Latest / The Uplift- with Luke Pollock / #33 - Peter Wright - Confronting The Beast - Athletic Groin Pain
Transcript
- Luke Pollock: Pete, great to have you on there. firstly I'm gonna hit you with osteatus pubis. Something my listeners know I've been harping on about for a good a good season now and you're one of the only people in the online space that I've noticed actually has been brave enough to try and tackle it. What sort of got you into osteatus pubis rehab or athletic groin pain, whatever you want to call it? What sort of got you into it and Yeah, was it personal experience? Peter Wright: Bi well before I go into that I actually how's your own journey been going? 'Cause I remember you reached out to me asking if you would be able to play essentially and treat the issue at the same time. So h how's that gone for ya? Yeah. Luke Pollock: Yeah, I didn't get the answer I wanted. which was you pretty much said you're gonna struggle too, but like there are certain things you can tweak, I think you said. That was when it was at its worst last Christmas January time. By about March or April, towards the end of my season, I had managed to find a place where I could level out, which I pretty much just had to cut out my leg gym work. and do half a session on a Tuesday and then full session on a Thursday. And that was that point where it was settled and I can get through a Saturday, but be in considerable pain on a Sunday. But now over the summer I did a good bit of actual focused rehab on it and decided to go and see I saw Rory Murray, if you know him from Bath Rugby. So he's d he's done a lot with it. So I went down to see him and that was good. Very enlightening experience. And Yeah, finally feel like I've got my head above the water with it now, but it is a beast. Like I was trying to consume every podcast under the sun on it 'cause just I couldn't get the answers anywhere really. Peter Wright: Yeah, and yeah, I remember giving you the answer that you didn't want to hear essentially, but that is common with it is because it's a a chronic issue and look, there's levels to the amount of pain that you're in and typically the pain occurs post session, more so than during and post match, and the subs or the subsequent days. Oftentimes athletes because they want to play, they're like, Well, I can play and then They also don't want to broach the topic with the the manager, the coach and and ask them and basically say, Look, I I need to take some time here. And it's like, Yeah, but you're grand, you played last week. It's like, but but I'm not grand. I'm I and Luke Pollock: Yeah. Yeah. Peter Wright: I know I'm playing within myself. And it's like, yeah, but you're just doing a job for us. And then managers get upset when you're not absolutely thriving and breaking lines and and running Luke Pollock: Yeah. Peter Wright: sport lines and hitting rocks. because you're just not physically able to do so. because there's some inhibition that comes with the pain. and even if you're not experiencing pain out on the pitch, that inhibition is still present. And as you just touched on there, your training and preparation for the actual games isn't going to be optimal too. So like you're not going to be in the best physical state to actually even achieve those outputs anyway. N never mind the the pain inhibition. So like w we've since moved in our business from probably working with athletes who are going through it and trying to manage it. and working almost exclusively with athletes that are are willing to take the time out from playing to actually treat it. And that's just comes from being frank with them on in my initial dealings with them, which I was with you as well. It's like, Luke Pollock: Yeah. Peter Wright: look There are things you can do to make it better, but the likelihood that you're going to be able to get it to go away while playing definitely a pro or semi pro season over in England, which is game to game basically week on week, which is crazy as well, i is gonna be pretty low. Luke Pollock: Yeah, yeah, yeah, yeah. Peter Wright: and same thing in the soccer sphere, same thing in the Gaelic games sphere, if they're in a league season depending on the county or if they're in an intercounty season for sure. But you get some mad stuff from people that they're doing to just to get game to game. But anyway, to take it back to answering your question, the reason I got into this like I I got into this industry almost by accident, or this side of the industry, because I just was put into a role as a head strength and conditioning coach with a GA team, a senior GA team in Dublin that were understaffed essentially and players weren't getting the treatment that they needed and then they were just going for treatment for hamstring injuries in terms of manual therapy, being told to do a couple of RDLs and then get back on the pitch and they kept tearing their hamstrings, obviously. this was Luke Pollock: Yeah. Peter Wright: also just post COVID, so that was was a factor two and I hadn't been there since the start of the year. So I came in midway through the year. So I think load management and th the gradual ramp up was probably not where it needed to be. So I just had to solve a load of hamstring rehab and return to plays. myself it was just i I just had to do it. it's what Luke Pollock: Yeah. Chucked in the deep end. Peter Wright: yeah, it was basically what my job was predicated on. Like if we played next week or not, which we obviously I think we had nine injuries in one week. Not all occurring in one week, but nine players out and we had to have them ready in fourteen days for a championship fixture. And when you're working with a squad of twenty-three, twenty-four and fifteen play Like obviously those nine are going to be pretty important, at least some of them. So Luke Pollock: Yeah, yeah. Peter Wright: then I just had more people coming to me that to take their RTP because other people weren't doing it. Luke Pollock: Yeah. Peter Wright: and then gradually I have started having conversations with more athletes experienced in athletic groin pain and osteitis pubis I've shared my own story, which is I suffered from the issue when I was a young athlete, nineteen twenty, and I actually it like it was so debilitating and was so hard to treat and solve that I made the decision I was like, I'm I'm just not going to play anymore. And that was Luke Pollock: Yeah. Peter Wright: that was a decision that I didn't want to make and and led me going down a dark road. But then eventually through connecting with through trial and error of working with multiple different practitioners, finding the right one that was able to help me, I was able to get back on the field and and get back playing, which was what I love to do. and essentially I've shared that that story as to why I became a coach and and and why I work in this industry overall. And then from athletes potentially connecting with my own story of going through that specific issue, they started reaching out to me and saying, Can you help me with this? And initially I said, No, definitely not. you need to reach out to X, Y, and Z. And then, like y y you know yourself, athletes can be pretty tenacious. They can keep coming back. And I now we now work on our team with in conjunction with our own physios. So we have Fargel and Mitch. and now we have kind of a multidisciplinary team. So we have myself as head S and C coach, and then the two lads working as coaches but as physios as well, given their experience. And then we have Darvla taking care of nutrition and Kieran taking care of sports psych too. so I think we're we're definitely true The amount of experience we have working with athletes that are suffering from athletic groin pain and osteoitis pubis. We've become probably better than most at treating it, particularly in athletes that are suffering from it and playing field-based kind of team sports like we play in the UK and Ireland. and now