E8: Smarter, Stronger Recovery: Criteria-Based Return for Basketball Athletes

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<v Kurt>Hello and welcome to the Physio Insights Podcast. I am Kurt Schütte co founder of Runeasi. At Runeasi. we are building running gait software designed to help rear professionals better understand their patients and athletes so that they can make smarter, data informed decisions in their care. Along the way, we sit down with thought leaders from around the world to explore expert perspectives and evidence based insights. Our goal: to give you the tools, insights, and reasoning you need to elevate your clinical practice and empower your athletes.

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This is the Physio Insights podcast. Today we’re joined by Joachim Boon, a leading Belgium sports physiotherapist who blends evidence based sports rehab with elite performance science. He helps athletes from runners to basketball players recover smarter, move better, and gain that performance edge. Joachim, thank you so much for joining us today on the pod. Thanks for carving out some time from the practice.

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Really appreciate it. What led you to becoming a sports physio? What’s driving your purpose?

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<v Joachim>Well, I think my own experience with injuries. So during my teenage years, I played soccer, or football for Europe, guys. And I had a lot of hamstring issues every season, couple of them. So I had some physio sessions myself. And they triggered me to be one of physio by myself.

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Also for the exercise parts, the lot of exercises, so it was immediately triggered by the human body and how it recovers quite quickly. But again, for the the other injuries coming again and again and again, yeah, it keeps bothering me, and I want to know more. And that was one of the, one for me personally, one of the big triggers. So yeah, personal experience, with with with some nasty injuries.

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<v Kurt>Yeah, it seems to be quite a common thread amongst sports physios is, personal experience and having to literally go through the same pain. When you say recurring injuries, what do you mean by that? Specific type of injuries or?

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<v Joachim>Yeah, mostly hamstring injuries. I think from my 16 years old, something like that, 16, 17, I had at least two or three hamstring or golf injuries in one season. And it was left to right, right to left. So it shifted all the time. And back then, yeah, you just do your thing to also all the time, speed your weight.

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So you did some exercises, but mostly you had some rest. So you just listened to the doctors, listened to your physio, you listened to your own body and they think, I’m not in pain anymore. So you go back to training, it all starts well. Then after some weeks, you had some some soreness, you think, oh, that’s okay. Just keep pushing.

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And then you do one sprint, then it’s it popped again and again and again and again. So it’s it’s one of the reasons I stopped playing, I think. It was not only that, also my studies came into place, it’s really like the efforts going to rehab and back again and back again. So it’s, yeah, it was one of the, one of the things hamstrings. Hamstrings are my, my biggest parts, not anymore, but it was.

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And that’s why maybe hamstrings are one of my favorite muscles to rehab as well because of the personal experience, mostly that. So no ACL or operations for me, it’s mostly the hamstring strain injuries.

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<v Kurt>Yep. Yep. And then I’m assuming more from sprinting type of

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<v Joachim>behavior. Was a really quick or it’s really, really quick. I was playing on the the flank. So really going for the long and deep, deep pulses. I’m not that big, so quick and agile.

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Played against some some older players for my six, seventeen, 18 zone. I played with the first team. So big guys for me. So it was always sprinting and then have to avoid a tackle or something like that. All in all, all the time.

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So yeah, I was just sprinting indeed.

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<v Kurt>So help me understand a bit and help the listeners understand how do you got from that curiosity and that personal experience to jumping into radiotherapy and studying movement science?

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<v Joachim>Well, during the studies I just went to with the flow. It was until my internships that I had a real hands on experience what it meant to to work with athletes and for them soccer players and during my when I started working here with basketball players, it really triggered me. One of the interns, internships I had was working with with some some some professional athletes. I went on a training week abroad with some track and field athletes and there I saw how they do prehab, how they do proper rehab, how load management is setting into place. So it really tricked me that the intensity had to be high enough to get not only to the point before, where you’re right before your injury, but getting even better.

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And that’s maintaining strength and conditioning in season, even in the absence of injuries, quite important. And it doesn’t matter if you are a recreational athlete or professional athlete, that’s an advantage for boats. It’s maybe the time you have for the time you want to invest in it. That’s another thing. But it’s important to get into shape and to get your particular muscles depending on your injury history to get there really to focus on.

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So it’s really the internships that triggered me and from then on trying to build my own level of expertise, my own level of interests and it keeps evolving. The longer I work, more experience I get, but also the more questions I ask myself. So it’s an ongoing process.

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<v Kurt>Can recognize that. Think even going back to the first time I met you in clinical practice as well, seeing, I could immediately see that you were drawn to that curiosity and being triggered by digging into the research, digging into the evidence base, looking for what options they are, and that mindset, the mindset that seemed to me is just continue asking more questions to help get the answers of course, but keep digging and evolving. And from that perspective, what would you say is like, you know, if you go back to when you’re

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<v Joachim>doing your

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<v Kurt>internship to today, if you could kind of compare, you know, the Joachim back then to now, what would you say like your, how would you say your views have evolved over time or been shaped? And maybe what are your, what are the keyest, biggest influences on that evolution?

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<v Joachim>Less is more. Let’s summarize that. So in the beginning when you were asked to come up with a workouts and with some exercises for that particular patient with that problem, you always want to impress maybe. So try to find like some really nice triggering exercises. But it’s really important that if you want to work on local load bearing capacity, the capacity of critical muscles, you have to know your biomechanics.

