Sweet Science of Fighting
Debunking Knees Over Toes Training w/ Nathan Kiely Of The Brisbane Broncos (SSOF Ep. 33)

Debunking Knees Over Toes Training w/ Nathan Kiely Of The Brisbane Broncos (SSOF Ep. 33)

with Nathan Kiely

calendar_todayNov 14, 2022
schedule41 Minutes
equalizerStrength & Conditioning
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Summary

  • Nathan Kiely is a rehab and speed coach at the Brisbane Broncos rugby league team with prior experience in cricket and rugby league academies. He documents his training daily on Instagram and enjoys experimenting with different training methods.
  • Knees over toes training involves letting knees track forward past the toes during deep knee flexion exercises like squats and lunges. This approach redistributes forces away from the hips and lower back, which can help those with lumbar spine issues.
  • The main benefit of knees over toes training is that it strengthens knees through full range of motion and develops strength across all positions. Kiely uses this as his default squatting approach because it balances forces across joints and develops both knee and hip strength.
  • Kiely criticizes knees over toes advocates for citing research that contradicts their claims. One study they reference shows peak VMO muscle activity occurs at 90 degrees knee flexion, not in deeper ranges as claimed, and another study does not strongly support the VMO-pain relationship they promote.
  • Athletes have worsened their knee pain by jumping into extreme knees over toes exercises without proper diagnosis or progression. Kiely reports professional athletes coming to him with worse pain after two weeks of this training, particularly those with patellofemoral pain or arthritis.
  • Knees over toes exercises should be placed late in training sessions as robustness work, not as primary exercises. Kiely recommends one exercise per joint area (one knee-focused, one calf, one hamstring, one groin) rather than multiple variations of the same movement pattern.
  • For strength and power sessions, Kiely prioritizes exercises requiring technical proficiency, speed, power, and high output early in the program. He structures sessions with Olympic lifts or heavy squats paired with jumps first, then heavy single-leg or single-joint work, then robustness exercises last.
  • For Achilles tendinopathy, Kiely uses long duration isometrics (45-second holds) with half to two-thirds body weight on single-leg calf raises for analgesic effects before training. For actual tendon adaptation and long-term improvement, heavy slow loading like weighted calf raises or sled pushes is necessary.
  • Pain tolerance during heavy tendon loading can be higher, around four or five out of ten, compared to other exercises. Tendons require heavy slow load to adapt and strengthen, while short fast contacts from plyometrics and running tend to aggravate them.
  • Tendinopathy is a long-term condition lasting 6 to 24 months or potentially an athlete's entire career if over age 25. Developing consistent preparation routines for managing tendon pain becomes essential for getting the most out of training and competition.
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Transcript

Edited from the episode's captions for easier reading.

James de Lacey0:01

All right, welcome to the Sweet Science of Fighting podcast. Today we have Nathan Kiely. Welcome, Nathan.

Nathan Kiely0:01

Thanks, mate. Yeah, cheers. Thanks for having me.

James de Lacey0:01

Thanks for coming on. We've been in touch before many years ago, I think when you were a member of Science for Sport way back in the day. But that was a long time ago now, so it's good that you get you on, get you on and chat to you face to face, well at least over camera.

Nathan Kiely0:25

Yeah, no thanks. I think the world's changed a bit since back, but yeah, keen to keen to have a chat today, mate.

James de Lacey0:25

Yeah, and obviously what you're doing changed too. Now you're working within the NRL, so do you want to maybe give a little brief background about yourself? Then we're going to dive into, I'm going to click the out of this podcast about knees over toes, so we're going to go some knees over toes stuff after that.

Nathan Kiely0:25

Yeah. My background, yeah, currently rehab and speed coach at the Brisbane Broncos, a professional rugby league team here in Australia. I've been there for 12 months. Prior to that I worked in cricket, which is a very different sport.

Three and a half years at Cricket New South Wales, different type of athlete, different sporting culture. So the contrast between that and a contact sport like rugby league has been an interesting sort of transition for me. And then yeah, before that, worked in Rugby League Academy, high school setting, all sorts of different sports when I was a bit younger.

Did a bit of research at the University of Technology in Sydney as well when I was sort of a fledgling S&C, so that's kind of, yeah, I guess my background. And yeah, apart from that, sort of love my own training, like messing around in the gym and trying out new stuff. And yeah, if anyone's not following on Instagram, you can follow me, post this training pretty much every damn day.

