BRINGING SCIENCE TO TREATMENT

Good talk: why verbal feedback matters

Trevor Langford explores practical methods for assessing specific sporting movements, and how appropriate feedback can help an athlete improve movement quality.

Jul 26, 2020; Houston, Texas,  Seattle Mariners starting pitcher Yusei Kikuchi (18) talks with pitching coach Pete Woodworth Credit: Troy Taormina-USA TODAY Sports

Athletes frequently train under stress and fatigue, which can lead to low motivation and poorly executed techniques(1). Fortunately, verbal and kinematic feedback related to technique execution enhances performance in athletes who are less conscientious(2).

Role of motor learning

Motor learning (ML) is a process whereby an individual alters their motor performance during a given task via the stimulation of key neural pathways in the brain(3). A change in motor performance must be gradual, yet sustainable to improve and perfect a movement or task. Many factors influence ML during the training process, such as verbal instruction, external feedback, and physical demonstration(3). Clinicians and coaches implement feedback strategies either as the task is performed (concurrent feedback) or after the activity (terminal feedback).

Providing effective feedback is not easy and can create confusion if not delivered succinctly(4). However, despite the complexity, feedback techniques are an effective means for improving ML(5). One approach to providing pointers is the ‘feedback sandwich’ model (see box 1). This technique focuses on delivering positive feedback on either side of a negative cue(5).


Box 1: Example of a feedback sandwich technique in an exercise setting

“You are looking much stronger in your lunges today. On your next set, focus on pushing your heel into the floor, instead of your toes. I can see how determined you are to improve.”


It is essential to provide concise feedback, so the athlete understands the requested modification. Feedback is also a way of building rapport with your patient. Be sure to implement positive cues frequently to encourage them. Frequent positive reinforcement prevents them from waiting for a ‘but’ after each positive prompt.

Another approach is the chronological fashion feedback, which focuses on a breakdown over a timeline (see box 2).


Box 2: Example of feedback in a chronological fashion model

 “You executed your first five press-ups well, but on your sixth press-up, your lower back started to arch on the down phase, and your hips dropped. This posture shows that we need to work on your core control and make sure you engage your trunk stability muscles throughout the down phase, ready to push the up phase with a stable trunk”.


Functional movement screening

Functional movement screening (FMS) is a reliable and efficient tool for measuring an athlete’s movement patterns and predicting injury(6). A score of 14 or less suggests that a patient is 15 times more likely to incur injury. While standardized testing helps, clinicians can also screen by watching an athlete’s movements – and in particular, how they load their body across specific tasks.

Astute movement analysis reveals instability, tightness, and strength imbalances. Some variances noted during movement warrant further investigation with objective measures. However,  providing appropriate feedback often allows the athlete to fix the problematic movement pattern on the spot.

To further understand the importance of feedback, researchers in the UK studied the effects of verbal and kinematic feedback on barbell velocity during a back squat(2). Twelve semi-professional rugby players received verbal or visual feedback on the kinetics of their performance, verbal encouragement, or no feedback. Each participant also completed a questionnaire to measure their level of conscientiousness. All three interventions produced similar improvements in barbell velocity during a back squat. The researchers concluded that the athletes’ performance improved with verbal and visual feedback relating to the kinetic data and verbal encouragement. These methods of feedback also lead to delayed onset of fatigue(2).

In another study, researchers evaluated the effect of informational feedback on ML during anaerobic exercises(3). The scientists randomly assigned two groups of ten handball players to either a control group (CG) or an experimental group (EG). Both groups performed agility and speed tasks twice weekly over eight weeks.

The EG athletes received verbal encouragement and critical feedback to enhance ML. The CG athletes only obtained basic instructions for each activity. The athletes underwent a baseline test before the intervention, midway during the experiment, and after the study ended. The test included a 15 and 30-meter sprint, a zig-zag test over 5-meter intervals, and a T-half test.

