#58 - Creating a Pre-habilitation Program with Dr. Davis McAlister, Part 2

WEBVTT
1
00:00:03.399 --> 00:01:07.439
The the the the between between the
Hi, guys, Welcome to The Factor
2
00:01:07.480 --> 00:01:11.079
podcast. I'm your host, Jessica
Riddle. If this is your first time
3
00:01:11.120 --> 00:01:15.719
tuning in, welcome and thanks for
listening. In today's episode, we're wrapping
4
00:01:15.799 --> 00:01:21.280
up the final segment of this two
part series with doctor Davis McAllister on creating
5
00:01:21.319 --> 00:01:26.760
a prehabilitation program. In part one, we discussed how using this proactive approach
6
00:01:26.799 --> 00:01:32.159
to prepare for activity can decrease the
chances of serious injury and optimize performance.
7
00:01:32.799 --> 00:01:37.760
Today, we'll discuss this evidence based
components that every prehab program should have.
8
00:01:38.239 --> 00:01:42.120
We'll dive into the research surrounding ACL
injury as well as the application of force
9
00:01:42.159 --> 00:01:48.680
and movement as it relates to injury
prevention. Our instructor is doctor Davis McAllister,
10
00:01:49.120 --> 00:01:53.519
a clinic faculty doctor for the Parker
University Dallas Wellness Clinic and a chiropractor
11
00:01:53.560 --> 00:01:57.519
that is served as a team doctor
for several sports teams from the amateurs to
12
00:01:57.560 --> 00:02:02.760
the pros. Prior to his career
in chiropractic, doctor McCallister served in military
13
00:02:02.799 --> 00:02:07.039
intelligence for the US Army. He
holds a bachelor's degree in anatomy, a
14
00:02:07.120 --> 00:02:15.000
master's degree in educational leadership and has
certifications in adaptive rehabilitation and acupuncture, amongst
15
00:02:15.080 --> 00:02:21.960
others. His specialties include chiropractic treatment
for sports related injuries, rehabilitation, taping,
16
00:02:22.039 --> 00:02:27.840
and soft tissue. So if you
aren't currently doing any prehab programming with
17
00:02:27.919 --> 00:02:31.400
your patients, I would listen closely
and take notes. I can guarantee this
18
00:02:31.479 --> 00:02:37.280
training will teach you strategies you can
implement in practice right away. Let's dive
19
00:02:37.319 --> 00:02:51.319
in so functional assessment. This a
by no, means a comprehensive list of
20
00:02:51.360 --> 00:02:53.599
all the possibilities that you can do
for a functional assessment. These are the
21
00:02:53.639 --> 00:02:59.800
things that I typically use when I
go through an assess somebody for an ac
22
00:03:00.120 --> 00:03:02.400
L injury risk as well as other
things that's looking for a lot of other
23
00:03:02.439 --> 00:03:07.120
things as well, but focusing on
aco risk. These are the main ones
24
00:03:07.159 --> 00:03:12.360
that I pull the information from.
So there's a list here that you can
25
00:03:12.360 --> 00:03:15.520
see. These are possibilities that you
can do when I go out and I
26
00:03:15.599 --> 00:03:20.879
go assess a team. These are
the majority of the tests that I will
27
00:03:20.879 --> 00:03:23.800
do. These on them. So
with backsquat, back squats key component of
28
00:03:23.840 --> 00:03:28.800
functional assessments. So you have the
functional movement screen or FMS, you have
29
00:03:28.840 --> 00:03:32.240
certain elements of the squat that allow
for assessments for deficiencies that lead to ACL
30
00:03:32.360 --> 00:03:36.560
risk. So we talked about lateral
displacement. Those are some of the things
31
00:03:36.680 --> 00:03:40.280
you also look for, anterior drift
knee collapse. You'll typically see the knee
32
00:03:40.280 --> 00:03:45.520
collapse more on going up out of
the squat position than you do going down,
33
00:03:45.719 --> 00:03:50.000
So those are things that need to
be addressed. Trump position deficits reflecting
34
00:03:50.080 --> 00:03:53.639
adequate core strength, which we already
talked about, and that will translate to
35
00:03:53.840 --> 00:03:59.400
deficits into hip mobility and asymmetrical positioning. Hip position definits relate to asymmetrical wayshifts
36
00:03:59.439 --> 00:04:02.560
and build the lateral and frontal plane. Then your frontal plane knee alignment deficits
37
00:04:02.599 --> 00:04:08.400
may present as valgus or various shifts
of the need due to poor neuromuscular control
38
00:04:08.479 --> 00:04:12.719
and function. On rare occasions,
you may see people that will have a
39
00:04:12.800 --> 00:04:15.360
valgus shift on one side and then
a various shift on the other, which
40
00:04:15.399 --> 00:04:18.680
means it just looks like their knees
are going like this when they've bend,
41
00:04:19.079 --> 00:04:21.959
and so those are things that you
need to go through and correct. So
42
00:04:23.160 --> 00:04:28.399
frontal plane knee alignment deficits may present
as valgus or varius due to poor neuromuscular
43
00:04:28.439 --> 00:04:31.160
control and function, so it could
also be a lack of strength in the
44
00:04:31.199 --> 00:04:35.120
lower extremity. That's probably one of
the hardest things to get high school athletes
45
00:04:35.160 --> 00:04:42.120
to understand, especially the non football
male players, and then just female players.
46
00:04:42.199 --> 00:04:46.879
The majority of female programs that I've
seen, they are very very lacking
47
00:04:46.920 --> 00:04:50.639
and their strengthened and conditioning programs,
in particular on the strength side. They
48
00:04:50.639 --> 00:04:55.560
don't like to lift weights a lot, and I understand the need to be
49
00:04:55.600 --> 00:04:58.319
able to do more functional lifting,
but at some point we've got to be
50
00:04:58.319 --> 00:05:00.600
able to increase the weights. I
have five kids, and I've seen the
51
00:05:00.680 --> 00:05:05.120
variety of programs. Both of my
daughters play volleyball, and I've seen the
52
00:05:05.120 --> 00:05:09.160
program that they put them through,
and they lift the same weight every time
53
00:05:09.199 --> 00:05:12.519
they go in, whether it's in
season or off season, and they never
54
00:05:12.600 --> 00:05:16.240
increase and there's no strength development at
all. So another thing to look at
55
00:05:16.319 --> 00:05:20.720
the backspat nieve valgus when the medial
aspect that knee passes the medial valuolis so
56
00:05:20.959 --> 00:05:28.439
decreased hip abductor and external rotation strength, increased hip adductor and ankle dorseflection restriction,
57
00:05:29.000 --> 00:05:31.399
So it could also be a compensatory
mechanism from pest planets that we talked
58
00:05:31.399 --> 00:05:34.560
about with flat feet, the ankles
roll in that you also have to look
59
00:05:34.560 --> 00:05:40.879
at ank orseflection and determine if that's
being a contributing factor for the lack of
60
00:05:40.920 --> 00:05:46.360
mobility and poor mechanics. Also,
during squat tibial translation angles, it should
61
00:05:46.360 --> 00:05:51.480
be maintained and parallel to properly positioned
upright trunk deficit will be excessive restricted translation.
62
00:05:51.519 --> 00:05:57.800
So if you have excessive anterior translation
increases sheer forces and knee extends or
63
00:05:57.879 --> 00:06:00.800
torque. This can be the result
of post to your chain weakness in particular
64
00:06:00.839 --> 00:06:05.680
weak astroc solius, wee camstrings,
weak blots, quad dominance, all those
65
00:06:05.720 --> 00:06:11.160
things that we've already talked about.
