Testing the Athletic Shoulder with Ben Ashworth - Episode 41

Standardized testing is commonly performed in the health and performance world to determine baselines, monitor performance, or help return an athlete to sport.

The lower extremity has received most of the attention, but the ASH Test, or Athletic Shoulder Test, popularized by Ben Ashworth, is a great option for the upper extremity.

In this episode, I talk to Ben about the ASH test and how to best use it for both rehabilitation and performance.

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Also, Ben was super gracious, and has a big discount for you on his new online courses on the testing and training of the athletic shoulder! 

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Full show notes: https://mikereinold.com/testing-the-athletic-shoulder-with-ben-ashworth

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Transcript

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On this episode of the sports physical therapy podcast, I'm joined by Ben Ashworth. After years spending time in field sports, such as rugby and premier league soccer. Ben is now focusing his time on his new venture athletic shoulder.com. And he's also consulting with teams and individuals to help solve shoulder performance problems. He's the inventor of the Ash test, which is something we're going to talk a lot about in this podcast episode. I'm really excited for it. Welcome to the Sports Physical Therapy Podcast. I'm your host, Mike Reinald from Mike Reinald. com.

GMT20231009-170407_Recording_avo_640x360: 1:10

Hey, Ben, welcome to the podcast. Thanks so much for joining me. How's everything going? Mike, it's going well. Thanks. It's been a long time since we saw each other. What is it? About two weeks? No, we, uh, we take a several year gap every now and then, but then we see each other for a bunch and then we'll take another few year gap, maybe hopefully less and less. Exactly. No, it was good to see you the other day. Um, I managed to fight, managed to pin you down for, uh, for a short time. I know you're a busy man, so. Yeah, no, it's, it's always fun. I mean, we, we've met in the past, just, you know, um, I think it's always fun to, to kind of geek out about things that you're really interested in, right? And I know you and I both have a passion for the shoulder, so I thought that was, um, you know, pretty good. So anytime I can hang out with Ben is always fun. And I, I recommend all our listeners. If. You see Ben in a conference or you, you, you see him coming to a seminar near you, go check him out because I think the post course dialogue is probably going to be epic, right? Something that you'll really enjoy, uh, hanging out with Ben. He's, he's a great mind. Is, is that a fair statement you think Ben? Uh, I don't like to sort of, uh, self, self promote. It's very nice of you to say that, so, uh, it's, it's great to hear. It's always nice to get feedback from, from, you know, people who, uh, know this area really well. And I remember reaching out to you. on my own personal development journey, um, about, I think it was 2016, something around that. And I just wanted to go and spend some time with people who, uh, could add value to what I, you know, thought I knew about shoulders, um, as I started to develop my knowledge. So yeah, I, I'm hopefully maintaining a level of humility rather than, rather than believing, believing I'm a world leading, world leading expert yet, but, uh, certainly I'm trying to, I'm trying to develop as we go. So. But, but I think that's what makes you great at your job though, in all honesty, it's your, you're going through a personal journey and you're sharing it. And I think to me, that's, that's always the best type of education. Yeah, that's, I think what these podcasts are for as well, isn't it? Sometimes you choose a podcast so you can have a good conversation with someone. Um, that's what I do with our, with our podcast too, is we invite guests on that we want to hear from, uh, and spend some time with. So yeah, hopefully it's the same the other way around. Yeah. Likewise. Well, well, for my listeners that may not be completely familiar with your work, um, even though they, maybe they are, and they don't even know they are, but why don't you start off a little bit about sharing a little bit about, about your journey so far, um, and what you're currently up to. Cause I know you have, you have a great past, you know, working in, in, you know, the soccer world, the football world. Um, but I, I know there's so much more to it than that, but, um, why don't you share with everybody just a little bit about your journey so far. Yeah, I'll keep, I'll keep it brief. Um, it's basically a 25 year, um, physiotherapy, uh, practitioner who has worked in a number of sports. And I started out in rugby, uh, professional rugby in about 2002. And then I went into Olympic sports where I saw a load of athletes from summer and winter sports. Um, develop some understanding around strength and conditioning, which really helped, I think, changed my career, actually, gave me a bit more breadth to my understanding of the whole spectrum of, you know, return to performance and return from injury, and then went to Arsenal Football Club, one of the Premier League clubs in the UK, great opportunity. Very lucky to get that job, um, with lots of applicants and not being from football myself. So I then used that job, worked with a brilliant team for six years, um, at the sharp end. Uh, had some midlife retirement and then was called to Europe to be the director of performance for Sparta Prague, which is a European, uh, soccer team. And then since finishing there last year, which is a choice based on coming back to family. Uh, in London, I then started to grow my own business, so I'm exclusively now working, um, as sort of directing my own, my own company, Athletic Shoulder Limited, which, uh, has, as we'll talk further about, I'm