E60 | Keep It Real Talk #9: Knee Valgus & More
On today's episode, Greg, Doug and Trevor #KeepItReal while talking knee valgus & more. Links of interest:
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Episode Transcription: I want to ask for your interest. We'd like to open up, keep it real episodes up to you, the listener, and have discussions on topics driven by the content of this podcast and our social media. If you're interested, we'd love to hear. So by dropping us a message on our Instagram, our handle is resilientppt. R E S I L I E N T P P T. Thanks. Welcome to the Resilient Performance Podcast. This is Keep It Real episode number nine. We're going to be talking about, we had some questions about, uh, knee valgus with running jumping, and we'll just kind of go into knee, knee valgus in general and, and talk more about it and kind of peel it back a little bit. Um, talk about some ways that we might address it and then, uh, Kind of dive into that. So I think the question was specifically, how do we, how do we like to address new valgus when we see it during running, um, or jumping with, um, with an athlete, it was specifically a soccer athlete, but I don't think it matters when we can just kind of talk about some, uh, different aspects that might be contributing to it. You want to just take that and run with it? Yeah. I think one of the things that I was wanting to consider when it comes to kind of a general topic or a general motion like that, like with Nita, algos is like, is it appropriate or is it inappropriate when it's occurring? Is it a, is it, is, is it a result of just how the person is kind of anatomically moving? And is it, or is it actually a negative mechanical pattern that's occurring? That is going to be something that we want to correct? Cause I think a lot of people see the knee. What they think is knee valgus. It's not true knee valgus, especially with this example of talking about like running or jumping. And you know, when you're running is basically kind of like a single, like jump in the sense that you're, you're going into a single foot contacts. And if that knee is over the foot, but the hip is outside of the knee. On that side, it may look like a valgus, but that's actually the appropriate strategy that the person should be using to support themselves and find balance. Cause that's what helps them get their center of mass over their base of support. And the difference between that. And then like the knee coming actually inside of the foot and the hip still saying way outside of the foot, like that to me is like kind of a true knee valgus or how I would define kind of a toony valgus of something that I want to correct. And if I see that, whether it is a single leg jump or in running or in a double leg jump, and whether it's broad jump vertical jump, I don't really care what the medium of the jump is. Um, You know, usually that somebody who isn't a good at absorbing. So they're there, excuse me, kind of leaking energy to there. The knee valgus is a result of them leaking it an energy because they can't control the forces of what they're doing. So maybe they're going to like decrease the intensity of the jump. Maybe we're not jumping as high. Maybe we're not jumping as far. I'm going to just, you know, decrease how much momentum they have to control with the jump itself. Um, and that's why I love things like snap downs and different kind of East centric, rate of force development, breaking activities that get people to create tension really, really quickly in the positions that I'm looking for. Um, a lot of that too, you know, sometimes like that's kind of like a long winded answer of like, what are some, some interventions that we can do to kind of help that. But also I can just be coaching sometimes too, especially when it comes to, I think some of the jumping stuff is like, you know, when, when, when you watch a basketball player, like take a shot, their knees almost 99% of the time, like kind of come together and going like whatever is a knee valgus position. To me, that's not like a negative thing. That's not a, that's not a bad strep. That's that it's, that's the strategy that they're using because it's appropriate at that time. So, because they're trying to change shingles to be able to push themselves vertically, to get where they kind of need to go. Um, so I think that nivo is not always a bad thing, but if we're kind of taking it out of the sporting context and looking at like somebody doing a broad jump and the knees are banging together, I might just honestly just coach them and simply tell them to like, just. Don't let your knees touch. That's it. And I will kind of be my only cue because then knees coming in and have occurs with that loading of, of flection of the ankle, knee and hip. You often see a little bit of hip internal rotation, which is going to orient the knee to the inside, into what can appear like a valgus. But again, I don't think that's like true valgus. It's not like their knee is. Being uncontrolled coming across the midline in the frontal plane. I think that's a huge thing that you mentioned is like actually defining it. And I think we've spoken about it on previous episodes, but knowing that like, just because the knee is underneath the person, it doesn't necessarily mean it's valgus. Like if, and if they can't get into that position, like they're probably going to hurt themselves at some point anyway, like that's a position that needed to get into and get out of. Um, and I