So restricted t build translation results and increased
66
00:06:11.199 --> 00:06:15.680
anterior torso translation. So as they
go down, you'll see the upper bodies
67
00:06:15.720 --> 00:06:19.639
start to drift forward more and more
over the knee and ankle to the extent
68
00:06:19.680 --> 00:06:24.040
where it goes out front. Because
sometimes it's even at what I referred to
69
00:06:24.079 --> 00:06:27.639
as the folding chair. They think
they're going deeper because the arupper body is
70
00:06:27.680 --> 00:06:30.079
going down, not the lower body, and they're not even properly engaging the
71
00:06:30.120 --> 00:06:33.319
muscles and get a proper range of
motion in their squad with a lower body.
72
00:06:33.560 --> 00:06:39.439
So this also can be a result
of ankle restriction from posterior talus translation,
73
00:06:40.079 --> 00:06:44.000
decreased hip mobility or decreased foot mobility. You'll see some of them that
74
00:06:44.040 --> 00:06:48.759
they get a posterior restriction and the
ankles and that will inhibit dors deflection and
75
00:06:48.879 --> 00:06:54.399
so on the car practice side.
Just a simple adjustment of that ankle to
76
00:06:54.439 --> 00:07:00.279
bring that talus back into the proper
midline position from a posterior restriction should be
77
00:07:00.319 --> 00:07:03.279
able to help increase that dorsy flection. Then it's a matter of also strengthening
78
00:07:03.360 --> 00:07:08.560
the ankle to be able to prevent
that from being a recurring problem. Foot
79
00:07:08.600 --> 00:07:12.639
position and entirely planned it on the
ground during the entire emotion, so you
80
00:07:12.639 --> 00:07:16.000
don't want to see heels coming up. Weight should be distributed over the midfoot
81
00:07:16.120 --> 00:07:20.399
to the heel and then the biomechanical
foot deficiencies translate up to the kneast and
82
00:07:20.519 --> 00:07:23.879
hips, so it just starts at
the ground, it works its way up.
83
00:07:24.120 --> 00:07:29.199
Why balance test or star excursion balance
test. There's these are similar tests,
84
00:07:29.199 --> 00:07:32.079
but they're not exactly the same.
I use the why balance itself.
85
00:07:32.600 --> 00:07:39.399
You can go through FMS as well
as part of an SMS assessment, and
86
00:07:39.600 --> 00:07:45.000
we actually have the sliding blocks and
so forth that we measure with and instead,
87
00:07:45.040 --> 00:07:47.279
a composite score of less than ninety
four percent lower limb results in a
88
00:07:47.360 --> 00:07:53.759
six to point five times greater increased
risk for lower extreamting injury, and a
89
00:07:53.800 --> 00:07:59.639
female athlete anterior reach asymmetry of greater
than four centimeters results in two points seven
90
00:07:59.680 --> 00:08:03.680
times increased risk in all high school
athletes, so it's pretty significant there.
91
00:08:03.839 --> 00:08:07.839
Another study on D three football players
showed a three point five percent higher risk
92
00:08:07.920 --> 00:08:11.839
of non contact injury with a composite
score of less than eighty nine point six
93
00:08:11.920 --> 00:08:15.560
percent. And so when you go
through and do the score, there's a
94
00:08:15.600 --> 00:08:20.319
composite score that you develop based on
the formula that incorporates lend length and distances
95
00:08:20.319 --> 00:08:24.120
that they can reach in multiple directions, and then you put that into a
96
00:08:24.160 --> 00:08:30.680
composite score and you get a percentage
of efficiency within each side and the lower
97
00:08:30.720 --> 00:08:35.519
limb. The drop jump screening test
that's probably used to measure knee valgus values
98
00:08:35.559 --> 00:08:39.279
by measuring knee separation during three separate
frames of reference by recording images from three
99
00:08:39.399 --> 00:08:43.080
jumps from a boss. It helps
if you do have video imaging if at
100
00:08:43.080 --> 00:08:46.480
all possible to do this, you
can do it individually, but also helps
101
00:08:46.519 --> 00:08:50.720
if you're having to do large numbers
of people. It helps to have that
102
00:08:50.960 --> 00:08:54.480
imaging to be able to go through
and view that. Most studies were related
103
00:08:54.519 --> 00:08:58.480
to the use of newer muscular training
programs to improve knee alignment, particularly in
104
00:08:58.519 --> 00:09:01.559
basketball and volleyball players. Currently,
there's no research to support using this test
105
00:09:01.600 --> 00:09:05.360
as it means of predicting injury risk. So I mean this is something that
106
00:09:05.399 --> 00:09:07.799
can be used, but it's going
to be an additive. This is not
107
00:09:07.879 --> 00:09:11.519
going to be able to stand the
loan to be able to assess injury.
108
00:09:11.519 --> 00:09:13.519
You're going to have to combine it
with other things. This would just be
109
00:09:13.600 --> 00:09:18.919
one component that you could use to
help with comparing information that you found from
110
00:09:18.960 --> 00:09:22.080
other tests. So the usefulness of
this test is related more to asymmetry during
111
00:09:22.159 --> 00:09:26.799
landing and kneevalgus, and it can
be used in conjunction with a force plate.
112
00:09:26.159 --> 00:09:31.080
So your tuck jump assessment, your
tuck jump assessment is commonly used.
113
00:09:31.159 --> 00:09:35.879
You'll see this commonly used with pts
and athletic trainers and performance specialists. It's
114
00:09:35.919 --> 00:09:39.159
going to assess ten aspects of the
jump and only texts about ten seconds to
115
00:09:39.200 --> 00:09:41.480
perform, so it's pretty efficient and
you have a couple of minutes to score
116
00:09:41.519 --> 00:09:46.960
while visually recording the test from a
frontal and satical plane. Does it require
117
00:09:46.000 --> 00:09:50.440
a box Like the lists, the
LS and the drop jump test. It's
118
00:09:50.519 --> 00:09:56.000
highly recommended that the same clinician should
administer so that way you're not running the
119
00:09:56.080 --> 00:10:01.399
risk of inter rate or reliability issues
of the same per doing the assessment each
120
00:10:01.440 --> 00:10:03.279
time. So if you're going to
do a pre ni POST, this ideal
121
00:10:03.320 --> 00:10:07.320
that the same person do both the
pre and the post, And if you
122
00:10:07.320 --> 00:10:09.960
have multiple people within the team,
then it should be the same person into
123
00:10:09.960 --> 00:10:16.679
administering that particular test each time for
consistency, so you're landing error scoring system.
124
00:10:16.799 --> 00:10:20.639
This is the less test similar to
the drop jump screening test. The
125
00:10:20.679 --> 00:10:24.440
exception is that it's recorded from the
front and sidgital plane. Testimants jump from
126
00:10:24.440 --> 00:10:28.240
a thirty centimeter box to the point
of it equillan to fifty percent of their
127
00:10:28.320 --> 00:10:31.320
height away from the box, so
you actually got to measure their high go
128
00:10:31.399 --> 00:10:35.480
fifty percent of that and measure that
line out to the front of the box.
129
00:10:35.759 --> 00:10:41.039
And it's followed by a maximal vertibal
jump. Jumpers scored based on seven
130
00:10:41.039 --> 00:10:46.519
technique in ten landing errors during four
jumps. Diticipants with low less scores demonstrate
131
00:10:46.600 --> 00:10:50.080
less knee and hip fletch and angle, so less knee valgus and hip adduction,
132
00:10:50.200 --> 00:10:56.080
increased internal knee and hip internal rotation
with interatibual sheer forces, and it
133
00:10:56.200 --> 00:11:01.759
was established as a reliable assessment with
recurrent THELID. It's a high value test.
