gear, take more time and be sensible about energy expenditure. Knowing that they can ramp it up again when the next time comes.  

If you have the opportunity to employ a mental skills coach, or perhaps you are one and you are part of a new team, how are you going to integrate and operate? Oliver himself was able to draw on reflections from a previous role where a proactive approach to build mental skills actually highlighted an unforeseen problem; if you have one mental skills coach, or sports psychologist, and they look after both staff and players, what does the player think when they open up about how they feel and then watch as the sports psych walks straight into the coaching office? One of the mental skills coaches we met actually withdrew themselves from a full time position and intentionally became part time, so that they didn’t become too familiar or part of the furniture, giving themselves some distance become a more intermittent but effective presence. 

Conclusion

I guess the overriding message through this reflection is the importance of a clear vision. Something that is easily articulated, frequently visible and actually lived. This then provides the foundation for who you employ, how they integrate into the team, what’s expected of individuals and the department and ultimately feeds performance of staff and athletes. 

I would be interested to hear people’s opinions or reflections on experiences of change, how you coped, how you were managed and supported. What will you do given the opportunity to influence a department?

Yours in sport,

Sam

 

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Outcome measures: An observation and a reflection

Sports science and strength & conditioning practice is built on a foundation of identifying a problem, testing the problem, applying an intervention and then re-testing to ensure progression. Athletes will buy into fitness testing, injury prevention and subsequent high performance behaviours if they are given the impression that their coach and medical team know what they are doing and things are done with a purpose (Kristiansen and Larsson, 2017). This begs the question whether coaches can justify and clinically reason their battery of performance tests.

When applying a performance measure, understanding of the underlying kinematics is essential to understand the validity of the test to the desired outcome. The OptoJump^tm is a valid tool in assessing a reactive strength via  drop jump (Healy et al., 2016) however what components of the jump is the coach wishing to address? The validity of the tool is the not the same as the validity of the test. For example, reactive strength index (RSI) can be influenced by a reduced contact time (stretch shortening cycle via the musculotendinous unit) or via total jump height (power output throughout the lower limb and nervous system) or a combination of both (Healy et al., 2017). Understanding these mechanisms may influence the instructional bias of technique given by the coach in order to test what is desired.

With complexities over a test like an RSI to something seemingly obvious like a jump, testing for broader components of fitness and multiple movement patterns is much more difficult.

The Yo-Yo intermittent recovery test (IRT) is reported to be a valid measure of fitness and correlates to match performance in football (Krustrup et al., 2003). However, this is an example of a fitness capacity test and in fact correlates to fitness capacity in a match scenario. In field based team sports, there are a large number of variables and complex interactions that all contribute towards “performance” as an outcome (Currell and Jeukendrup, 2008). Krustrup’s conclusion was based on correlated Yo-Yo IRT results to high speed running in a game (>15km.h^-1) with a strong correlation (r=0.58). Overlooking the methodological accuracy of this (pre-GPS, using VHS locomotive assessment retrospectively), the correlation is between two differing metrics. Where the high speed running was recorded over 90 minutes of varying intensities and periods of effort (12 players across 18 different games), the Yo-Yo IRT covered 1.7km in a mean time of 14.7mins with incremental increases in pace dictated externally. For a test to be considered a valid indicator of performance, it should meet the same metabolic demands as the sporting activity (Currell and Jeukendrup, 2008). The Krustrup paper does not make this comparison, instead analysing physiological markers from rest to exhaustion during the Yo-Yo IRT, not exhaustion markers in comparison to game data.

Perhaps semantics, but in fact there should be differential terminology to distinguish “fitness performance” from “athletic” or “sporting performance.” It should be considered that sporting performance is influenced by a large number of uncontrollable and non-modifiable factors that would make any comparison of validity and reliability to outcome measures unfair. Essentially, recreating a competitive environment is near impossible. This raises the question whether we are exercising just to improve test scores or, closing the loop and relating exercises to performance? Does raising the envelope of one, consequently improve the other? Something that we should not only be asking ourselves, but a question we could come to expect from coaches and athletes a like.

Does the research answer this?

It has been suggested that stronger athletes produce faster sprint time, quicker change of direction speeds and higher vertical jump scores when compared to weaker athletes of the same sport (Thomas et al., 2016). Squat jump (r = -0.70 to -0.71) and counter movement jump (r = -0.60 to -0.71) demonstrate strong correlations to change of direction speed (Thomas et al., 2016). Peak force during isometric mid thigh pull was significantly correlated to 5m sprint time (p <0.05) however this correlation was only moderate (r = -0.49). But again, does this correlation transfer into performance if the testing protocol doesn’t accurately mirror sporting performance?