sure, um, been sort of growing on a number of fronts over the last year. Yeah, that's awesome. It's been fun to watch this career too, just as I've gotten to know you over the years and kind of see all these developments and really starting to build out this athletic shoulder company that in your website and your educational products that you're starting to come out with now, I think they're going to be really great, great resources for everybody. Um, I'm excited about it. Um, I gotta ask though, you know, you have a lot of past experience in like, The field sport world, which I don't necessarily think of as a shoulder type situation. Oh, I guess rugby is right. Rugby has a lot of contact and a lot of, um, issues like that. But, um, being in soccer for, for so long, um, what got you into shoulder injuries? Yeah, actually, I mean, that was this sort of funny thing. I didn't go to Arsenal for shoulder injuries. I went there for the money. Let's be honest. Um, and, uh, I, I sort of, shoulders had passed me by in rugby because there was quite a lot of contact collision. And then. Um, we, we saw a bunch of different athletes from different sports. I worked with a few judo players, a few boxers, um, and some other like gymnastics and you know, all, all the sort of Olympic sports, but not specifically shoulders. Um, so it was only when I became the judo physio in 2009, as part of my English Institute of Sport role that I was. Almost knee deep in shoulders, right? We had 24 percent of our injuries, our time loss injuries were knees and 23 percent were shoulders. So I suppose I could have become a knee specialist, but those are easy, right? Right. I thought, I thought I'd challenge myself a bit and, um, you know what it's like, you sort of. Start to read, um, then you've got to rehab five label rehabs at the same time, you get better, you make some mistakes, you learn on the job and then people start to ask you for help in that area and that was just part of the, the evolution of my shoulder understanding. And then I just kept that on. I enjoyed it a lot. I worked with some good people, setting up some early courses. Um, people who I could gain great value from and I kept conversations going outside of the day to day job. I've, you know, I've always been someone who, who, uh, isn't a nine to five, uh, in terms of, in terms of work. And I engage with people, you know, like yourself and, and Eric Cressy and, uh, and Kelly Sturrett and whoever else would, would, would be out there that wanted to, wanted to share ideas. And got speaking to teams in a very non threatening way. So, uh, you know, people would contact me about it. I'd offer to present to them and for a number of years, um, developed some really good relationships, uh, as I started to sort of build a better understanding. So I think that's, that's it really, you know, like, over that time, shoulders have become more and more of an emphasis. And carving a niche out actually really helps you in any, in any other, you know, body part area, because if you can understand the framework and a model around one area, and you can really see the full spectrum, you can apply that to hamstrings, hips, knees, ankles, whatever else you're, you're dealing with and recognize your, Your level of ability, you know, so if I see a complex hit now, uh, which is rare, but if I did, I'd send them on to my good friends who are, you know, who are, who are much better at that top 10 percent than I am. So, right. No, I, I, I always think that's a great way to, um, You know, and when I talk to early career professionals, we always talk about making sure you're, you get really good at the basics first, right? Understanding the basics, but, um, there's so many benefits from following like a strict niche and actually starting to develop your competency in one area. Um, I, I think that's a great point. It's, it's, you're, what you're doing is you're building out a framework that you can use throughout the body. So, yeah, I mean, I think that's a brilliant way of putting it. So, um, you know, I appreciate that. You've done this because I know for me, when I look at the literature and I look at some of the things that we do for the shoulder, um, I've always felt like we've been missing something when it comes to functional testing, right? We, um, I feel like we're really good at the basics with the shoulder measuring mobility, strength, those types of things, but, um, return to sport testing, functional testing. Uh, the upper extremity is just falling behind the lower extremity, right? I think we all know that. So, yeah. It was really neat to see you start focusing on this and a big part of your career has been building some of this functional testing and monitoring systems for the shoulder. You developed the ash test, which may be the best branding of anything I've ever seen in my life. By the way, I love it. You know, Ben Ashworth with the athletic shoulder says it's just perfect. It's perfect though. Your parents were, were Brilliant. Um, but you developed this Ash test several years ago. Why don't we start with that? How'd you come up with the Ash test? What is it? Tell, tell everybody a little bit about it if, if they haven't heard about it before. Yeah, it was a, it was a journey. So it's a sort of, um, um, a marriage of a couple of things. It's, it's the actually working, looking at lower limb injuries and trying to, trying to minimize those in, in, in, uh, a premier league football club, looking at hamstring isometrics, working out how you can set up a monitoring system. And at the same time, one of those conversations, as I said, outside of Arsenal was, was with Saracen's rugby club and they, they had some issues with players who were breaking down in contact and return to contact. So that means they're reaching and trying to produce force with long levers. Um, and again, trying to stabilize the shoulder in space. In a tackle, but they were seeing players who could parcel the