A vision of high performance sport

 

I recently embarked on a professional development tour of North America, sparked by the inevitable malaise that comes from years and years of working in pro sports. I love my job and my profession and am incredibly lucky and grateful to have worked where I have, but the long hours and short recovery time don’t always allow for that enthusiasm to be re-ignited, to go out and learn from others and see what the world looks like. So, when Oliver Finlay, the concierge of sport, offered me the opportunity of a lifetime to visit Vancouver, Seattle, Las Vegas and LA to see some of the best high performance operators in the world, I jumped at the chance. 

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(Top row, left to right): Jeremy Sheppard & Elliot Canton; Andrew Small. (Middle row, left to right): Amy Arundale; Graham Betchart; Nick Pituk. (Bottom row, left to right): Scott Savor; Teena Murray; Per Lundstam.

 

This is a reflection of four key themes that I took from the meetings; Strategy, impact of change, ego and mental performance.

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(Top row, left to right): Marc Cleary & Brian Moore; Nicole Surdyka. (Middle row, left to right): Lindsay Shaffer; Sean Muldoon. (Bottom row, left to right): Amber Rowel & Damian Roden; Patrick Ward.

Out of respect for those that provided their time, I would like to acknowledge each and every one of those that met with us but also provide some anonymity & confidentiality to how they operate and what they are working towards. So, for most parts this is a general reflection and synthesis of information. With the odd tip of the cap where appropriate to the exceptional individual work that is being done. So, my thanks go to:

  • Jeremy Sheppard (Canadian Sports Institute)
  • Elliot Canton (Canadian Sports Institute)
  • Andrew Small (Milwaukee Bucks)
  • Per Lundstam (Redbull)
  • Teena Murray (Sacramento Kings)
  • Graham Betchart (NBA mental skills coach)
  • Scott Savor (NBA mental skills coach)
  • Duncan French (UFC)
  • Amy Arundale (Brooklyn Nets)
  • Nick Pituck (Cirque du Soleil)
  • Katie Perlsweig (Cirque du Soleil)
  • Brian Moore (Orreco bioanalytics)
  • Marc Cleary (Orreco bioanalytics)
  • Nicole Surdyka
  • Lindsay Shaffer (Headspace)
  • Sean Muldoon (Seattle Sounders)
  • Amber Rowell (Seattle Sounders
  • Damian Roden (Seattle Sounders)
  • Patrick Ward (Seattle Seahawks)
  • Sam Ramsden (Seattle Seahawks) 

STRATEGY 

We met with a range of disciplines with a range of experience in their current roles; athletic trainers, strength coaches, physio’s, performance directors, mental skills coaches; Ranging from 1 year on the job to entering their 10th year. But we didn’t meet one person that wasn’t aware of their process, where they were going and what challenges they faced. 

The environments that had a tangible feeling of sustainability all had clear and concise visions. Strategies of where they are now and where they need to be. Sounds obvious right? But it’s an easy thing to say and a different thing to do. 

“Build it and they will come”

Graham gave a great analogy that serves this thought well; who will be more successful, the person who tries to chase after the rabbit or the person who plants a field of carrots and sits quietly? The standout environments for me that planted fields upon fields of carrots were the Canadian Sports Institute and Redbull. Because their population within extreme sports have lived a life ungoverned by rules, they are the rule breakers that don’t conform to structure. So applying a regiment schedule that you may see in American Football just wouldn’t work. In very different ways, both organisations planted the carrots and waited. And there was a comfort in this superficial lack of structure because underpinning it were clear objectives and a vision that sat on a level that was detached from the athletes. 

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Away from working with the athletes, there were processes about building, developing and sustaining a performance team that again was underpinned by clear strategy and purposeful recruitment. Seattle Seahawks, under the wisdom of Sam Ramsden, stood out as one of the departments that had perhaps been on the longest journey and was now at a point that he was truly comfortable but still had a 3 year progression plan ahead of them. Consistently, performance directors spoke of the time that this took, between 5-7 years was the consensus to establish a harmonious and collaborative performance team. 

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At the other end of the journey were practitioners finishing their first year in the job, reflecting on the change around them, the change they wanted to create and how their environment was coping with the change that came with their employment.

CHANGE

Nobody likes change. Unless you are Oliver Finlay and you are studying change management as your PhD. Whether you are trying to implement change or you are a product of the change, it comes with uncertainty and requires an ability to balance and gradually influence. It was interesting to see that everyone had a different approach to this. 

