Every Art Requires (and Should Consider) the Whole Person: The Developing Role of Physiotherapy in Supporting the Whole Person

In our previous blog we explore the importance of autonomy supportive behaviours in the physical development of youth athletes. We proposed that the S&C coach should be encouraged to share planning and programme rationale and use language that internalises physical capabilities and enhances internal motivation. In this blog we continue to explore the diverse role of sport science practitioners in youth sport by considering the potential of the physiotherapist to recognise and respond to signs and symptoms of relative energy deficient disorder.

The role of the physiotherapists has changed over time to be more focussed on, not just the physiological factors of the human body, but a more holistic looking at the whole person. With this more holistic approach comes a greater emphasis on providing appropriately positioned education and advice. One key area of physiotherapy that is significantly gaining momentum recently is relative energy deficiency syndrome (RED-S). RED-S is particularly important within youth sports due to the fact that optimum bone density is laid down from around 15-24 years of age and peak bone mass is found at 18 in females and 20 in males (Bones.nih.gov, 2020).

The concept of RED-S is that energy input (food) vs. energy output (exercise and basal metabolic rate) is imbalanced and therefore the body does not react well and begins to suffer in a number of ways. RED-S is something that has previously been mainly linked to female athletes in weight dependent sports (light weight rowing, swimming and athletics for example), but more recently there has been a shift in an awareness for all athletes and coaches to be able to recognise and respond with appropriate support.

Some of the key indicators that an athlete is suffering from RED-S are recurrent injury, in particular stress fractures, chronic fatigue, decreased metabolism and menstrual dysfunction. The image below highlights the range of possible indicators.

The biggest hurdle in this battle is reducing the stigma around conversations with youth athletes about diet and health and in females in particular, symptoms such as menstrual dysfunction. A recent conversation with a young female athlete allowed me to understand what her thoughts were on the topic of being asked about these aspects. She, much like many other athletes and coaches, had never heard of the concept of RED-S, or even elements of it. We discussed the best method she felt of displaying this information in a non-invasive way and allowing for conversations to be had. It was clear that certain coaches would be ok to talk to and others would be more uncomfortable. She noted that she would trust a physiotherapist to discuss this topic if the opportunity were provided to her. It was also clear that if the topic of RED-S was not pushed upon the athletes (a questionnaire where the results were taken, and then automatic meetings were made if multiple symptoms were ticked for example) then they would not seek help if they were just given other sources of guidance, for example an advice sheet.

This major take-home from this experience was the lack of awareness. It is a well-established fact that awareness is poor of this topic, but how can we feel empowered to approach RED-S and put steps in place to overcome it? Does the conversation start with diet and bone density with regard to exercise and loading bones during these optimal ages? Our role as physiotherapy is ever-changing but having the awareness of topics such as this means we can have another checklist to consider when treating and supporting the development of young athletes. Within our environment we may be the first person to notice that someone has had recurrent injuries or illness, so it is essential our knowledge is sufficient to highlight any symptoms or risks. Having the confidence and knowledge to ask within a physiotherapy appointment about the symptoms stated above should be part of our remit and we must feel empowered and capable to do this. The challenge is ensuring you prioritise this topic when a symptom arises. With limited appointment times and a specific rehab and exercise role, it is easy to push it aside altogether. The long-term effect of ignoring something like this can be significant and impact the rest of these young athletes’ lives.

My top 3 pieces of practical advice would be:
1- It is our remit and we need the confidence to ask the questions.
2- Brush up on your knowledge of the symptoms of RED-S and have a plan of what to do when faced with someone who is displaying them.
3- Use your knowledge to educate those around you; coaches, athletes, teachers, parents and so on. The more people that know about it the better and one of those people will be approachable for that pupil to talk to, so make sure we are all equipped.

Control Leads to Compliance, Autonomy Leads to Engagement: Is Autonomy Support the Most Important Factor to Facilitating a Productive Coach-Athlete Relationship in Athletic Development?

In our previous blog we explored the true value of university placement programmes on the intra and interpersonal development of university students. The placement experiences shared in the blog highlight the ability of placement programmes to narrow the gap between the textbook and the real world in the sport science industry, with challenge and support being important aspects. In this week’s blog we will explore the role of the coach-athlete relationship in physical training, with a particular focus on autonomy support. Is autonomy support the most important factor to facilitating a productive coach-athlete relationship in athletic development?