normal tests, rotational kind of cuff testing in close to the body, and they would send them out when they pass those when they could bench press when they could move a lot of weight in the gym, but they were still breaking down with symptoms. So it was this great sharp group of people, including Daniel Cohen, who's a force platform expert. Um, uh, myself. Physio who worked in rugby all the time, strength and conditioning coach. So there's Laura Cullock, the physio, Paddy Hogben, the strength coach, sitting down trying to solve this problem. And I literally went into Arsenal one morning, thought this is how we test our ISO hamstrings, and then put the plates on the floor and just started to push into them. And that's how it came about. Can we find something to help us understand and quantify long lever stress? across the shoulder girdle in the same way we were using it with great success in the lower body to look at posterior chain load across the pelvis, which was a If you want to call it hamstring test, so that's how it came about. And then the initial results were great. The feedback from services was this is starting to pick up stuff we're not seeing in our, in our cuff testing. Okay. And so there's a knowledge gap that we were filling, and they saw historical shoulder injuries that were showing up as weak. They saw neck injuries that were showing a reduction in force, stingers, burners, those kind of transient issues as well. So there was some hope for it and some confidence that we built around the initial stage. And we thought, right, because we're scientists, really, underneath it all, we want to look at the reliability. So we published a very non sexy paper, um, back in, back in 2018 around the reliability of the ASH test. And I think that's really probably what started this introduction of this concept to most people was probably seeing that paper, right? And, and then starting to see you apply it and see how you've kind of used it over the years. I know it's something that we've, we've all wanted to learn more about. So, um, if. If the person listening hasn't seen the test before and you should, by the way, I'll put links to it. I know it's an audio podcast, right? So it's a little interesting to visualize sometimes, but walk us through it a little bit. Tell us a little bit about what the test procedure is, because I think it's easy to visualize when, when you describe it, but we'll put some links into it and into Ben's website so you can make sure you see it, but walk us through the test procedure and what is involved with the ASH test. Yeah, so the ash test is a, we get the, we get the player lying on their front, uh, in prone and we push down into the force plate. So we're pushing, if you like, into almost horizontal flexion, horizontal adduction. Um, but it's in three positions. So we wanted to capture the demands of overhead positions in rugby. They'll, they'll score a try with the arm in a. In a fully elevated position, so at 180 degrees, and they get some label injuries from doing that that are seen by some of the surgeons in the UK. But then you also, we also wanted to capture some of the more wide open field kind of tackle position. So a Y position and a T position. So 135 degrees abduction and 90 degrees abduction, all again pushing in an anterior direction, because we were interested in, can someone produce force? In those wide positions to prevent their arm going into hyper extension. Um, and, and so based on what we knew about the isometric test. We thought, well, this has got some, this has got some benefit, potential benefit. The test is a three second maximal, fast as you can go, so we're attacking it as fast as you can, and then sustaining that contraction for three seconds. And we do that across all three positions, if we're looking at pre season screening or getting a benchmark. Of a group of athletes. And then what we'll do is we'll use utilize that either in a return to play process, or we might utilize it when we're looking at tracking and monitoring a player across, uh, across the competitive season. So you do three positions. I think we're all familiar with I's Y's and T's very similar. Um, we're lying face down. So prone and pushing into the force plates. Um, Between the three positions, I'm kind of curious, what do you tend to find? Um, it seems like to me, from my experience, T's and Y's oftentimes are a little bit more similar, but I's tend to be a little bit different. Um, tell us a little bit about the three positions. Do you always do all three? Is it, is it, are you looking for different things in those three positions or do you think that this is better done as a series and that the summation of all the information is, is probably the most helpful. Yeah, that's good. Good insight, because I feel exactly the same. The T's and the Y's are pretty similar. And the other thing, the difference between the I and the T and the Y in the original ASH test protocol is that for the T and the Y, we've got our hand, the opposite hands behind the back. So you can't actually use it to fix on the floor. So we create this almost Rotational stability issue around, around the trunk and pelvis as one of the potential limiting factors for pushing out in these wider T and Y positions. So, when I've looked at pilot correlations of these, the eye tells you something different to the Y and the T, but the Y and the T are quite closely linked to each other. All right. And the other reason why the eyes. A little bit different is because it's more stable the arms by the side. So we get a max force there. We get if if the eyes 100 percent the Y will be about 85 percent and the T will be about 75%. So we see a normal kind of, if you like, ratio between those. And we know if something's a little bit off there, then it could be related to either a lack of range to get in an overhead position, or it could be due to a, an angle specific difference that we may pick up something in the