The Sports Physical Therapy Podcast

ACL Injury Prevention Programs with Amy Arundale - Episode 15

August 09, 2022 Mike Reinold
The Sports Physical Therapy Podcast
ACL Injury Prevention Programs with Amy Arundale - Episode 15
Show Notes Transcript

What's the best way to rehabilitate an ACL injury? To prevent it in the first place!

While it's never easy to guarantee we can prevent injuries, there have been several programs designed to specifically reduce the rate of ACL injuries.

And over the years, several research studies have shown them to be effective at reducing ACL injury rates.

In this episode of the Sports Physical Therapy Podcast, I'm joined by Amy Arundale to discuss her recent paper on ACL injury prevention programs from the Journal of Orthopedic Research.


Full show notes: https://mikereinold.com/acl-injury-prevention-programs-with-amy-arundale

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Introduction:

On this episode of the sports physical therapy podcast, I'm joined by Amy Arundale. Amy is currently a physical therapist at red bulls athlete performance center in Austria, where she specializes in working with soccer athletes. But she has an impressive resume of past experience around the world, including a stint with the Brooklyn nets of the MBA. One of the areas that amy specialize in is acl injury prevention programs in this episode we're going to talk about her experience and her recent paper on this topic in the journal of orthopedic research

Mike:

Hey Amy, thanks so much for joining us on the podcast today. How's this.

Amy:

Yeah, everything's good. Thanks. Thanks so much for having me really.

Mike:

Yeah, no, I mean, it's, it's an honor. You've um, you know, you, you, you've got such a neat background that I think a lot of people, uh, you know, probably envious of, or maybe not, I don't know. I mean maybe, maybe, maybe you're too nomadic. Um, but, um, but you know, you have such a neat background, So, many great experiences, like, like, I feel like the first question we have to get to here is almost like Carmen, San Diego. We're about like, w like where in the world are you right now? Like, what are you up to.

Amy:

So, yeah, so right now I'm in Salzburg, Austria. Uh, so I work at a red bull athlete performance center. Um, so we're, we're kind of based out a little bit outside of Salzburg. Um, so it's a converted barn and I've converted chemical factory that you wouldn't know from the street, our, uh, uh, world world-class performance. Uh, outside, there's a chicken walking around and inside. We've got all sorts of fun stuff going on.

Mike:

That's that's. That's awesome. I hope you detox the area before you guys built. That would be a, that would be good.

Amy:

Yes, I hope so too. I haven't, I haven't dug into the story or the history of the building. Uh, the furnace is still in it, but, uh,

Mike:

Yeah.

Amy:

and the Austrians are all about their regulations. So I'm going to go with it's probably. Okay.

Mike:

Yeah, I like that. You're going with probable, which is, which is always, always a good thing in sports medicine. It's probable that they, that they can play tonight. So, uh, I liked that, but, um, Yeah. you know, you've spent such a large part of your. Working in sports, which I think is pretty cool, obviously a large emphasis on soccer. And, you know, you can tell that's your passion. And, you know, as somebody that got into the sport that they love to, you know, I it's, it's, it's, it's an honor, right. That we get to actually work in the sport that we grew up loving. Right. So, you know, so kudos. Kudos to you for, for doing that. I mean, and, you know, and, and, and, and getting into like soccer and staying in it professionally because, um, you know, that it's hard to do, right. So, you know, so congrats for all your hard work for that.

Amy:

Thank you. Thank you. Yeah, I mean, there's a lot of, uh, a lot of ups and downs as there is at any point I think in anyone's career, but it's certainly, you know, it's kind of the thing that's kept me going and a lot of times, and, and. You know, finding those opportunities, talking to the people that, um, will open doors to me, you know, I I'm really thankful. And, um, you know, whether it was volunteer or, or an actual paid paid job, um, you know, along the way there's been, there's been a lot of fun. There's been a lot of soccer watching some basketball, watching, and now, uh, now some biking and skiing and, you know, Uh, along the side. Um, but you know, I think I learned a lot from a lot of other sports that have been able to bring back to, to soccer, um, and vice versa, things from soccer that had been able to take to other sports, which has been, I think, incredibly bad.

