ThermoHuman Podcast 8: Ralph Van der Horst (Former Rehabilitation Specialist at AFC Ajax. Co-owner of Sports Performance)

? In the eighth episode of “Thermography: Science, Health and Sport” (podcast in English) we introduce Ralph Van der Horst, Sport Physiotherapist, former Rehabilitation Specialist at AFC Ajax and co-owner of Sports Performance (sports medicine clinic) in the Netherlands.

? Ralph Van der Horst offers us a very interesting testimony about the application of thermography both in patients and high-performance sports athletes. His more than 30 years of experience as a sports physiotherapist and his various trainings (among which the sports training with EXOS stands out) allow him to have a great perspective on human performance and sports physiology. Among other examples, he tells us about an interesting clinical case in the rehabilitation of an ice skater who broke her ankle and how thermography helped to manage the recovery process.

Indeed, one of the most interesting statements from Ralph Van der Horst is the one about how thermography can support the rehabilitation process. In this sense, Ralph explained us how he includes infrared thermography in his stages of rehabilitation, assisting in decision making to progress from one phase to another.

“…for me, the most interesting and efficient applications from thermography are 2 things: it is first during the intake, the first picture (educational tool for your patient); but the way I use it the most is the return to play and load assimilation application”

Ralph Van der Horst (Former Rehabilitation Specialist at AFC Ajax. Co-owner of Sports Performance)

TRANSCRIPTION

Ismael Fernández (I): Hi everyone, my name is Ismael Fernández, ThermoHuman Co-founder and I welcome you to this new episode of the podcast “Thermography: Science, health and sports”. We are very happy today because I have a very good friend of mine but also a fantastic professional and we have to introduce you to Ralph Van der Horst. Hello Ralph, thank you for being here.

Ralph Van der Horst (R) : I there

I : how are you doing?

R: I’m doing pretty well

I: Mainly after listening to how I pronounce your name. Please let me briefly introduce Ralph despite his long career. Ralph is a sports physio expert with expertise in ACL and hamstring injuries, he has been working for more than 30 years as a performance coach and also as a physio with elite sports and we might highlight obviously his position as a former physio in AJAX F.C. the renowned football team from Amsterdam and he was at that time in charge of long term injuries, besides that, he is also a writer because he has published a book about hamstring injuries and indeed he is about to populate the second version of this title and currently he is working and his Co-owner of two-sport medicine clinics in the Netherlands called “Sports Performance”, so welcome and thank you once again, it’s a pleasure to have you here.

R: Thank you for having me

I: as you know the intention we aim with this podcast to bring the knowledge and mainly the testimonial of different professionals now are using thermography based obviously on his or your experience, and to highlight the most interesting things about your daily routine, so obviously as a physio and I would like to know that’s always my first question, how do you first know, how do you learn about thermography for the first time?

 R: OK, it started way back in 2014, I went to a clinic in Arizona and in doing the clinic at a company called “EXOS”  for athlete performance I met Javier, Javier is one of your co-founders in ThermoHuman.

I: Exactly

R: we became friends and we decided to organise a special week for trainers and athletes where we can do some more hands on stuff but also do some more scientific works, so he organised the first one called “The Performance Week” there was in 2015 and he organised that in Madrid and it was backed by the University of Madrid and then I met you in 2015, that was the first time you told me about the camera, the ThermoHuman stuff and got me a little interested but in 2015 I had a lot of things on my mind so in 2016 we went to Brazil an organised “ A Performance Week” in Brazil in Sao Paulo,  we met again and you explained during that week all the stuff about the camera and about the software and you invited me to come to Madrid again, so from there on I went to Madrid in 2016 and the rest is history, we started working together and you started explaining and I’ve been working with the camera ever since, so it’s been now more than five years.

I: It’s a long time, maybe it seems to be a short time but as we all know Thermography and its application on manual sports it’s a very early stage so five years is a long way.