it's 50% of our client base. And I think that Luke Pollock: Yeah. Peter Wright: that's probably down to some of the content we put up, some word of mouth, and also down to probably just as you said there, just a lack of that being available within the industry. So a lot of people come to work with us. it presents with some challenges in working online, but I think we probably know enough around identification of what the potential issues are as well as what can go wrong in the rehab and return to play that we've developed a pretty effective system and framework and we're we're copped on, I suppose, to a few of the things that maybe issues down the line. So we Luke Pollock: Yeah. Peter Wright: nip them in the bud early essentially, which is why we're we're pretty successful with it now, which is is great. But that doesn't mean it's easy as well. It's still really challenging Luke Pollock: Yeah. Peter Wright: to deal with. Luke Pollock: Yeah. I like so much to touch on from what you've just said, but even hearing and what what attracted me to your your message and to ultimately send you a message was the fact that you you posted one video bit like just talking about how rest is not gonna fix your athletic ground pain. And that's pretty much what what I had been relying on. So it was really bad up to about Christmas and then we had two weeks off and I was like, I'll be fine after that 'cause I was treating it like a like a flared up knee, post op knee, or I've just a a flared up tendon, like an Achilles tendinopathy. I was in my before I got the MRI I was I was kind of treating it the same and the physio at my club didn't have a load of experience with it. So he was just like, let's just take a rest. And it got so much worse when I came back, like so much worse to the point where it was unbearable after Christmas. And I saw that that message from that the video from you and I thought like that is exactly how I'm feeling. And I think that I don't know what your experience is, but just working with a coach who has not they don't have to have been through the injury themselves, but just what you're talking about, like your manager saying, sure, you're you're grand, you know, working with someone who who understands the whole picture is so so important. Do you have anything to touch on on on that? Peter Wright: I think it's useful for sure to be able to empathize with the the client and for the client to to understand that the person that's guiding them understands what they've they're going through because they've been there. expertise is definitely above all, but we have to be able to connect with the client and those practitioners that have the expertise but but aren't able to connect with the client or communicate with the client effectively or develop a relationship, they're not they're not successful. because they can't convey their message And distill all that they know and get it through to the athlete and actually get them to buy in. And equally, well, actually, the practitioner that can connect with the client and communicate effectively with them, but maybe lacks expertise, probably does better than the practitioner that has all the expert expertise and can't connect. And some Luke Pollock: I I agree, yeah. Yeah. Peter Wright: of that could be placebo and just probably getting things off your chest and then doing something. But the practitioners that can do both obviously are gonna be the most successful. and I think being able to say and connect through like shared experience of like I have been there and I know what it's like definitely helps people and also probably that piece of content like That blew up and I I still get people coming through to me messaging me about that. A lot of soccer players still seeing it on TikTok. I suppose that's just the way the the algorithm is on TikTok. and that's what they're told to do a lot of the time. And a lot of it comes from a lack lack of expertise from the practitioner they're working with because they treat it the same way as you kinda had just outlined with another town monopoly, right? We need to allow this to settle. Let's just allow it to go to go away and then we'll come back. But This chronic issue presents, we know, as a result of both an inability to tolerate the load, but that often comes from mo like maladaptive movement patterns and inefficiencies of movement. It's definitely not helped by them. if you take a rest to allow the issue to settle, sure you allow the inflammation to go away, but you're also potentially eliciting a detraining effect in those tissues that are being underloaded then as a result and you're just not looking at or addressing the issue of movement efficiency whatsoever. You're just brushing it to side. So when you come back, you're just gonna move in the exact same way, but you know now you're in a a less physically able state to tolerate the demands of your sport. So of course it's gonna get worse then. Luke Pollock: Yeah. Peter Wright: and when I say it that way it it probably makes more sense to people, but like still a lot of practitioners don't not maybe they I was gonna say they don't want to believe that how we move matters and movement efficiency is a thing, even though Luke Pollock: Yeah. Peter Wright: like it's clear that it is, from kinematics, kinetics, studies of biomechanics. So but they're probably try to dispel it because they don't want to go away and learn it and they're not in the know yet. Luke Pollock: Yeah. Peter Wright: but as long as they say that it doesn't matter, they're never going to be in the know. so we've got to not just solely focus on the movement efficiency. There's capacity is another huge as aspect of it and and we can look to train capacity and strength. And sometimes when we train the strength and the capacity of the musculature around the hip and and around other body parts, the issue can go away, but Luke Pollock: Mm. Peter Wright: the issue won't always go away when we do that because in a lot of cases we're not changing how you move. so it's not through solely focusing on the what we're doing or the how we're doing it. It's by merging both together and integrating them together, I suppose, that we achieve success. but again, coming back to your question, like you've got to be able to connect and explain that to the athlete and get them to understand it. And there are a number of other things you have to help them to understand with this issue too. And one of them that I didn't understand Back then, and I probably didn't understand early on as well when I was working with these clients, but I definitely understand now is a certain amount of pain, n I wouldn't even say pain, but discomfort is not only is it okay, it's expected. Because we're pushing the body to its limits in order to elicit adaptation. So if you're getting some discomfort or a little bit of pain probably if we're looking at a pain scale a one to a three the next day, that's okay. As long as the pain isn't increasing past where it is currently. And Luke Pollock: Yeah. Peter Wright: as long as that pain doesn't increase past a three, four out of ten, I would say that it's just your body is in a state of prob potential inflammation as a result of pushing it in your training sessions, which we absolutely have to do in order to elicit adaptation. But that pain that you're experiencing then, we don't want to be experiencing that when we're executing the exercises in the gym, because that's a sure sign that potentially what we're trying to work on is not working. and oftentimes with athletic groin pain or or osteoitis pubis, we're talking about about in this specific instance, which is a subheading of athletic groin pain, a lot of it's going to come through an overactive and overused groin and chronic groin. and if that groin is overactive, we're trying to often not stress and load the groin in the early to middle stages of the rehab and RTP. We're trying to load the tissues aro the other tissues