Mike:

Yeah. Yeah. And I think that's a good way of putting it too. And, you know, and again, yeah, super unique. You have to work in the NBA and, you know, it's, you know, it's, it's, it's different than soccer, right. You know, there's some similarities, but there, you know, it's a lot different, but, Um, but again, you know, you know, kudos to you for that. Like, I I've had NBA teams reach out to me for stuff in the past. I can't work with somebody that's two feet taller than me. I just can't, I don't, I don't think I could stretch out their hamstrings. Right. I don't think I could do it. So, you know, so, uh, so, you know, again, I, you know, amazing experience, uh, you've put a lot of emphasis into your career on. Injury prevention programs and some of your PhD work. Right? Um, you, you had a recent article that came out with, you know, a bunch of great co-authors, Um, in the journal of orthopedic research on ACL injury prevention. And I guess I kind of liked the title, right? The title is what, like really sucks you in a little bit, but it's like, where have we come from and where. And I liked that the retrospect and prospective like, uh, assessment of these programs, um, because it shows that, you know, these are still works in progress. Right. And, and I like that you, you guys, you know, named it that way. And I get admit I chuckled when I read the thing because, um, it was great. Uh, but, but it's just like me with like, with overhead athletes and baseball, the it's very similar to Tommy. John we've put so much emphasis on injury prevention with Tommy, John injuries over the years and injuries continued to rise. Right. So

Amy:

Yeah.

Mike:

it's the same thing with ACL's, right? Like we're trying so hard to prevent them, but I think just, you know, the culture of sport just keeps evolving and pushing it, but, um, you know, But it's, it's, it's just crazy. So, you know, why don't we start with that? Like before we even get into the prevention thing, like, why do you think with ACL, why do you think we keep seeing injuries just rising year to year? Like, and, and, and really all sports, you know, obviously you're you, you know, field sport type, you know, emphasis, but why do you think.

Amy:

Yeah. I mean, I think there's like anything, right? Everything's accomp. We'd love to say it's this is the reason it's it, but it's really a, you know, it's a whole complex system, you know, there's, there's no one reason that, you know, they continue to rise. Um, there's no one reason that causes them. Well, I think, you know, one of the things when it comes to, to injury prevention programs is we still have a lot of work to do. Um, and like we talk about in, in the article, um, from an awareness and an implementation standpoint, you know, we've done a good, we've done a lot of work. Prevention programs. We've invented all these different programs. A lot of them look really similar. Um, but what we haven't done is really sit down with coaches, sit down with players, sit down with parents and say, what do you guys need? What do you guys want to do? Is this a problem for you? All right. Like, yeah. Nowadays, if you were to go to the youth soccer club and say ACL, it's a pretty like household term term. Most people can at least say, okay, it's your, it's a knee injury. Right. We get that far, especially on the women's side, you know, most women's parents would say, oh yeah, no, that's going to be a big issue. We're concerned about it. But when you actually then say, well, what do you do about it? You know, the awareness, the knowledge isn't necessarily there. Same with, on the coaches side. Um, we haven't as researchers and as clinicians haven't really done the part of what do you guys. How do we help facilitate this? How do we help implement this? What are the reasons you don't do this? You know, if you know about it, why aren't you doing it? Um, and so implementation is really a complex, like. Thing to do. Um, but I think that's a big part of where we actually are right now. We need to make prevention, like brushing your teeth, right? Brushing your teeth as a prevention program. Right. We, but we all do it every day. We don't really think about it. It's a nominal cost, but it's a cost we're willing to, we're willing to pay. Um, and we're willing to set aside the like two minutes in the morning and two minutes at night to do it right.

Mike:

right.

Amy:

If we can get injury prevention to be like brushing your teeth golden. We're great. Then I think we'll actually start to see some of those numbers come down, but we have to do a lot of work to get it to that point, um, to get it in that, like back into your head, like, oh, I'm going to practice. I need to do this at the start and maybe this at the end. All right. And then that's, that's just automatic. That's just habitual, right? That's a goal that would be. Then I do think we start to see some, some actual changes, but we haven't gotten anywhere close to that point yet. Um, so, you know, I think our, that awareness, that education and that implementation piece is one of the big, big things that we still really need to tackle when it comes to ACL's.

Mike:

I think we need to take a big step back. We need to hire the PR firm that the American dental association hired back in the eighties. And I mean, I think the thing about the date, they convinced us all that it's, it's second nature that we go get our teeth cleaned twice a year. Right. I mean, there's probably no research behind that. Maybe there is, I'm not just speaking out of turn. Right. But like, it's amazing, but that's now that's common. Right. And that's like, well, if you don't do this, there's, you know, obviously, you know, oral hygiene, but there's, there's other health risks too. Um, and, and had that took PR that wasn't just like, you know, like, like a basic thing that everybody got it, it, you know, it got it. And, and we're the same way we've done all the things, same things in baseball. We've had, you know, uh, surveys of parents, surveys of coaches, right. And, and, and they're either. Or, or naive, right? It's one of it's one of the two, like meaning, like they, they don't believe in it so they don't push it or they just simply are unaware. And you could argue, both are unacceptable if you're going to coach youth, right. You need to, you know, do this. So, you know, there's tons of great programs that are starting to teach the coaches, these things, but, you know, again, it's, it's crazy. And you know, the part, I think of the article that, that hit me, I mean, a lot of things. Or we're, we're very impactful comments and, and, uh, analyses. But I think the part of that, that, that hit me was that you guys stated very clearly that we still don't know there isn't like a magical screen we can do and say like, bingo, you do this screen. If, if a equals B, then you have a 10% more chance of engineering race. Yeah. We don't really know that yet. So, uh, it's, it's one of those things where just performing an injury prevention program on its own, you know, is even better than going through all the hassles of trying to come up with a screen. Right.

