Ep 193: On the path to performing after injury, with Andrew Mitchell

[00:00:04] Hello and welcome to JOSPT Insights, the podcast that aims to help you translate quality research

[00:00:10] to quality practice. I'm Claire Ardern, the editor-in-chief of the Journal of Orthopaedic

[00:00:15] and Sports Physical Therapy. It's great to have you listening today. Andrew Mitchell

[00:00:23] knows a thing or two about supporting athletes to return to play after injury, especially

[00:00:28] in professional football or soccer. Today he joins me to outline his Return to Performance

[00:00:33] pathway, which is a criteria-based approach to help you keep focused on the Return to Performance

[00:00:39] goal. Andrew is a sports physiotherapist and strength and conditioning practitioner with

[00:00:44] experience working in the hospital, private practice and professional sports arenas,

[00:00:49] including in the English Premier League. He's currently working as a rehabilitation trainer

[00:00:54] at Red Bull Leipzig, which is a team that plays in the German Bundesliga and European Champions

[00:00:59] League. Andrew Mitchell, welcome to JOSPT Insights.

[00:01:04] Thank you very much. It's really nice to be here. It's a big honour for me. Thank you.

[00:01:07] It's great to have you on the podcast, Mitch, and I am going to refer to you as your football

[00:01:12] name because you told me earlier that it's only your mum who calls you Andrew when

[00:01:16] you're in trouble and we don't want to engender that sort of mindset on the podcast.

[00:01:21] Exactly right, but I might have a few players calling me Andrew now after that. But anyway,

[00:01:26] it's all good. Yes, the banter of the football environment, we love it. Now there's plenty

[00:01:31] spoken and written about returning to sport after an injury. I'm guilty of doing that myself.

[00:01:37] There's not so much on how to support athletes to return to performance after injury,

[00:01:42] which really isn't great because that's what athletes typically care most about. So it's

[00:01:48] wonderful today that we've got the benefit of your skills as a sports physio who is really

[00:01:53] focused on helping injured athletes return to performance. You've published your approach

[00:01:58] to returning to performance in JOSPT Open recently and we'll link to the paper in

[00:02:04] the show notes so people can find it easily. Let's start with a walkthrough of what are

[00:02:09] the headlines of that return to performance pathway, Mitch? The major components, the

[00:02:14] timelines and the progressions that you're looking for?

[00:02:17] Yeah, so it's an 11 phase pathway and I've got the pathway in front of me here now. And on the far

[00:02:23] left side you've got the diagnosis, the injuries occurred. And then on the far right side, you've

[00:02:29] got the return to performance. So that player's back playing Saturday, Tuesday, Saturday,

[00:02:35] Tuesday, the typical schedule, which is a game every three to four days. So once the

[00:02:41] diagnosis has happened, obviously the players got injured, the player will have the relevant

[00:02:46] examinations and imaging and a diagnosis is formed. And from that, the interdisciplinary

[00:02:52] team will sit down and they will start to make a plan for that player. And this is the first

[00:02:58] block, the first phase of the return to performance pathway. It aligns everybody's

[00:03:03] expectations and gives real clarity to everybody on exactly what's going to be

[00:03:08] expected during this injury process. The next phase is the acute phase. So classically,

[00:03:14] the player will be having treatment for pain relief. There we have a massage,

[00:03:19] cryotherapy, neuromuscular stimulation, all of the types of treatments on the table.

[00:03:24] During this phase, we will also be doing modified conditioning. So even if a player's in a boot,

[00:03:30] they'll be working on their upper body strength, they'll be working on the ski

[00:03:33] ergue, they'll be doing their contralateral limb training program, which is strength and

[00:03:38] plyometrics. Just to maintain that other limb and also the cross education effects. Once

[00:03:43] the players through this, they'll then go into gym phase one. So gym phase one is the

[00:03:48] phase where they look to regain their early load in a normal movement patterns. So for me,

[00:03:54] this is a real fundamental basic exercises. So double leg squats, bridge patterns, lunge

[00:04:00] patterns, heel raises, single leg balance, all of the classic things that a player needs to

[00:04:06] support them in that gate cycle. So when a player can show me this, that they're comfortable

