Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
Bullet Proofing the Athletic Knee with Dr. Cody Dimak DC
Ever wondered how athletes can safeguard their knees against sports injuries? Join us as we sit down with Dr. Cody Dimack, chiropractor and faculty lecturer at Parker University, to discuss the alarming trend of non-contact ACL injuries plaguing athletes. From Dr. Dimack's transformation from high school athlete to healthcare professional, we uncover the personal and clinical journey that fuels his passion for preventing these devastating injuries. Our engaging conversation reveals not just the risks but also the vital strategies for injury prevention, emphasizing the power of patient-centered care in enhancing athletic performance and rehabilitation.
As we navigate the complexities of ACL tears, particularly in female athletes, we shed light on the biomechanical and hormonal factors at play. Dr. Dimack guides us through the controversial topic of knee valgus, the role of muscle functions, and the intricate relationship between hormones like relaxin and injury occurrence. The episode also tackles the critical concept of workloads in athletic training, a game-changer in injury prevention. Discover how understanding acute versus chronic workloads, guided by Tim Gabbett's research, can revolutionize training practices for athletes.
This episode isn't just for the experts; coaches, clinicians, and athletes alike will find profound insights into optimizing movement. We delve into motor learning and the profound impact of external cues on performance. Moreover, we explore how to inspire durable motor learning through strategic cueing and coaching techniques. Our conversation concludes with the art of prevention in coaching, highlighting the importance of environment, non-verbal cues, and the potential of future research in enhancing athlete care. Tune in to arm yourself with knowledge and join the movement towards a future with fewer ACL tears.
Link to Dr. Dimak's Course July 26th-27th
https://www.eventcreate.com/e/dimak
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Hello everyone and welcome to another episode of the Art of Prevention podcast and, as always, I have another very special guest and today the guest is Cody Demack, who is a chiropractor, who's also a faculty lecturer and on faculty at Parker University in Dallas. And I had the pleasure of watching and listening to Dr Demack speak at Parker Universities in Las Vegas and his lecture was entitled Bulletproofing the Athletic Knee, and when I saw that title I knew one. I had to go to it and then two probably need to have them on the podcast too, because that's what this podcast is all about is injury prevention and, quote unquote, bulletproofing our joints, and we're going to talk more about what that actually means today, as well as actionable items that coaches and athletes and clinicians can utilize to prevent knee injuries, which we're facing an epidemic of non-contact ACL injuries right now. We're going to get into some of the reasoning behind that, some of the predisposing factors, et cetera.
Speaker 1:Dr Dimak was a football player back in the day and he's walked the walk and talked the talk, so he's also lived in California and owned and operated a cash-based performance care and active care practice before then going into faculty and giving back to students and giving back to the profession all the insights that he's gleaned from patient care and patient practice, and he also teaches a lot of seminars across the country with Rehab2 Performance as well as on his own. So, cody, thank you so much for sitting down with me today. Um, what is some of the stuff that got you interested in the knee specifically, or in this sort of active like rehab to performance style of care that you do?
Speaker 2:yeah, um, I will try and shorten that story as much as I can because it is kind of like a longer journey. I guess Originally going back to kind of high school. I guess I was very interested in physical therapy school actually, so I was thinking about going to PT school because I was always interested in the active rehab slash, strength and conditioning piece. I guess, yeah, um, and then, uh, I actually had a, uh, a back injury my senior year of uh high school.
Speaker 2:Uh, second round of the playoffs, I broke three transverse process off of my lumbar spine and so, um, yeah, ended up getting yeah, yeah, got treated the whole week by a chiropractor and I ended up playing the next week, so I didn't miss a game at all. Um, so, yeah, that's pretty, pretty significant. So, um, I had a great experience with the Cairo then, so, but I actually still wanted to go to PT school, so went through undergrad for, uh, as a pre-physical therapy um major it was really biology I studied a swamp grass called Spartina, alternate flora. I won't sit here and talk about that because it'd be pretty boring.
Speaker 1:Grass was part of your lecture.
Speaker 2:I mean turf versus artificial, so I can see why you love the. There's really just a bias towards natural grass and swamps and stuff like that.
Speaker 2:I am from South Louisiana, so at the end of the day I guess it kind of sticks there a little bit. So, but yeah, I ended up getting in a car accident when we were in off season and I ended up seeing a chiropractor and he kind of mismanaged my case a little bit. So I had previously probably about seven or eight months before that had a disc herniation where I went to see a PT. We ended up doing like what I know now, as McKenzie Ended up resolving within about a month and a half and, long story short, I ended up having a back surgery and so I had a microdiscectomy L5-S1. Six months later I had a second microdiscectomy, l5-s1. And after that I kind of hung up the football cleats, if you will.
Speaker 2:So in the middle of chiropractic school, uh, ironically enough, the chiropractor had mismanaged my case, talked me into going to chiropractic school. Great guy, uh, it just just just didn't manage the case. What I know now is like quality, patient-centered care, right, so, um, but again, the great human does a lot for his community, um, and so I ended up ended up, uh, getting a fusion, actually in the middle of chiropractic school. You know, 405 s1 anterior uh, lumbar interbody fusion. So, um, that really kind of set the stage for like how I kind of get into like the movement piece, uh, because I had to have a hard look in the mirror and say how, how can I stop this from happening again? Right, and uh, that's when I started reading uh Liebenson's rehab of spine to uh McGill's low back disorders. I mean through that happened between try um five, I think uh five and try six. My entire trimester six consisted of me reading Liebenson rehab of spine to probably like I read about two or three times uh cover to cover. I was just sitting, I'm just like sitting there reading in class right, don't tell my old professors this but uh, I was reading low back disorders. I probably read that about uh twice as well, cover to cover during trimester six. So I basically kind of started doing my own rehab for my lumbar spine.
Speaker 2:Um, and that kind of was the first domino over into the functional realm. And I'll be quite honest with you, r2p didn't exist within Logan yet. So I kind of felt alone. You know I I didn't, I didn't really know other people are out there that kind of love this stuff, you know, like I did. And so, um, you know, long story short, that's kind of like got me into the functional piece and I've always been drawn to low, uh, low backs and knees.
