Ian King

Supercross, Super Injured

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As the 2023 Monster Energy AMX Supercross season unfolded it become increasingly apparent that it was going to be a season remembered for its shocking injury toll.  I will specifically focus on the 450cc class, to keep the article as brief as possible. The 250cc class injury list was equal in length to the 450cc class.

Here’s he injured list as of 2 May 2023. These riders missed one or more rounds or failed to complete a round in the 2023 season due to injury sustained in racing or practice:[1]

450SX

  • Eli Tomac – Achilles
  • Colt Nichols – Unknown?
  • Jason Anderson – Neck
  • Cooper Webb – Concussion
  • Justin Barcia – Collar Bone
  • Benny Bloss – Collar Bone
  • Grant Harlan – Shoulder
  • Christian Craig – Hip, Elbow
  • Dylan Ferrandis – Concussion
  • Brandon Hartranft – Back, Shoulder, Hip, & More
  • Scott Meshey – Leg
  • Marvin Musquin – Wrist
  • Bubba Pauli – Thumb
  • Aaron Plessinger – Hip
  • Alex Ray – Finger
  • Justin Rodbell – Achilles Tendon
  • Malcolm Stewart – Knee

The author of this list acknowledged they may have missed a few injuries because the injury list was so long. They have missed at least:

  • Adam Cianciarulo – Concussion [2]
  • Kyle Chisolm – Knee [3]
  • Christian Craig – Hip and elbow [4]
  • Joey Savatgy – Wrist [5]

And in the week following the compilation of this list add the following:

  • Ken Roczen – Knee [6]

In the seventeenth and final round of the season in the 450cc class, 4 of the top 10 riders on points were not available due to injury. That’s 40% of the top 10 points leaders. And  if you add Ken Roczen  who didn’t complete the final round, that 50%.

But even that stat is misleading on the upside, as it only includes those riders healthy enough to be in the top 10 points leaders by the last round.

If we look at the riders who started the season, it’s worse. Using the 20 riders listed on the official series web site,[7]  only the following three (3) riders may have avoided missing 2023 rounds due to injury.

  • Justin Hill
  • Shane McElrath
  • Dean Wilson

Assuming the 20 riders featured were the top 20 riders for 2023, this means 85% (17 of 20) of the 2023 Monster Energy AMA Supercross top 20 lost rounds or their season due to injury.  85%. That’s a huge number, even for a high risk sport. I have not seen or made any comparisons to prior seasons; however I suggest it is a PB – for the wrong reasons.

Many were surprised and shocked, including the riders, and industry experts.

The final stretch in one of the most exciting years of the Monster Energy Supercross Championship is playing out much differently than we had expected … several contenders in the 450 Class are now sidelined with injuries. [8]

These injuries have brought out the armchair experts, submitting their theories as to the cause.

Firstly, you did not need to surprised and shocked. At least not if you had read my blog article on this very topic, warning of the impending injury impact and the reasons why.

Secondly, while everyone is entitled to their opinion, most have no ‘skin in the game’. What if their hypothesis as to the cause of the rise in injury incidence is wrong? There is no price to pay. However, someone in every racer’s team is or should be accountable for ensuring the riders enjoys an injury free career, and it’s obvious they are failing their rider.  Now this is not uncharacteristic in sport as very few athletes enjoy an injury free career for the same reason. I will share my vision for the athlete in this regard.

Thirdly I share another principle I have developed – injuries are predictable and preventable. But only if you can accurately predict them. If an athlete I injured, either they have ignored their advisors warning or their advisor failed them.

And fourthly and finally, what are some key steps a racer can take to avoid the arrival on the injury curse’ in their sport.

I told you so

I was going to name this article this ‘I told you so’. But I felt the perception that I am a smart-arse might leave the messenger targeted and obscure the message. The message is that the rise in injuries in the sport of moto/super ross was and Is predictable, and unless changes are made it will continue as the new norm. It has in most sports for their systemic failure to understand the cause of injuries, and there is nothing about off-road motorbike racing that leads me to believe they will rise above other sports in the similar situation.

Anyway, coming back to my prediction. On 8 Sep 2021 I wrote blog article titled A Lament for the Late Arrivals, where I spoke specifically about the relatively recent embracement of sports including moto/super-cross and the tipping point that has been passed in the relatively recent embracement of messed up popular dryland training methods. The lament was for the price they would pay – specially injuries and performance decrement.

I wrote:

I feel for the late arrivals, and I lament the collateral damage they are potentially walking into…. The outcome is increased injuries and decreased performance. The exact opposite to the proclaimed benefits of ‘strength and conditioning’.. 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.

The Monster Energy AMA Supercross class of 2023 walked into this collateral damage in this season.

I have a saying –

‘I take no delight in being right about my injury predictions.