[00:04:12] with gates, they can demonstrate all of those exercises, they would then progress into gym

[00:04:18] phase two. So in that first gym phase, we may use the pool or order gym to get those

[00:04:23] qualities back depending on the injury characteristics. But gym phase two, this is

[00:04:28] a reconditioning pathways. And this is made up of several different themes. We have a theme

[00:04:35] of muscular capacity, we have a theme of strength, we have a theme of movement retraining. So

[00:04:42] within the movement retraining, they'll be doing running preparation, they'll be doing

[00:04:47] plyometric preparation, they'll be doing work with the ball. But this is systematically

[00:04:52] progressed. So even that player that's got the boots on, they might be sitting on the

[00:04:56] floor doing ball skills. We really progress that in a very systematic way. And that takes

[00:05:02] time depending on again, whether this is a short or a long term injury. Once they've

[00:05:08] gone through this in a stepwise fashion, the player that answers gym phase three. And

[00:05:12] in this phase, we determine their readiness to start running. So each of those themes

[00:05:18] from gym phase two, we objectively look at those so we can look at their strength

[00:05:23] with some tests in which we can talk about, we will look at their capacity, we'll look

[00:05:28] at their movement quality. And off the back of that, we know that they're ready then

[00:05:33] to progress and go outside and start grass phase one. So in grass phase one, this is

[00:05:39] reload and their technical reintroduction. The player just starts on the grass again,

[00:05:44] they're going to be doing very low intensity running. There's a high level of

[00:05:48] control. They'll be starting to do some dribbling exercises with the board. The

[00:05:52] passing is really short. But key and underpinning that the player will be doing

[00:05:58] their power profiling. So although they're on the grass before they go on the grass

[00:06:03] in that day or later when they come in off the grass, they'll be doing their

[00:06:07] power profiling. And in our power profiling, we typically use objective

[00:06:11] measures like a single leg counter movement jump, we'll be using the hot

[00:06:16] battery all very traditional things. But when we know a player's regain these

[00:06:21] qualities, we know that they can then progress into grass phase two. So grass

[00:06:26] phase two is high speed running and agility based drills, accelerations,

[00:06:32] decelerations. And it's critical to achieve those power criteria, those

[00:06:37] power profiling criteria of grass phase one to enable them to go into

[00:06:42] grass phase two. Similar to that in grass phase two, they have a reactive

[00:06:46] strength theme with their exercises in the gym, drop jumps, time hops, rate of

[00:06:52] force development exercises. And we really believe they have to achieve

[00:06:56] this before they go to grass phase three. So grass phase three is when they

[00:07:00] make maximum speed work, they're doing maximum intensity work, and they're

[00:07:05] trying to perform their positional exercise at full speed. Now to do this,

[00:07:11] they have to have achieved those gym criteria because if they've got

[00:07:14] major deficits, not only are they at risk of a reinjury when they're doing

[00:07:20] those tasks, they're also at a risk of a detriment in performance. So it's

[00:07:25] really key those underlying gym characteristics, those qualities are

[00:07:29] there to support them with that grass work that they're going to build

[00:07:33] on and progress. Once they've achieved their metrics on the grass and

[00:07:37] they've achieved their metrics in the gym, they go to grass phase four.

[00:07:41] And this is a return to team training. This is again, this is graded.

[00:07:45] This is a gradual exposure depending on whether it's a short or a long term

[00:07:49] injury. So with an ACL, for example, that return to training, that might be

[00:07:55] graded in over two or three weeks and they may have a further two or three

[00:07:59] or four weeks completing 14 training. Obviously for an injury that's two

[00:08:03] weeks, they may grade back into training straight away within one day.

[00:08:07] Once they've achieved their training power metrics, we would then go into

[00:08:12] that grass phase five, which is return to play in again with short term injuries.

[00:08:17] They will be looking to hit their match performances very quickly with a long

[00:08:22] term injury. This could be reserved team games. This could be practice

[00:08:25] games that we need to use. And then they go into grass phase six,

[00:08:29] which is the returns of performance. And that's when they're back

[00:08:32] competing with no limitations. And I've tried to explain this with two case

[00:08:37] studies in the appendix E within the paper. There's a two week injury and

[00:08:43] a classic ACL nine, 12 month injury. I remember presenting this a few years

[00:08:48] ago to some coaches and they all sat there and listened very patiently.