R: The funny thing about that is that we all developed, I mean, I can still remember 2016 with the start of the software, with the different camera, with all the start of problems that we have, if you compare it to now that was just you know, we are just trying out and now so…

I: It is still growing

R: But were are much more mature right now

I: so my second question is as you mentioned, you have been working with Thermography for five years, even more, and nowadays, how are you using thermography on your daily and on your daily routine, how are you working with this technology?

R: Well, I actually use it on a daily basis, I make lots of pictures, not only through the software but also beside the software. I looked at the pictures and use them for my patience, I can use it with the first intake and show them and explain the way infrared thermography is working, me the most exciting part of it is what we do with the load simulation, we take pictures before treatment or before training and then we train and then after we see how an athlete or a patient will react through his body after training so we can see if we load the patient the right way if we load the correct part of the body or whether we are in a different direction that we should actually move away from.  We use it on almost all my athletes, I can see most of them are athletes that have problems with the lower extremities, so legs, feet, knees, hips like that, on the shoulder we sometimes use it but it’s a lot more difficult. Happily for us, most of my athletes have injuries in their legs or in their but or in their hamstrings because people know that I’m working with a hamstring a lot. I get a lot of hamstring injuries or people with a lot of hamstring injuries and that is just perfect. With the return to play we use it a lot and we use it in ACL rehab, it’s usually a long term rehab, it’s a year but what you see or what you saw in the past is that during that rehab patients would experience different pains and aches because of the rehabilitation and that means that they were overloading different parts of the body and now they don’t experience it all because every week we take pictures of those people and we have this trend that we can see and that we can follow an if there’s a trend you know, if it starts with a trend if I see two or three pictures that the trend is moving and already we act on that and we try to prevent different injuries so for me it’s, I tell you I got to know the camera and the software after me being working for 25 years as a physical therapist, it changed my way of thinking ,it totally changed and it’s not I can see shortcomings, but for me it is such a great tool to help me in establishing also to my patience, I don’t have to explain what’s going on, I can just say look take a look at the picture, can you see it? and everybody, if you take somebody out of the street, see that this area is red, this area is blue, this is whatever you do but they can if you explain it to them in two minutes, they will right away pick it up and so that’s really one of the strongest parts

I: I think that’s something that is very interesting from your experience and your approach is that you mentioned, that you are working with athletes and patients, so actually, the fact that you are working with elite and high performance at least but also with people that are normal sapiens without them having this high-performance context is very interesting and my question is, there is some difference in your opinion on applying thermography when you use that for elite athletes or when you use that with your normal patients?

R: For me there’s not,  I don’t look at whether they are elite or not, I look at what injury they have, and if there’s a patient like, we can warrior somebody who’s been going outside, start to run for 2K an experience and hamstring injury, the will see the same thing on a camera, on a picture, as an elite athlete, so that’s what I think, is the beauty of it, an eye let my PT that works for me they all use it and they all use it in a way that I want them to use, so we monitor. It’s a big monitoring tool, the age is not important, the level of sports is not important, what is important is that the status of the injury and they come to us, with let’s say normal knee pain, Patella femoral another really , really strong point about that is that if you take a picture, you let your patient or your client or whatever you want to call it, you let him okay Andrés and they stand in front you, they will stand the way they normally stand, you know what I’m saying?

“…I don’t look at whether they are elite or not, I look at what injury they have […],  It’s a big monitoring tool, the age is not important, the level of sports is not important, what is important is that the status of the injury […]”

Ralph Van der Horst

I: Yeah 

R: They will not stand really straight, they will stand in their normal position, now you take a picture and besides putting it into the software, through that picture you can tell and you can tell them, maybe your problem might also be something you know might be related to the way you’re standing on your feet because look at how you standing on your feet, look at your Achilles standing, look at your knees so, I use the camera not only for the software but I also use it as a tool for them to see like a mirror, to see them, okay why do I have these problems? if I have knee that is really going inwards, at what we call it valgus knee ,it is normal that or it’s actually logical, that problems will occur because of that and then you see well why don’t have I don’t I have problems on my knee but if you look at the way they stand on their feet, they say wow, yeah that that looks…

“…I use the camera not only for the software but I also use it as a tool for them to see like a mirror…“

Ralph Van der Horst

(I) That’s something very curious but it’s true that I don’t know the reason, but normally when you see thermal image things regarding the anatomy are clear, so it is something that I don’t know how to explain but it’s true, that it happens the same for me.

