Ian King

The athlete and boiling water – how the lessons are lost

/by

There is an old fable that a frog in water where the temperature is being slowly raised will not jump out of the water, as the changes to their detriment are slow. Compared to a frog suddenly placed in boiling that may realize this is not a healthy place to be.

It appears to me that as the injury incidence rises in sport from decade to decade athletes are like this fable. They assume it is normal and accept the environment.

In an earlier article (A Lament for the Late Arrivals) I spoke about four waves of acceptance of strength training in sport (Table 1 below).  In this article, I seek to give specific examples of the lessons that should have been learnt from any of these earlier adopter sports, lessons that could and should have been passed on to improve the lot of the subsequent generation of athletes, and the later adopting sports.

For the purposes of this discussion, I will focus on the tipping point in the adoption of non-specific training referred to as physical preparation (or in the case of the American interpretation, strength and conditioning) as it relates to one specific sport sub-category – elite female swimmers in Australia.  To highlight the impact of this tipping point, I compare two cohorts – the pre-2000 cohort (1980-2000) to the post-2000 cohort (2000-2020), with specific reference to performance threatening injuries and surgeries caused by training.

The tipping point being the term credited in the first instance to American sociologist Morton Grodzins who coined the term in the 1950s[1], as defined by the Merriam-Webster dictionary as:

“…the critical point in a situation, process, or system beyond which a significant and often unstoppable effect or change takes place…” [2]

Therefore, I am not referring in my classification of sports and time to the outlier who was an individual early embracer of say strength training, but rather to the critical point where the rate of acceptance accelerated.

US futurist Joel Barker talks about the time it takes to reach 10 percent uptake in a new trend is the time that it races up to 90 percent acceptance, suggesting that the 10 percent mark may be a typical tipping point.[3]

Without actual statistics in each sport, my classification relies not only upon personal professional observations and is a generalization.

Table 1 – Four waves of sports that embraced physical preparation.

Phase USA Australia Sports
1 – Early embracers <1980 <1980 Track & field, American football
2 – >1980 >1990 Power and mixed energy sports e.g. rugby, Australian Rules
3 – >2000 >2000 Diverse medium sports e.g. swimming
4 – Late arrivals >2010 >2010 Displacement, balance and more coordination-based sports e.g. off-road motorcycle disciplines

©King, I., 2021

I now turn to the concept of turning point.  Vocabulary.com defines turning point as:

“…a specific, significant moment when something begins to change…” [4]

 The specific application of the turning point I introduce is when the impact of a tipping point becomes apparent in a larger scale, for better or worse.

We can measure this from the perspective of the intended goals of physical preparation – to prevent injuries (specifically to reduce injury incidence and severity and lengthen careers) and enhance performance.

Further, we can trade off the performance enhancement benefits against the injury costs.

The post-2000 cohort analysis (2000-2020)

A 2016 article identified Australian top 10 female swimmers post 2000.[5] This list included, in this order:

Libby Trickett (nee Lenton)

Petria Thomas

Leisel Jones

Cate Campbell

Emily Seebohm

Jodie Henry

Stephanie Rice

Alicia Coutts

Jessicah Schipper

Bronte Campbell

Libby Trickett (nee Lenton)

Triple Olympian Libby Trickett’s (nee Lenton) career spanned the post-2000 era – including the 2004, 2008 and 2012 Olympics (with a brief retirement in 2009).

In the early 2000s, Australian swimming and triple Olympian Libby Trickett (nee Lenton) became the first swimmer celebrated by the swimming fraternity for their strength training induced physique changes, in contrast to the response that Australian triple Olympian Lisa Curry received for the same transformation in the lead up to the 1992 Barcelona Games.

Libby suffered from wrist pain throughout her career:

“I have always had weak wrists and this problem first flared up after Beijing (the 2008 Olympics),” she said.

However, in 2011 the injury got worse. It is apparent the pain was less related to swimming than to her dryland training, at least initially.

“But this year it has started to hurt a lot more, at first when I was doing push-ups, then chin-ups, then gym and boxing, and then actually swimming. It got to the point where it was extremely uncomfortable most of the time.”[6]

She subsequently underwent surgery in 2011 to remove a cyst from the right wrist. [7]

In late 2012 she then tore her scapholunate ligament in her right wrist during a “…regular gym session.’ [8]

In December 2012 she had a second round of surgery on the right wrist:

After a full wrist reconstruction that never completely healed, it became clear that her swimming career was over. Trickett retired for the second time in 2013 at the age of 27.”[9]

This injury forced her into retirement and denied her from fulfilling her intended legacy at the 2106 Rio Games:

Despite amassing great success representing Australia in three Olympics, the freestyler had her eyes set on Rio in 2016.   

‘The pack starts to fall away, and you find yourself in a rarer and rarer crowd: the elite of the elite. And you get a rush from chasing that kind of distinction. I’m swimming for my legacy. Three Olympics is impressive, but four is legendary,’ Trickett wrote…[10]

The value placed on strength training in Lenton’s career is reflected in the reference to and sequence of strength training in this quote, where it appeared before reference to swimming:

“AFTER all the hard work, sacrifice, hours in the gym and countless laps in the pool, Libby Trickett is about to find out if she still has what it takes to be an Olympian”[11]

Petria Thomas

Triple Olympian (1996, 2000 and 2004) Petria Thomas struggled with shoulder injuries throughout her competitive career:

“Recovering and coming back from her three previous surgeries during her celebrated career…” [12]

And by the age of 43 underwent her fourth shoulder surgery, what appears to be a shoulder joint replacement or similar:

“… recovering from a four-hour shoulder replacement surgery on her right shoulder – her fourth major shoulder operation…“Thankfully (I’m) not in too much pain after my shoulder replacement surgery today, which went well,” Thomas wrote….“My shoulder was very arthritic so (I) defiantly made the right decision to get a new one!”[13]

Thomas engaged in strength training at the Australian Institute of Sport whilst still in high school. Note the importance placed on strength training based on the sequence of training modalities in the below:

“Training at the AIS was gruelling for a full time student. Thomas would rise at 5 am and train at the gym or the pool for a couple of hours before school. After school she returned for more training before going to the study hall for her schoolwork.”[14]

Leisel Jones

 The first Australian swimmer to attend four Olympics[15] (2000, 2004, 2008 and 2012), Leisel Jones appears to be an exception.

“I work on injury prevention as part of my training. Luckily I haven’t had any major injuries, just a few niggles here and there…”[16]

Cate Campbell

Four-time Olympian (2008, 2012, 2016 and 2020) Cate Campbell’s underwent shoulder surgery in September 2014[17]:

CATE Campbell is prepared to sacrifice her world title defence next year for Rio Olympic glory and has booked in for shoulder surgery next week that has ruled her out of racing for the rest of 2014. 

The world 100m freestyle champion has silently battled through the “chronic pain” of a bone spur impacting upon a nerve in her right shoulder, but with her long course season now finished with another two gold medals at the Pan Pacs on Sunday night she revealed her next task was surgery. [18]

In addition to the shoulder surgery she received cortisone injections:

“…had six or so cortisone injections into her neck..”[19]

Suffered a hernia in 2016 and underwent surgery for this:

“Campbell developed the hernia 3 months ago, but was not able to have the surgery before Rio for fear it would disrupt her training and preparation….The Sydney Morning Herald says Campbell will have surgery in October, after taking a post-Olympics holiday.”  

That was her apparently second surgery for the same type of injury:

“That will be her second such surgery in the past year.”[20]

Campbell told The Australian that the hernia, her second in 12 months, did not impact on her performances in Rio de Janeiro where she failed to win a medal in the 100m despite being the favourite.[21]

She showed some appreciation of the injury implication for life quality post racing:

“I’m 22 and I’m waking up with chronic pain in the morning, it doesn’t bode well for 50 years’ time,” she said. [22].

Emily Seebohm

Four-time Olympian (2008, 2012, 2016 and 2020) Emily Seebohm is another exception to the post 2000 pattern.  She suffered a dislocated kneecap in 2015[23] whilst riding a horse[24] however otherwise describes herself as;

“…’lucky that I’ve never had any massive injuries.”[25]

Jodie Henry

2004 Olympian Jodie Henry failed to defend her 2004 title in the subsequent Olympics’ due to a hip muscle injury:

“Australian star Jodie Henry won’t defend her 100-meter freestyle Olympic title in Beijing because of a muscle imbalance in her pelvic area. 

.. “I have been struggling with an injury which has meant that I haven’t been able to train as much as I would have liked, and as much as I have needed to, to be ready for the Olympic trials.” [26]

An emotional Henry fought back tears as she admitted matter had finally won out over mind, confirming she would miss the Olympics after succumbing to a chronic and complicated pelvic injury.

Henry, 24, will now relinquish her 100m freestyle title and be a frustrated observer as her beloved 4x100m freestyle and medley relay teams try to defend gold against strong challenges from the powerful US and German squads.[27] 

She was adamant she was not retiring:

Henry immediately ruled out retiring and said the injury would only need a few months of physio and pilates treatment to be fully healed.

…”I’m happy to say I’m definitely not retiring. There’s no way I want to go out like this. Now I’m just looking at resetting goals and fixing my injuries,” Henry said.

