How to Be a Successful Physiotherapist

Today’s show brings on elite physiotherapist David O’Sullivan.  Dave has worked as sports physio with England Rugby Union in the 2019 Rugby World Cup in Japan and with England Rugby League in the 2017 Rugby League World Cup in Australia.  Dave is the founder of the ProSport Academy and now teaches his step by step pro sport approach that he uses with his own sporting and non-sporting patients in private practice to therapists all over the world. Dave’s mission is to empower people to restore control through their body and minds so they can truly live.  He has been a mentor to some well-known coaches/therapists such as previous podcast guest, David Grey. Knee pain and lower limb injury prevention are important topics.  Nearly every coach (and clearly therapist) will deal with either preventing or treating these issues with their athletes.  I enjoy learning about how to prevent knee or Achilles tendon pain, but I truly enjoy these conversations when we can take these principles of performance and scale them up to modes that can be used in late rehab or full-scale performance training. In today’s talk with Dave O’Sullivan, we’ll go into the basic muscle firing patterns that set up the baseline for performance in any bridging activity.  Dave will get into the importance of the Soleus muscle as a lower-body lynchpin, and how to optimally coordinate this muscle, along with the hamstrings in a spectrum of bridging exercises with specific cues for the feet.  We’ll take this all the way to how Dave utilizes jump training methods and drivers, along with foot cueing, to help athletes achieve a seamless and confident return to play.  Whether you are a therapist, strength coach or track coach, this is an information packed and truly relevant episode. Today’s episode is brought to you by SimpliFaster and Lost Empire Herbs.  For 15% off your Lost Empire Herbs order, head to www.lostempireherbs.com/justfly View more podcast episodes at the podcast homepage. Timestamps and Main Points 6:00 Discussing the systems that have influenced Dave the most in his career as a physiotherapist, and how he has synthesized them into his current system 12:20 Dave’s thoughts on the spectrum between basic rehab, and high performance return to play methods in the actions of the foot 22:40 How Dave wants the foot, and mid-foot to engage through various squatting actions, including the “split slouch” exercise 33:10 Mid-foot supine bridging drills as a regression for athletes who cannot tolerate proper load standing on the hamstring and soleus muscles 43:30 A discussion on cueing the mid-foot and how to cue the foot in rehab exercises, versus dynamic movements such as running or sprinting 50:30 Comparing low-hip position hip bridges with standard weighted hip thrust exercises, as well as the role of heel vs. mid-foot pushing in glute bridge work 1:01:30 How to know when to move athletes past supine bridges and slouches pushing through the mid-foot, and into more advanced work 1:08:45 Using “drivers” to help athletes with various jump landings in a return to play situation 1:17:00 When you actually do want to have athletes push through the big toe, versus when to leave it alone “When they go into the real world; the stress and movement, there is so much stimulus going into the nervous system, it’s so much different than being in the physio room doing 3 sets of 10 or a breathing exercise” “I just want to put load on these tissues, and let the system self-organize” “When that foot hits the floor, the soleus (muscle) is the king…. if you had to have one muscle for knee pain, that’s it…. the soleus takes between 6 and 8 times the bodyweight” “That’s an awareness to me that a lot of athletes have skipped, the mid-foot… athletes who stay on their heels or on their toes miss that mid-foot” “The interesting thing with the mid-foot and the soleus is that the soleus has to work with every other muscle in the lower limb” “When you squat, on the way down I want the weight through the heel, and on the reversal, on the way up I want it through the mid-foot/fore-foot” “If you keep the knee straight, that makes it harder to get onto the mid-foot” “It is so much harder to relax than to contract; that’s important for people with consistent pain” “Those top-down cues (squish oranges through the midfoot) are good, but ideally what we want are bottom-up cues where we don’t have to cue them… I wouldn’t have an athlete “squash oranges” running” “By the time that foot hits the floor at that speed (sprinting) the brain and nervous system has a strategy in place, and it’s not caring about turning a muscle on, it cares about not falling over” “We don’t want the bum to come too far up in a single leg bridge, because if you do you are going to start using your back; the lower the bum is the more you are going to use your leg” “I think a lot of those people that got more (EMG in glutes) through the heel… if they did the mid-foot bridge, I’m confident they would cramp in the hamstring or soleus” “You are going to feel (bridges through the midfoot) in your hamstrings for a few weeks, and then you’ll feel them in your glutes (after you build the proper hamstring co-contractions)” “It all goes back; have they got the ability to develop tension? When you are hip thrusting, if I don’t tolerate load through my soleus and hamstring, I am definitely going to use my heels to get up there” “If you want to put more load through the quad, push through the heel” “Continuous bounds, to me, that’s the pre-step to high speed running” “I want them to leap and land on the midfoot (in return to play jumping drills)” “If you push through the pad of the big toe you are going to get a massive calcaneus supination” “I wouldn’t be going out with a (healthy) athlete and be like “I’m going to strengthen your (Flexor Hallucus Longus) today” Show Notes: Supine Bridge:  https://www.youtube.com/watch?v=cYD4Jx_IXSw Slouch Exercises in Split Stance:  https://www.youtube.com/watch?v=B0COfbIzkIY About Dave O’Sullivan Dave O’Sullivan is a Chartered Physiotherapist and founder of the ProSport Academy. Dave has worked as sports physio with England Rugby Union in the 2019 Rugby World Cup in Japan and with England Rugby League in the 2017 Rugby League World Cup in Australia. Dave also has a private practice in Huddersfield where he built it up from scratch to now having a leading clinic with over 10 staff that help people who have failed traditional approaches every single day. Dave now teaches his step by step pro sport approach that he uses with his own sporting and non-sporting patients in private practice to therapists all over the world. Dave’s mission is to empower people to restore control through their body and minds so they can truly live. Dave is achieving this mission personally through his clinic and also through his vision with ProSport Academy. Dave’s vision is to support and guide over 1500 therapists in over 50 countries all over the world help millions of people in pain by having the confidence and clarity to help people who have failed traditional approaches. This all starts with understanding the ‘WHY’ behind everything you're doing and having a structured step by step system in place that gives repeatable outcomes and takes the emotion out of the decision making for therapists in private practice and pro sport.