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A recent study, led by Jan Ekstrand (2021), analysed trends in injury rates among male professional football players across 18 seasons. They identified a decrease in injury trends as well as an increase in player availability in both training and matches.
In the Australian Football League (AFL), recent results seemed to show stable injury rates and missed matches, as the player-salary costs remained stable too (Eliakam et al, 2020). In the National Basketball Association (NBA) recent results showed an increased in injuries (unique injuries) and games missed due to injuries (Torres-Ronda et al, 2022).
Nonetheless, what seems to be pretty consistent across the industry is that injuries cost money, and a few studies are starting to prove (objectively with data) they cost performance (success) too. And from the team and the individual perspective, every time we hear about a main injury in a player it makes me think, ‘here we go again; how these type of injury still occurs so often?’ or ‘why so many occurrences of this injury?’
The first question I want to pose is: what are we doing wrong when it comes to injuries, and are there steps we can take at an organisational level to buck the trend?
If we study the injury data that has emerged from the NBA in the last four years we can see that the occurrences of injury are increasing despite ever greater resource being poured into injury prevention.
It is in everyone’s interest to fix the situation, given that injuries cost both money and success. Beyond the bottom line, there is also the disruption to your team. When important players are absent it can increase the pressure on the rest of the roster and your coaching staff, as well as increase the working hours of your performance staff behind the scenes.
Risk-reward
Firstly, should we use ‘injury prevention’ or (managing) ‘injury risk’? Sometimes semantics can make us rethink what we’re doing. With ‘injury prevention’, we often see more of a focus on strength training exercises, whereas ‘injury risk’ allows an assessment of the likelihood of an injury occurring and enables decisions to be made to reduce that likelihood.
Of course, an opponent could step on a player’s foot at any time. There are things that we can control and others that we cannot. The schedule is not going to change, so could it come down to minute-management? Is it worth a player playing the second night of back-to-back games, with a high cumulative minutes (for his age, experience, strength levels, team’s season performance)? What other factors are coming into play? I believe decisions should be made in a risk-reward context.
With this in mind, what injury trends are you noticing with your teams? How have your internal review processes evolved to manage those trends? The greater investment in injury prevention has created a lot of moving pieces and still the injury numbers are ticking upwards. In the NBA, it is load-related, with tendon and ligament injuries on the rise (specifically, knee injuries).
There will inevitably be differences between teams, which could come down to playing style, the choices of the coach, or simple bad luck during any given campaign, but this tells me that we should be reviewing internally what we’re doing with our athletes.
With frameworks for decision making and tools such as strength assessments, biomechanics, and ultrasounds, among many other assessment tools for internal and external loads, and players’ subjective perceptions of fatigue ratings, we can have information about many aspects of the athletes’ day to day. But how can we use this information and communicate it to coaches and the various stakeholders to make a better decision around whether or not a player plays tonight or for how many minutes?
When staff are making assessments, are they allowed to do their jobs, and by this I mean, how is your player buy-in context and organisation support? Are we doing the right testing, at the right timings, and analysing the right metrics? Are the players using their time in the right way to promote injury prevention? Is it important to track and classify their drills for injury risk as well as for conditioning and performance? Which types of statistics are we using? Are they correct? Should we review deeply our resources, what we can realistically do and expectations about the risk of injury?
The missing piece
It is also important to consider the culture of a franchise. If a coach has been in tenure for three, five or more years they likely have more trust and stability for long-term processes. Such scenarios stand in contrast to some franchises where ‘you lose three games in a row and the coach is fired’, making the environment more unstable, and depending on how it affects the staff, more volatile. For those coaches, it is hard to say ‘we’re going to develop this player and every 20 games he’s going to rest for one game, depending on the opponent or difficulty of the game.’ They need to be successful today and they’re going to squeeze the sponge or play the cards that they have.
Sticking with the NBA, when a franchise is bringing in college players or players from overseas they will inevitably be impacted by the schedule, which is between two to three times the length (or congested fixtures) than the European average season. How should we manage those players and introduce them to their new context?
When the European competition increased the number of games there was also a spike in injuries and severity. The schedules are unlikely to be reduced in any corner of the globe, so the issue becomes: how do we handle that? Do we need bigger squads? Do we need to have greater rotation? Do these need to be enshrined in the rules?
