The Research Rundown (Ep. 5): Tommy John Roundtable — What the Data Tells Us (Dr. Michael T. Freehill, Dr. Steven B. Cohen, Brian Schulman, Paul Buchheit & Joe Rauch)

[Music] Welcome to episode 5 of the Research Rundown presented by the Inside Athletic Training Podcast. In this episode, we're sitting down with five of baseball's top sports medicine professionals for a roundtable discussion on the Tommy John Epidemic. Joining us are Dr. Michael T. Frehill and Brian Schoeman of the Athletics and Dr. Steven Beacon, Paul Bukkeit and Joe Rausch of the Philadelphia Phillies. Enjoy the show. Hello and welcome. My name is Joe Rausch. I'm just an athletic trainer with the Philadelphia Phillies. Welcome to our latest installment of the Research Rundown on the Inside Athletic Training Podcast. Today, we have a really great episode in store with a roundtable discussion featuring athletic trainers and team physicians from the top of baseball medicine. Joining us today from the Sacramento A's, head team physician Dr. Michael Frehill and senior director of sports medicine and performance Brian Schoeman. Also with us from the Philadelphia Phillies, my partners in crime, head team physician Dr. Steve Cohen and director of medical services and head athletic trainer Paul Bukkeit. Fellowes, thanks for your time. You've all been previous guests on the podcast before, so I say we just dive right in. Our topic today is one that we're all passionate about, one that everyone here today has published an article related to in the last couple of years. And we're going to look into the dynamic stabilizers of the medial elbow and Dr. Frehill, I'm going to start with you as an associate editor of the American Journal of Sports Medicine. You recently published a commentary kind of highlighting the role of the dynamic stabilizers in the bigger, broader kind of Tommy John epidemic and saga as you put it. We just give us an idea of what properties you'd make the commentary, maybe where the research has been that's led us to here and we can start diving into it. Yeah, yeah, for sure. And thanks for having me. It's a great group and an honor to be here. So, you know, I think that compared to a lot of other sports, I think baseball medicine is outstanding. I mean, we have a lot of interest in looking into things and doing research and trying to make the game better and avoid injury. So, you know, there's a lot coming through from a baseball research standpoint, which is good. But, you know, we have the same problems year after year, after year. And, you know, we try to go backwards, I think, with a lot of research that we can get into later. That's just giant retrospective type associations and whatnot. Not to say that I don't do the same and not to say that they don't have a place. But, you know, all the more baseball research coming out than ever with little change in the impact of what's happening with regards to injury in my opinion. And it's easy to assign velocity as the main culprit and easy to assign guys are bigger and stronger than they've ever been. And this is just the way it's going to be. And I think we're falling a little bit short there. For years, a decade now, I've been interested in what's going on in a more granular level with the Flexur-Pronator Mass. And it started with the youth pitchers. And we know that that's the heaviest concentration of UCLs that we see outside the professional game. And just what's going on with the Flexur-Pronator could that be fatiguing? And that's what's leading to increased stresses being born by the Tommy John Ligamenter, the UCL. And to me, even beyond the youth and going back to Pro Baseball, it started making more sense. We just hadn't gotten into the weeds yet with these, especially now I will say that with regards to pitch design and what is being, you know, deployed is probably better than it's ever been. And more exciting with these different pitch types. So we just don't know what that means and what kind of upstream effects it's going to have on the Flexur-Pronator. So that's where this all came from. That maybe, hey, we shouldn't just be thinking about velocity and going down that road. But maybe we need to get more granular with what's going on with the Flexur-Pronator Mass. And is it fatiguing? We know what muscles, FDS, and FCU. And now the pronators coming on board. How much, how important are those and if they fatigue in what time frame is the UCL seeing the stresses and with time can attenuation start to take place and then have catastrophic failure? So it was a long-winded answer, but that's like the 30,000-foot view of like my thought process and why I wanted to get it out there. Yeah, that's a great summary, Dr. Fiel. So you talk about the elephant of the room is like, hey, we have a lot of information that's coming out. It's really good. But we still have the same injury rates. And there is the, maybe the focus is on the performance aspect and the pitch design and quote unquote, cooking pitches and velocity. But that's not going to go away because that obviously is needed for pictures to do their job and to have a job. So what, you know, Dr. Cohen, Dr. Fiel, what are your thoughts on, can you achieve both? And is that something that is kind of a shift in focus and what are those things that could help us do both at the same time? Well, you know, I think just a kind of dub tail on Mike's great introduction. You know, I think we tend to want to think about one factor that's going to lead us to the answer, right? I kind of like the UCL to be ACL and obviously the one letter of change is not there. You know, there's no coincidence there. But, you