Dr. Zach Cogen: Physical Therapy in Soccer

On this episode of the Keiser Human Performance Podcast we sit down with Dr. Zach Cogen, DPT, who is the first team head physical therapist for the New York Red Bulls. He has dedicated his career to working as a physical therapist for elite athletes and is passionate about human movement. He has experience working with UCLA athletics, EXOS, and within Major League Soccer with DC United and no NY Red Bulls.

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Welcome to the Keiser Human Performance Podcast.

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The goal of this podcast. is to educate and inspire you to make the most of your

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journey in health and performance.

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Each episode will provide an in-depth discussion on a specific topic related to human performance.

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If you're a growth-minded individual seeking knowledge and better solutions,

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this podcast is for you. We're glad you're listening in, and we're excited to learn alongside

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you. My name is Gabe Durman, and today I'm joined by Dr.

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Zach Cogan. Zach is a sport residency and fellowship-trained physical therapist and is a board-certified clinical specialist

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sports PT. He has dedicated his career to working as a physical therapist for elite athletes and is passionate about

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human movement. He has experience working with UCLA

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Athletics,

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EXOS, and within Major League Soccer with DC

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United. He currently serves as the first team physical therapist with the New York Red Bulls.

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On

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today's episode, Zach shares some awesome insights into his work as a PT for a professional

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soccer club. We discuss quantitative assessments,

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metrics related to soccer performance,

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the return to play continuum,

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and how Zach implements Keiser as a tool for rehabilitation.

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You can follow Zach on Instagram at thesportsphysio_

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and take a look at all the awesome video content he

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shares. Please enjoy the episode.

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Zach, what's up? I appreciate you taking the time to sit down with me today.

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How are you doing?

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How we doing, Gabe? Good, good, good. Thanks for having me on.

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Appreciate it. You got it. So I understand you're an East Coast native, and after a few stops,

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some time in LA, some time in, uh,

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DC,

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you're in New York. How have things been for you since transitioning in your new, uh, role with Red Bull?

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So

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far so good.

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Um,

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yeah, it's, uh, it's really nice coming back home,

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uh, technically in Jersey right now, but, you know, originally born and raised in New York, so close enough. Um,

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and it's just nice to be back near friends and family and to,

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yeah, just be back in, in this

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general vicinity. Uh, DC wasn't too far away, but it's definitely

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a lot closer here. All right. Hopefully enjoying some of that good

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New York food too, huh? Yeah, definitely.

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Good.

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So tell me, how'd you get involved with the soccer population

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as a PT? Yeah. So,

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you know, just

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throughout my career,

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um, I've just been in different settings, different environments where I've had the opportunity to work with athletes and

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athletes of all populations, all different sports, all age

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ranges. And, you know, early

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in my career, I was seeing more of a mixed bag of these athletes.

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Um,

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and as my career went on, I got to be a little

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more specific, um, more in the elite sector. But throughout the entire time, I've been able to work with the

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soccer athlete, um, no matter what level it was. And,

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um, you know, especially during my time at EXOS, I had the opportunity to work with a few professional

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and collegiate soccer players, especially when I was at UCLA.

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Uh, I got the opportunity to work with some soccer players as well. And,

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um, you know, while I was at EXOS in San Diego, this opportunity kinda fell in my lap,

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uh,

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to originally join DC United and, um, you know, eventually moved across the country to do that.

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So, uh, had experience with the athlete, but

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understanding, you know, the demands of the sport and, and obviously having a learning curve. I knew there was

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a

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lot for me to learn, uh, once I stepped through that door, just because

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I didn't necessarily play soccer growing up, so it was definitely,

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um, a bit of a culture shock at first.

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Right. I imagine it's gotta be pretty cool now to be at the level that you're at,

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this elite level of soccer athlete, but also having the experience, like, working our way down from college into high

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school and, and,

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um, even

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grade school and those younger populations of a soccer athlete. I think you just have an appreciation for the entirety

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of that continuum.

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Yeah, certainly. Uh, and it's really cool, especially in an

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organization... You know, think about, uh, you know, a soccer organization has multiple levels, especially at

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Red Bull, uh, and how things are connected between

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the academy, the second team or

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MLS Ne- MLS NEXT Pro,

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and in the first team. You know, there is a continuum of development of young athletes,

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uh, as they move through their lifespan and, um, you know, develop their training

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age. And it's, uh, it's a cool thing to be a part of and see how that thing, uh, typically

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unfolds. Uh, and especially being able to work with the younger athletes early in my career and see,

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um, you know, where they can potentially lead up to is, is

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kinda cool and gratifying. No doubt. Excellent. So diving into some of your work, and now perhaps a really good

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lead into our conversation today would be to give us, the listener, uh, just a general understanding or outlook on

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just how you see human

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movement. Um,

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yeah.

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So I mean, human movement is

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how we move through space, right? So we're...

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Right? It's physics, right? We're physical beings.

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We walk forward, backwards, side to side, uh, against the forces of gravity. So three planes of motion, and we

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have to control all three planes

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at all times.

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Pretty simple-

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Simple ... straightforward. Simple. Ah, simple. I like

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it. Yeah. Um, so, you know, when considering all these things, uh, obviously

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there's

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a lot more to that, and there's a lot more depth within all of that, right? The physics

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of it, uh, the planes of motion, things like that. But, um, something I'd be curious to know and kind

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of dive into-This idea of just like assessments. Okay. So you're saying there's a PT and with a soccer population,

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and obviously assessments and assessing human

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movement is part of, you know, your everyday job. So,

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um, are you running all of your athletes

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that you're seeing, um,

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through the

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same assessments or are assessments specific to the individual

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based on some sort of previous information that

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you've gathered? Yeah.

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So and then you're getting more into, you know, the idea of what a screen is versus a, a true

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assessment. And, you know, understanding that screens are more general in nature and, you know, you can use those over

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a wide variety of athletes in a subpopulation. Uh, but then as a clinician and practitioner, getting a

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little more specific with, with our true assessments

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and taking,

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you know, ideas such as past medical

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history, um, any types of, uh, bumps, bruises or nicks that they may have at that current

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time, uh, things that they may have been dealing with chronically

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and looking a little more deeper and diving deeper into those types

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of things. Um, so, you know, there are certainly general assessment tools that we wanna look at and, and

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put athletes into different

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buckets. Um, but also understanding,

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uh, unique characteristics to that specific athlete in front of you, and then maybe diving a little deeper into

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what could be going on and, and why that's going

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on. And, um, you know, that's a whole different discussion for a different day.

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Right. So, uh, let me rewind for a second there because, uh, you provided a good distinction between screening

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and assessment. Let's just go back to that for a second. So to you, a screen is what, and

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then comparing that to assessment, that is what

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for you? Yeah. So

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a screen,

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um, I like to say is

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a, uh,

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a tool that we use to identify

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a potential body region or area,

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uh, that we could dive a little deeper on. Um,

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you know, for instance, we would do

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screenings as, you know, pre... during preseason physicals or entry

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screens, uh, to identify any potential yellow or red flags

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that we need to, you know, get somebody to go and see a physician for, or,

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um, need to do just a deeper local joint assessment,

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tissue assessment, uh, to see what could be driving some of

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the dysfunction.

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Um, and then, you know, a-and it really depends on what types of screening tools you would like to use.

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There are many,

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many out there,

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uh, but it's more general in

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nature, uh, that can give you an idea of what's going on, but not actually give you the most information.

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Right. But more of a, "Hey, we should look a little

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deeper on this." Right. And that's

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where your kind of more of your assessments

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is how you use it, uh, kinda come into play. Absolutely. "Hey, we've, we've flagged this one

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area. Let's dive a little bit deeper with maybe some more specific assessments."

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Absolutely.

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Okay, great. Thanks for, uh- Yeah ... clarifying that. Um, appreciate

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that.

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Yeah. So, right, when considering...

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Let's say we... Okay, we, we've done our screening,

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uh, and now,

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um, considering some of the assessments,

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right, what are some of the assessments

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or can you provide us some insight

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on maybe which quantitative assessments that, like, you find value in? Like, what do you find yourself using a lot

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with the population that you're working with?

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Yeah. So it's, it's really going back to

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the basics, uh, and the foundations of how we move, right? So we want to identify,

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right, mobility,

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control, and strength, right? So mobility, joint mobility, tissue length.

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Uh, we wanna identify neuromuscular control patterns, how this athlete

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moves. Um, can they move well against gravity?

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Um, and then also looking at strength and power, uh, reactive strength, things of that nature,

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uh, to identify those types of deficits side to side.

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Um, so

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quantitatively,

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you know, going back to basics with goniometry, uh, you know- Mm-hmm ... as a clinician, prac- physical therapist practitioner,

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you know, using goniometers or inclinometers to identify joint angles, comparing side to side differences.

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Um, but also understanding that sometimes side to side differences are normal, especially in a soccer population,

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where if you're a left-footed

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player, you're a left-footed player, you like to kick with your left foot a lot. If you're a right-footed player,

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you like to kick with your right foot a lot. So one leg is really good

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on the ground, while the other leg may not have the best control on the ground because that's typically your

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kicking leg. So understanding

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that these,

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these asymmetries could be normal. It's not always abnormal to have these, especially

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for an asymmetrical sport like soccer,

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baseball,

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volleyball,

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things like that.

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Um, but also moving into more of the strength realm of quantitative assessments

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using some of the equipment that we may use. Um, you know, I used it at EXOS,

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I used it at BC, I've used it... I'm using it now at Red Bulls,

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is, you know, our Evolve suite.

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So I'm using NordBord,

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ForceFrame, uh, ForceDecks. And for those of you who aren't familiar, NordBord is a, a hamstring assessment tool

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to assess hamstring strength and

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function. Um, ForceFrame, there are a multitude of different tests. You can test,

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um, hip abductors, adductors, hip flexors.

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Um, you can test soleus. Uh, you can test so many

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different things, uh, with the ForceFrame and then also

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ForceDecks, uh, being able to do i- different isometric strength testing, overcoming isometrics, yielding isometrics,

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uh, your, your plyometrics as well,

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um, reactive

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strength. So lots of different things we can quantify.

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It really just depends on,

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you know, what's your intent behind the assessment

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and how you're gonna utilize that data to drive,

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uh, what your, you know, your ultimate goal is, whether it's injury risk reduction, whether

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it's, you know, looking to improve performance. or strength in- the off-season. It, it really depends.

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Right. Absolutely. It'll depend on the person. But i-in your previous experiences, uh, everything together where you've had access

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to these types of assessments,

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um, and ability to, uh, test athletes, what kind of frequency are you' looking at, uh, and what...

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Or, or how do you. determine what kind of frequency you' wanna be testing your athletes at or assessing

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your athletes at? Yeah. So it's,

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it really ranges because it depend- it always depends is the best answer- Yeah ... but it is, right? So

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it depends- Right, right ... on is this athlete in a, in a rehab continuum?

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You. know, are they- Mm-hmm ... in a return to play continuum where, um, we're looking to

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track, you know, if they have pain or discomfort with their, you know, their strength? Is their

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strength continuing to come

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up? Are we... I- is this somebody that we're looking to get back on a certain timeline? Is this somebody

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that we're tracking who's a healthy athlete that we're using as a monitoring assessment to see if they're maintaining strength,

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losing strength, gaining strength

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within season? Is this the end of

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the season? Um, so it really depends.

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And those, you know, those testing frequencies really do range, so it

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really depends on what's,

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um, your ultimate goal is with that specific athlete. But I guess the main

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point is that,

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um, it can be any type of frequency as long as you can

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justify it. Right.

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Earlier you mentioned, just a second

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ago here, just the right and left leg differences

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and asymmetries a little bit. So I have a question,

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it's,

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uh, for you. I'm curious to know your answer

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here. How do you find the line

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between what is an, injury risk and what is good for performance, or what is normal for

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performance when, when considering asymmetries? I' mean, let's take a soccer population. Let's go right and left

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leg. Mm-hmm.

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Interesting question.