But Ralph, I have another question and it’s very important because you mentioned different applications, we normally focus on obviously, prevention is one of them but you mention return to play, so tracking and monitoring on an injury, obviously we know the diagnosis support, how it can help you in the way you can find the correct diagnosis and you also mention the internal loads, so the performance applications, based on your experience and your opinion from those four applications: prevention, diagnosis support, return to play or injury and performance, which is the main applications or the ones you find the most interesting or the most efficient from thermography?

R: for me, but that’s very personal, it’s two things: it’s first during the intake for you T0, let’s say the first picture get your educational tool to your patient but the way I use it the most is the return to play in the load simulation

“For me the most interesting and efficient applications from thermography are 2 things: it is first during the intake, the first picture (educational tool for your patient); but the way I use it the most is the return to play and load assimilation application“

Ralph Van der Horst

I: okay

R: I give you an example,I have a girl she’s number two or three in figure skating in Holland, she’s a very good she’s a talented girl 16 years old and she broke her ankle

I: okay

R: Now, the loads that you get on an ankle, on a figure ski are very, very large, big loads on that. So what we did we rehabilitated her and now she is up to a point where she is ready to go on the ice, now what we do, we take a picture before she started to train, we said okay you can go 15 minutes on the ice but no jumping, just riding, so she wrote 15 minutes on the ice and after the day after, we took again took a picture and you could see that angles were flaring up because which is normal because it’s still in rehab. That told me that okay, as long as I have this reaction, we cannot extend from 15 to 30 minutes, so next week you will go another 15 minutes and will take another picture and so after a while, you could see that the reaction on that 15 minutes skating was diminished we could see there was hardly any difference and that was for me and point to say OK, now you go to 30 minutes and from the 30 minutes you could see right away flaring up again so the tool that I’m using which I really love is that I can decide through my pictures whether they can make the next step and that’s if you don’t have that, it’s more or less based on tests that are subjective to my knowledge or it’s little gumball. Here you can see the way the body reacts to a new signal, to a new stress on it because the body needs to be stressed but how does it react, so for me that’s the most challenging and most beautiful thing on it and that’s what I use a lot but I also use it with normal athletes if they train a lot, we do every week, we do pictures to see that they’re not overloading 

I: Very, very interesting, thank you Ralph. Another important question because obviously we have been speaking about the good things, the advantages but I like always to explore the dark side, so to ask for the limitations, so from your perspective and your experience which limitations you find the most significant from thermography?

R: I think there’s maybe two or three fold. First of all, back problems are difficult because it’s based on circulation, on metabolic processes. If you go for back problems it’s sometimes not that difficult. The same goes for shoulders, I feel that if you take a picture of a shoulder it’s much less clear than a leg, but that’s because it’s much more refined and another thing that I came across by accident, I have right now a Ballet dancer and I think she does something like yoga but if you look at and that’s a different podcast, but if you look at hamstring injuries there’s two kinds of hamstrings injuries, you have the explosive ones and we have what we call the stretch ones, now the explosive one is like a football player who will run and you can it’s like a shot and that will flare up on the camera right away also because the location of the leg, now if you have like a ballet dancer, if they they have a stretch hamstring injury the only thing what they hear is like a pop, it’s like tac and they feel like, okay it hurts a little bit, but the problem is that it is so deep in the tissue that you will never find it on the camera and so that’s it what I feel is, that when it’s really deep injury and in this case specifically that stretch injury which is really high located up in the butt, there is shortcomings but course you have your tests and if you know that it’s OK, because it’s a great tool, but it’s an extra tool to decide what you’re going to do, but it’s not the only thing that you do so funny, that kind of a shortcoming

(I) And another question that is related to that, because obviously limitations can be compensated right? So as clinical, as a physio obviously, I can imagine that you’re combining thermography with your assessment, but are you using other technologies to combine with thermography in order to make decisions?

