E77 | Keep It Real #19: Operating Near Performance

Download Episode File On today's episode, Greg, Trevor and Doug #KeepItReal while discussing operating near performance.

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Episode Transcription: Welcome to the Resilient Performance Podcast, this is Keep It Real Number 19 with the boys Doug , Trevor Rappa and myself Greg. We're going to be talking a loop. We'll start talking a little bit about, um, uh, Derek Hanson podcast that Doug Doug did. I think it will be two weeks ago by the time this is released. Um, and just start off there with some of the principles that you guys spoke about Trevor or Doug, you want to, you know, take it and run. I'm going to unmute myself there. I just think when my, when I think about, um, Derek and influence, like he's just had kind of had on us from our own education and clinical perspective is he's always kept things. So. Um, practical and simple and like simple as I think is often kind of something that's looked at negatively for keeping things too simple, but he really keeps things so effective and simple and practical from how he coaches, how he progresses athletes. And I think that really comes across so well in his interview that you did with them. Doug. And I think one of the things that I really appreciated about the whole discussion of getting the athlete back to sport after a hamstring injury was. This idea that you're essentially just doing whatever they can do that is as close to what they need to be able to do as possible. Meaning for an, for a football player is kind of some examples that you guys use who has to be able to run in a certain, certain philosophy, hits certain positions after a soft tissue injury. You're going to basically just. Dial down the intensity and dial down the volume of, of what you're doing in the rehab setting, but you're still trying to be able to get them to get as close to those qualities as possible. So you're still trying to hit acceleration positions while respecting the biomechanics of, of what may have caused that. Athlete's injury, if it was a true upright max velocity position, so that bothered them well, then let's keep them more in a little bit of a deeper hip position, more of an acceleration position that doesn't put as much tension on the hamstrings, but still lets them work on some of the qualities of they need to be able to do to get back to sports. So I think like just that idea, cause, cause in, in rehab, I think people often skew away skew way too far away from a skill that the app it needs to be able to perform, which is then. They become detrained and it takes so much longer to get them back to their sport because you lose, you lose parts of the skill itself that they need to be able to perform, which then take time to train and get back to. So it's like if, if you don't sprint for two months because of a hamstring injury or. Let's say, um, say one month because of a hamstring, Andrea, and then all of a sudden you're trying to go back to sprint right away. You're going to be detrained in that month. So being able to do, to maintain some of those qualities, even though you are dealing with an injury and it's working with, with what you have so far and making sure that there's no adverse reactions are not insanely sore, or they don't feel like they're getting worse, things like that. It's like you can continue to kind of push the envelope and get them back to the store a lot quicker than if you just kind of go with the. Rested wait till it feels better. And then, okay. You can jog without pain and okay. Now let's just try sprinting and you're doing a much better job of kind of like checking all the boxes between walking and sprinting when you kind of go with there approach. Yeah. And Kayla Tober talk about the same thing and it starts with, you have to have, what is your template of how you prepare physically for your sport? And, you know, I like track and field because there's less variables in terms of like technical and tactical. So it's like in sprinting who runs the fastest and yes, there's a technical component too, to running into block starts and even a tactical component to running a race. But it's, there's less, less elements and less variables there would be in a team sport. And so, you know, most, most track coaches have a template, like, okay, Um, you know, one day of the week, we're going to work celebration one day, max velocity, one day special endurance, maybe, you know, one to two days of tempo or something more restorative. And so if that template is in place and you have an injured athlete, yes, there are things you might need to do to quote unquote, rehabilitate the athlete. But at the same time, you're trying to maintain a training effect. And that's where there's this seamless coordination between training and rehab. Like if it's a quote unquote acceleration day, one thing that. Okay, but talked about and Derek is okay. Like there is there's that neuromuscular piece where you want to be able to go fast, because even if you're not mimicking the position, you know, 100%, if you get somebody on a bike, let's say with a forward trunk lean, that's gonna, you know, without exacerbating symptoms, that's going to mimic an acceleration position. It's going to mimic. Some of the joint angles, you know, some of the speed you're not going to have, obviously the, the ground contact times that you would have in sprinting, but it's still better than doing everything slow. And how many people, you know, have heard their hamstrings on a bike. You know, I'm not saying it can't happen, but unless somebody has a really, really severe hamstring strain, there's a good chance that they can train with some decent intent and speed on a bike. So maybe, you know, instead of running up right that day, they're on a bike or maybe instead of running, they're doing step over. There's always something you can do that mimics. The thing that you actually care about. And now that there isn't a place for kind of just, you know, like lower level graded exposure type exercises, but sometimes that's all we do or people do in our field. And, um, there's a, you know, a lot of times, like, there's this message now, like, okay, the body is so adaptable and resilient and robust, and people like pay lip service to that