Amy:

Yeah. Yeah. You know, I think there's, um, there's a few pieces to that, right. If we say, okay, you know, if we take some of the frameworks around prevention, like van land on our bar, right. They set up this framework that says, okay, if we're trying to do injury prevention, we first we look at the injury. How, how big is the injury burden? Right. Okay. Once we've done that, we look at the mechanism and we figure out what that mechanism is. What are those risk factors? We develop prevent prevention program to address that mechanism. And then we reassess, how did our prevention program do at effecting the Andrew burden one we're taking ACL's. We kind of skipped that second part, right? We actually don't have really good information on the mechanism of ACL injuries. We've got all these like associations, but we methodologically haven't done a good job at figuring out. What causes ACL's

Mike:

right.

Amy:

Okay. We've got association with biomechanics. We think there's associations with strength. They can go on and on with this list, but we haven't really done a solid job when it comes to scientific methods of saying, this is the mechanism. These are risk factors. We skipped that step. And we went straight to making these prevention programs. So these prevention programs are really nice, broad sweeping

Mike:

Yeah.

Amy:

that kind of cover all our basis. It could be this, it could be this, it could be this. So we're going to offer that all into our prevention program. So because we skip that second step, we don't have risk factors, like truly, truly scientifically rigorous risk factors. With that we don't have predictive studies that are really, really rigorous. And so we don't have, like, we don't have information that says, if we intervene on this, it will lead to this. We don't have a, if this happens, this may lead to an ACL since we don't have that, we can't say we can really well screen for risk for an ACL.

Mike:

right, right.

Amy:

As a result. Okay. We've got this nice broad sweeping prevention program. We know that they are effective. We don't know why they're effective, but we know they're effective. So basically we're better off just having everyone do it because we don't know why it works.

Mike:

Right, right.

Amy:

We don't know what to look for.

Mike:

Yeah. we have, we have one component of a program probably helps this percentage of people and another component helps this percentage of people. So I, you know, but that's, that's, that's great though, because when you create a broad stroke kind of program like that, that kind of hits it from all different. It's almost like you're covering your basis. Right. And, and, and it's a good way of doing it. And, you know, and that's probably why, like, you know, you said there's some overlap between the systems, you know, th there's a variety of different ones out there for sure. You know, there's the, the FIFA 11 or is it just 11 plus now, as they get rid of the word FIFA from it's the 11 plus program.

Amy:

Yeah.

Mike:

You know, there's the sports metrics one, you know, those are probably the two most common ones that I think we hear talked about the most. Right. You know, like, like tell us a little bit about that. Like, so w what are the differences between the, the, the big ones that are out there that are trying to prevent these injuries, but like, what are these buckets that they're trying to fill? Like, what are the common mechanisms that they're trying to, to, uh, tackle? So that way we can prevent these.

Amy:

Yeah. Well, I mean, if we look, if we look at like the med analyses that have been done, especially the ones that are looking at components of these programs, right? Your big buckets are strength, plyometrics. Core strength. Um, and plus, or minus balance I say, plus or minus balance. Um, because if we're looking at, you know, the studies that go into. Those meta analysis. There's some that have only used balance and there's some that have, um, used balance as part of their programs. The ones that have only used balance haven't necessarily been successful. So when we're looking at these meta analysis, they're going to say, okay, May not need to be a component for ACL, but for me prevention, it may be. Um, so it's a little confusing, but where we have to then go back to is if we look at where those studies, where that information comes from. So we think strength, plyometrics that core plus or minus balance are probably our big buckets. And you see that in all of these, basically all of these really successful. So, those are kind of the check boxes that we're looking at. Same thing with the kind of duration on the amount of time they're used. So theoretically, we're looking at, you know, three plus times a week, 20 plus minutes each session, but that's also based on. Something like the 11 plus, which is supposed to take somewhere between 15 to 20 minutes, all the way to sports metrics, which takes 90 minutes, three times a week for six weeks. Um, and we're taking programs. So we've taken programs that are really different, right? So 11 4s, it's that 20 minutes pre pre session starting in pre-season through regular season. And we're trying to compare that to sports metrics, which is 90 minutes, three times a week for six weeks. And then.

