Measuring Strength with Scot Morrison - Episode 13

One area of physical therapy that I think we can easily improve is our ability to measure and monitor strength as a person progresses. Most people we work with have a strength deficit as one of the primary issues we are working on improving.

So why not measure?

Manual muscle testing has limitations, and is really just a gross screen. I think we can do better quantifying force.

In this episode I talk to Scot Morrison about how clinicians can get started with measuring strength, what that really means in regard to force and torque, and some advanced concepts for those with some experience.

Full show notes: https://mikereinold.com/measuring-strength-with-scot-morrison

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Transcript

Introduction: 0:34

In this episode of the sports physical therapy podcast, I am joined by Scott Morrison. Scott is a physical therapist working with the us air force special operations after spending 15 plus years, both lifting heavy weights and training people in the outpatient orthopedic setting. Many of you also know Scott as the chair of the American academy of sports, physical therapy, sports performance, SIG. And in this episode, we're going to talk about measuring strength in the clinical setting. Both for those that are just getting started, as well as some more complex topics for the advanced clinician. This is going to be a good one.

Mike: 1:15

Hey Scott, how's it going? Welcome to the podcast.

Scot: 1:17

Hey, thanks Mike. Doing pretty well. Finishing up coffee.

Mike: 1:22

Me too. I like it. We're both, finishing our morning coffee. I really appreciate you taking the time out. we've been trying to schedule this podcast for a couple of weeks, just, you know, between our schedule. So, uh, always, helpful to have somebody like yourself, joining us and sharing your experience. Um, one thing that I think is, really funny for me is I feel like your beginning to become the guy that's pigeonholed into something, right. And the guy that's online talking about measuring strength and, and handheld that a mom or especially knee. Right. You know, those sorts of things. Um, it's funny when you talk about something a lot online, you become that pigeonholed. W w why don't we start there? Like, how's it feel to be pigeonholed as the strength testing guy?

Scot: 2:04

Hey, if, if strength testing improves by my sacrifice of everything else I'm doing, uh, and I just focused on this and it actually improves people doing it, then I'm more than willing to sacrifice all the other things that are interesting to me for, uh, that. But Yeah. it's, it's always interesting to see how it emerges And where it comes from.

Mike: 2:26

Yeah. I always share this story, even just with like Lenny McKenna and I at champion, I'll have a patient where I'm rehabbing their shoulder and they're like, Hey, my knee hurts. You think I can get an appointment to see Lenny next week? And I'm like, I can treat a knee too, you know? But, uh, it, it, you know, it's, it's funny how the, the, you know, the general perception of you. Um, you know, but I think it's valid in this case because you've, you've risen up a little bit because I think you saw a need, right. And you saw maybe a hole in our profession where maybe we weren't strength testing enough, or we weren't doing it correctly. So, you know, kudos to you, you know, for doing that. Uh, I still think it's crazy that. W w we all admit that strength is one of the more important things that we do as physical therapists yet, for some reason not everybody's measuring it and we're not assessing this, and we're not seeing people progress. Uh, why don't we start with that? And why do you think that is? Why do you think that's been a big barrier for people.

Scot: 3:23

Yeah. Um, I mean, I agree it's, I think there's a couple questions here. One is the framework that you're operating under. And, uh, if we look at the last, uh, 20 or so years, the whole functional movement, uh, ideology really has dominated things. And under that model movement is what we care about. And we forget all of the, um, constraints that basically create that movement. And so think testing by its nature requires us to be. Reliable, which means that we have to eliminate a lot of the degrees of freedom. So most of the testing is associated with things like a single joint isometric tests. The reason we do that is because it lets us get a consistent answer to the question we're asking. But if your belief system is built around this idea, that what we care about movement, and there's not an understanding of how the underlying constraints afford those movements. I think that's one of the biggest disconnects there. And then the second one is because of that most clinics don't buy. Something that lets you test. And we have the old, you know, that's good five out of five on, on, on you there, right? For a manual muscle test. And so I think there's this belief that one manual muscle testing is good enough. And two, if we need something else, we should do something functional. Like I want to see how the person does the task, which is important, but it's probably not actually assessing what we care about. And I think that's the fundamental thing is lack of clarity on what strength is and then how we operationalize it, which means how do we actually test. The construct that right. Strength. I think it's probably good to start with that idea of what is strength, right? It's like everybody knows, oh, that's a strong person. And in your head you have an idea of what that person would be able to do. You'd be very surprised if the person you just saw lift the backend of the car would struggle to open the door or to unscrew a jar. Right. Cause strength to us is this idea that goes across boundaries. You're like they could probably throw far think of George Washington and all of his, you know, the legends around what he could do, that somebody we think of as a strong human, those are the characteristics that strength has. However, when we test string. We can't test that broad aspect. We're actually testing very specific components of it and that whole analogy of the blind men and the elephant who one grabs a tail and it's like, oh, an elephant's like a rope. And the other ones, Hey, an elephant is like a wall because it touches the side. That's you can think of strength as the elephant. And our testing is us being the blind person, which part of that construct are we actually touching? So I would say overall that's where the failure to integrate it is, is a lack of understanding of what question we're asking a lack of understanding about how these things work together to create what we care about. Um, and then some financial and resource barriers and resources would also include just, you know, at the end of the day, PT schools, aren't really doing this. So.

Mike: 6:51

Right. Yeah. And, and I, you know, a great answer, uh, you know, to your first point on the emphasis on movement quality or the older emphasis that I think I would agree with completely, you know, I was always stunned when I would hear people, especially the educators, but then, you know, everybody regurgitate some of the message on how isolated weakness was not relevant anymore. Right. And I remember at the beginning of this and I'm like, oh no, this is this isn't going to go well, because, you know, we always say like, you know, a weak muscle can't stabilize or it can't function. You know, if you have a weakness in somewhere within the pattern, how are you going to have a good movement? Right. And, uh, to me, I was always stunned that they said that, right. when you were going through that process. W what did, what did you think of during that? Like, were you scared of that? Were you worried that this was going to start this, this momentum that we're seeing now? Could you see.