134
00:11:01.120 --> 00:11:07.080
Research shows that the optimal cut point
for aco injury predictability was five point
135
00:11:07.200 --> 00:11:09.200
one seven through study of eight hundred
and twenty nine YUS. That's a pretty
136
00:11:09.200 --> 00:11:15.039
good number for a study to be
able to support evidence. The same study
137
00:11:15.120 --> 00:11:18.080
showed that those that had a less
score of five or more were at a
138
00:11:18.120 --> 00:11:22.720
ten point seven greater risk ratio for
injury is compared to those who scored less
139
00:11:22.720 --> 00:11:28.120
than five. The single leg motion
analysis this is basically a sidestep cutting maneuver
140
00:11:28.639 --> 00:11:31.600
that you go through an assess is
also referred to as the change of direction
141
00:11:31.639 --> 00:11:35.600
assessment. One of three primary techniques, with the others being the crossover cut
142
00:11:35.679 --> 00:11:39.200
and the split step or the other
two components to it. The side step
143
00:11:39.240 --> 00:11:45.039
generates higher degrees of knee valgus and
internal rotation movements key stressors to the ACL
144
00:11:45.200 --> 00:11:48.679
with high degree of test retest liability. One of the main things that I'm
145
00:11:48.679 --> 00:11:52.039
going to look for on this test
is the over extension not being able to
146
00:11:52.159 --> 00:11:56.399
not having proper weight distribution core controlled
during the course of that movement to be
147
00:11:56.399 --> 00:12:01.480
able to maintain and control momentum,
especially if it has to be a quick
148
00:12:01.559 --> 00:12:07.159
stop start type situation. So tests
on post a CEO reconstruction athletes show that
149
00:12:07.200 --> 00:12:11.799
eighty percent had greater than are equal
to five degrees of knee valgus on the
150
00:12:11.840 --> 00:12:16.240
plant foot, with sixty percent showing
an increased augus on the uninvolved leg.
151
00:12:16.600 --> 00:12:20.639
So that's that's something that really needs
to be looked at closely. So things
152
00:12:20.679 --> 00:12:24.840
that you need to consider when you're
doing this assessments. Forces generated during non
153
00:12:24.879 --> 00:12:30.679
competition are not as great as during
so it's really hard to replicate competition level
154
00:12:31.279 --> 00:12:35.639
forces and so, but if somebody
is already showing signs of lack of control
155
00:12:35.720 --> 00:12:41.679
over extension, excessive knee valgus internal
rotation, that type of thing during this
156
00:12:41.759 --> 00:12:45.360
simple test, then it's going to
be exaggerated more when they're out there actually
157
00:12:45.360 --> 00:12:48.799
competing. So there is some value
of that. Plan versus unplanned movement,
158
00:12:48.879 --> 00:12:54.799
So redirecting having a plant cut,
if you're trying to avoid somebody, how
159
00:12:54.799 --> 00:12:58.399
do you deal with that? Let's
see fatigue versus non fatigued Sharper angles generate
160
00:12:58.480 --> 00:13:03.279
greater own forces. Things to consider
with this one force is generated during non
161
00:13:03.279 --> 00:13:07.200
competition are not as great, which
we just talked about. Plan versus unplanned
162
00:13:07.240 --> 00:13:13.679
movement. Fatigue Sharper angles generate greater
ground forces approach velocity, so velocities are
163
00:13:13.720 --> 00:13:18.320
typically higher in competition. Visual disturbance
or dual cognitions such as as with a
164
00:13:18.480 --> 00:13:24.080
ball and interacting with other individuals,
will generate higher ground forces or make slow
165
00:13:24.159 --> 00:13:28.120
reaction times. So when they're having
multiple things like dribbling a ball, that
166
00:13:28.159 --> 00:13:33.480
type of stuff that's drawing more on
the brain and it's going to affect their
167
00:13:33.519 --> 00:13:35.519
ability to be able to properly react, to be able to focus on proper
168
00:13:35.600 --> 00:13:41.840
movement mechanics. So the time based
tasks may provide greater simulation of effort,
169
00:13:41.159 --> 00:13:45.879
So do things like a shuttle test
that type of stuff for a redirection that
170
00:13:45.919 --> 00:13:48.840
you can kind of get a decent
idea. When they're trying to do it
171
00:13:48.879 --> 00:13:50.960
as fast as they possibly can,
you may be able to get a little
172
00:13:50.960 --> 00:13:56.720
bit better assessment with increased effort.
So some basic components of an ACO prehab
173
00:13:56.799 --> 00:14:01.559
program. So after a value to
several research papers, they prove the need
174
00:14:01.600 --> 00:14:07.519
and validity of prevention programs for ACL
risk. Females have a risk reduction of
175
00:14:07.600 --> 00:14:11.919
fifty two percent and males have a
risk reduction of eighty five percent for a
176
00:14:11.000 --> 00:14:16.639
non contact ACL injury. So there's
some high validity for having an ACO injury
177
00:14:16.639 --> 00:14:22.039
prevention program within an athletic program.
So six principles that you need to consider.
178
00:14:22.320 --> 00:14:26.440
H Okay, the earlier that you
start working on these mechanics, the
179
00:14:26.519 --> 00:14:30.679
better studies are showing that introduction of
a CEO programs and younger athletes are more
180
00:14:30.720 --> 00:14:33.279
effective than older athletes. It's one
of those things that's better to take somebody
181
00:14:33.360 --> 00:14:37.480
that doesn't know any better and train
them up from the get go, rather
182
00:14:37.519 --> 00:14:41.279
than trying to take somebody who's already
developed bad mechanical habits and trying to get
183
00:14:41.279 --> 00:14:43.360
them to change them. It's it's
a whole lot better if you can start
184
00:14:43.399 --> 00:14:48.639
with youth programs and be able to
work them up that way, and while
185
00:14:48.679 --> 00:14:50.240
you're trying to work on the ones
that are older or trying to undo their
186
00:14:50.240 --> 00:14:56.240
bad habits. So biomechanics, there's
a need for assessing addressing different movement patterns
187
00:14:56.240 --> 00:15:01.200
that involve an increased possibility for increased
need. VALGUS clients is a huge deal.
188
00:15:01.320 --> 00:15:05.759
So compliance rates greater than sixty six
percent have shown a rate reduction of
189
00:15:05.759 --> 00:15:09.480
a CEO A injury by eighty two
percent. So basically, if they follow
190
00:15:09.519 --> 00:15:11.919
the program, it's going to work. If they don't follow the program like
191
00:15:13.000 --> 00:15:16.240
they're supposed to, you're gonna it's
not going to be as effective as it
192
00:15:16.279 --> 00:15:20.559
needs to. Okay, So number
four, you have dosage, and average
193
00:15:20.720 --> 00:15:24.759
of studies has shown that a session
should last between twenty to thirty minutes for
194
00:15:24.840 --> 00:15:30.000
three to four times per week.
The program should be initiated during preseason conditioning
195
00:15:30.000 --> 00:15:33.840
and maintain throughout the season in the
off season. So it's this is one
196
00:15:33.879 --> 00:15:37.279
of those deals that people look at
this while I don't have twenty to thirty
197
00:15:37.320 --> 00:15:41.440
minutes to just focus on aco injury
prevention type programs in my athletic program,
198
00:15:41.759 --> 00:15:45.600
it's because you need to take it
and incorporate it with the other things that
199
00:15:45.639 --> 00:15:48.840
you're doing. You have your different
phases, so you have your immediate postseason,
200
00:15:48.919 --> 00:15:52.960
you have your preseason workouts, and
then you go into your end season.
