E39 | Keep It Real Talk #1

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Hey everyone, and welcome back to the Resilient Performance Podcast! Today’s episode will feature our first ‘Keep It Real’ talk with Greg Spatz, Trevor Rappa, and Doug Kechijian. Our ‘Keep It Real’ talks will consist of the three of us addressing questions sent to us via Instagram followers, blog readers, podcast listeners, and anyone else that reaches out to us.  We want to keep things as simple as possible for you and not over complicate things for the sake of making ourselves sound smart. This is our way of ‘Keeping It Real’.

Topics discussed today:

• Is aerobic deficiency syndrome a thing and how can one recover from it
• Are there commonalities on mileage for runners training for say marathons vs half marathons
• How can nutrition affect one’s rehab
• What are the indications and benefits of soft vs stiff landings
• Sorting out the intent behind the execution of certain prescribed movements

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Episode Transcription: Greg: [00:00:00] Welcome to the Resilient Performance Podcast. I'm Greg Spatz. I'm here with Trevor Rappa and Doug Kechijian. This is our first, Keep It Real talk, is what we're calling it. So just going to be the three of us talking about any, any sort of questions that were sent in from listeners, from blog readers, Instagram followers, whoever, found us and sent in some questions. We'll talk about anything that we have so far with that. And we call it 'keep it real' because of, one of our more influential mentors, Alan Gruver, we all did a clinical rotation as PT students with him in Arizona. It was just something that sort of like his mantra, his motto to live by in this world where everything can be so complicated in the field of rehab and sports performance or training and a lot of his, you know, we, we'd be in the clinic and asking him questions and we'd have to have these thought processes in our head of like, we need to do something really out there and special for this patient in front of us. And he's, he would always just bring it back to, okay, well what do they need? Keep it real and let's just get them what they need. And no matter what it is or, you know, what clinical or, you know, con-ed courses you've taken, you just got to get the person what they need and let's just keep it real. So that's what we're talking about when we say keep it real, and let's just get into some of these questions here, but Trevor, Doug, anything to start? Trevor: [00:01:32] No, I think that was a great explanation. Yeah, we just always about keeping it real and kind of keep things as simple as we can and not overcomplicate it for the sake of just making ourselves sound smart or just for the sake of making a more complicated. Greg: [00:01:57] I don't think they're going to be too long, but we kind of take it from there. And if it turns into two different, two different Keep It Real talks, then so be it. Cool. So let's go the first one, Doug, you want to talk about. This question is aerobic deficiency syndrome a thing, and if so, how can one recover from it? Is it high volume of slow cardio? You wanna just take that and run? Doug: [00:02:22] Yeah. So aerobic deficiency syndrome. It's funny because I actually had to look that up cause I hadn't heard it worded in that way. But essentially what it means is if someone is training for like an endurance type event, that they're doing too much high-intensity training and not enough of the lower-intensity or more aerobic type training. So that's kind of what we mean by aerobic deficiency syndrome. And again, I, I hadn't heard it, where did it in that way, but, ultimately it comes down to like, what's the, what the goal is? So for first of all, like even the aerobic system, right? Is that really a thing? Is it really a thing to say something as aerobic, anaerobic glycolytic, these are all like words and constructs that we create to make this idea of bioenergetics more manageable. And you know, in, in biology, like when you know, an animals are running away from other animals, they're not thinking like, well, is this aerobic or is it anaerobic? They're just doing what they have to do to survive. And I think that it's important to learn energy systems, but I think they have limitations. I think that's just like any other model. That's one way to look at performance in this case conditioning or endurance through this, energy system lens. I think that in and for keeping it like really, really brief, the way that I would summarize energy systems is that you can call them whatever you want, but ultimately, depending on what your goal is from an output standpoint, that's going to change the relative balance of all these different chemical reactions that produce energy. And when we're producing energy, there's always a trade off between, efficiency and speed. So if you want to produce energy really, really quickly. Like you're sprinting. You can only do that for so long before you burn out. If you want to be more efficient and not produce as quickly, I E are being more aerobic, which is what we typically associate with that. Then you're not going to be able to produce energy as rapidly. So there's always a trade-off it just like any other—biological system. So with the aerobic deficiency syndrome, I know who asked the question without kind of getting like too personal, revealing his details and his goals. This is somebody who's training for a, a military selection course where you have to do a lot of long-distance running. And his training prior to us working together was a lot of like higher intensity type work, and then there are some systems that even say like, for even for like a, you know, an endurance event, whether it's like marathon, military selection, that you don't need to do any of the longer lower intensity type work. You can just do intervals. And certainly, like for example, if you're training for a marathon, you can, anybody can like finish a marathon. But the people who were winning the marathons tend to do a blend of high intensity work and low intensity work. I think the person who kind of explained this the most clearly from all the reading that I've done is Steve Magnes and Steve Magnes talks about when you're training for endurance, it's obviously context specific because endurance for a military special operations selection course is different than endurance for like a 400 meter runner. So that 400 meter runner, you know, there are people who train for the 400 and never run more than 200 meters in practice and are still pretty successful. When people start training for the 800 and above, it's kind of hard to just run 200 meters because you need more of a, an aerobic or a low end buffer. But what Steve Magnes says is you basically just take whatever it is that you want to do, so in this case, running training for a military selection course where you're going to do anything from like, you know, six mile time runs to 20 mile, rucks or hikes through adverse terrain with external load or a pack. So you have to support those energetic demands. On the high intensity end and the low intensity and you