Paul Kelly on Youth Development, Clinical Reasoning & Individualised Player Care | Season One, Episode Three

Recuper, Perform, Excel What do those words really mean in a world where injury, recovery and performance for every evolving? It's time to find out with the Performance and Rehabilitation Podcasts from Kiko Health. In our very first season, before the whistle, we're exploring how preseason testing and assessment shaped the outcomes long before the action starts. From I-Synch-Netic Data to On-The-Ground Insights, we're speaking to experts who prepare teams and individuals to move, perform and recover at their best. Let's get into it. OK, I'd like to welcome Paul Kelly to the podcast today as an expert footballer who's been at Blackpool Football Club, Blackburn Rovers, where I spent many a good year with him before he moved on to Manchester City and now currently working at Liverpool Football Club. Paul, if you want to give us a bit of an insight into your roles and responsibilities at the moment, at Liverpool, that would be great. Yeah, thanks John, thanks for inviting me. So, currently I am head of Academy of Physiotherapy at Liverpool Academy, so we generally have around 220 boys from age 6 to 21 within the Academy facility. We look after boys from nine upwards, really. Clinically, I dip in and out of the complex cases. I have a bit of a clinical role with the 21s, with the under 21s, but yeah, it's just working up and down the site with the various physios. We have myself and seven other full-time physios within the Academy. We have about 25 part-time staff. So it's just managing the part-time staff as well and we've put an atmosphere on this, the Soctober and doing the in-service. We've got some really good staff here, some great docs and some great physios as well. So yeah, I believe it's a good place to work. Now, we've just talked before about what a great enjoyment you get out of your current role at the moment and how you're enjoying it there. Do you want to give us a little insight into your own journey kills of how you ended up, I guess, choosing Physio as a career. Obviously, I know a bit of the backstory, but give the listeners a bit of insight to that. Then obviously, a bit of your pathway through and we mentioned the club of the clubs that you've worked at there and give us a few things over the years that have guided your career really for other people who might hope to follow in such a great career that you've had. I was in apprentice, a YTS footballer at Manchester City from 1986 to 88, maybe 85 to 87, so a while back. YTS footballer and basically at the end of the second year of my YTS, I like a lot of young players. I sustained an ACL injury to my left knee. Thirdary didn't work on two occasions, so generally we can turn an ACL round now in an academy player because I was under 17 at the time. In probably six to nine months, something like that, we are elongating it a bit more now to get the graft incorporated. If we say nine months, so my story was I didn't play for 23 months. At a time when it's a critical period in any young players, the other so you're still within the growth related phase and you're starting to make your career for 17 years away, certainly back then there were opportunities to get into first teams and obviously I just didn't play for 23 months, had three operations, two of them didn't work, the third one did work, but it wasn't a great option at the time. It was pre bone, patellar tender bone ACLs or hamstring grafts. It was an illegal band called a modified Macintosh operation, so it still left me with a really loose knee. I never basically got back to the same level. I did get a pro contract, so I was a professional in Manchester to lose about one to one and then it was obviously then I couldn't achieve the same level and needed to start thinking about other options. You went on then to look at different options and different career choices that you couldn't do. I had a lot of physio along the way, some good, some bad, but I was at Lillyshaw for 34 weeks, so that was basically, I don't know the club would just move me out of the way, but yeah. That was enough to move you off physio. Yeah, there's a guy down there called Phil Newton and his wife Pauline who were great people and looked after me at the time and obviously football was my life, was my passion. I wanted to stay in football if I could, as you could see, my career wasn't going to be as a player, I wanted to keep in the football field. Yeah, it seemed like a good decision at the time and it was 30 years qualified next year. So yeah, I was fighting 96. And whereabouts did you study Kelsa? I can't remember where it was. You were still Liverpool. Right. So yeah, commuted across as a mancunion. So you've gone full circle back at Liverpool Hall? Yeah. Yeah. So even I'm learning things from this podcast. Yeah, for some reason I got two offers, one in Leeds, one in Liverpool, Leet and Liverpool was nearer. So I took the Liverpool on. But obviously I charted physiotherapy at the course at the time, not a lot of sports physiotherapy within the course. The course leader was one of the, one of the, so the fellows of the CSP at the time, Eileen Thornton. Right. And it was a small group, 2020, a cohort per year and Eileen ran it really well and it was unmeticular and it was a good course. So it was a good grounding and obviously the replacements in and around Liverpool. But