201
00:15:52.360 --> 00:15:56.360
Those are all different components, but
these are things that you can incorporate
202
00:15:56.639 --> 00:16:02.120
and work into your program to be
able to assess and to be able to
203
00:16:02.519 --> 00:16:06.559
work and train so that you can
decrease that risk of injury. Feedback there
204
00:16:06.559 --> 00:16:11.320
should be a combination of visual and
verbal feedback with verbal correction que from the
205
00:16:11.320 --> 00:16:15.080
coach trainer, and visual in some
form of video or training film. This
206
00:16:15.159 --> 00:16:18.960
is where as a practitioner, you
can be able to come in and be
207
00:16:18.960 --> 00:16:22.639
able to make observation because coaches,
when think about a basketball coach, but
208
00:16:22.679 --> 00:16:26.000
basketball coaches out there watching, they're
watching to see if their players are executing
209
00:16:26.039 --> 00:16:30.080
proper alignment, if they're going into
proper formation, if they're setting their screens
210
00:16:30.080 --> 00:16:34.279
properly, those types of things.
They're not paying attention necessarily to the technique
211
00:16:34.360 --> 00:16:40.159
of what's going on. So you
need to have somebody specifically assigned for that
212
00:16:40.519 --> 00:16:42.879
to be able to watch techniques and
be able to make those corrections. Whether
213
00:16:42.919 --> 00:16:47.200
it's an assistant coach or you as
the trainer itself, can be able to
214
00:16:47.240 --> 00:16:51.320
watch and make sure that your athletes
are executing proper technique. You see a
215
00:16:51.320 --> 00:16:55.080
consistency in that it needs that's something
that needs to be addressed, and it
216
00:16:55.200 --> 00:16:57.759
also helps that they're filming practices.
You can go back and look at those
217
00:16:57.799 --> 00:17:02.200
things and be able to work on
some of those mechanics, pointing out to
218
00:17:02.240 --> 00:17:06.759
the coach, maybe have the coach
pointed out during film session. So exercise
219
00:17:06.839 --> 00:17:10.559
variety, So training should have three
different components. You should have pliometrics built
220
00:17:10.559 --> 00:17:15.599
in, neuromuscular training from balance and
then strength training with it. So your
221
00:17:15.599 --> 00:17:19.279
three components, you have pliometrics,
the keys focusing on proper technique and mechanics.
222
00:17:19.599 --> 00:17:26.680
So plyometrics should be incorporated at least
once a week into a training program,
223
00:17:26.799 --> 00:17:30.400
depending on what texts you read.
If you go through your CSCs certifications,
224
00:17:30.680 --> 00:17:34.039
tells you that you can incorporate pliometrics
at least twice a week if they're
225
00:17:34.039 --> 00:17:37.799
properly spaced out given the amount of
time, whether you're in season or off
226
00:17:37.839 --> 00:17:41.799
season. That's going to also dictate
how much you can actually work in pliometrics.
227
00:17:42.200 --> 00:17:45.960
So probably if you're in season,
you're only going to want to do
228
00:17:45.000 --> 00:17:48.079
it once a week. It's probably
going to be a little bit less intensity
229
00:17:48.160 --> 00:17:52.319
than what you would do during an
off season program. So those are things
230
00:17:52.359 --> 00:17:56.000
that you need to think about.
So your neuromuscular training, so improve the
231
00:17:56.119 --> 00:18:00.160
athletes ability to generate optimal muscle firing
patterns, improve a roll movement patterns,
232
00:18:00.200 --> 00:18:06.319
increase dynamic joint mobility, improve postural
control and lateral motion stability. So that's
233
00:18:06.319 --> 00:18:08.400
your overall objectives when you do this. So this is going to include some
234
00:18:08.440 --> 00:18:12.880
of your balance exercises, appropriate acceptive
training for balance. You could do wobble
235
00:18:12.880 --> 00:18:15.960
boards in that type of thing,
it's really best to be able to just
236
00:18:17.039 --> 00:18:22.119
do it on flat foots. I'm
not a huge fan of unlevel surfaces to
237
00:18:22.720 --> 00:18:26.200
work on those types of things.
It's better if you can do something simple
238
00:18:26.240 --> 00:18:32.079
as star pattern type movements with body
weight in order to be able to work
239
00:18:32.119 --> 00:18:34.119
on those mechanics. But a lot
of it also is going to come back
240
00:18:34.160 --> 00:18:38.400
to making sure that they're doing proper
core engagement and glute engagement and those things
241
00:18:38.440 --> 00:18:44.359
that they're actually doing all the proper
mechanics just to maintain balance. If somebody's
242
00:18:44.480 --> 00:18:47.680
able to do a single leg stance
and they can't stand on one leg and
243
00:18:47.799 --> 00:18:51.079
hold it, if you look at
that, see where the instability is coming
244
00:18:51.079 --> 00:18:52.160
out of. Is it coming out
of the knee, is it coming out
245
00:18:52.200 --> 00:18:55.680
of the angles, it coming out
of the hip, It's a core problem,
246
00:18:56.039 --> 00:18:59.640
or is a combination of those things? And then design your exercises to
247
00:18:59.759 --> 00:19:03.559
address those individual problems so that it
will address the balance overall. So then
248
00:19:03.599 --> 00:19:08.960
you have strength training, which can
include muscle specific retraining or overall power generating
249
00:19:10.000 --> 00:19:15.480
lifts. I'm not a huge fan
of overhead type lifts, power lifts,
250
00:19:15.519 --> 00:19:21.039
Olympic type lifting for especially high school
programs. I know that I've made some
251
00:19:21.240 --> 00:19:25.119
high school strength and conditioning coaches upset
with me by making that statement before,
252
00:19:25.640 --> 00:19:30.359
But having been in multiple high school
programs, and the minute that they start
253
00:19:30.480 --> 00:19:37.759
incorporating overhead specific lifts, now you're
going to have athletes with developing shoulder problems
254
00:19:37.799 --> 00:19:40.720
and those types of things because they
don't execute it right. If you can't
255
00:19:40.759 --> 00:19:44.799
get them to execute proper mechanics on
basic movement patterns that they need to do
256
00:19:44.839 --> 00:19:47.599
to be able to execute their sport. Why would you have them do something
257
00:19:47.720 --> 00:19:52.839
that is going to require even more
mechanics and focus and specificity and the way
258
00:19:52.880 --> 00:19:56.160
they lift rather than keeping general lift
movement patterns. So that's just my soapbox
259
00:19:56.200 --> 00:20:00.119
on that. So your training progression, all training programs should be organized into
260
00:20:00.160 --> 00:20:04.359
tiers and progressions that range from mildly
difficult to challenging. So you're going to
261
00:20:04.400 --> 00:20:08.440
start with a tier one and should
build into more complicated versions of the same
262
00:20:08.519 --> 00:20:14.119
mechanisms based on the target and muscle
group. Training progression should also reflect on
263
00:20:14.119 --> 00:20:17.920
ongoing assessment to determine readiness for tier
transition. So you need to be able
264
00:20:17.920 --> 00:20:19.319
to make sure that you're assessing.
So if you come up with your first
265
00:20:19.319 --> 00:20:22.480
tier level of exercises that you're going
to do, you need to make a
266
00:20:22.480 --> 00:20:26.039
determination or whether they're ready to move
to the next step or if you have
267
00:20:26.400 --> 00:20:30.000
some that are ready to move on
and others or not. You've got to
268
00:20:30.000 --> 00:20:32.720
have the flexibility in there to be
able to allow the ones that are ready
269
00:20:32.759 --> 00:20:37.039
to progress allow them to continue to
progress, and in some cases you may
270
00:20:37.119 --> 00:20:41.119
need you may have to have regressions. Somebody gets up to a certain level
271
00:20:41.400 --> 00:20:44.319
and then they can't seem to maintain
proper mechanics. You go back down.
272
00:20:44.759 --> 00:20:47.119
It's okay to take a step back
if you need to in order to be
273
00:20:47.160 --> 00:20:49.880
able to retrain and continue to build
back up again. And so you may
274
00:20:51.039 --> 00:20:55.039
know this as a remedial phase for
transitioning to the full training program. If
275
00:20:55.039 --> 00:20:57.200
somebody needs remediation, it is better
to get them down and the proper mechanics
276
00:20:57.200 --> 00:21:02.000
and proper strength levels to be able
to execute so that they're going to be
277
00:21:02.000 --> 00:21:07.319
better players overall. If you're listening
to this podcast and you've yet to attend
278
00:21:07.359 --> 00:21:11.400
a FACTOR Rehab live course, I
have a special offer just for you.