need, you need bandwidth because you could say like, oh, well if I want to train for whatever the 400 I could just do four hundreds and that'll work to a point, which is kind of like saying intervals will work to a point, but if you don't support the low end and the high end, then it makes it much, then you burn out without specificity. So for aerobic, having a well developed aerobic system makes a lot of sense for a military selection candidate because you're doing six mile run. So if all you're doing is 400 meter repeats, you've never actually done run for the duration that you're going to get tested on. So it's probably a good idea if you're training for that kind of a thing to do runs of even up to 10 miles, but at a lower intensity than what you would run when you were being timed. If you're only doing, you know, 400 meter repeats and then you put a ruck on and you go and walk 20 miles, like, yeah, this is the chance that you can do it, but are you really going to be prepared? So I think that, rather than looking at it as like being aerobic or anaerobic, I think that can be useful. But what's more important is to say that like whatever event you want to do, you need to support it with lower intensity work and support it with higher intensity work. And then as you get kind of closer to your competition or whatever it is that you're trying to prepare for, then you can do more specific work, but you need, you need lower and higher intensity work on the front and the back end to support the specific work because the converse of that is like, there are plenty of people who all they do is, is, low intensity work. But like, let's say your goal is to run your recreational runner, and your goal is to run a 5k at a seven minute mile pace, but right now you're only running 10 minute miles and you can do that all day. Like you can't even run a seven, one seven minute mile, so how are you going to run three if you don't have enough speed to develop the ability to run one seven minute mile? So for that person who can run 10 minute miles all day, it makes sense to do some speed work, which again, is a relative constructs of speed work for somebody who wants to run a seven minute mile, might be doing 800 meter repeats at a 3:30 pace, and then you can manipulate the rest periods in between repeats. You could, you know, demand a higher output on each repeat. There's a lot of ways to manipulate that, but you need speed and you need lower intensity work to support the specific demands. So for someone who's training for a true endurance event, like, like a military selection course, I, if I was preparing somebody, I would do way more than just interval work or high intensity work because having done this stuff myself, there's, it's just, it's, it's a unique stress to go out and walk for 20 miles. And running sprints and doing like, a bunch of higher rep lifting, I don't think as a way to adequately prepare for that. So yes, like aerobic work is important, depending on how you define aerobic work, but it really, it depends on your goal and some people are going to need a lot more of it. The lower intensity of like your event or sports, so to speak. The more of that, like quote unquote aerobic work you're going to need to do. So for a military selection course, I think that actually aerobic work should form the bulk of your training and it should be supplemented only in small pieces with higher intensity work. Trevor: [00:09:15] How important do you think like, like from your own experience in terms of, you know, really getting a lot of that low intensity work in is just like the tissue tolerance sets. You're kind of building up and tissue capacity to handle your crazy, you know, 24 hour training periods where you're on your feet all day and just kind of, you know what I mean? When you're constantly moving and you really have to have a tissue, a high level of tissue capacity, do you think that's important or you think it's kind of overrated for something like this? Doug: [00:09:39] I actually don't think it's overrated at all. Really training for like a military selection course in particular, like being able to meet the runtimes and the pushup times and the pull up times isn't really that hard. The hard part is like being able to survive the training because the training is very, very volume-based and if you haven't had. If you haven't stressed yourself enough in training where volume is the stimulus is the major stimulus, then how are you going to deal with that volume when you have to go to the course? So I think the tissue tolerance thing is, is a great point where like, yes, from like maybe like a physiological standpoint, like whether it's cardiac output or like local muscular adaptations, like yeah, you can, you can run a bunch of four hundreds and like you're not going to get, you're not going to gas out. On a ruck per se, but if your body's not used to rucking for 20 miles, then maybe like when you do it, then like, you know, you have an overuse injury like in your Achilles or your lower leg, or even a stress reaction, right? Because if you're not used to, for example, in a selection course, you run almost five, six miles a day, just just to get places, because you're not allowed to walk anywhere. So that doesn't even count as your actual run train. And you have to run to your meals. You've got to run to the dorms, all these different things. So you're running almost like 30 miles a week just as your means of transportation. So if you're only doing lower intensity work, like now your, your body's not conditioned for that kind of volume. So I think that what you said is that tissue tolerance is a huge piece. And that's why like all these models you have, like your tissue preparation model, your physiological model, your cardiac model, they all kind of have to be addressed because physiologically I think you can, with lower intensity work, you can like quote unquote prepare, you know, from a conditioning standpoint for some of these longer things. But then it's also like the, even from like a technique standpoint, like, you could say that like these runners who are doing these, like, you know, slow runs multiple times a week, we're at a really low intensity on, a lot of coaches will say, well, that's just junk mileage. If that's also, you know, they're also developing the ability to run technically, they're getting so many exposures to running, they become really efficient at running and they become good at running. You can almost think of it as like as practice a sport practice done at a low intensity where their sport is just to run, and then they can increase their output once they've developed that technique. So, there's a lot of components that need to be addressed that's not just like you know, how do you, how do you test in a six mile run? It's, are your tissues prepared for it? Are you biomechanically and technically prepared for it? And that's why I think that like if you, if you're playing a volume based sport, you need volume to know that you're prepared for it. It's just basic stress inoculation and you've got to attack the physiology, the tissues, the mechanical stuff, you know, all of the