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Um,

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and it's, it's a good one because, right, so there's, there's literature and research out there to

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talk about, you know, let's, let's take an. ACL reconstruction,

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uh, for example, and an athlete going through that return to

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play phase and

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continuum. Right? We know that, okay, some of the literature will point that nothing more than a 10%

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strength deficit to, to progress and to, you know, return to play. Whether or not

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that's, you know,

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right or wrong, that's, that's, again, a different discussion to... and we can have a really nice conversation about

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that. Um, you know, we know that there's also, specific to the soccer population, there's literature out there to talk

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about adductor strength, and that the kicking leg

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of the adductor, right, should be anywhere from two to two and a half times more

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strength than the non-kicking dominant leg. Um, there's literature out there to talk about power in our plant

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leg compared to our kicking

00:14:12.140 --> 00:14:16.060
leg, that if you imagine an athlete going to kick or going to shoot a

00:14:16.120 --> 00:14:17.960
ball two to two and

00:14:18.000 --> 00:14:22.080
a half times body weight going into the ground on the plant

00:14:22.160 --> 00:14:24.000
leg as you're kicking a ball. So

00:14:24.540 --> 00:14:25.280
you can imagine

00:14:25.360 --> 00:14:29.340
if you're a right-footed player, your plant leg is working pretty hard

00:14:30.200 --> 00:14:30.660
consistently.

00:14:30.720 --> 00:14:33.889
I mean, you know, if you can count how many times someone kicks in a game, sometimes it may not

00:14:33.920 --> 00:14:38.650
be much, but the amount of force that's going through the ground is pretty substantial. So you would have to

00:14:38.680 --> 00:14:42.400
assume that there are these imbalances and asymmetries.

00:14:42.420 --> 00:14:48.070
And I guess, you know, we don't know everything as a performance and medical community, but taking the information

00:14:48.080 --> 00:14:55.440
that we do know and understanding what's out there from our normal populations or healthy athlete populations and being able

00:14:55.580 --> 00:14:58.180
to, you know, identify who falls out of those

00:14:58.220 --> 00:15:00.990
ranges, potentially flagging those types of

00:15:01.080 --> 00:15:04.020
athletes. So it's, it's a challenging one, but it's also,

00:15:04.060 --> 00:15:06.340
you know, putting, putting your heads together with your colleagues

00:15:06.400 --> 00:15:08.060
too, um, and talking

00:15:08.100 --> 00:15:10.060
about, you know, what we all think and,

00:15:10.140 --> 00:15:12.200
and identify as a potential

00:15:12.240 --> 00:15:12.690
flag or

00:15:13.020 --> 00:15:16.020
risk factor, um, if that makes sense.

00:15:17.240 --> 00:15:22.820
Yeah, absolutely. So, uh, and kind of let's go back to, uh, ForceFrame I think you mentioned

00:15:23.040 --> 00:15:26.080
was for adductors. Sure. Adductors, adductor. Okay.

00:15:26.560 --> 00:15:29.020
So for you, you're looking at this and you're saying, "Hey,

00:15:29.540 --> 00:15:32.240
let's find out a standard. We're gonna do our serial testing for these individuals

00:15:32.260 --> 00:15:32.720
over however,

00:15:33.140 --> 00:15:34.040
you know, long period

00:15:34.080 --> 00:15:35.060
of time. However,

00:15:35.680 --> 00:15:36.040
you know, we're

00:15:36.100 --> 00:15:38.220
seeing here that we're having this,

00:15:39.200 --> 00:15:43.109
you know, deficit that it goes beyond, well beyond maybe four times,

00:15:43.240 --> 00:15:47.020
you know, you know, well beyond 10%. Or this, uh, kicking leg

00:15:47.080 --> 00:15:48.080
is, you know, four

00:15:48.180 --> 00:15:52.900
times as strong, uh, with this adductor- Mm-hmm ... versus that. Is that... So that's, for you, hey, we're flagging

00:15:52.940 --> 00:15:56.050
that. I'm just trying to get an understanding of a, of a practical sense. Like, hey- Yeah ... we're not

00:15:56.100 --> 00:15:59.440
gonna panic here, but this is something to- Sure ... look at potentially.

00:15:59.780 --> 00:16:02.020
Yeah. That's a pretty big step off, and those are types of

00:16:02.080 --> 00:16:04.040
things that we, you know, especially we

00:16:04.080 --> 00:16:07.000
like to, to find, or we as practitioners we would like to

00:16:07.060 --> 00:16:09.920
find in preseason, those types of things, so we can get somebody

00:16:10.000 --> 00:16:16.980
on adductor strength program. You know, get them doing Copenhagens or something along those lines to increase robustness,

00:16:17.040 --> 00:16:19.060
strength of the adductor tissue on

00:16:19.120 --> 00:16:23.000
that, that non-dominant or whichever leg was in that big of

00:16:23.020 --> 00:16:25.040
an asymmetry. Uh, but yeah, it's a good

00:16:25.100 --> 00:16:26.880
question and, yeah, it's,

00:16:27.000 --> 00:16:33.860
um, usually those drastic ones or those flip-flop ones that kind of make the most sense, um, that make you

00:16:33.940 --> 00:16:38.150
scratch your head and be like, "Hmm, doesn't really seem right." Right. And with all of your quantitative

00:16:38.200 --> 00:16:43.940
assessments from a preseason standpoint, you're just collecting and maybe nothing's happening. Thankfully, no injuries, things like that. But if

00:16:43.980 --> 00:16:45.020
something were to occur, it's like,

00:16:45.080 --> 00:16:46.140
hey, let's go back

00:16:46.180 --> 00:16:48.960
and look at, you know- Mm-hmm ... some of the testing that we've done

00:16:49.020 --> 00:16:53.100
and, and maybe see, hey, oh yeah, you know what? We might have missed this. Or, you know, this,

00:16:53.180 --> 00:16:55.080
we didn't think this was an issue, but turned

00:16:55.140 --> 00:16:57.940
out it may be one. Yep. And, you

00:16:58.000 --> 00:17:02.180
know, it goes even deeper than that, especially from a preseason

00:17:02.560 --> 00:17:04.020
data collection standpoint is,

00:17:05.400 --> 00:17:09.119
you know, you, you have a baseline eventually and, you know, if somebody gets hurt, you have their

00:17:09.140 --> 00:17:14.020
baseline number of what their strength value is, let's say with, you know, VALD and ForceFrame, we're using

00:17:14.060 --> 00:17:18.869
it in Newtons. Um- Mm-hmm ... and we know where they're at, but also you ask the question, okay, is

00:17:18.900 --> 00:17:23.220
that even strong enough? So once we get them to their baseline, do we want them to be over their

00:17:23.240 --> 00:17:28.010
baseline? And obviously, that's always our goal is to make somebody as strong as possible. Um, but also keeping

00:17:28.060 --> 00:17:32.780
that in mind of, you know, how we can use the, the earlier numbers we have and, and when we're

00:17:32.820 --> 00:17:35.140
talking about athletic development and strength development too.

00:17:36.140 --> 00:17:36.300
Mm-hmm.

00:17:38.260 --> 00:17:43.140
I'm gonna ask you, if you can, to elaborate a little bit on what that looks like, being strong enough.

00:17:45.800 --> 00:17:48.020
Uh, in, in terms of,

00:17:48.160 --> 00:17:51.950
uh, like, during our assessments, like how strong- Yeah, yeah ... we want them to

00:17:52.000 --> 00:17:53.100
be? Right.

00:17:54.180 --> 00:17:55.080
It's a good question.

00:17:55.680 --> 00:17:55.940
It's,

00:17:56.000 --> 00:17:57.920
you know, again, looking at the baselines,

00:17:58.180 --> 00:18:03.252
um, identifying if-If someone had athlete A had a baseline

00:18:03.292 --> 00:18:06.092
of, let's say, you know, on their right adductor

00:18:06.272 --> 00:18:08.032
they had 400 newtons

00:18:08.332 --> 00:18:09.912
of force that they could put in and they got

00:18:10.072 --> 00:18:15.052
hurt. Mm-hmm. You know, we know that that potentially, I mean, there could be other factors to that,

00:18:15.352 --> 00:18:16.232
uh, that,

00:18:16.272 --> 00:18:18.072
you know, outside of strength.

00:18:18.612 --> 00:18:21.252
Uh, but if we're talking about just strength of the adductor,

00:18:22.412 --> 00:18:28.072
getting over that, I mean, it's, it's difficult to identify, like, where we want them to be. There...

00:18:28.572 --> 00:18:28.972
Now you can have

00:18:29.012 --> 00:18:32.932
a discussion of can you create an equation that looks

00:18:33.032 --> 00:18:34.952
at the moment arm of the

00:18:35.032 --> 00:18:35.692
adductor,

00:18:36.132 --> 00:18:39.062
you know, in relation to the length of their

00:18:39.132 --> 00:18:45.222
femur and the body weight of the, the individual, and you can standardize for an elite soccer player-

00:18:45.632 --> 00:18:49.072
Yeah ... how strong you want their adductor to be to mo- you know, to strike a ball,

00:18:49.092 --> 00:18:51.032
and how well they can control the impulse force of

00:18:51.072 --> 00:18:54.082
the ball at their foot. You know, there are obviously... And these

00:18:54.152 --> 00:18:54.752
questions are,

00:18:55.092 --> 00:18:58.132
you know, I've never seen anything like that, but, you know, these

00:18:58.192 --> 00:19:02.032
are, these are interesting discussions that I think would be nice to have as practitioners as

00:19:02.042 --> 00:19:10.432
a community. Um, but, you know, we don't have, uh, normative values of how strong someone needs to be, um,

00:19:10.492 --> 00:19:11.982
in their adductor, but we have

00:19:12.032 --> 00:19:12.652
an idea of,

00:19:13.472 --> 00:19:15.272
you know, i- in general

00:19:15.312 --> 00:19:15.892
ranges, it's

00:19:16.592 --> 00:19:20.292
a, a short lever position. You should be able to produce a great amount of force.

00:19:20.352 --> 00:19:20.652
Meaning,

00:19:21.132 --> 00:19:23.152
you know, I would be concerned if someone had,

00:19:23.952 --> 00:19:26.952
obviously depending on how much you weigh, anything under 300 newtons is pretty

00:19:27.092 --> 00:19:30.032
low- Mm ... uh, for a short lever groin squeeze.

00:19:30.132 --> 00:19:33.052
So I mean, it's, it's really across the board. It depends on how old

00:19:33.112 --> 00:19:36.052
you are, um- Yeah ... you know, your maturity level. It, it, you know, there

00:19:36.062 --> 00:19:40.092
are a lot of just different factors that can weigh into how strong someone really is.

00:19:40.552 --> 00:19:41.422
But,

00:19:41.472 --> 00:19:41.582
you know,

00:19:42.152 --> 00:19:45.192
cool, good question, and definitely a cool discussion- Yeah ... to have.

00:19:45.232 --> 00:19:45.442
Yeah.

00:19:46.032 --> 00:19:51.942
It's an interesting one. Yeah. No, no doubt. I, I really actually appreciate the depth of, like, your thought process

00:19:52.072 --> 00:19:56.172
in that and sharing that, and I know there's no real great answer out there, uh, yet, but I, I

00:19:56.292 --> 00:19:59.062
do... Hopefully this will be able to spark some of that, and for some people that

00:19:59.072 --> 00:20:01.992
are listening in, at least spark an, uh, uh, some

00:20:02.152 --> 00:20:02.612
interest

00:20:03.212 --> 00:20:09.972
and some thoughts about really what we wanna be looking at. And like you mentioned, short and long

00:20:10.032 --> 00:20:12.072
lever. Are you testing in a short lever and

00:20:12.112 --> 00:20:12.992
long lever position?

00:20:14.192 --> 00:20:15.061
Yeah. Right.

00:20:15.061 --> 00:20:16.972
Uh, important to, to look at

00:20:17.032 --> 00:20:23.012
that. Obviously, you know, one is easier than the other. One puts a lot of more s- you know, puts

00:20:23.092 --> 00:20:27.992
different types of stresses on that tissue. Uh, also testing it in a standing position as well, right?

00:20:27.992 --> 00:20:33.732
Mm-hmm. So there are ways that you can use either the force frame or you can use the, um... We

00:20:33.772 --> 00:20:37.192
use a dynamo, which is a handheld dynamometer that you can- Yeah ... hook up with a length,

00:20:37.552 --> 00:20:42.172
uh, to a squat rack or the bottom of a table or something that you can, um, look at

00:20:42.212 --> 00:20:43.972
in a closed chain position. Obviously,

00:20:44.072 --> 00:20:48.092
you know, which has different factors equating into adductor strength.