as is probably still the case now, the sports medicine side of it or the manual therapy side of it is all sort of postgraduate, that was the same then. I mean, you talk about the department there at Liverpool and probably it's worth is looking at how things have changed over time as well at some point in the conversation. But I guess one of the biggest challenges you might face now from when you and I sort of work together back at Blackburn was you just mentioned a number of stuff that you have there. You know, seven full-time physios, did you say, 25 part-time members of staff. So I guess one of the questions of, you know, that we ask all the, all the guesses, you know, what are the biggest challenges that you're facing in your work right now? But I would imagine listening to that, that in itself, managing that number of people brings its own challenges. Absolutely. Different characters, different stages of careers, people want different things out of their role. Yeah, I mean, we have a lot of Liverpool sort of fans here who are who basically, you know, love the club unbelievably. And this is their life, which, which, you know, is really good. But sometimes it's good to be able to step back and not as a fan and just look at things with sort of those spectacles on. So, yeah, it's like managing any group of people really that ups and downs and get to know you start. I mean, I've worked, I've been managed well in some places, not so well in others. And I've sort of picked up along the way. I did, again, for my own sort of development. I did a sporting directors masters four or five years ago. And that was good to sort of, obviously, got the qualification, but it was good to reaffirm that some of the things are the way I manage, you know, people seems to work. And yeah, that was good. And it was good. You know, it's when it was like going to a conference. And if you come away from a conference, I mean, I've just been, we went over to Madrid recently, the Isocnetic conference myself and the docker. And it's, um, basically we came away thinking that, well, you know, there's not massive amounts, we're not far off. So you think, well, we must be doing something, you know, we must be going okay, obviously doing bits and pieces, but nothing drastic. So that's always good. So I always think the same, mate. I always think the same. You know, when you go to these conferences and you know, obviously, I appreciate it's sort of bringing, you know, current research, you know, a new research to the four, if you like. But yeah, if you come away, we want to do little bits. And then the rest of it is a, you know, reassuring you that you're on the right path and doing the right thing. And it's worthwhile in itself, isn't it? It is. I mean, obviously you mentioned there and we talk about challenges in this sort of section really, but how have you found, you know, you talked about then sort of some of the sports medicine and the advances that have been made over the last 30 years or so, just weren't in place? How, how do you feel now with, with the amount of technology that's involved in sort of, particularly in the rehab process or objective markers or, or the bits that we bring in? How do you think that's changed over time, I guess, and how have you been with that as it's gone? And I guess the second part of that question is, do you think we've gone too far? Yeah, I mean, we're fortunate here that I've got access to or we've got access to pretty much everything. So you can get X, you know, IKD, Bloods, this, that and the other, you know, whatever, the Cloth supporters really well. I do see in a lot of the younger physios maybe that, that or for me, I always think get your basics right. And if you get your basics right, everything can work off from that rather than going straight for the high tariff stuff, you know, even something that's basic is get you need to walls right, get your handheld dyno stuff right, hand position, get you get the get the same person doing it so that your data is reliable and robust. A basic level and then the other stuff can come in as an adjunct later on. So I just think, yeah, my, we don't start a problem, but I just think people generally are sometimes younger physios, they look for, you know, the Kangatex scores before doing something more basic, you know, and, and, and, get the basic stuff done first, you're a range of movement, make sure you range of movements good, make sure your power is good, then we move on to the Kanga tech stuff. So it's, yeah, we use it here as an adjunct, but we're constantly on about just get your basics right. With any injury and any rehab. I can't remember who it was recently. I read something recently, just again, a social media post from someone just talking about, you know, clinical nows, and I always talk about it myself in a sense of just having a feel. And I think, you know, like I say, sometimes that does come with the experience, but I think sometimes I don't know, you know, with all the tech, you know, do we detract from the feel and sometimes with your experience as well, you'll have that read or your sense that something's not quite normal. I tell you, John, with where we've worked, I've still got my Leon Chateau, Muscle Energy Technique book that we used, we were using 20 years ago. We're like, it's under this desk that we're on right now. Right. None of my physios are the youngest stuff, the younger people or