above. And it's also why, you know, like a lot of dancers, for example, do a ton of like low load, long duration stretching. And you could, people, you know, especially in strength conditioning can say, well, that's a waste of time. Just do dynamic stretching and PNF. But like, there's probably a reason why, you know, dancers spend a lot of time static stretching, and until a strength coach is hitting their range, the range of motion as a dancer by just doing, you know, contract, relax and dynamic stretching. We need to kind of keep our egos in check because, you know, we can, we can make athletes worse. And a lot of times like, we need to look at what athletes are doing in their sport that makes them successful. And there's a reason why like distance runners aren't just doing intervals. Why? If you look at like the training journals of even even runners who are more high intensity biased, their most of their work, like 70% or more is typically done at what we would consider a lower intensity. Trevor: [00:13:12] Right. Greg: [00:13:15] Great answer. That made me think of like some of this time motion analysis you see with like how far I think of the lacrosse player that you had done the postop rehab for and you programmed for and you wrote a case study about. And, and just like keeping it real and like what are they doing in their sport? And we actually know because there's all these people that are studying how many accelerations they're having, how much are they reaching a top speed, and then the total mileage. And it's like, okay, we know all this stuff so like who cares if it's aerobic, anaerobic, whatever. Just make them be able to do those things and just keep it real. Doug: [00:13:48] Yeah, because to your point, I mean, I'm not like doing blood gas and pulmonary analyses on people to know that when I'm working with them that it's aerobic or anaerobic. I don't, I don't really think that it matters, but I mean, you could substitute low and lower intensity, higher intensity, like glycolytic work is basically like moderate intensity work. Aerobic work is lower intensity work and then your higher intensity work is like more of your sprinting. So a lot of the models are kind of saying the same thing, but just use different, different words. So as long as we kind of, and Steve Magnes talks about this as long as we like see the commonalities between the models, it allows us to be less dogmatic about what we're doing. But you know, to be clear, to answer the question, like if you're doing an endurance type sport where I would say like anything where your outputs have to last longer than like 60 seconds. You need to do aerobic work or you don't need to, but if you want to be, I think as prepared as you can be, you should be doing a good deal of aerobic work, a lower intensity work. Greg: [00:14:43] You see so many runners in the city. Are you finding like, are there certain distances, like let's say a runner wants to run a marathon versus a half marathon, are you finding like commonalities for different runners on like the amount of mileage that they should be doing or what you might recommend or find yourself recommending like for per week?  How many miles? Doug: [00:15:04] Well, it's funny because the person that asked the question, like his training history was doing a lot more like, you know, like, like lifting for endurance, like higher rep lifting work, circuit type training, and then like low, like high intensity or higher intensity intervals, kind of like HIIT training. So for him, we always talk about, even when it comes to like movement. Like we're just getting people what they need and what they don't have. And we're trying to find like what have you neglected in your training to make yourself kind of a, a complete athlete? Complete again being relative to your goal. So for this athlete, like he wasn't doing really any aerobic work, so that's what he needs because he's neglected it. But for a lot of the other runners that I work with, they don't do any higher intensity work. Like all they do is like, they just run like five miles a day every day the same route. They don't really try to manipulate their pacing. It's kinda like the people you see at the gym where their workout is to like read the newspaper and go on the elliptical for an hour and like, that's not bad. Right? Like if your goal is just to like kind of be healthy and avert disease, like that might be good enough. But if your goal is to improve, you have to constantly be tinkering with something to get your body out of homeostasis. So for a lot of like the runners, the recreational runners I work with. And the clinical practice for them, they need to do more higher intensity work because they're like, well, I haven't improved my 5k time in five years. It's because you haven't asked your body to ever run faster than what your goal is. So if you're not running your, your goal pace, even at a like a shorter distance, you can't expect to magically be able to take that goal pace and then expand it for a 5K or a 10K. So I think it depends on like what people aren't doing. I think most recreational runners tend to overdo it with the, with the mileage, but like the elite runners, they tend to have it figured out, like they're doing both. Greg: [00:16:50] typically find that you're trying to reduce mileage with most of the people that you come in contact with. You know, being coached by somebody and have a program for them, it's just like, Oh, I'm just going to go run because that's what I do. Doug: [00:17:02] Yeah. And it's not even that they're necessarily running like too many miles. It's that, look, you're running six days a week. It's not that I can, I want you to like run five less miles a week or whatever, because if they're not getting injured, I don't really care. But it's like, let's just one or two days a week replace... You know, just a longer run with something that we're emphasizing speed for a shorter volume. So that again, cause you want to build the bandwidth. Like a lot of people say, okay I'm going to run a 5k so that it's run three miles a day. That specificity works to a point. But there's a reason why, you know, the best runners in the world aren't just doing like doing meets three days a week. They're trying to support their specific distance on the front end of the, in the back end. And then depending on where they are on the season, they might kind of expand. Or, contract that bandwidth. But you need some bandwidth to support the specific work you're doing. And a lot of the recreational runners aren't, in my opinion, supporting the bandwidth on the higher intensity end enough. Greg: [00:18:02]Nice. Think you that one up. That was nice. Trevor: [00:18:03] Great answer. Douglas, Greg: [00:18:07]what else do we have here? So that answered. Let's see. A nutrition's role in rehab. Just a general topic to talk about. Trevor, you want to take that? Trevor: [00:18:20] I mean, I would say like this is definitely not our area of expertise, just as like simple guidelines. Like I think, you know, in terms of healing from an injury, like your body has to have enough energy to be able to heal itself. And if you're in a