And what is happening in those moments that we can’t control? What are the athletes eating? What are their habits? Their professionalism? Their education in their own bodies and recovery? I think we’re making steps in general in the sports community because we have more professionals, more education, more investment in food, but then why are injuries increasing, or not significantly decreasing?
In addition, I don’t think we have enough good data to know why injuries are happening. The impact of data collection and analysis is another consideration, particularly when considering risk-reward and decision-making. When using that data, are we being too conservative? Are we using the data against our interests? Or are we pushing too much because of pressures (including players’ desire to play)?
It can also depend on the sport or the league. There are some risk management systems that have access to datasets on multiple teams and sports; they might be able to call upon injury or tracking information.
What are we missing in the analysis? We might be getting better at some things with injuries but there’s still the trend of injuries increasing. Should the leagues be more involved? because nobody wants the star players missing, not teams, fans, media or the broadcasters. As a league, how could we have a database where people submit anonymised information that can lead to analysis? I venture to say that injury analysis is way more complex than the way that we’re attacking it, and that we are probably ‘missing something somewhere’.
Lorena is one of six Leaders Performance Advisors, a group of leading performance thinkers providing more subject expertise to our member-only content and learning resources. To find out more about all our Performance Advisors, click here.
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By John Portch
“And the sense of leading or inspiring others to do things they don’t necessarily think they can do.”
Miller is speaking at our latest Keiser Webinar, which was titled ‘Developing the Person and the Practitioner’. He is joined by Duncan Simpson, the Director of Personal Development at IMG Academy and moderator Dehra Harris, who serves as Assistant Director of High Performance Operations at the Toronto Blue Jays.
The trio explored people development on a personal and professional level; what is done well, and what could be done better.
Scaffold your development as you scale
You are perhaps never at a better time to restructure than when you have reached a low ebb. Miller explains that British Fencing currently has just one podium athlete but that he, in his role as Head of People & Culture, is working with the wider team to build elite foundations ahead of the 2032 Olympic Games in Brisbane. He says: “[We want to] create an environment where people learn from whatever lens they’re viewing the programme through – be it a coach, be it an umpire, be it a parent or stakeholder in the journey – we’re building those world class foundations to grow and scaffolding the learning as we go through without having too much expectation placed on the individual athletes.”
The IMG Academy, which is based in Bradenton, Florida, serves 1,300 student-athletes across eight different sports, and employs over 800 staff. It is more advanced than British Fencing in its efforts to scale and support development but, as Simpson explains, there is a constant process of breaking down the silos that form between subject matter experts. For him, the key lies in its structure where the four facets of student-athlete life – school, campus life, sports and athletic & personal development – are given an almost equal footing. “How organisations are structured actually plays a massive role in the processes and how we see collaboration.”
The power of informal learning opportunities
Structures are important but culture also has a role to play and this informs the thinking around the Toronto Blue Jays’ new training facility, as Harris explains. “If we only meet separately then it doesn’t work,” she says of the staff based at the 65-acre Player Development Complex, which opened in Dunedin, Florida, in February 2021. “Having times where we’re socially together across disciplines helped and not just jumping into meeting structure but having five minutes of shooting the breeze where everybody’s just talking as humans. We recognised that we needed to shift from this relentless productivity of Zoom.”
Performance staff and coaches are also brought together through what Harris calls ‘intentional collisions’, a process that is also popular at Google. She says: “Strength & conditioning sitting down with hitting, we’re going through a bunch of players, we’re looking through an S&C lens and a hitting lens and we’re talking about a specific hitting goal. That’s a place where we’re anchoring a goal but maybe bringing people who aren’t always in the same room together.”
Do with not to the learner
“I need to have a ‘see, feel, hear’ sense of what’s going on so that I can, with the rest of the team, support [the athlete’s] learning in a way commensurate and at a tempo which is good for them,” says Miller. “Hearing, and feeling, and sensing what’s going on with the learner and how we build the learning around them in their context is really important.”
He sums it up with a pithy aphorism: “do with not to the learner.”
At IMG Academy, Simpson tells the virtual audience that learning is divided into three buckets: what the individual prefers to improve in, what they’re required to improve in, and where they are actually improving. He says: “It’s getting an understanding of those three elements. The actual development part is ‘maybe I can have a little impact there’, but it’s also getting them to understand that, ‘yes, you want to develop in this area and that’s fantastic but we can have multiple areas that we’re passionate about but your role may have evolved and changed, or the demands have changed, and you’re required to improve in this area.’”
