Barbell Shrugged - Keeping a Pro Rugby Player on the field without an ACL, with Dr. Ryan Summers- Active Life Radio #8

Episode Date: August 30, 2019

What do you do if you are a professional athlete and you have a potentially career ending injury to your knee that you do not want to get surgery for? You work with Active Life of course. . In today��s episode Dr. Ryan and I discuss one of Ryan’s clients, Max, who is a professional Rugby 7 player living in Hong Kong. Max tore his ACL for the second time and has elected to try and give his career a go without repairing the ACL. . You might be asking yourself, “how is a guy going to play professional rugby without an ACL when tearing an ACL keeps guys in Professional sports out for almost an entire year?”, and we are going to answer that question in this episode. . We talk about the mental side of this injury as well as the nature of the recovery from it and how it needs to look to make sure that Max is able to perform and perform well. Minute Breakdown:   0-10 - He tore his ACL for the second time 11-20 - He’s a professional athlete, why doesn’t his team medical and strength staff handle this? 21-30 - How to mimic sports movements with exercises in the gym  31-40 - Balancing the instruction from his on site S&C staff, and his Active Life coach 41-50 - Will he really be able to play? Work with an Active Life Coach like Ryan at activeliferx.com/shrugged Find Ryan at @dr.ryan.summers ------------------------------------------------------------------------------ Show notes: http://www.shruggedcollective.com/alr-summers ------------------------------------------------------------------------------► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedpodcast TWITTER ► http://twitter.com/barbellshrugged

all right dr ryan summers welcome to active life radio on the shrugged collective network my man what's up man glad to be here i'm happy to have you my favorite person in cleveland i mean we can't tell matt stevens that because i just don't spend as much time with him. But I mean, he's got to be 1B, right? Oh, definitely. Yeah, he has no interest in listening to this. But yeah, I don't think it's pretty much a competition at this point. Yeah, no. He's been usurped.

So, Dr. Ryan, I'm going to call you Ryan going forward just because it's easier. It saves me a syllable or two syllables. You own Pure Physio in Cleveland with Matt, right? You guys helped, what, five or six games athletes this year at the CrossFit Games, some headline athletes? Yeah, Matt was out there helping out. I think we had five to six overall that he was helping treat and get him through the games unscathed.

Yeah, so people who are listening to this, we recorded this podcast on the Monday after the CrossFit Games ended. So that'll give you some context for when we're talking about this stuff. But we're not going to talk about a CrossFitter today. What I want to talk about is your client, Max, who is a professional rugby player and knee pain um he's always interesting because he's not a crossfitter and he really didn't have a lot of pain um he had had a lot of previous injuries in particular uh he had torn his acl twice on the same knee so he had worked with us in the past and found a lot of value in what we had to do in terms of the programming with him and reached back out because he had retorned the ACL and decided to not have surgery on it, to treat it conservatively and just wanted to make sure that he was utilizing

all his resources to make sure that he stayed healthy and it didn't happen again. And so he could stay on the field performing and accumulating a paycheck at the end of the day. Yeah. So when we first worked with Max, he was on a template. He wasn't quite working with us one-on-one. But what I would love to hear from you so that the listeners can understand better, because one of the things that we like to do on this show, Ryan, is break down for the listeners complex medical terms and medical procedures and diagnoses and things like that, that everybody kind of feels like,

I guess I should know what that is. And that really people have no idea. So I think that when we talk about ACL tears, I think that if I had to guess, maybe 80% of the audience knows the ACL is a ligament in the knee, but doesn't fully understand what it does for the knee or how it tears. Can you go through that? Sure. The ACL is essentially the anterior cruciate ligament. It's one of the four ligaments in the knee. And it primarily just provides stability to the knee when the knee is planting and twisting and turning in different directions. So a lot of our field athletes, a lot of our jumping athletes, that's a ligament that they essentially need to have.

And if they do not have it, in the case of Max, for example, because he's decided that he doesn't want to go through the rigorous rehab process of rehabbing that type of reconstruction, essentially avoid his talons. And if that ligament's not there, which is again, its job is to provide stability to the knee, then a lot of other stuff has to happen to make sure that knee is staying healthy and strong. So it's a very commonly torn ligament in the knee. So probably the most recent example would be like Clay Thompson with the Warriors. That's exactly what he tore when he came down after a layup, and it kind of just shifted on him, and it tore.

