Latest / The Uplift- with Luke Pollock / #14 Solo Pod - My 3 Pillars of Rehab
Transcript
- Luke Pollock: Hello and welcome back to another episode of the Uplift. We have a solo pod today, just because I don't have any guests organized and I've quite a lot of guests episode recently and I actually started this podcast sort of with in mind that I would do quite a lot of solo podcasts to get my message out there and also to help sort of confine some of my thoughts and give them place because I was doing quite a lot of writing and then I realized actually I want somewhere that I can make these more concise into actual episodes that I can look back on and hopefully others can learn from as well. So being said I'm going to do a solo one today just covering sort of my rehab process, how I get away from a lot of the noise surrounding rehab. So I think it'll be really beneficial firstly for athletes to see if what they're doing sounds about right, if they need to reconsider what they're doing or who they're seeing or how they're being treated. ⁓ then it will also be really valuable for physios and rehab practitioners as well, I feel. Just there's loads of noise out there on what you should be doing, what you shouldn't be doing with different injuries. And it can seem like you have to know the whole textbook and more. And I really struggled with that at the start. ⁓ so this is sort of like a framework I've been playing around with and building with. sort of how I've been treating for a long time without knowing it. So this is just some words to my mindset behind what I do treatment wise. so yeah, we'll get into it. ⁓ aside from before we do get into it, however, yeah, just an update on where I'm at with stuff. I think I've sat on the podcast already. I'm fully took the leap to go self-employed, which has been really, really cool. So I am in a retail two days a week. And then I'm also in a gym in Clapham two days a week. And then I do the online stuff in between those days. like yesterday I only treated for two hours in train yard in Clapham, which is really, really nice because I probably earned the same amount of money that I would earn for a full day treating like 12 patients in a private clinic in London. So it felt pretty good. And also I give myself so much more time with my clients than I would have normally in the NHS or in private. And ⁓ allows me to just like really get to know them, get to know where they're at with things. Yeah, and follow a lot of the processes we're gonna talk about in a much more comprehensive way than I would just have previously when I only had half hour with clients, which was frustrating. So I've been really enjoying it, obviously. ⁓ It can be frustrating getting things off the ground with different like different platforms, getting to know different softwares and stuff like that. But yeah, if you have any specific questions on how I've set that all up, I'd be, I'd be keen to help people because it is a bit of a long process and you can be out in the, out in the dark, as they say. But yeah, how I've done it is I've given away free sessions to start off at the gym, which is pretty much just like free assessments. And then I will say, is where I think you're at. This is where I think you need to go to. If you want to do that with me, happy days. If you don't want to do that with me, then you can go and do that by yourself. So try and give as much value as possible on that first assessment, which has been working really well just to get my Neomir there, which is obviously loads and loads of big physio clinics in London. So you are competing with a lot of different ones. But yeah, enough of that. I've been enjoying my first week. I'm also going to take a drink of Sparkle and Moira throughout this. So I will take a little breaks as well. Because this is gonna be a bit of a monologue for a little while. So I hope you're having a good day wherever you are and let's get into it. So ultimately, like I said already, rehab can seem really daunting and quite confusing at the start, especially when you get into the sport specific rehab. I want to get someone back to a very high level of activity. If that's like a field sport or a court sport like netball or yeah. rugby, football, hockey, whatever it is, it's very demanding on the body. They are currently unable to do anything. They might be unable to walk without crutches at the minute. How do I bridge that gap? Okay. And that is rehab really bridging that gap from injury to performance. And it is difficult. It feels like you've got ⁓ of different things going around, loads of different things to consider. And there's also loads of excess noise now on social media. So it's really hard to know what to follow. took mentorships. ⁓ I consumed lots of different like free resources as well. And it ⁓ be frustrating you go from one world-class professional mentor and they're saying one thing, which is then different from what someone else has said. So this sort of led me to strip things back and follow what I believe is a much more simple framework. Now, before we start, need to caveat. I'm fully aware this framework has holes within it. I'm also fully aware that it doesn't cover everything, okay? But it's what I'm using at the minute. And I'm almost excited to go back in like, what is it, 20 episodes time or 30 episodes and go back and correct this framework and little bits to it, maybe take away a whole pillar of the framework as well. I'm excited for that because that will show some growth. But this is what I am working