Thursday, 17 January 2013

on performance therapy...

Dr Gerry Ramogida with sprinter Christian Malcolm
I'm going to take a little break from the on-going series on 'self-organization' and input, etc., while I share some thoughts on 'Performance Therapy', which I first discussed back in June of last year.

One of the things that the ‘North American Contingent’ (Canadians Gerry Ramogida, Kevin Tyler, Derek Evely, and myself, as well as American Dan Pfaff) brought to the UK three to five years ago was the use of therapy on the side of the track prior to- and during many training sessions.  It has been termed - erroneously, in my opinion - ‘track-side therapy’ (I prefer ‘performance therapy’, for reasons I will discuss later).  

It’s curious to me how this single factor seemed to cause so much controversy here. It may be that is indicative of a larger philosophical difference, that may stem from an ignorance of the system (no disrespect is all ignorance - it is borne out of misunderstanding), a failure on our part to integrate it properly into the culture, or a lack of understanding of high-performance, creativity, and expertise.

Regardless, it has never quite ‘stuck’, so I thought I would share some of my thoughts on why I think ‘track-side’ therapy is an essential factor in the development of the high-performance track and field athlete.

(I think that traditional views on track-side are analogous to traditional views of nutrition, biomechanics, supplementation, sports psychology, etc. - i.e. they are best left for the specialists, and are ‘not a coaches’ problem’).

Performance Therapy can be described as an attempt to normalize-optimize function by integrating the therapeutic intervention into the athlete’s sporting movement - i.e. the warm-up and training session.

Together, the coach, athlete and therapist periodically interrupt training (through manual intervention) whenever a ‘movement dysfunction’ (or particular movement pattern) lies too far outside the athlete’s individual ‘bandwidth of normality’ (or - as I prefer - typicality; for ‘normal’ just doesn’t exist).  

It is important that the integration of all is seamless, and that the athlete-coach-therapist partnership understand the specific goal of these interventions, to which I have identified three:
  1. By integrating mobility and stability intervention (‘the treatment’) into the training environment, we positively affect motor control, and thus can lend a permanence to the intervention that would not exist if these were treated separately. The instant feedback from the treatment leads to a greater kinesthetic awareness of how the athlete's body feels and moves. When the treatment is performed in the clinic separately from the training environment, the athlete often has trouble ‘connecting the dots’, and ‘true’ feedback (both for the therapist and the athlete) is delayed until the next training session.  With performance therapy, feedback is instant.  
  2. A necessary part of the optimization of the training session.  The human high-performance system has often been compared to that of a Formula 1 car;  where continuous ‘treatment’/tweaking is necessary for optimum performance.  Most athletes receive some type of therapeutic intervention prior to a race; why would they then not receive similar intervention prior to an important training session?  Both serve the same purpose (i.e. to optimize the performance).  To perform a therapy intervention prior to a race, and not prior to an important training session is not logical.
  3. Additional information on the ‘state of the athlete’ that can be used by the coach-therapist to better determine the details of the training session.  The more information, and the more directions that the coach-therapist can look from, the more educated decisions that are made.  For example, the athlete may have poor ‘feel’, and report being ‘ready to go’ - the athlete may move well, without visual dysfunction - in effect, everything suggests that the athlete has recovered well from previous session load, and is ready to be loaded again.  However, in many cases - especially at the elite level (where the better the athlete, the better they are able to ‘hide’ such things) - the therapist-coach will identify muscle tonus discrepancies-abnormalities, athlete sensitivities, etc. that paint an entirely different picture. It is with this additional insight that the coach can make a better, and more informed decision regarding the session.  This fact cannot be over-looked.

Performance Therapy is not:
  1. Created to make the athlete ‘dependent’ on the treatment.  Often, therapists and coaches can use such an opportunity to ‘validate’ their reasons for being at the track; not comfortable with the sometime necessity of passivity, they allow their egos to inform their process. Instead, performance therapy is used to hold the athlete more accountable.  With daily intervention, the coach-therapist has constant information about the athlete’s tissue, and can better recommend ‘homework’ (such as stretching, foam and ball rolling, hydro-therapy, etc.) so the athlete can begin to take more responsibility in their preparedness.  The goal of performance therapy is to reduce the amount of time needed on the treatment table - not to increase it.
  2. A replacement for other - more traditional - forms of therapy.   It is not simply moving the treatment room to the ‘track-side’ (thus my issue with the terminology). 
How I outline it, sport therapy can take one of three forms: 
    1. performance-based
    2. regeneration-based
    3. rehab-based
All are necessary components in the health-optimization of the athlete.   Ignoring any of these is fool-hardy for the high-performance coach-athlete, but I feel that ignoring the performance- form is the worst mistake, as a lack of performance therapy leads to an increase in the importance in the other forms (i.e. better performance therapy leads to more efficient movement, better optimization of training session, less systemic load, less movement dysfunction, etc. - all having a positive knock-on effect for regeneration and rehab).