So it's a pretty extensive rehab process. If you have the surgery, it's a minimum of four to six months before you're back to playing after that. And we always remind our athletes that it's actually probably upwards of 12 to 14 months to where that reconstruction in that ligament is still actually healing. So it's a really of factors and a lot of measuring that has to go into making sure that we're doing everything that needs to be done to keep that knee healthy and strong. So as people are listening to this, I imagine that one of the things would go through their mind is, well, if I have a ligament that connects my lower leg to my upper leg and keeps my knee stable and it tears, how could I possibly do anything without

it? Wouldn't their knee just flop around? So how do they understand better what occurs then? So in any joint, there are like passive structures and active structures. So the passive things of the knee are the things that are there and provide just structure, but they're not actually contracting, relaxing to provide stability to the knee. So again, in this scenario where that passive structure is no longer there providing the stability that it needs, we're going to do our due diligence to make sure that all the active structures around the knee are strong, the tendons, the muscles, that sort of thing, making sure there's strength balance around the

knee joint, making sure that things what we call like the neuromuscular stability. So when he's planting and cutting that they're turning on when they're supposed to turn on so that again that knee um isn't just becoming floppy as sean's openly put right so there are three ligaments that really hold the knee in place right there's the acl the mcl and the lcl and if the acl tears but the mcl and the lcl are still in place then the knee has a chance to stay stable. If two out of the three tear, then we're we're essentially going to need surgery. Right. Right. So it's a good thing that in his his scenario was a clean tear and nothing else was torn.

So there's there's a common scenario where there's three structures that can commonly be torn depending on the mechanism of that injury. So the ACL, the MCL, and what's also called the medial meniscus. So oftentimes if all three of those go, which is going to be pretty devastating, and there is any desire to return to competition or living an active lifestyle, then usually more often than not, that type of person is going to have to go under surgery. But in his scenario, it was a clean tear. Everything else was good. So he decided to go the conservative route. Yeah, we call that the terrible triad.

Right. Yes, the terrible triad. Not a good thing. No, no, no. No one ever goes to the doctor saying, hey, I hope I have the terrible triad. Right. So, okay. So at this point, we have a field athlete who literally makes his living playing a field sport who no longer has arguably the most important ligament in his knee.

And he wants to continue to perform this sport, which is a field sport with contact at a high level. He's not a crossfitter. So he doesn't care how much he cleans, snatches, how many muscle-ups he can do, how much weight he can squat. So he doesn't fit into the mold of what most people on this show that we've talked about fit into. How do you start? And he wasn't in that much pain. He was just like, I'm tired of tearing things. So how do you help that person? How do you start helping that person? Well, he's a really good client in that he understands his body really well. And these are the, when we start talking about what separates, you know, the quote unquote amateur

from the professional is the professional oftentimes isn't more athletic or more talented or that sort of thing is He understood really, really well. He was really into his body on what he was really good at and what he was really bad at. So from that upfront conversation, he had kind of identified, you know, what he felt like he needed at that point in time. And it was up to us just to kind of look at the grand scheme of things and then boil it down to a solution that was right for him.

And I think if there's anything that we do really well in active life, it's, you know, people will come to us and they have a grocery list of problems and they think that it's this, this, this, this, this, and this. And we understand and we appreciate that, but it's up to us to then take something that's very complex and macro and boil it down towards micro. We can create a list of low-hanging fruit and identify to them that if we address these maybe two or three things, that'll then create a trickle down effect. And that'll help us create a more long term lasting solution for him. So it was all about that initial conversation he had brought to us, that information that we just talked about, his prior medical history and all the tears that he had had and what he was trying to get back to.

And he had a really good medical support team with him. So he's a professional player, like Sean said, in rugby in Hong Kong. And he already had a team and they had to help him kind of identify with, you know, what he felt like he needed. But like he said, he had worked with ActiveLight before. So that initial conversation was really easy. From there, we just, we got him onboarded with our overall onboarding testing, which consists of movement screen and strength balance and that sort of thing, which helped us take his subjective reports of what he, you know, again, all these factors that have gone on in the past and then see if the objective data to where he was right now matched those subjective reports.

And for him, it did, which really made our job a lot easier moving forward to create that plan for him. So even though he's a field athlete, what you're saying is that the same general assessments were valuable for him. The ability to reach down and touch the ground, his ability to get his thigh to his chest, his ability to get his heel to his butt and so on and so forth. And then his ability to squat, hinge, single leg, squat, single leg hinge, all of that stuff was just as relevant for him as a field athlete as it would have been for a CrossFitter. Maybe, but the thing is we're never going to leave any stone unturned. So we're still going to go through the same grueling onboarding process,

whether it's a CrossFitter, whether it's someone like him, or whether it's a 65 year old grandfather who wants to bend over and pick up his child off the floor. I want to make sure that I'm getting all the information that I need and then identifying to how I implement that in the plan for him. So looking at something like an ass or grass squat or a kneeling heel to butt test, I still want to see if that's something he can do to make sure that joint has the full range of motion that is required. But that doesn't mean I'm then going to take something like that and then apply it to, okay, he now needs to do full depth squats, if that makes any sense to the listeners. I still want to make sure I identify the movement restrictions and the

strength imbalances for him, and then apply it to what I feel like he needs in terms of his goals and athletic requirements that he has. So how do you bring value to a professional athlete on the other side of the world who already has physio staff, training staff, S&C staff? S&C is strength and conditioning. How do you, random guy in Cleveland, bring value? Let's be real. That's what it is. The guy signs up, he's working with random dude in Cleveland. How does, how does he get the help he needs from there that he couldn't get from these well-paid professionals who are the most sought after people in his own country?