I did tell you it was coming, but I don’t take any satisfaction from it. I said from the outset:

I feel for the late arrivals, and I lament the collateral damage they are potentially walking into….

Every athlete should be given the opportunity to fulfill their sporting potential, free from injury

I have been publishing this vision statement for many years now:

My vision is that every athlete should be given the opportunity to fulfill their sporting potential, free from injury.

For two reasons – firstly, performance and career results are inversely related to injury incidence and severity. The less injuries and or the less severe the injury, the higher the performance and career achievements.

I learnt this lesson unequivocally by the early 1990s and used this ‘zero-tolerance to injury’ approach to produce championship and podium outcomes in team and invidual sports.

The second reason I formed this vision was that it’s the right thing to do. Unlike the majority of coaches, I believe we can dominate in sport and provide optimal long-term health outcomes for the athlete concurrently. They are not mutually exclusive.

Other than the occasional regurgitation of my vision claimed by the usual authors unable to create original content, I don’t see many embrace my vision in the coaching decisions.

Which I why I expressed the following in my blog article titled A Lament for the Late Arrivals:

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.

Injuries are predictable and preventable.

It appears that everyone has an opinion as to the cause of this injury rise in moto/super cross. And they are entitled to their opinion. What if their hypothesis as to the cause of the rise in injury incidence is wrong? You can’t prevent an injury if your hypothesis as to the cause is off track.

The most common ‘fail’ in injury explanation include:

  • It was a freak accident.
  • It’s just part of the sport.

This is a complete abdication of responsibility and ability to take control and prevent injuries.

Which is why I was shattered when I listened to and re-read Eli Tomac’s explanation for his season ending and championship denying Achilles tendon rupture in the 2023 season:

Basically at a loss for words right now over what happened and how it happened,” he said. “In my mind, it was just a freak deal and a racing situation, you know. I look back, I barely over jumped that tabletop and was just standing up into that ramp and I guess the high g load took a little too much for my Achilles there? I don’t know. I honestly just put it as a freak deal. I’ve over jumped into plenty of other jumps just as hard, if not harder, and have been totally fine before. I guess this stuff happens with racing.”[9]

You might notice some key words that I referred to above, including:

  • It was just a freak deal… I honestly just put it as a freak deal.
  • …a racing situation… I guess this stuff happens with racing.
  • … I don’t know.

I am not surprised he didn’t know what was going on with his Achilles before it tore off the bone. It would have taken a highly competent member in his support team to have provided this information. However, to not understand it better in retrospect – leaves a lesson not taken, and the probability of repeat injury.

He is a great athlete and dominating his class. This is the beauty of human performance. Even the best can be better. And one avenue available to Eli to advance would be to adopt a value-set towards injury more aligned with the philosophy described as the Serenity Prayer:[10]

God, grant me the serenity to accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference.[11]

I formed this saying many years ago –

Injuries are predictable and preventable.

However, if a coach lacks the ability to accurately and consistently predict an injury in advance – yes, in advance – then they have no chance of contributing to preventing them.

Let’s use Eli Tomac’s 2023 Achilles tendon rupture as an example.

It’s incredibly unlikely that there were no signs or messages that Eli’s Achilles was in trouble, and about to snap. Appropriate injury prevention screening would have picked this up.

If an athlete is injured, either the athlete has ignored their advisors warning – and that’s rare because why would they hire them only to ignore them? – or their advisor failed them.

Some key steps a racer can take to avoid the arrival on ‘the injury curse’ in their sport

It’s not good enough to be critical without providing at some solutions, so this section touches upon a few key, simple recommendations in the area of dryland training that will contribute to avoiding the collateral damage of mainstream training.

But before we go there let me clarity – my reference to ‘the injury curse’ was facetious. It’s the default go-to used by sports and coaches that want to abdicate their injuries to a source other than one within their control.

I have not seen it used in moto/super cross yet, but that’s only a matter of time…

Here are three simple considerations for racers to avoid injury, including crashed caused by training induced physical imbalances.

 

  1. Tissue length and tension.

I’ve been championing stretching and tissue manipulation for injury prevention, rehab and optical performance for decades. Then along came the abolition of stretching. I liken the attempts to scare individuals to avoid stretching to the many periods in history when reading or specific books were banned.  I suggest stretching has been pillared for the same reasons – because those who drive this paradigm stand to lose out (commercially) in the event you discover the benefits of stretching. Don’t became a victim to this. Stretch. Including static stretching.

As for tissue manipulation, the popularization of foam rollers is by the same interest attempting to ban stretching. Despite the economic gain for others of selling you a foam roller, the roller is innate. It can’t interpret your tension and adapt its work to address this. Whilst I do not suggest throwing out (or burring) your form roller, keep in mind it is just one of many modalities available to you to lower and monitor your tension levels. I suggest including some input from a competent human being e.g massage therapist or similar health professional with good hands and a sharp understanding of optimal tension.

