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Fit for duty: physio perspectives on training tactical athletes with Professor Rob Orr

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In this episode, Professor Rob Orr explores the unique assessment and treatment methods for 'tactical athletes', referring to military, police, firefighters, and nursing populations. We delve into their distinct physical, social, and mental demands, and the significant ramifications of injury, re-injury, or improper rehabilitation within this specific group.

Want to learn more about working with this population group? Rob recently did an awesome Masterclass with us, called “Treating Tactical Personnel” where he goes into further depth on treating military, police, firies & nursing populations.

👉🏻 You can watch Rob's class now with our 7-day free trial: https://physio.network/masterclass-orr

Rob is the director of the Tactical Research Unit, a multidisciplinary, international team of researchers nested in Bond University providing research, consultancy, and education services to tactical professions (military, law enforcement and protective services across their occupational lifespan (initial trainee to specialist) around the globe. 

If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!

Our host is Michael Rizk (@thatphysioguy)


UNKNOWN:

Thank you.

SPEAKER_00:

An athlete will have a set game day. We'll have an opposition that plays by the same rules. We'll have very specific clothing and equipment that they have to wear, which is uniform and has had a lot of money invested in it for performance. Tactical athletes, you know, tactical personnel, very, very different. Firstly, many of them aren't athletes. They're not hired because they're an athlete. They don't actually want to train. They want to do their job. They're wearing equipment, which is vital for safety. Their opposition often doesn't play by the same rules because if we're going to play by the same rules, they'll win.

UNKNOWN:

Thank you.

SPEAKER_01:

How might we treat our patients who are nurses, fireys, police or in the army differently? Today we had Rob Orr to discuss this. Now Rob was actually in the Australian army before designing the full physical training program. He's also a big part of the Bond University's Doctor of Physiotherapy. Now he took us through what we call tactical athletes, the considerations we have to make that are different, particularly the stresses and strains not only physically and mentally and also how we might approach their treatments. There were some really well thought out points here and it made me reflect on all the times I've had patients in that tactical athlete category. I hope you enjoy this episode. My name is Michael Risk and this is Physio Explained. Welcome, Rob. Thank you for joining us. Thank you for having me. We're talking about military populations or as you would, I think you said you call them tactical populations. Who was in that population cohort to start with?

SPEAKER_00:

So tactical populations is a broad term that we use to describe military, law enforcement, fire and rescue, paramedics. So those who basically put themselves in harm's way for the betterment of their community, whether it be internationally or even nationally or locally.

SPEAKER_01:

Yeah. Apart from the job title, what's the differences between that population and, say, the general pop if you're an allied health professional?

SPEAKER_00:

There's a couple of ways we can look at this. So firstly, when you compare it to the general population, obviously, They deliberately and knowingly put themselves at risk. So they go into situations which can be life-threatening and life-critical, which has important connotations for return to work, for example. And we can talk about some examples later. Yeah. But the physicality of their jobs is interesting because the physicality can be very, very high. So in the military, you could understand, okay, they're carrying a heavy pack on their back and They're doing battle maneuvers. They're doing fire and rescue. They're doing all these sorts of activities. So fire and rescue here, we're talking about firing rounds down range and then moving forward and retrieving somebody. But in law enforcement, for example, 80% of their job can be very sedentary. They're not actually doing a lot, but then suddenly they have to become very kinetic. We've been on ride-alongs with the police where I've been with one of the sergeants in the vehicles as he was a two-up. So he's driving around just listening to the other patrol cars out there and they call him if they need help. So he's driving around. We're patrolling around the vehicle for probably three hours. And he's saying, oh, it's great listening to that background community knowledge. And oh, this guy, yeah, he's on a run. So we're coming here. We're watching this area and doing that. And suddenly he gets a call that there's a situation that they request him on. And it's a domestic violent incident. And we literally drive across to where it is under lights. So now it's heart rate through the roof because of a hormonal dump. So he's been in the car sitting down for three hours. Suddenly he's got this hormonal dump, heart rate through the roof, literally pulls up to the apartment block. jumps out, sprints, runs up three flights of stairs and bang into an area where he doesn't know what he's going to find. So imagine sitting for three hours and then suddenly with all your gear, which is about 10 kilograms, getting up out of a vehicle and sprinting and then sprinting upstairs. And as you then get there, that's when you have to be at your optimal performance. So the requirement is incredibly complex. Very different, however, to paramedics. Paramedics, you don't hire them because they're very, very fit. You hire them because of their clinical skills. But fitness is critical because they need to be able to carry their struggle bags. They need to be able to move to a victim. They need to be able to lift and carry equipment so they can remain on the job. So you can see that there's these subtle nuances between them all, but physicality is an underlying principle, which is obviously the field that physiotherapists fit into. Now, this physicality has led to the term tactical athlete, and you'll see that term being thrown around a lot. Now, ironically enough, the person who came up with the term tactical athlete was a man by the name of Mark Stevenson. And he's actually doing his PhD with us now on stress and reactive firing. But when you actually ask, where did this term come from? He said, all he really wanted was for people to understand that these, particularly in the military, they need the same amount of dedication and support that you give to elite athletes. They need optimal meal plans. They need optimal recovery. They need optimal return to work, return to sport practices, which they didn't have beforehand. And yet everybody's automatically meant this means that, okay, there must be athletes, which they're not. So they're very, very different to athletes. An athlete will have a set game day, will have an opposition that plays by the same rules, will have very specific clothing and equipment that they have to wear, which is uniform and has had a lot of money invested in it for performance. Tactical athletes, tactical personnel, very, very different. Firstly, many of them aren't athletes. They're not hired because they're an athlete. They don't actually want to train. They want to do their job. They're wearing equipment, which is vital for safety. Their opposition often doesn't play by the same rules because if we're going to play by the same rules, they'll win. So if you have a look at how most police officers end up in front of riots and riot squads, compare the number of police officers as opposed to rioters. They're vastly outnumbered. You look at a fire that a firefighter is facing, the fire is an inanimate being, and therefore you can't reason with it. You can't say, okay, well, look, okay, I'm tired. We're going to have a timeout. So they work in a totally unpredictable, austere environment, which is different to that of an athlete. And the failure is the critical thing that we like to highlight here, particularly for return to work following injury. If they fail, they don't lose championship points. They don't go sit on a bench. They can get seriously injured. A member of the public could get seriously injured. And at worst, they could lose their life.