and other structures around the hip in order to improve their tolerance to load and their capacity for loading. So the groin has to do less. And then as a result of the pain going away, sometimes when you do just that, just focus on lateral posterior hip potentially some anterior hip and and pelvic lumbopelvic control as well as some abdominal work and always focusing a little bit at the foot and the ankle too. the groin will get stronger as a result of the pain going away in the longer term because the pain Luke Pollock: Yeah. Peter Wright: is currently the signal that is being sent to your brain to actually dull your output and dull force c like generation, I suppose, at that specific site. and that certainly was the case with me. It's not the case with absolutely everybody, but I would say it's the case with most of the cases. There's a lot of kind of jumping through hoops with this issue because it's not a one Luke Pollock: Yeah, yeah. Yeah. That Peter Wright: size fits all, but yeah, I I'm sure you get the message. Luke Pollock: Yeah, and that that's why I started with saying it is a beast. And just to to clarify and feel free to jump in if I I'm doing a poor job of this. But from my understanding, we we use the term athletic groin pain because there's so many different different differentiating factors around the groin and pelvis. Rory really broke it down for me nicely, so he did a anything above the Yeah, like the the groin line or above the hip pretty much and i anything below the hip and broke it down into sub settings because I was just getting pain generalized everywhere. I'd been told it was all status previous for my MRI, but I was getting pain like deep, deep ab pain. I was getting pain both sides and yeah, it was really, really helpful for him to break it down and be like, this is more than just a classic osteous baby's it's what we would call in the term athletic ground pain. And he The way he d deals with it and I'd be interested to do see if you if you do the same is he almost deals with it as like problemless. So problem one, two and three. So for me it was my adductor length was was short, like it was just so short all the time. And how I was trying to fix that was, you know, trying to do some groin squeezes because I thought my adductors were weak. Which was a looking back was pretty stupid after after a month I should have realized that wasn't making a big difference. But it's what a lot of the advice does does say. so yeah, that was a real light bulb moment for me. It's not osteatus pubis in my situation wasn't just an ad an adductor weakness problem. I didn't just have to do growing squeezes and strengthen my adductors. It was actually there was a lot more going on than just that. Peter Wright: And and you almost need to persist with something for about a month anyway to see if it's gonna work anyway. but Luke Pollock: Yeah, yeah. Peter Wright: I was the same and it took me a lot longer to figure out that this wasn't gonna work. I'd say I was doing groin squeezes every second day for six, seven months, maybe eight, and get nowhere Luke Pollock: Yeah, yeah. Peter Wright: and being almost like I shouldn't use it because the the practitioners probably well, not probably, they thought that they were doing the best thing for me, but be I was gaslit into believing that it was no no just keep Luke Pollock: Yeah. Peter Wright: Keep doing it, it's gonna work. And it's like, well, it hasn't worked Luke Pollock: Yeah, yeah. Peter Wright: for six, seven months. And maybe as a nineteen year old I was more susceptible to being to Luke Pollock: Yeah. Peter Wright: believe in them, I guess. but yeah, so I t the Doha agreement came out of Qatar, I think, Aspitar, and it Luke Pollock: Yeah. Peter Wright: basically broke athletic groin pain pain down into four subsections, I think. So you've hip related groin pain. you have you have inguinal related groin pain, you have abdominal related groin pain and you have adductor related groin pain, I think. that's Luke Pollock: I think you're correct, yeah. Peter Wright: that's off the top of my head, but then within them you still have subsections. So like all always I I would actually always explain this to clients that come into me once they've had this their scan and we have a look at it like Osteitis pubis is just like general a s swelling or edema or chronic swelling or edema on the pubic bone. and that is happening as a result of one of the other four factors essentially. Luke Pollock: Yeah. Peter Wright: and we need to try to identify which of those factors, and sometimes it's multiple, need to be worked on in order to deload the area, I guess, and then improve your movement efficiency over time and gradually return you to some sports safely and in a better position than you were when you've broken down. so like you will have a number of key areas that you'll always look at and it's probably well it's not why, but I I now only do like 90 to two hour sessions, 90 minutes to two hour sessions. And with athletic groin pain or any chronic issue like this, it's it's very much about asking good questions in order to find the answer. And asking multiple questions in order to find the answer because patients are going to present or clients are going to present with potential potentially and yeah, almost always I would say multiple factors that are contributing to the gr groin pain. And some of those factors can be around the foot and the ankle, some of them can be r around the actual hip. and We need to have a look at each of those and see what is not contributing to it because it's moving efficiently or likely not contributing to it because you can never rule anything out. and what is potentially the lowest hanging fruit in terms of the one, two, three things that definitely are significantly underdeveloped that we can go after in order to improve your tolerance to load, improve your functional capacity. And then as result of that, steadily progress you in terms of the exercises as we steadily progress you back to sport. and some like there's there's a number of different common areas, but the most common probably is the lateral hip. And a lot of the time with these groin cases, I well, actually I'm yet to see an athletic groin pain or osteous pubus case. And this could be just my bias because of what I've experienced. that is not also an over rotator when they accelerate and somebody that's very ground based when they're accelerating. So they lean forward excessively, they strike the ground in front of them. And when they strike the ground in front of them, because of their long stride length or stride length bias, they're in a position where their pelvis is behind them. And then as a result of their pelvis being behind them, and as a result of striking the ground in front of them, they have a a lot of excessive backside mechanics in their in their acceleration pattern. And then if you have excessive backside mechanics, it's going to be paired with a dumping of the pelvis anteriorly in that movement. And if you have a dumping of the pelvis anteriorly, you're going to have a lot of length through the adductors and through the posterior chain, the muscles of the posterior chain too. And you're going to not be in the best position to attack the ground with a a prepared ankle, an ankle that's pre-tentioned enough to be reactive off the ground. So it's often paired with an absence or lack of reactivity too. And then that's just a cascade of movement that occurs then step by step step going forward. so a lot of cases, and I think Endeking would attest to this as well, that present with athletic groin pain, also present with issues around the foot and the ankle and also present with a lack of reactivity. And some of that is coming because of the foot and the ankle and how they move through the foot and the ankle, but it's also the integrated movement of how the foot and ankle is moving in conjunction with how the hip is moving. And the