Education, Faculty of
Kinesiology, School of
DSpace
UBCV
Vecchione, Joseph
Master of Science - MSc
University of British Columbia
Changing technique, whereby a permanent strategy is adopted to improve performance or reduce injury risk, is a common practice among sport practitioners. Although the empirical literature is lacking quality evidence and consensus regarding best methods, there are several models and methods suggested; including the Five-A model, error amplification, and continual contrasting of the “old” technique with a new one. My aims with this thesis were to review the technique change literature to help identify commonalities and differences across methods and evaluate if and how these methods are being applied in high-performance sport across a range of practitioner groups and sports. In Study 1, I interviewed fifteen practitioners and in Study 2, I developed an online survey that was completed by thirty-six practitioners, all highly experienced and many working at the highest level of sport. Three practitioner groups were targeted including sport coaches, therapists and strength & conditioning (S&C) coaches and sixteen different sports. In general, there were more similarities than differences across groups; coaches and S&Cs intervened to improve performance, whereas therapists, as well as S&C coaches, intervened to reduce injury risk or regain technique post injury. When intervening, S&Cs and therapists would focus on physical assessments and modifications, often working outside the sport context, then back into it. Coaches would remain within the sport context, though scale back the task difficulty to encourage change. There was little evidence that exaggerating errors, or contrasting between old and new ways, was used to change technique, but practitioners did use error awareness, technique-focused feedback (directing attention both internally and externally) and direct-instruction regarding a desired technique. Despite practitioners reporting that they spent ~55% of their time changing technique, with a success rate of ~60%, many noted challenges associated with technique interventions. There are gaps in knowledge about current evidence-recommended methods, particularly the need to train and evaluate the new technique in competition-like situations. As such, greater efforts should be made by academics to engage in knowledge translation activities to aid practitioner awareness of the various tools that could improve the efficiency and efficacy of technique change interventions.
TECHNIQUE CHANGE: HOW PRACTITIONERS INTERVENE IN HIGH-PERFORMANCE SPORT by Joseph Vecchione B.Sc., The University of Guelph, 2014 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Kinesiology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2023 © Joseph Vecchione, 2023 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled: Technique Change: How Practitioners Intervene in High-Performance Sport Submitted by Joseph Vecchione in partial fulfilment of the requirements for the degree of Masters of Science in Kinesiology Examining Committee: Dr. Nicola Hodges, Professor, School of Kinesiology, University of British Columbia Supervisor Dr. Andrea Bundon, Assistant Professor, School of Kinesiology, University of British Columbia Supervisory Committee Member Dr. Catherine Madill, Associate Professor, Faculty of Health Sciences, University of Sydney Supervisory Committee Member Dr. Ben Sporer, Vice President, Performance Strategy, Research and Innovation, Vancouver Whitecaps Football Club Supervisory Committee Member iii Abstract Changing technique, whereby a permanent strategy is adopted to improve performance or reduce injury risk, is a common practice among sport practitioners. Although the empirical literature is lacking quality evidence and consensus regarding best methods, there are several models and methods suggested; including the Five-A model, error amplification, and continual contrasting of the “old” technique with a new one. My aims with this thesis were to review the technique change literature to help identify commonalities and differences across methods and evaluate if and how these methods are being applied in high-performance sport across a range of practitioner groups and sports. In Study 1, I interviewed fifteen practitioners and in Study 2, I developed an online survey that was completed by thirty-six practitioners, all highly experienced and many working at the highest level of sport. Three practitioner groups were targeted including sport coaches, therapists and strength & conditioning (S&C) coaches and sixteen different sports. In general, there were more similarities than differences across groups; coaches and S&Cs intervened to improve performance, whereas therapists, as well as S&C coaches, intervened to reduce injury risk or regain technique post injury. When intervening, S&Cs and therapists would focus on physical assessments and modifications, often working outside the sport context, then back into it. Coaches would remain within the sport context, though scale back the task difficulty to encourage change. There was little evidence that exaggerating errors, or contrasting between old and new ways, was used to change technique, but practitioners did use error awareness, technique-focused feedback (directing attention both internally and externally) and direct-instruction regarding a desired technique. Despite practitioners reporting that they spent ~55% of their time changing technique, with a success rate of ~60%, many noted challenges associated with technique interventions. There are gaps in knowledge about current evidence-recommended iv methods, particularly the need to train and evaluate the new technique in competition-like situations. As such, greater efforts should be made by academics to engage in knowledge translation activities to aid practitioner awareness of the various tools that could improve the efficiency and efficacy of technique change interventions. v Lay Summary Changing technique, whereby a permanent movement strategy is adopted to improve performance or reduce injury risk, is a common practice among sport practitioners. Our aims with this research were to review the research literature on technique change and determine if and how these methods are being applied in high-performance sport. We interviewed and surveyed coaches, strength & conditioning coaches, and therapists to learn about how they intervene and whether they use the methods from the research literature. We learned that practitioners use parts of some methods, though are largely unaware of the methods that have been studied. Because practitioners reported spending ~45-65% of their time trying to change athlete’s technique, that they viewed this process as challenging, and that success rates were only as high as ~60%, there is a need to better convey knowledge generated from research into practice. vi Preface This research was approved by the University of British Columbia’s Behavioural Research Ethics Board (H20-03794, H20-03772). Chapter 1 has been published as a book chapter with my Supervisor, Dr. Hodges, and Supervisory Committee Member, Dr. Cate Madill. Joseph Vecchione, Cate Madill, Nicola J. Hodges. (2022). Modifying technique in closed self-paced motor tasks. In G. Ziv & R. Lidor (Eds.), The Psychology of Closed Self-Paced Motor Tasks in Sports (pp. 122–145). I conducted most of the research and wrote the manuscript with editing support. This thesis project was designed and developed with the help of my Supervisor, Dr. Hodges. Research on the topic of technique change initiated from conversations between my Supervisor and Supervisory committee member, Dr. Cate Madill. The Supervisory committee made suggestions to translate the survey into an interview. Dr. Andrea Bundon supported in its design and analysis planning. I conducted data analysis for both the interview and survey study. vii Table of Contents Abstract ......................................................................................................................................... iii Lay Summary .................................................................................................................................v Preface ........................................................................................................................................... vi Table of Contents ........................................................................................................................ vii List of Tables ..................................................................................................................................x List of Figures ............................................................................................................................... xi List of Abbreviations .................................................................................................................. xii Acknowledgements .................................................................................................................... xiii Dedication ................................................................................................................................... xiv Chapter 1: Introduction ................................................................................................................1 1.1 Technique Change Definitions ....................................................................................... 2 1.2 Evaluation of Research ................................................................................................... 4 1.3 Descriptions and Research Evidence for Various Technique Change Methods ............. 8 1.3.1 Old-Way, New-Way ............................................................................................... 8 1.3.2 Identification-Correction-Control (ICC) Program ................................................ 10 1.3.3 Method of Amplification of Error ......................................................................... 12 1.3.4 The Constraints-Led Approach ............................................................................. 15 1.3.5 The Five-A Model of Technique Change ............................................................. 17 1.3.6 Traditional Method, Direct Instruction ................................................................. 19 Other Technique Change Methods ....................................................................................... 21 1.4 Summary of Methods and Identification of Common and Different Elements ............ 22 viii 1.5 Technique Change Methods across the Four Rs ........................................................... 25 1. Relearning and Resisting .............................................................................................. 26 2. Refinement .................................................................................................................... 26 3. Regaining ...................................................................................................................... 27 1.6 Conclusions and Thesis Aims ....................................................................................... 29 Chapter 2: Interview Study .........................................................................................................32 2.1 Introduction ................................................................................................................... 32 2.2 Methods......................................................................................................................... 36 2.2.1 Framework ............................................................................................................ 36 2.2.2 Approach and position .......................................................................................... 37 2.2.3 Participant selection, recruitment and composition .............................................. 38 2.2.4 Materials ............................................................................................................... 40 2.2.5 Data Analysis ........................................................................................................ 41 2.3 Results and Discussion ................................................................................................. 42 2.3.1 How practitioners intervene to change technique in high-performance environments ......................................................................................................................... 43 2.3.2 Use of evidence-recommended approaches in high-performance environments . 52 2.4 General Summary ......................................................................................................... 55 2.4.1.1 How are practitioners applying technique change methods? ............................ 55 2.4.1.2 Are practitioners applying evidence-recommended approaches? ..................... 57 2.4.2 Application Gaps .................................................................................................. 58 2.4.2.1 Measuring and Assessing Transfer ................................................................... 58 2.4.2.2 Role of Sensory-Cognitive Processes ............................................................... 59 ix 2.4.2.3 Use of evidence-recommended strategies ......................................................... 60 2.5 Conclusion .................................................................................................................... 61 Chapter 3: Survey Study .............................................................................................................62 3.1 Introduction ................................................................................................................... 62 3.2 Methods......................................................................................................................... 65 3.2.1 Participants ............................................................................................................ 65 3.2.2 Materials / Survey Design ..................................................................................... 68 3.2.3 Data Analysis ........................................................................................................ 69 3.3 Results ........................................................................................................................... 70 3.3.1 Aim 1: Role and Processes Related to How Practitioners Change Technique ..... 70 3.3.2 Aim 2: Use of Evidence-Informed Strategies ....................................................... 80 3.4 Discussion ..................................................................................................................... 92 3.5 Summary and Conclusions ......................................................................................... 102 Chapter 4: General Discussion .................................................................................................104 Chapter 5: Conclusion ...............................................................................................................112 References ...................................................................................................................................114 Appendices ..................................................................................................................................122 Appendix A Interview Materials ............................................................................................ 122 Appendix B Survey ................................................................................................................. 130 x List of Tables Table 1 The Four Rs of Technique Change Scenarios ................................................................... 3 Table 2 Summary of Technique Change Methods and Literature Citations .................................. 6 Table 3 Intervention Reason ......................................................................................................... 71 Table 4 Technique Change Scenarios ........................................................................................... 73 Table 5 Different Methods for Technique Change Scenarios ...................................................... 74 Table 6 Assessing Effectiveness of an Intervention ..................................................................... 76 Table 7 Time Spent & Success Intervening .................................................................................. 77 Table 8 Signals to End an Intervention ......................................................................................... 79 Table 9 Negative Practice, Error Awareness, Error Amplification, Contrasting .......................... 81 Table 10 Part-Practice, Physical Task Constraints, Competitive Pressure ................................... 83 Table 11 Instruction Technique .................................................................................................... 85 Table 12 Cueing & Focus of Attention ......................................................................................... 87 Table 13 Cueing Look and Feel of Old and New Movements ..................................................... 89 Table 14 Necessity of a Model to Change Technique .................................................................. 91 Table 15 Optimal Technique ........................................................................................................ 91 xi List of Figures Figure 1 Diagram of Thematic Analysis Results .......................................................................... 43 Figure 2 Sport Distribution Among Survey Participants .............................................................. 66 Figure 3 Years of Experience in Current Sport Practitioner Role ................................................ 67 Figure 4 Cueing of Look and Feel for New and Old Movements on Average among Practitioners....................................................................................................................................................... 88 xii List of Abbreviations CLA = Constraints Led Approach Five-A = Five A Model of Technique Change ICC = Individual Control Correction Program MAE = Method of Amplification of Error S&C = Strength & Conditioning Coach xiii Acknowledgements Firstly, I would like to thank my supervisor, Dr. Hodges for supporting my knowledge pursuit into the wonderfully nuanced area of skill acquisition research. Your patience and commitment allowed me to flourish as an independent thinker and grow into a capable researcher. I would like to thank my committee members, Dr. Andrea Bundon and Dr. Cate Madill, for your support to pursue knowledge translation efforts of my research through conference presentations and book chapters. Your involvement made the work better and pushed me to expand my thinking. I would like to thank my committee member, Dr. Ben Sporer, for your challenging questions about the application of this research and supporting my growth and development as a S&C practitioner during my graduate degree. I would like to thank my friends and colleagues in the Motor Skills Lab, the Vancouver Whitecaps Football Club, and in the UBC Strength & Conditioning Program. I couldn’t have asked for a better learning experience throughout this degree and am grateful for the opportunities and life-long friends I gained through my academic and professional efforts. Special thanks to my parents, friends, and in particular, my wonderful partner Jördis, who remained patient with me and supported me emotionally throughout my journey as I often chose the road less travelled. xiv Dedication This thesis is dedicated to those who are willing to think and do things differently in the pursuit of excellence in their craft. 1 Chapter 1: Introduction Technique change is foundational to the ongoing process of movement skill acquisition in domains such as sports, the military, or clinical environments. Consider the situation of an athlete who is experiencing discomfort from a rather unusual type of golf swing, or a swimmer who is consistently within the top 50 of her sport but cannot seem to break into the top echelon because of inefficient mechanics of her turn and kick. These examples epitomize situations in sports where a change in technique is needed. Technique itself refers to the movement of body segments and their position and orientation, as they change during a motor task to facilitate effective performance (Lees, 2002). Although generally “better” technique will result in improved performance, the relationship between technique and performance is complex, and is dependent on many factors including the sport, the athlete, and the technique (Lees, 2002). Despite the prevalence of situations in sports where a change in technique is needed, there is a dire lack of empirical evidence concerning the relative effectiveness of the methods used for changing technique. Moreover, there is a lack of detailed understanding as to potential methods that can be used to change technique and, importantly, the characteristics and mechanisms which might be driving their effectiveness. Our aims in this chapter are: a) to provide some definitional clarity regarding technique change; b) to detail various methods which have been studied in relation to technique change, as well as to evaluate associated empirical evidence; c) to determine common approaches and potential mechanisms across methods; and d) to make recommendations regarding research and application based on current knowledge. 2 1.1 Technique Change Definitions There are three interrelated features which characterize technique change: it requires a permanent modification, this modification is applied to a previously acquired movement, and an existing or old technique is no longer desirable and should be stopped, replaced, or modified (see Sperl & Cañal-Bruland, 2019). The process of technique change or modification is referred to in a number of ways and we have provided a summary of definitions in Table 1. We refer to these definitions as the 4Rs of technique change: Relearning and Resisting, Refinement, and Regaining, which reflect various technique change scenarios that vary in their severity. At one end, technique change can be relatively drastic, necessitating not only relearning but also the inhibition of a previous, undesired technique – what we term relearning and resisting. This drastic change, perhaps as a result of technology and/or sport science research, is expected to result in better performance outcomes. A commonly cited example is the “Fosbury Flop” high-jump technique, replacing the previous method of clearing the bar forwards not backwards. More subtle changes to technique have been described as technical refinement (Carson & Collins, 2011). Technical refinement does not require the cessation of an old behaviour, rather a modification to an existing behaviour. A recent example of technical refinement can be found in track cycling, where the standard upright standing position for the start is adapted to the more contemporary, forward standing start, with a low forward torso and head position to reduce aerodynamic drag and increase speed (Merkes et al., 2019). 3 Table 1 The Four Rs of Technique Change Scenarios Terms/Sub-terms Definition Reference Technique change The permanent modification of an already acquired skill where the task goal remains the same (Sperl & Cañal-Bruland, 2019) i. Relearning & Resisting Drastic change to technique which will necessitate not only relearning of the skill but also the inhibition of a previous, undesired technique ii. Refinement “An evolution of technique” that includes subtle changes to finely skills (Carson & Collins, 2011, p. 147) iii. Regaining “Returning to a previous state of optimal technique from current suboptimal execution” (Carson & Collins, 2011, p. 147) 4 A final way that technique change has been considered is as a process of regaining technique, which might be due to recovery from injury or a loss of form (Carson & Collins, 2011). In the regaining scenario, there is really no new learning but rather the recovery of a previous technique. Though cases of regaining may require the inhibition of undesired techniques, it is not a consistent feature of this technique change scenario. The changes are typically small or subtle, which covary with improvements in fitness or injury status. In general, technique change interventions are not always designed to improve performance, but rather may be instigated to prevent or recover from a technique that leads to (or could lead to) injury. They may be about change generally – not necessarily moving to an ideal or preferred way but promoting the need to do something different. This change may be required to improve performance, safety, or health outcomes and as such can be highly individualized. Understanding the differences among these definitions leads to the appreciation of the broad scope of scenarios where technique change interventions can be applied, and can also inform as to when different approaches are needed. 1.2 Evaluation of Research There is growing evidence that methods other than, or in addition to, direct instruction exist for changing technique, even though the research in this area is still limited. One of the main challenges in this area is conducting controlled research that is dependent on the recruitment and ideally random allocation of athletes to various treatment interventions spanning multiple sessions, including retention tests and transfer to competition. To our knowledge, there are only four studies that have had a relatively large sample of athletes (n >30), included the measurement of comparison groups across multiple sessions, and, importantly, included 5 retention tests to assess relatively permanent changes (Gray, 2018; Milanese et al., 2008; Milanese et al., 2016; Milanese et al., 2017). Moreover, there has been no assessment of the efficacy of an intervention for transfer to competition, and although retention tests have been used they were limited to weeks (maximum 1 month; Gray, 2018). In contrast, there have been a small number of case studies that have documented lasting impacts beyond one month and also in competition (Carson et al., 2014; Collins et al., 1999; Hanin et al., 2002; Hanin et al., 2004; Williams et al., 2012). In Table 2 we provide a summary of various methods that have been applied to technique change, along with information concerning common elements and research evidence. Many of the proposed methods are limited to case study evidence and, irrespective of whether the research is based on case studies or comparative studies, the time course of these interventions is wide-ranging. Relatively permanent changes are noted after as little as one session (e.g., the method of error amplification), whereas others appear to require weeks of practice (e.g., the Five-A method). There are other variations in factors that make comparisons across methods difficult, such as the athlete’s skill level, difficulty of the skill/technique, and inter-individual differences in the response to technique change interventions (Carson & Collins, 2015; Sperl & Cañal-Bruland, 2020). Effective technique change research in sports is obviously challenging, where there is a need to take a large group of experienced athletes, subject them to different interventions, and conduct longitudinal follow-ups and analyses to confirm relatively permanent change and effective transfer to competition. 