Y position, maybe through a painful arc. We might see that the T lines up more with a PEC major or fibers of the PEC major, as an example, in someone who's had a previous PEC injuries. So there's still a lot to learn, and... understand and put into context, but I think that's how we kind of can, can utilize this. We know based on thousands and thousands of athletes being done over a number of different athletes from different sports now that it, when we revert to the mean, we can see that relationship bears out with I's and Y's and T's. So if you don't see that relationship, and that's where I think they play well together, if you don't see that relationship, then we know now because there's there's so much data out there that there must be a reason and you have to dig a little deeper. So, um, I think I think you said that well with the wise and the tease. I was going to ask you about this about the eyes and I'm glad you brought it up. But in your experience if somebody has limited overhead mobility, does that correlate to them being able to produce less force, or is it. More force. I mean, what, what have you seen? Yeah. So, I mean, the sort of natural screen for going into these high force, high rate tests is firstly, like, do they have enough overhead range to get in that position? And if someone just is, you know, thoracic kyphosis big. Big rugby prop forward, and they just don't have that range of motion. We're not going to put them in that position and test them. That's just that's a given when we're coming back into someone we know has that overhead range and this sort of getting into that range from a mobility standpoint, but then you ask them to produce force there. that ability to produce force in that kind of outer range motion, it can be inhibited by, you know, muscle tension. Um, it can be inhibited by, um, a lack of, um, strength in those positions as well. And it can be limited by just inhibition and fear avoidance being in those positions. So that's, that's what we see. I think that I, because it's the highest force test, we see the biggest deficits when it's not right. Um, and certainly when we see someone who's got restricted right shoulder mobility, free left shoulder mobility, we'll probably see that bear out in an eye test in terms of their ability to produce. Produce peak force. We see drops in force in those positions when they lack range. Yeah. That makes sense. Um, how about symmetry? So in normal people, normal athletes, even, uh, some that even play, let's say unilateral sports like overhead athletes, are you looking for symmetry? Do you, do you find that to be normal or do you find that some sort of asymmetry is acceptable? Yeah, I think from, you know, from your experience as well as of testing, uh, unilateral sports, I mean, where are we going to draw the line in the sand? Right? We've got this, this bell shaped curve of. Normals and, and outliers, but it probably comes back to around 15%, something like that. If, if someone's going 20% plus in terms of asymmetry, we start to have a conversation and I think that's probably a good line in the sand for people who haven't tested overhead athletes is, is, is a 15 percent's a good start point for, for a conversation. Um, but it will depend on their training age. You know, what they've actually been doing in the gym with the other side, are they just, are they just throwing, are they just playing tennis, or are they actually doing some decent upper body conditioning, and if that's the case, we might see less than 15%. We might see somewhere around, you know, 10, 12%. That's not, not a worry because we can look at each shoulder kind of in isolation and say, well, relative to their body weight. You know, are they scoring as much as we'd see across a number of athletes, male or female, depending on age in that sport. And so we can use that and say, well, this gold is hitting a, you know, a minimum standard, if you like, for where we believe they need to be from a, from a force production point of view. And I think that's always a great way of looking at it, too. I know with my overhead athletes, oftentimes I want them to be stronger on that side, right? That's the arm that they use, um, especially with this testing and the ASH protocol. It's, to me, these are a lot of the acceleration forces that, that go with velocity and some of our overhead athletic, uh, motions that we see with our, our people in front of us each and every day. So for me, uh, I know for example, like internal rotation of the shoulder, when I look at their strength testing, I want it to be stronger on their throwing side than their non throwing side. So, you know, it's something to keep in mind too, is you can detect both asymmetries with a weakness, but also, you know, for example, you might want them to be stronger on that side. Right. And again, anytime you can look at a test that, that looks at side to side differences and trying to find just that small 1 percent to make our athletes better. I think that's huge. Right. So, um, So, so Ben, the, this involves force plates. Most of us have force plates. Oh, I shouldn't say most of us have force plates. A lot of people are starting to get force plates. I'll leave it at that, right? More people should have force plates. I think we can all agree. Um, what do you do if you don't have force plates? What have you done? And I know you consult with a lot of different groups and organizations. I'm sure there's some people that, that don't have access to force plates. What do you recommend? Yeah, we've done a load of different things. Um, and again, we try and try and make it as scientific as possible. So, you know, have we have we built some evidence around it? So we've got great confidence in the evidence or we just got great experience. So we still got confidence in it, but we need to go through a more scientific, you know, reliability leavers. Um, one of my colleagues who works with me, uh, Gus Morrison