Viewing Training Through A Healthcare Lens

Over the past several months, while researching different methods and systems for training, I’ve often landed on a home page explaining the ABCs of a given program. This would usually include a few action photos, a couple of catchy one liners, and some video examples: sprinting, jumping, lifting, and perhaps other standalone drills performed as part of a warm up or plyometric circuit.

Reading the comments and feedback from the consumers, I can tell that many of them are more enamored with the presentation and polarity of the program rather than the quality of the content. In other words, wrapping a philosophy up with a bow might make it look and sound great, but is it really doing what it claims? Additionally, does a philosophy holistically develop the athlete from the standpoints of speed, strength, agility, power, aerobic fitness, resilience, and technique? Or does it intentionally leave out certain aspects to pursue others ad nauseum? Are those aspects pursued at the potential risk of the athlete’s health and wellbeing? Are the right performance attributes being prioritized? How does each aspect in a given philosophy contribute or take away from performance?

These are a few of the questions in my mind when assessing any philosophy, whether in S&C, track and field, team sport development, academic study, or practical research—questions I don’t believe are thoroughly thought about nor addressed with enough intention.

Perfect Form for Lifts, but Not Sprints?

I currently run and operate a lone wolf, physical therapy clinic (one year) and athletic performance program (four years). When I am consuming information, working with physical therapy patients, or building programs, I often find myself switching and combining my roles and skillsets to help develop a more holistic picture of what is going on. Recently, most of the commotion on social media is generated around arbitrary outputs, whether it is lifting for max bar speed, max weight achieved, max sprint velocity, max effort, the list goes on.

In the presence of all of this max output, I find consistently that there’s rarely an emphasis on max technique, max finesse, max fitness, max resilience, or max strategic execution (outside of the weight room). Additionally, everyone is all about increasing speed reserve, but what about skill reserve? When I watch the videos, I am often in awe at how athletes at various levels can stay healthy while performing these exercises with blatant lapses in technique and posture, particularly in sprinting.

In the presence of all of this max output, I find consistently that there’s rarely an emphasis on max technique, max finesse, max fitness, max resilience, or max strategic execution. Share on X

I believe maximally performing sprints in this fashion creates ticking time bombs for various athletes in the form of injured hamstrings, shins, hip flexors, quads, feet, etc. Just as caution is demonstrated when overloading athletes in the weight room, I think it’s generally a good idea to allow technique to determine how often we push the limits in sprinting and other field-oriented activities (agility, deceleration, multi jumps, etc.) rather than forcing the output and hoping for the best.

This obsession with max outputs seems to have led many to forget that technique is often the limiting factor and that by solving the technical issue, the ceiling can be raised further in training density and in outputs. Ironing out the technical issues takes a skilled coaching eye and patience, as I’ve outlined in previous articles. In addition to identifying the technical flaw, the coach has to link it to injury risk so that they can make informed decisions with that athlete moving forward.

For example, when having an athlete squat in the weight room, most coaches would never have them put a bar on their back and ask them to max out if they have poor form. Why? Poor form shifts the concentration of stresses away from the desired muscles and towards more vulnerable muscles that aren’t ideal for bearing the brunt of the load in that given movement. Many coaches understand that this makes the athlete unnecessarily susceptible to injury and thus are typically on form patrol to ensure that doesn’t happen.

This obsession with max outputs seems to have led many to forget that technique is often the limiting factor, says @BrendanThompsn. Share on X

Acceptable form? Increase the weight. Sketchy form? Lower the weight. This concept is seemingly universally accepted and applied in the strength and conditioning community, most notably in the weight room. If the best ability is availability, why is sprinting treated differently?

Asking the Right Questions to Create Better Outcomes

When approaching training strictly from a performance standpoint, I often find myself watching and rewatching videos while looking for a set of qualities in the athlete or team, including:

• Intent
• Movement economy
• Subjective strain
• Other aspects of technique and execution

Along these lines, I start thinking about what I might change or reinforce. How might I cue them? What deficits do I see? What drills and other tasks might I give them to shift them to a better place on the mechanical spectrum?

These questions then begin to open up my physical therapy line of questioning. In the absence of a technical fix, what soft tissue structures are most likely vulnerable? What muscles are dominating this action and what tests might I perform to see if I’m right or wrong? Where are the major stresses occurring and why? Is there a reason for this compensatory pattern? What might my three biggest focuses be when building a preventative and corrective program for this athlete and why?