Mike:

Right, right,

Amy:

So we've combined programs that can be very different, um, and smash them all together and just try and say what's successful. So, you know, it's kind of tough to say, you know, for a under 11 team, 20 minutes is a long time when you have an hour practice,

Mike:

Right. Yeah. You, you can't do that

Amy:

of your practice. So that's where we're then needing to get creative in, in saying, okay, so maybe your team transferred for 90 minutes. Maybe 15 minutes of the beginning can be that prevention program. Maybe some of those things, those exercises you can do at home. And we're now seeing some really good studies. For example, Matt Waylon down in Australia has done some really cool stuff about saying, well, what if we split up, say the 11 plus, what if we do. Kind of something that I was running based, plyometric exercises as a warmup, and we use those stretch kind of more strength exercises after a session or at home. And we're finding pretty equal efficacy when it comes to the injury prevention. Um, at least in kind of some of those they're they're smaller scale studies, but getting creative then is probably our solution to saying, okay, we're coming up with these broad based programs. Here's our big buckets. But they don't necessarily have to be done all at once. Um, maybe we can get creative to help people, uh, you know, take them up a little bit more. And that might, that might help also then, you know, with that implementation that we talked about earlier,

Mike:

Yeah. for sure. And, and, and I like the way you said that because, Um, you know, anytime you try to do a research study and I hate when I see these types of studies, but when you try to isolate one of those components, right. I don't think you're doing it justice because they all play off each other. Right. I mean, what's the point of having power, if you don't have strength or, uh, you know, if you're working on balance, but you don't have strength, for example, I mean, you know, I, I always say like a weak muscle can't stabilize, right. So if you just go. Like functional stuff, but you have an isolated weakness of your quad. Well, what's, what's the point, right? So, you know, looking at any of those individual components, uh, by themselves is probably a disservice to, uh, to, you know, to answer that question appropriately. Um, but I liked the way you said it right there, as long as you, it's almost like nutrition, it's like you get your carbs, you get your fats, you get your protein as long as you get them in over the course of the day somehow. Um, that's probably beneficial. It's about then trying to figure out how to get it in a way. It's going to get done. Right. And I think that's what you're looking for here is how do, how do we get this to be done? Because I don't know, like, you know, I coach I coach you softball. I mean, you know, I'm pretty big league eight, you 10, you 12, you, uh, uh, you, you softball. So, um, I, I have a hard time getting the girls to warm up and I can't imagine them doing. Stretching program, right. That's not happening. Right. I can't even get them to play catch. Right. So like there it's it's I it's just, to me, it's, it's such a daunting thing to do with kids, you know, I almost want. And this is where it, like, how do we collaborate with the coaches to try to like, how do we integrate a drill? So say soccer, right. A drill. That's going to help them with their sports specific skill, whatever that may be, that the coach needs to work on, but also has our components together. Like why aren't we building programs collaboratively with the coaches that work on both skill and physical at the same time? Is that, is anybody doing that?

Amy:

Well, you know, it's actually, it's funny you say that and it will say this cause we did not set this up ahead of time is actually James and Brian and I are working on a J O S B T viewpoint. So hopefully it'll be do SPT viewpoint on this exact thing is, you know, putting the sport back in the warmup. Right. We we've come up with these like programs, but one of the things we are we're, we're finding out, you know, Dustin grooms is doing some really cool, um, Uh, with like augmented neuromuscular training. And so that for him is, you know, actually kind of a little bit on the VR side, right? So he's got athletes, performing basic exercises in front of a box that box reacts to their movements. Um, and so they don't know anything about that box. They just know, okay. As I move differently, this box changes. Through that like the fundamentals of that are some just basic motor learning principles, but an external focus it's implicit learning. Right. So even if we were, we're taking this, you know, an extrapolating a little bit, but if we take some of those principles and we put them in a sport context, right. What's the difference of doing some of your building? You're sprinting, some of your bounding, some of your, um, jumping. What's the difference of them doing those in two straight lines versus doing that in a small side of game. Right. So, okay. So now our athletes in that small sided game, they're suddenly in their sport context, they're increasing that from a physiological standpoint, increasing heart rate they're, um, you know, warming up, but from now we've got from a cognitive standpoint. They're warming up mentally as well. And they're warming up within that sport-specific context. All of those things are valuable. All of those things are what we want to accomplish in that prevention program. Um, so now we've got a COVID. It's like, oh yeah, I know a small sided games. I can do that. You know, maybe we've got four, four little boxes. Each has like a three B3, right. Coach blows his whistle, you know, and yells a number. And, and now our players have to sprint from one box to. So we've got changed a direction within those little boxes. Maybe they're got some possession, maybe they've got a longer sprint. You know, we can change pace. We can put little exercises within that. Maybe you blow whistle and you've got five, put five pushups, maybe blow us whistle, and you've got bridges. Maybe you blow a whistle. Um, and you've got to find a, another player to bump, right? So you've got to stabilize against contact. Now a coach goes, oh, I've got six exercises to integrate into a drill that I already want to do. I want to be playing soccer to build up towards soccer. I want to be, you know, catching and throwing to build up towards our softball practice. Suddenly that coach understands exactly what the purpose is. They're there they're achieving some of their practice goals and our athletes are really getting the benefit of not only the like sport warmup, cognitive warmup, and a physiological warmup plus a prevention program. That's probably the best of all worlds.