Sports psychology research has identified the importance of the coach-athlete relationship to both successful athletic performance and interpersonal satisfaction (Jowett and Meek, 2000; Jowett and Cockrill, 2003; Jowett, 2005; Lyle, 1999; Mageau and Vallerand, 2003; Poczwardowski, Barott, and Jowett, 2006). A well-conceived coaching philosophy provides the structure through which such performance and satisfaction can be coherently and consistently achieved (Cassidy, Jones, and Potrac, 2009; Martens, 2004; McGladrey, Murray, and Hannon, 2010). An important construct of the author’s own strength and conditioning (S&C) coaching philosophy surrounds the need for autonomy in the coach-athlete dyad. Autonomy is the experience of volition; for behaviour to be united with an integrated sense of self, empowering choice as a driving force behind behaviour (deCharms, 1968; Deci and Ryan, 2000; Reeve, Nix and Hamm, 2003; Ryan, 1995). The author will now provide a critical discussion as to whether autonomy support is the most important factor to facilitating a productive coach-athlete dyad in athletic development.

Autonomy support occurs when a significant other (e.g. S&C coach) embraces the target’s (e.g. athletes) perspective, provides appropriate and consequential information and encourages the target’s initiative (Black and Deci, 2000; Pelletier, Fortier, Vallerand and Bricre, 2001). Research suggests that behavioural strategies may be applied by the S&C coach to satisfy this support system (Grolnick and Ryan, 1989; Mageau and Vallerand, 2003; Pelletier et al., 2001). Through the author’s own S&C coaching philosophy (appendix 1) and experiences such strategies can be applied by providing the athlete with a clear direction and framework to S&C. Publicising the periodisation of training and expectations regarding adaptation, volume and intensity of training relative to the competition cycle provides pertinent information and rationale to the athlete. At this point the athlete should be encouraged to express opinion; consult on tasks, limits and policies and propose questions in order to fulfil self-determination (deCharms, 1968; Ryan and Deci, 2006). The author also positions the need for individuality in the coaching process relative to physical ability and the need for mentoring athletes. Autonomy supportive behaviour would propose varying strategies relative to training age and physical literacy to stimulate continued adaptation without threatening wider training aims. Variability in exercise progressions and regressions and considering action required on feedback from the athlete may be appropriate strategies. As such the sensations of competency, connectedness and autonomy may be internalised, thus mediating the effects of need satisfaction on the relationship between the coach’s behaviour and athlete’s motivation (Mageau and Vallerand 2003, Reeve and Deci, 1996; Ryan and Fredrick, 1997). #

Beyond the actions related to programme design and athlete competency, the author cites the importance of language and its impact and influence on the athlete (appendix 1). Language that provides structure and portrays involvement in the athlete’s welfare represents an important component of athlete’s perception of autonomy (Deci and Ryan, 1985; Grolnick and Ryan, 1989; Alvarez, Balaguer, Castillo, and Duda, 2009).  Research has highlighted the importance of communication being positive, open, honest and founded on mutuality and understanding (Culver and Trudel, 2000; Bloom, Schinke and Salmela, 1997; Headley-Cooper, 2010; Yukelson, 1997). Drawing on the experiences of the author, the use of such language may allow the athlete to ‘try’ a variation in technique or ‘may want to’ load or deload the barbell to achieve training adaptations. Such language creates a more motivating climate, providing the athlete with vital experience and information to internalise their own physical capability and facilitate self determined extrinsic motivation (Mageau and Vallerand, 2003; Pelletier et al., 1995). Research has shown that S&C coaches who undertake a process of self-assessment of their instructional behaviour are effective in modifying behaviours targeted for change (Gallo and De Marco, 2008). As such this process may be effective in improving the S&C coaches’ use of language to provide more effective autonomy support for the athlete.

While the concept of autonomy supportive behaviours fosters choice, rationale, emotive awareness and both intrinsic and extrinsic motivation (Cordova and Lepper, 1996; Grusec and Goodnow, 1994; Reinboth and Duda, 2004) it is idealistic to suggest such support can always be effectively delivered in the S&C environment. Coaching context is an influential factor on coaching behaviour (Mageau and Vallerand, 2003) and even if autonomy supportive behaviours are central to coaching philosophy, actual behaviours are formed within the context in which they operate (Deci and Ryan, 2000; Headley-Cooper, 2010; Oliver, Markland, Hardy, and Pethrick, 2008). From the author’s experiences, the S&C environment can be highly competitive as task contingent rewards are prevalent, athletes are continually observed, evaluated and assessed, competition and training are scheduled in advanced creating rigidity to training and performance and S&C coaches are afforded limited contact time with the cohort of athletes they engage with. Such circumstances can force ego-involved, controlling behaviours from the S&C coach that result in conflict, alienation, controlling regulatory processes and compensatory outcome goals (Conroy and Coatsworth, 2007; Deci and Ryan, 2000; Deci and Ryan, 1987). Autonomy relative to ideal supportive behaviour may be undermined and the equilibrium of the coach-athlete dyad affected.