James de Lacey2:02

Doesn't take much more effort to just sit the phone out while you're while you're having a lift or whatever, so...

Nathan Kiely2:02

Yeah, it's a bit of a hobby of mine. I like to sort of document what I'm doing and share it with people. I get a lot of really cool feedback from people and people seem to enjoy it, so yeah, like I said, a bit of a hobby I guess.

James de Lacey2:28

Nice. Well, let's start into the topic for today, so you recently, well kind of recently, wrote an article about knees over toes for sports. And obviously I think within combat sports, out of probably every sport, combat sports has probably picked up the knees over toes trend the most, is probably because of the influences around that.

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James de Lacey2:28

So maybe dive into, let's maybe start with what knees over toes is. Obviously it's not anything new, it's just kind of rebranded as something new. But knees over toes is kind of how it came about, kind of your just the track of your thoughts of knees over toes and kind of how it fits within training.

Nathan Kiely3:01

Yeah, I suppose it's a bit of a catch-all term that's being used at the moment. Like you mentioned, it sort of proliferated on the back of Ben Patrick, who kind of promotes it as his sort of methodology, I suppose. And I can imagine him, he got on Rogan at one point, that would have obviously exposed the style of training to his audience.

And like you mentioned, combat sports have jumped on the bandwagon. But yeah, like you kind of mentioned, sometimes it's a bit ambiguous as to what people mean when you're talking about knees over toes.

So essentially it's kind of an approach to how you would perform certain exercises, predominantly lower body stuff, and it's basically just that we let our knees track in front of our toes when we're going into deep knee flexion. So deep squats, deep lunges, anything like that where you've got that knee sort of moving forwards or anteriorly in front of the toes.

And I suppose traditionally people were advised not to do that. Don't let your knees go in front of your toes is a pretty pervasive myth as well, I suppose still pervasive now. And I think a lot of people don't realize that not letting your knees track in front of your toes can be a bad thing as well, because you're not stopping force, you're just redistributing it.

So if your knees don't track anteriorly, the sort of weakest link in the chain, where you get the most torque occurring in the system, is going to be predominantly around the hips and the low back. If you want to target those areas and make them stronger, a non-knees over toes approach is fine. But sometimes people have low back pain or they've got issues around that area of their body, and because of this pervasive myth around not letting the knees track forward, they can I suppose end up making things worse in themselves than they probably otherwise should.

But yeah, I suppose the knees over toes approach is kind of the antidote to that myth, I guess, and it's got a lot of uptake. I think, like a lot of things in the fitness industry, we have sort of accepted knowledge around a topic, and every now and then someone comes out and they've got the complete opposite perspective on things, and people seem to get really excited about that at times as well. They lap it up and jump on bandwagons.

And I think one of the things I notice with it was that it was a really positive message around sort of embracing what the body can do and adapt to, but there was probably a little bit too much jumping on the bandwagon and not really questioning or understanding the positives and the negatives. So I suppose that's what I tried to kind of delve into when I wrote that article for Sportsmith, just trying to, I suppose, provide a balanced approach and looking at why it can be good and also what some of the downsides might be as well.

James de Lacey6:21

Yeah, maybe dive into maybe starting with the positives of knees over toes style training, then we can jump into the negatives.

Nathan Kiely6:21

Yeah, I mean predominantly the main one is that it's good for training your knees. Just like any joint, any tissue, the knee can adapt to training. So if you apply the right amount of stress at the right time and you've got adequate recovery, you're going to get benefits.

So I think anecdotally a lot of people have found that their knees feel better, they're able to perform better when they train through full ranges of motion. We know from research that you get a better range of strength adaptations when you work through larger ranges of motion. So getting into that deep knee flexion is a good thing in terms of training muscles through their full length and being able to get strong in all ranges of motion and in all positions.

Whereas some alternative sort of training theory or other influences on the internet will tell you that you should never go deeper than 90 degrees. So there is value in that full range of motion approach to training. Like I mentioned before, it allows us to redistribute forces.

So my sort of default approach when I'm coaching athletes how to squat is more of a knees over toes type squat, because I think you get the benefits of developing strength around the knee joint and also at the hip. It also balances out forces across, like we said, the lumbar spine. I think those sort of hips back, knees not tracking forward type approaches can sometimes aggravate lumbar disc irritations and things like that.

