E49 | Keep It Real Talk #2: Return to Sport Testing

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This episode we #KeepItReal with Resilient's Greg, Trevor, and Doug.

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Episode Transcription: Greg: [00:00:00] Welcome to the resilient performance podcast. This is only our second keep it real talk. We're hoping to do some more of these a little bit consistently, but we have all three of us, Trevor, myself and Doug here. We wanted to just start out by talking about some questions that we've been getting from students, potentially from other clinicians online, other coaches and therapists, but first thing I want to talk about was came up today was, returned to sport testing. We kind of talked a little bit about it already, but who wants to take it, Trevor? Trevor: [00:00:44] Yeah, yeah. I mean, so that was a question that we had from one of our students today and the answer was like, there is no specific tests that we necessarily do further to determine if somebody is ready to return to sport because there is no single test that really tells you, if they're ready for all the different demands that they have during the return to sport process and the kind of example we talked about was like the three hop test is one of the ones that, especially for like ACL rehab, especially popular and it's a good test, but just because somebody has a symmetrical three hop test, doesn't tell you that they're ready to actually like get back on the court and compete against their peers and that was one of the things that we talked about before that's probably the most important thing is like, are they ready to be in the sport with their peers, with the physicality and the fitness that their peers can kind of play with. So just because somebody has symmetry and can do some really easy clothes change, change of direction or speed test, it doesn't mean that they have the fitness requisite to be able to compete against their peers. So being able to meet the standards of the sport, not just getting back some sort of level of symmetry is probably the most important thing. So, yeah, the whole training process, like that's our assessment, that's a return to sport testing is just the entire return of sport process. It's not just a single day and a couple of tests that we do. It's how we progress them throughout everything. After a while, it's like, if you have a healthy athlete, what do you want to see them be able to do to go and play the sports? Like that's the same thing we want for an injured athlete and once the injury process is kind of over and that's no longer a constraint for them, we just have to be able to train them and prepare them as we would for a normal athlete who's not coming off of an injury if that's still an issue and there are still underlying movement deficits or whatever you want to call it then, yeah, maybe they're not ready for the sport, but it's not like just a single day in a single tests that's given us all the information that we need to determine that I think for myself, all the things that we do with agility and speed and strength work along with the information that we get from split testing. It gives us a lot of information that we are kind of always making decisions upon. But again, it's not like a single 5,10,5, or a flying 10 or one sort of test that tells us whether or not they're ready for their sport. Greg: [00:02:54] Yeah. And like, if let's say it's three hop tests has some sort of correlation that's found in the research that's awesome. But that's going to be something you're already pretty much like incorporating into your training anyway. So like, no matter what the test is, it's also an exercise. So you can use that test as part of a training process and then, I mean, with the stuff that you're doing with ACL before you were saying, like, yeah, go and play your sport with your teammates. The stuff you're doing just before then is going to be way higher level than the three jumps test anyway. So it's almost like, all right, you should be able to do this test, like for sure, but that's not even close to the minimum that we're looking for. We're looking for a lot of, change direction movements in an open looped, chaotic situation under fatigue. These are some of the other things we were talking about today and being able to keep your plant angles, passing the eye test, do things, look the way that we want them to look in our model of movement. So yeah, I mean, it doesn't make the test itself or the test and exercise useless. It's just a starting point and it's something that like, all right, should be able to do this and a lot more than that. Trevor: [00:04:02] Yeah. And I think like, like I said, with the three hop test, like it's a good test and it gives you something that's, it gives you good information, but it's not even close enough to the level of stress that they're going to be encountering in their sports. So, it's a fine test I think during the whole rehab process and like you said, though, that's just, shouldn't be something you're kind of doing, whether it's through bounding or whether it's through repeat broad jumps, repeat single, like broad jumps. It doesn't really matter what it is. It's just, those are activities that should be incorporated throughout the entire process, but just because they can do that, make it up, it could be week 20 post-op BCL, that doesn't mean that they're ready for their sport. There's so many other things that they should be able to demonstrate control within, and like you said, pass the tests and pass what we think is good before you're making that call. Whether they're not, they're