This blog is a review of the Pacey Performance Podcast Episode 400 – Des Ryan, Dave Slemen, Chris Bishop

For this blog post I’ll be summarising in bullet point some of the main take away points to help you get, keep and excel in a strength & conditioning role in elite sport.

Meet the Panel

First up, we have Des Ryan. He’s Director of Coaching & Performance at Setanta College having previously being Head of Sports Medicine and Athletic Development at Arsenal’s academy. In the business since 1998, he’s also held roles at Connacht Rugby and the IRFU.

Next up is Chris Bishop. He’s Director of Postgraduate Programmes in Sport, at Middlesex University. Last but certainly not least is David Slemen, founding partner of Elite Performance Partners. His organisation helps recruit performance staff and senior leaders into team sport, namely football and rugby across the world.

🔊 Listen to the full episode here

Getting a Job in Sport

Des – ”There are jobs out there but a huge number of people are applying and it is very competitive so if you’ve just finished a Masters really you’ve got to tick all the boxes.  So you’ve got your Masters in strength & conditioning, that seems to be the basics now.  Then you’ve got to get your Accreditation because I need to know you’ve got your driving license, because if you join a professional sports team you are driving some very special cars.  But that’s only the baseline as well! And then you’ve got to get experience.  You’ve got to think about you as a coach, your coaching philosophy, how you develop players, how you work with other people, and learn off other people.  You’ve got to build up your community, who you hang around with and bounce ideas off.  Then you’ve got to have achievements, even if it’s just a poster presentation in the UKSCA conference.  Get a group together, run a project, have ideas and get them down on paper, and then you are ready for interview.

The other area I’d really highlight to people. People need to dig deep into topics.  We seem to be in a era of snippets, highlights, social media nuggets of information. No! Dig down deep and get the detail.  I’ve lost count of the amount of people who say ‘I’m into LTAD.  It gets to Rhodri Lloyd’s Youth Physical Development model, and then it stops.  No! Talk to me about Kelvin Giles, Dan Baker, talk to me about participation and elite performance in LTAD.  Do you have a curriculum, did you develop a curriculum? Talk to me about Sean Cumming’s work and bio-banding, and practical examples of managing growth and maturation.  It’s not there, that depth, and that depth comes from getting together with people and talking and having initiative.

When we are looking for someone we are looking for talent and energy and for all those boxes to be ticked.

Another area that could be an advantage if people studied it more would be on pitch periodisation/planning – working with the technical coach, understanding technical models and giving them guidance on acute training variables and how they can overload a training session.  It is a bit of a weak area and working on that area could be an advantage.

The more work you put into communities and the more achievements you have the more likely you will become known and highlighted as a talented person, and get the help of a good mentor to review the work you are doing and help you get ready for the interview.”

In Summary:

• Masters in Strength & Conditioning
• UKSCA Accreditation
• Develop a philosophy
• Go deep into an area
• Develop a network – get a mentor

David Slemen: ”You need a passion for an area and a thirst for knowledge”

Des – ”I like the attributes of someone who is mannerly, objective and someone who tells the truth.  When I ring around people, probably the first question is are they a good person, and a good coach, or do they start fires? I want challenging questions and performance questions but not difficulty with people who don’t get on with other people.”

Bish – ”If you’re not going to get a sport qualification, the very least you can do is going to chat with the technical coach to find out how they are designing their training and I think understanding the sport is really key.  If that means going and getting a coaching badge, that is probably only going to help and that’s your choice, but certainly get to know the sport and get to know the coach and their philosophy.”

David Slemen: ”If you can’t see it, you can’t be it!”

The comment from David was based on the topic around diversity and inclusion.  But I also thought it is important in the wider topic of having role models and helping people gain skills by making sure they are around people who already have the skills you want to develop.

Advertising Roles

Des – ”Coaching or physio positions should be advertised even when a pretty obvious candidate is within the organisation.  You can do this role really well, but if you go through this process you know you are the best person in the country for this role, and you’ve earnt it and you can go into it with confidence.”

Sportsmith poll with Top flight UK football leagues

13% – publicly available advertised role

37% – recommendations

35% – promotions within organisation

15% – went with the Manager, or other reason

David Slemen: ”It’s about trust and it’s about risk”

David – ”Being within an organisation and applying for a role is a distinct advantage as if we say that cultural fit counts for 50% of the job criteria then you already know what the culture is like there, so you already have more trust.  But the flip side to that is that if you stay somewhere too long, there is a saying that you will always be an apprentice at your first company, and you could be undervalued if you stay too long.”

Does Strong Academics Make you a Better Coach?

