James Boyd is a Sports Physiotherapist at the Team Bath Physio & Sports Science Centre. In this blog he looks at how physio and education can help the next generation of athletes achieve their full potential…
Well, what a fantastic few days I’ve had recently. I have not long returned from working at the 2015 Sainsbury’s School Games and I am proud to have shared company with a wonderful plethora of athletes, coaches, doctors and physiotherapists.
This was my second year at the Games and this time around, I found myself working with fellow physio and frequent blogger for the British Journal of Sports Medicine, Sam Blanchard.
While there isn’t much down time in such an environment, there is always time for discussion and one such chat between Sam, myself and the rest of the team got me thinking: what is the role of a physiotherapist in an environment such as the School Games?
The annual School Games event sees approximately 1,600 athletes, aged 13-18 years of age, competing across various sporting disciplines over a three-day period. For the medical team this is a busy 72 hours with plenty of assessments being undertaken and lots of new faces, each with their own complex histories and idiosyncrasies. So what can we do?
Well, for starters we need to make sure that we are performing the basics to a high standard. Thorough subjective and objective assessments need to take place with our detective’s hats on, so we can wean out any possible ‘nasties’ or serious pathologies. These could range from osteosarcomas to a previously undiagnosed stress response. It is also worth taking note of the possibility of apophyseal avulsions in the adolescent athlete.
But let’s assume that we’ve managed the basics well and we are left with those generalised aches and pains that any athlete will present with. Those that are not life or limb threatening but are a day-to-day issue with athletes who train and compete for many hours each week.
I’d like to present an example from this year’s Games. A 14-year-old male athlete entered the makeshift medical clinic (the changing rooms) with complaint of a vague feeling of soreness in his knees. This had been ongoing for a couple of weeks and had been linked with an increase in training load in prep for the competition.
Upon observation he was covered in tape from top-to-toe – three strips around each knee, lines up and down his ITBs and some obscure technique running across his lower back. He assured me he was not sponsored by a leading kinesiology tape brand but I was dubious. When asked who had implemented the taping, he confessed it was self-applied but was based on the techniques he had been shown by physios in the past.
“Do you think you need all that tape on?” I asked.
“Umm, I think so?” he replied with a questioning inclination.
My second line of inquisition: “Do you think it helps?”
“Umm, I think so” – his response came with a pondering pause.
“Do you think it will help your pain or performance?” My third line of questioning.
“Umm, maybe,” he replied.
I can’t promise this was verbatim but it holds the gist of the conversation and with it I aim to highlight the impact that previous physiotherapy input has had. At this stage I hasten to acknowledge that there are of course other contributing factors, such as the influence of peers and role-models who are seen sporting the same tapes, the effect of marketing strategies of the tape companies and much more.
But he has been shown how to perform these techniques by other physios and they have been remembered, to the point where he is applying the tape with no known knowledge as to what it does or why he’s even using it. He just feels that he needs it and has become reliant on wearing the tape.
I am not questioning the role of taping (that is a completely new blog topic altogether), neither am I questioning the quality of the previous physio input (as any athlete will come away with only a few key messages from a session and in this case, it may have been the tape that stuck – excuse the pun). However, by contributing in such a way, are we helping to build strong, robust athletes or those reliant on external factors?
Predictably enough, this athlete was a repeat user of the physiotherapy service during the three days of the Games. Each time presenting with fatigue-based aches and pains – expected after four to four-and-a-half hours of repeated jumping and landing per day.
He frequently asked for rubdowns and taping to help him get through the tournament and with time restraints as they are in such an environment, it would be very easy to slip into auto pilot and give him some therapeutic hands-on work.
However, what followed was a dose of education and reassurance that his own body and mind were resilient structures that could withstand the rigours of the sport and perform at a high level. While he may have left unsatisfied without his rubdown, he went on to medal with his team at the Games and I can only hope this experience went some way to reassuring him that he could still perform – even without his taping/soft-tissue work.
As a team, we pondered if there was something underlying that we were missing but we realised that this 14-year-old athlete had simply been institutionalised into the world of physiotherapy. He had become reliant on his tape and massages, with very little education as to how he can self-manage some of the rigours of training independently.
I would argue that the child/adolescent athlete should be empowered to manage their own bodies, as opposed to feeling dependent on techniques they may not always be able to access. I pose that if we are not considerate with our wording and actions as physiotherapists, we will nurture a generation of athletes (and on a bigger picture, adults) who are reliant as opposed to resilient, and those who may not be able to self-manage.
As elite programs for the young athletes develop and a greater number of kids are exposed to the pressures of high-level sport, the medical profession must identify that we are not working with young adults. This completely different client group requires a different skill set. It is my belief that as part of our practice to the developing athlete, we need to instill good habits, educate and, most importantly, empower them to become the best that they can be.
James Boyd is a Physiotherapist at the University of Bath and acts as the Lead Physiotherapist for the Southampton FC Satellite Academy and the University of Bath Badminton set-up. He is currently setting up the Team Bath Physiotherapy and Sports Science Podcast, so watch this space! Follow him on Twitter @jimmypboyd