This is the type of internal dialogue I’m constantly having with myself to guide decision-making. It creates a cycle of using my physical therapy tools to help me design a performance program, while my performance tools often return the favor in helping me design a physical therapy program. Athletes are not simply performance machines where all that goes into performance is arbitrary output. Rather, they are a complex integration of psychology, biology, kinesiology, and other core sciences that make up the individual. Being complex organisms doesn’t mean that we have to expose the body to complex inputs, but rather simple inputs with strategic implementation that go well beyond being an arbitrary stimulus.

Athletes are not simply performance machines where all that goes into performance is arbitrary output. Share on X

Compare and Contrast: Sprinting vs Lifting

There is obviously a large difference between overloading a bar for a relatively unnatural movement sequence compared to maximally moving your own body weight in a rhythmic sprinting motion. A max squat and a max sprint only last a few seconds each, followed by substantial rest. Sprinting is a much more natural, (sometimes referred to as reflexive) motion than squatting and thus less likely to have the same magnitude of deficits as you may see in a squat.

Athletes have been running since their body allowed them to in early childhood development and the body has a way of self-organizing movement around its unique structure and function to get the task done. A coach can maximally sprint many in the general population without much risk, it just might not be fast. This is the side of the argument that says max sprinting is generally safer than max squatting, and I do agree that there is some validity to all of these points.

Let me paint a different picture, one that some may not consider when comparing the stimuli. Max weight room testing tends to be between 1 and 5 reps at a given weight (1RM, 3RM, 5RM,etc.), whereas a max sprint may be anywhere from 20-60+ reps (each foot strike is a maximal rep). In a typical sprint workout, you may accumulate that same amount of steps 4-10+ times. So overall, you’re accumulating 100s more maximal reps in repeated sprinting than in a max weight room test.

To take this a step further, a sound lifting program is maxing out 1-3 days per month at most. The majority of structured lifting occurs at submaximal loads, with max day being the reward for the athletes after a tough block of training. Maximal sprints are performed several times, sometimes 2 to 4 days per week. Over the course of the month, the athletes have performed anywhere from 8 to 16 days of maximal effort sprinting. This means the athlete has accumulated 1000s more maximal reps (remember each step is a max effort motion) worth of sprint work compared to maximal lifting.

Now we can consider velocity. The bar speed during max testing is likely <0.5m/s, whereas the center of mass may be moving between 7-11m/s during a maximal sprint. For perspective, that sprint velocity is at least 14-22x faster than the bar speed expressed during max testing. Additionally, each step of a sprint may create ground reaction forces up to 5x the athlete’s bodyweight. While a max lift may have similar ground reaction forces, the discrepancy of 1-5 reps compared to several sets of 20-60 reps (steps) for sprinting shows that the cumulative stresses the body endures with sprinting over a session will far exceed that of a typical max lifting session.

Each step of a sprint may create ground reaction forces up to 5x the athlete’s bodyweight, says @BrendanThompsn. Share on X

When thinking about overload and wear and tear, is the athlete more likely to sustain an injury pushing their body to the limit in weights during max week once every month or two, or during regularly programmed max effort sprints that they do all the time? How does technique amplify or minimize this?

This isn’t to say don’t sprint or that either exercise is superior to one another; it is more to conceptualize that max sprinting potentially induces far more stresses to the body than max lifting and that if coaches are wary of max lifting when someone has bad form, they should be equally or more cautious with max sprinting someone with hazardous technique too frequently.

The Concept of Skill Reserve

As mentioned before, speed reserve is often pursued endlessly along with a variety of other max outputs, sometimes at the expense of the skill that goes into those outputs. Speed reserve is the idea that the faster an athlete is at max output, the faster that athlete will be when operating in a submax capacity or under fatigue. It will be easier for them to achieve, carry, and repeat higher submaximal speeds than their slower counterparts.

Now I’ll spin this into a related concept that we will call skill reserve, efficiency reserve, technical reserve, etc. The more skilled, efficient, or technical somebody is when operating at max capacity, the more skilled, efficient, or technical they will be when operating in a submax capacity and under fatigue. This concept can be applied in a multitude of ways across sports, work, life, and other tasks.