So yeah, I think there are some benefits in those regards, and I don't think letting your knees track over your toes is something that you should avoid by default. I think it's something that we should encourage. But my concerns, I suppose, are when this approach is promoted as the answer to knee pain and athletic performance, and some of the arguments that have been put forward for why it's the answer probably don't pass the sniff test at times as well. So that's where I kind of wanted to pick things apart a little bit.

James de Lacey9:09

Yeah, dive into those, into those, the kind of, I guess, the rationale behind some of that stuff.

Nathan Kiely9:09

Yeah. So there's a couple of sort of social media posts and articles as well that the sort of knees over toes guy and his group, or whatever you want to call them, sort of got a lot of traction with. And in one of them they sort of make some pretty poor mechanistic assumptions around how things work.

So they kind of argued that initially, the main argument they make is that the VMO, that sort of teardrop muscle on the quad, is the key to reducing knee pain in athletes or in any population really. But they actually cite some research which probably doesn't necessarily back up what they're saying to the extent that they claim.

So they're kind of saying that, oh, this is a no-brainer, big strong VMO equals no knee pain. But they cite this study and it's kind of, oh yeah, there might be a trend in that direction, but it's not a sure thing. So yeah, when I went and read that, the study that they talk about, and I think it's a good thing to consider, is when people cite research in a 30-second Instagram post, they actually go and read what they're citing. I think a

A lot of people just take it at face value, so I did a little bit of digging and I looked at that and I went, I don't know if this says what you guys think it says. And then on the back of that, they make this other claim around how deeper ranges of motion, so like knees over toes approaches to training, allow for preferential recruitment of the VMO muscles. And again, they cite a study, and this one basically says the complete opposite of what they're claiming.

It shows that around 90 degrees of knee flexion is where you get those peak EMG activities, muscle activity as measured by EMG, and it actually reduces once you get deeper. So when I saw those claims and the evidence they tried to use to support them, I just thought hang on, I think there's probably reason to pump the brakes here a little bit and just understand what the evidence really says.

And the other thing that stood out to me was that it's kind of like a cookie cutter approach to knee pain. So people with sore knees, they see this stuff on the internet and they go, "Yep, this is obviously the thing I've been looking for, this is the golden bullet." But they're applying these principles without getting a proper diagnosis for their injury. There's no, well, they do sell programs that are periodized and built out to obviously apply load in an appropriate way, but people are jumping on the bandwagon without buying the programs and they just go, "Oh, this is the way I need to train."

And anecdotally, I've heard stories of people who have had to significantly change their activity levels because their knee pain has gotten severely worse. I've had professional athletes come up to me with knee pain and say, "Oh hey, I've been trying out some of this knees over toes stuff for the last two weeks and my knees are killing me. Like, they're in a worse place than they were before."

So I just think we need to be a bit more measured with what we see on social media and probably just take a moment to ask some good questions around some of these sort of things that, I suppose, appear like gimmicks to an extent.

James de Lacey12:55

Have you, from your experience, maybe seen what I guess kind of knee pain seems to do well with this kind of training versus what doesn't? Obviously you mention there a few professional athletes making their knees worse. Was it, I guess, a similar, I guess condition around just the stories you hear?

Nathan Kiely13:31

Well, I think the problem is that all this knees over toes stuff, they just say it's good for sore knees, right? They don't tell you what it's good for. And then you've got athletes with history of meniscus damage, you've got athletes with patellar pain, you've got athletes with arthritis or any number of different conditions, and they're just throwing mud at the wall and seeing what sticks.

So I think a knees over toes approach to training can be part of rehab for any knee injury. It has a place. It's just when, how much of, how it's being applied, understanding where it fits in the big picture rather than just jumping straight into it from day one. So I lean heavily on my physios to help me with early management, get a proper diagnosis for the injury that the athlete has.

And I'll be honest, they're the experts in those initial stages of rehab and getting the guys going. And in consultation with them, I'll say, "Okay, at what point can we start to increase range of motion here and start to look at some of this stuff where the knee is tracking forward?" But it's like, they're the experts, and almost never is the answer that we should go straight into full knees over toes, deep ATG split squats, you know what I mean?

So it just makes me wonder, like, why is this the default approach that they're promoting when the experts that I deal with day to day would almost never lean that way, I suppose.

James de Lacey15:11

Is there a time where you would completely avoid, say, knees over toes, I don't want to keep saying it's knees over toes, but maybe you would modify training where you would try to keep that shin more vertical because someone does have such chronic knee pain that you don't want to get in the way of that, interfere with performance?