with at the minute. I said, there are holes in it, which I'm aware of. But think that's actually when you know you're doing something right, when you know there's holes in what you're doing and you can almost see your blind spots. Problems normally when you go in, help a leather think, ⁓ I've actually this completely done. I know this like the back of my hand, this bash, bash, that's normally when problems arise because you're too confident in your plan and rehab is so messy. And we kind of got to be comfortable within that mess as well. Okay. So rehab should be all three of these framework things at once. And I'm going to take you through them one by one, in about five minutes on each. Okay. So for me, rehab should be really specific. It should carry out a graded exposure approach and it should also be variable. So hopefully that's already caught your eyes. How can it be specific? and variable at the same time. I've kind of heard of graded exposure, but I'm not really sure how that fits into like a framework per se. Okay. So let's just start off with first pillar per se. ⁓ the first pillar for a reason. Okay. So rehab should be specific. Why I say that is because it really helps me from day one when I meet this person. ⁓ I will get to know them and say, what is it you do? What is it you would like to get back to and where are you now? And although that sounds quite simple, people often gloss over this, okay? And they think, okay, I don't really care where you are now, but I know what you need to get back to. But it's very important we're specific about where that athlete or that client, even if they're not an athlete, where they are now and what they want to get back to. Even if I'm not 100 % sure, what's going on with an athlete or a client. Like maybe they can't afford a scan or their scans come back clear and my tests are all coming back pretty normal. I'm not a hundred percent sure. I'm not 90 % sure. would say 90 % of the time I can help people with this three-step approach. Okay. Starting with specificity. Okay. So by making rehab specific, we make it more likely to achieve the end goal. I do this by making it very by being very clear what it is the athlete wants to go back to and then stripping that goal right back breaking it right down into specific tasks. So ⁓ gonna go through a of a short case study. A rugby player wants to go back to rugby. He plays in the second row, which is really important because that's completely different from a different position on the pitch. And he has an ankle injury. He's not quite sure what happened in the game. He thinks he maybe rolled it off a line out. And you aren't really sure what's going on because the ligament tests are coming back clear and he can't afford a scan because he's semi pro. He doesn't want to pay for anything. He it's kind of all right, but he definitely can't jump at the minute and he definitely can't go back to sports. So you're thinking, okay, a of a messy picture here. He doesn't, can't remember a specific mechanism of injury. He's not getting a scan. So quite a lot rests on the physio here. And this previously would have stressed me out a little bit, because I'd be thinking, ⁓ has he done this? Has he done this? Has he done this? clear on your diagnostic tests and you think you can confidently say, we're pretty clear for like a syndesmosis or an ATFL rupture. We're pretty clear for all that. Then it's just a matter of, okay, what does that thing need to get back to and where is he now? You get really, really specific about that. from your knowledge about the sport, and it's really important you have a knowledge of the sport. If you don't have a knowledge, get a knowledge. So if you are treating an ice hockey player and you don't know what the demands of ice hockey are, ask the player, ask them, is it you need to do? And can you describe to me what the movement is here? And then go away and watch ice hockey clips. Ask them if they have clips of themselves. And this is like the detailed approach you need to go into it with. Otherwise you will be guessing, okay? So for a second row, I knew rugby and I knew the following, but I would want to clear things up for them. So when you jump in the line up, what's that actually like? they often, they will have to brace a lot. They'll have to jump a lot. They'll have to land a lot as well. And I mean brace by going into contact and also tackling. So would probably just take them through this approach. Like, can you jump currently? No. Can you hop currently? No. And get them to do it. Can you do a single leg half race? Yes. Okay. So you can't hop, you can't jump. Can you do a single leg coverage? Yes. Okay. Can you do a single leg coverage quickly and repeat it loads of times in 30 seconds? Yes, you can, but maybe it's really ugly and they actually stop after 12 reps because they're, they're knackered and we have a bit of swelling. Okay. So this is where we are. I would start the person with some heavy leg single or heavy single leg coverages because that's where they are. Okay. And then we progress them into those like coverage pulses, which I described. So maybe a 30 second pulse. repeat it until that's pain-free, until that looks really good as well. And that's where you're like, people talk about your coach's eye, your physio's eye, that's where that becomes more more important when you can be confident that looks like a normal good picture for me. So we know where they need to get to. They need to get to jumping, bracing, tackling, and we also have a clear picture of