011 - Health Movement Podcast - Jeff Podaszwa - Human Performance Optimization Team - Concussions - Pararescue Jumpers

[00:00:04] Alright everybody welcome to another episode of the Health Movement Podcast. This is episode 11 and we do have a very special guest with us today. But before we introduce him I just want to start off as always we're not doctors so before beginning any new fitness regiments or changing your nutrition or anything please check with your doctor. I'm Derek I'm a two sport collegiate athlete and a certified personal trainer.

[00:00:27] My name is Tim I'm a nationally certified athletic trainer and a nationally registered EMT.

[00:00:33] And with us today we have Jeff Podaszwa who's an athletic trainer working for Duro Health contracting with the Armed Forces. He's out in West Hampton Beach and he's working with pararescue troopers for the Air Force. Thanks for coming with us Jeff.

[00:00:49] How you doing guys?

[00:00:50] Good good good. We're doing great. So we understand that your area of you know you've done a lot of research and a lot of background in concussion management.

[00:01:02] In that that kind of realm. What what can you tell us about that?

[00:01:07] Yeah for sure. I definitely think this is one of the hot topics that's kind of going around. It's been pretty hot for about the past 10-15 years.

[00:01:16] And then it's definitely popping back up in the media again with the unfortunate injury to Tua playing football. I think it was about two Saturday or two Sundays ago.

[00:01:26] But yes before I worked with Duro Health with the Armed Forces. I spent about six to eight years in the Division I collegiate setting. Worked very closely with the football team.

[00:01:40] Definitely want to preface that I am not claiming to be you know an expert by any means on concussions.

[00:01:46] But I've done a fair amount of research with some of the leading research individuals.

[00:01:51] Personally I do not do any research but I love reading it.

[00:01:54] So I follow a lot of the big heavy hitter concussion research leading folks and kind of dive into essentially their evaluation treatment and rehabilitation processes for concussions.

[00:02:07] And it's definitely something that I just find a pretty big interest in.

[00:02:12] Yeah I mean this is an area that is you know it's it's super common right.

[00:02:18] It's something that not only athletes deal with but you know the general population as well.

[00:02:24] Anywhere from you know from older older folks to you know just just people that are are regularly active and stuff like that.

[00:02:33] So I think this is an area where and I think the other piece to this is there's a lot of misinformation on income management and you know how to deal with it how to manage it.

[00:02:43] And the biggest thing is returning back to activity we're turning back to sport or you know work or even you know for for students the classroom that's a you know you talking about being in the collegiate setting.

[00:02:55] That was a big big area too so I think this is a an area that I think can be pretty broad but also it needs to be a little bit more well known and a little bit more positive information and the correct information you see it.

[00:03:11] Yeah yeah I totally agree. Just like anything kind of in the health world if anybody has sort of a basic understanding of health in America everything we do is based on evidence-based practice and that's all fantastic because obviously you need to show and prove that something works in order to utilize it.

[00:03:29] But it also has its drawbacks whereas things are always evolving things are always changing and and sometimes the information takes a little bit while to make it widespread and really get it out.

[00:03:39] Especially in the teaching curriculums of different sports medicine programs or so pretty much trying to put out new information is a little bit of a challenge but trying to get it to as many ears as possible is definitely something that we as practitioners want to try to do.

[00:03:55] Jeff to start off just because I know the level of understanding of everybody it varies what exactly is a concussion?

[00:04:04] Yeah for sure. A concussion is essentially a functional brain injury so we really don't have a full understanding of what actually happens inside of the brain that causes it but there's a lot of theories that kind of prove you know have been proven to make sense and so that's kind of what we're running with.

[00:04:24] So essentially it's a functional brain injury. It can happen in many different forces so depending on whether it's a blow to the head from an object, another human being, whether if it's a stop in momentum of you're running really fast or a car accident and suddenly you hit a wall and stop or there's also you know those whiplash injuries.

[00:04:43] Pretty much any of that force movement that's going into that head can cause dysfunctional brain injury.

[00:04:50] A lot of times you know it happens from essentially your brain inside your skull is not fixed. It sloshes around. It's got fluid all around it.

[00:04:59] So there is movement in there and so anytime you know when you're going at high speeds even if it's just running you know that is considered a high speed.

[00:05:09] And then sudden stops, sudden twists, sudden blows to the head can cause that brain to slosh around which can cause to bruising.

[00:05:16] It can cause to neuron injury where the neurons inside your brain essentially shear, stretch and can be damaged which can cause a lot of the concussions that a lot of people get hurt.

[00:05:29] A lot of the symptoms that a lot of people associate with concussions.

[00:05:34] I can go a little deeper into it if you need to but you know it gets a little heavy with the terminology.

[00:05:40] No, no, no. I think that's a perfect explanation right there. I appreciate that.

[00:05:45] Well, I think that the big piece too is you touched on the whiplash piece to that, right?

[00:05:50] So you don't necessarily have to hit your head to sustain a concussion and I think that is a misnomer that a lot of people don't understand.

[00:05:57] Yeah. And I think the other piece of that is you can get hit in the head and not sustain a concussion too.

[00:06:01] So, you know, like I said, there's a lot of misinformation and there's a lot of unknown information about that kind of stuff that really goes under the radar.

[00:06:11] Yeah, absolutely. Definitely one that I always see is, you know, just like you touched on, just because you got hit in the head does not mean you have a concussion.

[00:06:19] Just because you got hit in the head and your head hurts does not mean that you have a concussion.

[00:06:24] If you're going to hit anywhere part of our body, it's going to hurt, you know?

[00:06:27] And so that's true for the head just as well.

[00:06:29] It's really all these other factors, all these other symptoms that go into it, which really alert, you know, a practitioner to, you know, the presence of a concussion.

[00:06:39] But definitely that whiplash is also a pretty big one.

[00:06:42] It's not necessarily blows to the head.

[00:06:44] It can be those sudden stops and movements.

[00:06:46] It could be those, you know, tackles that you see in football where, you know, the linebacker hits the guy square in the chest.

[00:06:54] His head never gets touched.

[00:06:55] But as the guy falls back, that net goes through a massive whiplash effect.

[00:07:00] It can cause that.

[00:07:02] A lot of people can attribute it to, you know, the head's going to hit the ground, which definitely can play a factor into it.

[00:07:08] But that whiplash can definitely cause these injuries.

[00:07:12] Essentially, like I was kind of mentioning with that stretching of the neurons, you know, it makes sense when you think about it.

[00:07:18] Our brain is connected to our brain stem, which goes right through our neck.

[00:07:21] You get that massive whiplash effect.

[00:07:24] And you can just imagine that brain and that stem just getting sheared and torn apart and stretched to its maximum, which can cause these injuries in the stamina.

[00:07:36] You had mentioned when we were talking at the beginning that as an athletic trainer, you have had experience with a lot of these concussions.

[00:07:45] Are there specific symptoms?

[00:07:47] And again, we're not doctors or anything like that, but just I know as a father and a coach, we go through a concussion protocol that we, you know, in order to coach, you have to follow.

[00:07:58] So are there things that parents and things can parents and other people can look for?