Um, that's a good question. And one that I don't know if I have the answer to, but I think he, essentially he found a lot of value in working, Active Life and myself is because I think he appreciates that we're not going to sell a perfect solution for you. We're not going to say that here's a perfect ACL prevent that a map will show you where you need to get to, but it's not going to show you the obstacles in the way and the streams and valleys and what you have to overcome, whereas a compass, it'll allow you to guide through all those different things. I don't know if I've ever used that analogy before, but I kind of like it. I think we'll use that again.

We're a compass that, again, it's not going to be a perfect solution for him but i think he you know i think he appreciated that we're looking at all the different variables that could potentially get in the way for something like this happening again where he could potentially tear the acl again and a lot of our athletes whether it's someone like him or a crossfitter that the programming is what he was getting was good. You know, it was, it was really well around his strength and conditioning programming, but it didn't identify that 10 to 15 to 20% that he really needed that it's identifying. And again, his individualized strength and balances and his, his prior medical history of not having ACO, it wasn't addressing that. And it was up to us to fill that missing void for him and i think with

the conversations that we had um we said we sold him on that because again we identified ourselves as not a perfect solution but one that's going to take into account all the different variables that were missing yeah so for the people who are listening and don't understand what ryan's talking about with with the variables what what what happens when you work with a sports team is that generally this is generally the team gets a program maybe they break it down where your attackers get one program your midfield get another program and your defense gets another program and your goalies get another program whatever the sport is right baseball players the infield you know first and third get a program the middle infielders get a program outfieldfielders get a program, pitchers, catchers, whatever the case is, they're all getting a program that's specific to their need in the

sport. But they're not typically getting a program that is specific to their personal needs, which is crazy to think of, and yet it's the truth. So in this case, we were able to help this athlete with the little gaps in the well-rounded program for a person of his aptitude at his position in his sport by adding with his physiology. I hope that that clears all of that up for you guys. And I actually like the map and compass thing because the difference is a map is static. It's always going to say this is where you need to get. But what do you do when you wander off the map and compass thing because the difference is a map is static it's always going to say this is where you need to get but what do you do when you wander off the map you need the compass to guide you back nowhere on the map does it say hey if you want to be a great rugby player you should tear your acl right okay and then like there's nothing wrong with with template-based protocols you know that's why active life has been really successful with things like a bulletproof program.

There's people who are right for that. But for someone like him, that's not going to work out because of his, like you said, his physiology. And he needed to be more hands-on, the more consistent, the more communication so that each day, day by day, week after week, we were identifying how his body was changing in response to the programming and the volume and the things we were throwing at him. So how much of his program needed to change? And what I mean by that is he gets his program from his coaches. Then he gets his program from you, which is meant to match, fill holes, replace. I'm sure you're giving him instructions on what not to do how much does that change and did you need to help him communicate with his own

coaching staff so that they could get behind it too yeah and honestly that's really um it varies it depends on where he's at in his in. It depends on, for instance, one probably was maybe early this year, February to March, they were chugging all the time. He just really wasn't getting a lot of training. So at that point in time, I was a little bit more hands-off. I was just sending some basic little mobility pieces and stuff he could really do in the hotel gym, warm-up pieces. So from like a percentage standpoint,

it was like 10% of what his overall training programming type stuff was. But when we were working together in the off-season and in the early pre-season type stuff, it was upwards of 75% to 80%, where I wanted to have a lot of control over the programming because I think I identified it where a lot of – that was where a lot of our improvement and progress could have been made. He wasn't having the accumulative volume and workload of in-season competition where he would just get beat up all the time.

So it was a little bit more hands-on. And, yeah, we were having communications with his support team and his medical staff to make sure that we were balancing all those different things. And I think that's something that we're really, we're really passionate about is creating a multidisciplinary approach. You know, we never downplay the importance of, you know, working with a dietician, working with even like a mental health,

you know, sports psychologist, which, which he does and that sort of thing and working with physicians. So we're always taking into account all those different pieces. But in that off season type thing, we were a little bit more hands-on and, and that sort of thing and working with physicians. So we're always taking into account all those different pieces. But in that off-season type thing, we're a little bit more hands-on and we're really auditing and overseeing a lot of the program that he was getting and making sure that the right pieces were being implemented. So again, it depends on where the athlete is in their overall season. We can be as hands-on or hands-off as we need to be accordingly.