Bish – ” those students that have spent time in a high performance sports environment actually tend to be the best students, which is not something you have necessarily  I would like to think that the MSc and PhDs that are being obtained hopefully help with their decision making processes, so in turn maybe it makes them a more holistic coach so they know when to use data and when not to etc.  It might not improve your coaching skills directly but improved decision making skills still make you a better coach.

They can take some underpinning knowledge that they didn’t know before and they know when they can apply that, it’s the experience of working that help you pick and choose little bits that lets you help you develop your philosophy while you are working (and studying at the same time).”

Doing a Masters part-time while you are coaching might be a good option if this is part of journey that you envisage you want to go on.  You know who you are, and then you can apply some of the things that you knew would work based on your experiences.”

David – ”Be in charge of your own career.”

Top 5 Take Away Points:

This blog is a review of the Pacey Performance Podcast Episode 385 – Paul Comfort

The majority of the episode focuses on isometric training.   Due to the amount and quality of information the full podcast review will be split up into two parts.  This is a Part 2 of 2, which will focus on practical applications of isometric training and eccentric training.   Click here to read Part 1.

Paul Comfort

Paul Comfort is a Reader in Strength and Conditioning and programme leader for the MSc Strength and Conditioning at the University of Salford, and is this week’s guest on the Pacey Performance Podcast. He’s here to talk to Rob about isometric testing and training, and why there has been a recent resurgence in its popularity.

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Isometric Testing & dynamic performance

”So if you look at something like the isometric mid thigh pull or the isometric squat, there’s a huge number of studies out there that show strong correlations between your ability to produce very high forces, so the peak force or peak force relative to mass, and performance in other dynamic strength tests or tasks. So 1RM squat, 1RM deadlift, snatch, power snatch, clean, power clean performance, etc. And in weightlifters, they’re almost perfect correlations, which isn’t surprising because they’re so used to getting into those positions for the isometric mid thigh pull.  But even if we look at how they relate to things like sprint performance, jump performance, there are still strong correlations there. Now correlation doesn’t mean cause and effect just because there’s a strong correlation. It doesn’t mean if we increase peak force in an isometric mid thigh pull, you will increase your 1RM performance or your sprint performance.

However, there are a few studies out there that do indicate that as your peak force increases, your ability to accelerate increases. Or as force at a specific time point increases, your ability to accelerate during a sprint or a jump, etc increases. Now that makes sense if we go back to your basic biomechanics, because we know that it’s your relative net impulse, with impulse being force x time and relative meaning dividing it by your body mass. As long as your body mass stays the same, if you can increase the amount of force you produce in the same given time point, your ability to accelerate will have increased.

Now when we evaluate it in a isometric task, then we’ve got to hope that the athlete can actually use that force and still produce a higher force in the same time frame when they perform their dynamic task. But if you’ve got the right balance between what you’re doing in the weight room, and their skill specific training, the sprint drills you might do, the jump training, the bounding and plyometrics. If you’ve got the right balance there, you should get that transference. No amount of work in the weight room will immediately transfer to a really highly skilled task. But even just on observation, if you get somebody much stronger and their peak force goes up and then their force at 150 milliseconds goes up, their ability to accelerate when they’re sprinting, jumping, does start to improve.

There is sometimes a lag time. So the problem with some of the research is that you do a four week or a six week block of training. You get to the end of that block and you retest them [without doing a deload first]. Well, actually, if you’ve used progressive overload, which we should all be doing, you’ve had a progressive increase in possibly load or intensity, definitely in volume. And therefore we’ve added fatigue across that few weeks of training, whether it’s four or six weeks. And you look at some studies, there’s not an unloading week, there’s not a deload week, but that’s what we do when we train people normally. You have an accumulation of fatigue during that three, four, five, six week buildup. And then we have a week where we back off, we deload, we taper, whatever term you want to use for it, then retest them when fatigue is dissipated.

And the reason I mention that is if you look at a lot Dr. Andy Fries early work on overreaching, over training, they really battered people. Some of their training programmes, you look at them and think how the hell did people get through that? And you find that peak force or their maximum strength is pretty stable. It doesn’t decrease dramatically. You can push people really hard and maximum force production doesn’t go down. But their ability to produce force rapidly decreases. So if we’ve got a similar approach where we’ve got a progressive increase in volume and we then test them right at the end of that block, it’s not surprising that you’re going to see a slight decrease in their ability to produce force rapidly because they’re fatigued. So we need that appropriate deload or taper before we retest.

And it doesn’t always happen within the research. Partly due to time constraints, partly due to them getting the athletes to actually take a bit of time off. And sometimes because people just don’t know any better, which is problematic in itself. So, there is that strong correlation, but it all comes down to your ability to produce force, high forces in a short duration, which is why it’s so important to have that. If we do an isometric testing to really try and quantify how much force they can produce in a certain time point, because that will indicate that they can generate a greater impulse and therefore if they can apply that greater impulse during sports specific tasks, we will get greater acceleration, whether that’s of their mass or whether that’s of an object they’re throwing or whatever it might be.”