[00:08:03] Yeah, definitely.

[00:08:05] So one of the gold standards currently used in kind of concussion assessment and treatment is called the post concussion symptom scale.

[00:08:13] It's a super easy Google.

[00:08:15] If you just type in PCSS to your Google, it should pop right up.

[00:08:18] And essentially what it is, is it's a list of 22 symptoms on a zero to six scale.

[00:08:25] So it essentially gives you kind of a severity score of a potential of 132 if it was sixes across the board.

[00:08:32] And so what that does is it kind of gives you that knowledge and that information of those heavy hitting concussion like symptoms that we typically see with these injuries.

[00:08:42] It can be anything from headache to neck sensitivity to little things that are harder to notice, but more emotional symptoms such as a little extra nervousness, a little extra anxiety that's very uncommon.

[00:08:56] Frustration over little things that doesn't seem to be quite right.

[00:09:00] Things like sensitivity to light, sensitivity to balance.

[00:09:05] This list really does a great job of comprehensively touching just about all these different types of symptoms you could have.

[00:09:12] And it's definitely a good resource to kind of check out and be on the look for those things because it's not necessarily just the simple my head hurts and I don't feel good.

[00:09:21] You know, there could be all sorts of different mechanisms to it.

[00:09:24] And the great thing about that scale is there's a subjectivity to it, right?

[00:09:28] It allows the it allows the it allows the patient to kind of scale it on their own and it doesn't lead them into certain, you know, thinking they feel certain things there.

[00:09:39] And especially when you're when you're going through that, it's hard to really understand what you're feeling or know what you're feeling.

[00:09:45] And it kind of helps them to kind of weed through that themselves and kind of work through that themselves.

[00:09:51] The symptom scale is really big, big factor for both identifying but also monitoring the progression of the healing process too, right?

[00:10:04] Yeah, I couldn't agree more.

[00:10:06] So you definitely just hit it, you know, perfectly on the head.

[00:10:08] So the subjectivity nature of it does make it less of an assessment tool and more of a progress tool as how you're recovering from some concussions.

[00:10:21] So obviously, you know, day one, you're going to have a high number of symptoms and a high score, you know, but seven days down the line with a little bit of treatment and rehabilitation, you're looking to see those numbers obviously fall.

[00:10:34] And so the subjectivity nature of it is fantastic.

[00:10:37] In my personal opinion, I get to kind of see the progress of each individual and see how they're changing.

[00:10:43] Also, it kind of gives me a little more information on how to tailor my rehabs and treatments specifically because one area may be responding very well, such as the headache may be going away, the dizziness may be going away.

[00:10:57] But maybe there's some other aspect of it that's not quite going away.

[00:11:01] And it allows you to kind of tailor your rehab to, you know, switch gears and get a new focus in a different area.

[00:11:08] I'm glad they have this.

[00:11:10] I remember I played football in high school and college in the late 90s.

[00:11:15] We'll say late 90s, not mid 90s.

[00:11:18] And back then, especially in high school, it was all right, cover one eye.

[00:11:22] All right, move it.

[00:11:23] Let me see your eyes dilate.

[00:11:24] And it's like, I think that was good.

[00:11:26] You can go back in.

[00:11:27] And it's I'm sure a lot of us, a lot of us were playing when we shouldn't have been.

[00:11:33] And it's not through like the coaches weren't trying to do anything to put us into a bad situation.

[00:11:39] It's just the knowledge is so much better now and the understanding and what people go through so that you can be in a good position to help out the athletes as much as possible.

[00:11:50] Yeah, of course, there's a whole bunch of different assessment tools that you really want to dive into when taking a look at one of these things.

[00:11:56] Any sports medicine practitioner should be pretty familiar with these kinds of tests and should and hopefully are utilizing them to essentially assess individuals who are potential suspects for concussions.

[00:12:12] A lot of the really good ones, there's one in sports called the SCAT, SCAT 5.

[00:12:16] I believe they just released the SCAT 6 as well that has just changed a couple of things, made it a little more challenging, a little longer.

[00:12:24] I do appreciate them, but obviously this is a sports concussion tool.

[00:12:29] So it's trying to be as quick and efficient, but also being as thorough as possible.

[00:12:34] We have something also in the armed forces world called the MACE.

[00:12:38] It's very similar to the SCAT, but it actually does one thing that I really, really like that the SCAT, I think, falls short.

[00:12:47] So there's a doctor out of the University of Pittsburgh.

[00:12:51] His name is Michael Collins.

[00:12:52] I believe he pronounces it Collins, but it's spelled Collins.

[00:12:57] And essentially, he came up with a couple years ago a quick vestibular and ocular test.

[00:13:04] So what that kind of means and what that is, is we have two major symptoms that have been proven to directly correlate with concussions.

[00:13:13] Our vestibular system and our ocular system.

[00:13:16] Ocular is pretty straightforward.

[00:13:18] It's how we look.

[00:13:19] It's how we see.

[00:13:20] It's how we perceive the world.

[00:13:21] Our vestibular system is a little tricky.

[00:13:24] It uses our essentially inner ear functions to really understand where we are in space.

[00:13:29] So if you ever close your eyes, it makes sure you can still stay standing and know, kind of have a general idea of where you are so that you're not just falling over the second that ocular input goes away.

[00:13:40] And he created essentially a quick assessment of those two systems.

[00:13:46] Excuse me.

[00:13:48] Those two systems.

[00:13:49] That is more of an objective, harder to hide type of assessment tool that practitioners can use to really identify deficiencies in these two symptoms, which have been directly correlated to actually sustaining the concussion.

[00:14:06] I think that's something I've heard of.

[00:14:09] Is that MACE?

[00:14:11] Yeah, so it's MACE.

[00:14:13] I believe it stands for Military Acute Concussion Examination.

[00:14:18] They had a prior version of it, and then now they've graduated into the second version.

[00:14:25] And essentially, when you take a look at that specific test, it's just the SCAT 5.

[00:14:29] It's that whole portion.

[00:14:31] But then it adds this really nice vestibular ocular motor screen test at the back, which really, in my opinion, makes it a much more comprehensive assessment.

[00:14:42] Now, when you worked in the collegiate level, was there, I'm assuming, some sort of baseline test that all the athletes went through so you can get this?

[00:14:51] Yeah, of course.

[00:14:52] What does that look like?

[00:14:53] Yeah, so anytime we had any athletes come in, you know, you got physical day.

[00:14:58] And I'm sure you remember physical day kind of going through it.

[00:15:02] You know, we didn't really do that back in the 90s in terms of baseline testing.

[00:15:06] It was like, can you stand?

[00:15:07] Yep.

[00:15:07] All right.

[00:15:08] You're good.

[00:15:08] You're good.

[00:15:09] Fair enough.

[00:15:09] Fair enough.

[00:15:10] Well, for us athletic trainers, it's definitely a gauntlet of a day.

[00:15:13] You know, you're getting 50, 60, 70, 80, up to 150 new freshman athletes coming in that you all have to screen and you have to get this baseline testing done.