Tip: If you spend more time on your bike than you do lengthening and softening your connective tissue, you will become an injury statistic.

  1. Reverse the damage of your sport before you seek to replicate it.

It shatters me to see athletes, including now off-road racers, performing ‘sport specific’ dryland training, especially strength training. A key principle I have developed and teach is that the primary goal of strength training in the first instance is to reverse any inappropriate adaptations that occur your specific sport. Let’s take the landing from jumps.. Let’s imagine that the calf and Achilles tendon increase in their tension and reduce in their length over time due to repetition of absorbing the G-forces in landing. Let[s pretend that if you don’t reverse this adaptation they become shorter, and weaker, dysfunction and inhibited, and finally experience a tear or worse a complete rupture. Actually we don’t need to ‘pretend’. That’s what happens and Tomac’s 2023 injury is a classic example of potentially failing to prioritize this ‘reversal’ work in dryland training.

Tip: Yes, you can do so-called ‘performance enhancement training’ by doing so-called sport-specific training – however if this is contributing to performance decrement because it is making the sport specific adaptations worse, you are creating performance decrement. On the other hand, if you enhance your muscle function by reducing negative sport specific adaptations through injury prevention/rehab training, you are going to enhance your performance. Sounds counter-intuitive but that’s my perspective.

  1. Challenge every adaptation.

 All training results in an adaptation. Is this adaptation truly serving you as a racer? I divide training into two simple categories – specific and non-specific. The only specific training is playing your sport, so that means when you are on the bike. All other training, no matter how much lip-service any gives that it is ‘sport specific’, it is not. It will give you specific adaptations. The only question is whether those specific adaptations will transfer to your riding.

Many athletes get a warm feeling from the muscle mass and strength increases from strength training. In part because of the social rewards placed on ‘getting buffed’, and in part because it gives them a feeling of being a warrior. There is no correlation between muscle mass and or non-specific (gym) strength that trumps optimal technical and tactical development. More likely, you will see a decline in technique if your dryland adaptations contest skill execution e.g., if you develop leg imbalances in the gym, which most do even if they are trying not to, you will load inapproachably over jumps and increase crash frequency. Just one of many examples.

Tip: Critically analyze, and in a futures sense, the adaptations your dryland training is and will give you, and question it’s transfer. If you a getting big and strong because of low-self-esteem, read a self-help book. And remember this – most of the current crop of riders leant to ride well before adding dryland training, after which they will experience a higher frequency of crashes and related injuries (because of the imbalances ij their dryland training).

Conclusion

I did intend to keep this article brief, however as I wrote my empathy for the athlete, in this case the racer, took over, and I sought to give a bigger lifeline.  (Lucky we restricted the focus to 450cc class injuries, and only over the one season!)

I don’t take any joy in saying ‘I told you so’, but it was quite ironic that what I wrote about 2021 came to be manifested within two years.

There are ways to train that can reduce a racers crashes and subsequent injuries, however it will take a fresh look at the options. Simply following the herd will not avoid this rising phenomenon of injuries that will be blamed on anything and everything other than the actual cause.

As an athlete you are not expected to solve all the problems and challenges of a long, injury free career by yourself. However, as an individual sport athlete the onus is on you to ask the right questions, and to appoint guides who have the best answers. That is you burden. Those appointments can make or break your career.

And if injuries do occur take the lesson. Avoid writing it off as a ‘freak accident’ or ‘that’s what happens in racing’.  The injuries will occur in conjunction with a crash so don’t rush to assume the injury was caused by the crash. The injury might have caused the crash. In the same way an equipment setup can cause crashes (e.g., inappropriate sag setting or similar placing too much weight on the front tyre and front washouts occurring more frequently), inappropriate body set up (e.g., imbalances in your musculoskeletal system) can cause crashes. If you don’t fully understand what causes crashes, you may never unlock the code of body-bike relationship and miss an opportunity to ‘tune’ the body in the same way your suspension mechanic tunes your bike to avoid you crashing.

Your physical coaches KPI (Key Performance Indicator) should be a reduction in crashes and injuries ahead of an increase in non-specific performance (VO2 max or load displaced in the gym or the size and strength of your muscles).

In my five decades of helping athletes fulfill their potential in a wide range of sports and in diverse countries through a double-digit number of Olympic cycles. I have seen that despite the challenges faced by athlete due to adopting misguided but dominant paradigm-based training programs, many athletes seem to want to cling onto the ego attachments of their choices. Others want to conform.