“It does cross your mind but I quickly put it out of my head. I’m only 24. I’ve got good swimming years ahead of me. I’m a sprinter. There’s a 40-year-old trying out for the American team and she’s a good shot. I can keep on going.“[28]

She retired the next year:

“The 25-year-old said her persistent injury gave her insight into life outside of the pool and ultimately led to her decision to retire.”[29]

Stephanie Rice

Dual Olympian (2008 and 2012) Stephanie Rice struggled with shoulder injuries throughout her competitive career:

By 2010 she had racked up an un-viable amount of cortisone injections:

She has had seven cortisone injections in the shoulder, which is three more than what doctors recommend. If she had more it could cause structural damage that could end her career. “It is really inflamed,” Rice said.”[30]

She then underwent shoulder surgery in 2010, missing the 2010 Commonwealth Games:

“If she delayed the arthroscopic surgery, the 22-year-old Queenslander risked permanent damage and derailing her hopes at the 2012 Olympics in London…

 … Rice’s injury is not just one inflamed joint in her shoulder, but three joints, making surgery inevitable.” [31]

“Just got out of surgery. Things went well, thank you God … just cleaned the bursa in my right shoulder.”[32]

She repeated surgery in 2011 on the same shoulder:

“In a bit of deja vu, Australian superstar Stephanie Rice has undergone shoulder surgery and pulled out of the remainder of the Queensland State Championships, much like what happened in 2010 at the Pan Pac Championships when her problems first came to a head. It was last year’s version of these State Championships where she made her return after the prior surgery.”[33]

And there was a third surgery on the same shoulder, date unclear:

“Rice…having undergone three shoulder operations.”[34]

The surgeries did not resolve the issue as reported during 2012:

“The triple Olympic gold medallist revealed this morning at the New South Wales swimming titles that her troublesome right shoulder has not improved from recent surgery.”[35]

“Triple Olympic gold medal winner Stephanie Rice has admitted her injured right shoulder is giving her so much concern as she continues to nurse the injury towards next month’s selection trials, that if this wasn’t an Olympic year, she would have taken 12 months out of the water.”[36]

She managed to qualify for the 2012 London Olympics.

“Rice competed in London after undergoing three shoulder surgeries between the two Olympics. She finished fourth in 200 m individual medley and a joint sixth in 400 m medley. The London Olympics was her last stop as a swimmer and she eventually announced her retirement in April 2014”[37]

However, despite more shoulder surgeries:

“Rice, who has been plagued with injury, has not raced competitively since her unsuccessful 2012 London Games campaign, having undergone three shoulder operations.”[38]

And retired in 2014[39] without having raced since 2012.

Alicia Coutts

Triple Olympian (2008, 2012 and 2016) Alicia Coutts suffered a serious shoulder injury in 2014,[40] which remained with her in the following years:

“A chronic shoulder injury that refused to go away..”[41]

She retired in 2016 following the Rio Games:

In the final individual swim of her three Olympic campaigns, fellow Australian Alicia Coutts finished out of the medals in the final of the women’s 200m individual medley, touching in fifth place before tearfully signing off. …I’m just excited I could go out on my own terms after shoulder injuries…I’m proud of my achievements.”[42]

Regarding the shoulder injury her coach, post her retirement, shared:

“Alicia tore her labrum in her shoulder but it was never fully repaired, leaving her swimming in constant pain for two years,” Fowlie said. 

“She had a choice, surgery and end her career or push through and basically swim over one million strokes of constant pain to get on that team for Rio. [43]

Jessica Schipper

Triple Olympian (2004, 2008 and 2012) Jessica Schipper is another exception to the post-2000 pattern, with no significant injuries or surgery.

Bronte Campbell

Triple Olympian (2012, 2016 and 2020) Bronte Campbell sums up her relationship with injury with:

“I’ve been injured for five years, which is half of my swimming career..”[44]

The joints involved are listed below:

“The 25-year-old former world champion freestyler has a history of shoulder, neck and hip injuries and the 2019 season had a lot to do with rehabilitation and recovery.”[45]

Further details of the impact on her availability to compete are outlined in the below:

She was hampered by hip and shoulder injuries in the lead-up and during the 2016 Olympic Games in Rio de Janeiro. She took two months out of the pool after the Games. She continued to suffer issues with her left shoulder and then her right in the lead-up to the 2017 World Championships in Budapest, Hungary. (swimswam.com, 06 Sep 2016, 23 Jul 2017)

She was hampered by a hip injury from November 2015 until February 2016. (au.news.yahoo.com, 05 Feb 2016)

She had glandular fever and chronic fatigue syndrome in 2010 that disrupted her career for two years. (smh.com.au, 10 Apr 2012)[46]

And not just one shoulder:

“Campbell, 23, struggled with inflammation in her left shoulder during the Olympic year and could only manage fourth in the Olympic final in Rio. And just when she began to feel she had that injury under some control, her right shoulder has gone.”[47]

She underwent shoulder surgery in 2018:

“However, injuries including her lingering shoulder issue that required surgery in 2018, conspired to ensure she had never re-scaled those heights.”[48]

Summary of the 2000-2020 Era

All these swimmers achieved great things in the pool as measured by the podium and the stopwatch. There is no question of that. The question I raise is ‘How good could they have been had they not suffered these injuries?’

A further challenge may be raised regarding the cause of the injury – some would suggest that shoulder injuries are ‘part and parcel’ of swimming. They didn’t use to be, at least not to this extent.

The pre-2000 cohort analysis (1980-2000)

In the absence of a third-party article, I can use to identify the ‘Top 10’ Australian female swimmers from 1980-2000, I include the following (listed alphabetically by surname), I apologize to any swimmers who perhaps should have been on the list. The intent is to provide a comparative sample.[49] Note also finding data on pre-2000 athletes is a challenge due to the relatively recent arrival of this platform:

Lisa Curry

Janelle Elford

Hayley Lewis

Eli Overton

Samantha Riley

Julie McDonald

Susie O’Neill

Nicole Stevenson

Petria Thomas

Karen van Wirdum

Summary of the 1980-2000 Era

Whilst the data pre-2000 is not as readily available as the post-2000 data due to the timing of the arrival of the internet, my professional experience combined with the limited data now available suggest the pre-2000 cohort had very limited incidence of competition threatening injury and surgery.

Comparative summary of both eras

The following table attempts to summarize and compare the injury statistics of these two cohorts.  The injuries included are indented to be training related injuries that caused loss of performance or ability to compete.  Both injury and surgery information are reliant upon that which is in public domain on the internet. The information for the pre 2000 cohort is more difficult to obtain.

Table 2 – Comparative analysis of injury and surgery between the pre-2000 and post-2000 Australia elite female swimming cohorts.

1980-2000 Injury Surgery 2000-2020 Injury Surgery
Lisa Curry

 

 Libby Trickett (nee Lenton)  

X

X
Janelle Elford Petria Thomas X X
Hayley Lewis Leisel Jones – –
Eli Overton Cate Campbell X X
Samantha Riley Emily Seebohm – –
Julie McDonald Jodie Henry X –
Susie O’Neill Stephanie Rice X X
Nicole Stevenson Alicia Coutts X –
Petria Thomas X X Jessica Schipper – –
Karen van Wirdum Bronte Campbell X X
Total 1/10 1/10 7/10 6/10
%age 10% 10%   70% 60%

Based on this analysis, the post-2000 cohort experienced performance and competition threatening injuries at a rate of 70% and surgery at 60%.

The pre-2000 cohort, based on the limited data available, experienced performance and competition threatening injuries at a rate of 10% and surgery at 10%.

Irrespective of the limitations of finding injury and surgery information about the pre-2000 cohort, and not withstanding any information that may come to light about the injuries of the pre-2000 cohort in the future, its fair to say there is a significant difference between the injury and surgery statistics of the pre-2000 cohort compared to the post-2000 cohort.

Put simply, there is a significant difference between the two cohorts in these measurements.

The next question is why? Many would justify the post-2000 cohort injuries and surgeries by saying look at the stop-watch – they are swimming faster and that is the price you pay.

Which leads to a second question, which I have not seen being proposed elsewhere – could  the performance improvements of the post 2000 cohort relative to the pre-2000 cohort have been achieved without such a dramatic lift in injury and surgery?

That is a subjective conclusion and I will leave that to the values of the modern day swim coach.

Swimming techniques may have changed, and average meter/second speed in training may have changed. However, I am not sure if any of these changes account for the changes in injury incidence and severity.

Let’s be clear – this is a non-impact sport – apart from the risk of swimming into the wall, the athletes don’t bang bodies as they do in classic impact sport. Nor is their gravity impact – the swimmers are in a medium where they are supported in part by the water.  The most significant impact is the drive off the blocks or wall in the starts, and the push-off the way in the turns.

The length of the pool the same. The medium – water – the same.  The events – very similar. The competition schedule is similar. States, Nationals, Pan Pac’s, Commonwealth Games, Olympic Games.

So what has really changed between the training of both cohorts? The training? If so, is it the swimming training or the dryland training?

In relation to training, I suggest that the swimming training frequency and volume are not the difference. I suggest the most significant difference is the time spend in ‘dry-land training’ and the type. The average post-2000 cohort swimmer is performing maximal strength training three times a week all year around, a frequency that was not apparent in the pre-2000 era. The pre-2000 era may have conducted that frequency of dryland work but it was more literally by the pool, and bodyweight exercises.

The type of dryland training has changed in that in the pre-2000 ear the dryland training was more about circuits of bodyweight exercises. In the post-2000 era, a premium is placed on load displacement in the non-specific strength training exercises.