Isometric Training

”Transitioning to the isometric training side. So as you’ve said right at the start, this is a complementary method of training to your traditional strength training, but just taking it back again, what are the benefits of isometric training and what areas does it plug that traditional strength training maybe doesn’t?”

”Well, I think one of the things that’s really useful is it’s minimally fatiguing. So because you are actually not moving through a large range of motion and you can easily control the duration of each isometric muscle action, you can minimize fatigue. It doesn’t have the eccentric component in there, which we get with traditional strength training, which while really beneficial, actually, if you are using an unfamiliar task may cause muscle damage, may cause DOMS, pain, inhibition and that’s one of the concerns with athletes when you introduce a new stimulus is if they come back in a day or two later complaining to the medical staff that they’re really sore. Some of them, if they’re not used to that type of training, we’ll be saying they’ve pulled the hamstring or they’ve pulled the groin or whatever.  No, you are just sore because you don’t train hard enough.  That’s what happens most of the time. It’s unlikely they’ll have pulled something in a structured weight training programme or resistance training programme if you’ve been appropriately progressive in nature. So it’s not as fatiguing.

And then the other benefit is everyone has sticking points during certain exercises. You start trying to do a squat, a deadlift, if you fail, there’s always a specific point you’ll fail at, normally somewhere midpoint through the range of motion, depending on where your weakness is. So you can train people in those weak positions and that can help them get through those sticking points.

And you can do that without adding a huge amount of extra volume. But as I mentioned earlier, and as you’ve just restated, it isn’t a substitute for your standard resistance training. Otherwise you’d have to train at so many different joint angles to get that transference throughout that full range of motion that you’d end up with all sorts of issues in terms of time.  For example, I’ve been trying to do an isometric squat. It’s taken me an hour to get all these different positions for enough repetitions with enough force while that was really counterproductive because I could have done that just with a few sets of squats doing a dynamic squatting type task.

So, you know, there are some benefits, but you’ve also got to take a step back and think, what do I really need from this?”

”What does the research say around that transference of specific positions? So if I’m training at a particular angle, what’s the transference?”

”Well, a lot of the early research seems to indicate that you’re looking at plus or minus 15 degrees from the joint angle you were training at. And that seems to be correct if you are just doing isometric training. Some of the more recent studies that have been published seem to show a slightly greater range, but that is when they’re combined with dynamic heavy strength training. So that probably helps with that transference, because you’re still doing other training and that’s the problem you get sometimes when we’ve got to do really well controlled studies in very controlled environments so that we know that whatever our intervention is, is what’s had the effect.

But then we also have to do those studies where they’re more ecologically valid. They are what we would do in an applied environment. So they are what we’re going to do with our football team, with our rugby team, with whatever that sport is. And then that’s when we seem to find that either what was done in that control lab environment doesn’t work or it doesn’t work as well; or sometimes, oh my God, this works much better because it’s in addition to other types of training. Some of the early studies on isometric training showed an increase in rate force development, but a decrease in jump performance. Well, how does that work? You would assume that if your rate force development increases, your jump performance should increase, but actually they were assessing rate of force development during a single joint isometric task. And then comparing that to jump performance where you’ve been training at zero velocity for the last six weeks.

So, and your jump height is determined by your velocity at takeoff and you are used to training at zero velocity. So is that really surprising when we think about specificity of training that your jump height decreased? No, it’s probably not. But again, look at the studies where it’s combined as an addition to your normal training and we tend to get beneficial adaptations. And it’s not just about the performance side of things, there’s a lot of research showing the benefits for isometric type training. As an analgesic, if you’ve got tendon pain before training in competition, actually to create adaptations in your tendons to make them stiffer, to increase the amount of collagen, etc. So they’re more resilient to stress strain and therefore injury.

However, bear in mind a tendon doesn’t know what type of muscle actions are occurring. It’s just got stress and strain applied to it.  But the benefit is it’s very, very controlled when it’s isometric. And if somebody has got a bit of pain, you can ramp that up progressively. Whereas it’s not quite the same because you suddenly throw them into a plyometric task.”

”If you look across the research, it’s pretty varied. I don’t think there is a true consensus because the studies are set up to get different results. Some are tendon related, some are for performance. If you think about it practically, if you identify where someone’s weak point is, that point that they slow down,  unintentionally during an exercise. So if you are going to use an isometric squat to supplement your dynamic squat training, find what that sticking point is. Find the point that they’re really having to grind through and you don’t need to assess velocity of the movement. That point with a heavy load where they really start struggling, we can all see that. They can tell you that posture. They know it because they thought they were going to fail at that point.