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You have to know how the leverage arms are working, especially with hamstrings. If I may take that example, because they are articular in nature. So you have to know, okay, which of the hamstrings is biased for more hip dominance versus knee dominant exercises. And they need, they don’t need to be complex. So if you want to train the medial hamstrings, leg curl is a really fantastic exercise.

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If you want to go more biceps femoris or lateral hamstrings, then try to find some hip dominant like RDLs or stuff like that. So it doesn’t need to be fancy or whatever that really need to feel the muscles working and then embracing the complexity. So you have less is more so you work on a local capacity, but it’s always in complex interaction with other muscles. So try to incorporate that, but also know your limits, knowing that what you do in the gym, what you do in during rehab, it has to be, it has to have a transfer to training. But if you want to work really sport specific, then see how you can get your athletes or patients back on the field, back on the beach as soon as possible, safely as soon as possible, so that they can run, they get high intensity efforts in which you monitor the volume.

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So for me personally, that is the biggest change. So based on biomechanics, knowing biomechanics really well know, okay, what do I need to do to get them to the beach as soon as possible? And that’s where they work specifically on their sport specific capacity. So for me, working on the local capacity is of primary importance in the acute phase. And then you get like the gray zone in which you have to introduce sport specific capacity as well.

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And when you work in the professional setting, you have maybe a strength and conditioning coach or you’re communicating with the head coach or the trainers who are working with track and field athletes. And then you just have to benchmark that you can do with the volume. Ask the coach themselves, okay, what do you think? Because you have a lot more experience regarding a load management in their particular fields. And you listen to them and you say, Okay, I’ve done this and that, they can do this and that.

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And then you communicate. And if we have if you have a recreational athlete in which you don’t have all the settings or you have like a coach who is maybe not that experienced, okay, then you have to take it in your hands and know, okay, I don’t let you train before you sprint. Once again, when you have hamstring or calf muscles, you know, from literature that you can do any exercises that even come close to the level of activity when you go for high intensity sprinting. So if you don’t let them sprint, you’re missing a really important piece of the puzzle. If you’re not sure they can sprint, don’t let them train and see that you have your clear benchmarks.

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So that’s maybe another point. Less is more. Embrace complexity over time and have your benchmarks in place or test, retest and don’t be shy. Don’t be too hard to yourself if they don’t meet the benchmarks. You just need more time.

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It doesn’t mean that you’re doing something wrong per se, but try to map it out. Try to be sure about yourself and let that patient or the athlete feel that you’re confident in what you’re doing. And sometimes it just needs some more time. Some athletes recover quickly, some others don’t. But it’s really to do like a criteria based rehab so that you actually depend on the criteria, meeting your criteria, really the time.

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So taking the time from the injury is for me like something to keep track on. But if they meet the criteria, that’s for me more important than the time, the timeline. Timeline, you need to know your biological healing process, etcetera. But if they hit the criteria, you can take next steps. That’s basically how I work.

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And that’s the biggest difference from the beginning because you’re all stressing out, my exercise needs to be fancy. My exercise needs to be, to be the out never seen before. You know, basically if you have one, if you have no material, can do proper rehab. For me personally, that’s not true case, it’s a black and white story, but if you have no stretch bands, no fancy equipment, yeah, you can still do a lot of stuff that can help your athletes. So it doesn’t need to be fancy or it needs to be smaller, but not complex per se, or complicated.

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So let’s say that.

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<v Kurt>Yeah, that resonates with me a lot. I remember when I was, doing my internship, in fact, and it was linked to the university back in Stellenbosch in South Africa. And downstairs was the clinical practice where we did the internship and upstairs was where we were doing the master’s research. And we also had a journal club where once a week we would, someone would present the latest paper or two papers where, yeah, it was exercise prescription for certain rehabilitation or return to sports. And I can remember how, you know, kind of like how excited we were, know, starry eyed we were when a new exercise was was kind of discovered or in some way validated.

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And you know, immediately we just wanted to plug it into the the next athlete that came through the door. Super inspired to do it, trying to force it in there. It sounds all fancy, but very quickly I was realizing, there’s definitely a lot more context and there’s a process about when and how to interject these new exercises that come through the literature. So I’m actually curious, do you have a specific process or framework that you use to know like personally or based on other frameworks that you use to know when and how to implement a new exercise that comes about in the literature?

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<v Joachim>Yeah, think there are more, it’s a combination of different frameworks and personal experience. But for me, like a really nice template is from Matt Taberini, think, control to from control to chaos continuum. So it maps out like a general framework in which you start with like really controllable exercises, more focusing maybe on the local capacity of certain areas of the injuries. It can be like for ACL or hamstring, particular muscle group or joints. And then based on the criteria, you know, from literature like strength, need to have that for maximum strength, that much for capacity, motor control has to be this or that, then you can take the next step, go to the next phase and introducing more complexity, more chaotic environment.

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And I’m not per se meaning that you have, for example, you do an RDL and chaos, meaning that now we’re doing RDL on the foam pads. That’s not chaos for me. Chaos for me is introducing higher intensity stuff, single leg stuff, for example, or doing more reactive stuff. That’s more interesting chaotic environment for me. And then you can work with some cues with cognitive task, dual tasking.

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That’s really the chaos. And then once again, once they have met some criteria from a strength based perspective, from a capacity based perspective, from a motor control based perspective, then they can go back to the pitch and a form of chaos is then taking place on the pitch and not anymore in the gym. But you continue doing like the local capacity stuff because it’s not linear. For me, nothing is linear. It’s like overlapping all the time and embracing that overlap, embracing that complexity is something you have to be, you have to let it go and you have to embrace it because it’s complex.