Whilst the role of autonomy supportive behaviours has been recognised as important to facilitating productive coaching-athlete relationships, the ability to execute such behaviours in the S&C environment may be challenging. The S&C coach should be encouraged to expose S&C planning and rationales, provide individual support to stimulate athletic development and use language that internalises physical capability and motivation. Such recommendation fulfils the athlete’s self-determined need for choice, independence and expression of feelings and motivation. However, the challenge is represented by the context in which the S&C coach and athlete engage. The limitations surrounding competition, reward systems and scheduling places stress on the coach’s ability to deliver autonomy support and as such controlling behaviours may prevail. S&C coaches should understand the importance of autonomy supportive behaviours and the positive effects on the athlete and their physical and emotional development. However, the coach must also be aware of factors that limit the facilitation of productive coach-athlete relationships such as the coaching context. How do you go about developing autonomy support to facilitate a productive coach-athlete relationship in athletic development?

No Good Experiences, No Bad Experiences, Just Learning Experiences: The True Value of University Placement Programmes

In our previous blog we explore the importance of a dynamic and personalised approach to nutrition to supporting the development of pupils in a youth sport setting. We gave examples of interventions to ‘kindle the fire’ for learning related to appropriate fuelling and behaviours with food. We gave an example of the importance of considering the energy costs of growth and maturation as a primary focus. We highlighted how evidence informs us of the concurrent peak in energy requirements as physical activity increases alongside increasing rates of growth and maturation around the ages of 14- 17 years. As such, this period becomes critical for well informed nutritional behaviours.

In this blog we divert to explore the benefits of placement opportunities for university students. As a department, athletic development at Millfield has been proactive in creating opportunities for early years practitioners to gain valuable industry experience and practical learning experiences to supplement their academic studies. Below, we have an insight into the lessons learnt during the first 6 months on placement from two of our current placement students. How do you support the development of placement students in your programmes?

“The experience to date has been a real eye opener. I quickly became aware that adding practical experiences and skills to the exercise physiology theory I had learnt at university would be key. What has hit me most is the difference between textbook theory and applied practice. I have learnt that there is more to coaching, more than designing the perfect plan and programme. Since being at Millfield I have been exposed to a lot of applied research, reflective practice sessions and daily discussions about the art of coaching while also delving deeper into strength and conditioning principles. My key take home is to stay focused on the development of young people over time and to continually focus on adding value to their journey.”

“I have become more aware that it is as important that pupils come away from sessions having been challenged to learn; whether it is around strength training or more generally, for example life skills; making the pupil a better and more rounded person. Within sessions I have focused more time and energy on pupils developing the ability to make the most of every coaching opportunity; what went well last time? what is the focus of this session? what could I do better next time? This ranges from remembering technical points of a squat pattern, bringing more energy to the next session and working collaboratively with peers to support their learning. Everything I have learnt to far and shared above I believe can be transferred to future roles within coaching, making me the best coach I can possibly be and highlights to me how coaching is coaching. Fundamentally it is about connecting with people and supporting their development over time inside and outside of sport.” (Callum, Athletic Development Placement Student from Bournemouth University)

“Whilst on placement with the athletic development team at Millfield, the one think that has struck me most is the importance in building meaningful relationships with pupils, coaches and teachers to provide the best support to our young sports people. Developing trust, respect and understanding individual needs are what I believe are the key attributes that have led me to become more effective in my coaching delivery. My university degree has given me the foundational and theoretical knowledge that I know is essential to become a successful S&C coach. My placement so far has added another layer of understanding around the practical implications of theory and most importantly, working with and supporting the development of people.”

“ In addition, during my placement at Millfield I have really become to understand the importance of integrating into the culture of an organisation and how important it is to continually uphold the highest standard of practice both within my coaching, through the use of evidence based practice and outside of coaching, by contributing positively to the community that I am working in.”