[00:15:25] And in addition to all of the, you know, the typical routine stuff, the heart looks, the physical looks, the orthopedic looks, essentially we do this concussion specific section where they're getting their baseline information.

[00:15:41] So what I was kind of mentioning before that SCAT and that MACE, those are actually just assessment tools.

[00:15:48] Some people use them for baseline.

[00:15:50] Personally, we would not.

[00:15:52] Those were our sideline assessment tools.

[00:15:54] But as a part of the baseline ones, that vestibular ocular motor screen I was going kind of over.

[00:16:00] That is a fantastic tool that only gets stronger when you have that baseline from an athlete.

[00:16:06] There are certain parts of the test where us as normal individuals, there are small populations that can have some deficiencies in the area due to non-concussion things.

[00:16:16] So that's why it's important to really get that baseline to understand who you're kind of looking at and understand who they are so that when there is an incident, you can really compare the two and make sure that, oh, no, they didn't have any of these deficiencies before.

[00:16:30] This is most likely due to a potential concussion rather than this is just who they are as an individual.

[00:16:36] We'd also have them go through the impact test.

[00:16:39] It's pretty much the gold standard in computerized neuro-screening tests.

[00:16:45] It takes about 45 minutes.

[00:16:47] They're running through a whole bunch of different exercises on the computer.

[00:16:52] Really what you want to do is you want to try to get them in an enclosed environment for your distractions so that they can really try their best.

[00:16:59] It's really grown over the past couple of years and it's actually really hard to sandbag.

[00:17:04] A lot of people, you know, talk about that worry when it comes to baseline concussion testing is are athletes able to sandbag these?

[00:17:12] Are they able to do poorly so that they can attempt to hide in the future?

[00:17:18] And these tests do pick up on any attempts like that.

[00:17:22] And us as practitioners can see those results and say, hey, man, it's pretty clear you didn't try.

[00:17:28] We're going to need you to take it again, which they're never going to want to hear.

[00:17:31] You know, it takes time.

[00:17:33] But then it's going to give them the motivation to try a lot harder.

[00:17:37] And essentially that kind of made up our baseline testing.

[00:17:40] So we take care of that impact, the bombs testing I was going over.

[00:17:46] And that's kind of what we would look at.

[00:17:48] We keep all that on file and make sure we have that readily available.

[00:17:52] Yeah.

[00:17:52] And I personally saw that a lot as well.

[00:17:55] Right.

[00:17:55] And it comes you get to like upside down tease.

[00:17:58] Right.

[00:17:58] That tells you that's an invalid test.

[00:18:00] Right.

[00:18:01] But the thing is that the piece of that, too, is the education of like, listen, this isn't this isn't because we're trying to hold you out.

[00:18:10] It's because that long term, this is going to have an effect on you.

[00:18:14] And, yeah, we know we're starting to see the long term effects of, you know, sustain, you know, either blows to the head, you know, whether it's subconcussive forces.

[00:18:24] Right.

[00:18:24] And that's another piece to this where, you know, it doesn't necessarily always need to be a, you know, a significant blow to the head or even maybe even.

[00:18:35] With those those symptoms initially, but over time, you see it with people, you know, like soccer players.

[00:18:42] Right.

[00:18:42] Because they're heading the ball so much or or those those other, you know, contact sports where you get those subconcussive blows sometimes.

[00:18:50] And that stuff can add up over time and trying to get them to understand that if you go back, it's it could not might not be safe for you.

[00:18:59] You might, you know, sustain other injuries or it could be life threat, too.

[00:19:02] And the big piece of that is is the education, too, of getting them to understand, like, this isn't like a hamstring pull.

[00:19:09] This isn't like your orthopedic type of injury.

[00:19:12] This is a lot more.

[00:19:13] And it has a much bigger impact than than those, you know, those type of injuries.

[00:19:18] Yeah.

[00:19:19] And I totally think I'm hitting a little bit.

[00:19:21] All that kind of topic is is really just the education is so important with, you know, that that personal connection that you can develop between you and your athlete or you and and your your person that you're kind of dealing with.

[00:19:35] Really, the biggest thing is having those conversations of if these are treated and rehabilitated properly, they can be just a typical injury that you can deal with in all sports.

[00:19:45] You know, so it's like obviously when you get a hamstring injury, the last thing that you want to do is just do nothing and then immediately return because then what is that going to do?

[00:19:55] That's going to make sure that that hamstring is pretty, pretty destined to fail.

[00:19:58] The same thing goes for concussions.

[00:20:00] You want to make sure that you're giving it the proper treatment, giving it the proper rehabilitation, giving it the proper amount of time for it to fully heal so that someone can return in that safe environment.

[00:20:10] The unfortunate circumstance right now is we really don't know what links any of the things that are happening that we can see here today to any of those longer term things that we're seeing with the development of cow protein and potential really lifelong catastrophic effects of this.

[00:20:28] We really don't have a good understanding of the link yet.

[00:20:31] Science is really trying to evolve and it's really good that this is consistently a hot topic in today's world because it really makes sure that the focus stays on trying to figure out those answers so that we can have a better understanding.

[00:20:44] But, you know, a concussion is something that can be a simple injury that can be rehabilitated and can be treated in a safe manner so that you can have the best chance of it not affecting you later in life.

[00:20:56] Just like anything that we see, you know, if you tear an ACL and you get really, really good rehab and you get a great surgeon who can put in a new ACL for you, you won't have those issues further down the line.

[00:21:08] And that's essentially what we're trying to do as practitioners is really just provide the best care so that people can do what they want in their life and can continue to do what they want for as long as they possibly can.

[00:21:21] That's good.

[00:21:22] I was going to ask about what are the long term impacts, but it sounds like it's such a wide range that it's tough to draw a direct correlation between a concussion and where you are 20 years down the line.

[00:21:35] Yes, it's very challenging.

[00:21:36] We really don't understand necessarily the bridges.

[00:21:39] We've had people who there is no real number.

[00:21:42] I think this is another kind of one of those misnomers that's going around.

[00:21:47] There's no real like half or max number of concussions that you can sustain where you should stop doing all activity.

[00:21:55] I do not know of any number.

[00:21:57] I do not know of any practitioner who's really trying to put that out there.

[00:22:01] It's really just are you getting the care and are you getting the proper rehabilitation to take care of them so that if you sustain one, it fully has recovered and healed so that you can move on and continue your time.

[00:22:15] I know a lot of people say five or six.

[00:22:18] Oh, you should stop playing sports.

[00:22:19] I don't really subscribe to that.

[00:22:21] I don't really believe in that.

[00:22:23] I really think that this is something that if treated properly, you know, can continue.

[00:22:27] And continue, you can continue as a healthy lifestyle and potentially put yourself in the situations where you could sustain concussions like four.

[00:22:36] It's definitely a case by case basis, right?

[00:22:39] And it's all dependent on symptoms and what they're feeling and, you know, all those types of things.

[00:22:45] And I've seen, you know, in my experience, I've seen kids get shut down, you know, because of too many concussions or they, you know, they're still experiencing long term symptoms from those, you know, those injuries.