My hope is that you can do what the truly best I the world athletes do. Feel no desire to be like everyone else and find a way to train in a way that is best for you. This will need you to be willing to be different, and to make your own mind up. This alone will reduce your numbers of competitors. That’s the way of top performance. There are a few at the top so far ahead of the rest. There is a reason they are there, and you need to scratch below the perceptions to understand what sets them apart. Look beyond your sport for the best clues.

 

References

[1] https://www.vitalmx.com/forums/moto-related/current-2023-injury-list

[2] https://motorsports.nbcsports.com/2023/04/26/adam-cianciarulo-aaron-plessinger-detail-injuries/

[3] https://www.fullnoise.com.au/fullnoise-news/the-emergency-department-2023-ama-supercross-championship-round-7-arlington/

[4] https://motorsports.nbcsports.com/2023/04/10/christian-craig-timetable-for-return-uncertain-after-glendal-injuries/

[5] https://www.vurbmoto.com/joey-savatgy-injury-update-2/

[6] https://mxvice.com/injury-update-ken-roczen-10/

[7] https://www.supercrosslive.com/riders/450

[8] https://www.swapmotolive.com/2023-supercross-late-season-injury-updates-championship-changes/features/kickstart/

[9] https://www.vurbmoto.com/eli-tomac-on-future-after-achilles-injury-in-denver/

[10] https://en.wikipedia.org/wiki/Serenity_Prayer#:~:text=It%20is%20commonly%20quoted%20as,wisdom%20to%20know%20the%20difference.

[11] https://uscatholic.org/news_item/commentary-how-i-discovered-i-was-wrong-about-the-origin-of-the-serenity-prayer/

Ian King

The athlete and boiling water – how the lessons are lost

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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

Injury reflections for physical preparation coaches

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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

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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 glutes are over-rated

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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

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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.

Ian King

Where’s the evidence?! Part 5 – Which ‘evidence’ will you choose?

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A young adult was watching a physical coach performing a pre-training static stretch with a large group of young athletes. They turned to those around them and said:

“You know they are wasting their time!?”

The coach whose professional implementation judgments they were calling into question was myself. The year was 2018.

Which type of evidence were they operating on? To understand that answer here’s a clue – they were an undergraduate student. There’s additional irony in this story as their college course was in physical therapy.   Here a few years in undergraduate study trumped the experience and conclusions of a person who had conducted four decades of multi-year, large sample size, many sports, many different countries experiments.

Reminds me of the 1980s when periodization was taught dogmatically and as a fact in coach education despite having no real science to justify it. If you were to engage in any speed work before developing an ‘aerobic base’, you were also ‘wasting your time’. Actually, more than that, the athlete was definitely going to get injured.

Was there any real science in this? No, but that didn’t matter. Once enough people were echoing the myth, and that was enough. Once it’s in printed word, that’s enough. Once certain ‘experts’, ‘gurus’ or ‘leading’ coaches saying it, that’s enough. It forms a ‘truth’ all of it’s own and everyone assumes that for a theory to reach this level of ‘definiteness’ it must be fact, supported by science.

I was keen to understand the science of this conclusion. With all due respect to the aerobic base proponents, I didn’t agree. So when I got the chance to listen to a strong advocated of this training method at a national convention I listened intently….. Until I heard the evidence – this is what it was:

…a newspaper article published a story where a person said they heard an New Zealand All-Black say they felt fitter because of their off-season aerobic training.

That was it?!

I was keen two to learn of the convincing science confirming that static stretching before training is bad. Here are two examples of this ‘evidence’:

xxxx says wild animals don’t do static stretching–they do long, slow-moving stretches, or even explosive bounding movements that form an integral part of all of their lives. “And the stretch is not a relaxed stretch; it’s done with a lot of tension. That’s an important point because we are often told to stretch only relaxed muscles. Look at the stretch of a cat, how it stretches up to its maximum with tension, according to what feels right. This type of active intuitive stretching equips you to cope better with strenuous exercise.[1]

Really? That was it?!

If you took rubber bands out of the freezer and prepared to use them by stretching them, what do you think would happen? You would easily break quite a few. This is why athletes frequently pull muscles…[2]

Really? That was it?!

So it must be true. After all, here’s a professional development organization also stating it’s true:

In general, there is little need to place much emphasis on stretching in your exercise routine, at least from a health or injury prevention perspective. [3]

And here’s another ‘guru’ telling you it’s true:

None of our athletes, from pros down to middle school students, stretch prior to these workouts…Our athletes do not do static stretches…[4]

Now did the science change with this very ‘guru’ ‘changed his mind’? An, no.

