As we have discussed addressing the specific needs of the individual in front of you provides an opportunity get the best outcomes. And our previous article highlighted establishing a profile based on the individual features of that individual may give you clues to the injury or performance characteristics of that individual. This type of profiling looks to understand the features of the individual, and this creates one of the key pillars of the needs analysis framework that we currently use. The other is the problem profile.
What is a problem profile?
When we are presented with a musculoskeletal problem in our setting, we take the time to understand this problem. We use this assessment to determine the features of what this problem are, and then how we may need to target an approach that will assist this individual back to the activity that they undertake at the best of their ability.
To do this we typically undertake the following steps.
- Classify the problem
- Define the problem
- Establish the contributing factors or risks
- Task analysis
- We classify the problem at hand
- Classifying the problem uses a broad assessment of the type of problem that we have encountered. In clinical or performance settings these problems may be an injury or a performance or skill deficit. To understand the problem, identifying the development of these types of problems uses the classifications of whether the problem has a clear aetiology (such as blunt force trauma) or unclear or multiple factors interacting that contribute to the aeitiology (complex problem).
Now we wont get into a deeper discussion on complex frameworks, but the clear distinction in the assessment of the problem classification is whether it is related to a known or multiple interacting features that create the aetiology.
- Define the problem
- This may seem simple. A strained hamstring for example, but in the context of musculoskeletal problems that is not the problem, that is the pathology. The problem definition is based on the motor task activity that the individual needs to participate in. For instance for a soccer player a hamstring strain is a problem because they cannot run at velocities, execute skills or defend at the required intensity due to the insufficient hamstring function. In this way if I strained a hamstring stepping down from a gutter in the street that did not limit my ability to walk, it would not reduce my capacity to function day to day at all. So the problem at hand is limited in such a circumstance, even if the pathology was similar to that of the soccer player.
- Establish the contributing factors to this musculoskeletal problem (the problem, not necessarily the individual)
- In the above example, a broader assessment of contributing risk factors for hamstring strain injury include risk factors such as previous injury, muscle fibre typology, age, hamstring strength profile.
- This understanding provides the basis by which your assessment can be completed, it gives you the clues needed to determine whether this individual you are dealing with may have some of the risk factors and gives you clues to assess and treat.
- Task Analysis
- This part of the problem analysis is typically the most time consuming as it requires profiling the task that the individual needs to return to. Again if we use the example given above, it may be completing a profile on soccer as a sport ad undertaking an assessment on the tactical, technical, physical and mental (psychological, emotional, social) features that are required for performance. We wont speak further to this here as we will highlight some of these in an upcoming article.
With the problem profile outlined, the opportunity to customise your assessment of the individual in front of you becomes much clearer. You have an understanding of how the development of the problem, its contributing factors and features are part of the observed issues and you can use this understanding to determine which features need to be addressed to work towards a solution.
In our next few articles we will take a deeper look at task analysis and assessing the individual to put the pieces of your needs analysis together.
Task Analysis
We have spoken in our previous articles about getting a greater understanding of the problem at hand. The next stage of the process in a Needs Analysis is the assessment of the task that the individual will/wants to return to.
But where do we start with task analysis?
A framework that has been helpful in the discussions of task analysis is the pillars of sports performance. Now this represents but one lens to look through for performance and whilst we have seen it described in sport, it is clearly applicable to more than just sport. We have seen a few versions described, and the scheme that we have found useful is to place the task under the following component headings; Tactical, Technical, Physical and Mental (Emotional/Psychological/Social).
These broad areas provide the foundation to establish where the individual that we are dealing with is placed in relation to the task that they need to return to.
If we use the example of a basketball player, who plays as a point guard, is a leader within the team and typically plays the full 48 minutes of the game we start to get some understanding of the requirements that individual needs to return to sport, and ultimately a high level of performance. As healthcare and sports professionals we get obsessed with preparing for the physical features that describe the task. In this case 48 minutes of high intensity sprints, change of direction and jumping tasks, interspersed with stoppages and dribbling the ball to set up plays. But this is just one component. Understanding the tactics of the team for instance significantly shifts the requirements of the physical preparation. An example would be a team that plays a very physical defense with lots of aggressive screens and zoning. This type of play is significantly more physically taxing and requires greater physical preparation due to the increased physical contact and body work that is used for this type of defensive set up. So you can see understanding the type of play and the role of the individual within the team is likely to shift based on the tactical approach.
The technical requirements are also a significant factor. If you are a point guard who shoots lots of 3 point shots, coming back from a shoulder or wrist injury to your shooting arm is likely to require more input to assist with shot accuracy, compared with a player that rarely shoots as part of their team role.
Finally understanding the mental/psychological/emotional requirements of the task is important. If the player is a leader in the team, or sport is their financial livelihood, there is much more attached to their performance and their ability to perform at their best.
Now I can here you saying how does tactical assessment relate to outside of sport?
It may seem odd but understanding the tactical approach that is taken by individuals or teams in relation to their occupation provides significant insight into where your planning might go. We work with a removal company as part of our work in injury management. And something that is really clear is that there is a very strong tactical approach to how they pack the trucks for two reasons. The first is obvious. If you pack in certain order you fit more in the truck. The second may not be so obvious, but is very clever. The management have devised an order of the move to allow their workers the opportunity to build into the move. They start with items that require a low to moderate level of difficulty, movement capacity and preparation that effectively acts as a warm up for their workers when they get to a job. They don’t start the job by moving a 250kg marble table. So you can see in this simple example that tactics are a part of everyday occupational duties, we just don’t see it that way intuitively.
With all of this in mind, we encourage you to use the pillars of performance the next time you want to understand a task with more depth and plan a rehabilitation or performance plan with greater acuity.