“By researching relevant topic areas and applying my understanding within a youth context, I have been able to take ownership of my programmes and review their success with fellow coaches and my placement supervisors. This has helped me to take a more holistic approach in ensuring that I meet my long-term targets and the longer terms aim with each pupil. Finally, I have learnt that good conversations are important to support good practice. Working in a multidisciplinary environment, we are never shy from an opportunity to learn from fellow practitioners. I have exposed myself to be challenged in my critical thinking, through presentations and being open to be challenged, which has ultimately led to developments in my coaching and thinking. Similarly, I have learnt to not be afraid to challenge both my peers and the young athletes that I coach to support their own development.” (Idris, Athletic Development Placement Student from Bath University)

This narrative provides a fascinating insight into the true value of industry-based placement programmes. The message is clear that the experience provides a genuine opportunity to narrow the gap between textbook and real-world practice. It provides early years practitioners the opportunity to embed themselves in an organisation and appreciate the importance of working and connecting with people to contribute to the aims of an organisation. Finally, it highlights the importance of a challenging and supportive placement programme with a network of mentors and supervisors who are invested in contributing positively to the experiences of the student whilst on placement. In short, there are no good experiences, no bad experiences, just learning experiences. How do you create great learning experiences for your placement students?

It’s About the Kindling of the Fire, Not the Filling of the Vessel: Dynamic and Personalised Approach to Nutrition Support for Youth

In the first two decades of life, youth undergo an array of anatomical and physiological changes resulting from growth and maturation. These include but are not confined to changes in body size, and architecture, including the rate at which these changes occur. Additionally, youth develop key beliefs and attitudes which form the basis of behaviours in adulthood. These fundamental physical, social and psychological changes result from and are influenced by nutritional behaviours and habits.

Adolescence is a period when bone growth is at its greatest and when musculoskeletal, endocrinal & thermoregulatory systems are fully developed. All these developments require energy. However, quantifying this energy requirement is challenging due to the individuality of growth and maturation rates, especially around peak height velocity. Recent work (Hannon et al., 2020) highlights some of the differences in energy needs of youth athletes as they move through stages of maturation, with concurrent peaks in energy requirements and rates of growth and development, between the ages of 14-17 yrs.

With this in a mind and as a practitioner supporting youth in an educational environment, the importance of pupils, and particularly pupils with high sporting loads, meeting their daily energy demands is key. My primary focus then, is to educate pupils on how to optimally fuel and support the process of growth and maturation through nutrition. Developing good nutritional behaviours in our pupils will not only support these processes but will also cross over to influence behaviours with food in relation to the demands of their sport and life beyond sport. In short, my focus is on kindling the firing for learning and development.

With education being paramount in my practice at Millfield so far, two concepts driving my practice have become apparent. They are dynamic and personalised nutrition. A key understanding that I aim to embed into my communication is that nutritional requirements are dynamic not static. As such, behaviours with food should be dynamic and adjusted to match daily variations in energy demands of for example training programs, extracurricular activities and general free play in a boarding school environment. Personalisation of support is equally important, to account for differences in maturation stages, specificity and uniqueness of the sport and practical challenges regarding nutritional knowledge, preferences and needs.

Application of these concepts from a practitioner and pupil point of view can be challenging in an environment which you do not control food availability, quantity and meal timings. Therefore, a practical strategy to counteract these challenges has been the use of photographic food dairies and visualisation of portions to provide education and practical application of a dynamic and personalised nutrition to meet training energy demands and support development. This use of combining both visual and written nutritional support has been effective in my practice so far, empowering pupils with the knowledge of “why” but more importantly to power of “how” to improve their nutritional intake according to their individual needs. The aim continues to be to kindle the fire for learning related to appropriate fuelling and behaviours with food.

Failure as Teacher, not Undertaker. Failure as Delay, not Defeat: Professional Development in Physiotherapy

In our previous blog we looked at the significance of utilising video capture, processing and sharing of training and competition to optimise knowledge and understanding of sport, leading to the personal development of pupils and coaches. The blog touched upon the understanding that modern youth sport is a rich learning environment which pupils and coaches are constantly evaluating and adapting their practice based upon these learning experiences.

In this blog I wanted to look at the role of failure within physiotherapy practice, and how this is can act as a catalyst for learning and practitioner development despite the negative connotations around the term ‘failure’. Failure in most domains is considered a negative. Failure is seen as ‘the undertaker’ and a defeat. To be seen to fail is to somehow demonstrate a lack of knowledge, competence or experience within physiotherapy. This viewpoint often leads to individuals feeling anxious and having low self-worth and perceived competence. In the current climate where people’s mental health is in focus, we must question if this view of failure is healthy and sustainable.