One thing that’s fundamentally different now from when the original ‘Functional Training for Sport’ book [2004] was written is there was no emphasis on tissue quality…tissue work…rolling, stretching. I can’t believe there was no reference to static flexibility and no reference to foam rolling just a few years ago. We had no concept of changing tissue density [tension]. [5]

I couldn’t believe it either! That this ‘expert’ published on such limited experience in that they no idea in 2004 that stretching and rolling contributed to altered muscle tension! The ‘we’ needs to be ‘I’….”I had no concept….”

What didn’t change was the damage that was done. The myth became a paradigm and the paradigm became ‘assumed science’. Sure there are some abstract short term studies showing that pre-training did certain things. Where there any conducted over years confirming that removing pre-training static stretching was superior?

So perhaps we can forgive or understand this undergraduate ‘I know’ attitude on the basis that all she knew was the theory she was told, and we are in an era of anti-static stretching.

But what about the ‘gurus’ who mess with the values of the average professional and end user and whose ‘teachings’ depends on the popular trend at the time? The way the wind is blowing on any given period of history….

Here’s a great example of this questionable influence. Say a physical coach with university qualifications and 20 years of industry experience? And who was struggling with chronic back pain? What ‘evidence’ would they rely upon to guide their ‘stretching is bad’ position on static stretching? The below is a verbatim transcript:

Strength Coach: I’ve read a lot of stuff that says doing static stretching before [training] actually makes the muscle weaker and the contractions less forceful. So I’ve always seek out stuff to validate this bias. So I’ve never really dived into stretching.

IK: So just as a matter of interest, you’ve heard the theory. Did you test the theory?

Strength Coach: No.

IK: So you’re leading a life on the basis of other peoples opinions? Can I ask you another question – how many original studies have you cited that came to that conclusion? The hard copy or electronic copy in your hands?

Strength Coach: Zero.

IK: I’m glad you’re honest with me.

Yes, just as the majority do – this extremely well intended and experienced physical coach has chosen the ‘evidence’ of the consensus thinking.

And they are not alone in doing so…..

You have choices in evidence, and that is your prerogative. I simply encourage you to be clear about your ‘evidence’, and encourage you to consider a more holistic approach to ‘evidence’. This means that personal and professional experience and observations with cause-effect relationship do count!

References

[1] Reference withheld to protect the message.

[2] Reference withheld to protect the message.

[3] ACSM’s Health & Fitness Journal (July/August 2009), Question Column by David C. Nieman Dr.Ph., FACSM

[4] Reference withheld to protect the message.

[5] Reference withheld to protect the message.

Ian King

Dysfunctional Training

/by

A method you are already employing

After four decades of professional involvement I have concluded that what most of what the world does in their so-called ‘strength and conditioning’ programs is create dysfunction in the body. I have now chosen to call it dysfunctional training.[1] I understand it is not their intent to create dysfunction, however I firmly suggest it is the outcome.

It’s not a totally new thought. In the 1990s, after nearly 20 years in the industry, I wrote:

… I believe that most injuries are actually caused by the way athletes train… – training, during which focus is geared towards performance enhancement, may induce most injuries…. [2]

In the 2000s I wrote:

I have formed the opinion that most strength training programs do more damage than good… [3]

…from my observations, most physical preparation programs do more harm than good….[4]

In the 2010s I wrote:

How many people around the world are being led into less-than optimal training because their trainers/coaches lack the ability to discern and evaluate information? And at what cost to their health, injury status, and longevity? Only those in the sickness industry could celebrate this.[5]

Rather, it is a term coined with the benefit of extensive reflection. I have had four decades professionally to gain additional clarity and have decided this training should be labeled ‘dysfunctional training’. This term not only aptly describes the situation it also provides a counter-balance to the common use of the term ‘functional training’.

Use of the term functional training is complete misnomer. In fact I suggest that is the myth perpetuated by equipment distributors for commercial gain. What I strongly suggest is that what you are doing and what the world is doing would be more actually described as dysfunctional training

I appreciate that the overwhelming majority of my industry ‘colleagues’ are not going to like what I have to say here. That’s okay with me. Just stop reading and move on to more agreeable content. [6] My goal is to help those who are seeking a better way with no intent to offend, nor any fear of doing so.

What is the definition of dysfunction?

I define dysfunction as it relates to training as a collection of training decisions (aka a program) that result in the decrease in function of any systems of the body. Dysfunction is only really noticed when it reaches its finally stage, injury. And even then it is typically denied.

In the early stages of the development of dysfunction in any system, the positive adaptations in other systems can appear to provide a net positive training effect. However as the dysfunction grows it outstrips any positive adaptations, at which point causing some to question what is going on. However prior to this tipping point of a net negative outcome, few if any are aware of the growing dysfunction they are developing through their training decisions.

How does dysfunction occur?

Dysfunction of a system of the body occurs when a stimulus applied to the body (e.g. training) and the adaptation or response to that stimulus degrades the function of any system of the body.

