We recently had the opportunity to meet and talk to Steve Mah, lead physiotherapist for the Chinese Olympic team for TWIST Performance + Wellness China between 2016 and 2017. Steve is also a partner at Vancouver’s Oakridge Physiotherapy and has worked with many sports teams over the years.
His experience with the Chinese Olympic team was full of challenges and life lessons. One year later, he has returned to Vancouver with many stories to tell and a wealth of knowledge from his experiences.
So Steve, you spent the past year trying to integrate physiotherapy as a treatment method into the Chinese Olympic Team's practices. How did they hear of your expertise and how did they approach you?
It all started when the Chinese Olympic Team contracted TWIST Performance + Wellness China to bring their functional training philosophy to China. Peter Twist is the President and CEO of TWIST in Vancouver, and has an excellent reputation working with high-performance athletic teams.
The Chinese Olympic Committee requested physiotherapy services as part of the Twist Conditioning China contract.
I believe Twist Conditioning felt my level of maturity as a physiotherapist from Vancouver and my sport medicine experience was an attractive fit for the needs of the Chinese. I also think my Asian heritage had contributed to me being selected as well. However, although I have a Chinese last name, I have limited knowledge of the language, being born and raised in Regina, Saskatchewan.
Going in, I didn't know what to expect. It was a big job, and my reputation would be on the line as I had to deliver for a large national team. But I was ready to take on the challenge. It all happened so fast. I was interviewed for the position and within two weeks, and the support of my family and business partners, I was in China working with their Olympic team.
What were your observations as you became involved with their program?
It was still hard to believe that I had received an opportunity to work with one of the best summer Olympic teams in the world. I would get a chance to see what exactly it was that made them such forces to contend with and so strong in their different sports, compared to other countries.
The facilities in China were state of the art. They had all the necessary equipment, the diet was tailored to the different qualities each athlete needed to develop, and the coaches themselves were world class. They housed all of their athletes in one spot. These were both their living quarters and their training facilities.
Training was intense. The athletes were training between five and six days a week full-time. Here in Canada, things are a little different. The athletes usually have a part-time job, which means it is difficult for Canadian athletes to train full-time. The Chinese, on the other hand, focus on athletic excellence. This is supported throughout all the levels of authority, and the government provides proper training resources.
That’s wonderful! Okay, so you have a Chinese last name. You also mentioned that you are not fluent in Chinese. How did you communicate with the athletes and their trainers?
It was a challenge in the beginning. I spoke a very minimal amount of Chinese going in but was assigned a translator to assist me most of the time. However, as time progressed I was able to learn some basic Chinese and was able to communicate using a translation app I downloaded on my phone.
At what level was their physiotherapy program?
I was surprised that as a country with such care and devotion to its Olympic team, China does not yet have university physiotherapy education programs. The unfortunate consequence of this is that the Chinese are still very new to integrating the role of a physiotherapist into sports medicine management. However, they do utilize and contract foreign-trained physiotherapists for rehabilitation, and also send athletes abroad for this type of treatment if necessary.
Performance coaches and trainers have a critically important role. They go through rigorous training before they are allowed to work professionally. Their expertise is focused on different types of training, such as dryland training and specialized training for athletes, to optimize them for a particular sport. However, rehabilitation and injury management do not generally fall under the areas of expertise for most coaches.
Can you tell us more about the differences in training style in China, compared to here?
In China, the coach and leader have considerable authority. The Chinese trainers will mostly follow the direction of the coaches in regards to dryland training and training for the sport.
The best scenario is where you find the trainer and the coach collaborating to develop dryland training programs. They bounce ideas off of each other and decide what regimen to follow.
There were some challenges around structuring teamwork among the physiotherapists, team doctors, and coaches. This was mainly because many of the coaches are developing an understanding of physiotherapy and how it fits into their training regimens.
What do you believe contributes to the disconnect between physiotherapists and coaches?
In my opinion, the cause of all of this is a fundamental difference in the approach to training. Chinese coaches are new to integrating injury mitigation and recovery into their training regimens.
Coaches have their traditional ways of coaching - ways that have worked well in the past, and won the team many gold medals, for example. As a result, they will often continue to train athletes in the same way. Many of their programs are traditionally developed. That was part of the reason why Twist Conditioning was invited over to become part of their team in the first place. They were called to introduce the Chinese coaches to different methods of training and recovery.
I think the Chinese performance coaches found it challenging to see exactly how physiotherapy fit into athletic development prior to me arriving there.