Secondly, in relation to flexibility training, swimming appears to have bought into the ‘all-sports just happen to think the same way’ paradigm that if any static stretching is to be done, it should only be done after training.

Thirdly it is possible that the post-2000 cohort may be doing more ‘cross-training’ than the pre-2000 cohort, to comply with the paradigm that ‘professional athletes’ have to do more training. So perhaps there are more road runs, more stationary cycles and rowing ergometers beside the pool.

Swimming has perhaps yet to work out how to achieve the advantages of dryland training, especially maximum strength training methods, combined with low injury incidence, minimal surgery and the avoidance of career-ending injuries, as experienced by the pre-2000 cohort.

This performance vs. injury trade-off dilemma/challenge is faced by all sports who have passed the tipping point in US-influenced physical preparation.

Conclusion

Yes, swimming is tough on the swimmer’s body. The initial goal of physical preparation is to prevent injuries, not compound them. I suggest this pattern underlines that is exactly what has happened since the tipping point of embracing strength training in swimming post-2000.

Another argument proposed may be that ‘the sport has changed’. The swimming pool is still 50 meters long, and there is nothing about the impact with the water that would explain shoulder injuries akin to contact sport injuries, such that they result in surgery.

Another argument proposed maybe that ‘Australia’s post-2000 cohort of elite female swimmers are achieving higher world rankings than the pre-2000 cohort’.  If this were true, does that demand the injury and surgery rate? Or could this performance be achieved with lower rates? The answer to that question alone creates a self-fulfilling outcome.

In my opinion, there are lessons here. I believe that that the injury and surgery incidence has increased beyond what can be justified.

Perhaps no one else is alarmed by this or sees the same concerns.

Either way, the lesson is not being used to serve sports or athletes within these sports that come along later.

This means the next generation of athletes and the sports I describe as late arrivals to physical preparation, especially the US version called ‘strength & conditioning’ will suffer the same fate.

I am sure they would have preferred if someone warned them about the hot water they may be about to get themselves in.

Something like this – ‘At the moment if you achieve your goals and reach elite status (in female swimming) AND keep doing what they (and basically everyone in sport) are currently doing, you have a 70% chance of experiencing performance and competition threatening injuries and a 60% chance of surgery. And a comparison to the generation before suggests that the next generation will probably be at 90 and 100% respectively. Unless things change….’

That’s a message that should be passed on.

 

References

[1] https://www.economist.com/free-exchange/2009/07/13/the-original-tipping-point-wasnt-one

[2] https://www.merriam-webster.com/dictionary/tipping%20point

[3] Barker, J., 1993, Paradigms: The Business of Discovering the Future Paperback – May 26, 1993

[4] https://www.vocabulary.com/dictionary/turning%20point

[5] https://www.dailytelegraph.com.au/sport/swoop/rio-2016-susie-oneill-to-libby-trickett-and-steph-rice-top-aussie-female-swimmers-since-2000/news-story/d9240b9a40e5e7ff5097f9770fca4405

[6] https://www.theaustralian.com.au/sport/libby-tricketts-cold-turkey-approach-to-relay-fight/news-story/694d8d397af4c63305ce03213318359a

[7] https://www.theaustralian.com.au/sport/libby-tricketts-cold-turkey-approach-to-relay-fight/news-story/694d8d397af4c63305ce03213318359a

[8] https://www.kalminer.com.au/news/goldfields/tricketts-focus-on-glasgow-ng-ya-284150

[9] https://hope1032.com.au/stories/life/inspirational-stories/2019/aussie-olympian-libby-trickett-opens-up-about-her-mental-health-struggles/

[10] https://www.dailymail.co.uk/news/article-7517073/Libby-Tricketts-sudden-retirement-pool-confronting-truth.html

[11] https://www.adelaidenow.com.au/ipad/trickett-up-to-the-weight-of-expectations/news-story/276c2e1074796e951e46c825bf38bb2f

[12] https://www.swimmingworldmagazine.com/news/four-hour-shoulder-operation-a-success-for-olympic-great-petria-thomas/

[13] https://www.swimmingworldmagazine.com/news/four-hour-shoulder-operation-a-success-for-olympic-great-petria-thomas/

[14] http://www.womenaustralia.info/exhib/sg/thomas.html

[15] https://www.news.com.au/sport/olympics/swimming/hurtful-dawn-fraser-sledge-leisel-jones-still-cant-get-over/news-story/e7f81f5c30e6090142a47abf237c25d2

[16] https://www.adelaidenow.com.au/ipad/how-i-look-like-i-do-leisel-jones/news-story/66a71b34c994f1c758bb731a765f981a

[17] https://olympics.com/tokyo-2020/olympic-games/en/results/swimming/athlete-profile-n1482861-campbell-cate.htm

[18] https://www.foxsports.com.au/news/cate-campbell-to-undergo-shoulder-surgery-after-starring-role-at-pan-pacs-with-rio-2016-on-the-horizon/news-story/3b98b78fabf72ec414ff0ce53dce2a41

[19] https://www.sbs.com.au/news/bronte-campbell-battles-shoulder-injury

[20] https://swimswam.com/cate-campbell-undergo-hernia-surgery-upon-return-rio/

[21] https://www.scmp.com/sport/other-sport/article/2007791/no-excuses-australias-cate-campbell-swam-hernia-olympic-games

[22] https://www.foxsports.com.au/news/cate-campbell-to-undergo-shoulder-surgery-after-starring-role-at-pan-pacs-with-rio-2016-on-the-horizon/news-story/3b98b78fabf72ec414ff0ce53dce2a41

[23] https://swimswam.com/australias-emily-seebohm-suffers-knee-dislocation/

[24] https://www.fina.org/athletes/1000096/emily-seebohm/profile

[25] https://www.theaustralian.com.au/sport/how-an-eating-disorder-nearly-ended-seebohms-swimming-career/news-story/2715dd0679644965018eb77ae343d10c

[26] https://www.espn.com.au/olympics/swimming/news/story?id=3269786

[27] https://www.theage.com.au/sport/henry-refuses-to-retire-20080301-ge6sdz.html

[28] https://www.theage.com.au/sport/henry-refuses-to-retire-20080301-ge6sdz.html

[29] https://www.olympics.com.au/news/athens-golden-girl-retires/

[30] https://www.sbs.com.au/news/tearful-rice-quits-games-for-surgery

[31] https://www.sbs.com.au/news/tearful-rice-quits-games-for-surgery

[32] https://www.sandiegouniontribune.com/sdut-rice-has-right-shoulder-surgery-2010sep01-story.html

[33] https://swimswam.com/stephanie-rice-undergoes-second-minor-shoulder-surgery/

[34] https://www.theguardian.com/world/2014/apr/09/australian-olympic-swimmer-stephanie-rice-retirement

[35] https://www.perthnow.com.au/news/shoulder-hurting-stephanie-rices-london-hopes-ng-3534790be8aa2e2415f9d3d363ff70c8

[36] https://www.smh.com.au/sport/injured-shoulder-an-olympics-concern-for-stephanie-rice-20120210-1sdr4.html

[37] https://en.wikipedia.org/wiki/Stephanie_Rice

[38] https://www.theguardian.com/world/2014/apr/09/australian-olympic-swimmer-stephanie-rice-retirement

[39] https://www.theguardian.com/world/2014/apr/09/australian-olympic-swimmer-stephanie-rice-retirement

[40] https://www.fina.org/athletes/1006023/alicia-coutts/profile

[41] https://www.espn.com.au/olympics/story/_/id/14897629/alicia-coutts-ready-make-splash-nsw-meet

[42] https://www.theguardian.com/sport/2016/aug/10/australias-emma-mckeon-claims-bronze-as-alicia-coutts-signs-off-olympic-career

[43] https://www.olympics.com.au/news/triple-olympian-coutts-bids-farewell-to-swimming/

[44] https://www.theguardian.com/sport/2021/jun/05/bronte-campbell-ive-been-injured-for-five-years-half-my-swimming-career

[45] https://www.swimmingworldmagazine.com/news/bronte-campbell-counts-blessings-of-olympic-delay-that-grant-injuries-more-time-to-heal/

[46] https://olympics.com/tokyo-2020/olympic-games/en/results/swimming/athlete-profile-n1482860-campbell-bronte.htm

[47] https://www.theaustralian.com.au/sport/injuries-cast-doubt-on-bronte-campbells-50m-100m-defence/news-story/51890d3b1684e4868b13f825417b21c8

[48] https://www.illawarramercury.com.au/story/6218777/bronte-campbell-seals-swim-titles-berth/

[49] Note that this list is intended to include swimmers whose careers spanned both the 1980s and 1990s

Ian King

A lament for the late arrivals

/by

In the modern history of athletic preparation, there has been growing consideration for physical preparation. What the Americans call ‘strength & conditioning’. It may not be accurate to suggest that physical preparation is a new concept. The interpretation of the stories of the Greek athlete Milo of Croton from 6th BC gives support to a longer history.

However physical preparation has changed a lot in the forty-plus years during my professional involvement in sport.

A review of literature review reveals that track and field and then American football led the way in embracing physical preparation during the last century, especially the American version of physical preparation where ‘strength training’ dominants, literally and figuratively (i.e. in the title – strength… and then conditioning).