Speaker 2:Essentially, uh, experiencing a catastrophic knee injury myself and uh, in college as well, uh, having a contact ACL, mcl, medial lateral meniscus. Uh chipped my lateral femoral condyle, whole shebang almost dislocated it so, but I did get up and I did get up and jog off the field, if you will, it wasn't much of a jog, it was more like a, a limp, with like a totally disconnected lower leg. So but that's what kind of got me into it there. And so a big piece too, that's kind of got me into the knee pieces. As you, as you, you know, you heard, in Vegas, females are much more likely to, you know, experience a non-contact ACL injury and I have two girls, so I'm kind of looking at them and I'm I'm, I'm trying to see like, hey, what's the impact that I can make before it kind of gets their time where this stuff actually starts to come to play, you know? So I guess at the end of the day, that's kind of my why behind it.
Speaker 1:So yeah, and you know, I think so much of like what makes like a lot of really great like people in a designated area is like previous like injury, like in that area.
Speaker 1:For me it's like a lot of tendinopathies with running, so like half my episodes are about running right, um yep, and like having that personal connection to patients and clients, people that may be experiencing this, and you having your daughters is such a huge thing and good for us, because now we've got a ton more information from you about specifically this epidemic of non contact ACL injuries in female athletes, especially in, like high school soccer and volleyball, basketball, etc. Etc. And you shared a lot of really great information from a lot of amazing researchers on this topic. So can you tell me, like, why do we see such a huge differential? I've got a couple of questions like specifically about this but why do you think we have this huge differential between male and female? Rates mean the rates amongst males are still pretty high, but 6.2 times greater incidences in females just for non-contact. So we're talking about not, they don't get hit, they're just trying to pivot and turn a different direction and then that ACL goes out. What's going on here?
Speaker 2:Yeah, I mean with the, and just to define non-contact ACL, like kind of like you already started doing there. There's what that means is there's no direct contact to the knee right, so there's not another player rolling into them from the side, creating that common mechanism of injury going into valgusity. Those types of things be a perturbation to the upper body, throwing off the center of mass, uh that that you know which which can cause um a whole. It's another risk factor essentially for uh non-contact acl. So like that's still not considered a contact acl tear, it's still non-contact mechanism at the knee right, um. So to answer your question is, like I, there's so many variables that are kind of playing into this and like to kind of pinpoint one thing.
Speaker 2:Like you know, back in school we learned like knee valgus is like the devil. Essentially you don't want knee valgus. Well, it's a little bit more complicated than that and originally we learned that if you have knee valgus you want to address glute medius. Well, you know, basically glute medius is a huge frontal plane stabilizer at the pelvis, obviously, but when, if, if we're, you know, landing with a foot and you know, underneath us and that femur is going to flexion into rotation, a deduction. Technically it's kind of glute max eccentric function that's controlling that. But when we start looking at um, we started looking at the mechanism of injury, it's more. Looking at um, we started looking at the mechanism of injury, it's more, it's more in depth than the vagus right, so um, but in terms of like, why is it so so much higher for females? I mean, clearly there's other biomechanical things that they have.
Speaker 2:Uh, you know, from a structure standpoint that that's different than their male counterparts. But one thing that's not really considered that much is actually like hormonal when specific hormones are released during their menstrual cycle. Right, and so, as you know, that was kind of a big piece of the beginning of my talk. There is to kind of throw that out there, and because originally it was thought that, um, you know, relaxing is, uh, is highest, you know, between day 21 and 24 in the cycle, and so, um, people thought like, okay, well, that's when ACL tears happen, when, in fact, that's not actually when most of the tears happen. Most of the tears happen within between, uh, day zero and day 14 of the cycle. So it's, uh, there seems to be something.
Speaker 2:Uh, well, some researchers were saying, okay, well, relax and doesn't have anything to do with it. And and, as I kind of alluded to in the talk, I don't, I actually don't think that's we should go there, I think we should actually still consider relaxing levels there. And but, specifically, when I read the article it was a great article, um, um, that specifically looked at acl tears and like when certain, certain you know spikes and hormones happen during the cycle, immediately the thing that popped in my head is all the work that Tim Gabbitt's been doing and if you look at just some of his first few studies, like the one that's often quoted as the rugby study, where specific workload spikes, those types of things can basically end up you don't want to say predict injury, because it's kind of hard to predict injury because there's so multifactorial, but there is a huge piece, I believe, from a workload standpoint, that we're not monitoring during the cycle, essentially.
Speaker 1:So yeah, and for the for those of you listening relaxin is a hormone that's naturally produced by females and that hormone, relaxin, literally relaxes and loosens some of your connective tissues. You can see this most evident during pregnancy, when pregnant women, a couple months before they give birth and a couple months after they give birth, they go wow, my joints are just so loose and so relaxed. And there's an important reason for that and that's for opening up of the birth canal. But women, during their menstrual cycles, do have fluctuations in this relaxing hormone, which a lot of researchers would pinpoint to and say oh well, this must be a causative factor.
Speaker 1:If that ACL is relaxed literally, then it's going to be stretched out a little bit more and more predisposed towards an ACL tear or an ACL rupture, and what we're saying here is that that's not really when those ACL spikes and injuries occur. It's more during the initial onset. However, like you were saying, there are a ton of different factors at play here and I love that you segue to automatically into the Tim Gabbitt's work looking at acute and chronic workload ratios. And for the coaches out there and the parents and people like that, what's the difference between an acute workload and a chronic workload?
Speaker 2:Yeah, so your acute workload is basically the total amount of work or training that you've done whatever sport, or even the general population out there trying to get fit, if you will within the last seven days. So what have you done within the last seven days? That would be considered the acute workload. The chronic workload is kind of the basically what you've done on the short end, the last four weeks, right, and you can kind of couple in like, I guess, four to six weeks in there too, but like, if you've, let's say you've done nothing. You've been a couch potato all winter, right, and all of a sudden, you know, snow starts to melt a little bit. I think you know you get a little snow where you're from we don't get much over here in Texas, so but you're starting to be a little bit more active outside.
Speaker 2:Let's say you're a runner. In your case, right, for some reason somebody didn't run on a treadmill or go to the gym, so their workload is pretty low, but they're like you know, I'm feeling good, I'm feeling motivated, I'm going to go out and run eight miles when you haven't run anything over the last few months. That's a drastic spike in workload. You have not built up enough tolerance, essentially in tissues that can allow you to run that eight miles efficiently and honestly injury-free, right? So we think of every tissue in the body. We need to try and create some type of adaptation and unfortunately that takes a long time. It takes a long time to slow cook it. Essentially build up that tissue adaptation, right?