Mike:

Absolutely.

Amy:

so, so yeah, that's actually one of the papers we're writing right now.

Mike:

Well, and you also left out one thing. And I think I, I didn't appreciate this until I did get into coaching youth, you know, but, um, you left out the biggest thing in my mind. What you just outlined right? There sounded like an absolute blast. The girls would love it. They'd have they, they would have so much fun doing those drills. That would be fun and they love that little competing thing. They love the, you know, the teamwork of that. Um, and it's just, it's a, it's a, win-win win right there when, when you do it that way. And, and you, you know, you talk a lot in your paper about implementation and compliance and those sorts of sorts of things and the differences between those, like, um, when you start to integrate everything together and it just makes sense. And, and, and that is such a great way to do it. So I, I, I really. Forward to, to seeing that, um, I would much rather do those types of things then like walking knee hugs. Right. I mean, like, and you know, like it's, it's, I, I think for the kid, it's going to keep their attention span a little bit and it's going to be, it's going to be pretty good, but Yeah. One thing you, you alluded to that, I want to hear more of your thoughts on, cause this was in the paper too, but the, the concept of, of internal versus external cues, and I know some of the programs do that slightly differently. Right. And I, you know, you know, there's, there's probably something said about both of them, but, you know, talk to us briefly about internal, external cues. And then maybe even like that external like attention focus that, that you, you, you of, you said all those things briefly, like in that last little segment there, but I want to learn more about.

Amy:

Yeah, definitely. So an internal cue would be something that directs your inner ear attention internally, so towards yourself. So, you know, I think that if we're thinking knees, right, or we're say we're, we're renown as PTs for saying, all right, we want your hips over your knees over your toes. Right. We're trying to create a nice, you know, I want you to be in a nice straight line when you're on a single leg. All that does right. As an athlete is suddenly, I'm thinking about my hip, my knee and my toe, and try and keep them in a straight line, which that's great if we're doing this in a gym and there's nothing else going on, I don't have to pay attention to anything else. I can stare at the ground to hold my balance. Um, perfect. I've mastered this exercise. If we take that and put that in a sport context, though, it's absolutely useless, right? When our athlete is on a single leg in the middle of a game, they have visual cues. They've got auditory cues, they've got, they might have contact. Uh, the last thing we want them thinking about is their hip, their knee and their toes. We want them paying attention to all of those, that information that's coming at them at an incredibly rapid rate. And we need them to be able to pay attention kind of filter, um, and process and. We don't need them paying attention to what's what their need is doing. So external cue is purely trying to direct their attention outside of their body. So it could be a queue outside their body, or it could be acute directed at say like a goal, like the goal of an exercise. So, well, if we go back to that squat, maybe we're doing a squat in front of him here. I can put, I'm going to put a big tapeline on that mirror and say, I want you to do this school. In line with that, that line, right. Instead of now paying attention to what I'm doing with my body, I'm at paying attention to that line. And so I've taken my attention from internal to external. We can also do other fun things, right. We can add a dual task, a dual tasking, not only is your, your attention external. Um, but now we're actually bringing in another motor learning principle. That's called implicit. So the best way to describe implicit learning is to think about that athlete that knows exactly what they're going to do, what they are, what like emotion is. Um, a great, actually a better example is, um, one of the NBA players I used to work with, uh, got a question, um, from, uh, from a reporter at one point that said, how do you shoot a step back free? It sounds like a dumb question, right? Because his answer was, uh, I stepped back and I shoot.

Mike:

a three.

Amy:

That's all he can describe in his head. He's got this perfect movie picture is he knows internally exactly what his body does when he takes a step back three.

Mike:

right,

Amy:

But to put that into words, basically, isn't.

Mike:

right,

Amy:

that's implicit learning. You have that it kind of internal knowledge, that internal movie, that internal ability to know exactly what you're supposed to do, but you can't put that necessarily into explicit knowledge into words. There's no rules that you follow to do this movement

Mike:

Right. and and, and

Amy:

learning. We can facilitate with an analogy or dual task. So simply by throwing and catching during that single axis. Suddenly that athlete can't pay attention to what their knees doing, because they've got throwing catch while also doing that single leg squat. Um, and so it kind of opens up a lot of possibilities. Again, we're bringing back fun. It's a lot more fun.