As surprising as it seems to the younger generation these were the only sports up until about 1980 in the US and 1990 in Australia that fully embraced the American interpretation of physical preparation.

Post 1980 (North America) and 1990 (Asia Pacific) a new wave embraced the American interpretation of physical preparation. Power and mixed energy sports such as most field sports e.g. rugby union, rugby league, Australian Rules Football, to name a few Australian based sports.

I call this the second wave.

Post 2000 there was a third wave that involved sports such as swimming. Some may suggest that swimming embraced strength training earlier – not based on my experiences working with both US and Australian-based swimmers. Let’s just say the discussions in the national team environment, that I was party to, were not favorable in the direction of strength training for swimming. I did not see any real acceptance of this until post 2000, and I include observations of coaching protocols as well as the content being shared at the annual Australian Swim Coaches Association (as it was known then) conventions.

Post 2010 there was a fourth wave that involved sports with great balance and less direct relationship with swimming e.g. surfing, off-road motorcycle racing. I call these the late arrivals.

There is I suggest a pattern to the sequence of acceptance by sports of the American influenced ‘strength and conditioning’. From sports where strength training plays a bigger role through to sports where strength training plays a lessor role.

Table 1 – Four waves of sports that embraced physical preparation.

Phase USA Australia Sports
1 – Early embracers <1980 <1980 Track # field, American football
2 – >1980 >1990 Power and mixed energy sports e.g. rugby, Australian Rules
3 – >2000 >2000 Diverse medium sports e.g. swimming
4 – Late arrivals >2010 >2010 Displacement, balance and more coordination-based sports e.g. off-road motorcycle disciplines

©King, I., 2021

Put simply, there is a reason they are late arrivals. And therefore, blind acceptance and embracing of methodology applied in all other sports has even more potential downsides the further along the continuum you go.

I feel for the late arrivals, and I lament the collateral damage they are potentially walking into. To see they feel, they are being more ‘professional’ by the mere act of ‘going to the gym’ and embracing the same training values as their predecessors sports is hurtful to watch.

There is a reason certain sports were later to the ‘strength training’ party, and if you fail to respect that and fail to reflect and consider more optimal ways, then these sports will pay the biggest price of them all. And I suggest it is happening.

Firstly, if the lessons of the last century of strength training for sport were made available. However, they are not.

Let me give an example. There would be very few swimming coaches in the Australian high-performance environment alive and coaching today who were around in the 1960s when Australian swim coaches began their initial flirtation with strength training. They learned certain things and reacted appropriately, pulling back from this modality, in at least the way it was being done. I base these observations on personal discussions with the late John Carew. I doubt too many if any of the current Australian elite swim coaches have had such discussions. The lessons have been lost.

The outcome is increased injuries and decreased performance. The exact opposite to the proclaimed benefits of ‘strength and conditioning’. A great example of this is Australian rugby, where it’s been nearly 20 years since Australia beat the New Zealand All Blacks for the cherished Bledisloe Cup, and the nation has sunk to a historic low world ranking of 7th in recent years. There are reasons for this, and a big part of this I suggest is the misguided off-field training resulting in decreased performance potential and increased injury incidence and severity.

It’s tough to beat a nation where the players may be more culturally and genetically suited to the game when your off-field training is letting you down.

Secondly, it may also be fine if strength training for sport, the American way, has evolved well past the programs used for American football. However, I suggest they have not.

Again, in anticipation of challenges to my last statement, let me give you an example – a golf scholarship athlete at a Div. 1 US NCAA college given the exact program as the American football team at the same college – post 2010…

Many American football players do not run far, do not touch the ball and so. If you are not playing American football and conduct your off-field training in a way that is heavily influenced, you will pay a price. And I suggest that is happening.

However how many were around in the 1970s transition to the 1980s in physical preparation to know from a personal/ professional perspective what had transpired in the formation of the American interpretation of physical preparation. Not many. The lessons have been lost.

All athletes want to play, and some want to play at the higher levels. In this pursuit, they seek additional and ‘new’ ways to train, to gain confidence they are ‘on track’ e.g., training like ‘all the other pro’s’.

I feel for the late arrivals, and I lament the collateral damage they are potentially walking into. There should have been a better message for you by now, however there is not. Tread carefully.

Ideally, I should be saving I hope your non-specific (physical preparation) training helps you thrive. That would be nice. However, based on my experience and observations – what I know – if you do what the rest of your colleagues are doing in their interpretation of the best way to train, survive may be a more appropriate term.

You deserve better. Our profession has failed to deliver safe training, let alone optimal training. Now it’s up to you to be more discerning. Don’t assume. Don’t imitate. Seek answers, dig deeper, objectively question and interpret the cause-effect relationship of what you are seeing and doing. Be more scientific in your review than our profession is.

Your future depends on it.

And not just your sporting future.

Ian King

Still hamstrung, after all these years

/by

The story goes that back in about the 1970s two high level bodybuilders agreed to a sprint race, and during that sprint race they both tore hamstrings.

This story entertained many, however I took a more serious lesson from it.

Combined with my observations of the shift in posture from the 1960s to the 1970s bodybuilder and took into account that the clients I served displaced further and faster that the average bodybuilder, alarm bells were ringing.

The development of the Lines of Movement Concept (especially the hip vs quad dominant component was a direct response to my concerns about injury potential from muscle balance.  As was the introduction and innovation of bodyweight and unilateral exercises into strength training in a way that was considered unconventional at the time (however since 2000 have become the backbone of the so-called ‘functional training’ movement). [1]

Or you can learn about it second hand, however I suggest the power of the message may have been diluted in these versions.

That’s just not my biased opinion – that an observation of the direction of injuries globally.

So in the 1980s I  committed to ensuring the muscle imbalances evident from mainstream strength training trends would not be part of the life of athletes I worked with.

Decades later I look back with confirmation that my Zero Tolerance approach to injuries, especially soft tissue injuries, has been successful.

Successful for athletes that I have worked with during the past four decades. However, the message, even with the concept being republished endlessly by others, has not been successful.

It appears humans are still struggling to prevent simple yet debilitating injuries such as hamstring strains.

These soft tissue injuries are predictable, preventable, unnecessary and non-productive.

Recently at an off-road motorcycling competition I observed a rider enter the pits prematurely and heard him declare he has torn his hamstring.  I was more than intrigued, mixed with the usual compassion for the athlete.  He had torn his hamstring on a motorbike?

As a student of injury prevention, not only did I provide care and guidance over the next hour, I tested my hypothesis as I typically do with a series of questions to the rider.

My conclusion – just another victim of mainstream training paradigms. He was buffed. Anyone male would be proud of the physique he had developed. But stretching? No, not much of that. I checked out his all-important quads and they were rocks. They looked great.   A real Men’s Health model candidate. However, the rest of the body was suffering for the training outcome he had produced – especially the hamstrings.

At first he was keen to tell me had been tight all is his life. That was shut down quickly with his – and to his credit – acknowledgement he had not done much to change this.

Then he went down the path of ‘I am a rower and that is why I am tight’. That was shut down quickly when I raised some of the elite rowers I had worked with, and that I had failed to observe tightness as a common theme in rowers.

Once we got through the excuses and the defense mechanisms and got to hear how he trained – there were no surprise. He had absorbed the current paradigms of training and was just another victim of the times.

There is no shortage of statistics on the extent of hamstring injury; Here are a few collated by Eirale C. and Ekstrand (2019)[2]:

  • Epidemiological studies assessing sports constantly rank hamstring injuries as one of the most prevalent factors resulting in missed playing time by athletes.[3] [4] [5]
  • Hamstring ‘strains’ account for a substantial percentage of acute, sports related musculoskeletal injuries with a prevalence of 6 to 25%, depending on the sport. [6]
  • Hamstring strains are far more common in positions in which sprinting is more often required.[7] [8] [9]
  • A survey of the UEFA Champions League showed that muscle injuries make up more than 30% of all player injuries and cause about 1/4 of total time lost due to injury.[10]
  • Over 90% of muscle injuries seen in this study involved four major muscle groups of the lower extremity: hamstrings, adductors, quadriceps and gastrocnemius. [11]
  • Injury to the hamstring muscle group is reported to be the most common injury subtype representing 12% of all injuries and more than 1/3 of all strains.[12]
  • A professional male soccer team with 25 players may expect about five hamstring injuries each season, equivalent to more than 80 lost football days and 14 missed matches.[13]
  • In soccer injury to the hamstring muscle group is reported to be the most common injury subtype representing 12% of all injuries and more than 1/3 of all strains.[14]
  • In a track and field sprinting study the most frequent diagnosis was hamstring strain.[15] For example, thigh strain was the most common diagnosis (16%) in sports injury surveillance studies at the 2007, 2009 and 2011 IAAF (International Association of Athletics Federations) World Athletics Championships.[16] [17] [18]
  • In the American football muscle strains account for 46% of practice injuries and 22% of pre-season game injuries, the second most common pre-season injury.[19]
  • More than half (53.1%) of all hamstring injuries in American football occurred in the 7-week pre-season, before the teams had even played their first regular-season game.[20]

And there is also no shortage of claimed causes and preventions. Perhaps the most popular of these is described in the following statement:“The best evidence for injury prevention is available for programmes designed to increase hamstring strength, particularly eccentric hamstrings strength.”[21]

So, what impact have all these theories and research had on hamstring injury incidence?