Scot: 7:46

I mean, you know, I, I was young 98 probably is when I was really starting to get into, uh, I mean, shoot, I think early mid nineties to late nineties was me going to libraries and checking out books. Strength training. Right? So it's there wasn't a whole lot of stuff there. Um, my undergrad started off as mechanical engineering and I think that helped ground a lot of these things. Uh, but it wasn't until I started digging deeper into some of the, uh, motor control ideas and understanding the difference between goal directed movement and how those movements were accomplished, which again was benefited from some of the, um, understanding of just robotics and learning. And so I don't know that there was a point where I was like, oh no, because I was learning right alongside of a lot of these others. And I think we all have things. We look back at it and it's like, eh, you know, I've, I've told plenty of people don't do a leg extension early on because it's not as good as a squat. And, you know, in a lot of situations that might be the case, but, um, I would say the concern started arising more and more as the confidence around all of these things started coming up. And then as you know, especially finishing up undergrad, spending more time training people, and then digging deeper into motor control, motor learning and starting to see the difference between what is a goal-oriented movement. And what is, how is that movement being accomplished? Um, I think that's the fundamental thing, so yeah, sure. You don't have the strength to do the, you don't have the strength to do the task in the way that you want to. You'll find another way to do it. The task gets accomplished. And so if all we're focusing on is the task. Yeah. That's great. You, you accomplish the task, but I think that's where from a rehab perspective is our goal is really to start. Backing off of where you able to accomplish a task and see. could you have accomplished that task in any other strategy? Right. And so like the, you know, if your posterior cuff doesn't have the ability to decelerate that on there, you can still throw, but then there's going to be an altered strategy for how that arm is being decelerated. And that's where we start seeing her. I, you know, that might increase some of the likelihood of issues that we have. So, um, you know, I, I wish that I was like, oh, I saw this forever ago. Uh, looking back, I'm like, I should have paid more attention to Tom Purvis and I should have paid more attention to like I read, um, was it the paper on functional way back when Mel Siff wrote it? And that was hugely influential when it came out for me. So it's been tangental, but you know, we're all learning. I'd say I have a better perspective now than I did 15 to 20 years ago. So.

Mike: 10:39

Well that's evolution though. Right? And I think that when you, when you first learn a concept, you get really excited about that concept. And sometimes people go all in on that concept in sacrifice of some other key fundamental components that sometimes we lose sight of. So, you know, I think, you know, you know, well-intended, and I think we're better for it as a profession. Right? I do think that, but, you know, I dunno if it's a pendulum swinging or, or we got a little bit too focused on functional movement versus, um, you know, some of the bigger, broader concepts, but, um, you know, I, I, I like to see the pendulum swinging back, maybe an understanding that there is some complexity to that, and it's not quite so simple. So, uh, you know, I agree. I like that. Uh, you mentioned five out of five on a manual muscle test. What do you think is, is that not good enough? And why.

Scot: 11:31

I mean, it depends on what your question is. If we're screening someone for a neurological type thing. Sure. Maybe if you're trying to identify whether or not someone has the ability to produce enough torque at the joint to accomplish a task or to be normalized, I decide, or to, um, identify changes from training then. No it isn't. And why is because it's not sensitive enough? Uh, so your ability to identify change kind of peaks, once you can start moving against gravity and from a gross screening of that felt off, um, you know, neurologically we'll, we'll get some of that stuff where you get some, all right. You know what, but what do we do with that? Well, then we go test it, Right. That's that's the thing is the screen is a lower extremity screen or upper extremity screen is not to identify whether or not someone's. Strong And put a label on that level of strength is to identify whether or not there's something occurring that is abnormal, that we need to investigate further. Um, so fundamentally, if you care about something, you should measure it with a device that gives you units of the thing that you care about. And so pushing on someone and saying that feels well, manual muscle testing is this whole complex interplay between your perception of how hard they were willing to push into the amount of force that they perceived, you giving them. So it's an inner set. It's an interplay between two people's perception of each other, and then you are using your own perception of what occurred. And then you're assigning an arbitrary label to that. That's pretty convoluted to then say, oh, this is strong or not. Right. We have a unit for four. It's very well established, right? Newtons. We know that Newtons is how we measure force. This is something we don't, we don't get to just make up new things like we should do, like you were saying earlier. Sure. Pendulum swing back and forth. But if something has been around for a long, long, long time, you know, maybe don't try and reinvent. I, my biggest problem with pendulums is at the end of the day, you're still in the same place you haven't moved forward. You're just going side to side over some local point. So you look at stuff like Belinda and, you know, I was writing about publishing what in the seventies and eighties. Um, and well, before that, like as soon as. George Davies. Some of his isokinetic like there's good stuff being done. And then 150 years ago, there was questions, you know, Galton was looking into testing this, isn't a theory that we get to just go, oh, I have an opinion on this. It's fairly well laid out and established how measurement occurs and how we measure things. And just because we happen to be in physical therapy or performance doesn't mean that we have to reinvent all of this. Like we still use the same process, which is measuring something slightly different.

Mike: 14:54

And I like how you said it's a screen because you do need a quick screen to look at some things. Um, I think it's really funny though. I mean, I would never be content with, for example, like labeling somebody a four out of five, right? Because the spectrum from four to five is like a a hundred point scale, we'll say. And, and if you're not five, I'm not happy, right. That could be a large spectrum of, of improvement. And, you know, we, we always say, you know, a couple of studies we've done in house that, you know, we've really never published, but it takes about a 15% strength deficit, uh, on handheld dynamometer for the rotator cuff to get a four out of five. Right. And we tell everybody that because, you know, we, we, we did a study on that above. You know, the subjects were probably about 150 subjects. So it was a large study that to look at that number and, you know, you had people that were 85%, the strength of the other side. Um, and there were still five out of five. You had to be 84% before he became a four out of five and gosh, with the knee, right. That's probably 20, 25, 30 3%, you know, when, when you start to detect it. So it's just not sensitive enough. Right. It's not the right kind of test. So, um, yeah, I like that.

Scot: 16:03

Yeah. I would say, I mean the sec to add to. The uncertainty around your test with a device sensitive enough. So the handheld dynamometer will always be better than you, Right. Uh, if we look at the standard error of measure or whatever form of a variance you use, we're usually seeing somewhere from five. If you're doing a really good job, upwards of 10 to 20, 30% in some publications. So let's say that it's 15% and the big thing here is. This is a continuous variable. So it's not like they were 85. You didn't notice it. And they were 84. You've noticed it. It's they become more and more noticeable, right. As you go down. So let's say that's a 10 point curve where you're starting to be confident that you're going to be right. So you'll pick up something. The probability, as you drop below 85 starts going up that you're going to notice this. And then you add 10% just to be optimistic here, right? A 10% error of uncertainty. Now you have this potentially 65 to 80% range or even larger before. You're starting to notice that. And then to your point, you look at the leg and most of the time with the leg, you're measuring how much force it takes to push you over. Not how much torque their knee is capable of generating.