vast majority of cases will have a bit of a hip drop when they're loading into mid stance on that side and into toe off. And they won't be finding an effective hip lock position in their linear sprinting as well as their change of direction movements. and then as a result of all of those factors then Well, not as a result, but definitely contributed to by all of Luke Pollock: Yeah. Peter Wright: those factors heavily and the likelihood of suffering from chronic groin pain is gonna be far higher. So if we improve all of those factors, the likelihood is gonna be lower. So that's just what Luke Pollock: Yeah. Peter Wright: we we try to do, I guess. And and then as well as that there will be movement deficits in each individual too that will need to be improved and they can pertain to both range of motion and functional capacity too. So some athletes may have an absence of control in internal rotation. often with these clients they they can be quite externally rotated. and then as a result of that external rotation they have a lack of range through the lateral portion of their hip. so then their strength and their ability to generate force is going to be inhibited out there too. and sometimes that's paired with a lack of control in the internal rotation as I said too. But we always look at the pelvis and the hip in three planes of motion. So we've sagittal, we have frontal, and we have transverse. sagittal plane, sometimes they struggle to get into anterior tilt. Sometimes they struggle to get out of anterior tilt. It just depends on the client. frontal plane Luke Pollock: Yeah. Peter Wright: control then, hip hike, hip lock, that's usually something that they're not generally that proficient with. And that's why everybody goes for lateral hip now, but it's not always the solve. and then if we move back to sagittal plane for a moment, in terms of posterior hip, hip extension is something and full hip extension that is rarely seen with these cases too. and that pertains to their toe off position as well. are they extending the hip over the knee effectively in order to finish that stride, get up nice and tall and prepare for the next one? And as I've gone through with their typical pyramid. pattern in terms of their axel and max velocity mechanics, it's not likely that's happening. and then the last one's transverse play and internal external rotation of the hip. and sometimes they'll present with loads of like range in there passively, but actively a lot of the time there's not that much control. Luke Pollock: Yeah. Peter Wright: so we need to go after neuromuscular control in that area. and that's just go after the hip. Like I haven't even mentioned what could be going on at the foot and the ankle too. in terms Luke Pollock: Yeah. Peter Wright: of range of motion and and capacity too. So there's there's a lot going on basically. And it's Luke Pollock: Yeah. Peter Wright: our job to try and find it. Luke Pollock: Yeah, I was the the perfect example of what you just talked about. So very naturally anterior tilted athlete, like when I if I was to wake up and go for a walk or a jog first thing, I would always get lower back pain, you know, especially after I played. Which and I know is a bit of a yeah, you you might have some hippogroin issues in future. and then we moved on to a much harder surface, an an old four G that's thankfully since been resolved. been renewed and then I also had a left sided ankle injury the year before, which I would say I probably had a couple degrees range of movement to clean up on that and like my RSI was n was not the same as the other side, definitely. So that perfect concoction, like you said, it's probably not y you can't attest any one of those things to your osseus pubis, but sometimes the concoction of the the three of them or your athletic groin pain. Peter Wright: Yeah, and and just to touch on the ankle as well, like if you can't like I sim I always make it simple with clients in this way and and with our our our my coworkers as well and our staff like If you can't generate force through the foot and the ankle or transmit force through the foot and the ankle, you're going to have to generate it somewhere because you need to move forward by imparting Luke Pollock: Yeah. Peter Wright: f force into the floor. And if you can't generate it from below, you're going to generate it from above. And if you're generating it from above and you're doing so ineffectively, because the the groin assists with both flexion and extension of the hip, it's going to be quite active. It's going to be likely to be quite active. Luke Pollock: Yeah. Peter Wright: and Sometimes we can improve your ability to transmit force into the floor or generate force through the floor by improving range of motion at the foot and the ankle and control and just strength at the foot and the ankle too. That's something that a lot of athletes just neglect, especially team Luke Pollock: Yeah. Peter Wright: sport athletes. They never do calves because I don't know, I I never did them either. I just thought like, Asher, I'm I'm doing enough on feet anyway. I don't need Luke Pollock: Yeah, yeah. Peter Wright: to do any calf strength work and now reading literature around like how plant reflection strength is correlated with sprint performance. I'm like, what? And change direction performance too. What what was I doing? Luke Pollock: Yeah, and if we do it, we underload it massively. We Peter Wright: Yeah. Luke Pollock: d we do like ten ten kilo dumbbells, when when you're a strong athlete. Yeah, I've noticed that too. Peter Wright: Yeah. Yeah, definitely. Luke Pollock: Yeah, super interesting. And I think like from to round this off nicely from a personal point of view, the the big light bulb moment for me was okay, this isn't necessarily a an adductor issue. This isn't a a groin issue, although I'm feeling it there and the pain is there. I have to look elsewhere. And that's when I started getting real joy when I was sort of doing real deep core stuff, trying to get out of anterior till, even for small periods in the gym, whether it would be I was given this goblet squat and but I had to force myself into posterior tilt and it just r felt like my abs were ripping apart, you know, I was so weak in that area. when you find those areas of weakness and it's not causing me any growing pain, it felt it was less like a light bulb went off and I was just been smashing that and and also just like self self-release stuff pre pitch and post pitch. So just like sitting on a foam roller in an isolated position or on a kettlebell. I'm trying to just like let that I'm not lucky enough to get massage pre and post session. But if you can get that as well, just self release stuff, allow allow it to to calm down and that's made a big difference as well. Peter Wright: And I I'm really glad that you touched on both of those things. First off, the torso rib cage abdominals play a huge part in this too. and often we'll see a lot of excessive rib flare with these athletes that are in anterior tilt, obviously. and their control Luke Pollock: Yeah. Peter Wright: of their abdominals like is poor, especially in that scenario that you're talking about, or in that position that you're talking about, but not always, as as I said with the others. and then oftentimes their strengths of the oblique. as well as their ability to rotate towards one side is often impaired as well. something that that I had myself, something that I still probably struggle with, rotating towards one side. and it leads to reliance on one side of the body when accelerating. And that's never a good thing in anything for injury risk reliance on one side to do anything. Luke Pollock: Yeah, yeah. Peter Wright: not that we need everything to be perfect, but we want them to be not that far away from each other essentially. And and then manual therapy can be useful for sure, but I was treated a lot with manual therapy. in the early stages and I thought that