Speaker 2:I kind of like to equate it as like cooking a brisket. I can take a brisket and put it in a pressure cooker and cook it. It'll be done in about an hour and a half and technically you can eat it. I don't know why you would want to, but you could right. Or I can take that brisket, give it some love. I'm not going to take my cigarettes, but we can smoke that sucker for about 14 to 16 hours, 18 hours depending on how big it is. The process takes much longer, but the end product that comes out on the back end of that that slow cook, that smoke, uh, the brisket there is much, much, much better.
Speaker 2:And fitness is no different. There's no difference, uh, from a uh lifting standpoint, from a uh running standpoint, like it's all slow cook fitness. Now, if we have somebody who, um, who has like an acute workload spike, and you can. You see this in a running world, I see this in the, uh, the exercise world. Uh, if I look at a pro, somebody comes into me with an injury. I can look at their program and I can just say that's it. You know, you can, you can pick it out. It's like sticks out like a sore thumb.
Speaker 2:There was a drastic spike in load, a drastic spike in volume that didn't uh, maybe the, the volume went up and the load wasn't adjusted. You know something, uh, from a, from an exercise standpoint, you can always just pick it up, right, and I think that's kind of what's going on here with the knee as well. And when we look at cycles, so, like, I think what's happening basically is when we have a spike in relaxin. I'm thinking that's probably something that's happening is whenever relaxin is high and we have a drastic spike in workload, maybe too much to create adequate adaptation in the tissue. Tim Gavin's research says it doesn't happen. So usually it doesn't happen when the workload spike.
Speaker 2:It's actually one or two weeks after that acute workload spikes, and so you can look at the day 21 through day 24, we have relaxing high. If we have a high workload spike there, meaning training on the pitch, if you will, in soccer, let's say, or football, right, training increases, intensity increases. Maybe they've upped their post-training conditioning, maybe they changed the routine in the weight room, something along those lines. There, if we have too big of a spike in workload, at that point I think we don't see that injury until you know one to two weeks then that's. That's been pretty consistent with a lot of Tim Gavitt's work as well. You typically, depending on the workload, spike obviously, uh, you typically see one to two weeks after that huge spike in workload. Um, that's when sometimes injury occurs, especially if the workload stays high after that spike.
Speaker 1:Yeah, I completely agree and that actually sounds a lot like a couple of ago we did a lot of episodes and put out a lot of content on bone stress injury and it's the same thing.
Speaker 1:You get that huge spike at the beginning of a season or something like that. The kids are supposed to be doing their summer mileage, you know, maybe they don't hit exactly those summer numbers because it's a little bit hot outside and they're out by themselves or something like that. They were on vacation. And then you hit that first week of school and the coach is like all right, guys, we're doing 45 miles this week and we're going to add in some some workouts because we got to race next weekend, you know, and it's not like people get hurt that week, but that bone stress injury crops up and appears three, four, sometimes five weeks later, because there's that lag time between the osteoclasts coming through and debriding all that damaged bone and then later on the osteoblasts coming in and rebuilding that bone matrix. And what it sounds like to me is that that same issue is happening with our other connective tissues like our tendons and our ligaments etc.
Speaker 2:Yeah, and I think you know I just see those two kind of connected here with from what the researchers did in that one paper and then Tim McGavin's work as well, and in full context there's pieces in that original paper there I was talking about by Raj I think it was the first author on that title that title, by the way, for your listeners the Impact of the Mental Cycle on Orthopedic Sports Injuries in Female Athletes, and they had some other interesting things on there as well.
Speaker 2:Right, and this is kind of like this piece here that I mentioned in the talk. I don't know if there's anything we can do to control this piece right. And this is kind of like this piece here that I mentioned in the talk. I don't know if there's anything we can do to control this piece right. So when we look at whenever relaxin is not at its peak between day 21 and 24, men and women actually have the same similar levels of baseline serum relaxin, but female ACLs have a receptor for relaxin and males ACLs do not. So actually male ACLs are not impacted by the relaxin uh feed, but females are.
Speaker 1:What? Yeah, that's a, that's a brain blaster for me.
Speaker 2:I'm sorry, that's like so so that, yeah, so that kind of. When I read that, you can hear my jaw hit the floor. I just couldn't believe it. And sure enough, you read into it and that's, that's. That's the case. You know, females have a receptor on ACL for relaxin and males do not.
Speaker 2:So the some other pieces too, and I've tried to find out why and I don't know if this is maybe a you know environmental thing or what but uh, some female elite athletes, um, this, these were soccer players, I believe the study they looked at, um, in, uh, females who tore the ACL versus females who did not tear the ACL, um, the ones who had, who tore their ACL, had higher baseline serum levels of relaxin compared to the other groups. And so I tried. The paper doesn't say why that's the case. They didn't really dive into that piece there and that that. But that paper is about all the way back in 2011. So they should probably. There's probably some more work done since then on that specifically, but I haven't, I haven't read anything of why, I don't know. Again, it was for viral metal, you know, or nutritional, or I so, but but it's just, it's there's something going on to where, like, hey, you have higher levels of relaxin and, sure enough, there was a huge connection with ACL tears as well.
Speaker 1:Wow, I mean I, I knew that the ACL had all of the different mechanoreceptors, but to have a specific receptor for a hormone like relaxin, that's a I mean I'm still kind of reeling from that that's pretty, that's pretty incredible yeah and it doesn't.
Speaker 2:It doesn't impact males, so yeah and again and again it's kind of like it's another another thing, another nudge against the, if you will, the um that we have to kind of consider and maybe train around. I'm not really sure you know from an action standpoint if, if this is a thing where I don't know if we really need to be monitoring like um levels you know consistently, but I think we should probably be aware of where are our athletes at in their cycle and how are we monitoring their workload. Because when we think workload, typically what you think is rest right, well, that's not actually the case. Deload should not be rest. What we should do is we should just see kind of pulling back on the volume, maybe the minutes or um, uh, whatever your sport or your mileage you know or something you know, whatever you're measuring in your sport, I guess um, we should probably consider that too.
Speaker 2:And when we look in the strength and conditioning field, I mean clearly I think this is something we could probably like start to peel back. Maybe we, if we're at specific portions of our cycle, maybe we should, uh, we could probably peel back and some of the more dynamic um, or the volume at least of the more dynamic uh, plyometric activities and kind of hone in on a little bit more, maybe motor control or like saturn plane stuff at that point, and then when we're kind of off of that piece, then we can kind kind of up the uh more dynamic. You know multi-planar things, I don't know, it's just kind of some things that they'd consider.