calorie deficit, when you're, when you're really trying to recover from even just training in general, like your recovery is going to be slower, you're not going to heal as well, especially in terms of like just having a surgery. So you've got to make sure that you're eating enough. Yeah. Calories in general. But yeah, like I would say like we're, we plan on having some actual nutrition experts on at some point in time to really kind of delve more into this advocate's definitely a huge part of, of the rehab process and can make the rehab process a lot smoother. If you really have, have good nutrition. But I would say like, as a general rule of thumb, it's, you know, making sure that you are eating enough calories, enough fats, enough proteins, enough carbs to make sure that your body can actually have enough energy to fuel itself. Greg: [00:19:12] And I remember, I mean, I know a lot of, a lot of times we're working with high school athletes when we're in New Jersey. When you're in New York, it's a little different, but it seems like a lot of the high school athletes that we see don't actually really understand like how much they're supposed to be eating and they're not, they don't realize that. Or maybe they know that they need to be eating more and they need more of whatever macronutrient. But they just don't actually realize how difficult it is to be eating the amount that they should be, where like, they might not be skipping breakfast every day just because they're too tired to, you know, make it happen or, or whatever. So, yeah, I mean, that's something that I always find is like, it's, it's hard to make the gains that we want either, especially in rehab, but even in like performance training with the other athletes that are in the gym. It's like this constant conversation of making sure that they're eating something because they can have a good week, but then, you know, it's easy to get out of that habit for sure. Trevor: [00:20:05] Well, and how many of those high school athletes do we hear talk about how they're like, they're not getting stronger right now, or they are, it's like they're plateaued and it's like, but I'm eating so much. It's like, okay, what'd you have for breakfast? I had four bowls of cereal. It's like, okay, they may be calorically a lot of calories, but it's not a lot of protein. It's, it's almost zero protein, so they're just getting a ton of carbs without really getting any protein or anything else in their diet. I think like just, just that kind of thing alone, it's like what people think they're eating and what they're actually giving themselves are often two very different things. Greg: [00:20:37] And I've seen that recently with like a one patient that had an ACL surgery. You know, at this point, probably almost over maybe a year, maybe a little less than a year at this point. Like the goal is a lot of rehab is like you got to build your muscle. Like that thing is just dead and we got to build some muscle and get stronger. And if you're not eating breakfast or you're eating just cereal, it's probably not very helpful. So there's a lot of like very simple things that we recommend. Like most people aren't ready for all the detail that I'm sure like you've gone into with your coach, you know? But yeah, it's always just smaller recommendations. So, yeah, it's a big role in rehab. I guess it's the, to answer some of the questions. It's very important. Yeah. Eat a lot of calories and enough to recover. Doug: [00:21:48] And just to kind of add to that, I mean, with any of these like performance-based profession, there's always going to be overlap. So like how do you go to a nutritionist and not talk about exercise? I think it comes down to obviously like scope of practice, legalities and then like, what are you actually comfortable talking about? Like what are you educated about? So if somebody comes to me and asks a question about nutrition, I kind of look at it more of a screen. Like I want to make sure that I'm ruling out a red flag. They're not doing something to make themselves unhealthy. Like from a rehab standpoint, I think the biggest thing we're looking for is, are people like getting enough calories. Cause I work with like even a lot of, like endurance athletes and some of whom like are on the continuum of disordered eating. And this is like males and females. So if I think like that's something that I'm identifying, that's, you know, probably a strong chance it's going to interfere with their recovery from an injury. And then like with a high school athlete, it's like are you eating enough? But I'm not talking about like magic ratios, like this percentage carbs and this protein, but if you're saying that you want to put on muscle and you're eating like a thousand calories a day, you're not going to put on muscle no matter how much you lift. But I wouldn't be comfortable if somebody was like 8% body fat and they were like, how do I manipulate my nutrition to get down to 6% I just don't have the expertise in that and I don't think it would be fair of me to try to speculate, nor am I trying to like resolve someone's medical pathology. I think the biggest thing is. I want to make sure that like nutrition is not the low hanging fruit. Like is there like a health issue? Cause if someone's like healthy enough, I mean there are great athletes who eat McDonald's five, five meals a day. So it's like how much it actually matters from like a pure performance standpoint. I don't know. But I think that there is a point where like if you're not eating enough. You know, it can cause health problems or if you're eating too much, right? Like the extremes are really easy to, to identify. So I'm trying to like, identify extremes and if I identify an extreme, I'm not going to be the one to tell them how to change it. But that's what I would refer out to another provider. So it's like, where can we identify an extreme when it comes to eating? But if it's a really specific thing, like, you know, even like, let's say an endurance athlete who's like, how do I do my in race nutrition for an ultra marathon? I'm not the person to be to be doing that. That's Robert. I would refer out. So like performance versus health, I think is a big, a big thing when it comes to nutrition in the context of physical therapy. Greg: [00:23:45] Yep. Cool. I want to do one more question before we talk about that one topic that we want to talk about.   