Does Athlete Low Self-Efficacy Predict Injury?

A very interesting article and subsequent review , which I found by way of the excellent site The PT Project.

As a Sports Physiotherapist of over 20 years, it is extremely interesting that my profession and indeed the sports science and coaching community have, and continue, to search for predictive factors of injury via musculoskeletal screening. Indeed, as world renowned Australian Sports Physiotherapist Peter Blanch so aptly noted of musculo-skeletal screening in 2004;  “the holy grail is the ability to use a set of musculoskeletal tests to predict the likelihood of future injury or poor performance in athletes”. However perhaps we should make a shift and think outside the box , considering not only physical characteristics of the athlete, but also emotional and psychological well being. Whilst these thoughts are certainly not new (and athlete monitoring software used by many professional clubs does take into account athlete well being to assist in the prevention of overtraining), my experience in Elite Rugby League would suggest that coaches do not necessarily consider the need for consideration of athlete's sense of "self confidence" in performance or injury prevention. Indeed many coaches and sports scientists (at least in Rugby League) require education (and readiness to be educated) on the requirements of sports specific behavioural screening tests that may compliment musculoskeletal screening to predict performance and risk of injury. I do find it incredible that enormous funds are invested in training facilities and equipment, whilst  findings such as those in the study reviewed note that the utilisation of a low cost athlete questionnaire  suggest that those athletes who had a low self-efficacy score on the health questionnaire were almost twice as likely to be injured as those who had scored high on that measure. Clearly performance, and injury prevention, is not just a matter of bigger, stronger, faster, and coaches and teams, in searching for that "extra 1-2%" in performance achieve more by understanding the need to train, not only physical performance, but equally importantly, self-efficacy. Indeed, what is obvious from the research is that to achieve ultimate performance in a team environment a coach needs not only tactical and technical knowledge and expertise of his sport, but behavioural science training and support to ensure that communication and management of players is designed and executed to facilitate maximum athlete self-efficacy. A "winning coach and team" not only performs in a physically superior way, but exhibits and encourage behaviours that support athlete self-efficacy.

References:

Blanch,P (2004). “It’s Time to Screen Screening” Sportslink: Sports Physiotherapy Australia Jan: p.1,4-5

 

 

With the debut of the Gold Coast Suns at the Gabba Stadium last night vs Carlton it's much too early to judge the success or otherwise of the new franchise. However, attending the match as a Carlton supporter I couldn't help but come away disappointed knowing that the result, and the difference between the two sides, isn't what the AFL needs to help the game expand. My first thought was that the lack of competitiveness and intensity in the game would have had the NRL hierarchy celebrating. In these days of fierce competition for the fan and corporate dollar, and on the Gold Coast in a season where the NRL Titans team is currently struggling to make early season impact , the lack of immediate Suns success must have the NRL feeling that there will be no immediate pressure on the hearts and minds of the difficult and complex Gold Coast sports fan base.

As a sports medicine professional who has worked at the elite level of the NRL and AFL, my other interest on the night was to watch the debut of NRL code switcher Karmichael Hunt. Having seen Karmichael at close quarters in the NRL there is no doubt he is a super athlete, and even though I do support Carlton nothing would have given me more pleasure than to see this young man achieve success. Indeed, regardless of critical opinion, Karmichael has done what no other athlete (to my knowledge) has done, representing his country in NRL, playing at elite professional level in Rugby Union and subsequently debuting in the premier elite AFL competition. Well done Karmichael!

However, in the harsh reality of post game analysis, how did Karmichael's debut rate? While I am hesitant to make a judgement on one game, the reality (and Karmichael- being the professional athlete he is - will be well aware that today he is being judged nation wide) is that many critics were and are going to assess the success of his venture on last nights game. Statistically Karmichael achieved 5 possessions, which is probably even more of a concern given the ball spent 80% of the game in his zone (Suns defense). Karmichael very obviously showed limited spatial awareness and ability to position himself in defense, which rather than being a criticism of the man himself shows the significant difference in the cognitive demands of the multi-directional sport of AFL and the 2 dimensional "territorial/invasive" nature (back-forward, offside etc, attack always coming from front) of NRL. Simply, Karmichael looked lost, was lost, trying to man up an opponent who could and would run each and every way, and receive the ball from a variety of directions. There is less predictability in AFL than NRL, and it showed. The lack of game awareness extended to Karmichael's attempt to clear the ball from defense, where he again ran into pressure and turned the ball over through a lack of awareness and quick hands. The other obvious overlay from Karmichael's NRL days was his positioning at stoppages and times when the Suns took possession. Karmichael was flat footed, static and in effect looked like a man ready to take the ball from dummy half before accelerating into play, rather than offering a running option ready to burst through play. It will take time, exposure, practice and some lessons like last night. 

The other aspect of the NRL/AFL debate was the much touted ability of Karmichael to lay a tackle. Indeed, the most common derisive comment I have heard from NRL players is that AFL players can't tackle, and that Karmichael will be a weapon with his tackling. That may be true, but in AFL you have to catch an opponent doing his best to not only avoid you but deliver the ball to a team mate, and guess what guys, in AFL they just dont run straight at you knowing that taking the tackle and getting a quick play of the ball is acceptable. AFL players are rewarded by taking on the tackler, and disposing of the ball (if caught) in any number of fashions and directions (rather than just backward like NRL). Quite simply, Karmichael's ability to tackle relies on him reading the play, catching his opponent (prior to ball release) and laying an effective tackle. Last night Karmichael simply didn't demonstrate these skills (especially given the amount of time the ball spent in his area). Even worse, his ability to lay a "big hit" on one of the smallest players in the AFL, Eddie Betts, resulted in Eddie bouncing off him, leaving Karmichael lying ineffectively on the ground (a cardinal sin in AFL- going to ground in a contest) and Eddie strolling in to kick an uncontested goal. Harsh lesson Karmichael- use your arms; however one must forgive old instincts especially this early in his AFL career.