6 Table 2 Summary of Technique Change Methods and Literature Citations Various Technique Change Methods and Studies Associated With Each Technique, Along With a Description of Common Elements and Types of Sports and Scenarios Where These Methods Have Been Studied Method Definition Common Elements Sport Skills References Application (Four Rs) Old-Way, New-Way/ Identification-Control-Correction Program Repetitive contrasting of movement with desired technique / A systematic approach to identifying an individual’s optimal technique Direct Instruction Practising errors & correct technique Error Awareness Contrasting Technique-focused feedback (internal FOA1 on difference) Swimming block-start, Javelin, Sprinting, Tennis Serve, Diving (Hanin et al., 2002, 2004, Lameiras et al., 2015; Hanin & Hanina, 2009) Relearning & Resisting, Refinement, Regaining Error amplification/ Augmentation error Exaggerating the movement and contrasting it with attempts to achieve the desired technique Indirect instruction (mostly) Practising errors Error Awareness Contrasting Technique-focused feedback (on error) (internal FOA on error) Broad Jump, Golf, Olympic Weightlifting (Milanese et al., 2008, 2016, 2017) Refinement 7 Constraints Led Approach Manipulating individual, task & environment constraints to change technique Indirect instruction Practice to achieve outcome Low error awareness Outcome-focused feedback (external FOA) Hitting in Baseball (Gray 2018) Refinement Five-A Model A five-step approach requiring Analysis, Awareness, Adjustment, (Re)Automation, Assurance Direct instruction Practising errors & correct technique Contrasting Error Awareness Technique Focused Feedback (internal FOA on difference) Golf, Olympic Weightlifting, Javelin (Carson et al., 2014, 2016; Collins et al., 1999; Carson & Collins, 2011) Refinement, Regaining Traditional (direct instruction only) Providing a verbal and/or visual description about the desired technique and feedback related to the error Direct instruction Practising correct technique Error Awareness Contrasting Technique focused feedback (internal FOA on difference) Hitting in Baseball, Olympic Weightlifting, Golf swing, Broad jump (Milanese et al., 2008, 2016, 2017; Gray, 2018) Refinement 1 FOA = Focus of Attention 8 In the following section, we introduce the various technique change methods, discuss key and potentially common elements with other methods, as well as speculate on mechanisms through which the methods will likely work to change technique. We also highlight research related to their effectiveness, addressing the successful application of these methods for self-paced, closed motor tasks and sports. 1.3 Descriptions and Research Evidence for Various Technique Change Methods 1.3.1 Old-Way, New-Way Description and procedures: The Old-Way, New-Way (OWNW) approach to technique change, also called Negative Practice (Lim et al., 2017), has been adapted from Lyndon’s work in educational settings addressing habitual spelling errors in students (Lyndon & Malcolm, 1984). The aim of the intervention is to actively contrast an old-way with the learning of a new-way, which is thought to reduce inhibition (also called proactive interference) of the old on the new, promoting forgetting of the old. This comparative method has also been referred to as contrast training and it has been used in a variety of settings, including technique change in sport (Collins et al., 1999). Practicing the old-way, or what might be thought of as “the error”, contrasts with more conventional direct instruction approaches, whereby errors are avoided (Adams, 1971). The OWNW approach typically has three distinct phases: (a) preparatory phase, (b) mediation phase, and (c) application phase (Lyndon, 2000). In the preparatory phase, the goal is to clarify the difference(s) between the old- and new-way of performing a skill. This process of differentiation or error awareness requires elaboration between the coach and athlete, and can be time intensive depending on the skill. This is really a process of perceptual training, where the 9 learner is trying to form an understanding or image/template of what is desired and relate this to their current performance (Madill et al., 2019). There are five steps in the mediation phase, simplified as readiness, being able to describe the new-way, practising both the old and new ways and identifying links between them, then practising both and describing any differences, and finally continuing to alternate practice of the old-way and new-way for five attempts. This suggestion of five attempts is based on work with spelling errors (Lyndon, 2000), which are likely much simpler to identify and correct than errors involved in whole body movement where the dosage would probably be higher. In the application phase of the OWNW approach, the goal is to apply the refined skill in training. This application involves progressively decreasing the reliance on external feedback, while increasing environmental stressors and competitive demands to mimic performance conditions. Research: With respect to sports, there have only been case studies attesting to the efficacy of OWNW with athletes (Hanin et al., 2002; Hanin et al., 2004; Lameiras et al., 2015). The most convincing data come from three case studies with high-level athletes across three sports (javelin, sprinting, swimming; Hanin et al., 2002; Hanin et al., 2004). In all three cases, a single trial, involving the three phases as described above, produced stable changes with >80 % frequency of the desired technique. In a case study of an Olympic swimmer, stability was observed over an 8-month window, where the athlete improved their race times and starting speed in international competitions (Hanin et al., 2004). These case studies show that the OWNW method is potentially an efficient intervention tool for relearning and resisting scenarios related to technique change. 10 1.3.2 Identification-Correction-Control (ICC) Program Description and procedures: The Identification-Correction-Control (ICC) program is a three-step technique change method developed and tested by a group of researchers in Finland, working with internationally competitive elite athletes (Hanin & Hanina, 2009). The three steps of the ICC program include: a) identification of an individually optimal movement pattern, b) control and monitoring of this movement pattern, and c) correction of habitual performance errors. The ICC program is an interdisciplinary approach that has roots in skill acquisition and psychology principles, and is built upon ideas outlined in OWNW (and contrast training). The main difference between the OWNW and ICC programs is the added dimension of emotion control through sport psychology principles. This is evidenced by their two classification systems used to identify the target of emphasis in a technique change intervention – “emotion-focused” or “action-focused” coping (Hanin & Hanina, 2009). The ICC program places an emphasis towards what the authors term “action-focused” coping strategies by focusing on the movement execution and how it relates to perceptions and the emotional state of the performer (Hanin & Hanina, 2009). “Emotion-focused” coping is emphasized more when an athlete experiences challenges with emotional control, perhaps in high-pressure situations. In both scenarios, emotion and effort regulation tools (i.e., self-rating tools and imagery) are used to bring athletes into what are referred to as “individual zones of optimal functioning” (Robazza, 2006), before engaging in contrast-focused practice. Typically, the first step of the ICC program is completed in concert with the athlete by reviewing past performances and establishing what is individually optimal in regard to their movement, emotions, and efforts to improve performance during practice and competition. The second step involves error awareness and perceptual training of the desired movement pattern, which leads 11 into the third and final step of contrast training involving alternation of the old and new way. These three steps are typically carried out in a single session (ranging from ~1-3 hours), with specific direction provided to the athlete as to how to apply what they have learned into their practice, thus reinforcing the correct technique. There is a clear overlap not only in the intervention process of the ICC program and OWNW method, but also in the empirical evidence. However, we list the ICC program as a separate method due to its extensive application across a variety of sports and how it has developed from the OWNW method as a unique model of application (with detail given to the movement analysis and psychological analysis). Research: The ICC program has been studied with a large array of athletes across different sports, including track and field events: high jump, long jump, pole vault, javelin, hammer, shot put, 100m and 400m sprints; individual sports: swimming, diving, racing, pistol shooting, sailing, bowling, and free-style skiing; and team sports: volleyball and soccer (Hanin & Hanina, 2009). However, the research has been limited to case studies and only a small number of these have been published (in swimming, javelin, sprinting, and diving, Hanin et al., 2002; Hanin et al., 2004; Hanin & Hanina, 2009). Besides the diving case study, the other research was referenced above in relation to the OWNW. In a response to multiple commentaries regarding their article outlining the ICC program, a case study was discussed of an Olympic diver who was practising to regain his previous performance in international competition (Hanin & Hanina, 2009). The authors explained how they worked with the diver to develop an optimal yet individualized technique through review of past performances, how they established optimal levels of emotion and effort to improve performance during practice and competition, and how they supplied direction on how to apply the ICC criteria to a consistent training regimen. This 12 arguably resulted in a successful return to previous form and the winning of multiple competitions in the upcoming season (Hanin & Hanina, 2009). One of the strengths of the work with this ICC method is the matching of the technique change intervention with subsequent improvements in performance, often in international competitions (Hanin et al., 2002; Hanin et al., 2004; Hanin & Hanina, 2009). With respect to comparative studies, the step of identifying individually optimized movement patterns makes it difficult to compare across groups of individuals undergoing different methods, even though there will likely be technique similarities across individuals. The ICC program appears to have a strong record of success, adding to other evidence attesting to benefits of the OWNW to technique change. Although both the OWNW and ICC programs are grounded in mechanisms of contrast between desired and undesired actions (and as such, reduction of proactive interference), the appreciation of the psychological state and willingness of the athlete to undergo such a change is considered integral to the success of the ICC program. 1.3.3 Method of Amplification of Error Description and procedures: In the Method of Amplification of Error (MAE), the performer is typically instructed and given feedback to purposely exaggerate the technical error (Milanese et al., 2008). In rehabilitation literature, this error has been exaggerated through the use of robotic devices and the learning has been a result of adaptation to the error after the device is removed (e.g., Patton et al., 2013; Reisman et al., 2007). However, we are unaware of studies where physical devices have been used to exaggerate undesired techniques in sport settings. In the method used by Milanese and colleagues (2008), performers alternated between attempts to perform the movement with repetitions that exaggerated their identified technical error (through 13 the use of cues) and attempts without an error. This error/no-error type of training has similarities to contrast training typified in the OWNW. However, for the MAE, in the non-constrained/no-error trial, no instruction is provided about what a correct or desired movement should be. As such, learning is believed to be a consequence of correcting and adapting to large mistakes, rather than trying to match a desired technique goal (Milanese et al., 2008). The assumption with MAE is that performers will adapt their technique through the augmented intrinsic feedback about how the movement feels and looks, and in response to the impact of the movement error on performance outcomes (Milanese et al., 2017). In terms of the time course of such interventions, there are typically pre-instruction trials (i.e., a baseline assessment where the authors identify the main technical error), intervention trials (typically one practice session consisting of 3-4 rounds of alternating between error amplification and non-constrained trials), and post-intervention trials including delayed retention tests (Milanese et al., 2008; Milanese et al., 2016; Milanese et al., 2017). Research: Unlike many of the technique change methods, the effectiveness of MAE has been empirically demonstrated when compared to randomized control groups, as well as to traditional methods of direct instruction. However, this method has only been investigated in sports by one group of researchers (Milanese et al., 2008; Milanese et al., 2016; Milanese et al., 2017). In a comparison of the MAE to a direct instruction and no-intervention control group in a study designed to change technique in the standing long jump, adolescents showed significant improvements in jump distance in both the MAE and direct-instruction groups post-session (Milanese et al., 2008). However, in a 1-week delayed retention test, the MAE group outperformed both groups. In more recent work involving kinematic analyses as well as qualitative measures of technique from expert coaches, there were some indications that the 14 MAE was a beneficial technique change method. In one study involving experienced golfers and one practice session, no statistical differences in kinematic parameters of club head speed or ball speed, linked to golfing performance, were noted between a MAE group and a direct-instruction and no-instruction control group (Milanese et al., 2016). However, the MAE group increased club head and ball speed to a greater degree and showed a greater reduction in technical errors as compared to the other two groups. Similar results emerged in a second study with experienced weightlifters (Milanese et al., 2017). Again, there was a greater reduction in number of technical errors in the MAE group compared to the direct-instruction and no-instruction groups. Although both the MAE and direct instruction groups improved across practice trials in key kinematic variables related to horizontal displacement of the barbell, which was a selected error identified by the coach, there were no statistical differences between the three groups at the end of one practice session or after a 1-week delayed test. In summary, although the data are suggestive of the success of this method following only one practice session, the performance data are not strong, especially when more objective measures of performance are considered. The authors cite the possibility that more training sessions are likely required to reveal statistical differences in these performance measures across the groups. Moreover, although the MAE shows some evidence that it is superior to the traditional approach of direct instruction regarding the desired technique, the long-term retention across weeks or months and in competition settings has not been tested. In all three studies by the Milanese group, an error amplification group has only been compared to a direct instruction group or a no-feedback control group. To be able to make recommendations for use of this technique in the field, comparisons to other technique change methods, like the OWNW, are needed. 15 1.3.4 The Constraints-Led Approach Description and procedures: The Constraints-Led Approach (CLA) to motor behaviour and development, first proposed by Higgins (1977) and later applied to development by Newell (1986), is based on the consideration of behaviour as a consequence (or movement solution) of various task, environment, and person constraints. These constraints contribute to every athletic endeavour, whereby factors like body size, prior experience, and habits interact with equipment changes (such as ball or racquet size) or rules (such as not allowing more than three steps before take-off in a jump) to bring about behaviours. If we consider the example of a golfer practicing a drive, by improving the golfer’s strength we are influencing individual constraints to bring about a change in behaviour, whereas varying the type of golf club used is a manipulation of task constraints. Practice driving into a net or on the links is an environmental constraint which will also impact movement behaviour. Although task constraints can be broad-ranging, most often it is physical task constraints which are manipulated to bring about technique change (Renshaw et al., 2020). According to the CLA (or what is also referred to as ecological dynamics), coaches manipulate equipment constraints to aid in the emergence of individually-optimal techniques (Davids et al., 2013). Through manipulation of a constraint (e.g., modification of the task, such as sprinting with resistance via a sled/resistance band), a change in behaviour can be brought about – not necessarily with the awareness of the desired behaviour by the athlete (e.g., the athlete will adopt forward-leaning posture to accelerate). As such, there is no explicit instruction about errors, desired technique, or error correction methods. This absence is in contrast to other technique change methods where conscious awareness and adjustment of an identified technical error, often towards an individually optimal technique, are critical components of the intervention. Of 16 course, a degree of creativeness and perhaps trial and error are needed to find the right constraint(s) to bring about a behaviour, which may also necessitate some awareness of the error and desired technique on behalf of both the coach and athlete. Research: To our knowledge, there is only one experimental study where the constraints approach has been evaluated in a technique change intervention (Gray, 2018). In this study, three groups of baseball players received six sessions of extra-scheduled batting practice in a virtual baseball simulator. The aim of the training was to change hitting outcomes (and indirectly technique) by increasing the launch angle and exit velocity of the ball (parameters correlated with increased home runs). The constraints group practised with a physical barrier in the virtual environment, which had adjusted height and distance across trials based on hitting performance, to modify task challenge. The two other groups received either body-focused or bat-focused instructions about coach-informed good technique. However, they received no other feedback beyond where the ball travelled on the simulated field, and there was no adjustment in task challenge. In post-tests, the constraints group showed a significant improvement compared to both instruction groups in terms of key kinematic parameters related to their baseball swing technique (increased launch angle and increased exit velocity). Although this research is encouraging for the use of constraints in technique change, further research and better comparison groups are warranted (where all potential motivational, feedback, and information sources are controlled). It would be of interest and importance to compare the CLA to other technique change methods, such as the OWNW or error-amplification method. 17 1.3.5 The Five-A Model of Technique Change Description and procedures: The Five-A Model (Carson & Collins, 2011) is an interdisciplinary guide for technique change which brings together multiple theories from motor learning and psychology. The five stages (Analysis, Awareness, Adjustment, (Re)Automation, Assurance) provide coaches and practitioners with both tools and a roadmap for applying a technical change intervention for experienced athletes. The Five-A model was proposed to aid in making subtle changes to technique in order to refine or regain previous form (Carson & Collins, 2011). This model has received conceptual and empirical validation through multiple case studies (e.g., Carson et al., 2014; Carson et al., 2016; Collins et al., 1999). One of the defining features of this five-stage approach, applied in each of the studies referenced below, is the use of contrast drills, similar to those discussed in the OWNW. In addition to contrast drills, the multi-step approach relies on biomechanical analysis, psychological support, and application of motor learning principles (e.g., verbal/visual feedback, focus of attention, part practice) to successfully change technique. Although it is not empirically understood what aspects of the technique are responsible for success or what is the relative importance of the various steps, the authors would likely argue that all of the steps are necessary. Research: Early work involving the regaining of previous technique and performance after injury in an Olympic javelin thrower laid the foundation for what would later evolve into the Five-A model (Collins et al., 1999). In a case study aimed at regaining previous pre-injury performance while refining technique in an Olympic weightlifter, improvements in both technique and performance of the snatch were established after the Five-A model was applied across a 10-week period (Carson et al., 2014). The interdisciplinary intervention included a three-dimensional video kinematic analysis of the error as a template for reference and feedback, 18 in comparison to the “correct” technique; ongoing reporting of self-efficacy through questionnaires; mental imagery practice; and integration of the coaching and therapy staff to prescribe exercise progressions. The change in technique was maintained at a 2-year follow-up, the athlete avoided further injury, and they achieved a personal best at the European Championships. While both of these examples highlight the long-term efficacy of the Five-A, the time course and effectiveness of the interventions can range. In a set of case studies involving three elite golfers’ refinement of swing mechanics, the intervention’s effectiveness and duration ranged for each golfer (Carson & Collins, 2015). Two of the three golfers successfully maintained their new technique (one golfer through ~10 weeks of training with no follow-up; the other at ~28 and 36-weeks of follow-up). The third golfer reverted back to their previous technique at both ~25 and ~33-weeks follow-up, which the authors attributed to the athlete’s lack of “buy-in” to the method. The authors did not relate these technique changes to the athletes’ golf performance or even to injury avoidance. These case studies reflect the real-world challenges in applying technique change methods with the range in their time course and effectiveness. The interdisciplinary approach in these examples, utilizing psychological, biomechanical, and motor learning principles, highlight many factors that could play a role in effectively changing technique. To date, there is no experimental research where individuals have been allocated to different intervention/control groups and compared across multiple sessions. 19 1.3.6 Traditional Method, Direct Instruction Description and procedures: Instructing the desired technique, which could be achieved through various modalities, is the hallmark of what others have termed more traditional or conventional technique change methods (e.g., Hanin et al., 2004; Milanese et al., 2017). It is difficult to ascribe this direct instruction approach to one researcher or set of researchers, as it is more of a default method of instruction. Individuals are told or shown what they should be doing and then are either left to figure out how to achieve a desired goal or are prescribed steps to achieve a desired state. Instruction is a broad umbrella term that can include video, live demonstrations, verbal feedback, instructional cues that focus attention on supposed key aspects, and verbal explanations about what is required and sometimes about what is deemed an error (Hodges & Franks, 2002). With respect to instruction, there are various variables that will affect both performance and learning outcomes. Verbal instruction, demonstrations, and cues can have different effects on how the performer learns (Hodges & Franks, 2002; Lohse & Hodges, 2015). In the case of cueing, whether an athlete’s attention is directed to their body (termed an internal focus) or the movement outcome (termed an external focus), it is a known factor influencing the efficacy of instruction in terms of short-term performance and longer-term learning (Wulf, 2007, 2013). Attentional focus has also been shown to be an important consideration in a technique change intervention (Wulf & Su, 2007). Although attentional focus is often directed to the movement and body in the majority of technique change methods (perhaps with the exception of CLA), as the performer approaches the later stages of the intervention there seems to be a shift to externally-focused cues on the environment and performance outcomes, in the hopes of stabilizing technique and performance in competition (e.g. Five-A, ICC). Despite the known 20 effects of direction of attention on performance, it is unlikely that direction is the main ingredient underlying the success of an intervention. Research: Of the literature we have reviewed on technique change, there are four studies that have included a direct instruction comparison group (Gray 2018; Milanese et al., 2008; Milanese et al., 2016; Milanese et al., 2017). As mentioned in a previous section, in two of these studies (Milanese et al., 2016; Milanese et al., 2017), there were no statistical differences in key kinematic variables between direct instruction and MAE, though coaches reported MAE to have led to a greater reduction in technical errors compared to the direct instruction method in training and at retention. However, direct instruction led to reduced technical errors in weightlifting technique during retention, as compared to the no-intervention control group (Milanese et al., 2017), but this was not the case (i.e., differences between direct instruction and control groups) during training or retention of the swing technique in golf (Milanese et al., 2016). In two other comparative studies, the direct instruction groups performed worse than the comparison groups after one session and six sessions, respectively (MAE, Milanese et al., 2008; Constraints, Gray, 2018). Though the comparison groups in the constraints experiment differed in their focus of attention (internal, external) and performance outcomes (external focus outperformed the internal focus group), they would both be considered direct instruction methods (Gray, 2018). Indeed, in the baseball study by Gray (2018), providing externally-focused instructions on the bat and the ball led to improved performance outcomes (e.g., increased mean exit velocity of the ball) compared to internally-focused instructions onto body kinematics on the 24-hour post-test (although the CLA group outperformed both). Both direct instruction groups improved their mean launch angle (indexing technique), and even though the external-focus group performed 21 better at the post-test than the internal-focus group, these groups did not differ at the 1-month follow-up, but the CLA group maintained its technique advantage. Based on the available evidence, we should not dismiss the effectiveness of direct instruction for changing technique. By itself, it may not be sufficient to bring about lasting change or the same degree of change as other methods, yet research is still lacking regarding the necessity to include error contrasting, amplification, or indirect methods of technique change which bypass the need to focus on technique at all (e.g., constraints) in order to efficiently and effectively bring about lasting change. Of course, there are good and bad ways of delivering instruction (with respect to frequency and content), and merely dismissing the relative effectiveness of a method based on a few studies where only specific cues were provided, rather than specific and progressive steps, is likely premature. Other Technique Change Methods Outside of the established technique change methods that have been reviewed in this chapter, there may be potential alternatives that offer solutions to technique change scenarios but have not necessarily been considered as “technique change methods”. One potential alternative that has yet to be empirically tested is part-practice, whereby tasks with multiple components are practised independently (e.g., components of a gymnastic routine). Serial tasks that have multiple components may benefit from part-practice (Fontana et al., 2009). Some technique change methods use part-practice principles to help contrast the correct and incorrect technique (Collins et al., 1999; Lameiras et al., 2015). In the ICC program, progressive part-practice is explicitly described as part of their program. They describe the second stage of control and monitoring, as the “deliberate and step-wise practice of the entire chain of optimal movement patterns from the first component to the last component in the chain” (Hanin & Hanina, 2009, p. 53). Another 22 method that might be deserving of study is implicit learning, where the method of practice is based on limiting the explicit buildup of knowledge about how to perform. This method is thought to keep the individual at a level of performance that is relatively automatic, with low attention demands, in comparison to explicit instruction methods that encourage the decomposition of a skill into components that can be verbalized components (for a recent review see Masters et al., 2020). Some of the ways in which implicit learning has been enacted include using dual-tasks to direct attention away from what a person is trying to learn; errorless learning, where individuals progress from easy-to-difficult practice conditions in an attempt to limit the buildup of knowledge; and analogy learning where complex skills and interactions are conveyed by simple analogies to well-known examples. 