[00:08:53] And at the end of it, they were like, wow, these guys have got so much

[00:08:57] to do before they get back playing. But then when I explained to them

[00:09:00] that, you know, grass phase one, you might do that in 20 minutes.

[00:09:04] You just tick those criteria in a stepwise fashion. Grass phase two

[00:09:08] in 20 minutes, whereas your ACL may have six weeks in grass phase one.

[00:09:13] And then they understood how it was flexible and adaptable to different

[00:09:17] injury situations. Absolutely. And I love this idea that it's flexible

[00:09:22] and also that you acknowledge that sometimes these phases go through

[00:09:26] very, very fast. You could get through multiple phases in one session.

[00:09:31] You mentioned that there's pretty simple metrics and testing that you're

[00:09:36] using. You mentioned things like hop tests. I love that that's really

[00:09:40] accessible to people. You're not talking about having very fancy,

[00:09:43] very expensive equipment because a lot of people who are supporting

[00:09:46] athletes at many different levels of competition, they don't have

[00:09:51] access as you know, to expensive equipment. So that's really great.

[00:09:55] I also love the fact you acknowledge that there's multiple phases

[00:09:58] and you were that you were looking at this off a piece of paper

[00:10:03] because I really want to underscore that no one is expected that you're

[00:10:07] going to have all of these phases ingrained in your memory and you'll

[00:10:10] just go, you'll be able to recall all of these phases every single

[00:10:14] time you work with an athlete. So I would really encourage people

[00:10:17] to go to the paper, print it off. You've got great graphics

[00:10:20] in there to help people get a sense of the different phases

[00:10:23] and progressions and really underscore that this is not

[00:10:26] something you have to commit to memory and then regurgitate every

[00:10:30] time you're working with an athlete.

[00:10:31] It's user friendly and really start to interact with it really.

[00:10:36] Where is your player? Where is your player at this point? Now,

[00:10:39] what have they done? What criteria have they achieved? What do

[00:10:43] they want to go and achieve? What are the bridge points?

[00:10:46] What are the bridge criteria to take them to that next point?

[00:10:49] So it's really, really there for people to use and you talk

[00:10:53] about tech. I mean, I think now we're so lucky with our phone.

[00:10:57] So if you don't have force plates, you can use the jump up.

[00:11:00] If you haven't got GPS, I actually really strongly believe

[00:11:05] user stopwatch count your meters measure your meters count

[00:11:09] your accelerations. You can you can create your own GPS

[00:11:13] without without having the unit. You can study that and you

[00:11:16] can observe that. And I actually think that real attention to

[00:11:20] detail about something like not having GPS is your that's when

[00:11:25] you really learn you really learn the exercises you really

[00:11:28] learn your craft.

[00:11:30] So Mitch, what's the difference between returning to sport

[00:11:33] and returning to performance? Because I heard a little bit of

[00:11:36] returning to the pitch and getting back to the grass when

[00:11:39] you were talking about these different phases. So let's make

[00:11:41] this distinction.

[00:11:42] So I know return to sports commonly used in the

[00:11:46] literature. And I have a big respect for this is published

[00:11:49] and these are these are very useful terms for sports and some

[00:11:54] people in their environments. Within this specific environment,

[00:11:58] I've been in day to day meetings with coaches and day to day

[00:12:01] meetings with players and the words that I've been here in our

[00:12:05] return to running when when can I start running again?