The open conversation around those three elements, which can be scaled from the individual to the wider team, are the starting point for goal setting each year.
Comfortable being uncomfortable (and curious)
Miller wants people at British Fencing to be comfortable being uncomfortable and, for the audience, draws on his experience serving aboard a nuclear submarine in the Royal Navy. “When people join a submarine they’re walking into a learning environment, which is a high performance learning environment,” he says of an experience he and his shipmates called the ‘fourth dimension’.
“The importance of that is regardless of where you are hierarchically, when you walk into a submarine for the first time you are a learner and the philosophy and the culture inside that submarine is that we need you to be the best version of yourself as soon as possible because you might walk past an incident and you need to know how to deal with it because you’re the first person there. You can’t rely on a subject matter expert to come and bale you out, as it were. That sense of learning, that sense of curiosity, is inculcated in every fabric of every human interaction inside a nuclear submarine.
“Everybody takes responsibility for their individual learning but also their collective learning.”
It is an attitude he has taken into his post-military career with England Rugby, the English Institute of Sport and now British Fencing. “If we can help people to flex their curiosity muscle and encourage people to ask really insightful questions and be curious and want to develop themselves, where we get to is a sense where ‘it’s OK to ask a good question. It’s fine. It’s OK to not have the answer.’ But what we’re encouraging is the ability to be hungry for that learning.”
Making learners feel safe
Harris, who previously worked with medical students, recalls a time when she experienced a safety shift when delivering feedback. “A friend helped me to think about the difference between calling someone out and calling someone in,” she says. “When you call someone out there are relationship stakes. I might fire you, I might do something at you; there’s going to be something happen versus if I’m calling you in, it can be very direct but I’ve removed the relationship stakes by saying at the beginning of the conversation: ‘I appreciate that you’re here, I see all the hard work.’ This is potentially a difficult conversation but there are no stakes. This is us being honest about what is happening. I have to give difficult feedback but I want you to be very clear that we’re working on whatever I say.”
In addressing the question of belonging and psychological safety, Simpson cites American entrepreneur Charlie Munger. “He always talks about how much he underestimates the power of incentives,” he says. “When I sit down with individuals, I may have this picture of how great it is to work here, and we’re all pushing in the same direction, but I also need to understand the individual’s incentives. Why do they come to work, what are they here to do, what are they motivated by?”
Time is another factor, says Miller, who stresses the importance of trust and rapport. “Also with the learner, it’s giving them attainable goals in the short-term so that they feel success for themselves. Harris concurs, adding: “Succeeding is cooler than only failing.”
Tracking growth and development
The panel agree that evaluating learning can be difficult and Miller uses the Kirkpatrick Model, which is widely used for evaluating training and learning programmes, to explain why he feels he has fallen short at times.
“Organisations that plan big learning and development programmes often stop at the reactionary phase, the foundation phase i.e. ‘how did it feel? What was the learning like?’” he says. “The next level to that is how you are transferring that knowledge into your context. Then Kirkpatrick will suggest, actually, it’s a bit deeper than that because it’s how are you applying it? This takes time. Where we want to get to is how has it behaviourally made a difference to the organisation?
“When I think about learning programmes now, I think about how I’m going to evaluate it in the first six to eight weeks after the experience; what does the transfer of knowledge into the context look like? I plan that, six weeks out to three months. Three months out is how they’re applying it in their context and then, finally, in a year’s time, if we review and reflect on that learning experience for those individuals, what does that look like and how does it change the human behaviours inside the organisation?”
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Wendy Borlabi, the Director of Performance & Mental Health at the Chicago Bulls, has spied a noticeable shift.
Less than a decade ago, she says, there was a desire for, “having a coach with the credentials to take you from point A to point B. [Athletes] were looking for coaches who could do that; they hired coaches who could get you from A to B, it wasn’t about the relationship.”
“Now,” she continues, “I see more of the connection with the coach; they want to have that relationship. In my opinion, a lot of it has to do with the age. In the NBA we’re seeing younger players; they’re coming into the NBA at 17 years old. They’re babies, they need that nurturing, they need someone who’s going to take them under their wing that’s going to help them do the everyday pieces, that’s going to look after them, that’s going to ask about them, come and visit them at their house and be there to sit with their parents. They’re looking for that because they’re so young and when that’s there and that trust is there then I think that they’re able to expand on that, that they’re able to ask them to do things outside of their comfort zone and challenge them because now they’ve got a trust and it’s built on more social and emotions than [the question] can the coach move me from Point A to Point B.