Mike:

Yeah. for sure. Yeah. Yeah. But, but, you know, but it's also, it's almost like letting them work through it themselves a little bit. Right. And I think, you know, I, I can't tell you how many major league baseball players I've seen their six-year-old sons, like take. Fast swings in the world for a kid. Right. Because they just try to emulate their dad. Right. Same thing with P PGA golfers. Right. You look at tiger and his son, like that's been getting all the publicity lately, you know, like tiger and tell him like, Hey, I want you to rotate back on your right hip. He's just trying to do what his dad's doing. Right. And it's, and it's, it's amazing how much, um, you know, like, you know, just anytime you try to overthink something, It, it can, it can just make things muddier. Right. And you deal with that. But, um, you know, this kind of reminds me though, like the concept of like blocked verse randomized practice a little bit too. Um, is there a benefit of starting with some internal cues for the educational process and then evolving to external cues? Or do you do think you go right to that?

Amy:

so I think there's, there's a few different thought processes and I will, I will admit, you know, I'm not up on the literature here. Uh, I read some of it. Um, but there's more of it that I've not delved into. There is support for, yes. Starting kind of more on the internal building up some degree of say it will say some degree of mastery and then progressing. I think there's actually, there's also thought processes and theories that actually support kind of almost throwing you in the deep. Um, some of the implicit, uh, implicit learning literature. I love it. It's hilarious because I just have a great mental picture of, of these like test participants, um, doing it is, you know, what they've done is they've taken people. Who've never played golf and, uh, you know, your experimental. Is learning to putt the learning, but, but every time they hear a signal, they have to yell a number. So I just had this hilarious mental picture of people out on a putting green, just yelling

Mike:

Yeah.

Amy:

you're the control group basically just got, got to learn to putt. Like all they did was they, you know, they, they got instructions. They learned to putt. This other group didn't get much instruction, but had to start yelling numbers while. Well in the end, right? This group that just got thrown into kind of thrown in the deep end and all of a sudden the yell numbers, not only do they end up better putters, but they're better dual taskers and they're better. There's better transfer of that task. So not only can they actually perform that skill better because they've been forced to figure it out on their own. Um, so they're more successful in the task, but they can then also take that task and modify it. Um, cause they've now kind of got that internal. Okay. This is what I do. This is how I do it. Um, and so for me, a lot of. It depends on the athlete. I'll tailor it to the athlete. There are some athletes that really kind of struggle with something. Um, and so like maybe an internal cue might help them get them going. And then I'm going to start kind of creating situations where then they kind of play a lot more. They still struggle. They still have that opportunity to figure it out for themselves. Other athletes they're better off. We just kind of throw them in the deep end. We'd give them something challenging. Let them play with it. Let them struggle with. It creates, you do have to create kind of that safe situation for that athlete so that they know. I know I'm going to struggle with this a little bit. That's okay. In the end, that's better off. Um,

Mike:

right.

Amy:

It also means we're going to laugh a lot more, right? Not only is a physio. It's hard for me to watch someone struggle, but a lot of times we're going to end up laughing because you know, something funny happens, you know, I throw something, then it goes in totally the wrong direction because I am inept with my hands. Um, I can kick anything. I can't get to anything. So we ended up actually having a lot more fun, but we've created kind of that safe environment for that athlete to struggle a little bit, to play a little bit, um, and in the end, figure it out on their own. So I I'd say, you know, I think, I think for me clinically, um, it really depends on the athlete and the situation and tailoring it to what they need at that point.

Mike:

Yeah. And I wonder, I mean, you're unique that you, you probably have higher-level athletes that, um, you know, I think what makes elite athletes elite sometimes is their ability to understand their own perception, you know, kinesthesia, you know what, whatever it is, they have something different about them, right? Like I know how to pitch a baseball better than most baseball pitchers, but I can't. And they can, so it certainly not just knowing it, but I think what makes you different though, is. Like, if somebody is struggling with those external cues, you're a experienced enough clinician to know when to take a step back and maybe give them a couple of internal cues. So that way they get it. And I've seen light bulbs go off in athletes heads. They were like, oh, that's what I'm supposed to do. I didn't even know that. But now that you're telling me that, let me work on it. And then you go back to an external focus and they're doing it because they, they, they just didn't know. They just, they didn't know that was the right movement pattern. Right. So you, you know, and I, you know, for those working with younger athletes, or maybe some, uh, you know, uh, inexperienced people that not, you know, D one athletes are pros, like, you know, that is something to keep in mind because you go on social media and so. You know, just like talking negatively about internal cues or, or block practice, like type things like, like yes. You know, external and randomized, those types that, yes, those are better, but sometimes people just need to, they need a little bit beforehand. So, you know, I, you know, you're, you're dealing with the best of the best. Um, it's fun to see them progress, but I think that's a cool way of kind of putting the two together sometimes. But you're right. If you don't, if you don't take that step, then they're never challenging themselves to learn and they're not going to figure it out. It's probably not going to happen. So awesome.

