David Joyce – Setting rehabilitation goals and reducing energy leaks with movement efficiency
David Joyce, co-author of ‘High-Performance Training for Sports’ and Head of Athletic Performance for Greater Western Sydney Giants AFL team has a wealth of experience from working with a diverse range of athletes and sporting professionals.
David’s unique perspective and appreciation for structure stemmed from his time spent as a rehabilitation specialist with Team China and pushing performance outcomes for teams including Western Force and Hull FC.
As an expert in rehabilitation and reducing efficiency leaks David provides a valuable source of information on the often-pressured field of high performance sport.
How can a coach best convey to an athlete that injury downtime is an opportunity rather than a setback?
The best way a coach can do that is to be pragmatic and acknowledge the fact that when they’ve got an injury it’s certainly undesirable. You’ve got to acknowledge the elephant in the room because if you don’t the athlete just thinks that you are basically in denial.
But then once you’ve got an idea of how long the rehab is going to take, you plan it so that when they are going through the various stages of rehabilitation, that they are ticking off markers, which ultimately sees them in personal best shape.
For example, we’ve got a guy going through ACL reconstruction at the moment and we went through his plan today. We’re currently in phase three, its up to the strength accumulation stage. He will be hitting personal bests with squat strength and deadlifting strength and then in stage four his targets are to have personal bests in vertical jumps and then in phase five, the final phase he will have personal bests speed so when you explain this to them ultimately they can say:
‘It is undesirable that I’ve got an ACL injury but I can see that the athletic performance team has actually targeted me to come back stronger than I ever was before.’
That’s kind of the silver lining if you like, so it really presents us with an opportunity rather than a crisis.
And when you’re creating rehabilitation schedules for athletes, do you have contingencies in place for if they don’t meet the timing you set for them?
Yes, so we go down the approach of using exit criteria as apposed to timelines. If it was just timelines used, you would just sit at home and watch the calendar sheets tick over but what we’re actually doing is saying your ready to return to play when you’ve ticked off these exit criteria. You’re ready to go into stage five when you’ve ticked the boxes of stage four.
Now we know from experience that with a particular injury, stage three might take two months so that’s based on background knowledge. The way we present it to the player is:
‘In our experience this stage takes generally between six and nine weeks. This puts us on target for between the 14th and 23rd of January.’
You always build a bit of fat in there because things can go wrong but equally they can go very right, some people tick off quicker than what you expect sometimes.
Does the interdisciplinary approach you mention in podcasts regarding rehabilitation differ much for countries like China?
Yes it does in the fact that the Chinese run a very different medical model than to what we do in the west. Everyone is working towards the same goals, they just approach it in a different manner from the medics. They are often traditional Chinese medicine trained and there are some that are western trained but also there is a growing brigade of physiotherapists in China, but its not a formally taught profession over there. But there is more going over there I would say.
We thought it would be interesting to know the cultural differences, not being such a democratic country and how they allocate responsibility as a team and if those things are hard to deal with or it’s just the way they do it?
They weren’t hard for me to deal with, the hardest thing was getting my head around the language and the various different politics of the country but ultimately everyone is working to the same end, and that end is to get a player back on the field or the court or the pitch or track, whatever the sport is.
They are probably not as developed in high end sports medicine as you and I would recognise it, but the motives are still there and to get the player back as quick as possible. I’d say there are more similarities than there are differences.
How do you personally disassociate from the stresses and pressures applied by athletes and their performance teams during the rehabilitation process?
You get pressure from all sources really, from the athlete; all they want to do is be out there. Then you get pressure from the coach and the fans, because they want the athlete out there as well. You also place pressure on yourself.
So ultimately you’ve got the same goal and I don’t think anyone puts more pressure on me than I put on myself, but the reality is you need to deal in facts and not emotions.
As difficult as that may be you’ve got to say:
‘We know that this injury is going to take a certain period of time to get ready so if you’ve got a hamstring strain the day before the grand final it’s terrible news, but the biological healing time is such that that’s not going to be right and that player is not going to be doing themselves justice.’
The two things that go into my head are the safety and the health of the athlete, so that’s first and foremost and if they fail that, well they’re out. If they pass that then they go into the second filter; are they capable and competent to do their job?
You may say that someone coming back from a shoulder injury or shoulder reconstruction may be strong and stable but the fact is that they haven’t necessarily done all of the high performance training that you need to go through to get back into a full blown grand final. So they’re not really going to be up to their best.
Those are the two filters I apply and then you just deal in facts. It’s quite simple.