1.4 Summary of Methods and Identification of Common and Different Elements As should be apparent from our review and the summary provided in Table 10.2, the similarities between methods are almost as notable as their differences. That is, many of the methods are based on developing awareness of the undesired technique (or error) in order for change to occur, perhaps with the exception of the CLA and potentially direct instruction about what to do (rather than what not to do). This awareness is a critical component of the OWNW approach as well as any other method based on contrasting. In addition, many of the methods have what we term a direct instructional approach, where the desired technique or goal is prescribed and/or demonstrated and feedback is given that is typically technique and body-focused (e.g., Direct Instruction, OWNW, Five-A Model, ICC Program). Again, the constraints approach is one exception here, in addition to the MAE where the explicit goal is to exaggerate what is wrong, rather than try and mimic what is considered “correct”. These distinctions 23 between error awareness and striving toward a prescribed ideal may prove to be important elements of successful technique change interventions, but as yet change can be manifested in the absence of either (although good empirical research is lacking). Rather than considering error awareness and technique-focused instruction as separate components, what is common among many of the technique change methods is the combining of these components through contrasting practice (e.g., OWNW, Five-A Approach, and ICC). Although again good empirical research is lacking, at least in the sports domain, there appears to be some benefits associated with the continual comparison between the old and the new which leads to successful changes in technique. The reason many coaches and practitioners find it difficult to change habitual errors in technique is because they have to create in their athletes an alternate (new) response to a stimulus which is not as robust as the original (old). As such, an old technique can resurface in competition and under stress. It is thought that contrasting the new way to the old way, in the presence of some augmenting instruction or perhaps a physical device, will bring about awareness of the error and help to inhibit potential interference (Lyndon & Malcolm, 1984). Contrasting has been suggested to work through a mechanism known as proactive inhibition. Proactive inhibition diminishes the competition between motor responses in a given context, increasing the retrieval of the desired response (Lyndon & Malcolm, 1984). Understanding that an undesired technique may reappear (i.e., a lapse or relapse of behaviour) provides some rationale for practicing the error. Appreciation for these competing mechanisms seems to be critical, given that we cannot simply undo previous learning (Bouton, 2000). It is possible that an old technique may resurface under pressure or in competition, highlighting the 24 importance of specificity of the environment and context in relearning a new technique, facilitating the selection of the desired response under conditions when it is needed. By bypassing the focus on either the old or newly desired technique, the constraints-led approach seeks to bring about change merely as a result or consequence of a new goal or constraint. Because there is no explicit desired goal, but rather a number of potential solutions to solve a performance goal, the idea is that the performer adapts their performance to the current task constraints through a process of self-organization (Davids et al., 2013). Although there has been some success with this method, even when the physical constraint is later removed to assess transfer, it is unclear whether this method will be effective at developing techniques which are stable over time and durable in the face of competitive stressors. If the discovered technique or solution is not required to hit a ball forcefully or score a point in competition, yet a change in technique is still deemed important to compensate for changes to rules or to help avoid injury, then what would be the motivation to continue to display a particular technique? Similar issues arise when considering error amplification, where errors are magnified in practice and the desired action is thought to develop as a result of self-organization (rather than direct attainment of a desired action). In the MAE, however, as opposed to the constraints approach, there is clearly some awareness of what should not happen. Therefore, learning would more likely lead to the replacement of an old, undesired way of performing, aided by the contrasting which takes place where the performer alternates between exaggerating their error on one trial and not making an error in a subsequent attempt. In summary, it appears that in general there are more similarities than there are differences between the technique change methods which have been applied in sports to date. Common elements such as error awareness, practicing the error, and contrasting with another 25 more preferred action seem to feature highly in these methods, potentially playing a key role in provoking “permanent” change in technique. However, because technique change can also be brought about indirectly, through manipulation of constraints, those facets detailed above (i.e., error awareness, practicing the error, and contrasting) do not appear to be necessary conditions for success, at least in the short-term. In the discussion that follows we consider how these various approaches and associated elements might be best applied under the 4Rs of Relearning and Resisting, Refining and Regaining. 1.5 Technique Change Methods across the Four Rs Since different scenarios exist that necessitate a technique change intervention (e.g., avoiding potential injury, improving performance), there may be specific technique change methods that are more or less suitable to these applications. Currently, there are no guidelines as to how to select an appropriate technique change method based on context. However, it appears that certain technique change methods may be more applicable in particular scenarios than others (see Table 10.2 for the scenario details for each method). One of the first steps in applying these methods, regardless of the scenario, is to consider the individual (or group) and the technical error/skill in question. Understanding of the competition demands, the athlete’s proficiency, and previous coaching, as well as the current psychological state of the performer and their motivation, are important pre-intervention considerations. Additionally, it is important to understand how the technical error is affecting performance. Classifying the main error correctly can have implications on both the intervention design and, ultimately, the success of the intervention (Corte et al., 2015). Even with a detailed diagnosis of the technical error, individuals will respond differently to the intervention based on previous coaching and their psychological 26 and mental state (Carson & Collins, 2015). This multi-dimensional approach prior to intervention, based on individual technical and psychological needs, is consistent with recommendations from various technique change methods, including the Five-A Model and the ICC program. 1. Relearning and Resisting When a drastic change in technique and a suppression of previous form are required, the evidence to date supports employing the Old-Way New-Way method (Hanin et al., 2002; Hanin et al., 2004; Lameiras et al., 2015). One of the challenges of resisting an old movement is that the same stimulus (perceptual input) remains, and thus the “programmed” response to the stimulus may persist. Contrasting the correct and incorrect technique seems to be a critical feature that applies to the scenario of relearning and resisting. This direct instructional approach may be necessary to change technique and resist habit-based errors through common elements such as being alerted to the error, practicing the error, and contrasting the error with the newly desired action (see also the ICC program and Five-A Model). Though the Five-A model has been framed as a tool for subtle changes to technique (i.e., refinement) and regaining previous form, there is reason to think it can successfully be applied to relearning and resisting, as long as the OWNW is used in the awareness and adjustment stages. 2. Refinement Technique refinement, which is a subtle change to a finely tuned skill, is linked to the ongoing process of skill expertise in high-level performers. It is considered to be the most commonly presented technique change scenario for coaches and practitioners (Carson & Collins, 2011). The individual’s skill plays an important role in deciding on the best technique change approach. For athletes who have highly tuned movement patterns aligned to certain conditions as 27 a result of years of performing, a relatively direct instructional approach to technique change may be most effective. From the literature reviewed, the case studies that were successful with high-level athletes (e.g., medalists at the international level) often cited the need to elicit conscious awareness of both the technical error and the desired technique (Carson et al., 2014; Collins et al., 1999; Hanin & Hanina, 2009; Hanin et al., 2002; Hanin et al., 2004). Alternatively, if athletes are younger and/or less experienced, such that the techniques are more malleable and less ingrained, the need to directly instruct and contrast will be lessened and constraints-based methods could be considered. In technique change scenarios where a subtle change to technique is required, there is positive evidence supporting each of the technique change methods reviewed. However, there are three technique change methods that have been exclusively applied to refining technique: direct instruction, the constraints-led approach, and error amplification. Because refinement is the most commonly studied of all the technique change scenarios, it generates more examples of successful interventions. 3. Regaining Performers who are regaining their technique – perhaps after injury, pregnancy, or other life circumstances, are looking to re-establish previous technique and performance outcomes. This regaining may also be needed for athletes who see a consistent decrease in typical performance or experience the inability to perform a previously automatic skill, termed “loss move syndrome” (Day et al., 2006). Regaining is a challenge to any clinician rehabilitating an injured athlete who needs to mitigate the risk of re-injury. For example, there may be known biomechanical risk factors associated with the degree of knee flexion during landing mechanics, associated with injury to the anterior cruciate ligament.). 28 It appears that with regaining, psychological assessments and supports, in addition to analyses of previous performances, are important. In the literature we reviewed with respect to regaining (e.g., Carson et al., 2014; Collins et al., 1999), athletes engaged in mental imagery practice throughout the intervention, as part of the Five-A model. The imagery was designed to change their experiential memory of the past, build confidence, and reduce the need for physical practice which could aggravate any past injuries. Though evidence for the efficacy of the Five-A Model is based solely on elite athletes competing in international competition; there is no reason to suspect that the same success would not be seen with lesser skilled or younger athletes looking to regain their technique. In the case of regaining, the goal is to achieve previous performance levels, though the starting points may differ in that a performer may be returning from injury, or is otherwise healthy. There does not appear to be any notable differences in approach based on these factors. With regaining technique, there is likely a conscious awareness of the problem (i.e., the need to regain previous performance), which lends itself to more direct instructional approaches. Constraints-based methods and error amplification have not been studied in this scenario, so their potential efficacy is undetermined. Because it is less about what not to do, and more about aiming for a past technique, error amplification would be challenging. The constraints-based method may prove to be useful in this regaining scenario, as it puts the emphasis on attaining an outcome (i.e., previous performance) rather than on a specific movement form. Regaining of form may be difficult given changes to the individual as a result of injury, age, or other factors. In summary, relearning and resisting and regaining have received the most empirical study and positive support. This has come from researchers working with direct instructional approaches involving awareness of error and of the desired movement, as well as contrasting. 29 For refinement, both direct and indirect instructional approaches have been successfully applied. As such, until more research becomes available, current technique change guidelines should be scenario-specific. 1.6 Conclusions and Thesis Aims The literature on technique change specific to sport is largely dominated by case studies. The collective of rich and detailed accounts from various technique change scenarios helps to define commonalities in process, specific elements, and potential mechanisms that underlie stable changes to well-established skills. However, there are very few examples of interventions where technique change methods have been compared across experimental and control groups, either in sport or in other movement applications. Usually the control comparison, when there is one, is a so-called “traditional”, direct instruction approach. However, it should be clear from this review that we need to make comparisons across other methods, with a focus on isolating mechanisms that are driving a successful change (such as contrasting or error awareness). More of these non-traditional technique change methods should be studied and compared in both experimental and field-based settings, in order for practitioners to confirm claims about relative effectiveness (and efficiency). Currently, little is known about the awareness and frequency of application of these technique change methods among sport coaches and practitioners (e.g., therapists, strength & conditioning coaches). Although it has been suggested that coaches do have a process by which they approach technique change, there are inconsistencies in the steps taken and no evidence of scientifically informed best practices to intervene (Carson et al., 2013; Kearney et al., 2018). There are both knowledge and application gaps related to technique change interventions in 30 sport. Future research should be directed at isolating common elements and mechanisms of technique change through controlled experimental research designs. Once we better understand the critical ingredients of an intervention, then more robust guidelines can be formulated and it will be possible to direct research efforts to determining limiting factors or participant interactions impacting success. It is also important to continue to gain insights into current practice and knowledge among sport practitioners (e.g., therapists, strength and conditioning coaches) from a variety of sports, to help in evaluating the type and use of various technique change methods, as well as to be informed about knowledge transfer activities and research into these methods. As we gain greater insight into the most effective strategies to affect lasting physical movement change in specific scenarios, we can move towards more efficient and effective training across all sport and rehabilitation domains. For my thesis, I addressed some of the questions and knowledge gaps outlined above through structured online interviews and an online survey. Unfortunately, do to the COVID-19 pandemic, I was unable to perform an experimental study comparing across various technique change methods. Instead I used a mixed methods’ approach to answer three related research questions: 1) how do high performance sport practitioners, working with team and individual sport athletes, intervene to change technique, 2) are there differences in how coaches, S&Cs and therapists view and approach technique change and, 3) are sport practitioners applying evidence-recommended approaches to change technique? I chose to use semi-structured interviews and qualitative thematic analysis as a first step, in order to determine the experiential knowledge of high performance sport practitioners, to give voice to these experiences, to provide a rich account of how technique change is viewed and applied, and to help inform the design of a survey for Study 2. I developed a survey to gain a broader appreciation of how technique change is 31 approached from a more diverse sample of practitioners and to help determine whether some of the themes identified through the interviews applied more broadly across a larger sample of practitioners. 32 Chapter 2: Interview Study 2.1 Introduction Changing technique, whereby a permanent strategy is adopted to improve performance or reduce injury risk, is a foundational component of ongoing movement skill development and performance (Vecchione et al., 2022). Technique change exists on a continuum ranging from drastic changes (i.e. an overhaul in strategy), to refinements than can be thought of as subtle changes leading to “an evolution of technique” (Carson & Collins, 2011, p47). Consider the case of a volleyball player who is experiencing shoulder pain due to their arm swing, or a sprinter who is consistent in running meets but struggles to make a final due to their poor starting mechanics. These situations exemplify when changes to technique are needed. Fundamentally, technique change refers to “a permanent modification to an already acquired movement pattern” with the cessation of a previous technique that is no longer desired (Sperl & Cañal-Bruland, 2019, p22). With this definition, it is reasonable to assume that relearning a skill requires a different approach to that adopted for the acquisition of new skills. Despite the prevalence of situations in sport where a technical change is needed, there is a scarcity of research on the topic. Moreover, the research that does exist in sport is mostly based on case study methods and there is a lack of comparison studies on the available evidence-informed methods. In a recent review, six different technique change methods were identified with varying levels of empirical evidence (Vecchione et al., 2022). There is a general lack of consensus as to whether one method is superior to another, though this may be in part due to shared commonalities between some methods, such as contrasting (i.e. alternating practicing the old technique or “error” and the new/desired technique). However, there are also quite stark 33 differences between some of the methods. Most methods (4 of 6) use a relatively direct prescriptive, instructional technique. In this case, explicit information is provided about the desired technique through video, demonstration, or verbal cueing, often directing attention internally to the body (e.g., Carson & Collins, 2011; Hanin & Hanina, 2009; Hanin et al., 2002). Other methods (2 of 6) can be classed as more indirect in their instructional approach. In these latter cases, a new/desired technique is “discovered” and emerges, either through error amplification or task and physical constraints (Milanese et al., 2008, Gray 2018). One other characteristic that appears to distinguish across some of the technique change methods is the programmatic nature of the method, involving systematic steps; such as the Five-A Model (Carson & Collins, 2011) and Identification-Control-Correction (ICC) Program (Hanin & Hanina, 2009). These programs also emphasize the need for an individualized approach, where the importance of athlete buy-in to the program of change is critical, as well as a focus on non-physical factors; such as sensory and psychological processes. It is unclear whether the identified methods have greater applicability in specific contexts, such as group versus individual training or in self-paced sports versus those performed in unpredictable “open” environments. There is also a lack of knowledge concerning the efficacy of the methods for various technique change scenarios such as refinement, regaining, or relearning and resisting (Vecchione et al., 2022). Currently, there is little evidence that coaches are using evidence-based approaches in how they intervene to change technique (Carson, et al., 2013; Kearney, et al., 2018). Both golf and athletics’ coaches reported using a step-wise process to intervene, but the approach was not standardized (i.e. did not consistently progress using similar steps/tools), nor did it appear to be referenced back to any scientific literature (Carson et al., 2013; Kearney et al., 2018). In view of 34 the general lack of guidance as to what methods are best for technique change from the literature, which may in part be due to a lack of quality empirical evidence comparing across the various methods, this situation should not be surprising. However, determining what methods practitioners are applying in the field and how they resemble or differ from current evidence-recommended methods can be insightful for academics and knowledge translators. Learning how high-performance practitioners change technique can: (a) confirm whether the current evidence-based approaches are being applied, (b) inform future research and the development of methods, and (c) improve the bi-directional sharing of knowledge between practitioners and academics. By furthering research into technique change and how it is being applied, we can positively impact coaches’ ability to change athletes’ habitual errors and enhance their performance. Behind the scenes of high-performance sport is an integrated support team (IST) of practitioners who work to support both the athlete(s) and coaching staff. Most common amongst support staff are therapists and strength & conditioning (S&C) coaches who are often integral to planning and training processes. Their specialist skill-sets provide value in addressing technique change from differing perspectives which can compliment sport practice. Currently in the technique change literature, there is little mention of these practitioners and the role they play within technique change interventions. Experts in the area point to the role of the sport psychologist in technique change (Carson & Collins, 2016), though sport psychologists are typically not as entrenched in the daily training environment as the therapists and S&C specialists. We would expect that therapists and S&Cs would have a stronger focus on physical aspects of technique change than sport psychologists. Understanding how IST members function within the technique change process can help to (a) provide clarity over practitioner roles when intervening and (b) highlight differences between coaches and IST staff that could inform 35 technique change processes and targets for knowledge translation. This information regarding technique change roles and knowledge among ISTs could help to inform organizations who assemble ISTs to support athletes and/or teams, as well as the design of curricula. Previous research on how coaches intervene to change technique has been mostly focused on individual sports (Carson et al., 2013; Kearney et al., 2018), with little mention about team sport athletes. It is problematic to transpose the same methods that have been researched in sports that involve mostly self-paced tasks, that take place in predictable “closed” environments, onto team sports. In team sports, technique is often a reaction to unpredictable situations that arise and where outcomes (such as scoring a goal), are not dependent on the method used to achieve the goal (e.g. kicking or heading to score a goal in soccer). Another issue with team sports is in controlling and replicating game-like situations for an athlete to re-train their technique with repeated exposure. These constraints provide challenges to practitioners to effectively train and monitor progress of specific techniques and outcomes in isolated moments. Closed-sport skills with discrete measure of performance (i.e. speed, time accuracy, and distance) are favourable for empirical purposes given their repeatable, quantifiable nature. Though open reactive skills pose different challenges to study, there are ways to standardize an evaluation of technique through situational video analysis and standardized ratings (Giles et al., 2019). As such, just because evaluation of technique change is challenging among team-sport athletes, it cannot be ignored and there are ways of surmounting difficulties. Understanding the challenges and processes that exist in both team and individual high-performance sport with respect to technique change is important if we wish to gain practical knowledge that addresses the gap in team sport technique change interventions. 36 The aims of this study were to learn how high-performance practitioners (coaches, S&Cs, and therapists) view the process of technique change and how they intervene to change technique. We also wanted to determine whether high-performance practitioners are applying any of the current evidence-informed technique change methods and if so, under what situations (Carson & Collins, 2011; Gray, 2018; Hanin & Hanina, 2009; Hanin et al., 2002; Milanese et al., 2008). Interviews can offer a rich, in-depth, experiential perspective into technique change approaches for sports practitioners, which would help inform future discovery and experimental research regarding technique change interventions. Based on the study aims, we chose to conduct semi-structured interviews with high-performance practitioners to learn about their opinions, potential barriers and positive experiences with technique change. 2.2 Methods 2.2.1 Framework Our research follows an experiential qualitative approach, designed to learn from and understand the experiences of practitioners in high-performance sport engaging in technique change interventions. This research is framed in a post-positivist paradigm (i.e. belief that reality can be measured, though meaning can also be interpreted through subjective experience) and ontological critical realism (i.e., there is a single reality, though our understanding of it is mediated by language and culture) (Braun & Clarke, 2022). With this ontological and epistemological framework, we sought to understand what technique change means to practitioners and how their experiences in changing technique with athletes align with evidence-informed methods. We also wanted to determine whether different practitioner groups (i.e., sport 37 coaches, strength & conditioning coaches, and therapists) differ in their approaches and thoughts about technique change. A review of the technique change research helped us to define elements of technique change which would form the basis of an initial codebook template and aid in developing our interview guide (King & Brooks, 2017). We were also guided by previous research exploring the knowledge and approach of technique change among elite track & field coaches (Kearney et al., 2018). The research team also brought applied experience, knowledge, and perspectives from years of working in high-performance sport as practitioners and sport researchers. 