message. But then. Even in people that, that have pain, they're not actually doing that much. So it's one thing to say it, but like, if you really believe that, then even when people are quote unquote injured or in pain, there's still a lot that they can do. So how do we, you know, address what we think might be underlying root causes of an injury while also also continuing to quote unquote train. That's where I think we can learn a lot from people outside of our field, because our field tends to even despite that optimistic message now to pathologize things and, you know, diagnose things and find things that are, that are wrong with people. And, you know, we've talked about it before. I think that if someone truly has like a structural diagnosis, they shouldn't be seeing a PT anyway. So if they're with us and it's, it's appropriate, then there's probably a lot more that we can do than we think that we can. That was an interesting point. That dart brought up. Um, the podcast of, um, talking about, or I think you asked him about, um, like looking at someone's imaging related to a hamstring injury and talks about how he always likes more information. Cause it just gives him again, more information to possibly make decisions from. But there's times where it doesn't matter. If you have somebody with like a great three hamstring strain, they could still possibly get back to a sport in a week or two versus he's like I've had people with a grade, one hamstring strain that take longer to recover and it's, he's basing that off of. Not the imaging itself, but he's basing off of this trainable menu that you're talking about and, and his, his progression of activities that he knows, he wants to see somebody be able to get through and handle these volumes and handle these intensities before he would say, yeah, you're probably ready to get back to your sport, but it's things like, like that idea of, of, you know, Trying to stay as close as you can, to what they need to be able to do. And just being able to modify things from a volume intensity position standpoint, um, is, is it's a valuable lesson. Uh, and like, like, like you just said, they're done with like the, um, you know, not just trying to go slow all the time. It's like, if people have to go fast, we have to do things that are fast and a bike is a great way. That's low impact kind of decreases some of, some of the risks involved that, that. You would have with sprinting, if somebody is really sore, but that's probably an activity that is going to mimic some of those, um, velocity qualities that, that like muscular contraction, velocity qualities, that the app, it needs to be able to have, um, in a safe way that is gonna at least, and also kind of build their confidence to know that like I can at least do something that's working hard and making me feel like I'm moving fast. Even if it's not that. Upright actually running on, on the field or on, on the track right now, but at least you're keeping them in shape and you're keeping them, um, doing things and, and, and you're, you're keeping you keeping some of those other output and trainable qualities that we're always looking for. Yeah, definitely. And I think a lot of what you're saying translates to anything in what we do. Uh, with philosophy, like I think that's going to be like the speed and the velocity of contractions and movements, and probably going to be the things that you lose the fastest compared to like your max deadlift or something like that. Um, I know, uh, you know, count deets. We'll talk about that and truck as a training. So if we're not doing something fast, because somebody is on the shelf for four weeks, We're doing nothing fast for four weeks and we're doing more like therapy related stuff that, you know, whatever it is on the table exercises or therapy, therapeutic exercise, if that's all we're doing and there's no speed of velocity element to it. And then they go back to trying to run. It's almost like Kevin was talking about on the podcasts. Like he's, he's got to get people back into shape almost when they get back to him. So it's like, they're not really ready to get ready. Um, so that. Period of being shelled is really important to not try and make it look as similar to what, like you said, Doug cause normal training week would look like and just make fine adjustments to that. But I would agree that it's like whatever the fastest movements that you can do, um, obviously within reason within any precautions or indications or contraindications cause of your injury. Those are the things that you need to be doing, um, to kind of push the envelope and keep progressing, or at least slow the regression potentially. Um, I think about that too, with my, a lot of my baseball players that I have, it's like, Oh, like you're, you're injured. So now you have to do the throwers 10. And for me, that's like the lowest hanging fruit that like these probably these kids are probably already doing all of those, those exercises. Cause it's already sort of embedded within the baseball culture. Um, But for me, it's like, all right, are you doing that stuff? Like check that box, like do that two or three times a week. Like if you have any questions about it, let me know. But that's stuff so simple and so easy to do that. Like, we don't need to spend time on that. Um, and maybe I'll check someone's technique on it and just be like, all right, you're good. Do this on your own. Um, but other than that, that I'm trying to do things that are a lot faster. Uh, you know, I'm not gonna have kids out there. Sprinting and throwing a weighted ball as hard as I can into a net. Cause I'm just not at that point in, uh, they're not at the point in where they can do things like that. Um, but I'm doing things with small med balls where they're, they're trying to move the weight, the small, you know, two and a half pounds med ball as fast as they can in a throwing position. And to me, that's going to be way more valuable than just doing like a slow, uh, you know, slowly rehearsed bandit exercise. Um, I know we've kind of spoken about that type of approach before, but, uh, just all of this stuff kind of brings me back to that. And it's why we probably keep looking outside of therapy. When we look for continuing education for ourselves, we're always looking to people like