To give examples as they relate to the musculoskeletal and neuromuscular system, I refer to my joint gap theory as an example of function or dysfunction:

I’m going to share with you very simply my philosophy on use injuries. I have two bones and some connective tissue. 

We have increased compression of soft tissue as a result of that changed relationship between bones [joints]. We can also have a nerve impingement….[7]

This is my number one reason for stretching. Put simply, if the bones get drawn closer together than desirable, the impingement of connective tissue at the joint can cause all sorts of problems, especially nerve pinching – this can set off all types of neural activity which translates as muscle spasm through to feelings that the muscle has been torn.

You can have a reduction in muscle function due to changes in joint relationships – and you don’t necessarily even know it. This can occur before measurable discomfort occurs. And joint surface changes can also commence before you experience or acknowledge the pain. Pain inhibits function.

In addition to the performance enhancement benefits, your joint health is at risk….

It makes little difference how big and strong you get in the short term, if in the long term you are physically limited because you allowed the joint to become damaged. Joint damage will be accelerated if the joint gap or relationship (distance between two bones) changes. [8]

As it relate to the function of the musculoskeletal and neuromuscular system, any training that negatively impacts the optimal joint relationship is one way to create dysfunction. This form of dysfunction is beyond epidemic – its almost inevitable due to the way programs are designed.

What are the stages of dysfunction?

I have identified five stages of dysfunction:

  1. Dysfunction
  2. Discomfort
  3. Pain
  4. Injury
  5. Surgery

Characteristics of the different stages of dysfunction.

Stage 1 – Dysfunction

Assuming that the human presents in an optimal systems condition prior to the commencement of any physical training program, this period (Level 1) spans from the first stimulus that creates dysfunction through the Level 2 where some signs of discomfort are felt. This can be a lengthy process, depending on the training stimulus and other stresses on the body. What I suggest is that this phase is the phase that occurs over the longest time period, relative ot the other four phases.

This phase is the period during which anyone relying on detectable signals (e.g. pain or injury) is at a loss, as there are no obvious signals. There is a downward trend that is measurable, but only if those performing the assessment had the awareness to look for subtle changes. In other words, this is a period of naïve bliss, typically referred to as the ‘short-term’ adaptations, where the initial conclusion is that great things are occurring, because the initial interpretation or adaptation appears positive.

Stage 2 – Discomfort

The ‘discomfort’ stage is such that it can, and is typically, ignored. Alternatively it is misinterpreted. Either way, the messages being sent out by the body to the brain at a conscious level are rarely respected. Or if they are recognized, the symptoms are addressed, not the cause.

This stage is potentially the second longest time period.

If these messages were respected and a genuine solution sought, it may result in obtaining the solution their and then.

Stage 3 – Pain

This level may be enough to force some to find a solution e.g. rest, or therapy etc. However not all will respect the messages even though they have been raised to a higher level.

The higher the pain threshold, the more ‘determined’ (stubborn?), the more the person has reason to ‘hurt themselves’ – the more the pain will be ignored.

So some may stop here, some will not. This stage is typically shorter in time frames than Stage 2 – Discomfort.

Stage 4 – Injury

After a period of time where the messages from the body are ignored, the body will break. This stage is typically one of the shorter time frames.

Most will stop here, some will not. Either way few will seek and find the true cause, and address it. As such, their injury is likely to return or an injury in a related, explainable way will occur.

If a person reaches this stage they are less likely to acknowledge their contribution to the condition.

Stage 5 – Surgery

If the injury is severe it may warrant surgery or the individual may choose surgery for its expedience or due to the conviction of their advisors.

For the most part surgery requires the same amount of rehabilitation that a less invasive/more conservative approach would require.

Again, if the individual fails to recognize or accept that factors that caused the condition in the first place they are likely to reinjure the same or a related site.

Time based phases of dysfunction

I identify or recognize a sequence or progression of dysfunction that can be categorized as follows:

Short term

It is quite common that a short term positive effect is felt by the person. For example, they may experience increase in muscle strength or size.

Even if the program is dysfunctional – and there is a near 100% probability it is – the negative changes such as changes in join relationship, tissue length, tension or posture will not be apparent, and these degradations may not outweigh the perceived benefits in the short term.

To use the most simple example, a person may be seeking to simply increase muscle size in say their chest and this is occurring. Currently, and beknown to them, their humerus (upper arm) is becoming internally rotated and their chest muscles shortened.

Could you be creating an injury through your training? Even though you are getting bigger, stronger, and leaner and really enjoying it? Sure can – in fact I usually judge how long the average person has been training for by giving their bodies a quick once over visually – the more advanced the postural ‘flaws’, the longer they have been training! Sad? Yes, but fairly accurate.? [9]

Medium term

This is where the individual begins to question either their lack of progress, or clear limiting factors in their function, of the reduced functionality of their body.

