Webinar led by Dr David Hancock
Why do People get Injured?
Duration: 1 hour – cumulative hours: 71.75
I did a little bit of research into Dr David Hancock’s background before the webinar because I was interested to learn about his CV and professional experience. He has a very impressive CV having worked in professional rugby and football in the UK and with the New York Knicks in the USA. I also learned that he has worked with some high profile footballers, football coaches and musicians and is now CEO of Apollo MIS which is a software company that helps coaches, players and parents communicate and uses objective data and sports science to assess an individual’s performance, strengths and weaknesses. The system is used by Manchester United FC, Nike, AC Milan and the Washington Nationals. During lockdown his company has set up a phone app to allow UK football clubs to keep a check on player fitness, diet, mental health and sleep patterns.
The webinar focused: on Dr Hancock’s philosophy on injuries and physiotherapy; the blind screen approach to treating clients; what makes a great physio and the ingredients a physio needs to be successful; the toolbox for a physio followed by a Q&A at the end.
During the webinar the host asked Dr Hancock questions to stimulate the discussion.
- What are your thoughts on injury and physiotherapy – how has it changed over the years?
During Dr Hancock’s long career he has seen a dramatic change in the manual side of therapy. There is a cross-connection between osteotherapy and chirotherapy and not everyone has the perfect answer regarding the best approach to treating an injury. Physiotherapy isn’t always exact like in the textbooks and practical experience is one of the main contents of the physio’s toolbox. His advice was to adhere to the main principles of rehabilitation and not jump stages too quickly.
- What comparisons re learning would you take from working in Rugby – how has it developed?
In Dr Hancock’s experience working in the field is very different from working in the clinic. Therapists are under a lot more pressure and there isn’t a lot of time for mistakes.
There is a lot more objective data available now than in the 90s which enables therapists to see the progression lines but the data is not the be all and end all. There has been a huge shift between manual therapy and where it currently sits in our profession. Rehabilitation is the component that is missing in private clinics because there are more time constraints for therapists when they only have 30 minutes or an hour at a time with their patients.
The body is resilient and can cope with more load than we generally put on it. Manual therapy isn’t everything and there is less recurrence from injury when the rehabilitation component is included. The toolbox should include a mixture of both manual and rehab therapy. It is an art to know when to progress rehab or when not to. Rehab is specific to the individual because everyone responds differently. Sometimes it is better to do nothing and let the body repair, so rest can be the better option. Therapists also have to respect the healing process.
- The Blind Screen Approach
When assessing a patient ask yourself the question ‘Why did the injury happen?’ Dr Hancock carries out an orthopaedic-holistic assessment without knowing anything about the patient. The assessment involves palpating tissue and bony points and movement. When the patient moves it is possible to see flaws in the kinetic chain that have developed as a result of the body adapting to allow it to move. Whatever injury we incur, the body will still move. Sometimes the body doesn’t rehab from a previous injury properly and it adapts. During the adaptation, the body creates flaws. By identifying and addressing specific flaws you can begin to put together a package which may not be specifically related to the current injury (secondary) but related to the flaws that developed from earlier adaptations to a previous injury that did not rehab properly (primary).
It is good to listening to other people’s ideas and philosophies on treating patients – there are different approaches that are safe and still get results. Dr Hancock however is more interested in ‘Why’ an injury happened and it is a question that we sometimes don’t ask.
Rotation of a joint is a problematic issue in torque control and is the area where the most force control comes from. The body needs to be able to stabilise one area to allow another area to move. Rotation and stability are important elements. If a previous injury has not been rehabilitated properly overtime we end up with tissue and joint adaptations that lead to dysfunction. There should be more emphasis on rotation/stability elements.
Another thing that is missed during early rehab is isometric holds in different planes to activate a muscle. For example – the Achilles tendon twists – isometric holds should therefore be held in different planes. The Talus not only DF and PF, it also slightly abducts and adducts which needs to be considered when performing isometric holds.
Understanding physiology and recovery is important for effective rehab. When prescribing exercise it is important to consider the demands of the athlete’s sport. Practitioners are taught to be safe however exercise prescription is not enough to build resilience, to enable the athlete to cope with the demands of their sport.
Dr Hancock has changed his approach over the years. It is important to prepare the body to move and be resilient in both prehab and rehab and focus on balance, neural, pelvic, hip and lumbar spine. When observing an athlete it is better to see them moving without their kit on to establish how they move, what is moving, what isn’t moving, can they balance, can they exert control of movement, to identify flaws and dysfunction. Observing an athlete using the blind approach is more basic but you may see more than you would using a force plate or a Nordic board. Basic observation allows you to see more than the technical kit.
Dr Hancock in response to a question from an attendee in the webinar said that currently there was no protocol available for others to use to practice the blind screen approach. He is an old-school practitioner and is too busy at present to write or publish work. He did say however that if there was enough interest he would be happy to do a practical session in the future.
At the end of the session there was a Q&A session.
Listening to Dr Hancock talk about his experience and his approach to prehab and rehab was very interesting. I can identify with some of the pearls of wisdom that he imparted. I found his explanation of the blind screen approach fascinating. I can understand how it is possible to be led down a route that may not resolve the primary cause for dysfunction by the information collected during the subjective assessment of an athlete. I must admit that the format of the webinar was not exactly what I was expecting. I visualised it as more of a presentation demonstrating how the guest speaker worked with injured athletes using his ‘blind screen approach’. Instead it was more like a Q&A session or a podcast. I did however find it very interesting learn about Dr Hancock’s experiences over his career. I would be very interested in attending a practical session should Dr Hocking and Physique organise one in the future.