“This shift is happening and I know we’ve talked about it that we used to see it a lot with female athletes as opposed to male athletes, but not now I think it’s more age-related as opposed to gender.”
As those coach-athlete relationships shift, so too does the role of the sports psychologist, which was a major theme of Borlabi’s appearance at June’s Virtual Leaders Meet: Evolution of Leadership alongside Kate Hays, the former Head of Performance Psychology at the English Institute of Sport [EIS]. The duo joined moderator Dehra Harris, the Assistant Director of High Performance Operations at the Toronto Blue Jays, to discuss the stability of an athlete’s confidence as well as the athlete’s ability to root confidence in a firm understanding of their strengths.
“For me, there’s been a real shift in sports psychology and how it’s delivered,” says Hays.
“When I think back to when I qualified, the focus was still so much on mental skills training and a lot of work at individual level and there’s certainly been a huge shift now. A lot of the work that the psychologist is doing around the team is facilitating environments that are psychologically informed and working alongside the coaching, sports science and sports medicine team as a collaborative effort; and I think that talks to the culture of people as well.
“It requires an entire sports organisation to be aligned in terms of the mission, behaviours, the philosophy around coaching, whether we take strengths-based approaches etc. when it has worked really well and you have athletes that have given the opportunity to learn, develop and grow, it’s because you’ve got a collaborative group of people that are coming together and working really effectively; and I think these things are difficult to do in isolated pockets.”
Borlabi also elaborated on the ways in which her work has changed. She says: “My role is so different now to when I first started. I need to teach athletes some very basic pieces of socialisation and emotion before we even get to the performance piece, because there’s these things that they don’t even know that.
“Besides working with the Bulls, I have a consulting business on the side and work with [Olympic] athletes as well. I think of so many times I spend the first four sessions just helping them understand that we’re not returning a call or text to their coach.”
Mental skills and learning to problem-solve
Harris asks Borlabi and Hays a question about the mental skills that athletes need to be working on. Both have already discussed emotional intelligence and self-awareness and it is a theme to which they both return.
“In working with younger athletes, it is establishing who they are,” says Borlabi. “One of the things I’ve always wanted them to try to figure out is how they like to be coached. I don’t think that they know that or how can they improve, and when do they listen the most, and what is the aspect they value the most in a coach and teammates.
“You miss that piece when you’re younger, so when they become professionals, I want them to try and think about that. It’s definitely something we learnt with the Olympic [athletes], they’d think about the coach. How are they coached? How will they work with their teammates? And how do they work at their best?
“Another aspect of that is their support system. Wanting them to be able to know who is in their support system and who gives them what kind of support and who do they gravitate towards? Who reinforces what they’re trying to do and who brings them down? I think that’s important because they don’t know that at a young age and it’s helping them to figure that piece out that helps them to grow as athletes.”
Hays shares her own experiences on the matter. “I’ve learnt a lot in diving [she worked with British Diving for more than a decade], which is an early-starter sport,” she says. “You’re quite often working with young athletes, aged 9, 10 etc. Obviously their cognitive ability is not the same as an adult and one of the most important things, very gently and slowly, is getting them to start to self-reflect.
“Quite often, they’ll go in, and the coach will direct them in what they’re doing, they’ll execute the training session, they’ll have a great one, and then they’ll get in the car and tell mum and dad how brilliant it was. But then they’ll go in the next day and the same thing will happen. It’s because they haven’t necessarily taken the time to take a step back.
“It’s a slow process, particularly when you’re dealing with younger athletes, but that process of self-reflection, the earlier that can start, the more robust athletes are in terms of what happened today; ‘why do I think that happened, and what does that tell me about what I need to do tomorrow?’ It encourages that problem-solving, that reflection, and that thought. Essentially, it’s a cyclical process, you get to that point where you’re able to recreate the things that you do well and lose the things that you’re not doing as well.
“With the youngsters, it’s about getting them into the habit of just asking questions around ‘why?’ and then figure out how they’re going to problem-solve and how they’re going to figure out the different things that they could try. So that the failing becomes part of the learning process rather than something to be worried or scared about. It’s that real message around failing smart and learning fast. How you make sense of your experiences and utilise that information. At this stage, it’s not about performance.”
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