That’s the point that their face goes purple as well. So it’s really easy to spot. So actually doing some repetitions, not necessarily for a prolonged duration because you still want a really high effort. And again, the problem is if we do a really prolonged duration and a near maximal effort, we will induce fatigue. So you’re looking at your three to five second efforts, we know that you should be able to achieve peak isometric force in under two seconds. And from looking at all the forced time data that I’ve collected with isometric squats and mid thigh pulls, within five seconds, everyone’s force production starts to go down. So if you’re looking at a three to five second effort near maximum, I personally find that to be one of the most effective ways of getting people to get through sticking points. And we also want to train our athletes to express force rapidly.

So actually doing really prolonged holds may be grate for rehabilitation purposes. And if somebody’s had a niggling injury and that’s continued, that might be really, really beneficial, but from a performance point of view, doing three to five repetitions, three to five seconds per effort. And if you can assess that with a strain gauge or with a force plate setup, that will give you some additional feedback, but even without that you can tell if they’re working hard or not.  Watch an athletes’ face, are they holding their breath? Are they gasping for breath when they finished a repetition? Are they shaking during the task? Most people will. So you can see most of that without the strain gauge or without an isometric mid thigh pull. But actually if you’ve got the force plate to do this type of testing during their training you can also get people really competitive.

So if you and I were training, we can both, if we’re sort of a similar stature, we can both get onto a force plate, and do an isometric squat. I do a five second effort. Step away, you do a five second effort and we compete against each other. You’re really going to get maximal buy-in and maximum intent then. And you might not need to do it with your whole squad. There may be some athletes you think, right, this will be really useful for them. And again, a good way of sort of judging those joint angles based on where you perceive their weaknesses to be. And that’s easy during some of those dynamic strength exercises. You’ll really see that.”

Eccentric Training

”I’m just conscious that we’ve talked about isometrics been supplementary and not to miss out eccentric and concentric contractions, which you’ve mentioned as well. So where does eccentric focus training fit into this and what are the benefits? What we can gain from eccentric training?”

”So with eccentric we can again get really, really high forces being produced. We’ve got to implement that eccentric load appropriately though. And I’ll come to that in a moment. We know that if you’ve got a high eccentric load, which is greater than the load during a concentric task, that we can increase fascicle lengths. And if we can increase muscle fascicle lengths, we increase the potential for those fascicles to shorten at higher velocity. So I’ll try not to go off topic here, but if you look at the force velocity relationship, the majority of people get that wrong and I’ll hold my hands up. I’ve probably made that worse with some figures I’ve put in publications, textbooks, etc, but the force velocity relationship comes from fascicle shortening velocity and individual fascicles and the amount of force they can generate.

It’s not movement velocity, which is how most people interpret it. So it’s how quickly your fascicle can shorten. Now if your fascicles shorten more rapidly because they’re longer and you’ve got the optimal pennation angle for that, you will undoubtedly get a higher movement velocity from those individuals.  Eccentric training increases fascicle length because you are getting the muscles being stretched while it’s producing a high force. And that’s the key. You need a high force, so you can do tempo type eccentric training. We can get people lowering down over a prolonged period of time. That increases time under tension that may create a hypertrophic stimulus where we get more muscle mass. But it’s not truly eccentric training.  You’re moving at a really low velocity. 

[Personal communication with Paul: ”it’s not truly eccentric training because as was stated earlier, a high eccentric load has to be one which is greater than the load during a concentric task, in order to increase increase fascicle lengths.  tempo training prescriptions are usually around 80-85% 1RM for 3-5 seconds lower and you the lift it back up concentrically.  This is a good introduction to the controlled tempos but the load is insufficient to overload the eccentric component.] 

The goal of eccentrics is to get a higher force at a higher velocity but how you train that in the weight room is focus on the higher focus component. Imagine trying to squat down quickly with a high load.  That doesn’t happen if you are squatting and you put extra weight on the bar. If you want to move at high velocity, you relax and gravity accelerates you down. You can’t move any quicker than just relaxing and letting gravity push you to the floor. With safety bars and stuff like that in your power rack, obviously you don’t want to get squashed or crush your athlete.  So the key thing is if you are trying to apply really high force or using a high load, the eccentrics in that situation with multi-joint movements need to be slow and controlled.

Personally, if I’m doing it and I’m trying to use an eccentric overload, I’ll do a front squat because it’s so easy to drop the bar rather than a back squat. You’ve got to be good at jumping out from under that bar if you start to move too fast or have it set up inside a rack with the safety bar set just around your minimum squat, your maximum squat depth, the minimum height you’re going to achieve.