2.2.2 Approach and position We adopted a critical realism stance concerning methodological rigor based on our ontological and epistemological frameworks (Smith & McGannon, 2017). We aimed for rigor related to three criteria; transparency, prior knowledge and potential applied benefit. To achieve these methodological aims, we clearly state the relation between our derived knowledge (the reported findings and conclusions) and the steps taken to produce this knowledge, including the project design and processes linked to data collection and analysis. Before engaging in the interviews and their analysis, we did an extensive literature review (Vecchione et al., 2022) to help inform the interview guide, coding of data and interpretation. Finally, the interviews were conducted with our goal of producing research that directly benefits high-performance practitioners and indirectly, the athletes they work with. Though this benefit can only be assessed in retrospect, we have taken initiatives as a starting point by sharing these research findings with high-performance coaches across Canada through the Canadian Association of Coaches Research Insights’ Conference and high-performance practitioners (directors, physiologists, S&C coaches, therapists, etc.) affiliated with the Canadian Sport Institutes at their annual SPIN conference. We 38 intend on continuing sharing this knowledge through practical educational workshops focused on skill acquisition, which has been suggested as a method of engaging coaches and translating knowledge (Fullagar, McCall, Impellizzeri, Favero, & Coutts, 2019). In keeping with a critical realism ontology, the first author is a strength and conditioning (S&C) coach in high-performance sport. As such, although their experience and beliefs on the topic have influenced this research project, they have attempted to remain objective throughout the development and analysis. Template analysis was chosen as a method of qualitative analysis that would allow apriori knowledge to inform both the development of the transcript and data analysis. However, the researcher’s subjectivity plays a role in understanding the participant’s experiences, as noted by Braun and Clarke (p. 305, 2022), “interpretation inescapably takes place through the lens of your cultural memberships. The goal of a critical realist in thematic analysis is to provide a coherent and compelling interpretation of the data, grounded in, or anchored by, the participant’s accounts, that speaks to their situated realities, and the limits and constraints of the world the participants exist within”. As such, we seek to understand the experiences of high-performance practitioners in changing technique and how they align with current recommended methods. In keeping with a critical realist approach, inter-rater coding reliability was not conducted. Instead, the aim was to achieve methodological rigor via transparency in the coding process as well as through the use of apriori knowledge from the literature to inform the template codebook 2.2.3 Participant selection, recruitment and composition We used maximum case sampling to identify potential practitioners for further pre-screening (Sparkes & Smith, 2014). Maximum case sampling is a process whereby the research team pre-determines the variation in the target population that are most relevant to the research project and 39 systematically recruits these individuals who can speak within this scope. The most important dimension of this variation was the role of the practitioner, but we also wanted to get variation related to level of competition and the type of sport (team and individual). To participate in the research project, practitioners had to belong to one of three practitioner groups: sport coach, strength & conditioning coach (S&C), or therapist (including athletic therapists, physiotherapists, & chiropractors). These practitioners had to be currently working or have experience working with adults (18 years or older) to change technique in high-performance sport (provincial, collegiate, national and/or professional levels). The research team reached out to known contacts in the field within sport and educational organizations to participate and distribute our invitation to participate. We shared links to the pre-screening form and consent form with individuals who work in targeted practitioner roles. We recruited via email through a network of administrators, coaches, therapists, and S&C coaches that we are in contact across various Canadian Sport Institutes, the Coaches Association of Canada, the Canadian Strength & Conditioning Association, as well as various collegiate programs and professional sport organizations. We recruited Canadian practitioners working across Canada and in North America. Potential participants were encouraged to contact us if they wanted further information and their contact information was not shared with the research team. We targeted five participants from each practitioner group. Fifteen of the seventeen respondents who completed the pre-screening form were invited to participate in semi-structured qualitative interviews. Participants were excluded only if they answered that they work primarily with athletes under 18 years or that technique change was not part of their role. Fifteen practitioners participated in the interviews; one woman and fourteen men. There were five participants in each practitioner group (sport coach, S&C, therapist). Ten of the 40 practitioners came from team sport (soccer = 5, ice hockey = 1, American football = 1, basketball = 2, volleyball = 1) and five from individual sports (javelin = 1, sprints = 1, swimming = 1, jumps = 1, skiing = 1). Seven had worked at a national team level, six at a professional level, and two at the collegiate level. Fourteen of the practitioners reported coaching for 15+ years, and one reported having 10-15 years coaching experience. Our sample consisted of highly experienced practitioners working with elite male and female athletes across a diverse group cohort of sports, including Olympic medallists, national champions and championship winning teams from professional basketball and soccer. 2.2.4 Materials Pre-Screening Form The pre-screening form was sent to potential participants to primarily confirm they met the inclusion criteria of working with adult athletes in high-performance sport. These forms also allowed us to collect biographic information about their level of competition and coaching experience, as well as to determine whether they had been involved in technique change (by providing a brief account of a time when they’ve helped an athlete change their technique; see Appendix A for pre-screening questions). The form was created using Qualtrics (https://www.ubc.qualtrics.com/; which met the University ethics board’s data protection laws with data stored in Canada). The pre-screening form also included 13 questions asking about work history (years practicing, hours/week and months spent working with adult competitive athletes), type of athlete and sport they worked with (team or individual, specific sport) and preferences for interview scheduling. All participants electronically signed an informed consent form before taking part in any interviews, after completing the pre-screening form. 41 Semi-Structured Interview The interview was developed based on gaps identified in the literature and themes common to technique change methods. The interview was subdivided into five sections including: (1) defining technique change, (2) discussing how technique change fit into their job requirements, (3) a case-study with follow up questions based on common steps and elements of technique change methods, (4) process focused questions (i.e. critical elements, different approaches for different scenarios), and (5) exploratory, open-ended questions (e.g., differences between youth and adult athletes). The interview template is given in full in Appendix A; we asked many direct questions throughout the interview and as follow-ups to case study reports to ensure practitioners were prompted about specific technique change intervention elements. The interviews averaged 66 minutes in duration and totalled 17.7 hours. The interviews were all conducted over Zoom and were recorded verbatim. Participants were located throughout North America during the COVID-19 pandemic, which made online interviews the preferred choice for both geographical and health considerations. 2.2.5 Data Analysis The pre-screening responses were exported from Qualtrics into an Excel file. Interview audio recordings were transcribed as Word documents. The transcripts were then uploaded into NVivo 12 (https://lumivero.com/products/nvivo/) for analysis. The dataset was analyzed using an iterative hybrid template analysis, a style of thematic analysis (King & Brooks, 2017). Template analysis is a process which includes seven phases as outlined by Kings and Brooks (2017): (1) familiarization with the data, (2) preliminary coding, (3) clustering, (4) producing an initial 42 template, (5) applying and developing the template, (6) final interpretation. The final interpretation phase includes examining patterns of themes in the data, prioritizing themes and finding and developing connections between themes. We use the word “iterative” to define this approach due to the fact some components were not carried out in the step-wise fashion. Some stages were revisited many times, carried out concurrently, or done in a back-and forth-fashion. We use the term ‘hybrid’ to describe the coding process because an initial template (codebook) was created by the research team during the design phase but codes were also developed at later stages, through data familiarization, preliminary coding and further development and application of the template. This data analysis approach aligns with our critical realist stance and experiential inquiry that allows us to both align the data with existing literature, while going beyond it to examine the experiences of our participants (Braun & Clarke, 2022). Data management was facilitated using NVivo 12 to code, export node reports, and write memos and coding reflections throughout the research process. Personal identifying factors have been removed for confidentiality in all reporting and presenting of the data. 2.3 Results and Discussion In Figure 1 we have provided a summary figure showing the primary themes that developed from the interview data with respect to “how practitioners intervene” and “use of evidence-recommended approaches”. These themes and practitioner responses are discussed below. 43 Figure 1 Diagram of Thematic Analysis Results 2.3.1 How practitioners intervene to change technique in high-performance environments Theme 1: Stepwise Process of Change Step-wise technique change interventions have been reported in the literature, such as the Five-A model (Carson & Collins, 2011) and ICC approach (Hanin & Hanina, 2009). Coaches also reported the use of step-wise methods of technique change when interviewed (Kearney et al., 2018). Similarly, during the case study portion of our interviews, practitioners freely described multiple steps when intervening. When we prompted practitioners to think about any critical steps on the path to changing an athlete’s technique, practitioners responded with the need for a step-wise approach. When discussing steps in both contexts, practitioners listed steps that aligned with published work; such as buy-in from the athletes (n=14), assessment (n=15), modification (n=14) and assessment of transfer to representative competitive environments (n=7). Despite the enthusiasm for such a systematic approach, only 5 out of 13 practitioners who 44 were asked, reported having written criteria and steps for moving an athlete through a technique change intervention. Athlete ‘Buy-In’: Nearly all the practitioners highlighted the need for athlete “buy-in” when prompted to consider steps needed to change technique. Practitioners (n=14) commented without prompts that getting the athletes involved in the decision-making process was an important piece to achieving buy-in (see also Kearney et al, 2018). They discussed approaches such as creating environments for the athlete to realize and voice their desire to change, often through competition debriefs or video review. To aid with the buy-in, practitioners spoke about the need to clearly define a relationship between the proposed intervention and improved performance and/or health, and establish a common goal to work towards, with timelines. Support practitioners (i.e., therapists and S&C coaches), discussed the importance of buy-in from the sport coach too. According to S&C Coach 1: “Well firstly, the athlete buy-in. I think I’ve said that a couple of times now, that’s so important. So, athlete buy-in. Buy-in from coaches as well, right? It’s extra time that you need to take away potentially from their football training. So, buy-in from the athlete, buy-in from the coaches. Really showing that it’s impacting performance as a whole. So, step one, is this going to impact performance? and if it is, that’s step one… yeah like the athlete buy-in is absolutely critical. They need to be brought into the process and understand what you’re going to be doing” S&C coach 1 Assessments: Both S&C coaches and therapists prioritized physical assessment, ranging from: manual muscle testing, traditional strength and range of motion testing, as well as screening foundational movements such as jumping, squatting, lunging, etc. Therapists relied mostly on manual skills to assess physical limitations, while S&C coaches would primarily use dynamic 45 movement screens, with some using technologies such as force plates to aid in understanding of an athlete’s movement strategy. For example, S&C coach 2 provided an account of the process taken to understand the jump strategy required in shooting a basketball that allowed them to profile and pick-up asymmetries that aligned with shooting performance: “We started having her do different drills on the force platforms themselves. We were doing what we were calling pulses - this was everything but the coming off the ground part of the jump…the idea was we were trying to see: a) what these things look like and b) how quickly the jump gets off. We wanted the force curve to be more V shaped, as opposed to U shaped. So, that was where this started and we started noticing as well that there was this constant coming off of the right leg. Everything was staying on the right leg which caused her shot to drift left” S&C coach 2 Modification stages: Unsurprisingly, there were notable differences across each practitioner group in how they approached the modification stage of a technical intervention. Beginning with therapists, many mentioned using manual interventions such as tactile cues and joint mobilizations to assist an athlete in achieving a technical outcome. S&C coaches described the process of developing physical capacities that would enhance movement skill deficits. As such, strength training was emphasized and the transfer of strength into movement drills that would typically involve both general (no sport context) and specific (sport context) demands (eg., jump/landing mechanics and jump training, spike approach jump with reaction to ball/teammate). While therapists and S&C coaches generally worked out of the sport context and back into it, sport coaches typically intervened by scaling back sport-specific tasks to achieve a desired technical outcome. One volleyball coach (Coach 1) provided a step-by-step example: 46 “So, every time we try and do a big change like that, we keep the ball in an isolated situation. So the ball is going to be in the same spot. So he went to a two-step approach, compared to a normal three-step approach, and it was just doing his right-left, and then the feeling of that while hitting a ball, but it was a stationary ball. And then we just progress that to, went from a stationary ball to two steps, to two steps off a live setter, to two steps of a ball being passed, and we would just start to lengthen his approach. We kept him in a very common situation where it was very linear, the ball is going to be here and you had to go to the ball. And then we changed how the ball got to where it was, So he had to time it… when we added the third step we put tape on the floor to give him an indication where the first step had to go. And then we just kept building it with a little bit of randomization - now the ball came past him off the net and he had the time, and then it came over his left shoulder, he had to time it. So we just kept putting the ball in different situations and putting him in different read and reactions situations” Coach 1 Transferring the new technique to competition: Though transfer of the new technique into competition is the goal of any intervention, less than half the sample (n=7) discussed efforts to observe or quantify technique in the athlete’s representative competition environment. This result may be partly influenced by the fact that six practitioners reported that their intervention was in progress at the time of interviewing. When we directly asked practitioners about how they would evaluate technique under competitive conditions, most suggested using smaller scale, representative tasks; ranging from 1 versus 1 drills and small sided games, to analyzing video collected during practice episodes performed at competition intensity. S&C coach 1 provided a comprehensive example of how they ensured transfer, utilizing the full spectrum of 47 representative training tasks and assessment from practice drills and performing under fatigue, to evaluating isolated moments in games: “The final phase is really putting it into very reactive or opposed drills and seeing if it is actually transferring…then, is he able to do this late in games? So, went down that avenue a little bit and improved conditioning and after that it started transferring better, even late in games and stuff like that…from the subjective eye through video and then seeing him in games in those 1v1 situations and seeing the difference” S&C coach 1 Many practitioners discussed using video to qualitatively assess transfer in competition. Discussions around the challenges of precise measurement and using assessment technology in competition environments were noted. Some practitioners commented upon time constraints and resources as a challenge to assessing transfer. Though challenges exist to quantify transfer, video seems to be a pragmatic tool to qualitatively assess transfer in both representative training and competitive environments. Perhaps with the advent of marker-less applications and artificial intelligence that track movement in situ through phones and/or specialized cameras, this will change. Theme 2: Collaboration of Integrated Support Team Many practitioners (n=11) discussed the integration process between IST and coaching staff when discussing a technical intervention. Both coaches and support staff provided examples of how they work together through a variety of stages from identifying technical issues, assessing deficiencies, to modification and transfer. S&C coach 2 provided an account of how observation with a coach can begin a discussion around intervening: 48 “When I was with rowing we’d go in the boat and would be watching athletes and it would be like, alright, so the coach is seeing this happening. And the coach wants to fix that. And we would then start having a discussion. Is this a technique change that has a physical basis to it? Meaning a strength or flexibility basis to it. Is it a technique change that is purely a coaching thing because the coach is really not expressing what they want… or the athlete isn’t understanding what the coach is trying to express? Is it a cognitive thing, in that, does the athlete understand what the technique is supposed to look like?” S&C Coach 2 Support staff offer value to coaches through their advanced knowledge of biomechanics and physiology for example. Both coaches and practitioners expressed the need for collaboration in both identifying the driver of technical errors and applying joint interventions to change them. Coaches provided examples of consulting experts in biomechanics to assess and provide technical optimization strategies, therapists who could assess and provide therapy to improve range of motion, as well as strength & conditioning coaches to improve resilience and physical capacities that could facilitate technical performance. This collaboration is crucial as sport coaches alone do not always have the solutions to each technical problem. Therapist 1 highlighted the role support practitioners play in aiding coaches to support technical changes: “What I do find …is that oftentimes the coach has been trying to change something but couldn't get it to change. The problem is the assumption that technical coaches can identify movement deficits and change them, and a lot don't know why they're there. They know what they like, so they know what is desired, but they don't know what's messing it up. So, my job is to understand what's messing it up and understand what they're looking for so that I can give them that profile, and they can then induct it into their training.” Therapist 1 49 Overall, there is a mutual appreciation between practitioner groups in the role they play within the intervention process and the value they provide. Often, sport coaches will determine a technical change is required and consult support staff for their respective input. Collaboration between S&C and therapy staff is important specifically in regaining or drastic change scenarios within return to play planning. Theme 3: Emphasis on Physical vs. Sensory-Cognitive Aspects When discussing the intervention process, the majority of practitioners emphasized the physical characteristics and processes needed for technique change (n=11). Some spoke about anatomical constraints and how these factor into a desired technique. The need for physiological adaptations with respect to strength, conditioning, and mobility were commonly discussed, as well as warm-up strategies to prime the body for “ideal” movement. Interestingly, all five sport coaches commonly referenced physical characteristics as the emphasis to drive technical change. An emphasis on physical characteristics for technique change is somewhat at odds with models of technique change, such as the Five-A (Carson & Collins, 2011) and ICC model (Hanin & Hanina, 2009). In these models, the emphasis is on sensory-cognitive and psychological processes rather than physical processes in changing technique. For example, in both the Five-A model and ICC model the importance of “contrasting” is outlined to create awareness of an error. Visual aids, such as video, are proposed to help with the awareness, or mental imagery, to both improve awareness and manage negative emotions during high-pressure moments. Practitioners in our interviews did report using video (n=14) and modelling (n=12) (i.e. using video of an expert or a coach demonstration), to support technical changes, though less than half of the participants (n=6) emphasized the importance of sensory-cognitive processes 50 when discussing how they intervened. S&C coach 2, however, did illustrate this prioritization in the technique analysis stage: “The process I would go through with the sport coach is, before we get involved in trying to change it through physical stuff, does the athlete understand what you're trying to do? So we go through a coaching process first, of well, here's a whole lot of cognitive stuff, do they understand what it's supposed to look like? Are you describing this well to them? Have they ever experienced it before? Then we would start looking at whether there are underlying physical issues that we need to address.” S&C coach 2 In summary, nearly all of practitioners (n=14) focused on physical characteristics when discussing the intervention process in comparison to less than half the sample (n=6), who highlighted the importance of sensory-cognitive processes while intervening. In previous interviews with six high-performance athletics’ coaches (Kearney et al., 2018), psycho-social factors such as buy-in, analysis of error and potential alternatives, and performing under pressure were listed as important to changing technique. In our interviews, almost all practitioners (n=14) noted buy-in and assessment/analysis as important components of an intervention. Though we did not ask directly about performing under pressure, questions aimed at performing under fatigue (n=4), competitive environments (n=7), or simulated competition (n=3) provided some indication that pressure situations were not commonly used. Many coaches encouraged athletes to slow down their speed of execution (n=10), which may play a dual role impacting both physical and sensory processes, by potentially helping to improve confidence and awareness of body positioning while acquiring a new technique. However, there was little mention of mental imagery (n=1) and contrasting (n=1). Therefore, while some practitioners are including 51 important psychological-related processes in their interventions, there is little emphasis on these processes which point to a potential knowledge and application gap among practitioners. Theme 4: Facing Challenge and uncertainty with technique change Challenge was a commonly discussed theme with respect to changing technique (n=13). Challenges such as time needed to intervene, a lag in performance, competition schedules in-season, and resources available to assess and quantify movement, particularly transfer to competition, were commonplace. With more skilled athletes competing at world class levels, the solutions were deemed particularly complex. Practitioners discussed the notion of high-performance athletes needing to balance the proposed benefit of a new technique and its relationship to injury risk and performance as it can both improve or decrease these two variables. Among practitioners, there was uncertainty in defining what an optimal technique should look like. When prompted with the question as to whether an optimal technique exists, many practitioners answered “no” (n=9); they believed that there was an individual optimal for each athlete. This finding aligns with the Five-A and ICC approaches (Carson & Collins, 2011; Hanin & Hanina, 2009), which prioritizes an individual approach, as well as recent commentary challenging conventional paradigms in biomechanics from defining optimal mechanics from averages, to more individual analyses and their impact on performance (Glazier & Mehdizadeh, 2019). Defining optimal for an individual athlete, likely requires patience, exploration and some experimentation. One swim coach (Coach 2) described the process of working through uncertainty around optimal technique with a swimmer looking to improve on their Olympic performance: 52 “The higher up you get in swimming, the more the models are doing it very differently. So you'll have three different world champions in the same event, with some similarities but can be very different. In our case, with the demographic I'm working with, sometimes there's not a well-defined new state. So, I've got to admit here that we're going through some trial and error…we're with an athlete at such a level that we're just trying things to get them to get an edge, a competitive edge, and maybe these things haven't been done with anyone else before. Certainly not with this athlete. And so we’ll fail a couple of times before we kind of come back to it, and we won't really know if the technique change is an optimal technique change.” Coach 2 Changing technique with high-performance athletes can be a challenging endeavour. Whether the goal is to improve performance, reduce injury, or regain technique, there is much at stake. To ensure optimal results and alignment, a thorough individual assessment and analysis procedure is recommended to establish buy-in and adherence to the intervention process. Though challenges exist with measuring and assessing transfer, practitioners note the necessity to focus on performance and health outcomes, including athlete feedback 2.3.2 Use of evidence-recommended approaches in high-performance environments Theme 1: Instruction about the desired technique Across the technique change methods, although there are notable similarities, one factor that seems to differentiate methods is the instructional approach. Many technique change methods espouse (implicitly or explicitly) a more traditional direct instruction (prescriptive) approach. Athletes are made aware of the error or technical issue and then they are given explicit instructions, verbally and visually, about what and how to change. With the focus on what is wrong with current technique and what needs to change, the focus of attention will be internally 53 directed towards changing body position/mechanics. In our recent review of the technique change literature (Vecchione et al., 2022), four out of six methods could be classified as based on a direct instructional approach. A direct instructional approach to technique change can be contrasted to one that can be classified as indirect (non-prescriptive) instruction. Accordingly, the athlete is not given explicit information about the desired technique but is encouraged to discover it as a consequence of practice tasks, rules and physical constraints aimed to bring about this desired or at least different technique (termed self-organization). There are two technique change methods which fall under this “indirect” category. The first is the method of amplification of error (MAE; Milanese et al., 2008). This method involves athletes alternating between correct practice attempts and attempts where they are asked to exaggerate their main error. The assumption is that performers will adapt their technique based on self-generated feedback about how the movement looks and feels and in response to performance. The second is the constraints-led approach (CLA), which