the part-time people, or the generally, it's gone out of fashion, but I still use those Muscle Energy Techniques and you're right. Again, it's because of where we're at and I mean, certainly we are fortunate from an imaging point of view that an in professional football as a whole now. I think we're losing clinical assessment skills because everyone gets a scan in the Premier League and that's we're fortunate and I'm sure people in league one, league two up and down the country would want the same facility, but we, so I think everyone now managers want scan results, players want scan results, agents want scan results, parents, it's all about scans. So we have to be careful as a group that you just say, so the feel of something in Leon Chateau talks about bind, how does a muscle move? You're actively extension, how does that feel? It's that we are, we've got to be careful I think as a group of practitioners that we aren't losing that. I think we are in a lot of instances. I guess it's a leader of a department there and you talk about that. We talk about the number of staff that you manage. I'll let you answer the question first and then I'll share how I dealt with it or still deal with it now with how do we try and get that into our younger clinicians and things. How do you go about a leader with the youngest staff of developing that aspect of the field? Yeah, I mean it's just sort of the ethos of the department. The department I walked into was a high level department and the wrench I'd moved up to the first team and I was brought into to take over head physiognomy. It was a high level department really well functioning when I got here. It's not a bigger problem. We've just got a guide. People say this is how we do, this is what we want as a department and for me as a manager of the staff, it's just yeah, get hands on. That's how I practice and invariably it's more, we don't have that many sort of newly qualified physios. One or two years out of uni, we generally are fortunate or we're able to employ people with a bit more experience. It's definitely one of the things I look for. We've just gone through a process of interviews and I want hands on therapists and I like, they've got access to this, that and the other. I can teach someone how to use the Kangatek or we can get the Kangatek lads in a weekend but clinical reasoning to assess a joint in a certain way. That takes years in my opinion. I agree with it and I've tended to now, I think even going back to our days at Blackburn, I remember obviously with Phil Batty as the dog there, all sounds scanning or MRI scanning was becoming, so everyone was getting scanning some way and I felt even at that point years ago, we were edging away from it. I always started playing the game myself where you'd go, particularly when BAMIC came in mid-2040, 2015 and guessed the result of this scan. From my clinical assessment, I think this is this grade of injury and this bit of the muscle and it's affecting this and then see how close you were and I think that's always stood me and my staff going, "All right, we're going to scan it but what do you think it is? What's the scan going to come back with?" Just to try and not lose that clinical reasoning bit of from your assessment and what you're predicting, this scan is going to say, I always found that a bit of fun, someone was miles off it, "We need to get you more experience, I'm training, but it was good and reassuring to them if they were looking at it going, all right, yeah, actually, I was pretty close and I think that's always nice to keep that bit of it going." But look, we talked about different tools and you've mentioned a couple of bits there. Over the years, you've seen different bits of equipment come and go, you've seen some hang around and stay. What do you find have been the bits that you've found really? We talked about getting the basics right and the clinical bits right and the assessment right. Do you feel the tools that you've used along the way? What do you think the ones that have really worked for you over time? Obviously, I'm a big IKD fan. So, from my education, obviously, with Dave Feever and that. Yeah, we've got access to IKD, so I do a lot of that. Has a lot of positives, has a lot of negatives. What we try and create here is, I mean, most clubs are doing it, is a pathway. So, we would test people from under 14, under 15, and hopefully when they're in our first team at 19 years of age, then we've got all that data in place. So, it's not a question of one to me being that much better than anything else, that most of them are pretty much strength measures. So, what sort of things then, Kels? Can you just go into a bit of detail? Obviously, there's such a broad range and some people have been listening, probably, and won't necessarily work or have access to the fantastic clubs that you've been involved with. What sort of things would a young player get tested? Would that be different to an older player? Or? Yeah, I mean, we don't, we IKD from sort of 15 up, that sort of stuff. But the go back to the basics type of stuff. It's stuff, something like need to wall. Your squeezes with a Svig, we can isolate it in various different ways, but it's squeeze scores, actively extension, with a basic Goni. That type of stuff, yeah, the players in the academy, the younger age groups get screened on the Monday after the game. So that type of stuff, don't go over the top