No-Holds Barred Interview with Carl Valle
It is always fun and
insightful to have a no-holds barred talk with Carl Valle. Hate him or love
him, whatever you ask him he always provide no BS answer and for that he needs
to be respected.
I took the chance to ask
him 5 nasty questions and he really took his time and energy to answer them in
great detail. All I can say is enjoy the interview and the insights of Carl
Valle.
Mladen: Everybody
seems to big into monitoring and analytics lately. What I wonder is how the pro
clubs solve the frequent human nature issues, which I like to call (1) “self
fulfilling prophecy” and (2) “bad performance alibi”. What happens if an
athlete sees bad score – he might expect bad performance and injury (“self
fulfilling prophecy”) and/or use that metric as an excuse for a bad performance
or a game (“bad performance alibi”). Assuming that athletes’ buy-in into
monitoring is there, along with accountability culture, what is your opinion on
the mentioned human nature issues and how to solve them?
Carl: I am fully aware of the problems of merging
monitoring or any feedback to athletes and have made more mistakes here than
anyone and will make more in the future. Most of my work is track and field,
but do work with some team sport athletes. I experiment and fail more than I
succeed because if you are not winning every race, you are not perfect. It’s very surprising how much technology I
use that people don’t realize because I focus on fun and the human side and try
to hide the sport science as much as possible. Passive aggregation of data is
key, and good monitoring is efficient and minimal. Data mining has some hype
and I want to encourage people to get more out of their data though since we
tend to want to add more monitoring and testing and not do what we know is
helpful.
Back to your question, how do we solve the
interaction of objective feedback of monitoring to a human athlete? Human
problems need human solutions, so it’s a combination of sport psychology,
education, salesmanship, and trust. I said in an interview in 2010 it’s not
what you know it’s what you can get your athletes to do. Many coaches are smart
but when it’s applied it’s not effective.
- Sport Psychology- The “soft science” is the strongest variable
because it’s about dealing with the human element of emotion and behavior. One
can argue it’s about connecting but I think it’s about placing the athlete in a
mind state of doing what it takes to succeed with conscious decisions. Coaches
should be aware of the three Ps, personalities, perspectives, and what has
worked in the past. Motivation is also a part here, and tapping into the
athlete’s goals is about bridging behavior to belief.
- Education- Another three letter approach using the three Vs in monitoring or
athlete education in general. Explaining just enough information, be it verbal
(dialogue) or visual (infographics) is extremely helpful to get the athlete to
value the data. Talking about parasympathetic changes or wattage in jumps is
not the language of athletes (although they are evolving fast thanks to the
internet) but the use of creative analogies and layman’s terms is helpful here.
Numbers are ok as well, since solid objective feedback of the clock, the bar,
and the tape all ensure the athletes know what is going on.
- Salesmanship- Having athletes buy in requires coaching marketing and campaigning
a cultural reset. Sales is easy when you love what you are doing. If monitoring
is a pain to the coach, no way is the athlete going to leave feeling positive
either. If you don’t use the data or don’t demonstrate
- Trust-
A combination of experience, history of results, knowledge, and the coaching
relationship determines everything. Athletes want to know your motives because
caring is hard acquire in large group situations. You can claim to care when
you barely know names or spend time with someone. Sharing your motivation for
helping them gives the athlete a perspective to how much effort you plan to
invest in and what your limits are. Is the coach in it for the passion and art
or financial reward and ego?
At the end of the day athletes are not horses and
even horses are not just four legged athletes who don’t talk back. Make sure
what you get from them isn’t a pain to those involved and the value of the data
is beyond actionable but reinforces the difference of not doing it and the
difference between other options. Your specific example of the feedback of poor
or even great physiological or testing readings being a possible blow or
creating overconfidence is something one must manage. This is especially
helpful during tapers and playoffs when the stakes are higher with things and
the key I believe is being positive and realistic. I think the coaches body language and
expressions of getting data and the plan after the information will shape how
the athlete responds and time will shape how the athlete interprets this. I
think when data is suppose to predict, it can lead to some interesting responses
and the above four components of athlete and coach interaction can help direct
the mental outlook to where it’s needed to go.