Some people were energised by the positive approach to change at their organisation, whereas others clearly demonstrated signs of “change fatigue” where year on year something operational or structural had occurred and was creating a demotivated approach to change

“what’s the point in getting on board with this when it will probably change again next year” (paraphrased quote amalgamated from a few different conversations). 

The introduction of new staff was a major component of this association with change. And it was interesting to hear how new staff are integrated at different organisations. Take Cirque du Soleil, an environment where every single person has a very different personality and background, from dance, gymnastics, trampoline to military, NFL or academia. As part of the circus family, each individual was celebrated for who they are, no one had to conform. Equally, we were told that a new member of staff is almost expected to know nothing, with a robust and consistent induction period to each show. 

At one end of the scale, we met people who agreed that their philosophy in year one of a new role was to sit and be quiet, to observe and speak when spoken to. To essentially use the year to “be accepted”. At the other end we met people with vast depths of experience that could identify early on where changes needed to occur and how to improve, picking that “low hanging fruit” but on reflection, felt that perhaps too much change at once had been detrimental. 

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And this made me reflect on my experiences, having been a contractor that “fills in” or on a 1 year fixed term contract and how that compares to being part of a project on a permanent contract. Going into any role now, I would know what questions to ask of those above me. What are the expectations? Knowing it’s a short term contract means you know to do the quick fixes, but if its permanent, what do year one expectations look like compared to year 3? What changes are necessary and what can be a longer term project. I am forever grateful to a conversation I once had with Dr Ben Rosenblatt who outlined a matrix for change, looking to “traffic light” interventions and opportunities that:

1) would be immediately important

2) would be easy to implement 

3) had greatest magnitude of effect?

Outlining these things and revisiting them regularly helps you to gauge the need for change. Herein lies a thin line, and what side of that line you fall depends on ego.

EGO

An overriding message from the trip was “there is no room in performance departments for ego”.

What you implement, what you decide to change, who you decide to invest your energies in, can not be driven by ego. And here was the deepest level of reflection for me. I would like to think I am not known as having a massive ego, but when I spoke to people much wiser than I, I realised I did have one that perhaps was enough to influence my practice over the years. 

Another gem from Graham, as soon as you feel you have to justify your job, you are onto a loss. The athlete has reached this level without you and, more often than not, will remain there in spite of you. Supporting them doesn’t come from enforcing your beliefs on them, it also doesn’t come from running monitoring systems that serve a purpose to publish your data. The best organisations we visited again had a structure in place to safeguard this. Whether it was a layered approach to implementing a new monitoring system, robustly scrutinised at each level to ask “does this serve the athlete?” Or whether it was an end of season audit to review practice and ask “what have we done and why did we do it?” Both approaches served the purpose to ask, “Am I satisfying myself and my ego or does it benefit the program & the athlete.”

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Now, this is a two sided relationship. To have that ability to sit and be patient, to not feel the need to prove your worth, to know where the low hanging fruit is with immediate impact whilst planning the longer term vision, it all requires support from above and around you. Again, those organisations stood out. The Seahawks, UFC under Duncan French, Canadian Sports Institute among many others, all had people at the helm who knew the happiness and development of their staff was crucial to the long term success of the organisation and their athletes. 

MENTAL PERFORMANCE

We all know sport is tough, rarely does it come with the glamour or success that we dreamed before entering the profession. Instead it is long hours, time away from family, missed weddings, flying visits to hotels and long delays in airport waiting rooms. It also has a lot more adversity than it has championship medals. I personally took great motivation from Pep Guardiola’s advice to John Stones: “In football, there are more mistakes than success and you lose more than you win” 

From a medical perspective, I think this can sometimes be overlooked. Its is easy to chase success; a successful rehab, a low re-injury rate, a correct diagnosis after initial assessment, even thinking outside of your department and focusing on team selection and competition results. But focusing on chasing success can mean you aren’t learning from the mistakes.

If the staff are feeling the pinch from the characteristics of sport listed above, or perhaps an injury that doesn’t go to plan, it can be compounded by the fact that the majority of interactions through the day have negative connotations; “I am in pain” “I can’t do this” “why does this hurt”…. no one sticks their head in the treatment room to tell how amazing they feel. 