[00:23:00] The other piece to this is, you know, depending on where you are and what hospital system you use or when I was working in the Worcester area in Massachusetts, we would refer out to UMass Medical who actually had a concussion clinic.

[00:23:19] So they had a clinic that was specifically devoted to dealing with post-concussive cases.

[00:23:25] In many of those, like, cases, they're long term, long term, long standing symptom cases.

[00:23:33] So, you know, you're really starting to see the treatment side of this really start to kind of pivot and change.

[00:23:41] And I think we talked about it when we were, we were, we had our free podcast call here where we're talking about, you know, the treatment, like rest isn't a treatment, right?

[00:23:54] And you had even mentioned it, like, we're not sticking people in dark rooms anymore and just having them sit in there and just rest, right?

[00:24:01] And it's really trying to progressively and over time start to reintroduce the day-to-day things or even the activity levels of what they're doing.

[00:24:12] And again, this goes beyond athletes.

[00:24:14] This is something for people that are active in the general population too.

[00:24:18] So what are some things that, as far as post-concussive treatment, what are some of the areas that you really have kind of dabbled in or, you know, you've read some research on that have some validity to them?

[00:24:34] Yeah, no, for sure.

[00:24:35] You're totally correct.

[00:24:37] Sticking athletes in dark environment for multiple days is totally out.

[00:24:43] That is not the treatment that we're doing anymore.

[00:24:45] I will say there is a little bit of some research that suggests within the first 24 hours, there's nothing wrong with that.

[00:24:53] It's not going to set them back.

[00:24:54] It's not going to do anything wrong.

[00:24:56] Allowing that brain to really rest in those first couple hours is pretty crucial, especially because we're always, always worried about the things that concussions, I wouldn't say could evolve into.

[00:25:09] But when you sustain a massive blow to the head, you could have also more severe things going on that don't necessarily appear right away.

[00:25:18] So you could have those brain bleeds that can be life-threatening in the moment right for that person.

[00:25:24] So definitely allowing for rest during that first 12 to 24, maybe stretching it to 48-hour period is okay, especially if you're monitoring that person to make sure they don't have any of those red flag symptoms that suggest they could have something more severe going on in there.

[00:25:43] But really, I mean, you just got to think about it through any injury that you can sustain.

[00:25:49] So if you pull a hamstring and you sit in a bed for seven weeks until it stops hurting and then you decide, okay, I'm healed, I'm going to go run again, what do you think is going to happen to that hamstring?

[00:26:01] I mean, it's not going to do anything.

[00:26:03] Yeah.

[00:26:04] Exactly.

[00:26:04] Exactly.

[00:26:05] And so we're trying to take the exact same approach that we take to every other part of the body and apply it directly to concussions.

[00:26:12] And so there's a big push for essentially called an exposed recover model.

[00:26:18] And so kind of using that PCSS that we were talking about, that symptom scale guide, realizing where those individuals are having their difficulties, where the most severe symptoms are.

[00:26:31] And then we're trying to, in a safe, controlled environment, expose those people to those symptoms that actually makes them worse in the moment and then allowing them to have time to recover and bring them back.

[00:26:44] I mean, just think about it.

[00:26:46] You take a hamstring, you have a hamstring strain, what are you going to do?

[00:26:49] You're going to do very, very light load.

[00:26:51] You're going to try to increase that range of motion, but everything that you're doing is safe.

[00:26:56] But what you're going to do is you're going to annoy it.

[00:26:58] It's going to get angry.

[00:26:59] It's going to hurt.

[00:27:02] But it's all in the process of trying to restore its function and restore its health.

[00:27:07] That is exactly what we're doing with concussions.

[00:27:09] You expose it to the stimulus that's bothering it so that the system can learn how to recover and repair itself so that those symptoms actually, over time, drop down to your baseline of zero is what you're obviously going for.

[00:27:23] So, exposed recovery is essentially what we're really trying to target with these kinds of injuries.

[00:27:29] It's very active, very safe, controlled, but doing things, doing exercises, going for walks, being out with people despite the fact that the noisy environments bother you.

[00:27:41] The biggest thing, though, is just being able to take rests away from the things.

[00:27:45] So, you want to expose yourself to the thing that's obviously going to bother you, but then you want to try to remove yourself from that environment, allow yourself to kind of calm down those symptoms, to kind of come back down, and then continue that process over and over again.

[00:28:00] The more you do that, the more you're going to see that decline in symptoms and the more you're going to see better recovery.

[00:28:05] Yeah, it's similar to your progressive overload, right?

[00:28:08] Like, that's where you're...

[00:28:09] Exactly.

[00:28:09] And the other piece to that is trying to make sure that you do it in a controlled environment, like you said, be able to take the brakes from it.

[00:28:21] And the other piece for that is, I think people think stress is a negative thing sometimes, right?

[00:28:27] You're introducing a positive stress to that and using that in a positive way without it becoming a negative factor, right?

[00:28:37] So, it's a delicate balance.

[00:28:39] And I think the other piece is people are afraid to do things that are going to elicit symptoms.

[00:28:46] Even as practitioners, I can talk from experience.

[00:28:49] It's like, you know, you don't want to make somebody...

[00:28:53] It's tough to put somebody through an environment where you are eliminating symptoms and it's becoming an issue consistently, right?

[00:29:01] You want to make sure that it's progressively heading in the right direction and trending in the right direction before you continue to progress that and continue to introduce those strep.

[00:29:14] Absolutely.

[00:29:15] You know, if your goal is to squat 500 pounds, the last thing that you're going to do is strap 500 pounds to a barbell and go for it.

[00:29:22] You know, you're going to start with those lower weights, that 100 pound and progress it to 150 to 200.

[00:29:28] And over time, you're going to see yourself get better and better at it so that you can attain that goal.

[00:29:33] But along the way, what's happening?

[00:29:35] You're dealing with soreness because you're increasing the weight.

[00:29:39] You're dealing with those muscle fatigue, a little bit of micro tearing, but it's all in the greater good to increase that muscle so that you can handle heavier weights.

[00:29:48] We're taking that exact same process and applying it directly to our concussion rehab.

[00:29:55] And what you really want to do is you really want to get as specific as possible and we can kind of dive into a little bit of not all concussions are the same.

[00:30:04] There's very different variations of them and I'm happy to dive into that with you guys.

[00:30:10] Yeah, yeah, yeah. Dive right in, buddy.

[00:30:12] Yeah, so when you're looking at the research, a lot of this, all of the reading that I've done is mostly under the University of Pittsburgh and Dr. Michael Collins.

[00:30:21] I know they're doing a lot of research over in Stanford as well with Dr. Angela Brown.

[00:30:27] I'm really excited with some of the things that are kind of coming out.

[00:30:30] But a big change in this past, I would say 10 to 20 years is we're not looking at all concussions as just a concussion.

[00:30:40] We're looking at different subtypes and different athletes and trying to make it more individual and seeing what we're seeing.

[00:30:48] Kind of going back to my analogy of the hamstring strain, you know, you don't just have a hamstring strain.

[00:30:55] Which hamstring is it? Is it a grade one? Is it a grade two?

[00:30:58] All these factors play a role into the decision making on how you're going to treat and rehab.