Speaker 1:Yeah Well, I'll stick that relaxant sensor right next to my continuous glucose monitor on the back of my arm so I can monitor that a little bit better. So we can't necessarily control these fluctuations in hormones, or at least, like you know, that's not necessarily something that's actionable by a coach or anything like that, right I?
Speaker 2:mean there there are some. Uh, if you sorry to interrupt you there, the authors did mention that they noticed um, oral individuals who are on oral contraceptives did have a less instance of ACL tears. But clearly there's like there's the the, the cons with that as well, from just a you know a risk factor standpoint with with the world contraceptives. They didn't promote it or or neither am I, but like it's just, there's something that they did notice in their study.
Speaker 1:So, all right, let's listen to some Tim Gabbitt interviews on uh with Brent and Taylor on the Gestalt education podcast. They brought that up, and they brought it up very hesitantly too, because it's like oh yeah, maybe not a popular thing to say, but the evidence is there, so it's like something to be aware of.
Speaker 1:So there are some means by which we can modify, um, some of the hormonal levels in females, um, but from a coaching standpoint, there are other things, such as the surfaces that we're playing on, right, yeah. So what are some of the things? Like, I know, the big thing right now is like turf versus grass, so way more sports play at the highest levels are occurring on turf, but now I mean so I actually grew up in texas, by the way. Oh cool, yeah, uh, the woodlands like just north of Houston.
Speaker 2:Yeah, absolutely yeah.
Speaker 1:And I mean Texas puts a lot of money in football and soccer. So you're seeing these multi million dollar facilities for kids to play football and a lot of those facilities are maybe the majority of those newer facilities are on turf. We see a little bit of a higher incidence in non-contact ACLs, especially in American football on turf versus grass. So if I'm a coach, like, how do I navigate that, like where we're probably playing on turf, like in our big games and things like that, but maybe our practice field might be different, or should we be doing some of our training on grass to decrease that injury risk? What are your thoughts?
Speaker 2:Yeah, um, that's a, that's a load. It's not a loaded question, it's the answer is loaded because there's uh, and again it comes back to exposure to an environment and building up tolerance around that exposure. So, um, the problem with, um, well, there's a problem with every surface, essentially right, cause none of them are the same, so you can't, you can't, have the exact same surface everywhere you go. You can try and be more as consistent as possible, um, which I think grass would probably uh, depending if you have a very specific type of grass, you know, that's like kind of like like hey, we're, we have this type of grass that we're playing on this grass, then you could be a little bit more consistent. But how feasible is that, especially when you're getting into, uh, higher levels of competition, when just different areas of the country, you have different environments, right. So sometimes that's not sustainable.
Speaker 2:But when we look at uh, we look at synthetic turf. Synthetic turf, there's some pretty good research out, especially by the NFL, showing that, um, there is a higher incidence of, of of injury on synthetic turf non-contact injury. And I think there were a few uh, there were a few um couple of papers that were uh, that show that. No, actually it was on grass as a higher incidence, but both of those papers were were actually funded by synthetic turf companies. So that's always good, it's always good.
Speaker 1:Sometimes you got to look at who's paying the money to get that published.
Speaker 2:You got to you got to, you got to read the bottom at there. You know any conflicts of interest, so you got to read that piece there. So but I think one thing to consider when we were looking at turf is that even when you you have a turf field, it doesn't mean the surface is actually the same stiffness throughout the entire field. You can test, let's say, we have a football field, american football field, we test the 10, the 10 yard line on the hash mark. It might be that stiffness there it might be completely different than right in the middle of the 50 yard line for the field, right. So like if you have pellets, all that stuff kind of disperses everywhere too. So even on the same field, the stiffness is not the same. I think the problem comes in like you know, if you play the majority of your games on one turf and you practice on that turf, then you're probably going to build pretty decent adaptation to that surface. But if we, you know and this is happening in the NFL too you know, usually teams have I'm sure they all have grass, a grass field and they have a turf. Well, even though you have a turf field, just because you have a turf field and let's say the Saints, right. So I would be willing to bet, if you go to their indoor facility and test the turf, even if it's made by the same company, they have the same exact thing. You're gonna, you're gonna find all these spots of variability in terms of stiffness and give and those types of things compared to what when they they load it up in the superdome. You know, it's just, it's just going to be different. You know what I mean. So, um, so that throws out a whole that goes up in a monkey ridge, essentially, when it comes to like workload, and so, um, and derrick hansen talks about this um, he's got some pretty good stuff on his instagram too. Um, uh, talking about like achilles injury and acl, non-contact injuries and stuff like that.
Speaker 2:And from a turf, from a field standpoint. I think it's the variability in it. Essentially, you're not building tolerance to everything and it's kind of it's almost impossible to do so it's it's especially when it's so diverse, and I think probably the only the only answer would be, if you have enough money, like a conglomerate like the NFL is to mandate like a particular type of grass, but then then you look at fields that can't sustain that. Right in new orleans. They wouldn't be able to do that because they have a superdome, you know I mean. So I I'm not really sure what the answer is there, but uh, it's from a from a youth field standpoint it's yeah, especially travel teams like you don't have one place. You're playing, you know you're going all around, you know playing on different types of surfaces and part of that could be a good thing from a variability standpoint.
Speaker 1:I mean, this is one of the things that really stuck out to me in your lecture, because to me I would have assumed if you're putting down turf and you're putting down pellets, then the consistency of the stiffness of that surface would be more similar across the entire playing field than like a grass field.
Speaker 2:But it seems like it's a little bit more of the opposite yeah, when you you think about the pellets I mean, I mean, if you've ever stepped on a field before, especially um one that hasn't been uh, well, there's drastic differences in like, where some pellet, some areas are concentrated with pellets, so it's like falling on a cloud versus like another part. It's like, it looks like it's, it looks like the grass is a little higher, but it's actually not. It's just the pellets are gone and basically it's like almost like concrete, you know. So that piece of it there is kind of like there's a monkey wrench into it.
Speaker 1:That'd be an interesting thing to see like a hotspot map on a field of like, where I wonder if that would be a thing where you know, in this one really soft spot where the where the cleats really dig in, then do we see higher rates there? Or in these really stiff spots that you're talking about, with the grass being really high? That'd be an interesting thing to do.
Speaker 1:That would take a ton of time and like a lot of watching football, I guess, which wouldn't be a bad thing, necessarily, right? Yeah, I bet we could find some volunteers that would probably mark down on a sheet of paper where that's happening.
