Sean Fyfe explains how he created his dream job
The conventional role of a sports injury practitioner tends to focus on treating a big list of patients, week in, week out, in a clinic setting. It can be enjoyable and rewarding, but it can also become physically and mentally draining at times. After doing this kind of work for a number of years, I found myself wanting a little more variety in my working days. Fortunately, the evolution of the sporting world, and the role of therapists within it, makes it quite feasible for someone like me to realise my ambition for change.
Although it has taken considerable hard work and further study, I am now happily and busily employed in a role that I envisaged as ‘my ideal job’ when I began my foray into the world of tennis.
As a kid, tennis was my life and I am lucky enough to have played at a professional level. My aim was to be able to integrate my sporting passion into my profession as a physiotherapist. This way, as well as my days being full of variety, I believed I would be able to make a positive impact on more athletes, rather than just those I saw in the clinic setting.
Tennis Australia has established a new player development programme. There are five National High Performance Academies for tennis (NHPAs) in the state capital cities, whose purpose is to work with talented 10 to 18 year olds to produce young players ready to enter the national Australian Pro Tour Programme (the feeder for the world professional tennis tour).
The NHPAs are well funded. They give their young players a complete on-court training programme, as well as physical training, sports psychology and sports medicine. In Brisbane, the NHPA is linked to the Queensland Academy of Sport (QAS) for top athletes.
My role at the Brisbane NHPA is to:
* programme and deliver strength and conditioning training
* work with another sports physiotherapist to manage the rehabilitation of injured athletes and prevent injury
* liaise with the other coaches on matters of technique, players’ workloads and injury l undertake on-court coaching.
I am present at most training sessions and am in constant contact with the head coach regarding the progress of our young players. These are progressive times in Australian tennis player development and it is exciting for a sports injury practitioner to be involved in a team environment, motivated to help young athletes.
An expanded role for a sports injury practitioner does imply ongoing professional development and further training. During university I gained Level 1 and 2 coaching qualifications and am completing Level 3. Alongside this I have by now gained my Level 1 and 2 strength and conditioning qualifications. My own belief is that it is also important to go beyond official study and get to know the ins and outs of the sport or industry that you are aiming to become a part of.
Tennis is an incredibly competitive international sport. Players have to push their bodies to the limit to achieve high levels of skill at a very young age to give them a chance of progressing through the ranks. As a result, injuries are prevalent and can cause long periods of disruption to the development of a talented young hopeful. One of my main aims in working with the NHPA was to limit the number of injuries. I started with a review, based on the literature and my own experience, to identify the main injury concerns and what would be needed to reduce these injuries.
I and the other coaches together restructured the overall training programme, using the principles of ‘long-term athlete development’ (LTAD) as outlined in my article in SIB61 (July-Aug 2006).
Movement education became one of my initial priorities. I envisaged all athletes being able to perform a range of fundamental bodyweight movement patterns, as well as rotator cuff work, that would form the platform for our long-term strength and stability development training.
The young athletes involved found it frustrating to have to make the time and effort to master specific exercise techniques when all they really wanted was to run around and hit tennis balls. But the benefits have become obvious to them. Aside from preventing injury and improving physical qualities that we measure in our physical testing, the other aim of the exercises is to improve on-court performance, which is very hard to measure objectively because there are so many variables. However, subjectively the other coaches and I believe the players are moving better and, in particular, are stronger when pushed wide on the court.
Our stability and strength training sessions run efficiently and the athletes have progressed to more complex exercises. Teaching them body awareness and stability has been a significant factor in improving their physical development and preventing injuries.
In terms of stability I had four general aims:
* good scapula stabilisation
* rotator cuff strength
* lumbar spine stability
* pelvic and single leg stability.
Our stability training includes exercises to accomplish these goals. We have also progressed well beyond this to increase tennis specificity. For example, now that athletes can perform rotator cuff strength exercises, they also perform fast theraband rotation exercises in an elevated position, with the aim of increasing throwing velocity and gaining stability at higher speeds of rotation.
