Staying in the Green: A Proactive Approach to Athlete Health & Readiness

Over the weekend I had the distinct privilege of presenting at two incredible events- ALTIS Speed Summit in Chicago, and then EscaLAte hosted by Tyler Lesher at UCLA. In Chicago for the ALTIS event, for the first time I was able to share publicly the project I’ve been working on throughout this year- Staying in the Green.

Staying in the Green is the heuristic that was born during the NFL combine process working with Les Spellman. Between Les, myself, Chris Guarin, Kevin Leung, and Joesph Bautista, we had the collective responsibility of keeping athletes healthy throughout this grueling 9-week process. Despite often feeling complicated, hectic, and damn near ineffective at times, we can proudly say that throughout this process, we had zero athletes miss training due to pain or injury. And according to Les, this was a first for him in 8 years of running combine training.

What began as a heuristic and a crash course learning process has matured into more of a foundational framework, a core philosophy, and a strategic mapping for how we can all go about improving athlete health and how we manage workloads with our athletes. Importantly, what we’re developing is not something that is just limited to the NFL combine, but rather, an adaptive and flexible framework that influences decision making more so than work application.

Aside- The work of Staying in the Green has been a collaborative and ongoing project developed with my good friend Chris Guarin, and under the guidance of Les Spellman, who also provides the profiling, workload, and general insight. 

The Cost of Performance

The rigorous and unscrupulous demands sports put on the body are undeniable, and seemingly increasing over the last 25 years. As it relates to the higher levels of sport, the accumulation of sheer volume and repetition alone is a cumbersome thing to manage. But from the pros, all the way down to the youth level (especially in today’s world), sports and training break the body down. Athletes make unrelenting sacrifices, beyond just physically, to endure what it takes to play the sports they love. As this pertains to the performance world, our job, fundamentally, is to help support these athletes however we can to simply give them a better probability to play at a higher level, and for longer, without incurring damages.  

As the level of competition rises, the game becomes more and more of a battle of attrition- the athlete who stays the healthiest often has the best chance of continuing to play, just as the team who can stay healthiest is typically the one with the advantage. Techinical skill and physical capacities are of course important, but we cannot overlook the value health and regeneration provide an athlete. The chart shown in the graphic above is illustrating the injury rates by week in the NFL, and interestingly, this study was analyzing what factors are associated to injury rates. Across several variables they analyzed- schedule demands, travel, surface types, there was only one factor shown to be correlated to injury rates- winning. Meaning, teams that won, stayed healthier,  and to that end, shows legitimate evidence that the best ability does become availability.

Sport Injury Landscape

Injuries have been on the rise for the last 25 years. This is the case from the professional level all the way down to the youth level and appears prevalent in nearly all major sports. While throughout the same time period, we have seen an equal rise in human performance, where athletes are moving more, and moving faster than ever before. Combining this with the expansion of early specialization and general demands of youth athletics, it’s becoming increasingly evident that we are doing something wrong. At a surface level, and simply stated- we have done a shit job of managing the demands, capacities, and outputs we’ve imposed on our athletes.

There are an unquantifiable number of factors relating to, or potentially contributing to injury. If we want to be technical, just about anything can be considered a factor (i.e., chronic hamstring tightness, poor sleep or nutrition, a breakup with a significant other)… it’s a very lengthy list. My approach is to try to be aware of as many relevant factors as I can, while really focusing on a few that I believe matter- “wide lens, narrow focus”.  

We can find solid research or evidence to support every one of the individual items listed on this graphic, however, we can almost certainly find something that suggests it doesn’t matter. Once again, injuries are uniquely complex, but even with this ambiguity, there is a clear consensus on at least two factors- workload/stress management, and previous injury history. Virtually all injury focused research ultimately points back to these two factors, and for that reason, has become a central consideration for us. We organize it as having several  surrounding factors that are potentially significant, that feed into one or two central factors that certainly matter.

My belief for explaining the persistent rise in injury rates across sports is the combination of increasing early specialization, increased force exposures and velocities in competition, and overall effects of modern lifestyles are likely what I believe it all comes down to. Particularly with the increased specialization, what we are facilitating with this is a perpetual disproportionate development of connective and contractile tissues. The more we just do one or a few things, the more we lose motor dexterity and complementary tissue balance. The greater this imbalance becomes, the more fragile the system is.