Speaker 2:Um, yeah, man, I would, I would. I don't know why. It's just like everything that sticks out in my head. It's like most of those occur between the hash marks and the numbers and I don't know. Just I don't know if that's that's usually just because that's where most of the those types of movements are taking place, you know, from skill positions, if you will, in American football anyway. So I don't know, it'd be interesting.
Speaker 1:It'll be interesting to look at. Yeah, yeah, I'm sure somebody would make a hotspot at some point, you know yeah.
Speaker 2:Yeah, create fear, avoidance for the football players to run into.
Speaker 1:They're all just running on the right by the sidelines going down. Now you said we've mentioned variability in fields and surfaces might be a good thing, kind of try to get prepared for anything surface wise. What does movement variability mean to you and what could that mean to coaches, because you talked a lot about movement variability in your lecture as far as hardening the joints and hardening the body for all of these movements and all these joint positions that they might be exposed to during gameplay?
Speaker 2:Yeah, for me, movement variability is more than going outside of the normal range of joint alignment or joint positioning.
Speaker 2:For me, movement variability is exposure to different types of exercises, different types of implements, but still, especially if there's, you know, some type of force, high amounts of force or power that's needing to be expressed, we still want some decent biomechanical integrity. Right, we're not throwing caution to the wind necessarily and just kind of getting into crazy positions and say if we challenge tissues, tissues will adapt. But remember that that's true, but that has to happen over a long period of time. It's not just some exposure, that that's true, but that has to happen over a long period of time. It's not just some exposure. So for me, I look at movement variability as kind of expanding, like a cup essentially of what we call affordances in the motor learning literature. So basically, I'm trying to expose individuals to different types of tasks, maybe different types of positions, different types of force vectors. I think is a big one. When we look at different types of force vectors, I think is a big one. Um, when we look at, uh, different types of exercises to try and increase or give people more options, right and so like this is kind of uh, I go back to some of.
Speaker 2:I don't think I actually mentioned this in in my my lecture uh at vegas, but when you look at, there's a few running papers where they looked at I mean, I'm sure you're totally aware of these, for sure too. So, like the, they looked at individuals with knee pain and they uh had valgus when they were running and they did like I think it was an eight to twelve week training program, uh, strength program, and they re-filmed them and the pain was gone, but the valgus was still there. But for me, like, so people are like, oh, so biomechanics doesn't matter. Well, I don't know if that's necessarily the case, but I think what happened was you gave those individuals more options to use, right, you increased their affordances. And another one that kind of brings up that point of affordance and movement variability is when they looked at runners runner.
Speaker 2:Another study looked at runners. Uh, I may be butchering this one here, so correct me if I'm wrong, but they look, they looked at runners and they, um, they had knee pain. The one individuals who had knee pain were the exact, had the same exact cadence. They never veered from the cadence right. There was no variability within the cadence, and so all they did was they had them run to different uh to metronome and they fluctuated the metronome and it decreased their pain. And so, like you're giving, you're giving individuals more options. Essentially and I look at that from a strength standpoint um, we need to be doing that as well, um, and because, you know, when we look at this, this is more than just building up a tissue robustness, acl robustness, quadriceps, bmo robustness, glutes robustness, like I need them to be able to control and produce force outside the sagittal plane, and for me, that's where kind of portions of the movement variability come into play, and a lot of that's generated from the variability overuse hypothesis but I think James is the last name of that and uh, individual.
Speaker 1:So yeah, I I recently did a pretty deep dive into iliotibial band syndrome and it was. I looked at a lot of the papers that you're talking about where they maybe have that little bit of medial knee drive and a little bit of internal rotation during the gait cycle, which we say, oh, biomechanically that would put more forces at the knee and put more stress on specific ligaments and tendons and things like that. And then they do like a hip muscle strengthening intervention and it's like the hip muscle strength goes up a little bit. But then you look at their gait afterwards and it's like, oh crap, it's the same and hip muscle activation is the same.
Speaker 1:One thing that I like to think about is like the work of like Pavel Kolaj and people like that, and one thing that Pavel talks about is internal forces versus external forces.
Speaker 1:So external forces would be like that ground reaction force or like if I'm lift, if I'm doing like a bicep curl, and if I'm doing a bicep curl with a five pound weight, then theoretically that external force is going to be consistent no matter how I'm doing that bicep curl.
Speaker 1:However, if I tense up all of my muscles and do basically like an isometric contraction and then bring that weight up, then I could significantly increase the amount of internal forces that are placed on my elbow. But biomechanically it's the exact same and that's one of the things that. That's one of the things that I kind of think about, because we can't really measure internal forces that well without being a bit invasive with our measurement techniques, like we'd have to implant some sort of like force sensor like within the muscles or the tendons or the ligaments, and that's just like not a practical thing to do in a high volume and that's not really something that has been done. I mean, we've seen that a little bit with like low back research, which we know we can alter force transmission and pressure within the low back and the intervertebral disc with specific movements and cues and things like that, and it seems like we're doing a similar thing with these affordances that you're talking about as well I we're doing a similar thing with these affordances that you're talking about as well.
Speaker 1:I would agree, and in your lecture this is a little almost off topic, but in your lecture you've talked a lot about like. You cited multiple books right by Rob Gray, Gary Gray, all of the Grays. Really, If you had to recommend one book to a coach or a clinician or an athlete that they should just like put in there, you know, look at your local bookstore first but put in their amazon cart like what would that book be? Because I'm literally like being selfish and like I want to look, I want to get the book that you think I think everybody for the most part is like so drawn in on the hard biomechanics piece uh what there's.
Speaker 2:There's nothing wrong with that, but I think what we need to do is we need to zoom out a little bit and see how the hardbound mechanics piece uh interacts with the environment and the task, and so, for me, my bias is towards motor learning, and so a great book. Um, uh, he's actually got two books out. Now he's come out with a third, which the third would probably be more geared towards people like us implementing these strategies right away with individuals is Rob Gray. So how we Learn to Move is a great book. And then a second book that's escaping my brain right now. It's a great follow-up to that as well. They're not very long. The paper copy is only about that thick. It's an easy read. And then the audio books are great too. So I listen to audio books, so those are solid too.
Speaker 2:But those are good solid motor learning it's. Those are specifically about ecological dynamics, so, um, it's a constraints led approach essentially. So uh, and I kind of touched that on that a little bit in the, in the talk too with the um at the triangle. So the individual task environment and then the perceptual motor landscape I love that, yes that's when the affordance piece came out right, so, um.
