– Derek M. Hansen –
Back in May of 2014, I had the pleasure of presenting at the Boston Sports Medicine and Performance Group Summer Conference. The BSMPG conference is a world-class event and everyone involved in sport performance should consider attending it on an annual basis. It also gave me an opportunity to spend time with the founder of BSMPG – Art Horne. Art is originally from Ontario, Canada but has made Boston his home working at Northeastern University since 2003. Currently, he serves as the Director of Sports Performance for Northeastern, heading up both the Athletic Training team and the Strength and Conditioning program for all the teams. In addition to his work with Northeastern, Art’s dedicated involvement with BSMPG has made him a central figure in all aspects of sport performance in North America.
During my time with Art, I was able to ask him some pointed questions about the Sport Performance field and what is on the horizon for the future of collegiate and professional sports.
DH: Art, given the advances you have made in the area of sport performance at Northeastern University, why haven’t other universities and professional sports organizations been able to successfully integrate their medical and performance services?
AH: At the present time a number of professional sports organizations are already beginning to move towards a more integrated model and also bring sports science and advanced data management under one roof with single oversight. The most successful teams have already been doing this for a while – San Antonio Spurs and Oklahoma City Thunder for example have an integrated and well thought-out process to player management, evaluation, treatment, reconditioning, and performance training strategies. Other professional sporting teams are scrambling to catch up and have recently added a position of ultimate oversight to both sports medicine and performance after either a well-publicized injury and/or re-injury to their star player. In other cases, teams have added oversight after years of “unexplained” injuries and poor performance.
At the college level the gap between sports medicine and performance training is massive and doesn’t look to be closing anytime soon. The reasons for this at the college level is multi-factorial and ranges from inappropriate reporting structures to massive personality conflicts between department heads. If either department recognized how critical the other is to their very own goals and success, an integrated approach would not only be a viable option, but would become the gold standard.
DH: Based on what you have seen and heard, do you think this is more of a personal issue in the trenches or a lack of vision by management?
AH: Good question Derek – not a simple answer.
At the college level reporting structures tend to be the first challenge at the present time. Many sports medicine directors still report directly to either the athletic director or an assistant AD with no medical experience. These same professions, with no formal training in sports medicine care are then asked to judge and provide a performance evaluation of the sports medicine professional’s body of work on a yearly basis – this just doesn’t make sense. The same can be said about the performance coach who reports to a similar administrator with no knowledge of their particular craft. It would be the same as me walking into a construction site and judging the integrity of the building and the quality of the concrete foundation. Just because I put a hard hat on doesn’t make me a foreman.
There are a number of institutions as of late who are moving their sports medicine departments over to their health centers with oversight by a physician, which not only makes sense from a reporting perspective but also absolves the institution for the most part from a conflict of interest and is, ultimately, where sports medicine professionals should sit and report through. However, this move away from the traditional athletic home only creates an even deeper divide between the two departments with the performance professionals still reporting directly to directors within the athletic department.
DH: Okay, so accepting that these changes are here and coming, – what is the biggest challenge that performance teams face moving forward?
AH: The key is getting the right people on the bus, and then putting the right people in the right seats – this is straight out of Good to Great by Jim Collins. The Performance Director is simply the bus driver and their role is really twofold:
1. Ensure that only the best people get on the bus: The hiring process in my opinion is the most critical piece in forming any high performing team. Each year you’ll talk to sport coaches about a kid that they recruited that has become a cancer in the locker room and is discouraged because they have to ride out their 4-year scholarship. Hiring within a performance team is exactly the same but even more is at stake – instead of 4 years that “recruit” might be with you for much longer. The hiring process is a high-risk endeavor and should be treated as such.
2. Educate all team members in the “overlap”: Hiring and creating a great performance team doesn’t mean that you hire athletic trainers that strength train, or performance coaches that have undergrad degrees in athletic training – this is often misunderstood in my opinion. You seek out and hire the very best performance coaches and athletic trainers in their particular area that also UNDERSTAND and APPRECIATE the overlap.
Let’s take the pre-participation screening process for example. This is should serve as the athlete entry point for both departments and an opportunity for professionals from both areas to collect data points, observe and evaluate the status of the athlete, followed with candid conversations regarding the athletes current functional status, limitations and goals for the season outlined. Unfortunately, the vast majority of institutions continue to “screen” and test their athletes separate from one another and worse still fail to share these findings with one another. If institutions could ever put tradition (this is the way we have always done it), and ego aside, conversations regarding an athlete’s back pain, her limited ankle range of motion and poor squat testing would produce a performance plan reflecting both medical and strength/conditioning initiatives. Instead, so many current strategies fail to recognize the importance of the opposite group’s work and keeping the athlete in a state of injury purgatory and underperforming.
DH: Is there a significant difference between the way college athletic departments operate as compared with how professional sports organizations conduct business? If so, how does this impact the way in which sport performance services are offered to athletes?
AH: You’d think that there would be a huge difference but unfortunately in many cases individual silos continue to separate great staffs – both in college and professional sports. In the college setting, besides elite level BCS institutions, both performance and medical staffs are often charged with multiple teams and are understaffed. Asking staff members to invest time into areas directly outside of their initial charge is often a difficult conversation and one that is met with great resistance – from both sides.