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It’s not complicated per se, but it can be very overwhelming because it’s finding like the sweet spot and it’s maybe that’s like the final line or the great zone between what’s the science says and what is the art. So you have to, it’s like the feeling you have, okay, I have my benchmark, so I’m really, really clear about that. Then you have the stuff here, looking at your patients to see, okay, what’s, how are you feeling? So basically when you don’t, when you’re feeling that there’s not, you’re not there yet, just ask, ask your patients, ask how do you feel? Are you, do you, do you feel ready going back on the pitch to introduce like, for example, ACL?

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You have all the, all the, all the strength capacity and then you say, okay, let’s start jumping or start running. And that’s, that’s something like I didn’t do a one for like five months, maybe if you if you recall, pre injury months as well, of preoperative periods as well. So it can be very overwhelming. And the criteria, the objective criteria helps to give them confidence. But there’s in literature that states also that the mental preparedness to go back on the pitch is really one of the biggest criteria that is a risk factor for reinjury.

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So if you’re not taking that into account, and it can be a simple question, how do you feel? Do you feel ready to jump again? Do you feel ready to run again? And I take the example of an ACL, but it’s the same for any muscle injury versus injury as well. So they have to be confident.

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And if they’re not confident, then you just continue to try to adapt some exercises to get smaller steps. And that’s where it gets really, really interesting. How can I do that? And there’s no clear answer in that. It’s just, okay, let’s see if we find some intermediate steps to give you more confidence in it.

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We were talking about frameworks a little bit of side, but for me, the control to care is continuous. It’s a big framework to map it out. And then you start care where do you want to end. And then you do like reverse engineering. So you need to know once again, biomechanics, how what’s the loads they have to endure when they go to full practice, full competition again.

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And then you map it out what do I need to do I need to have to endure that loads. And then it will be strength, capacity, motor control once again, but also conditioning. So I start really early by reintroducing conditioning stuff. If they can run, then it will be stuff on the bike, stuff on the air bike, maybe the maybe stuff on if you have like a ski or kind of stuff, you can do it as well, some upper body conditioning to get them sweat again as early as possible. So that’s one of the things for me was really, really important to introduce because I saw that it was like it gets some relief.

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So at the beginning, you’re only busy with like the mechanics, the strength, etcetera, etcetera. But it’s really repetitive in nature. And sometimes they just need to raise their heartbeat a little bit. So I have a patient right now who is, like a really good cyclist, professional, but really, he was really close to that. And he was just, we introduced some kind of conditioning and he was like, okay, finally I get some like the point I was really feeling the pain, the good pain, going really deep it felt so nice because it was really a long time ago.

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That’s basically if you can reintroduce it quite early, they are still rehabbing, but also have the feeling they’re training again. So besides going step by step to get them where they have to be, introducing conditioning stuff, upper body, lower body, impact, non impact as soon as possible, gave them the feeling they’re working on their body once again, and then not too restricted by their injury or their post hoc restrictions per se. So that’s, that’s another thing, try to reintroduce conditioning as soon as possible. And that will lead to the control to chaos. The conditioning, conditioning stuff, read a lot of papers of Busheit, I think.

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Martin Blanchard, yeah. Yeah. So it’s like for me, the golden standards regarding conditioning and reconditioning. For me, that’s, that are the guidelines that I follow more or less. And then based on the, based on this particular injury, there’s also flow for groin injuries from End of King, which I quite like.

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It follows more or less the same line of thinking from metameni in the Control to Chaos theory, but then applied to groin injuries. And then regarding hamstring injuries, it’s for me Mandy Gucha. There’s also a nice multifactorial framework. But once again, for me, comes back to you work on local capacity, you have the global capacity you have taking into account, but see that you have like a nice compromise between the two, so not over focusing focusing to the local capacity, but you lose something, but not going too fast to just for specific or general capacity, because that’s also a pitfall as well. And I think going too early, fancy with your exercises and just overlooking the basic stuff, building capacity and strengths can be, is for me one of the biggest pitfalls.

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That’s why framework is a nice guideline, nice hold on for yourself to not losing it. So yeah, in a nutshell.

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<v Kurt>No, awesome. Yeah, I can relate to that as well. And if you think about from the controls of the chaos continuum or from the, you know, the local specific training all the way through to the global dynamic. I’m sure at some stages or phases of that continuum, you probably not just from a training perspective, you want to have assessment criteria as well. I’m curious to know what assessment criteria do you have at certain phase?

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And how do you introduce objective? You mentioned subjective criteria a bit with literally asking them how do they feel. What other criteria do you use?

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<v Joachim>Well, I think to get, we trust strengths, so maximal strengths. We have four capacity, so how long can they repeat some exercise. We have motor control in which you can do more like a qualitative analysis. For example, single x squats, can use as an example. We have conditioning stuff as well.

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That’s more for taking a baseline basically of what can I do and then to build on? But for example, strength testing to take an ACL as an example, or hamstring, maybe we test the golf muscles. So one of the first post op testings that we do for an ACL is more or less around three months, four months post op. And there we do general strength testing if you have an isokinetic machine or you can have access to it. Then we go from there.

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And that’s to be the baseline. But if you have a handheld dynamometer, you can do strength assessments quite easily as well. And one of the things is okay to really get into the strength training. Or for the jumping of the running, have to like 70% limb symmetry index for at least that’s for the calf muscles, for example, we’re aiming at 1.5 or two point zero times body weights for maximal isometric strength. For the glutes, there is a good benchmark is, I think it was 30%, 35% of body weights in the sideline position and then holding it.