Speaker 2:So, though, I think those are, um, that would be a good place to start from that standpoint, because we're, you know, there's a so much, so much information on biomechanics but, like, at the end of the day, like, how does, how can we actually make a true change? And it's integrating the individual into the environment in a way that we, we don't have to be there all the time from a coaching standpoint. So, um, those you know your listeners, who know Nick Winkleman is right, uh, language of coaching, great book. Um, from a verbal coaching standpoint, that's a, that's a great one. Uh, but from a task, environment constraint, manipulation, or um, or you know that Rob Gray's work has been, has been, really, really, really good.
Speaker 1:Yeah, and I've actually. I've got your lecture up right now.
Speaker 2:Thanks, partner.
Speaker 1:Giving us those show notes, if you will. Learning to optimize movement.
Speaker 1:Yep, that's the other one so how we learned to move obviously a great starter and then learning to optimize movement after that. And gosh, I think a lot of the stuff that you're talking about is just so pertinent to coaching and like movement. Obviously, because previously we would give all of these like extra or not extra, but previously we'd give all these internal cues make sure you activate your glutes when you're doing this run, make sure that you're using your calves, or stuff like this.
Speaker 2:Activate your core. What does that mean Exactly? And it's like you know. Nobody knows what it means, but it's provocative.
Speaker 1:And like in, like Paul Hodges' work, it would mean something, because they literally had an ultrasound scanner on their core and they're like, no, you need to make that thing twitch right now. And then you can get like that immediate biofeedback, just saying like activate your glutes. I mean I have people that come in and they're like I can't activate my glutes, I can't feel my glutes and it's like I'm sorry, but your somatosensory cortex is not designed to tell you when you're getting more activation in your glutes.
Speaker 2:It's just that's like the smallest strip of real estate in your brain is for. Like your glute max and external rotators in your hip, you figure out how to how to, how to this, you know, determine whether or not they're activated or not.
Speaker 1:Let me know Cause. So, besides, like a fine wire EMG, like while you're doing the exercise, can you, can you tell us a little bit more about those internal cues versus external cues, why just telling somebody to just activate their glutes when they're doing something isn't necessarily the best way to?
Speaker 2:do it? For me it's. It always comes back from a cueing standpoint of an exercise. It always comes back to like what am I trying to do with the exercise, right? So what's my goal of the exercise essentially? And then how can I get this person to execute this movement or exercise with the least amount of instruction essentially amount of instruction essentially and how can I get this individual out of their own head? How can I? You know so essentially, when we give focuses of attention or cues that are directed to the body or a body part or a body position or um how their body moves during a um, a movement, then that's basically called an internal focus of attention or internal QE, and that what that does is that interrupts the automatic uh or the smoothness of the movements called the constrained action hypothesis. So it actually increases uh, it's so in in like in dynamic neuromuscular stabilization, we talk about uh co-contraction, having adequate co-contraction around the joint. Well, basically, what internal focus of attention does, is it? It flips that on its head, so it's it's poor co-contraction around a joint, so increase antagonist muscle activity. Um.
Speaker 2:But some people might say let's say I'm trying to do a uh, an exercise, let's just say like a deadlift and basically what I want to do is I want to stand up and create hip extension at the top of the exercise. Right, I want to create hip extension and not hyperextend through the lumbar spine at the top of the exercise. That's what I want to do, right? So if I give an internal focus of attention that's going to make me create hip extension, I'm going to have a high EMG for the glute max. I'm going to. But the reason why it's really really high is because internal focus of attention also give you high antagonist muscle activity, so your psoas and your rectus femoris activity is very high as well. Um, so, but if I give an external focus of attention, uh, let's say I want you to, as you're coming up through the exercise, I want you to push the ground down through the earth to create full hip extension. That would be considered a distal external focus. That is going to give me high glute max activity, but not as high glute max activity as an internal focus of attention, because the external focus of attention now does not have the psoas or the rectus femoris activity, so it's not having a good enough fist fight with the antagonist. Essentially, it's clean, it's cleaner, it's smoother, it's more authentic, um, and that's like the, the most rudimentary level of cueing, essentially, uh, from a, from an external focus of attention standpoint.
Speaker 2:Now, when we, uh, when you're looking at more holistic movements or, uh, more let's say, functional movements or more dynamic movements, or let's say you're, you're uh starting to like organize portion of practice, um, you don't want, you want the cues to be a little bit more exploratory, a little bit more about the environment and honestly, you want your cues and direct the person or the athlete's attention to potential affordances.
Speaker 2:Don't say, you shouldn't say, hey, don't do this, do this. You should say, okay, we did that, that happened. What about over here? Do you see anything over here in this area? And so, like, maybe they can start picking up things that you kind of direct their attention to an area but the individual is still making the decision to go. Do that, let's say, right, that brings up the whole, the whole monkey wrench that I talked about at the very end of the talk, when it comes to like practice schedule and how you organize practice, actually reducing knee injury risk factors as well. So it kind of bounced around a little bit there from a cueing standpoint, but but yeah, hopefully I can answer your question oh, definitely so.
Speaker 1:Like the internal cue might accomplish what we want activate your glutes, the activity of that muscle is going to go up, but the activity of the other muscles. That kind of goes back to that internal forces argument too. Yeah, the internal forces on that joint are going to be far more because you're co-contracting other muscles that don't work well with the glutes or maybe work against the glutes yeah, and that I do.
Speaker 2:I do need to kind of point something out here too, because there's a there's a sometimes there's confusion on internal focus of attention to execute a movement and intrinsic sensation.
Speaker 1:Oh, those are, those are two.
Speaker 2:Those are two different things. So an internal focus of attention is thinking about a body part to execute a movement. An intrinsic sensation would be you feel your glutes on fire after doing an exercise. Right, we want the person to be able to sense things internally. We want them to be able to feel things right. So let's say we have a chronic low back case. Uh, they only feel the low back. They never quote feel the glutes. Right, we do an exercise that fires up the glutes and, uh, at the end we say did you, how's that? Did you feel anything? You, yeah, I felt my glutes on fire. Awesome, that is great. We love that there.
Speaker 2:Right and so we want them to feel that that is different than thinking about your body to execute an action or movement. So sometimes those get kind of tripped up, because even in the constraints-led approach literature you need the feedback from the athlete. How did that feel? I felt like I was doing this and this right, okay, well, let's uh, instead of like focusing on their body to do it, let's focus on the environment or give them a different, different thing in the uh, you know, in the uh on the field to focus on so we kind of we start relating.