[00:12:08] When can I start training again? When can I start playing

[00:12:11] again? And if you actually listen to the media around

[00:12:14] football, you will hear the media journalist asking the

[00:12:18] same questions. It's when can I get back when they're back

[00:12:21] training and to keep it real crystal clear and words that

[00:12:26] coaches use in meetings and words that they use in the locker

[00:12:29] room with the players in the dressing room, we've put into our

[00:12:32] pathway return to running, return to training and return to

[00:12:36] play in and then return to performance. I think that if I

[00:12:41] was to say to a coach, their back returning to sport, it

[00:12:44] wouldn't really have that same resonance as what I hear in

[00:12:48] the meeting. So that's the reason for that I really respect

[00:12:51] that that's out there in the research and that is very common

[00:12:55] in other sports. In my eyes, return to performances when

[00:12:58] their back is unrestricted availability, they can play

[00:13:02] Saturday, Tuesday, Saturday, Tuesday, whatever the player

[00:13:05] and the coach wants to coach doesn't need to think of them

[00:13:08] as injured or worry about are they going to be okay in the

[00:13:12] last 10 minutes of a game? This person is back playing

[00:13:15] now. Hopefully their gym data and their gym metrics also

[00:13:19] represents this and even a higher performance. Hopefully

[00:13:23] they match outputs again at a higher but the reality is

[00:13:27] sometimes with long term injuries, players may go back

[00:13:30] and be compromised. They may not get back to that previous

[00:13:34] level. There's plenty of research saying players don't

[00:13:37] get back to that and I think when you have a player that

[00:13:40] maybe doesn't quite get back to that performance, I

[00:13:44] think you have to observe it over a long period. I think

[00:13:47] it's a bit foolish to watch a player in one game and say, oh,

[00:13:50] he's not he's not back to to where he was. So I think you

[00:13:53] have to be very long with your observation of this. I think

[00:13:57] you have to look at the gym data. You have to look at

[00:14:00] the metrics in a game and I think you have to be really

[00:14:02] sensitive as well about how this is spoken about whether

[00:14:06] you're speaking with the player or coaches or

[00:14:08] stakeholders and try to take the emotion out of it and

[00:14:11] look at the real clean and clear data over a long period of

[00:14:17] time. I love that idea of a long term view, Mitch, rather

[00:14:21] than the single the single game and and it's really hard

[00:14:25] because you've got you're in the professional environment.

[00:14:27] You've got media who are very focused on a single game.

[00:14:31] It's very easy to fall into that habit of just

[00:14:34] looking at the short term. The classic is the ACL

[00:14:38] when somebody first had an ACL and they got back to

[00:14:41] the player was given a season's grace and they could go

[00:14:44] back and the coaching medics and performance staff.

[00:14:47] Everybody understood he's had an ACL. It's going to take

[00:14:50] in 12 months to get back and that's shortened now

[00:14:53] and that time period shorter and shorter and it may

[00:14:57] even be two or three games, which actually, from my

[00:15:00] opinions, really crazy. It needs to be longer than

[00:15:03] that. Yeah, it's a bit of a double edged sword where

[00:15:06] the extra support around the player we've got our

[00:15:09] skills are constantly developing. There's better

[00:15:11] support around players and then the other side of

[00:15:14] that is the media pressure has increased, the

[00:15:16] salaries have increased. So there's a lot of pressure

[00:15:20] on so many different people to get it right and

[00:15:23] to perform from the get go, which is pretty

[00:15:26] unrealistic on athletes, especially after a long term

[00:15:28] injury. Let's come back to your framework, Mitch,

[00:15:32] who can use this return to performance framework

[00:15:35] and with which athletes we've been talking about

[00:15:38] the professional soccer or professional football

[00:15:40] environment. That's what you know well. Who is

[00:15:43] this framework aimed at?

[00:15:45] So I think any practitioner that's involved in the

[00:15:47] process of taking an injured player from their

[00:15:51] injury back to getting back into any form of

[00:15:53] multi directional sport, you can use this

[00:15:57] framework. Couple of quick examples when you've

[00:16:00] got an interdisciplinary team with 10 or 15

[00:16:02] staff members, you may have one staff member

[00:16:05] that does one of the phases and he's a real

[00:16:07] expert in that. And he may actually fine tune

[00:16:10] some of the details, but the fundamental

[00:16:13] building blocks stay in place and it gives

[00:16:16] everybody that alignment. I think when you've

[00:16:19] got a really small IDT with three or four

[00:16:21] just three or four staff members, maybe one

[00:16:23] member takes three or four phases on their

[00:16:25] own, but it gives them that accountability.