Mladen: Postural Restoration Institute
(PRI) is all the rage lately. What is your take on their postural restoration
and ‘corrective movement’ and ‘movement gurus’ in general, along with the
newest breathing re-education? How should these “soft” skills be implemented
with hard-core high-performance athletes and clubs?
Carl: Remember every rage means it’s a trend, and
trends come and go. I remember in the late 1990s I was an intern with the then
Tampa Bay Devil Rays (I joke all the time since when I left they dropped the
Devil from their team name) and I was suggested to go on the “World Wide Web”
and see what they were doing because posture was again trending because of Paul
Chek and NASM at the time with Mike Clark. Ken Crenshaw was the assistant
trainer at the time and was ahead of his time, but we need to see the impact of
the therapy by stepping back and seeing the results. Since everyone is talking
about Bulletproof bodies and even drinking bullet proof coffee, where are all
of the legions of resilient athletes playing unholy minutes with zero injuries?
If someone goes to Kenya and introduces the breathing techniques will we see a
wave of sub 2 hour marathoners?
Do I believe the information has value? Yes. Do I
believe the information has limits in a practical manner? Yes. What are those
limits and how do we properly evaluate them? I think we need to recalibrate our
expectations with any educational option out there. We have athletes that are
out of shape conditioning wise breathing fire for circus performances or
whatever they think they are doing still getting injured. What is amazing is
how therapist and coaches on social media is hyping every workshop or seminar
like they are resurrecting people or making freak athletes like Dr.
Frankenstein. A healthy approach is to see what investment organizations should
place into those methods and see what real world outcome one has. People always
talk about value but nobody quantifies the value in real world coaching terms.
I think an integrated approach to breathing is
needed since many coaches will be reinforcing habits and actions with athletes
during training. In July of 2003 I blogged about breathing because I was seeing
a spike of asthma medications with a team and noticed none of them got tested
or evaluated, just prescribed drugs and inhalers. Regardless of one’s beliefs, the
medical responsibility of the coach is to be educated on what he or she should
do and when to refer out, something I am seeing less of. Anyway we all focused
on strategies of coping with intense exercise and recalibrating what is hard.
Most of the athletes simply were soft and went to inhalers when things go tough
and I never intervene with medical situations besides following doctor’s
orders. The moral of the story was clear, when training improved and mindset
was integrated about dealing with strain some athletes were revaluated to find
that symptoms don’t always mean problems. A Rugby or NFL player with broken
ribs in the past may need some reeducation here but after speaking with Dr.
David Lain on the phone years ago, we can’t make assumptions until one tests an
athlete properly. Spirometry, capnography, and other pulmonary testing should
be done holistically and have realistic plans in place. The goal is that
athletes acquire better breathing by better program design and coaching
reinforcement, not by spending hours on balloon sculptures.
Corrective exercise is a wide stroke of options
coaches have to improve something and that can range from a self directed ankle
mobility sequence to a clean lift off exercise for the upper back, glutes, and
hamstrings. Like breathing training, we need to create a balance of what
options will create safeguards against injury and get back to improving
performance or at least sustaining output. I am a fan of the Dan Baker and want
to ensure my speed, power, range of motion, and conditioning are sufficient
before I look at smaller or micro problems. It feels good to the ego to see
problems others can’t, but when I see athletes who are out of shape getting
hurt, do the basics before we start fishing around for dysfunctions.
I am not a team strength coach but have witnessed
some very progressive and creative solutions when I visit teams to learn or to
install custom hardware or other technologies I can quickly assess who is
organized and who is pretending. The best teams have a mapped out hierarchy of
interventions based on impact of the options and created a culture to support
the implementation by having clear policies, straightforward transparency, and
a little marketing for compliance. When one follows those suggestions the
effectiveness of any treatment option will rise, truncated, or be excluded from
a system.
Mladen: You are big on using foot
pressure mapping and TMG. How these tools are used to predict performance and
injury and how are they used in return-to-play programs? How are these linked
to manual therapy and corrective work (see PRI question above) and orthopedic
corrections? What is their “logistic
burden” on the team sport clubs compared to individual sports?
