World Class Therapy Review – Part 6

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The final installment is not a crude summary but a reflection of best practices observed by the best internationally. Being firsthand witness to some of the masters, it was humbling to see how much craftsmanship and system based thinking exists when collaboration with great people occurs. So often I have seen coaches limited my medical professionals, coaches ruining the therapy of amazing talents, and coaches stuck or causing problems with the two aforementioned. Without all three cylinders running smooth and dedicated athletes, nobody will be able to crack the code with high performance training and therapy. This is the most important, because it’s far more difficult to get a group of people communicating and working like a well oiled machine, and without the documentation to prove it, it’s hard to repeat.

The most important factor in successful group approaches is infrastructure. I remember before email workouts were faxed or shared verbally on the phone as an athlete, and now with texting and online cameras it seems the world is more mobile and faster. Ironically the same benefits and extensions to coaching are creating problems. Apollo, Edge10, Smartabase, all are early versions of athlete management systems that are painfully expensive, obsolete in innovation, and mysterious in nature to the average coach because of their price point and lack of diffusion in the market. Much better solutions exist, but the question is who will see the data and how are decisions going to be made. With Erik Korem taking over for Kentucky, the question is how big an impact is the change will be with the GPS technology in place? I predict that improvements will be made because when you invest money, people pay attention more. I don’t believe in the metrics coming from Catapult except for raw data, but paying attention to loading during practice is a cultural change.

World Class Therapy is not about hype, but based on results, not just attachment to great athletes. The body with time heals. This is why I hate when such and such a therapy is added to the equation and people assume it was the element that had flavor being the cause of the results. Results must be identified to have statistical impact, or it’s just likely an artifact. Now for best practices:

Annotation must be done consistently and shared openly with the staff regarding all departments. Any walls will create delays and possible additional problems. For example the corrective exercises are often low load strength training and can be done in a lifting program and save the valuable time for manual therapy, something that can’t be done in group settings and requires legal and specific expertise. Or when a strength coach spends hours doing mobility exercises when a therapist can do more with minutes? Roles must be in place or one is overdosing or neglecting problems with the wrong approaches.

Timelines are the most graphic ways to see decision making based on actions and patterns. Some software packages have it, but they are added features to help sell the product, not robust tools that really engage coaches who may not know medical and performance data. Timelines tell stories and help put all layers into one location. I have suggested Tiki Toki to many people trying to get use to basic collaboration work and to help summarize season data. Tiki Toki is free, but it’s good enough to upgrade for a short term solution.

Dashboards should be simple and summarize 5-8 real items through the year. I know HRV is popular but people are allowing one data set to lead them like a dowsing stick and HRV should be used for weekly guidance or when 3 other data points confirm the information. HRV is valuable but some communities, especially domestically, need to calm down. When guys can’t do reverse lunges with 50 pounds or when bosu ball exercises are the norm, we have bigger fish to fry. Dashboards should be running all times and aggregate data. Daily alerts are the most obvious such as pain and illness, and gray areas such as blood analysis and GPS data needs more interpretation.

A master outline of testing and decision making trees should be made in advance. What happens when an athlete shows up out of shape? What is the team philosophy? What happens when an athlete’s rehab fails? What happens when an athlete’s blood analysis shows poor Anabolic Index profiles such as a bad insulin drive and testosterone profile? Do interventions have ways to follow up and evaluate their effectiveness? What is expected of the athlete? Regardless, minimal testing with maximal resolution is expected, or one is just guessing with confirmation bias.

Tensiomyography- Yearly testing combined with medical screening and performance testing can create instant benefit. One is getting fiber estimation and is seeing why athletes may be screening poorly with a Neuromuscular Contractle Pattern than can add reason to why one is not working well. Also, TMG creates functional benchmarks on muscle that are much better than observations and milestones that people are claiming they see. Nerve issues can be mapped, and it can audit a training program as well as the medical results. Those that are frightened of TMG are not worried of the pricetag, but a objective indication of results. The research is there and frankly people are afraid. The best way to kill a tweet conversation? Bring up TMG. Eventually Management and ADs are going to be aware of TMG in the next few years and I expect some different opinions. It’s not going away so it’s best to investigate the research and adopt realistic uses in team settings.

Thermography- Soft Tissue therapy should map issues pre and post practice with cameras with high risk athletes. With less than 30 seconds of documentation, one can see the results of practice and cross validate with TMG or other data points. I have seen a few set-ups that use clever ways to capture data with freestanding cameras with remote capture. Athletes don’t get annoyed because this process is the menu order for massage, and who doesn’t like therapy that helps you feel better? If it’s done randomly athletes get annoyed and are not compliant. The best consultants find ways to make things we know work work well in settings when people don’t want to do things over and over. If athletes can put on Normatec pants and play angry birds, it will work because it’s passive and allows athletes some distraction. Boring fails in group or team settings.

Note: One of the problems with Thermography is it is deceptively simple and much protocol and backend is needed. It’s not point and shoot and find where’s Waldo. If one wants to do it I suggest cloud software from Equine Sports.

Medical Imaging – Sonic imaging is key as it doesn’t cost huge amounts of money compared to MRIs and they can track injuries daily or weekly. I find it strange that more people don’t use MSK ultrasound more when merged with MRI findings. With software filters and other techniques, Elastography is valuable way to start visualizing injury besides symptoms of pain. I have suggested Pain Tracking earlier as it’s a good way to document pain, but objective measures must be combined or it could be ghosts in the head. Pain is hard to manage and everyone seems to be an expert in it, but if we are so great as a profession everyone would be pain and injury free and HS teams would have hordes of 9.9 athletes.

Pressure Mapping and Motion Capture- Gait is the cornerstone to screening yet I see optogait as a popular option to many teams looking at symptoms of kinetic data (stride length differences) versus the cause of it. Motion capture helps bring the data from pressure mapping options of the foot all the way up to see the relationships. The relationships may be limited or very graphic, but one must screen the entire body moving and EMG can be added to see the results and influences of the body. I do think everyone should be screen in the preseason and at least have the data captured. RTP (return to play) strategies should look to compare to baseline or improve baseline. Now motion capture is very inexpensive with open source solutions outside kinect and Eliteform. Those investing into force platforms should rethink investing into something with far more granularity.

Education- 20% of all investment of technology should be put into education and consultants. Nobody wants to pay for ideas or education, but it’s amazing how much progress one can get if they look at the leaders in performance and see what the experts do with the technology. Often those that home brew their own solutions are making the mistakes the experts did years ago, and it’s best to learn from experience and specialists, than to spent too much time learning on your own the hard way.

Resources: Here are some of the best tools for solving injuries and performance incompetence. I am not compensated in anyway to endorse the products and I am sure the engineers find my requests very demanding and a bit of a strain. Here are the equipment companies I suggest.

Tekscan- Makers of Fscan and Matscan and have one of the best systems in the world.

Novel- The Pedar system is excellent, but I prefer using Tekscan’s system.

Tensiomyography- TMG is a monopoly now and they provide solutions to some of the best teams in the world.

Terason- One of the best MSK US solutions for teams looking for portable imaging for athletic injury.

FLIR- The leader in infrared cameras and the standard for research and lab grade technology.

SuperSonic Imagine- Elastography provider to the US and other markets.

Night Cloud- The top mobile platform consulting group in Sport and military.

Normatec- The provider of Pneumatic Medicine Equipment to the best teams in the world.

Carl Valle

Carl Valle

Track & Field Coach
Carl is an expert coach who has produced champions in swimming, track and numerous other sports. He is one of the foremost experts in the fields of nutrition and restoration.
Carl Valle

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