Dr Claire Minshull – Getting Efficacious About Rehab and Conditioning – Injury Rehab Network Event

The latest event of the Injury Rehab Network with BASRaT featured an insightful presentation from rehabilitation and conditioning specialist, Dr Claire Minshull.

Claire is one of the most highly respected rehabilitation and conditioning specialists in the UK. She has worked in the field of sports medicine and health for over 20 years as a Senior Lecturer, Researcher, Consultant and as a Practitioner. She has designed, led, and managed major clinical and nonclinical research trials, supervised several PhD students, and has published over 30 research papers in leading peer-reviewed sports medicine journals.

Claire’s area of expertise means that she uniquely spans the gap between the physiology of conditioning and physiotherapeutic rehabilitation. She is Principal Researcher at the RJAH Orthopaedic Hospital and Director of Get Back To Sport, an international education and training company.

Claire’s talk, ‘The Principal Role of Strength & Conditioning: Prevention or Treatment?‘  explored Conditioning Efficacy and the role of strength and conditioning in both the prevention and treatment of sports injuries.

The event was attended by 130 sports rehabilitators and sports injury professionals from across the UK and included some of BASRaT’s members from around the world.

What is Strength and Conditioning?

Claire kicked off her presentation by asking attendees to comment on what strength and conditioning means to them. Some fantastic ideas were put forward in relation to strength, power, speed, and function.

Claire focused on the role of strength and conditioning in injury prevention, injury treatment and in conditioning efficacy.

The English Institute of Sport refers to strength and conditioning as, “Strength and Conditioning is about more than lifting weights – it encompasses the entire physical development of the athlete and what is required to allow them to be the best physical version of themselves.”

Claire posited that some of the key elements and terms that we think about when considering strength and conditioning might include:

• Science
• Sport
• Performance
• Movement
• Injury
• Risk
• Optimal

Strength and Conditioning – A Key Ingredient in Injury Prevention and Treatment

Claire discussed the role of strength and conditioning in both injury prevention and treatment. From a prevention perspective, strength and conditioning might play a key role in facilitating improved performance and continuation of play. For injury treatment, strength and conditioning likely supports practices for return to play and rehabilitation. Across both prevention and treatment, strength and condition can build resilience.

With the return of sport from COVID-19 after the national lockdown, strength and conditioning will play an important role as players, athletes, coaches, and physios work to ensure a safe return to play. Claire discussed the importance of strength and conditioning as training load and volume is increased in working towards the performance demands of competitive sport.

Conditioning Efficacy

The definition of conditioning efficacy in rehabilitation and performance settings is, “The ability to achieve the performance or rehabilitation outcomes through the conditioning prescribed.” (Minshull, 2020). To build an efficacious, or effective programme, Claire described the importance of three key and interlinked areas:

1. Planning and design
2. Basic principles
3. Performance demands and risks

Planning and Design

Claire described how planning and design needs to be focused on each individual participant/ athlete and their needs. Therapists should identify the priorities for each person; from a coaching or rehabilitation perspective, this might include increasing muscle strength, power, flat sprint speed and/or a combination of these plus other things.  All of which are important contributors to enable the achievement of the individual’s ultimate goals, such as returning to play. Specific exercises can then be prescribed to provide the appropriate stimulus on an individual level to achieve these outcomes.

Planning should not be generic as this can lead to wasted time and is therefore unlikely to be efficacious.

Basic Principles

Once the specific rehabilitation and conditioning needs have been identified, Claire presented some fantastic content about the basic principles of strength and conditioning and how these should be addressed first in exercise design. Claire described the three basic principles as:

1. Specificity
2. Overload
3. Progression

Exercises should be tailored to the specific needs of each goal or outcome, for example, increasing muscle strength will have a different prescription to increasing a person’s flat sprint speed. Overload is the need to assign a training load that is greater than the individual is accustomed to, so that adaptation is achieved.

Claire described how the repetition maximum continuum is a useful tool for planning strength and conditioning training as it facilitates the selection of the overload, or resistance required to achieve different types of muscle adaption (e.g. strength, endurance).

Performance Demands and Risks

In supporting the performance and rehabilitation goals of individuals and athletes, Claire discussed the need to understand the specific demands of each person’s activity. Rehabilitation and conditioning programming should be based on the understanding of the performance demands of a person’s sport or activities and the potential injury risks.

An exercise programme should be designed to factor in threats that may come from sources such as:

• Fatigue
• Carryover from session to session
• AMI (Arthrogenic Muscle Inhibition)

Often at the start of a rehabilitation or conditioning programme, there can be many factors to consider and many outcomes to achieve.  Claire presented a hierarchy of importance and a periodisation model to help therapists and coaches prioritise what elements to consider when throughout the rehabilitation process, starting with the consideration of muscle strength.

Take-Home Messages

Claire summarised her presentation with a reminder of how efficacy is the ability to achieve outcomes. Claire reiterated the needs for a structured, planned, and specific approach to rehab and conditioning and for professionals to have a good understanding of performance and injury risks.

Q&A

Claire kindly answered several questions following her presentation.

Question 1 – How can I effectively rehabilitate a patient who has a lot of pain?
Answer– Adapt activity and exercise to minimise pain. Consider training the other side and focus on loss mitigation to minimise strength loss.

Question 2 – Which acronym do you use to help with planning and goal setting?
Answer– I don’t, I start with understanding the patient, their needs and goals, their barriers, and perceived limitations. Clearly all goals need to be meaningful and of course achievable.

Question 3 – Which periodisation model should I use?
Answer – Linear is usually the best approach.

Question 4 – How should athletes train for power vs strength?
Answer – High-intensity strength training will give some adaptation to power as well as strength, so if you are only going to do one thing, do this. Afterwards, you can manipulate with speed and load of lad commensurate with the goal.

Question 5 – How should an injured athlete return to strength and conditioning training?
Answer – Firstly consider the person and which activity they are doing. A progressive approach is likely best.

Question 6 – Can you recommend any return to play tests for athletes coming back to sport after lockdown?
Answer – Watch for tendinopathies. Progressive loading is generally the best approach with training volume increased by around 10% each week. Tests should be sport/ activity-specific. Pre COVID-19 baselines could be used to work towards.

Question 7 – What is the best way to support an athlete through a painful injury?
Answer – Undertake initial assessments to identify the source of pain. Take time to use clinical reasoning skills to identify individuals’ barriers, confidence, and motivations. Make activity experiential and build on small wins to help patients to gain confidence and become empowered to achieve their goals.

Question 8 – Which equipment would you recommend for a small rehab gym in a sports physio clinic?
Answer – Simple items such as a weights vest and resistance bands. A cable machine is multipurpose and can be used by patients at all levels. Weights could include an Olympic bar and weights, dumbbells, and kettlebells.

Follow Dr Claire Minshull

Keep up to date with the latest from Claire on Twitter @Claire_Minshull and find out more about Get Back to Sport.

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