think that's awesome that you just mentioned, like to create the forces. They're going to have to get their knees underneath them a little bit more to drive. No vertically with the jump, let's say. Um, so that's, uh, I think that's a great point to make. And then, um, so something else I was thinking about was like fatigue, right? So we've spoken about that before with rehab and like how much, you know, how much conditioning do we need with, let's say an ACL reconstruction patient that we're trying to get back to playing their sport. And I know you're dealing with, with one athlete now and you've written them. A conditioning program and they're at the point where they're back playing their sport and it's not the sport isn't enough, or it's almost like we need to kind of build up their ability to play the sport. Cause sometimes they might play it too much. Initially like the coach might. Kind of push them a little bit more than what we did say is, is ideal to kind of progress them back. But, um, so that's one aspect of it. What sort of fitness level do they have specific to the energy systems they need for their sport? Um, and then another thing too. If you just break it down into like all these different departments, it's like, can they access the positions they need on the table? Can they access them when they're strength training? You know, can they, are they strong enough to, to deal with the forces that you're even talking about, um, with absorbing or, uh, or jumping and then going into yeah. And then going back to like, okay, do they have the condition to maintain moving competency while under fatigue playing a, you know, 60 minutes? Game and whatever sport it is. Um, you want to just touch on some of the. Not that your athlete is displaying knee valgus, but ultimately like how to address anything is just having an appropriate plan. Having a program that gives the person what they need for their goals, for their sport. Um, and having it be well rounded and hitting all of the different checkpoints, like getting the elasticity you need getting the power, the strength, the conditioning. Um, you want to just touch on some of the ways you got into that it's understanding, like what are the qualities that they need? What are the end stage qualities that they need to be able to display. And then if we can kind of backtrack from that, how do we get them to be able to display those qualities appropriately? So like in the end stage, people have to be able to be, you know, fast and explosive and quick, and all these, you know, things that have basically like displaying shrink or less density with a, with a very, um, Kind of strict time component in sports. That's kind of what athletes kind of end up having to be. Are you able to do whether they're sprinting or whether they're throwing a ball or whether they're hitting an opponent or it doesn't really matter what the context is, but all of those qualities are kind of built upon initially just strength and controlling position. So during those first early stages, it's getting people just getting an athlete stronger. If they actually do have like a true weakness and that we can kind of talk about that a little bit too. Um, cause sometimes it's, you know, people. We see clients all the time who are told that they're weak and it's like, you don't have a weakness issue. Meaning like you have the muscular strength. Maybe you're just, you know, you've been taught, use it inappropriately. Um, but. With kind of what you're talking about here with, with, with having them work with, we really prioritized in those early couple of phases of just getting her straight as high as we possibly could, because I know that's, what's going to set her up for success in the long run. As, as we transitioned from strength to power and to start introducing an elastic component with shorter Brown contacts, it's just. Being able to get them, excuse me, into the good positions and to be able to handle force in those positions. And then can we handle force in those positions and decreasing time segments? Um, so. Initially, I don't really care how fast he does anything I just want, so you're be strong. I'm gonna see your get stronger. And as they progress throughout the return of sport kind of continuum, it's like, I want to keep the force and the intensity, or keep the force high, but the intensity will increase as the time component. It kind of goes down. So things are going to be done in shorter periods of time, which is going to increase the intensity of the activities that we do. Um, but I'm still kind of always meeting those benchmarks. Does it fit my model of movement? Is it a, is it, am I really training the quality that I want her to be able to train? And I think, again, a lot of that really comes back to like the kind of, you've mentioned it before, like the kind of table range of motion tests, making sure that they kind of have all these benchmarks and then it's okay. Do they have the strength and the requisite force production capabilities in force absorption capabilities, um, and the appropriate positions, then how do we kind of transfer them into just doing higher level activities? Like all the different change of direction and acceleration and agility, uh, things that we kind of ended up doing with her down in the later stages of the return of sport. Yeah. And then you, you also mentioned how, you know, if you watch somebody do a broad jump and you see their knees kind of like buckling how you might tell them, um, you