“Despite a massive amount of recent research and consequent prevention programmes, hamstring injury incidence is not decreasing.” [22]:

I shake my head as to why the sporting world is still plagued by soft tissue injuries. Everyone now wants to be a ‘injury rehab specialist’ – yet no-one wants to be an ‘injury prevention’ advocate.

Perhaps it is understandable, when you search the ‘web you find so many articles, website and experts purporting to have the education to prevent hamstring injuries. I am very uninterested in theories. I want to know of sporting seasons with high volumes of athletes and minimal if any soft tissue injuries. That’s the only evidence that matters.

Soft tissue injuries such as hamstring strains are completely optional and unnecessary. It’s pretty easy to make them extinct or near extinct. Yet they continue.

Two things are apparent to me – the rise in soft tissue injuries, and the concurrent rise in funding and research on how to prevent them has been ineffective.

Yet the ‘search’ continues. The NFL has just allocated $4m USD (yes, 4 million) to:

“…fund a team of medical researchers led by the University of Wisconsin” to “investigate the prevention and treatment of hamstring injuries for elite football players.” [23]

The NFL has had only one century to solve the mystery of hamstrings…[24]

This statement was made in relation to this research:

“The persistent symptoms, slow healing, and a high rate of re-injury make hamstring strains a frustrating and disabling injury for athletes and a challenge for sport medicine clinicians to treat,” said Dr. Bryan Heiderscheit, PT, PhD, FAPTA, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison.” [25]

I agree it would be frustrating for the athletes – if they were trained in a manner that resulted in hamstring strains. I agree it would be a challenge for sports medicine clinicians to treat – if they didn’t know how to prevent and rehabilitate them on the rare occasions they might occur.

However, I don’t agree with the following suggestion in relation to the recent NFL funding:

“To truly understand and reduce hamstring injury risk requires a study of an unprecedented size and scope.”

And what will it result in? Will it solve the leagues 100 years search for answers to hamstring strains? Let’s review the hamstring strain stats in the NFL in about a decade. That should be enough time.

I have my predictions, and I am sure they differ from those invested in the ‘research’ of hamstring strains. Our profession has been ‘researching’ hamstring strains for decades, and I suggest that it has not resulted in a downturn in hamstring incidence.

But you don’t need my opinion. The statistics tell the story.

It appears the world is still hamstrung, after all these years.

 

References

[1] You can learn more about these concepts in the original writings of How to Write (1998) and How to Teach (2000), the Legacy book (2018) or the KSI Coaching Courses.

[2] Eirale C. and Ekstrand, J.,  2019, Hamstrings are dangerous for sport and sport is dangerous for hamstrings, Aspetar Sports Medicine Journal, Vol. 8, p. 438-444.

[3] Ekstrand J, Healy JC, Walden M, Lee JC, English B, Hagglund M. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med 2012; 46:112-117.

[4] Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 2001; 29:300- 303.

[5] Eirale C, Farooq A, Smiley FA, Tol JL, Chalabi H. Epidemiology of football injuries in Asia: a prospective study in Qatar. J Sci Med Sport 2013; 16:113-117.

[6] Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010; 40:67-81.

[7] Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med 2011; 39:843-850.

[8] Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39:1226-1232

[9] Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian football league. Am J Sports Med 2013; 41:734-741.

[10] Ekstrand J, Hagglund M, Walden M. In jury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 2011; 45:553-558.

[11] Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39:1226-1232.

[12] Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39:1226-1232.

[13] Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39:1226-1232.

[14] Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39:1226-1232.

[15] Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Renstrom P. Prevalence of musculoskeletal injuries in Swedish elite track and field athletes. Am J Sports Med 2012; 40:163-169.

[16] Alonso JM, Junge A, Renstrom P, Engebretsen L, Mountjoy M, Dvorak J. Sports injuries surveillance during the 2007 IAAF World Athletics Championships. Clin J Sport Med 2009; 19:26-32.

[17] Alonso JM, Tscholl PM, Engebretsen L, Mountjoy M, Dvorak J, Junge A. Occurrence of injuries and illnesses during the 2009 IAAF World Athletics Championships. Br J Sports Med 2010; 44:1100-1105.

[18] Alonso JM, Edouard P, Fischetto G, Adams B, Depiesse F, Mountjoy M. Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF Championships injuries and illnesses surveillance. Br J Sports Med 2012; 46:505-514.

[19] Feeley BT, Kennelly S, Barnes RP, Muller MS, Kelly BT, Rodeo SA. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med 2008; 36:1597-1603.

[20] Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med 2011; 39:843-850.

[21] Bahr, R., 2019, Prevention hamstring strains – a current view of literature, Aspetar Sports Medicine Journal, Vol. 8

[22] Eirale C. and Ekstrand, J.,  2019, Hamstrings are dangerous for sport and sport is dangerous for hamstrings, Aspetar Sports Medicine Journal, Vol. 8, p. 438-444.

[23] https://www.nfl.com/news/nfl-scientific-advisory-board-awards-4-million-research-funding-hamstring

[24] https://en.wikipedia.org/wiki/National_Football_League

[25] https://www.nfl.com/news/nfl-scientific-advisory-board-awards-4-million-research-funding-hamstring

Ian King

Life’s not fair. Even at the Olympics.

/by

Having the 2020 Games postponed by a year and not really being sure whether it was even going to happen was tough.

How hard was it to time a peak in the unknown?

There were the 12 Victorian (AUS) swimmers denied the opportunity to compete in the Olympic trials due to COVID regulations around travel. [1]

There is talk of a Canadian swimmer whose positive COVID-19 test precluding them from their Olympic Trials was shown to be a false positive the day later.

Then there were the three Olympic athletes ruled out of the Games before leaving home due to positive COVID tests.[2] And that was just the tip of the iceberg.

And the Ugandan athlete who test positive upon arrival in Japan and has been ruled out of the Games. [3] And that won’t be the last case we hear of.

And the athletes who have been ruled out after testing positive at the Games – and this is just  Day 1.[4]

Then there was the Canadian female basketball player who had to choose between being a breast feeding mum or an Olympian, as family members have been banned from the Tokyo Olympic Village.[5]

Then there was the US track athlete who had to choose between copping a drug ban for not opening the door to drug testing officials or sharing the abortion she had two days prior to the visit as the reason for not answering the door. The end result – no privacy and a drug ban.[6]

On the flip side there is the 80+% of Japanese who disapprove of the Games happening at all.[7]  One can only assume they feel the imposition of the Games is not fair.

Life’s not fair. Even at the Olympics.

References

[1] https://www.theaustralian.com.au/sport/olympics/swimming/tokyo-olympic-swimming-trials-australian-athletes-hopes-of-qualifying-crushed-by-covid19/news-story/436ca2c9da2be93cdef478ae4e40ea92

[2] https://www.insidethegames.biz/articles/1110516/chile-taekwondo-player-tests-positive

[3] https://swimswam.com/vaccinated-ugandan-olympic-athlete-denied-entry-to-japan-after-coronavirus-test/

[4] https://www.npr.org/2021/07/18/1017606827/two-athletes-have-tested-positive-for-covid-19-inside-the-olympic-village

[5] https://www.cbc.ca/sports/olympics/summer/basketball/olympics-canada-basketball-kim-gaucher-breastfeeding-1.6078717

[6] https://www.nytimes.com/2021/07/01/sports/olympics/abortion-doping-olympics-mcneal.html

[7] https://www.japantimes.co.jp/news/2021/05/17/national/tokyo-olympics-cancel-survey/

Ian King

Tokyo. It’s actually happening!

/by

Its July 2021 and the Games of the XXXII Olympiad originally scheduled for Tokyo 2020 are now happening!

Up until a few months ago no-one was sure they would.

Many Games become ‘known’ for something.

Especially since 1968….

Mexico City 1968 was known for two African American athletes, Tommie Smith and John Carlos each raised a black gloved fist during the playing of the US national anthem.

According to Wikipedia[1] – “Smith and Carlos delivered the salute with heads bowed, a gesture which became front-page news around the world. As they left the podium they were booed by the crowd. Smith later said, “If I win, I am American, not a black American. But if I did something bad, then they would say I am a Negro. We are black and we are proud of being black. Black America will understand what we did tonight.”

Tommie Smith stated in later years that “We were concerned about the lack of black assistant coaches. About how Muhammad Ali got stripped of his title. About the lack of access to good housing and our kids not being able to attend the top colleges.”

One can only hope the public reaction would be more considerate in these times.

These Games were also know for the introduction of drug testing resulting in one athlete being banned. This was the the lowest positive drug testing count of all subsequent Olympic Games, and only one of three times the count was single digits (along with 1992 and 1996)

Munich 1972 was known for the group of Palestinian terrorists storms the Olympic Village apartment of the Israeli athletes, killing two and taking nine others hostage. Understandably this overshadowed the feats such as American swimmer Mark Spitz’s seven gold medals and teenage Russian gymnast Olga Korbut’s two dramatic gold-medal victories.

Montreal 1976 was marred by an African boycott involving 22 countries, protesting the New Zealand rugby team had toured Apartheid South Africa.  In addition, the locals financially supported debt from these Games for a number of decades.

Moscow 1980 was known for the United States led a boycott of the Summer Olympic Games in Moscow to protest the late 1979 Soviet invasion of Afghanistan.  Over 60 countries joined the US in this boycott.