Amy:

Yeah, definitely. Definitely.

Mike:

last question I wanted to talk to you about here is going back to the implementation of these things, because this is an important thing. I know a lot of sports physios people in the states here that are trying to say, Hey, I, I want to go work for my local soccer club or whatever my lacrosse team. And I want to do this. Uh, what advice do you have to give somebody in those shoes? Um, you know, how do you convince the coaches, the parents, uh, the players, even, you know, to do it. How do you build those into the programs? What is a great way to get started with some youth athletes?

Amy:

Yeah. I mean, I think the best starting point is, is building relationships. Right. You know, and if I'm going to come in and walk in and say, all right, you need to do this, this and this, no matter what it is, right. You're going to go. No. I'm good. All right. If I come in, we sit down, we have a conversation, we build a relationship. We have a bit of rapport. Suddenly our starting point is up. We're doing this together rather than you should do this. As soon as you're at, we're doing this together. Now we can start to figure out what are the reasons why it's not happening. Right? How do we overcome some of those barriers? Right. Is that knowledge, they just don't know it is that, um, is that knowledge of cost, right? Uh, so Les Dick's wrote a great paper. I think it came out two years ago, um, on NCAA, uh, coaches and for them, the number one reason why people didn't do a prevention program was. Right. Well, that doesn't make sense. There's so many free programs. The 11 is free. You can get sports metrics through its original papers. Um, even though it is a proprietary program, right? Um, cannot control like pet program. All these are free, but yet cost is the thing that's being cited as the most, the biggest barrier. Right. So, you know, having some of those conversations and saying, this is. Having some of those conversations and saying, Hey, let's go out to the park. I can show you this. Let's run through it. You can coach me through it. So you feel confident in doing it. You know, another great example is, um, one of the rugby prevention groups in bath, um, came up with this grape injury prevention program. Um, tried to implement it in a bunch of rugby clubs. Um, came back, you know, six months later, however long the parental parent program was. And was trying to get feedback on why people didn't do it. You know, the number one cited reason for not doing it was this prevention program had a lot of things lined down, right. If you're in England, Playing rugby. It's going to be wet. Okay. So maybe you don't want to lie down in the grass for a half an hour before you then play rugby. All right. Some of these things, they might, they might seem obvious or they might just be, you might have totally missed it. Right. But then you sit down and you're like, oh, duh, sense. Well, let's figure this out. We can, we can, we can overcome this. Um, so I think that, I love that example, I think, because it's just, if you have this conversation, You know, some of these barriers may seem really big in actual fact, they may not be. Um, but if you're building that collaboration, if you're working with clubs, the coaches, the parents, kind of, all of those stakeholders, um, you can start to figure out where those barriers and start to break them down more easily.

Mike:

Yeah.

Amy:

so just having those conversations, kind of building those relationships, I think is, is probably one of your biggest starters.

Mike:

And any type of friction, we'll slow down the process, even if it's the smallest amount of friction and, and the easiest hurdle to get over. So keep that in mind. It seems like it's a mountain at first, but just getting over that initial friction, like you just said with a couple of ways that I think that's a good one. Um, you know, I would just throw in too, from my experience with baseball that you can go give a talk about, Hey, do this exercise and. Prevent Tommy John injuries, but you know, most people, I think it's just like this with everything in life. They're like, ah, that's not going to happen to me. Or, or I'm willing to take the risks. Like, um, you know, that won't happen to me, but you know, the, the thing that we try to sell most of our programs on is for their performance enhancement capabilities as well, because it's the same program, it's the same program. Right? And you may have to tell the coaches, the parents, the athletes, that too is like, look, this is, this is going to help you with your agility. This is going to help you with this time. This is going to help you, you know, Scout exposure, that type of thing. Like there's so many things that you can come up with there, but like you almost have to, you know, sell it. We, we tell our students when they're like trying to do like some of our baseball programs in their communities, you know, I keep saying like, look, stop trying to sell an injury prevention program. Nobody wants to buy an injury prevention program, but they will buy a performance enhancement program. Right. And then make it the same thing. Just don't tell them. It's amazing. Right. So, you know, and I feel like it's the same thing here. So, um, so awesome. Amy amazing style. I mean, w we could, we could keep going for days. I feel like. So this was, this was really fun. This was amazing. Um, it was good to really connect with you. Um, I like to end with a quick high five, so five quick questions, five cooking answers. Just to get to know like a little bit about the inside of your brain a little bit more. Cause I like this. It tells you, it tells you a lot about people, but first question real quick, like what are you currently reading or working on? What are you doing for your own con ed or professional development?