Derek or give, uh, her, you know, I know Doug, you just recently interviewed, uh, Boosh X Nader, who I think he's actually the one who is going to be on two weeks from today when this is released. But, uh, And I remember like right before you had interviewed bill, he had this whole like string of tweets come out or he was on fire and he was just kind of, you know, like, I dunno, I dunno another way to say it besides like, he's kind of trashing like the standard of rehab and we'd loved it. Cause it's, it's kind of like where we want to be. We want to be more like, boom, we want to be more like Derek. Um, you know, we want to be more like the people who are functioning. At the higher levels and then just be able to kind of scale it back with more of our rehab centric type stuff, but keep things as, uh, as fast and as related to the skill as possible. I agree with that. I mean, I think if, if you can do the stuff on the right end of the continuum, the stuff on the left is actually like kind of easy, you know, once this becomes like, it's all just a warmup, it's all, you know, if maybe it has a place, because it's just kind of, like you said, restorative, maybe. Um, you do that stuff. Like if you haven't been doing it to, to kind of like work on any patterns, maybe that you haven't spent time on because you're not injured and maybe you need to kind of like, all right, like we have a clean slate, like let's work on some of these lower hanging fruit things that I just don't do because they're boring and, and, and doll, but definitely. Yeah. And I think like, we talk about, you know, speed in rehab, like it's all relative, right? That could be somebody doing like some kind of extensive plyometric variation. Like what, like the author calls, like there, the rudiment series, like that might be the most that they can do, but that's fast relative to just doing like glute bridges or lateral band walks. And I'm not saying that those other things you shouldn't be doing and just saying don't, don't neglect the things look more like training because. We often assume, Oh, well look like they're hurt. So in a couple more weeks, there'll be able to train. But like you mentioned, Greg, I mean, if you're not doing the things that look more like your traditional practice, then when they're clear from rehab, they're going to have to do that stuff again anyway, just to be able to get back and participate normally. So we're just trying to eliminate some of the redundancy and the, and the dead time. And what I think this all boils down to is risk mitigation. And I actually, you know, I want to do a series on this podcast. Like I already have one guest lined up. He's a friend of mine and he's a professional mountain guy and he's one of the few people that has a certification. At the highest level and guiding on, on ice, on snow and on rock and everything that he does is risk mitigation, because people are basically paying him to have fun and to do dangerous things. But if he gets them hurt or killed, he's going to be out of work, you know? And so again, looking outside of our field, how do people who do risky things make the determination as to like, alright, these people are paying me to have a lot of fun. And most of the time, the more. Risk that we assume the more fun they're going to have, it's like skiing, right? Like th typically the conditions that are the most fun to ski in are avalanche type conditions. And, you know, a good guy can determine like, all right, like here's a line, that's going to be a lot of fun, but it's not going to get us killed. It's like in the military, I mean, the most realistic training would be to train with, you know, have an opposition force and, uh, you know, a training force and have them. Shoot with live bullets on each other, but that's obviously that's unsafe, right? Like it's, it's realistic and it would have a high degree of specificity and transfer, but it's dumb. Right. So then how do we scale that down and make it where it's like sufficient risk to get that adaptation and a stress response and mimic what we want to do, but without assuming unnecessary risk. And so. Yeah. Getting people like that. I would love to hear from somebody who is like, like a compulsive gambler professional poker player, like how do you, how have you gambled this long and not gone bust because that's what playing poker is. It's calculated risk. Right. But I think in rehab, a lot of times, like the easiest thing to do is the safest thing. Um, just to say, you know what, like, we're not going to do provocative things. We're just going to do the lower level things. And then once, once we do these lower level things, you're out of my hands. You've been rehabbed now go to your coach, but you know, if. Assuming that the coach is somewhat competent. If you're a rehab provider and you, somebody, their coach, and I think to their coach and like the first day they strain a hamstring. Again, assuming that the coach isn't doing ridiculous things, it's not the coach's fault. It's probably your fault as the PT, because, you know, you're like, well, it's the coach's job to run that person. And it's not like it's, you know, we should be doing things with running athletes that look like running, or at least have. Again, with the whole specificity thing is a very subjective discussion, but that at some transfer over to running and, you know, in some cases that could be an extensive plyo. In some cases it could be a bike, it could be a step over, but at least if your mind is thinking like, okay, I've got to be something that resembles running. And a lot of times we think, Oh, hamster and we have to just like do hamstring exercises and that's, that's a part of it. But if it's the attachment, the thing you care about, then you're leaving a lot of potential on the table and you're just deferring risk. Kind of reminds me of another podcast you did with Nicole. do not pronounce it, start it again. And she talks about doing no harm. That was like a major theme in that episode. And you know, like Kevin was saying what you were just saying, like, if you. If you do no harm, quote unquote, like you don't hurt them when you're, when they're with you as a physical therapist, you're doing harm because then they're not ready to go back to do anything. That's the sport coach or