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Wednesday, 3 April 2013

The 10 keys to keeping your athlete healthy...a guest-post by Steve Fudge



Currently employed by UK Athletics as Institute sprint coach, Steve Fudge is one of the top coaches in the UK.  Already enjoying some good success with sprinters such as James Dasaolu and Richard Buck, Steve is the epitome of the ‘lateral thinker’.  With expanding interests in therapy, nutrition, philosophy, and neuro-science, as well as a background in strength & conditioning and massage, Steve has been able to successfully apply his studies to the science of his sport.  
At the most recent UK Indoor Championships, Steve was personal coach to the winners of the 60m (Dasaolu) and 200m (Chris Clarke) as well as the 4th place finisher in the 400m (Buck).  Dasaolu then went on to finish in a dead heat with Jimmy Vicaut at European Indoor Championships (he was given 2nd place), with a big personal best time of 6.48, putting him on track for a successful outdoor season and a possible sub-10 second 100m.  
Prior to joining up with Steve (and his former mentor-coach, Kevin Tyler) last year, Dasaolu had spent much of the previous four years injured.  In fact, he had suffered almost twenty injuries in five years.  Like Steve and Kevin, I don’t believe in the term ‘injury-prone’.  Injuries are rarely flukes.  There is always a reason - whether it be poor mechanics, inappropriate programming or loading, or an ineffective medical set-up. Blaming bad luck for injuries is a total cop-out.  
One thing we all struggle with is balancing the fine line between performance and health.  Push a little too hard, and we fall off that tightrope...don’t push hard enough, and we risk sub-optimal adaptation.  With his background and depth of understanding, Steve has an excellent perspective on how to walk this line.  I asked him to share his top 10 keys to keeping a sprinter healthy:


10 keys to keeping an athlete healthy...
A guest-post from Steve Fudge

1. Stress Management 
People get hurt because their system is unable to cope with the level of stress that they are getting exposed to. People never get hurt by accident. Even when something seems accidental, my belief is that the body is smart and finds ways to protect itself from overload. 

2. Multi-dimensionaility of Stress
Don’t get trapped into thinking that training stress is the only type of stress. I always talk to my athletes about the bath tub with several taps coming into it. Each tap represents a different stressor in your life: training; relationships; money; car issues; travelling etc,. The bath tub will over flow if all the taps are on. It is the same with the body. It doesn’t distinguish between stressors. So be very aware of the whole picture around your athlete. 

3. Inappropriate Training Loads
Your athletes will only get hurt because you expose them to inappropriate training loads. If they have a lot of stress going in their life, adjust the training load. If their mechanics are poor, then adjust the training load (until their mechanics improve of course). If they have banged up tissue, adjust the training load. If their joint system isn’t functioning right on that day, adjust the training load. If they have had a long-haul flight two days before, adjust the training load. It doesn’t mean less training. It means using the training options you have in front of you to make sure they survive that particular training day.  You have to accept that certain changes are long-term in nature (mechanical, tissue, joint changes) so in the short-term you have to be very smart in the training loads you expose your athletes to whilst you work on resolving the longer term issues. 

4. Injuries Don’t Happen in Isolation
As appealing as the ‘black swan’ idea is; in my experience it doesn’t really fit the process of injury occurrence. I read once that significant injuries can be like a light bulb going out. With a light bulb you will always get signs that the light bulb is about to go out. Small flickers happen before the light eventually blows. It is the same with injuries. There are a thousand different signals that the body is not coping. Colds, cramps, ground contact quality changes etc,. You just have to be observant enough to read the signs. You also have to be emotionally removed to allow yourself to accept the signs. Conformational bias and denial can lead to you building a picture you want to see. Don’t be that guy. 

5. Healthy Joint Function 
In my experience if the joint system is not perfect then the soft tissue will have to take up the slack. This is bad news. This situation reminds me of the butterfly effect. Small fractions away from optimal joint movement can lead to massive demands placed on the soft tissue.  

6. Quality of Soft-tissue
Work constantly on the quality and capacity of your joint system and soft tissue. This is your insurance policy. We are in the business of producing the largest possible forces in the shortest possible times. This is hard and stressful task. Overload will and needs to happen. But conditioned tissue and joints will be able to deal with things much more efficiently than banged up tissue and poor functioning joints. 