So let's talk about here, this question, soft versus stiff landing. So what are, what are the indications and benefits of doing each type of landing? So I'm assuming with jumps, maybe postop, maybe not. It doesn't really matter. Let's just talk all about that. So soft versus stiff landing. So for me, it's the ability to absorb force and then recreate it, right? So if you have a soft landing or absorbing your force and you're giving yourself more time to absorb that force, loading your tissues probably and your joints a little bit more versus a stiff landing where you want to be bouncy and be more elastic. Talk more about that. Trevor, you're doing a lot of, you've done so much with changes direction, and that sort of delves into, Trevor: [00:24:43] I think what you just said is exactly like the most important part with just considering kind of how to, why either one would be an important, and it's like the forced time principle. You know, we can only produce force, like in terms of how much we're interacting with the ground. So like you just said, if I'm lending really soft and giving myself a ton of time to absorb for, so I have a much smaller impulse to deal with versus if I land really sharp and I have a really like a relatively shorter ground contact time, I have more force to absorb rapidly, which is just harder to do overall and kind of need more strength for. So initially I want to start somebody with more, you know, quote unquote softer landings where not the whole like land like a cat, don't let me hear anything. But I want to give them time to develop their rate of force development and, and control the motion a lot more than having them try to do something really quickly or they're probably just not strong enough and can't handle that amount of force yet. So we, again, we want to progress to a harder kind of landing and I don't even think hard, like stomping your feet. It's just kind of being sudden and being quick, learning how to generate tension really fast. So the, sounds somebody's foot makes definitely kind of tells me what's going on. And like one of the athletes I'm dealing with right now, is a few months after their ACL injury. And you can just see the difference when we do skips in terms of how one foot hits the ground hard and that's the one that is a non-injured extremity versus the one that hit the ground a little bit softer, which is their injured extremity. You see, you know, just in terms of how the foot contacts, they try to land differently on the leg that has an injury cause they're trying to give themselves more time to absorb force. So again, that's the kind of difference between a soft and a stiff landing is just how much force are we having to deal with in a certain amount of time? We have, the easier it is to deal with that. For us, we're essentially, by the softer ground contact or the, or the longer time, we're giving them a longer runway to decelerate. So if I'm jumping from a 12 inch box and I, and I have a soft contact, I'm giving myself a lot of time to absorb the force of fall into a 12 inch box versus if I hit the ground in a stiffer, kind of quicker tension position, I have to generate that force a lot quicker to stop my body. So again, that's the kind of difference is just how much time am I giving myself to absorb and generate for us? Doug: [00:26:53] Yeah. And I think it depends on what the goal is to, right. I think that if you look at someone who's like characteristically a stiff lander and it's very, very bouncy, they tend to be the people that we look at and say, these are the better athletes, right? Because, they have that gift of whether it's like long tendon, short muscle bellies, where they just don't spend a lot of time on the ground and a lot of sports that come down to speed. You know, if you can produce force in a shorter amount of time, you tend to be able to create space and evade your opponent. But also like from a rehab standpoint, that's where people are more at risk for injury. A lot of times the people that are like, quote unquote twitchier, and we talked to Lee Taft about this last week on that one call where we were like, you know, obviously there's no way to look at an athlete and know who's more at risk for injury because people have different strategies, but the people that tend to have these stiffer, more explosive landings where they reverse force more quickly, they tend to have a more like joint centric versus a muscle centric strategy of changing direction and they're probably more at risk for catastrophic injury, but they're also faster. So the people, a lot of times with people that aren't explosive are the ones that oftentimes aren't as likely to hurt themselves because they're not strong enough or fast enough to do it. There's obviously exceptions to that, but then it depends on the sport too, because if you look at it like Barry Sanders, right? Like, yes, he was explosive and twitchy to a degree, but he was also very, very powerful and like he could just stop on a dime using oftentimes a muscular strategy, where his knee and his hip would go into quite a bit of flexion because he's accelerating and then all of a sudden stopping and stopping to kind of create enough time to evade an opponent and come up with a new strategy to, to get down the field. So and, and, and like linear sprinting for example, or like track and field and jumps you probably want someone who's going to be a little more like, just purely springy and stiff. But in a, in a sport like football or a field sport, you probably want a little bit of a combination of both because I think in, in Trevor, you know more about this than I do, but like to change direction, you have to be able to, to load to explode. And if you're just stiff all the time, you don't give yourself enough time to bend, it can be hard to produce the right angles to change direction outside the sagittal plane. Trevor: [00:29:07] Yeah. You know your example, Barry Sanders, and there's a difference between like those kind of taller, longer athletes that are using relatively stiff straighter limbs to change direction versus somebody like Barry Sanders who, you know, call them like a Squatty body, but can, can actually flex at their ankles, knees, and hips to be able to get appropriate plant angles. So they're using, I would say like a concentric muscular strategy to change direction versus this kind of like stiff limb lock on all my joints. I'm trying to create static, muscular tension to be able to propel myself in the opposite direction. And like, like we were talking about with Lee, those are the people that they're relying on, like passive restraints, like tendons and ligaments, and bone contact, more so than, than, you know, kind of more active stability and muscular tension. And I think, you know, going back to the stiff landing thing, and we were talking about Barry Sanders and like the flexion angles that he gets when he changes direction. Like, when we see somebody... If I were to jump off of that 12 inch box, I can still land soft with my legs straight and I'm just absorbing force in my knees or my ankles or whatever joint I'm kind of biasing versus if I land soft, but I'm letting myself like hit the ground and then I'm flexing on my ankles, knees and hips. I just use kind of two soft landings that have very different outcomes and different, different muscular, outcomes basically. So I'm using either like a really joint centric approach with that stiff landing or I'm going use muscular tension, but I'm still giving myself time to develop muscular tension by having a softer landing versus if I'm landing kind of like in a squat and I stick it right away where I'm not or once I touch the ground, I don't move versus when I touch the ground, I give myself time to yield and develop for. So again, like, like you said, they'll get just kind of why do we want one versus the other? And I think from a return to sport standpoint, like