– Derek M. Hansen –
In today’s world, we tend to rely on innovation and technology to solve our problems, with the simple approaches often lost in the shuffle. We must walk a fine line between being open to new ideas, while at the same time retaining methods and ideas that have been proven to yield results day after day, week after week and year after year. Reproducibility of results should be the standard by which we measure excellence, as opposed to being content with one good game or even one good season. The combination of appropriate innovations and the retention of tried and true methods should be the goal of every high performance sports team, or any organization for that matter. Sounds easy, doesn’t it? Well it isn’t.
Solving problems is not about quick fixes. It is about addressing the key issues that have contributed to the problems, and developing a comprehensive strategy for creating improvement. In addition, good people must be part of the process. When discussing the issue of reducing injuries within a sports team, checks and balances must be in place to monitor the nature, frequency and severity of injuries, as well as the amount of time it takes to get a player back on the field or court. Milestones along the way should be identified and if an athlete is not on schedule, appropriate alternative actions should be identified to help rectify the situation. I am not advocating for rushing athletes back to practice or competition if they are not ready. However, I am proposing that teams institute a global process for evaluating their current approach – involving the entire organization – while not pointing fingers at one isolated cause.
As such, I have identified some potential issues around the current climate of injury management in the high performance sport world. No single factor is at fault for lost games due to injury, but all relevant factors combine to create a situation where injuries can easily cripple a team’s chances to be successful. There are, in my opinion, very effective interventions available to move teams into winning ways. If you have the right players in place, and relatively good coaches, you can simply put the team in a position to win by fielding a healthy team on a consistent basis. Provided below is my list of realities and recommendations on the subject:
1. There is too much emphasis on the mythical concept of “injury prevention.”
We have fallen into the trap of believing we can save almost everyone from injury. There are special routines, protocols and products that are providing the answer to problems that cannot always be solved. The terms “injury prevention” and “prehab” have been thrown around – more often than not – as marketing tools to persuade athletes, coaches and sports administrators to adopt a specific technology or methodology in an effort to sidestep injuries. Yet, by giving people the hope that they can make a difference by implementing these routines and devices, perhaps we are giving them a false sense of security. Despite all of the alleged advances made in “injury prevention” technology in the last 15 to 20 years, injuries are as prevalent as ever. In some cases, individuals would argue that certain types of significant injuries are even more common, particularly ACL and achilles tendon ruptures. Hamstring injuries are still a thorn in the side of most professional sports teams and very little, if any, progress has been made in this area.
If I provide someone with a bulletproof vest and place him or her in a combat situation, I am not naïve enough to believe that it will make this individual invulnerable. I can inform them that the body armour can stop a particular bullet, fired at a specific range from entering their body. Even if the bullet does not penetrate the body, it can still be fatal. And, an individual can still be fatally shot in the face or head. For this reason, bulletproof vests are not classified within the realm of “death prevention.” More appropriately, these vests are used collectively with other techniques to maximize safety and manage the risks of being a law enforcement officer, armed forces member or a combat participant.
Thus, perhaps we collectively need to change our terminology when preparing athletes for the demands of their sports. “Injury prevention” is an unachievable concept in my opinion. Athletes will continue to be injured at all levels of sport, whether by accident or the simple fact that athletes – many times prodded by their coaches – will often push themselves beyond their physiological abilities and capacities. If we simply adjust our efforts to encompass all aspects of physical preparation and effective return-to-competition protocols, there would be an improvement in the number of games lost to injury and, perhaps, even the severity of injuries incurred. However, this involves the coordinated efforts of coaches, physical preparation staff, rehabilitation professionals and medical specialists. Too often, these groups work independently of each other, with athletes passed from professional to professional with very little in the way of communication, humility and/or teamwork involved in the process. Lip service, ego and ignorance cannot be a part of the equation. In the end, it is the athletes that lose out and, ultimately, the fortunes of a team.
2. Decision-making is overly influenced by fear and risk aversion.
I hear about it all the time through my various connections throughout professional sport. An athlete gets injured – whether it is in a game or in practice – and the first thing that happens is everyone runs for cover. An athlete can pull a hamstring, blow out a knee or dislocate a shoulder and people love to point fingers at someone else – as a means of shifting attention away from themselves – and the majority of staff start worrying about job security. While I understand the reflexive human component to this chain reaction, particularly given the sums of money at stake, I would hope that a more progressive and constructive approach was in place to handle such adverse incidents. If an organization does experience a rash of significant injuries, the appropriate way to deal with the situation is to evaluate all facets of sport specific practice, physical preparation, rehabilitation and even surgical procedures. Being proactive and collaborative goes a long way to eliminating finger pointing and building team confidence – similar to what happens in an After Action Review in the military.