this is gonna help it to go away progressively but it doesn't. It probably sets you up to get more out of your loading thereafter Luke Pollock: Yeah. Peter Wright: as well as alleviating symptoms in the short term, which is great. there's Luke Pollock: Yeah. Peter Wright: like I I wouldn't knock it. but it's not it's a short-term solution to a long-term problem essentially. Luke Pollock: Yeah. Yeah. It's just allowed me to get through like a rehab session following day without being like in pain. And last night we had a we had a forty minute hit out against each other and I wake up this morning and you're almost like expecting expecting to feel it, but I don't today. It's just a massive win and it can feel like you can attest to this. It can feel like a such a curse at the time and you probably were dealing with it a lot longer than me, but now like just listening to you talk it's shown that you wouldn't have gone to this level of detail to figure out if you hadn't had such a negative experience trying to rehab it yourself. Peter Wright: Yeah. Luke Pollock: and I had my first client in person came to me with growing pain and I was like Yeah, to be honest, I've been struggling with something like this myself. I've been struggling to get it better, but recently it's been getting a lot better and we've already had some really good wins with him and he's buzzing. So yeah, I think sometimes it although although it can feel like a massive curse, it can be the best thing there. Peter Wright: I think another thing to touch on with this too is a lot of the time and and this is with any chronic issue. athletes that present with this issue and with any chronic issue as I've said, they have had it so long that they almost become attached to the pain. but they're so worried about it that they go searching for it all the time. And any flare up that they have, they take as a huge setback. psychologically Luke Pollock: Yeah. Peter Wright: and they take it that things aren't working but you're not only in like you're not only progressing in your rehab because pain is going away and this is something I didn't understand at the time too. Rehab can imp can can progress and you can be getting better by your capacity and your tolerance to load and and your range of motion all of those things increasing and the pain staying the same Luke Pollock: Yeah. Peter Wright: If obviously those things are staying the same and the pain is getting better, then that might be some sort of progress too. The golden goose is all of those things improving as well as the pain getting better and reducing. But that doesn't happen all of the time and it doesn't happen Luke Pollock: Yeah, yeah. Mm-hmm. Peter Wright: with with absolutely every client e ever. And you will suffer flare-ups through the process too. but a flare-up doesn't mean that everything that you've done to this point is not worth anything. It just means the tissue has got a little bit angry because you've pushed it for too long, you've pushed too much load through it, your recovery was suboptimal, all of these things like potentially could have happened. But all we do is we just back off for a couple of days, allow it to settle, and then we just get back on the horse at with the same level of intent and the same level of tolerance that you've already built up through the number of weeks working up to that point. it's just about minimizing the frequency of those flare-ups in order to get you back to sport where potentially when you do get back to sport you'll have a flare up from time to time a as you've just said. like we had a guy that has been pretty much pain free for a couple of months back playing sport and then he went to a music festival last weekend. And then he had he woke up with pain on Monday. And like, Luke Pollock: Yeah. Peter Wright: that's fine. That's all right. Like, because obviously he was gonna be drinking at the music festival, probably not sleeping a fec like and probably completing a a high Luke Pollock: Yeah, yeah. Peter Wright: amount of steps and probably more dancing than he generally would. So like we we Luke Pollock: Yeah. Peter Wright: would expect that your body's not going to be optimally recovered to so to have a flare-up for a day and a flare-up meant pain of about a two out of ten that he hadn't had in the last while. That's grand. We'll expect it. Let's just dial back in our habits, dial back in our recovery strategies and our training and that should be fine. It should go away progressively and we'll just get back on the horse. so Luke Pollock: Yeah. Peter Wright: I think that that's useful to to go through too. And I've also seen the athletes that present with this and that it lingers around with most are those athletes that are more negatively biased and more kind of focused on trying to find the pain. Luke Pollock: Yeah. Peter Wright: you have to have belief that you're gonna get better. if you're gonna get better. And that's not to gaslight them into saying that they're they're gonna get better by just telling them they are. It's by having Luke Pollock: Yeah. Peter Wright: objective markers to show them that their capacity is improving. and that's why that's useful. It's more difficult in an online setting when you're not getting the ability to test them on multiple different metrics, but we can still test some, and oftentimes the ones that we're testing in the online space as opposed to once we get one when we're in the early stage, but in the late stage we can assess what they've got through on the pitch and we can compare that on a weekly basis and a session by session basis to what they've got through previously. And if there's been a huge spike in load of greater than fifteen, twenty percent, then obviously we would expect that there potentially could be some sort of a flare up. and that's that's Luke Pollock: Yeah. Yeah. Peter Wright: normal. So we just allow it to settle and and bring our load back down and then progressively ramp it back up again. Luke Pollock: Yeah, the psychology around it is so important. I've noticed that myself. Like there's a there's a lot to be said for going and speaking to someone to feel the activation energy of I've done something different here. Like I was just it was just myself and my club physio trying to deal with it, but wasn't until the summer where I went and spoke to someone externally. And it it's almost like the activation energy. You've like, I can kinda see a way out of this 'cause he's described in. Like I probably left that session actually in in way more pain 'cause he got me in horrible positions for an hour and a half. But I d I didn't bot Peter Wright: But he probably he probably told you that that was gonna that was gonna happen. Luke Pollock: Yeah, yeah. He was like, don't worry about the pain today or tomorrow. Like you're gonna be in pain. and he actually said, You're gonna probably be in pain a good bit throughout the season. which was in some ways nice for me to hear 'cause I was like, others he he he wasn't worried about it, you know. and we had the for surgery, not for surgery chat that I know Andy King's big on as well. which was very reassuring too, but The the sportsite piece and I suppose we we can touch on a bit of the the neuro aspect to injuries and and so on, but was that more and more when you started having these conversations, did that probe you to bring someone onto your team to sp who's like sort of specializes on those, or am I jumping the gun? Peter Wright: No, definitely. Definitely not. Definitely this. I I've worked with athletes one on one for a number of years now and previously I used to do like weekly calls with them, bi weekly calls. I still do a monthly call with them and they have a weekly or bi weekly call available with Mitch or Fergal if they're working with one of those as physio because I think if they're rehab and return to play that's more their scope than mine. I'm overseeing everything and and can set goals with them