[00:31:04] Again, we're taking that same thought process and applying it to concussions.

[00:31:07] So really the most recent research is looking at there's pretty much five different subtypes.

[00:31:13] There is a vestibular where patients will have more symptoms associated with vestibular dysfunction, loss of balance, sensitivity to light, sensitivity to noise.

[00:31:25] Anything you can kind of associate with that inner ear function.

[00:31:29] There's an ocular trajectory where essentially the person is dealing more with ocular issues where their eyes aren't functioning properly.

[00:31:38] That's not necessarily they're not able to see.

[00:31:41] It could present that way, but also that their eyes aren't moving necessarily as efficiently as they should.

[00:31:48] We have an anxiety component, which is your athlete who's dealing with more emotional symptoms, getting very lost in their head.

[00:31:55] So telltale signs are that always thinking about their symptoms.

[00:31:59] And when they think about the symptoms, they get worse and just kind of that snowball effect there.

[00:32:04] There's a migraine trajectory where you're dealing with a lot of patterns that are associated with migraines that are presenting themselves as concussion symptoms.

[00:32:15] So, you know, pretty severe neck pain, pretty debilitating headache with that kind of aura.

[00:32:23] If anyone's familiar, if anyone has had migraines in the past, they'll know exactly what I'm talking about.

[00:32:28] And then there's also a cognitive fatigue trajectory where it's your individuals who are seemingly low symptomatic in the mornings.

[00:32:38] But the more they do activity, the more they use their brain, those symptoms get worse and worse until eventually they just decide to shut down.

[00:32:46] There's also two smaller components that can go into these things.

[00:32:51] Cervical, as we've talked about with kind of the whiplash mechanism, the neck plays a massive part in kind of the health of your brain.

[00:32:58] And so when your neck is having a lot of dysfunction, it can cause concussion symptoms.

[00:33:04] And then there's a sleep pattern one as well where it disrupts your sleep and you're just having really hard times initiating sleep and also maintaining sleep throughout the night.

[00:33:14] And so all of these kind of different types allow us to really tailor our rehab specifically.

[00:33:20] So we're targeting the areas of dysfunction, which is making it a much more personalized treatment and rehabilitation plan to get the most effective recovery out of them.

[00:33:32] You can have essentially one.

[00:33:34] You can have a mix of a couple.

[00:33:37] They can overlap.

[00:33:38] They can come.

[00:33:39] They can go.

[00:33:40] It's very fluid.

[00:33:41] And that's why this kind of daily check-ins, symptom watching, and the PCS follow-ups are really, really important to really see the progression and really ease out these dysfunctions in these specific areas to be able to tailor that rehab.

[00:34:01] Yeah, you answered my question.

[00:34:02] I was going to ask if there is overlap or if you see some matching of the different trajectories.

[00:34:09] And again, these are areas that I've had a lot of experience in with too.

[00:34:15] But I think the biggest thing is, and the other piece is like a lot of that is area of the brain that is damaged, right?

[00:34:21] So that's where not every concussion is the same.

[00:34:26] And what you were saying, right, with the hamstring strain is, you know, which muscle in the hamstring is it?

[00:34:31] Is it in the tendon?

[00:34:32] Is it in the belly?

[00:34:33] Is it distal?

[00:34:33] Is it proximal?

[00:34:34] And it's all going to dictate your treatment.

[00:34:37] And that's your same thought process for that too.

[00:34:40] So that's, you know, I think that's great for people to hear is, you know, it's the same thing.

[00:34:47] Especially somebody that's had multiple concussions, like this one's not going to be the same as the last one.

[00:34:52] Your recovery is going to be different and your treatment plan may be different.

[00:34:56] And those are all factors of the recovery too.

[00:35:00] And that's why I really think the education on this stuff is so important because, you know,

[00:35:06] if you can have these conversations with the individual who's experiencing the concussion,

[00:35:10] you can tell them that, hey, your symptoms, you know, make sense.

[00:35:14] They kind of fall into this.

[00:35:16] And so this is what we're going to try, you know.

[00:35:18] And okay, maybe this isn't working.

[00:35:20] So maybe we'll try something else or even exactly what you're saying.

[00:35:24] Hey, I know you've had one in the past and this one feels a lot different.

[00:35:28] This is why it feels different.

[00:35:30] You're not going crazy.

[00:35:31] This isn't something that's, you know, potentially really detrimental.

[00:35:35] But being able to have those really good conversations with that person can really get them more engaged in their ability to try to recover,

[00:35:42] which is only going to just give you even more positive effect on the back end and really allowing them to be a part of the treatment and recovery process as much as possible

[00:35:51] and allowing them to really feel that this stuff is okay.

[00:35:55] You know, sometimes when you when something's wrong with your brain, you don't understand what's going on.

[00:36:01] And it can be a very emotional.

[00:36:04] It can be a very frustrating thing.

[00:36:06] But giving them more information on why they're experiencing things and then trying to target exercises to essentially point out those deficiencies and then speed that recovery can really get them bought into this process and really can, you know, give you really great rehab.

[00:36:25] As someone who has been on the concussed side of this discussion, it's good to hear all the different information in terms of how different each one is, just like any other injury you have.

[00:36:42] An ACL is not always an ACL.

[00:36:43] There's a lot of other damage that can happen to the knee.

[00:36:46] So your recovery and your rehab is going to be different for each one.

[00:36:50] So that that's good for everybody to hear and know that.

[00:36:54] All right.

[00:36:54] Whatever concussion I have, it's going to be could be different than the last one I had.

[00:36:58] And I know my brother had one.

[00:36:59] But what I need to do is going to be different than what he need to eat, what he needed.

[00:37:04] Your anatomy is different, too, though.

[00:37:06] You know what I mean?

[00:37:06] So it's the anatomical differences make up a big aspect of this, too.

[00:37:10] So that's and I think, you know, some people recover faster than others.

[00:37:14] Some people have, you know, a higher metabolic rate.

[00:37:17] Like those are all, you know, some people are in different levels of fitness and these are all things that play a factor.

[00:37:23] And these are things like when I had kids that were recovering from from concussion or trying to get back, you know, and they're all trying, especially in the athletic world.

[00:37:31] They're all trying to and people that are more active, too.

[00:37:33] They're all trying to get back as soon as as fast as they can and as soon as they can.

[00:37:37] So that's where I used to tell them to control the controllables.

[00:37:40] Right.

[00:37:40] Make sure you're getting enough sleep.

[00:37:42] Make sure you're hydrating.

[00:37:43] Make sure you're eating properly and fueling your body correctly, because if not, if you're not doing those things properly, those can also mimic some of these concussion type symptoms.

[00:37:55] Right.

[00:37:55] So, yeah, if you if you're doing all the things that you tend to control the control your how your body is operating and how your brain is is you're trying to.

[00:38:06] You know, give your your brain the best possible chance at recovering and healing.

[00:38:11] You need to do all those things.

[00:38:13] And these are things that I don't know how much you if you've listened to a lot of the first, you know, 10 episodes of what we've done.