SPEAKER_01:

Yeah.

SPEAKER_00:

So the end state can be incredibly critical as part of your return to activity platform.

SPEAKER_01:

I really appreciate that you went into that and the language distinction because it completely... reframes. Even for me, I was sharing with you off air that I did one of my placements in Holsworthy Barracks, but it just reframes, even the language tactical athlete, it reframes for you the level of care you need to have. Given what you've just said, what is the general cause of injuries and how is that different for the tactical athlete?

SPEAKER_00:

Yeah, look, that's a really good question. They're the same, same, but different. So for example, in the military, you play a lot of sport. They play sport for a variety of reasons. And sometimes it's not actually just the physical element of playing sport. It's the teamwork. It's the ability to communicate whilst you're doing things, you know, while you're huffing and puffing and breathing heavy. So your ability to communicate, have situational awareness is something that they'd use in battle. So sport is a very, very useful enabler. However, it's also one of the leading sources of injury. And now I will share with you a little comment, which is a little bit amusing on our point of view. Because I used to play for our battalion, whenever we used to play one of the other battalions in sport, Our battle cry used to be free medical, free dental. So you go in at 110%. It was all about winning. Now that I'm older, wiser, and more broke, and I was going, well, that isn't obviously the smartest thing to do. But you can see that win mentality, which is important to the military. Your aim is to win a land battle. So little nicks, scratches, you shrug it off and you keep going. You go at 110% even if you're limping, which as we know in the sporting environment probably isn't the smartest thing to do. So you can understand why Physical injuries from sport are very, very high in the military context. So physios are primed in that realm. We know sport. We know sporting injuries. We know how to fix them. The difference, however, is the context in which we return them to work. That's the big difference. Now, you also have a whole bunch of other things apart from the sports that cause injury. Physical training causes injuries. One of the things I did when I was at the Royal Military College, when I was posted to Duntroon, and I was working there as a physical training instructor and then as a physiotherapist, is I'd take our physiotherapists, the civilian physiotherapists that were contracted, to watch a military PT session. It is not like going to the gym. It is not like many of these boot camp classes that you see. Very, very different, incredibly physically demanding. And there is a whole different element there of peer pressure and performance requirements as a group. And a lot of the pressure is self-imposed pressure, or sometimes it is an externally motivated pressure. So The physical activity element is incredibly high, incredibly complex, and it's not like you'd see in a gymnasium. So understanding the differences and when they say, okay, it's a physical training related injury, what that actually means. A lot of people don't try and push a unimog tire up the side of a hill whilst carrying, you know, ammunition boxes and, you know, running with weapons and carrying stretches. So a lot of the physical elements of their training can be very, very different. They do your standard, let's go for a run in a standard circus. That's common. But again, there's these other elements of physical training that are very, very different. So again, physical training, sport, leading causes and mechanisms of injury, which can obviously fit well within the PTI realm. And the nature of the injuries are definitely the bread and butter of a physiotherapist. Sprains and strains, still the leading natures of injuries. your typical bodily sites, although they do change. So for example, the lower limbs in the military, very, very common. Your standard lower limb injuries, typically the knee, very, very common. Shins, very, very common. Feet, depending on the activity. Let's go to law enforcement. The lower back is typically the leading site of injury, followed by the knee. And this will change depending on the nature of the law enforcement population, which makes sense. We know that if you're a highway patrol officer, if you're a mounted police officer, Well, obviously, you're going to be in a seated position with all your load-bearing equipment on so that there's going to be a lot more compressive stress on your lumbar spine because, as you know, obviously, seated, Newton's third law, for every action, there's an equal and opposite reaction. The weight of the body goes into the seat and straight back up into the spine. So if you look at the research by Nashimson, it shows that standing is classified as a 1.0 as your baseline amount of force through your L4, L5. Sitting is about 1.4 times. So if you think about that 1.4 times more load for your back, There will be differences in the environments that you return these populations to, which means the nature and sites of the injuries are very, very different.