If you don’t like hearing these questions then you shouldn’t be a health professional. But my point is, if the staff are looking after the players and absorbing or buffering their negativity, who is looking after the staff? 

This was a recurring question we asked of performance directors and of the mental skills coaches we met with. Headspace, in a move that just oozed with everything Headspace stands for, blocks out two 15 minute spaces in the day to ensure staff get some alone time. No meetings can be booked in these times, they are free to meditate and group meditations are encouraged, but equally they can just sit in a quiet room and breath for a small period of time in a busy day. This made me think about its application in sport. Why not? 15 minutes should be achievable, right?

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Without having a rigid meditation structure like Headspace, there was acknowledgement of the need to decompress at UFC, where work can intensify over a period of weeks. Duncan made it clear that when the opportunity comes, he encourages staff to go down a gear, take more time and be sensible about energy expenditure. Knowing that they can ramp it up again when the next time comes.  

If you have the opportunity to employ a mental skills coach, or perhaps you are one and you are part of a new team, how are you going to integrate and operate? Oliver himself was able to draw on reflections from a previous role where a proactive approach to build mental skills actually highlighted an unforeseen problem; if you have one mental skills coach, or sports psychologist, and they look after both staff and players, what does the player think when they open up about how they feel and then watch as the sports psych walks straight into the coaching office? One of the mental skills coaches we met actually withdrew themselves from a full time position and intentionally became part time, so that they didn’t become too familiar or part of the furniture, giving themselves some distance become a more intermittent but effective presence. 

Conclusion

I guess the overriding message through this reflection is the importance of a clear vision. Something that is easily articulated, frequently visible and actually lived. This then provides the foundation for who you employ, how they integrate into the team, what’s expected of individuals and the department and ultimately feeds performance of staff and athletes. 

I would be interested to hear people’s opinions or reflections on experiences of change, how you coped, how you were managed and supported. What will you do given the opportunity to influence a department?

Yours in sport,

Sam

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Viewing balance exercises with eyes closed

For a long time, I have questioned prescribing balance exercises with eyes closed to athletes in sport. Regular readers of the blog will know that I continuously explore the clinical reasoning behind treatments and interventions but have a particular interest in exercise prescription. I have to admit that single leg balance with eyes closed is an example of exercise prescription that just doesn’t make sense to me, how many athletes close their eyes to perform a sport related task? I’m regularly seeing discussions online about “what is functional?” and most of the debates are based around semantics without much weight behind them but provide a good opportunity for people to have a little disagreement about something. To avoid getting into a debate about “functional” I thought it best to better understand the concepts and demands behind “balance” to see if I can answer the “why” behind balance exercise progressions.

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Now stay like that for 1 minute or until another player throws a ball at your face
One argument for closing eyes during balance exercises is to remove the visual stimulus and encourage the athlete to challenge vestibular and proprioceptive senses. Remove one thing and make others compensate for this deficit. In a study of track athletes, sway velocity (cm/s) increased two-fold when athletes closed their eyes during a static balance test (here) but the only significant finding in the study was the difference in centre of pressure displacement (cm) between non-dominant and dominant limb across the medial-lateral plane. So, no difference between male and female athletes and no difference between “eyes open” and “eyes closed”.

So how does this explain the increase in sway velocity? The sway velocity is the area covered in both the anterior-posterior and medial-lateral planes of the centre of pressure per second, indicating speed of correction. The fact that the displacement between “eyes open” and “eyes closed” was not meaningful suggests that the demand on the fine motor correction increases. A decent argument to include “eyes closed” in a balance program, if that is the aim.

Static balance in dynamic sports

Compared to dynamic balance tests, static tests do not allow re-positioning of the centre of mass within the base of support, so the athlete becomes more reliant on smaller corrections. Different sporting populations have demonstrated varying abilities in static and dynamic balance skills, with gymnasts outperforming in static balance but soccer players demonstrating better dynamic balance (here).

This may seem obvious given the control on the balance beam vs changing direction to avoid an opponent. But actually, perhaps where the argument becomes more broad and complex.

As with any exercise selection, it needs to be appropriate to the aims of the rehabilitation program and the demands of the sport, taking into consideration open and closed skills and linking these to fixed gaze drills vs dynamic gaze drills.

Have we gazed over “skill”?