They are either experience pains in the shoulder or similar, or wondering why their chest is no longer growing.

Really astute individual may change direction in their training at this stage, but this requires the willingness to be non-conforming with what the masses are doing, ruling out the majority. Most continue as they are despite internal questions as to the efficacy of their approach.

To continue on the simple example of above, this is where the internally rotated upper arm and shortened chest muscles from their dysfunctional, imbalanced program, begin to become evident.

…Imagine that – training and being worse off for it. Well how do you think the athlete would feel if he/she found out! Yeah, they’re real fit – to sit in the stands in their team uniform and watch![10]

Long term

This is the stage where their performance is declining, either through injury induced limitations or limiting factors such as reduced power output etc.

In the simple example above, the individual either faces serious shoulder pain, injury or surgery; and or their chest muscle mass has not progressed for some time. It is quite common to see massive anterior deltoid development in these cases, giving the false illusion of their chest muscle mass. This rarely fools expert observers, however, including bodybuilding competition judges.

…most strength training programs do more damage than good. However it takes many years for the average person to realize this, if ever. The short-term results cause pleasure, but the long-term results inevitably pain. [11]

……most physical preparation programs…may give short term results or confidence to the athlete, but result in significant performance restrictions and or injuries long term.[12]

Why is achieving improved function versus dysfunction so challenging for the masses?

The greatest challenge the world faces in relation to receiving a functional training adaptation is the inability to define and measure it. What is optimal function of the systems of the body? Sure, many can give lovely theoretical response. Let’s be realistic – the industry has yet to learn how to do and or teach individualization of training – what chance do we have of ‘professionals’ being able to diagnose trends in function?

…You need to determine what’s optimal length, tension, stability, and joint position/relationship for each of your “at risk” joints. . Good luck with the latter. I haven’t found too many who’ve mastered the relationship between optimal length and tension and joint health….[13]

The second challenge is the length of time that passes, and the associated change in function of the body, that occur from the point of optimal function to the first sign of discomfort. This is potentially the longest time frame of all five stages. Which means the challenge of reversing the function becomes greater for two reasons. Firstly because ‘professionals’ do not possess the competence to reverse the issues, and secondly because the time frame of reversal is beyond the attention span of most end users.

The third challenge is my perspective or reality that commercial forces, specifically equipment manufacturers, influence the majority of training decisions. The fact that it is rare to see an exercise promoted that didn’t involve the subject holding onto or connected to a training device of some kind is not a coincident. And ideally, a new device, which requires the market to go out and replace their prior purchases. As to what Kettlebells are to Dumbbells, etc. In other words between commercial influence in marketing, the desire to conform by individuals, and the lack of or unwillingness to apply the level of discernment granted the human brain, there is very little chance of the masses moving towards let along achieve true improved functions in the systems of the body as a training adaptation.

Training trends have nothing to do with improving function. The promotion of the term ‘functional training’ sounds as if it does, however I suggest that this very ‘phenomenon’ is in fact a classic example of equipment distributors manipulating the market. I suggest that if you study the rise of this so-called ‘functional movement’ trend, it coincided with the decision by a previously relatively unknown distributor of track and field equipment to shift their focus to the importation and distribution of small pieces of diverse equipment post 2000.

To facilitate this they funded years of national seminar tours under this very name, and promoted willing ‘experts’ who were taken from unknown to recognizable names in exchange for their willingness to espouse the benefits of ‘functional training’. These newly promoted ‘experts in functional training’ were supported in this exchange with the opportunity to publish books on the subject, despite only years before being violently opposed to the suggestion that multi-joint maximal load exercises (e.g. the power lifts and Olympic lifts) were not optimal options for athlete development.

In order to pre-empt the argument that the presence of the term ‘functional training’ in professional development organization’s training modules and seminars etc. is indicative of it’s validity I suggest you look at who is sponsoring the professional development organizations. Equipment manufacturers and distributors figure prominently.

What is significant about the post 2000 era that is tied to a rise in dysfunction?

Post 2000 saw the proliferation of ‘strength and conditioning’ (I really don’t like using that term however I appreciate readers can relate to it) down the ages. Prior to 2000, in Australia, there were less than a dozen or so individuals that were making the equivalent of a full-time salary.

Post 2000 witnessed a strong progressive increase in demand for these services. By 2010, most high schools in the country had strength and conditioning coach and or their own strength training facility.

The more an athlete participates in physical preparation, including the younger they start in physical preparation, the greater the incidence and severity of injury. Unfortunately these injuries are being blamed away by many involved in sport as being a function of the increased demands and impact forces in ‘modern day’ sport. This to me is little more than an excuse, an exercise in putting one’s head in the proverbial sand. Quite simply, the majority of training programs are flawed from a physical preparation perspective and are causing the increased injuries. [14]

Put simply, the same crappy programs that were bring introduced to adults pre-2000 are now being given to children.