Speaker 2:So because they need that auto, they need to kind of be able to like automatically make shifts and changes themselves, right, but sometimes they just need a little nudge and guidance on what does that actually mean? Where should I go from here? And we don't tell them the solution, we try and guide them towards the solution. So I did want to bring that up about internal focus of attention, intrinsic sensation. So those are, those are two different things and both are important to understand.
Speaker 1:Right. So that was something that I really hadn't taken the time to thought theoretically like kind of tease apart in my mind. So thank you for bringing that up and I feel like one good one good example that I've heard with like runners in particular. Well, one thing we know that if we give a bunch of internal cues with running like, oh, use your glutes, or something like that, then it actually decreases running economy and it decreases running economy about the same or more than getting super shoes. So if you're getting super shoes, you're spending 250 bucks on those and you're also using this like internal focus for your running gait and you're doing that for the entire marathon. You're actually just negating all of that $250 you just spent.
Speaker 2:One that I've heard Burning more calories as well, and not in a good way either. You're going to fade faster.
Speaker 1:One thing I've heard is, instead of telling someone to land lighter with their foot strikes or footfalls to make less sound. What do you think of that cue?
Speaker 2:that's a great cue, uh, so it's not telling them how to do it, it's giving them a goal and they have to search for the solution. That's, that's an ideal cue for running right or like anything. Is you kind of give them basically that's called a task constraint, by the way, in the constraint sled approach. So you give them like a rule or like a kind of parameter, like a challenge.
Speaker 2:The challenge, but the person's searching for that solution. You're not telling them how to do it. You're not telling them how fast to go. You're not telling them what foot strike to use. They're searching for the solution that is an ideal cue.
Speaker 2:And they're figuring it out, which is what learning really is Exactly, they're searching for the environment and the cool thing about that is that is going to stick. It's going to be more stickier than any other cue or any other thing you do from a hard biomechanical standpoint, or heal the toe, heal the toe, heal the toe or like you know anything, any type of cue that, from that standpoint, you have to be there in order for that movement to, to, to to come out Right. And so that's kind of one of the the conversations I have sometimes with coaches, physical therapists and chiropractors about cueing is like they'll tell me okay, so I'm not supposed to tell somebody how to move their body or what you know position of their leg and their knee and stuff like that and look at that movement right there. Can you tell, does that look good? Yeah, it looks pretty good. Well, I just did that with my words. How can you tell me that that's a bad thing?
Speaker 2:Okay, coach, let's take a breath here, let's remove you from the equation. Next week when we come back, is that going to be exactly the same? And the answer is going to be no, because they would have to tell the person how to do it again. That would be the problem with a motor learning standpoint. Internal focus of attention promotes motor performance, doesn't promote motor learning, and the difference between those two things are retention, right, and so, like the piece that you talked about, having the person search for the solution that promotes motor learning. They might not get it right away.
Speaker 2:It might take them a little bit longer for them to kind of get it, but when they get it they get it they retain it and it's going to be there without you having to run by them, by their side, cause you could, you only run so many miles a week. You can't do that with all your patients. You know what I mean.
Speaker 1:So it's a lot less than it used to be, that's for sure.
Speaker 2:And more than me, more than me.
Speaker 1:So, going back to Tim Hewitt's work, like one of the things that he found is that people land really stiffly. Yeah. So with that stiff landing I've had 16-year-old volleyball players in my office and I have them hop off of a 12-inch step and it sounds like an elephant fell over in the woods or something. And that's just that super stiff landing. And I tell them do that same jump, but don't make any sound at all. And then it's forcing. The first couple of're like how do you, what do you mean? And then I do it and they're like well, how do you do it, you know? And I'm like, well, you got to figure it out, you know yeah, that just goes to that learning piece that you're talking about so eloquently.
Speaker 2:Yeah, yeah, yeah, yeah, especially when you get into like, uh, dynamic pieces like that from for specific sports, specific things to the I think I kind of touched it on the end the talk in vegas, um, your demonstration to of those things are so important, actually arguably more important than verbally telling, like guiding them of what to do yeah I mean mirror neurons are firing and all those different things just watching somebody.
Speaker 1:so make sure that you're showing off your exercises as well. And we talked about variability and increasing affordances, and one thing I would really like to talk about is getting outside of the sagittal plane. Now I see that you have an addendum to that too. What were you?
Speaker 2:Yeah, so no, no, I mean, getting outside of the sagittal plane is probably one of the things that some people think that they're doing. They may be moving outside the sagittal plane, but I don't think they're truly loading outside the sagittal plane, because a lot of times people will be moving in the frontal or coronal plane, they'll be moving in the transverse plane, but the load that they're having their hands, they can be twisting it and moving it, but usually it's still going, it's it's fighting gravity, right, so it's still loading in a sagittal plane. We need to find exercises that force you and apply force in the frontal plane. You know, and some of the you know all the things that I do.
Speaker 2:From that standpoint, I learned from Koichi Sato, who's I believe he's the head of performance for Japan's national basketball, like oversees, all their performance things, and when he was here in America he was, while he was the, I think it was the strength coach for the T-wolves for a period of time and he used to come out to LA and, along with Craig Liebenson, did his frontal plane workshops and I'll be honest with you, it was one of the more, it was one of the better workshops and seminars I've ever been to. You know, being from Japan, you can speak English, but it was still a second language, right, and so watching him coach was one of the most amazing things, because he had to find a way not to use his words but to use the environment and load and stuff like that. It was really. It was really enlightening to me really to see how he coached um and uh.
Speaker 2:But the exercises that he applied with his athletes, you know, in Minnesota at the time and I'm sure he's doing same in Japan um, like not a lot of people are doing, you know and uh one thing that I guess is not there, as well as force um, looking at the data from like force distribution on those things during those types of exercises that are truly loading in the frontal plane, uh, using the cable machine and the strap and stuff and the XOs uses, uses a lot of those things too, and I believe that's actually where Koichi might've learned that from Exos, and really Vasocronos is a physical industry industry's functional training strap, so but there's not a lot of data on that and that's actually something that I'm kind of we're looking into start doing actually in the future. Parker, a little bit, is kind of a dip her toe in the water, of kind of looking those, those uh force profiles with some of those exercises to get some data on that and see, see if we can start creating some tissue adaptation from that standpoint yeah, I, I think next time.