[00:38:19] But that's a lot of what we are on anyways is is diet, nutrition, hydration, sleep.

[00:38:25] The main things that you're going to need to be a healthy person anyways.

[00:38:30] Those are all pieces to this that need to be, you know, check off the foundational boxes first and then start to work on some of these other things.

[00:38:39] Yeah, it's seriously, it's almost like you see my PowerPoint.

[00:38:42] I have a giant slide that says exactly what you're saying.

[00:38:45] Control the controllables.

[00:38:47] So your stress, your fuel, your hydration, all of those things are so important.

[00:38:52] Your sleep, trying to keep those in check is so vitally important.

[00:38:57] As I was kind of going over one of those trajectories, one of those was a migraine trajectory.

[00:39:03] We know that migraines are a threshold disease.

[00:39:06] So when you lack, when you have one really bad night of sleep and you didn't drink any water, maybe you were boozing the night before.

[00:39:15] And then all of a sudden you're not hungry and you're not eating.

[00:39:18] When those three factors play into it, those people that are susceptible to migraines get them right away.

[00:39:26] And that plays especially into exactly what we're talking about, about concussions.

[00:39:30] If those things aren't in check, if you're not controlling the things that you have control over, that rehab, that recovery is going to take longer.

[00:39:38] It can present in symptoms that don't necessarily fit the box because it's more attributed to that than the concussion.

[00:39:44] It can make concussion symptoms worse.

[00:39:46] You hit it perfectly when you said making sure you control the controllables and really taking care of those things.

[00:39:53] We got your t-shirts made up with that, Timmy.

[00:39:56] Because that's a comment.

[00:39:57] That's something you say a lot.

[00:39:58] But it's true.

[00:39:59] It's really, if you're on point with your nutrition, your sleep, your water, everything, and then you, you know, experience something, a setback, an injury, a concussion, you're going to be able to deal with it a lot better because your body is already, you know, at its peak.

[00:40:15] So you can handle things a little more easily.

[00:40:18] And it doesn't necessarily have to be, you know, you don't have to find that one nutrition blog that, okay, it's a keto diet and everything specific.

[00:40:27] You don't have to worry about those kinds of things.

[00:40:29] You can just take in the things that are going to help you the most.

[00:40:33] You know, one of the biggest things that I see with all of the individuals I treat and deal with is one of the biggest things that they forget about is hydration, is water throughout the day.

[00:40:42] Unfortunately, I don't have it with me right now, but if you ever see me walking around, I always have a gallon jug of water with me at all times.

[00:40:49] Oh, you're that guy at the gym walking around with a gallon.

[00:40:53] I'm definitely that guy.

[00:40:54] I'm that guy at work with that's sitting on his desk.

[00:40:56] I'm super worried.

[00:40:58] That's not a bad thing.

[00:40:59] That's not a bad thing.

[00:41:00] It's so important.

[00:41:02] Our body is made up of water.

[00:41:03] What we were talking about before, about that brain being able to slosh into that skull, that cerebrospinal fluid, all those fluids in there are mostly comprised of water.

[00:41:13] The more dehydrated you are, the more at risk those structures are.

[00:41:17] Same with our muscles.

[00:41:18] The more dehydrated those muscles are, the more likely you are to have a strain, a strain of a ligament.

[00:41:26] You know, these things are really important.

[00:41:28] So water is just a really great starting point.

[00:41:31] And if you're not doing that, that's something that you can add into your everyday that can really have tremendous benefits for you.

[00:41:37] And if you ever work with the general population, it's probably the number one thing that goes by the wayside is water intake.

[00:41:46] And then you hear a lot of, you know, in my current setting, I hear a lot of, oh, you know, I drink like tea or I drink, you know, these other things that are actually more of a diuretic or a dehydrator.

[00:41:58] And they're working against you.

[00:42:00] So it's, you know, these are all pieces to the puzzle that I think go, again, it's the foundational piece to what you need to do for your overall wellness anyways.

[00:42:13] But to kind of go back to the concussion type of stuff, right?

[00:42:17] The other piece is, well, it might not just be that concussion, right?

[00:42:21] There's other, there are other secondary things that you might be dealing with that could be contributing to some of these symptoms as well.

[00:42:29] So that's where, you know, I think we talked about it the other day of addressing, you know, addressing stuff, taking you in the upper torso and your neck and working on posture related things.

[00:42:42] Focusing on, you know, what is your cervical range of motion look like?

[00:42:46] And trying to get some of those basic, again, foundational type of movement things back and being able to work that into some of the recovery stuff too, which I'm sure you've probably done a lot of as well.

[00:43:00] So it's not, it's not, it's a very multifaceted approach to the healing process.

[00:43:09] Yeah, when I was in college athletics and essentially in the position where I was training some of our new hires on kind of the way we did our concussion rehab and treatment, going through those different trajectories, the number one thing always was treat the neck, treat the neck, treat the neck.

[00:43:28] No matter what you think you're dealing with, even if you're so confident it's this particular trajectory and you want to work on that one, always treat the neck.

[00:43:36] One, you're never going to do anybody harm as long as you know exactly what you're doing in treating that neck.

[00:43:42] You're never going to do anything that's going to set you back in the concussion rehab world.

[00:43:46] And so it's only going to give you positive benefits.

[00:43:48] We know that the neck is severely connected to all of these different systems I was going over, your vestibular, your ocular system.

[00:43:56] So if you have, excuse me, any of that neck dysfunction in there, that can translate into concussion symptoms and actually prevent you from getting over.

[00:44:06] Over that last little hump to fully recover.

[00:44:09] We've had a numerous amount of cases where, you know, I'm dealing with somebody else who had been treating with a concussion and recovering and walking them through the whole process.

[00:44:18] And they're walking me through there.

[00:44:20] They say, hey, Jeff, like we just were stuck.

[00:44:23] You know, you've got a couple of symptoms left.

[00:44:25] I can't get them over that last little hurdle.

[00:44:27] And so, you know, I deep dive into what they did and everything they did was absolutely spot on.

[00:44:33] But you know what they forgot?

[00:44:34] They forgot to take a look at the neck.

[00:44:36] We did a little bit of cervical range of motion testing.

[00:44:39] Try to tease out some of the dysfunction in there.

[00:44:42] We treated that neck.

[00:44:44] Two days later, all those symptoms were gone and they were ready to return back to their sport that they love.

[00:44:49] You know, it's an important thing to definitely continue to remember and can go pretty much with any trajectory.

[00:44:55] I think we've covered the we've pretty well covered the concussion, the concussion topic a little bit more.

[00:45:02] I'd like to get into kind of your current setting, what you're doing on a day to day with sounds like you're working with paratroopers.

[00:45:09] Did you say paratroopers or what's your day to day?

[00:45:12] Like, I know I know you work with my guy, Nick Zananey, who is a little bit of a maniac, but he's got, you know, one of the smartest, one of the smartest people I've ever met.

[00:45:22] So he's great, dude.

[00:45:23] So what do you what do you guys do on a day to day basis?

[00:45:26] Yeah.

[00:45:27] So we're part of the human performance optimization team.

[00:45:31] If you know anything about the military world, they love slapping pretty names on things.