00:20:48.632 --> 00:20:52.912
Again, the plant leg comes into play and how, how well do you stabilize through your plant leg

00:20:53.152 --> 00:20:59.792
into the ground, and then, you know, subsequently produ- able to pro- produce force with your kicking leg. So, uh,

00:20:59.852 --> 00:21:01.232
there... You can definitely get,

00:21:01.352 --> 00:21:05.152
um, get creative with how you want to test, but short and long lever,

00:21:05.312 --> 00:21:07.492
uh, would highly recommend.

00:21:08.512 --> 00:21:12.982
Yeah. I like how you're kind of testing along this entire... It sounds like it's testing along this,

00:21:13.052 --> 00:21:18.412
or assessing along this entire spectrum of, uh, hey, this is, like, on the table constrained,

00:21:19.052 --> 00:21:24.112
like very constrained environment, and now we're getting into maybe some other positions that are, you know, s- more, maybe

00:21:24.121 --> 00:21:30.112
more, quote, "specific" to soccer or relevant to maybe soccer. And just, like, all those provide opportunities to

00:21:30.192 --> 00:21:33.012
demonstrate or display and exhibit different types of strength,

00:21:33.092 --> 00:21:37.952
I guess. Yeah, absolutely. And it's, it's not even just the idea of short or long lever,

00:21:38.012 --> 00:21:42.792
but also the joint angles that you're at too. Yeah. Right? So the adductors, different fibers will contract more or

00:21:42.832 --> 00:21:46.002
less with more hip- flexion that you're in versus more hip extension that

00:21:46.032 --> 00:21:46.132
you're

00:21:46.192 --> 00:21:51.162
in. Um, so, you know, when, if you're in a short lever position, you know, we're testing whether

00:21:51.192 --> 00:21:54.121
it's at 30, 40, 50, 60 degrees of hip flexion,

00:21:54.592 --> 00:21:59.922
it would, obviously will change, could change, um, the strength numbers you get. And also, if somebody has,

00:22:00.072 --> 00:22:00.212
coming

00:22:00.272 --> 00:22:00.882
back from an injury,

00:22:01.352 --> 00:22:06.512
it could change whether or not you can reproduce or provocate their pain.

00:22:06.632 --> 00:22:12.232
Um, you know, sometimes someone will have no pain in long lever at zero, but someone will have discomfort

00:22:12.252 --> 00:22:14.092
at 40 or 50 degrees of hip flexion when

00:22:14.112 --> 00:22:16.112
they squeeze. So, it really depends.

00:22:17.472 --> 00:22:21.061
Okay. So now for you, if you're able to identify that, and thank you for letting

00:22:21.092 --> 00:22:22.092
me just continue to go

00:22:22.102 --> 00:22:23.012
on this. Yeah,

00:22:23.012 --> 00:22:24.812
no. It's good. Uh, a- a- it, so

00:22:25.032 --> 00:22:28.252
now if you're able to identify, hey, at this 45

00:22:28.272 --> 00:22:31.222
degrees, your priority then becomes,

00:22:31.752 --> 00:22:34.372
uh, tell me what your priorities become, actually.

00:22:34.572 --> 00:22:38.132
Uh, do you take them into the weight room now? Is this something that you're working on manually?

00:22:38.192 --> 00:22:38.272
Is

00:22:38.292 --> 00:22:40.391
this something you're like, "Hey, we're, we're experiencing

00:22:40.432 --> 00:22:43.032
now, not just like discomfort, we're experiencing some pain here."

00:22:43.432 --> 00:22:45.892
What's the next step for you? Mm. Is that, hey, let's get them

00:22:46.032 --> 00:22:49.952
to an angle that is similar to that or what they can tolerate and build out from there?

00:22:50.072 --> 00:22:50.152
How

00:22:50.192 --> 00:22:54.012
do you approach that? Yeah. So now we're getting into the idea,

00:22:54.072 --> 00:22:56.332
like, just principle, principles of rehabilitation,

00:22:56.692 --> 00:22:59.172
uh, and tissue healing timelines and things of that nature,

00:22:59.212 --> 00:23:03.672
and, you know, always circling back to what's the severity or grade of the injury, right? What's the amount of

00:23:03.732 --> 00:23:07.912
tissue that's involved? Uh, if they did und- you know, let's say the athlete w- has

00:23:08.052 --> 00:23:12.292
a, you know, an adductor strain, um, of adductor longus. You know, it, it's,

00:23:13.012 --> 00:23:16.092
it really depends on what the severity of that is, you know, how long

00:23:16.132 --> 00:23:21.132
we need to give, um, in time to start loading that tissue, uh, in an appropriate and safe

00:23:21.172 --> 00:23:21.372
way.

00:23:22.012 --> 00:23:28.252
Um, you know, so starting in a more controlled, constrained environment on the table and then eventually, you know, transitioning

00:23:28.292 --> 00:23:29.992
into the weight room, or even getting into the weight room

00:23:30.072 --> 00:23:36.732
early, uh, but starting to, uh, do things that are, are a little safer at first, such as starting with

00:23:36.812 --> 00:23:38.092
isometrics as we start to-

00:23:38.092 --> 00:23:38.962
Right ... reload that

00:23:39.012 --> 00:23:41.072
tissue. Uh, and we're targeting...

00:23:41.752 --> 00:23:44.252
If that's the only joint angle that they have discomfort

00:23:44.312 --> 00:23:51.812
at, we're targeting that to try to reload that tissue, remodel the collagen, get to, um, develop strength and resiliency

00:23:51.912 --> 00:23:53.292
within that

00:23:53.372 --> 00:23:56.132
range. So eventually, as we retest,

00:23:56.692 --> 00:24:03.152
let's say we're doing a groin squeeze at 45 degrees of hip flexion, short lever, they have pain-In

00:24:03.252 --> 00:24:05.052
seven to 10 days, the next time we

00:24:05.092 --> 00:24:05.672
test them,

00:24:06.272 --> 00:24:09.972
you know, their pain goes down from a five out of 10 to a two out of 10 at the

00:24:10.012 --> 00:24:11.992
same joint range, and then seven days later they have zero

00:24:12.012 --> 00:24:17.051
out of 10 pain. You know, we're objectively tracking that over time and seeing their progress change.

00:24:17.592 --> 00:24:17.872
And

00:24:18.612 --> 00:24:23.572
if they felt the two out of 10 pain at 250 newtons, but now they're reaching 350

00:24:23.592 --> 00:24:25.072
newtons and they feel zero out of 10 pain,

00:24:25.532 --> 00:24:30.082
you know, you know that tissue's responding well and, you know, it may be time to start doing

00:24:30.092 --> 00:24:36.472
different types of exercises, loading the tissue differently, starting to move heavier loads through concentric and eccentric patterns,

00:24:36.512 --> 00:24:38.012
you know, things of that nature.

00:24:38.012 --> 00:24:40.982
Um, so it's, uh, you know, that, that's kind of

00:24:41.012 --> 00:24:47.012
what, you know, from a soft tissue rehabilitation standpoint, kind of thinking through that lens and, uh, through those

00:24:47.032 --> 00:24:52.172
buckets. Right. Thank you for that. It's awesome. I mean, some great stuff right there to start off.

00:24:52.232 --> 00:24:55.002
And, um, you mentioned just a second ago

00:24:55.052 --> 00:24:59.052
again this return to play continuum. So I'm gonna ask you to speak on that a little bit. How

00:24:59.092 --> 00:25:02.292
do you see and segment the return to play continuum?

00:25:05.952 --> 00:25:06.192
Yeah.

00:25:06.272 --> 00:25:06.552
So

00:25:08.252 --> 00:25:13.072
athlete gets hurt, uh, something's going on. Obviously it depends on what the injury is,

00:25:13.192 --> 00:25:16.232
but you know, whether it's surgical, non-surgical,

00:25:16.752 --> 00:25:19.072
uh, somebody needs to go from a point A to point

00:25:19.152 --> 00:25:20.312
B, almost

00:25:20.372 --> 00:25:24.962
like a, like a reverse engineering type of thing, right? So who is this athlete?

00:25:25.122 --> 00:25:28.152
What's their position, right? What are their demands on the field?

00:25:28.972 --> 00:25:30.252
Uh, what do they need to do

00:25:30.292 --> 00:25:36.092
from a power strength development standpoint? What do they need to do, uh, from a performance standpoint that makes

00:25:36.132 --> 00:25:37.062
them good at what they do?

00:25:37.752 --> 00:25:44.142
Mm-hmm. And then working backwards in time from, you know, whatever point in time is, is discussed upon with

00:25:44.192 --> 00:25:46.222
the medical team, with the physicians,

00:25:46.332 --> 00:25:49.052
with, uh, the coaching staff, and everybody coming to

00:25:49.092 --> 00:25:51.132
a consensus on this is an appropriate,

00:25:51.512 --> 00:25:53.112
you know, initial timetable.

00:25:53.532 --> 00:25:54.032
Um, I'm saying

00:25:54.072 --> 00:25:58.012
initial because, you know, things fluctuate and are fluid and things change in rehab

00:25:58.052 --> 00:25:58.972
continuums. But,

00:25:59.552 --> 00:26:02.332
um, finding an endpoint and, and we're reverse engineering

00:26:02.392 --> 00:26:06.092
from there. Uh, and, and progressing the athlete, uh, when,

00:26:06.672 --> 00:26:13.152
you know, objectively we're monitoring and seeing progress and seeing benchmarks and criterion, and we're checking boxes along the way

00:26:13.212 --> 00:26:15.072
from phase to phase and, you know, from

00:26:15.092 --> 00:26:20.372
a, a table-based phase to a gym-based phase to a field-based phase or an integrated

00:26:20.432 --> 00:26:23.012
phase between the gym and the field. And then eventually,

00:26:23.372 --> 00:26:24.972
you know, getting into more positional work

00:26:25.012 --> 00:26:31.032
and, and back into partial team trainings and full team trainings and, and moving on that sliding scale and,

00:26:31.132 --> 00:26:33.012
and adapting as you need to and speeding

00:26:33.072 --> 00:26:38.012
up or slowing down, uh, you know, when we feel is necessary. And obviously, um, this

00:26:38.072 --> 00:26:42.162
is a, it's a joint effort rather than just a, an individual practitioner effort when,

00:26:43.072 --> 00:26:44.952
um, an athlete's moving from that point A to

00:26:45.012 --> 00:26:51.212
point B. Yeah, no question. Um, can you speak on that a little bit of what that kind of collaboration

00:26:51.272 --> 00:26:53.232
like has been, either with your experiences now or previous

00:26:53.292 --> 00:26:59.052
experiences helping that athlete back in with the strength conditioning personnel and then eventually back into sport

00:26:59.072 --> 00:26:59.932
with the sport coaches?

00:27:01.372 --> 00:27:02.092
Yeah. And

00:27:02.472 --> 00:27:03.092
you know, I've been,

00:27:03.592 --> 00:27:05.072
I've been fortunate enough in my career

00:27:05.472 --> 00:27:06.492
between EXOS,

00:27:06.912 --> 00:27:07.132
uh,

00:27:07.632 --> 00:27:08.192
DC United,

00:27:08.212 --> 00:27:11.052
and up until now, obviously until from UCLA back

00:27:11.092 --> 00:27:11.892
during my fellowship,

00:27:12.512 --> 00:27:15.152
um, you know, having the, the

00:27:15.572 --> 00:27:19.152
different disciplines, multiple disciplines under one roof and, and working together.

00:27:19.772 --> 00:27:20.972
Uh, I've been lucky enough to

00:27:21.012 --> 00:27:23.212
be able to work with

00:27:23.672 --> 00:27:25.492
different practitioners and different professionals

00:27:26.372 --> 00:27:29.312
in different phases and transitioning into different phases and,

00:27:29.392 --> 00:27:31.052
um, you know, getting ideas from

00:27:31.092 --> 00:27:35.012
one another and, uh, and it's really about the communication and, you know,

00:27:35.532 --> 00:27:40.092
uh, if somebody's in an early phase understanding that they certainly can be working with a strength

00:27:40.112 --> 00:27:41.021
and conditioning coach on

00:27:41.072 --> 00:27:44.052
conditioning, uh, that's appropriate for them. You know, if they

00:27:44.112 --> 00:27:48.052
have a lower body injury that they can't really tolerate a lower extremity conditioning

00:27:48.312 --> 00:27:48.882
activity,

00:27:49.372 --> 00:27:53.312
right? Utilizing upper body conditioning, right? Doing an upper body HIIT circuit or doing,

00:27:53.772 --> 00:27:54.032
um,

00:27:54.352 --> 00:27:56.512
something that can, can stimulate their cardiovascular

00:27:56.552 --> 00:28:04.712
system. Now I'm just giving ideas of how, uh, each professional is integrated throughout the different processes and specifically our

00:28:04.732 --> 00:28:06.432
performance and strength conditioning coaches.

