Pies Sports Science - Cause of Injury Woes

[aflfan1990]

I think the issue could be, how does treatment get decided.

If we look at Lazerus, it seems like a lot of his academic phd related work the statistical justification is based on MBI which it seems has been proven to be false.

So if players are being told that this treatment or this preventative measure is working, when it doesn't isn't that a problem?

To me it makes sense from a workers point of view, if Lazerus is getting a PhD in sports science looking at injury, he would be crazy not to recommend his findings. The issue for me is that these findings are based on fake statistical evidence.

If this is how they manage/research injuries who knows what they do in terms of game analysis.

 

[aflfan1990]

Need to move away from continual resigning of injury prone players also. Can only carry one or 2, we seem to carry more than our fair share year after year. Reid, Broomhead, Sharenberg, Varcoe, Dunn etc. Moore and Treloar big concerns as well but obviously valuable when fit.

Injury prone? Or just getting bad unfounded advice?

 

[jackcass]

count me in - love sparking burgundy--- but usually with turkey @ Xmas - guess could swap for a nice Provence chook or even with Beef bourguignon ?? - maybe?

I've researched this extensively and any pretence of food will suffice.

 

[Drought Break]

Injury prone? Or just getting bad unfounded advice?

well if its the same players year after year while others remain "uninjured" playing on same surfaces with same physios, coach, trainers etc then yes, injury prone.

 

[Scodog10]

well if its the same players year after year while others remain "uninjured" playing on same surfaces with same physios, coach, trainers etc then yes, injury prone.

I think the broader question was would those players still be “injury prone” if the physios, trainers, rehab etc. were different? It’s obviously an impossible question to answer, but would one of those players have the persistent injuries if they received different treatment?

Personally the only Collingwood player who seems “injury prone” to me is Reid who has suffered soft tissue injuries to every area of his legs and seems to have a genetic predisposition towards injury with his brother having similar issues. Moore for instance has had one soft tissue injury in 18 months, completed two full pre-seasons and seems to suffer from mental fragility rather than physical.

 

[aflfan1990]

well if its the same players year after year while others remain "uninjured" playing on same surfaces with same physios, coach, trainers etc then yes, injury prone.

Maybe the first injury was bad luck and subsequently they were not able to rehab properly because of bad advice?

Seems like say the Hawks for example are able to turn around a players injury history (Omeara, Scully) and if we look at the Gold Coast Suns their sports scientist head has a lot more MBI studies

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=%22magnitude+based+inference%22+author%3Athornton&btnG=

Issues with getting Ablett, Lynch, Omeara on the park once injured.

 

[Gone Critical]

Yes

Be interesting to know the details of what he thinks the club should do. was it a difference in philosophy of how the rehab should be handled or a view the Collingwood physios were out of date

Different physios will approach similar problems from different tacks. Any more info would be interesting

 

[Gone Critical]

I think the issue could be, how does treatment get decided.

If we look at Lazerus, it seems like a lot of his academic phd related work the statistical justification is based on MBI which it seems has been proven to be false.

So if players are being told that this treatment or this preventative measure is working, when it doesn't isn't that a problem?

To me it makes sense from a workers point of view, if Lazerus is getting a PhD in sports science looking at injury, he would be crazy not to recommend his findings. The issue for me is that these findings are based on fake statistical evidence.

If this is how they manage/research injuries who knows what they do in terms of game analysis.

i think they way it should be looked at is not that the MBI is poor stats, it is, but that the reason areas like physio looked at it was they were seeking a way to find valid statistical evidence for their treatments when that is a forlorn hope. All of physio is hamstrung by this problem.

Doesn’t mean that what physios do isn’t helpful it’s just that their numbers are low and they don’t have the size to get good quality well funded scientific trials done.

Also means that there is no scientific way to assess the merits and outcomes of different treatments. If you understand basic stats you will understand that all the statistical information used in sport is largely flawed

 

[Apex36]

Be interesting to know the details of what he thinks the club should do. was it a difference in philosophy of how the rehab should be handled or a view the Collingwood physios were out of date

Different physios will approach similar problems from different tacks. Any more info would be interesting

I’m not sure about his views on the rehab that was actually done, just that it was insufficient in that they should have been continuing treatment after the injury had ‘healed’ to strengthen the area and avoid reoccurrence and they were not.
As an interesting side note, the player he’s treating is a recently qualified physio himself, so it will be interesting to see if he gives the club direct feedback on their treatments.

 

[Gone Critical]

I’m not sure about his views on the rehab that was actually done, just that it was insufficient in that they should have been continuing treatment after the injury had ‘healed’ to strengthen the area and avoid reoccurrence and they were not.
As an interesting side note, the player he’s treating is a recently qualified physio himself, so it will be interesting to see if he gives the club direct feedback on their treatments.

Thanks, that is interesting. Wonder whether the VFL care doesn’t extend very far. Poor if that was the case

 

[aflfan1990]

i think they way it should be looked at is not that the MBI is poor stats, it is, but that the reason areas like physio looked at it was they were seeking a way to find valid statistical evidence for their treatments when that is a forlorn hope. All of physio is hamstrung by this problem.