involves the manipulation of physical constraints or task goals designed to prompt the discovery of a new, potentially better, technique (Gray, 2018). Currently, there is no literature comparing instructional approaches, though both direct and indirect approaches have support for their use and application. Practitioners did not make mention of specific evidence-informed technique change methods, but nearly all commented on using strategies associated with direct instructional approaches. Practitioners reported making athletes aware of a technique related problem or “error” (n=15), verbally cueing aspects of technique to change, directing attention internally to a body part (n=14) and prescribing how to change through direct instruction (n=13). Coaching tools such as video (n=14), modelling (n=12) and part-practice (n=12) were also widely used and 54 mostly align with direct instructional approaches, such as the Five-A model (Carson & Collins, 2011) and ICC method (Hanin & Hanina, 2009). There was little evidence that indirect instructional approaches, such as MAE or CLA (n=1), were used among practitioners. Though indirect elements such as physical constraints (n=8), cueing with an external focus of attention (n=8) and movement exploration (n=8) were discussed by practitioners, they were applied in a hybrid fashion, where certain parameters are described (i.e. direct instruction), but the athlete is encouraged to explore and attempt a new technique within certain constraints or bandwidths. Theme 2: Contrasting Contrasting, defined as alternating between practicing the undesired technique (or error) and the desired technique, is common to four out of six technique change methods. It is a central feature of both direct (Old-Way-New-Way/OWNW) and indirect (MAE) approaches and is a significant component of systematic approaches such as the Five-A model and ICC method. Given the lack of identification of these methods during interviews, it is not surprising that there was little evidence of contrasting being used among practitioners (n=1). One practitioner, S&C coach 1, outlined how contrasting between the error and desired technique was helpful in creating an understanding and feeling of error awareness: “In our initial sessions it was one of the things that I noted, getting the athlete to feel … a good rep and a bad rep and showing them video of that good rep and that bad rep was really good as well…especially early on he would revert back to that technique all the time. So yes, definitely back and forth and that’s where video really helped as well.” S&C coach 1 55 Even though contrasting is common to many technique change methods, it may not be appropriate in all technique change scenarios. Some practitioners noted health and safety concerns, particularly in return to play settings from injury. When probing a therapist working to change technique in an ACL return to play scenario about using contrasting, they commented: “Not really for this one. I do use that sometimes. I think there is value in it but because the negative movement can potentially cause pain and stress to the graft we didn’t do much of it. I might have demonstrated it for sure, but I didn’t have the athlete do it too many times. We were trying to avoid it.” Therapist 2 Some practitioners did note that they have used contrasting in previous cases, or would in the future, but only one noted it was part of their approach during interviews. Alternatively, there were others who were less optimistic about the usefulness of this counter-intuitive approach. One coach, Coach 3, when asked if he would have an athlete practice the undesired “error” as part of contrasting commented: “I don’t think, I mean no. The reason why I was there was to help, was to fix their issues right? Solve the problem. So yeah, I wouldn't say I've ever told somebody to do something incorrectly. Is this a trick question?” Coach 3 2.4 General Summary 2.4.1.1 How are practitioners applying technique change methods? Technique change among high performance practitioners appears to be both a common and a challenging process, supporting the importance of the need for knowledge about effective strategies to intervene. Through systematic discussions with high-performance practitioners, 56 there was a knowledge gap regarding current evidence-recommended strategies to change technique. Although practitioners are applying strategies which align with direct instructional approaches in a stepwise fashion, these strategies often lack key features mentioned in the research literature, such as the need to assess how well the technique transfers to competition and working on the mental elements of technique change such as using mental imagery or practising the new technique under pressure or fatigue, when it is most likely to break-down. The methods of contrasting and error amplification are techniques that were not being used by practitioners, despite evidence that these types of methods are thought to lead to robust changes over time and under psychological pressures such as those experienced in competition. A novel finding from our interviews was the importance that a simple strategy of slowing down the movement (n=10) had used to help practitioners in improving technique. They discussed the need to slow down the movement in early modification stages and slowly increase it to game speed at end-stages of any intervention. This strategy seemed to work on both physical (i.e. enhancing bodily awareness) and sensory-cognitive processes (i.e. improving confidence), making it a useful recommendation to aid the intervention process. This method of simplification through slowing movements (as well as movement demonstrations) has been discussed in the motor learning literature and is relevant to discussions regarding changes to task constraints (e.g., Al-Abood et al., 2001; Newell, 1986). To date, it has not been noted as a method for re-learning and hence empirical research is recommended. To date, only coaches, specifically only coaches in individual sports, particularly golf and athletics (Carson et al., 2013; Kearney et al., 2018), have been questioned about technique change methods. We addressed this oversight in this study by interviewing team sport coaches and practitioners other than sport coaches. Of our interviewees, ten (67%) worked in team sport 57 with the other five in individual sports (33%); almost half (n=7), reported that they engaged in technique change daily, with five of these individuals working in team sports (although appreciably we sought out practitioners who were engaging in technique change). By interviewing support staff such as therapists and S&C coaches, we are able to highlight the role that these practitioners also play in changing technique, in addition to coaches. These “support” practitioners intervene differently from sport coaches, particularly in the assessment and modification stages of technique change. Many coaches highlighted the important role that therapists and S&Cs play in supporting the process of technique change. The collaborative role among the practitioner groups that were interviewed helps to underline the need to consider technique change from a multi-person lens, including the dynamics among staff. 2.4.1.2 Are practitioners applying evidence-recommended approaches? We set out to build on the available literature to investigate if practitioners are applying evidence-recommended approaches in high-performance environments. Previously, data from golf and athletics’ coaches regarding technique change have been related back to the Five-A model (Carson et al., 2013; Kearney et al., 2018). Here, we considered technique change through multiple methods, including systematic, step-based approaches such as the Five-A Model and the ICC model, as well as methods that have received empirical verification, and some attention in an applied setting, such as the Constraints-Led-Approach (CLA), Old-way-New-way (OWNW) and the Method of Amplification of Error (MAE). Only one practitioner, a therapist working in an individual sport setting, explicitly noted using any of these methods (i.e., the CLA) in their approach to technique change. Practitioners reported use of strategies that aligned with the stepwise, direct instruction approaches, even if a 58 specific model or method was not mentioned directly (n=13-15). These data align with previous work (Carson & Collins, 2011; Kearney et al., 2018), showing that coaches did not explicitly mention an evidence-recommended systematic approach, but that their steps aligned with the Five-A model. Kearney et al. (2018, p1124) commented that “given that the model was derived from applied literature and for coaches, this finding is positive if unsurprising”. Contrasting was only adopted by one practitioner and no one discussed methods of error amplification as a strategy to change technique (c.f., Milanese et al., 2017). Based on the findings of our interviews, we summarize gaps that may exist for practitioners in their technique change interventions, focusing on three main themes identified in our interviews; measuring and assessing transfer, the role of sensory-cognitive skills and the general use of evidence-recommended strategies. 2.4.2 Application Gaps 2.4.2.1 Measuring and Assessing Transfer One of the main gaps in the stepwise process for practitioners was the absence of assessment and measurement of technique under transfer conditions in the competitive environment. The key barriers noted were the equipment or technology to measure movement accurately and the lack of the movement or scenario presenting itself (regularly) in competition, with this issue typically isolated to team sports. One solution for the issue of equipment/technology, is to use video as a cost-effective solution for identification and analysis. There are now many applications designed for smartphones, including marker-less AI motion capture, that make video analysis a relatively simple and cost-effective option for practitioners in 59 high performance sports (e.g., mocap.com). A qualitative assessment of technique, either in situ or with video assistance, was discussed by approximately half of our practitioners (n=7) and it was discussed in relevance to monitoring an athlete’s progress in changing technique. Subjective technique analysis questionnaires, completed by both coaches and athletes, could also be a helpful tool to use alongside video, in order to both capture objective and subjectively perceived changes in performance over time. Perceived improvement over time, coupled with objective data would positively impact athlete buy-in and engagement with the process. As to the second barrier related to the specific nature of technique adaptations that may present only occasionally in competition, isolating these situations, under pressure, in a competitive practice environment, would be useful to ensure the successful transfer and long-term retention of specific technique changes. Capturing these isolated moments on video and subjecting them to video analysis would also be a helpful way to measure and assess transfer under representative conditions. 2.4.2.2 Role of Sensory-Cognitive Processes One of the main differences between our data and that of previous work with coaches (Carson et al., 2013; Kearney et al., 2018) was the emphasis on physical changes, during modification and assessment, at the exclusion of sensory-cognitive/psychological processes relating to mental imagery, confidence, and performing under pressure. Practitioners spoke about the importance of the psychological process of athlete “buy-in” (n=14) as part of initial planning, though there was little discussion of sensory-cognitive processes related to relearning and performing in the modification and end-stages. For example, the use of contrasting to help understand the role of the error on outcomes, improving confidence, or mental imagery to stabilize performance under stress or fatigue were not discussed. In some cases, it may be beneficial to consult a sport 60 psychologist to support the development and application of these processes (Carson & Collins, 2016), specifically at later and end-stages. In a survey of coaches and golfers who underwent a technical change, those who were unsuccessful typically failed due to a reversion back to old strategies (more than 50%) or were unable to perform the technique under pressure (more than 30%) (Carson et al., 2013). Achieving a robust, successful technical change of a persistent problem requires more than a focus on physical aspects. For sustained transfer, methods have been recommended that emphasize the need to practice and test the new technique in appropriately challenging environments, under competitive pressure or fatigue, and through imagery practice, to maximize the chances of the new technique becoming more habitual in competition (Carson & Collins, 2011; Hanin & Hanina, 2009). 2.4.2.3 Use of evidence-recommended strategies Many practitioners reported strategies that aligned with direct instructional approaches, but they did not include the method of contrasting which is common to many of the methods (3 of 4). Contrasting has been suggested to work by a mechanism known as proactive inhibition (Lyndon, 2000). When relearning a technique, there will be competition between motor responses (old and new) to a given stimulus. By contrasting the old (i.e. technical error) and new (i.e. desired technique), there is proactive inhibition of the old response, thus increasing the strength of the desired response (Lyndon & Malcolm, 1984). This contrasting method, which may seem somewhat counter-intuitive to practitioners who want to be make progressive steps forwards towards a new technique (not backwards), can be efficient as well as effective. For example, there are data attesting to “lasting changes” with as little as one practice session involving MAE (Milanese et al., 2017). The knowledge gap among practitioners regarding evidence- 61 recommended approaches can be remedied by continuing to share the available literature through articles, conferences, other types of media such as blog posts, social media and podcasts and engaging with education and certification bodies for coaches. 2.5 Conclusion This study is the first to provide an in-depth analysis of the role support practitioners in S&C coaches and therapists, in addition to coaches, in supporting the technical changes of athletes in high-performance sport environments. Using thematic analysis of interviews, we have concluded that practitioners do engage in a stepwise process of change and collaborate as an integrated support team when intervening; they also note intervening to be a challenging process that can include uncertainty. We have identified differences between practitioner groups, namely in how S&C coaches and therapists intervene during assessment and modification phases, and that practitioners seem to be emphasizing the role of physical qualities rather than sensory-cognitive processes when intervening. The use of evidence-recommended approaches is largely limited to what we’ve termed direct instructional methods (Vecchione et al., 2022), with limited evidence that the use of contrasting is being applied or that practitioners are aware of the recommended technique change methods from the literature. We have outlined gaps that appear to exist among high-performance practitioners in measuring/assessing transfer, the use of sensory-cognitive elements of technique change methods, and applying evidence-recommended strategies to changing technique. Given this limited sample size, future research with a broader sample, including more women participants, is needed to validate and test the reliability of these findings and recommendations to better inform knowledge translation efforts in this area. 62 Chapter 3: Survey Study 3.1 Introduction In high-performance sport, multiple people have a role to play in helping an athlete change technique; including coaches, therapists and strength and conditioning (S&C) practitioners. Through interviews with fifteen practitioners in Study 1, we gained quite a rich understanding of the challenges, processes, and differences among these practitioner groups with respect to technique change. Because of increased validity and reliability that can come with more voices, yet given economical limitations of interviewing a large sample of practitioners, we designed an online survey. Our aims with this survey were to continue to learn about how high-performance practitioners change technique and apply evidence-recommended methods, facilitating more general statements about technique change based on different practitioner groups. Based on previous literature and data collected in Study 1, we knew that measuring the success or otherwise of transfer of an intervention to competition was a challenge for practitioners, but we wanted to learn more about measurement of success. Related to this point, we did not get information about practitioner’s success rate when engaging in technique change interventions, so we hoped survey questions would address these points. Additionally, there was a lack of information about how much time different practitioner groups spent intervening to change technique, what types of technique change scenarios they encountered (i.e., drastic, subtle or regaining/change back post-injury), and whether methods used were adapted based on the type of technique change scenarios. Based on our study 1 data, practitioners either reported changing technique daily/all the time, yet were unable to provide an estimation of the amount of 63 time spent intervening, or reported spending ~3-15 hours per week. Similarly, practitioners were relatively split during the case study section of the interviews between drastic and subtle change scenarios, with only 1 reporting a regaining/change back scenario. In the current study, we designed the questions to gain further information about time spent in technique change as a function of the practitioner’s role, the prevalence of different technique change scenarios, and the dependency of the method on the scenario. Based on interviews from Study 1, we expected practitioners to report using video and coach/athlete feedback to measure transfer and intervention effectiveness. We also expected that practitioners would engage in subtle change most often, with therapists engaging in change-back (from injury) scenarios more than coaches and S&C coaches. Success rates were expected to be about 60%, with practitioners spending ~25% (10 hours/week) of their time changing technique, with therapists spending less time than both coaches and S&C coaches. From our interviews in Study 1, we learned that high-performance practitioners were applying more direct methods of instruction, such as error awareness, direct instruction and cueing attention towards the body and the desired technique, often described as the traditional method (Hanin & Hanina, 2009). There was little evidence from Study 1, or previous literature surveying and interviewing coaches (Carson et al. , 2013; Kearney et al., 2018) that practitioners were applying more indirect instructional methods, such as contrasting (cf. Lyndon, 2000) or error amplification (c.f. Milanese et al., 2008) to change technique. Interestingly, some practitioners discussed applying indirect strategies in a hybrid fashion, where some parameters constraining the technique were described, but the athlete was encouraged to explore a new technique within these bandwidths/constraints. In the survey, we asked multiple questions about different instructional methods and cueing strategies, including contrasting and error 64 amplification, to gain a more reliable understanding of how practitioners apply evidence-recommended approaches. Based on Study 1, we anticipated that practitioners would report only using direct strategies such as error awareness, direct instruction, part-practice, and cueing an internal focus of attention to the new movement. We did not expect differences between practitioner groups in how they intervened or their use of evidence-recommended methods. We anticipated that practitioners would respond to the questions in the survey in a way that was consistent with our observations from Study 1. The survey was developed and refined throughout the interview process of Study 1, to assess the reliability and generalizability of conclusions reached in this previous study, particularly as related to the use of evidence-informed strategies and measurement of transfer and effectiveness. We also sought more information about role requirements of different practitioner groups and how technique change methods were dependent on the athlete scenario. An important aim was to recruit a more diverse sample of participants from that of Study 1, as this group comprised mostly of males and 1 women (although working with both male and female athletes and teams). We aimed to address this limitation by increasing efforts to recruit females when conducting the survey. As with Study 1, the primary aims of this study were to survey high-performance practitioners (coaches, S&Cs and therapists) about their roles and processes used during technique change interventions and to determine whether they apply evidence-informed strategies in their practice (Carson & Collins, 2011; Gray, 2018; Hanin & Hanina, 2009; Hanin et al., 2002; Milanese et al., 2008). Because we had information about technique change from the interview data collected in Study 1, an additional aim was to collect data from a broader sample, representing the three practitioner groups, to help validate and expand on knowledge gained from 65 Study 1. We hoped to add to the literature on the role of integrated support staff (IST) in coaching practice, as well as determine the use and prevalence of different types of technique change dependent on practitioner role. 3.2 Methods 3.2.1 Participants High-performance practitioners were invited to participate. They were required to be currently working or had experience working with adults (18 yr or older) to change technique in high-performance sport. High performance sport was defined as working at or with provincial, collegiate, national and/or professional athletes/teams. The participants had to belong to one of three practitioner groups: sport coach, strength & conditioning coach (S&C) or therapist (including athletic therapists, physiotherapists, and chiropractors). The research was approved by the University Research Ethics’ Board. The research team reached out to known contacts in the field within sport and educational organizations to participate and distribute our invitation to participate (i.e. snowball sampling). Those targeted for distribution of the study details and recruitment were administrators, coaches, and therapists across the Canadian Sport Institutes, the Canadian Association of Canada, the Canadian Strength & Conditioning Association, and various collegiate, national, and professional sport organizations. We followed up with targeted groups to help ensure equity in numbers across the practitioner groups, diversity in sports and also to try and recruit female participants. All individuals who began the survey completed 100% of the questions. Participants who decided to participate (through email request), were sent personalized survey links made in Qualtrics (www.ubc.qualtrics.com; 2021, Utah, USA). Participants were compensated with a 66 digital $10 Amazon gift voucher upon completion. If participants had not completed the survey after 2 weeks, they were sent a follow-up reminder e-mail. The total sample was N=36, with n=12 from each of the practitioner groups. There were 11 people who identified as female (30.6%) and 25 people who identified as male (69.4%). Our sample included both individual (n=11) and team sport (n=25) practitioners from a variety of sports as illustrated in Figure 2.1. Soccer was most represented, followed by track and field athletics and a general category we have called multi-sport which included individuals who worked with athletes across multiple sports in varsity and national sport institute settings Figure 2 Sport Distribution Among Survey Participants 67 In Figure 2.2, we have shown participant numbers based on the number of years of experience in their current role. Experience ranged from 0-2 years to 15+ years, with the majority of our sample being between 6 and 15 years of experience. Many practitioners worked at multiple levels of sport simultaneously (e.g. both a Varsity program and with a National team), hence the numbers of each in each category is greater than our overall sample size; University/Varsity (n=18), Provincial (n=4), National (n=16), International (n=16), and Professional (n=7). We recruited practitioners working in both head and assistant roles, including: Head coach (n=6), Assistant coach (n=6), Head therapist (n=4), Assistant therapist (n=8), Head S&C coach (n=8) and Assistant S&C Coach (n=4). Figure 3 Years of Experience in Current Sport Practitioner Role 68 3.2.2 Materials / Survey Design An online survey was developed using the survey platform software Qualtrics (www.qualtrics.com; 2021, Utah, USA). The survey was developed in concert with and based on interviews conducted with high-performance practitioners (Study 1). The survey was reviewed by a research committee, consisting of both academics with knowledge of the topic and practitioners with applied experience, to ensure the questions had face validity and were relevant to the aims of the study. The survey was piloted with two participants who were not included in the final analysis with experience in the area before further refinement of the survey questions. The final survey comprised 34 questions divided across five sections including: (1) demographics, (2) technique change definitions and role requirements, (3) intervention tools and their application, (4) scenarios of technique change (including subtle, drastic, and regaining/change back post-injury), and (5) exploratory questions about changing technique. The full survey is given in Appendix B. It consisted mostly of closed questions with a variety of answer choices including binary choice (yes/no), rank ordering of lists, and Likert scales responses on a 0-4 scale (0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time). Survey logic was used to hide irrelevant questions (e.g. an individual who indicated they agreed with our definition of technique change would not be prompted to expand on what was missing). Some questions had an “other” option to provide an answer not listed. This option was designed to both mitigate possible bias in our predetermined answers and allow for new knowledge and responses that might help inform the research questions, providing the most valid representation of practitioners’ approaches to changing technique. 69 3.2.3 Data Analysis For many of the questions, frequency in responses were obtained and submitted to Chi-squared statistical tests. This method was used for binary responses and rank ordering of items. For chi-square, when frequencies within a cell were <5, we did not run analyses to test for differences between practitioner groups. Descriptive statistics are reported for questions that required a Likert scale response. Between-groups ANOVAs were used to compare across the practitioner groups. For questions that were based on the same factor (such as whether attention was directed to the old-technique or the new technique) we conducted mixed design ANOVAs. For group or condition effects involving more than two means we used Tukey’s HSD post-hoc tests to locate differences. Statistical significance was set at p<.05 for all analyses despite high probability of type I errors due to repeated questions and analyses on the same participants. Given the relatively exploratory nature of the research we did not perform statistical adjustments. However, due to potential issues relying on statistical comparisons, for both type I and type II errors, we report Cohen’s d effect size estimates for all pairwise group differences. Partial eta squared values are reported for all ANOVA effects. Our main aims in the data analyses were to assess: 1) the role of the practitioner in technique change and the processes related to how they change technique and 2) if practitioners apply evidence-informed strategies in technique change and if/how this is dependent on role. The survey contained both frequency and Likert questions related to the first aim in sections 2 and 4 of the survey (Appendix B), regarding role requirements and technique change scenarios. Answers related to the second aim were provided in section 3 of the survey, which related to evidence-informed intervention strategies. The presentation of the results is based on questions 70 related to aims 1 then 2. Data from section 5 (exploratory questions) are discussed in relation to both aims. 3.3 Results 3.3.1 Aim 1: Role and Processes Related to How Practitioners Change Technique Intervention Reason We asked practitioners to rank how frequently they intervene to change an athlete’s technique for various reasons (see Table 3) using a scale from 0 (almost never) to 4 (nearly all the time). Out of six different reasons, potential to improve performance had the highest overall average frequency, in the “often” range (M=2.97, SD=.91, Mode=3) as well as to reduce injury (M=2.56, SD=1.05, Mode=3), in the “sometimes-to-often” range. Lack of improvement and because athletes asked, were also rated on average as “sometimes” (M=1.92, SD=.69, Mode=2; M=2.06, SD=.73, Mode=2). The reasons are ordered from highest to lowest in Table 1. When we compared practitioner groups, they differed in reported intervention frequency to improve performance (hp2 =.31) and decrease injury risk (hp2 =.25). Based on Tukey posthocs, as would be expected, coaches and S&Cs intervened more frequently to improve performance than therapists, but it was S&Cs and therapists that intervened more frequently than coaches to reduce injury (all ps<.05). 