ready to get back to a sport. Doug: [00:04:50] Yeah. Since this is the keep it real talk, I mean, I'll be real and say like, what's probably not going to be that popular and I don't want people to think that like we're anti testing all these simpletons, and we don't want to use like any kind of objective measures. I mean, we have to ask like, why do people, it might be obvious, like why do people use quote, unquote objective tests in the first place in the context of say, like ACL return to play, but one of the reasons why you have testing and for example, like, let's look at forget ACL. It's like, let's talk about like getting into college, there's this whole debate should there be standardized tests or not? And in an ideal world, like you would have very ethical, fair people who could subjectively evaluate candidates and look at the totality of the applicant based on like their academic performance, their extracurricular activities, their character, the reason why you have like these objective tests is because you open things up to subjective bias. If you don't have any kind of like quantifiable number to when you're trying to like, identify talent, we all know that like SLT is an example. Like it's more of a proxy for other things. It's a proxy for are you good at studying for tests? Do you have access to a prep course or a tutor in a lot of cases? So it's often testing not the thing that you want to test, but more like other proxies for performance. With like ACL testing, it's like, yes, hop testing can be valuable, but like Trevor said, there isn't one test that tells you, okay, this person's ready to play. You want to look at a lot of things and the more things you look at, the more you realize there isn't one test or even a battery of tests, because you have to draw boundaries at some point, you can't just say we're going to test every single thing in the world, but then it's like, okay, well that test looks like the training process because in your training process, if we're talking about ACL, it's like, you're going to start out with passive range of motion and then active range of motion and then quad strength. So like we might not do a specific ISO kinetic quad test, because we don't want to drop 50 grand on an ISO kinetic quad tester, but we can look at like a leg extension machine, which is a lot cheaper and as long as we're not violating the rules in terms of like, okay, we'll start out at zero to 60 initially and then we'll add know, terminal knee extension later on. But we're looking at what weight people are using. We're looking at their tempo, we're using our eye, but we're also, like the amount of weight they use and those kinds of things like can be quantified, even though we're not formerly testing and we're not progressing somebody to running until they, you meet certain strength benchmarks and a lot of times, like maybe the three of us, we don't all do the exact same thing, but we all think the same way conceptually. But another reason why people test is because in a large organization if you're trying to standardize care across the profession, it's very helpful to have tests so everybody speaks the same language. For the most part the only people that the three of us have to communicate when it comes to rehabilitation is each other and then the physician and the physician isn't really, they speak a different language than us like they don't care so much about functional testing as like their own internal things. But when we communicate with each other, it's like, okay, here's the last thing I did with this person and that kind of gives us an idea as to what they're capable of and we also assume that we wouldn't let somebody do something if they hadn't met the benchmarks to get up to that point. Now, probably we can do a better job internally of like writing what are our actual benchmarks because we all kind of do it in our head and we trust each other. In other words, like I can trust the both of you that I don't need you to be like, well, I did a bunch of testing to see where this person is at, but as we probably grow our practice internally, we probably are going to want to have more objective tests because if we have somebody that isn't as experienced or that hasn't been doing things like kind of been immersed in the way that we do things, we're going to want to have quote unquote objective things. But like you said, Trevor and Greg there's no, it's hard to say like, okay, here are the five tests that we do because we're doing different things every day in training and we're trying to prepare for every bio motor ability and even psychological quality and physical quality that is involved in the return to sport process and I think that like the larger the organization or group you are in, the more like standardized testing is necessary. We are a small group and we want to obviously check ourselves subjectively, but we also have each other to check ourselves subjectively. So that the test can do that, but we can do that amongst ourselves and we also communicate freely. So I don't want to make it seem as though we don't think that there's a place for testing. I don't think it's; we don't need to be as dogmatic about it because of the way that we operate but I think there's a place for it. I'm not trying to say that people who do it are doing the wrong thing, but it also, I think has limitations and it's kind of a rant, but I guess it's like there are a lot of ways you could do things and I think do a good job and that includes testing and that includes maybe being a little bit more informal, like we are and I wouldn't derive somebody who does either one of those things, as