Los Angeles 1984 was known for the Soviet Union boycotting the games.  Perhaps payback for 1980?

Seoul 1988 was known for the first high profile positive drug result given to Canadian sprinter Ben Johnson. The 100 m track sprint event  has since been notoriously referred to as ‘the dirtiest race in history’.

Barcelona 1992 became the first Olympics where athletes were disqualified for the use of the drug Clenbuterol (US athletes Jud Logan and Bonnie Dassie).  Tough calls, as this Games had the second lowest positive drug test numbers in the post 1968 history of drug testing (5 positives). Unlike Montreal, the locals appeared happy with the long-term impact of the Games.

Atlanta 1996 was known for the domestic terrorist pipe bombing attack on Centennial Olympic Park which killed one person and injured 111 others.  This overshadowed many of the results, however it was also the third lowest positive drug test Games with only 7 positives in the record books.

Sydney 2000, Athens 2004, Beijing 2008, London 2012, Rio 2016 – all seemed relatively calm in comparison.

Then along came Tokyo – and the global pandemic of COVID-19.

Perhaps Tokyo will be known as the Games that were delayed for a year and nearly didn’t happen.

Tokyo may be one of only 11 cities that have hosted more than one Olympic Games (1964 and 2021), however they also cancelled an Olympics previously (1940).

Hopefully they will not also become known as the Games that were cancelled during the event….

 

References

[1] https://en.wikipedia.org/wiki/1968_Olympics_Black_Power_salute

Ian King

Injury reflections for physical preparation coaches

/by

Sometimes our personal experiences really shape our professional direction. The injuries I suffered in the 1980s gave me a massive kick-start towards solving injuries in athletes, not the least rupturing my ACL when tackled by a motor vehicle at about 20 years of age, before even the advent of arthroscopic surgery for knees in my country.

It was my early rehab of athlete with surgery, specifically shoulder and knee, that gave me more reasons to help athlete avoid surgery.

Then working cases such as a skier that was airlifted off the slopes with a 50% chance of living and working with another who nearly lost the ability to walk (and did lose the ability to be a racer), in part because I remained silent, were further motivators for my strong zero injury policy.

My ‘crusade’ began before anyone in our profession was interested in injury prevention, let alone rehab. The concepts and exercises I published on this subject have since become the domain of many in a way that I question whether it has advanced the profession or retarded it. Like the presenter at a recent convention who flew internationally to share an incredible secret to avoiding shoulder pain from benching – the flutter, an exercise I named and released back in the late 1990s.

The explosion of injury prevention and rehab experts has significantly diluted the original teachings, which means much of the meaning has been lost.

The reality is that the world has gone backwards. Injury and surgery rates have become epidemic. The very country I initially released much of my injury prevention and rehab content in has the highest incidence per capita of ACL surgery in the world. Perhaps in part because Australian’s apparently are ‘all equal’ and only the American’s know what they are talking about. So when my concepts, such as my Lines of Movement, are published unreferenced and slightly ‘tweaked’ to appear original works, the power of the message is lost.

Injury rehab has become a much larger component of my work than it was 20 years ago when I began published decades tested strategies I was convinced would reduce injuries in training and competition globally. For example, in the last 7 days alone, I have worked with:

• A knee replacement
• A case of chronic back pain
• The most extreme case of kyphosis I have worked with (I have seen one worse but he quit before we got started)
• A brain haemorrhage that has been a long term impact on nerve supply to the rest of the body’s musculoskeletal system
• A traumatic lower back injury

Lets go past prevention and rehab. After all, if you surveyed the industry, most would rate themselves fairly highly on these skill sets – which is bullshit and the stats reinforce my cynicism.

Let’s take a look at an area of injuries that no one has in the physical preparation industry has popularized yet and made a ‘new trend’ out of it. I am talking about management of acute injury. And I am not even talking about this work in the heat of battle, during a sporting event. I am talking about a far more garden-variety form that every physical coach (or so called ‘strength & conditioning coach) will face often in their career – managing the acute phase of injuries that occur during training and travel.

Let me give a few examples.

I was supervising the strength training of a North American national ski team doing another coaches program. The program was devoid of pre-training stretching (and this was before the commencement of the stretching inquisition) and warm up sets. Straight into heavy sets of front squats, exacerbated by very questionable technique. No surprise, one of the athletes suffered an acute injury during a work set. As they lay writhing on the floor with a specific condition occurring in the vicinity of their thoracic spine, the team management considered transportation to hospital. I took a different approach, and after many hours of work in situ, the athlete skied the next day, something that would not have happened I suggest had the more conventional approach taken place.

In another case I was moving around the cabin our jumbo jet en route from Australia to South Africa to play the then Southern Hemisphere championship rugby game. This was only the second year South Africa had been allowed back into competition following the apartheid ban and the size and strength of their forward pack was legendary. At the team hotel in Singapore I asked where one of our props was. I was told his neck has gone into spasm and he had been placed in bed rest, immobilized with a brace and sedated. I had just been speaking with him on the plane a few hours ago, and I had a different thought as to how to deal with this. Because the team medics had already been involved, I called a meeting with my suggestions put forward. They were shot down, as expected. I consulted the athlete and acted on their approval. In my opinion, the athlete was at risk of suffering spinal damage and even death had they gone from being immobilized for a few days to then face a forward pack famous for their size, strength and scrimmaging prowess. As it turned out they played the whole game, including winning two scrums against the head (feed) on our 5m line.

I could go on. The bottom line is that as physical coaches we are often the first responders and despite the attempts of division of labour (specialization of profession) we may be the athletes best solution, or at least a strong advocate.

I do have a zero tolerance for injury, but injuries still occur on my watch. So they are going to occur on yours. One difference is my injuries are less often, less severe, and fixed faster. But they occur.

So who is teaching you how to deal with the acute injury?

I would prefer to ask who is teaching you how to prevent the injury, but have accepted that you are all apparently pretty competent, despite the stats suggesting otherwise.

Something to think about. Assuming you really care about the athlete, that is.

Ian King

The best gift a physical preparation coach can give

/by

At a time of year when giving is on the mind, I want to share that in my opinion the best gift a physical preparation coach can give is the gift of quality of life. And whilst the cardio-vascular benefits have decades of support, and the muscle density has now been raised to the same level of value through recognition of muscle mass loss as a correlate with aging and other risk factors, this is still not what I am specifically referring to.

I am referring to the muscles, bones and nerves.

In the early 1980s as I set out on my professional journey I realized the shift in posture from the 1960s and earlier bodybuilder (Reeves, Park etc) to the post 1970s bodybuilder such as Arnold. Their shape changed, and from my perspective for the worse.  I trained athletes, however I respected the power of bodybuilding as a medium and knew that these ‘dis-eases’ would filter into athlete preparation.  It was not happening, at least not on my watch.

This realization along with a desire to categorize strength exercises led me to the years of reflection that resulted in the Lines of Movement concept. Quite simply I wanted to avoid imbalances, and I ultimately shared this concept so the world could do the same.

Now that has not happened. Despite every ‘professional’ being able to recite the major categories in the Lines of Movement (albeit with that little one word twist that is a reflection of in individual’s attempt to be ‘original’), wax lyrical on the need for balance, and show the vernacular of push pull etc. in their training programs, the results show that knowing something and doing something are not the same.

Not that our Eastern philosophers are surprised, as they were very clear –‘To know and not do is to not know.’

In fact since the 1970s, more ways to create imbalance than I had ever expected have been added post 2000, as I speak about in Vol. 3 of Ian King’s Guide to Strength Training.

I don’t expect to save the world anymore. I have learned to let it go. I even witness young athletes see me one day and then be overwhelmed by the opportunities of professional sport and embrace all that is done to them, including the young highly gifted athlete whose shoulder relationship degraded by another say 10% in as little as 3 weeks. We know which bed he will be resting on soon and it is one with bright lights above and a person standing over him with a scalpel…

The greatest power I have is to identify and empower those rare individuals who are have come to a point in their career when they realize something is not right. Who have the courage to think for themselves, to train in a way that is not supported by the dominant trend or the current internet driven guru. It is these individuals that I now communicate almost exclusively with in a professional sense.

For whilst I have given up on expecting to save the world, based on the failure of the late 1990s teachings to achieve the intended goal in the ensuing 20 years, I have also given up the expectation that any but an incredibly small minority of the professionals in this industry either have the humility and courage to do what is best, or care enough for others to take these steps.

And for this minority, the best gift you can give is the gift of quality of life. The ability to move for as long as possible in the later years. The ability to play with your kids and grandkids in the back yard. And in the perfect world, your great grandkids.

For this gift will be the exclusive domain of those who listen to and are guided by my brutal search for the best way to train and remain injury free. A search I have been on for 4 decades now, and a few more planned!

So it is incredibly rewarding when I receive feedback such as this. And note this person has only just completed our Level 0 Coaching course! A very powerful experience, yet so many move levels to follow. If we can change lives through you, we are fulfilling our potential, for together we can do more than I an on my own.

“Really enjoyed it Ian gained a lot of information and knowledge (also when I look back at my training/ injury history it all seems very clear why I had those injury’s now. Incorporating a lot in too my training and clients. so far so good. Really like the way KSI goes about things. I am interested in learning more and progressing to level 1.”—CE, NZ

Ian King

The Barbell Hip Thrust – Winners and Losers

/by

I was receiving requests from some of my coaches to write about the barbell hip thrust. They knew I didn’t buy into it, yet I had remained silent.  They were tiring of the market pressure for them to conform, and wanted me to make a statement.