71 Table 3 Intervention Reason Descriptive results for the frequency response data (0-4) and statistical analyses relating to comparisons of the three practitioner groups for the six intervention reasons (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mean Upper Lower SD F p-value 1v2 1v3 2v3 Potential to improve performance Coach (1) 3.42 3.92 2.91 .79 7.40 .002* .36 1.23* 1.04* S&C (2) 3.17 3.53 2.80 .58 Therapist (3) 2.33 2.96 1.71 .98 Injury due to current technique Coach (1) 1.83 2.68 .98 1.34 5.38 .01* 1.13* .93* .26 S&C (2) 3.00 3.38 2.62 .60 Therapist (3) 2.83 3.29 2.38 .72 Athlete asks for help to change technique Coach (1) 2.00 2.76 1.57 .94 .23 .80 0 0 0 S&C (2) 2.00 2.38 1.62 .60 Therapist (3) 2.00 2.38 1.62 .60 Lack of improvement Coach (1) 2.08 2.59 1.58 .79 .51 .61 .36 .33 0 S&C (2) 1.83 2.20 1.47 .58 Therapist (3) 1.83 2.29 1.38 .72 Current technique is unusual Coach (1) 1.25 1.86 .64 .97 .65 .53 .41 0 .39 S&C (2) 1.67 2.35 .98 1.07 Therapist (3) 1.25 1.92 .58 1.06 Change in teammates Coach (1) 1.17 1.92 .41 1.19 .93 .41 .50 .40 .10 S&C (2) .67 1.16 .17 .78 Therapist (3) .75 1.30 .20 .87 0-4 scale; 0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time. S&C = Strength and Conditioning coach. Data in bold relate to statistically significant group differences, * = p<0.05. DF for all analyses = 2,35. 72 Technique Change Scenarios We asked the practitioners to rank the prevalence of different technique change scenarios from 1=most common, to 3=least common. As shown in Table 4, subtle changes had the highest frequency of responses ranked as “most common”, followed by change-back, then drastic change. For subtle change, it was the coaches and S&C coaches that most commonly applied subtle changes (only n=1 therapist rated this as most common). For therapists, change back (after injury) was most common, but among coaches this was rated as least common amongst most coaches (67%). No therapist reported implementing drastic change. These were least common among the S&C coaches, but somewhat common was the most popular response for coaches. As displayed in Table 5, practitioners said “yes” more often than “no” when asked whether they would use different strategies when intervening to make a subtle versus drastic change. This was not the case when comparing change back to subtle or drastic change in terms of frequency of responding yes or no and there was no general pattern across practitioner groups. 73 Table 4 Technique Change Scenarios Frequency data relating the prevalence of the three different technique change scenarios (given in order of most common to least common) across the three practitioner groups. Statistical analyses pertains to comparison across the 3 response categories when n>5/cell. Least Common Somewhat Common Most Common Chi-Square Test N (%) N (%) N (%) c2 p-value Subtle change Coach 0 1 (8%) 11 (92%) / S&C 1 2 (17%) 9 (75%) Therapist 0 11 1 Total 1 14 (39%) 21 (58%) Change Back Coach 8 (67%) 4 (33%) 0 .17 .92 S&C 4 6 (50%) 2 Therapist 0 1 11 Total 12 11 (31%) 13 (36%) Drastic Change Coach 4 7 (58%) 1 / S&C 7 4 1 Therapist 12 (100%) 0 0 Total 23 (64%) 11 2 (6%) S&C = Strength and Conditioning coach. DF for all analyses = 2 74 Table 5 Different Methods for Technique Change Scenarios Frequency data relating to the need to use different methods for different technique change scenarios across the three practitioner groups. Statistical analyses pertains to comparison across the 2 response categories and 3 groups when n =>5/cell. No Yes Chi-Square Test N (%) N (%) df c2 p-value Cramer’s V 1. Different Methods for Subtle vs. Drastic Coach 4 (33%) 8 (67%) 1 5.44 .02* / S&C 3 (25%) 9 (75%) Therapist 4 8 Total 11 (31%) 25 (69%) 2. Different Methods for Change Back vs. Subtle/Drastic Coach 7 (58%) 5 (42%) 2# .22 .89 .08 S&C 6 (50%) 6 (50%) Therapist 6 6 Total 19 (53%) 17 (47%) #3x2 Chi-Square (Comparing Yes/No Across 3 Groups) Data in bold relate to statistically significant group differences, * = p<0.05 75 Measuring Effectiveness, Time Spent & Intervention Success We asked practitioners four questions regarding how they assess the effectiveness of their interventions and to rank these on a scale of 0-4. As shown in Table 6, on average, practitioners had video analysis (M=2.78, SD=1.05, Mode=2,3) as the most frequently used assessment tool, within the “sometimes-to-often” zone, closely follow by self-report (M=2.64, SD=.96, Mode=2). Interestingly, coaches were the only group to report ‘almost never’ for use of self-report (n=4, 33%). Assessing effectiveness based on success in games (M=2.19, SD=.75, Mode=2) and other objective measurements (M=2.19, SD=.98, Mode=2) were used “sometimes” among practitioner groups. Surprisingly, only 1 coach rated ‘nearly all the time’ for basing effectiveness on success in games, with 6 practitioners (3 S&Cs, 2 therapists, 1 coach) scoring it a 1 or ‘rarely’. Practitioner groups differed in how often they assessed interventions based on self-report (hp 2=.18) and success in games (hp 2 =.21). Compared to coaches, S&Cs were more likely to use self-report and less likely to use success in games as assessments of effectiveness (p<.05). Though not statistically significant, there was a similar trend for therapists to be less likely to use success in games compared to coaches. Descriptive data and statistical comparisons of the practitioner groups relating to time spent intervening and intervention success is presented in Table 7. When asked to give a percentage of time spent changing technique, on average they reported ~55% of their time, but there were no differences between groups (hp 2 =.09). When asked to give a percentage indicating how often they successfully changed technique, practitioners reported being successful ~60% of the time, but again there were no between group differences (F<1). 76 Table 6 Assessing Effectiveness of an Intervention Descriptive results for the frequency response data (0-4) and statistical analyses relating to comparisons of the three practitioner groups for the four specific tools to assess effectiveness (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 0-4 scale; 0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time. S&C = Strength & Conditioning Coach. Data in bold relate to statistically significant group differences, * = p<0.05. DF for all analyses = 2,35. 95% CI One Way ANOVA Cohen’s d Mean Upper Lower SD F p-value 1v2 1v3 2v3 Video Analysis Coach (1) 2.83 3.59 2.08 1.19 .02 .98 .08 .67 .74 S&C (2) 2.75 3.14 2.36 .62 Therapist (3) 2.00 3.57 1.93 1.29 Self-Report Coach (1) 2.08 2.72 1.45 1.0 3.55 .04* .99* .82 .20 S&C (2) 3.00 3.54 2.46 .85 Therapist (3) 2.83 3.36 2.39 .83 Success in Games Coach (1) 2.67 3.16 2.17 .78 4.29 .02* 1.03* .97 .13 S&C (2) 1.92 2.34 1.49 .67 Therapist(3) 2.00 2.38 1.62 .60 Objective Measurement Coach (1) 2.42 3.05 1.78 1.00 .80 .46 .50 .17 .33 S&C (2) 1.92 2.55 1.28 1.00 Therapist (3) 2.25 2.86 1.64 .97 77 Table 7 Time Spent & Success Intervening Percentage mean frequency and average rating (1-5) for self-reported measures of time spent intervening to change technique and self-reported success in changing technique, across three practitioner groups. Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mean % Mean Upper Lower SD F p-value 1v2 1v3 2v3 Time Spent Coach (1) 65.4% 3.58 4.46 2.71 1.38 1.69 .20 .42 .72 .34 Changing S&C (2) 54.2% 3.17 3.82 2.51 1.03 Technique Therapist (3) 44.6% 2.75 3.30 2.20 .87 Total 54.7% 3.17 3.55 2.78 1.13 Success Changing Technique Coach (1) 62.5% 3.50 3.83 3.17 .52 .26 .78 .26 .29 0 S&C (2) 58.3% 3.33 3.83 2.84 .78 Therapist (3) 58.3% 3.33 3.75 2.92 .65 Total 59.7% 3.39 3.61 3.17 .64 Time Spent Changing Technique 1-5 scale; 1= <25%, 2= ~25%, 3= ~50%, 4= ~75%, 5= 100%, all my time; Success Changing Technique 1-5 scale; 1= 0%, never successful, 2= ~25% success, 3= ~50% success, 4= ~75% success and 5= 100%, successful all the time 78 Signals to End an Intervention Practitioners were asked to rank order (1=least frequently used to 5=most frequently used) the primary signal for ending a technique change intervention as detailed in Table 8. The signals that were most highly rated on average were that an athlete was able to demonstrate the technique in training (M=4.03, SD=.69, Mode=5), that an athlete/coach reports success and improved performance in competition (M=4.03, SD=1.06, Mode=5) or in training (M=3.75, SD=.91, Mode=4). Exhausting available resources and/or time constraints (M=1.69, SD=.62, Mode=2) and completing a set allotted time (M=1.50, SD=.81 Mode=1) were ranked the least common signal to end a technique change intervention. There were no practitioner group differences for any of these end-of-intervention signals. 79 Table 8 Signals to End an Intervention Descriptive results for the frequency response data (1-5) and statistical analyses relating to comparisons of the three practitioner groups for five signals used to end an intervention (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mn Upper Lower SD F p-value 1v2 1v3 2v3 Athlete/Coach reports improved performance in competition Coach (1) 4.08 4.77 3.39 1.08 .31 .73 .21 .10 .32 S&C (2) 3.83 4.68 2.98 1.34 Therapist (3) 4.17 4.62 3.71 .72 Athlete demonstrates desired technique without instruction Coach (1) 3.92 4.55 3.28 1.00 .13 .88 .17 .17 0 S&C (2) 4.08 4.66 3.51 .90 Therapist (3) 4.08 4.66 3.51 .90 Athlete/Coach reports improved performance in training Coach (1) 3.67 4.08 3.25 .65 .17 .85 .26 .10 .11 S&C (2) 3.83 4.20 3.47 .58 Therapist (3) 3.75 4.30 3.20 .87 Allotted time constraints and resources are exhausted Coach (1) 1.42 1.74 1.09 .52 2.93 .07 .91 .50 .53 S&C (2) 2.00 2.47 1.53 .74 Therapist (3) 1.67 1.98 1.35 .49 Completed dedicated allotted time (i.e. 5 sessions in 5 weeks) Coach (1) 1.92 2.66 1.18 1.17 2.63 .09 .76 .66 .17 S&C (2) 1.25 1.54 .96 .45 Therapist (3) 1.33 1.65 1.02 .49 1= least frequently used to 5= most frequently used, S&C = Strength & Conditioning Coach. DF for all analyses = 2,35 80 3.3.2 Aim 2: Use of Evidence-Informed Strategies Contrasting, Negative Practice, Error Amplification, Error Awareness We asked practitioners to report on their use of contrasting, negative practice, error amplification, and error awareness. Frequency data pertaining to these questions are given in Table 9. Overall, more practitioners responded “no” to whether they used contrasting, error amplification and negative practice and differences from “yes” responses were statistically significant for error amplification and not contrasting; there were too few “yes” responses to statistically compare negative practice. Practitioners overwhelmingly answered “yes” (94% of respondents) to the question of whether they would make the athlete aware of the error. Although we did not run any practitioner group comparisons due to low number of participants in some of the cells, the only small differences between groups were for the question about using contrasting. Coaches were evenly split on using this method, whereas the majority (67%) said ‘no’ among therapists and S&C coaches. 81 Table 9 Negative Practice, Error Awareness, Error Amplification, Contrasting Frequency data and results of statistical analyses comparing across the “yes”, “no” responses for questions relating to four methods used to change technique. Data are shown across the three practitioner groups (data are presented in order of greatest response differences). Statistical analyses pertains to comparison across the 2 response categories when n>5/cell. No Yes Chi-Square Test N (%) N (%) c2 p-value 1. Negative Practice (i.e. practicing error) Coach 12 (100%) 0 / S&C 11 (92%) 1 (8%) Therapist 12 0 Total 35 (97%) 1 (3%) 2. Error Awareness Coach 1 (8%) 11 (92%) / S&C 0 12 (100%) Therapist 1 11 Total 2 (6%) 34 (94%) 3. Error Amplification Coach 8 (67%) 4 (33%) 4 .045* S&C 8 4 Therapist 8 4 Total 24 (67%) 12 (33%) 4. Contrasting Coach 6 (50%) 6 (50%) 1.78 .18 S&C 8 (67%) 4 (33%) Therapist 8 4 Total 22 (61%) 14 (39%) S&C = Strength and conditioning coach. DF for all analyses =1 Data in bold relate to statistically significant group differences, * = p<0.05 82 Constraints, Part-Practice, and Competitive Pressure Descriptive data and statistical analyses are reported in Table 10 for three questions about use of constraints, part-practice and competitive pressure, which were rated from 0 (almost never) to 4 (nearly all the time). Practitioners reported using part-practice ‘sometimes-to-often’ on average (M= 2.47, SD=1.00, Mode=3) and similarly reported ‘sometimes-often’ for using physical tools or equipment (i.e. task constraints) to bring about technique change (M=2.44, SD=1.10, Mode=3). Two coaches reported ‘almost never’ and two reported ‘nearly all the time’, along with two therapists for using physical tools or equipment (i.e task constraints). However, there were no differences between practitioner groups for this question or questions about use of part practice or competitive pressure (Fs<1). With respect to competitive pressure, in general practitioners reported ‘sometimes’ for using “a competitive or pressure situation to challenge the athlete’s technique” (M=2.22, SD=.90, Mode=2). Interestingly, no S&Cs reported using competitive pressure situations 'nearly all the time’. 83 Table 10 Part-Practice, Physical Task Constraints, Competitive Pressure Descriptive results for the frequency response data (0-4) and statistical analyses relating to comparisons across the three practitioner groups for the use of three technique change intervention strategies (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mean Upper Lower SD F p-value 1v2 1v3 2v3 Part-Practice Coach (1) 2.25 3.02 1.48 1.22 .51 .60 .40 .23 .19 S&C (2) 2.67 3.23 2.10 .89 Therapist (3) 2.50 3.07 1.93 .90 Physical Task Constraints Coach (1) 2.42 3.33 1.50 1.44 .42 .66 .14 .21 .17 S&C (2) 2.25 2.86 1.64 .97 Therapist (3) 2.67 3.23 2.10 .89 Competitive Pressure Coach (1) 2.33 2.83 1.84 .78 .23 .80 .32 .08 .17 S&C (2) 2.08 2.59 1.58 .80 Therapist (3) 2.25 2.97 1.53 1.14 0-4 scale; 0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time. S&C = Strength & Conditioning coach. DF for all analyses = 2,35. 84 Instruction Type We asked practitioners six questions relating to how they instructed the desired technique and again asked them to report on the frequency of use (0-4 scale). As shown in Table 11, overall, both video (M=2.83, SD=.85, Mode=3) and physical constraints (M=2.67, SD=.79, Mode=3) were rated highest among instruction types being used ‘sometimes-often’. Rarely was error amplification (M=1.22, SD=1.05, Mode=0,1) reportedly used, with practitioners ranking it the lowest among instruction types. Interestingly, there was a difference in how often practitioner groups used error amplification. Therapists and S&Cs were more likely to have an athlete exaggerate an error (to change technique) than coaches. 85 Table 11 Instruction Technique Descriptive results for the frequency response data (0-4) and statistical analyses relating to comparisons across three practitioner groups for the use of six instructional techniques (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mean Upper Lower SD F p-value 1v2 1v3 2v3 Video Demonstration Coach (1) 2.75 3.14 2.35 .62 .81 .46 .43 .10 .44 S&C (2) 3.08 3.66 2.51 .90 Therapist (3) 2.67 3.30 2.04 .98 Physical Constraints Coach (1) 2.50 3.14 1.87 1.00 .51 .60 .22 .36 .23 S&C (2) 2.67 2.98 2.35 .49 Therapist (3) 2.83 3.36 2.30 .83 Error Awareness + Indirect Instruction Coach (1) 1.92 2.34 1.49 .67 .49 .62 0 .32 .31 S&C (2) 1.92 2.42 1.41 .79 Therapist (3) 2.25 3.07 1.43 1.29 Demonstrate New Technique Coach (1) 1.58 2.22 .95 1.00 1.01 .38 .48 .53 0 S&C (2) 2.08 2.77 1.40 1.08 Therapist (3) 2.08 2.66 1.51 .90 Demonstrate Error and New Technique Coach (1) 1.42 2.16 .68 1.16 1.31 .28 .61 .51 .07 S&C (2) 2.08 2.72 1.45 1.00 Therapist (3) 2.00 2.72 1.28 1.13 Exaggerate Error Coach (1) .50 .93 .07 .67 5.50 .01* 1.17* 1.31* .16 S&C (2) 1.50 2.14 .86 1.00 Therapist (3) 1.67 2.35 .98 1.07 0-4 scale; 0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time. S&C = strength and conditioning coach. DF for ANOVA analyses = 2,35. Data bolded shows statistical differences between practitioner groups, *denotes p= or <.03 86 Cueing & Focus of Attention We asked practitioners a number of questions related to cueing and focus of attention (FOA) with responses concerning frequency of use on a 0-4 scale (0 = almost never to 4 = nearly all the time). As shown in Table 12, cueing towards a body-related internal cue (M=2.64, SD=.96 Mode=3), to an external cue (M=2.72, SD=.81, Mode=3) and to a combination of internal and external cues (M=2.83, SD=.85, Mode=3), were on average rated as being done ‘sometimes-to-often’. There were no practitioner group differences. Auditory and tactile cueing were generally reported to be used ‘rarely-sometimes’ (M=1.92, SD=1.08, Mode=2), but responses to this question did depend on group (hp2 =.21). Coaches were less likely than S&Cs to use tactile and/or auditory feedback. There were no other group differences, even though the difference between S&Cs and therapists was relatively large (d=1.07). 87 Table 12 Cueing & Focus of Attention Descriptive results for the frequency response data (0-4) and statistical analyses relating to comparisons across three practitioner groups for the use of external/internal focus of attention (FOA) and auditory/tactile cueing when changing technique (presented in order from highest average overall rating to lowest). Group comparisons are shown based on a between-groups’ ANOVA and posthoc testing. 95% CI One Way ANOVA Cohen’s d Mean Upper Lower SD F p-value 1v2 1v3 2v3 Combination of Internal and External FOA Coach (1) 2.58 3.22 1.95 1.00 .81 0.46 0.48 0.38 0.10 S&C (2) 3.00 3.47 2.53 0.74 Therapist (3) 2.92 3.42 2.41 0.80 External FOA towards movement Coach (1) 2.50 3.07 1.93 0.91 1.89 0.17 0.78 0.09 0.68 S&C (2) 3.08 3.41 2.76 0.52 Therapist (3) 2.58 3.16 2.01 0.90 Internal FOA towards movement Coach (1) 2.50 3.14 1.86 1.00 .74 0.49 0 0.40 0.44 S&C (2) 2.50 3.00 1.99 0.80 Therapist (3) 2.92 3.61 2.23 1.08 Auditory & Tactile Coach (1) 1.42 2.25 0.58 1.31 4.46 0.02* 1.17* 0.29 1.07 S&C (2) 2.58 2.91 2.26 0.51 Therapist (3) 1.75 2.36 1.14 0.97 0-4 scale; 0=almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time. S&C = strength and conditioning coach. DF for ANOVA analyses = 2,35. Data bolded shows statistical differences between practitioner groups, * = p<.05 88 We also asked questions to determine whether practitioners focused attention to how the new or old movement looked and felt. These data are visually represented in Figure 4, collapsed across group. In general, higher frequency ratings were given for the new versus old movement and there was a greater tendency to focus on feel than look. These effects were confirmed when we ran a mixed design 3 Group X 2 Type of movement (old v. new) X 2 Focus (look or feel) ANOVA. Output for these analyses are presented in Table 13. There were main effects for group, type of movement cued and cueing how a movement looks and feels. A posthoc analysis of the group effect showed that coaches had lower ratings concerning how frequently they cued any movement in general (M= 2.23, SD =1.31), but they were only significantly different from S&Cs (M = 2.81, SD = .98, p=.049, d=.50), not therapists (M = 2.77, SD =.97 , p=.07, d=.47). Figure 4 Cueing of Look and Feel for New and Old Movements on Average among Practitioners 89 Table 13 Cueing Look and Feel of Old and New Movements Statistical output for the 3x2x2 mixed design ANOVA comparing practitioner groups across the four questions relating to type of movement (old– new) and type of focus (look -feel) when cueing technique df F hp 2 Between Practitioner Groups 1,33 3.77 .96 New or Old 1,33 27.13 .45 Look or Feel 1,33 7.13 .18 New or Old * Look or Feel 1,33 1.22 .36 Group * New or Old 2,33 2.54 .13 Group *Look or Feel 2,33 .27 .02 Group * New or Old *Look or Feel 2,33 1.37 .08 Data bolded shows statistical differences between practitioner groups 90 Modelling, Optimal Technique Nearly all practitioners (94%) responded “Yes” to the question that a technique change intervention can be done without a comparison to a more skilled or elite athlete, than those that answered “No”; Group based frequency data in Table 13. There were too few ‘no’ responses to compare responses with a c2 analysis. When prompted whether an optimal technique exists, most practitioners voted there was a spectrum of optimal technique that exists (72%) compared to those who believed there was an individual optimal (28%); no practitioners selected that a biomechanical optimal exists across athletes; these data are presented in Table 14. Again, we were unable to statistically compare with a c2 analysis due to the lack of responses for the existence of a biomechanical ideal. 91 Table 14 Necessity of a Model to Change Technique Frequency data comparing practitioner group responses, ‘yes’ or ‘no’, whether model is needed when conducting a technique change intervention. Data are shown across the three practitioner groups. No Yes N (%) N (%) Can a technique change intervention be done without a comparison to a more elite or skilled athlete? Coach 1 (8%) 11 (92%) S&C 0 12 (100%) Therapist 1 11 Total 2 (6%) 34 (94%) S&C = Strength and conditioning coach. No statistical analysis comparing ‘yes’ and ‘no’ across the two response categories due to n<5/cell. Table 15 Optimal Technique Frequency data comparing responses to whether there is an optimal technique as a function of the three practitioner groups. S&C = Strength and Conditioning coach. No statistical analysis comparing across the three response categories due to n<5/cell. Yes, there is a biomechanical ideal There is a spectrum of optimal accounting for variance across athletes No, there is an individual optimal for each athlete N (%) N (%) N (%) Is there always an optimal technique? Coach 0 9 (75%) 3 (25%) S&C 0 10 (83%) 2 (17%) Therapist 0 7 (58%) 5 (42%) Total 0 26 (72%) 10 (28%) 92 3.4 Discussion The purpose of this research was to learn about role requirements and intervention differences among sport-support practitioners involved in technique change. This study was an extension of previous qualitative interviews conducted on the same topic, designed to elicit data from a wider and more diverse group of individuals involved in technique change. We recruited a highly-experienced sample, with half of the sample of participants having over ten years of experience and representing over sixteen sports. The majority of participants also had experience at the international and/or professional level. Importantly, practitioners reported spending ~45-65% of their time engaging in technique change, with therapists being on the lower end of this amount and coaches on the higher-end, underscoring the value of learning more about this process. We know from Study 1 that support practitioners, such as therapists and S&C coaches, play an important role supporting both coaches and athletes to change technique in high-performance environments. The survey results confirmed the role that support practitioners play in technique change and also highlighted some differences in how they intervene. Reducing injury risk and managing return to play programs were key functions of S&C coaches and therapists, different to coaches. In our experiences with high-performance sport and from previous interviews (Study 1), it is typical for S&C coaches and therapists to work collaboratively on both return to play and performance training and planning, with S&Cs typically leading the delivery of on-field components in late stage return to play. In the survey, it was S&Cs and coaches who reported intervening to improve performance statistically more often than therapists and engaging in subtle change scenarios most often. Therapists reported intervening to regain or change back technique post injury as most common. As compared to 93 coaches, both support staff members were statistically more likely to intervene in change back scenarios or to reduce injury risk. These data underscore the different roles yet important collaborative nature of practitioners involved in technique change and align with themes from Study 1. Practitioners mostly agreed that different steps/processes are needed for subtle versus drastic changes to technique, yet there was less consensus regarding change-back (from injury) scenarios. The need to relearn and resist a movement, as required for drastic changes, compared to what has been referred to as an ongoing “evolution of technique” (i.e. subtle adaptations, Carson & Collins, 2011, p47), does intuitively suggest that different change processes will be needed. For example, where subtle change is required, what we have termed more “direct” approaches, where athletes are provided criteria about a desired technique and what to avoid, may be better suited than less prescriptive “indirect” methods (Vecchione et al., 2022). Because subtle changes are minor, it’s potentially more difficult to gain awareness of the new technique and more likely to revert back to old habits, thus, contrasting between old and new ways, may work better in helping both to relearn new and resist old, undesired ways (Lyndon, 2000). For more drastic changes, which are more major and potentially less likely to revert back to old technique once a new strategy is acquired, less prescriptive and more exploratory methods, could perhaps be better suited. In the survey, practitioners did not offer this information, just showed awareness that different methods are likely needed across different scenarios. In Study 1, practitioners reported a range of 3-15 hours a week changing technique, with many reporting it as a daily occurrence. Assuming a full-time work week is 35-40 hours, the data from our survey suggests that 3-15 hours may be a lower end estimate. In the survey, practitioners reported spending on average 55% of their time changing technique, which would 94 be ~20 hours/week (although a few practitioners were not full time). As remarked, subtle changes were most common and practitioners reported that they were continually fine-tuning technique as part of their ongoing daily practice for high-performance athletes. Practitioners self-reported successfully intervening ~60% of the time, which was consistent across each practitioner group. This is a positive finding, showing that what practitioners are currently doing seems to be working a large part of the time. What this survey data helps to alert us to is the room available to increase this number and potentially bring about “success” more effectively and efficiently (i.e. decrease time spent intervening). From our interview thematic analysis, we concluded that measuring “success” was an important but challenging process and that assessments of success were not always based on determining the robustness of the new technique under transfer to competitive, stressful or fatiguing conditions. As such, it is likely that estimates of 60% success are overestimated, again supporting the need to facilitate technique change methods as well as the assessment of the success of these methods. The use of competitive or pressure situations to test the robustness and ensure transfer of the new technique has been discussed as important to end-stages of an intervention (Carson et al., 2013; Kearney et al., 2018). Our survey data aligns with this research, with practitioners on average using competitive/pressure situations ‘sometimes-often’. However, there was a subset of practitioners who reported ‘almost never-rarely’ using competitive/pressure situations when changing technique (19%). A similar finding was noted during interviews in Study 1, where the majority of practitioners did not discuss using competitive/pressure situations during technique during interventions. Only