we want to start with the easier one first, which is a softer landing and eventually start progressing to harder landings that again, fit their demands and they're going to be happy. Greg: [00:31:03] And you brought up before with your, patient with the ACL that you're working with now. It's like more of a fresh, postop case right now. And you mentioned how she was more, wait, what did you say? You said she was more stiff on her surgical side. Right? Trevor: [00:31:19] So kind of interesting. Greg: [00:31:21] I can see it both ways. I have seen it both ways. Trevor: [00:31:24] So there's two things that we've been kind of see what, so we do, you know, as we're getting back into our, like our running progression, I want see people like hop and skip a ton before we start to get back to actual running. Where are you have single limb support versus bought double limbs for it with a double leg hop or skipping, which is more like one and a half. So when we do double leg hopping, she yields on her nonsurgical leg cause she let herself absorb more versus when she's uncomfortable loading her surgical leg, she kind of locks her knee. Doug: [00:31:52] Right. Trevor: [00:31:52] Versus when we do skipping, when she skips, she's able to put down the nonsurgical leg a little bit more forcefully and abruptly. And then when she puts on her surgical leg, she puts on her toe a little bit more first. If she's just giving yourself time to absorb force, because that's the difference between having two feet on the ground where I can kind of save myself with my opposite side, or am I having to use my involved limb a lot more where I have to now give myself time to be able to dampen it. Greg: [00:32:18] So it's interesting both ways. Trevor: [00:32:20] Yeah. And again, that just depends on the context and the person in general. So it's just interesting kind of seeing those things, like what's their strategy? And like we use our force plates in Jersey and you know, I've seen people with similar cases to this, case that we're talking about where if we do an isometric mid-thigh just to see where they comfortable kind of generating force intention right now, and it shows which legs or so your left leg, left leg versus your right leg. So if somebody has a right leg injury when they do a mid thigh pull, we may think that the left leg will show more force, but it's the right leg that shows that's being the dominant force because they're letting that leg serve as the break. So they're not exceeding what their force potential is with their opposite side. They're using their involved limb as a break to cap wherever they are.  So, so it just kind of interesting to see like the strategies that people use. Cause some people you do see the opposite where they're like, okay, this like hurts. I'm just not gonna use it, but I'll go hard on my other one versus alright, this like hurts. This is going to slow me down. I'm going to ride. Like I said, let let that be my governor and that's going to be how much force I can actually have. Doug: [00:33:28] Yeah. I think this also kind of like is very similar to the question about the aerobic system where you need to have bandwidth. So depending on what kind of an athlete you are, if you just train the stiffness end of things and the force side of things and the sport's going to dictate like how big or small that bandwidth is. But you always, you know, we hear about like the explosive strength deficit and like, you know, like where the counter movement vertical jump versus the non counter movement. I kind of look at, look at it like, is it if you had a really, let's say like stiff, springy athlete, like you don't want to take that away from them. Cause that's how, that's usually what makes them good and better than everybody else. So you're not going to like stop training that, but you're just going to do enough strength works. So that's not like such a weak link that it can be exploited. So ultimately, like you're, you know, you're going to train plyos and you're going to train strength, regardless. I think that as long as you're exposing people to those things, like the things that need to shake out are going to shake out. That's why I don't get as like, I don't know about you guys as crazy about, well we have to find like this magic ratio between counter movement jump and non counter movement. Because a lot of times like the people that have, the really bad non counter movement jumps, they're the best athletes anyway. So are we going to, are we going to make them like more quote unquote explosive by, having them like do, do like squats or weight room work or is the weight room work really serving more as just, it gives them more muscular support so that like when they do hit an angle, they're not used to hitting, maybe they're not as at risk for injury because they're not going to impinge all the way or get to end range. I just think that like if you're a field sport athlete, you need strength work and you need explosive work and it kind of, the sport itself kind of shakes it out, but I don't know if there's any magic ratio as far as that goes. Do you guys have any thoughts on that? Trevor: [00:35:06] I would definitely Greg: [00:35:08] you said it perfectly. We're doing everything with everybody essentially, and then just sort of prioritizing what maybe what they don't have because of an injury or if they don't have an injury, then I still like what they don't have that they need for their sport, just whatever their goal is. Trevor: [00:35:23] Like somebody who's super springy, like. They should still be able to like have a decent squat and be able to reach decent depth. And if they can't, then it's like, that's probably a big red flag. And or could be a possibly a red flag for just what they have to be able to do on the court or on the field. So it's like, I want to just spend more time, like we always talk about just giving them what they don't have. And same thing, somebody who has great mobility, like yeah, I want to stiffen them up a little bit cause they're probably not good at transferring force. Greg: [00:35:50] If you can dunk, you should probably be able to squat like that's safe to say. And we're just trying to get people over that range and bandwidth and Doug: [00:36:00] like, we're not talking about squatting 400 pounds, like we've literally said, who could like three 60 dunk? But then when you ask them to like goblet squat like you know, a quarter of their body weight, like they can barely do it. So we're just looking to like, again, avoid, avoid extremes. Same thing with someone who's like, you know, who can squat 400 pounds. Like if they can't do a depth, jump onto a 12 inch box that's spending five seconds on the ground. Like, that's, that's a problem too. So, and Greg, you see this with baseball where I've seen people who can throw 90 miles an hour, but like they literally can't hold themselves in quarter pad without like, you know, their scaps popping up in the air. So it's not like we're not going to make somebody worse by having them do that. We're trying to achieve. We're trying to make people, human beings before, like athletes. I don't know if what we do makes