Carl: After the Sydney Olympics was over, I was
informed about the “muscle tester” by a few athletes and about custom spikes by
the top sprinters. I was very skeptical and every Olympic cycle athletes coming
back from Europe would tell me about the “electronic muscle fiber tester” and
about pressure mapping for foot function evaluation. Years later at the BSMPG a private workshop
lead by two leading experts in TMG and pressure mapping evaluated an athlete to
showcase why something subtle down the kinetic chain may be more important than
we know. Remember movement screening is usually slow, unloaded with forces, and
very unspecific to problem identification. It’s a good tool, but most
practitioners never talk about other tools besides their movement screen and
seem to forget gait labs at Universities are not fiction.
So that the readers are informed, TMG is
tensiomyography, a way of evaluating muscle status and pressure mapping is a
method of seeing foot kinetics using cells that collect levels of pressure.
Some systems with pressure mapping have 12 markers and some medical and
research grade options may have hundreds and sample at high rates while some
clinical models that are more walking speeds and sample the data slower. TMG
falls under the category of MyoAnalytics or muscle diagnostics, a growing area
that we are seeing interest. Elastography and Myoton readings are exploding
with some consultants because at the end of the day athletes don’t tear their
CNS and pull mitochondria, they hurt their soft tissue. Physiological
monitoring is still important and the data is far more simple to manage and
should be done, but managing soft tissue and joint function is essential. You
have asked three good questions in this topic and I will do my best to explain
what is best practice and what is reactionary and frustrating. Logistical
burden can be a logistical nightmare if not done right and I have witnessed
cautionary tales and legendary stories from a high-resolution evaluation and
treatment plan. What can be learned with implementation of many data sets can
be true with surface EMG, motion capture, video, and now biochemical and
physiological data. One has more information that can identify underlying
causes that may slip through “movement screening”. Testing, analyzing, and
interventions with this data is hard work, please don’t mistake me.
This is the most loaded question and perhaps most
controversial one I will attempt to address. Perhaps this question is the most
important one I have answered in any interview so far. You have asked a
question that I hope will show why making changes in sport is so hard. I will
actually show real examples of how I have used the technologies and metrics.
Injury
Prediction
Increases of risk from mechanical strain on the
body can be calculated but the body is a living organism that can adapt. Models
or algorithms that claim to predict injury are usually very crude and
impossibly short in calculation and data sets. The idea of risk analysis is to
work backwards based on etiology of the injury and what biomechanical, loading,
and biochemical risk factors are known to increase the chance of specific joint
or muscle injury. I am talking about
internal biomaterial disruption from projected biomechanical variables. Sounds
complicated but to simplify what does the research suggest with regards to
movement and specific site injury.
- MyoAnalytics (Tensiomyography and myoton metrics) – This data is more fleeting and variable and
can be used to do preseason screening and monitoring of manual therapy and
training interventions. Also combined with Player tracking data and motion
capture, a real profile of athletes can be made. Movement signatures with force
plates or accelerometers is like painting with a wide brush for houses and
trying to do a portrait. One high
profile team is including military grade thermography surveillance cameras as
early warning tools and then validate with muscle diagnostics. When patterns
calibrated by research and estimated coefficients are added, the early warning
system alarms or tags the event.
- Pressure Mapping (In-shoe and barefoot)- Injuries from the plantar fascia to lower back
can be linked to ground reaction forces that may not a good fit with the
athlete. Remember athletes are now over-competed and under prepared, a death
sentence coaches and medical teams are trying to manage. Asymmetries can be
absorbed from the amazing nervous systems of athletes, but the workhorses are
muscles that may not have enough ability to handle rapid eccentric forces.