Nathan Kiely15:43

Well, the simple answer is if doing deep knees over toes training is causing you pain, there's probably a good sign that you probably shouldn't do that. And every individual is going to be different. There's an extent to which we can work through discomfort in rehab. I think like an awareness that something is there, and if you use like a relative scale of, say, out of 10 what your pain feels like, if you're working at two, three out of 10, depending on the injury, there's some tissues that really do need to be protected.

But if you're two or three out of 10 with a bit of discomfort, that's one thing. But I mean, I hear of athletes who are pushing through six, seven, eight out of 10 pain so that they can perform exercises that they've seen on the internet because they think this is the answer. And like I said, my physios are the experts in terms of when and how tissues need to be protected.

But it just makes me bang my head against the wall when I've got athletes coming up to me and saying, like, "Oh, this is excruciating. I don't know why my knee pain is not getting better." And they've got patellofemoral pain or arthritis in their knee. It's like, well, yeah, maybe you should stop doing that.

James de Lacey16:46

Doing hard, like, those sissy squats with the knees going forward to the floor and things like that, just loading the shin. Yeah.

Nathan Kiely17:14

It's just like an extreme. It's the world we live in at the moment is extremes, right? I think a lot of people forget that we live on the bell curve, right? And two-thirds of reality sit in the boring middle, and everyone gets excited by stuff that's happening on the fringes and they jump on those bandwagons. And sometimes you just got to be a bit more measured and think about doing simple stuff and doing it well and try not to get too carried away with gimmicks.

James de Lacey17:47

And the pendulum will swing back soon, I'm sure, as it always does within fitness training and fitness. Obviously you got the pendulum that's gone from knees should never go over the toes, so now knees should always go over the toes, and it'll swing back to the middle. Same thing with diet as well, you know?

Nathan Kiely17:47

Yeah. I think there's a lot of value in exploring movement and trying different stuff out, and I've said this before. I think it's really cool to have an athlete come and approach me and say, "Hey, I saw this, I was reading about this, what do you think? I want to try it out." Because the reality is, until people try stuff out, they don't know really what's going to work for them. That's how I approach my training. I try stuff out. Like, I don't have a coach telling me what to do. You explore different movements and you try things out.

And people who think outside the box and promote different ideas, they allow us to have these discussions. But I think the challenge is, a lot of the time, the stuff that gains traction on the internet, it's not because it's the best idea. It's because it's the idea with people yelling the loudest about it.

And I don't want to point fingers at Ben Patrick and that around the success that they've had, because I see the value in what they've done. And I actually admire the way that they promote their message. So I think their social media marketing strategy is awesome. Like, they've got very eye-catching imagery, the way they talk about it, it's really exciting, gets people amped up to learn more and want to try it out. And I've got a lot of respect for what they've done with their business and their brand.

But on the whole, if we're looking at what's the best thing for an individual athlete at any given time, it's probably not going to be jumping all in on an extreme approach to training. It's probably going to be balanced fundamentals done consistently and periodized and built out with a plan for long-term athletic development in mind.

James de Lacey19:42

You obviously mentioned about your own training too. Would be good to kind of dive into obviously the work you've done with various athletes as well, but your own training as well with your strength power stuff. And maybe dive into kind of your philosophy around strength and power training for sports performance. I guess, I think it's more so an overarching view of kind of how you see it fitting within an athlete's program.

Nathan Kiely20:16

I mean, my approach is pretty boring. I look at fundamental movement patterns: squatting, hip hinging, lunging, step-ups, upper body pushing, upper body pulling. And I respect that all of those are general physical preparation. They are not specific. But what happens when you remove specificity and you're doing something very general is it provides a great window for overload.

So you can't have high levels of specificity and high levels of overload at the same time. We know this intuitively, right? Because this is why we train. If you had 100% specificity, that would just be playing the game or doing the sport or whatever, right? And we know that that can only take you so far in terms of your performance levels. You then need to remove some level of specificity so that you...

Can apply an overload and adapt and get better. So in the gym when we're doing strength and power training, I think we just need to understand the limitations of that space, but also embrace the strengths of it. And the strengths are that you can get bigger, stronger, and more powerful.