know, we think about ACL tears and, you know, lead level athletes and we think, well, why do they still happen? Right? I mean, why does a professional running back, you know, why is the rate of ACL tears still high? And, you know, when you, either you reconstruct an ACL or you have somebody who tears an ACL, you think, oh, there's got to be one factor here, right? There's, oh, well, it's, you know, they didn't train well or it's the surface. These are so multi-factorial that I don't think we can even add up the number of factors that go into this. And, you know, and the reason why I say that is because, you know, we have the flex and pronator, we have, you know, pitch design, we have, you know, the kinetic chain. We have all these things that are playing a role here. And there's probably a hundred factors that go into somebody injuring their ACL. And, you know, all these studies that we're doing and again, great publications, you know, a lot of things that are coming out that are great. But most things are really kind of looking at one or two factors and, and they're missing probably 98 of them, you know, in our, in our design. So while I think it's incredibly helpful that, you know, we do this, like we, we add the, you know, the flex and pronator, are we, are we, is there, is there fatigue that happens when, you know, that's leading to this, this catastrophic injury that, you know, Mike said. But I think there's so many factors that go into this. I mean, we have a lead level, sci-on level pitchers on throughout the league that are trying to add a pitch, you know, in the middle of the season or after spring training or, you know, and so these new factors, well, how we, we, the guys are changing grips on a pitch that they've thrown for 15 years and then trying to change a grip by making little modifications. Well, how does that factor into what we're doing here? So I think that, you know, when you talk about pitch design, and again, I'm going to be as long as I did earlier, I don't mean to say you're long-ended. You know, when we, when we change, when we change one little factor, that sounds like an American league national league thing, or, you know, exactly. When we, when we change one factor, like, how does that, what is the downstream effect on that? And so the answer is, no, we're not going to be able to change velocity, what, what they're trying to do to get hitters out, but can, what, what can we do to aid them into preparing them? Right? How can we, how can we impact their soft tissues so that they are ready to do those things? And that's what I think is probably the, the, what we're really trying to get at today. Yeah, that's great. Um, there's a nice little bit of soft between the, the positions here and I really love that. I mean, I was going to ask Brian and, and Joe too, but Brian, you're in, uh, you're a senior director role, right? So you're getting the gray all the time. How do you take that information and, and what are your thoughts? Can you, can you work on both at the same time? Performance and health and, and how do you do that? Yeah. So I think that's a great question. But, you know, before I just wanted to take a step back and, you know, I know Joe and Paul, this is your podcast, your baby. So you're not going to like touch yourselves in the back. But you guys took a major step forward last year, year before when you guys put out this grip study, the, you know, and how you guys did this because that is actually actionable items that has been brought to the forefront now, right? And, and Mike alluded to, you know, there's a lot of retrospective studies that it go on. And we hear them, um, you know, we read them. We hear them when they stand up at, um, you know, whether it's Dr. Amod's course, whether [BLANK_AUDIO] when our meetings and it's great information to know it, but we need to have actionable items. And how can you work on effective performance and how can you also mitigate those strengths? And I think you guys took a major step forward. I think you opened the eyes to myself, to Dr. Frehill, we jumped on and was like, look, we need to start doing this. Dr. Frehill, back in, what is it, I got it right here, what year was it? Mike, you're still at Michigan. So your hand size article was published and. - Oh, it just got, I mean, we did that back in '98. - It was just published, but yeah, you guys didn't want everybody, but COVID happened and there was all. - You okay. - So, but it was a step forward. It was another national item. Hey, what can we look at? And so, we often get the question that's asked, hey, is this, sometimes we get the question that's asked, sometimes we don't. And Paul, you probably got it, Joe, you got it. Hey, we're thinking about adding a new pitch. Is this safe, right? For years, I got the question, or I heard the question, hey, can we add the splitter? What do you think about adding the splitter? And my answer was always like, no, it's just the most dangerous pitch, but I didn't really have any concrete evidence. It was just like, that was just all my thought process. And Mike and I sat down a couple of years ago, and we're like, we need to figure out a way to do this. And it was not scholarly, it was not academic, but along with our Leedsport scientist, Ethan Stewart, we were able to get NARAXON sensors and we placed them on FDS, FDP, Flexor Perinator, and FCU. FCU, thank you. And we first held the splitter in our finger, in our hands. And Mike threw his splitter when Mike was pitching. So he obviously had a little bit more of a background to do it correctly. I'm 5'9", 5'10", I have many hands, so it didn't really work