Every sprint is an opportunity to build efficiency, coordination, power, relaxation, finesse, rhythm, and more. This is what makes sprinting potent. It is not the simple fact that the outputs produced are difficult to match anywhere else; more so, it is the combination of attributes and energy systems working together in synchrony that stress the body in a variety of ways that very few exercises can (if any).

Every sprint is an opportunity to build efficiency, coordination, power, relaxation, finesse, rhythm, and more. Share on X

As a workout wears on, the body must also learn how to operate under fatigue to maintain a level of proficiency to complete the task. If a fresh athlete has poor mechanics and an associated higher mechanical susceptibility to injury, that same athlete—when operating under fatigue—will multiply that risk by some factor as their mechanics exponentially deteriorate with each additional rep.

The body actively copes with the stresses induced on it during a workout and will compensate accordingly. If the task at hand is to get from A to B as fast as possible and the body is nearing a breaking point, it will sacrifice coordination and rhythm in the name of speed to achieve this goal. To see this in action, look no further than the final 100m of the 400m dash or 400m hurdles; watch the last 200m of the 800m or the final lap of the mile. The athletes that break down the most also tend to decelerate the most, oftentimes costing them a spot in the final or a medal on the podium.

In the context of team sports, as fatigue sets in with an athlete, watch how sloppy their quality of play becomes. Uncharacteristic turnovers, bad throws, poor shooting, giving up plays they typically wouldn’t—the more flawed a given skill is when fresh, the more that skill will deteriorate under fatigue.

In contrast, the most skilled athletes when fresh will still be operating at a technical level head and shoulders above their opponents and peers when working under fatigue. Watch a local high school conference championship and compare the 8^th place runner with the first place runner in how they look when battling throughout the race. Next, compare that experience to watching Olympians battle it out where the skill discrepancy is far less than at the high school level.

There’s a certain grace to elite performance that is often overshadowed by their brilliant performances and otherworldly outputs. Unless an athlete is at a certain standard of excellence already, it is extremely difficult to work on the skilled aspects of performance when operating in top gear all the time. It takes skill to demonstrate grace while operating at maximal outputs, and ultimately this balance is what leads many to expressing their optimal performance when it matters: competition.

There’s a certain grace to elite performance that is often overshadowed by their brilliant performances and otherworldly outputs, says @BrendanThompsn. Share on X

To add to the concept of skill reserve, it is helpful to revisit the idea of how fatigue impacts performance. While two athletes may have identical skill levels, the athlete who is more resilient to that fatigue will ultimately express that skill competency much longer than the athlete who is susceptible to fatigue and breakdown. Additionally, when comparing two athletes, an athlete with greater skill may outperform an athlete with lesser skill for a period of time.

But if the more skilled athlete has a susceptibility to fatigue that the athlete with lesser skill doesn’t, the skilled athlete may eventually perform worse than the less skilled athlete as a game or competition wears on. This is why it’s generally good to train holistically, as it addresses every aspect of the game rather than a select few attributes that may only last for a short period of time.

Applying Skill Reserve to a Training Program

To bring things full circle now and apply this concept to sprinting, it’s helpful to revisit the weight room equivalent. When developing form, technique, and precision for someone in the weight room, is it best to practice with max or submax loads? In other words, is the athlete operating near their max when working on technique, or with a weight that is manageable that they feel they have good control over?

The answer here is simple: the manageable weight. As the athlete demonstrates mastery at said weight, they’re allowed to graduate to the next weight to continue challenging their body under harsher conditions. Once they’ve demonstrated a level of competency that seems to prove to you that their form will only falter when they’ve encountered a weight that is too heavy, it becomes easier for a coach to allow them to test the waters of where their current ceiling may be because it is not as big of a perceived risk as it was before.

Applying this type of progression to sprinting is difficult. Athletes demonstrate different mechanics at submaximal and maximal speeds that don’t seem to mirror each other as much as might be preferred. An athlete may look like they’re jogging during tempo and like they’re fighting for their life when going all out. With sprinting, I tend to take a reverse approach to the weight room squatting example. Rather than starting them off jogging and whatever else, I want to get an idea of what they look like when they sprint first and go from there. Does it appear forced? Rushed? Weak? Exaggerated? Awkward? Hazardous?