and whatnot and and definitely can hear their their struggles, their frustrations and and definitely help them with them. but I think if it's something more around pain and and specifics of the injury and whatnot, the lads are bet better served doing that. As well as the fact I'm working on the business as opposed to in the business and I'm overseeing all the clients as opposed to being in the weeds of each one. Luke Pollock: Yeah. Peter Wright: a lot of those conversations that I was having were around the psychological aspects of it and trying to get them to adhere to the work and trying to get them to believe that they're going to get better and trying to deal with frustration, struggles as a result of the injury and their worries and all these kind of things, setting goals with them and all this general coaching stuff, but a lot of it was from a psychological perspective. Luke Pollock: Yeah. Peter Wright: so It was a no brainer for me when I was thinking about making our team more comprehensive. to bring on board a sports psych or performance psychologist to help in that regard because they're they're better able to to deal with that stuff than I am. Luke Pollock: Yeah, yeah. Peter Wright: Prior to that, I was thinking about going back and doing a a sports psychology masters, which would have been a huge commitment. And but and maybe I will do that in the future, I don't know. But I think it's much more effective for each of us to stay in our area of expertise but have knowledge of what's going on in the other areas of expertise as a result of the other experts or or practitioners that are dealing with that. And we and that's why we have Darville taking care of the nutrition too, because sure I can give nutritional advice, but I'm not qualified to be diagnosing eating disorders and and dealing with the emotions that are paired with nutrition, which is a huge aspect of it too. Luke Pollock: Yeah, huge undertaking. Yeah. Peter Wright: So I I I've just tried to develop develop a team that would deliver a high quality and elite level service to the athletes in multiple different areas as they would get if they were an elite high performance sporting setup. because that's what Luke Pollock: Yeah. Peter Wright: we're trying to to serve those athletes with. We're trying to give them what they're not getting because they're not playing for they're not playing for Ireland, they're not playing for England like they're they're playing for the club. Maybe they're playing for the county in some instances Luke Pollock: Yeah. Peter Wright: But even at at that level, they're probably not getting the care in all of those areas that they will get when they're with us. so that that was a motivating factor for sure in that I understand how tough it can be mentally. and I going through my own journey ACL wise, I have like seen in other practitioners they will have like a section on Sports I and they'll have some helpful videos and kind of webinars and stuff to go through, which can be useful for sure. But same thing with them as it would be with an S and C webinar or whatever. Nothing is going to beat connecting and working with a coach one to one. Luke Pollock: Yeah, yeah. Peter Wright: and even if that's only quarterly, I think that's huge for athletes. And I think almost every athlete should be doing that. because we focus so much on the physical ac aspect of the game. The tactical aspects of the game and training, sometimes a lot of technical stuff in terms of execution of skills too, but we very rarely think about developing the psychological side to the game. and it it can't be understated how important it is. Like Luke Pollock: Yeah. Peter Wright: a bad player can get away sometimes with just having an elite mindset and just keep coming Luke Pollock: Yeah. Peter Wright: back. They could they could be a real asset to the team. and Luke Pollock: Yeah. Peter Wright: a a a top player with an elite mindset is obviously elite. But a a a very well skilled player that is tactically adept but just has a mindset that isn't capable of tolerating or or performing at that competitive level, they're they're never going to be able to reach their potential. and the same thing for rehab, I think. Like you can do everything with certain level of intent, but you can definitely do it better if you have an elite level mindset and approach to it. Luke Pollock: Yeah. Do you think we've just just when you're talking there about creating the team that maybe some of your athletes are missing essentially from their club and and their sport is something I've talked a little bit about on social media, but it's kind of why I I started treating rugby players specifically because I realized hold on that the the champ and that one and all that in league level is higher standard than it's ever been before. But the resources to accompany that are just not not the same. And it's the same in the GAA. Like you got players running faster, they're more skillful, they're probably their training loads are higher. And the the lag effect almost of like the medical, the the the support the support network that you've essentially provided or described there is just not not there. Do you feel like that is part of our business now is to to to try and serve some of those athletes? Peter Wright: yeah, absolutely. Because like let's be real, it's a financial issue. that the teams Luke Pollock: Y yeah. Peter Wright: can't invest in long term care in those specific areas, as well as it's probably an issue of supply too. Luke Pollock: Yeah, I think I think it's a f personally what I've seen is an understanding issue as well and a priority issue. Like we there there's still the lack of understanding that employing a more skilled physio or rehab S and C coach will actually allow your players to be available more readily. Whereas it's often seen as the quickest way to skimp out is like, yeah, we'll just get a new grad in or And there's no bashing on that because I've I've I've been the new grad in those Peter Wright: Yeah. Luke Pollock: in those environments. But it does frustrate me when we get the fancy new this, that and the other. But the the last thing to be upgraded is the medical department. And obviously I always caveat, I'm not talking about my club in particular, but just athletes I've worked across the company with and and seen. Peter Wright: Yeah, but it it happens everywhere. And it is an understanding level issue at the top because the players Luke Pollock: Yeah. Peter Wright: understand that and sometimes the coaching staff understand it too. But oftentimes, especially in the GA and sometimes in those championship clubs too, the resources that are invested in, like so they'll invest in a high tech new gym, but they'll have one fella just out of college leading everything. and y Luke Pollock: Yeah. Yeah, no, it's class. Peter Wright: like what what's the point like in having the resources if you can't use them? Luke Pollock: Yeah. Yeah. Peter Wright: It's the same thing as inve a lot of a lot of practitioners are now investing in testing equipment but they don't know how to actually use the data. Luke Pollock: Yeah, yeah, yeah. Peter Wright: So it's it's just there as a nice kind of to look at and kinda look what we can do over here. But they're not actually doing anything with the information. Luke Pollock: Yeah. Peter Wright: and it's it's contrary it's contrary to that or in contrast to that in the instances you're talking about, in that they they don't have the information. They have the resources to run a high performance setup, but like everybody has the resources really to run a hyp an elite high performance setup. Like when I was down with the New Zealand Sevens, they were just training in like a university gym at Bay of Plenty Rugby. And like they had four racks, I think. They had a number of WAP bikes and they they had their testing equipment, which was great, and they had a set of force plates. But like nothing was