[00:16:28] It gives them criteria and it allows everybody

[00:16:32] to see what's been done, what's expected

[00:16:34] before they're transferred to the next member of

[00:16:37] staff. Anybody working in multi directional

[00:16:39] teams hockey would be they may have a similar

[00:16:43] structure, they may have really specific

[00:16:45] metrics that are traditionally collected

[00:16:48] within that environment, but fundamentally

[00:16:50] the building blocks for me can transfer to

[00:16:52] any sport. From my experience of working

[00:16:55] in private practice and hospital settings,

[00:16:59] you get 45 minutes with a patient once a

[00:17:02] week and you really have to maximize that.

[00:17:05] So if I hadn't seen a patient before and they'd

[00:17:08] come to me, I'd really be trying to place them

[00:17:10] on this pathway. Where are they on this

[00:17:12] pathway? So are they still in gym phase one?

[00:17:15] They're still learning those fundamental

[00:17:17] exercise and movements I described or are

[00:17:20] they maybe trying to return to running

[00:17:24] and we need to check those returns of running

[00:17:26] criteria so you can use it. And I think

[00:17:29] maybe that play that's in gym phase two

[00:17:31] where they're building up their reconditioning.

[00:17:34] Obviously in the professional setting, we can

[00:17:36] do all of the pathways and we can do all of

[00:17:38] all of those and we can have two hours with

[00:17:40] a player in reality. So if we've got a

[00:17:43] syndosmosis injury for the capacity

[00:17:46] profiling or the capacity exercise, I would

[00:17:47] just do one exercise to heal raises for

[00:17:50] the strength again, I would just look at

[00:17:52] plant deflection strength in a Smith

[00:17:54] machine or isometric device for the

[00:17:57] plyometrics. We may not do all of the

[00:17:59] hops. We may just look at media in the

[00:18:00] actual hops. For the running preparation,

[00:18:03] we put the players through eight to ten

[00:18:05] different variations. We may just do two

[00:18:08] or three different techniques with that

[00:18:09] patient and really I'm learning, I'm

[00:18:13] gleaning all my information from that

[00:18:15] patient to know exactly where they are.

[00:18:18] So I'm profiling them and I'm probably

[00:18:20] sending them off with their exercise to

[00:18:22] do as their rehab at home and then

[00:18:24] they come back in to be re-profiled

[00:18:27] to see how they're going along their

[00:18:29] journey through those phases. I remember

[00:18:32] doing this 20 years ago, I was working in

[00:18:35] the hospital and I was given a late

[00:18:37] stage ACL group there in the gym doing

[00:18:40] all of the classic hopping and after a

[00:18:43] while I had four or five really keen

[00:18:45] amateur players and I noticed a bit

[00:18:48] of grass in the hospital grounds. So

[00:18:51] I thought we could use this. So we

[00:18:52] took our gym class out onto the

[00:18:54] grass and we turned it into players

[00:18:57] doing very easy accelerations and

[00:19:00] decelerations and they were doing work

[00:19:02] with the ball and when I look back now

[00:19:04] they were working in grass phase one

[00:19:06] and grass phase two off the pathway

[00:19:08] and the patients loved it. I think I had

[00:19:12] a few strange looks from outside the

[00:19:14] windows because I think people thought

[00:19:15] we were just kicking the football

[00:19:16] about but it gave them real focus,

[00:19:19] they enjoyed it and it gave them a

[00:19:21] bridge from their sport that from their

[00:19:24] gym back to their sport.

[00:19:25] Absolutely. Mitch, I think your return

[00:19:29] to performance pathway is informed by

[00:19:31] the control chaos continuum and you

[00:19:34] alluded to some of those principles

[00:19:36] in your answer just there. How do you

[00:19:39] think about applying the control

[00:19:40] chaos continuum in your work generally

[00:19:42] as a sports physio?

[00:19:44] It's undoubtedly influenced how we

[00:19:46] think about rehab and how we move

[00:19:49] these players from being injured to

[00:19:50] back to performing and for anybody

[00:19:52] interested in this area I definitely

[00:19:55] recommend reading Matt Bookthorpe's work.

[00:19:58] Matt Tabner has also 2019 did five phases

[00:20:01] and this is game changing stuff

[00:20:03] really for everybody. It's changed

[00:20:05] the whole landscape.