Athletes demonstrate different mechanics at submaximal and maximal speeds that don’t seem to mirror each other as much as might be preferred. Share on X

After a quick video assessment, I’m able to see what their immediate needs are and correct them with cues. The athlete then takes these cues and does another max sprint (or several). If they appear to be struggling with the changes at max effort, it is time for submax reps for practice. Take the timer away, take the arbitrary distances away, and let them experiment with the cues where they feel most comfortable and have a sense of control.

Repetition for these athletes will be their best friend in making meaningful changes. As a coach, it is important to problem-solve to find a way for the cues to click for them. This can be achieved by exposing the athletes to a wide variety of feedback, constructive drills, and positive reinforcement. Once an athlete has reached this point, I spend a large portion of time addressing these factors each session and then periodically letting them test the waters with what they’ve learned. I dial the sprinting back for the same reason we start athletes with lighter weights in the weight room: they need to be under control to make necessary adjustments.

I dial the sprinting back for the same reason we start athletes with lighter weights in the weight room: they need to be under control to make necessary adjustments, says @BrendanThompsn. Share on X

Patients that exhibit movement faults in my clinic don’t tend to respond well when the exercise is graded too high. Take, for example, a patient with a hip drop and the posterior gluteus medius not doing its job during the gait cycle. If I start them on a difficult exercise that exceeds their capacity for controlling the hip drop, the likelihood of that particular exercise improving the gait fault is slim to none.

So, it’s necessary to grade down to the nearest level where they demonstrate control, but still challenge them. As they demonstrate competency in the exercises or tasks I’ve given them, they can dip their toes in the water of more demanding tasks for better carryover and eventually conscious manipulation of the task I am trying to correct—in this case focused gait training with typical circumstances (variable surfaces, variable grades, distractions, stairs, differing speeds, etc.).

I look at sprinting and other training the same way. If I see faults at X-intensity that the athlete can’t consciously correct, the likelihood I can make meaningful mechanical changes at that intensity is low. Grading that level of sprinting down to a lesser intensity and searching for the sweet spot of controlled yet challenging will yield greater benefits to the athlete from a technical standpoint. In similar fashion, as they demonstrate some competency, it’s great to graduate the athlete to the next level or allow them to experiment with their new skills at max output to see if the carryover is there. If it is, awesome! If not, it’s my job to figure out why and what I can do about it.

Training is one big experiment with each athlete I encounter: finding what works for whom, when to implement it, and to what degree while continuing to assess strengths, weaknesses, and how I can continue to holistically build the athlete throughout.

Training is one big experiment with each athlete I encounter, says @BrendanThompsn. Share on X

Submax, Tempo, and Technical Mastery

I know up to this point it probably seems like I am against max sprinting but I most definitely am not. As a high level sprinter who has been exposed to long, slow training and short, fast training, I know there is a balance that must be struck to achieve optimal results. Too long and too slow builds the aerobic system more and won’t develop fast twitch fibers to the degree they need to reach the speed ceiling.

Conversely, too much short, fast training will yield a very explosive athlete who may not have the gas tank to repeat performance or even sustain a highly technical performance for a single repetition. Breakdown may happen prematurely, and as mentioned earlier, technique decay increases injury susceptibility, especially at maximal outputs.

Technique decay increases injury susceptibility, especially at maximal outputs, says @BrendanThompsn. Share on X

I am a big fan of maximal sprinting and a big fan of technical training, whether through tempo, drills, or submaximal sprinting. Many of you may be reading this and thinking submax sprinting and tempo are the same thing. By definition, submax just means anything under an all-out effort, so yes, tempo is technically submax sprinting—but I differentiate the two.

I look at submax sprinting as dialing the thermostat back from 100, to 99, 98, 97, etc. until I find the point at which the athlete can still run extremely fast while sustaining control. It looks and feels like a sprint, but without operating with the pedal to the metal. Conversely, tempo is a much slower, controlled, rhythmic type of run that helps the athlete learn how much effort they need to give to hit x pace, minimizing strain, and maximizing repetitions. Athletes that display control with tempo and submax sprinting tend to show some level of carryover in their skill mastery when resuming max sprinting.