Besides a lack of time, the fundamental challenge as I see among sports medicine and performance areas is communication. Both areas surely want to do what’s best for the athletes whom they’ve been charged with but are unable to communicate with other team members because the is no overarching system or philosophy in place. Top level sports medicine professionals will never be able to communicate with traditional performance coaches who are barbell-centric, and top level performance coaches who understand movement, readiness, and recovery will never be able to discuss an athlete’s status with a sports medicine professional who only has the understanding or opportunity to reach for a bag of ice and electrical stimulation as their primary treatment option.
DH: You bring up some very good points Art. However, there are very few organizations currently doing this. Given the fact that many professional players’ contracts are worth tens of millions of dollars per year, does it not make sense to invest more in their preparation, injury prevention, monitoring and rehabilitation? In the college realm, athletes in basketball and football are bringing in hundreds of millions of dollars for numerous programs. It only makes sense to have the best people serving these athletes, does it not?
AH: You’d think that would be the case. Let me first say that there are many great performance coaches and athletic trainers in the college setting that go well beyond the normal call of duty and have instituted incredible programs. Unfortunately, these are not common place and instead are outliers or limited to only revenue sports as you mentioned above. The NCAA limits the amount of time one can spend in the performance area and additional time in sports medicine is often viewed by coaches as players being soft and not supported to the same degree. What has been instituted to protect student-athletes in many cases has only hurt overall development. As we discussed earlier, NCAA college football players all gain weight and strength over their four year period but very little, if any performance gains are ever realized with vertical jump height and 40 yard speeds rarely improving. Authors of the study we discussed suggested that these performance metrics were limited by genetics and fiber type and, therefore, one would not expect much improvement. I would suggest that lack of recovery, poor training methodology and general overtraining play a massive part in this equation. If the NCAA allowed performance coaches an additional 2 hours per week in the off-season to monitor and manage fatigue and run recovery sessions I think you’d see player health and performance improve dramatically.
DH: You mentioned sports medicine briefly, where would a top-level athletic trainer/therapist fit into the training model?
In an ideal setting a member of the sports medicine team would directly beside the performance coach. This type of “teamwork” is commonplace in track and field but, unfortunately, not so common in many team organizations that allow for silos develop among staff members. As you know, great track coaches such as Charlie Francis and Dan Pfaff have always had great therapists working directly beside them. When minor issues are observed on the track they are immediately addressed before becoming major issues down the road. I am reminded of the story you told me about Charlie sending an athlete home after warming up because he simply wasn’t ready to train that day, even though he didn’t complete one working set on the track. Great performance coaches and sports medicine professionals constantly evaluate and monitor their athletes.
DH: Okay, we’ve discussed may of the organizational challenges facing sport performance and sports medicine staff in elite college and professional sports. In your opinion, what are the next big movements in sports medicine and performance? This is always a big question for me because it seems that injuries continue to be prevalent and heavily influence the success of a team. Those organizations that cannot manage these issues effectively are doomed to fail. What are your thoughts?
AH: Derek, I hate to disappoint you but the next big movement will be addressing the two main challenges that I’ve outlined here today – reporting structures and treatment and training philosophies.
Let’s just focus on philosophy here as the reporting structure I think is self-explanatory and needs very little additional commentary. Within the last few years much has been made of regional interdependence within the therapy world, and rightfully so. However, what I’m suggesting here is not the traditional, ‘ankle-motion-affects-knee-pain’ model as one would suggest. Organizational philosophies moving forward will reflect an appreciation that all human biological systems are interconnected. Therefore, to maximize true athletic performance all systems must be considered and catered to at all times. Examples of such systems and sub-systems include, but not limited to, movement literacy, emotions, blood chemistry, breathing and rib kinematics, nervous system evaluation, vision, rest and recovery, sleep, intestinal health and nutrition along with the traditional health and performance systems. The next big movement in sports medicine and performance will be an integration of all subsystems under one philosophical approach in an effort to maximize athletic potential while mitigating injury and illness risk. All systems and sub-systems have the potential to either contribute to or harm elite athletic performance and all must be managed appropriately.
You can have the healthiest, most explosive athlete in the world peaked perfectly to play in the league championship but if he’s stressed out about whether or not his wife and family members have seats for the game and are safe walking to the arena from the parking lot you haven’t addressed all the components that affect health and performance.
Some people would say that the above example is not part of their job. This is just another example of people working in silos and ultimately harms the performance team. In my opinion, if it affects performance than it is your job and must be managed; if not directly then indirectly through discussions with player personnel and organization management.
DH: Thanks for taking the time to answer a few of my questions Art. It has been a great opportunity for me to share thoughts and ideas with you. I look forward to hearing more about your strategies for providing the best possible care and training for athletes. Your combination of work with athletes and coaches at Northeastern University, and your professional development opportunities provided by BSMPG have made you an important leader in the field of sport performance. Keep up the good work.
AH: Thanks for the interview Derek. Coming from one of North America’s top speed experts and performance consultants that means a lot.
For more information on Art Horne and the Boston Sports Medicine and Performance Group, please visit www.bsmpg.com and plan to attend the BSMPG conference in the spring of 2015. I will look forward to seeing you there.