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Then it’s more like a brake test you do, in which you do basics. So you do a raise above horizontal and then you go around the ankle and you push down and 30%, 35% body weight is quite good benchmark to hit. Work capacity for the hamstrings, for example, single leg glute bridge is one we use. And then we use a metronome, which have to do on a box from 60 centimeters in the flexion of 100 and thirty-one 135 degrees, so really quite extended. Single leg glute bridges fifteen-twenty times at least with a metronome going to 60 beats per minute.

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So really up, down, up, down, up, down. Then you look, just look what happens. Same principle we use for the single leg heal rates to test capacity there. And the benchmark for there is like, it depends on the age, but let’s say between 20, 25 or 30, it’s I think it’s of age, 30 reps is something to hit for. I think that’s really an important one, especially when you track and field or when you’re team sports athletes, running based athletes.

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The call has to have the strength. So that’s the isometric stuff. And then you have to work capacity as well. You have to pair both, basically. And then further on, when they do the strength training, from some point on, you’re going to test jumping capacity as well.

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And then for me, RSI is a really, really important one. It’s more like an overall metric for me in which you get a lot of, a lot of information. And RSI depending on if you test it with a repeated jump test or it’s drop jump, there is a difference. But for me, a good score and a good average scores, everything between, let’s say two point zero, 2.5 for like a more general perspective, it can be a little bit higher when you’re dealing with track and field athletes. They tend to be have higher RSI scores.

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If compared to team sport athletes, they’re a little bit lower. But that’s for me a good benchmark in which we have like a nice index of reactivity, so they can start running, for example. But looking at your side by themselves is not enough for me. So I look down, I would say jump height, would say ground contact time. And if we see that ground contact time is really high, let’s say above two fifty milliseconds, okay, then they’re good concentrically, but not reactively.

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So it’s a good first to look metric, but then you have to dig deeper and then you have to decide, are they ready to run? Maybe on a lower base, but are they ready to sprint? Not at all. So they need to work on their reactive capacity and trying to hold their concentric capacity with their concentric work, but try to do it in a shorter timeframe. So that’s from an RSI and jumping perspective.

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<v Kurt>Could I ask you just for the listeners or the physios that have not worked with the RSI, which is the reactive strength index, to what is this metric and how you measure it?

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<v Joachim>Yeah. So the RSI is a ratio between, depending which ratio you use, but it’s basically jump heights compares to ground contact time. So in general terms, it looks how high you can jump, see how many time you have to take for that. So you want to have like a really nice compromise in which you jump as high as possible with the least amount of time possible. And for me, the time variable is really important because that’s for me the most important part that gives you like an indication how reactive they are.

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So the jump height gives you an idea of how strong they are. So it’s like their ceiling basically. But how much of that ceiling can they use within like timeframes that are really resembling their sport specific timeframes. So you can have really, you can be really, really strong, like a good maximal isometric strength, one on one strength, good squat jump capacity. But if you are slower, if you have to take more time compared to an athlete, we would jump a little bit less high, but do it in a proper, quicker timeframe.

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Then within a sport specific context, the better athlete will be the one who can produce force quicker. So basically RSI gives you like an overall score with that, but you have to dig deeper. So you have your RSI. It gives you like a first glimpse. Okay.

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You have some frames two point zero, 2.5 for the average team player, a team sport athlete, more 2.5, three point zero and higher going to up to four point zero maybe for the track and field at least. It gives you like, is there smoking gun maybe? If it’s out of that range, then you know, okay, we need to work both on the concentric stuff and the reactive stuff. If it’s good, then you have to dig deeper, look at jump heights, quite nice, but their ground contact times is way too long. Or it can be other way around as well.

00:27:19.705 –> 00:27:49.085
So it depends. It gives you like to which way I have to divert my rehab. Do I need to have to do concentric work, some more power work, working on like squat jumps or really the ballistic work or needed to be more like reactive stuff that can be be pogo jumps, can be drop jumps. Either way, they have to have to work more in attendance, stiffness maybe. So isometric work for me is really a nice way to work on that as well.

00:27:49.085 –> 00:28:07.330
So it’s really for me the first to look at metric when you, when we do jump testing, and then you can dig deeper. So we start with that, and then you dig deeper to look at jump byte or fly times. Depends on which ratio you use. And ground contact times is then to see if it’s more reactive, more ballistic stuff you have to do. Yeah.

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<v Kurt>Cool. And when you mentioned smoking gun, what do you mean by that?

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<v Joachim>Well, you have to have an idea for it’s like the benchmarks for the population you’re dealing with. So if you have teams for athletes, you have to know, okay, on average, what’s the RSI score we are dealing with. If they’re way underneath that, you know, okay, we have to do work both in jump heights and ground contact time. So it’s really, really, really below that, then just usually do work. But if it’s within the proper ranges, then you can dig deeper and see, okay, do they they do it with enough concentric capacity or general strength?

00:28:46.455 –> 00:29:04.050
And do they think are they reactive enough? So it’s more like, can we even further enhance it? And where do we need to focus on? So you can do concentric work again, again, again, again. But especially for like the high level athletes, normally they’re doing that stuff for a couple of years.

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Introducing reactive stuff oftenly can have like the next stimulus to get them, push them even further. And the same is for heavy isometric work That works really well, especially with not only older athletes, but the older athletes. It really, yeah, they’re reacting really good on isometric stuff because we’re working on the tendons, the tendons stiffness. So yeah, it’s for me, it’s like give you an overall picture of smoking gun is are they out of range? Are they better than average?