As one of our physiotherapy team states, “I fail every day in my physiotherapy practice. This may be in the form of a diagnosis that evolves over the course of someone’s rehab, not providing the optimum loading for an individual’s exercise program or not doing all I can to ensure a pupil buys-in and is compliant with the rehab program I have provided them with. I have had cases where I have missed the mark and failed as a physiotherapist. The knock-on effect is that a pupil may feel unsure of what they are to do or their direction of travel or maybe that individual will seek a second opinion and never feel able to seek my support again.”

Now you may be thinking at this point ‘if they fail so often then how can they continue to be a therapist and consider themselves effective?’. This was a concept I struggled with earlier in my career when situations like this would lead to a high degree of self-analysis and scrutiny and a negative emotional cycle for an period of time. What was gained from this process? Nothing. It wasn’t until the emotion had passed that I was then able to reflect on the situation and gain an insight into what I could have done differently and how it could have played out in another way. Then it began to dawn on me. Failure was a tool for learning and by learning from these situations I was able to improve my subsequent practice and not repeat the same mistakes again. The ‘future me’ is now grateful for these experiences and so are the pupils that enter the clinic for rehabilitation.

The reality of the world we work in is that we are rarely going to be presented with a situation that is straightforward and ‘perfect’. We are more likely to encounter the ‘perfect storm’ where all the variables in each situation will come together to conspire against us. Rather than fear this situation and fear the failure which will inevitably coincide with these scenarios, we must be willing to ‘fail fast’, learn and move forward with the challenge. Overcoming these challenges will ultimately give us the greatest sense of satisfaction when we have helped someone overcome their own significant challenge (injury) and supported them in achieving their treatment goals. Being comfortable with failure will allow you to become a better, healthier and happier practitioner. Remember, the journey never stops. See failure as the teacher, not the undertaker. See failure as delay, not defeat.

By Viewing the Old, we Learn the New: The Impact of Video Feedback on Coach and Pupil Development in Sport

In our first blog of 2020 explored the importance of general physical preparation in the athletic development programme at Millfield. We proposed the importance of the concurrent training of physical qualities, the preference for volume over intensity, the use of exercise variation as a driver for neuromuscular adaptation, the importance of exercise technique validity and reliability and finally, aiming to elevate an individual’s technical strength threshold. In our second blog of 2020 we will move into the field of performance analysis and explore the importance of video footage to support the development of coaches and pupils in sport. In this short blog we will provide evidence on the importance of video footage within the coaching process. How do you use video footage to enhance the coaching process?

In the modern era of positive youth development in sport, coaches and pupils are continually exploring avenues to enhance their learning experience. This desire to improve has resulted in the enhanced integration of technology in youth sport, such as biomechanical analysis, data analysis and video analysis. The incorporation of video within the workflows of the coaching process has become common practice and one which can support both coach and pupil development. As highlighted in the quote below, the impact of video analytics on the development process in sport at Millfield is no different:

‘We believe that video plays a vital role across a number of sports here at Millfield school and benefits both coaches and the pupils. For pupils, the ability to self-reflect on their sporting performance post game or training is significantly enhanced though the support of video observational analysis. The ability to correctly interpret and propose improvements to both team and individual performance is vital for any inspiring pupils looking to develop in their sport. In relation to coaches, video allows them to provide meaningful visual feedback and frame coaching challenges within the context of real sporting scenarios.’ – Jack Like MISW Performance Analysis.

In supporting this position, research from the Social Science Research Network found that approximately 65% of people are visual learners. This strengthens the argument for the value and impact of video content on pupil’s and coach’s reflective practice in sports. In addition, The England Institute of Sport highlighted research that shows that on average, athletes and coaches can only recall 30% of previous performance correctly. This statistic again, highlights the true value of embedding video analytics within coaching workflows to support both pupil and coach development. In conclusion we aim to support the development process through Millfield sport by supporting the capture, processing and sharing of competition and training footage to allow pupils and coaches to optimise their knowledge and understanding of their sport and their enhance their personal development through sport.

To be Prepared is Half (May be More) of the Victory: The Importance of General Physical Preparation in the Youth Athlete

To be Prepared is Half (May be More) of the Victory: The Importance of General Physical Preparation in the Youth Athlete.

