#014- Thinking differently about objective testing...

Imagine you are lost and driving in the middle of a foreign country… you and your passenger have a deadline to reach your destination, but there’s nobody else around to ask for help. How would you find your way, and how would you know how long it would take to get there?

Scenario 1:

Easy. In this modern age you could just whip out your phone, open the Maps app, punch in the address, and click GO (making sure to avoid toll roads of course). You would get there in the time it tells you by following the exact roads and speed limits it suggests.

Scenario 2:

Now what if you didn’t have your phone? Well hopefully you have one of those old school physical maps that you can follow along with your finger and a pen. You would have to keep an eye on the street signs and look for landmarks as well to ensure that you are in fact on the road you think you should be on. You’ll be able to get there, but you’ll have to stop periodically to pull over and re-orient yourself.

Scenario 3:

There’s no phone, and no map. You’re purely relying on following street signs (that you can barely read because they are in a foreign language). You would want to hope that you can find a service station soon to ask for directions, otherwise you’ll just have to keep driving in the hope that you eventually see something that gives you the confidence you’re on the right track. Lets hope you don't run out of fuel!

Where am I going with this?

When guiding an athlete through a rehab program, the athlete is the driver and you’re in the passenger seat giving directions. The destination you’re both trying to reach is a successful return to their sport.

Wouldn’t it be great if there was an iPhone Maps type app that could guarantee you’ll reach that destination within a particular time frame! You could put your feet up on the dash and listen to Spotify while the athlete does all the work.

Unfortunately, this doesn’t exist (yet… who knows with the future of AI). Injuries are far too multi-factorial, and the rehab journey is ever evolving. Set-backs, barriers to completion, and psychosocial influences are going to creep up on you like toll roads. So in the absence of this super AI rehab robot, scenario 2 is where you need to be playing.

If you want to give both yourself and the athlete confidence and direction in your rehab plan, you need a map that you can follow, and you need to refer to this map at scheduled stops along the way.

So where do we find this map? Good old objective testing. What I mean by this is meaningful strength and performance testing that gives you a numerical output.

The equipment that I frequently use to do this are force plates and hand-held dynamometry. If you’ve ever come across the AxIT System or VALD Performance technology before, then you’ll know exactly what I’m talking about here. This technology has been around in the research and performance spaces for years, but it feels as though it has only recently risen in popularity in private practice.

For the first four years of my career, I relied on tests like how many calf raises somebody could do, and using my hand to "feel" how strong they could push against me (MMT 5/5 for literally everyone). Now that I've learnt more about performance testing and have become familiar with using the tech, I realise that I was playing in scenario 3. Those unspecific markers of improvement I used to rely on were just street signs, and I still had no idea where I was really going.

You need numbers. Real numerical values for how strong or springy an athlete is.

You can measure things like how much difference there is between limbs, how much force they can produce with particular movements relative to their bodyweight, and what their flight time and ground contact time is when they're jumping.

You can then use these numbers to guide your exercise programming, set targets and milestones, and to improve the athlete's adherence and buy-in to the program (essentially, giving you both a map!).

Soon this technology will become the norm, and athletes of all abilities will be expecting it to form part of their experience with you as a podiatrist working in injury rehab.

Street signs and landmarks are still super relevant, such as how an athlete feels and their movement quality. You definitely should stop and look at these things along the way, but you can't rely on them as your only measurement of progress. You need to refer back to the map (re-test), and let the data inform your decision making, as at the end of the day you can't hide from the numbers!

So my question to you is this: what strength and performance tests do you feel are most relevant to podiatry?

More on this next week...