And what was it like for you working with somebody? I know you do this in your clinic all the time, but this is not physical therapy. This is active life online coaching where they're basically just getting smarter strength and conditioning. Less conditioning, more strength, more movement. What was it like working with a client? Because most of the people who work with us are CrossFitters. Only like 20% are not. We love it when they come and they're not, but most of the people who come are. Most crossfitters are going to say, I need to be able to squat more because I need to be

able to squat more. That's part of what I do. A field athlete just frankly doesn't care how much they can squat as long as they can perform at a high level. So what was it like getting him behind the idea that his numbers needed to be in a certain place and his frequency needed to be in a certain place? Yeah. And again, for him, he's the perfect client where those conversations are early or when we're easy and that he came to us in the early process and, and really anything he said, he was like, sure, I had the utmost a hundred percent confidence in whatever you say is good to go. But for those of our clients who are a little bit less convinced, we'll say it's important to show them the numbers and then relate that back to,

to some sort of research, whatever it might be. So for him in his particular scenario, we laid out the strength testing, went through the onboarding, whatnot, and then I had the conversations in terms of what those imbalances and those discrepancies and things that I would have liked to have a little bit more strong. For just an example, in the case of an ACL, the posterior chain has to be really, really strong.

Reason being that the way the ACL works is it prevents the shin bone from sliding forward. So the back of the knee, the posterior chain, the hamstring, that sort of thing has to be really strong to prevent that from happening. So if the quads are really, really strong and the hamstrings are really, really weak, that's an imbalance. That's a force couple that we're not a huge fan of from a preventative standpoint. So it was identifying him, showing the numbers what they look like, and then having a conversation as to why that's important for them not to look that way. It's really important from the buying standpoint because, again, people can say they feel different ways and whatever it might be,

but if the numbers match the subjective complaints and having the conversations of why that's important and applying it to further those goals. That's really important for him. He didn't really need as much of that for a lot of our clients. They do, but the numbers don't lie. And we make sure we appreciate them. Part of the reason why a guy like that is such a high level athlete is because he buys into the process of the people who he trusts to help

them. So I imagine if his coach is like, Hey, Max, we're going to do sprints today. He doesn't ask, Hey coach, um, I was watching a YouTube video and they said that we shouldn't do sprints as rugby players. Can you just explain to me why we should do sprints? He's probably just puts his head down and does sprints. And that's how you get where you need to go when

you're working with the right people. What I would love to do with you, Ryan, is we're going to take a short break. And after the break, I would love for you to talk about how to train the posterior chain, the hamstrings, the glutes, the muscles on the back of the leg so that they can protect a knee because there's a right way to do it. And there's a less right way to do it. Not necessarily the wrong way, but there's definitely a better way. So we're going to come back and we'll talk all about that. Cool. Sounds good. What's up shrug nation. Are you enjoying this episode? I bet you are. I'm going to keep this brief. We'll get you right back to the show in a moment. In the meantime, if you're interested in anything that we're doing at active life,

make sure that you head to active life, rxcom slash shrugged. You want to be a better coach. You want to help your clients better. You want to get out of pain, but you don't want to go to the doctor or miss the gym. ActiveLifeRx.com slash shrugged. That's where you need to be. We'll see you when you get there. Turn pro. Here we go back to the episode. All right. I hope you guys enjoyed that brief commercial break. And if you like what you heard, take action on it. You can pause the podcast, go do that, and then come on back here and listen.

Now, so Ryan, we're dealing with strengthening the posterior chain so that we can protect the knee. Are we talking about sitting down on a machine and doing a bunch of hamstring curls to keep the hamstring strong so the knee doesn't explode? More often than not, no. Not to say – so one of my favorite sayings is there's no such thing as a good or bad exercise. There's no such thing as a right or wrong exercise, but how it applies to the client. But I actually did not program that in for him. Reason being, long story short, that particular exercise puts a lot of torque on the knee

joint. So that was not something that incorporated. Okay. So I would love to understand how you are going to strengthen the hamstrings specifically, because really we're talking about the hamstrings here, right? I mean, there's a little bit of gastroc that can help out with this because it goes above the knee, but this is going to be hamstrings mostly, you know, popliteus is a muscle that would cross the knee on the backside, but we're not really training popliteus very much. So how do you then specifically load the hamstrings for the

purposes of protecting the knee without putting that torque that you described on the knee well so it first just starts with looking at the overall programming and making sure that we're not identifying something as a strength deficit and then and then making the mistake of well that's weak let's just load the shit out of it and do too much to it whether it's something like this and okay it's hamstrings are weak let's get them strong and just start incorporating random hamstring exercises or when we talk about crossfitters single arm high pulls through the week let's start doing them start having them do four by ten four days a week and that's the worst thing that could ever happen to the shoulder because now it's too much too soon and now the shoulder is irritated.