In our final blog of 2019, we looked into fuelling in the developing youth athlete. We proposed that providing engaging and impactful nutrition support will be an important objective for nutrition at Millfield moving forward. The use of clear, consistent messaging across the campus and well positioned education and guidance on fuelling will be important to optimise the potential of our pupils in sport and beyond. In short, we suggested knowledge isn’t powerful until it is applied, therefore we believe our nutrition education must be a ‘live’ and evolving process with pupil development at the heart of decision making and planning.

In our first blog of the new decade, we aim to continue to promote the development focused and pupil centred message as we explore the fundamental importance of general physical preparation in the athletic development of our sports pupils. We believe preparation to be half (may be more) of the victory in developing skilful movers and robust young sports people.

General physical preparation (GPP) is typically understood as the foundation upon which more developmentally advanced physiological adaptations are formed. As such, GPP is typically followed by training blocks that are more corresponding to the demands of the sport in which the individual is preparing for. Thus, in the context of youth physical development, in which an emphasis on technical mastery, consistency of technical execution and the development of force production are basic tenants, GPP becomes a critical, repeated and extensive training paradigm to prepare the youth athlete for future and more advanced training means.

In this context and based on our interpretation of GPP for youth development, we believe GPP can be executed through the following principles:

• Programme the concurrent training of physical qualities – Given the low to moderate training age of many youth athletes, the vertical integration and horizontal sequencing of training aims provides an opportunity to enhance technical mastery across a wide range of skills and develop neuromuscular adaptations across a range of training methods.

• Preference for volume over intensity – In the context of a 5, 10, 15 year training process and given a bias towards technical mastery and the development of strength capacity, a preference for volume driven programme gives the opportunity to better achieve these aims.

• Appropriate exercise variation acts as a driver for neuromuscular adaptations (Fonseca et al., 2014) – Given points 1 and 2 above, exercise variation rather than intensification is utilised to support the development of neuromuscular adaptations to movement skill and strength training. This point is both developmentally appropriate for our most junior (fundamental movement skill focus) and most senior (development of basic strength, acceleration, change of direction ability) youth athletes.

• Elevating the individual’s validity and reliability of exercise technique (Siff, 2003) – Given our wider aim of preparing youth athletes to successfully transition into the next phase of their sporting and physical training journey’s, validity (accuracy) and reliability (repeatability) of exercise technique is of critical importance. Our evidence to date, suggests this take time and we need to start early to ensure this aim is achieved.

• Elevate the individual’s technical strength threshold – To complement point 4, and as intensity in any strength training task begins to be elevated, we believe we must work just below the youth athlete’s technical strength threshold (the point at which force expression relative to load is compromised and thus a deterioration of technical execution is presented).

The principles outlined above position the young athlete’s physical development and future physical preparedness at the heart of GPP. We believe the process of GPP in young athletes is of critical importance to their future engagement and development in sport at a variety of levels and should be implemented with the past, current and future physical ability of the individual in mind. GPP should not be rushed and will likely form the majority if not all of the training process for the developing youth athlete.

Knowledge Isn’t Powerful until it is Applied: Fuelling the Developing Youth Athlete

In our previous blog we explored an insight into the performance analysis provision within our rugby programme at Millfield. We shared our video and analytical processes around pupil review meetings, training session and match analysis as well as statistics and reports. Taken globally we suggested simple insights provide the best opportunity for profound conclusions and positive impacts on our rugby pupil’s development. In this blog we will explore the importance of developing knowledge around nutrition and appropriate fuelling in the developing young athlete, with the key consideration of the energy demands of not only sport, but also academics, emotional and social load. We believe knowledge isn’t powerful until it is applied, therefore we value the application of knowledge and are focused on supporting that journey in nutrition.

Evidenced-based nutritional practices are integral to support a young athlete’s training and performance. For senior performers, the balance between their energy intake and demands of training, recovery and performance is key. However, energy requirements in young people is multifaceted, with elevated energy needs to optimise growth and maturation. Equally high nutrient needs are prevalent to ensure all bodily systems develop at their optimal rate moving through maturation. In addition, the energy demands associated with training, multi-sport participation and free-play in a school environment create a unique yet complex nutritional profile for the developing young athlete. Thus, the primary nutrition focus for young people in sport and their support personnel should be to ensure energy requirements are met, followed by a consideration of the sporting energy requirements.