Sprint times over 40m have been shown to decrease following an acute bout of heavy loaded squats, hypothesised to be due to post activation potentiation (Mcbride et al., 2005). Higher squat strength scores also correlate with sprint times over 0-30m (r= 0.94, p=0.001) and jump height (r = 0.78, p=0.02) (Wisløff et al., 2004). Importantly, we know sprint performance tests have demonstrated construct validity to the physiological requirements of a competitive field based game (soccer) (Rampinini et al., 2007), which is ultimately what we are aiming to do; relating performance testing to physiological and metabolic markers from a given sport.

The addition of a jump squat exercise into a training program may help improve 1RM squat and 1RM power cleans (Hoffman et al., 2005). So perhaps yes, there is a perpetuating loop between exercise, tests and performance but the link between them all may not be tangible or direct.

But how do we translate all of these statistics and data sets this to a non-scientific population, as a lot of our athletes are? I’ve developed the following analogy to try and help with this.

 

Solar system analogy:

If we consider that “athletic performance” is the main focus of any intervention, much like the sun at the centre of the solar system. This is the bright light that everything revolves around; media, finance, fan base and support and so on. It could be argued that any intervention we have as coaches will never truly replicate “athletic performance” but should be influenced by it. This influence works both ways, positively and negatively. For example, if we maximally test an athlete before a competition, this will likely have a negative impact on “athletic performance”. Conversely, if we were able to collect data that informed a training program to improve athletic performance, despite not actually replicating “athletic performance” it would (hopefully) have a positive impact. For example, a football game is determined by so many uncontrollable variables that can not be replicated in a gym, but we might identify that a player needs to improve their 5m sprint time which in turn, will benefit performance.

Figure 1: An analogy depicting the relationship between “athletic performance” and controlled interventions / measures. The skill of the coach is identifying which outcome measure or intervention is going to have the greatest influence on athletic performance.

Let’s consider our potential interventions to be orbiting the sun (Figure 1). There is an interaction between the planets and the sun via gravity but they do not have a direct overlap, where the planets do not collide with the sun just as an outcome measure does not truly match sporting performance. We know that larger planets have a greater influence, so as coaches, we are trying to affect the level of positive interaction with “athletic performance”, the gravitational interaction. By influencing links between exercise intervention and outcome measures, we can affect the size of these planets. In turn, this will have a greater interaction with the centre of our solar system, “athletic performance” (Figure 2). Much like the universe, there will be many different solar systems just as there are different sporting codes and contexts, so the skill lies in identifying the most influential planets in your solar system.

Figure 2: The impact of enhancing an intervention or measure on sporting performance, in this case there has been a greater focus and development of the blue “planet” which has changed the interaction with the “athletic performance”

 

A clinical reflection:

For long term injuries, I utilise a continuum to guide return to play (train / play / perform), often these stages are guided by outcome measures linked to goals and aims for stages of rehab. Typically these tests are scheduled in advanced and often follow a planned “de-loading” micro-cycle. This helps with continuity and, as much as you can in sport, standardisation of the test.

A recent case study found me questioning my judgement and to a degree, wondering if my intrigue and curiosity about my rehab plan drove me to test out of sync with the schedule, instead of doing the test for the athletes benefit.

Following a good period of return to train, the proposed testing date previously scheduled clashed with a squad training session. Observational assessment suggested the athlete was coping well with the demands of training and it seemed counter-intuitive to pull them out of training to undertake some tests. A few weeks later, a gap in the daily schedule presented an opportunity to re-test. The test scores were down compared to the previous month, most likely because the athlete had trained in the morning and trained the 4 out of the last 5 days in some capacity. In previous tests, the athlete had come off of a de-load week and tested the day after a day off.

The result:

The athlete began to question their ability and availability to train. They were visibly knocked in their confidence given a drop in scores, despite me being able to rationalise why this could be. Having had the opportunity to feed my own interest and try to prove to myself that a rehab program had worked, the outcome was much worse. I threatened the confidence of a long term injury returning to training, potentially adding doubt and hesitation to their game and I did not get the results I was expecting.

On reflection, given their time out through the season so far, I should have stuck to protocol and tested on the scheduled day (one training session was not going to increase their chances of availability).. or, not tested at all. Instead, i shoe-horned some testing into an already busy schedule. What did I expect given the current level of fatigue?!

Previous results had reached a satisfactory level to return to train and I was now chasing the final few percentages available. To give them confidence? Probably not, as they were training and enjoying the return to train. So perhaps it was just to give myself confidence. An interesting lesson learnt, mostly about myself.

 

Yours in sport,

Sam

Motor learning theories – why should progression stop at physical?

As a younger physiotherapist, I don’t think I ever consciously paid attention to the psychological aspect or power of my job. By that I mean, I didn’t read any research around it – it all seemed a bit wishy-washy and non-tangible. But quickly you realise that a verbal cue that just clicks with one patient turns into a complex dance choreography with another.. “No, I just wanted you to bend you knee.. why are you doing the worm?”

I’ve talked before about the clinical reasoning behind exercise progression and regression and in doing so, I skimmed the surface of the addition of intrinsic & extrinsic stimuli.  So now I want to build on the concepts of motor learning to underpin that exercise progression.