279
00:21:11.880 --> 00:21:15.839
See, I realize that sometimes you
need to kick the tires a bit to
280
00:21:17.000 --> 00:21:21.839
learn more about a course before you
register, especially one that offers a certification
281
00:21:21.880 --> 00:21:26.200
track. So I've developed a special
offer just for those of you who are
282
00:21:26.240 --> 00:21:30.000
interested in learning what this FACTOR thing
is all about. See, We've put
283
00:21:30.039 --> 00:21:34.240
together a free one hour webinar to
introduce the concept of having a systematic approach
284
00:21:34.279 --> 00:21:38.319
to rehab. In this one hour
online course, our director of Education,
285
00:21:38.440 --> 00:21:42.759
doctor Todd Riddle, will show you
how implementing a system for patient treatment can
286
00:21:42.799 --> 00:21:48.640
improve patient outcomes, streamline your operations, grow your profitability, and help you
287
00:21:48.680 --> 00:21:53.799
to build a practice that you absolutely
love. You'll also hear from doctor Riddle's
288
00:21:53.799 --> 00:22:00.519
personal experience in using the Factor rehab
system, both with elite athletes as well
289
00:22:00.559 --> 00:22:03.759
as the everyday patient just looking to
move and feel their best. It's a
290
00:22:03.799 --> 00:22:08.799
great first step to learn more about
FACTOR certification and how Factor could impact your
291
00:22:08.799 --> 00:22:14.759
patient care. And to sweeten the
deal, we're offering CE credit for completing
292
00:22:14.759 --> 00:22:19.920
this online training absolutely free. Yes
you've heard that correctly, free CE so
293
00:22:21.200 --> 00:22:25.839
CE credit is available in a number
of US states for chiropractors, as well
294
00:22:25.880 --> 00:22:30.920
as for massage therapists, athletic trainers, and physical therapists. To learn more
295
00:22:30.960 --> 00:22:34.799
and get your free CE while learning
more about how Factor can impact your patient
296
00:22:34.880 --> 00:22:40.839
care, visit the free Factor webinar
link in our show notes. Now back
297
00:22:40.880 --> 00:22:45.480
to the show. So that brings
me to the end. Thank you so
298
00:22:45.559 --> 00:22:48.759
much, Dr McAllister. We have
a few questions that have come in.
299
00:22:49.440 --> 00:22:56.160
So one of the questions was related
to you mentioned that when the ACL is
300
00:22:56.200 --> 00:23:02.920
replaced with dabbing daver ligament that oftentimes
that makes it a little bit tighter.
301
00:23:03.440 --> 00:23:07.680
So how would you suggest what type
of rehab or what things would you take
302
00:23:07.720 --> 00:23:11.880
in consideration when you're doing rehab for
a patient that has received cadaver versus those
303
00:23:11.880 --> 00:23:17.039
that have just had a simple repair. So the couple things that you have
304
00:23:17.119 --> 00:23:21.079
to factor into that when you're rehabbing
somebody with that is one, you got
305
00:23:21.079 --> 00:23:22.799
to make sure that you don't tear
the graph, So you've got to allow
306
00:23:22.839 --> 00:23:26.640
it to have time to set in. So you want to do a lot
307
00:23:26.640 --> 00:23:30.559
of passive range of motion, not
active, and then start building up the
308
00:23:32.000 --> 00:23:33.759
musculator around the knee. The musculator
is going to be weak, so I
309
00:23:33.799 --> 00:23:40.039
always recommend a lot of isometric type
exercises start working around that knee, and
310
00:23:40.079 --> 00:23:44.559
then once the orthopedies that you've worked
with, they will give you the time
311
00:23:44.599 --> 00:23:48.359
frame that it usually takes for that
ACL to set so that you retear it.
312
00:23:48.359 --> 00:23:51.880
I can't tell you how many times
that I've seen people go to their
313
00:23:51.920 --> 00:23:55.319
rehab and a matter of fact,
I had a neighbor that he had to
314
00:23:55.359 --> 00:23:59.559
shoulder repair went to rehab and they
tore his shoulder back. So I would
315
00:23:59.559 --> 00:24:03.519
think that you need to go It's
better to go conservative at first. You
316
00:24:03.559 --> 00:24:07.599
want to obviously instill as much motion
and you can get as much passive motion,
317
00:24:07.039 --> 00:24:11.880
even bike type movements that type of
thing, and then as that that
318
00:24:11.960 --> 00:24:15.799
graft is set, then you could
be a little bit more aggressive on stretching
319
00:24:15.839 --> 00:24:18.279
that out. Then a lot of
that's just going to come from strengthening.
320
00:24:18.359 --> 00:24:23.480
So you want to progress from on
your isometrics to your eccentric type contraction movements,
321
00:24:23.480 --> 00:24:26.720
then you can progress your concentric which
is going to allow you to be
322
00:24:26.759 --> 00:24:32.680
able to get more flexibility in that
need. Absolutely, thank you. Do
323
00:24:32.720 --> 00:24:37.920
you have any advice or guidance on
specific prehab that you would do with winter
324
00:24:37.039 --> 00:24:42.200
sports athletes such as downhill skiers and
those that are on the slopes a lot,
325
00:24:42.319 --> 00:24:48.240
so you get a lot of acl
injuries obviously when it comes to skis
326
00:24:48.519 --> 00:24:52.799
and snowboards where your feed are kind
of locked into position. Is there anything
327
00:24:52.880 --> 00:24:56.880
that you would suggest specific things to
look for and to assess in the preseason
328
00:24:56.920 --> 00:25:00.480
before they started. Yeah, that's
the the thing with a lot of your
329
00:25:00.519 --> 00:25:04.000
snow skiing, because there is more
of a predisposition for the needs to go
330
00:25:04.039 --> 00:25:07.519
into a bogus position, So that's
going to take a little bit of retraining
331
00:25:07.559 --> 00:25:11.359
that's going to have to be done
to get them to where they can still
332
00:25:11.359 --> 00:25:15.039
be able to ski, be able
to execute their maneuvers and not allow that
333
00:25:15.160 --> 00:25:17.839
need to collapse. Because if you
watch a lot of your downhill skiers,
334
00:25:17.920 --> 00:25:21.400
especially during the Olympics, as soon
as they hit that reduration, look at
335
00:25:21.400 --> 00:25:25.079
that extent the outside leg on their
turn. If you start seeing that knee
336
00:25:25.440 --> 00:25:29.319
drop in, They've got to work
on their lateral strength development. So really
337
00:25:29.359 --> 00:25:33.160
a lot of that where that would
be concerned is more focused on your strength
338
00:25:33.200 --> 00:25:37.160
development and more concentration. I'm keeping
those knees pushed out more so that they
339
00:25:37.160 --> 00:25:41.400
don't allow that. Snow skiing is
one of those I've done it. Fortunately
340
00:25:41.440 --> 00:25:45.200
I managed to do it without actually
had to learn how to do it when
341
00:25:45.200 --> 00:25:48.519
I was in the military, which
was interesting enough. But this is the
342
00:25:48.640 --> 00:25:52.400
level of force that's actually applied.
Because you're going to much faster speeds.