In practice, understanding the importance of personalised nutrition to accommodate individual athletes’ needs is paramount. Thus, consideration of current health, nutrient needs, development goals, training strategies and other practical challenges need to be considered, all of which influence a young person’s nutritional behaviours. Every sports person and pupil’s day-to-day energy demands vary; therefore, their energy intake should be dynamic to match these. It then also becomes questionable to the appropriateness of translating nutritional guidelines for adult across to young people in sport. When you consider the multiple physiological and metabolic differences between adolescent and adult athletes, you soon realise it is not.

Is lunch a time to fuel or train?

From informal conversations, consultations and survey feedback it has become apparent that time and convenience are the key determinants driving the nutritional behaviours for many pupil’s and in particular, young people in sport. With lunch offering another opportunity to train, it can be perceived as easier to skip a main meal and choose a convenience option or worse, nothing at all. This can lead to the formation of unhealthy habits and routines becoming regular occurrences if left unattended. This reiterates the need to educate young athletes and young people on the importance of understanding “food for purpose”, and the practical side of “what does this actually look like?”, to empower them with knowledge to make informed nutritional choices to meet their development and sporting needs. Support personnel have a big role to play in creating a positive environment around nutrition practices and driving key messages around fuelling.

“I read it online, so it must be right”

For teenagers, media and advertising from the nutrition industry can influence their dietary choices and provides a common source of education, which is often ill-informed, outdated and poorly sourced. Adopting poor nutritional practices during teenage years can have a long-term impact, building negative perceptions of foods and potentially reliance on nutritional supplements. Chronically, this could lead to nutrient and relative energy deficiencies and associated injuries/ illnesses. This reiterates the need of providing evidence informed nutrition support to ensure pupils become knowledgeable and competent in making suitable independent dietary choices.

Clear consistent message to support competent behaviours

Moving forward, the key nutrition objective within our programme is to provide engaging, impactful nutrition support to all students by creating clear, consistent nutrition messages from the dining hall, to the sports field, emphasising the importance of a well-balanced, dynamic and varied diet tailored to their individual Millfield journey. We believe knowledge isn’t powerful until it is applied, therefore our focus is on the application of knowledge and are supporting that journey in nutrition.

Simple Insights, Profound Conclusions: An Insight into Millfield Rugby Performance Analysis

In our previous blog we considered the growing influence of social media within the field of sport science. We concluded that the ever-increasing accessibility, networking potential and limited financial investment gave various social media platforms huge potential to influence our daily practice. In this context we stressed the importance of be broad in our engagement with social media content, as well as being a proactive consumer; willing to give and take in equal measures. In this blog, we will share an insight into our performance analysis processes to support the development of pupils within Millfield Rugby. If we believe that simple insights provide profound conclusions, we hope our analysis processes with this cohort of sports pupils supports their development over the short and long term through easily accessible video and statistical content. As such, within this blog we delve into the following areas:

• Pupil analysis review meetings

• Training session capture and analysis

• Match analysis

• Statistics and reports

Pupil Analysis Review Meetings

Analysis meetings within the rugby 1st program consist of reviewing video of match performance. Statistics are utilised to support the messaging around video content. Within the meetings, coaches and the analyst will introduce new methods of presenting to maintain a high focus and engagement from pupils. For example, using video animation technology, using wooden blocks to replicate a scenario on a table taken from the video footage and using tools like Mentimeter to gather feedback from the room.

Squad and unit meetings are carried out twice a week on Mondays and Tuesdays for the 1st team program. These are led by coaches and the analyst. Individual reviews are carried out throughout the week and are led by coaches and pupils. In the lead up to high profile games, when opposition footage is accessible, the rugby team will review and break down the key performance indicators to present back to the team. Junior analysis review sessions are led by coaches and teachers who support the match analysis with basic analytics of game performance.

Training Session Capture and Analysis

A combination of analyst, coach and pupils participate in the capture of training sessions throughout the year. Not every session is filmed, although often in the lead up to big fixtures or when key sessions are taking place a higher quantity of sessions are filmed analysed and reviewed. Sessions are captured through a combination of handheld cameras and IPcameras positioned around the school.

A breakdown of content is created per session filmed and projects are often undertaken to break down individual pupil performances and report back to coaches and pupils. This includes the following; analyse work rates, pupil impact, coach observation and session flow.

Match Analysis

During match days, 1st team matches will be analysed live. This supports instant video and information feedback. IPcameras allow for a fast turnaround of video collection and sharing, whilst also offering a high-end video view at unique vantage points.