The challenge:
True integration and understanding between athlete, coach, and therapist is essential for performance therapy to work effectively.  All three must understand what the goals are, what the goals are not, and the difference between ‘mechanical-movement dysfunction’ and ‘technical fault’ - as it is often difficult to observe. The distinction between the two is the driver of any intervention: a technical cue for a mechanical-movement dysfunction can only lead to further compensatory patterning; while an acute therapeutic intervention of a technical fault may affect an otherwise finely-balanced mobility-stability equilibrium – each enhancing any injury risk.

It is not a question of whether performance therapy works or not.  It clearly does (again - if it doesn’t, then why do almost all athletes receive pre-race treatment?).  The only question - for me - is who is charged with its implementation?  I have traditionally been heavily involved out of necessity (lack of quality therapists, usually) - as have many others. I have been in situations, though, where I (and the athletes I have been coaching) have had access to quality ‘track-side’ work (for example, the last three years in London, with Dr Gerry Ramogida and Andy Burke).  Even in this situation though, I have found that my occasional input serves a multitude of purposes; the main one being it gives me more information on the athlete’s ‘system’, its response-adaptation to loading, and its ‘readiness’ for subsequent loading.   For this reason, I feel it is imperative that high performance coaches at least have a rudimentary understanding of treatment protocols; and specifically ‘track-side’ - performance therapy.  

I am quite positive if you asked any coach who has applied such work into his practice, if it has made him a better coach, he would reply in the affirmative.  This should be enough for its justification, but I feel it goes deeper than that, and involves the very nature of high-performance, expertise, and creativity generally...

to be continued...

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  1. Great words Stuart! Thank you for this one. I think performance therapy is the missing link in most elite sport programs. Often i see al lot of "strong" men and women but with bad mechanics or a lot of dysfunctions in movement. The treatment they use is based on fixing the painful areas and is mostly done several times a week.

    I feel really blessed with the possibility by meeting Dan and Gerry in 2010 and meeting you and Andy at my visit in Lee Vally last winter. It really inspired me in what i now do as a daily job. I had the same feeling when I met Gray Cook and Kyle Kiesel for the SFMA courses level 1 and 2 in 2010 and 2011. I feel that all you guys did set me on the right track and I am very pleased with that.

    Performance therapy makes sense and I think that this will be the future in sports! In the Netherlands over here its the same thing as the UK. It's new, people don't know it. I have to explain it very often! Like you say " a failure on our part to integrate it properly into the culture, or a lack of understanding of high-performance, creativity, and expertise." I'm hopping between those two aswell. But i feel it as my task to and goal to hold on to the first option: better communication and integrating. I think it takes tim....
    But the most important thing for me is, that some coaches do see the benefits and the most most important: the athletes feel it!

    Better movements/mechanics, better results in technique due too symmetries, flexibility and good motor programming, less issues on strains and pains, better recovery and most of all: stable performance outcomes in meets! And that pays off in confidence and self esteem.

    So thanks again for the inspiration and these words. I'll send it trough to some colleagues over here.
    Maybe in the next 10 years, performance therapy is more common, excepted and appreciated.

    " Don't chaise the pain! "

    Take care, Rogier Ummels

    1. It was great hosting you in LV Rogier...I enjoyed your visit a lot - as I know Dan, Gerry, and Andy did's been a long and slow transition, that many are weary took over a decade of work by a heap of folks for it to be accepted practice in Canada - and this is still only in small pockets - it's the same in the US. As Dan says "these folks can't see the forest for the trees".

      All we can do is keep banging away at what we feel is best practice, and hopefully others will jump on board and it all gains traction (or we find a better alternative, and change our ways)...great job on all your work in Holland. I'm sure we'll run into each other somewhere at a competition this Summer!

      'don't chase the pain' could be a good bumper sticker!

  2. Stuart,

    Any suggestions on how to become better acquainted with performance therapy as a coach? This is something I would like to be able to provide for my athletes but I don't have access to a qualified therapist.


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