7. Good Mechanics
As above we are in the business of producing the largest possible forces in the shortest possible times. Good mechanics can help you optimise this. And will allow you to be more efficient at doing this. So constantly work on the technical aspects of your event. In the long run, the improved efficiency will also allow you to achieve significantly more training load by reducing the stress on the body. And more training at the appropriate speeds will make you run faster. 

8. Balancing Long-term with Short-term Success
As a coach you have a fine line you need to walk between short-term success and longer-term sustainability and success.  Short term success can be easily achieved with a huge exposure to training load. This will bring with it many injury issues, though. Some people operate on the basis of the people who survive and don’t break are the ones that are going to be successful. Or the season you get through and survive is worth the ones that you don’t. So as a coach you need to decide your philosophy. If you have a huge talent pool, then choosing the short term strategy might be appropriate. In situations of smaller talent reserves then you might need to get your tight rope out and walk the line.   

9. Team around the Team
Be very aware of the team you build around your athletes. Our job is to stress and overload the athletes as much as we can without breaking them. It is a very thin line we have to tread. To help you tread this line you will need the support of a very skilled and sensitive medical team. As a coach take responsibility for establishing roles, creating understanding and developing lines of communication with your team. If problems arise your ability to manage them effectively is completely dependent on the strength of the team you have created, and the collaboration you have encouraged.

10. Develop a Relationship
As a coach, be totally connected to your athletes. Tap into their rhythms. Observe. Reflect. Be patient. Make smart decisions. Make more smart decisions than you make bad ones and you will have a chance. 

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If you would like to reach Steve, you can do so on Twitter: @SteveHFudge

68 comments:

  1. As an athlete and doctor, Steve Fudge's piece indictment of doctors working with athletes saddened me.


    "Medical people will medicalise everyday training responses."
    As an athlete, I know we push our bodies to the limit, and beyond. Exercise physiology differs from the physiology of a hospital patient, so whereas I may be calling intensive care if my patient in A&E had an elevated lactate,if you're having a trackside test, that might be 'normal' for you. Likewise, we understand the demands of training and when it's a niggle versus an injury and how to tell between fatigue and overtraining. It's important to work within the athlete's team, with them and their coach and to communicate with physiotherapy and sports scientists to get this right. For those outside of funded athletics, it is also our role to guide rehabilitation.

    "They will tell athletes they are hurt when they are not. "
    As doctors, medical ethics is taken seriously in codes of individual conduct and in court of law. It is unethical to decide or collude with athlete or team that they are injured if there is another separate reason for their underperformance. But it is also unethical to overlook signs and symptoms that reveal injury or illness that could impact on longterm health as well as an athletic career. This does not mean shutting down the athlete for every niggle. It takes eight to ten more years after medical school to train a doctor who can work with athletes and those of us who choose this route are pretty passionate about doing the best for our patients and making the right call.

    "Sometimes they will scan your athletes to convince them that they are actually hurt. This makes them feel good about their jobs"
    Breaking bad news to an athlete does not make us feel good about our jobs. Telling an athlete their dreams are on hold and watching their hearts break does not make us feel good about our jobs.
    As doctors, it is a fine line between over and under investigating and sometimes concern about the catastrophic potential of a suspected injury means a scan is important to plan the athlete's care. But this is what we train to understand and only a poor practitioner would scan without a strong idea of what they are looking for. Stress fractures are a case in point. They are along a spectrum of bone stress to actual fracture and we need a combination of the athlete's training history, examination and a scan to diagnose. It is much better to diagnose a stress fracture than a devastating full fracture to a tibia or femur because we missed the early signs and no doctor would last long in their job if this were the case.

    The best part about the job is seeing our athletes back on track, whether they're a world champion or a grandmother completing a 5k charity walk. There would be far easier job options out there if this were not an incentive to go to work.

    If certain sports can so assuredly put down medical input, I hope that there will be someone else willing to pick up the pieces of broken dreams and make sure the athlete of the moment is not forgotten about tomorrow. Until then, sports doctors are here to help heal.

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