[00:20:06] I think something we've tried to do

[00:20:08] is really layer on a lot of the

[00:20:10] pre-grass information in this

[00:20:13] pathway just to give maybe those

[00:20:15] practitioners working in a hospital

[00:20:17] setting that those real early stages

[00:20:20] and what you need to do and how

[00:20:22] you can be objective and how you can

[00:20:24] progress in a systematic way.

[00:20:27] And really for us that gives the player

[00:20:29] and the patient that performance base

[00:20:31] then when they go on to the grass

[00:20:34] they've got a performance base to do

[00:20:36] the grass work

[00:20:37] and also chase those power criteria

[00:20:40] that we've got in phase one

[00:20:41] and those reactive strength criteria

[00:20:43] in phase two because if they

[00:20:45] haven't got that performance base

[00:20:47] on the grass you're chasing too

[00:20:49] many things

[00:20:50] and you're trying to prioritize too

[00:20:53] many things whereas through this

[00:20:54] pathway

[00:20:55] grass one reload them get them going

[00:20:58] and really focus on that power

[00:21:00] undoubtedly they'll be doing little

[00:21:02] bits of strength work during their

[00:21:04] week

[00:21:04] but the power is the key

[00:21:06] and also failure to get those early

[00:21:08] stages right. If you get those

[00:21:10] wrong you fail with those

[00:21:11] players will definitely

[00:21:13] they'll they'll they'll swallow

[00:21:15] they'll have instances of setbacks

[00:21:17] five, ten days and for a player or

[00:21:19] coach this is mega frustrating

[00:21:21] and it just prolongs the rehab.

[00:21:24] I don't want to be in a situation

[00:21:25] where I take a player on the grass

[00:21:27] I'm really uncertain how are they

[00:21:28] going to be, how are they going to react

[00:21:30] if we put that performance base

[00:21:32] in them early

[00:21:33] and we've done it systematically

[00:21:34] we know exactly how they're

[00:21:36] going to react.

[00:21:37] We talk about building foundations

[00:21:39] and getting the basics right

[00:21:40] and I think that's exactly

[00:21:42] what you're describing there

[00:21:43] it's so critical you can't do

[00:21:45] any of the fancier stuff later

[00:21:47] on if you don't have that

[00:21:48] strong foundation.

[00:21:50] What's the most important lesson

[00:21:52] that you've learnt from your time

[00:21:53] working in professional sport Mitch?

[00:21:56] I guess what advice do you have

[00:21:58] for people who are listening to us

[00:21:59] chat today

[00:22:00] who um maybe earlier in their careers

[00:22:02] and trying to get into that

[00:22:04] professional sport environment?

[00:22:05] I think for any young practitioner

[00:22:07] starting out on their journey

[00:22:10] reach out to good people

[00:22:11] whether that's online or

[00:22:13] ideally in person

[00:22:15] say yes to opportunities

[00:22:16] and be willing to give it your time really.