know, don't let your knees touch when you're doing that. And that would be like a simple cue. You probably wouldn't want to take it too far after that. Um, so that was sort of another question someone else brought up was, um, maybe the opposite of like, yeah, you can be over coached where. Nice out is a fine, could be a fine cue for somebody. If that's appropriate. If all of the other things are sort of checked to make an access, the positions they need, but then we've also seen sort of the opposite where it's like, there's an overcorrection. And, um, people don't really know where, where knees out should end sometimes. And we'll see it where like people's needs are like all the way out this way and their feet are underneath them. And, and. That's sort of what they're coming in as like a preconceived notion of what needs out should be. Um, I know I've seen that before it, and I, I would say, um, with a lot of like people who are into like hit training and. Be sort of under like a CrossFit style type workout, like they're, they're often coached to like really drive their news very far out. Um, do you want to just comment on anything with that? I actually had a conversation like that with a client yesterday who, um, came in with like, like general, like mid thoracic spine, like just discomfort. And he reported it mostly during like rolling activities and reported it during like just body weight squatting, um, feels like it's like, you know, Orthopedically and anatomically and stuff like, he's totally fine. He just has this like, spot that irritates him right. In his mid thoracic spine. And when we're going over like a squat, he's trying to keep his shins verdict. Cool. He, I, I can see his toes kind of floating up the entire time. And I'm like, are you trying, like, are you trying to keep your weight on a certain part of your foot? And he's like, yeah, I'm trying to keep it on my heels. And I'm like, don't like, just stay balanced, keep the way in your whole foot, just squat. Like, don't think about exactly kind of what you're doing. Just all I want you to do is like, One thing, stay balanced. And then the second thing, I guess, sit down, um, and he's like, yeah, no, I don't feel that in my back anymore. It's like, well, But I was always told that I should keep my weight on my heels and it's like, that's a good cue. And there's a lot of cues like that in general, where it's like, that's a good cue that had just been taken to the extreme. So if I see somebody squatting with weight and their heels are popping off the ground, I'm going to say, get your weight on your heels. Or if I see somebody squatting and their knees are. You know, touching as the descendant into their squat, I'm going to say, keep your knees out. But when that just becomes the kind of canned cue that everybody who then receives, um, you're really like, we're kind of doing a disservice and we're not letting people kind of find the appropriate movement strategy, which the one thing I always want people to feel is to feel balanced. So, you know, it's just kind of people get over over coach and there's a queue that was, you know, That that was given to somebody at one point in time that has just kind of become the number one cue that coaches kind of start to use. I think that's a lot of times when people come to us, they have like a preconceived notion that like, Oh, I shouldn't do this because they've been told at some point in time, by some authority figure by some coach that they respect by some therapists that they respect that they shouldn't be doing these things. And I think one of the ways that I use to kind of tackle that is I ask them like, like, like, well, why should you know, like, Oh, I shouldn't let my knees. Go with my toes. And I'm like, well, why not? Like, what's wrong with that? Why is that? And I'll kind of put the emphasis on them to like, Rationalize it to me. And if they can convince me, that's great, they can convince me. And then, then they were right. But, you know, I kind of say that jokingly because I know what my answer's going to be to like their response for that. Um, but yeah, it's like, there's a lot of things that just people naturally do. And then when it gets taken to the extreme, they get told to do the opposite to kind of be in the middle. But then when people are in the middle, they get a cue that takes them. I think of that exact same cue that then takes him to the extreme. Um, so I think that's just kind of something we see in like, example with a rolling, instead of being like taught to just pull his arms back, I was like together. So if he's always pinching Shoba together was always extending his thoracic spine. Who's going to keep irritating that spot. And my cue was. Pull your arms back. Just pull your arms against your side. You're so doing the movement, so doing a row, but you're just using a more efficient strategy rather than focusing only on like the specific shoulder blade movement we're making kind of more of a total body movement. Yeah, definitely. And then I'm just thinking too about like, if you, if you do all of your strength work where your knee is never like. Inline with your foot or inside of your foot only do strength work on like the outside part of that sort of spectrum. And then you go and play the field court sport athlete, where you need to rotate around your femur and like change direction. Like that's probably worse if you never actually have to put stress through your knee in like a straight position or slightly. Even