that well for me, but that actually goes in hand with Mike's article because pictures come in all different shapes and sizes, and they all have different hands. And is this pitch safe to throw? And we first saw as we held the splitter and all of a sudden the EMG study lit up just by ripping it. And we're like, okay, that we're onto something here. And we attempted to have, we had about six pictures, we only had six pictures in our minor leagues at the time actually threw a splitter. And it was really interesting because we took pictures of all of them, all six had different grips. It was not a, if there's not one traditional splitter grip, right? Some is a fosh, some is a fork, some split the seams, what not. And when they threw the pitch, nothing really on, when we did the, broke down all the data, nothing really changed. Okay, obviously there's some limitations, right? It's sensory, it's sensory level EMG studies. The pads probably slipped around a little bit. We're not gonna publish it. This was more for our own knowledge. But the point was is that we took it the next step and we're like, let's just get some answers. But we knew when we held the ball, that the magnitude of the amplitude of the sensory is like increased right away. So something has to change. And then all of a sudden there was this article that was published about like the next year at a Japan, Oshima did it and basically showing that the, they use sheer wave, the lastography, showing that there was increased muscle hardness with the fork ball grip. Okay, again, amazing because now we've got some academic evidence on there, but that's just a static measure. You can't hold a sheer wave device while someone's throwing. We're not gonna put fine needles into someone's muscle groups while they're throwing or maybe we can't, maybe we can get some lab rats, but it's not gonna be, as advantageous as otherwise. But that's again, another long-winded answer, but yeah, you can do some changes and you can look during the year because you can start looking into things and we can start getting an idea of like, hey, one is what is appropriate to do. I backed off and I was like, yeah, maybe the splitter is okay. Let's try it and see. I think there's some other tools that are coming out these days. Mike obviously has some interest in this, but in terms of looking at, how much force is being impacted on the ball, and what does that do when you add a pitch? But the question is, pitch design's great. And if you talk to Dr. Meister, he's death to the sweeper. Everyone wants to throw a sweeper, everyone is gonna get hurt if they throw a sweeper, but that might be true if you can't throw the sweeper because you might just not have that physical ability to do it. So you've got to look all the way up and down the chain. You've got to look at a whole different number of factors to determine, is this right? But when you go all the way back to like the youth model, they see it on Instagram or they see it like, hey, so and so is throwing the most wicked sweeper. I want to do it because it's going to get me to the next level, but they really can't. And then they wind up with Dr. Colin, they wind up with Dr. Freehill, they wind up with any of the other comrades in baseball medicine because they're probably on the table because they did something that their body couldn't do. So there's my answer. So proud. - This is great. You started peeling back a lot of layers here. Before we move forward, I do, by the way, I don't think I was involved in the reviewing of that paper, you guys all as authors in the Philly's group because I echo what Brian said and I quote that in all the talks I give now, where you guys, it's so hard to do a prospective study. And the fact that you guys could pull that off in professional baseball, measuring the pincer's strength and the hand grip strength, doing that over the course of a season, getting people to buy into it, and just and seeing it through and then looking back and then what you found, I agree. I mean, that's impactful. And guess what? It's a heck of a lot harder to do that because you gotta have manpower and you have to buy in and you have to have consensus and everything else, but that's what moves the needle to me. So I echo that 100% with Brian. Going back to the split thing, it's pretty fascinating because since that point in time, when we measured those, like he said, we only had six guys in the whole minor leagues. And the other thing that was interesting when you looked at that, those grips is this hand sizes on these guys were vastly different. They would be on the seams in different ways, but some of their hands were so small, well, I shouldn't say so small. Some of their hands were smaller than the other guys. They were basically like blanching white compared to a guy with a bigger hand. And I think, I hope I don't mess this up, but I think, Brian, we were talking, I think it was Scott McGuff, who was talking about shilling. And I don't, I apologize if I got the wrong person there, but Kurt Schilling had a nasty split and a great all of fame career, right? And he told someone, my split grip doesn't feel, my forearm feels fine because his hands were so big, he just split his fingers. And his capability to do that is different than someone else. So I agree with Brian 100%. We shouldn't say that someone shouldn't throw a split or we shouldn't say that someone can't pitch design into a sweeper, but I think that what do the inputs look like probably more valuable than or more important than what the outputs are. 