So we're always making sure we have some sort of gradual volume buildup in terms of exercises we're implementing. With that said, specific exercises, we always want to make sure we're keeping a balance between what we call a closed chain exercise and an open chain exercise. For him, that ratio is a little bit more biased towards the closed chain exercise for numerous reasons that I'm not sure if we'll get into this podcast. Before you go any further, can you break down what's the difference between a closed chain and open chain exercise? Okay. So closed chain is essentially anything to where either your hand or your foot is planted and your body is moving around that planting. So if I was to do like a reverse lunge with my left leg being planted,

my foot is screwed into the ground, and now my body is moving around that foot and that screwing in mechanism. So that's a closed chain exercise versus if I was to do like a standing hamstring curl. Now my foot is being lifted up and I'm kicking my heel towards my butt up and down. I'm still training my hamstring, but it's in an open chain movement. So for our athletes who are doing more cutting, more planting,

more jumping and landing, that kind of thing, we're usually going to have a little bit of more of a bias towards a closed chain exercise because it's a little bit more sport specific first reason, but it also engages what we call like a neuromuscular efficiency so all the the nervous system and all the muscles have to be active to keep that joint strong in those different planes of motion where that's not going to be happening as much when we're just doing something like a standing uh butt kick for example and and why not how does that change things because i want i really think it's important people understand when to incorporate each. And if I'm doing a standing hamstring curl, my hamstring lights up. I mean I can fatigue my hamstrings, especially if I lay flat on my belly and do hamstring curls in a prone position.

I mean my hamstrings, it could be a bad day in terms of how sore i am so why is that the wrong way to train it if we're just looking to get change across the muscle what's what's the difference yeah and i'm not sure i would say it's the wrong way it's just sometimes not the most efficient way when the application is back to a sport related movement so we can do that to make sure that the hamstring is strong and that the capacity for it to activate and be strong is there, but then we're usually going to implement it into something, again, like a sport-specific movement, like a reverse lunge or a single-leg squat

or just a double-leg squat because, again, it mimics the sports-related nature of that type of movement. My hamstring doesn't need to be strong doing a standing butt kick kind of thing because that's not a movement that that hamstring needs to be firing to keep the ACL healthy when he's going back to playing rugby. Whereas when he's doing rugby and he's planting that leg into the ground, his body weight's going left and he now has to change direction going back right. And that hamstring has to be super strong to make sure that that tibia isn't driving forward.

And again, for a knee that doesn't have the passive structures hanging onto it, that hamstring has to be firing it the right way. Or again, that knee is going to buckle and bad things are going to happen. So it's the implementation from like the training and this return to sport back into the chaotic nature of activity and competition, where the bridging of the gap is a little bit closer versus me laying face down and doing butt kicks and now going again running full speed under fatigue someone's trying to tackle me and now the hamstring has to be able to do the same thing the gap is a little bit wider yeah and another simple way for people

i hope i'm explaining that the right way you are you. You are. And I'll add a little bit to it. A simple way to think about it is if you lay and do prone hamstring curls, you can grow your hamstrings. They can get bigger. You can get jacked. That will work. The thing is the neurological input, your brain-to-muscle input, brain-to-joint input isn't going to improve doing anything except prone hamstring curls. The hamstring has multiple functions. Some of them are not curling the knee. For example,

they could be breaking. It could be helping you to slow down. It could be helping you to plant and change direction across multiple joints. If we don't train those things at the volume and frequency that matches what we're going to need them for and we do too much time building hypertrophy, then we might end up with a really good-looking, strong hamstring that can't break and ends up blowing your knee out again. Cool?

Yeah. All right. So carry on. So he's going to – maybe – I mean in this case we didn't but maybe in your case you might find yourself in a physical therapist's office doing some hamstring curls understand your physical therapist is not wrong what they're probably trying to do is re-educate that muscle on how to go through a full range contraction potentially build somerophy, especially if you've been not weight bearing for a while and you've atrophied. So that you can produce more force through the ground when they go to closed chain exercises.

And again, there's always a right and wrong place for that type of exercise. Early on in a rehab phase, perfectly acceptable. And for him, again, when he had progressed all the way back to full competition and playing, hamstring curls were actually something I implemented when he was doing more of that hotel-type training. Last thing I'm going to have him do after playing four games in a week is now start doing reverse lunges when his body is just beat up

and he's sore and just not willing to do anything. I gave him 10- to 15-minute pieces where hamstrings were a part of it just to make sure that they're still having that low-level adaptation strength that is needed to, again, be strong when it's called upon when he's playing. But implementing full reverse lunges and front squats and that type of thing after the accumulated volume and feeling beat up at the end of the week, one, it wasn't efficient.

Two, he wasn't going to do it. And three, he didn't really need it. So a little bit of the hamstring curl stuff,'s what he needed that's what you know that's what i gave him so again there's a right and wrong place for everything but that now overall programming wasn't hamstring curls but again just trying to appreciate that there's you know there's no right or wrong way going about it we're just making sure we implement the pieces accordingly right so what did he can you tell us what like a day in his program looks like yeah um off the top of my head i mean so yes i can't answer your question i don't have it up in front of me um but essentially to in a nutshell it was when he would go into the gym um i would