on screening too much, till they sort of get to the sort of 15s and 16s, because obviously we need to make decisions then on on scholarships and things like that. So, again, keep it nice and basic. We don't throw the younger players on IKDs or anything like that, but one of the things we do try and do is we call it the core continuum. So we were finding that that boys were getting to 15, 16, 17 years of age and basically becoming full-time pros and had really poor control. When we're held at control and that type of stuff couldn't dissociate movements, patterns and this and that. So we try from a young age to put this core continuum, which is seven or eight exercises that they work through. Hopefully to gain this control, so that when they're going through or coming up the other side of the peak height, the growth stuff, then they've got some sort of control because we were finding that they were struggling bridging under 16, the 17, and right team and yet next minute the training with under 21 players. 13, 14, 16 and stuff. Yeah, I mean we don't, the screening stuff is just, the younger age groups quite basic. We get more serious about it at 15, 16 level and we're hoping that that will carry them through from under 15 and the plane with the first team at 21. And like I say, if it's, if your data going in is of the right quality and it's not rushed and we try and standardize it up and down there on the academy, that helps. So we can see progression. Because we're from a generation where the FA Musculoskeletal Aviation Form was there with millions of measurements, particularly in the academy setting, which is obviously your focus at the moment. But that was there and so much information generated and research papers off the back of that. But it's interesting to see, given, like you said, the support that you have from a financial point of view to have the equipment that you need, to what you still find, sort of the most solid and reliable, if you like, aspects of monitoring these athletes as they develop it's because probably people out there think it's probably more magical and more weird and wonderful than that potentially. Well, up until under 15 level, most of our children are still at school. So we get them from, you know, we get them from sort of half four, five o'clock in an evening, till half seven. So you're competing with coaches, coaches want them on the grass. There's a big competition, we've got to feed them, we've got to make sure we feed them post training or we're trying from a nutrition point of view, which is massive for finding. Well, we knew about, but we're constantly trying to get them to eat more and get more calories in them from a growth perspective. So yeah, there's always competition for that time. And it's a healthy competition, but we only get a certain amount of time with them because the career and the coach's argument is the careers are made on the pitch and they're probably right. Yeah, no, it's fair. I guess we just have to try and figure out how the best way, hopefully, to keep them on the pitch. Yeah, absolutely. And if we can work through that in a front end, preventative, pro-falactic, injury prevention, whatever you want to call it, that probably comes as, makes our job easier from the rear upside then, doesn't it? Hopefully, I guess, less numbers in that sense. So I guess with it, like we mentioned, along through the loads of things we live common gone, I guess. So it's to talk about this little section sort of myth or method, is there any method in some of the madness of the things that go on? Obviously, lots of new things always enter the market. You know, maybe I haven't been around. Or they probably have been around for a while or they've been in and out. Is there any sort of things that are probably a bit more niche, maybe, that you've experimented with or you've thought was good or well or didn't work so well? I remember the old power plates coming in. Yeah. Or a certain club had a mission for aiming outside the, outside the dressing room on the way out to play. So yeah, anyway. And yeah, I didn't wear everyone. I think we'd get them up blackburn or I think we had a couple on it and this soon got, yeah, thrown out or I didn't get up. I don't ever open to those because I think you still see them in gyms and stuff, don't you? Yeah. I mean, it was early pre-act, wasn't it? It was an early form of pre-act. And yeah, I didn't get that. I did not still don't. So do you know what? I've kind of forgotten about that as an entity. And I guess like things like, you know, BFR had sort of drifted in and then drifted out a little bit. And that seems to have made a much stronger comeback in recent years and months. You know, well, why do you think that is? Why do you think that sort of something like, I think it, can we look constantly looking for that extra, you know, with fortunate enough financially we can go for it most things. We're all looking for those extra bits. But I can say, my mindset is that's great. Get the basics right. Get the acute care right, you know, before we start. If that's in place, then everything else will fall on from that. But the problem we have with football is that in my opinion is, there's a lot of case studies out there. So sample size of one. So there's not a lot of RCTs out there for these things in our cohort. Yeah, do you find that difficult? Obviously, you're trying to, you know, lead the way at one