Pressure mapping alone has merit, but sEMG and motion capture connects the
dots. If you look a professional soccer they are on a runaway train to
imploding with higher outputs of both speed and conditioning, and small
problems may be fine driving around a lazy Sunday to church, but on the
autobahn going 180 kilometers per hour, alignment issues are sometimes
exponentially problematic. One example
of this is an athlete that had one foot injured as a child with morphological
and structural changes that caused him to drift 10% while sprinting. For every
ten meters he veered a meter. As he got faster he experienced muscle strains
and had him get pressure mapped and the COP trajectory of foot strike was
radically different and this caused the drift each step. Combined with the
analytics run on his fiber testing and jump tests, his fatigue pattern didn’t
create a solid buffer zone. The patterns of muscle status cross validated the
predicted patterns from EMG and motion capture, and the pressure mapping
identified the potential cause.
Return
to Play
Return to play is sometimes a removal of pain story.
Pain is a growing subject of debate. I am appreciative of the science but
chronic pain and chronic injury is not the same. Healing takes time and who has
that in modern sport? Can one play and can one play effectively is up to the
team coaches, performance staff, medical team, and the athlete of course. I see return to play as a process of personal
pain and function. I understand pain is in one’s head but injury or trauma to
tissue is real. Imaging isn’t perfect but I like the idea of using TMG as a
return to play tool rather than a monitoring device. One can compare the less
injured and fatigued group bilaterally to baseline and normative data from past
historical data. Teams can use pressure mapping for ankle and foot sway
analysis and combine it with jump and running tests to ensure treatments
actually did something.
Manual
Therapy Integration
When people think about Podiatry they think
orthotic prescription. Podiatry is similar to Psychiatry and people assume that
you meet and greet and get drugs or an orthotic. Podiatry is about managing
foot mechanics and sometimes physical therapy is prescribed. Sometimes
podiatrists manage problems or do rehab with manual therapy with manipulations
but all of this is fleeting. I am shocked how many barefoot gurus and therapist
do youtube infomercials for their courses and think they are making amazing changes
to foot performance. Some changes to foot mechanics can be done by bodywork and
strength training and I encourage everyone to not think a modification to a
shoe or change in footwear will do everything. Small felt inserts and orthotics
may help, but manual therapy and other modalities are a small part of the
process if individualized properly. For example the FAST protocol by ASPIRE
showed different foot loading from exercises and EMS, but performance didn’t
change. With injuries rising coaches and medical professionals are likely
interested in maintaining performance and minimizing risk since most athletes
come premade at elite levels.
Sports Medicine is getting more data driven and
those that are against it are usually bad at technology. Many hands on people
are brilliant and can juggle everything in their minds but are isolationists
and the key is working collaboratively and future medical health records will
integrate google glass and voice recognition. One team preparing for the world
cup has a consultant doing this already
and the key with soft tissue therapy and joint work is to see what it’s
doing objectively. Hands on work is perhaps placebo and neurological relief,
but I have seen amazing data showing the connection and value of it. Combined
work must be evaluated and I find myoton readings with massage to be a great
predictor and evaluation of treatment because communicating tissue tone needs
objective status for everyone to be on the right page. Like R2P strategies one
needs to evaluate the treatments with objective data otherwise it becomes an
ego war and the loser is the athlete.
Logistical
Concerns
Sometimes outsourcing or referring out is needed
when dealing with specialized knowledge and experience with technologies. SaaS
models are growing for good reason. Nobody can do everything and know
everything and teams are more likely to act as case workers. Teams should
invest into internal budgets and external budgets and just look at sport
science and sports medicine a potential service. Planning is the most essential
part of screening and monitoring, and usually such exhaustive approaches are
done after repeated failure and sometimes not much can be done to resurrect
players after enough structural damage and deconditioning is present. Screening
during preseason when people are healthy or less injured is key. Companies who
can work like a SWAT team and be in and out quickly and thoroughly are going to
be the winners in this space. More data, less time, and less annoyance is
essential. Every private vendor loves what they do but never seems to get what
the constraints of a team is dealing with and never see a perspective that is
in the trenches. Any vendor that is making a silent impact with less invasive
approaches is going to be coveted. A culture of fun, enriching, and minimally
disruptive and educational will change sport.