However, what I am seeing happen in professional sports is that numerous people are getting gun shy. While I have many personal friends with teams doing their best to fight the good fight, it is getting harder and harder to do the right thing. Strength and Conditioning staff begin to move away from heavy loads, high velocity running and explosive exercise. Some rehabilitation professionals tend to push for physical preparation exercises that should be reserved for general population retirement homes, and also continue this passive approach in their return-to-competition progressions. I see athletes being kept on anti-gravity treadmills and wading pools for far too long, as though they are being prepared for an upcoming moon landing, not 16 regular season games in the NFL or 82 games in the NBA or NHL. Intelligence and common sense are not ruling decision making in all of these cases. Fear is rearing its ugly head and claiming many victims.
Eradicating fear starts at an organization-wide level. Off-season meetings amongst administration, coaching staff, physical preparation staff and medical professionals should be focused on developing a comprehensive, cohesive approach that everyone can sign off on. If there are differing opinions on specific staffing roles, training volumes, exercise selection and rehabilitation progressions, these differences need to be resolved in the off-season, not half-way through the regular season or after a team figures out they are not making the playoffs. Just as no single person should be taking credit for a team’s wins, no single person should be blamed for a team’s misfortunes. As we always hear, “It’s a team game!” Teamwork and integrated approaches must prevail.
3. Practice is Killing Us
A few years ago, I wrote an article entitled, “Specificity is Killing Us.” Well, a new contender has stepped up to the podium, but really it’s not much different. While it would be too easy to insert an Allen Iverson quote about the practice of “practice,” the discussion of the impacts of practice in team sports must be investigated further. It is not uncommon for physical preparation staff members at professional teams to tell me that they have no time or athlete energy to implement proper strength and speed development programs with their players. When I ask what the source of the problem is, the word “practice” always comes to the forefront.
The “practice” factor is more of an issue in sports such as American football and soccer than it is in ice hockey, basketball and baseball. In the latter sports, game frequency and travel can be the confounding factors. But the need to over-prepare can have drastic impacts on levels of accumulated fatigue and, ultimately, susceptibility to injury. Practice durations are set by collective bargaining agreements and other organizational reasons, but have little to do with physiological realities. Tactical objectives always take priority. If a coach is allotted two hours to practice, 99.9% of the time he will make sure the practice lasts no less than two hours. If athletes look slow, tired or sloppy, the solution is almost always “more repetitions… until you get it right.” Because doing more is always better. If teams are going to make a commitment to reduce the amount of time lost to injuries, the composition of practice has to be one of the first places to evaluate and address.
There have been some improvements on the side of science over tradition. NHL teams are re-evaluating the practice of performing early morning skates, diverging from the pronouncement, “Well, that’s how we’ve always done it.” GPS technology is being used on a regular basis by many teams to analyze player movements during practice sessions to determine “training loads”. However, very few of the conclusions reached by GPS evaluations actually result in significant interventions in the organization of practice. As was mentioned previously, tactical objectives take precedence over physiological realities by a significant margin. I am not advocating for coaches to operate as robots, basing absolutely every coaching decision on data, statistics and scientific probabilities. However, integrating both art and science to arrive at the best decisions can go a long way to help the cause of the team. Sometimes, taking the players off the field will help to keep them on the field in the long run.
4. Don’t Rehab Athletes, Train Them
My good friend and veteran physical therapist, Rob Panariello, taught me that rehabilitation is really no different than well-planned and effectively implemented training. This was re-iterated in my recent podcast interview with another physical therapist (and New Yorker) Doug Kechijian. In many ways, training should reflect the abilities – and in some cases, the disabilities – of the athlete, with adjustments made to loads, progressions and complexity of movement. In my mind, rehabilitation should not look much different than conventional training. Obviously there will be times when movement must be broken down and adapted to the circumstances facing the athlete. However, a plan must be in place to move the athlete to more complete movements that transition into the regular training environment (i.e. into the weight room, onto the field or court) as soon as possible.