of the biggest clubs in the world and provide that, you know, right support or right environment to do things like say, they'll be pressured to try different things. But a lot of the research might not be in your specific areas. But a real difficult thing then to integrate things into practice. It is, but I mean, we're again, we're mega fortunate. We have a data analysis department. So we can throw it there way and say, right, what are your thoughts on this? But we use our clinical reasoning and we sit down as an MDT with our medics. And if something's out there, then, you know, we will try it. Then somewhere along the line, we hope to see that the RCTs come out and it doesn't always happen, you know, and like I say, so if we put, you know, like the blood flow restriction sort of stuff, we've got players using it now. But it's a sample size of one or two, you know, so they'll get stronger anyway in our cohort with again, because the young foot men generally strength is not an issue for these players. It's all the other stuff. The range is a movement. The load management growth is a massive issue within academies. So strength as on its own is not particularly an issue. And even the post stop stuff, when we use the BFR for that, they get the hypertrophy very quickly. And we generally, because of the cohort we're working with, the young fit men or boys. Yeah, and like I say, I guess the potential for their athletic development and their athletic ability in the first place has possibly got them this far. Obviously, with their ability, you know, skill acquisition to be able to play football in the first place, something I wasn't blessed with anyway, as well as you were poor. But yeah, you know, it's, yeah, you're probably right. Trying some of these things out on the fittest parts of that population and age group. So would they, would they get there on their own anyway and they will heal quickly. Yeah, that strength is not an issue in an academy boys, in my opinion. Okay, with with that in mind, then obviously with, with the guys with the fluctuations within the season, like obviously, do you find obviously you've had great experience in, in, in both, you know, men's first team and, and you know, academy football. As the players go through the season, like particularly sort of through preseason, there is things like load management and managing the athletes any different in an academy setting as it is, as it is to a first team environment, you know, when they're going through like, like it just preseason different anyway, or is it pretty similar? The actual preseason sort of number training days is slightly differs, but I sort of have a theory that generally most people do a six week preseason. And so my maths, six, sevens or 42, you've been a day off a week, probably 35 training days in in a, in a full preseason. So if, if players can get on, some, these players, if you can get through 30, 90% of that 35 days, that will set you up in my opinion for the start of the season. So that's how it worked in my mind and the coaches understand that. So there is a big difference between under 18s training and under 21s training. In what sense? Eternity wise. Eternity, everything. Yeah, because generally under 21. So if we start at the beginning, the average age of most Premier League under 18 teams is 16.4, something like that. The average age of most under 21 teams in the Premier League is 18.4 something. So it's the not necessarily under 21 teams. What to go from, if they make the jump from under 15 to a full time scholar, big jump in intensity, volume, everything, then there's a jump again. So if they train or play for the under 18s, there's a big jump there to train from the under 18s, there's a play from the under 18s to train with the 21s. Again, big jump in intensity and volume, not so much volume intensity definitely. And then to play for the under 21s, again, big jump in intensity, that's before you've even looked at maybe hopefully one or two of them training with the first team. So there's these constant increments that we have to be aware of. And yeah, we, you know, we, in some ways with a grim reaper, but I, you know, I've always thought of our part of our role is sometimes we have to be the break because invariably these injuries, these, these boys or even children get the not days or most of your growth related stuff for your stress responses. It's months and months. So from a development perspective, which we are, and then academy has to be all about development, whereas a first team has to be about performance. So there's not constant, not battle, but I guess a balance balance. We have to find the balance. And yeah, and it's, it's the communication here between between up and down 18, up and down the academy is really good on the communication with the, with the first team is good. So, you know, we can send them, I mean, they've took some boys away with them and we can have an input on what we feel, how they should be managed. And yeah, invariably that gets listened to and because we know that these boys that have gone within a 16, 17, you know, they're still the, the skeletally immature. So I don't believe these boys become skeletally mature until the 21, 22, but if they're good, I mean, you go back to the biggest names around the, you know, go back to the, everyone's one about Stephen Gerard here. Stephen Gerard had a lot of injury problems in his early part of