'Cause we're obsessed with the outputs right now. Velo, Spinray, Action on the Ball, Vertical Horizontal Plains, all that stuff, but what's happening upstream? And is there a way that you can develop, let's say a sweeper or a split, and you can make modifications, but understand what's happening with the inputs, I-E-F-D-S activation, F-C-U activation, pronator activation, if you can get less, you're working less upstream to get the output that you desire. To me, that, going back to this original question, Paul, can you do both? Yeah, I think you can. And I think that that's where it's gonna go, because I echo what you said, guess what? We guys need to get guys out. Winning is still at least at the big, big level, the most important thing we want to do it safely, but that's where the envelope's gonna get pushed. And so the question then, because- - Microbride, do you think that there's one, one out of any of the 30 organizations, pitching development group that is actually saying to themselves, this guy, oh, he wants to throw a split, he has the appropriate hand size to do that. - No, I don't. I mean, and I wanted to plead the fifth and not answer but I just. because you don't know and sometimes, I hate to say it, but like all Joe, you guys know, it's a players league, right? The player comes up and they start doing this and it's hard to tell them not to without like really empirical evidence. And even if you have that evidence, like for them, you know, they throw one pitch in the bullpen and they see, like, you know, they're throwing a split and they see, you know, such a decrease in spin and they see this negative and they see that, you know, they're, they're, they're, they're, they're, they're, drop and they see this nasty pitch and they're like, yeah, that's it. I'm doing it again. And that's just what happens. You know, I'm like, hey, you shouldn't do this. You just had Tommy John. You just had it. The name of the game is getting guys out and how can I do that? And I don't think that there's enough. You know, maybe in the, maybe in certain organizations and player development, they can do that, they can recommend it. But there's, there's so much, you know, matriculation across the league and people coming from one organization to another organization, one, you know, coming from colleges where they have, you know, that name of the game has changed so much too in terms of like, these guys have three years and they're, those coaches depend on winning, no matter what. And if you have a nasty slider, you're going to throw 90% sliders in college to get guys out because the name of the game is to win. It's not player development. So those guys come to our organizations somewhere and that's all they're throwing. Is that right or wrong or indifferent? I don't know. But that's what they're doing. And then it's our job to kind of help not our job in terms of pitch, or, you know, that's the, or player development of pitching coaches, but it's our job to like, find ways to allow them to continue to do that. And maybe we need to start changing our exercise prescription. Maybe we need to start increasing, you know, I've started going down the rabbit hole of a different isometric loading strategies. And something that like, you know, you learned in school years ago, right, it was in the books, it was in our time, apprentices, it was in all this, it was, you know, it was like, okay, you do this, you do this, you do this, and write in surgeons all the time, right? Okay, you got to do some, some isometrics into the wall, internal external rotation after shoulder surgery. But no one really thought about it at the time. Keith Barr out here in Davis has super elevated the thought process in all of his research in terms of isometrics. And like I've died then quite a bit. I know, you know, other, and a poll and Joe, we've talked about it. And some other guys have talked about it quite a bit. There's obviously some other devices that are out there to measure isometric strength and to train isometrically. And maybe that's something we need to do. And that's another way to allow guys to continue to have this performance during the season. Yeah, I just, I would, I would, I would agree with who you're saying Brian, but I do think we're doing a better job of having, of profiling pictures of what they are capable of. I do think that that's moving forward in a good direction to be able to say like a guy is physically more capable to be a sweeper, slider guy versus a guy that probably should be throwing cutter, change up, whatever. And and I think we're getting better. It's not to where I think we want it to be. And we're alluding to that piece a little bit from the standpoint of maybe having a better understanding globally. And this is like a shared responsibility, not just a medical response way, but a shared responsibility of everyone that impacts the pictures, the coaches, development people, all of that. Of the, of the, the impact to just a like a really like not thought of changing grip changes the function of the flexion pronator group, right? And changes the way it's being used. So that's where we see some of the soreness come on when guys start doing something simple as changing the way the seams are coming off their fingertips or something like that. That's where I think some of the research we're talking about here gets really, really exciting because we're learning more about how that is actually functioning, not just from a force production standpoint, but from a fatigue standpoint as we've alluded to. And maybe more importantly, I don't know the way, just the way I think about, but from a force transfer standpoint, right from the ground up and all of the things we talk