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Osteopathy & Elite Sport

I sat down with Steve Nightingale, strength and conditioning coach for the Chinese Men's Speed Skating and asked him about his role in helping the team win gold at this year's Winter Olympics in Pyeongchang. He tells me his views on osteopathy in elite sports, the challenges of balancing Western & Eastern medicine and how he developed specific training programs for the skaters


Congratulations with your Gold Medal success at the Winter Olympics in Pyeongchang this year with the Men's Speed Skating! What was your role in the team to achieve such an amazing result?

Thank you. I worked in a team as a performance coach which is another name for a strength and conditioning coach. There was a huge team of performance staff, we had strength coaches, speed coaches, physiotherapists and team doctors. We had about 50 athletes in two teams; a senior team and a junior team. I worked with the junior athletes and then if there were senior competitions and athletes didn’t go, they would come into our squad and if athletes got injured they would also join our squad.

How did you formulate your training program to be specific to speed skating?

It’s really interesting as coming from an ice hockey background everybody just assumed that I would know what to do because they are both ice sports but they’re completely different.

I spent a lot of time reading and researching the specifics [of speed skating]. There is a lot of good research out there from people who have really looked into the biomechanics of the sport and what needs to be done. In the first few weeks I spent a lot of time at training practices and taking videos so I could really get a sense of what they needed.

Was that research period a long process?

I went in with a three to four month plan and soon realised after a week that the training I originally had planned I no longer wanted to do. I’d say it took a month for me to be happy with the training I was doing.

What obstacles or difficulties (if any) did you come across during your time with the team?

I think the biggest obstacles are the very different approaches of Eastern and Western

medicine. We had a very multi-national team. We had two Canadian physiotherapists, an American athletic therapist, we had two American strength coaches and myself. We also had a Chinese physiologist, three Chinese doctors and all of the technical coaching staff were Chinese. What I noticed was a huge difference between how Western and Eastern protocols work - I will give you an example. We had two skaters crash in a tournament and both were showing signs of concussion and so all of the western staff were taking lots of precautions and also had guidelines from different governing bodies. When we put our rehabilitation plans to the coaches, they basically laughed at us and said “we don’t know what the problem is – they don’t have an injury”. I was thinking, they have concussion and the doctors said we don’t know what you’re talking about, that is not an injury. So we were just mind blown that they do not consider concussion to be an injury. So there were problems with trying to bridge that gap and some of the battles we won and some of them we didn’t win.

How were you able to manage that conflict?

Erm… Slowly! I think is the answer! We were trying to put a lot of evidence based practice to them, for example, we were taking return to play protocols from the Canadian speed skaters who have won quite a lot of medals to say this is the current practice around the world.

Actually, one of our Canadian physios did a really great job at contacting people at the International Olympic Committee (IOC), she was reaching out to higher-up bodies, like rugby federations and all kinds of different sports to pull information from lots of different places so we could take it to the Chinese and say, well I know you don’t really believe in this but this what the rest of the world believes in. So we tried to approach it with that evidence based approach. You can’t just go in and say everything you’re doing is wrong, you just have to be like – Well, maybe we could try and do something like this? That worked in some cases and didn’t work in other cases.

So finding middle ground and working together?

Yeah, absolutely.

I know we have spoken about concussion, but in terms of musculoskeletal injuries, were there any injuries such as that picked up along the way? If so, which team members were in place to rehabilitate the injury?

Loads of injuries! There were lots of overuse and chronic injuries as the Chinese training methods are very thorough. They will train for six to seven hours a day, six days a week, so the body is under incredible amounts of stress. If you consider the position held in speed skating the athlete is always flexed forwards from the waist and they will always turn in one direction - always to the left and never to the right. So we saw a lot of low back problems and lots of shoulder problems, so they will be dropped on one side and the other shoulder becomes affected. The back problems we saw would feed down a chain and cause knee issues.

We had one girl when we came into the programme who had chronic knee pain for

eighteen months, she was only eighteen years old. In terms of who was there to look after them, that was challenging as we had physiotherapists, athletic therapists and strength coaches who would come together to formulate play protocols for them but a lot of the time the Chinese doctors wouldn’t agree with the approaches that we had. In the hierarchical culture of China the doctor trumps everybody else, so a lot of the time we would put plans to the team coaches and they would give them to the doctor and they would end up doing what the doctor wanted to do instead. So, yeah, it was challenging.

We had other issues, using the eighteen year old athlete with chronic knee pain as an example, we sent her off for an MRI for both of her knees. Now what’s wonderful about China is that we requested the MRI in the morning and had her imaged by lunchtime, which is amazing in comparison to the UK. The problem was, the reports we got back were three lines of text stating that one knee has an ACL problem and the other knee was fine. I was thinking – she has had eighteen months of chronic knee pain, I’m pretty sure it’s not fine.

So there was lots of problems with trying to diagnose injuries. What was really interesting though is over my eight months with the team, seeing different physios come and go and seeing their different approaches. Looking at how they diagnose and having one person thinking it was this and the other thinking it was that, is why we decided on imaging to give us a definitive answer. But it actually didn’t give us a definitive answer – which was a challenge in itself.

Do you think osteopathy could play a role in the prevention and management of injuries and enhance the performance of an athlete at an elite level such as the Olympics?

Yeah, I think any intervention that promotes recovery and regeneration and particularly redressing the balance is good. Like I said, the athletes spend so much time doing really high volume work that they don’t get a lot of rest and recovery and a lot of the time rest and recovery is not very well understood in China. I now a gold medal female athlete, she is a long track skater, had chronic knee pain for about a year and had seen a couple of different physios and six months before this winter Olympics her team doctor told her she should have three months bed rest. No exercise whatsoever just staying in bed for three months. Of course everyone who hears that is like that’s the worst thing you can do! We saw lots of different types of therapists coming through, such as very clinical physiotherapists to very applied athletic therapists and everything in-between.

That’s why I like osteopathy as I feel it falls as an applied physiotherapy, if that makes sense? As it can be a lot more sports specific. I find that some of the clinical physiotherapists are very focused on the things they want to achieve and the movements that they want but they don’t necessarily transfer that over to sport so much. I think that anything that can help to counteract all the damage that the training does would be fantastic.

Am I ok to ask what you have planned for the future in terms of moving forward during your time in China?

Absolutely, I am going to be going back to China in a couple of weeks and I am going to take on a new role as Assistant Director of Education for the Chinese Olympic Committee.

So a lot of the problems that I have seen over the last eighteen months stem from a difference of opinion between Eastern and Western medicine, so I am really looking forward to try and bridge that gap between them. I do have a lot more appreciation of Eastern medicine since I have been out there and I would encourage a lot of Westerners to be a little bit more open minded.

I find it funny that a lot of western strength coaches, for example, would look at something like acupuncture and be like that’s just rubbish! It doesn’t do anything! But the first thing they will have their athletes do is get a lacrosse ball and do some foam rolling – and I’m like, y’know you’re basically just doing the same thing?! So, you know, it’s very interesting to see what different people believe. We are going to have a hundred and fifty foreign coaches and two hundred Chinese coaches under our banner, so to be able to bring a lot of collaborative thought to the project is going to be really good. We are going to have this project going until the next Olympics up in Tokyo in 2020 and then see where we go from there.

Fantastic! Thank you for talking with me today Steve and I wish you all the success for the future.

By Siân Steel M.Ost, D.O. 2018

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