long as they have a rationale and they get to the same point later on. Trevor: [00:10:05] Yeah, I think like we talked about there with like the bio motor abilities. There's not any one specific test that's the best for any specific bio motor ability, but you kind of throw out the training process or you're developing all of those qualities, whether it's strength, power, elasticity, rhythm coordination, all of these different qualities and that's where you're progressing throughout the entire time. So if they should look like their peers based upon whatever sport and whatever age they're kind of in and if they're lacking any one of those abilities, like, well, then we're spending more time on that in training. So you don't need to have necessarily like a formal test, during any of that stuff and then I think from what we're talking about with our students was most of the return to sport tests don't really, we have anything to do with fatigue and if you're not really assessing how somebody moves under fatigue, then we're not really doing a good job of determining whether they can maintain movement competency in a sport when there is so many other demands, not just like where's my foot and how is it moving when I run or when I change direction. So I think understanding and pushing people during the return to sport process and getting them into fatigue and challenging how they move in fatigue is such a huge part of ultimately what we need to get athletes to do it. Because moving under fatigue is dangerous because fatigue changes how we move and if we don't push people to some sort of limit with that and stress them in those situations, then that's one thing that we're not really assessing and that's ultimately what athletes kind of get back to and then when the other things that they were talk about too was, I think knowing what they are returning to is so different it's not just the based upon like the high school athlete or a college athlete or basketball or soccer or whatever. It's kind of knowing like, what are they going to be expected to do by their coach when they get back to sport? Because we've seen a ton of athletes who did the first six months of rehab somewhere else and then kind of came to us for a little bit before they go back into actual practice and things like that and it's like, If they didn't come and see us and we didn't work on some of those more fitness equalities, not just range of motion and motor control, if you will. It's like if they got cleared by their PT to return to sport and then their coach just hears that oh, this person is cleared they're a hundred percent and hey can do whatever they want it's like, well that person's just going to get destroyed. So I think it's or is it the situation where like, hey, look, we can talk to a coach and like, I want them and just kind of individual skills for a couple of weeks and then maybe they're in small sided games and just kind of graduate exposing themselves to distress because of a game and getting into scrimmage and then playing with the minutes of restriction, like which because look with the high school athletes that we work with. There's such a range of what the coaches kind of expect them to be able to get back to and what they're comfortable expressing to their coach. I think like all of that really makes a difference. If I have somebody who I know they're going to get back and their coach is like, you're a starter, you're going to play the entire game just like you did last year it's like, well then, I have a lot more work on my end in terms of what they need to be prepared for to get back to sport versus if there's someone who maybe their coach expects that but they also have a strength coach that they work with or something else is just some sort of other variables that changes how far we have to push them in the process. Greg: [00:13:16] Definitely there's some times like I'm going through it right now with a post-op case where the athlete's going to return to his team in college and he's going to be expected to do things that aren't necessarily related to his sport. So unless we have the conversation about what are the things you guys are normally doing in practice? What sort of testing do you guys do from like a fitness standpoint and you mentioned like we do a ton of burpees. We do a lot of workouts that include burpees. So it's like, I don't typically do burpees with people. So if I don't and at least expose them, if I don't expose them to them at all, and then he goes back and all of a sudden day one is doing burpees. He's probably not going to do so well and he might like, think that I did a poor job or like his rehab wasn't good enough or he might think maybe his confidence is lower, he's not fully ready yet, but it's only specifically because I didn't do that one thing or like walking, I think his team, he has to do some handstand walking, which again, it's like not exactly relevant to the sport but he had a shoulder injury. So it's pretty important that... Doug: [00:14:16] What sport is this he's playing? Greg: [00:14:17] Wrestling. So, yeah and like just an example of like, absolutely. Yeah. That'd be a little wacky. I'd be calling coaches about that, but it makes a little sense, like, all right, he's done some handstand walking, he's doing some burpees, like I could see how that's related to wrestling a little bit, but it's sort of outside of what I would normally do with even a wrestler, anybody with a shoulder issue post-op. So, one other thing going off of the testing or more so like return to sport activities under fatigue, we've got these force plates in New Jersey and Trevor has been doing a