Nothing was like, my god, wow. Do you know what I mean? It was just like Luke Pollock: Yeah, yeah, yeah, yeah. Peter Wright: a a a normal gym. But like still they're really successful on the seventh circuit and they're winning Olympic medals and whatnot. And they're Luke Pollock: Yeah. Peter Wright: and some of those athletes that were in the sevens team when I went down there have now represented the fifteens, like the All Blacks. Like Luke Pollock: Yeah, that's so cool. Peter Wright: what's his name on the wing? Corey his name escapes me now, but the Luke Pollock: Or the new lad. Peter Wright: yeah, the winger, he like and he's killing it, like and Luke Pollock: Yeah, he missed the tackle on the weekend there, didn't he? Yeah, yeah, yeah. Yeah. Peter Wright: Yeah, he did. He did but it was after setting up a try, so let's focus on that. he just switched off I suppose after doing something fantastic, but yeah, but like that Luke Pollock: I know, it's often the way. We won't bash him. Peter Wright: that just shows you like so you're developing athletes, but it's not the resources that are ultimately making the difference, it's the coaching and the athlete themselves. and their coaching level was like just that was what wowed me. The culture Luke Pollock: Really. Peter Wright: and the coaching. That was what blew me away. it wasn't like the facilities or anything like that. yeah, I was blown away by by all the other stuff, all the the soft skills things. and I think like I I remember having a conversation with one of my mates and and their senior hurling here in in Tipperary, which is is a high enough level. And a few years ago, not that long ago, probably just before COVID, twenty nineteen, twenty twenty, they had a meeting with the board and he was the player rep and they had said, Look, lads, this is the end of it now. We actually need to invest in some high quality strength and conditioning this year. We're not skimping on it again. We have the we Luke Pollock: Yeah. Peter Wright: have the money there. All the other teams are physically more capable of us, they're they're rolling us over. It's like and every year we we just get somebody in who who's all right and a good fella but just doesn't have the expertise there. Luke Pollock: Yeah. Peter Wright: so we need to invest in it. And one of the older lads on the on the board said, Well look, I think we can't be investing in any of that stuff until your hurling is at a sufficient level. It's like, but you're Luke Pollock: Yeah, yeah, class. Peter Wright: not get you're not getting that like Our hurling can only develop in line with our physical strengths. So like we're the gap is widening because we feel the physical is so far away from our opponents. So we need to raise the floor by doing that and then our hurling will unfold from that. And if you have a really high quality strength conditioning coach or athletic development coach, they will help everything. They will help the structure of your training sessions. They will help the intensity, the planning of your training sessions. They will work in conjunction with the the coaching staff. to lead just a a a better run service or a better run organization. and that that's missed, I think, by a lot, but I don't know if it'll be missed forever. I hope not, but there is probably a lot of people in the industry at the moment that finish college and think that, okay, that's it, I'm ready to go. And then there's an abundance of coaches looking for what seems like a lot of roles, but the vast majority of the roles are poorly paid. you're working with multiple athletes, and as a result of that, you're just putting out fires left, right, and center. and then there's a small amount of roles with those top teams that are really sought after, but they're only got by a a a small amount of coaches. And those coaches typically stay in those roles for years on end. Luke Pollock: Yeah, yeah. Peter Wright: so a lot of the time, like I I have some mates that are really intelligent really would have made really good coaches and they've chosen to just leave the field altogether and go into other industries because Luke Pollock: Yeah. Peter Wright: the level of compensation just isn't there for the the workload. Luke Pollock: Yeah, which i so frustrating because the athletes are there, you know. everything everything else is there. And I think we can look at someone like the like the all black sevens and think, they've got you know, a lot of coaches could say, but the players are so much more bought in. But players like especially in Ireland will buy in. They will. Like we have I work with a retail performance over here. I don't know if you're familiar with those guys, Peter Wright: Yeah, yeah. Luke Pollock: but they do the London GAA stuff and they're like compared to rugby, because they've worked a lot on rugby and other sports, they're like, they're mental. They'll just do anything we say and they want to do more as well. And the the managers as well are enforcing it so heavily. So like as far as coaches, they're a dream to work with. For the most part, obviously. yeah. And I think we can It it's i it makes it even more frustrating when you have the players who are keen to do it and you just need to pay pay a coach appropriately and not a hundred quid a week to turn up. Peter Wright: Yeah, yeah. And and I think That is the other thing as well. So we're offering a service that some athletes won't be able to get because they're not playing at an intercounty level. Their club doesn't invest in that side of of things of development whatsoever. So working in the private space, you get to work with those athletes in those setups that don't receive that care, but are really motivated to do so. And that that's potentially why I work more in the GA because I I previously wanted to work in rugby, but I just found Gaelic Games athletes were just absolutely mad for training and mad to Luke Pollock: Yeah. Peter Wright: be directed. And I I've thought about it as well and like obviously it it's l in terms of a sport and and the demands, it's elite. Like they have to they have to tolerate like huge demands on pitch Luke Pollock: Yeah. Peter Wright: in terms of training and match play and whatnot. It probably was below where rugby was a number of years in term ago in terms of care and delivery. potentially it's probably up there in and around the same on average now. maybe not in terms of buy into actual strength training and and training age and whatnot, but it's close for sure. But the fact I think that the athletes have to play with where they're from is definitely important in that too, because they're doing it. Sure, they get benefits in their community, they get status and whatnot from performing well, but they're like they're playing at the level they can play at. Like and they're playing for the team they can play at and there's no possibility of a transfer Luke Pollock: Yeah. Peter Wright: or going elsewhere or whatever. they're either doing it because they absolutely love it and they want to win, or they're not doing it basically. whereas in Luke Pollock: Yeah, yeah, yeah. Peter Wright: rugby there can be more extrinsic kind of motivating factors Luke Pollock: Yeah, of course. Peter Wright: and whatnot of I'm just playing with these this year, but hopefully I'll get a contract elsewhere next year or whatever, Luke Pollock: Yeah. Peter Wright: or I'm negotiating X, Y, and Z. whereas in Gaelic Games it's like you're you're with us, buddy. That's it. Like you can be as good as you wanna be. Luke Pollock: Yeah, yeah, yeah. You were you were born here. Peter Wright: Yeah, you were born here, so this is where you're staying for the most part. so I think a lot of time because of that lack of care they've experienced before as well as the more intrinsic motivating factors and that's not to say all rugby players like are are extrinsically motivated or whatever. but there's just more of those factors in in the