Mike: 17:27

Yeah. Well said. Yeah. And, and, you know, to me, I think that's one of the things that people don't understand, what some of these things, and maybe this is why we have such persistence and weakness with a lot of our rehabs and issues with people, um, you know, restoring strength, um, is we're not quantifying it. Well, we're not doing a good enough job. So, uh, you mentioned a handheld dynamometer, which obviously I'm fond of and something that we use all the time as well. Um, is that the premier way? I mean, I know there's a spectrum of we'll call them financial, maybe a range of devices, but what would, what would you say the best items you can do if you want to get your clinic started with measuring strength? Where, where would you, where would you start if your budget was unlimited in, what would you do if you're like most clinics and you don't have that unlimited budget?

Scot: 18:17

Yeah. So with an unlimited budget? or not unlimited, but a budget that can be stretched, um, uh, an isokinetic dynamometer and a good handheld dynamometer that can be push and pull as well as a set of force plates is probably one of the best. Like if you're going to look into this, that sequence will get you where you need to be. Um, the nice thing is it's becoming cheaper and cheaper to get into that. So instead of$150,000, you can probably get into all of that for around 50 grand. Um, the key though, I think there's this, the single biggest thing. Is to understand that the process is what matters more than the device. Your device has to have the ability to consistently give you the same number when the same amount of force is applied to it. Beyond that it's up to you. And I think that's the big problem is people, you know, they're, you open your box with your new dynamometer and you pull out your handheld dynamometer, and then there's a little bottle of reliability that you squirt on it. And a little bottle of validity that you squirt on it. And now, you know, that trap, that's not how this works. Right. And so when people will ask, well, has that dynamometer been validated? Well, that's not how this really works, Right, This is a scale. It's just a strain gauge. Um, it's a fancy bathroom scale basically for the force plates. What it does is it tells you a measure with some amount of area. Of how much force it was subjected to. That's all it does. What that force is, is up to how you subjected the force to it. And this is where we start making our biggest issues is we believe that because we had a dynamometer in our hand and we cared about something that the dynamometer told us what we cared about. And the example I usually use is if you step on a scale to see how much you. What you care about is your weight. What the scale tells you is how much force it was subjected to. Now, if somebody else puts their toe on the back and adds a little bit of force, you're like, oh no, I gained five pounds. It's not the scales fault. That was an error in how you ask the question. You believed, you were asking how much you weighed. What you actually asked was how much mass is on the scale. That's the same thing when it comes to dynamometry. So you set someone up, you're like, Hey, I want to know how much knee extension torque, this person's capable of producing. And then you set up in front of them and you hold down and they start pushing, you start losing your balance, but you feel like you're still kind of there. Their butt comes up a little bit and you're like, oh, wow, look, you got 45 pounds. You did not measure what their knee was capable of. right. So these, the ceiling is always going to be whatever the week is, whatever breaks first. And so your, your goal here, the most important thing. Create the test in the way that everything else supersedes the ability of that joint to produce force so much that the force at the joint is always the limiting factor. I mean, you know, testing shoulders, like I've I think the strongest guy I remember testing was Right. around 89, 92 pounds. External rotation did not exercise at all. He just, uh, was a jujitsu guy, blew me away. I was not ready for it. He pushed me over. Now the first measure that I got was about 45 pounds. Why was that? Well, he felt me starting to get pushed and stopped pushing harder. So if I had to just okay, 45, Hey, you know what? that's not bad. Right? If I'm just thinking, is that sharp? You don't have a weakness. Well, then I reset and then we got 80 and I was like, oh, damn. That's all right. And then we go to the other side that I had, um, that was the uninjured side, or I'm sorry. Uh, we, we started on the uninjured side, he got 90 something and then we go over there and like 70, something like that. And I'm like, all right, well, you do have a deficit. 70 is very, very strong, right? So if your ceiling, though, if it took 40 pounds to push me over and I tested both sides, Yes, there's an asymmetry, but it's well above what my stability would have been. And so I would have walked away saying you don't have any symmetry now, whether or not that asymmetry matters. There's a whole other discussion. My job when I'm testing is to identify what's going on there and make sure that the question I care about is the question I'm asking. So to circle back without that, it doesn't matter what you buy. If you're, if you're set up is not appropriate, then it doesn't matter beyond that. Then just get a device that is consistently able to give you that. Honestly, the tin deck and I have no financial association with any of these, because I don't want it. Um, 10 deck for about 150 bucks. Uh, it gives you 150 kilograms. The app interface is phenomenal. You can do isometric programming with it. You can set it up where they're doing holds. I love it. I use it all the time. Um, I've uh, everybody that has bought a crane scale and then bought this, it's like, ah, dude, I should have never bought their crazy scale. Like it's 50 bucks difference or so, and such a massive difference between the two that it's not even, it's not even in the same conversation. So I typically say from a string scale perspective, if you have to make. But I have some concerns. It's not designed to get a peak force with a moving, uh, type thing. It's a static load scale. Most of the crane scales that have a hold function, there's a lag. And so if you're not getting a peak and holding the peak long enough, it will miss the peak. So you have some issues with potentially getting that. Um, Yeah, And then beyond that, the, uh, the mark 10 is usually the one that, uh, so JLW modified the mark 10 to let you do push and pull that's about 900 bucks. Um, so one that I use the most, I, I, again, I worked with them to help design this, to make it feasible for clinicians. We went through a few iterations. I like it. Well, I think Rob, Whitley's the one who had originally told me a number of years back that they use the mark 10, because it's one of the most robust doesn't really break on them. And 500 pounds force push pull. A few hundred bucks, less than Lafayette or the, um, uh, what's the other Marc pro or J tech, which are all phenomenal. And if you can get them, the biggest problem with most of those is they are push only. So when it comes to something like the knee, you're starting to, you can do it, but it's a little bit more complicated. So,

Mike: 25:02

I would agree. And I would say, you know, we've traditionally used the push one because you know, we've been doing it for 25 years or so. That's the push ones that are available. So the Lafayette's and one of the more common ones in micro fat that I think are probably the two more common ones, um, they're always pushed base and we've modified things like knee Accenture, for example, to be push based. But again, you, you have to wonder if the person's just not producing us because they don't like the set up it's uncomfortable. They don't like the strap. And I like the positioning of it. So it's not a true, uh, four. So if you are in the market, I just really want to emphasize what Scott just said right there, because, um, uh, the ability to push and pull I do think is, is, is very important. And there's so many good options out there nowadays that, that there's no reason not to. Right. Is that, is that a good way of saying it? So,

Scot: 25:50

And it's, it's awesome to see it every year. There's four or five new ones coming on the market. And it's great because the prices are plummeting and that's what we want to see. As, you know, as users, give me all the options and let me decide,