published a paper on using a blood pressure cuff. So, correlation of the blood pressure cuff looking at pressure out in those wider positions and the force plates. And there was a very good correlation between those two. We can also use a dynamometer. So if you've got a dynamometer, great. You know, use a dynamometer, put that on the floor, make sure it's stable. And again, we've got very good... Reliability when we look at the force plate versus the dynamometer too. Um, but some people don't have dynamometers or spade cuffs. So we use dumbbells and what we're doing a lot more of now, especially if we have a remote client. So we want to be able to see how strong you are. So we'll get them lying on their back in supine and we'll put a dumbbell in their hand in a T position or a Y position. And we'll look at a 10 second hold. And what percentage of their body weight can they hold in those longer lever positions? And what's their rate of physical exertion for that 10 second hold? Then we start to get a really nice gauge of, okay, where do they sit? Is it good, bad, or ugly? And if they're not hitting a minimum standard, There may be strength is a limiting factor in those positions and then actually the testing becomes the training, you know What do we need to do? Well, we need to increase your force production to get you up around 10 percent of your body weight in in those positions We'll do that for anterior and posterior shoulder, you know, I test a lot of other stuff other than other other tests are available Apart from the ash test, but you know where we see an anterior deficit In an ash, we'll, we'll get someone loading out in those kind of bookend positions, like an ISO supine hold, uh, or even standing in a doorframe, but where we measure it without the technology, we'll be using a dumbbell at a percentage of relative, uh, relative body weight. And in your experience, the dynamometer and the force plates were, uh, very similar, like equal or close enough. Very, very similar. The only differences for those people who are really into this testing stuff is the height. So if you put a force plate on the floor, and it's 4 centimeters above the ground, and if you put a dynamo on the ground, and it's it's 3, there's going to be a slight offset. But that will that will remain consistent across the tests. Um, and the reason why that's important is because, you know, if you're coming into. An environment of facility testing on the plates, but then the player or the athletes going off playing tennis in another country, and they're taking a dynamo with them, maybe to use as a monitoring tool, we just need to be cognizant of the slight offset there. So, we don't start getting too concerned if those numbers drop by 10, 15 Newtons in it. It's a different test. I think that's what we've got to understand, you're testing different equipment, it's going to give you different answers and we just need to be aware of that. Right. Well, but I like the options though, right? You know, you talked about a blood pressure cuff, I mean, I don't think you can get any more low tech than that, right? And the dumbbells I think is fantastic for that, um, for that distance client like you mentioned. There's doesn't even have access or you don't even want to try to explain to them how to use that blood pressure cuff, right? That must be terrible. But, but I, I, again, another reason why people should at least have a dynamometer, like a handheld dynamometer in their clinic, I think should be kind of, kind of one of the baselines of what we do nowadays. But, um, I, you know, I think it's great to see that you can use some lower tech stuff, like the blood pressure cuff as well. So, um, awesome. So. Okay, we have our force, right? We're looking at that position. Tell me what metrics matter the most to you because I know anybody that's used force plates know that there's a ton of different data points that we can get. Um, obviously we have, we have force. Right. But there's also the concept of the, the, how fast you can produce that force or rate of force development and so many different ways to look at that. What do you like to look at for the metrics that you think tell you the most from this test procedure? Yeah. I mean, peak forces are given it's very stable and it actually gives you quite a lot of good information. Um, But for me, the rate of force stuff is interesting. It comes back to, uh, we've done quite a lot of work now. Part of my PhD has been looking at, uh, validation on, uh, and, and reliability of rate of force development. And whilst it's never going to be as, as, uh, reliable as peak force. When we compare it to other tests, like handheld testing, and we look at the minimum detectable change that we see within the tests, so that we can identify that a true change has happened, it's very consistent across, across things like a counter movement jump or a, or an ISO mid thigh pull in terms of the variability. So, the measures we look at actually kind of make sense, but the, the shorter the timeframe that you try and look at for rate of force development. The more variable that's going to be. So if you start to look at 50 milliseconds after someone starts their contraction, that's going to be more variable. In some people with neural superpowers, they're going to be consistent, but it's not many who can do that. When we start to get up to a window around 100 milliseconds, things start to get a bit better, and we can see variability of less than 10 percent, which is kind of the gold standard. But the longer you take, the more reliable it gets, and the window we're trying to look at is around 250 milliseconds. So 100, 150, 200 or 250. It gets more reliable the longer you take. But we want to find somewhere where we're looking at that real aggressive attack phase and want those kind of markers that may be more sensitive to pick up, um, return to performance, maybe, uh, performance kind of correlations like a throwing