00:29:36.280 –> 00:29:56.820
And then you can dig deeper. But it gives you like a rough guideline to look at other metrics because sometimes it can be overwhelming, especially when you have the selective force plates. You get a lot of data and it’s okay, let’s first look at RSI and then you can look, you can dig deeper when you’re using one easy. There’s less data. There.

00:29:56.820 –> 00:30:14.345
It’s more, it’s more comprehensive. But even then I look for a set RSI and then I look at the rest to get like for me, like a decision tree in my to, and also to get it explained to the athletes and to our patients. So, yeah, that’s how our work.

00:30:14.345 –> 00:30:51.825
<v Kurt>Yeah, interesting. It sounds like you found a kind of a good algorithm or a good testing algorithm there in a sense to say, what’s the, what we would call maybe a hero metric that you look at first. And it seems that you’ve defined those your RSI. And based on that criteria, if I hear correctly, you then say, okay, well, if we wanna dig deeper based on what we see in RSI, the time components, the flight time and the ground contact time, which component there, or jump height should I say, is is where we need to to go deeper in. And then if you see certain below criteria for that benchmark population, you might look further into a secondary or a third metric.

00:30:52.340 –> 00:30:53.300
<v Joachim>Yeah, correct.

00:30:53.300 –> 00:31:04.820
<v Kurt>What would you maybe look at if you need to look deeper into a specific case? Say a basketball player with a low RSI index relative to the benchmarks. And what other things might you be looking at going deeper?

00:31:05.485 –> 00:31:37.305
<v Joachim>Well, if they have a lower RSI for me, besides the isometric, if you do like isometric stuff of isometric testing, it’s not only their peak value that’s important for me. More importantly, it’s the RFD. So, having an idea of the rate of force development, especially in the first one hundred milliseconds is quite important. Once again, when you’re on the pitch, on the court, you don’t have that much time. So you have constrained time frame in which you have to produce as much force as possible.

00:31:37.305 –> 00:32:09.765
So once again, it can be really strong, but if they take too much time, yeah, then you’re, you’re second on the ball, second on the rebounds, and it can have some, some really implications when it’s a close game, for example. And so that’s really the next step. You look at RSI, you have an ID, jump height, a ground contact time, let’s say the ground contact time is way too long. Biometric stuff, reactive stuff can be in place. As I said before, isometric work as well.

00:32:09.765 –> 00:32:23.530
And then we look if we have done some testing, for example, the CT scan. But also there is one of those. I don’t think there are once again, that’s that’s that feeling you have. Okay. That can be a little better.

00:32:23.530 –> 00:32:49.770
Even if you have to compare it with other teammates or you have like a rough idea of the look of the shape of the curve. You force weights, the curve has to be like this and not like that. Also queuing and feedback is, yeah, it has to be sharp, tall, sharp and tall, depending on the queuing you give. So if you want the RFD in place, then you really have to queue that you want to see the sharp and tall. So it all depends how you queue.

00:32:49.770 –> 00:33:16.020
If you don’t queue it correctly, then yeah, you may not expect that the athlete knows what to do. So if your queuing is in place, then you have to see the curve being sharp and tall. And then you can take the numbers so to see, okay, that’s your peak RFD at one hundred milliseconds right there. We see if we can push it. And then you you’re going like for isometric stuff, like pushing isometric in which you try to push something.

00:33:16.020 –> 00:33:39.815
I think it’s calling, is it yielding over? I think it’s overcoming isometrics. It’s they’re switched in between, but the pushing, you push against something that’s not movable, like a seeding call phrase or like standing call phrase. You can do it as well with a squat, depending on which kind of movement you’re looking at. And then if possible, try to have like feedback in place.

00:33:39.815 –> 00:34:20.050
So if you have ForcePlates, and we are lucky to have them quite recently, we’re gonna use them repeatedly for feedback loops to see, okay, we have to boom, boom, boom, boom, boom, and really see that you always have the sharp and tall curve going on. If you don’t have that, because it’s like in Swiss ball two, you have first place. If you don’t have first place, then queuing is everything and you really have to stand besides them, sign your feet and then go, go, go, go, go and losing. So like five seconds, go, go, go, go and then losing it. For example, you really have to push them and they really have to push, push, push, push all the way through because you can push at the beginning and then go a little bit sloppy.

00:34:20.050 –> 00:34:37.245
But they really have to try to push all the way through and it has to be heavy. It’s really taxating on your neural system. It has to be fatiguing after five reps, five seconds, they really are fatigued, but it’s neuromuscular fatigue. It’s not physical. It’s not metabolically.

00:34:37.245 –> 00:35:02.495
It’s like the nerves are wearing down, then you rest, but they’re really quite it’s acute fatigue, they when they rest, it recovers very quickly. But it’s very taxating on neuromuscular stuff, but it has to be intention 100%. So that’s really important. You have to be quiet with your RPE. It has to be peaking like seven, eight out of 10.

00:35:02.495 –> 00:35:22.170
And if you have the force plates in place, you can have the feedback. But the RPE is one of my go to go to feedback loops as well. Try to push yourself that you’re the last five seconds, you’re done with it. You have to be relieved after five seconds. And then once again and again and again.

