Freelap Friday Five with Matt Taberner
Matt Taberner is an experienced practitioner who spent more than 12 years working within the English Premier League. He joined Everton Football Club in September 2013 as assistant first team sports scientist and was promoted to the role of Head of Sports Science in June 2014, before becoming Head of Rehabilitation from July 2017 to August 2019. Previously, Taberner spent six years at Aston Villa Football Club as Lead Academy Sports Scientist.
Taberner holds a B.Sc. in Sports Science and an M.Sc. in Sports Nutrition and has received an NSCA-CSCS qualification, a British Weightlifting accreditation, and an F.A. Fitness Trainers Award. He is currently studying for a Professional Doctorate at Liverpool John Moore’s University, investigating effective return to sport processes in elite football, alongside completing the BASES High Performance Sport Accreditation. He has published articles in the British Journal of Sports Medicine, Science and Medicine in Football, and the NSCA’s Strength and Conditioning Journal.
Freelap USA: You decided to include videos in your research—how does that help coaches and therapists specifically? I would imagine that the inclusion of videos helps professionals understand the nuances of technique and the need for proper progression.
Matt Taberner: The idea for video content alongside my research was to add an additional qualitative element and provide a distinguishing feature in face of the ever-changing publishing landscape. The aim was to provide the reader with visual details for exercise technique, exercise progression, and on-pitch conditioning while providing an extra layer of evidence for my research. When it comes to topics such as exercise technique, it’s very easy to list the exercise(s) performed within a research paper, but readers learn few details on how the exercise was executed in practice.I share video content alongside my research to provide readers with visual details for exercise technique and progression and an extra layer of evidence for my research, says @MattTaberner. Click To Tweet
This is a very important component because if an exercise is performed incorrectly or with poor form, then how can we expect to achieve the required adaptation? Furthermore, how do we provide progression, especially in the context of rehabilitation? A great example of this is a recent editorial in the British Journal of Sports Medicine, which crucially highlighted for readers what the stages of the “control-chaos continuum” looked like in snapshots of session content. This provided context to the actual delivery of the framework in practice. I’m hoping this will encourage more practitioners to share video content alongside their work, so we can all learn from each other and work to bridge the gap between academia and applied practice.
Freelap USA: The sliding hamstring curl can be done with different equipment and change the demands enough to warrant a discussion. With slide boards, suspension options, and even eccentric overload, can you describe in detail what you find to be good for early rehab and what may be a good off-season option? I am sure you can’t just randomly assign the exercises to athletes.
Matt Taberner: The sliding leg curl (SLC) is a very adaptable exercise, for which I outline several different variations and exercise progressions within our article in the NSCA Strength and Conditioning Journal. First and foremost, it is important to consider the athlete’s ability and training age, and what is an appropriate variation to include and when to include it during their rehabilitation process following a hamstring strain injury (considering tissue healing). During rehabilitation, as outlined in our piece in the BJSM, I would look to implement optimal loading with the aim to induce increased tensile strength, collagen reorganization, and increased muscle-tendon unit stiffness.
Although I mention these mechanistic effects, the future challenge is to study these processes in vivo. Early on, isometric exercises such as heel drives (overcoming isometrics) provide an ideal mode given the restrictions within the early healing phase, progressing from submaximal to maximal efforts, and repeatable maximal efforts (in cluster format). Additionally, long-lever isometrics would be included—i.e., double-leg isometric hip extension (yielding isometrics)—adding more load, before progressing to single-leg (SL) variations to target the injured limb.
Dynamic strength exercises such as the SLC would then be progressively included, starting with double-leg (DL) eccentric and progressing with design parameters (reps/sets/tempo, etc.) emphasizing the athlete actively driving the heels down into the Valslides/slide board pads to generate tension throughout the hamstring musculature. The athlete’s hip extension strength-stability would be a key determining factor for whether to switch to the SL derivative of the SLC. Again, the intention is to develop strength at the longer lengths, but ensure hip extension is maintained while undergoing knee extension (eccentric phase) with maintenance of good technique.
Overload can be provided in the eccentric phase of the exercise using resistance bands. This challenges the athlete to resist and brake against the pull of the band, controlling knee extension while maintaining hip extension. Unless the athlete is competent (i.e., has good exercise technique), the use of eccentric overload is likely unwarranted. Suspension options can be used—Siff would term this a form of “imperfect” training. Again, it depends on what type of adaptation you are trying to achieve and whether the athlete is competent at the exercise in question.
In terms of off-season options, an appropriate derivative of the SLC can be programmed to maintain a training effect (strength of hip extensors/knee flexors) with minimal equipment required to perform either the DL or SL options (eccentric or eccentric: concentric) or, in the case of the Nordic hamstring exercise, where a partner is required to hold the ankles.
Freelap USA: Chaos is sometimes a messy concept, but you came up with a continuum for return to play. Can you expand on possible mistakes that are common with even the experienced sports medicine professional? Lots of return to play strategies look good on paper but end up having setbacks.