Doesn’t mean that what physios do isn’t helpful it’s just that their numbers are low and they don’t have the size to get good quality well funded scientific trials done.

Also means that there is no scientific way to assess the merits and outcomes of different treatments. If you understand basic stats you will understand that all the statistical information used in sport is largely flawed

I don't know, to me I'd lean on if a physio is willing to use a method that is known to be flawed in the industry to justify what they want to do, that's not the position I'd want from any medical professional. If there is sound biology behind it fine, but it seems as though there isn't hence they have to use the ''allure'' of statistical evidence (fake)

 

[Gone Critical]

I don't know, to me I'd lean on if a physio is willing to use a method that is known to be flawed in the industry to justify what they want to do, that's not the position I'd want from any medical professional. If there is sound biology behind it fine, but it seems as though there isn't hence they have to use the ''allure'' of statistical evidence (fake)

i like the term “the allure of statistical evidence”. Sums up the problem. Physios, sports med doctors, high performance trainers and the AFL in general would be better off getting over that “allure” and explaining that their methods are based on experience at the upper levels, belief in what works, their philosophical approach to their discipline but they don’t have any good quality stats or science to back up their beliefs

 

[Quicky]

i think they way it should be looked at is not that the MBI is poor stats, it is, but that the reason areas like physio looked at it was they were seeking a way to find valid statistical evidence for their treatments when that is a forlorn hope. All of physio is hamstrung by this problem.

Doesn’t mean that what physios do isn’t helpful it’s just that their numbers are low and they don’t have the size to get good quality well funded scientific trials done.

Also means that there is no scientific way to assess the merits and outcomes of different treatments. If you understand basic stats you will understand that all the statistical information used in sport is largely flawed

Might as well throw in the towell then? Any ideas on other approaches to improve rehab?

 

[Gone Critical]

Might as well throw in the towell then? Any ideas on other approaches to improve rehab?

Absolutely not. If you look to assess efficacy of treatment in an area then evidence based is the gold standard and well designed double blinded prospective controlled trials are the flag bearer.

In so many areas though this type of evidence is unrealistic and just can’t be obtained. Sports med, physios and high performance areas just need to realise this doesn’t work for them and they need to rely on other, less evidence based methods to assess performance.

As long as you understand how strong the evidence is and qualify your treatments accordingly you are using an honest approach to the best of your ability

 

[The Royal Sampler]

i like the term “the allure of statistical evidence”. Sums up the problem. Physios, sports med doctors, high performance trainers and the AFL in general would be better off getting over that “allure” and explaining that their methods are based on experience at the upper levels, belief in what works, their philosophical approach to their discipline but they don’t have any good quality stats or science to back up their beliefs

Although I largely agree, I think this overlooks the aspect of a doctor/physio’s role which is to educate the athlete and prevent further injury, or unnecessary roadblocks to recovery. In many regards the athlete’s body will heal itself if permitted to do so. Overtraining, as Tay Adams did last year resulting in a setback, may be preventable if the medical staff and physios can get the athlete on board with the recovery program. None of this requires much in the way of controlled trials or powerful studies to back it up.

 

[aflfan1990]

Although I largely agree, I think this overlooks the aspect of a doctor/physio’s role which is to educate the athlete and prevent further injury, or unnecessary roadblocks to recovery. In many regards the athlete’s body will heal itself if permitted to do so. Overtraining, as Tay Adams did last year resulting in a setback, may be preventable if the medical staff and physios can get the athlete on board with the recovery program. None of this requires much in the way of controlled trials or powerful studies to back it up.

But what is the education based on? If its based on studies that were only done to build to doctor/physios reputation by getting an academic publication by using a dodgy method is that what we are after?

I think a key point is the human nature element of the doctor physio, its human nature to if you go and get an academic publication to recommend using that at your place of work I would think and this is where the issues happens.

 

[HeadInTheSand]

I think the issue could be, how does treatment get decided.
So if players are being told that this treatment or this preventative measure is working, when it doesn't isn't that a problem?

It isn't that simple.

There are numerous evidence-based ways to rehabilitate a hamstring injury. There aren't any comparative studies that prove one way is superior to another.

That means if the chosen method isn't working - due to reoccurrences - then either the program isn't being supervised correctly, there are other contributing factors that are leading to that result, and to which the practitioners don't believe are relevant, which can come from either prior experience, or a steadfast belief in evidence-based medicine, or that the return to play criteria isn't correct or isn't being met.

Finding the right amount of exercise to do is very difficult. Too little won't do enough, and too much can cause setbacks.

 

[aflfan1990]

It isn't that simple.

There are numerous evidence-based ways to rehabilitate a hamstring injury. There aren't any comparative studies that prove one way is superior to another.

That means if the chosen method isn't working - due to reoccurrences - then either the program isn't being supervised correctly, there are other contributing factors that are leading to that result, and to which the practitioners don't believe are relevant, which can come from either prior experience, or a steadfast belief in evidence-based medicine, or that the return to play criteria isn't correct or isn't being met.