velocity or spike velocity. Um, and we also want to be around the meaningful time points for injury. So in a blink of an eye is when an injury happens. So if we're starting to look at, we're starting to look at time to peak force, which is a measure that people often use on handheld dynamometers. There's 50 percent coefficient of variation in those tests, because it is so inconsistent. If you ask someone to produce force, they'll end up producing their peak force around 2 or 3 seconds into an ISO test. So if you ask someone to attack it, they never hit their max force in the first 250, but what percentage of their max? Can they hit there? So, long story short, you can tell I think a lot about read a lot about RFD. If I had to put my hat on it, I'm, I'm using 100 milliseconds rate of force development over the first 100 milliseconds. That's been the one where I think we've got that sweet spot between something that's really relevant. to the demands of the sport and protecting the joint and keeping it stable against injury. It's reliable enough, like how accurate do we want to be? It's reliable enough to give us some consistent information and we can use that then in return to play or we can use that to understand whether an athlete's potentially under, under fatigue. So tell me a little bit more about that. I like that. So we have two variables, essentially, uh, peak force, right? And how fast they can produce that. So the rate of force development, um, how do variations in those two metrics change what you're going to do with people? But when are you concerned? Is it when somebody is weak, but, you know, fast or, or strong, but slow, like, like what are the different ways that clinically that changes your judgment with each person? Yeah, I think the training the training pathways is always to try and kind of build a bigger muscle first and then and then access that as much of that bigger muscle as fast as you can. So if someone's weak, that's the limiting factor, you know, and I think it's all very well going down the route of doing some kind of. low load, quicker, faster actions, catches at low level, but we really want to move them into a place where rates of force development is about force. You know, it's not just about how fast you're moving. It's about how much force you can produce in a, in a, in a quick time. So we want to move people to a place with a high force, high rates. And the way we do that is to build a bigger muscle first and then, and then allow them to access it. So my training will change completely. We might do some, um, you know, In terms of like developing force in those weak, uh, athletes, we'll just do some, you know, slower movements or ISOs under higher load, we might progress them from initial capacity work to more max strength work, but then the emphasis shifts towards a truly ballistic intent behind the exercise. So we can still use an isometric, but we want them to go as fast as they can. We're, we're tapping into neural elements of an exercise. You know, and that's, that's where I think this makes it, this makes a true difference. You know, your, your question's insightful because essentially it's like, so what if we get a low rate of force, so what, what, what do we do with it? We got to then, if we want to move the needle on rate of force, we've got to perform an exercise that drives an adaptation. That's going to be a rate of force exercise. And that is really challenging. It's really challenging. I bet. I bet. And I see the logical progression to where let's say in the injury environment for example, where we're focused on strength for so long in the early middle phases of rehabilitation approach. But if we don't make that transition then start to use that that force that you can now produce at a little bit more game speed or a little bit more max speed, then I think you're missing a boat in the rehabilitation process as well right? Absolutely. I think that it mirrors the lower body. What we see is in rehab that peak force comes back much earlier than rate of force. That's just a natural, uh, return, uh, after injury. And we also see that rate of force suffers more. You know, if you look at lower limb counterparts, like a counter movement jump where you've got more time to produce force versus a drop jump where you've got less time, you can probably counter movement jump the same way after a big lower body exposure. But if you're given that short space of time to Do that real fast, less than 2 50 millisecond ground contact. If you're fatigued, you can't do it anymore. So that's, that's, I think, where this will go with upper body testing. We're just, we're just trying to, you know, stand on the shoulder of the lower body research and development from ACLs and hamstrings over the years. And we're trying to now get to a place where we really are able to put some studies in place that are going to capture that. Um, rate of force development deficit that I think in one podcast episode, you used two amazing phrases. You said, um, stand on the shoulders of lower extremity research, which is amazing. And earlier you said you were knee deep in shoulder, but it's all connected, right? Cause we know it's all connected As we're constantly told. But, uh, I, I. I, I. These, these are the things that I pick up on Ben. It's, uh, that's crazy. But, uh, uh, no, great stuff. But, so I, I, you know, I can see this as being super, super valuable for contact athletes, people with instability, those types of things. Tell me a little bit about your experience using this specifically with overhead athletes. Uh, what have you seen for maybe injury, uh, concepts and even performance based things? Yeah, so I think where this, where this comes into its own is, is, as you said, right, right at the start, it's like an end stage return to play marker. So it's not designed to be a throwing test. It's not designed to be a tennis test. It's not designed to be a weightlifting overhead snatch