shit load of testing with those and from my eye and I don't know how good you've gotten with it, but if I watch somebody jump on there, I might think like, that looks really good until you look at the actual data and you can actually see some percentages and it puts numbers on it makes it objective so that it's not just your eye testing. There's no ideal, it's really just like trying to get it as good as possible. And then having some sort of range of what's it acceptable from like an asymmetrical standpoint or a force production standpoint. Can you just talk about that? Like real quick, what are things that you're seeing typically with you can use your ACL patient as an example, and just like the eye test versus quantifying it and then sort of like where's the in between and where do we want to fall? Trevor: [00:15:34] I think, yeah, like the force weights have been extremely helpful for being able to understand like the phases of the movement because you do see like with the kind of jump you have the breaking and the propulsive phase and the force weights give us data in terms of the asymmetry during both parts of those movement, which then from a corrective exercise, or basically just all we do in our movement prep and some of our warm-up stuff is we're doing things kind of more targeted towards each phase of the jump. So initially when we first started testing there was a large asymmetry in both the braking and the propulsive with the breaking comes first and the breaking kind of sets up your propulsive phase. So we spend a lot of time doing e-centric focused activities, like a bunch of different variations and things like that and now over the last like month, that asymmetry is like almost gone and now we still see in asymmetry more just the propulsive phase, which is really based upon like the strength that she has in her leg. So now we're doing a little bit more stuff based in our movement prep to work on strength in her leg like power skips and things like that. They're a little bit more of like a concentric focus. So I think the force weights are great because they kind of let me be a little bit more specific than I could be with just my eye. It's not to say, like if you see those things and people have soft landings, it's like, okay, I need to kind of give them a little bit stiffer with that so you can introduce snap bounds if you know that's the activity that you should do. But in terms of like the forced weights, it helped me understand, like that's a good activity now. Not necessarily something that maybe I would have waited a little bit longer to do it. Greg: [00:17:05] I think maybe, yeah. I was just going to say and that's like stuff that you probably would be doing eventually at some point and maybe you'll start to find like patterns with ACLs, for example, where it's like, I already know, I don't need to actually force play test this person. It's not practical. It's a luxury that we have that we have the force plate. So not everybody has that at their disposal, so that we'll start to see some patterns, I think, where it's like, alright, ACLs until this week. I typically see, they need to work on snap downs more than they need to work on concentric power or something like that. So that'll be pretty cool. Trevor: [00:17:35] Yeah, absolutely. I think, and then so like, even once she's ready to get back to sport. It's like, I hope that the force plate data looks the way I want it to look because that makes me sleep better at night, if you will. But ultimately it's like, if I continued to see the things that I do when we do reactive change of direction or are reacting to joy of the work, it's like I wouldn't be comfortable with a person returning to sport like that because I still see like during a week they're in a lateral shuffle cut or some sort of a lateral stop with like that foot being open whether or not when a trainer kind of bias the hip and not load their needs. If you continue to see these movement strategies take place over time and especially as fatigue kicks in, it's like, well, then I know that something, we've got to keep working. There's something else that that's kind of holding us back, whether it is strength or whether it's confidence or something else. But I think like the force weight data helps us understand like, well, how can we be a little bit more specific with some of these interventions, but ultimately it's like we have to get them to move competently and move safely and move quickly and move with force and speed and power and understanding what should we be looking for? How should it look basically when we're doing those activities is kind of where you have to take it and I think a lot of people it's just because like everybody who has seen her is like, oh, she looks great. And I'm like, she does. Greg: [00:18:54] She does. Trevor: [00:18:56] I'm not comfortable with it yet. I think there's; knowing the type of athlete that she is, you can go so much further and there's so much more that you're capable of and the moving body and continue to improve and there's lots of little things from like the subjective side like Doug had mentioned before, it's like, just from doing this stuff for awhile and coaching people and breaking down video, it's like, you kind of find that the trends that you're looking for and if you can work on those things, just because you did a five,10, five at this speed, like that's great, but what if the movement quality and the strategy and the movement pattern was jerky and uncoordinated and I mean, but really they're outfits fantastic. So it's like they accomplish the task, but maybe they didn't accomplish the task optimally or as