I sometimes send data to Chicago, Copenhagen, and
Johannesburg to allow the groups to use their knowledge to create a more
comprehensive evaluation. My Chicago guy does more injury and pathomechanics,
the expert in Denmark helps with therapeutic integration, and my bioengineering
contact looks a biomaterial remodeling and strain calculations. All three help to see if the solution
investment is going to work in the long term. I do all of this part time as am
a track and field hobbyist and if I can do it teams with far more resources
should as well.
Mladen: Let’s talk about new monitoring
tools that emerged lately – CheckMyLevel and MOXY. Can you share your opinions
on both and how do you use them?
We are going to see an explosion of non-invasive
technologies from start-ups and CheckMyLevel and MOXY are two players in this
space. Crowd funding campaigns with Kickstarter and Indiegogo are producing a
bunch of amazing products and some I worked with a start-up from Germany testing
body suits and without getting into detail, consumer products are not always
team friendly or even athlete friendly. Non-invasive solutions are estimations
to internal chemistry and are convenient but one must be warned. Even
biochemistry is an estimation of what is going on for the most part so lactate
is limited.
CheckMyLevel is a device that uses muscle
stimulation to the hand and measures the response time and motion with an
accelerometer to the thumb. Based on that data, the voltage and response is
trying to gage an estimate of total body neuromuscular fatigue. The question
remains how to this data is compared to and what prior approach we can learn
from to see. Reaction time or finger tap tests are not new, but this device is
trying to control for motivational variables with a controlled contraction and
using the convenience of mobile devices it seems on paper a good solution. What
will be needed is actual product validation and more development on the
algorithm. I have used this for ten months and similar technologies for years and
everything looks promising.
The MOXY Monitor is one of the many Sm02 and Sp02
products that are starting to come down the pipeline and are all promising to
be the lactate tester killer in some form. Several studies have shown to
support various lab tests but the question remains how does one use local muscle
testing (Sm02) and regular conventional Sp02 work in practical settings. Look
at the product MuscleSound.com and ask yourself is this going to be the Holy
Grail doing this everyday? I think the MOXY Monitor needs to be micronized more
so athletes don’t feel like Robocop or Inspector Gadget. Also the placement of Insight to the calf is
interesting because most optical sensors don’t use that location and specific
details such as arteries and capillaries must be factored in. Estimating hydrogen from calculated optical sensor
data is prone to a lot of artifacts and any algorithm should be made public or
at least validated. Look at the Mio Alpha and see that this technology isn’t
perfect.
“Alpha is the world's first
strapless, continuous coronary heart rate check you can dress in on your wrist.
It has been tested accurate even although you are operating at performance
speeds of up to 12mph (20km/h)."
Anyone trying to get intra rep recoveries of
lactate readings will want to get the data if it’s valid as it’s a pain to get
repeat speed endurance reps. Still, I am interested in the following?:
- I would like
to see MOXY or a similar product used during speed tests and player tracking
devices more in order to see how offensive linemen and defensive linemen
fatigue specifically in American football. GPS and accelerometer data is like
Jackson Pollock paintings, it’s popular and people believe they interpreted it
right but I question the value of it’s use. We need more muscle fatigue information
with sEMG and other data to see what is going on in the trenches. Also, let’s
see how well those breathing “workouts” are transferring between reps and
between sessions. Certainly we should se some changes in recovery that is
showing up somewhere.
- As for the
CML device I want to see it cross-validated with CNS testing from Omegawave and
have both compared to some intensive analysis. While central fatigue and the
peripheral fatigue are different, both have the same general purpose of seeing
nervous system fatigue interact with performance incompetence and injury from
fatigue. I love jumping tests but can’t do them daily so we want a passive way
to look at general explosive ability status of the body. Perhaps some field
tests mixed with some non-voluntary testing as well as POMS like scores can
show what is more precise, assuming both are valid and reliable.
Of course all of this data needs to be merged to
provide better enlightenment to what is really going on. Either device is one
data set, and algorithms that can analyze and provide indications of risk that
are realistic would be great.
Mladen: I have seen some examples of the
clubs that have bought (and/or can buy) and used Athlete Management Software
solutions (like SMARTABASE, Apollo, EDGE10, SportsOffice) switch back to using
Excel and Dropbox. Do you think this might be the case because of staff
rotation (new staff every 6-12 months in some clubs) or complexity of such
tools? What is your experience in using those and can you make quick comparison?
