Elle wrote:Fri Nov 01, 2024 9:32 am
Thank you, thank you, much appreciated!
The problem with tests is that not only do you have to identify which ones have the right sensitivity/specificity, but you also have to know how to perform them and have them performed.
This is why I often send the people I train to a trusted specialist, who can give me much more precise information than I could get myself. I really like the Chinese approach (I don't know if it exists elsewhere, here in Italy it doesn't): there is the weightlifting coach and the strength and conditioning coach who takes care of all the issues not directly connected to snatch, clean and jerk and squat. In the absence of collaborators, a weightlifting coach often does everything (even an orthopedic/physiotherapist and nutritionist). I don't want that to be my case.
Related, the Chinese men's weightlifting S&C coach (Nathan Stockley, UK) and Physiotherapist (Sam Stewart, Australia) did a
podcast a few years ago but I don't think it got many views.
I'm not sure of any other national teams who have in-house allied health professionals all under one roof. Some particular gyms are lucky enough to have that but it's much more common in well funded sports than in weightlifting.
As with any field really, it helps to talk to people and form connections/relationships where you can. I'm in the fortunate position that I can do basic assessments for injury screening when athletes have problems, but if I'm not getting where I want with management I will refer to the relevant specialist (e.g. physiotherapist, medical doctor).
This applies often with nutrition. I know enough about nutrition to know what to do and give general advice, but I'm not a dietitian which means that I'm not legally able to provide dietary plans and more importantly, I don't have the time as a coach nor the knowledge to really create an effective plan for behaviour change around food. This is especially true when people have body image issues or eating disorder history - very common in weightlifting. Referring out to sport dietitians is unfortunately expensive and takes time, but I strongly recommend it to athletes who struggle with dietary management. I also recommend dietitians over nutritionists - dietitians are more expensive, but they have a postgraduate education and a lot of mandatory clinical hours. Nutritionists are a half and half mixture of people who try to keep learning all the time, and people who learn nothing outside of their biases.
More commonly in most scenarios, it's the individual athlete who seeks out help - from MSK professionals, sport psychologists, sports dietitians, GPs and sometimes sports physicians (usually for more serious injuries that may require surgery). This multidisciplinary approach is good, but unfortunately rarely ever results in true interprofessional collaboration. Half the time I can barely get an email back and I am instead relying on the athlete's memory of their appointment. I'm afraid true multidisciplinary collaboration usually only happens in hospitals and the Chinese team.
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IMO regarding the S&C coach role, I think weightlifting coaches are very well positioned to learn how to become an S&C coach. S&C is made unnecessarily complicated by acronym collectors. From a weightlifting perspective, S&C is basically speed training (jumps/hops, throws) and general strength training/bodybuilding training.
1. Progressively jump higher, further or quicker. Progress from extensive to intensive jumping over time. This is great to incorporate towards the end of a warmup, before lifting.
2. Progressively get stronger and lift more weight in the 5-20 repetition range in all joints/planes of movement and positions, especially the ones ignored by weightlifting (e.g. dynamic rotational or lateral ab work, hip flexion/adduction training)
3. Probably some cardiovascular work in zone 2 is good for general health and wellbeing.
That's it. When people prescribe hyperspecific exercises that look like mid-flight rocket surgery, they're usually trying to sell their S&C expertise rather than actually just load up a tissue or system. A couple of exercises, done consistently to work on weakpoints, 1-2x a week for 1-3 sets of 5-20 reps and gradually progressed over time.
Elle wrote:Fri Nov 01, 2024 9:32 am
The Squat U approach has always left me perplexed because of its "simplistic" nature: positive FABER test? Ok, do this exercise and... oh the Faber test is now negative, you are cured!
I have no idea what kind of test Corbu is referring to (I imagine he will also get help from the national team specialists) but I fear an approach similar to that of Squat U, which is now quite popular here.
Your instincts are partially right and wrong regarding his methodology being oversimplified. What the patient sees isn't (should'nt be) the clinician's thought process. Testing, exercise prescription and review should always be as simple as possible, but the thinking behind them must be complex in order to make the intervention simple. There have been times where I've prescribed 3 simple exercises for about 10-15 reasons.
Once you have ruled out red flags (medical emergencies), a lot of testing and exercise prescription is basically about managing patient expectations, loading in an ideal zone for the patient/condition to rehabilitate whilst time heals the body. It's like the old quote from the 1800s: “The art of medicine consists of amusing the patient while nature cures the disease.”
Exercise analgesia can occur with many different exercises, not just his pet favourite exercises. It's a temporary effect but you can use it as a powerful tool (and placebo) to get people training/moving confidently and progressively, which as long as you're within the Goldilocks zone (not too much, not too little) can help with rehabilitating the athlete and movement. My preference is to use the desired task e.g. squat to test for or provoke pain, and retest afterwards. You can use a FADIR/FABER to assess hip pain in the squat, or you can do a bodyweight or weighted squat and tell me when the hip hurts (e.g. ROM or load provocation etc).
Italy has some awesome physiotherapy and sport science professionals, so the expertise does exist in the country but it needs to be accessed and listened to.