Speaker 1:Uh, dr morgan needs to give you a little bit more time for your, for your talk. This sounds like it needs to be a three-hour workshop. Just start with what you already did and then the last two hours we just need to dive into, like how to do this stuff yeah, yeah, I've got uh more doing the same talk in orlando actually coming up here.
Speaker 2:Uh, it's going to be two hours, um so I'll have an extra. I'll have an extra hour yeah, have an extra hour and then but I'm actually kind of expanding the talk um, I'm probably going to do about a day and a half workshop now on it and kind of get into it and expand, expand outside of just a non-contact ACL and just get into, like other other things as well, in the knee and stuff.
Speaker 2:And you know that you mentioned the title originally bulletproof in the athletic knee. It is a hundred percent a clickbait title, it is for sure. It did exactly what it was meant to do to get you into the, into the room, as you, as you know, you know, within the first, you know the first sentence it's uh, you've been, you know you've been bamboozled. There's no way to to bulletproof necessarily, something we can do our best, though, to mitigate as much as we can.
Speaker 1:so oh, don't worry um having the a podcast named the art of prevention. People, people have let me know cody that you can't, you can't prevent every injury.
Speaker 2:It's context, it's context, it's context.
Speaker 1:I know we can. We can still try. Unfortunately, the art of risk reduction and mitigation really doesn't roll off the tongue as well, does it? It?
Speaker 2:doesn't sound that good. It's not a sexy title, it's not provocative.
Speaker 1:So, wow, I mean I think I have more personal notes than I've ever written down on for a podcast before. Uh, so I'm going to be following up on those things. I'll be linking to things in the show notes. Um, dr demac, we've talked about so many different things, uh, regarding the knee and everything from hormonal influences to chronic and work, chronic and acute workload ratios to all these different things. But if we could sum up this, I mean we've been talking for over 50 minutes now and we could keep going for another two, three hours, I think, so I'm definitely going to have to have you back on.
Speaker 1:But if we could sum up this into just a little ounce, a little ounce of prevention, which was started by Ben Franklin for the volunteer fire department in Philadelphia, which announced a prevention might keep your house from burning down, and today, the sounds of prevention might keep your knee from exploding. What would you tell athletes, or coaches, or clinicians?
Speaker 2:Well, um, I think I would probably have a uh, somebody, something for for everybody actually. Um, so, from athlete standpoint, um, I think one thing you need to do is understand that, uh, tissue adaptation takes a long time and you have to be patient. You have to be persistent. Uh, there's not a lot of legal things you can do to speed that up, right, and so even the illegal things have their setbacks and their kind of hiccups as well, right, so it takes a long time to create the tissue adaptation. You have to be persistent.
Speaker 2:From a coach standpoint, let's talk about maybe not even a strength coach, but an actual coach coach, right, understand that there are some. There's actually three solid articles, a couple, I think, two with soccer and then one with basketball, maybe one with soccer, two with basketball, I can't remember off the top of my head that integrate just purely motor learning, different motor learning strategies that reduce ACL injury risk factors and testing. That's just how you structure practice. Only, right Now we look at the strength coach piece. I think the key with a strength coach is now how can we start to break free of the sagittal plane and start to truly load in the frontal and transverse plane from a, from a force standpoint where's the load pulling me and what are my joint angles and force production angles as we do those things and from a chiropractor and physical therapist standpoint, you got to know it all. Essentially, you got to know. You don't have to know it all, but you have to know the pieces of all the moving parts yeah, yeah, yeah, it's it, it's it, yeah.
Speaker 2:So your tissue adaptation piece from the athlete standpoint. The motor learning piece and how you, um, you know how what's the coach doing in the practice, so you can kind of you can, uh, go help the athlete move forward in their uh, um, know, their training. And then definitely the strength piece because honestly, like the, there should be a very I don't want to say very blurry line, but there should be. The line should be kind of like overlapping overlapping significantly when it comes to the care we're providing. And then the ideal scenario is that you have a strength coach or a personal trainer you can get with your, you know, with the athlete, with so it's a little bit more than an ounce being able to communicate with those, with those individuals, because, at the end of the day, that's who's your athletes are going to benefit the most from in terms of tissue adaptation, injury prevention.
Speaker 1:I'll take a pound of prevention any day. Where where can people find you to go to some of your lectures or like do you have a speaking schedule or anything like that?
Speaker 2:Yeah, I don't have anything up up right now. We're actually getting ready, I'm getting ready to kind of the get that started here soon, so I'll I'll be. Um, you know, right now I'm just, uh, the only Instagram formally I'm on right now is, uh, it's called fake max perform Cairo.
Speaker 2:I saw that our practice used to be the max maximum performance chiropractic in California, and so I. Our practice used to be max maximum performance chiropractic in california, and so I started, started a satirical page of fake max perform chiro or just do a bunch of funny stuff. So that's currently where I'm only at right now on instagram. But, um, I'm going to be starting with um kind of like, basically a site and places to sign up and stuff like that. So right now, um, we got I have a workshop planned. It looks like it's going to be at the end of july in, uh, southern california. So, uh, and it'll be. It'll be bulletproof in the athletic name. So it'll be a day and a half out in socal. So, um, that's probably going to open up for registration here in the next uh, probably within the next week.
Speaker 1:So, okay, well, I'll try and get this out. Uh around then, so then more people can learn more about this. Obviously, we have so many other things to talk about that it deserves a day and a half or a couple of days of workshopping.
Speaker 2:It takes a while, yep, yep, and the goal of that is is trying to be as much workshop as possible, so like rubber hitting the road, exercise, coaching strategies, those types of things, and obviously the didactic portion is important, but we want to get people moving and feel it.
Speaker 1:Yeah.
Speaker 2:Feel the glutes.
Speaker 1:Feel the glutes. That's the. That's what everybody should take away from today. Feel the glutes Awesome. Thank you so much, cody. I'm looking forward to having you on again. I'm looking forward to reading a couple of these books and some more articles, uh, from your, from your lecture and from what you've told me today.
Speaker 2:Awesome Sounds good. It was a pleasure talking to you and, uh, look forward to having you on anytime.
Speaker 1:I hope that you enjoyed this episode of the art of prevention podcast. I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy and or benefit from some of the information in this podcast, please be sure to like, subscribe and share this podcast, or please give us a five-star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No patient is formed, and if you are having any difficulty, pain, discomfort, etc. With any of the movements or ideas described within this podcast, please seek the help of a qualified and board certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, etc.