They’re really, really beneficial, but again, as an addition to your normal training. Now, if you’ve got no equipment and I’ll just stick with a squat as an example, because it’s probably the easiest one. If we want to create eccentric overload, go above your 1RM, set those safety pins. Go to about your maximum squat depth and do a very slow controlled squat. Probably going to take three to five seconds to get down there. If you think about when you’re going for a 1RM anyway, you squat down slowly. You don’t go down rapidly, because you’re going to get squashed. So you go down slow. If you’ve gone 10% above that (concentric 1RM), you’ll go down slower. The only problem is then you need a couple of strong people to lift that bar back up or you need to unload it and then lift it backup.

So it’s not always practical. There are some commercial devices on the market where you can do that and it’ll winch it back for you. But most people won’t have those. The other option is to use weight releasers, the j hooks that hang on the end of the bar, you can put weight on it. You get to the floor, they’ve got an angle on them, so they’ll actually flip off when you get to the bottom. Just make sure you set the height of those weight releasers, five to eight centimetres longer than you need so that when you get to the bottom of your squat or whatever lift you are doing, that they do release and make sure you’re symmetrical when you squat down because if one comes off one side and not the other, you’re in a whole world of trouble there.

So practice it with the warm-up weights and slowly build up. And you’ve got a whole range of things you can do with that. You can do it to almost try and potentiate or enhance your propulsive phase. So you could put 80% of your 1RM on the bar, 30% of your concentric or your traditional 1RM on the weight releases, you’ve got 110% 1RM. Squat down, then release, and then you come up as explosively or fast as you can. You can use it for hypertrophy as well. So we get that increased time under tension on the way down and we can use it for actually just getting that higher eccentric stimulus. As long as you squat, you get back to the top and then two people hook the weights back on for you.

The nice thing is for that you can end up doing that as a cluster set. Somebody put the weights on, you then pick the bar back up, step back, squat again. It takes a little bit longer, but actually you do less volume if you’re doing that high loads eccentric type training because it does create some muscle damage.

Now the other thing to bear in mind with this is that muscle damage is not a bad thing because it gives you the repeated bout effect. And it’s not just from eccentric training. You get that just from a novel stimulus. So if you’ve been focusing bilateral training, front squat, back squats, deadlifts, and you suddenly throw in a load of split squats, lunges, rear elevated split squats, you’ll ache in different places. The next day you’ll feel it more in your glutes and you groin, etc, because you’re stabilizing.

That’s not because it was a much higher load. It might have been a lower load overall. If you work out the total load lifted, it might be a lower volume. But it’s a novel stimulus. So when you introduce a novel stimulus, whether eccentric or whether they’re just going from bilateral dominant to unilateral, ideally build it in progressively because you will get a little bit sore, but that initial bout of, especially if it’s eccentric training, protects you against some of that muscle damage and the soreness and the inhibition during the subsequent bout. So your first bout, do a really low volume. If you’re doing it with squats, maybe do it on your first repetition of a squat or weight releasers. So if you’re training at 80% of 1RM, you put that extra 30% on, so you lower 110% your 1RM.

Do do it for one rep. Your first rep of a set and do it on the first rep, maybe the three or four sets. That is likely to give you a protective effect. Next time you can do it within the set. You know, you can cluster your set. If you’re doing sets of six, rep one as the weight releases on, then you do two and three normally, rank the bar, put the weight releases back on, do rep four with the weight releases five and six or without you’ve doubled the volume of eccentric training. So build it up progressively, because the last thing you want is your athletes coming back in telling you how much they’re aching the next day, turning around to the coach saying that they’re in bits, turning around to the medical staff because they won’t want you doing that type of training again, but it can be really beneficial.

And the few studies that are out there that there’s one by Mellissa Harden, where she used a control group trained athletes and some very well trained athletes. It was some GB cyclists, and they showed within a four week period substantial improvements in maximum and rapid force production from doing that type of training, using an eccentric leg press. Now there is an issue with that. No one else has access to that eccentric leg press apart from British cycling, but hey it worked. It shows, you know, the theory holds true. There’s a couple of studies by Simon Walker, which I think both Rob Newton, Keijo Häkkinen and Gregory Haff were part of that research group at that point, looking at different types of eccentric training in a more applied environment, more ecologically valid. So not just isolated, single joint eccentric training. And again, they’ve shown big increases in a short duration.

But again with a relatively conservative loading paradigm that they’ve used and I think that’s the key thing is you have to do a small amount because we know it will create some muscle damage. So be conservative with it. A lot of the research, researchers will say, we need to get this stimulus. We need to make sure it has a positive effect, but you know, if you turn around, look at some of the early studies on Nordics where they were doing 50 plus repetitions in a week, or sets of 10. I know after three, my subsequent reps are pretty poor because it feels like everything’s going to cramp up. And we now know that those lower volumes are maybe not quite as effective, but you get much better adherence and longer term, they will be more effective.