00:28:07.032 --> 00:28:08.002
Um, and

00:28:08.132 --> 00:28:12.092
you know, really just being on the same page of what the boxes we have to check are

00:28:12.132 --> 00:28:13.832
to get to the next phase and, and

00:28:14.132 --> 00:28:19.012
what the, the goals are for that phase and, uh, what each person is

00:28:19.032 --> 00:28:22.232
working on. Um, so it's, uh, it's certainly a team effort

00:28:22.292 --> 00:28:27.002
and it's, it's a lot more of an in-depth question that we can continue to speak onto, and

00:28:27.012 --> 00:28:31.112
there are papers written about this kind of stuff, so it's, it's a really cool topic and

00:28:31.152 --> 00:28:35.912
something cool to be a part of. Right. Well, we see the term high performance model, right? Every sport now,

00:28:35.992 --> 00:28:39.052
every sport organization wants to adopt a high performance

00:28:39.112 --> 00:28:43.852
model and just got back from a conference last week ago. The, you know, Los Angeles Clippers were there, Maggie

00:28:43.872 --> 00:28:48.092
Bryant, uh, who's over there. She did a terrific job just talking about her stages of return

00:28:48.112 --> 00:28:52.062
to play and mirrored a lot of the same things that you had just said, right? These early stage conditioning,

00:28:52.132 --> 00:28:56.622
okay, what's appropriate? What can we tolerate? So it's nice to hear that, but really the, the main theme that

00:28:56.712 --> 00:29:02.022
always finds its way to the top and the word that is always used is communication, and you said

00:29:02.052 --> 00:29:08.092
it yourself. Uh, it, it kind of starts and ends with communicating at a high level, and that's everybody that's

00:29:08.132 --> 00:29:10.052
involved. Yeah.

00:29:10.472 --> 00:29:11.052
And it's,

00:29:11.732 --> 00:29:12.992
it's communicating, especially

00:29:13.052 --> 00:29:13.312
with,

00:29:13.692 --> 00:29:19.072
with a lot of people in the room who are important to the process. So everybody's hearing the same

00:29:19.092 --> 00:29:22.072
messages. We're all here, we're all communicating the same language,

00:29:22.632 --> 00:29:23.232
and

00:29:23.712 --> 00:29:29.032
thus we're all help... able to help the athlete with the same objective and goal and narrative in mind.

00:29:29.572 --> 00:29:32.092
Um, and I think it's, I mean, it, it goes without being said and

00:29:33.652 --> 00:29:35.172
s- I can certainly say,

00:29:35.202 --> 00:29:38.212
you know, early in my career I thought I knew what communication was,

00:29:38.792 --> 00:29:44.072
uh, but as I've moved forward through my career and have just had different experiences and met

00:29:44.092 --> 00:29:45.232
different people, I can definitely,

00:29:45.792 --> 00:29:48.972
I have a different view of what communication is versus, now versus what I

00:29:49.012 --> 00:29:49.592
did back then.

00:29:50.192 --> 00:29:52.332
Um, so it is certainly important.

00:29:53.172 --> 00:29:57.002
Is that more of a general statement or is, like, there are some things that you really like, concrete things

00:29:57.052 --> 00:30:00.152
you're thinking about or like, no, this is actually true- It's more of a gen- Yeah. It's

00:30:00.392 --> 00:30:06.432
more of, more of a general statement. Right. More of a general statement to really just understand the intricacies and

00:30:06.652 --> 00:30:10.092
the, the important points to continue to touch on-

00:30:10.492 --> 00:30:13.032
Mm-hmm ... uh, when communicating through these processes and not letting

00:30:13.052 --> 00:30:17.864
things slip through the cracks. Right. Absolutely. And I think, uh, we, we had Scott Morrison on a few weeks

00:30:17.924 --> 00:30:21.003
ago talking about tactical populations and what that was like.

00:30:21.424 --> 00:30:23.264
One of the things he had mentioned was also

00:30:24.024 --> 00:30:28.884
allowing the athlete to be a part of that process. We talked so much in high performance about,

00:30:29.004 --> 00:30:34.004
uh, the coaches, sport coaches, the ATs, everybody being on the same page, and sometimes it feels like people forget

00:30:34.024 --> 00:30:35.084
about the actual athlete.

00:30:36.064 --> 00:30:36.344
Mm-hmm.

00:30:36.764 --> 00:30:36.884
Yeah,

00:30:37.164 --> 00:30:37.664
absolutely.

00:30:39.124 --> 00:30:43.084
So, um, I'd like to go back to that kind of collection of

00:30:43.704 --> 00:30:47.174
quantitative data here for a second and maybe bring in some other

00:30:47.204 --> 00:30:49.074
pieces, um, things

00:30:50.704 --> 00:30:50.924
such

00:30:51.024 --> 00:30:52.424
as, uh,

00:30:52.424 --> 00:30:58.024
monitoring, right, training loads, maybe loads on the field, on the pitch field, uh, whichever term you'd like

00:30:58.044 --> 00:30:58.544
to use there.

00:30:58.544 --> 00:31:03.084
Mm-hmm. What tools do you lean into for meaningful data that helps the organization

00:31:03.164 --> 00:31:07.964
make data-informed decisions that are on top of those kind of assessments that we already

00:31:08.064 --> 00:31:11.144
talked about? Yeah. And I mean,

00:31:12.344 --> 00:31:14.224
this boils, this comes down to,

00:31:14.644 --> 00:31:14.684
you

00:31:14.704 --> 00:31:17.024
know, we're using the things that we

00:31:17.044 --> 00:31:21.224
were talking about, which are, you know, more in the weight room, um-

00:31:21.544 --> 00:31:25.044
Mm-hmm ... you know, our objective monitoring strength and power deficits, things of that nature.

00:31:25.064 --> 00:31:29.984
But on the field, I mean, there are multiple things that you can use, um,

00:31:29.984 --> 00:31:34.224
a- and we're talking about internal and external load metrics, right? So

00:31:34.644 --> 00:31:40.064
the difference between internal and external load, we're thinking about, right, stress and strain on the body internally,

00:31:40.104 --> 00:31:44.604
and, and specifically we're talking about heart rate monitoring and heart rate- Mm-hmm ... zones and, and how our, our

00:31:44.644 --> 00:31:47.064
athletes are responding with heart rate variability and such of that

00:31:47.124 --> 00:31:47.504
nature.

00:31:48.104 --> 00:31:49.944
Um, and also external load

00:31:50.004 --> 00:31:50.484
monitoring,

00:31:51.004 --> 00:31:55.044
uh, from whether it's a GPS system or an LPS system. Um,

00:31:55.124 --> 00:32:03.004
I've, I've had the privilege of utilizing both and really understanding, um, how to utilize these external load metrics to

00:32:03.084 --> 00:32:04.144
track our return to play

00:32:04.224 --> 00:32:08.024
processes and, and to periodize athletes and, and make sure

00:32:08.044 --> 00:32:13.364
that they're, you know, hitting numbers and hitting different, uh,

00:32:13.864 --> 00:32:19.264
loads and stresses on the body that they need to, to continue adaptations to take place and to,

00:32:19.284 --> 00:32:24.964
you know, hopefully advance their, uh, their robustness and resiliency, e- especially as the season goes on, 'cause

00:32:25.003 --> 00:32:25.924
seasons can be long.

00:32:26.664 --> 00:32:29.164
Um, you know, there are other things such as 1080 sprint.

00:32:29.564 --> 00:32:32.024
Uh, there are timing gates that we can use, right? So there are different things

00:32:32.184 --> 00:32:34.244
on the field, uh, that you can certainly

00:32:34.324 --> 00:32:40.174
track, um, athlete's progress, but also track performance metrics too, um, and the health of population.

00:32:41.324 --> 00:32:45.204
Yeah. I think obviously it's, you know, I, I've spent a long time as a training and conditioning coach,

00:32:45.704 --> 00:32:46.724
and early on

00:32:47.024 --> 00:32:48.004
in my years, I

00:32:49.444 --> 00:32:54.084
would say it this way, I didn't fully appreciate the fact that these were athletes that

00:32:54.104 --> 00:32:54.984
were there to play their

00:32:55.004 --> 00:32:57.964
sport, and not athletes that were there

00:32:58.064 --> 00:32:59.954
to see me and train in the

00:33:00.004 --> 00:33:00.524
weight room.

00:33:01.104 --> 00:33:03.104
Uh. Yeah.

00:33:03.204 --> 00:33:03.604
And it's,

00:33:04.084 --> 00:33:06.184
yeah, it's, it's to play the sport

00:33:06.204 --> 00:33:08.024
and with those

00:33:08.084 --> 00:33:08.764
tracking,

00:33:09.284 --> 00:33:11.124
um, whichever modality

00:33:11.204 --> 00:33:15.964
is used, being as specific as possible to that athlete in their

00:33:16.004 --> 00:33:18.164
position, right? What does a,

00:33:18.624 --> 00:33:21.044
you know, a center back need to do that's different from a

00:33:21.144 --> 00:33:21.624
striker

00:33:22.064 --> 00:33:24.064
or a 10, um, or someone

00:33:24.264 --> 00:33:28.194
more, you know, at a six position, so in the midfield, more in the defensive side?

00:33:28.664 --> 00:33:33.974
Uh, what does a winger have to do differently than a keeper? Right. So, you know, there are different

00:33:34.104 --> 00:33:39.064
speeds they travel at, different distances they travel, different times, you know, the amount of times they change direction at

00:33:39.144 --> 00:33:41.124
a, a higher or lower magnitude. And

00:33:41.904 --> 00:33:46.864
being able to specify to that athlete the, you know, to the best of our ability is,

00:33:47.024 --> 00:33:49.044
uh, hopefully sets us up for a success,

00:33:49.604 --> 00:33:52.084
um, with the athletes moving forward in rehab or,

00:33:52.624 --> 00:33:54.054
um, on the field with performance throughout

00:33:54.104 --> 00:33:55.984
the week. Yeah. I mean, I like you're,

00:33:56.124 --> 00:33:56.984
you're like, "Hey, let's,

00:33:58.004 --> 00:34:04.924
um, reduce this down. Let's get more granular with it. Like, what does this actually look like from this position?"

00:34:05.044 --> 00:34:07.944
And, uh, that's the only reason I mention, you know, my previous

00:34:08.004 --> 00:34:10.063
experience there is I looked at it more globally.

00:34:10.103 --> 00:34:15.813
Like, hey, I work with baseball, rotational power is important. Hey, coach says running from, you know, making rounds at

00:34:15.824 --> 00:34:16.984
third base is really important. We gotta

00:34:17.024 --> 00:34:21.034
be really good at that. It's like, hang on, let's stop for a second. Like, who needs to be really

00:34:21.063 --> 00:34:26.884
good at that? Who is good at that? Who isn't? And then also, like, what does that actually look like?

00:34:26.944 --> 00:34:29.984
Okay, cool, we're talking about curve linear. Like, what sort of standards do we

00:34:30.024 --> 00:34:34.944
have? Like, creating operational definitions, which is kinda sounded like you were talking to or at least alluding

00:34:35.004 --> 00:34:38.164
to, is really helps sets you up for success moving

00:34:38.224 --> 00:34:38.683
forward.

00:34:40.083 --> 00:34:42.244
Um. Yeah. Yeah. And that's,

00:34:42.384 --> 00:34:43.884
uh, you know, like I said,

00:34:44.043 --> 00:34:48.504
in that, in that continuum, going back to the original question of point A to point B and- Mm-hmm ...

00:34:48.504 --> 00:34:51.964
reverse engineering return to play, is really understanding what that athlete needs to work

00:34:52.024 --> 00:34:57.004
towards, uh, at that endpoint, and then- Mm-hmm ... you know, identifying, okay, this is

00:34:57.324 --> 00:34:58.064
where they're at. Is that

00:34:58.104 --> 00:34:58.564
good enough?