So I began to prepare, to research.

Didn’t take me long to realize I didn’t need to write an article about this exercise. There are already enough good ones out there. [1] [2] [3] [4]

What I have chosen to do instead is speak to the generation that ‘invented’, endorsed and more pertinently marketed this concept.

According to the number one advocate and ‘originator’ of the exercise, it all began in about 2006.

Almost 11 years ago, I thought up the barbell hip thrust in my garage gym in Scottsdale, Arizona. [5]

So in about 2008, this coach had a ‘bright idea’, apparently. Coach and writer Kim Goss has a different perspective on the history of this lift. [1]

Since then, I’ve been on a mission to popularize the movement….  took this information and ran with it, posting numerous article links and infographics on my social media channels relaying the news that hip thrusts are very well-suited for improving speed and that the force vector hypothesis was legitimate.[5]

Now the first ‘coach’ referred to above is a great marketer.  I like to give credit where credit is due. The world adopted the movement.  Not that they appear to need my acknowledgement. Enough acknowledgment was evident:

…I recently polled my newsletter list and social media followers and received over 7,600 responses as follow……As a prolific S&C educator with a large online following who gets rewarded for being “ahead of the research,” making bold predictions, and playing to the masses…

Rewards? Sounds like a game of winners and losers. And that may be accurate….

Then the bombshell. Some of his academic colleagues failed to support his own earlier studies.[7] [8]  (And yes, the research undermining this exercise may have its own flaws, but no more than the original ‘research’ used to support it…)

Now the retraction did show humility and gained respect from some quarters.

Unfortunately, I spoke too soon. The combination of 1) my inherent biases as an inventor, 2) my role as an online educator always seeking to provide cutting edge information to my followers, and 3) my greenness as a scientist prevented me from exhibiting a more tempered approach to the emerging evidence.[9]

Here’s my challenge.

How many of the athletes and coaches currently engaging in this exercise are aware of this reversal of support and admission of  ‘jumping the gun’? Not many.

Will the impact of this incredible marketing of this exercise go on for generations? Yes. 

Who takes responsibility? No-one.

Who cares? Not enough people. Their too busy moving on to the next way of becoming significant or popular.

Now I understand no-one really wants unsolicited advice, however to those keen to be significant – I express my hope that a few more may first reflect upon the impact of what they market before they met their needs to be significant.

Now I am not suggesting that validation through science is needed before sharing an innovation. I personally don’t.  Science is often a lagging indicator, confirming or otherwise at a later date.   I would just recommend greater reflection or more transparency. If science is going to be invoked as a validation technique, you might want to have more than one of two ‘in-house studies’.

To the physical coach – please use the grey matter you were gifted by your Maker.  I know this plea will fall for the most part on deaf ears, for the same ailment that Dr. Albert Schweitzer lamented in the 1950s  remains. When he was asked by a reporter ‘Dr, what’s wrong with man today?’ he responded:

Man does not think. [10]

To the athlete – you need to be, and have a greater capability to me smarter about your training decisions than your physical coach. They have many masters – ego, colleagues to professional associations, marketing trends. You only have one agenda – the future health of your body and the fulfillment of your potential. Its okay to reach your own conclusions about what’s right for you, even if it differs from your coaches….

This rush to the market exemplifies one of the key reasons I have chosen historically to test a new concept for about a decade before publishing it….

A coach can ‘change their mind’ (even as they hope for a recovery) after marketing, publishing and endorsing something so effectively. [11] [12]

But the stain remains.

With influence comes responsibility.  

[1] Goss, K., 2016, The case against hip thrusts, The Poliquin Group, June 14, 2016, http://main.poliquingroup.com/ArticlesMultimedia/Articles/Article/1478/The_Case_Against_the_Hip_Thrust.aspx

[2] Kavanaugh, J., The heavy hip thrust is ruining our backs and this industry, Speed and Sports Institute, https://www.sportandspeedteam.com/the-heavy-hip-thrust-is-ruining-our-backs-and-this-industry/

[3] Kechijian, D., 2017, Science’ and the Barbell Hip Thrust, Simplifaster, Sep 8, 2017, https://simplifaster.com/articles/barbell-hip-thrust/

[4] Valle, C., 2018, Should Advanced Athletes Use the Barbell Hip Thrust?, Simplifaster, Jan 29, 2018, https://simplifaster.com/articles/athletes-barbell-hip-thrust/

[5] Contreras, B., 2017, Science is self-correcting – The Case Of The Hip Thrust And Its Effects On Speed,  Bretcontreras.com, July 27, 2017, https://bretcontreras.com/science-is-self-correcting-the-case-of-the-hip-thrust-and-its-effects-on-speed/

[6] Contreras, B., 2017, Science is self-correcting – The Case Of The Hip Thrust And Its Effects On Speed,  Bretcontreras.com, July 27, 2017, https://bretcontreras.com/science-is-self-correcting-the-case-of-the-hip-thrust-and-its-effects-on-speed/

[7] Bishop, Chris, MSc; Cassone, Natasha, MSc; Jarvis, Paul, MSc; Turner, Anthony, PhD, CSCS*D; Chavda, Shyam, MSc, CSCS; Edwards, Mike, MSc, 2018, Heavy Barbell Hip Thrusts Do Not Effect Sprint Performance, An 8-Week Randomized–Controlled Study, The Journal of Strength and Conditioning Research · July 2017

[8] Kun-Han Lin, Chih-Min Wu, Yi-Ming Huang and Zong-Yan Cai, 2017, Effects of Hip Thrust Training on the Strength and Power Performance in Collegiate Baseball Players, Journal of Sports Science 5 (2017) 178-184

[9] Contreras, B., 2017, Science is self-correcting – The Case Of The Hip Thrust And Its Effects On Speed,  Bretcontreras.com, July 27, 2017, https://bretcontreras.com/science-is-self-correcting-the-case-of-the-hip-thrust-and-its-effects-on-speed/

[10] Schweitzer, A., in Nightingale, E., 1975, The strangest secret, Nighingale-Conant.

[11] Contreras, B., 2017, Science is self-correcting – The Case Of The Hip Thrust And Its Effects On Speed,  Bretcontreras.com, July 27, 2017, https://bretcontreras.com/science-is-self-correcting-the-case-of-the-hip-thrust-and-its-effects-on-speed/

[12] Cressey, E., 2017, In defense of the hip thrust, ericcressey.com, September 13, 2017, https://ericcressey.com/in-defense-of-the-hip-thrust

Ian King

The glutes are over-rated

/by

Prior to the publishing of the Lines of Movement concept in the late 1990s no-one gave a ‘rats-arse’ (an Australian colloquialism) about the glutes. At least no one outside of a therapy clinic. Twenty years later the glutes have been given the same prime time rating as the Swis ball got in the late 1990s. 

I know the message in this article will be as popular as most of my comments at the peak of the popularity of any trend (i.e. not very!) so I am just going to rip the band aid off. 

If you really want to help people, if you want to make significant and more complete changes to the way a human functions, you have got to get past this narrow focus on the glutes.  The glutes are over-rated and you don’t need to be part of this.

Before we go further lets appreciate the short history of ‘glute focus’.  As I said, prior to the Lines of Movement concept (you know, those categories of movement/exercises that a few post 2000 authors got amnesia about when it came time to referencing) there was zero focus, discussion or exercises on or for the glutes – outside of selected physical therapy clinics. The legs were the legs.

Check out the program I use for analysis in Volume 3 of Ian King’s Guide to Strength Training – How to Transfer.  You can see very quickly there is no focus or attention on the glutes. This program was published in a populist mainstream bodybuilding magazine about 6 months prior to the 1998 publication of Vol 1 of Ian King’s Guide to Strength Training – How to Write Strength Training Programs, in which the world got it’s first real view of the Lines of Movement concept.

So what happened post 2000? I guess a few people felt caught out and wanted to compensate. And compensate they did.   Before we get into some of these over-compensation examples, allow me to expand on where I see the glutes in the bigger picture.

Yes, the glutes and glute activation are important.  No, I am contradicting myself! Keep reading.

They were and still are a big part of the pre-activation drill concept (I called this control drills) I began sharing late 1990.  They were part of the reason I expanded the range of unilateral single leg (compound and single joint) exercises when I realized that the Quad Dominant range was far greater than the Hip Dominant range. This is why I took a few exercises out of the aerobic class of the 1980s and 1990s, a few from physical therapy, and made up a few more.

Then why I am so critical of the light now being shone on the glutes?

For a few key reasons. 

Firstly, from my perspective, and from the way I design and teach others to design strength training programs, the glutes act as a ‘force couple’ with the abdominals, in their role in determining the positioning of the pelvis.  Now the abdominals have less role in hip and thigh extension than the glutes but at least equal role in injury prevention as it relates the pelvic stability.

Now I know the debate of pelvis stability and I don’t really want to open that can of worms. I seek to wrap that discussion for now with this comment – a powerlifters competitive day at the office may involve 6 efforts of pelvis control, and who really gives a shit where the pelvis goes? They don’t and therefore, for now, I don’t. It can flap about like a ‘dunny house door in the wind’.  (More traditional Australian colloquialisms!)