So you’ve really got to be conservative with how you apply that eccentric load. There’s lots of different ways to do it. But there are some pretty simple and easy to apply options in a normal setting if you haven’t got specialist equipment. And the weight releasers you can buy those for probably 200 pounds or if you know anybody that’s good with metal work, they can probably make some for you.”

Top 5 Take Away Points:

Paul Comfort Research Gate

This blog is a review of the Pacey Performance Podcast Episode 383 – James Moore

James Moore

James is the leader of the specialist physiotherapy team at the Centre for Health and Human Performance (CHHP) in Harley Street.  James has 25 years of experience in physio, graduating with an honours degree in physiotherapy from Kings College London. He was Clinical Lead Physiotherapist to the English Institute of Sport, with a special affiliation to UK Athletics. He spent a period of time working as Head of Medicine for Saracens RFC, before moving on to manage the intensive rehabilitation unit (IRU) at Bisham Abbey for British Olympic Association and was Head of Performance Services for the British Olympic Association and Deputy Chef de Mission for the Rio 2016 Olympics and beyond. He is currently in clinic two days a week and also has a number of consultancies including with Andy Murray.

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There is no substitute for what is in essence four years of competitive play, if you go back to 2016 I think he played 87 matches when he was world number 1 and last year we played about 40, so we are at about 50% and so you need to build that tolerance up and that 10% top end fitness.

His V02max is low 60s which is great, but at his best he was low 70s (ml/kg/min).  He’s strong, he’s deadlifting 270 kg, quarter squatting 260 kg at 84 kg and can produce 1500 W on a Watt bike so physically we are in a good place and what we need to do now is transfer that into the consistency on the tennis court.  That just takes time, good coaching and continuity from the rest of the team to help him deliver.”

”Why do athletes get hip and groin pain in the first place?”

”I don’t know that we have all of the answers yet.  Do we have the exact aetiology?  [MEDICINE- the cause, set of causes, or manner of causation of a disease or condition.]  I don’t think we do.  I think we have strong indicators, for example, we know that if you play a kicking sport (football, rugby, Aussie rules, Gaelic etc) you have a much higher percentage chance (you’re probably 3 x more likely to overload your pubic joint and your adductors) than you are in any other sport.

However, when you start to shift from a kicking sport to twisting/turning sports (non primary based running sports so badminton, squash, tennis, ice hockey, short track speed skating), yes you might run as part of your conditioning to supplement the sport but it’s not a primary requirement of what you have to do in the sport.  Yes, you’re sprinting on the Tennis court but you may be covering 3 km in a two-three hour match, and we know that when you twist you increase your risk of hip related injuries.

We also know that if you run in a straight line you also really increase your risk of hip related injuries and a lot of that comes down to the cumulative repetitive force within the joint and what we know is that bones don’t like reciprocal movement- the same movement over and over again, so running in a straight line is generally one of the worse things you can do for bones.

We also know that women as a rule will have a lot higher risk of running related injuries in the hip and men as a rule will have a much higher risk of groin related injuries.  So when you put all that together, I think it’s really hard to find a place to hide on the sports field.

The lumbo-pelvic-hip complex as a unit is the hub for power creation in speed and power based athletes.  Yes, the soleus might be one of the strongest muscles in the body, if not the strongest, but when you’re really looking at peak torque in high level sprinting and running and kicking, you’re talking way over 9 x bodyweight of impact loading and in the triple jump it is 15 x bodyweight going through the hip!  So the forces are just huge and then it just comes down to capacity, tolerance and how much you can build up.  I would just call it supply and demand – there is a huge demand from the sport, and then you have got to build up the supply for the individual.

If you don’t get that right, in terms of training capacity and/or individual capacity, that’s when you’re potentially going to get an overload and injury.”

”So why are the sites of injury for males and females different, it is purely anatomical?”

”No, I don’t think it is, for a number of different reasons, although the reason why I hesitate is because there is more evidence coming out more recently starting to look at that (anatomical differences).  Around 15-20 years ago we were talking about width of pelvis and angles of muscles going into the groin, like you would talk about the Q angle of the knee and patella-femoral load, and really there was no evidence around it. So the morphological (structure of the body) may not make a difference.  Certainly the muscle mass and the forces being produced may make a difference.

There are also a number of other factors such as line of force (males tend to be more straight down and females tend to be more diagonal), angles at the pubic joint, and the anterior pubic ligaments being significantly stronger in the female, as well as hormonal profile and elasticity of ligaments in females.”