efficient as they possibly could. So that's why I think like the subjective part matters in my mind as much as the objective stuff, because you can watch a good mover and everybody, even if you're not a coach or a therapist, if you know what a good mover looks like it's just it looks smooth, it looks organized. There's always words that kind of come into play and it's like, that's what we need to get people back to. Doug: [00:19:58] Yeah. You brought up a couple of key points there that I think, I'm going to talk about a little more and one of them is like, some of this stuff is semantics right? Because we're talking about testing and somebody could say, okay, well, you're doing what you would normally do with like some of these pliers, but you're doing it on a force plate. So you can consider that testing, I think that we look at it, like we don't probably have a separate day where we say today is test day. Every day is a test essentially and anytime that we can quantify what we're doing, we try to do it. So like, in New Jersey, you guys have the force plant, you would be doing pliers anyway because you have the luxury of the force plate in New Jersey now you're doing pliers on the force plate to get objective data and you're actually using to influence your decision. So if we're talking about some people could say, oh, well, you guys actually do test, sure. We're just saying that we don't necessarily like do things that we wouldn't otherwise do in the name of testing, because even like a triple hop test, for example, like that's pretty much like that's bounding on one leg and when we go do like our running progressions, we're pretty much doing bounding as a part of that and we might start out with alright we're doing like a bound and a stick. We're not doing it as elastically and we're just worried about landing in a safe position and we're not worried about a ton of projection. Then as that gets better, we might do something that looks more like what a triple jumper would do towards the end stage of it but like to get somebody who doesn't do anything that looks like bounding and then say, okay, now we're going to test you in a three jump hop or whatever, like three jump tests, that would be insane. You want to do something that looks like that test and so we just look at it like some of these tests are just good plyometric progressions, otherwise be doing and if we can quantify it, we will. You also made a point that how can people gain the test? Because you can give somebody a three jump test and they might do better on the surgically repaired leg than on the quote unquote good leg. But if it's a knee surgery and they're using hip and an ankle strategy to do it are you going to say, okay, well, that's good, let's return to sport. Again, that's part of your process, whether it's a test or in your training you would know, okay, well, I had a formal quad testing session on an ISO kinetic device so I know that the quad strength is either adequate or it's not, or we could use like a leg extension and we would say, okay, well we know their quad strength is there or it's not. Chances are, if they have the quad strength, they probably won't need to use that hip or that ankle strategy. So again, the more, if you look at any one test in isolation, it can be gamed. That's why you need additional tests. Some of which aren't that quote unquote functional that are more isolated to kind of check yourself. But then the more tests you have, the more you're like, well, this is just my training process, I'm testing anyway. So as long as people have a rationale for what they're doing and they're using multiple tests or multiple training iterations to check themselves and it's all kind of good. Again, it comes down to semantics and that's why we like sharing case studies because we can talk about these abstract testing, no testing, but ultimately it's like, all right, what did you actually do with this person? And how did you track it and I think those conversations are more productive than saying, like we do these batteries of tests and that's it because your testing and your training should be seamless anyway. So how does that all kind of work together? And that's a case study, right? Greg: [00:23:14] Yeah, I know Trevor has been like practicing force plate jumps so that he can have better numbers than some of his college basketball players. That's pretty funny. He can game it, figure out ways to jump in a way that gives him better numbers than a college athlete who's like a freak and just an absolute animal on the court. So it's pretty funny. Doug: [00:23:34] Yeah. Like, I mean, is there a case on the force plant where you can get a better force plate reading, but the person that you're competing against actually jumps higher, which is what we care about? Trevor: [00:23:43] That's exactly what Greg's talking about. My force plate numbers would look like I'm this unbelievable... Greg: [00:23:54] Which you are. Trevor: [00:23:54] But if you look at your; just watch him move, watch him jump, watch him do the sets, he is way better athlete than me. Well, he's a D one basketball player. Like it would have been different, but between us into what our output abilities are, but I know how to change my jump a little bit and what kind of looks better on a force plate, but if you do a Vertech with us, it's like, his jumps going to be five inches higher than mine. Doug: [00:24:21] So what metric are you performing better out on the force plate, even though you're not jumping as high? Trevor: [00:24:26] How I like unweight and slammed the brakes on is better than how he does it, that's what it is. But there's a lot of