00:34:59.564 --> 00:35:03.104
I don't know. Um, but we know that this is typically where they're at, and

00:35:03.164 --> 00:35:06.024
we can, you know, have good discussions about where we want them to

00:35:06.044 --> 00:35:12.514
get at the end. Yeah. And the nice part about the, you know, having a common operating definition is that

00:35:12.544 --> 00:35:16.004
then it goes back to that piece of communication between disciplines, like we just talked

00:35:16.044 --> 00:35:20.144
about. Like, okay, cool- Mm-hmm ... we're all on the same page about what this actually looks

00:35:20.164 --> 00:35:20.884
like and what this actually

00:35:21.084 --> 00:35:25.014
is. Now we can all work towards that, right? Now we can all reverse engineer in

00:35:25.044 --> 00:35:26.114
the right manner, in the right

00:35:26.144 --> 00:35:30.894
way together to get to where we need this athlete to get to. So, uh, you know, appreciate that, and

00:35:30.924 --> 00:35:32.014
it's nice to hear,

00:35:32.174 --> 00:35:36.104
uh, from you. So if you're, if you're willing to right here, I would love to kind of roll

00:35:36.144 --> 00:35:37.244
up our sleeves in a sense,

00:35:37.624 --> 00:35:44.074
um, and discuss maybe some hypothetical situations. I have two here. I'm just curious to know how you'd

00:35:44.104 --> 00:35:44.974
approach this.

00:35:45.164 --> 00:35:45.734
Very general.

00:35:46.424 --> 00:35:50.604
Um, but let's say athletes dealing with two different types of injury, obviously a soccer athlete.

00:35:50.724 --> 00:35:52.724
Um, soccer professional,

00:35:53.024 --> 00:35:57.224
24, male, no previous pathologies, no significant injuries previously.

00:35:57.254 --> 00:36:00.224
He's a striker. Uh, blows out his right hamstring chasing

00:36:00.264 --> 00:36:04.024
down a ball, right? So he goes down, he can get up. You're at, you know, you're at the

00:36:04.064 --> 00:36:09.084
match. Limps off the field, but it doesn't appear that this is really minor. It's not, like, really a day-to-day.

00:36:09.144 --> 00:36:14.894
How do you approach these early stages of the continuum up until performance? Right. You see that right away, and

00:36:14.924 --> 00:36:20.054
now your head starts thinking, "Okay, what's this process gonna look like? Hamstring." What, what... Kind of

00:36:20.064 --> 00:36:25.024
where do you start? Yeah, I mean, it all starts on the

00:36:25.064 --> 00:36:32.704
field. Uh, you know, primary responders, right, typically are athletic trainers on staff and, um, you know, in, in any

00:36:32.744 --> 00:36:37.244
sport- sporting setting for soccer, you know, athletic trainer will run on, assess the injury acutely,

00:36:37.764 --> 00:36:40.984
and moving forward into our diagnostics and determining the

00:36:41.024 --> 00:36:44.044
severity of the injury, uh, the location in the hamstring tissue,

00:36:44.084 --> 00:36:44.744
the size of it,

00:36:45.344 --> 00:36:49.974
um, you know, what tissue's involved. Is this, uh, more of a myofascial injury?

00:36:50.024 --> 00:36:54.204
Is this more in the, the central tendon? Is this more of a musculotendinous junction injury?

00:36:54.744 --> 00:36:55.824
Uh, so identifying the

00:36:56.024 --> 00:36:57.024
spot on

00:36:57.084 --> 00:36:59.424
the hamstring, uh, proximal or distal.

00:37:00.024 --> 00:37:00.284
Mm-hmm.

00:37:00.804 --> 00:37:01.744
And then when you have all

00:37:02.044 --> 00:37:05.124
the, the pieces of information you need to know and identify,

00:37:05.644 --> 00:37:11.004
you know, beginning to then, you know, progress the athlete forward through a rehab continuum, especially in that

00:37:11.044 --> 00:37:13.064
acute phase, um, you know,

00:37:13.404 --> 00:37:14.824
through our subacute phase,

00:37:15.004 --> 00:37:20.224
getting them eventually back, you know, into the, the weight room, moving through space in the weight room, moving

00:37:20.264 --> 00:37:23.194
in the gym, moving on the field, and then eventually,

00:37:23.684 --> 00:37:23.814
um,

00:37:24.404 --> 00:37:27.154
you know, into soccer-specific activities,

00:37:28.164 --> 00:37:32.954
position-specific activities, and then back into team training. So a very 10,000-foot view of

00:37:33.024 --> 00:37:34.244
it, um,

00:37:34.584 --> 00:37:34.804
from,

00:37:35.144 --> 00:37:35.184
you

00:37:35.204 --> 00:37:36.064
know, beginning

00:37:36.124 --> 00:37:36.954
to end. But then,

00:37:37.424 --> 00:37:39.164
you know, getting a little more,

00:37:39.524 --> 00:37:40.084
uh, under

00:37:40.124 --> 00:37:47.964
a microscope. Loading tissue when it's appropriate really boils down to understanding tissue healing timelines, right? So

00:37:48.004 --> 00:37:51.244
we're dealing with a soft tissue injury, and we want to understand how that tissue's

00:37:51.304 --> 00:37:55.204
gonna heal, how the collagen is gonna tack down and scar down and eventually

00:37:55.224 --> 00:37:58.984
mature over time, and what those timeframes look like and those windows

00:37:59.024 --> 00:37:59.524
of time.

00:38:00.124 --> 00:38:04.644
Um, and our loading principles, right? Starting with a, right, an isometric

00:38:05.364 --> 00:38:07.444
into a slower concentric,

00:38:08.024 --> 00:38:12.244
uh, and then eventually moving into eccentrics and, you know, back into,

00:38:13.364 --> 00:38:18.004
as they're moving forward, into other types of athletic movements with plyometric and

00:38:18.064 --> 00:38:18.644
ballistics.

00:38:19.264 --> 00:38:22.064
Um, so yeah, it's, uh...

00:38:22.444 --> 00:38:22.924
You can-- we can

00:38:23.044 --> 00:38:27.164
spend the entire episode talking about different points of the hamstring,

00:38:27.784 --> 00:38:35.024
um, rehabilitation from beginning to end, but trying to best summarize it, uh, for you and the listeners so

00:38:35.104 --> 00:38:36.184
I don't get too lost-

00:38:36.184 --> 00:38:39.944
... uh, in my words, 'cause I can te- I can tend to go down rabbit holes

00:38:40.024 --> 00:38:44.274
and- Sure ... um, get too stuck in the beginning phases or too stuck in the middle phases.

00:38:44.904 --> 00:38:44.914
Um,

00:38:45.544 --> 00:38:48.114
but just know that these are, these are being tracked over

00:38:48.244 --> 00:38:50.044
time. When it's appropriate to strength

00:38:50.084 --> 00:38:53.024
test them up to pain thresholds, we're looking at, like we said

00:38:53.064 --> 00:38:55.984
about the adductor, right, we're looking at isometric strength

00:38:56.044 --> 00:38:59.984
of the hamstring. We're looking at how many newtons of force or how much force they're putting

00:39:00.024 --> 00:39:01.224
into it at that point in time,

00:39:01.944 --> 00:39:03.144
where they light up their pain,

00:39:03.584 --> 00:39:05.084
tracking that over time, seeing as

00:39:05.124 --> 00:39:08.044
that gets better. Um, you know, so we're tracking strength.

00:39:08.684 --> 00:39:10.104
Uh, we're tra- And then also,

00:39:10.224 --> 00:39:12.304
you know, come back to the acute phase.

00:39:12.864 --> 00:39:14.183
Uh, you know, we're working on

00:39:14.544 --> 00:39:15.933
other areas of the body that,

00:39:16.104 --> 00:39:17.324
you know, potentially

00:39:17.364 --> 00:39:21.084
need work, right? So how is their T-spine moving, right? How is their

00:39:21.124 --> 00:39:24.024
hip rotation? How is their ankle dorsiflexion or their foot

00:39:24.084 --> 00:39:28.364
function? Um, you know, things that we can work on. Maybe we can't load their hamstrings

00:39:28.504 --> 00:39:30.064
early, but

00:39:30.124 --> 00:39:34.224
we can work on global movement. in general to potentially

00:39:34.344 --> 00:39:39.224
optimize how well their hamstrings can respond from a neuromuscular standpoint,

00:39:39.724 --> 00:39:41.144
um, and feed into that tissue.

00:39:41.244 --> 00:39:41.384
So,

00:39:42.004 --> 00:39:42.164
um,

00:39:43.544 --> 00:39:46.904
yeah, I, I really- ... like, went all over the board, but I,

00:39:47.024 --> 00:39:49.084
um... Any specific questions you have

00:39:49.124 --> 00:39:51.034
on that, yeah, throw it back

00:39:51.064 --> 00:39:53.984
at me. I will. I have one. Uh, but before I

00:39:54.064 --> 00:39:58.074
get to it, it's just, it's going back to what you were saying here with

00:39:59.304 --> 00:40:03.004
are there any other areas we need to work on? In my experience in working with athletes, those ones who

00:40:03.044 --> 00:40:03.144
are

00:40:03.184 --> 00:40:06.044
injured, okay, this is all contraindicated, you know, in this

00:40:06.054 --> 00:40:11.873
acute, you know, inflammatory phase. Just forget about this one area that's affected. Let's work on some other things. I've

00:40:11.904 --> 00:40:15.064
actually found that to be a really, been a great time to try to build, let's

00:40:15.074 --> 00:40:20.933
say, musculature or power or strength, like, in other areas, just because you have that huge drop-off in workload from

00:40:20.984 --> 00:40:21.084
the

00:40:21.124 --> 00:40:25.204
pitch or the field, and now they can allocate a lot of that energy and resources towards-

00:40:25.204 --> 00:40:27.304
Yeah ... developing other qualities.

00:40:28.424 --> 00:40:31.204
Absolutely. And right when we're talking about

00:40:32.084 --> 00:40:38.104
injury risk reduction for hamstring strains, right, we know hamstring... We know s- muscle strength is preventative for strains,

00:40:38.184 --> 00:40:39.004
right? That's something we do

00:40:39.044 --> 00:40:39.903
know through the literature.

00:40:40.564 --> 00:40:43.024
Um, I actually just, I literally just read a

00:40:43.064 --> 00:40:45.784
paper on this. Um, you know, there... And

00:40:46.044 --> 00:40:48.144
I mean, just there's, uh,

00:40:48.464 --> 00:40:51.044
a dearth and, like, a dense body of research to talk

00:40:51.084 --> 00:40:52.264
about, um,

00:40:53.104 --> 00:40:56.124
preventative means or r- risk reduction means for hamstring

00:40:56.864 --> 00:40:58.044
injuries subsequently.

00:40:58.184 --> 00:40:58.444
And

00:40:59.204 --> 00:41:01.244
core strength, pelvic control,

00:41:01.724 --> 00:41:04.084
things of that nature to also help with

00:41:04.724 --> 00:41:09.144
hamstring risk reduction or improve hamstring strength to help hamstrings function,

00:41:09.664 --> 00:41:13.224
uh, through space. Now, whether or not we can maintain a pelvic neutral while sprinting

00:41:13.244 --> 00:41:16.064
at max speed is another discussion and another topic.

00:41:16.064 --> 00:41:20.144
Right. Um, but the, the actual awareness of how to control

00:41:20.184 --> 00:41:24.004
their pelvis, especially in a controlled environment when they're building

00:41:24.104 --> 00:41:29.034
strength in the weight room. Let's say they're in their gym-based phase, and they're, they're really just in

00:41:29.104 --> 00:41:36.284
that, you know, 10 to 21-day window of a grade three, something that's a little longer of a timeline,

00:41:36.604 --> 00:41:40.144
right? They're really developing strength, but we're focusing on core

00:41:40.244 --> 00:41:42.424
strength, core control, pelvic control.