[00:22:19] Something I've always advocated

[00:22:21] encourage younger staff to do

[00:22:22] is to write up case studies

[00:22:24] I think by writing up a case study

[00:22:27] you can then present it to your colleagues

[00:22:29] or a local working group

[00:22:30] and it forces you to read around the injury

[00:22:34] it forces you to put your ideas

[00:22:36] down on paper

[00:22:37] and really justify what you did

[00:22:39] and have real clarity

[00:22:40] on your practice if you like

[00:22:43] and then to get it critiqued by peers

[00:22:45] you're definitely going to learn some things

[00:22:47] and they'll see things that you've not done

[00:22:49] so that whole process of reflection

[00:22:52] that mindset just to

[00:22:53] just to get better again really

[00:22:56] I mean we briefly spoke about equipment again

[00:22:59] not having equipment is no excuse

[00:23:01] so you can do the whole path over that

[00:23:04] with your iPhone and the stopwatch

[00:23:06] and the take measure

[00:23:07] and you can be objective

[00:23:08] with all of those things

[00:23:11] Yeah and it sounds like you're encouraging

[00:23:13] people to develop that reflective

[00:23:16] skill

[00:23:17] and it is a skill to be able to look back

[00:23:20] at what you've done

[00:23:21] self-reflect and think what did I do well

[00:23:23] what are the things I need to work on

[00:23:25] and then who am I going to go and speak with

[00:23:28] to help me develop that part of my practice

[00:23:30] it's it definitely is a skill

[00:23:31] and it takes a lot of practice

[00:23:33] and it takes time

[00:23:34] it's really investing in yourself

[00:23:36] as a as a clinician

[00:23:37] or as a practitioner

[00:23:38] Definitely but I think there's lots out there

[00:23:40] there's cases have been written

[00:23:42] you can take that case study

[00:23:44] and see what they wrote for their history

[00:23:46] and see what they wrote for their

[00:23:48] return to play tests if you like

[00:23:51] so there's enough out there for us to do

[00:23:53] and I think to really get it on paper

[00:23:56] but to really get that that in ink on paper is

[00:23:59] it definitely has helped me

[00:24:01] and I'm sure I'm sure it'll help other people

[00:24:04] Getting that clarity in your thinking

[00:24:06] as a practitioner

[00:24:08] Mitch for people listening to us today

[00:24:10] who were a bit more experienced at supporting

[00:24:12] athletes to return to sport

[00:24:14] or return to performance after injury

[00:24:16] what's one thing that you would encourage them

[00:24:19] to think differently about or to try

[00:24:21] something that they might think about

[00:24:23] changing in their current practice

[00:24:26] I would still encourage people to be objective

[00:24:28] and to look at their phases of their progressions

[00:24:31] how are we objective

[00:24:32] how do we collect that data

[00:24:34] what methodology do we have for collecting that data

[00:24:38] can somebody else collect the data

[00:24:40] if you'll happen to be off sick or away

[00:24:42] can somebody else step in and

[00:24:44] reproduce those processes

[00:24:46] and I think that forces you to look at what you're doing

[00:24:49] understand the whole process from top to bottom

[00:24:53] the advantage this pathway gives people is

[00:24:56] it allows them to map from day one

[00:24:59] so when the injuries occurred

[00:25:02] within that first couple of days

[00:25:03] everybody knows exactly the phases

[00:25:06] the players going to go through

[00:25:08] and with experienced clinicians you can really

[00:25:10] say well this one's going to take 10 days here

[00:25:13] so for instance like a return to running criteria

[00:25:15] with an ACL it takes a week

[00:25:18] and we kind of know that to fulfill all that

[00:25:20] return to running criteria with a

[00:25:23] two week injury takes half an hour

[00:25:25] and it's really I think if you can

[00:25:28] use the pathway to really align yourself as a team

[00:25:32] have real clarity on your roles

[00:25:35] and get the player involved in that process

[00:25:37] show the player you are here

[00:25:40] we're going to do these things

[00:25:41] you're going to go to there

[00:25:42] you're going to go to there

[00:25:44] and really get the player involved in it

[00:25:46] they understand the philosophy

[00:25:48] and they understand the link between the exercises

[00:25:50] to the grass to performance

[00:25:52] and you can do that with the objective data

[00:25:56] and when you can sell that to a player

[00:25:58] you've hit the jackpot really

[00:26:00] that's the real true alignment of everything

[00:26:02] you have the pathway on paper

[00:26:04] but then you sell it to the player

[00:26:06] you educate the player and this exercise is going to make you

[00:26:10] run quicker jump higher whatever we decide

[00:26:14] Mitch we often hear people talking about

[00:26:17] working in teams and the sports performance team

[00:26:21] the interprofessional team

[00:26:23] I am often struck by how little detail people give

[00:26:27] about how that actually works well

[00:26:29] you've given us a great roadmap

[00:26:31] of how to make it work with practical concrete examples

[00:26:34] thanks so much for taking the time

[00:26:36] to put your philosophy down on paper

[00:26:38] as you say taking that leap and publishing it

[00:26:42] and saying to the world

[00:26:43] hey this is what I do

[00:26:44] what do you reckon

[00:26:45] and I'm sure you would invite people to contribute

[00:26:49] to come back and to talk more about this

[00:26:51] so I'm so grateful for you joining us

[00:26:53] on JOSPT Insights today

[00:26:55] thank you very much

[00:26:59] Thanks for listening to this episode of JOSPT Insights

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