So you just try and put as much of the emotional pressure to the side and ignore it in a way?
I think you have to. My job as Head Of Performance really is to deal in facts. I’ll leave other people to get involved in the emotions of it. Sport is an emotional thing, but I have to deal in truth. If you let your emotional brain get in the way of your rational brain well then you’re in trouble. You’ll make errors and poor decisions.
Is it the Head Coach’s responsibility to address any communication breakdowns that may occur when undertaking an interdisciplinary approach to rehabilitation?
I think it’s everyone’s responsibility but I think often what you need a Head Coach to do, or in my case, they’re there for performance and to ensure that systems and structure are placed around the communication process.
We often have a lot of systems and structures around football but we forget how to communicate and the rules you need to apply to communication. What I did very early on with my team and here at the Giants was to say:
‘Right, this is how I like to receive my communication. This is how I want our APU (athletic performance unit) to communicate via these systems and structures.’
Once you’ve got a good system in place the communication is absolutely fine. And if it’s not, someone’s not obeying the rules. So that’s a really quick way to identify where the error is and then you go and speak to that person individually.
I don’t think it should be the responsibility of any one person. Whether it’s the Head Coach or whether it’s the Head Of Performance, I think it’s everyone’s responsibility.
There are exhaustive amounts of physical drills for injury rehabilitation, can you give any examples of mental drills that may reduce anxiety and divert attention away from the recovering body part?
I’m lucky where I work, because we have a fantastic psychologist that works with us in our performance team so she’s a proper performance psychologist. She deals with that side of things right from the very beginning, like reducing what we call pain catastrophisation.
You often see it where you’ve had a big shoulder injury and then every little pain that you get when you’re starting to come back into full training, you think your shoulder is about to fall off, so that’s catastrophising the pain that you get.
There are specific ways you can do that (reduce catastrophisation) from a psychological point of view if you’ve got that facility.
If you don’t, a lot of fear and anxiety is reduced by explaining very upfront about what it is that the athletes commonly experience and when they’re coming back from an injury.
For example someone coming back from an ACL injury, I will always talk to them about the pain, I will always talk to them about what’s acceptable and what’s not acceptable pain. I will always talk to them about how the knee doesn’t feel normal when you start to come back and explain in layman’s terms when you have physiology behind that.
Once you’re calling the elephant in the room it’s no longer a big scary monster, it’s something that’s acknowledged then you work through that. That’s the way we do it, it’s education intensive.
Do you find yourself reinforcing that message continually? Or does it only usually take one or a few consultations to get catastrophisation out of the players mind?
I find myself doing it a couple of times, it will depend on the person. Some people are just ready to go and then you’re absolutely fine, but some people need a bit more constant reassurance and that’s the individual isn’t it? It’s a play it by ear approach according to the individual you’re dealing with. It’s certainly not a recipe.
What is a good way to measure increases in energy efficiency, whilst other improvements are being made? How do you determine that efficiency contributed to performance increases?
I don’t think you can attribute one to the other, any gains in one domain or the other. The reason is because you are dealing with all aspects simultaneously or certainly in sport, you don’t necessarily have a randomised control trial where it’s clean.
For example, this group underwent motor efficiency and this group underwent strength training and we saw ‘x’ improvement in one and not in the other. So ultimately in sport what you’ve got to do is hit all of them.
So you couldn’t attribute one or the other exclusively but certainly if you are talking about running or swimming for example, if you are improving technique, which ultimately with movement efficiency that’s what you’re trying to do, improve technique, then they’ve got less drag in the pool or they’re jumping better or not leaking as much energy when they are running. You could put that down to technical improvements, which is motor control.
So you must use motor efficiency as a tool to reduce injury and stress?
Yes absolutely. The most efficient cars are the ones that run the longest, so that is what we are trying to do in sport. The inefficient ones, they are the ones that the wheels fall off and that’s what an injury is.
Always what we’re trying to do is perfect technique but you also need to be mindful of the fact that if you’ve got someone that walks into the club and he or she is 29 years old and always ran a certain way, the gains you’re going to get from investing your time are going to be marginal.
But if you have a look at some of the players that are coming back after back injuries like fast bowlers and the like, effectively what they try and do is improve their technique and improve their movement efficiency.
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High-Performance Training for Sports features contributions from global leaders in athletic performance training, coaching and rehabilitation. Experts share the cutting-edge knowledge and techniques they’ve used with Olympians as well as top athletes and teams from the NBA, NFL, MLB, English Premier League, Tour de France and International Rugby.