Mike: 26:06

I in, and I would probably say too, like, I've evaluated quite a few because, um, you know, people will send them to me to say like, Hey, what do you think is a new device? And I will say that some of the cheaper ones I have been very unimpressed with, um, and w we'll leave it at that. So w what I would just suggest is rather, we're not going to call that out or anything, but I would just say is, look, Scott's vetted these, because he's the, uh, he's the handheld dynamometer guru right now. So, yeah, Scott, I mean, Scott is vetted. These we've vetted these, you know, so just stick to the ones that, you know, your peers that you really appreciate the experts out there are recommending, because I, I think that's, um, I think that's, that's a smart way to learn from our mistakes, I think. Um, but, but definitely go push, pull. Um, I'll be honest with you, Scott. I haven't had a isokinetic machine in, um, I guess it's been almost like 15 years now and I don't think I miss it. Right. I mean, and heck, is that a short-sighted comment maybe, but I don't know. What do you think? I mean, for the price, for the size, for the, you know, for the, you know, the extensive setup and time are we are, have we gone too far away from that? And do you think we're missing out that we're getting away from ICIC kinetics or, or do you think it's okay to just go handheld dynamometry

Scot: 27:27

Well, it goes back to that analogy of the elephant, right? So the handheld dynamometer always brings you up to the side of the elephant and you're always touching that. So you're, you're, you know what you're getting as long as. As long as you're aware of the fact that strength, this higher order construct is not defined by isometric force production at a single joint ankle. That is just a component of it. It's a proxy for strength. It gives us an indication, but the further you get away from it, the more we might see, then I think your Oak, like we're talking here bare minimum, right? We're saying at least start with something that we know, and it probably most bang for your buck. Isometric isokinetic gives us the ability to examine multiple things across multiple domains. We can, we can mess up and start. Like I don't see much value in measuring it. Some of these really high velocities, I think a rate of force potentially isometrically would give us a little bit more as opposed to, you know, 300, 600 degrees per second. Like some of those things as we start getting away from it, I don't know that we're doing as. It's not that it's bad. It's just that the information doesn't tell us much more, right. 60 degrees per second with the knee probably tells me about as much as I need. I don't need to keep going. You can get more from it. And if you have the luxury of doing so, where I start finding value is the ability to test ecentric strength and start looking at endurance. So for instance, my shoulder protocol looked at isometric, um, and then I also looked at east central strength tests. And then I would do a 20 rep test at 90 degrees per second, and basically push, push the whole time. So con ease centric. And then if I wanted to internal rotation at the same, and what I would do is comparison of total work side to side. Um, I don't, I don't know, I'd be interested in your thoughts on this, but I find it the shoulder a lot of times out get a good peak, but the endurance is a massive issue. And that's where, like, just because you're getting that peak does not mean that you're having this. And I've worked with a lot of tennis players, not as much baseball, but that was a fairly common thing that I would see is those who were sort of having issues and struggling, especially as the matches went on, endurance became this big deficit that we would, uh, tend to see. So you can test that. Alternatively and I like, uh, Mike Maloney's, uh, 90, 90 setup where you hold 25% of peak and you go for time, works really well on the tin deck. Um, but those are the things that I, the isokinetic dynamometer absolutely gives you the ability to do more. And it has a built in system for stabilization. So a lot of the backend, um, modifications you have to do to make it work in your clinic, do work well. Uh, it does a very good job at what it does. I think there's either an over or an under emphasis on what it does.

Mike: 30:24

Right. Right. And, and yeah. And, and to go back to your endurance thing, just real quick, what I've done with a handheld dynamometer, I do agree with, uh, Mike Malaney too, with the endurance component of it. For me, what I've done is I do serial testing with minimal breaks. Um, and what you'll find is, is some of the guys that are strong and stable and feel good and not having any, any issues, there'll be fairly consistent with their numbers rep to rep, but somebody that's struggling a little bit, they may be, they may have a good peak force for a second or, or maybe even just one rep. But if you do three, four or five, just real quick, I don't take minimum breaks. I'm not doing a research study, right. I'm not trying to like, make sure they're fully recovered. You actually see that that endurance becomes a little bit more of an issue in the, and that is important. So, um, yeah. I would agree and, you know, gone to your point too, again, between isokinetic and isometric and stuff. And again, it's, I think it's, it's a shame if you're doing nothing. Right. I think we can both agree to that. Right. You should be doing something and then it's like, yeah. I mean, there's, you know, a Corolla versus like a Lamborghini, right? Like, you know, they, they both drive you to work. Right. But it's about how many other things can you do with it. And I think that goes back to your population, the people you work with, their goals, their objectives, and just really how fine tune, like measuring different measurements. If you're not going to program them differently, based on that is just a waste of time. Right. So it's all how you use it.

Scot: 31:55

Yep. Never, never take a measurement that is not going to change what you're going to do. However, Be sure that you ignoring the measurement, it's not incorrect. Right, So just

Mike: 32:09

right, right,

Scot: 32:10

change what you did doesn't mean that you're right, in that circumstance. Um, I would say with the serial to touch on that serial testing, it absolutely will reveal it. The main reason why I will do an endurance test, whether it's isometric time to loss of, uh, strength or position is just to quantify it. right. So now I can, when I retest, I can identify if I intended to improve endurance, did their endurance improve, whereas the serial measures which I've done and absolutely you will pick that up. That's a lot harder to then go and say, your you've improved your endurance, because like you said, it's more of a screen as opposed to a test that identify something that I can refer back to.

Mike: 32:53

I am. I love it though, because what you just said was it was, was the main point again, is, is you want to test things that you want to quantify, so you can document progress and you can assess not only their improvement, but how, how accurate was your programming? Right. How, how, uh, how well did you do at actually improving the metric that you just tested? And, and man, that's, that's huge,

Scot: 33:20

that's everything, it's more, it is so important. And this is where testing, I think probably has the biggest benefit. I, I I'm the, the one-off testing at the end to say, Hey, you're ready to be cleared is probably less important in my mind than the serial testing to audit your process. If you have decided that an increase in force production capability matters.

Mike: 33:43

Right.

Scot: 33:45

You need to identify whether or not you increase force production capabilities, because unless you expose yourself to the likelihood or the, unless you expose yourself to whether or not you've been wrong, you are insulated from the effects of everything that you've done and you can confidently walk forward in ignorance. But the key is not only, yes, we need feedback, but this goes back to the, uh, manual muscle testing feedback that does not orient us to reality is probably more dangerous because now we have a mistaken belief that the information we're getting is telling us what's going on. So yes, we need feedback because that is vitally important, but also we need to make sure that the feedback we're getting is representative of the reality that we are, um, engaged in and interacting with.

