Find The Gap.
It may seem like a simple process but clearly defining the current capability and the desired capability is something that is often not done well. There are a multitude of reasons for this which we will briefly discuss, but they tend to fall into a few categories.
- Poor ability to measure whats important
- Inability to define the contributors to the outcome location or state
- Difficulty determining what is considered a satisfactory outcome for that individual
In the last two articles we have looked at how our understanding of the type of system that we are interacting with, and the characteristics of that individual system are important in establishing how we will attack the problem at hand. In this article we are looking to use that information to determine what is the gap between where we currently are and where we want to be. And as suggested on the surface that appears pretty easy to identify. But in practice it is not always the easiest to define and even more difficult to navigate our way there, particularly when the outcome is a little murky.
So how do we start?
Defining the problem at hand can be easy enough. A patient has pain, has functional limitations in daily tasks (such as walking up the stairs) or is unable to run at maximum speed without straining a hamstring. The hard part is often having some acuity about the measure and the underlying contributors that will lead to the success of that tasks.
For instance it has been repeatedly shown that hamstring strain injuries are multi factorial. Some factors are non-modifiable such as age, race, previous injury and some are clearly modifiable such as strength (eccentric, concentric at various muscle lengths and velocities), flexibility, running mechanics, training loads (especially exposure to high speed running), plus others that may play smaller inputs but are present nonetheless.
So with this in mind measuring these features accurately in itself can be a task that requires clear understanding of the features of these capacities as well as some evaluation of what is considered a good baseline and a good destination. To measure some of these items accurately is clearly still not that easy. The most obvious of the modifiable factors that is difficult to measure is running mechanics. The good thing is researchers such as Mendigucha/Lahti/Morin/Clark are heading in the direction of attempting to quantify and provide a clearer evaluation process for this, but it still varies significantly from athlete to athlete. And we know that this will never be a perfect match due to the individual characteristics of that person, who over time is likely to have developed characteristics that support their idiosyncratic expression of movement.
What this means is that despite having a reasonably clear understanding of what may be considered excessively poor running mechanics, what is considered the point or the destination for running mechanics that will reduce injuries for an individual is much harder to clearly define. And as we have suggested in the first two parts, this is constantly varying and may be very different in each complex system due to the interactions of all of the modifiable and non-modifiable factors relating to hamstring strain injury risk.
Despite some of these limitations, the need to identify the potential contributors, measure them as accurately as possible and establish a desired end point of your intervention is still your best bet. Literature on risk factors for many injuries has tried to define the failure point or the minimum standards for many contributors of particular injuries and as suggested by researchers such as Tim Gabbett, it may be better to set these as minimums, the floor that one tries to be above to reduce the risk factors influence on contributing to an injury. Whilst this may be a minimum standard, it at least provides some acute understanding of whether a factor is disproportionately affecting the presentation of a problem. In the hamstring example a very low measure of hamstring force output (particularly in eccentric movements) may present a disproportionate contribution to the problem. Raising the floor of this, may then allow for other less significant factors to be addressed.
Something that has become apparent to me is that because the end point required is much harder to define for an individual, there is likely more merit in expanding their capability away from failure points, even without understanding the destination. If you have a clear destination it makes the entire process much easier but it may not always be possible. For instance the example of running mechanics is easy to demonstrate that very poor mechanics is a limiting factor or a cause for concern, however the end point is much harder to define. The thing that becomes apparent in clinic practice with this is that the job becomes less about understanding the destination, but rather continually progressing the development of these characteristics and skills. There may be a point at which the importance of the time spent working on that characteristic diminishes. So ongoing evaluation of other contributing factors or features that may need to be addressed are then given more scrutiny if the problem continues to present irrespective of the improvements in other contributing characteristics.
So when doing a gap analysis
- Measure what you can identify to be the largest contributors to a problem from the understanding of the characteristics of the individual that you are working with
- Work to increase these identified capacities away from known failure points as much as able in an individually appropriate manner.