the, uh, you know, the skill coach would, uh, is in there in their wheel house. And then it's like, Oh, well I didn't hurt the mother with me. So it's not my fault. Yeah. And Kayla and Nicole, I mean, they, they said that, yes. Do do no harm in the sense that like, you don't want to make things worse, but yeah. Training is implicitly. You're sort of harming someone to elicit a response. So then it comes down to like how much harm, right? Like how do you mitigate risks too much risk, bad, too little risk, bad. What's the middle. I mean, you know, all of these discussions again, that's why we share case studies because in the abstract everyone's like, Oh yeah, find the right amount of risk. But it's just like, with some of these things with, you know, closed loop versus open loop, change, the direction drills, like. No one is for or against any of those things people are for and against that coaching and bad rehab. And so again, that's a very subjective, you know, kind of conversation, but we just don't want, it's like one of our, you know, friends and mentors, Ben Hagar cities that don't suck, like no one likes things and people that suck. Right. Um, but I think in principle, almost everybody agrees on one of the things that we should be doing, but how you execute that and how you operationalize that. And, you know, from a practical standpoint implemented. That's the interesting question. That's what I think Derek was, was such a great guest because he goes into some of those details of like what his progression actually is to get back to those activities. It's not just purely kind of abject when he gives some of those distances. He wants them to cover, especially how the volume drops. You know, substantially as the athlete is, is each, each repetition or each run is covering a great distance. They're able to achieve a greater velocity. Therefore the whole volume session needs to drop. I think it's like those kinds of discussions that I think people take for granted, uh, that we all kind of know and assume, but it's like until you have someone like Derek who is super well-respected and really knows his stuff, telling you that, like, this is how he does things. Like, again, from a practical standpoint, I think that's why. I appreciate Derek so much. Cause he is very open with what he actually does and, and shares, um, shares just things like how, how we share our case. It is about what do we actually do with client, because you're totally right there. Cause like people don't really disagree on a lot of like the fundamental principles of things, but then once you, you can see some of these application with Spencer polls, not really. Actually follow what, what they kind of say and what they actually do. That's why, you know, I think we, we are going to be continuing to kind of push out some of those case studies and to share the things that we actually do with the clients that we work with. That's the only way to be truly transparent about, um, kind of what happens in the actual clinic itself. Yeah. And I remember, like there was a time, it was like a year or two ago when there's this big social media thing about like the Jefferson curl challenge. And it's like, let's just prove to everyone that like the back is. You know, the back is resilient and we'll ditch do like selfies and Jefferson curls. It's like the back of the hamstrings ramp. And it's like, okay, but if you play a field sport where you have to run, like, yeah, you can do Jefferson curls with like a lightweight, but that's still like, that's not actually, that's not risky enough. Like you should do things that look more like running. So maybe that's, you know, the stuff that we talked about, but Derek talked about, but, so what do you, you know, you only have so much risk that you can assume, like you should put the risk and things that are going to have the highest return. So in the context of like lower back rehab or hamstring rehab, like is the Jefferson curl the thing that you want to, you know, where you want to assume the risk, if you want to be something that actually does have more carry over and more of a preparatory effect on performance. So, um, yeah, again, it comes down to like, what are the details of how are you actually implementing this? Because no one district, no one like disagrees that like, yes, you don't want to do. Be cavalier and careless, or you don't want to do nothing and, you know, have somebody be de-conditioned. So it's like, where, where do you draw those lines? And I think it's, while we have those conversations and we try to share case studies and we encourage other people to do that as well. And it's also why things like Instagram can actually be very telling because you can see what, what people allow from an execution standpoint and what people are actually doing, even though it can often be without context. It's like, all right, well, we know that this is like, Something that somebody values they're putting it on, on the internet. Right. So there's a place for all that stuff. That's all we have. We can wrap this one up. Anything else guys? No, I think we're good on that. Cool. Just a quick note, we're trying to push out more frequent free content deleted too. The return to sport course that a tremor puts together and we continue to put together as we speak, um, all that acceleration and agility. So we're having people opt in to kind of get all of that free content. We've already put out two or three things, uh, that are specific to, um, change the direction and acceleration speed and agility. Um, so if you are interested in that, definitely. Hop into our mailing list and then you'll eventually get some sort of email about it and you'll be able to access any of this stuff we've already put out. And then anything new that is going forward and we're planning on releasing a whole bunch of stuff. Just leading up until the course is released. It should be like in the March that the course is released. Something like that. Well, we'll give out a free sample ACL shanks program. We got all sorts of video breakdowns of. Athletes, real athlete footage. Um, a lot of cool stuff there. So definitely check that out. And then, uh, that's all for this week and we look forward to talking to you again. Thanks everybody.

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