his career when he was 19 in the first team, because he's playing against men and that intensity and, you know, you need to be really careful with it and we don't always get it right. And to be fair, there was probably less emphasis in those days on, on the lot of the, you know, I guess medical sports science aspect that we have currently in, in the, environments, you know, there was, it was, if you're good enough, you're old enough, that's what that's what the bunch was then. Yeah, I don't know. Well, for that time, do you know what I mean? And the guys there, you know, provided the highest possible, you know, level of service to their players, it's just, you know, times change, aren't they? And evolve. But you talk about Paul, you talk about their, about the environment that you're in at the moment. and it sounds like a really positive, good communication, good interaction. Now, you know as well as I do, and we've all been around a block without naming names, you must have a couple of good stories where things haven't quite been like that and things haven't quite gone that way. If you ever found yourself in any sort of funny situations where you're thinking, I can't believe I'm in the middle of this conversation or I can't believe that just happened. I'm sure to have, I can't really remember John to be honest. I remember ones where I've had a fitness coach take over from treating somebody on the bed because they felt I was interfering in their performance work on the grass. So, comical days, but no, I mean, look, you know, the reality is it sounds like, obviously, you've been there, I think you mentioned before, was it coming up to nine years at Liverpool now? Yeah, nine years in September, yeah. Yeah, so I mean, obviously you've managed to shape that environment into an outstanding sort of environment for the club of support. It was really well. We were in a, we were in a quarter cabin to start with, and now obviously, we're in the axle that's under 21's, we're in the axle. So, and yet, yeah, the club of support does really well. And we are just about to redevelop our academy, our main academy building. So that's exciting. Yeah, there's some big developments. And, you know, why not? Because the academy has certainly functioned well, not just, I mean, I've been here nine years, but the part of players that they've produced or, you know, even up and down the leagues, the one league two, the players that we've sold, you know, there's hundreds of millions of pounds there. So it's definitely functioned really well. Part of the podcast is as well. A question gets passed forward from previous guests, and we give them an insight who to the previous, the next guest is going to be, if you like. So it seems given what we've discussed, we may have touched upon a lot of these topics already, but it was trying to say, obviously, because of the experience you have in the different environments, what's the main differences you've found between first team environment and the academy environment? I think you'd have to split it up into under 15 years and under. I think the one of the, the one of the major, the biggest point there we, or the that problem, it's just the way it is that we have to manage parents expectations. Maybe it's because of the internet or whatever the information that's out there, but we, you're not just treating the child, you're managing and looking after the parents as well. So that's the challenge at under 15 years and under, if you like. The older stuff is managing load and getting that right. It was like a save. If we get a stress response, a pubic stress response or a pass stress response or something like that, it's not weeks. It's invariably months and months. So you're taking that they've only got a certain amount of time to develop. And obviously they can't develop if they sat on one of our plants in the treatment room. Do you find that one of the biggest differences that tells you know, between the types of injuries that you would get in the academy? Yeah, definitely. And just so you just go about to the question that you asked the difference between first team. You know, we have time. We have time because we're like I say, our thing is development, not performance, yes, but they can't perform if they get these growth related stuff. You know, like I say, they miss big chunks of the development. So that's the difference. First team is, you know, in the academies, we can respect healing times. Whereas in the first team, it's like you're working back from a game potentially or games you're ready for. And you're thinking, well, that's the inflammatory process. We'll want of, you know, we took, took gone through its full course by the time you're wanting into play or start a game. But that's when you get your MDT together and you go, right, are we happy as a team? You know, we move forward together. Anyone got any issues? Speak now or else if we decide as a team to go with it, we go with it. Do you think that's an easier conversation like you say in an academy setting as opposed to a first team environment? Yeah, definitely. Because I presume they're still the same pressures there to, you know, that you might have a couple of good players in the academy that you might have as an important game or the coaches would want. I would imagine that there's still an element of pressure there for you to deal with. The whole aim of our academy is to get players into