people like quote unquote more athletic. I think we're just giving them the raw materials to display whatever gifts they have so that they can self organize in a way that they see fit. But if they're missing pieces of that, then it's really hard to self-organize. So that's why, I mean, I don't, I don't really know if somebody is like sport changes, how I prepare somebody necessarily because everyone's kind of ordering from the same menu, but it's just maybe they use different proportions of different things, but it's not like, Trevor: [00:37:11] yeah, I think that like that last point that I like. It just changes how much of it we're doing. It's like then you would spend more time in deeper positions with somebody if they really suck at that versus somebody who's not springy, where spend more time trying to get short ground contact times and really get them to develop tension quickly. It's always the same stuff. It's just the proportions change. Doug: [00:37:30] Sure. Greg: [00:37:30] It's like we're trying to make them better at what their sport doesn't really require of them while also making them better at what their sport does require of them. Yeah. Both of them. We can talk in circles about this. It's on both ends and we're trying to. Doug: [00:37:44] Yeah, no, but there's a school of thought like, do you, do you try to take what like, especially at the elite level, like take what makes somebody really good and give them more of it or work on a weakness. I think that like if we're talking about very specific, like on the field stuff, maybe you don't try to work on somebody's weaknesses as much because then you're, then you're like, you're taking something away. But in the weight room, like if you work on someone's weakness, are you going to make them worse in the field? Like I don't think that we make that much of a difference necessarily one way or the other. So I've been at that. It's tricky because you can really justify either way. Like, right? You know, somebody who's got a 40 inch vertical leap, like if you do. You know, if you emphasize like, low ground contact time work, are you really going to make them? Are you going to add a lot of, you know, inches to someone's vertical leap who can jump 40 inches? But at the same time you can make a case that like how much better are you going to make them if you do a ton of weight room work? So I think you're going to do both no matter what and then just hope that it shakes free and admittedly, like I don't, I don't have a great answer for how much of each you should do. It's really just like a lot of guesswork and exposing people to a bunch of different things. We have a reasonable bandwidth relative to their sport and then hoping that they work it out on the field.  You know. Greg: [00:38:53] Right? Yeah. All of this was one answer to one question about soft vs. stiff landing. So that's awesome that we get these questions and just good question. Keep going with it. All right. So last thing you want to talk about, Trevor and I had a, just kind of had a discussion yesterday about a patient he saw and we were going to be talking about execution essentially. Where we might see somebody who is doing some PR, they have an exercise list or they have a program that they're given by somebody else. And we might give somebody the same exact program. It might be the same exact exercise lists like sets and reps, whatever it is, who cares? But the execution of each of those items on the list is what we are finding can be a big sort of determination in how people wind up doing either in their rehab or with deal with pain or performance doesn't really matter. So you want to just talk about that a little bit and maybe try to, you can bring up more about the example from yesterday. Trevor: [00:39:51] We were just talking, you know, so somebody, came in with just a general, you know, aches and pains kind of a thing.  And, and told me about where they feel those aches and pains when they're training and all that good stuff. I did my assessment like we always do, and then gave them some correctives or whatever you want to call our movement prep to be able to deal with some of those, you know, mobility limitations that they had. And like, almost the answer to every single one that I showed them was like Oh, I've done this before or I'm already doing something like this. But then, you know, we make these little bit of tweaks, like a modified pigeon stretch. They were doing a modified pigeon, but it's like, all right, let that opposite hip rotate down towards the table. And they're like, Oh my gosh, it feels completely different. And there's just so many little things I think we do from a clinical experience standpoint that gives us the insight into the, those little cues that we give our clients that really make the biggest bang for your buck with all the different exercises that we choose. I think that's one of the reasons why, we like to keep things very simple, but those simple things can be very effective if they're executed really, really well, because I'm sure you guys, about to you, you've had somebody come in who was like, oh, I'm doing a couch stretch. I was like, okay, show me your couch stretch, and it's their backs arched and their heads look in their eyes looking at the ceiling and they're, their chest is six inches in front of their butt, and then we get them into a different position and it completely changes what they experienced and what they feel with the movement. I just think that that value of making sure we're doing the basics extremely well. Doing the basics of savagely well really makes such a huge difference, and it can save people so much time, rather than giving them 35 more exercises that are trying to do the exact same thing. Greg: [00:41:22] Yeah. And it's not always the person that they've seen. It's always like that person's fault necessarily, because they might have shown it the same way that we would have shown it to the, to the patient or the client. And then there's like a lost in translation there where once the client leaves or patient leaves and they go home, then when they execute it, they're missing all the details because they're not with somebody. So it's not the clinician's fault necessarily could or could not be, but it could also be, you know, keeping things as simple as possible. Like almost like I try and find like, what is my one goal with this one thing that I want to do? So the couch stretch, like I want to stretch the anterior thigh. Like if that's the one goal, like I'm not going to care about anything else and I'm going to try and give them person like one cue or like one thing for them to remember and like have them tell me like, what do you think has helped you feel this stretched the most? And that's what I'm going to type in that email that I sent to them because that's probably what's going to make it stick or make it more easy for them to replicate it. And then, you know, obviously besides the videos that we send people to, but. Doug: [00:42:20] Yeah. Yeah. And that's, you know, cause we can go off on tangents with like all this stuff. And I think what this really comes down to with the execution