where they are now. this is me like quite a lot of the messy daunting part of the rehab, just much more simple because now all we need to do is get them to where they need to go, which is jumping and bracing. And we just follow a measured approach to that, which leads on to the second point, which is gridded exposure. So I hope I've explained the specific part well. It's to quiet a lot of the noise that might be going on in your head. What about this? about this? What about this? Strip it right back. What's the task they need to complete? Where are they now? What can they do now? How do I bridge that gap? And this is where I would introduce the second pillar, which is graded exposure. All right. This is what takes our second row from a single leg calf race to jumping and bracing. And it's important to have an understanding of a graded exposure approach. So it's important to understand strength and condition, understand basic rehab principles. And this has also really helped me like going out on my own and starting a business. Because if I have it... If I have a comprehensive understanding of what creative exposure looks like, of how someone will progress through the stages, then I can clearly outline that to them. And I don't have to sell myself every session because I can say, this is going to probably take you this long. We're going to go through these different stages, provided there's no setbacks along the way. This is probably what return to play will realistically look like. And you're not saying. ⁓ yeah, maybe three months. I don't know. Yeah. And you can maybe come see me every other week or whatever. Like it's so much less clear and the athletes can be a lot more nervous around what's going on. You say, this is where you are now. This is my understanding is you need to get back to these specific activities. This is the process I want to take you through to get there. Okay. So for the second row, would be, We'll go in for some dynamic cab pulses. Then we will introduce some double leg Pogos with a band assisted. Then we will remove the band that assisted. And then we'll go into like a split stance Pogo. Then we'll go into a single leg Pogo. And that's sort of how I progress it. Then we'll go into more explosive on pitch specific stuff. And then we're getting much closer to our return to play at that point. And that's sort how I would outline it to the client in that situation. And you'll get a lot more buy in because they can picture, okay, I know where I am now and I know where this guy's going to take me. I know I probably can't do this by myself. I could give it a good go. And I would allow your person to open that up to them. If you want to give this a good go by yourself, it's no longer this crazy complex thing. These are the steps you probably need to take. You need to have a good eye and knowing when to pull back and knowing when to push up. So graded exposure is just that it's graded and it should be, but not all grades are created equal. So this is where it gets slightly more complex, but return to sprint in, for example, should take a lot longer than progressing from an isometric to an isotomic exercise. Okay. Because the demands are so much greater on the ankle, on the knee, on the lower body. of three sprints. I hope that's clear. a graded ⁓ approach is important, but it's important to remember not all grades are graded equal of that approach. ⁓ what you're exposed to is not equal at the same time. And you need to respect that. Okay. ⁓ is normally where re-injury happen when we treat timelines like, or we treat exposures. equally almost. So you'll say, ⁓ you've jumped from isometrics to isotomics this week. Let's go from isotomics to plyo. So we'll try on a single leg plyo out in the pitch and then yeah, reinjury. Okay. Boom, rolls his ankle again. the approach must be respected. You have to have a, you should have a knowledge of the of that exposure that you're, sorry, that sounds a bit convoluted. You should understand what you're asking the athlete to do. Okay. And you should understand the repercussions of what that might be for the body. Okay. So for example, if you go for, if you return to sprints, know that that's a lot more load on the body. So you're probably not going to do loads more around that. And you're not going to try and get them to sprint every day. Cause that'll be, that'll be re-injury. If it's isometrics, we could probably smash a few isometrics daily. Okay. So you need to know ⁓ dose and you need to know how, yeah. how quickly we progress through those exposures and those grids. the exposure is that it should be graded. It should not be rushed. It should be respected. Okay, graded exposure, I maybe made that sound a little bit more complicated than it should have been, but hope you understand. just want to get across that because graded exposure is not like a three step system where you go, okay, isometrics, isotomics, plyos, sprint and boom, you're back. Let's go. That's when reinjury happens. Graded exposure should be respected with each exposure. The grade of H exposure should be respected. in isolation, if that makes sense. I hope it does. I hope I've explained that well. The pillar then is variability. Chaos, intrigue, and managing variability. So that's sort of like the tagline I've given it. Chaos, intrigue, and managing variability. So this pillar is really wide for me. ⁓ and is a nice word. It's kind a buzzword, but I actually, ⁓ I think so important when it comes to rehab. So the athlete, client, whatever you call them, perhaps