So in my own training, I'm in the gym doing basic fundamental stuff. I do filter in some elements of specific developmental exercises. Typically they're going to be around getting strong in positions that are relevant for the sporting activity that I want to do. And I'm by no means a real athlete. I'm a recreational, I suppose you'd call it sprinter, but I don't go very fast Sprint. Yeah, recreational very high speed running I suppose is what I would call it.

But yeah, so there are some positions that we hit in fast running that I think we should overload and get stronger in. I'm also a big fan of jumps and plyometrics, so I'll include them in my strength and power training.

But the lifts I'm doing in the gym are typically barbell based. We're going to do some bilateral work, we're going to do some unilateral work. I do like to try and hit different muscle contraction types, so there'll be some exercises that are eccentrically overloaded. I'll put in some accessories that target the weak link in the chain, so some calf work, direct calf work, direct distal hamstring work, some groin work, more robustness type work that's going to support everything else that's going on.

I know if you build a race car with all this horsepower and the driver is no good, or the suspension and the wheels and the camber and stuff isn't set up correctly, think about it that way. Your calf and ankle, the intrinsic muscles in the feet around the groin, they're those finishing touches. So it's really important that we also address them. But ultimately in the gym we're building horsepower, so that's what I primarily focus on when I'm in there.

And then if I'm out on the field doing running, I have some fundamental drills that I like to use, but essentially they're a warmup. I think we get very carried away with running technique drills and A skips, B skips, D skips, and I don't know how many other letters you can think of skipping to. But ultimately they're just a way to warm up, feel some positions, get moving. And then doing the thing is the thing that makes you better at it. So if you want to get better at sprinting, you need to sprint.

So I suppose that wraps up what I do in my training. I'll get on the field and do sprints one day of the week. The next day I'll go and do low body weights. Day after that I'll do some upper body weights. And then I'll start that three-day cycle again.

James de Lacey24:55

Nice. I do. I think what might be helpful for listeners as well is maybe laying out how that training day in the gym works in terms of exercise order. Because I think a lot of people, they're going to do it on their own, we just kind of throw anything in any order without much rhyme or reason to it. So don't we just run into how you like to plan that day?

Nathan Kiely25:22

Yep. So this is strength and power training theory 101, and it's really important that people understand this. So we need to prioritize exercises that have elements of technical proficiency involved. So something where you need to be focused on executing a skill, we need to prioritize things that include speed and power elements early in the program, and we also need to prioritize things that have high outputs earlier in the program. So what we want to try and avoid is doing those elements of our training under duress or fatigue.

So an example of that might be a box jump. It's become increasingly common to see box jumps done under fatigue at the end of workouts as CrossFit WODs and things like that. Yeah, for me, I think that's bad training in terms of we're looking to try and develop power, but we're struggling to even express power because of the fatigue and duress. So we want to prioritize our ballistic lifts.

So that's any sort of loaded jump, Olympic lifts if you're so inclined to use them, any other jumps, plyometrics, medicine ball throws. They all need to be towards the start of our program. Now, if I'm putting together a low body strength session for myself, I'm either going to have a power clean or variation of it, it's probably going to be 1A in my program. Or on the other day I'll do lowers, I'll do a squat variation. So the power clean's a little bit more dynamic. The squat is more heavy overloaded, and I'll superset those exercises with some sort of jump or plyometric.

The next thing I'm going to move on to, my main accessory lifts, they're usually going to be something that's heavy single leg or heavy single joint focus. So that might be an RDL, which is really a hip dominant type exercise, or a split squat, a step up. Exercises like those, they're going to fit there in the program. You can still perform them under a little bit of fatigue and duress, but there's still an emphasis on doing them with quality.

From there I'm going to put my more auxiliary type exercises. So as I mentioned before, stuff that targets just a single joint, robustness type exercises. So that's where I might be doing a nordic hamstring curl or some calf work or some groin work, or something that targets the knee extensors. So I might be doing a seated knee extension, any of those types of movements. Those more single joint robustness building, targeting a weak link in the chain, they're going to come last.

And the reason for that is that there's not a lot of technical requirements when you're performing them. You can probably do them while you're a bit tired, a bit gassed, and you're not going to hurt yourself. And the outputs in terms of speed and force production are not particularly high. So yeah, they're safe to do later in the program. That's basically how I tend to structure a lower body strength session in the gym.

James de Lacey28:51

Have you delved into any, I guess, targeted foot training?