like me in, um, so I feel like it would actually be doing them a disservice if, if that coach or if that cue is overused and they're really just relying on like the outside of their, you know, that spectrum where their knees, the side of their foot, or, and then sometimes they'll even put their weight on the side of their foot and you'll see like people. We'll have these enormous arches because of that. And then it's like, that's again, like that's recipe for increased knee valgus when you're doing something else. Maybe not during that movement, but that's where that's going to, that could potentially, I could rationalize cause a breakdown when you're doing something faster, um, where you're not actually thinking about like, Oh, I have to keep my knee out when I'm playing soccer. Like you're not going to do that. Um, and that could potentially just set you up for like, I can't actually bend my ankle because my foot is too stiff. And then. Foam knee valgus, or I can actually load my knee in this straightened position. So it's going to buckle on me and I just can't do it with those forces. So, um, definitely an important distinction for people to realize that like, not all, uh, not all cues are like gospel and. They're good for at certain points. Um, but it should almost be like, well, when is it? When, when is it no longer, useful to even use that cue? Cause then you're just overusing it and could potentially be causing other problems. Um, do you have any more comments on that before? I wouldn't say that that's something that I would say, like, even for myself, I know there's been moments where I've been guilty of that, where it's like, or. Maybe I'm trying to give the cue to somebody and it's a cue. I really like for whatever reason it like, cause it makes sense to me, that's pretty much why any coach, I think uses a certain cue is because it makes sense to them in their head. And maybe it's worked for the majority of the people I've worked with, but then for whatever, the specific athlete or the specific client. Yeah, I'm not getting the intended result that I want with that cue. And if I'm not, we give cues to change movement or to change what somebody is doing. And if we're not getting that change, we have to change what we do. We have to just give them something else. Um, So the thing it's like, you know, we was talking about like, not being married to any, um, any exercise, like, like, you know, like a back squat or deadlift or whatever it is not being emotionally attached to like any really specific like exercise thing. I think Q and kind of goes the same way. It's like, just because that, you know, keep your chest up queue has worked for somebody. It doesn't mean it's the rescue for everybody. And, you know, just because that keep your knees. Out Q has worked for some people who push their knees together. It doesn't mean it works for every pursuit. Like don't be afraid to experiment and kind of try different cues and see what works. And because everybody's different, like everybody everybody's experience and the context behind how, what the word kind of means to them is always so different. Um, and like I said, I've definitely been guilty of that kind of like hammering the same cue and not getting the change that I want. And I keep trying to use that same hue and it's like, you gotta like take a step back. Reevaluate what's going on or what am I trying to give him to do? What's a different cue that might make more sense for this client based upon, you know, some of their different experiences that they've had, like what kind of contextually will make more sense to them. Yeah. And that's definitely something like queuing wise, something I've. I feel like I've learned. I feel like it was with, with that Derek Hanson, like retreat that we did. Like that was something that I like a major thing I took away from, from watching Derek work. And coach was that he's, he's picking cues. Obviously he's got a lot of experience, so he can kind of pull from his experience to decide like, Oh, I've seen this before. I know this cue will work, but oftentimes you've asked him like, Yeah. Why do you pick that cue? It's gonna be like, well, I can rationalize like, mechanically doing what I want to do, but so like, why not? Like let's try something and if it doesn't work, that's fine, then just don't do it again and find something else that does work. And, you know, not. The same cue you use for 10 different people. I'm going to give you the same result. So, um, for sure, definitely. That's like, that's another good point too. And that's something we'll see a lot is like, if your cue of knees out, isn't causing the knees to not hit each other, like you have to find there's something there that. You need to find that isn't, isn't being taken care of and it might not be the cuing. Maybe they just can't even get into that position or they're not weak enough or they're not strong enough for them, or it's not the right exercise for them or blah, blah, blah. Um, and it's like, maybe there's something else there that needs to be, uh, checked out under the hood. Um, anything else before you, we want to kind of move on to, okay, cool. Um, So one other thing, somewhat related to this, this whole knee valgus, this topic with athletes, we had a question from a PT student specifically about, uh, talk from, uh, from our podcasts that Doug had with Nicole. I think that's her name. I hate it. I hate it. I'm like destroying the culture to she. She did a great talk with