The transitory period between submax technical improvements and testing the waters in max sprint carryover varies from athlete to athlete. Some athletes may catch on fast and be ready to implement relatively quickly, others may take more time before seeing meaningful changes made in that domain. Athletes will progress at their own pace, with a tendency for novice athletes to take a bit longer than those with a higher training age and maturity. Additionally, athletes that have gone through a significant growth spurt recently will have difficulty developing that coordination in a timely manner, as their body must reform connections to catch up with its recent changes.

Athletes will progress at their own pace, with a tendency for novice athletes to take a bit longer than those with a higher training age and maturity. Share on X

Technical changes that need immediate intervention tend to stand out in a bad way on video. A short list might include:

• Wild arm swing
• Excessive trunk rotation
• Lack of postural awareness
• Degree and progression of body lean
• Heel recovery
• Foot strike
• Hip and knee mechanics
• Head control

Some reasons for fixing these items include:

• Energy leakage
• Efficiency
• Power outputs
• Excessive stress to soft tissues
• Poor timing and sequencing
• Excessive braking
• Insufficient propulsion
• Other factors that may lead to suboptimal performance and injury

Excessive casting of the knee in a sprint places the hamstring in a lengthened position and typically the most vulnerable position. Now imagine an athlete does this habitually over 1000s of steps over a training period. This is where the ticking time bomb I referenced earlier tends to come into play in the form of a hamstring tweak, pull, tear, tendinopathy, tendonitis, etc. The injured athlete must then go to their primary care provider, athletic trainer, physical therapist, and/or other supporting staff to help remedy the situation through rehab, training modifications, and other means.

In the absence of a meaningful technical change, the athlete will go back to sprinting the same way they did before and the likelihood of another injury to the same tissue is greatly increased. The process is likely to repeat itself again and again. If you do what you’ve done, you get what you’ve got.

If you do what you’ve done, you get what you’ve got, says @BrendanThompsn. Share on X

This is one of many examples to illustrate the cumulative stresses of sprinting and the cost of poor technique. It’s not to say that sprinting is inherently dangerous and needs to be avoided, it is more so to say that in the absence of technical coaching, a sprinter with poor technique may underperform, increase their risk of injury, and subsequently, battling that injury over time will lead to chronically underperforming and further injuries.

My career progression is a great example of this as my high school peak was 10.98s 100m and 22.41s 200m my senior year, which wasn’t much better than what I ran as a freshman in high school (11.12s/22.83s). I trained, but I never understood there was strategy in racing, value in technique, or levels to performance. I just went for it every single day and only ever knew one gear: GO.

After entering college, I shaved time consistently each season, eventually achieving 10.57s/21.18s, a sub-21.0s time trial in practice, a 46.2s 400m split, and a 9.4s split on an All-American 4x100m that ran 39.12s at the NCAA Division I Outdoor Championships. With the help of coach Joey Woody, I was able to mature as an athlete and really understand how to apply the skill that allowed me to progress the way I did. This led me to eventually have the most healthy and prosperous season of my career.

I’m a sample size of n=1, but I’ve personally witnessed athletes all over the country follow similar progressions. Learning sprint technique was career defining for me and it took me really dedicating myself to learning the art of sprinting to finally have my moment in track and field.

Taking it to the Track

In summary, the current state of training is heavily focused around arbitrary max outputs, particularly in sprinting, without the appropriate technical focus needed to balance and hone those max outputs. I have found success in sprinting 2 to 3 days per week for advanced sprinters, but the largest improvements I’ve seen in performance have been through technical training and changing the speed demands of sessions to balance output with requisite posture and technique. Being willing to take the time to identify technical faults and iron them out has been one of the hardest, yet most fulfilling changes I’ve made to my program. It should not be beneath someone to slow things down to work on these alterations.

Lessening the loads in the weight room to refine technique and control is intuitive, and sprinting is no different. A submax sprint, tempo running, or other methods for instilling technique have been some of my most fruitful uses of time to complement the output aspect of training. Going 90-95%, while less physically demanding, is extremely demanding from a technical perspective. The cognitive demand during the task makes the submaximal efforts more demanding because it is working against the athlete’s natural tendencies, requiring total concentration throughout.

Taking the time to experiment with different cues, drills, and demonstrations to help my athletes understand what they’re doing and what is expected has helped them piece together better tendencies and many eventually have massive breakthroughs in their performances, all while staying healthier along the way.

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