[00:45:35] And that's the pretty name and HPO designation we get.

[00:45:40] So we're part of the team.

[00:45:42] Awesome name to human optimization team.

[00:45:46] That's no joke.

[00:45:48] We're a part of a three man team.

[00:45:50] So it's myself, the athletic trainer, as you mentioned, Nick, our strength coach.

[00:45:55] And then we also have a physical therapist, Drew.

[00:45:58] Shout out those guys because they're definitely awesome to work with.

[00:46:02] And we've got a really great team out here in New York.

[00:46:04] And what we do is we essentially take care of we're assigned to a specific squadron within the Air Force.

[00:46:11] These guys are parrot jumper rescuemen, or PJs for short.

[00:46:16] They are just some of the most humble, hardworking, modest individuals I have ever met in my entire life.

[00:46:23] And they're really, really good people.

[00:46:25] Their big motto is that others may live, which I think just speaks to their humbleness and really the major piece that is their job,

[00:46:35] which is rescuing and recovering individuals who find themselves in really bad situations.

[00:46:40] And frankly, most likely the worst situations that they could possibly deal with throughout their life.

[00:46:46] And they're the guys that are there to rescue and help and provide treatment and especially to get them out of there as well,

[00:46:54] which is just something special that they do.

[00:46:57] But our day to day, you know, we're working their strength training for them.

[00:47:03] So essentially, they're allowed physical therapy or PT, personal training time in the morning.

[00:47:10] We're making sure that we take care of the structure of their workouts so that they're getting really good, applicable training.

[00:47:17] But we also have to be very careful not to crush them as they can receive calls any moment they need to be able to function.

[00:47:23] Oh, that's true.

[00:47:25] On my side of the house, I work very closely with Drew and we essentially do all of the treatment and rehabilitation of any injuries that can provide.

[00:47:35] I'm sure, you know, people who have dealt with the American health care system before, things aren't always the fastest

[00:47:42] and you can't always get straight and clear answers as quick as possible.

[00:47:47] Having us in-house really allows us to get eyes on injuries as soon as they happen

[00:47:51] and also not only be able to treat them and fix them and help them recover,

[00:47:57] but also facilitate navigation through that American health care system if it's a little bit beyond our expertise.

[00:48:04] So what I mean by that is if they receive an injury, you know, that requires surgery,

[00:48:10] we have the ability of we speak that kind of health care lingo

[00:48:14] and we can facilitate getting the doctor's appointments, getting the radiological tests that need to be done

[00:48:20] and getting them, you know, the surgeries that they need

[00:48:23] and then also following them through with the whole treatment recovery all through post-surgery stuff.

[00:48:29] So we're doing really awesome stuff over there

[00:48:31] and allowing them to have that resource where they can come and show us what's going on

[00:48:37] so that we can make sure that they're operating at their best every day

[00:48:41] is really our main goal in making sure they stay in the fight

[00:48:45] and take care of what they need to take care of.

[00:48:48] So do you guys have like a...

[00:48:49] Oops, sorry.

[00:48:50] I just said, do you guys have a functional working relationship with the VA

[00:48:54] or do you have like a specific surgeon or doctor that you guys do?

[00:48:59] You don't have to tell me who or anything, but is that part of that?

[00:49:02] Because that's how it works in the collegiate world, right?

[00:49:05] It's like you have a team doctor and, you know, whether it's a physical therapist

[00:49:09] or an athletic trainer, we basically defer out when it's, again, if it's above, you know, above our level,

[00:49:16] you defer to the team doc.

[00:49:18] So is there a functional working relationship there?

[00:49:20] Is it to work through, you know, through the system, right?

[00:49:24] Yeah.

[00:49:25] So that was actually, in my opinion, one of our big accomplishments

[00:49:28] of when we actually started with this particular unit

[00:49:30] is just trying to establish sort of that medical network that exactly we were talking about.

[00:49:35] If anybody's unfamiliar in the athletic world, in the sports world, you have all of this stuff on staff.

[00:49:41] You have a team orthopedist.

[00:49:43] You have all these different faculties that anytime anything goes wrong,

[00:49:46] you can make a quick phone call and they can be there in seconds.

[00:49:49] If they're not already there on site, you know, it's really, really helpful for that.

[00:49:54] That doesn't necessarily exist in these different non-traditional settings.

[00:49:57] And so being able to create that is one of the things that you really need to focus on.

[00:50:01] So we don't necessarily per se have a traditional team doctor or anything like that.

[00:50:08] We are dealing with individuals who are full-fledged adults who can take care of themselves.

[00:50:12] And that's going to come with, you know, their personal general practitioners.

[00:50:16] You know, these men and women have families.

[00:50:18] They trust the doctors that they are using, that they deal with on a daily basis.

[00:50:22] And by no means are we trying to come in there and mess any of those relationships up or anything.

[00:50:27] And so it's more of we have actually, you know, created relationships with different orthos,

[00:50:34] different specialties kind of throughout our area.

[00:50:37] And then we provide that as a resource for that service member so that they can either,

[00:50:43] you know, go and say, hey, this is somebody we trust.

[00:50:45] We really think that they do a good job.

[00:50:47] We think that this is the right person for you.

[00:50:49] And, you know, we have those conversations.

[00:50:52] And nine out of ten times, it's like, yeah, that sounds great.

[00:50:54] And then creating that working relationship of trying to expedite those referrals.

[00:50:59] If anybody, I mean, anybody's had an injury, they know what a referral is and they know how daunting those can be.

[00:51:04] How it can be weeks until you can get that MRI that you need.

[00:51:08] How it can be months until you can see that specialist that you need to see.

[00:51:13] Essentially, we're in the position to establish these connections.

[00:51:16] Try to, I wouldn't say manipulate,

[00:51:18] but it's just navigate the system so that we can be as quick and as efficient as possible

[00:51:24] so that they can get seen in, you know, a significantly shorter amount of time compared to your average experience.

[00:51:31] Grease that wheel a little bit.

[00:51:32] It's super important.

[00:51:34] You know, hitting that motto that others may live,

[00:51:38] like these men and women are putting themselves out there.

[00:51:41] So they deserve and they need to get back into shape and get healed up as quickly as possible.

[00:51:49] What brought you and Nick and Drew into this?

[00:51:54] Because this is a very specific world to work in in terms of training and, you know, athletic treatment and all that.

[00:52:02] Yeah, absolutely.

[00:52:03] I don't want to speak too much for Nick and Drew.

[00:52:06] Oh, yeah, yeah.

[00:52:06] But Nick is prior military service.

[00:52:09] He was in the Army.

[00:52:10] So he definitely has a strong connection with trying to take care of that population.

[00:52:16] Drew is actually currently in the Army and serving as a physical therapist in addition to doing this contracting job.

[00:52:23] So he's very involved in that.

[00:52:26] Me personally, I was working with athletics about four years at the same place.

[00:52:31] In my opinion, I was doing really good things over there.

[00:52:34] I'm sure you were.

[00:52:36] Yeah, exactly.

[00:52:37] But unfortunately, my school wanted to transition to a hospital-based model, which definitely has its pros and its cons.