My inspiration for this blog came from a couple of podcasts by the PT Inquest gang, Erik Meira (@erikmeira) & JW Matheson (@EIPConsult). Well actually, first I bought a chinchilla, then I wrote this blog. If that doesn’t make sense, don’t worry. It doesn’t. But listen here (PTInquest).

The gents speak in detail on two particular podcasts about non-linear pedagogy and how this teaching concept & theory of motor learning ties in with implicit learning. I will break down the idea and definitions shortly, but the reason I wanted to blog about this rather than just direct listeners to the podcast, is I feel the motor learning concepts need to be progressed just as much as the physical demands of an exercise are considered.

What are we talking about?

Ok so breaking down some of the terms. Because from first hand experience, these terms can be confusing. Cap in hand moment but, I Published a model to explain exercise progression (here). You will see I have described implicit & explicit learning – where in fact I mean intrinsic and extrinsic. Very different things, here’s why:

Intrinsic exercises – relies on internal feedback mechanisms, such as capsuloligamentous structures – Pancian & Ruffini receptors within joint capsules providing proprioceptive feedback that the athlete is acutely tuned into. A good example is a single leg stand where the athlete is consciously thinking about balance, aware of every movement in the foot & knee, the upper body and arm position etc – those exercises where nothing else in the room matters apart from the mark on the floor you are concentrating on to keep your balance.

The opposite to this are Extrinsic exercises – these revolve around the athlete and their environment. A snowboarder reacting to a sheet of ice after carving through powder, or a downhill biker absorbing the changes in terrain – their thought process is very external. Its about the factors they can’t control. At no point (or at least for an extremely limited time) are they consciously aware of their scapular position or degree of knee valgus, for example.

Explicit teaching – This is probably something that is easy for us to relate to. It’s a teaching technique that most of us are comfortable with because we can achieve quicker short term goals. “I want you to put your feet shoulder width apart” or “keep your knees in line with your second toe during the squat” – very clear instructions that require the athlete internalise their thoughts, suddenly their actions become intrinsic. But we get quick results in line with our (not necessarily their) goals.

Implicit teaching – this is a bit more tricky. It is giving the athlete non-directive instructions with the aim of externalising their thoughts. “When you jump onto that box, I want you to land as quietly as you can” or as the PT Inquest lads say “Land like batman” (in the batman voice). If you are encouraging effective change of direction, Conor always says “Push the ground away with your foot.” We are still giving instructions, but the athlete is thinking about external environment; noise, surface contact etc.

And this is where non-linear pedagogy comes in. Creating learning environments for athletes to explore movement variability. After all, that perfect text-book single leg squat we spent weeks mastering isn’t going to look so perfect on a skier trying to regain their balance. Chang Yi Lee et al (2014) use the example or learning a tennis stroke – comparing linear pedagogy of prescriptive, repetitive drills versus non-linear pedagogy of more open instructions like “make the ball arc like a rainbow.”

Think shoe lace tying – easier to learn with the rabbit going round the tree etc

 

How does this fit into progression?

The ideal scenario is for the athlete to have as little reliance on us as therapists or coaches as possible. We wont be following them around the track, or on the pitch reminding them of their pelvic tilt.

I think the concepts of non-linear pedagogy are brilliant to explore with coaching. Working with young athletes for example that are still developing their motor control and have some fantastic imaginations to tap into.

However with a rehabilitative role, I think we need to be more inclusive of all concepts. Learning of a new task is initially rapid but without the addition of further stimuli it can quickly plateau (Gentile 1998). A rehab program should always be low risk, high demand (Mendiguchia & Brughelli 2011).Consider the pathophysiology and the structures injured. No injuries happen in isolation, if muscle is injured we will have some neural limitations also. The presence of swelling and inflammation decreases cell metabolism along with a decrease in the presence of oxygen; so we can assume that proprioception is reduced and risk of secondary injury is high.

Therefore, following injury, it is always a good concept to assume that skill level has regressed to novice, regardless of the level of athlete pre-injury.

“So whats the knee brace for?”                                             “Well you only had your surgery 2 weeks ago – just being safe”

What if we were to encourage intrinsic, explicit, linear pedagogy exercises in the early stages? We don’t need to be adding external stimuli at this stage. It’s important to internalise in order to rehabilitate proprioception. You can’t safely expect someone to externalise while proprioceptively deficient – as soon as someone can weight bear, we don’t start throwing them a tennis ball whilst stood on a Bosu (I hope!)

As the injury improves and skill levels progress, it is then important to move our instructions towards non-linear pedagogy methods, encouraging extrinsic thinking via implicit instructions. By end stage rehab, our instructions should be “start – stop” and hopefully not much more.

Just as we would progress the demand of physical activity following injury, we should really progress the cognitive demand also – but we need to start from a safe, effective position in acute stages.

Yours in sport,

Sam