00:41:43.064 --> 00:41:44.074
While we're strengthening

00:41:44.084 --> 00:41:48.024
the hamstrings too, it can help that ischial tuberosity stay in a different position,

00:41:48.164 --> 00:41:50.214
so the hamstring can anchor a little differently,

00:41:51.424 --> 00:41:53.004
potentially grabbing on a little stronger

00:41:53.024 --> 00:41:57.154
with more force. So, you know, these are, these are really nice discussions to have- Yeah ... and cool points

00:41:57.184 --> 00:41:58.184
to talk about because

00:41:58.524 --> 00:42:00.084
it's talking just about global function

00:42:00.124 --> 00:42:02.344
and how, you know, the proximal tension

00:42:02.404 --> 00:42:06.224
really can impact how the distal, distal segment moves,

00:42:06.784 --> 00:42:09.164
um, or vice versa. So, um,

00:42:10.164 --> 00:42:17.104
yeah, it- good times to work on those beginning things in the acute phases, table work with pelvic control,

00:42:17.204 --> 00:42:18.124
standing work with pelvic

00:42:18.144 --> 00:42:20.024
control, kneeling with pelvic

00:42:20.064 --> 00:42:23.144
control, things that aren't gonna stress the hamstring tissue,

00:42:23.724 --> 00:42:25.084
um, but we can get a lot of bang for

00:42:25.104 --> 00:42:30.951
our buck later on. Right. So now you invited me to ask a little bit more about any certain spots.

00:42:31.012 --> 00:42:35.782
So I do have a question. Uh, you mentioned isometrics early on, right? Uh, subjecting them to, you know, when

00:42:35.812 --> 00:42:43.642
they can tolerate some early on isometric exercises. Um, potentially dependent on, like you mentioned, okay, where's the location of

00:42:43.672 --> 00:42:45.352
this? What's the severity,

00:42:45.412 --> 00:42:48.012
right? Um, but when addressing hamstrings and

00:42:48.072 --> 00:42:48.872
hamstring strains,

00:42:49.552 --> 00:42:54.092
uh, you're starting mostly in, like, vertical positions and challenging them. Is this first the table and then,

00:42:54.172 --> 00:43:00.502
you know, going into, hey, let's get you, like, into more of a vertical position to maybe perform an isometric,

00:43:00.612 --> 00:43:03.072
maybe a short lever isometric to start

00:43:03.152 --> 00:43:06.012
and then go from there. Kind of where's your starting point? Um,

00:43:06.072 --> 00:43:09.032
let's say either table, and then once they

00:43:09.052 --> 00:43:13.402
get off the table even. All of the above. Okay. I mean, let's ... You know, where- where can we

00:43:13.472 --> 00:43:16.192
challenge the athlete and- and do an isometric

00:43:16.272 --> 00:43:17.092
that's not

00:43:17.132 --> 00:43:19.022
irritable, that doesn't, it doesn't ... They don't

00:43:19.072 --> 00:43:21.312
feel pain with it. Uh, it's not provocating.

00:43:21.892 --> 00:43:22.272
Um,

00:43:22.972 --> 00:43:25.172
but it's- it's challenging the hamstring in different positions.

00:43:25.232 --> 00:43:29.072
So, right, to give you an idea, on the table, you know, you can have them lie in

00:43:29.112 --> 00:43:30.212
supine or on their back

00:43:30.671 --> 00:43:33.032
and bring- you bring their- your hip up to

00:43:33.752 --> 00:43:36.032
30 degrees, or you have them bend their knee a little bit and you

00:43:36.072 --> 00:43:38.032
have them just dig, gently dig- Yeah ... their heel

00:43:38.052 --> 00:43:42.672
into the table. Mm-hmm. Right? Or you bring them up to the hip to 90 degrees so it's a tabletop

00:43:42.752 --> 00:43:47.692
position- Mm-hmm ... and you have them just push their heel down gently into your thigh at, like, 30 or

00:43:47.752 --> 00:43:53.572
40% max effort. You know, something that's not provocating, but just enough to put some tension in the tissue. You

00:43:53.632 --> 00:43:55.062
have them lying in- in prone

00:43:55.192 --> 00:43:58.732
or on their stomach, and you can have them do it with their hip in an extended position, and they

00:43:58.792 --> 00:43:58.982
just

00:43:59.012 --> 00:44:03.732
bend their knee up, and you gently have them hold you there. And you can mo- play with the shin

00:44:03.812 --> 00:44:06.192
angle or the angle of the tibia to get different length

00:44:06.212 --> 00:44:09.532
on the tissue. And you'll find, obviously, that goes with our hamstring assessment.

00:44:09.912 --> 00:44:14.172
You know, these are the types of things that we're testing when we're seeing what the severity of the injury

00:44:14.252 --> 00:44:14.352
is,

00:44:14.412 --> 00:44:20.062
right? Maybe they don't have pain with their knee at 90 degrees, but maybe if we bring their

00:44:20.112 --> 00:44:22.232
knee to 30 degrees when the hamstring's more at length,

00:44:22.532 --> 00:44:25.992
that's when they get a little more provocation in the tissue. So maybe during the acute phases

00:44:26.032 --> 00:44:27.042
we'll spend a little more time with

00:44:27.072 --> 00:44:28.972
isometrics acute. You know,

00:44:29.092 --> 00:44:31.492
so, um, utilizing our clinical,

00:44:31.892 --> 00:44:32.192
um,

00:44:32.852 --> 00:44:37.252
you know, just our- our- our clinical thought process and reasoning behind why we're trying to do things.

00:44:37.792 --> 00:44:41.072
Uh, especially in the acute phase, we want things to calm down. We want the tissue to calm

00:44:41.132 --> 00:44:42.972
down, but also work around

00:44:43.032 --> 00:44:45.042
that, uh, and build up some resiliency

00:44:45.232 --> 00:44:49.112
and robustness. Right. Something else that I think is ... It just popped into my

00:44:49.132 --> 00:44:51.372
head- Mm-hmm ... uh, and the idea

00:44:51.592 --> 00:44:51.912
of,

00:44:52.452 --> 00:44:59.212
um, arthrokinetic inhibition or arthrogenic inhibition. Um, more so the idea

00:44:59.332 --> 00:45:01.032
of when you have an

00:45:01.072 --> 00:45:06.022
acute injury, right? Let's say ... I mean, this- this is really ... Arthrokinetic would be more for, like, a

00:45:06.152 --> 00:45:08.052
joint, like ACL

00:45:08.792 --> 00:45:12.172
tear. They have a huge joint effusion, sometimes meaning a joint swelling.

00:45:12.502 --> 00:45:14.952
Their knee's- Mm-hmm ... really puffy. Their quad can go to sleep. It's hard for them to

00:45:15.012 --> 00:45:15.132
turn

00:45:15.152 --> 00:45:20.852
their quad on. Mm-hmm. More so, there are- there is some evidence out there to talk about arthrogenic inhibition and

00:45:20.892 --> 00:45:25.172
with soft tissue injuries, muscle injuries because of the- the effusion that's around

00:45:25.232 --> 00:45:28.272
that area, that the motor cortex can down-regulate

00:45:28.432 --> 00:45:33.132
tissue neuromuscularly in that area, that the hamstring has a tough time firing or turning on again.

00:45:33.492 --> 00:45:34.912
So thinking about just

00:45:35.112 --> 00:45:44.102
pure activation of the muscle again in a unloaded and, you know, very basic way so they can feel

00:45:44.132 --> 00:45:44.552
it work,

00:45:46.152 --> 00:45:51.222
feel a burn in it, just feel tension in it. So something along those lines to get those motor pathways,

00:45:51.752 --> 00:45:56.072
right, from the brain down to the muscle again. So something else in that acute phase to keep in

00:45:56.132 --> 00:45:58.072
mind that really foundation

00:45:58.452 --> 00:46:00.092
of that, we want to maximize our motor unit

00:46:00.132 --> 00:46:02.232
potential within

00:46:02.312 --> 00:46:08.072
a, you know, unprovocating positions and things like that. And obviously, as they become more asymptomatic,

00:46:08.512 --> 00:46:09.432
working into,

00:46:09.772 --> 00:46:11.112
you know, some of those more provocated

00:46:11.192 --> 00:46:17.042
positions. Yeah, absolutely. And you mentioned one of the cues, digging the heel in. I found that

00:46:17.092 --> 00:46:22.172
to be, like, a great cue, especially for firing the hamstring. Even if it's a little bit. Like, hey, early

00:46:22.252 --> 00:46:23.072
on. And

00:46:23.852 --> 00:46:27.121
you have- Yeah ... you have your list. You have your check marks. Like, okay, they got this down,

00:46:27.212 --> 00:46:31.152
boom. No, fine. Hey, you got this down? Fine. Let's kinda keep going. What can they tolerate,

00:46:31.252 --> 00:46:33.092
right? And then how do they respond maybe over 24

00:46:33.132 --> 00:46:35.052
hours, and then come back and see. Yeah.

00:46:36.272 --> 00:46:36.382
Um,

00:46:36.872 --> 00:46:37.392
but

00:46:37.452 --> 00:46:42.012
the ... I- I totally, I agree with a lot of that. And I think, uh, getting them back to,

00:46:42.092 --> 00:46:46.182
right, what's the mechanim- what's the mechanism of injury, kind of that reverse engineering you were talking

00:46:46.212 --> 00:46:48.251
about. And then from, like, more of a movement

00:46:48.311 --> 00:46:54.352
standpoint, like, okay, cool. What positions can we put them in now? Okay, they've demonstrated that this bent knee position

00:46:54.372 --> 00:46:55.052
is fine. Can

00:46:55.112 --> 00:46:57.052
we maybe get them doing some

00:46:57.112 --> 00:47:03.872
slow walking, uh, or some wall marches from that same bent knee position, just holding that position isometrically, right?

00:47:04.032 --> 00:47:04.212
Like,

00:47:05.032 --> 00:47:08.112
um- Yeah, absolutely. And you bring up good points because that's,

00:47:08.832 --> 00:47:12.092
you know, those are the positions that they're gonna be in on the field. Let's say, you know, you're doing

00:47:12.152 --> 00:47:12.212
a

00:47:12.252 --> 00:47:13.972
wall march or a wall drill

00:47:14.032 --> 00:47:14.632
type of thing

00:47:15.152 --> 00:47:17.032
and, you know, you're progressing

00:47:17.092 --> 00:47:21.052
towards what's, what's very stressful for hamstrings on the field is

00:47:21.072 --> 00:47:26.112
sprint, right? So linear sprint. Typical, typical mechanism of injury for a soccer player is just a lin-

00:47:26.152 --> 00:47:31.072
straight up linear sprint. Right. Um, so, you know, w- we're working towards one of those check boxes at the

00:47:31.132 --> 00:47:33.452
end is can you sprint at max velocity?

00:47:34.032 --> 00:47:38.212
You know, can you, can you really open up and stride out? So it's, um,

00:47:38.592 --> 00:47:42.072
you know, starting with the foundations and the positions and patterns that you have to be in, like

00:47:42.132 --> 00:47:42.212
a

00:47:42.272 --> 00:47:42.872
wall march

00:47:43.172 --> 00:47:45.112
early on. Can you isometrically

00:47:45.132 --> 00:47:48.012
hold that position? Can you then move and undulate throughout

00:47:48.072 --> 00:47:49.092
it? Yeah.

00:47:49.912 --> 00:47:53.032
Can you do a load and lift? So one, you know, I don't know if you're familiar

00:47:53.072 --> 00:47:56.892
with any, you know, load and lift or, you know, switches at the wall- Yeah ... and any of your

00:47:56.952 --> 00:47:59.062
wall drill complexes you can do. Moving

00:47:59.062 --> 00:48:04.752
through those, and then eventually getting onto the field so you can, you know, do those and express those types

00:48:04.812 --> 00:48:09.032
of movements, but while moving through space. And it goes back to the initial question of how you view

00:48:09.042 --> 00:48:10.072
human movement. That's just how

00:48:10.082 --> 00:48:14.042
we move. Yeah. It's great to be able to tie that back in. And that's, that's kind of

00:48:14.052 --> 00:48:17.912
where my, that's kind of where my head is going is, like, hey, the earlier that you can subject these

00:48:17.932 --> 00:48:19.952
people to a- and these individuals,

00:48:20.132 --> 00:48:25.072
athletes to the movement that they need to get to and it's comfortable for them, they can handle it and

00:48:25.132 --> 00:48:25.712
tolerate it,

00:48:26.192 --> 00:48:28.124
the better. Yeah

00:48:28.124 --> 00:48:28.944
... you know, the better.

00:48:29.264 --> 00:48:29.444
So,

00:48:30.184 --> 00:48:30.964
uh, awesome.

00:48:31.024 --> 00:48:33.104
That was great. Could talk about that all

00:48:33.144 --> 00:48:33.384
day.