two practitioners (therapist, coach) reported using competitive/pressure situations ‘nearly all the time’ which is surprising given its importance in ensuring stability of the new technique and transfer to competition. Data from the survey seem to 95 align with previous research overall, though there appear to be outliers with the survey responses combined with the interview data that suggest competitive/pressure situations are not always applied by practitioners. One limitation comparing our findings with earlier studies (Carson et al., 2013; Kearney et al., 2018), is that only individual sport coaches were investigated. It seems reasonable to expect differences between individual and team sport practitioners. Presumably, individual sports may have less barriers in training environments to manipulate and ensure pressure when performing/training, as opposed to team sport practices which are not typically individualized. Surprisingly, in our survey sample, individual sport coaches reported ‘sometimes’ using competitive/pressure situations as opposed to team sport coaches who reported using it ‘sometimes-to-often’. Questions remain around the applicability and feasibility of technique change methods in these different sport settings. One of our practitioner-informed recommendations from Study 1 was that using video review during training and competition, along with some quantitative scoring systems, such as a technique checklist under competitive scenarios, could be a pragmatic solution to the challenges presented in determining success of interventions in high-performance environments. Survey participants showed agreement with these ideas and reported using video analysis (25%) and self-report (17%) ‘nearly all the time’ to determine the success of an intervention, more often than relying on success in games (1 coach, 3%). Surprisingly, six practitioners (17%) rated using success in games to measure effectiveness of an intervention as rare, although coaches reported using it significantly more often than S&Cs (and descriptively more than therapists, p = .06). We see further evidence that performance in games/competition is not always the signal to end an intervention. Practitioners reported ending an intervention if the athlete demonstrated the desired technique without instruction as frequently as ending an intervention based on improved 96 performance in competition. One plausible explanation when interpreting these data may be due to different practitioner goals. For example, when intervening to reduce injury risk, keeping an athlete healthy does not depend on game performance, it depends on improving their tissue quality, load tolerance, among other biomechanical factors. As such, although it should still be important to see evidence of the technique under game situations, the athlete’s actual performance in games is less of a concern from the therapist’s perspective. Although definitions of success are likely to depend on the practitioner’s role, the importance of determining success in reference to competition, to confirm transfer and realization of newly adopted technique, is still paramount. Due to challenges associated with quantifying successful transfer of technique change, a combination of self-report, video analysis, and evidence of the new technique along with performance success in competition, is recommended. In a recent review of the technique change literature, we distinguished across different technique change methods as being either more direct, based on prescriptive instruction about how to change a technique and what this should look like, or more indirect, bypassing such prescriptive instruction (Vecchione et al., 2022). From the survey data, direct methods of instruction were popular among practitioners, with many common elements of direct methods, such as error awareness, cueing an internal focus of attention, and part-practice being reported as used ‘sometimes-to-often’. Among the two indirect methods, error amplification was less popular, though physical constraints were commonly used among practitioners. Whether practitioners applied these physical constraints without direct instruction about a new, desired outcome, remains unclear. It is plausible that many practitioners who reported using constraints may use it in a hybrid fashion, similarly to participants from Study 1. During interviews in Study 1, practitioners gave examples of hybrid instructional approaches, providing some instruction, 97 yet creating opportunities to explore movements within constraints. Furthermore, though nearly all practitioners reported alerting athletes to the undesired technique or error, it does not necessarily follow they were all applying a direct instructional approach. When prompted about a more hybrid approach in the survey, involving a combination of error awareness and indirect methods of instruction to bring about change, practitioners reported using it ‘sometimes’. This survey data provides further evidence that practitioners are using a combination of methods that are for the most part prescriptive, yet may also allow for exploration and discovery of a more optimal method. Most of the technique change methods in the literature encourage practice of the error or undesired movement, through contrasting or error amplification, often at earlier stages of the intervention (Vecchione et al., 2022). From study 1, there was little evidence that contrasting between the old/undesired technique and the new/desired technique, or error amplification, were being used among high-performance practitioners. However, from the survey, contrasting was reported to be used on average approximately 40% of the time (with coaches reporting using it 50% of the time compared to 33% by therapists and S&C coaches). In both the interviews and the survey, practitioners were explicitly asked about contrasting, though the survey may have biased practitioners towards answering “yes” given that two of the three response options to this question were prefixed by “yes” (i.e., “‘yes, only at the start”, “yes, throughout” or “no”). Indeed, when further asked in the survey whether they would have an athlete practice the error after they’ve demonstrated they can perform the new technique (also termed negative practice), an overwhelming majority answered “no” (97%). Given that six practitioners stated they would have an athlete use contrasting throughout, we would expect that at least the same number would have answered “yes” to engaging in negative practice. What we can take from these data is that 98 some practitioners are using contrasting, coaches more than other sport practitioners, but that it is infrequent in its use, especially once the new technique has been evidenced. In the literature, contrasting is typically limited to the awareness and modification phases of an intervention (Carson & Collins, 2011; Hanin et al., 2002). However, there are also recommendations to conduct follow-up sessions to ‘recover’ technique or ‘prevent’ regression to previous form that could involve contrasting throughout (Hanin & Hanina, 2009). Error amplification is one method that has received empirical verification as a valid method of technique change and one that works by indirectly searching for a new (better) method through amplification of the undesired technique (Milanese et al., 2017). Practitioners answered ‘no’ twice as much (67%) as ‘yes’ (33%), when asked whether they use the method of error amplification. When asked to rank how often they use error amplification among other instructional techniques, practitioners most often selected ‘almost never’ and ‘rarely’ (61% of responses). Interestingly, coaches were statistically less likely than therapists and S&C coaches to have an athlete exaggerate an error. One possible explanation for this difference may be that therapists and S&C coaches are more likely to intervene to reduce injury risk and could be using error amplification to bring about a sensation as to why a movement should be avoided or is harmful. It may also be the case that non-sport coaches have less insight or knowledge about what a desired technique should be, but by exaggerating an error, they can help an athlete discover new solutions on their own. As remarked earlier, the current data conflict somewhat from past data ascertained through interview methods (Study 1). In the interviews, not one practitioner discussed using error amplification during the case study portion of the interview, nor answered “yes” when prompted if they would use error amplification. If error amplification methods are being used, it is rare, likely as a result of poor knowledge translation regarding 99 empirical evidence supporting benefits of this method for technique change. As such, efforts to better translate knowledge to end-users in sport, along with guidelines as to how these methods work and when they might be most effective, are needed, especially for methods that may appear rather counter-intuitive. The use of physical constraints to bring about a desired technique was reported as being used ‘sometimes-to-often’ in the current study, which was comparable to commonly used strategies such as part-practice and video feedback. In Study 1, although over half of the sample of practitioners reported using physical constraints when explicitly asked, it was not similar compared to the use of video and part-practice being use by nearly all practitioners. Like the interviews in Study 1, the constraints led approach (CLA) was the only referenced method among participants. This was surprising given that at the time of writing there was only one technique change study published with this method (Gray, 2018). However, the CLA has become increasingly popular among coaches as evidenced by previous research (Woods et al., 2020) and it’s references within the survey and interviews. What remains unknown is whether practitioners applied physical/task constraints in an indirect instructional approach, similar to Gray (2018), where explicit instruction about technique was bypassed. Physical or task constraints can also be used in combination with a more direct instructional approach. For example, in the case of a sprint start, directing an athlete to lean forward during initial acceleration, coupled with this use of a resistance band at the waist to aid in this forward lean, would indirectly allow the athlete to achieve this prescriptive aim of greater lean. It is likely that practitioners were applying physical and task constraints in such a hybrid manner given that they generally did not report using more indirect instructional methods. Interestingly, Gray (2018) showed that the constraints group (that also had progressive task difficulty), outperformed two other groups that only received direct 100 instruction (internal and external-focused cueing groups) about what to change. This result supports the recommendation that practitioners may want to apply these task/physical constraints in a low prescriptive environment, allowing the athlete to find what works for them. Whether a hybrid approach using task/physical constraints and explicit instruction, compared to task/physical constraints alone (i.e. indirect) is more effective is unknown, though use of physical constraints appears to be a somewhat common practice among high-performance practitioners. The use of cueing and how to provide instruction is an important part of the technique change intervention and is a point of distinction across available methods (Vecchione et al., 2022). In the technique change literature, systematic methods such as the Five-A model and Identification-Control-Correction (ICC) program place importance on understanding how a movement feels and looks (Carson & Collins, 2011; Hanin & Hanina, 2009). Our survey data showed that practitioners favoured cueing the feel of a movement, more than the look, and this was independent of whether they were cueing the new or undesired/old technique. However, practitioners do not appear to rely on tactile cueing as this was ranked as the least frequently used cueing method, although S&Cs used them statistically more often than coaches. Although we can only speculate on reasons, and admittedly cue use was infrequent, it may be because S&Cs often perform more manual assessments and will use tactile cueing to provide feedback more than coaches. Therapists followed a similar trend as S&Cs, though they were not statistically different from coaches. This is likely due to the question combining the use of tactile and auditory cues together, and while therapists have a manual skillset, S&Cs are more likely to use auditory cues such as a metronome, clapping or whistles to instruct or lead training sessions. Practitioners also reported providing cues more often about a new movement as opposed to an 101 old movement, which aligns with remarks earlier about the relatively infrequent use of methods such as contrasting that rely on going back to the old technique. Our data showing that practitioners would focus more on how a movement feels as opposed to looks, and the new movement more so than the old, aligns with previous evidence-recommended approaches (Carson & Collins, 2011; Hanin & Hanina, 2009) and interviews with practitioners from Study 1. The language used to provide cues, specifically how practitioners direct an athlete’s focus of attention (FOA), has been shown to impact learning and performance (Chua et al., 2021), with external-focused cues, those directing attention to the effects of an action or an outcome and away from the body, proposed to be more effective for performance and learning than an internal-focused cues towards one’s body. However, in the relearning and technique change literature, generally both an internal and external FOA are encouraged (e.g., Hanin & Hanina, 2009; Hanin, et al., 2002, ). Though there is some evidence that external-cues are superior to internal-cues to changing technique (Gray, 2018), the internal-cueing group was not taken through the same systematic methods which espouse the use of such cues to change technique during the awareness and early modification phases (Carson & Collins, 2011; Hanin & Hanina, 2009). In our survey, practitioners overall reported similar frequency (‘sometimes-often’) of using internally or external-focused cues, as well as a combination of both during an intervention. During interviews (Study 1), nearly all participants discussed using an internal FOA, whereas only half the sample discussed using an external FOA. The difference between results may lie in study methods. In the interviews, we did not ask practitioners directly about how they cued, rather, this was deduced from the case-study explanations and in discussion about the topic of technique change in general. In the survey, practitioners were asked to rank how often they might use different cueing strategies. Based on findings from both studies, it 102 appears practitioners seem to apply a combination of both internal and external cues, progressing from an internal-focus to an external-focus of attention, which aligns with evidence-recommended approaches such as the Five-A and ICC program (Carson et al., 2013; Hanin & Hanina, 2009). 3.5 Summary and Conclusions In summary, we have shown that technique change defines a large portion of the role of practitioners in sport; including coaches, S&Cs and therapists. In general, practitioners share more similarities than differences with respect to technique change and generally rely on prescriptive methods and report similar levels of intervention success of ~60%. We have identified some gaps in the practice behaviours and knowledge based on current research and recommendations to address them. One of the most significant gaps relates to the assessment of success and measuring technique change effectiveness under transfer-appropriate competition conditions. It appears that the definition of success is practitioner role/goal-dependent, with more emphasis put on assessment of performance and outcomes for coaches, rather than avoiding or rehabilitating an injury for therapists, with S&Cs operating distinctly in both areas. There is also a general lack of contrasting back to the undesired technique, even though this method has been shown to be more robust under competitive conditions, helping to inhibit the old habitual technique in favour of the new. The data from our survey mostly supports that from prior literature (Carson et al., 2013; Kearney et al., 2018) and interviews conducted in Study 1. The research-practice divide is quite apparent in this area, though admittedly, the research is not strong, despite many ideas and programs for changing technique being around for decades. It appears that coaches adopt little 103 parts of various methods, depending on the situation, rather than adopting a specific program for change. Although there is some appreciation that different situations will require different methods, there was no clear-cut divide as to when certain methods would be chosen over others. It does appear that better knowledge translation of technique change methods outlined in the current literature is warranted, specifically the use of methods such as contrasting and error amplification, that may appear counter-intuitive to practitioners. These efforts would be aimed at increasing both the effectiveness and efficiency (decreased time spent intervening) of technique change interventions. Alerting practitioners to these methods, as may have been achieved through this survey and hearing the voices of practitioners, is potentially one step to help educate. Using the insight gained from this survey and previous literature (including Study 1), we propose the need for a summary of methods (i.e. a ‘toolbox’) and how they may best apply across different technique change scenarios, in the form of an infographic, blog, or white paper, to circulate amongst coach education committees and social media in an effort to enhance knowledge translation. 104 Chapter 4: General Discussion The two studies conducted are the first to document the role that support practitioners, such as S&C coaches and therapists, play in technique change within high-performance sport. The practitioner-informed literature on technique change to date (Carson et al., 2013; Kearney et al., 2018) has also been limited to individual sports (i.e., golf, athletics), overlooking the unique challenges that exist within team sports. For example, team sports require the execution of technique in open, reactive and dynamic environments, which are less typical in individual sports. Across both studies, we interviewed and surveyed over fifty practitioners in high performance sport, including coaches, therapists, and S&C coaches, with ~65-70% of these people working primarily with team sport athletes. There was a wide variety of sports represented, providing a diverse and nuanced understanding of technique change in sport generally (sixteen sports covered in the survey study, nine from the interviews). The practitioners in our study were all highly experienced, with over 40% having 15 or more years of experience and over 60% having experience at either the international or professional level. These high-performance practitioners reported spending approximately 45-65% of their time changing technique. Almost half of the sample of interviewees reported technique change to be a daily occurrence, that it was a predominant focus of their job, underscoring the value of gaining insight into this process. A major aim of both studies was to evaluate differences across the various practitioner groups with respect to when and how they intervene in different technique change scenarios. In Study 1, we learned that support practitioners assess and modify technique differently from coaches. Both S&C coaches and therapists were more likely to perform physical assessments. These tests could involve manual testing or movement screening (i.e. visual assessment of 105 coordinated multi-joint movements such as jumping, squatting, lunging, etc.) in order to link deficiencies in technique to deficiencies in physical, body constraints, such as range of motion about a joint. S&C coaches were more likely to use technology and monitoring tools (e.g., force plates, physical tests) to quantify the physical capacities and movement strategies of athletes during assessment. Practitioner group differences existed during technique modification phases, with therapists using manual techniques (e.g., joint mobilizations) to assist with technique change, whereas S&C coaches reported working on improving physical capacities and general movement skills related to the sport, which would indirectly improve technique. One way to think about the differences between practitioners with respect to technique change is that therapists and S&C coaches adopted a more outside-in way of working, taking the change outside of the sport-context, before bringing it back. In contrast, coaches stayed within the sport context. Although they would scale back on context, such as by using part-practice methods, slowing the movement down, decreasing any context-related pressures, the modification was, generally speaking, always within the context of the sport. The differences in how technique interventions were prescribed and delivered between practitioners as discovered throughout the interview process (Study 1), led to asking practitioners more directly about their intervention rationale and the types of technique change scenarios they typically encountered in the survey (Study 2). In a broad review of the literature on technique change (Vecchione et al., 2022), we expanded the definition of technique change by suggesting it be an umbrella term encompassing three different scenarios informed by the literature and personal experience as a practitioner in sport; 1) subtle change; 2) regaining/change back; and 3) drastic change. The prevalence of these scenarios differed among practitioners with subtle changes being most common to coaches and S&Cs and change back (typically after injury), 106 being most common to therapists. Drastic change was the least common among therapists and S&Cs and change back was the least common to coaches. In line with these scenario differences among practitioners, coaches and S&Cs reported being more likely to intervene to improve performance compared with therapists who were more likely to intervene to reduce injury risk or facilitate return to play. These role differences seem to support the theme of a collaborative integrated support team (IST) from the interviews in Study 1, with each practitioner group having strengths and specific skillsets that when combined support a variety of intervention goals. With respect to use of the various methods recommended in the technique change literature, data from both the surveys and the interviews showed that practitioners were not typically using contrasting, or indirect methods of technique change, such as the Constraints-led Approach (CLA) and error amplification. Indirect instructional methods are those where a different or desired action is brought about without direction instruction, instead through a manipulation of task constraints where a new movement is discovered. Though there was little evidence that these methods were used from the interviews in Study 1, the survey data did point to their use by some, but only one therapist who mentioned using CLA and one S&C coach who used contrasting. Direct instructional methods of technique change were by far the most commonly adopted by practitioners, where there was a prescriptive approach to alerting athletes what not to do and what to do. There were also reports of more hybrid methods, where both direct and indirect methods were combined, promoting exploration of movement with some prescription about either the desired outcome or movement error. Intervention elements common to direct methods such as alerting the athlete to the error, direct instruction about the desired technique, part-practice of specific components of the desired technique, and an internal focus of 107 attention, were routinely used among practitioners. Importantly, the only empirically-tested technique change method to receive a mention across both studies was the Constraints-led Approach (CLA), which was noted by one therapist during the interviews and multiple practitioners in the survey. This is not entirely surprising given the popularity of the CLA and concerted efforts to apply the ideas to real-world coaching environments (Woods et al., 2020). The overall conclusion that can be made about the use of the six recommended technique change methods alerted to in the literature, along with varying quality of evidence supporting their efficacy (Vecchione et al., 2022), is that practitioners are largely unaware of these methods, particularly those that comprise contrasting between the old and new or augmenting of the undesired error in early phases of change. One of the more interesting findings from this research project came from the interviews in Study 1, where many practitioners discussed how they would slow things down for athletes to support technique change. Based on my review of the current literature, this appears to be a relatively understudied approach to technique change, although it has been used in a motor learning context and is relevant to discussions regarding changes to task constraints (Al-Abood et al., 2001; Newell, 1986). This slowing down strategy may work through both psychological and sensory process, by potentially helping increase confidence while simultaneously improving awareness of body positioning while stabilizing a new technique. In a study of elderly individuals acquiring a novel bimanual coordination movement, slowing down and then gradually speeding up, helped the participants break away from intrinsic habits, something extremely important to technique change (Wishart et al., 2000). This strategy can likely be applied in both direct and indirect methods, making it a flexible practitioner-informed tool to aid technique change interventions. 108 Many insights were gained from our two studies, though there are also areas where a lack of clarity remain. For example, even though practitioners discussed the use of a model to convey the desired technique during interviews from Study 1, nearly all of the participants chose ‘no’ when asked if a comparison to a more elite or skilled athlete was necessary. One limitation is that we did not ask whether a coach demonstration (i.e. model) would be required as it is presumably a regular practice in the absence of a peer model. In the literature, the use of a model to convey a desired technique is not something integral to technique change methods. According to proponents of the Five-A model, a role model is suggested, rather than a technique model and there is emphasis on recording the athlete themselves (i.e., self modeling) in order to reinforce what the desired technique looks like, when available (Carson & Collins, 2011). In the Identification-Control-Correction (ICC) program, there is also a focus on using video of the athlete’s own previous performances to determine optimizations to technique (Hanin & Hanina, 2009). Because the practitioners were not agreed on the role modeling should play in technique change across both studies, it appears that their current knowledge mostly aligns with that in the research literature. However, some did discuss the use of role models and self-models where instances of desired technique are demonstrated during interviews, though based on survey results, there seems to be a need for better knowledge translation. Another place where there were discrepancies across the two studies was with respect to attention focus when cueing the athlete about how to achieve a new, desired technique. During the interviews in Study 1, nearly all practitioners discussed using internally-focused cues directed toward their body when coaching new movements and just over half the sample discussed the use of externally focused cues. When surveyed in Study 2, practitioners reported the use of internal, external and a combination of both cues, as similar in frequency of use 109 (‘sometimes-to-often’). Interestingly, while there is some data in the technique change literature specifically, suggesting that external cues compared to internal cues elicit greater changes in performance and technique (Gray, 2018), there are multiple methods where internal, body-focused cuing is emphasized, specifically at earlier stages of awareness and modification (Carson & Collins, 2011; Hanin & Hanina, 2009; Hanin et al., 2004). Based on the literature and data we have collected, it does not appear that the type of cueing strategy is an either or decision, and that a combination of both is likely to be an effective and pragmatic strategy. There were also inconsistencies across the interview and survey studies regarding the use of competitive/pressure situations among practitioners to both train and assess technique. From our interviews in Study 1, less than half the sample of practitioners discussed training or assessment in competitive or pressure situations when given case studies to discuss. In the surveys, practitioners reported using such methods of training and testing technique ‘sometimes’ on average. However, a closer look at the data show that ~20% of practitioners reported using this method ‘almost never-to-rarely’ and only two individuals (a therapist and coach) reported using it ‘all the time’. Why practitioners show inconsistencies in their technique change methods when it comes to testing the technique under competitive situations might be related to the goals of the intervention. When improving health related outcomes (e.g., joint function or reducing injury risk), intervention success will not be directly linked to match performance. Practitioners agreed that different steps would likely be necessary dependent on the type of technique change scenario (i.e., subtle, drastic, regaining/change back), which may include different exit-criteria and outcomes. Combining data from both studies left an unclear picture whether different methods are needed for different scenarios. 