it's you, maybe you are the person being rehabbed, ⁓ need variability in your rehab, but why? Some may say this crosses over like the other two pillars, but I actually disagree. So some may say, well, you just said that it needs to be specific and needs to be quite like a graded approach. So how can then you just chuck in random variability throughout that? seems like it's counterintuitive. I think variability is really important to include in rehab because sport and activity is so variable in and of itself. If we want to break rehab down into specifics, we can't leave, we graduate these specifics off in isolation. So if I that you need to sprint and jump, I can't just let you sprint. and jump in isolation, we need to bring those in together with some chaos ⁓ into that. Ultimately, this is what successful athletes do well. They solve problems on the pitch when chaos is unfolding around them. So they have specific tools. if it's, need to jump higher than this other person, perform that while there's a ball in play, while there's another defender there. So they perform it when chaos is unfolding around them. So if we... ⁓ stick to very specific movements without ever adding any variables to it. When that athlete goes back to their sport and they're chucked with a load of different variables at them at once, they're going to freak out and they're going to re-injure more than often. you're increasing their chances of re-injury. So if we think of like clutch moments, why are they clutch in sports? So a big moment, for example. Um, it's not so much to do with the movement themselves, but it's actually what surrounds that movement. So when Johnny Wilkinson hits a world cup winning kick in 2003, yes, he has to perform the skill, but he also has to perform it with a hundred kilo plus blokes running at him, the world watching 80,000 plus people, um, watching in Persian and then all the chaos happening around him. His nervous system's probably going nuts. His adrenaline's through the roof. but he has to be calm and composed to perform a very complex skill in that moment. Okay. take Johnny Wilkinson out of that moment. He hits that kick 99 times out of a hundred, but in the moment when you add the chaos around it, that's what, that's what makes it exciting. That's what makes sports sport. Right. And athletes want to get back to those moments. And that's what, like I said, that's what makes sports sports. So the variability for preparing athletes for game scenarios is really important. You want to add, As much of those elements, obviously all your athletes are going to be Johnny Wilkinson going back to that moment, but you want to add chaos elements before you put them back on the rugby pitch, hockey pitch, netball court, whatever. Because performing that movement in isolation is not specific to what they're going back to, and it's not realistic either. Further to this then, to add to this, what does actually that look like? I would say adding variability is really important, but what does that look like? And this is a big question I had. So how does that actually look? I would say the earlier this happens, the better. So even in really early stage ACL rehab, I'm trying to add some variability. So whether that's they're throwing and catching a ball or they are having a conversation or they're in a busy gym, you don't want them doing everything at home in silence. ⁓ because it's not what they're going to be going back to. They're going to be going back to slightly chaotic environments. They're going to be going back to multitasking, dual tasking. So we try and add in that chaos early. And there's loads of different ways to do this. So I won't get too much into the specifics, but it's keeping the sessions variable within sessions. So it's not just a hundred million isometrics at the start. It's keeping the environment variable as well. So I'll have some work on the cardio machines as well as in the gym as well as try and get them on the pitch quite early even if it's just like running mechanics stuff. The earlier this happens the better. For all the reasons I've just mentioned but also athletes get really bored very quickly and this is just the case like no matter what type of athlete it is no matter how disciplined they are they will get bored quickly if you give them a boring straightforward exercise routine. So if I was only focused on, okay, I need to be really specific, and I need this approach to be very graded. So every day you have to do the same isometrics at the same time in the same place. And I want to measure everything here. Okay, they're going to get super bored. They're going to take the intensity of the isometric, they're going to miss reps, they're not going to tell you. And then ultimately, they go and try different stuff, because they're bored of your plan. They don't really trust the plan anymore. And yeah, they've just got bored. So they don't they don't feel it's challenged enough. athletes want to be challenged in their sport and in their rehab. this is like another sort of sub reason why I think it's really important to add variability. I've had it with athletes before ⁓ they know who they are if they're listening to this. I haven't pushed them quickly enough for them and they haven't understand why that grid approach is important. So a mix of both. So haven't outlined why it's important they don't push on enough yet. And they also haven't maybe ⁓ challenged enough within their rehab. So for example, week 11, or week 10, I think it was, he went back running on the