As I have written many times before on this blog, I am a big fan of stealing training ideas from areas like business and the military. Why? These disciplines are far older than a young professional sport like rugby, so practitioners have a far more established track record in developing sophisticated systems, managing large projects and manning successful organisations. The price of failure is also far higher, with far less room to hide in business and the military than in sport, where errors can cost billions or, far worse, lives.
During this year’s Rugby Science Network Conference 2016 online, I watched an interesting presentation by Professor Ross Tucker of world rugby on the science of concussion and head injuries in rugby. Whilst the findings of the study won’t have any great implications for my work as a strength coach (bend at the waist!), I am extremely grateful for having watched Ross’s presentation because it introduced me to the concept of hierarchy of hazard control.
Hierarchy of hazard control is an industrial health and safety/risk management concept, which aims to minimise the harm employees are exposed to within the workplace.
Those items that sit atop the pyramid offer the greatest reduction in risk/harm. With each descending level of the pyramid, the effectiveness of harm reduction declines. These categories can be divided as follows:
- Elimination- completely remove the hazard from the working environment
- Substitution- changing the hazard for something similar but less risky
- Engineering controls- making modifications to the existing hazard to reduce risk
- Administrative controls- changing how people work with the unmodified hazard
- PPE- providing personal protective equipment to workers to reduce risk of injury
It is fairly obvious that this can be easily applied to industrial risks like fire, electricity, falls, trips and poisonous chemicals. But in watching Ross’s presentation I also realised that this model could be adapted to provide an extremely useful framework for modifying training or progressing rehabilitation of injury.
At its heart non contact injury is a consequence of exposing the body to levels of stress it is not prepared for either acutely or chronically. Thus activity has to be carefully tailored to daily readiness in the context of regular training, or to the current level of healing/physical preparation in the context of rehabilitation.
Modification of training
Imagine you are scheduled to perform a full intensity sprint session, but in your morning screening an athlete shows up extremely fatigued, with tight calves and hamstrings, and in a bad mood. Clearly this athlete is not in shape to do the session as planned. The hierarchy of hazard control provides the framework. The level of the modification can be selected according to the state of the athlete, feedback from medical staff and your decision as the coach:
- PPE- change shoes, change surface, tape or support the joint etc. then perform the session as planned in the slightly less risky environment.
- Administrative controls- PPE alone won’t cut it, so now we have to cut intensity and/or volume, perhaps increase rest periods etc.
- Engineering controls- perhaps the original session in any form is too risky? Now we have to modify the activity to a less risky variant, perhaps from flat sprints to sled towing or hill sprints.
- Substitution- if the situation is quite bad, perhaps on-feet activity of any type may not be viable. Sprints may have to be substituted out in favour of an activity that comes close but removes the risk e.g. bike sprints.
- Elimination- if you or the athlete really F’d up, even bike sprints may be out of the question. In this case speed training will have to be removed completely from the programme.
The biggest threat to rehab is re-injury, when the athlete is pushed too far, too soon. The athlete exceeds his or her current capacities and SNAP. As such strength coaches and other rehab specialists have to be extremely careful and methodical when progressing return to play and not letting athletes fall into the cavernous gap between acute injury management and performance training.
Let’s imagine a player with a calf strain returning to full intensity agility work, but now with the pyramid flipped up the original way. The hierarchy of hazard control again provides a useful framework:
- Elimination- no agility work whatsoever is possible. Do not pass go, do not collect $200.
- Substitution- even closed environment agility work is not possible, but it may be appropriate to perform a similar activity that stresses the same musculature and energy systems albeit in a less risky manner e.g. slide board conditioning, jump rope etc.
- Engineering controls- open environment agility work with decision making under fatigue is inappropriate, so the activity must be re-engineered to remove these risks for example by performing pre-planned agility work only with no reactivity, decision making or fatigue.
- Administrative controls- the athlete may now be ready to perform highly specific agility work but it may still be appropriate to modify the activity to match the current level of ability. This may manifest itself as a slight reduction in intensity, volume, decision making outcomes, environmental stimuli or fatigue.
- PPE- The final stage of return to play before the training wheels come off may be performing a regular, full intensity session but with a heavy taping of the calf for support, both mechanical and psychological in equal measure. When the athlete finally reaches full confidence in the injury, the PPE can be removed and full, normal training resumed.
See how you can apply the hierarchy of hazard control to your own programmes and rehab training. Let me know how it works out.