Doug about. A lot of different things, but regardless the question was about adding cognitive load to your therapy or to your like return to sport programs. Um, you know, how do or let's see. So adding cognitive modes, rehab program, changing the environment to add specificity for the athlete, um, how, when and why to incorporate some of these, uh, different, um, approaches and then how to progress and regress, something like that. Um, Do you want to take that? Yeah. So I think when you think, when we think about movement, especially like, cause this is, this question is more specific to not necessarily weight room stuff, but dynamic, sporting, athletic movement patterns. Um, those moving pendants that occur like on the field or in the rehab and training setting and different cone drills or reactive drills or agility, drills, whatever you want to call them occur because of that, the kind of. Um, the relationship between the three constraints of the task, the athlete, or the organism, some people call it and the environment itself. So when we're kind of progressing an athlete back to sport, Their physical, their physical constraints are fairly high. Like they may not have the appropriate strength, the appropriate range of motion. They may be very fearful. Um, so the task, so we keep the tasks simple and keep the environment simple to deal with those individuals. And, you know, Actual constraints. So we kind of go do things to improve their strength, right. Range of motion and things like that. As we kind of clear those individual constraints, we have to be able to get them to do things in a much more dynamic and chaotic environment, uh, that the progression through that in my mind, kind of how I do it is is I keep. And let me define that first, like the task is like what the athlete's goal is with this specific thing. Um, and the environment is the literally like the environment, like the space that they're in the size of the field, the, the, um, obstacles in the field, other athletes just kind of, uh, the, the like external things, um, rather than just what they're specifically doing. So like a task in sport could be like, Attacking space, creating space, getting away from permanent opponent. Um, it could be, you know, corralling somebody like, like not trying to necessarily like make a tackle, but trying to get into a better position to cut somebody off and, and things like that. So, um, when we kind of go through the. The task things. The task initially is pretty simple. Well, and that's where those difference between change of direction and agility. A change of direction is kind of a closed loop. There's no reactive component, the African preplan where they're going. We use closed drills to get athletes, to practice the movement patterns and the movement skills that they need to be able to do in sport. So we design the task. To be very simple. And in terms of, there's no kind of like cognitive component to it, other than they got to figure out how to complete the movement problem in front of them, of negotiating the cones or, or doing whatever kind of the drill itself is. So like a five, 10, five is an example of kind of a closed loop, simple task where the athlete knows where, and when they're going to herbs, they know when they're going to go, you know where they're going to turn, they know how they're going to turn. They can kind of figure that stuff out beforehand. Um, as they kind of master those close task, um, drills, what we do is we can, can increase the complexity by changing the environment and making things more chaotic and changing the task to not be focused on what they're doing, or, sorry, not focused on how they're doing, but more of like what they're doing, if that of makes sense. So that's when we kind of like, I do things where we'll do like different ball throws in different like reactive drills to get the nuts. Not thinking about what they're going to be able to do, but it changes their attention from what their body's doing to like where their body has to go. So it's not like, Hey, I'm going to shuffle at this point in time. It's like, I gotta go get that ball as fast as I can so that they have to self-organize quicker. Um, cause they can't. They can't predetermine what they're going to do and how they're going to do it, or when they're going to change direction or they can't take a couple of breaking steps earlier than they should cut and things like that. So I think that five, 10, five examples is a good one to kind of think of, of like in a five, 10, five, there's a few yeah. Different patterns that you kind of do. You need to do like a shuffle or a lateral run. You go into a lateral cut. You accelerate, you do a rotational stop at the other end and then accelerate again. The athlete again, knows when and where they're going to cut so they can kind of predetermined how fast I can go with that. We can then get somebody to do that exact same distance and do those same patterns in a reactive way. If we were doing like a mirror shuffle drill and with my athlete, if they're the defender and I'm, and I'm an offense and their job is to mirror me. I as a person in charge of it, I can predetermined where I'm going to go. So I'm going to do that same kind of five, 10, five, um, pattern. But the athlete does not know it. So they are going to be having to kind of figure out from a cognitive standpoint, like what I'm doing to keep up with me and keeping a good position relative to their opponent. Um, and do the same to do the