test, but because of the high demands and the correspondence between some of the things that we see in an ash test and what we see in the high demands of those different sports, it becomes a really good. Long lever high force high rate test. So it's positioning itself towards the back end of a return to play process. And that's where I think it's coming into its own in a number of different sports. Um, we're seeing correlations between volleyball spike and ash test rate of force development in a wide position. We've seen, um, that in one cohort of NCAA pitches, uh, division, division one pitches throwing above eight, seven miles an hour. So it starts to become more, more credible. You know, some over, some over 90. So some decent throwing athletes. We've seen that there's a, a, a change in the ASH test. Of 50 newtons per second in a T position from RFD perspective is equivalent to an increase of 0. 5 miles an hour on a radar gun. Now, these are early studies with smaller groups, but, you know, that's where kind of these, these projects and ultimately, um, the larger cohort studies can can probably be built on that. So there's definitely some interest around, you know, the key determinants of throwing and the key requirements. Of the ash test, but part of my PhD is looking into, you know, digging a little bit deeper into that. I'm looking at some of the muscle activation, some of the timing and firing around that. And then really, how does that then all link together? So we link. The, the performance testing to actually the demands and tasks that we're, we're, we're asking the athletes to be fantastic. I look forward to seeing that. Um, I, I agree with you when you say a later stage, um, test and even in the overhead athlete, if you can produce a good amount of force in these positions, you have a pretty healthy shoulder. Right. Things are functioning well. Things are in the right position. I think that's, I think that's a great way of putting it for overhead athletes. So, um, it makes sense to me to see some correlations with velocity, right? Remember we said that earlier in the podcast where I almost see those as like the acceleration based muscles. So I think that's fantastic as well. Um, what have you seen With the results of this test from just monitoring healthy athletes over the course of a season and maybe that's in any sport a contact sport versus an overhead sport But have you seen that that the the data that you're getting does it change over the course of a season does it stay? Consistent, is it just something you see in injured players, but what's your experience with using this to actually monitor people? Yeah. So I think it's, it's a test that's been used in a number of different ways around monitoring and some people might do this once a week in, in a throwing population, as an example, um, some people have done it every day, by the way, for four weeks, I apologize to the athletes that had to go through that process as part, as part of my PhD. What's interesting is, and I suppose the summary is even in those four weeks, yeah. Because it's a new stimulus and this is this is quite an interesting thing I think because it's a new stimulus and you're asking someone to do this high rate of force development exercise Actually athletes get better at doing it. That's training training is testing testing is training So where we'd expect people to actually drop off maybe after throwing, you know You know pitching a number, you know in a number of innings or however We want to do that in terms of RPE for a session We still see that people who are on an upward trend will continue to improve with repeated, uh, repeated ash test performance in a, in a daily. A daily environment when we use it as a monitoring tool, it's been used really on a kind of, let's say, we take a starting picture. We use it on day three. Um, some people use it on day two, if they believe that there's, you know, someone's going to go out and do something intense on that day. And then historically, people like to do that. We can use it to see, are they back up to where they are normally at 48 hours? And if they're not, it might be used then to say, well, you're going to go 100 percent today, or can we just. retest you tomorrow and make sure you're back up at 100 percent of where we want you before you go and throw a ball pen or before you go and do those higher intensity actions. So that's conceptual originally taken from lower body, but now it's been implemented in a number of places. And I think there's, um, you know, some, some people have adopted this more than others, as you know, like, is this, there's this reluctance to probably, um, do something new, but when you're talking about a one second version of this test, and you might do two or three reps, I think the, the load demands compared to throwing a baseball, you know, 95 mile an hour, um, is Um, and I think also compared to a lot of the, you know, the preparation work that's done, which is slow speed, um, you know, low load, high repetition, actually putting in something in there. That's in a stimulus. That's going to protect a joint and challenge a joint is a really useful tool to help develop athletes in terms of protection against those kind of throwing demands. Fantastic. I'm really excited to see this PhD research that you're working on come out, Ben. I think that's going to be really impactful for us all. I can't wait to continue to see more and more people that have started to use it start to produce some research with it. You know that's about to come, right? That's just how these things tend to evolve over time. Uh, it's going to be great to see all the different things that we can, uh, get out of this testing. So thank you for this and thank you for joining us on the podcast today to share a little bit about this. Um, you guys got to check it out. Um, go to the show notes, uh, on the website or in the podcast and, um, Click some of those links to find