Nathan Kiely28:51

I do a little bit. So generally I'll do that more as prep for running sessions. So I like to get out of my shoes before I run. So barefoot warmup. I've got a couple of foot intrinsic exercises that I like to do, so kind of different walking patterns, like rolling from heel to toe, walking on toes, walking on heels, walking with inverted and everted feet. That's probably the full extent to what I'll do there.

But I also in my strength sessions will typically try and do some direct calf work as well. And when we're performing calf work, obviously we've got a lot of tension through the intrinsics of the feet, through the arches, because you're pushing through that lever there. So that's probably the full extent of what I do from a foot training perspective.

James de Lacey29:58

Nice. And then how does your upper body day look? I'm assuming your upper body day follows a pretty similar principles to your lower body day.

Nathan Kiely29:58

It's evolved. It used to look like that. It used to be based on sound training theory, and these days it's just dirty bodybuilding because I just don't care anymore.

James de Lacey29:58

Same as you. I'm just yeah man, if I'm upper body I'm just looking to get jacked.

Nathan Kiely29:58

I don't care anymore. Yeah, I'm just old and I don't care. But yeah, in theory we're looking for heavy barbell movements or heavy chin up, heavy pulling movement, something like that. It's going to be at the start of our program. If we want to do some sort of upper body power, it's going to be early in our program. So a dynamic bench press with bands or medicine ball throws, stuff like that early in the program.

I think it's really important that we get a decent balance between pushing and pulling movements. I don't necessarily subscribe to a specific ratio of how much work you should do pushing and pulling, but I'd say it's a bad idea to just do heaps of pushing and no pulling. And then if we want to do any targeted single joint stuff, you're going to typically do that at the end. So that's where you can join the arm farm.

James de Lacey30:54

Yeah, yeah, for sure. And for anyone listening who maybe does some of the knees over toes, I guess, coined exercises, or a lot of them, a lot of different ones of different intensity, but where would you fit those within same lower body training day?

Nathan Kiely31:23

Yeah, so the place that they fit is late in the program. They're your robustness training type exercises in my opinion. So your reverse sled drags, your nordics, and then your ATG split squat and things like that. I think they fit later in the program after you've expressed our levels of force and power with your fundamental, more traditional based movements.

I tend to target one joint, use one exercise to target one joint when doing those auxiliary type movements. So what I mean by that is if I've already done my squat, my lunge, my hip hinge movements, and I need to do some auxiliary movements, I'll collect one knee-focused exercise.

One calf-focused exercise, one hamstring-focused, one groin-focused. I wouldn't throw the whole kitchen at it, if you know what I mean. So I'm not going to do ATG split squats followed by reverse sled drags followed by... like, that's probably overkill. But you could select one of those and include it there and then hit some of those other areas as well. You can just create like a little circuit of three or four exercises and do two or three rounds of that at the end of your session.

James de Lacey33:07

Nice. Have you played around with long duration isometrics for I guess tendon health or even numbing the tendon before training and things like that?

Nathan Kiely33:07

Yeah, we use that with in particular athletes who've got like Achilles tendinopathies. We'll do long sort of light to medium load holds, more for an analgesic effect in terms of reducing sensitivity and pain. It's probably not going to drive adaptations that reverse the damage that you've got there, but it definitely helps athletes to feel better, which can help them get through training sessions.

But tendons, if we want to train them to make them bigger and stronger so they can handle forces and make long-term changes that reduce pain and symptoms, then they need heavy slow load. So isometrics are heavy and slow, I suppose, with the fact that they're actually not going anywhere. They're very slow. So your overcoming isometrics have a role to play there, but yeah, it can be pretty boring stuff too.

Like if we've got patellar tendinopathy, it's probably going to be heavy knee extensions or, yeah, it could be a reverse sled drag, something like that. There's a place for that there. Like I mentioned around the calf or the ankle, the Achilles tendon, we're looking at heavy calf raises, heavy sled pushes, things like that that are going to be slow and apply a lot of overload. Those are the things that are going to help from a long-term perspective.

But yeah, those sort of light to medium holds for longer durations, they're a really good way to help get you up and prep you for training if you've got like awareness or soreness in a tendon.

James de Lacey34:48

Nice. Is there a pain threshold, I guess, you would advise for when doing some of these heavy exercises for I guess repairing a tendon? So if you had a sore Achilles and you're doing heavy calf raises, obviously if you've got 10 out of 10 pain, there's probably something you don't want to do. But some kind of guide that you use in that regard?