Post-game, within minutes of the final whistle rugby 1st match footage, team analysis and data reports are uploaded onto our online analysis platform, myTPA and shared to the pupils and coaches to review. Coaches and analyst will start communications post game and prepare video reviews for presentation sessions. Within a few hours post-game, coaches have selected who they require individual pupil analysis reports for, the analyst will then send these across for coaches to review and prepare for 1 to 1 meeting with individual pupils.

The analyst documents several other useful areas which support the review process across the Millfield Institute of Sport and Wellbeing; such as injury incidents. As a result, we can achieve a fast review of injuries by the physio department to inform best practice around treatment for the pupil. Students who participate within our performance analysis activity programme also have an opportunity to participate within the analysis of junior fixtures.

To Question Much is to Learn Much and Retain Much: Being a Proactive Stakeholder in the use of Social Media within Physiotherapy

In our previous blog we pressed pause and took a moment to look back on the lessons learnt from a range of internal projects we have completed within our athletic development programme. We surmised that our biggest investment over time should be focused on enhancing movement skills and competencies, balanced against high quality yet small doses of high threshold running and change of direction exposure. Alongside this we referenced the critical importance of the appreciating the holistic development of the young athlete in sport through optimising the coach-athlete relationship and supporting wellness. In this blog we will divert slight to consider how the growing impact of social media can act as a rich environment for professional development as a sport science practitioner in youth sport. If we believe that to question much, is to learn much and retain much, our engagement and filtering of content, resources and opinion on social media may be critical to optimising social media as a learning environment.

Our clinical working environment often dictates the clientele that walk through the door. As a physiotherapist in a youth sport environment, sports injuries and growth disorders are our bread and butter. We can often go a whole day seeing nothing but anterior knee pain. But then someone, outside your normal population will walk through your door and challenge your clinical reasoning, simply because it’s a condition you haven’t treated in a while. So how do you stay abreast of the evidence base and stay current with your practice?

In recent years we have recognised the growing impact of social media on the accessibility of research articles, opinions and knowledge sharing in the area of rehabilitation. The interactive nature of social media not only helps knowledge exchange amongst healthcare professionals (Davis and Voyce 2015), but it also allows for the promotion of physiotherapy services and the wider healthcare practice. Social media is being utilised by individuals across their working lives. A YouGov report in 2014 revealed that 38% of participants were using social media for learning, networking and/or sharing knowledge. Lawson and Cowling (2015) and Benetol and colleagues (2015) found that worldwide, health care professionals were using social media to facilitate networking, development and reflection. This includes popular platforms such as Facebook, Twitter, LinkedIn and a range of blogging platforms.

There are a number of reasons why social media as a CPD tool has become so popular. These include:

• Accessibility: content is available 24 hours a day and is accessible around your job and home life.

• Networking: there is the ability to talk and discuss with a variety of different professions and professionals, with easy access to so called “experts”

• Learning: the fast-paced nature of Twitter and other platforms allows for sharing of new developments in real time, such as policy changes and release of new research that help clinicians stay at the forefront of their profession and work to the latest practice guidelines

• Financial: there is no cost to using social media. You can read about new research, watch conference presentations, share ideas and learn from others all in one place.

The points above highlight how social media can be utilised as a live and freely accessible platform for professional development in the field of physiotherapy. As long as we keep sharing, learning and engaging, social media can positively influence over practice over time. In order to optimise this learning process it may be that we can better filter incoming content and be active in our engagement. The process below may be effective in doing so:

1. Reach – be broad in your engagement with social media. Use multiple platforms, engage with content across multiple domains and from a range of sources.

2. Act – be proactive on stepping in to social media and engaging with content. Reply to posts, ask a question or share an opinion. Be an active consumer.

3. Convert – be brave and utilise content that you believe may positively impact your practice. Ensure you re-mix and convert relative to the opportunities and constraints of your working practice

4. Engage – re-share your experiences of utilising content that you have reached out for, acted on and converted from social media. Contribute back into the learning process.

In summary, we cannot shy away from the growing influence of social media with the field of sport science and potential for social platforms to influence our practice. The accessibility, networking potential and limited financial outlay means the impact of social media on professional development is here to stay. We challenge you to reach, act, convert and engage with content as a proactive stakeholder to optimise the use of social media to enhance not degrade learning in the field of physiotherapy in youth sport. How do you question, learn and retain content on social media?