things that kind of come into play too. It's like, are you kind of more of a hip and knee or a hip jumper, a knee and ankle jumper? Just kind of like all those things matter a little bit in terms of the force plates and basketball players don't have a lot, they're hardly not, I wouldn't say hardly, but like they're not just a vertical jump. To max up, or maybe if you're taking a jump shot, you're jumping purely vertical, you're not coming off of some sort of movement, but if you're going for a dunk, it's like, you're usually taking a couple of gathers that you have momentum and have in your favor that you're transferring to a new direction. So it's like, it's completely different, but if I'm just doing a counter movement jump, I could quote unquote, beat him, but look at the sport and look at like what he would actually have to do and it's night and day it's like he would jump. I can learn all I want or be a better jump on the force plate, but his output in real life, if you will, is significantly better. Doug: [00:25:26] That's really insightful because I mean, with these force plates you can literally look at a jump, a hundred or more different ways. You've got to figure out like, all right, what are the ways that actually matter? And even we work with these athletes a lot of times and like we don't know what they were like before they were injured and oftentimes not just like us, the three of us, physical therapist, strength coaches, we assume that like, well, somebody got injured therefore what they were doing before they got hurt, must've been wrong. But like maybe what they were doing was totally fine. So like, how do we say, like, okay, if the athlete naturally, even before they got hurt, when you use more of a hip dominant jump strategy, but they jumped a 40 inch vertical, who are we to say that like that's bad and if they need more of a knee strategy when like maybe that strategy had zero to do with why they got hurt. So it's like, there's so many unknowns with this stuff. So it's like, I'm not saying we shouldn't try to look at data because we should, but even when you look at data, it takes you down a rabbit hole of like, how did you even come to the conclusion that this data matters in the context of what you're trying to do? Trevor: [00:26:27] Yeah, absolutely. That example of that the hip strategy, that's fine, if that's the strategy they choose are their body is best with the majority of time that's great. But if that's their only strategy then that's probably an issue but again my plates don't tell me that. But when I watched them in different deceleration positions, it's like, oh, I see they never want to load their hips. So that gives us just more information, like you're talking about it. And then, I have another ACL athlete who she's pretty far post-op around a year a strength coach asked me to look at her and I tested her and it's like, oh, she kind of see, you see things are kind of normal symmetry and things like that and I was like, how did it happen? It was contact or non-contact and it was like a brutal contact injury. So it's  did she do anything wrong to have that injury? Like her force plate data may show certain strategies and that wasn't how she had her injury. She had her foot planted in somebody and she goes on one leg and somebody drove her lateral from her knee and completely tore her ACL. Understanding the context behind the numbers and the kind of story that all of the bits of information that we're trying to gather to tell the story for this single person is, is what we need to do. We can't just, like you said, take one test or a couple of tests in isolation and just treat them as like the whole story. Doug: [00:27:45] I mean, these conversations are interesting because we want to talk about like, all right, what's like the 1% stuff, what do we test? The reality is it's like the profession and the medical world would be a lot better if people just did, when it came to like ACL rehab, do you even do any strength training? Forget like testing it, do you even do it? Because if the answer to that was yes. This conversation wouldn't be nearly as important. Do you have a return to run progression? Do you have a change of direction progression? Do you even do change of direction of work before you say that someone's ready and some of this stuff is people just don't know any better and some of it is they know better, but they got like a limited number of insurance visits. So there's a combination of things, but like, and then it comes into like the systemic issue of who pays for health care. Even if someone let's say is limited by insurance visits, okay, let's say, we worked in an environment where like, we were only in network with insurance. I wouldn't feel comfortable, even if we had, let's say we were authorized 20 visits, we might be at 20 visits and if I have to like kick you out, if you can't pay, I would at least like have some, or we would I'm sure have some online resource that we created. Maybe it's generic and not perfect, but it's like, okay, you're at three months now, we've done these strength training things. You're just about at the point where you're ready to like return to running and change the direction, here's our online program. It's free because you just work with us for three months and I know it's not as good as being here, but it's something so there's got to be some way to fill in this gap, whether it's like a knowledge void or insurance and a payment void, because I mean, let's face it like most of the ACL situations that we encounter from other places, they really didn't do any strength training beyond maybe a leg press or a goblet