343
00:25:52.720 --> 00:25:56.720
Strength development is going to be a
whole lot more focus for me if I'm
344
00:25:56.720 --> 00:26:00.960
going to work with somebody on that
to be able to pushed and keeping that
345
00:26:00.079 --> 00:26:04.680
lateral strength, also making sure that
you are looking at their glute and glue
346
00:26:04.720 --> 00:26:08.839
mead so they may need to do
more monster walk type of things. Keep
347
00:26:08.839 --> 00:26:14.759
the pureiformists loose, because what tends
to happen after time is that as the
348
00:26:14.920 --> 00:26:17.559
glue, you get that quat dominance
and then the glute I mean, because
349
00:26:17.559 --> 00:26:19.759
you think better constantly got those quas
contracted, they're in a been over position,
350
00:26:19.839 --> 00:26:25.359
been over exaggerated athletic position. Eventually
those glutes continue to weaken. Well,
351
00:26:25.359 --> 00:26:27.359
what happens in is your entrance that
muscles it up underneath, like your
352
00:26:27.359 --> 00:26:32.039
puiformists, and all those start to
take the brunt and then you'll get glue
353
00:26:32.400 --> 00:26:34.279
mead weakness on top of it.
So they're going to have to really focus
354
00:26:34.319 --> 00:26:37.960
on keeping those strong during their strength
development to be able to help with that
355
00:26:38.519 --> 00:26:44.039
wonderful we've talked a lot about in
the past, and it's kind of made
356
00:26:44.039 --> 00:26:48.119
a lot of headlines, especially in
the public community about fear avoidance behaviors.
357
00:26:48.799 --> 00:26:53.240
Fear avoidance behaviors. So essentially,
athlete tears one acel, and as you
358
00:26:53.319 --> 00:26:57.920
mentioned, the research supports that they
are more susceptible to tearing the other acel.
359
00:26:59.519 --> 00:27:03.279
But yeah, you as aquatitioner are
faced in a situation where you want
360
00:27:03.279 --> 00:27:07.599
to try to help them rehab post
surgery, but then also strengthen the other
361
00:27:07.640 --> 00:27:12.759
aco, how would you come back
to some of that fear avoidance behavior and
362
00:27:12.880 --> 00:27:17.599
an athlete that's already had that tear
once. That's the first part of the
363
00:27:17.680 --> 00:27:22.400
question. The second part is do
you feel that fear avoidance can be a
364
00:27:22.519 --> 00:27:26.319
contributing factor to re injury? Yes, it will, just because they tend
365
00:27:26.359 --> 00:27:29.680
to be more timid, they're going
to exaggerate, They're going to tend to
366
00:27:29.680 --> 00:27:32.559
put That's where you're going to see
a lot more to that lateral displacement that
367
00:27:32.599 --> 00:27:36.119
we talked about, just even something
as simple as a squad pattern. That's
368
00:27:36.119 --> 00:27:41.519
what I refer to as the neuromuscular
rehabilitation. You've got to get them,
369
00:27:41.599 --> 00:27:45.240
make them aware that they're doing that
shift. There's always that tendency that they
370
00:27:45.279 --> 00:27:48.880
have to gain confidence in it.
So you want to build them up.
371
00:27:48.920 --> 00:27:52.960
You have to kind of assess where
they're at. Sometimes when I coach powerlifting,
372
00:27:52.319 --> 00:27:56.000
when I'm working with an athlete,
it's not always necessarily looking at where
373
00:27:56.000 --> 00:28:00.640
they're at, but where their potential
is. And so you have to allow
374
00:28:00.680 --> 00:28:04.160
them to be able to build the
confidence up and by slowly working them back
375
00:28:04.279 --> 00:28:07.640
up and letting them be able to
feel it and know that it's going to
376
00:28:07.640 --> 00:28:11.680
be stable and it's not going to
give out on them. So there's a
377
00:28:11.720 --> 00:28:15.720
progression that has to take place and
allow them to build that confidence. And
378
00:28:15.759 --> 00:28:19.039
as they continue to build that confidence
and realize that, Okay, I'm not
379
00:28:19.079 --> 00:28:22.960
necessarily going to hurt this now,
they're going to build confidence just by knowing
380
00:28:22.960 --> 00:28:27.759
that their movements are stronger if they
are aware of what the mechanics were that
381
00:28:27.839 --> 00:28:32.160
caused it to happen the first time, so that they can be able to
382
00:28:32.200 --> 00:28:36.279
focus and not do those patterns again
and work out of that so it can
383
00:28:36.440 --> 00:28:38.880
develop. But you're going to have
to really educate them along the way and
384
00:28:38.920 --> 00:28:44.960
allow them to be able to develop
that confidence and work of and not necessarily
385
00:28:45.039 --> 00:28:48.759
rush them. I feel like sometimes
athletes are rushed way too fast before they
386
00:28:48.839 --> 00:28:53.240
even have a chance to even get
the proper strength of mechanics. Now I'm
387
00:28:53.279 --> 00:28:56.960
trying to get back into play.
So it can be done, but you're
388
00:28:57.000 --> 00:29:00.599
going to have it's going to require
a lot more patient and it's going to
389
00:29:00.720 --> 00:29:03.720
require a lot more analysis on your
part seeing when they're ready to go,
390
00:29:04.119 --> 00:29:07.640
but also being able to just show
them what they're doing in those patterns and
391
00:29:08.480 --> 00:29:12.680
get them focused on correcting that and
then once they get more confident and that,
392
00:29:12.799 --> 00:29:18.640
then their confidence overall will increase.
Yeah. Absolutely. Another question here
393
00:29:18.759 --> 00:29:25.559
was regarding assessing kind of return to
play in this situation where you have a
394
00:29:25.680 --> 00:29:30.440
patient who has gone through surgery to
repair, how do you assess them in
395
00:29:30.559 --> 00:29:34.400
terms of their readiness and their ability
to return the point so as based on
396
00:29:34.880 --> 00:29:38.920
where they need to be for the
level that they're at. So obviously you
397
00:29:40.039 --> 00:29:41.920
know, like I said, when
you start them off, and you start
398
00:29:41.920 --> 00:29:45.799
somebody off, it's going to be
more passive isometric, and so you have
399
00:29:45.880 --> 00:29:48.799
to determine, Okay, they seem
to be responding, well, there's no
400
00:29:48.839 --> 00:29:52.160
pain, we're not having a problems
with isometric movement patterns anymore. We've been
401
00:29:52.160 --> 00:29:56.039
able to progress the full range of
motion at this point. Now where you
402
00:29:56.079 --> 00:30:00.559
going to start doing some more eccentric
type movement patterns once they it stronger with
403
00:30:00.559 --> 00:30:03.680
that and there's no knee pain associated
with that, and then you can progress
404
00:30:03.720 --> 00:30:07.640
it to your concentric pattern. Start
off with the lighter weights and then start
405
00:30:07.759 --> 00:30:11.559
building up and strengthening from there.
Once you get it stronger, then I
406
00:30:11.599 --> 00:30:15.960
would start progressing into more sports specific
type movement patterns to start working on movement
407
00:30:17.000 --> 00:30:19.640
mechanics, Start them slow, allow
them to be able to get the because
408
00:30:21.160 --> 00:30:25.079
they're having to get a feel for
their legs are not going to feel the
409
00:30:25.119 --> 00:30:27.640
same like they did before and so
and then you're also having to what was
410
00:30:27.720 --> 00:30:30.920
reference in the last question, You're
going to have to work through some of
411
00:30:30.960 --> 00:30:36.119
that hesitancy and some of that subconsciousness
that they have a fear of reinjuring.
412
00:30:36.160 --> 00:30:40.759
And so it's just it was going
to require a constant assessment throughout the process
413
00:30:40.759 --> 00:30:42.640
to be able to determine that they're
really ready to go. A lot of
414
00:30:42.640 --> 00:30:48.680
times people will try to focus more
on readiness based on time rather than performance.
415
00:30:48.240 --> 00:30:55.160
So I would shift your focus to
more performance and less on time to
416
00:30:55.720 --> 00:31:00.400
determine whether somebody's ready or not.