00:48:34.084 --> 00:48:34.304
Um,

00:48:35.104 --> 00:48:40.014
so my next question for you, in the intro we mentioned, and you had mentioned

00:48:40.044 --> 00:48:42.374
a few times now, you've had some early experiences

00:48:42.384 --> 00:48:47.094
at EXOS. Um, it was there you were able to get, uh, your hands on some Keiser equipment

00:48:47.984 --> 00:48:48.944
and start to really understand,

00:48:49.024 --> 00:48:51.224
experience kinda the benefits of pneumatics.

00:48:52.544 --> 00:48:52.964
You have a lot

00:48:53.024 --> 00:48:57.824
of old videos that you share, and at the end of the episode, for anyone listening, I'll make sure that

00:48:57.864 --> 00:48:59.264
we share your, uh, Instagram

00:48:59.304 --> 00:49:02.964
account. A lot of old videos from years and years of

00:49:03.004 --> 00:49:07.984
filming athletes, uh, on your Instagram. Can you shine a light on some of kind of why

00:49:08.024 --> 00:49:10.384
you've choose to use Keiser

00:49:10.984 --> 00:49:12.424
for a lot of your exercise prescription?

00:49:16.064 --> 00:49:17.924
Yeah. So, I mean, the, the facilities that

00:49:18.004 --> 00:49:19.004
I worked in, uh,

00:49:19.104 --> 00:49:21.004
with EXOS, they had Keiser

00:49:21.044 --> 00:49:21.704
there. So,

00:49:22.064 --> 00:49:25.184
um, being that I didn't necessarily choose

00:49:25.244 --> 00:49:29.944
it, and this is not just because I'm, I'm talking to someone who's with Keiser right now,

00:49:30.024 --> 00:49:30.944
but I probably would

00:49:31.024 --> 00:49:33.104
choose Keiser if I had the option.

00:49:33.684 --> 00:49:33.964
Um,

00:49:34.684 --> 00:49:37.964
just because the e- first of all, the ease of use is, they're super

00:49:38.024 --> 00:49:40.424
easy to use. Um, changing,

00:49:41.364 --> 00:49:42.004
and this is something

00:49:42.044 --> 00:49:47.044
that, I mean, I didn't, like, I had to even, like, just sit and think about for a little bit

00:49:47.084 --> 00:49:49.144
when I started using Keiser, I just took for granted, is

00:49:49.944 --> 00:49:54.144
just pressing the yellow button to go up or down in the middle of an exercise is super easy.

00:49:54.184 --> 00:49:54.464
Instead

00:49:54.504 --> 00:49:57.144
of racking the weight, taking the pin out, putting the pin back

00:49:57.224 --> 00:49:58.404
in, um,

00:49:59.784 --> 00:50:00.224
the weight's

00:50:00.304 --> 00:50:05.984
getting... Like, the pin not going in all the way, or the pin getting jostled loose. Or how many

00:50:06.064 --> 00:50:08.214
times, like, back in the day when,

00:50:09.384 --> 00:50:10.054
just, like, growing

00:50:10.064 --> 00:50:13.064
up, I would, I'd put the pin in and it wouldn't

00:50:13.444 --> 00:50:14.184
latch into

00:50:14.224 --> 00:50:19.164
the right position and, like, I went to pull on it and it would get stuck and I would break

00:50:19.624 --> 00:50:19.704
the

00:50:19.714 --> 00:50:24.024
machine. Um, sometimes the, you know, the cables getting off track and just

00:50:24.604 --> 00:50:28.164
things just, the ease of functionality and the efficiency

00:50:28.664 --> 00:50:32.224
is huge. And something as a physical therapist and a practitioner,

00:50:32.844 --> 00:50:33.424
especially,

00:50:34.184 --> 00:50:34.224
you

00:50:34.244 --> 00:50:38.064
know, it's a little different in, in the pro sports setting just 'cause we have the time and

00:50:38.604 --> 00:50:42.204
the resources. We, you know, I work with, sometimes work with the athlete seven days a week, so

00:50:42.224 --> 00:50:45.004
it's a little different. But when you're in an outpatient facility like I was

00:50:45.024 --> 00:50:50.024
in EXOS, seeing sometimes people two to three times a week. So your time with them is valuable and,

00:50:50.044 --> 00:50:54.424
and efficiency of your sessions, 'cause sometimes you only have an hour with a patient or- Mm-hmm ... in some

00:50:54.524 --> 00:50:56.084
settings 30 minute with a patient one-on-one.

00:50:56.544 --> 00:51:00.144
So you need to make sure you maximize the use of your time to down to the minute.

00:51:00.724 --> 00:51:07.364
Uh, so being able to easily bump up the weight, bump down the weight, not re-rack it. Is this too

00:51:07.424 --> 00:51:10.984
light? Okay, we can bump up the weight right away instead of racking, putting the pin in

00:51:11.024 --> 00:51:15.684
and out. Things add up. I mean, we're talking about seconds to minutes, but it could add up, and I

00:51:15.704 --> 00:51:16.033
think that's

00:51:16.084 --> 00:51:20.184
important from especially those settings that I was kinda mentioning before where

00:51:20.644 --> 00:51:21.184
time is

00:51:21.324 --> 00:51:24.264
of the essence. Um, so that, that's really important

00:51:24.324 --> 00:51:24.664
as well.

00:51:25.304 --> 00:51:28.084
Um, you know, there are other things with functionality of use,

00:51:28.144 --> 00:51:32.084
with just moving the resistance on the fly. I mean, like drop sets,

00:51:32.484 --> 00:51:32.873
like, just-

00:51:33.144 --> 00:51:37.044
Mm-hmm ... you know, moving starting with a higher weight and you're just going to

00:51:37.124 --> 00:51:40.364
failure. They can't go it that way and just slowly

00:51:40.404 --> 00:51:41.804
pressing, you know,

00:51:42.024 --> 00:51:44.984
the, the negative button and decreasing the amount of air

00:51:45.044 --> 00:51:47.884
pressure in there. It, it's, it's cool and it's nice

00:51:48.064 --> 00:51:48.524
and,

00:51:49.144 --> 00:51:51.004
um, it's definitely something you can't

00:51:51.124 --> 00:51:51.264
do

00:51:52.064 --> 00:51:56.044
with a, with your traditional rack and pin system. I don't even know what you would call

00:51:56.104 --> 00:51:56.854
that. Uh,

00:51:57.024 --> 00:51:57.964
is it a rack and pin?

00:51:59.064 --> 00:52:01.224
Uh, mass- Pin ... it's mass-based resistance.

00:52:01.844 --> 00:52:02.004
Yeah,

00:52:02.404 --> 00:52:03.364
mass-based resistance.

00:52:03.924 --> 00:52:05.304
Um, so, you know, it's,

00:52:06.104 --> 00:52:06.254
it's

00:52:06.304 --> 00:52:06.754
just different.

00:52:07.284 --> 00:52:13.224
It's just different. I, I've noticed in a lot of your videos, too, you implement the what's that strap or,

00:52:13.324 --> 00:52:16.104
uh, a vari- uh, iteration of that. I think that's the strap you're using.

00:52:16.104 --> 00:52:19.444
Yeah, it's a variation of the what's that strap. Some- something like, something like it. Right. Something like it. It's

00:52:19.564 --> 00:52:24.924
a rotational strap. Yes. Right. So for a lot of those, like, slow, controlled rotational movements, I'm, I'm... Like, anyone

00:52:24.964 --> 00:52:29.344
listening, you gotta go check out his page. You'll see exactly what we're talking about. Any of those, like, really

00:52:29.504 --> 00:52:34.684
slow, controlled movements or even the really violent movements that you have people performing maybe onto a box or jumping

00:52:34.744 --> 00:52:39.024
off of a low box and then into another position, um,

00:52:39.064 --> 00:52:40.964
you know, I think the

00:52:41.064 --> 00:52:42.964
smoothness and the

00:52:43.004 --> 00:52:46.064
consistent resistance I think

00:52:46.074 --> 00:52:53.184
provides- Yeah ... you the ability and, and the individuals the ability to actually perform those exercises, like, consistently and

00:52:53.224 --> 00:52:54.164
in a safer manner.

00:52:54.344 --> 00:52:58.864
Is that right? Absolutely. Yeah. And

00:53:00.684 --> 00:53:03.024
you know, when you're talking... I'm gonna, I'm gonna refer back to what you said,

00:53:03.064 --> 00:53:07.824
like, when you called it mass-based resistance. Like, the friction- Mm ... on those, I know that the machines are

00:53:07.864 --> 00:53:11.084
different and the, the way they're oiled up or the way they move

00:53:11.104 --> 00:53:13.044
on the pulleys. Like, sometimes you can get a

00:53:13.064 --> 00:53:17.404
hitch where something can be different in your resistance, and it's very consistent with pneumatics.

00:53:17.884 --> 00:53:20.104
Um- Yeah ... you're gonna get the same tension throughout.

00:53:20.284 --> 00:53:25.114
Uh, and especially with your violent movements, this is something that I didn't mention before, but,

00:53:25.924 --> 00:53:32.164
you know, the, the power output, the metric that's given where how, you know, how fast or how, how forcefully

00:53:32.184 --> 00:53:32.304
you're

00:53:32.324 --> 00:53:36.124
moving. You can get a number that pops on the screen to give you some sort of

00:53:36.764 --> 00:53:36.984
whether

00:53:37.024 --> 00:53:39.004
or not, you know, uh, whatever, you

00:53:39.044 --> 00:53:40.064
know, unit that's

00:53:40.164 --> 00:53:41.324
in. Um,

00:53:42.884 --> 00:53:43.074
being

00:53:43.124 --> 00:53:48.444
able to utilize that is something, "Okay, I want you to get over that number," whether or not, like, let's

00:53:48.464 --> 00:53:50.733
say 400 pops up on the screen. "Okay, get

00:53:51.004 --> 00:53:54.004
600. Move a little harder, quicker. Let's go."

00:53:54.384 --> 00:53:55.064
So something

00:53:55.564 --> 00:54:00.004
that the athlete can latch onto as well, and I think that's kinda cool and nice to see.

00:54:00.584 --> 00:54:01.084
Uh, and I know

00:54:01.104 --> 00:54:01.984
that, um,

00:54:02.684 --> 00:54:07.184
you know, those numbers have been used with multiple different, whether it's upper body or lower body.

00:54:07.704 --> 00:54:09.004
Um- Mm-hmm ... I've even utilized that

00:54:09.064 --> 00:54:09.964
with, uh,

00:54:11.284 --> 00:54:13.464
with some quad streaming rehabs.

00:54:13.784 --> 00:54:15.114
Like, how hard we're at, or like how

00:54:15.144 --> 00:54:18.104
hard can you kick, uh, and attaching a cable to their ankle

00:54:18.504 --> 00:54:19.024
and, like, really,

00:54:19.064 --> 00:54:21.144
like, "Okay, think about kicking with your laces,

00:54:21.784 --> 00:54:25.004
um, as fast as you possibly can. Like, go," and look at the number

00:54:25.044 --> 00:54:25.844
and see what they're at.

00:54:26.484 --> 00:54:30.044
Um, do they have pain with that? Do they not? Okay, they have pain at that number. Maybe we shouldn't

00:54:30.124 --> 00:54:33.116
hit that. Or-Their full systems go.

00:54:33.456 --> 00:54:37.156
Their kicking leg has a lot more than their plant leg, and things look good.

00:54:37.936 --> 00:54:41.046
I don't know. So just playing around- All right ... ideas of how to use it, but it's

00:54:41.046 --> 00:54:44.976
something else with the pneumatics too that, that was really nice to see and, and cool to

00:54:45.056 --> 00:54:48.896
use. Right. And obviously, that low inertia allows you to be able to do that,

00:54:49.056 --> 00:54:51.956
you know, both starting and then finishing with each, each

00:54:52.036 --> 00:54:54.276
part of the movement. Sure. So what's some of the feedback

00:54:54.416 --> 00:54:58.176
that, uh, has given to you from athletes when they use Keiser maybe, like, for the first time?

00:54:58.236 --> 00:55:01.716
Like, maybe they've never seen that before, and they get on it. Is it sometimes... You know, people see a

00:55:01.756 --> 00:55:01.956
cable

00:55:02.016 --> 00:55:02.956
stack and like, "Okay,

00:55:03.036 --> 00:55:06.056
cool. It's kinda like a cable stack." Is there any sort of feedback like, "Oh, this feels really

00:55:06.096 --> 00:55:08.336
good," or, um, uh, open-ended

00:55:08.396 --> 00:55:14.045
question. Yeah. So I think most of the feedback has been, "What is this?"