our first team. That's the main aim. That's from day one. That is what we're all told. We develop these players, get them ready. So that's how we sort of manage things lower down is, well, basically okay, we want that under 16 player to be ready or under 15 player for this game or your semifinal that's coming up. But really, if we're not happy, then the overall aim is to see if we can get in our first team when he's 19 and become the nots Trent or become the next Curtis Jones or become the next Connor Bradley or, you know, there's a line of them. So that's where, yeah, what we do at 16 is important and they have to develop, keep them on the grass as much as we can to give them the most time to develop. But really, the bigger picture is, can we get them in the first team? I guess then the final part, again, a lot of the questions that you've gone through and I'm said there as we've gone along is, you know, what would it be your one piece of advice for sort of young practitioners coming into the professional physiotherapy or coming into elite sport? What one or two things would you sort of say to them going, this is the most important thing you need to focus on? I mean, it's patient mileage. So if I'm a young practitioner now coming out of uni, get your hands on. So go and join, you know, I mean, I, my first when I was in a third year at Liverpool, when I was driving home two nights of the week, I would go on be a part-time physio for Winston United. So I'd drive across from Liverpool on a Tuesday and a Thursday. Then do the game in there. I think it was the uni bond prem at the time for 20 quid. But it got me hands on and it got me working with players and I could make mistakes and, you know, it just, it's patient mileage. The more you see, the more you learn. And I'm with the lyr, I feel I'm still learning now. You see stuff every other day and it's like, wow, well, yeah, where's that come from or that presentation? I've not seen that before or, you know, it's, that's the good thing. It's probably because we've still got so far to go to feel like we've cracked things, you know, it's the way it is, but yes, I find it really every day you're learning. We spoke before and between us, we've been in football 55 years. As physio. As physio was between us. We've got a bit of patient mileage, but you mentioned one thing, mentioned one thing there, Kells, which was making mistakes. And I think a lot of the time people worry of fear, you know, making a mistake, maybe. How do you feel about that? I think it's an important thing. Obviously, we don't want mistakes. I just think mistake, I might use the wrong terminology or the wrong way. I've set rehabs up and I mean, the analogy I'll give you and it, it was again, our mate Dave Fever. I remember him telling me about salacious injuries. Once you think you've got a salacious right, give it an extra four or five days because the number of salacious is we've all been bitten by where you think you clear them, you're hot testing you this, you're whatever you want to do, objective markers, you clear them, give them a few extra days. And there's no rhyme and reason about that apart from the tissue that you're trying to get to heal, the function and the muscle, what it's trying to, you know, what its function is. And all our experiences just give it an extra couple of days if you can because the last, the number of recurrences with the salacious injury in my, you know, even, you know, it's something like that, that's patient mileage. And that's my experience. So you have to break a few people down in the nicest possible way to step back and go, right, reflect on that, what would I have done differently? And then hopefully the next one goes, and generally you get to a point where you get most of them right, but still you get the odd one that catches you. And then again, you know, you just step back and you reflect and and as we do as an MDT and you move forward. So there's not, there's not a mistake, it's just we tried to push in a certain way and it's not worked. Yeah, no, and like you say, mistake might not be quite the right word, right? But I think sometimes learning from things that don't quite go to plan. It's sometimes the best learning that you can have, but I think you've picked probably the greatest problematic injury of all time where we've all been bitten. So no, like I couldn't agree more. Well, look, I'll say thanks ever so much for joining us today and giving us some insights into the world of Liverpool football club and obviously operating at the highest level as you have done for the last 30 years. And many more to come, you know, with everything that you talk about with Liverpool and I can sense the enjoyment that you have have been there and the environment that you're working. So that's fantastic to see as well, but no, amazing. Thanks ever so much for giving us the insights you're given us today and I'm much appreciated. Thanks, girls. Oh, it's fine, John. Thanks for inviting me. So that's it for this episode of Recover Perform XL. Thank you for listening. If you took something useful from today's conversation, share it with your team, your colleagues or anyone on the rehab and performance gym, you can subscribe and find all episodes on Spotify. Apple Podcasts and it's kekehullhealth.com. And if you've got a MrBust or a method to share, reach out. We'd love to hear from you. So until next time, keep moving forward.