”How can we differentiate who needs surgery and who doesn’t’?’

”The decision making process around surgery becomes multi-factorial, and we certainly have advised surgery for a number of different reasons.  Certainly from a clinical point of view, there has been a anecdotal significant reduction in groin surgeries as there has been an improvement in core stability in terms of the functional load transfer across the anterior pelvis.

In football we typically see 15-20% of footballers having a groin related injury, so 1 in every 5.  The game is faster, the players are bigger, stronger, the ball is moving faster on the pitch, and it’s in play for longer, which increases your exposure.  So while we are seeing this transition we are still playing catch up with the demands of the sport.

The key really is that the physical signs should match up with the subjective complaint of pain.

If the pain is disproportionate to the physical signs then you have probably got tissue damage beyond the point of repair.  When we start to look at groin surgery, whether we are talking about abdominal or adductor surgery, with abdominals they can produce force but it’s painful and you’ve got palpable gaps or issues with the inguinal canal, and they fail a period of rehab (2-6 weeks) where there they just can’t put enough load the tissues without provoking symptoms.

You’ll genuinely know whether they are going to succeed in a programme of rehab.  We’ve looked at them and we’ve said ”this is surgery,” but they want to go down a conservative route but at 2 weeks, 4 weeks, 6 weeks they fail their markers, and so you then go through that.  That’s a really good process psychologically to let the player adapt as well as tick the box in terms of doing your strength work before you go down that route; and then there’ll be certain people who will have been told that they need surgery, but there will be some obvious deficits and when they start to load the pain subsides but the pain is usually fairly consistent with their physical signs.”

”Do athletes have to stop playing in order to recover from these kind of injuries?”

”Most groin overload injuries don’t stop you from playing but they just limit your performance.  So we will have lots of people who will just feel like they are at 60 or 80%, I can pass the ball, I can run but I can’t put some shape on the ball, and put my foot through the ball.  Everything has to be controlled, and if I do try and push it I get sharp pain, I’m a bit incapacitated for a few minutes but then it settles and I’m able to go again.

It’s very easy to manage people and keep them ticking over and then it comes to the bigger question of the relevance to the individual- if they are 80% fit are they better than the next individual coming in?

As a medic part of our job is to protect the athlete from themselves and protect them generally, but then also as a performance scientist is to push them to that red line and get them as close to that red line as possible and keep them there for as long as possible.  It’s easy to stop injuries, you just don’t train very hard, but if I want to win stuff I need to go right to that top end and push my body and that’s a difficult balance to strike.

With overload load related injuries, if we want to strip that back we need the reduce the load and then build it back up in a progressive overload manner and then you can build capacity.  So it would mean dropping them out of training, whether that means complete reduction of training or modified training (allow them to run but don’t allow them to kick) to reduce some of the markers.  So they can do part of the training but not all of the training, and it depends on the demands of the training.”

”How do we decide how to structure the rehab programme, are there some key approaches that need to go in no matter what?”

”Does the tissue that is the source of pain need to be loaded or unloaded?  I get a lot of people coming in with adductor related groin problems, and they’ve been loaded but the adductors are the strongest part of the chain when you assess it, and their abdominals and/or hamstrings are not functioning well.  So in that case, you want to reduce the adductor/adduction load and increase the abdominal/hip flexor load and maybe hamstring.  A lot of that comes down to asking where are we from a capacity and/or strength point of view which requires a little bit more investigation away from just the pathology point of view.  And that’s part of the trick of examining the individual from a pathology/pain source point of view and also examining them from a function perspective.

The adductors bring the leg across your body but they are also a significant hip flexor- and there is an argument that the adductor longus is the second most important hip flexor behind iliopsoas but they are also significant hip extensor, so once you go above 45 degrees of hip flexion they become your most significant hip extensors (and adductor longus decelerates hip extension in running mechanics).

The adductors are the main muscles that bring you out of a deep squat and they the are the main muscles of hip flexion and the adductor magnus off loads the hamstring, so maybe the adductors are over working because the hip flexor complex is not good enough, so maybe we need to bring up iliopsoas (which has an adduction moment arm).  Or maybe the hamstring and the glutes are not doing their jobs properly so we need to increase the hip extension function to take some pressure off the adductors.

So what makes it a little more complex is that your abdominals also aid in hip flexion and control hip extension moment arm, and your obliques also control side flexion which your psoas also controls, so my right side psoas is a controller of left side flexion.  So that becomes quite critical in terms of how the adductors, abdominals and hip flexors work as a unit to get a balance across the anterior pelvis.”

For every adductor load you give someone, you should give them an abdominal load to balance the pelvis.

For every abdominal and adductor load you give someone, you should give them a glute load to balance the pelvis.