00:35:22.250 –> 00:35:59.975
And then we combine it. You can combine it with some more dynamic stuff to do some plyos depending on the player’s position. If they’re more like over there, one area more like in an extended position, if you are more like a big guy in basketball, they’re more starting from a flex position, you can have the same movement pattern in place. You do like, for example, drop jump or jump or like some deep tiers, pliers stuff, but more dynamically, to get the muscle stiffness going on. And then with the ISO work, you’re working more with tendon stiffness with the pliers, more in muscle stiffness.

00:36:00.215 –> 00:36:23.325
And the combination of two let them enhance your elasticity. And hopefully with that reducing ground contact times within proper limits. That’s how we work. So we contrasting a lot of the stuff. So that’s how I like to work doing all those things, some max strength, some ISO work, pliers.

00:36:23.325 –> 00:36:36.500
I try to combine it in a contrast training way of work, depending on stage or depending on the athletes. But that’s how I like to work basically. So RFD, that’s a really important one for me.

00:36:36.500 –> 00:36:53.105
<v Kurt>And when it comes to, from jump, we’ve talked about jumping, you progress to say the other phases of rehab, and you also mentioned biomechanics, What do you use? Or how do you, what metrics do you use when you go towards running? Whether it’s inside the clinic and or outside the clinic?

00:36:53.185 –> 00:37:41.475
<v Joachim>So the criteria for go for running, it’s the max archer strength for the calls. So it has to be in place 1.5, two point zero body weight isometrically from an RSI, from a limb symmetry index. Once again, for ACL, for example, within at least 70% or 80%, they have to be jumping, they have to be ready. So we have to do repeated jump testing in there and RSI for at least two point zero to have one benchmark, but they have to be able for work capacity to get like a 10 or five tests single leg. They have to endure it without any pain.

00:37:41.475 –> 00:38:15.655
So really the pain is really one of the most important things. And with no pain, there’s nothing between, nothing higher than two out of 10. From a biomechanics standpoint of view, single leg caliphates 15 times with a proper alignment of the knee is an important one. Single leg glute bridge as well for the posterior chamber capacity is an important one so they can hold the rhythm. And then when we do the running, we start running, we do also an assessment in TurnEasy to see how the impact is going.

00:38:15.655 –> 00:38:44.295
And that’s mainly the thing I decide if you can bring up the volume, if not. So we’re looking at peak impact, the impact magnitudes, impact absorption. I see if that’s in place. If their dynamic stability is in order because once again, when you do stuff like single leg, like squats, it gives you like a smoking gun. But then you have to see if they’re pelvic dropping or they have not enough strength in their glutes, 35% body weight.

00:38:44.775 –> 00:38:56.610
And you have to see it within in the running mechanics as well. So I think there’s a nice paper of Brahma, I think, who looked at a lot of runners and

00:38:56.610 –> 00:38:58.370
<v Kurt>I think it’s just Brahma.

00:38:58.370 –> 00:39:24.340
<v Joachim>Sorry, it was Brahma. And I think they stated that every 1% increase in pelvic drop increases significantly the odds of being classified as injured. And it was for ITB, patellofemoral pain, Achilles tendon as well, I think, and some MTSS stuff. So for me, on a whole, pelvic drop is one we don’t want to see. It’s intuitive to think about that, that’s making sense.

00:39:24.820 –> 00:39:51.615
But either way, it’s backed by science and you can have a trunk tray that has to be quite controllable as well. And you have the dynamic stability metric from from Arnesi, who gives you like a nice framework for that. If you can just look at look at the coloring scores, and if it’s all within the greenish area, or even a little bit yellow. For me, that’s okay. We have to work, but you can start running.

00:39:52.150 –> 00:40:20.215
If your impact absorption, if your impact loading is in order. So if your impact is shitty, then you have, that’s my experience, then your strength screening and capacity screening will be not good as well. But sometimes you have like the not matching stuff and then we need to think further. But that’s basically what we first do. We do like the strength testing, capacity testing, motor control testing, like single leg golfers or stuff like that.

00:40:20.620 –> 00:41:12.080
We have jumping capacity, RSI scores is really important to track. And then we do the running mechanic stuff, which is easy and we film it to have like to see what happens. We’re not measuring angles per se, consistently, but we’re looking for like a bird eye view and then we’re looking at the data from really easy to get like a deeper picture. If impact absorption is okay and impact magnitude is controllable and dynamic stability is not too off limits, then they can start running. But if impact absorption is not in order, then they’re not clear to run because there’s too much of a risk to develop secondary injuries like patellofemoral or but most importantly, the patellofemoral pain, anterior knee pain is one of the things that’s, that’s, it’s one of the biggest risks to get, especially after ACL.

00:41:12.080 –> 00:41:36.705
It’s my experience. So yeah, that’s how we work in a nutshell. And maybe as a side note, the calves and the ankle, that’s really important. Also ankle mobility we tested as we need to wall test to get a left or right difference and also injury history to see, okay, do you have a lot of ankle distortion in the past? That’s really nothing I go light on.

00:41:36.705 –> 00:41:49.750
So it’s really important for me and sometimes really often dismissed if you ask for like, kind of injury did you have. Yeah, right. Nothing major. And you really have to ask, and what about your ankles? Are my ankles here three to four times a season?

00:41:49.750 –> 00:42:14.040
But it’s nothing, nothing, nothing to worry about. It is. But you really have to ask particularly for the ankle. And that’s because the ankle for me is like, if I have to choose one particular joint that it’s overall important, warning base, change direction and going to my head, I would say the ankle. It’s not black and white, but the ankle has to be, has to be strong.