Matt Taberner: The concept of chaos can be a difficult one to determine, but with reference to the “control-chaos continuum,” we refer to chaos in a sport-specific context—i.e., attempting to simulate the variable, spontaneous, and unanticipated movements that reflect the unpredictable nature of sport. Chaos in sport is not running in and out of poles or chasing someone like in an invasion tag game; there are no aspects here that challenge the neurocognitive system in the same manner that occurs in professional sport. The challenge is for practitioners to analyze qualitative data (video content of match play or training); identify specific player traits, movement patterns, areas on the pitch (heat map); and try and recreate those scenarios specific to the individual. They need to do this in combination with the running load demands, target energy system conditioning, and technical aspects of load such as passing, shooting, or crossing, while also understanding the healing process.Every injury and player is different, so it’s important to use a considerations-based approach involving the entire interdisciplinary team planning the rehab process, says @MattTaberner. Click To Tweet
Consequently, because of the number of considerations in the return to sport (RTS) process and the balance of risk to reward—i.e., player being available for the team or delaying return—it’s understandable that mistakes can occur even with the most experienced sports medical professionals. Sharing information on the RTS process in formats such as case reports and educational reviews helps to educate other practitioners while also promoting that rehabilitation should not be a rigid protocols-based approach. Every injury and player is different, and it would be negligent, for example, to treat every hamstring strain injury with the same rehabilitation protocol. This is why it is so important to use a considerations-based approach involving the interdisciplinary team to plan the rehabilitation process following each injury, and the team shares in the decision-making process to help facilitate an optimal outcome for both the player and the team.
Freelap USA: Hamstrings are not easy to rehabilitate, but some are harder to rehabilitate than others. Your return to play outline was positively received, but I am sure you could say more now. Do you have any additional recommendations to handle the psychological factors of working with an athlete who was injured and could be hesitant to go hard?
Matt Taberner: The psychological influences upon the RTS process vary, with the degree to which these impact the process dependent upon the gender of the athlete, inter-individual differences between athletes and injuries, and injury reoccurrence. One of the benefits of the RTS framework we proposed was that phase progression, supported by strength and power diagnostics, and the absence of both pain and effusion show the athlete they are making progress on their RTS journey. Once the athlete moves into the sport-specific phases (control to chaos > high chaos), the structure of training becomes more aligned to the training structure of the team, again highlighting progression to the player.
Communication between the athlete, rehabilitation coach/scientist, and medical team is integral to this progression, making sure the process involves all of them and they know and share the same outcome goal. Ensuring all members of the interdisciplinary team relay the same message is another important factor, as miscommunication may cause unnecessary distress to the athlete. Once the athlete reaches the high chaos phase, emphasis is placed on designing worse-case scenario drills (within the rest of the proposed session content), as speed or speed-endurance conditioning becomes the focus. Objective information serves to provide the practitioner with confidence that the athlete is ready to achieve/sustain higher speed and, thus, able to handle the given musculoskeletal demands of the applied external load.
In the case of hamstring strain injuries, drills that attempt to mimic the mechanism of injury can provide the athlete with confidence that they are ready to return to the team training environment, especially interacting with other players in positional-specific contexts. In cases of severe, long-term injuries such as ACL reconstructions, there should be communication with the athlete at all stages, providing them with evidence they are making progress (goal-oriented using objective information) and ensuring a phased return to competition in which the coach is involved in the process to identify that the athlete is displaying the typical playing traits that they had prior to injury. Ultimately, match selection and athlete-coach communication serve as an extra layer in the communication network on the journey toward a return to performance.
Freelap USA: Jumping and plyometric exercises are popular but often done for more cultural reasons or for glorified warm-ups. Is there anything you suggest coaches do differently with injury reduction and for continual athletic development? I am sure you have some ideas on better ways to train than passing over a few mini-hurdles.
Matt Taberner: I think needs analyses of the sport, athletes, cultural barriers, training structure, and way the coach wants their team to play are really important factors for designing an athletic development program within soccer and other team sports. In the modern era, it is far too easy to jump onto social media and watch others perform exercises that look glamorous and spectacular, but do they meet the needs of what you want to achieve for the athletes on your team? I’m not dissing social media, by any means—it’s a great vehicle to share research and opinions, which help you reflect upon your own practice.Analyzing sport demands will help practitioners identify the key athletic qualities they need to train, which should simultaneously help reduce injury risk, says @MattTaberner. Click To Tweet
Analyzing the sport demands will help practitioners identify key athletic qualities that need to be trained, which should simultaneously help to reduce injury risk. Furthermore, the training structure will dictate how these sessions are implemented within the program (i.e., when we should expose athletes to the damaging nature of eccentric-type exercises), and the content of outfield training sessions should help the practitioner design appropriate warm-ups to develop and prepare the athletes for the session (i.e., acceleration/deceleration qualities for intensive training in restricted areas).
Additionally, training should look to progressively overload players where appropriate in the season schedule. (This can be difficult in the English Premier league, given game turnarounds.) Soccer may be able to learn from other sports such as rugby and American football, where teams split into units to work on specific qualities in relation to their positional demands (e.g. full-backs, over/under-lapping, context specific speed/speed-endurance drills).
Due to monitoring of the load demands of match play, it would be logical to use the external load data objectively (i.e., conditioning of maximal intensity periods), but doing it in a sport-specific context rather than just running in straight lines. Note that running in straight lines has a time and place to overload specific conditioning qualities in the post-match period for athletes who do not play or as additional top-ups to training (post-session), but it’s important that the practitioner has a solid rationale for the integration within their programming.