Finding the right amount of exercise to do is very difficult. Too little won't do enough, and too much can cause setbacks.

Sure its difficult, but that doesn't mean you should be able to say lets do this and I have this statistical evidence saying this is good. When its been known for years that the statistical evidence is false.

Is using a known fake method to justify doing something any different from making up data?

I get its hard, my issue is more the reasoning behind doing something, if you have a good biological reason fine, but if you need to use a fake method of statistics that is not fine.

 

[Gone Critical]

But what is the education based on? If its based on studies that were only done to build to doctor/physios reputation by getting an academic publication by using a dodgy method is that what we are after?

I think a key point is the human nature element of the doctor physio, its human nature to if you go and get an academic publication to recommend using that at your place of work I would think and this is where the issues happens.

I wouldnt get to worried re "dodgy" methods. Whats happened is an attempt to find proof where it can't be found statistically.

Doesn't mean the treatment being examined is flawed just that the question of statisticial benefit can't be answered. So you accept the physio will use their knowledge, experience, anecdotal evidence etc to make treatment decisions.

In medicine many trials are poorly designed, poorly powered and never stand a chance from the outset of answering their hypothesis. Huge effort goes into study designs even before they commence with a statistician being integral to the planning.

I would guess that the AFL clubs never uses a proper statistician in any of their work.

 

[aflfan1990]

I wouldnt get to worried re "dodgy" methods. Whats happened is an attempt to find proof where it can't be found statistically.

Doesn't mean the treatment being examined is flawed just that the question of statisticial benefit can't be answered. So you accept the physio will use their knowledge, experience, anecdotal evidence etc to make treatment decisions.

In medicine many trials are poorly designed, poorly powered and never stand a chance from the outset of answering their hypothesis. Huge effort goes into study designs even before they commence with a statistician being integral to the planning.

I would guess that the AFL clubs never uses a proper statistician in any of their work.

Isn't that the problem, if the physio needs to use ''statistics'' to justify a treatment then perhaps it goes against conventional wisdom? Otherwise why not just use the techniques and justify them as has been done.

I guess its like work, when people want to do something ''new'' they justify it with data the issue here is that the analysis is done incorrectly at best, is misleading or misconduct at worst

 

[Gone Critical]

Isn't that the problem, if the physio needs to use ''statistics'' to justify a treatment then perhaps it goes against conventional wisdom? Otherwise why not just use the techniques and justify them as has been done.

I guess its like work, when people want to do something ''new'' they justify it with data the issue here is that the analysis is done incorrectly at best, is misleading or misconduct at worst

I think it’s an attempt to get the best analysis especially in an evidence based age where the prospective double blind controlled trial reigns.

Where that sort of analysis isn’t possible, and that’s a lot of areas, would be best to accept that and not go the route they have. It comes back to being honest with your data, knowing it’s limitations and applying it accordingly.

 

[The Royal Sampler]

Exactly. Very hard to blind a physiotherapist in an RCT, it’s not like a drug trial.

The science behind strengthening and rehabilitating is there; it’s lacking when it comes to comparing the relative value of one largely proven treatment to another, cooling gloves, ultrasound, massage, kinesio tape and all that fluffy stuff. I don’t go much for that gimmicky bullshit, that’s not what physio should be about... and I absolutely support anyone who is skeptical about it.

 

[aflfan1990]

I think it’s an attempt to get the best analysis especially in an evidence based age where the prospective double blind controlled trial reigns.

Where that sort of analysis isn’t possible, and that’s a lot of areas, would be best to accept that and not go the route they have. It comes back to being honest with your data, knowing it’s limitations and applying it accordingly.

Is it though, surely attempting to get the best would be using a method that is accepted, not one that the president of the statistical society thinks is garbage.

I'm fine with methods being used on players if there is sound biology behind it, however if the sports scientist needs to use a fake method of statistics to convince the player or the other staff its worthwhile surely that has to be a problem?

if a player wants to roll the dice, they should be given accurate information around the probability of success, but also the uncertainty around that probability.

 

[HeadInTheSand]

Sure its difficult, but that doesn't mean you should be able to say lets do this and I have this statistical evidence saying this is good. When its been known for years that the statistical evidence is false.

You're being seduced by Gone Critical's argument about powering studies.

Thirty people in two arms of a trial involving a particular treatment method is ample if the study is well-designed, eg. there are a wide range of occupations, body types and activities recruited into each arm.

Most studies for physical therapy fields are flawed in other areas, in that only one type of treatment is being used (multiple methods may be considered in a clinic), everyone gets the same dosage - which has obvious drawbacks - and the hypothesis being tested is often too simplistic, in order to try and prove that something particular is effective, rather than comparing two different types of treatment to see if one is more or less efficacious than the other (which is a different type of study anyway).

Hamstring rehab is relatively simple if you use logic, common sense and apply some basic science. It doesn't go wrong because therapists are using underpowered studies.

 

[Gone Critical]

if a player wants to roll the dice, they should be given accurate information around the probability of success, but also the uncertainty around that probability.

That’s it in a nut shell