Mike: 34:36

If you're waiting to strength, test somebody for the first time at their nine month or to sport assessment period, then you've, you've missed some golden opportunities because, you know, I mean, I can't tell you how many times that we get somebody. Into a position where we think they're going to succeed and for whatever reason they don't. And if we don't document a plateau in their progress, by looking at these variables, then we miss that chance to pivot. And we miss that chance to maybe take a step back and say, what's going on and be like, you know what? Your swelling in your knee has persisted a little bit longer. Maybe w maybe that is now inhibiting our strength gains. And maybe we need to take a step back off some of our agility work and focus on that. I mean, it's just, it's it's again, it's, it's just really emphasizing that importance that not only do you need to be measuring strength, but you have to be using it in a way that you can apply it to what the person is doing each and every day in front of you, or what are we doing right. Awesome. All right. So I think we both agree a handheld dynamometer is cool. We can do a whole other podcast on force plates because you want to talk about opening up a bee's nest of, um, uh, of metrics that are not relevant right. At floors plates are amazing. And maybe we will, we, we will get back on and do a podcast on that in the future. But, but let's think with handheld dynamometry because I feel like that is our low hanging fruit for most clinicians right here. Um, I always tell people that it's more art than science and there is a huge learning. Behind how you perform handheld dynamometry because not only do you have to figure out how to set up the patient for example, but you have to figure out how to set up yourself and you have to figure out how to stabilize and to make sure that other joints aren't interacting, that they're not compensating, that you're motivating them enough, that you're, you know, there there's, there's so many things that you can do wrong to get inconsistent results. And it's funny, sometimes you see people like, you know, for example, young clinicians that are starting handheld dynamometry, they'll take the mean of like three reps and just make up numbers. But it's like 25. 45 42. And you're like, well, why did you take the mean of that 25? That was clearly a bad rep. Right? Um, you know, because it's very easy to do handheld dynamometry poorly. So w w let's let's hit on that because you talked about this. I saw her presentation years over the summer. I think it was last year or the time is flying by with COVID. So I don't remember, but, uh, you talked about that. I I'm, you and I were chatting online because I was doing a presentation for my inner circle and the same thing as how to like, maximize your outcomes and your liability, but what are some of your tips for somebody to get them the most reliable and accurate data as possible from a handheld data monitor?

Scot: 37:29

Uh, so I will slightly, um, disagree, I guess. Um, mostly cause I don't like the terminology of art and science. I would not say it's more art than science. I would say it is a hundred percent science. However, you need to explore the optimal process for your setting. Um, and so too, with a nod to the problem I have with a lot of times, we start thinking art means that you can interpret this and you can apply your own perception of things to it. You don't get to

Mike: 38:03

No

Scot: 38:04

apply your perception.

Mike: 38:05

zero.

Scot: 38:06

is explore exactly. You get to explore the constraints of your setting and identify the process that works best within it. But it's not like you can bring your own world. To this forces force pretty fundamental concept. And it's your ability to ask the question? Um, so the single. Issue with handheld dynamometer testing as the fact that there are humans involved. So the more you can eliminate your ability to have an opinion, the better things are, the more you can, uh, Billy it, uh, eliminate your ability to influence things. The better things are. And so process that is consistent. And so if you're thinking of a checklist, first thing is patient is stabilized. And when I say stabilize to the point, I usually tell people two to three times the amount of force you expect them to produce is probably the amount of force that you should have them stabilized for. This is where some of the really cold testing setups that you'll see, like, uh, standing, you know, uh, an external rotation or whatever, uh, with the dynamometer into the wall. That looks awesome. But your base of support is very narrow because your feet are small. Your lever arm is massive because it's your height. So most of the time with something like that, you're measuring how much force it takes to move your center of gravity outside of your patient support. You're not measuring the shoulder. So that's, that's really the key stabilization of the patient. Second step is stabilization of the device. the individual is still, you want all of the torque that is being produced at the joint, you're testing to go directly through that device because that's what we're trying to measure. You do not want torque being generated from other aspects, being able to go through the device. So this is where it line of pole starts being, what is the motion you're trying to test draw a 90 degree angle to that. That's the line of force that needs to go through. So then fixation of the device becomes key. Usually what I tell people is beyond about. I don't know, 50, 60 pounds. It should probably be fixated 50, 60 pounds. If you're a bigger human you might be able to do. So. Like even when I'm testing a shoulder, external rotation, I have the device braced up against my hip. I'm in a wide stance. I have their arm stabilized underneath my other hand and they're pushing, right. Because I want there to be no doubt, no hesitation. That story I told about the guy earlier, I was set up, but it wasn't for 80 pounds. It wasn't for 90 pounds. Right. So that is, and that will happen. But the key is like, to your point, Mike, if you get that 25 and then you get the 40, all Right. you now have information. Your first test was not giving you a measure of force. Your first test just told you your setup was incorrect.

Mike: 41:03

I have well said, well said.

Scot: 41:05

So then it becomes this idea of. Stabilization around the minimum. And so, or about around a, um, a more accurate measurements. Typically the observed measurement is equal to the true measurement plus the error. And that's, there's nothing we can do about because all we see is the observed. So our goal is to standardize the air. We're never going to eliminate it. We want it to be as small as possible, but even more importantly, that it's stable. So that's the same thing. And that's why all of this process matters. But then to self audit yourself as you're going through this, if you look at it from the standpoint of. What I'll usually do is you have to have two to three measures within 10% of each other, and then take the peak. Now you can average if you want there's there's arguments for both peak or average, I find peak the most clinically useful, um, it's the easiest one to sort of calculate and talk, and that it also holds you a little bit honest the next time you're testing to where they have to actually beat them, but you don't just get to choose a peak because you might get an error on the high end. You might get 40 to 45 71. You don't get to choose 71. You have to do another test. So that's that's, those are the two key things. Usually two to three tests within 10% take the highest one, and that will help regulate. And then the last component is your warmup and your queuing. You have to cue the same way you have to warm up the same way. You don't get to be extra excited for one person and then not say anything you do. You want to encourage them to produce the maximum cause that's the whole point of this test. It's a maximal test. So there has to be an element of QA. You have to be a little bit loud. You have to, but terminology is always has to be the same. So my typical thing for a peak force forces, I'm telling the patient, all right, we're going to do we go through the motion that they're going to do. You're going to push into this as hard as you can, what we're going to do. It's not fast. You're going to build up to a peak for somewhere around one to two seconds, and then you're going to hold till I say. So it makes sense. Yep. All right. We're going to do our acclimation and then we'll do 50%, 75%, about 90%, these very little rest in between Right. Five, 10 reset. Basically, this is just to get them acclimated. And it's also my chance to see if my setup breaks. So if we're at 90% and I'm getting pushed over, I have the opportunity to restabilize things before I'm taking those tests. So just because this isn't the idea of, you know, jumping off a cliff, and now that you started the testing, you can't modify anything, adjust based off of the feedback that you're getting. So

Mike: 43:45

I hate to say it's Scott though, but you know what? I think that is, that's the art of it. I hate to say it that's the art to realize that

Scot: 43:53

that's, that's the process that's process.

