Last week, Usain Bolt withdrew from the Jamaican National Track and Field Championships with a grade 1 hamstring strain, a mild but extremely untimely injury with the Olympics approaching. The reaction from some factions in the physical preparation and sports rehabilitation community has been disappointing and speaks to a larger issue in these fields- the propensity to criticize other practitioners without proper context. Many Internet commentators suggested that if Bolt had practiced what they preach he would not have sustained an injury. Hamstring injuries in sprinting are like shoulder injuries in pitchers. They are completely unavoidable at the highest level of sport. Repeatedly running or throwing as fast as humanly possible is not conducive to longevity or health. Elite sport requires one to subject the body to stresses that elicit adaptations at physiological extremes. The relationship between elite performance and health is a tight rope that medicine will never definitively navigate regardless of technological advances, improved surgical procedures, and the emergence of commercial systems of movement analysis. Considering all that Bolt has accomplished in his career, his injury history is actually quite unremarkable.
I make a living modifying people’s movement abilities to reduce pain and improve performance. I recognize, however, that despite my best, most sincere efforts there are limitations to what can be achieved with sound physical preparation. The absence of injury in competition is not something I can promise to any athlete. To be fair, the creators of the different movement assessment courses I’ve completed never claimed that their model is sufficiently comprehensive to identify every variable that could contribute to injury. Movement quality, assuming it can be operationally defined and objectively measured, is just one piece of a multi-disciplinary puzzle. The message from the instructors at these courses is more nuanced than the way that overzealous attendees interpret it to be. While the principles that unite various rehabilitation-based outcome measures may be applied to sprinting, no commercial movement system can explicitly predict what will break down when a human runs 27mph.
Some enthusiasts, however, perpetuate the notion that achieving some arbitrary movement ideal under little physical or emotional duress is 100% protective against pain and injury. The implication, therefore, is that if Bolt did “X” like these commentators recommend, he wouldn’t have suffered a setback so close to the Olympics. Those critical of Bolt’s training are essentially suggesting that he would be in a more favorable predicament under their supervision. It’s almost as if these people are hoping for somebody else’s misfortune so they can say, “I told you so.” Bolt would still have sustained an injury at some point in his career if he better utilized his left hemi-diaphragm, had better rotary stability, improved his intrinsic foot strength, crawled like a baby more, did more Nordic hamstring curls, mimicked a salamander on the beach, etc. Clearly, Bolt’s coaches are doing something right. The more appropriate question is, “What can I learn from Bolt’s team?”
Soon after he withdrew from his most recent competition, Bolt posted a picture of his physiotherapist performing electrical stimulation on his hamstrings…
The condescension from many of the physios on social media speaks to our tendency to criticize people without context. Where is the evidence for electrical stimulation, they ask? Passive modalities are useless, they opine. Since starting a private practice, I have never once utilized electrical stimulation. I don’t even own an electrical stimulation unit. I am limited to an hour with patients so electrical stimulation is low on the list of what I think most people need. However, if I worked in a setting like Bolt’s physio does, I might consider it. Bolt’s physio probably spends hours with him each day. How much manual therapy and exercise do you expect him to do?
Moreover, what if the low level contraction from the electrical stimulation unit provides a salient afferent input to reduce threat perception and ultimately pain? In this instance, electrical stimulation might persuade Bolt’s nervous system to perceive contraction and activity, and not protection, as normal. This rationale is totally consistent with current evidence in pain science literature. Besides, with a grade 1 strain, it is unlikely that extensive tissue damage is what’s really keeping Bolt from achieving his potential at this point. People often see a snapshot of the care someone like Bolt receives and assume nothing else is being done. Before we are so critical of others we must ask ourselves how we would conduct ourselves if we operated under as much pressure as Bolt’s coaches and medical team. If we were more honest with ourselves, the Internet would be a lot quieter and less dogmatic.