Amy:

Yeah. So I've kind of started trying to identify who, who, uh, people I really admire are, um, and going to spend some time with them in their environment to kind of really learn from them in their environment. So that's kind of my new con ed, uh, goal is, is building kind of a portfolio of people. Um, we're going to go and spend a few days with, um, learning from them in their, in their.

Mike:

Yeah. And listeners, this is part of Amy's success that she's not telling you about here. Her network is huge, right? Because she, you know what I mean? Like she she's, this is part of her success that I, that I, that was a great one. That was a great answer. I hope people do that as go, go spend some time with people that you admire. That's that's unbelievable. Good. Um, all right. Number two. What's one thing that you've recently changed your mind.

Amy:

Um, so I don't know if it's reason, but I feel like it's ever evolving is my curiosity with the brain. Um, and learning about the brain. Yeah. I think as you know, sports are musculoskeletal PTs, we got, at least I got raised as like you're treating, you're treating muscles, ligaments, bones, um, maybe a nerve or two, but you know, it's like neuro is separate from, from musculoskeletal and it's so not, you know, like there's so much of these motor learning principles that are basic in neuro PT and it's like sports PTs. Oh, Hey, look, this is all really new. It's not new,

Mike:

Yeah, right. Yeah. Yeah. That's decades old, but putting it together is, is

Amy:

putting it together. So I think my, my fascination with, uh, with the brain is kind of ever evolving. And so I feel like, you know, where I can take continually learn and continually change. Um, certainly. I would hope improve in what I do in my practice, um, comes from what I'm learning about the brain, learning about motor learning, learning about learning, uh, learning about attention and memory and all that kind of good stuff. So,

Mike:

yeah. I feel like you're in that point in your career where you're starting to get smart. Right. And you're starting to realize that the more, the more you learn, the less, we have no idea what we're talking about. Right? Like, like I think, I think that's, that's the key. I wish everything was as simple as all the young people on Instagram are making them sound right. But they're, but they're, but they're just not, and you'll see that it gets there, but, um, awesome. What

Amy:

Now it just means that my research agenda is getting longer and longer and longer and longer, which is also done the fun part to try and answer some of my questions. So

Mike:

Exactly. I love the energy. So keep it. I'm so answering those questions here, cause you're going to get tired eventually. It's going to, it's going to get there, but, um, w what's your favorite piece of advice that you like to give to.

Amy:

yeah. So two things is one Gaucher. Uh, whether that's virtually now or, or in person, um, is, is go network. Um, because the more you go and introduce yourself to the people who you're interested in, or, um, who you look up to, um, the bigger your network is, and you don't really get anywhere in this world, um, without a network, um, and get involved, um, is, is go volunteer. If you want to work in sports, um, you know, go, go talk to go start. Getting involved, whether it's volunteering or actually working and, you know, all, all experiences valuable and, and whether it's a year team or a NBA team or anything in between, um, you know, all of that experience is super valuable. So, so network and get involved.

Mike:

Awesome. And we're seeing some recurring themes here. I like that. And you know, again, the key to your success. I like that. Um, awesome. What's coming up next for you. Uh, w which country's next? What do you think?

Amy:

Which country, uh, in terms of living or, or what's actually like, what am I doing? What's next on deck?

Mike:

what's what's coming up next for Amy in general? You tell me.

Amy:

Uh, and in general, uh, so next week is the ice connect conference in Lille. Uh, and then I go to the mountain bike, world cup and, uh, Leo gong, Austria. Um, there, we got a little break and then rural Congress on sports PT, and then the Argentinian, uh, sports PT conference. So I'm pretty, pretty stoked for that first time to south America.

Mike:

Yeah, that'll be a fun one. That'd be, that'd be amazing. Good. So awesome. And then last, if people want to learn more about you, what's the best way to find more about you.

Amy:

Um, that's the way to kind of follow what I'm up to is actually on Instagram these days. So I actually recently left Twitter. Um, so Instagram I'm at squeaky Edgar. Um, and that's where, you know, whether it's courses or conferences or, or my own ACL rehab, um,

Mike:

Yeah.

Amy:

or squeaky anchors and ventures. Uh, those are, those are all on Instagram. So that's probably the best way to.

Mike:

Awesome. Fantastic. Thanks again so much for taking the time to. to share your experience, your vast experience with everybody. That was really beneficial. So thanks again.

Amy:

Yeah, no, thank you. Appreciate it.