1.  Hamstrings first – as they produce extension moment and adduction moment at the hip and help to control the pelvis, and if the hamstrings are inefficient the adductor load will go up.
2.  Abdominal load – in particular oblique bias including CSA of tissue not just control
3.  Hip flexor load
4.  Muscle capacity of running muscles – calves, quads and glute function as it relates to muscle capacity, and what does normal running look like technically, as if we can’t run then we are always going to struggle to kick or twist on the run?

It’s all about quads and calves

”So it’s about addressing the whole kinetic chain.  Also be cautious about having the philosophy of it’s all about posterior chain and hamstrings and glutes and a posterior bias.  If you just look at elite track & field athletes they have huge quads!  So the first point is you have to produce vertical force in order to start running and that’s all quads and calves which you need to get that right first to produce your stride length.  Then once you’ve got your stride length, it’s all about hip torque to produce your stride frequency.    Stride length gets you up to 7 m/s and hip torque gets you beyond that!”

”Would attention on running mechanics help with this return to performance following groin injuries?”

”I think we need to start with what do we think is the minimal dose that we need to apply to the individual to try and reduce the risk, and if that comes in the form of a running mechanics or another stimulus.  If the goal of a running stimulus is to improve the running mechanics and get them to move more like a sprinter I think that is really really difficult.

An elite 400 m sprinter will probably do near enough 2000 m of high quality speed work three times a week plus of all the drills which will probably be about 500-1000 m of work at the beginning of every session.   So we are then talking about 7,500-9000 m per week of high quality speed work and that’s done week in week out for about 9 months before you get to race season.  So the dosage to really get good mechanics and to really condition the tissues to that kind of load are really really high.

So maybe a footballer or rugby player is doing 1000 m of high quality speed work per match so I’m not sure you’ll necessarily see them get the same amount of dosage.  But with that being said, if our goal is to condition the tissues to increase limb speed, shorter foot contact and a cognitive stimulus to get the patterning from a central nervous system or Frans Bosch decentralised spinal reflex point of view, that is reasonable.  We’re not trying to turn them into runners, we are just trying to condition the tissue and not necessarily trying to hit the ”right positions’ from an elite sprinting point of view, but we are trying to get quick limb movement and short foot contact, where the outcome and the coaching cues will look different which is a very different coaching approach to coaching an elite sprinter on a track with spikes where you want a high knee, I want you to increase your stride length and that sort of thing.”

”Are there any key positions that you are looking for when you are observing a change of direction?”

”Different sports will have different strategies- e’g a rugby player may use muscle forces (concentric/eccentric) vs a basketball player using elastic/reactive (isometric forces).  A change of direction also looks very different if you are moving over 5-10 m and getting up to 6 m/s versus a winger bombing down the pitch at 9-10 m/s.

Look at it with a coaching eye.  Does it look efficient? Does it look effortless and free and I’d almost go back to coaching the individual and the way the individual moves and what feels right rather than getting into a very specific criteria for this is how you change direction.”

”We have different markers for different stages of rehab.

Early stage – start with clinical markers and reduction of pain such as squeeze test, abdominal load test and then can I get the abdominal to adductor ratios right (see next stage)?  Markers need to move away from pain/pathology to function around the groin so 20 kg HHD or 2 Newtons/kg force across the groin and progressing to 25 kg HHD.

Next stage – progress to running specific markers, and balancing the pelvis, looking at ratios of adductor/abdominal and adductor/hip flexor and hamstring/hip flexor ratio, so you can start to see where the weak link is.  Most elite level athletes get injured where they are strongest not where they are weakest, because they compensate to their strongest area which is the path of least resistance.    Most of the aspiring athletes get injured where they are weak because they are trying to produce force and they just don’t have the capacity to do it and don’t have the compensatory strategies.

We might also have a functional test such as split squat for indication of capacity across the pelvis.  When we get to return to running we can look at vertical force qualities, what’s their isometric squat like, peak plantar flexion force like, have they got some RSI markers we can look at?  As well as looking at the balance between flexion/extension ratios.”

Key ratios:

ADDUCTORS – 30-35 kg, and should be 60% of hip flexion, and 80% of extension.

ABDUCTORS – a little bit less than adductors- 20% behind adduction, and 60% of extension.

EXTENSION – should be primary torque producing force and FLEXION should be about 10% behind extension.  Adduction should be 20% behind extension.  You should be 40% stronger into extension than you are into abduction as a general ratio across the hip.

Look at those numbers relative to performance.  In order for the way you run and/or kick, what do we know is your norm or what is the ideal we need to get you to?  It’s about ratios around the hip rather than absolute numbers and it’s about the relative number relative to the numbers the athlete can produce in the demands of their sport demands.

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