110 There are some well-established methods of technique change in the research literature. Multiple groups of researchers have demonstrated the efficacy of systematic, direct instructional methods comprising stepwise approaches (Carson & Collins, 2011; Carson et al., 2014; Collins et al., 1999; Hanin & Hanina, 2009; Hanin et al., 2002; Lameiras et al., 2015). There is also empirical evidence supporting benefits of more indirect instructional methods where technique change is a consequence of changing something else, rather than a direct prescription (Gray, 2018; Milanese et al., 2017; Milanese et al., 2016; Milanese et al., 2008). However, one significant issue with the research literature is that it is mostly limited to case-study reports. There is a notable lack of comparative studies testing between methods. Furthermore, the research has mostly been conducted in self-paced, individual sports (apart from hitting in baseball, cf. Gray, 2018) and there are a lack of data about technique change methods in open, dynamic sport environments. Even though experimental and comparative empirical research is limited, there are examples of research on technique changes in baseball hitting (Gray, 2018), Olympic weightlifting (Milanese et al., 2017), golf driving (Milanese et al., 2016), and broad jumps (Milanese et al., 2008). These studies have involved comparisons to control groups and they have yielded positive results. The individual and contextual nature of habitual errors, including differences between scenarios (i.e. drastic versus subtle changes), make it difficult to conduct group-based interventions and thus perform comparative empirical research. With respect to the available comparative group-based studies mentioned above, perhaps because they had interventions that were not dependent on direct instructions about what to do, instead involving manipulations to constraints and the method of error-amplification respectively, it was relatively easy to design group-based studies, as they overcome the need for individualized instructions. There may be solutions to these experimental challenges that involve a hybrid case- 111 study approach. By assigning multiple athletes to groups utilizing different methods to fix similar issues in a case-study fashion, some degree of method-based comparison may be possible. For now, based on the current research evidence, there is not enough evidence to be strongly advocating for one method over another. 112 Chapter 5: Conclusion Through interviews (Study 1) and a survey (Study 2) we have shown that practitioners in high-performance sport spend a significant amount of time intervening to change technique, including coaches, S&Cs and therapists. Even though practitioners report technique change to be a challenging process, they self-reported being successful ~60% of the time. Generally, practitioners intervened at similar frequencies, relying mostly on more direct methods of technique change, rather than methods that may appear counter-intuitive, such as contrasting of the old and new technique and/or amplifying the error at early stages of the intervention. Differences existed in how practitioners assessed and modified technique, as well as the type of scenarios they engaged in. These differences were largely due to practitioner skillsets, underscoring the importance of a collaborative approach among integrated support team members. There are gaps in knowledge about current evidence-recommended methods to change technique as well as appropriate training and assessment to ensure transfer of new technique into competition. Given the significant portion of time spent intervening to change technique and the apparent room for improvement based on self-reported levels of success, there is a clear need for better translation of knowledge among researchers and practitioners. This translation is particularly important for areas where there seems little to no awareness, such as to do with contrasting and error amplification. There is also a need to test the feasibility and efficacy of current technique change methods in reactive, dynamic sports, including team sport settings. 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Team 123 7. What sport or type of athletes do you primarily work with? a. Throwing/shooting sports (e.g., basketball, volleyball, handball) b. Speed sports (e.g., sprint, downhill skiing, bobsled) c. Jumping sports (e.g., high jump, hurdles, gymnastics, ski-jump) d. Kicking sports (e.g., soccer, martial arts) e. Individual repetitive sports (e.g., swimming, long distance running, cross-country skiing) f. Interceptive racquet or bat sports (e.g., tennis, baseball, golf, (ice) hockey) g. Other (please detail) ________________________ If Other is selected, Please provide details about the sport or type of athletes you primarily work with: __________ 8. Please select the title that best represents your role as a practitioner: a. Sport Coach b. Strength & Conditioning Coach c. Therapist d. Other (please detail): ______________ If Other is selected, Please provide a title and description that best represents your role as a practitioner:_____________ 9. How many years (approximately) have you been coaching/treating athletes? a. 0-2 years b. 3-5 years c. 6-9 years d. 10-15 years e. 15+ years 10. Would you consider that part of your role is to change technique and/or the movement strategy of the athletes you work with? a. Yes b. No c. Not sure. If “yes” is selected, please provide a brief description of an intervention where you’ve helped an athlete change their technique: ______________________ If “not sure” is selected, please provide details about your role in the space below:__________ 11. Are you interested in taking part in an interview to discuss technique change methods or would you prefer to complete an online survey? a. Interview b. Survey c. Neither 124 If Interview is selected, please select the day(s) which you would prefer? (please select all that apply) d. Monday e. Tuesday f. Wednesday g. Thursday h. Friday i. Saturday j. Sunday If Interview is selected, please provide your name and email for our research team to reach out and schedule an interview : ______________________ 2. Interview Questions and Guide Interviewer = JV Welcome Briefing JV: Hello, how are you today? JV: Thank you for taking the time in your day to spend some time with me answering questions. My name is Joe and I am a Master’s student at the University of British Columbia, my research is focused on technique change in sport and the effective sharing of knowledge between academics and practitioners. We are interviewing sport practitioners, in various roles, who work to refine and change technique of adult athletes. The purpose of these interviews is to a) learn about current methods of technique change and how these methods match with current academic knowledge and b) to inform a survey tool that we can distribute to a larger and wide sample of practitioners, to help inform future research and knowledge translation in this area. SECTION 1: TECHNIQUE CHANGE DEFINITIONS AND JOB REQUIREMENTS JV: Thank you for taking the time to talk to me today. I just want to thank-you for (remind you to) fill/ing out the background information survey. I understand that you work with ________ and are a ___________. Could you provide some detail as to what “technique change” means to you AND what that technique change looks like in your current role or previous roles? JV: That’s great, thank you for sharing. I’d like to share our definition of technique change based on how it’s typically described in the literature and then see if there’s anything you want to add, disagree with or want to clarify. (JV will share it on the screen and also read it out) 125 • Technique change is getting an athlete from a current state (i.e., movement form/way of performing) to a new state (i.e., desired form/technique). The current state should reflect a relatively well-practiced and consistent (habitual) technique. • Change is the critical factor, implying re-learning and not “new” learning. • Technique change methods should change movement form over the long term, so that a new technique replaces an old, yet undesired technique in the same context. • Technique change might involve gradual refinements or more drastic changes in strategy. The term technique change is an umbrella term that can be applied to three scenarios: 1) Drastic Change = Overhaul in strategy, while resisting a less-than-optimal technique (what we also call relearning and resisting). 2) Change Back to a previous state = Regaining technique, which is common in return to play scenarios after injury. 3) Subtle Change = Refinement or small changes to technique to more finely tune current skills. What do you think about the definition? Is there anything you wish to add, delete or clarify/elaborate? Participant: Yes/No, etc. JV: Thank you for your feedback. Can I probe a bit further… Do you see technique change as different to learning generally – i.e., acquiring a new skill? I’m just wondering whether you would apply different methods to changing behaviour depending on whether someone is learning something new or adapting something old? JV: You’ve stated in the background survey that in your current job working with athletes, part of your is role to change technique of the athletes. I’m wondering what that looks like in your environment? Do you work with athletes individually, small groups or in a team? How do you determine that a technique change is necessary for a given athlete? JV: How often are you intervening with athletes to change their technique? 126 JV: How much time do you spend intervening with athletes to change their technique in a typical day? Typical week? (If infrequent) typical season? SECTION 2: INTERVENTION / CASE STUDY JV: Have you recently completed a technique change intervention? Participant: Yes If yes, follow-up questions: JV: Can you tell me about that time (i.e. recent technique change)? JV: Do you think this was a more Drastic change, a Change Back to previous form or a Subtle change? Participant: type of change… etc. JV: How long ago was that? JV: Could you walk me through the process? JV will probe practitioner to expand on specific details as they describe their account. Some example questions: JV: - How old was the athlete? What level was the athlete? - How did you decide that a technique change intervention was required? Was the athlete involved in the decision-making process? - How did you assess the effectiveness of the intervention? What specific measurements (if any) were recorded? Did you evaluate whether the athlete could demonstrate the new technique under competitive conditions? - Did you make the athlete aware of the error? Did you (and the athlete or coach) define what a successful intervention would look like? If so, how? - How did you (or did you) convey the desired technique? - Was there anything specific that you directed the athlete’s attention (through cueing) to when trying to change their technique? Did that change/progress throughout the intervention and if so, how? - Did you use video at all? How and when did you use it? - Did you use contrast training throughout your intervention when trying to bring about technique change? That is, do you ask your athlete to alternate between two opposing drills/techniques by having them alternate between the old technique (error) with the new technique (correct) when practicing? How and when did you use it? - Did you use physical (task) constraints/objects to help bring about a change in technique? For example, this might be asking the athlete to wear a band/athletic tape when throwing 127 or running over hurdles when working on sprinting technique? How and when did you use it? - Did you train the athlete in a simulated competition environment at any point in the intervention? - Once they started to understand or demonstrate the new technique, would you ever ask the athlete to continue to show you the old way? JV: Is the intervention that you’ve detailed typical for a technique change intervention? Or is there another situation that comes to mind which is quite different or more typical? If no, follow-up questions: JV: No problem. I have a case-study question that we could work through. Case Study #1 Running example – Here is a case study of a National-level field sport athlete sprinting. She and her coach are looking to reach her personal best sprint time by regaining back her technique. She has been suffering from recurring low back pain which appears to be affecting her technique and slowing her down. When running, she lacks knee lift resulting in more time spent with legs behind torso (i.e. “backside mechanics”) and excessive low back extension. These technical issues have coincided with her decrease in performance and may be leading to her back pain. How would you intervene to change/ improve her running form? Case Study #2 Jumping Example – Here is a case study of Varsity-level court sport athlete jumping and landing. Her knees are collapsing (valgus) when landing from a jump, placing excessive strain on the knee joint and its structures. How would you intervene to improve her landing mechanics? JV will probe practitioner to expand on specific details as they describe their account. Example Questions (same as above) If participant is struggling to answer the running or jumping example, follow-up question (only if they did not provide an example of their work). JV: Could you give me an example of a scenario in your sport where an intervention technique may be required? Participant: _________ JV: Could you walk me through what you would do in this particular instance? JV will probe practitioner to expand on specific details as they describe their account. Example questions (same as above) 128 SECTION 3: TECHNIQUE CHANGE PROCESS QUESTIONS JV: What do you think are the critical steps on the path to changing an athlete’s technique? For example, do you have a checklist of criteria you need to see before moving to the next stage of an intervention or do you have some general guides? Are these criteria explicit and written down or something you generally aim to do? Do these criteria change if it was a drastic, subtle or change back? JV: Is there a technique or method that you feel is particularly effective at getting athletes to change their technique? JV: Is there a specific method or equipment that you feel is particularly effective at getting athletes to change their technique or that you’ve used to help bring about a change in technique? SECTION 4: TECHNIQUE CHANGE EXPLORATORY QUESTIONS JV: Do you think there is always an optimal technique? Additional probe: Can you tell us a little about what you have in mind as the end goal for a technique change intervention and whether (and how) it differs depending on the athlete? Additional questions (time permitting) 1. JV: Would you approach changing technique in an adult vs. a youth athlete differently? 2. Considering the many different roles and tasks in your current job, how important is technique change? a. Not at all b. Somewhat important c. Important d. Really important JV will have them elaborate based on their selection. 3. Do you view technique change as a time-consuming endeavour? Closing JV: Thank you for your taking the time today to share your thoughts and experience with us. This interview along with the others I have conducted will be of great value to our survey and informing future research and knowledge translation efforts. If you’d like to be informed about the results of this study and our future work, we will keep you posted via email. Would you be okay if we contacted you for further clarification if necessary when reviewing/analysing the data? 129 JV: Thanks again. If you have any colleagues that you believe we’d benefit from interviewing on this topic, we’d appreciate your recommendation. JV: I look forward to being in touch. Have a great day. 130 Appendix B Survey SECTION 1: DEMOGRAPHICS 1. What is your current position/role in your organization with respect to athlete interactions? a. Head or assistant coach b. Therapist c. Strength & conditioning coach d. Other (please detail) _______________________ 2. Would you consider part of your role to change technique and/or movement strategy of the athletes you work with? a. Yes b. No 3. In any therapy or technique-change related work, are you working primarily with adult athletes (18+)? a. Yes b. No 4. How many years have you been coaching/treating athletes? a. 0-2 years b. 3-5 years c. 6-9 years d. 10-15 years e. 15+ years 5. What level/standard are the athletes you work most with? (select all that apply) a. Recreational b. Varsity /Collegiate c. Provincial d. National e. Olympic f. Professional 131 6. What sport/athletes do you primarily work with? (select the main sport and please add detail in text box or “other” if needed) a. Throwing/shooting sports (e.g., basketball, volleyball, handball) b. Speed sports (e.g., sprint, downhill skiing, bobsled) c. Jumping sports (e.g., high jump, hurdles, gymnastics, ski-jump) d. Kicking sports (e.g., soccer, martial arts) e. Individual repetitive sports (e.g., swimming, long distance running, cross-country skiing) f. Interceptive racquet or bat sports (e.g., tennis, baseball, golf, (ice) hockey) g. Collision sports (e.g. rugby, football) h. Other (please detail) ________________________ 7. Do you work primarily with team (e.g., soccer), partner sports (e.g., tennis) or individual sport athletes (e.g., swimmers)? a. Individual b. Partner c. Team SECTION 2: Technique change prompted questions SECTION 2.1: DEFINITION + ROLE REQUIREMENTS DEFINITION: Technique change methods are ways of getting an athlete from a current state (or form) to a new state. The current state should reflect a relatively well practised and consistent (habitual) technique. There should be sustained change to movement form, replacing an old technique. Technique change methods can range from subtle or gradual refinements, a return-back or regaining of a previous technique (as a result of injury) or a more drastic change in strategy needing inhibition and replacement of an old technique. 8. Does your definition of technique change align with the one we have provided? a. Yes, completely b. Yes, somewhat c. No, I have a different definition If no, please provide details about what is missing or needs modifying in our definition ______________________________ 9. Approximately how much of your work with athletes involves intervening to change technique? a. All my time (100%) b. ~75% c. ~50% d. ~25% e. Less than 25% 132 10. Based on your experience with athletes and assessment of technique change interventions, what value would you assign to their long-term effectiveness in terms of frequency of success? f. 0 %= never successful g. ~25% success h. ~50% success i. ~75% success j. 100% = successful all the time SECTION 2.2: WHEN TO INTERVENE 11. Please rank order (from 1-3) the most common types of technique change interventions you work with (1 – most common, 3 – least common) a. Subtle Change b. Return-Back/regain after injury c. Drastic Change 12. Which of the following are reasons you have encountered for changing an athlete’s technique? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time) for each response option below a. Risk of Injury from current form b. Potential to improve performance through refinement or a new technique c. Lack of improvement/development (plateau in performance) d. Change in team-mates, partner or opposition e. Current technique looks unusual compared to others f. Athlete asks for help to improve by changing current technique g. Other: _________ SECTION 3: INTERVENTION TOOLS In this section, we ask questions about specific “tools” that are sometimes discussed in various technique change scenarios. We ask that you answer based on what you have done in your sport (not what you think you should have done). We provide examples to help give context where relevant. 13. Do you make the athlete aware of the error (e.g., lack of knee lift when running) when trying to change their technique? a. Yes b. No 133 14. How do you assess the effectiveness of any type of technique change intervention? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4 = nearly all the time) for each response option below. a. Athlete self-report b. Video analysis c. Success in games d. Other objective measurement (e.g., goniometer, speed test, etc.):_______ e. Other: _____________ 15. What method(s) do you use to convey the desired/new technique? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4 = nearly all the time) a. I use a video or demonstrate the desired technique b. I ask the athlete to demonstrate what they think is a best/better technique than their current way c. I ask the athlete to demonstrate what they are currently doing wrong and also what they should be doing (the new technique) d. I use some sort of physical constraint or equipment to bring about the desired/new technique: __________ e. I ask the athlete to exaggerate the error and then adjust their current form to bring about the new technique f. I focus the athlete on becoming aware of what’s wrong and changing/adjusting the error (not drawing attention to a specific new way of performing) g. Other (please detail): ______________ 16. What do you primarily direct the athlete’s attention to? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4=nearly all the time) a. How the desired/new movement looks b. How the desired/new movement feels c. How the old way/incorrect movement looks d. How the old way/incorrect movement feels 17. Do you use film/ video to provide feedback to your athlete? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4 = nearly all the time) _____________________________________________________________________ 0= almost never; 1 = rarely, 2 = sometimes, 3 = often, 4 = nearly all the time 134 18. What type of cues do you use as part of your technique change intervention? Please answer on a scale of 0-4 (0 = almost never, 1=rarely, 2=sometimes, 3=often, 4 = nearly all the time). Please provide a comment in the text box as needed. a. I try and direct the athlete’s attention to their body, describing how their old or new technique feels and/or looks. b. I try and direct the athlete’s attention away from their body, using analogies or thinking about the result of the desired action (e.g. cue to improve projection angle for a broad jump – “imagine you are jumping out of a cannon”) c. Combination of both body cues and cues in the environment and away from the body. d. Auditory/tactile cues (e.g., clapping to provide a rhythm when running to throw a javelin) 19. Do you use any type of “contrast” training when trying to bring about technique change? Do you ask your athlete to alternate between two opposing drills/techniques by having them alternate between the old technique (error) with the new technique (correct) when practicing? a. Yes, but only at the start of the intervention b. Yes, throughout the intervention c. No 20. Have you asked an athlete to exaggerate the error to help bring about a change in technique? For example, encouraging an athlete who doesn’t extend their hips when performing a broad jumping to stay bent over while jumping. a. Yes, but only at the start of the intervention b. Yes, throughout the intervention c. No 21. Do you use physical objects or equipment to help bring about a change in technique? This might be asking the athlete to wear a band/athletic tape when throwing for example or running over small hurdles to change sprint technique? _____________________________________________________________________ 0= almost never; 1 = rarely, 2 = sometimes, 3 = often, 4 = nearly all the time 22. Do you use “part practice” to isolate specific components of a technique? For example, just working on the arm swing in sprinting technique? _____________________________________________________________________ 0= almost never; 1 = rarely, 2 = sometimes, 3 = often, 4 = nearly all the time 23. When you are trying to bring about a technique change in an athlete, do you use competitive /pressure situations to challenge the athlete’s technique? _____________________________________________________________________ 0= almost never; 1 = rarely, 2 = sometimes, 3 = often, 4 = nearly all the time 135 24. Once the athlete has started to understand or demonstrate the new technique, do you ever ask the athlete to continue to show you the old way (error)? a. Yes b. No 25. Do you have any further comments or clarification to add which would give us further context as to how you answered these questions and engage in technique change? _______________________________________ SECTION 4: SITUATIONAL CONTEXT The following questions are aimed at uncovering differences that might exist when intervening across different scenarios. Three Scenarios: 4) Drastic Change – Overhaul in strategy, while resisting a less-than-optimal technique (what we also call relearning and resisting) 5) Return Back to a previous state / Regaining technique; common in return to play scenarios or preseason 6) Subtle Change – Refinement or small changes to finely tuned current skills 26. Is there one or more things you would do differently when making a subtle versus a drastic change to technique? a. Yes b. No If yes, can you please elaborate _________________________ 27. Is there one or more things you would do differently when changing back technique to a previous form, typically following injury, compared to either a subtle or drastic change? c. Yes d. No If yes, can you please elaborate _________________________ SECTION 5: EXPLORATORY QUESTIONS ABOUT CHANGING TECHNIQUE 28. Do you think a technique change intervention can be done without a comparison to a more elite or skilled athlete? a. Yes b. No 136 29. Do you think there is always an optimal technique? a. Yes, there is a biomechanical optimal across athletes b. There is a spectrum of optimal technique that accounts for variance across athletes c. No, there is an individual optimal for each athlete 30. Please rank order the following 5 options from 1-5 with respect to the primary signal for ending a technique change intervention. 1 = most frequently used approach and 5 = least frequently used approach a. Completed dedicated allotted time (i.e. 5 sessions in 5 weeks) b. Allotted resources and time constraints are exhausted c. Athlete consistently demonstrates desired technique in the environment where assessments are made (i.e., is able to produce the desired form without instruction) d. Athlete/coach reports success and improved performance in training e. Athlete/coach reports success and improved performance in training and in competition/match play. Are there any references you can direct us to that inform your approach to technique change? Please provide us any links to resources or references below. Many thanks. _________________________________________________________ Thank you very much for giving your time to answer the questions in this survey. If there is anything else you would like to add with respect to this topic then please do use the space below to give any further comments or insights that might help us support this aspect of skill development. __________________________________ Is it okay to follow up with you on any of your answers above? a. Yes b. No Would like us to notify you of the general results of this survey? a. Yes b. No
Thesis/Dissertation
eng
Kinesiology
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Hodges, Nicola J., 1970-
Technique change : how practitioners intervene in high-performance sport
Text