Wonderful, thank you. Is repair or
417
00:31:00.559 --> 00:31:07.359
reconstruction good better for acl injury to
receive better outcomes? And what does the
418
00:31:07.400 --> 00:31:11.200
research say in regards to repair versus
a reconstruction? And I know that might
419
00:31:11.240 --> 00:31:18.160
be subjective based upon each individual case
or circumstance. Yeah, it depends on
420
00:31:18.160 --> 00:31:21.559
what they're wanting to do. I
mean, if they're in a sport that
421
00:31:21.599 --> 00:31:25.240
requires them to do a lot of
cutting maneuvers that they need an ACL to
422
00:31:25.240 --> 00:31:27.319
be able to do that, and
you can brace. There's certain sports that
423
00:31:27.359 --> 00:31:30.799
allow you to be able to brace, especially if somebody does have that fear
424
00:31:32.039 --> 00:31:36.079
going to allow them to brace,
and it may not necessarily be necessary for
425
00:31:36.119 --> 00:31:37.720
them to have a brace on that
knee, but if it gives them that
426
00:31:37.839 --> 00:31:41.759
extra confidence, then allow them to
do that. You'll see both of orsopetas
427
00:31:41.799 --> 00:31:45.680
will recommend though, if you're not
going to play anymore, if you're retiring
428
00:31:45.680 --> 00:31:48.000
from your sport, but you still
want to stay active, you can still
429
00:31:48.000 --> 00:31:52.359
be active as long as you're not
trying to cut and do those hard type,
430
00:31:52.359 --> 00:31:56.720
redirecting type movements. If you're going
to do those types of things,
431
00:31:56.759 --> 00:32:00.319
then it's better to get it redone
so that you can continue to do that.
432
00:32:00.400 --> 00:32:02.319
You're just you're just going to have
to know that once you get cut,
433
00:32:02.880 --> 00:32:06.799
that you're going to be dealing with
other issues later on down the road.
434
00:32:06.920 --> 00:32:09.079
Eventually you're going to have plaque that
builds up, scar tissue that builds
435
00:32:09.119 --> 00:32:12.279
up in that knee, and that
may have to be dealt with later.
436
00:32:12.799 --> 00:32:15.039
There's no easy solution there, but
it really kind of depends on what the
437
00:32:15.039 --> 00:32:22.599
goal of the athlete is absolutely.
Would you suggest any type of sports psychology
438
00:32:22.119 --> 00:32:30.279
or some adjunctive therapy that deals with
progressing pain and pain psychology. Yeah,
439
00:32:30.319 --> 00:32:34.880
absolutely, Any good sport program from
the college level up is going to have
440
00:32:34.920 --> 00:32:38.519
a sports psychologist, and you definitely
need to co manage with that. Talk
441
00:32:38.559 --> 00:32:44.240
to the psychologists, collaborate, let
them know what you're seeing, let them
442
00:32:44.319 --> 00:32:46.880
know what you're seeing, what their
tendencies are, and then they can talk
443
00:32:46.880 --> 00:32:50.759
to the athlete and figure out what
their what their concerns are, and their
444
00:32:50.880 --> 00:32:53.599
fears are. Yeah, that's that's
absolutely a necessity. I mean, especially
445
00:32:53.640 --> 00:32:57.319
when you're dealing with athletes that need
to be able to perform at a high
446
00:32:57.359 --> 00:33:00.920
level consistency. There's a lot of
stress that goes on all with that mentally,
447
00:33:00.200 --> 00:33:04.039
and you'll see it in the way
some athletes end up in the news.
448
00:33:04.079 --> 00:33:08.079
They handle their success or they handle
the stress of their role better than
449
00:33:08.079 --> 00:33:13.880
others. And so yeah, absolutely
you need the psychologists to be able to
450
00:33:13.880 --> 00:33:19.799
help with that. Absolutely. So
we've talked in the past about how hormone
451
00:33:19.880 --> 00:33:25.319
fluctuations at different times of the month
can affect things like ligament laxity. How
452
00:33:25.359 --> 00:33:30.000
do you take that into consideration when
it comes to the precab or the recab
453
00:33:30.079 --> 00:33:36.279
work and do it female athletes that
are dealing with eclog us. So,
454
00:33:37.279 --> 00:33:40.039
and it's funny because I actually the
majority of the athletes that I coach right
455
00:33:40.079 --> 00:33:44.759
now or female, I've kind of
transitioned over that. In all honesty,
456
00:33:44.799 --> 00:33:49.200
it's I've actually enjoyed coaching female athletes
more than I have males at this point
457
00:33:49.200 --> 00:33:53.880
because they tend to listen better.
But there's always that ongoing issue you'll see
458
00:33:53.920 --> 00:33:59.359
when they have those times that you're
also going to see that they're going to
459
00:33:59.400 --> 00:34:04.400
be weaker during those hormone fluctuations.
They're also going to be at increased risk.
460
00:34:04.880 --> 00:34:07.880
And so that's when it's really going
to be imperative for those athletes to
461
00:34:07.920 --> 00:34:13.760
be more focused on technique and their
strength development and being able to rely on
462
00:34:13.800 --> 00:34:16.360
those things to be able to execute
because with the joint laxity, they're going
463
00:34:16.400 --> 00:34:22.440
to have to get more comfortable with
that dynamic and know that they may have
464
00:34:22.480 --> 00:34:25.280
to be a little bit more reserved
in their movement patterns to be able to
465
00:34:25.320 --> 00:34:30.119
compensate for that because of the joint
laxity that can exist. So and then
466
00:34:30.199 --> 00:34:32.039
a lot of that. It's also
coaches don't want to hear about that stuff.
467
00:34:32.079 --> 00:34:35.440
They really should, but they don't
want to hear about that. All
468
00:34:35.920 --> 00:34:37.159
they care about is that their player
can get in there and play or not.
469
00:34:37.320 --> 00:34:43.039
So that's unfortunately, that's kind of
a no win situation with that,
470
00:34:43.079 --> 00:34:46.159
because I would recommend that certain athletes, if they're going, you would have
471
00:34:46.199 --> 00:34:51.920
to kind of gauge how they react
during there and how their bodies processed during
472
00:34:51.960 --> 00:34:55.760
that time. And if somebody has
severe reaction and their joints seem to have
473
00:34:55.800 --> 00:34:59.559
a lot more laxity, you can
get in there and assess during that time
474
00:34:59.559 --> 00:35:02.159
to be able to see where their
level of acts that he is and some
475
00:35:02.199 --> 00:35:05.920
of them it's just it may just
be better that they don't play during that
476
00:35:05.960 --> 00:35:10.360
time. Absolutely, So, someone
was asking, essentially, given your experience
477
00:35:10.599 --> 00:35:15.000
kind of working as part of a
helping your team with these athletes, how
478
00:35:15.159 --> 00:35:21.039
are coaches responsive to some of your
advice that you How have you found that
479
00:35:21.679 --> 00:35:24.480
some of them were resistant than others. How do you usually broke swoose topics
480
00:35:24.480 --> 00:35:29.880
with coaches that, as you mentioned, sometimes they're not concerned with certain things
481
00:35:29.920 --> 00:35:32.960
that you know are very much a
priority for that with coaches, and I've
482
00:35:32.960 --> 00:35:37.280
been on both sides of that,
both sides of that table, and it's
483
00:35:37.360 --> 00:35:42.400
tough. I mean mean, you've
got coaches that absolutely just don't want to
484
00:35:42.440 --> 00:35:47.079
listen. They're actually putting themselves at
risk and liability by not and that would
485
00:35:47.079 --> 00:35:52.760
be It also depends on if you're
the trainer or are you the medical provider
486
00:35:52.840 --> 00:35:57.639
for the team, or are you
part of the overall medical team, depending
487
00:35:57.639 --> 00:36:00.039
on what level you're at. Because
with the high school will I work in
488
00:36:00.119 --> 00:36:04.960
conjunction with the trainer. There,
with the pro teams that I've worked with,
489
00:36:05.320 --> 00:36:07.719
you have the trainer that kind of
acts as a filter. But I've
490
00:36:07.719 --> 00:36:10.840
always been successful in developing a good
working relationship with the Modican team as a
491
00:36:10.880 --> 00:36:15.159
whole. As far as the coaches
are concerned, they've got to have a
492
00:36:15.159 --> 00:36:20.000
confidence that you know what you're doing
that because they just look at it as
493
00:36:20.119 --> 00:36:23.760
is you're keeping my player, keeping
me from winning games because you're keeping my
494
00:36:23.800 --> 00:36:29.159
player off the court. They have
to understand the liability and sometimes it requires
495
00:36:29.159 --> 00:36:31.280
a little bit of extra education for
the coach, especially if they're a young
496
00:36:31.360 --> 00:36:36.000
coach and don't know any better your
older coaches. I tend to find that
497
00:36:36.079 --> 00:36:39.199
they don't resist it as much because
they know the benefit that if they allow
498
00:36:39.239 --> 00:36:42.960
their player to heal up, they're
going to be a better, more benefit
499
00:36:43.000 --> 00:36:45.119
to them a little bit later on
if they'll just be patient. It's your
500
00:36:45.199 --> 00:36:50.119
younger coaches that tend to be more
impatient and they don't want to listen.