00:42:14.040 –> 00:42:31.055
Sloppy ankles doesn’t sound that, that good for a change of direction and especially not sprinting and, and going for a run for like two hours or something like that. So yeah, sloppy ankles is a no go in for every injury for me. Yep. That’s important.

00:42:31.055 –> 00:42:56.025
<v Kurt>It sounds like you have a good, you’re striking a good balance between clinical reasoning and data and using technology. And I think if you look at how things are evolving with the availability of new technologies and thinking towards the future, what do you think are the biggest factors or criterium about working technology into your workflows and into your clinical reasoning process?

00:42:56.025 –> 00:43:45.160
<v Joachim>Yeah, I think the next, for the next step is getting more like things like force plates or an easy really integrated into daily practice. You have like a clear understanding of the current reaction forces going on, how many forces are produced, get an idea of the reactive stuff like RSI or RFD to really get that into place because a lot of research is really stating that the R and D stuff being reactive, being quick in strengths, in building up strength and force is really important, but it’s not easy to assess. If there’s developing tools that it’s getting more integrated into daily practice, that should be of importance. And then combining that with kinematic analysis. And there’s some something going on on Markless Motion analysis.

00:43:45.480 –> 00:44:18.815
And I think that’s integrating that with data, more kinetic data from Bernice or Force Base or whatever you will be the next big thing. You get like a comprehensive picture of what are they doing and how are they doing it. Because looking at one thing only, it doesn’t give you like the whole picture. So looking only at kinematics, maybe there are pelvic dropping, it could be, but you have to know how is their strength. So is their strength enough?

00:44:18.815 –> 00:44:32.170
Is their RC enough? Okay, then they can have a pelvic drop, but it’s okay, but it’s controllable. The same for like orthopronation and some stuff like that. Is it okay? Well, it depends if they can control it.

00:44:32.170 –> 00:45:00.630
So you have your kinematic data, then you’re going to have to look at your kinetics and your strength assessment. So it’s really trying to integrate it all. But let’s say the first step is to get really nice intuitive tools that get you the kinetics. And then you can combine it with kinematics either via Markov’s Motion Analysis or just filming it and do like basic drawings with Kinovea or stuff like that to get like a broad picture of it. But I like data.

00:45:00.630 –> 00:45:29.410
I like precise data and I only use stuff that’s validated or reliable, backed by science if possible. If it’s not, then I just use my phone to, to look and try to comprehend it and don’t always use common sense. And does it even matter? The second question I ask myself, does it, does it matter? So, and to get a real nice answer to that, I need to have data that is validated and reliable.

00:45:29.410 –> 00:46:03.030
So yeah, so the combination of kinetics, kinematics in an easy to use tool will be the next step. And yeah, just get a good knowledge base of what’s Quartient Reaction Forces, what’s RFD, what’s RSI, so really have a clear understanding of what that is. That’s maybe the most important thing. Just physio assess to be strength and conditioning knowledge, even if you’re working with athletes. If you’re working with patients from all levels and they do sports and change of direction sports, running sports, are really important criteria.

00:46:03.190 –> 00:46:25.780
So you need to know what they are, how you can train it. And if you don’t have the tools to assess them, you really have to have good knowledge of what they have to deal with when they’re doing their sports. And if you have that knowledge, you can do a good job. Maybe you can’t assess it, but you’re doing a good job as well. If you’re doing that, athletes try to have the tools that you can assess it.

00:46:25.780 –> 00:46:53.145
So it’s really a good investment to have handheld dynamometers who give you like RFD indications to run or to use when you use force plates or some kind of that. So it’s really like the investments that have a good return of investment as well, because it gives you like good data that is important backed by research. So yeah, it gives you a good guideline for your rehab. So yeah, that should be the next thing I think.

00:46:53.500 –> 00:47:33.410
<v Kurt>Yeah, I can see and also, yeah, also knowing you for the last few years, being one of the innovators, early adopters of technology, and building that, you know, accumulating that experience of how to implement, how to use data and metrics into shaping your rehabilitation protocols, your strength and conditioning. It’s really nice to see how that’s evolved. And we can only commend you on how you’ve evolved that and leading that, a lot of those pathways and frameworks. Let’s maybe, yeah, let’s maybe end off with some rapid fire questions. You know, what would be, if you have to select, what would be your go to strength exercise?

00:47:33.410 –> 00:47:35.570
If you had like one or two, yeah.

00:47:35.805 –> 00:47:49.485
<v Joachim>Or two strength exercise. Okay. If you from a local, I’m to complicate the answer. From a local perspective, seated golfers, if have to have one seated golfers, nice, solisse work, sloppy ankles there.

00:47:49.860 –> 00:47:52.020
<v Kurt>No sloppy ankles. I love that.

00:47:52.420 –> 00:48:25.560
<v Joachim>Or so the seated golf race for the ankle, for the soles, and then the hamstrings for me also important. Single leg, RDL to get a little bit more complexity and get posterior chain work going on. That’s that are my if I have to to pick two. So CS Golf is for the Solis and Cingealic RDL for the whole posterior chain. If you make it more difficult and have to say only one, then I will say everything with rhythm like skips or progress because then you have both of two worlds.

00:48:25.560 –> 00:48:44.495
So yeah, so the rhythm getting everything integrated. Yeah. That’s if you have to pick one, I think you that’s the one I would choose. Power jumps, skips, everything with some rhythm in it, and just feel the movements and feel the burn maybe as well in the calf muscles or in your glutes or in your hamstrings, whatever. Yeah.