In summary, I walked away wondering if the Suns had done Karmichael a disservice by playing him first up. Harsh lessons and early errors exposed before a waiting national  media and fan base. Would he have been better to spend some time in the lower grades, building confidence and game awareness, working through early hiccups, which although undoubtedly observed by a waiting media hungry for his success (?or failure) being less harshly scrutinized? Only time will tell. Is Karmichael, as claimed, the teams 3rd best defender, or is he indeed holding back a young talented AFL player just waiting for his chance? No doubt it is too early to make any judgements - other than wishing Karmichael every success and hoping he does reach his potential. I did however leave being reassured of my opinion that NRL and AFL are vastly different games, equally tough in different ways, and it will take a very special talent to succeed at both. I wonder what Israel Folau is thinking today?

 

Vern Gambetta is a gentleman whose work I respect immensely in the world of exercise, coaching and fitness. Although I have not had the pleasure of speaking with Vern one on one, I have attended some of his seminars and followed his writing's and blog with much interest, and particularly like his ability to "cut to the chase". Vern does not suffer fools, and anyone who spends time examining his work will soon realize that training and exercise without function or purpose has little place in his coaching.

Recently Vern has posted on a topic for which I have much interest, namely ACL injury prevention in the female athlete.The consequences of ACL injury to a young female athlete cannot be underestimated.

Vern's most recent post discusses his thoughts and illustrates several excellent exercises which assist hip and knee control. As an addition I would encourage the reader to consider research and activities designed to assist the athlete with hip and knee control in more dynamic landing/cutting activities, which does require  progression in the complexity of the exercise prescription - however only after the athlete has demonstrated appropriate control in the pre-requisite exercises so nicely documented in Vern's post. Indeed, as all good coaches will agree- advancement or progression is only after the athlete has "earned the right" by displaying competency at less complex exercises. In my experience progression is often prescribed on a recipe approach, where the athlete is advanced to more complex exercises on the basis of time at previous level rather than any degree of assessment of competency.

Clear Illustration of various lower limb landing postures demonstrating the difference between good (A,B,C) and poor (D,E,F) neuromuscular control of hip and knee during landing.

In my experience it is at this time when athletes are performing activities or exercises beyond their level of competence , where they are "out of control" that injury occurs. Interestingly, it is not just exercise competence (or lack of) that may result in an athlete competing or undertaking activities where control is compromised- I have observed an increase in musculoskeletal (not only knee) injuries in the weeks post an athlete suffering concussion. These observations, and my reading of the literature have reinforced to me the importance of neuromuscular control as an essential element of injury prevention, rather than the oft cited but poorly defined "core stability".

Given the many competing time demands on coaches and athletes, when does one find time for neuromuscular control exercises aimed at assisting injury prevention? My solution to this difficulty has been to include these activities as part of the sports specific dynamic warm up for training.  This ensures athletes get time to practice landing and cutting maneuvers in an appropriate environment- however the athlete must be aware of correct technique, and offered relevant and appropriate feedback along with instruction on how to achieve appropriate control. In this regard- the foundational exercises illustrated in Vern's blog go a long way towards providing the athlete with the necessary pre-requisite strength and control to be able to practice and achieve dynamic neuromuscular control.

 

Barefoot running is one of the current 'hot' topics in fitness. Barefoot aficionados point to human history, and the fact that the modern running shoe has only been in existence since the early 1970's to suggest that the human foot is designed for locomotion without support. Indeed evolutionary anthropologists such as Daniel Lieberman suggest that the human lower limb is 'designed to run' and is perhaps a key aspect in the progress of the modern human species. In light of these theories, how then can we justify supports and external devices designed to control foot motion? Is the 'control of motion' a misguided concept doomed to failure on the basis that the foot and ankle actually function as mobile adaptors to the terrain underfoot, and external control simply inhibits the neuromuscular feedback from the propulsive system? Comment and justify your position- the shoe; to control or not?

Simple pleasures; swim at the beach,morning surf, ride to work, move, exercise.

All before work. Not done because I have to- but because I want too.

Simple

Well it's been some time since my last post- something for which I sincerely apologize!

In preperation of a guest lecture I am preparing for a podiatry conference, I recently re-read a news report on one of the the current hot topics in fitness,  ' barefoot running'. This article is of particular interest to me as I very much enjoyed being cjhallenged in my thinking regarding running shoes and the role of "motion control" whilst reading the excellent book ' Born To Run- A Hidden Tribe, Superathletes. and the Greatest Race the World Has Never Seen" by Christopher McDougall. McDougall's book is a riveting read, and brings into question how effective the changes in running shoe technology have been in reducing running injuries. Perhaps, however , the answer is more complex than just comparing 'barefoot' to 'advanced shoe technology'? In order to understand our ancestors ability to run without shoes we perhaps need to consider factors such as diet, habitual activity, literal survival of the fittest (perhaps in our ancestral hunter gatherer times - if you couldn't run you were unable to catch prey- or worse still became prey yourself- leading to genetic advantage of the skilled runner), life expectancy compared with todays society where activity (and running) is a choice rather than a necessity of life. Regardless, have a read of this New York Times article and I'd love to hear what people think. http://well.blogs.nytimes.com/2009/10/21/phys-ed-is-running-barefoot-better-for-you/