In a given skill, experts can recognise which cues are relevant and avoid information overload (Martell & Vickers 2004). Below is a slide from my presentation “3 sets of when?” It explains the concept that following any injury, the athletes ability to perform a given skill returns (temporarily) to novice level.

skill level injury

Take a skill like walking. Immediately after an ankle sprain, your ability to perform that skill at an expert level is decreased. A skill that has taken years to perfect, to become automatic, now becomes a task which requires concentration. Thankfully, the return to expert level doesnt take years (hopefully!) and this is where our exercise selection becomes crucial to optimally load and sufficiently challenge. We can’t presume that the pre-injury skill level is the same post-injury. We should also consider experience of the balance task specifically. I can think of experiences where athletes are standing on one leg on a Bosu throwing a reaction ball at a 45 degree trampoline. “Oh you’re no good at that are you… we need to address your balance”

I’ve digressed slightly from single leg balance with eyes closed… and actually I still haven’t discussed “gaze control”.

off on a tangent

Gaze control links specifically to experience of a task. Comparing those skilled at orienteering to non-skilled (here) demonstrated an increased ability of the orienteering folk (what do you call people that go/do orienteering?!) to employ a wide focus of attention and to shift efficiently within a peripheral field. The test very cleverly measured gaze control to flashing images with varying degrees of relevant and irrelevant information. What is interesting from this study was that the control group where physically active and proficient in other sports, but the “skill” advantage lay with the orienteering-iers. [shrugs and thinks “sounds right”].

I did not know that about balance!…

Elite athletes have heightened spatial awareness and processing capabilities vs their non-elite counterparts, where gaze control is cool and calm, with long duration of fixation of specific locations. This results in better body positioning end efficient limb actions (here). What better example than ballet. When comparing professional dancers to controls walking along a thin taped line, it was observed that experienced dancers focus far into space, delivering effortless and accurate movements where as controls looked down and focused on the line, moving with greater speed and less control (here). Dancers shift their neural control from somatosensory inputs and to an increased use of visual feedback, via peripheral fields and focused gaze control. Interestingly, sub-maximal exercise has been shown to increase visual attentional performance (posh words for reaction time) and a decreased time need to zoom focus of attention (here). This is useful for prescription considerations.

This efficiency has been demonstrated in other studies also, where the addition of a 4-week balance training program to Physical Education classes in school resulted in increased CMJ, Squat Jump and Leg Extension Strength (here). A time period that can’t be associated with physiological adaptations to muscles (regardless of time, they did balance exercises!) and even when a balance training program has been compared to a plyometric strength program (here). It is thought that improved centre of pressure is linked to spinal and supraspinal adaptations, due to high inter-muscular activation and co-ordination.

My question for any budding researchers out there… if there is a spinal level involvement here, can we utilise the contralateral limb at the very early stages of injury to improve balance on the injured side?

Finally, I get to my argument… balance is the output. Balance and proprioception are different entities, as are gaze strategies and balance. But they may all be interlinked via “skill.”

In researching this blog, I’ve certainly become more accepting of “eyes closed” as an addition to balance programs. But also think I’ve gained more clarity on appropriate prescriptions and the suitable progressions for individuals.

Perhaps “eyes closed” is not a progression, but a starting point!

Immediately post injury, we are looking to internalise feedback (intrinsic) and focus on local, fine movements. There are plenty of regressions within “eyes closed” balance that we can make the athlete safe from secondary injury. Graded progressions from static to dynamic, trying to keep the demands appropriate to the skill required to return the athlete to “expert”.

From here, our progressions should not be the removal of a visual stimulus, but instead optimising and enhancing gaze control:

  • Focus on a stationary target –> moving target
  • Head still –> head moving (repeat stationary and moving target progressions within this)
  • Static balance –> dynamic balance (repeat progressions above)

Essentially, we progress through from intrinsic cues to extrinsic cues, where gradually the athlete is thinking less and less about the mechanics of balance and more about skill execution and performance. We know that gaze control components improve with sub-maximal exercise, so our ordering of our program can reflect this. It is commonplace for balance exercises to be at the beginning of the program, but if balance is our primary aim for rehabilitation, perhaps it should be later in the schedule.

I don’t think this is too dissimilar to how most people prescribe exercises, but for me at least it has given me a better thought process into the “why” which ultimately should make rehabilitation programming more effective and efficient and therefore more elite.

Yours in sport,

Sam