00:48:44.575 –> 00:48:59.535
That will be, maybe that will be my go to. But I can answer shortly. That’s not in my nature. It’s a tough question, but serious golfers, single RDL and hops. Yeah, history.

00:49:00.655 –> 00:49:07.295
<v Kurt>For sure the hops bring elements with specificity, coordination and complexity as well.

00:49:08.095 –> 00:49:22.920
<v Joachim>Yeah, and it’s one of the most sensitive assessments post ACL based on the work of Asperdar. So if it’s important to assess, it’s also a good exercise. Single eye coping. Yeah, let’s go for that. Single eye coping.

00:49:24.120 –> 00:49:31.775
<v Kurt>All right. Question two of three. What is a must read book or paper that you would recommend for clinicians?

00:49:31.775 –> 00:49:59.675
<v Joachim>Well, paper wise, I love the work of Mendi Goodcha and his work at Centrum Sports. So it’s more sprint related and really with the practical recommendations as well. So they, one of the most must reads is their paper in which they’re asking, can we change maximal sprinting posture? And we can, we can do it multifactorily and it has implications for hamstring injury. So Mendi Goodia for the sprinting and Nakim for everything GROM related.

00:49:59.675 –> 00:50:31.445
It’s really nice. And if you want to dig deeper into the biomechanics for sprinting, GB Moren, I can pronounce correctly, but that’s really, that’s right for me. It all started with his research on biomechanics and sprinting. And then when you look at change of direction stuff from Dos Santos and their work at, there’s a site, multi directional speed science, I think it’s called. They have like a nice sized site in which they group all of their research.

00:50:31.445 –> 00:50:59.325
So it’s really nice to have a look at that. And when you’re working with deceleration athletes or generation athletes and the work of Damien Harper. It’s really nice to look at also more from biomechanical stuff, but they have also some really elaborate reviews to get a practical translation, so exercise wise, etc. And then from a book, if you get, if you want to question everything, then you have to read Frans Bosch’s books. It’s quite complex.

00:50:59.485 –> 00:51:39.630
Quite, it’s not that easy to digest from the beginning, but it’s, it triggers you. It triggered me to rethink and to see, okay, where do I fit it in? Because it’s like for me, what he’s saying, and especially when you look at his course, it’s like a little bit elephant in the room. So it’s just like, it’s really maybe principle in his ideas, but I like their ideas, but I have placed it within a broader context. So at the beginning, was like all hyped with complexity and it has to be specific and sport specific, but sometimes you get it’s, it gets it has its places, but it’s one piece of the puzzle.

00:51:39.630 –> 00:52:15.040
So we had the papers I mentioned quite nice for the project to get, if you have like a solid base of the basic stuff of strength and conditioning, so know the stuff that you want to be triggered, then that’s my go to. And to have an overall picture, advanced strength and conditioning from think Turner, Anthony Turner. It’s like a book getting like a bird’s eye view of everything related to strength and conditioning, especially for the physios who are not really into strength and conditioning, wants to, gives you like a nice overview of relevant topics.

00:52:15.225 –> 00:52:29.465
<v Kurt>Fantastic resources and recommendations. Thanks. Thanks for sharing that. Great. Just bringing to a closing, where can our listeners get in touch with you if they want to hear more about the ways you integrate data and your work?

00:52:29.465 –> 00:52:32.320
I know you also do some courses. Yeah, where could reach out to you.

00:52:32.320 –> 00:53:09.150
<v Joachim>Sometimes I post on Instagram, if we do, for example, the screenings with basketball, with Levee Bears, or we have some patients we can track, Sometimes they post themselves. But if we do some screenings, I post something with some making a case study out of it. So Instagram, you can take a look at, but I’m not that active. I’m more a passive user, let’s say. But if it’s an interesting course of during the season, sometimes I post something, maybe you guys, your channels, for blog or something like that.

00:53:09.310 –> 00:53:44.530
If I, if there is interests, I read something, a case study. So yeah, I had some course, I had the course with smart education, but, that’s, there’s no new course planned for the moment. So yeah, Instagram, I will say, and look at the stories from both me as love bears or the place I work, the Move From Spectacular. There we play some, sometimes some cool stuff or some interesting stuff to look at through the tool beads. And otherwise you can send me an email if you have questions yourhimautmakermoveintheir.

00:53:44.530 –> 00:53:54.675
You can always send me an email if you have some questions. I’m happy to answer it or to have a call or chat if you want. But Instagram will be the most easy to access, I think.

00:53:54.675 –> 00:53:58.595
<v Kurt>Fantastic. And your handle, Instagram handle is your name, right? It’s Joachim Bo.

00:53:58.595 –> 00:54:05.980
<v Joachim>Yeah, it’s Joachim Bo and just that Of the move, Forswag Tech, Love and Bears, there we will post some some stuff during the season.

00:54:06.060 –> 00:54:13.500
<v Kurt>Awesome. Thank you for your time. I really appreciate it. I know you’ve got a lineup of patients and athletes today. Yep.

00:54:13.500 –> 00:54:23.035
We’re giving up your lunch break. Yeah. We really appreciate you sharing your insights on the Physio Insights podcast. And, yeah, have a great summer vacation and Yeah. Keep in touch.

00:54:23.035 –> 00:54:24.555
<v Joachim>Thank you. Thank you.

00:54:31.600 –> 00:54:44.080
<v Kurt>That’s it for today on the Physio Insights podcast by RonEasy. Would you like to share an interesting case, insight or thought about this episode? Comment below and don’t forget to follow us for more episodes.