On November 16th I gave a lecture at the RCCSS(C)'s Run Faster Conference in Whitby, Ontario. The objective for my lecture was to put forth a therapists viewpoint of treatment integration into a performance enhancement environment whereby my goal was to suggest ways we can make 1% of our interventions 100% better.
I started off by suggesting that every interaction between athlete and therapist is to be considered a “treatment” or more accurately, an intervention. That is, there is always an input - physical or not-physical, conscious or subconscious - with a subsequent output or adaptation by the athlete. Be it passive therapy, exercise intervention or communication, there will always be an after effect of each encounter. It is our job to understand this and do our best to ensure that every adaptation is a positive one.
I spoke about performance therapy - aka performance engineering - and that in a performance enhancement environment, that it may be important for us therapists to be able to wear many hats. Trent mentions this in a recent Q&A, that:
“In many ways, the applied sports practitioner has to become an “expert generalist” being able to link and apply many interventions across many scientific disciplines to optimize performance.” Because we may often need – and therefore know how – to play the role of an associate coach."
I also suggested that everything we do should be athlete centered. That all interventions in a performance enhancement environment will have the end goal of performance enhancement (obviously), cognitive resiliency and injury prevention.
The guiding framework and its application were discussed and in so doing, we must not be a be a slave to our methods. Being athlete-centered will minimize the opportunity for this.
I spoke about three key components of dynamically assessing the athlete: the neuromusculoskeletal, the cognitive integrity, and the physiological. For the neuromusculoskeletal, I generally like to think of assessing along a static-dynamic continuum where I’ll start with watching the athlete in action (dynamic) in order to know what I see and what I don’t see, then progress along the continuum toward the static if I want to know why I don’t see what I don’t see. It is important though, that we have a standard operating procedure to be able to decipher what’s normal, when we expect it to be normal and when we expect it to be abnormal.
Dynamically, I will also want to understand – assess though interaction, observation, etc – the cognitive integrity and resiliency, or mental hardiness, of the individual since mindset always differs between individuals. Understanding athlete physiology is important as well since levels of stress may vary at any given moment in time. Therefore, how we intervene in their current state should be kept in consideration. Athlete monitoring comes to mind when it comes to physiology but in my opinion, just being present should be the top priority.
As I mentioned above, if every interaction we have with, and every intervention we give to, the athlete is considered a stressor that results in adaptation – positive or negative – then we need to “pick our battles” and intervene where we think is necessary rather than all the time. Manual therapy, in particular, can be a negative input on speed/power days or prior to competition if performed either too aggressively or in too high of a quantity. Additionally, we must time our recovery interventions as Joel Jamieson explains in this video.
While many of the attendees at the conference were clinicians who specialize in clinical rehabilitation, part of my discussion was how we can implement traditional rehabilitation exercises into a performance enhancement environment. Especially during warm up and in general strength training circuits. Because whether it be rehab, corrective exercise, or skills coaching, my opinion is that it all falls through the filter of motor learning toward neuromechanical adaptation.
We do need to remember that there are two methods of attacking motor learning: 1) The Hard Disk via direct upload through automated subconscious control and the other; 2) The Working Memory via conscious control. Unfortunately, the latter – internally directed attention - often results in reinvestment (excessive conscious control of one’s skills) and may be more prone to breakdown in automaticity/fluency of performance through such means as paralysis by analysis so we must keep in mind that any of the techniques (physical or verbal) we employ can be positive or negative. And what we don’t want to achieve is paralysis by analysis.
Other methods to foster motor learning that I spoke about were implicit learning, good cueing and effective communication. Implicit learning is essentially presenting information at levels of perception below normal levels of awareness, whereby how we set up our intervention environment takes priority over verbal feedback. Again, verbal feedback can result in overthinking during motor executions and subsequently excessive conscious control of one’s skills. So often, we should STOP telling athletes what to do, LOOK – assess motor skills, and LISTEN to the athletes thoughts.
Effective communication essentially boils down to three main objectives: prevent paralysis by analysis, facilitate an optimal state of mind and readiness, and remove doubt. I shared my thoughts on effective communication through explaining what nocebos were (the same principles apply with Trent's Q&A above) and how we may be creating nocebos in our interventions. Again, we want positive adaptations and while many of us possess highly effective skillsets, it’s less about what we do and more about how explain it. Remember, it’s about the adaptation and it’s about what we leave behind.