Balance vs Precision

The body requires balance for health and precision for performance, and our job is determining when, and how much of each is required. We understand and appreciate the demand for precision- the targeted workload, the peak velocities, mechanically overloading the body. All of these things are not only required for sport, but contextually, are the best “immunity” to injury. We want to prepare the body for as many physical  demands as we’re able to, from the bioenergetics and peak velocities to the force exposures and range or position of the game. And preparation, fundamentally, relies on gradient exposure.

The route to staying in the green isn’t compromising the demands, but better strategizing for them. This requires strategizing from multiple lenses or points of performance (i.e., subjective/structural, functional, and technical), while also aiming to support athlete health on as much of an individual basis as possible. Balancing the body speaks to all aspects of training and performance- the energy systems, the CNS (SNS:PSNS balance), the motor patterns, and so forth.

But largely, and particularly for the sake of this article, balance speaks to the tissues. Mechanically, think about the connective tissue resiliency compared against the contractile tissue capacity. Can the connective tissues support what the contractile structures can produce? This is a foundational component to our strategies for balancing tissue.

Staying in the Green

No matter where you are within the human performance umbrella, it’s imperative we recognize and appreciate the compounding effects of stress. Both from an injury probability and acute readiness point of view, multiple datapoints and areas of monitoring should exist. The foundation of staying in the green is creating actionable strategies that promote athlete availability and readiness, and effectively aiming to improve performance through the preservation of health. Think of staying in the green as a multifaceted risk stratification process, prompting us to look at the composite readiness based on multiple contributing factors. These factors include subjective and structural criteria, functional capacities, and technical expressions or movement quality.

The strategies are variable and led by driving individualized athlete protocols within the team setting. There are a few areas, or components of the performance plan that specifically apply here- pre-session, modifying strength training parameters, post-session/homework, and for cueing and setting constraints. In order to be individualized, it requires a thorough intake process with a spectrum of data, information, and understanding of each athlete. We view the athlete intake process as requiring a thorough initial awareness that is followed by an emergent understanding. Once we’ve gathered enough data and understanding of the athlete, we are then able to develop a full scope profile for each athlete (i.e., archetyping).  

These strategies, which are versatile and wide reaching in nature, start by monitoring and coordinating athlete workload, training stimulus, and durations/frequencies of training and other modalities. We need to recognize that “methods” or specific applications, no matter how good or robust, can overcome poor load management. We want to see planning and programming, down to each specific exercise prescribed, as being modifiable at any moment. If we aspire to keep athletes healthy, we must understand plan modification.

Beyond the training parameters and management strategies, the applications, which are also versatile, are largely implemented through a combination of manual, positional (isometric) load, or integrative patterning. These interventions help to form an autoregulatory process for each athlete, in which we are continuously evaluating and intervening based on who the athlete is and how they are responding to the training demands.

Zero Missed Training Days

The NFL combine is a grueling and depleting process that can be sobering in many ways for the athletes. They’re in a pressure cooker, where hundreds of a second, or the way they answer a question in an interview can become the difference of tens of millions of dollars.  There is a clear and obvious priority in this combine process- run as absolutely fast as possible in Indianapolis. But in order to do that, staying healthy along the way and being available day of are the foremost priority.

Staying in the green is as much about fully adopting the philosophy across all domains and departments- something Les has done extremely well. It’s about the monitoring and the screening to understand precisely where each athlete is at. Being able to do that relies on the thoroughness of the intake process to provide us with a clear stating point and reference throughout. It’s about having a robust communication network, both with the athletes and within the staff or team you work with. Having multiple inputs that are aligned to a common outcome, with clear assignment of responsibilities along the way.

Athlete health and availability are reliant on providing the appropriate balance to the system at the right times throughout the training process. Our approach to keeping athletes healthy throughout the combine process wasn’t about redacting or restricting athletes and reinforcing what they couldn’t do, but rather, strategize and structure an environment that emphasized what they could do on that day.  Staying in the green is a dynamic management process, contingent on acute observation and quick decision making, understanding the efficiency of time is everything.

This was my first year working the NFL combine, and not only was that new, the application and demands for my work were largely new for me as well. It was far from a perfect process. It was hectic, it was disorganized, it was incomplete. We, namely I, made several mistakes along the way, and was overwhelmed with what I needed to learn. But we made it, and despite the struggles, we can proudly say that no athlete missed any training time due to pain, injury, or setback.

I’m extremely grateful for having the opportunity to work with Les, he’s been transcendent for me already in our short time of working together. I’m equally grateful for having the partnership with Les, lead me to an adjacent partnership with Chris. What we are collectively building feels special, and over the next few years, we intend to ratify the way our field views the integration of health and performance, and ultimately, keeping athletes in the green.