Mike: 43:57

th the, the art of it is to realize that, you know, that, that 70, that I got probably wasn't valid. Right. There's a little judgment involved with that, but no, I, I I'm teasing you. I

Scot: 44:09

Well, I'll disagree because the, uh, two, two within 10% tells you that. So there's no art

Mike: 44:16

That's true.

Scot: 44:16

that is, you're not allowed to, again, I, I get it. And there is an element of, you need to understand the question that you're asking and if we want to call that art, That's fine. But it has to be based off of an understanding of the fundamental principles. We don't get to reinvent Newton's laws here. Like there's just things that happen.

Mike: 44:36

I don't know, I'm Twitter. You can do anything nowadays. I think you might be able to do that.

Scot: 44:41

right. now that Elan's here.

Mike: 44:43

here. Right? So here's a big one for you. Make, test or break test. What do you think

Scot: 44:50

Oh, I'm a make test person. Um, and here's why it's more easily reproduced. I think east centric strength is valuable. If I have an isokinetic. Device I'll do it, uh, at the shoulder at the hamstrings. I frequently test a break test as well. Um, but I am, I am making my make test as my foundational test, just because of the reliability component.

Mike: 45:20

I like it. And it's funny, it's not every day that Scott DMS me and asked me a question, but you did ask me that question and I, and you know, you didn't, you didn't tell me what you do first. And I said the same thing and I, uh, I confirmed your bias. I think that was

Scot: 45:35

Yeah, there, there we go. Yeah, I know Malania and I have discussed it cause he's a, he's a brake test and I there's a good argument for the brake. The problem with brake is it's only available in a few tests for you, right. You have to be significantly stronger than the other individual. Um, it's not something that every clinician can do for everyone because the just anthropometrics and stuff. Um, I find it very meaningful to test, but it's, it's an, and my foundational test is make

Mike: 46:09

Yeah. And you know, I mean, you get into maybe the clinical implications. I mean, are we getting plenty of clinical implications that at trying to document somebody's make-able peak force? Yeah. I think we're doing, I think we're doing pretty good with that. Um, all right. One last question I have for you. We talked a lot about fours, right? We didn't talk about, you know, there's, there's many other things we can talk about, but what about rate of force development? And you mentioned peak and I agree with the peaks important, but what about the ability to develop that peak quickly? How important is that to you and how accurate do you think a handheld diamond on rate is in measuring that.

Scot: 46:46

Yeah, that's the everybody wants rate. Um, how important is rate one of the most important things now? How important is it that you measure it? Uh, it, it's probably, it's probably valuable. It's just all of these things that we were discussing about the complications around testing peak force are exacerbated when it comes to rate. So the easiest way to think of rate is rate is what happens when you start at no force and start. Producing force moving towards a peak. And because we happen to work, uh, exists in a temporal space, time passes. And so you have to go from. To peak rate is how fast you got there. Now we can look at rate as that definition, which is overall the average rate, or we can start taking timey POCs. So let's say every quarter, second, what is the increase in force during that time? So what is the rate? The slope of the line. If we're drawing this force time curve, that those time E-box seemed to be more valid. Now, then we start looking at different time demands. So the first a hundred milliseconds is influenced by things differently than the next hundred milliseconds, which is different influenced by things differently than the next hundred milliseconds. You will also find that the closer you get to your peak, the slower the rate is Right, because initially you can have very, very significant rate of strength or force increase. What makes sense? right, You started from zero and you've got a whole host of force still to produce. As you get closer and closer, you're going to your rate's going to slope. And if you draw that line, you'll see it. If you just put a pencil or something parallel to the line throughout. There's a lot of different ways to measure this clinically. I think Dan Caribbeans convinced me that the, um, taking 20 to 80% of peak and getting the average slope within there clinically as meaningful, uh, for, for a number of reasons. But. The best ones is it's a much more stable measure that cuts off the beginning and the end, which is usually where you see the biggest changes. So the biggest difference is remember that initial rates really high, that last bit of rates really low. Um, if you cut that 20% off of both ends, now you have an average that's over the duration of the production. So that increased. The cool thing though, is that you probably don't need sampling at as high of a rate if you're doing it that way, because you're measuring across a longer time span. So it solves the problem of the, you know, when people talk about time to peak force as a proxy for rate, that's a bad proxy, it doesn't tell you anything about you could have gone really, really far and then just gone really slow for part of it. right. So that doesn't give us much, but the slope of the line between that 20 and 80% seems to be meaningful, um, his work and, uh, I'm blanking on, there's a paper out on this as well, where they take in, um, force typically a thousand, 2000 or more, um, Hertz is what it's sampled at. And that's usually the. Frequency that we need to identify this. And this just goes into some basic sampling type, uh, signal processing. You need to be sampling at a rate that's about twice as fast as what the process is occurring at in order to capture what's happening. But if you're taking that average, they've been able to down sample to around a hundred Hertz and find like a, I believe it was within about four, four and a half percent. If you look at the bland Altman, um, plot of the limits of agreement, so pretty, pretty Good, Um, from that 1000 2002, the hundred with that being said, I think that a device that samples at least at a hundred. With a processor that is able to do that. And this is actually 10 DEC is working on that. Um, one of the things I've had conversations with him about is he's, he's updating his rate of force because currently it's an instantaneous peak, which I don't find that valuable, but he's changing it over to that 20 to 80%, which I think, yeah. Yeah. My, my concern with this is people go Yeap, rain, forest, yay. And all the stuff we've just been discussing about becomes so much more important. So the, the more variable, the measure, the more precise you have to be. So if you're not stable with your peak, don't worry about rate. If you don't have the ability to measure weight rate, don't sweat it pretty much everybody needs to work on rate and you can program that in and then just keep checking your peak. Right? So

Mike: 51:53

good point. Why not just do it anyway, right. Hey, that's great. Yeah.