(R) sometimes. We have a very good contact with some orthopaedic surgeons and in this case, with his ballet dancer I wanted him to make an MRI for her because if there’s a really tear in that hamstring deep you can see it on the MRI, so we combine that sometimes, that’s the most thing we combined with the orthopedic evaluations, but most of the time it’s a combination of the camera and all the tests and all the knowledge that we already have.

(I) From the performance, are you combining with functional test, strength test, with both sides?

(R) Well, what i felt it´s that a functional test is more subjective than a picture, and what I mean by that, if I have an athlete and let’s make an example, you have 11 football players, they have to do a test, now the captain who’s number one might do the test at 80% because he doesn’t care, because he’s going to be in the team anyway, but number 12 might do the test 120% because he wants to get into the team, you know I’m saying? So it is very subjective, I mean if you look at the ACL test, hop test, jump test… they are scientifically proven but also everybody says it is subjective. What is what I like about the camera?  It’s fast and you can hardly manipulate it. You can manipulate but you have some certain rules, right? you have the rules, they have to be in 15 minutes before, they have to relax…. all that stuff and if they go by that, the only thing they have to do is stand in front of and the body will tell me the rest and that’s what I really, really like. For me, that makes my first evaluation a lot easier.

I: Ralph, how do you see the future of this technology, how do you think that thermography or companies like ours, should invest to improve and to get closer to what we expect about thermography?

R: It is difficult, I am living in a country where the first question they will ask me is, how much does it cost? And it is an investment for every PT but every trainer, what I feel in the future is that we should keep it really, really high quality. This is to my idea, this is the Mercedes of the work that we do and that means, the product can only be this strong when there’s a professional behind it who knows what he’s talking about and let me explain about that, and I have lots of, let’s say I really like trainers, I really like personal trainers, but there needs to be some anatomical, Physiology that needs to be some pathology background, professional behind the camera because if you don’t have that, you will miss out, so I still feel that in the future I hope it’s going to be more into the professional sports because that’s a bigger exposure, but I wouldn’t sell it to anybody, it should be something really good because if you don’t do that, then you might be selling the product short, you know what I’m saying? It’s great product, it has really a lot of potential and there’s a lot of science behind it and I still feel in the future also we need to keep it that way, we need to work on the site, we need to work on the high level quality of that and that’s the way we should marketing. I think we can expand it into lots of countries but we have to see where people are willing to look into quality and not only in money, that’s why we have such a hard time in Holland because the only thing they look at it´s, do I get it from the insurance company and how much does it cost and for me that’s disappointing because I think the product is just outstanding. I think there’s a bright future but we shouldn’t run too fast, I think the basic, the foundation should be strong, we should keep that strong because if you lose the foundation we’re going to lose the product and then it’s just going to be… 25 years ago we had like infrared laser and everybody had to have the infrared laser probably the old PT know and was great for two years and now nobody knows about it. They should not be like that, it should be a product that everybody with knowledge should, every self respecting clinic should have this tool.

“…the product can only be this strong when there’s a professional behind it who knows what he’s talking about […]  there needs to be some anatomical, Physiology, […] pathology background, professional behind the camera…“

Ralph Van der Horst

I: Thank you very much Ralph, it was very touching to have you with us. It’s always very nice to hear your thoughts. Thank you very much and see you in the next episode.

R: Alright, thank you, bye bye.