exact same thing. So I could still elicit those same movement patterns without, um, Without letting them know what's going to happen ahead of time. So in terms of like the whole cognitive load thing, like we're increasing the complexity throughout this return to sport process as they, um, we're increasing the complexity as, as we kind of go along by changing what the person's focus is during the different movement tasks that we do during the different movement, drills and agility drills that we do. That's why, like we kind of start with change of direction, drills that are closed and it can kind of figure out what. Um, what their body kind of is doing and how it's feeling and how they're reacting to things. And then we can, and then transfer it into now, your focus is not just what you're doing. It's external. It's I got to get to this spot quicker. I got to go chase this ball. I got a cut off. I got to keep up with you as we kind of changed it into more like that, more of an environment. That's similar to what they're gonna experience in sport. Cause in a sport, the athlete can't think like I should be shuffling this point in time. They're just reacting to their opponent or what the situation is, what the environment on the field actually is. That's why I think like my preference for athletes when they kind of leave the. Quote unquote, like rehab setting and they're getting back into the team sport and getting back into practice that the go and they start doing like small side of the games before they're doing like full scrimmages and getting back onto the court because it's the same thing. We're gradually increasing, like the, the size and the complexity, the size of the environment and the chaoticness of the environment by getting multiple players involved. So they're just having so many more things to kind of deal with and to draw their attention rather than just like, where are my feet? How am I changing direction? Where am I cutting? Like, as we start to increase. The cognitive load and make things more chaotic. They can't focus on just what their body's doing, but they have to figure it out the movement problem that they're trying to solve. Um, which is I can, that's just kind of how, how we progress people from, from that initial, you know, get your strength back, or then how can we get you back onto the field appropriately in a way that you're going to be safe and you're gonna be effective when you get back on the field. It's pretty often. Uh, yeah. And then, you know, this isn't specifically something you can only do with like lower body injuries or like returning somebody back to a field or court sport, um, where, like, you know, the legs are typically more of the focus for sports like that. Um, you know, and I know I had a college wrestler in here over the summer who like the same idea, like we started with. Closed environment type things we started with, you had a shoulder surgery and we did like, you know, you start with bears and you start with like, you know, pushups with your hands elevated. You start with things like that, where you're load bearing, but you're an enclosed fire. And then eventually, like when he was leaving here, we had him, you know, the day of doing like, uh, essentially like a bear where he's reacting to me. He doesn't know which direction I'm going to go. And he needs to try and stop me from getting to a certain point, whether it's behind him or like a point on the turf or something. And that's where, like, like you said, he's no longer thinking about. Oh, like, I need to make sure my technique is good with his bare exercise. It's now like, alright, I've done this position a million times now. I don't need to think about it. Like, I'm just going to try and win. I'm going to try it, react to what I'm doing. Um, or the therapist is doing to try and beat them. And then, like you said, you've trained it long enough and they've developed the strike that they need where it's an appropriate. Yeah. Thing to do and it's appropriate strategy and it's 1000% something he needs to be able to do for me to feel comfortable with him going back to a sport, like wrestling, where he's going to be load bearing on his, on his hands, um, through his shoulder, under this crazy chaotic environment. Um, so that was just one example of how it applies to the upper body, um, as well. Anything else? Yeah, I think, you know, cause one of the, like there's always, um, It's like, why does it have to get hurt when they go back to the sport? And I think, and this is not like a blanket statement thing, but I think sometimes some of the times what happens is they get cleared only after doing change of direction. Things where like, yeah, they may look like they're going fast and they're, you know, um, where they're there, they have good output and they're, they're moving well and they're, they look safe and they look, you know, whatever, but like, Those athletes aren't ready for that next level. And the next level is like getting them to react and that thing. And then the next level beyond that is like, all right, let's kind of be one-on-one where your offense or your, or, or defense. And then we're trying to get you to, to. Reflexively move in a way that's actually appropriate. And then to the next level, doing it in small sided games where you, where you have teammates and they have teammates and then right. Just kind of gradually increasing like the number of variables that they're having to deal with at one time. Um, so I think it's