out a little bit more about the Ash test and Ben, but Ben, before we let you go, we got to do quick high five, five quick questions, five quick answers to learn a little bit more about you as a person. Right. I, this is kind of my favorite part of the show, but, uh, first question, what are you currently working on for your own professional development, your own con ed? And I know that's hard when you're going through a PhD, so I'll give you a little credit on this first one, but what are you doing for your own personal development? Well, I do like to listen. I do like to listen to stuff. If I'm not reading, if I'm not on holiday, I don't tend to have a actual hard copy book. Um, but the one book I bought on my recent trip was, um, Never Split the Difference, which is Chris Voss, who was an FBI negotiator. And for those people who haven't unlocked the secret power of negotiation in, uh, you know, contract negotiation or even any, any sort of. Day to day, um, day to day, uh, challenge buying a car, whatever it's Brilliant. I mean, it takes you to some pretty awkward places, uh, it's, it's not easy, but just by putting some of the stuff into practice, incredible, the shifts you can get with, um, with, uh, negotiation and, and the way it's sort of sold is, is brilliant, resonates very well with me. So that's a good one. Yeah. I mean, isn't everything in life a negotiation, technically. Pretty much where it comes down to. Yeah. And if you've got those special set of skills like this guy has, um, then, uh, yeah, you, you can start to really influence people. I would hate to be married to that guy. I apologize. I don't know. He's probably a great guy. I apologize. But, what is one thing that you've recently changed your mind about? Um, unfortunately this is a bit technical, um, but it's around, uh, Trunk assessment. So we, we historically look at a lot of these hold isometric endurance tests like bearing Sorensen's and side planks and, and actually, we've kind of got really good at measuring peak forces and lower body got pretty good now upper body. But the missing link is, is the trunk so I've been starting to look at peak force in like a modified Palos isometric. And, um, we're starting to see some pretty good information around that. But I would, a call to action for everybody else is to just have a look. It's on my Instagram page, what we're doing, but, um, there's more and more people in rotational sports looking at rotational peak force testing. I think that's going to be the next, the next sort of big game changer, if you like, with, with this kind of physical profiling and, um, strength and conditioning. For sure. And then subsequent to that would be rate of force development, right? Exactly that. Yeah, because you can get both isometrics are great. So once you set up a good position, a good process and you, you and I know, because we were standing over Lenny the other day looking at, you know, the requirements of quality assurance to get the best data. And you can always tell when someone has. Thought about it, tried it, practiced it, and refined it, like Lenny had with the, uh, iso knee extension as an example. Um, and you can see others who just never have because they haven't done it, felt it, tried it, and looked at it, uh, over a period of time. So that's, that's what needs to happen with the trunk, trunk rotation test. I, I agree. I agree. Um, what's your favorite piece of advice that you love to give, uh, your students or early career professionals that you mentor? Yeah, from my own personal experience, I got a lot of patient mileage. I was exposed to a huge amount of individuals, and I had the opportunity to make Make mistakes and learn, um, in a very well supported, uh, low pressure environment. It's also important that you get a chance to, to try things, apply things yourself. So not just to go along and take notes, but actually to have a chance to put things in place. Um, because if you've never problem solved, uh, even at lower levels, how are you going to do it when you end up in, in, in the elite game? Um, so that's it. Protected, but high level exposure, volunteer. Get yourself out there, multiple different sports, multiple different environments, um, that will set you up, set you up well for your future. I love it. What's coming up next for you, Ben? You never know when you're trying to grow a business, do you, but I'm sort of going where the wind blows at the moment, but well, a skiing holiday in 70 days, not that I'm counting. Um, and as one of the athletes said, Oh, you must, you must be doing well as a business if you're able to take a ski holiday on December the 12th. So that was a, that's, that's a great thing. Basically, developing online learning and education with my business partner there, Alex Wolfe. That's been going well. We'll release a training course early in 2024 to complement the level one course and the, um, and the testing course that we just released in September. So that's that coming up, um, and then we're going to try and get a few more people on board working in London on the on the rehab side as well. Some good people. Um, hopefully to build the business nice and steadily so we can, we can, um, deliver to, to more people in London. That's fantastic. I love it. Well, how do people learn more about you and the Ash Test and Athletic Shoulder? What's the best place to find you? Yeah, so I'm on, I'm on all the social channels, uh, LinkedIn, just Ben Ashworth and, uh, Instagram is probably the best place at the moment at Athletic Shoulder. Um, or you can go to the website, uh, www. athleticshoulder. com. That's awesome. Ben, thanks so much for joining us today and sharing your experience with this. That was awesome. I'm sure everybody's going to take a lot out of this and hopefully more and more people use this Ash Test. So please check it out if you didn't. And again, thank you, Ben, for joining us. Mike, an absolute pleasure. Can't wait for the next one.