There was also some resistance to the new methods I was introducing. This was to be expected to some extent - I think all of us can be resistant to change sometimes. But in the end, for me, it was all about navigating the coach-athlete relationship while encouraging collaboration to achieve excellence. And that’s what we set out to do.
For how long were you involved with the team? Are you still involved?
I spent a year with the Chinese Olympic teams – summer and winter from April 2016 to April 2017. At the moment I am still involved to a limited extent. They have asked about my availability to return to China, but I have respectfully declined. We have discussed possibly working with some athletes should they choose to send them to see me here in Vancouver. They want to involve me more on the rehabilitation side. I can say there will definitely be an on-going connection to their team.
What is your legacy with the team? Are they looking to integrate physiotherapy as a part of their training regimen?
For starters, I think I have left the impression that athletes can be rehabilitated, and do not necessarily need to retire if they get injured. China has a deep talent pool. Traditionally, if an athlete gets injured, they can be easily replaced because there is such a long queue of talented athletes. Hopefully, they will take away a sense that athletes can heal, and even continue to improve after they’ve been injured.
I worked with athletes from all the different sports that China participates in. These include gymnastics, synchronized swimming, boxing, track and field, swimming, water polo, wrestling, badminton, table tennis, weightlifting, beach volleyball, basketball, figure skating, short track speed skating and hockey. Despite working with all of these, the ones I influenced the most were long jump, synchronized swimming, gymnastics, badminton, figure skating and to some degree, weight-lifting, boxing and table tennis.
Are there any specific examples where you felt that you made a lasting impact?
There are a couple of particular examples I can point out. I worked with a badminton player who was highly ranked globally at the time. He had a chronic back problem that put a limit on how well he could perform and he was seriously considering retirement.
They flew me into the city of Chengdu, where he was training, with the notion that I was going to treat this guy exclusively. He wasn't able to complete a full practice session because of the pain in his back. It was a major struggle for him. After just two sessions, he was practising full time once again. We continued working together and even developed training programs to strengthen his back and implement recovery methods. He ended up winning a gold medal. Here is a guy who was thinking of retiring, and he reaches the pinnacle of his sport. That's powerful stuff.
This is one example of the impact rehabilitation can have on a singular athlete, if you identify the problem accurately.
Another example is the women's synchronized swim team. They are very good in the water, but they become like fish out of water when they do dryland training. Their coach wanted them to be stronger, and for their bodies to have more muscle definition. For this, they brought in a performance coach who had them doing a lot of Olympic lifting.
Unfortunately, Olympic swimmers don’t often know much about lifting. Their bodies are not accustomed to deadlifting heavy weights and, as a result, the team developed a lot of injuries. They had back injuries, wrist injuries and knee injuries, all from trying to lift bars.
The coach and I consulted to determine what the girls were doing and why they were injured. Together, we questioned the rationale for Olympic lifting and that maybe it was not an appropriate dryland training regimen for synchronized swimmers. I suggested they try something else.
We sat down with the performance coach, and we redesigned the program to come up with something that was safer for the athletes while remaining aligned with the coach's goals. The program was about strengthening without injuring. It was overwhelmingly successful, and the team went on to win a silver medal in Brazil at the summer Olympics. They were stronger, had developed the muscle definition the coach wanted and didn't experience repetitive injuries in the process.
When the support team (the coaches, athletes, performance coaches, medical staff, and I), were on the same page, we made great things happen.
At what point are the Chinese coaches in fully integrating physiotherapy into athletics programs?
I think it will take some time to further integrate physiotherapy and sport medicine into their Olympic program. They need to create education programs for physiotherapy. They haven't done that yet, and it's probably going to take some time before there is full integration into their training regimens.
I am very pleased and honoured for having had the opportunity to work with the Chinese Olympic Team. It was a once-in-a-lifetime experience, and I think it benefited everyone. I'm happy to be back home with my family and back to my local practice. Going forward, I think the Chinese will benefit greatly from more physiotherapy education. Their team is recognized for excellence internationally, and they work very hard to maintain that position. However, I think they have the capacity to achieve more, and when they invest more in physiotherapy and embrace sport medicine management in a collaborative manner, they would be able to tap that potential. I look forward to continuing my collaboration with the Chinese Olympic teams to contribute in some small capacity towards their continued success in the Olympics and international sport competition.
Finally, I would like to acknowledge Peter Twist and TWIST Performance + Wellness for providing me with this wonderful opportunity.
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