What do the coaches want in Athlete Management Software solutions?
Carl: My biggest warning to coaches is not to buy most
AMS that are currently out on the market and visit other coaches. A big
difference exists between custom solutions with a vendor versus the cookie
cutter products we see available. Since professional teams are demanding and
require very powerful looking tools for sales, the vendors are providing
products to satisfy an array of professional teams. When you try to make everyone
happy you tend to make nobody happy. On the other hand, pro teams are a small
percentage of customers in sport, and that means to be profitable you need to
saturate a 1% market with an expensive tool that is designed by business people
to get adoption and this will frustrate coaches. I don’t think a mob hit out
for me, but I have had conference calls on the behalf of few teams and asked
some very uncomfortable questions to providers of Dashboards and AMS tools. I
strongly suggest seeking out medical data software vendors or hire competent
bodies to build your own tools. I can’t stand the garbage that is out there.
Dashboards that are showing cartoony pie charts and emoticons for $30,000.00
USD? AMS tools that don’t work offline or are glorified and skinned Opensource
CMS tools with team logos and colors? Embarrassing! Talk about American Hustle but most of the products
are from the UK.
You mentioned the revolving door of coaches and
of course change in rosters being a problem. Data dies on the vine if not warehoused
properly and few teams have historical data to make future decisions correctly.
Excel files may not be high tech or sexy, but we are not being held back by it
when it takes teams weeks to investigate if an athlete got fat during the
season. Red tape is choking internal problems that already exist and the
smarter option is not fight rapid changes and keep things simple and fast. Some
star athletes will services and specific data while others avoid it like the
plague.
For example what does a team in the NFL do when
they are subscribing to HRV, Catapult, Zephyr, and countless other data sets.
No company wants to be a data provider, they want to be a data aggregator and
want team eyeballs on their software. Look at the dismal API status with all
the devices or data feeds. Very few companies are seeing what teams are doing
with all of the data, not just their own. SaaS models need to be cleaner and
feed to custom solutions like Haloview. This is normal and I agree with them.
The problem is no vision exist except a underworld of “Mercenary High
Performance Advisors” that come to teams and offer their expertise on how to
manage it and are usually not their a year after. Why? People are drowning in
junk data or “noise” and are dying of thirst for valid and effective data.
Now we have the software itself. Who is making
this stuff? Who is signing off on the user experience with it? Most AMS software
is designed by lazy programmers who don’t have a passion for elite health and
performance and the results show it. How many people that code and design are
like you and understand training? Not to stereotype most programmers but they
are not all educated on sport science and coaching. The vision of software
should be by the power users and not the pretenders. Paradoxically the most
vocal complainers of software should be listen to. Many products don’t get used
and people are so embarrassed that they don’t bother at all, or even worse, just
use a brief period to pretend they are using the product! Coaches want a
product that does what the marketing material promises. Coaches are likely to
want simple and clear data with very little annoyance factor by the athletes
and flexibility for changes down the road. Excel and Dropbox are not as fancy
but the cloud tools listed I can replace with a few subscriptions to online
tools and mobile phones. Sometimes it’s
better to do less and do it well, then have a diluted product that tries to do
everything and is subpar. Most coaches want some sort of simple and clear
reporting, and like mentioned earlier most of the PDFs and Dashboards I have
seen are so bad they need repeat workshops with Stephen Few and Edward Tufte.
A note to owners, general managers, and athletic
directors- Most of the problems are getting good data and not storing it.
Algorithms are going to be the next big purchase because everyone has one now
that can predict the future but without data to enter they are powerless.
Listen to your medical and performance staff and ask what data is hard for them
to get and invest their with human power and then rethink the AMS use. Some
great products exist but please be an educated shopper. Vendors of AMS and Dashboards need to realize
they are more warehousing and displaying data and that is a feature, not a full
product. Platforms are the real tools and that is a very long discussion but
look for that change in the next year or two.
Data not Doping