piece, like, especially in physical therapy now, there's like, everything's like, you know, tribalistic and in two camps you've got like kind of the, the biomechanical camp where it's like, everything has to be quote unquote, perfect. And then you've got kind of the just load at camp where it's like, look, the execution doesn't matter. And I'm using the extremes to make a point. I'm not saying that everyone's like this, but with just load it, the idea is like, look, it's all about low tolerance. The execution doesn't matter as much as developing a tolerance for a position and then just gradually building up that tolerance. But I think that like regardless of what you're doing, there needs to be an intent behind it. So even if your intent might not be necessarily pain reduction, right? Because pain, pain is a complex phenomenon, but it could be an, at least for my evaluation, I think we kind of treat similarly like I'm giving somebody something to do because during the evaluation, there was something that I thought was important that they didn't have, whether it was for pain reduction or performance. So it's like if you are missing a ton of hip extension and you play a sport that requires hip extension, whether you heard or not, I want you to have that, because also like you're a human being and you should have some amount of hip extension. You know, we're looking for the extremes and a lot of really good athletes often test extreme in a not great way, whether they have pain or not. So if we're having somebody do a movement and the goal is to, promote hip extension, if they're doing it, but they're not actually actually extending their hip, they're just going through the motions, then like we're not, we're not saying to be judgemental, like, Oh, you're moving poorly. It's like. No, we have an intent behind what we're doing. So to me, the execution always matters because you should have an intent, even if the intent is just the ability to tolerate load, like all right, well, depending on where you like the position you put somebody in that's going to determine where the force goes. So like where are you trying to develop the ability to tolerate load? What part of the body, what joint are you trying to buy us? Because the execution dictates where that force is going to go. So even if you're in like the just load it camp, there should be an intent and intent behind what you're doing. And that intention dictate the manner in which you teach the movement and the execution. So I think execution is always very important. It might not be popular to say that now, because people can think of it as judgmental. It's not judgmental. It's like we're trying to be purpose and intent driven, and if we don't exercise execution, then what's really our role as like movement professionals. It's kind of my opinion on it. Greg: [00:44:47] Yeah, and I mean, I'm just now remembering a patient from yesterday who said she likes to do deadlifts at home and with her exercise program when she's back at the gym. I'm just like, okay, let's go over.. here's the kettlebell. Like show me how you show me how you deadlift. And it, it's almost like two people, like if the same exact exercise and they're just completely different things because of how the patient does them. So it's more about like the details of, of how it's done. We probably care more about than like what someone's actually doing. Like you could squat or deadlift. I could care less, but you better do it like really well. We're loading, we're loading your lower body. We don't, I think we would all agree, we don't care too much about like quad versus hamstring dominance or glute dominance or whatever. It's just like we want to load the lower body, like pick a dead lift or squat, but they should be done. It should be done really well and that doesn't really matter. Trevor: [00:45:37] Well, so like I liked your point about like intent Doug. Cause I think, I think we would all say like, there's really, we don't believe in like a bad movement. Like, like I'm just like, this exercise is bad. Like a squat is not bad. Maybe how you're doing it isn't the best for you at this moment in time or whatever kind of rationale. But it just about having that sort of intent behind the execution, like the, the dip thing that we talked about last week. Like we don't really give a lot of people dip just for the sake of giving people dips. But if we do have. Like, you know, somebody who's getting like a wrestler who's going to get their shoulders and really crazy funky positions, like they gotta be able to control those positions and they should be strong there. So that's a case where we would give somebody that exercise for a certain reason, but that doesn't mean that we don't care how that dip looks. We still want to have that dip done with really, really good execution and just high quality movement that meets, you know, the standard of what a good dip looks like, whatever that is to the coach. Doug: [00:46:27] Yeah. I think you have to allow for some idiosyncrasies with movement, like people are going to have their own signature. But I think as the provider, you have to have some standards, you know, and that the standards allow for some flexibility. But like, why are you doing what you're doing? Even with going back to the intent thing, like people do like Jefferson curls, and there was a movement where people were like, physios were just saying, Oh, just everyone should do Jefferson curls just to prove that, like you can do it and not herniate a disc. But like, is that a good reason? Like are you doing something just to prove that it's not bad or is there an attempt behind it? Like if you're working with like a wrestler, let's say you have to, you know, like throw somebody from like these disadvantaged positions and that exercise might make sense. But like there's a reason why like a power lifter who is like, their goal is to lift as much weight as possible and competition, even if they're like lumbar spine visibly moves under load in their setup, they're not trying to get their spine to end range. It might be, it might happen during the setup because they're working at a maximum load, but no one is like deliberately saying that deadlifts over like 500 pounds. Like, yeah, like let's take your lumbar spine to end range and then rip it off the floor. So it always comes down to intent. And if your goal, like with the Jefferson curl is like, you actually want to bias the erectors, then like, then go ahead and do it. But if you're doing it just because you're trying to like, you know, be like a contrarian and oppose this like movement perfection thing. We don't get wrapped up in these like you should do it this way or that way. It's like what's the person's goal? And everything else has kind of politics and kind of almost a waste of time, in my opinion. Greg: [00:48:01] Yeah. Awesome. Well, I think that's enough for, for this one.  You guys have anything, else? I think that was really good. I think we had some good questions and I'm looking forward to doing more of these. This is, this is good. Keep them coming. Trevor: [00:48:15] Thanks, everybody. Doug: [00:48:16] Thank you. Keep it real!