always so this was just using the scenario of when i was being a um like a 20 of what his overall programming was going to be so i had his whole programming he would send it to me i would audit the programming and i would align my programming that i would send to him through our through our app true coach um it would line up to what he was doing in the gym so on a day where he was doing some some double squatting and just general hypertrophy and strength type stuff, I was making sure that we incorporated some single leg movements because, again, from his physiological makeup, he needs that single leg strength. But also in his testing, it identified that that right leg was super weak when, whether it was a front rack step-up with some heavy weights and a dumbbell or a loaded barbell in the front, whether it was some reverse lunges, whatever it might have been. I made sure that we were doing maybe an extra set or two on that right side to keep things balanced so that when he went into his general team strength conditioning stuff with the double leg, we weren't continuing to feed into that single leg discrepancy. In addition to that, through our testing, we identified that he actually had some relatively poor resiliency

to fatigue. So we do something that's called a biofeedback test. And all his biofeedback tests were negative, or he failed those. It's what essentially tells us that he's more of a strength-based athlete than he was a stamina-based athlete. And if you're familiar with rugby, it's essentially you're just moving and running into objects and trying to pull objects for long periods of time. And if there's any indicator for injury, it's when people get really tired and they're trying to do things when they're tired. So like late in the game in the fourth quarter, that's when a lot of injuries occur. So those are just a lot of elements that didn't fit to what he needed so we did a lot of um time under tension type pieces um so we would do just loaded carries because again his uh his stamina testing was a little

bit weak but also through his farmer carries test they were pretty weak as well so we did some single leg work we did some carrying type stuff we also just gave him some weight and just had him move around for a little bit. That would just be an example of what we would do for 15 to 20 minutes. And then once he wasn't completely gassed, now he got the important elements, again, from like a strength and training standpoint, but also a preventative aspect. And then he would go right into the team workout.

So there's no having to trade off essentially it's not that he has to take a step back from what he's doing in the gym and and just focus on what we're doing we can still have the best of both worlds which i think a lot of clients um are confused about that they have to give up training cross or they have to give up training whatever they're doing and just go to what we're doing which isn't true we can make sure that we're keeping everything balanced you know a day like that, it was 15, 20, 25 minutes. And he followed up with another 45 minutes of the stuff that the team had been doing that day.

And what is the value of a single-arm heavy carry for somebody who's going to be running top speed? Well, top speed or just for him in particular? Let's do him in particular. Because I just meant he's going to be running top speed in his games. And you're talking about him, him needing to do a better job of resisting fatigue. Yeah.

I think he's going to be running top of his feet, but he's also going to be doing that with, with six dudes trying to pull him to the ground while trying to run. So the implications were him taking 135 pounds on a farm or a farmer carry bar and carrying that for 100 150 meters that mimics a lot of what he's going to be doing in a training type state you know so again the sport of rugby there's not a lot of moments where you're just not on it's not basketball where it's it's go go go you stand and rest go go go, stand and rest. It's a moderate level of activation and exertion for very long periods of time,

which again, from a translation standpoint to the single arm farmer carry, it's not where it's a one rep max. You're not carrying it for 10 meters. It's something that's relatively difficult, but you should carry it for 45 seconds to a minute and a half. And your body should be able to withstand those forces without crumbling into a pile of mess and so for him um if we identified that he wasn't very good at it simply put he would carry it and

the biofeedback tests were essentially we're doing a test and we're stressing the system in the retest he would continue to be short and again when we're looking from the pharma carrier we're going to relate that back to his deadlift he had a pretty heavy deadlift but the pharma carrier didn't match that so we want to make sure that we're we're looking at overall there's different strength ratios and trying to to address them as needed and for an athlete like him i imagine that there's some requirement for him to be able to be explosive. I mean, he's going to have to tackle somebody and he's going to have to put a burst through somebody every once in a while. So how do you balance out the need to have that

high-end explosive force with the need to be able to produce moderate force for a long time? I mean, we balance it in the programming by just making sure that it was implemented when it was needed. So that's not something that I eliminated from his programming. We, we still did, we still did heavy cleans, whether it was with a barbell or with a, with a kettlebell, we still did box jumps. We still did broad jumps. We still did medicine ball slams. But again,

if we're looking at things of priority and making sure we're addressing those first we also did something like a post-activation potentiation which is a fancy word for saying do something that's really really heavy and very slow and then followed up with something that's really light and very fast and very explosive what's an example of that let's let's hear an example of that uh that could be something as simple as a heavy uh five reps on a back squat and then just taking a step back and immediately going into five explosive jump squats towards the ceiling. And what's the value of that?