The number of young Australians undergoing knee reconstruction surgery has risen more than 70 per cent in the last 15 years, according to the study published today in the Medical Journal of Australia, with the greatest increase among children under 14…

… Nearly 200,000 ACL reconstructions were performed in Australia between 2000 and 2015. The annual incidence increased by 43 per cent, and by 74 per cent among those under 25 years of age,..[15]

Interestingly, these statistics completely support my repeated references to the period post 2000 as being a period of increased dysfunction and injury.

The only discrepancy with this research article is that their conclusions as to the cause does not include my hypothesis – that the number cause of this sharp increase in injury incidence is more correlated with the introduction of so-called ‘strength and conditioning programs’ into the younger age groups than any other potential contributing variable.

So why do the majority allow these dysfunctions to take hold?

I suggest one of the major contributing factors to this blindness to the creation of dysfunction is that is few understand at a sufficiently appropriate level the mechanisms for optimal systems function, and dysfunction in systems performance. They fail to understand that any changes to the joint gap and or join relationship will negatively impact the nerve and blood supply distally.

In fairness the physical therapy professions have limited ability to predict and prevent injury, the final stage of dysfunction. They have zero ability to identify and prevent the early stages of dysfunction. So is it realistic to expect a physical preparation coach (read ‘strength and conditioning coach’ if you need to) to be able to do so?

However I am less interested in what is reasonable for our industry standards currently. I am more interested in what’s best for the end user. And being guided to train to degraded systems function is not what clients/athletes sign up for. But that is what they are getting.

Conclusion

Quite simply what you and everyone else is doing is creating dysfunction. The only difference or question is when will this become apparent? Will you or your client be that exception that survives? Or will your client or yourself be another statistic of unfulfilled potential and or injury?

I understand that this is difficult to accept, and it is much easier to criticize the concept and move on. You can do this, however your body does not lie. If you are creating dysfunction in yourself and or your client/s it will come out one day.

Most of the concepts I published in the 1990s are now universally accepted. Not all – yet – but most. And if this is not apparent to you, this is in part a reflection of the acceptance of low standards of publishing especially in the US where plagiarism in the ‘new frontier’ has been rampant.

Everything I teach will come to pass. Whether in my life-time or after is the only question. The only question that really matters is whether you will take advantage of the concepts I share, or whether you will put your head in the sand (figuratively speaking) and hope I am off-track.

I publish challenging and disruption concepts such as this to give you an opportunity to benefit now. I understand that most of you will choose not to. That is your prerogative. I look forward to studying the long term adaptations from which ever path you choose.

The first thing I recommend you determine is this – is anything you are doing or omitting to do in your training creating an injury? What I am saying is eliminate the self-inflicted injury potential first, as this is the one you have the most control over! [16]

 

References

[1] An original concept which I trust fares better than many of my earlier concepts in terms of receiving appropriate referencing.

[2] King, I., 1997, Winning & Losing, King Sports International, Ch 5, p. 25

[3] King, I., 2004, Get Buffed!™ III, King Sports International, p. 8-9

[4] King, I., 2005, The Way of the Physical Preparation Coach, King Sports International p. 66

[5] King, I., 2010, Barbells & Bullshit, King Sports International, p. 100,

[6] You won’t see the word ‘research shows’ so you have great justification already. There I have given you your excuse, so don’t waste my time with troll-like responses about the lack of science. If anyone chooses to disregard my four decades of processing more bodies elite athletes than anyone you are likely to meet that’s fine by me. However if you are an end user, you might want to keep reading because at least you won’t have a professional ego to protect, and my message could really save you a lot of grief.

[7] King, I., 2000, Injury Prevention and Rehabilitation Series, Disc 1

[8] King, I., 2002, Get Buffed!™ (book), p. 102

[9] King, I., 2003, Ask the Master, p. 87

[10] King, I., 1999, So you want to become a physical preparation coach, p. 30-31

[11] King, I., 2004, Get Buffed!™ III, King Sports International, p. 8-9

[12] King, I., 2005, The Way of the Physical Preparation Coach, King Sports International p. 66

[13] King, I., 2003, Out of Kilter III – End needless knee pain!, t-mag.com, 28 Nov 2003

[14] King, I., 2005, The way of the physical preparation coach, p. 66-67

[15] https://www.msn.com/en-au/health/medical/acl-reconstructions-up-more-than-70-per-cent-among-young-australians-study-finds/ar-AAwbKpY?li=AAgfDNO&ocid=mailsignout

[16] King, I., 2003, Ask the Master, p. 87