sport. I think that's why when you say to a Gaelic Games athlete like jump they're like, Okay, how l how high do you want me to jump? When do you want me to jump? whereas if yeah said to a rugby player jump they'd they'd be like why? Why do you want me to jump? Luke Pollock: Yeah. Yeah, sh sure I I jumped yesterday. Why am I jumping today? That's what I'd say. Yeah, Peter Wright: Yeah. Yeah, yeah. Yeah. Luke Pollock: and more more often rugby now you're getting, especially over in England, is a little bit different in Ireland because it's not professional, although a lot of the teams pay at like under the table. But You're getting people drop down leagues 'cause there's more money. Like a team will have just got a big investment. So now this player can just chill out pretty much in a new team 'cause it's like three levels lower than he's used to. And then it sort of breeds an element of complacency within the team and you just don't get that angular because you're you're at the top and like everyone wants to be there and that's a level, you know. Peter Wright: And you're culled. You're culled rootlessly if if you don't typically if you don't contribute to the group, like, okay, you can play with the the junior team or yeah, you're you're not part of team. Luke Pollock: Yeah, yeah, which is which is so good and it should be like that because it can faster and yeah. Peter Wright: You can't do that in rugby when there's contracts on the table though. You can't say, Here, sorry. it's like, well, pay me my money. Luke Pollock: No. No. Yeah, exactly. Exactly. but no, mate, it's been it's been great talking to you. And then we haven't even got into like ACL, game speed stuff, the stuff that I thought we were gonna talk more about. but another time I'll have to get you back on for part two. Part Peter Wright: Yeah, for sure, for sure. Luke Pollock: two, ACL. ACL overview and how you do things because it seems to be pretty elite. Just finally, what is like a recent breakthrough you've had or a recent light bulb moment? It can be business, rehab, or anything you find you've you've found recently that's been like, wow, that's really made a difference, or something perhaps you've come back to and thought, why'd they stop doing that? Peter Wright: Hm, that that's a really tough question. Big breakthrough in terms of from a a business perspective. So I've transitioned, as I said, into more of a managerial role in the last twelve months, and that that's new to me. and I think initially I was so focused on being a good manager, or not not being a good manager, but being a nice manager, that I wasn't stringent enough on what I demanded. and I let things that I wasn't happy with slide from time to time. and I I wasn't comfortable repeating myself multiple times after I'd already repeated myself a couple of times. Luke Pollock: Yeah. Peter Wright: and when you're a manager, sure it it is important to be nice. But if you want to be a good manager, you can't you can't negotiate on your standards that you're demanding. And motivating the the your your coworkers to reach those standards comes in multiple different ways and there are multiple different strategies to to do so. but they do need to understand why those standards are in place and what they are as a number one. But if those standards are in place and it's still not being met, then something needs to change in terms of that client's or not that client, that that coach's or coworkers' motivation to execute those tasks to that level, or potentially they're not a best fit for for working with your company. and and because of that you just need to be straight. And it's something that I I I've come around to in rehab as well. and working with athletes in rehab RTP. The importance of honesty in it. Like can't Luke Pollock: Yeah. Peter Wright: like it's so important. And there's no beating around the bush. Like, sure, how you deliver the message is important for sure, in order for them to digest it and you can d convey it in a nice way. But it ne as soon as you know the answer, you need to let them know what the answer is. And sometimes They're not gonna take that fantastically well. But that's okay because it's the truth. Luke Pollock: Yeah. Yeah. Peter Wright: and it it's a short-term pain for them getting buy-in back into the process down the line. Like, Luke Pollock: Yeah. Peter Wright: just as an example, we d we have well, we like given it's championship season, we have loads of athletes returning to play. So I think w like last month I think we had 11, 12 return to match play. Luke Pollock: Yeah, well. Peter Wright: in August, which was huge. and then multiple return to running, return to training and whatnot. And we have a couple of ACL clients at the moment. And one was eyeing a return to match play recently. despite the fact that kind of we had said, look, let's just stick to process, tick the boxes, get these done and then we can eye your return to match play once these boxes are all ticked. Luke Pollock: Yeah. Peter Wright: And then when that that athlete went for their testing, they passed absolutely everything e except for their quad deficit strength was outside Luke Pollock: Yeah. Yeah. Peter Wright: of twenty percent. and for that reason, I had to be straight, it was like like Luke Pollock: Yeah. Peter Wright: it would be negligent of me to let you go back and play now because your risk of injury is quite high. We can work on this aggressively in the next couple of weeks and then back off for a week in taper and then you'll be ready for to progress back to match play 'cause he'd already completed all his return to training, everything, but he was still complaining Luke Pollock: Yeah. Peter Wright: of a little bit of a an issue of a spasming of the quad and we were like, what is this? And then the testing made sense. So I Luke Pollock: Yeah, yeah. Peter Wright: I I was just honest and he didn't take that fantastically well, but after he sat in it he realised, Okay, Pete's not doing this just to be a prick. He's doing it Luke Pollock: Yeah, yeah. Peter Wright: because he cares about my return to play and how Luke Pollock: Yeah. Peter Wright: successful it's gonna be. And then Luke Pollock: Yeah. Peter Wright: in another example with another female athlete that was testing, her deficit between her counter movement jumps was really close, like it was like five percent, four percent. And I'd look at it and she was hitting less than ten centimeters on both jumps. And I was like, Well, it the the deficit here doesn't really matter. Sure it's good that Luke Pollock: Yeah. Peter Wright: they're fairly equal, but they're both not good enough to to graduate you to return to team training that both need to improve. And sure, Luke Pollock: Yeah. Peter Wright: that sounds harsh initially, but the data doesn't lie. Luke Pollock: Yeah. Peter Wright: and I I I'm not gonna lie to you either because I've your best interests at heart and your safety at heart too. so Luke Pollock: Yeah, of course, yeah. Yeah. Peter Wright: that that that's probably something that's been a bit of a light bulb moment. not just in management, but in rehab return to play and in everything in general, I guess. Luke Pollock: Yeah, having the hard conversations earlier and more straight up. Peter Wright: Yeah. Luke Pollock: Yeah, it's something that like we need to always come back to. And I think you can you can sort of drift away from it as well time to time, especially with in rehab 'cause it can be so fickle and you can have lots of people like my hamstring feels a bit weird and you can like, you listen, it'll be all right, you know. But ultimately you're just pushing the pushing the the problem down the list. But Thanks so much for coming on Pete. I really appreciate it. And we'll hop hope to have you on again soon. Peter Wright: Yeah, no worries, Luke. Anytime. Thanks for having me on. Really appreciate reaching out. Always good to to chat shop. Luke Pollock: Chairs, Matt,