about in Dr. Cohen, talk about all the factors go into it. Like that, that, that dynamic stabilizers of the flexure pronator group might be that last piece of the force transfer where things start to break down when it gets a little bit fatiguing. So when we start looking at the research that we're putting out and it's being put out and you reference the, the tendon hardness paper from Japan, like you start grouping all of those things together and you start seeing what makes up like the ability to stay healthy over time. And everybody's kind of pointed to kind of like danced around this a little bit, but what makes it most exciting for me is when we're starting to co-late all of the different information as people are diving more into this, I'm thinking myself as a clinician 15 years ago and it was like a wrist six way and you were done, right? And now we're learning how to train the FCU and how to train the, the, the, the, the, the, the. Fundus and, and get more detailed about that because on the pitch design side of things, Brian, you just said it. If a guy throws it once, it's in there. So this idea that we're not capable of doing it. I don't agree with. It's our ability to do it over time and repeat it. And that's where I get excited about thinking, maybe we can make an adjustment and how we're training and pairing guys that could make them more resilient to these changes and make them healthier over time. I don't know. I went off on a, I don't know. Joe, I, Joe, you did, I'm going to jump in with a quickly, really quickly. So because this happened and I don't want to, I mean, we can go on a whole nother, you know, like side tangent with this. But you know, all of a sudden, we took away the sticky substance, whatever it was, five, six, seven years ago, I mean, maybe it was four years ago. And, you know, yeah. You know, I think, I think it was, if you talk to Maxures or right here, stay in on a soapbox and tell you that that's why we had the rise in, in elbow injuries, guys are starting to death grip the ball because they can't, they can't spin it the way they used to spin it because of the sticky substance. But like he's not wrong because, you know, in, in Arizona, spring training, the ball, like your slider doesn't slide the way it's supposed to. And it's whether it's the air or whatnot and guys who aren't there, they, they get upset in spring training because they're not seeing the movement that they want to see that they're used to seeing during the year. And so they start death gripping in. We start getting more so on and so on, spring training. We started thinking about this from like, okay, just, you know, you try to educate guys like, hey, just relax. Like your ball's going to move the way it needs to move eventually. You know, Mike has done this incredible study looking at all the different baseballs across all the different leagues. And that's going to be coming out pretty soon. But sometimes, you know, some things that we, we saw is that the Japanese balls, they come pre-tack a little bit. And so, and these guys are throwing splitters left and right. And now is it a split? Is it a fork? Is it what not? I don't know. But like, maybe that's has something to do with it. Maybe they don't need to put the pressure that we need to. Maybe it's not just a split of the grip, but maybe it's the, like Mike said, the input. What is the input doing? And, you know, we don't have this sticky substance. Yeah, look, every, every guy still does something to try to get some tack on the ball. And I get it. But like, we are, guys are manipulating their grip strength so much. They're manipulating a little pressure here, a little pressure there. And that's what it is causing the output. That's what's getting the spin. So like, if we can train and we can help look at those inputs. And like, you know, whether it's not just like Joe, like you said, like, old school wrist six way and like, you're out. But like, hey, do we do some manual, long finger extension, some short finger or flexion and extension. Do we do some, some long and index finger ABA, A D, Dutch, and, you know, some, you know, other little grip strikes with that. And that's how we can, you know, let's go all the way back to Pulse Prussian. Can you do this during the year? Yeah, you can. How do you do it? That's what we're all here trying to solve. And that's what we're all here going to be continuing to try to trial by error. I think I, so Joe, I think everything that everyone say is amazing. I would, I would go so far as to say, this is so important that if the, and hopefully this is coming, if we're, if you're looking at your draft board, and you had two pictures that are that you're interested in, and you had input information, and they both, let's say, throw, you know, their high leverage, high-intensity guys who throw 60% sliders. If I had the input information and the FDS was working less, which is the most active with a slider, I'd take the guy that with the FDS that works less, 100% right now. I would take, I would draft that guy over the other guy. And I just, I think that what everything Steve said is correct with all the variables upstream, but it's kind of like a team going down to score a touchdown. There was a ton of variables to allow the offense to go all the way down the goal line. Now the goal, now they're at the goal line. And unfortunately, I think the flexor pronator is the barrier to the end zone. That's the last thing. All the things that might have led up, you know, scapular dyskinesia, weak core workload adding up and all those pieces starting to fatigue a little bit, but now there's more on the