Essentially, you're training explosiveness. So you're training the nervous system in a different way. There's actually some really interesting research going out of post-activation potentiation, which is essentially saying we're not as sure it's as effective as you once thought it was. But essentially the benefits are you're training your nervous system to respond in different

stimuli so it can do something like handling very strong or very heavy loads, something like a five rep max back squat, and then implementing it into something very explosive so you're kind of balanced on both ends of the spectrum simply put um but that's something we would do because again i didn't want to make sure we were lacking on that the power and the explosiveness and then apply metric style of training because again like you said that's something he needs for for the

competition setting but from the preventative standpoint we want to make sure we're still incorporating those heavy slow time under tension intensity, high volume type pieces because that's what he needed at that point in time. Okay. Did he mention feeling a difference or was it just like, okay, I guess that I'm getting better? Because that's a hard thing when you're working with someone who's not necessarily in pain all the time, but they're at risk for injury. The way I like to describe that person at a workshop when we're teaching this to coaches is people who aren't hurt are all standing on the top of a big cliff. And it's a big area. It could be the size of a football field. But it's still the top of a cliff. Like picture those Mesa's in Arizona,

those flat top plateaus and, and they're blindfolded and they're just walking around and they have to walk the whole time. They don't know where they got dropped off. They don't know how close they are to the edge, but if you didn't tell them that they were standing on a cliff, they would all feel totally safe. That's what happens when you're training and you have no idea what your assessments would find.

Like that, to me, that's what every single client who we're not working with is right now. And if we assess them, we essentially take off the blindfold and tell them that's how close you are to the cliff. Now he got assessed. He was relatively pain-free. He worked with you for like a year. So I imagine six months in, he's like, all right, well, like, I mean, what's, what's the point now? Yeah. So that's a good, always a good conversation to have and again he's kind of an ally where he wasn't having a lot of pain but he did have the the pain of memory of having to go through two acl tears which is a powerful uh motivator to work with someone like us so and i think a lot of people can relate to that as well where they've been battling something

for years and years and they just can't figure out whether it's pain or injury um and they're just looking for the resource to to put everything in line and show them the light at the end of the tunnel and just have someone help them walk that way so but for him where he wasn't having a lot of pain and he was performing really well and he's on the top of the world i think he continued to appreciate that he wanted to stay that way and we could continue to show him that there were still a lot of things that he needed to improve in the weight room and through the program. And whether that's every three months or so, continuing to have a retest from the onboarding strength testing and still show that there's some discrepancies with the strength and how that can relate

back to the performance and potential injury on the field. I think it's just, it depends on each individual and each client. So again, whether it's pain as a motivator, whether it's performance as a motivator, whether it's having past injuries and just continue to show people why they don't want to continue walking the way that they are and why we need to maybe take a different route. It all applies differently and like you said if we were to unveil the blindfolds from different people we would all have different motivators but um

yeah and again some people at this point in time he's not working with us because he's gotten to the point where he has a really good idea of what he needs to be doing and he's in the off season right now um we just finished up the season so he might work with us again he last time he stopped working with us and took some time off and re-signed back up and he still might do that um but you know again some people get to the point where they don't they don't see the the benefit of it and we have a lot of different options for that type of person as well well i think the big thing one of the things that we aim to do as a company is educate our clients well enough that they don't need us forever you know on the active life podcast and if you haven't if you're not listening to the active life podcast go listen to that one too i have an episode on that that i call uh it's you

know be wanted not needed and and that's where we aim to be where we've educated our clients to a point that they don't need to work with us forever they should know what they're doing by the time that we are, you know, done, quote unquote, working with them. It's just a question of whether they want to be guided or if they want to do it on their own. And we create environments for clients who want both. So one of the things that I find interesting about a client like Max is he doesn't care what his strength numbers end up being. He just wants to know that he's as far from the edge of that cliff that we described as possible.

So are you making transitions with a field athlete faster from one exercise to the next than you would with a CrossFit athlete? For example, I know Amanda Barnhart is somebody who you know well is in your clinic on a regular basis is that you know with her we watched her like muscle clean 220 pounds at the crossfit game it was stupid stupid so ridiculous amanda if you're listening that was incredible um she's not like you're not going to stop going up on how much her muscle clean is going to be because we want that explosive upward force in that specific movement. But with Max, he doesn't care. Just wants to know he's as far away from injury as possible. So when do you make those

transitions with somebody like that? Um, I don't know if there's a right answer to that. I think it's, you know, again, if there's's something that we we really pride ourselves on is communication and for max and i if we didn't talk every day we were definitely talking every week and just continuing to you know to figure out where he was in his headspace in terms of you know being a high performing athlete but also someone who just wanted to make sure he was he was staying healthy and doing everything that he could possibly do to stay healthy and not have something like this happen again. So having those conversations I think are really valuable. And for him, maybe it is a little bit different because, again,

he doesn't maybe need to be spending as much time in the weight room. He needs to be maybe spending a little bit more time on the field and a little bit more rugby specific. Again, I'm not sure if I have the right answer, but I think it's just continuing to identify where people are each day, each week, where they are in their process of growth and progress and seeing how much of a factor we need to be in getting into where they want to be in their goal setting

and achieving up those goals. So I'm not sure I have the right answer for that, to be honest with you. There's no such thing as a right answer. You gave me a good answer. What was the most challenging thing for you working with someone like Max? What would you say? The easy answer is the fact that he was on the opposite side of the earth. We had a 12-hour time difference.