The results showed that the EG group performed significantly faster during the 30-meter sprint distance from weeks four to eight. The EG also experienced significantly better times for the zig-zag test and T-half test compared to the CG. The researchers concluded that informational feedback improved functioning in the EG compared to the CG. They also found that limiting feedback can impair performance and the potential for ML.

Practical guidelines

Clinicians must understand good form to identify what needs improvement. Many athletes perform common exercises with poor technique (see figures 1 to 4). Immediate verbal feedback is invaluable to an athlete who plays at high speed; simple cues could enhance performance and potentially reduce injury.

Figure 1: Lunges from a lateral view (A = forward lean lunge; B = neutral spine)

The lunge is an exercise optimally performed by applying a ‘driving through the ground’ force with the front leg. Figure 1A demonstrates an often seen poorly executed technique with forces distributed to the lower back. Figure 1B shows the parallel vertical lines of the left leg and trunk. This position generates an upward force through the front leg and a reduced load on the lumbar spine.

Researchers in the US studied variations in the trunk angle during a lunge exercise(7). They found that a forward-leaning lunge (1A) increases the peak hip flexion angle and the contraction of the gluteus maximus and ankle plantar flexors. This position may also apply increased and undesirable stress to the lumbar spine. To correct this, cue the athlete to straighten the trunk and drive down through the front heel into the floor to maximize the gluteal and quadriceps muscle activation in the front leg.


Figure 2: Press up from a lateral view (A = incorrect technique; B = correct technique)

A press up or push up, primarily targets the pectoral muscles. There are two common variations of a poorly executed press up (see figure 2A). There should be a neutral line from the ankle to the head (see figure 2B). This is effectively a moving plank exercise, which may help athletes visualize proper form(8). The variations indicate reduced strength in the core and pectoral muscles. When seen, cue the athlete to lower the knees to the floor to focus on building core control and developing chest strength before returning to the knees off the floor.


Figure 3: Single leg squat from a lateral and anterior view (A = incorrect technique; B = correct technique)

The single-leg squat (SLS) is a widely-used exercise in both functional screening and rehabilitation. A common variation reveals poor hip stability from a frontal view with a lateral trunk lean (see figure 3A). The lateral view shows reduced gluteal and core muscle activation. The more desirable SLS forms parallel lines between the shin and the trunk, and an imaginary vertical line from the head over the heel (see figure 3B). The anterior view shows a neutral pelvis and spine, and level shoulders. For correct form, cue the athlete to drive the heel into the floor and raise the arms slightly to load the gluteal muscles and assist with balance. If needed, the athlete can place the non-working leg behind, placing the toes on the floor to improve stability (but maintaining 99% of their weight on the front leg).


Figure 4: Speedskating from an anterior view (A = incorrect technique; B = correct technique)

The speedskating exercise is an effective tool for single-leg loading and weight transfer from one leg to another at higher speeds. It trains for speed, power, and stability. Poor stability and control over the loading leg lead to postural variations (see figure 4A). The weight-bearing leg lands with control due to the activation of the gluteal muscles (see figure 4B). When deviations appear, cue the athlete to slow the movement down. By transferring their weight at a slower speed, they don’t lean too far across the standing leg. Thus, they learn how to recruit the hip stabilizers for a more controlled movement.


Summary

Providing feedback can improve strength and performance, with the potential to reduce the risk of injury and enhance ML. Provide feedback that is concise and exact, so the athlete knows what you are asking and why. If an athlete cannot correctly perform an exercise due to weakness, instability, or tightness, modify the activity to help them develop the control and strength needed.

References

  1. J Strength Cond Res.2011;25(12):3282-7
  2. J Strength Cond Res.2018 Oct 4; online ahead of print
  3. Frontiers in Psych.2019, Sept;10:2097
  4. 2017 Dec;13(4):327-333
  5. Eur J Sport Sci.2014;14:36-43
  6. Int J Sports Phys Thera.2015 Feb;10(1):21–28
  7. J Ortho & Sports Phys Thera.2008 July;38(7):403-409
  8. Strength Cond J.2012 Oct;34(5):41-46
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