Monday, July 19, 2010

Training Prescription: Placebo

A post on Precision Nutrition got me thinking about a key aspect in the Art of Coaching; the Placebo effect.  As a performance coach you will have to understand this and manage it, and potentially employee it.

During this year's NFL Draft preparation, we had athletes that struggle with the over-reaching phase.  Now understand, most collegiate football players have not gone through an extended over-reaching period that affects them neuromuscularly.  This may sound like a knock on strength programs, but its not.  In a football offseason, they are making steady progression and the emphasis is strength, power and mass in most cases.

Under the stress of the NFL draft process and preparing for the Combine and Pro Days, these athletes struggle with the feeling of over-reaching. We often look to effectively use some methods that may be as much "placebos" as anything else. 

Here's one we see every February. We have the case of an athlete preparing for the NFL Combine. His focus is the 40 and nothing but. Training is going great. Times in the 10 and 20-40 are dropping. He's been training hard and technique is better when we breakdown the video analysis.

The problem, he's 2 weeks out and is coming out of an overreaching phase still. Even though he has shown all those improvements, his NMS is just recovering and supercompensating as evidenced by various jumps we measure.

This concept of overreaching is hard to fully accept for a few. He has to have that current 40 time. When he gets it and doesn't see that all time PR yet, he flips out. Literally. Loses all belief. Wants to throw everything in the training plan out the window. Wants to go find another speed coach to work magic.

So what do we do as coaches? For one we go back and review the plan we set. We remind him how we said this would happen and actually means everything is working. We show him the same progression for guys who have ran great PRs in the 40 in previous years training with us.

Still he's off the reservation.

So, we also breakout PLACEBO.  

Now most people have some idea of the placebo effect.  In a classic pharmaceutical study design, there is the group that gets the drug, the control group who gets nothing, and the group that gets the placebo .  The placebo is something that is inert.  It has no effect.  However, what has been documented for the last half 50 years is that the placebo group will probably show results.

"Whether you believe it will or won't work, you're right" is an old adage that sums it up.  The placebo effect is any phenomenon that occurs from a person’s belief and perceptions, rather than from the actual chemical-physiological effects of a drug.

Placebos can have a huge effect.  It is one of the confounding factors in many areas of medical research.  It's also a confounding factor in performance training.  What is really causing some of the results we see. 

If an athlete uses _____________(fill in the blank with any treatment or modality here) then after 3 weeks receiving it, they feel 90% better.  That's an effective treatment it seems.  Great!

Looks great until you realize that an athlete receiving what looks like the same treatment, but its a sham, and they still get 60% better.  A little confusing to what's really happening.  They feels 60% better, but the treatment/modality wasn't real so that's not why.

Now imagine there was a way (in pharmaceuticals this is easier) that a third athlete get the treatment but doesn't know it. takes the real drug, but they don’t know. (Maybe we do myofascial work while they sleep?) They only feel 30% better.

If we compare these three groups we can see that that 90% is actually 30% real effects plus 60% placebo.

OK, so the placebo effect is real. But this is training not a pharmaceutical study, right?  This is physical, you can't fake it can you?

Not so fast.  Watch this video.

Remember that NFL Combine athlete?  What ails him is doubt, so we breakout one of our tools to address it.

He mentions during the discussions that his hip was tight. 

"Really? Tell me more." "That could hold you back a little. Let's see the PT."   The PT finds that its a little tight like always. We know he has been convinced that he needs something "extra"and he's heard the hype that A.R.T. is amazing from some other guys.   So we schedule some A.R.T. on it for him.  We address the "hip issue" while also taking care of the normal recovery we'd planned. 

Walla!  When he runs again he sees improved times and is fired up again to get to the Combine.

Do we know if its the treatment or the placebo effect?  No.  

We know we trained him well and that the additional A.R.T. wouldn't hurt.  (don't misunderstand, I strongly believe in many soft tissue techniques including A.R.T.)  We allowed an opportunity for his beliefs in A.R.T. to help him.

Make sure you look at the entire picture.  The placebo effect is scientifically documented.  Don't forget it.