But again, we made it efficient we were when i would be going you know i'd be get home from the clinic late and i'd be getting ready for bed at eight o'clock at night maybe waking up and we'd be having conversations on what the day looked like what i was expecting from him so honestly that was that was the easy part i think the hardest transition or the hardest factor was the was that he he was again, a high performing athlete, which had a lot of requirements from what he needed to do day in day out training and being a professional rugby player and the accumulative volume of what that required for his body to withstand and having a knee and a joint

that wasn't optimum, wasn't functioning optimally. It's, it's, it's really hard to incorporate all the variables and make sure that that knee joint stayed really, really healthy. But at the end of the day, it's taking something that's really complex and big picture. And, you know, there's a lot of things to measure and manage and, you know, not to toot our own horn, but that's something that we do really, really well. We take things that seem really complex in nature and boil it down to something that's something that we do really, really well. We take things that seem really complex in nature and boil it down to something that's very simplistic

that really anyone, again, someone like Max, who is on the upper echelon of being a high performer to someone who just needs to stay healthy to bend over and tie their shoes, it doesn't really matter. It's managing and measuring the variables and creating effective, long-term, tangible solutions for whoever it is.

Yeah. I mean, I think again, two, two, one of the things that we do really well and the thing that we aim to do is that we don't sell people on the idea of getting out of pain. We sell them on the certainty of what the path is going to be at all times. So when you go to a physical therapist in a physical therapy clinic, oftentimes what happens is you have a diagnosis from your MRI, from your orthopedist, from wherever it is, and then the physical therapist is going to do things. And even in the circumstances where they have the best explanation, it's difficult to understand because of the amount of touch

points that a physical therapist can have in person with you as compared to what we can do with somebody online of where you're at in your treatment process and where you're going. Since we're not a treatment process and we're talking to you every day, we can talk about things like, this is the next goal. This is what we want you to be able to do before we do this. And then every day that you do it, provide the feedback on what you did well, what you did poorly, how we're going to advance it. We're selling clarity. Again, it's not better than physical therapy. It's different.

It's just a totally different thing. It's the three Cs, right? We sell clarity, we sell communication, and we sell consistency. And if you have those three Cs of any program, it's going to be effective. Get in the gym. Do something. Hopefully something we tell you to do tell us about it and then you know make sure that we have the clarity on back and forth

of what we need to do moving forward it's a bulletproof plan yeah the fourth the fourth C's is confidence okay You're fired. Just to kind of go real quick touch on the, like you said, the MRI x-ray finding type thing. We talked, I just had a client before we jumped on this call, a new client who, the first thing he wanted to do was email me his MRI findings. And we never downplay the importance of something like that. But when we're talking about risk factors for,

for whether or not we improve and have the progress we want, there's non-modifiable risk factors and modifiable. Non-modifiable being things like MRI findings, age, gender, that kind of thing, which people put a lot of emphasis on. And when we're looking at the overall potential roadblocks

of what we have moving forward, that stuff isn't really as important as if we're looking at things like strength balance and range of motion and that kind of thing, which we can modify. We can look at those. We can address those through programming. Those are going to be a lot of the things that we put a lot of weight on, not MRI findings and x-ray findings and that kind of thing. Well, and a big part of that is also because if they have those findings and they need

to be in a clinic, then we can't help them. Sure. I mean there are patients who come to you as a clinician at Pure Physio in Cleveland who would not be a good fit to be active life clients. That's just the bottom line. Some people need to be in a therapist's office. And if their MRI findings are so severe that that's who they are, then that's where they need to be. So it's good for us to know that those things exist as they're coaches from a distance, but it becomes less relevant for us because we're still going to do what we do

because we're not treating a diagnosis. We're creating our own functional diagnosis through our own procedural assessment, which is totally different than physical therapy. Dr. Ryan, this has been awesome. And I appreciate you coming on today. Where can the Shrugged Collective fans find you? Yeah. So my, my personal Instagram, assuming everyone's going to go to Instagram at this point, is at doctor.ryan.sommers. And then our business account is at pure underscore physio, P-H-Y-S-I-O. That's our business account located here in Cleveland. And you guys do a phenomenal job on that account. It's not just another, oh, here's patient Sally with a rubber band. It's a fun account to follow.

Every time you make a post, I learn something. So I highly recommend you guys go ahead to pure physio and follow it. Head to Dr ahead to Pure Physio and follow it. Head to Dr. Ryan Summers and follow it. Those will be in the show notes. Thanks so much, man. Appreciate it. My pleasure. Good talk, my man.

That's going to be a wrap for this episode of Active Life Radio on the Shrugged Collective Network. I hope you enjoyed it. If you did, please head to wherever you listen to podcasts and leave us a five-star rating as well as a great review. If you really love this episode, make sure you're sharing it with the people who need to hear it. Value unshared is value wasted. to get more from us, whether it's coaching courses, one-on-one coaching from one of our staff members to help you get out of pain without going to the doctor or missing the gym, head to ActiveLifeRx.com slash shrugged. We'll see you then. Turn pro. Thank you.