front. flexor pronear, whatever it might be. And if that's weaker, I think that's when you kind of get this least resist, you know, you're finally to the end, to the breaking point. And who knows, maybe if all the variables upstream are better or more balanced, then a little bit of a weaker flexor pronear can survive a little bit longer. So I think these are all pieces. And I think we do monitor. I mean, I see Brian and the guys monitoring, constantly monitoring, looking for imbalances, et cetera. But I agree with what you said. I think that there's minutiae with the grips. And this ball study that's coming out, you're going to be interested in why? Because you look at the differences between an NCAA ball and a pro ball. And I know where this is going to go when it gets reviewed. They're going to say, oh, is that clinically relevant? In pitching, guess what? It is. Because what's the difference in missing by this much when you release at 60 feet, six inches out here, when it gets to the plate? It's this much, and that gets hammered, right? So I think that the minutiae of the differences in the balls is a problem. And it's the best in the big leagues. And the major league balls, you know, they're hand-sown in Costa Rica. They have the least amount of variance. And that shouldn't surprise any of us. But are we doing a favor when we're bringing guys from college? And I remember this distinctly. You know, you get these college baseballs, and now they're rolling. So they're a little bit better, I think. But the same profile is different. The weight profile is different. And they put the ball in your hand. And I remember vividly feeling the baseball thinking, how in the hell do you do anything with this? And we went to short season A and Boise, and our pitching coach for those probably some people remember Zimmerman, crazy guy. And then Rover that came through was Bert Blileven. And the first thing they taught us all was how to raise the seams. How you drag your fingernail across that thing. How when you're rubbing it up, you're dragging your fingernail. And it was like, whoa, this is crazy. And that became part of the routine. Because if you couldn't raise those seams, you could not do with the ball, in my opinion, even close with what you could do with a collegiate ball. And that has to have some impact. And that, you know, so it's exciting stuff. And I agree with what's going on with the Japanese guys, they all throw splits. And I'm not so sure. If you get one of the ball that's made in the MPL in the Nepali is Mizuno. And it's not like, you know, you guys see the big league balls. They open up the carton and there's a dozen and it's in like a tissue paper. Right. And if you look at the Nepan leg, you open the box. And it's sealed, like in a sterile sealant, blue bag. And you open it and it's game ready. The tackiness is so much versus our balls that, you know, they use the different mud, Mississippi mud, in the ways that they rub that. And so I think it's cool stuff. It's fascinating. But I think there is some, you know, there's some information in the weeds there. And we know, you know, Chris Amade had that paper in AJSM a couple of years ago. And it not only showed that, you know, more velocity on fastballs, changeups, and sliders were potentially detrimental. But it started talking about the higher spin rates on the slider. So again, can you get the outputs and not necessarily just get fixated on velocity and spin rate? I could give rats ass if my spin rates down 100. But the motion and action or an electricity on that pitch is the same. And it's getting more widths or more miss hits or whatever. To me, that's the, those are exciting aspects that Nick sports medicine with performance. And ultimately winning and staying healthy. Well, you have a unique perspective, Dr. Feele, because out of this group here, you're the only one who actually pitched. I don't want to take away from Dr. Cohen and Joe. But yeah, you were the one living it. So it's a unique perspective. I go back to what Dr. Cohen was saying. You have all this evidence, right? But how do you translate? And we may not be able to isolate all these little factors. But it comes back to the medication of the clinician or the physician and the stakeholders in coming to a shared decision. And one thing I'm hearing from Brian and Joe is that it's maybe not just a one-pitch can you do it? Great. Well, how can you replicate that? Are you moving efficiently? Are you accessing the kinetic chain to maybe take off some of the stress of the FDS? And how do you do that? Time comes to my mind, right? Like having proactive planning, not just saying, OK, can you do this all? That sweeper was sick. Well, that's great. But can you replicate that? And maybe that's one thing that the focus on performance and health is, all right, can you do it? But can you do it over time? And can you do it efficiently? And can you build more resiliency into the body from an input perspective? Can you target maybe the types of pitches that are beneficial for certain guys? Like, yeah, we all have different anatomies. We all have different strength profiles and all that. But what is the best type of pitch for each guy? And also, if another pitch may be a little bit harder for them to do and replicate, what do we need to do to build up those inputs so that way they can do it? I don't know. I'm just rambling at this point. But I think like kind of piecing together with some of you guys said, it's making sense a little bit. But it doesn't involve a data point. It involves us. And I think, coaches. And I think Paul, that what you're getting at is there's got