progression of those activities is really basic. Mmm. The progression of those activities is based upon like the cognitive load and it's, and it needs to become similar to what they're going to encounter in sport. It's not just trying to keep things, um, like safe. We have to decrease some of the safety course as they progressed later on, because otherwise when they, if they're cleared only after being really good at like change of direction, closed loop stuff with, with no competition and no reactive component to it like that entire time, they've been able to determine. The best way for them to move because they have time to think about it, but you don't have time to think like that when you're on the court. So. Then when they get back and put in those situations that are more dynamic and chaotic, it's like freeze. They don't move, they don't move well. It's okay. Cause they haven't just been exposed to those environments yet. Like, like we always talk about graded exposure. This is no different than anything else. We have to graduate, expose them to the stresses that they're going to encounter. And like those stresses that happen in sport are so chaotic and so dynamic that. That it needs to be part of the return of sport progression rather than like, kind of skipping multiple steps. Um, and this is, again, this is different from talking about like an ankle rolls. I mean, hold their ankle and they're off for a couple of weeks, but when we're talking about somebody cough coming off of a major injury or a major surgery like that progression yeah. Needs to be longer than it needs to be more thorough because they need to be, um, they need to experience those types of situations. Prior. You've been clear to get back to the sport, in my opinion, Yeah, definitely. You know, I don't think the question was getting at it, but I feel like we've seen people do like math problems with our athletes, like while they're running or something. And I don't think that's what the question was about, but just want to be clear that that's not what, that's not the cognitive load we're looking for. And, and no, it might not seem like cognitive load actually just changing their environment is the best way to increase cognitive load. Sorta summarize what you're saying. And then. It's specific to what they're going to do. They're not gonna be doing math on the soccer field, so they need to be dealing with an ever changing environment, different sizes and different amounts of chaos over time to, to, like you said, expose them over time, gradually to get back to where they, where they want to be. Um, yeah, I think, I think we beat the hell out of that one. Um, and a lot of this stuff that you've already spoken about. You know, you've gotten into, at depth here in a depth that is appropriate for a podcast. I think, um, it's stuff that's going to be part of this, this course that you're working on for us, that I'm pretty excited about that I believe we're going to have out by the end of the year. Yeah. The goal is to have it out by the end of the year. So yeah. I want to include, you know, kind of this discussion and more of like the. Cause I love, I do love, like enjoy these kinds of theoretical discussions. Mmm. How we're kind of programing things and how we're progressing things and how we're changing, what the athletes actually doing. Um, but ultimately it's like, we got to know the, got to have to understand like the X's and O's and what to do and what things should look like. Um, I think that's one thing you kind of lose over the medium of a podcast is you don't see it. Right. So you don't see, like, what does that kind of my five, 10, five mirror shuffle example. Kind of, you know, maybe it makes sense if I explain it well enough, but I think it's kind of hard to visualize. So that's kind of stuff that I want to spend more time. Um, in the actual course, it'll be like breakdowns of that. So you can see athletes that I've worked with. I've taken tons and tons, a video of, of throughout their returns were progression and seeing how we have progressed from just doing that and shuffle on them low intensity to a really, you know, intense. Hard shuffle into a rotational cut and just all these different, uh, dynamic sporting movements. How can we get people to excuse me, to kind of, um, to progress them safely from learning those things in a pretty safe place to getting them to do it in a much faster, more intense, um, way. Awesome. Yeah, I'm really looking forward to that. And, uh, that would finish up this episode episode, uh, or keep it, yeah, real number nine. We're going to make sure we keep track of those numbers and we'll see you next time. If you have any questions or you'd like to sign up to be part of the live discussion that takes place just after we record this, um, feel free to head over to, if you're on our Instagram, you could click the link in our bio and then. You'll figure it out. I feel like, um, or go to our website, resilient performance.com, sign up for the mailing list. And then you'll kind of be sent an email to opt into to join us to these and no commitment at all. You could come and just be a fly on the wall. You can ask as many questions as you like come in and out as you please, but, uh, we're here and, uh, looking forward to engaging with you. As a thank you for listening, we'd like to offer a 10% discount on all [email protected]. Please use promo code podcast at checkout that's P O D C a S T. 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