Scot: 51:57

Correct. So rate with caveats has benefit, um, with a lot of isometric test, if you're sampling at a higher rate and you have access to something like, uh, about, uh, for instance, I really like taking force at a time point as a proxy for rates. So 250 milliseconds in, like, let's say we're doing the Ash test. I'll usually look at peak force and then I'll look at force at 250 milliseconds and that's a. Proxy measure for rate gives you an idea of where they are. Um, I would say that also within like isometric mid-pipe pool, any isometric tests, if you can do that, however, it needs to be sampling at a rate sufficient. So a hundred Hertz, probably isn't going to do that because you're going to see all sorts of misses within there. Um, but if you do have something like the force decks or a Hawken dynamics or any of the other ones out there that lets you look at those too, I find that works as well.

Mike: 52:58

Yeah, that's fantastic. And, and, you know, I, if you've listened this far into the podcast, I hope that means that you're super interested in the complexity of all this, because I feel like Scott and I, you know, we enjoy geeking out about this. So I think it's, it's, this is a fun conversation for us. Um, if you're an advanced, uh, clinician and you've been doing this and you're trying to get a greater understanding, I think we probably just got the tip of the iceberg in this episode, right. With, with some of this information, but I also don't want. The person that isn't doing any quantification of strength testing to be kind of like inundated with all this information and just in feel overwhelmed with it, just get a handheld dynamometer, get one that does push and pull, right. And, and just start measuring peak Flores and be as consistent with it as you can. You're going to screw up. It's not going to be great for months maybe, but it's a start of the process. And over time, you'll continue to refine your skills and, you know, seek out mentorship with people that are doing it more. And I think it would get better. I don't want you to be scared to get started just because Scott and I used a lot of complex, you know, uh, you know, advanced scenarios for you here, you know, I, I just, I wanted to make sure people feel that way, but it's got I any additional thoughts. Yeah.

Scot: 54:12

Yeah. I was just going to add, even if like the 10 deck has a pole, only 150 bucks. If you're going to just get one, get a pool only you can do the shoulder with pool only. Um, typically what I'll do is a belt around the waist, fixate the device in front of you, and then your stance sets you up. So instead of pushing, you're pulling force measurement, doesn't matter whether it's push or pull. The reason why we do push versus pull is because. Bobby anthropometrics and also, yeah, it's very easy to enter in. The 10 deck was recently looked at as its ability to measure what it says. It measures against some of the alternative devices that have more plastic covers and Tyntec was phenomenal. And this was a mechanical engineering based type study where they just applied appropriate force to it and said, does it measure what it measures and does that change as we go from the lower end to the higher end. So for 150 bucks, you can test anything you want to, you got a great little app that lets you also program like I'll have patients come in. It's it's so easy to your point that patients will come in. I clip them in, they pull it up on their app and then they know just to watch, like we have their benchmarks and they're doing their holds and all their, so It's absolutely not a high barrier to entry. If you've learned how to a manual muscle test, you have a good idea of some of the setup. I mean, you think back to your manual training of a therapist, position of patient, direction of force line of all those things are

Mike: 55:43

a whole textbook,

Scot: 55:44

this. Yeah,

Mike: 55:45

right?

Scot: 55:46

Exactly. So you're, you're already trained to how to do it. You just have to realize that those principles need to be applied here.

Mike: 55:52

That's awesome. And as you get better and you get more comfortable and you want to upgrade your tech, or you want to start looking at multiple things, or you want to add your tech stack and add force plates and stuff like that, then more power to you. But don't, don't stop the process of getting started because of, of the overwhelmed with how deep you can go or how many metrics you can look at, just get started. Right.

Scot: 56:13

Yeah, a few good metrics applied well will always Trump multiple metrics. Think of a guy who trains in TaeKwonDo for one year versus a guy who trains in boxing for one year boxers usually gonna win because they're much more qualified to use the tools at their disposal.

Mike: 56:30

I love it. Awesome. Scott, good stuff. Um, I like to end with a little high five segment, five quick questions that gets into your mindset a little bit, because to be honest with you, I do want to know your answers cause I care, but I also want to show all the listeners that, you know, people like yourself have a growth mindset and you know, you're always evolving and stuff like that. So I love to kind of hear examples of that. So first question, what are you currently working on for your own professional development?

Scot: 56:58

Yeah, I'm always a number of things, right. I usually buy about three books for every one that I finish. And, uh, I start probably four for everyone that I, uh, finished. Um, I'm currently also pursuing a PhD, so that kind of takes a big component of my time. A lot of reading around psychometrics, uh, quantitative methodology based and analysis. As far as that end of things, I'm always spending time from a biomechanics perspective. Um, and then at the end of the day, I'm still a little bit of a meathead, so strength and conditioning type stuff I have. That's, that's my biggest interest. That's what I've spent the most time on is that so, um, table of contents of a number of journals sent to my email, that's one of the biggest things for looking at it. And then research gate is actually a great place. That'll suggest things. So I'm skimming across those domains, but more of the deep dive is, um, some of the. Fundamental stuff around it, more specific to the educational setting.

Mike: 58:00

I like that. Keep your eye on what maybe coming out, because you never know what you might want to shift your, your, your focus towards, but, you know, always have something in queue that you're learning. And I think that's, that's important. Um, second question. What's one thing you've recently evolved your thoughts on,

Scot: 58:19

Oh man. I actually, I have two very specific ones. The first one is neurocognitive training. Um, and the reason I've changed, my thoughts is due to discussions with, uh, dusty grooms and Meredith Shapoo, um, and a very good clarification on, their part of the difference between how it's being presented writ large versus the argument being made. And I think there, there is value there. If you think of the neurocognitive component as a modifiable physical constraint, the same as you would train anything else makes a lot of sense. Um, and then you think of the idea. Well, just because people doing strength training does not like a lot of people do strength training poorly. It doesn't mean that strength isn't valuable, just because a lot of people are doing or cognitive flashy stuff doesn't mean that the fundamental underlying principles. So that is something that. Um, I wouldn't say I was skeptical. I was just concerned, concerned about a lot of glaring his interactions or, um, places where, what was being presented missed sort of fundamental aspects of motor control and learning just basic good programming talking to both of them. They're like, yep. We have the same concerns. Here's actually what we're trying to do and say. And, um, uh, so yeah, talking to them, reading the papers, uh, more specifically, I think that that would be the big one. And then the second one. effort as an anchor, uh, and represents, um, so using effort instead of percentage of rep max, and the idea that, you know, probably rep zones probably don't matter at all from a hypertrophy perspective, um, as opposed to believing more, you know, that there's, these. Zones that are better for hypertrophy. I think now I would, I would agree more with, uh, you know, James Fisher and, uh, Brad Shoenfeld's sort of current work where they're saying, yeah. You know, looking back at this, the, the rep zones that we've traditionally thought of as best for this are just the ones that are easier as humans to do. Like it's miserable to do 30 reps of something,

Mike: 1:00:40

Yes.