[00:52:45] But it's something that, you know, I was taking a look at kind of how my life was going.

[00:52:50] If anybody knows athletic training in the athletics world is it's definitely a grind and it definitely puts a lot on you.

[00:52:56] And it definitely can take away from some of the aspects of life, like family and time with family and things like that.

[00:53:03] And, you know, as I started to get a little older, I know I look a little young, but, you know, I'm 31 going strong.

[00:53:10] Snow off.

[00:53:12] Nice.

[00:53:14] But really, I try to do realign my priorities a little bit of kind of I wanted to spend more time with family.

[00:53:21] And so making a decision to transition into a job like this has its pros where we have set hours.

[00:53:27] We have boundaries.

[00:53:29] Like I was saying of how great these individuals are, they're also adults that know how to take care of themselves.

[00:53:35] And they know that they don't necessarily have to reach out to us every second something goes wrong.

[00:53:40] But when they do reach out to us, we know that it is important and it needs our attention.

[00:53:44] So there's definitely boundaries and there's that respect for boundaries.

[00:53:48] When I was working as a grad student, I was studying under I had a supervisor preceptor who eventually ended up moving on and became associated with this company, Duro, while I was still in the athletics world.

[00:54:06] So when I was kind of thinking about making a change, she actually reached out to me and told me about this opportunity.

[00:54:13] And so I definitely wanted to hear out and hear what kind of it was all about.

[00:54:18] And the more I did research on it and then when they got me on site and I met the individuals I'd be working with, I definitely saw it as something that I could really sink my teeth into and be a part of and decided to make the jump.

[00:54:31] That's fantastic.

[00:54:33] Worthwhile.

[00:54:33] Incredibly worthwhile, too, I imagine.

[00:54:35] Definitely.

[00:54:36] Definitely.

[00:54:36] And I think that's, you know, speaking as somebody that's an athletic trainer, I think we all get into this for that sense of helping people, that sense of fulfillment.

[00:54:44] And it sounds like that's a position that would really scratch that itch.

[00:54:48] And being part of something that's larger than yourself, right?

[00:54:52] And I think that's a big piece to what, you know, a lot of the reason why I got into athletic training to start.

[00:55:00] So it sounds like that's, you know, and we, you know, personally, I appreciate you for doing, you know, God's work doing that stuff.

[00:55:07] You know what I mean?

[00:55:07] And I think that's the kind of stuff that we need more of.

[00:55:11] And, you know, it's great to hear that.

[00:55:14] You know, I think this is a very progressive, you know, progressive model.

[00:55:18] And it sounds like it's, you know, in speaking with Nick, too, it's it sounds like something that is I know he's passionate about it, too.

[00:55:26] So, you know, I really appreciate you guys.

[00:55:30] Yeah.

[00:55:31] So, yeah, in the past two years that, you know, we've worked with this particular unit, you know, they've given us nothing but positive feedback, which is excellent.

[00:55:40] And frankly, like you kind of highlighted a little bit, it's a little sad that these things aren't necessarily everywhere.

[00:55:46] They're not ingrained everywhere for these individuals because, you know, they would they would tell us what they had before us.

[00:55:52] And what they had was very minimal and they were very much on their own.

[00:55:57] And and it's just something that it's something that they shouldn't have to deal with.

[00:56:01] They have to deal with so many bits of training.

[00:56:03] They have to make sure everybody else is up to date on so many different things and really put their job first in order to put others first so that they can take care of them.

[00:56:12] And so having to deal with the whole piece of taking care of yourself and making sure that you're doing the right trainings and figuring yourself out for injuries.

[00:56:21] It's just something we really want to take off their plate so that they can just continue to focus where they're needed.

[00:56:27] And then we can focus on assisting them to exactly fill that need that they you know, that they're filling.

[00:56:34] Awesome.

[00:56:35] That's that's great.

[00:56:36] Is there like a shout out or anything that you want to give or do here?

[00:56:40] Like I not that we have thousands of followers at this point in time, but for the tens of listeners, Nick and Matt and, you know, we can.

[00:56:49] Let the attention on Nick and Dream, the guys I'm working with, they're they're great individuals.

[00:56:54] You know, Nick, very personally, he's he's an incredible human being.

[00:56:57] He's very, very smart when it comes to strength and conditioning.

[00:57:00] I mean, it's also a dual credentialed athletic trainer.

[00:57:03] So we have really good stories back and forth of, you know, our time in athletics.

[00:57:08] And but also he's a great sounding board when it comes to, you know, athletic training specific injuries.

[00:57:14] He's really a great person to work with.

[00:57:16] And then Drew, he's probably one of the smartest physical therapists I've ever met in my life.

[00:57:21] He's also one of the most positive going guys ever.

[00:57:24] He's always keeping our spirits up.

[00:57:25] And so our team is just really awesome, really huge fan of it.

[00:57:29] I definitely want to shout out the guys in the unit.

[00:57:31] You know who you are, who I'm talking about.

[00:57:33] They're just great individuals that I have, you know, the utmost respect for.

[00:57:38] Awesome.

[00:57:39] We appreciate all that you guys do as well.

[00:57:42] So, you know, that's the kind of stuff that this is where we felt passionate about getting you on here and kind of giving this a little bit more of a sounding board for that.

[00:57:52] But for that type of work and in that setting for not only for athletic trainers, but just in the health care for the military as well.

[00:58:00] That's a that's a big piece for us.

[00:58:02] So we really appreciate your time.

[00:58:04] Yeah, I'm really happy to be here.

[00:58:06] And I really appreciate you guys having me on because this was awesome.

[00:58:10] And you guys seem great and doing great things.

[00:58:13] And and I'm really appreciative of you.

[00:58:15] Oh, we'd love to have you.

[00:58:17] We'd love to have you back, too.

[00:58:19] You know what I mean?

[00:58:19] I think, you know, there's and this doesn't have to be concussions.

[00:58:22] There's all kinds of there's all kinds of stuff we could we could talk about, too.

[00:58:25] So, you know, and then we're not trying to be as far as you're not trying to be too formal.

[00:58:30] I think the big thing is just trying to be fluid about it, having an organic conversation, really just trying to educate people on on, you know, areas that that we can help with.

[00:58:42] Yeah.

[00:58:43] And I don't know how Nick and Drew would feel if they wanted to pop on as well.

[00:58:47] I don't know if Nick can keep the the language clean while he's here.

[00:58:52] We'll see how that goes.

[00:58:54] But that that could be a fun conversation to have to have all you guys on at some point.

[00:58:59] That's doable.

[00:58:59] Yeah, that would be cool.

[00:59:01] It would definitely we'd have to watch the language.

[00:59:04] The three of us in the room together.

[00:59:06] Just let us start bantering going on.

[00:59:08] Yeah.

[00:59:10] I know it'd be interesting.

[00:59:11] All right.

[00:59:12] Well, thank you, Jeff.

[00:59:13] We appreciate it very, very much.

[00:59:15] Everything you guys are doing over there.

[00:59:16] So thank you.

[00:59:18] Thank you, guys.