to be an education and communication aspect of this, right? Like Mike's saying, oh, I threw-- the guys are out there. They're floating in flat ground. They got their buddies sitting next to them. It's like, here's how I grit my sweeper. Hey, why don't you try this? They do that. They think it looks sick, right? And then they just keep doing it. But yet, they've never gone back to the pitching staff sort of where they never go into the training staff or the medical staff to say, hey, by the way, I just threw this today. This was great. I think I'm going to implement this. How can you help me be successful here? Right? So there's got to be pitching development and the medical side to say, oh, by the way, he just decided to do something different. We can help him with this. Let's help him with this. But-- 100%. We do it. Right? I had those conversations with our pitching coaches and spring training. And I'm out there watching sides and all of a sudden, this guy's throwing a split. I'm like, when did we start doing this? Let's help to train it. And Paul, like, you know, something that I want-- Paul, Joe, you guys know this. Mike, you were probably victim of this, right? Like, you've got a pitcher who throws at six sweeper. And it's great for that one bullpen. And then they bring into the game and it's OK. And then the next bullpen, they can't find it. Well, how many sweepers are they trying to throw them? They're trying to rip it. Same guy who loses their swing in the cage. And they don't just go do their two sets of six-- two sets of six flips and they go. No, they're sitting there and they're swinging 300 times in the cage trying to find their swing. And then what happens? We probably have it oblique or we have something else. Well, all of a sudden, they're in that bullpen or even the flat ground and they're trying to find it. They're trying to find it. Well, what if there is a way for us to help them find it? Mike is-- I'm not going to-- Mike is working hierlessly on something like that in some of his research and some of his and stuff. But if we know they're trying to do that, are we doing enough as clinicians to help them prepare to do that? Have we trained their bodies enough to do that? Have we trained their muscles? OK, what all of a sudden fatigue sets in, like Dr. Cohen said, upstream, downstream. They're trying to throw these pitches, but something else is not allowing them to do it. They think it's just the grip. But maybe it's something else. And we've got to step back and look. But again, Dr. Cohen said, if we don't know that they're trying to do something, we can't help. We can do our best. And we can bring the guy in. We can talk in the cast. All you do in this, what can we do? And we can start doing things the way that our own philosophy, organizational philosophy, what we think is best, and that's great. And we can do that, but what can we do to-- the biggest thing is just to train and prepare them to do what they need to do. And again, we talk so much about what happened after the fact. It's all reactive. And there's such little proactive stuff. and that's where I know this conversation is going. That's the way it is. what we talk about online offline between all of us. And I just think that's the, that's where it is. And that's in our game, right? That's in Pro Ball, where we're there. Who knows what's going on in the youth game? And unfortunately, Dr. Cohen and Dr. Freyhill, they have to deal with that, right? I think we all chose to work in pro sports and not have to deal with mom and dad and tell them not to do this because they think, you know, Johnny's going to be the next Kurt Schilling. But like, that's going on way before they even get to us and those things are adding up. And that's what's scary. - Brian, this makes me think, this is kind of taking me, as I'm thinking through this, this takes me to the differences in how we create our training programs in season versus out of season. And it makes me kind of, and we've done a lot of re-examining of what we're asking guys to do to be prepared in spring training. And I just, I think about just the, the power creating the tissue resiliency so that they can like chase performance, all right? 'Cause what we don't want to do is take away like the art piece of pitching, when a guy's teaching a guy what's made him so that's wanting what's, like we don't want to take that piece of the game away. So, let me tell you how many stories do we all know about? This guy taught me his grip and it changed my career, right? Like we've all, so we don't want to take that piece away. But I think from, for me, it's changed a lot about how I think I do our shoulder care and our form programming in the, to prioritize pitching, right? So can we be more aggressive? Can there be more time under tension? Can we push things in the off season when they're not competing? Can we get a more resilient prepared athlete to show up to spring training where the priority then becomes getting people out and winning games and on a college level developing, winning games as you said and things like that. And then we make adjustments to how we train those things from a volume standpoint, from a resistance standpoint, from a time of attention standpoint, and all of those modifiable factors that we can control. And as I think Dr. Cohen, everybody's kind of sit here a little bit. The educational piece of understanding the importance of the communication becomes like a vital piece to this, right? Because if I've got a shoulder care program for a guy schedule for that day, and we're at a moment in season where we're doing like, maybe like some higher