Scot: 1:00:41

but eight to 12 reps seems to work pretty well. And since all of it works okay. You know, from a efficiency trade-off perspective, um, and then training to failure within that is I think the more I dig into it, the more I'm like, you know, with, unless you have a reason not to using effort as your anchor, like I, I was kicking And screaming for a while, but I can't come up with a good argument. not to, it seems to be the way to do it.

Mike: 1:01:11

And not everybody, like you have a good training age, right? That's something you've always you've done for, you know, your, your life. But a lot of people don't understand intent. They don't understand working to failure and they wonder why they stall and their progress when they're never really pushing themselves.

Scot: 1:01:27

Yep. And that's where that anchoring to failure is just you have to do it, show them where they think they are compared to where they are. So, yeah, those are probably the two biggest ones that have been the most grumpy changing on just because of years of opinions.

Mike: 1:01:46

Yeah, I like that. Um, what's one big piece of advice that you like to give to students and early career professionals.

Scot: 1:01:53

Absolutely. Like everybody says, reach out, et cetera, et cetera. That's all important. But do backend work so that when you reach out, you have demonstrated that you understand what the person you're reaching out to. Does you understand their operational tempo of what they do? So not reaching out to someone in the NBA during playoffs, Right. Not know what they do know when they do it, be considerate of it and come to them, demonstrating that you've put in work. So that the question you're asking, or the comment that you're making is one that that person will look at it and say, okay, I understand that they have paid attention to what I've done. They have an understanding to this point. And the clarification here is such that I can, I know what they understand that that's probably the single do some work. Not, and then last, I guess he had to do the work, but didn't show up when you say you're going to show up, like if you volunteer for something, do it

Mike: 1:02:55

Right.

Scot: 1:02:55

That is the most simple thing, but it's, it's amazing how rarely that happens.

Mike: 1:03:02

So take, take everybody listening that you remember these things, because this, God didn't just make those things up. He's talking from experience like these are what people DM us. Right. We get these crazy like messages that make no sense. I love when people ask like, Hey Mike, where are you located? I'm like, that's one of the most easiest things for you to find yourself. Don't ask me that, like just.

Scot: 1:03:25

Right, And it's, it's not intended to be disrespectful. I get that. Sometimes it, I get it. But if you're looking to maximize the odds and just consider all the things that you do every day, and then add onto that, having people reach out to you and asking questions, like most of the videos that I put up on Instagram, most of the blog posts and a lot of the papers I've written are big so that I can send a link to people instead of rewriting the

Mike: 1:03:53

I that's, it that's the whole point of my website for 15 years. It was to, to answer questions. People are asking me so, and our whole other podcast. Right. I mean, that's why we do it. So, um, that's awesome. Awesome. Well, w what's coming up next for you? What can we expect next from Scott? Anything in the works?

Scot: 1:04:10

the. Coolest thing. I think that I'm kind of working on right now that, or the thing that I'm the most excited about is, um, the sports performance enhancement SIG I'm pulling together. And this has been the last three years was creating content. And what we're working on is pulling that into a coherent. Curriculum. So that physical therapists interested in performance have a place where they can go. That has a series of lectures, uh, on the topics with links to relevant info. So you can go as deep as you want to. Um, the goal for this is really for, especially students who want to do a study group, because they're not feeling that their school is covering this, which understandably there's a lot to teach in school performances, relatively niche, um, residents and fellows who are interested in having sort of a comprehensive thing. And then any professional who just sort of wants to go through it, having a place to start. This is not the end point. Um, but I think it will be a valuable look at the question from the viewpoint of a lot of really great people in the field. Um, that's going to be freely available to members. So

Mike: 1:05:31

Yeah,

Scot: 1:05:32

I think

Mike: 1:05:32

I look forward to that. Yeah, that'd be great. And then last week, where can people find out more about you? Like you've mentioned Instagram, where are the places that you like to hang out and interact with people?

Scot: 1:05:42

Yeah. So Twitter is usually where I have conversations. Um, Instagram is, I mean, DMS are now more common than anything else, Right. So Instagram, DM, and Twitter are two that I probably interact with people The most, but Twitter, as far as if you're more of a conversation thing, Twitter works a lot better for that. Instagram is more content like videos of all the different tests and setups and discussions that we've had. It's all on there. Um, have a website, physio, Praxis dot C O, which I actually just woke up to notification that one of my certificates expired. So I have to fix that. Uh, um,

Mike: 1:06:20

of the job,

Scot: 1:06:21

exactly. And just all the backend nonsense. Um, Research gate, if you're interested, like all of the stuff that I've published is available there. Uh, pretty much, I believe it's all free. Um, Lee available except for one or two, like book chapters and all that. I'm not allowed to share on there. Um, and then, you know, podcasts like this one.

Mike: 1:06:42

Yeah. That's great. That's awesome. And just so people know in case they don't want to click on the show notes, but what's your Twitter and what's your Instagram handles.

Scot: 1:06:49

Oh yeah. So, um, Twitter is S C O T M O R R S N. If you put that into Instagram, you'll come to my fly fishing and photography stuff. So if you're interested in that, feel free to, but, uh, the, the business or the professional one on Instagram is physio underscore Praxis, and that's P R a X I S.

Mike: 1:07:11

Are you smoking any meat in your, uh, in that fly fishing one? Or is it just purely fly fishing?

Scot: 1:07:18

You know, I don't think I've put pictures of, uh, smoking on there. I'll have to consider that I do. Most of my photography is specific to outdoor type stuff. Occasionally I'll do other stuff, but yeah, it's just, I enjoy it. I actually do it. Um, I try not to make money on things that I really enjoy. Uh, I figure I should make money in the things that I do, but then have other things that I invest a lot of time and effort in that bring me nothing financial. Um, so photography is something I've, I've shot for a decent number of places. Lot of times I'll trade like a photo shoot for a guide trip or something like that. And so keep it within some of the, uh, Yeah. Fishing side of

Mike: 1:08:03

That's great. Now I'm going to have to check that. I don't know if I follow that off though. I'll have to find it. That'd be great. So awesome. Well, Scott, thanks again for taking a ton of time. This is a big episode, but, and again, I, we just scratched the surface of this topic, but, um, you know, I appreciate you taking the time to break down some of those complexities for everybody to make it easier. So thanks again for joining us.

Scot: 1:08:22

Yeah, thanks for having me, Mike.