Flexibility training includes both static stretching and active flexibility exercises, such as holding long lunges. Tennis players generally become very tight through the playing shoulder and the hips. We have identified the main areas, and the athletes have to perform certain stretches at the end of every training session.
At their compulsory medical screening, which takes place when they enter the programme, any athlete who is identified as having injury concerns, flexibility or stability deficits is prescribed an individualised programme and reviewed to ensure they are making progress.
We have complemented the medical screening and movement education with a range of other injury prevention strategies. We have a relatively standardised compulsory pre-training warm-up, which includes a series of running drills, dynamic stretching and movement drills. Players carry injury prevention packs in their tennis bags: trigger point ball, self-massage tool, stretch band to improve the effectiveness of certain stretches and a self-mobilising device to prevent thoracic spine stiffness.
Inevitably, injuries do happen. We have an excellent sports medicine team on hand, comprising a sports physician experienced in dealing with tennis injuries, a range of orthopaedic consultants, a podiatrist and nutritionist. The team’s main role is to manage injuries so as to minimise lay-offs and prevent injuries turning into larger and more long-term/career-threatening problems.
At my weekly meeting with the coaches, we review the status of injured athletes and adjust their training programmes accordingly. The nutritionist has observed the training sessions and has conducted a series of educational seminars for parents and the young players, to encourage them to fuel up appropriately prior to, during and after training.
More to be done
Our approach has, for the most part, been successful, and many of the injury concerns I anticipated at the outset have not been an issue. The one exception has been some problems we have encountered with lumbar spine stress fractures. Although these are an occupational hazard for tennis players, we believed we could reduce the risk. We set about identifying a list of risk factors, based on the literature and our professional experience, and adjusted the training programme accordingly.
Lumbar spine stress fractures arise from repetition of extension and rotation movements, leading to pars articularis overload. To counteract this we introduced greater variety to the structure of on-court drills. Poor technique that causes excessive rotation and extension is also a risk factor, so we singled out those athletes whose deficiencies in technique were likely to make them vulnerable, and began the process of modifying their technique, using individualised video and software analysis. We took a similar individualised approach to tackling athletes who demonstrated other risk factors, including:
* youngsters hitting a growth spurt (modified the training schedule)
* athletes with poor core stability (individualised physical programme prescribed)
* players with poor flexibility (given extra flexibility work)
* new players previously working at lower training volumes (graduated the build-up in training load).
It has been the team’s experience that the players at greatest risk are young males who are particularly explosive, grow early, have a tendency to hypermobility (which may lead to less spinal stability) and have a doublehanded backhand (with a particular technical deficiency beyond the scope of this article). This is definitely an area we are looking into further.
I feel as though, as a team, we have come along way, but we can still get a lot better. Recently we started a research project to monitor the workload by recording the number of balls hit and types of shots played in practice sessions compared to matches. This will help us to monitor the athletes’ training load better and hopefully be more accurate in our replication of match conditions during training.
Another recent addition to our injury prevention strategy is a compulsory screening review of all athletes returning from extended overseas competition tours before they are allowed to return to training. In future we also intend to provide statistics on injury types and rates.
As we continue to learn from our experiences, we will add strategies to improve the programme.
These days there are plenty of examples of sports injury practitioners and strength and conditioning coaches looking for strategies to prevent injury and improve performance – you can see these in practice at many elite sporting events. Take the AFL (Australian Rules Football League): 20 years ago you would never have seen players lying in a prone position propped on elbows (a strategy to prevent hamstring injuries) on the bench, or players on exercise bikes to help recovery and prevent muscle tightness. At a recent rugby league game I went to, I saw the trainer taking the bench players for regular sport-specific and movement drills so they were kept physically and mentally ready to play. I have seen warm-ups at football games before, but this was much more structured and professional than the norm.
The NHPA has been a great challenge and has taught me much about working with organisations. It is just one example of how a sports injury practitioner can branch out and build on their core skills, experience and knowledge to increase their own job satisfaction and bring wider benefits to athletes.