00:55:14.776 --> 00:55:18.956
Yeah. Uh, "I've never... I didn't know you can use air for resistance." Mm-hmm. And

00:55:19.016 --> 00:55:21.096
then being like, "Oh, that's pretty cool," and, and really

00:55:21.176 --> 00:55:23.516
just kinda enjoying what the exercise

00:55:23.596 --> 00:55:23.856
is.

00:55:24.396 --> 00:55:26.136
Um, you know, and, and

00:55:26.556 --> 00:55:27.116
identifying

00:55:27.156 --> 00:55:27.576
like, oh,

00:55:28.016 --> 00:55:31.216
you know, you need to rack it. Uh, and again, I'm gonna go back. Like, that's

00:55:31.256 --> 00:55:36.186
really the most, uh... 'cause I'm ask- constantly asking the question, is that easy, medium,

00:55:36.236 --> 00:55:39.156
or hard? 'Cause right, you know, I don't want things to be too easy at certain

00:55:39.196 --> 00:55:43.926
points in rehab. Um, so, you know, being on the fly and being able to adjust it right away, and

00:55:43.996 --> 00:55:48.136
people seeing like, oh, you can just do it in session. Um, so it was more so along

00:55:48.196 --> 00:55:51.136
those lines. Yeah. I gotta say, the leg press

00:55:51.856 --> 00:55:55.876
and the biaxial row that we have, not having to walk around a weight room and find

00:55:56.016 --> 00:56:00.916
45-pound plates, you know, and leaning... Like, y- you'll see- Yeah. ... traditional mass-based ones. They're just, they're leaning up

00:56:00.956 --> 00:56:04.636
against the machine typically, like, you know. Yeah. And then they're, they're falling over, then you gotta pick up the

00:56:04.876 --> 00:56:08.016
45. Like, the ease- Absolutely ... of having that right there is

00:56:08.076 --> 00:56:10.495
incredible. Absolutely.

00:56:11.416 --> 00:56:11.636
Um,

00:56:12.256 --> 00:56:15.916
well, that's fantastic. Well, thank you, you know, for sharing some perspectives there, and obviously,

00:56:16.016 --> 00:56:19.016
you know, we'll mention, uh, that Instagram page

00:56:19.056 --> 00:56:20.006
as well, uh, at the end of

00:56:20.006 --> 00:56:24.936
the episode here. So couple questions to finish up for you here. Yes. Uh, what advice would you have for

00:56:24.946 --> 00:56:29.076
a young student of kinesiology potentially, or practitioner with aspirations to work

00:56:29.116 --> 00:56:29.996
in professional soccer?

00:56:33.356 --> 00:56:36.016
Um, good question.

00:56:36.876 --> 00:56:37.176
So

00:56:37.576 --> 00:56:38.116
the first thing

00:56:38.176 --> 00:56:44.085
is, is, you know, did you play so- I'm assuming that most people that wanna work in soccer have played

00:56:44.136 --> 00:56:48.126
soccer in the past, and they have a really good idea of what soccer is like, what the culture is

00:56:48.196 --> 00:56:49.196
like, the, the rules

00:56:49.236 --> 00:56:54.616
of the game, um, what the demands of each pition, uh, position and things of that nature. Uh, but for

00:56:54.636 --> 00:56:57.396
somebody who didn't play soccer, like myself,

00:56:57.976 --> 00:57:00.986
um, you know, really trying to get an idea or

00:57:01.056 --> 00:57:02.916
grasp on soccer as a

00:57:03.036 --> 00:57:09.036
game, what's required of each athlete, uh, the different energy system demands that are, that are required for the

00:57:09.096 --> 00:57:11.205
athlete or important for the athlete to, to harness.

00:57:11.876 --> 00:57:17.156
Um, and what they need to do, uh, really can s- kinda set you up for how to,

00:57:17.276 --> 00:57:24.076
uh, develop your mind from a strength, conditioning, or performance-based standpoint or a rehab standpoint, whatever practitioner you're looking to,

00:57:24.496 --> 00:57:25.136
to go into.

00:57:25.776 --> 00:57:26.036
Um,

00:57:26.636 --> 00:57:27.216
and,

00:57:27.336 --> 00:57:31.056
you know, on top of that, it, it really boils down to

00:57:32.696 --> 00:57:37.316
your drive and willingness to talk to different people and reach outside of your comfort

00:57:37.356 --> 00:57:39.986
zone, uh, if you're uncomfortable reaching out to people, and

00:57:40.016 --> 00:57:44.116
networking, um, and, and meeting different people, going to different conferences, uh,

00:57:44.596 --> 00:57:44.936
learning

00:57:45.256 --> 00:57:45.676
from,

00:57:46.236 --> 00:57:50.196
uh, different mentors or, or people who have been in the field for the business or the industry

00:57:50.236 --> 00:57:51.036
for a long time.

00:57:51.676 --> 00:57:52.076
And

00:57:52.376 --> 00:57:52.676
getting,

00:57:53.856 --> 00:57:57.196
getting yourself out there a- and getting your hands dirty and your feet wet

00:57:57.216 --> 00:57:58.656
and volunteering.

00:57:59.256 --> 00:57:59.576
Um,

00:57:59.956 --> 00:57:59.996
you

00:58:00.016 --> 00:58:00.996
know, uh, really

00:58:01.076 --> 00:58:05.016
just the more you can expose yourself to those environments in

00:58:05.096 --> 00:58:07.136
any way, the

00:58:07.176 --> 00:58:08.256
better. And,

00:58:08.576 --> 00:58:08.936
um,

00:58:09.256 --> 00:58:09.276
you

00:58:09.296 --> 00:58:11.136
know, things will, will fall into

00:58:11.196 --> 00:58:14.056
place. Uh, but it's really understanding that,

00:58:14.816 --> 00:58:14.936
uh,

00:58:15.316 --> 00:58:16.076
you gotta really

00:58:16.456 --> 00:58:21.036
dive and, like, submerge yourself in the, in the culture and, and what's happening, and you have to

00:58:21.076 --> 00:58:23.176
be in it to really understand and learn

00:58:23.196 --> 00:58:25.046
about it. So yeah,

00:58:25.496 --> 00:58:26.176
it's, uh,

00:58:26.616 --> 00:58:28.036
get involved some way, shape,

00:58:28.176 --> 00:58:28.406
or form,

00:58:29.096 --> 00:58:31.096
whatever it takes. I like it. Roll, roll up the sleeves

00:58:31.136 --> 00:58:36.496
and get in the sandbox. Yeah. Yeah. That's really it. That's really it. And, uh, and don't be scared to

00:58:36.536 --> 00:58:39.096
do it because everybody at one point was in your

00:58:39.156 --> 00:58:39.516
shoes.

00:58:40.176 --> 00:58:41.096
Um, so,

00:58:41.156 --> 00:58:46.036
you know, uh, uh, you'd be surprised how many people are willing to,

00:58:46.156 --> 00:58:49.016
to help you out and to have a conversation,

00:58:49.115 --> 00:58:52.156
uh, to, to talk for 10, 15 minutes to answer

00:58:52.216 --> 00:58:52.875
some questions.

00:58:53.476 --> 00:58:56.126
Um, even if you don't think so, you'd be surprised at how many people

00:58:56.236 --> 00:58:56.896
are willing to do so.

00:58:58.556 --> 00:59:01.976
Awesome. And Zach, I have one more question for you, but before I do, I'm just gonna mention

00:59:02.016 --> 00:59:03.036
it now. Mm-hmm. Instagram

00:59:03.096 --> 00:59:04.976
is @thesportsphysio_.

00:59:05.856 --> 00:59:07.996
So thesportsphysio_.

00:59:08.756 --> 00:59:08.996
Make sure

00:59:09.036 --> 00:59:13.036
you give him a follow there. Um, last question for you, and again, just super

00:59:13.056 --> 00:59:13.876
appreciative of your time.

00:59:14.556 --> 00:59:19.036
Uh, what does your own exercise routine look like right now? What's your own training

00:59:19.056 --> 00:59:23.336
regimen? Uh, if I walk into the weight room there and I'm watching Zach,

00:59:24.216 --> 00:59:28.056
is he at his desk working, or is he training? And if so, what does that training

00:59:28.076 --> 00:59:28.406
look like?

00:59:30.076 --> 00:59:37.096
Yeah. So usually, my schedule, I'm an early riser, so I'll work out in the morning. Um, just gets, gets

00:59:37.136 --> 00:59:39.056
me going on the right foot beginning of the day.

00:59:39.776 --> 00:59:40.096
Um,

00:59:40.756 --> 00:59:41.236
and

00:59:42.016 --> 00:59:42.436
honestly,

00:59:43.396 --> 00:59:44.836
I p- I try, I try to practice what I preach.

00:59:45.096 --> 00:59:49.036
Um, you know, I, I utilize a lot of the exercises, uh,

00:59:49.936 --> 00:59:51.376
that I prescribe athletes.

00:59:51.956 --> 00:59:52.216
Uh,

00:59:52.516 --> 00:59:52.556
you

00:59:52.596 --> 00:59:52.676
know,

00:59:53.036 --> 00:59:55.116
I... The firm believer in,

00:59:55.756 --> 00:59:59.086
you know, I won't prescribe or give something to an athlete that I haven't done myself. Uh, 'cause

00:59:59.156 --> 01:00:00.886
I wanna know what it feels like and, and

01:00:01.016 --> 01:00:02.256
do it to,

01:00:02.956 --> 01:00:04.016
to know how to instruct

01:00:04.076 --> 01:00:06.056
it, tell them what they're supposed to feel, how they

01:00:06.096 --> 01:00:10.036
should feel it. Um, so if they're not feeling it in the right place, right, it's my favorite

01:00:10.096 --> 01:00:11.046
question is, "What are you feeling, and

01:00:11.076 --> 01:00:14.836
where are you feeling it?" If they're not answering those questions how I want it to, then we have to

01:00:14.876 --> 01:00:16.116
adjust or cue or figure

01:00:16.136 --> 01:00:17.956
out a different way to, to set them up to get

01:00:18.016 --> 01:00:21.076
them to achieve it. So I'm doing the things that I prescribe

01:00:21.136 --> 01:00:22.006
people. Um, but

01:00:22.076 --> 01:00:28.496
also I'm prescribing myself things that I know I need to work on. Um, so I'm always looking to,

01:00:28.516 --> 01:00:32.096
you know, improve my body. I was a wrestler growing up in high school and college, so my body

01:00:32.176 --> 01:00:35.316
is, is feeling it in some areas. So I'm always trying

01:00:35.376 --> 01:00:35.656
to,

01:00:36.376 --> 01:00:39.996
um, you know, just make myself a little stronger and better just moving forward

01:00:40.016 --> 01:00:40.556
every day.

01:00:41.316 --> 01:00:42.036
Um, so

01:00:42.096 --> 01:00:42.336
yeah.

01:00:43.136 --> 01:00:43.315
Yeah.

01:00:43.636 --> 01:00:48.136
Awesome. Um, well, Zach, can't thank you enough. Thank you for joining us on the Keiser Human Performance,

01:00:48.216 --> 01:00:51.116
Podcast. This was really fun. Love discussions. Can't wait to follow

01:00:51.196 --> 01:00:54.036
up with you, and I wanna wish you, uh, good luck with the rest of the season.

01:00:54.036 --> 01:00:58.056
Yeah, man. I appreciate it. Thanks a lot for having me, Gabe. Uh, this was a pleasure,

01:00:58.116 --> 01:01:01.736
and, um, yeah, if anybody has questions, uh, feel free to reach

01:01:02.296 --> 01:01:03.216
out.

01:01:07.496 --> 01:01:11.176
We appreciate you tuning in to this episode of the Keiser Human Performance

01:01:11.276 --> 01:01:14.126
Podcast. To stay up to date on all things Keiser,

01:01:14.616 --> 01:01:16.376
follow us @keiserfitness

01:01:16.416 --> 01:01:17.986
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01:01:18.056 --> 01:01:22.216
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01:01:22.656 --> 01:01:26.036
and at our website, www.keiser.com.

01:01:26.616 --> 01:01:26.796
Thank

01:01:26.856 --> 01:01:28.156
you, and have a great day.