SPEAKER_02:

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SPEAKER_01:

Again, while sharing my time in Holesworthy, actually, this thought just came to me. There are a lot of stress fractures, particularly in the lower limb. So what are your considerations when returning the tactical athlete back to work? And I also wanted to add, this was a personal question I wanted to ask you about mindset. Is our goal to get these tactical athletes back to 100% or is there a level of acceptance around 90% is good enough because of the job we do, we need to go out there in pain? I'd love your perspective on that.

SPEAKER_00:

It's a good question. They actually both feed into each other. The most important thing you need to realise is what return to work looks like and where they are in their occupational cycle. So for example, if it's the beginning of the year and the military unit doesn't have any exercises or anything coming up, You can send it back at 90%. The sooner you get them back to their unit, the better. And then they just start to see you as needed from the unit. That's easy to do. However, for example, some law enforcement officers, depending on the nature of their job, they will either be zero or 100%. And we've heard of situations where an officer's gone back and was only given desk duties because of their injury. And now they're at about 80% to 90% just sitting down at a desk, manning a radio. And then some pork chop comes in, half drunk in the middle of the night after watching Rocky or Rambo or something. and starts taking a swing at everybody in the station. So this officer who was sitting down, manning the radio, suddenly leaping over the counter, being involved in a physical altercation, which didn't do the back any good. So it's really important to understand the context in which you're returning them to. However, prior to releasing them for full occupational duties, you have to make sure they're at 100%. Because as I said, when they're on job tasks, it's not only their life. Yes, they can push to their own pain, but it'll start to distract them. And it can have huge second and third order consequences on everybody else around them.

SPEAKER_01:

Yeah. I was mindful of that. And again, I was only a placement when doing that, but I definitely sensed from the patients, the tactical athletes, that they were tough and they were very tough. And they were like, this is just pain in my shins. I'm happy to go back now. But my clinical brain was like, this isn't 100%. So, how would you deal with those situations? Do you have to go above them and say, are they needed for 100% tactical duties or are they okay to come back 90%? How do you handle that?

SPEAKER_00:

That's a really important distinction that you've made there, and we've actually had to discuss this at the Royal Commission. You've got to remember, we're training the military to have, particularly in the Army, their three primary mindsets are teamwork, courage, and initiative. Basically, they've got to push through pain, whatever hurts, niggles, et cetera, to win the land battle. So for them, being taught to push through pain is an important part of their mission-critical element. Unfortunately, there's this back cast where they get injured during physical training, et cetera. That mindset still exists. So we know, and we've done this research, particularly in the Australian military, they are very, very likely to under-report their injuries. They typically self-manage their injuries. And it was about literally 50% of minor injuries aren't being reported because they work their way through it. And of course, once you've got lots and constant minor injuries, it becomes a more major injury, and that's when they start to report because the tissue doesn't magically heal themselves. And they also don't understand that the absence of pain does not mean that they are better. So quite often, it's sitting down with them and saying, look, you can either miss two or three weeks of activity now, or you can miss two or three months of activity later when your shin finally blows out. Your choice. And educating them that pain is not a good indicator of recovery is critical, because that's all they know. Pain means that sore means it's broken. No pain must be fixed. And we know as physiotherapists that tissue healing doesn't work that way. So education is the critical piece here and second order consequence. Hey, you can take two to three weeks now or you can take two to three months later. I

SPEAKER_01:

think that's a great point to finish on and such wonderful insights with this population and different things to think about. Thank you so much for your time.

SPEAKER_00:

Well, thank you very much for having me. It's been great.

UNKNOWN:

Thank you.