squat. Not a lot of unilateral loading, nothing that heavy, no real running progression. The running progression is started out by running a 10 minute mile, but you play like a speed based sport and then there's the change of direction is really non-existent. So full circle, it comes back to like, like everybody do the basics and then we can talk about like what the perfect battery of test is, but you can make the point that at least if you have a good battery of tests, you'd be able to identify people that aren't ready to go back because they didn't do the basics. But the basics also informed the test. So it's kind of a circular thing. Trevor: [00:30:15] Just like the tug in PT school, Greg, right? Greg: [00:30:18] Oh yeah, that tug test. It's a brutal one. Trevor: [00:30:21] Greg asked, because it was like the research for the timed up and go. If you get better at the timed up and go, your likelihood of falling decreases like substantially and Greg asked, I was like, well then why don't you just like practice the test? And I was like, why would you practice the test that doesn't make any sense to get? But if getting better at the tests improves your life and decreases your chance of falling in line. It's like well then that should just be the exercise then it's just kind of doing that thing. Doug: [00:30:49] Yeah and anything that is worthy of testing should be worthy of including like a training session. Greg: [00:30:55] Yeah, and we we're having this conversation all about like force plates and all this like really fancy stuff and then, I mean, like our online course, it is not this, it is like what you're saying, Doug, it's doing the basics as best as possible and having things pass the eye test, not using technology, which is like what we try and do with pretty much anybody. With our patients, with our students, we try to get across like 95% of the stuff you're going to do is very simple and you're going to do it all the time and you have to master that stuff. You don't need force plates to tell you if you're doing a good job typically. Doug: [00:31:33] But maybe we have like a delusional sense of like our ability to like see things and we're like, so we need to do something to check ourselves and I think that we rely on each other to do that, but technology and testing we can do that as well and like you're using a Trevor with the force plate, so like we are doing it. It's just that probably if the process is not good, it doesn't matter how robust your battery of tests are. So it's not like it shouldn't be one of the other, it should be both. But I think that a lot of times the conversation is over besides the testing part, but it's like, all right, like if you have a process to get good at the test, you should be able to throw any tests at somebody and they're ready to go. Whether it's a hop test or some kind of like a lateral test or a 40 or a 5, 10, 5, or a small sided game or a force plate. Because again, the real test is when you're in the game and there's only so many ways to simulate that and the way to simulate it is just through a lot of variety and exposure to a bunch of different things that somewhat mimic the sport. Trevor: [00:32:40] Yeah. Greg: [00:32:45] Awesome. Anything else? Trevor: [00:32:48] That's good. Greg: [00:32:49]  Anything else you want to touch on before we end this one? Trevor: [00:32:52] That was one topic that... Greg: [00:32:57] Yeah. One question. What has it been? 35, 40 minutes but yeah, I think that's it for this keep it real talk. This is only our second one. Hopefully we do some more and then right now we have a promo going on, actually for our course, we have a 15% discount and then you get our exercise database access for a year for free. So, I don't know if you guys have even seen like the web based exercise database completed and everything, but that's pretty cool. We have all those videos that we send to people it's like you type in deadlift and any data variation pops up, you copy and paste, it's pretty easy and quick, but, hopefully we can get some more people involved with our course and go over stuff that we want to do with people every day and with our students and just try and get better. Doug: [00:33:44] And all this return to play talk, Trevor is in the lab putting together the ultimate change of direction return to sport resource. So stay tuned for that. Greg: [00:33:54] Yeah. Can't wait for that. Hopefully that's... Doug: [00:33:58] I don't think he wants to be pressured, but I'm going to put it out there. Trevor: [00:34:00] No, it's good. I like it. I think we can get it done by the end of the year. Doug: [00:34:03] End of the year. Trevor: [00:34:04] We got to film it still. Doug: [00:34:08] No joke. I mean, I am excited to use this for myself because we had a conversation. We don't actually get to talk as much as we would and we were talking a couple of days ago and he's showing me, I mean, just footage, qualitative analysis, things that seem like they're very simple, but the amount of depth that he goes into with some of this stuff is really, really huge when it comes to a return to play and even people who are uninjured, just like it's really a great just movement analysis course as it pertains to change of direction. So I'm excited for it. Greg: [00:34:36] I'm going to learn a ton for sure. Trevor: [00:34:38] Thanks guys. I appreciate that. Greg: [00:34:40] Yeah. Doug: [00:34:40] Pump your tires a little bit there. Trevor: [00:34:41] Yeah, there you go. Greg: [00:34:43] Yeah, that's it then. Let's sign off and we'll do this again sometime soon. Trevor: [00:34:47] Thanks everybody.

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