But athletes on a continuum from there onwards – athletes whose completion involves more than 6 reps of pelvis control e.g. an athlete who runs 30 kms in multiple directions on a field as part of their competitive day at the office – if you don’t give a shit about that – and by the way I see their programs looking like most of their strength coaches don’t  – then you may as well take a 12 gauge to their lower extremities, because that would quicken the inevitable.

Yes, a bit dramatic – but I really tire of those who use powerlifting as their basis for athletic preparation. Powerlifting is a sport. It is not the basis of all other sports!  

So if you want to muddy the waters about how the focus on certain abdominals muscles and or actions make you ‘weak’ – you need to stay in the powerlifting circle, because outside of that, the need to be able to run pain free for years to come is far more pressing than the ability to displace maximal external load 1 meter in a few very simple movements!

I suggest that this whole misguided discussion about abdominal contribution has singularly contributed to more lower extremity injuries in sports than…well, as equal, at least to the next factor.

The second additional factor that is overlooked is the length and tension of the quads.  Of course many of you will want to say that stretching makes you weak, and really, do I need to go back and tell you to tell someone who cares?

Sadly, many coaches and athletes have been sucked into the vortex of ‘but it makes you weak’, when their future career, their income, their health, their legacy, is more dependent on their ability to remain pain free than their ability to perform some non-specific expression of strength immediately after performing some non-specific stretch, as is the basis of these studies!

So let me put this simply and concisely – the health of the lower back, hips and lower extremities – relies on a discerned distribution of focus between:

  • Length
  • Tension
  • Stability

Of the:

  • Quads/hip flexors
  • Abdominals
  • Glutes

The way I see that, there are nine key focuses (3 x 3 = 9). NOT ONE!

Those of you who are familiar with my work will be familiar with this statement:

Muscles aren’t weak – they are inhibited!

Now if the concept was simpler, and more trendy and closer to Malcom Gladwell’s tipping point – then I am sure you would have read that multiple times by now in a functional training book or heard about it in a functional seminar already!  But’s it not.

It’s not as a brain dead simple as many need to absorb, and it’s not currently popular and it sure as hell isn’t sexy.

But it’s not that difficult either!

Now the reason I raise the above point is this – you can bash the shit out of you glutes as much as you want – but if they are too long, too short or too tight – then they just won’t work anyway!!! It’s not that simple! But it’s not that difficult either – it’s a more holistic approach.

So what are the grounds for my suggestions that glutes are over-focused on in our industry currently? Here’s a real world example:

Question:  A 15 year old female basketball player, who has talent to play at the next level, frequently has to take a game or two off (or play reduced minutes) due to knee pain. She has been diagnosed with bilateral chondromalacia patella.

She has come to you in the early off-season to try to get stronger and reduce the pain in her knees. Starting with an assessment, what do you do?

Answer: 

1) The first thing we would do is to take the athlete through a [functional movement screen]

2) After this assessment we would more than likely confirm our suspicion of weakness in all of the lower body musculature with a large glute med deficit.

3) Next we would palpate the glute med for point tenderness. Our experience is that athletes with patella-femoral pain almost always have significant soft tissue inflammation in the glute medius.

4) I will make the assumption that all leg extensors are weak (quadriceps, glute,hamstrings) particularly the glute med and that there is a significant soft tissue component involving the glute med.

Note: The best description of the glute medius issue is that the glute medius is the muscular connection of the IT band connective tissue to the knee. Inability to stabilize with the glute med will result in knee pain that will exist at a conscious level and glute med pain….[1]

Here’s the scoreboard on this advice – the gluts were mentioned ten (10) times. The abds didn’t rate a mention. The quads / hips flexors earned one (1) mention. 

Unbalanced? I suggest so.

Now what about modalities? Strengthening of the muscle got 7 mentions (6 glutes, 1 quads/hip flexors).  Tension got four (4) (all Glutes) and length didn’t rate a mention.

Unbalanced? I suggest so.

In literal summary, this injury  (bilateral chondromalacia patella ) rehabilitation and (therefore prevention) approach is that the condition was caused overwhelmingly (91%) by weak glutes (and this conclusion was reached by pushing on the glute to see if it was tender…), and would be solved predominantly (60%) by strengthening the glutes.

And the advice above, of course, was concluded with the obligatory promotion to buy a specific coloured band to perform that all-solving strength work.  Hard to sell space on a mat when all they are doing is stretching with no other equipment….or a control drill with no equipment needed…

Now many would say  – so what? That advice sounds right, because that’s what we do. In fact most do this, so go and stick it where the sun don’t shine Ian.

And of course you will get those spineless Internet trolls who will roll out the lovely adjectives I hope they don’t use when their grandmother is listening.

Which is fine by me. My goal is not to convince. Rather to give the opportunity and encouragement to those have this burning niggle in their mind that there is must be a better way, to find that better way.

Because quite simply, in my humble yet firm opinion, if the above example solution is where your commitment to excellence stops, I hope you never get to train a child, or a person who feels compelled to conform.

You can imagine what I think about those articles (marketing pieces) where the story is based on how some guru wrote a glute training program for them and it solved all their problems! It even cleaned the plaque on their teeth, and took out the trash. Okay so maybe I went to far with the add-ons.  However you will find these articles, and they are not helping place the glutes in perspective, which is what I seek to do.

So let me sum up the key reasons I have shared for why I believe the current focus on the glutes is over-rating them.

  1. The glutes act as a ‘force couple’ with the abdominals, and therefore the abs should be getting equal attention.
  2. The length and tension of the quads impacts the functions of the glutes. If they are winning the battle against the force couple of the abs and gluts, – that is, if the pelvis is excessively anteriorly rotated as a result – and if as a result the gluts are not at an optimal length, the gluts are never going to be able to express optimal strength. No matter how much many exercises for the gluts you do.

Thirdly, I suspect a marketing factor –

  • The glutes may have a higher ‘sexy currency’ currently than the abs. Perhaps because the focus on the gluts has a greater gender readership than a similarly narrow focus on abdominals (more females focused on the shape of their butt than whether they are running a six-pack).

The glutes are over-rated in the industry simply because certain other factors are under-rated. The solution provided lacks holism and is doomed for mediocrity, at least in everywhere other than in those miraculous ‘Guru X did a glute program for me and now I don’t need surgery’ articles….

Again, in conclusion I can only encourage you to reflect on this before buying into the current dominant trend that the glutes are the primary cause of all lower body ailments.

[1] Xxxx, 2006, Reference withheld to protect the message.

Ian King

It’s Not Fair

/by

The Golden State Warriors were 1-3 down to the Toronto Raptors in the 2019 NBA Finals Playoffs when Kevin Durant made a return to the court after about a month layoff with a calf injury.

His presence made a difference and the Golden State won the game, taking the playoffs to 2-3. Kevin paid the price and left the court during the second quarter, with an injury related to the reasons he had missed the prior month.

Devastated the franchise’s President of Basketball Operations, Bob Myers, spoke about the decision to play him and also defended Durant against criticism that he didn’t care enough for the team to make a comeback. He also said:

It’s not fair.

Now I’m not sure if he was referring to the unwarranted criticism of this great player or the fact that he was injured…again.

I will address the injury side only, and with no intent to make any judgement on the decision to play. Finals are different, the stakes are higher, and this changes the decision making.

What I will talk about is how he got to being injured in the first place. It may not be fair, but that opens a whole discussion about what’s fair.

I actually believe the body is pretty fair. It gives us heaps of warnings -through pain messages, through changes in length, tension and stability/function. And if we don’t listen, it sends bigger messages. Higher level pain, higher level tension and reduced function.

At some point of time the body gives it up, and we have a real injury.

Now don’t get my message wrong, because I’m a big fan of Durant. As an athlete, as a basketball player, as a person who is willing to stand up to being judged, and as a person willing to prove his doubters wrong.

I don’t expect athletes to have all the decision making skills. They rely on, as Myers said, ‘experts’, to guide their decision making.

The mere fact that Durant got injured in the first place was a failure to provide him with the care and guidance that is possible. And not just Durant – any athlete, any person, who is the care of and reliant upon others to guide them. To make, as Myers said, ‘collaborative decisions’.

Injuries are not a new challenge. They are a growing challenge. I call it an epidemic, in fact. And those willing to look at the injury stats are beginning to agree, at least in relation to the well-documented rise in ACL surgeries in Australian sport.

However allow me to really alienate many in my and related professions – nothings going to change. Why? Because if your interpretation of the cause of injury is off-track, you are not going to solve the problem. And in my opinion, based on my four decade professional journey of seeking to understand and optimize human performance in sport, and based on my interpretation of the causes of these injuries – the interpretations of the causes is off-track.

It’s not fair that people judge Kevin for sitting out for a month with the intent to rehab his injury. But the body’s not fair. It gave enough messages. It’s unfair in a way that Kevin was not looked after in so much as preventing this injury in the first place. I mean, how many times do you have to see the patterns of injury to understand in an accurate sense the causes and therefore prevent their repeat?

Kevin is not the ‘lone ranger’. He just happens to be one of the more high profile examples.

There is a better way, and I’m hopeful for those athletes and others who gain access to a high level KSI Coach, because for us – one injury is one too many. And we operate on my fundamental belief that all injuries are predictable and preventable, and this is our aim. Do we always get it right? No, but we go pretty damn close. A lot closer that what is happening to those athletes and others who do not have a high level KSI coach to help them make collaborative decisions.