Nathan Kiely35:17

Yeah, I think that pain scale, you could probably push it a little bit higher when it comes to the heavy slow tendon loading. Maybe a four, maybe a five. If you're starting to get into six, seven, eight, then you probably need to regress a little bit. But tendons love load, they love heavy slow load. That's what's going to make them adapt, make them stronger, make them bigger and thicker. That's the answer to your long-term issues with tendons.

What's going to stir them up is the short, fast contacts, so plyometric jumps, running. So you need to try and offset that with the heavy slow stuff. But yeah, like you mentioned there, that pain scale can probably be a little bit more aggressive when it comes to the heavy slow loading for a tendon.

And then, yeah, if you're experiencing pre-skills training, if you've got tendon pain, those longer holds, they're actually probably going to reduce your level of pain. So you might feel like a four out of 10 pre-training, and some of these long holds can really help reduce that down to a two or three, which can make a big difference in terms of allowing you to get some quality training under your belt.

James de Lacey36:43

To maybe give some examples for maybe some of the major pain points, might be knee, Achilles, maybe shoulders if you did something there. Is like a long duration isometric, how long and maybe an exercise example?

Nathan Kiely36:43

Yeah, so the one we do deal with the most is probably Achilles and patellar tendon pain. There's different protocols out there that you can find, but an example that we might use would be, say, some 45-second holds in the Smith machine in a single-leg calf raise. So just bringing the heel up off the ground about half an inch or so, holding that for 45 seconds with probably half to two-thirds of your body weight on the bar.

Then we'll take the athlete over to the wall and do some wall holds. Not necessarily like your reactive kind of switches and stuff like that, but putting your hands against the wall, leaning at 45 degrees, coming up onto your toes, sort of like in a running position, one knee up, extending, pushing into the wall. Again, sort of 30 to 45-second holds there, sort of trying to feel some pressure through the hands that you're developing by pushing through the ground, through the ball of the foot.

And then we'll progress from there into some marches, or we can even potentially take them over to the stairs and do some slow jogs up the stairs and start getting them moving. Because tendons do warm up, they do get better with activity. So some of those longer holds and then like a softer entry into activity can help those tendons feel a bit better before you roll them out on the field and get stuck into some speed and agility or intense football skills.

The other one, the patellar tendon, might get the guys in the knee extension machine, sort of again moderate to light load, single leg, kind of looking at about 30 degrees of knee flexion, and just holding there for 30 to 45 seconds. You can do two or three holds on each side there. And again, then progressing to some lighter activity, so getting into like a dynamic warm-up, going through some movements. You can get into like your sissy squat holds and things like that as well, again, 30 to 45 seconds, moderate load. And from there, again, progressing into your skills and things like that.

But I think what I've noticed is that there is individual preferences in terms of these exercises. So some athletes will find one exercise helps them more than others. So experiment a little bit with a couple of options, see what works for you, and build that into your prep routine.

It's really important to understand that tendon pain is a long-term injury. So once you've got a tendinopathy, it's going to last 6, 12, 18, 24 months. Like, it's not the sort of thing that just goes away after 6 weeks. And in fact, for most athletes, if you're sort of past 25, it's probably just going to be something that you have for the rest of your playing career.

So developing routines around how you prepare your body and get ready to get the most out of that tendon and how to load it in between bouts of exercise as well becomes a really important part of being able to get the most out of your body.

James de Lacey39:42

Nice. That's some great advice. I actually want to end this. I want to keep this podcast kind of solely on that knees over toes, tendon kind of topic, which has been awesome, and we've managed to do that. But if people want to follow you, find out what you're doing, all of that, where can they find you?

Nathan Kiely40:13

Yeah, like I said, bit of a hobby of mine's like the Instagram stuff. So if you want to follow me there, it's just my name, Nathan Kiely, with an underscore at the end of it. I don't know if I've got anything else really to share. I sell some programs and stuff on there, so if you want to separate from some of your hard-earned cash, you can find the link on my bio and buy my programs.

James de Lacey40:36

Nice. I like the plug. I like the plug. I'll throw Nathan's Instagram in the description too, so if anyone watching wants to follow, easy, you can go down there and you can check that. But other than that, thanks for coming on, man. I really appreciate it.

Nathan Kiely41:01

No, you're welcome, mate. Awesome. Thanks for having me and stay in touch. Thanks for reaching out and connecting.

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