501
00:36:50.159 --> 00:36:52.400
They just want their player out there, and so they require a little bit
502
00:36:52.480 --> 00:36:57.199
more education, a little bit more
patience on your part, and also just
503
00:36:57.280 --> 00:37:00.679
talking to the athlete, because really
it's the athlete that gets caught in the
504
00:37:00.760 --> 00:37:01.960
middle of that. They know that
they need to be able to get in
505
00:37:01.960 --> 00:37:07.000
there and play. They're concerned about
their keeping their position, and sometimes it
506
00:37:07.079 --> 00:37:10.800
may require the athlete being able to
tell the coach say, look, I'm
507
00:37:10.840 --> 00:37:14.360
almost there, but please, I've
got to get healed up so I can
508
00:37:14.360 --> 00:37:17.920
get out there and play better.
And sometimes it may take a joint effort
509
00:37:17.960 --> 00:37:21.320
of the player, the coach,
and the trainer to get in there and
510
00:37:21.360 --> 00:37:24.800
have that conversation so that they can
get that player ready to go. That's
511
00:37:24.840 --> 00:37:30.800
one of those I haven't had that
much of a problem too too much with
512
00:37:30.920 --> 00:37:34.960
getting coaches to listen. I think
I feel like they've gotten better about it.
513
00:37:34.960 --> 00:37:37.400
But it depends also what lovel high
school coaches they're ten to tend to
514
00:37:37.440 --> 00:37:43.000
not listen as well as your college
or your pro coaches. And so you
515
00:37:43.079 --> 00:37:45.239
know, again, if you want
coaches that are gonna listen better, you
516
00:37:45.239 --> 00:37:47.280
probably need to move up the chain
a little bit and get out of high
517
00:37:47.280 --> 00:37:52.800
school or middle school. So doctor
McAllister, thank you so much for joining
518
00:37:52.880 --> 00:37:55.719
us today and presenting such great information. Thank you for having me. I
519
00:37:55.800 --> 00:38:07.840
really appreciate it. All right,
guys, that is it for today.
520
00:38:08.199 --> 00:38:12.519
Be sure to tune in for episode
fifty nine, where we kick off a
521
00:38:12.599 --> 00:38:17.280
new two part series titled Supercharge your
Clinical skill Set with doctor Benjamin Fergus.
522
00:38:19.000 --> 00:38:22.840
This training is one of my favorites
because we get to talk about the business
523
00:38:22.840 --> 00:38:28.000
side of developing and managing a successful
team in your practice. You won't want
524
00:38:28.000 --> 00:38:31.599
to miss it. Episode fifty nine
drops in two weeks. Now. Before
525
00:38:31.599 --> 00:38:36.239
we end today's episode, I have
a quick favor to ask. I want
526
00:38:36.280 --> 00:38:37.880
you to visit the top of the
show notes and click the link for our
527
00:38:37.920 --> 00:38:43.079
sixty second factor survey and fill that
out for me. It's only a few
528
00:38:43.159 --> 00:38:46.000
questions and it literally will take you
no more than sixty seconds to complete.
529
00:38:46.719 --> 00:38:51.119
See, we're working on some exciting
new things a Factor, and while I
530
00:38:51.159 --> 00:38:53.800
can't yet announce everything, what I
can say is that I want to be
531
00:38:53.880 --> 00:38:58.599
sure we're delivering on all of the
things that you most want to see from
532
00:38:58.679 --> 00:39:02.159
us. See, We've already received
a ton of responses, but I want
533
00:39:02.159 --> 00:39:06.440
to leave this survey open a little
bit longer to make sure we're reaching as
534
00:39:06.440 --> 00:39:09.199
many of you guys as possible.
For those of you that have already filled
535
00:39:09.199 --> 00:39:14.079
it out, thank you. I've
read each response personally, and I am
536
00:39:14.119 --> 00:39:19.159
prioritizing the most popular requests so that
they're a big part of our strategic plan
537
00:39:19.320 --> 00:39:22.679
moving forward. And as a little
thank you gift for filling out our survey,
538
00:39:22.960 --> 00:39:29.679
I'll send you a cultivated playlist of
our most popular Factor podcast episodes from
539
00:39:29.800 --> 00:39:34.639
the past year, custom tailored to
your submissions. So to give you a
540
00:39:34.639 --> 00:39:38.000
few quick updates, we have two
new Factor websites currently in process, one
541
00:39:38.039 --> 00:39:43.400
of which will be dedicated solely to
our Factor podcast, which I'm super excited
542
00:39:43.440 --> 00:39:47.679
about. We're also doing a complete
facelift and overhaul for our online store,
543
00:39:47.840 --> 00:39:52.000
so a lot of really great things
are rolling out in the months ahead.
544
00:39:52.679 --> 00:39:54.960
I can't wait to tell you all
about them in a future episode, so
545
00:39:55.119 --> 00:40:00.000
be sure to hit that subscribe buttons
so you'll get new content from Factor right
546
00:40:00.119 --> 00:40:05.239
here every two weeks and shameless plug
here. Please do give us a five
547
00:40:05.239 --> 00:40:07.880
store rating. It means more than
you know. That's all for today.
548
00:40:08.039 --> 00:40:14.039
We'll see you next time. Hey
guys, if you like what you heard
549
00:40:14.079 --> 00:40:17.960
today, I encourage you to visit
our website at Factor hyphenstore dot com that's
550
00:40:17.960 --> 00:40:25.199
spelled fak tr hyphenstore dot com to
find out more information about all that we
551
00:40:25.320 --> 00:40:29.679
have to offer. We have a
variety of online offerings as well as our
552
00:40:29.679 --> 00:40:34.079
hands on Factor Rehab System course scheduled
in cities around the globe. Be sure
553
00:40:34.079 --> 00:40:37.480
to also check out our event calendar
and bookmark any of these upcoming live webinar
554
00:40:37.599 --> 00:40:40.639
dates coming up in the near future
so you can join us live. And
555
00:40:40.679 --> 00:40:44.800
of course, the biggest compliment we
can receive is for you to help us
556
00:40:44.800 --> 00:40:47.480
spread the word to your friends,
colleagues, and classmates. You'll find all
557
00:40:47.480 --> 00:40:51.880
the important links, as well as
info about our sponsors in the show notes,
558
00:40:51.920 --> 00:40:52.239
so be sure to check those out.