treadmill when I hadn't said that was okay. Just because he was a bit bored, he felt like he could do a little bit more. I hadn't really explained it to him very well. So I learned from that, okay? I need to add variability. Even if he's not ready to go back running, I can add more playoffs, more difficult sessions, maybe more frequent sessions, maybe a pitch session where he's doing A marches, A skips. That would give him the feeling that he's ready to go back, okay? Obviously we can't control everything athletes do, but I think if we challenge them enough by throwing different variables at them, it will really help. ⁓ The other part, the other string inside of variability, and I was too in and fro on whether to actually put this in, but I think it is important, is being aware of the athlete's different variables throughout their week. So I feel like, this is why I love my online rehabs so much and also the hybrid rehab I do. And when I see people in person, I try to do this as well. Quite selfishly, I try to take control of their week. So I'm aware of every variability, if that makes sense. Wow, we've said that word quite a lot. So while it's really important to include variability, it's also important to manage that and be aware of that. Okay, because in one hand, if you're giving, you know, really, really crazy good rehab program three times a week, but then you don't actually know in their upper body, they're sprinkling in some like hand cleans as well. And they're not telling you that and you haven't asked that. Then it's important to know, right? Cause that's, that's increasing their load for that day and that week. And then we could be, think, okay, why are they getting re-injured or why does that exercise look so sluggish on that day? you need to be aware of variability throughout the week. So that's why I like to take control and know exactly what's happening with upper body and conditioning throughout the week. If you're aware of what's happening in those areas, then you won't be fully aware of how, if you're not aware of what's happening during the rest of the week, then you won't be fully tuned into what might be holding that athlete back or what might be pushing that athlete forward. So to me, this looks like programming their upper body sessions, programming their own feet and conditioning sessions. And that's why I feel it is really important to have an understanding of the sport, what they want to go back to as well. Let me circle back here. also having a good base knowledge of S &C and strength and conditioning and what is going to make the athlete better aside from the specific rehab they're doing. Okay. ⁓ to get better, they must be rounded. To be rounded, they should not only rehab, okay? Because... When they go back to their sport, they're cleared for injury. They're also going to need upper body strength. They're also going to need cardio. They're also going to need a really, really good aerobic base. And if you're not taking care of that, they will probably take care of that themselves if they're a serious athlete. And if they don't take care of that, that's even worse. But you just want to know what's going on on that side of things, because that might be holding their injury back. It might be pushing them actually forward, and it might not be a rehab at all. So yeah, I think that is sort of where I fall with everything to, and that's sort of my current thought process to bring it all together. would say specificity is function. So know the destination, strict it back to where they are not. That's really, really important. Graded exposure is adaptation. So build systematically from the floor to the ceiling where they need to get back to. And then thirdly, variability is building in resilience. So we're injecting chaos early and we're accounting for everything outside of the session, which might be contributing to their injury progression or lack of progression. I know there's quite like a lot of buzzwords in that. And I felt I could have maybe described that better, especially the graded exposure part. But if anyone has found this helpful, let me know. Like I say, there are loads of holes in this. I'm not 100 % aware of all of them, but I just know there are some balls in it because rehab is never straightforward. It's never really linear, but this is the process sort of using with a lot of my athletes at minute. And if an athlete, would encourage you, if your rehab isn't looking like this, so if you don't know where you're going, if you don't know how, what you're doing today relates to where you are going. And If it's really monotonous and really boring and not challenging enough, then one of those pillars, if not all three of those pillars are out of whack. Okay. And to me, that is a bit of a red flag. If you're going back to a complex sport, which is, which is extremely demanding and your chances of brain injury are much higher. I hope you find this episode helpful. I've really enjoyed over the last few weeks, just thinking through these things. I probably need to think through how I, um, talk about the graded exposure approach a little bit more and how I can really push that across. But yeah, if you've got any questions on any of this or any comments even, I would really appreciate you letting me know at lookpolic online on Instagram. And also if you could leave the podcast a little five star review, it helps push it out to other people. So yeah, I appreciate your support. I appreciate you listening and I hope you have a really, really good day. Thanks.