Additionally, manual therapies and use of modalities can be performed in a clinical setting, but these methods can also be integrated with actual training in a non-clinical setting. I have been a user and advocate of electrical stimulation for over 20 years for use in training environments as part of the return-to-competition process. The results have been profound as compared with doing electrical stimulation and conventional training as separate activities. This is no different for a manual therapy scenario where an athlete receives a specific treatment protocol, and then is asked to perform a run or series of movements on the field. It is exactly than what I learned from Charlie Francis almost 20 years ago when he would combine therapeutic interventions with technical sessions on the track – something he perfected over 30 years ago while working closely with Waldemar Matuszewski.
Finally, we cannot underestimate the psychological value of providing return-to-competition protocols in a non-segregated (i.e. injured vs non-injured) conventional training environment. As soon as you start to treat an athlete like a regular member of the team, you enhance the psychosocial dynamics of the return-to-competition process. Additionally, you can speed up the mental healing that may often be overlooked by classical rehabilitation professionals. However, this type of approach requires an exceptional level of teamwork on the part of both rehabilitation staff and physical preparation staff, with all egos and issues of trust left in the parking lot. Without total integration and buy-in from all parties involved, the full benefit of the team-based approach cannot be fully realized.
5. Adaptation must be driven by profound stimuli that create significant impacts on multiple systems.
How do we make athlete stronger and faster? Most good physical preparation coaches would say that we have to put athletes in a position to move heavier weight and run at higher speeds. In addition, these qualities must be supported by training elements that improve overall work capacity, sport specific skill, flexibility and coordination. However, these individual training elements must be planned and implemented in precise amounts and proportions in order to elicit improvements in multiple systems. This type of approach has significant implications for minimizing the probability of injury during practice and games, but also must be applied on the other end of the spectrum when an athlete is taking part in a return-to-competition process. A given level of high-intensity work must be involved to move someone forward – for the dual purpose of upgrading the “software” of the central nervous system, but also testing and conditioning the “hardware” under real-world conditions. I believe this is why I have had so much personal success with using sprinting as part of almost every return-to-competition case I have been involved with over the past 20 years. The volume of high-intensity work need not be high, but balanced off with higher volumes of low-intensity work to provide support and capacity required for the daily grind.
As I mentioned in the discussion of team practice, if practice loads are resulting in the significant accumulation of fatigue throughout each week and for the entire season, an environment for positive adaptation is virtually impossible. All work is diluted and no high intensity adaptations can be achieved. As we often hear, it is like trying to have a “No Peeing” section of a public swimming pool. There is no way to separate and isolate the side effects of too much work, regardless of the system being challenged. No barrage of recovery and regeneration strategies – much less 10-12 hours of sleep per night – can undo the damage of excessive training loads. This underscores the importance of a “systems-based” approach to planning all aspects of practice, training and rehabilitation that requires buy-in by an entire organization and constant communication and circulation of information.
The intent of this article is not to give the perception that the sports injury problem is easily resolvable with five simple points. It is an exceptionally complicated issue, given the multitude of moving parts involved with all teams. Once teams recognize the complexity of the issue, the steps to moving forward become easier and easier, and the key pieces begin to fall into place. However, chasing injuries with short-term solutions or purchases never results in the desired outcome.
As a side note, I think it is important to point out a realization that I came to a few months ago. I had the opportunity to once again work with one of the most highly regarded actors in film. I have not only witnessed numerous fans approach him and compliment him on the quality of his work, but have also listened to other highly respected actors commenting on how he has influenced them and how he has set a standard of excellence in the film industry upon which others may be judged. Based on what I have seen with my own eyes, have been told by others and through my personal conversations with him, I have determined that he is successful and earned the respect of others because of the following:
• He is passionate about his field, first and foremost. I get the strong impression he would still be an actor if he were getting paid only a fraction of the amount he receives currently.
• He assumes responsibility for his performances and works every day to rectify any perceived deficiencies.
• He sets high standards and expectations for himself and, in particular, everyone around him
• He is exceptionally knowledgeable about his field, and continues to expand his knowledge – beyond his industry – on a daily basis.
• When he doesn’t know something, he immediately seeks out someone that can provide the expertise in that area. He recognizes that operating in this fashion makes him better at his job.
• He knows the his performance alone will not make or break the success of the project, and that he must enlist the combined efforts of the cast and crew to achieve a positive outcome.
I firmly believe that if all members of an organization embodied these qualities, success would come easily and frequently. In the realm of injury management, the points above must be part of the equation for each and every member of the team. There are no exceptions. Excellence is excellence, regardless of your environment.