resistance and some lower repetitions, but he's a bullpen arm that has thrown three at the last four days. And I know that he wanted to do a touch and feel that day because he's, as you said, maybe lost a pitch that he relies on. And I know that information now. I can make an adjustment on what I'm doing. And you can kind of do this like teeter totter with the weight room and like what's going on in the field and we can do this pie slice thing that's not going over 100% or buckets not going over. We're prioritizing things on the field in season. And that's where we're at, make the adjustments on the back end. And then how does that change in the off season when we don't have to compete? When there isn't that extra stressor and that extra thing. So can we be, you know, is does a 35-pitch bullpen turning into a 50-pitch bullpen, make the player better and then we can make an adjustment with what they're doing from an arm care standpoint? That's the stuff that I think about from a proactive standpoint is everybody's kind of talked about a little bit. - So it scares the hell in me, right? Like the off season. It does every year because I don't know where these guys, I mean, I know where they go, we talk to them all the time. Are they 100% forthcoming with what they're doing and how they're training some are, some are, some are going to their gurus to do their own thing and we don't know what they're doing and we might be prescribing one thing because that is where we think is going on. Then are they doing it? Then they show up just for training and we're there. And unfortunately, that sounds like a cop out answer, but I think it's just true. Sometimes we don't know. This year is scariest, how right if there is going to be a work stoppage and lockout, we can't talk to anyone, who knows what's going to happen. But in season, you're absolutely right. I mean, look, we may have our shoulder playing, like hey, we're going to do this with the guy. Okay, well, after he pitched, we were hoping to get six endings at him, we were hoping for him to go around 100 pitches. He threw eight in the third and he threw 105 pitches and it absolutely dealt. Okay, do I want to do the same program with him? No, we're going to kind of, that's the art form of what we do is we can back off a little bit or the guy threw two endings, but he threw 64 pitches, high stress, high effort, trying to get guys out and we need to modify. And the tissue resiliency is such a, and Joe used the term all the time. It's always like we talk or I hear you, you know, on the research podcast or whatnot, but like it's so true because like that changes all the time. And there's not like this map, right? It's not like this micro cycle that I'm looking at from like say an Olympic athlete and we know we've got a four year window to train them to peak at one time, right? Our guys are trying to peak every single time they pitch. And sometimes they do and sometimes they don't. And there is no blueprint. It's the constant adjustments in what we can do, that help us attempt to mitigate a bad outcome, medically, right? And how do we do that is by like knowing what they're doing, okay? Do we need to create more time under tension? Do we need to work on muscle endurance? Do we need to do this? And you know, I think there's some really unique new research that's coming out there and that's in out there. And even if it's not academic scholarly, but it's more, you know, just in house and like, hey, we've seen this working. Let's, you know, this is what's going on now. Like do we take the, right? I talked about Keith Bar and Keith, there's a ton of research out there about the tele-attendent isometrics, right? And using a force trace to develop, you know, tendon health for the patellotendent, right? But we've got tendons all over our body, right? We just talked for the first, I mean, we're still talking about it, like the flexor tendon muscle, the common flexor tendon muscle, the like, what do we do there? And do we need to research it? Yeah, it would be, it would be awesome if we could. It would be absolutely awesome if we could. Can we? I don't know, but we can continue to try and educate. Yeah, okay. Sorry for those listening, right? We had a couple of eyebrows raising on. Well, that's what we're all trying, I mean, I think that's what we're trying to do, right? Yeah, 100% as we're trying to do. Yeah. And it goes pieces together. Yeah, and Mike is trying to do that with some certain things. You know, we are, you know, constantly talking about how we can do that, and that's what we need to get to. And that's where it's, that's where this, you know, but not just the flexor tendon, but like the shoulder, the rotator cuff tendons, like what do we do there? And that's where this unique group that we have right now, like the six of us, the four or five buss, you know, are forward thinking and trying to look at this as opposed to just doing the same thing we always did and trying to hope for different results, right? So it's the classic definition of insanity. And if we don't look for different ways and we don't take some of that knowledge that's coming out and trying to apply it, we're not doing anyone any justice 'cause everything else is changing. So we need to change and adapt to them as well. Well, what it sounds like to me is despite some pretty sobering numbers and some trends, that there's some level of a light at the end of the tunnel. And I think in baseball medicine, we've shown in the past that we can mitigate some stuff. Our shoulder surgical trends in our labor injuries have regressed, like we've done a better job in those areas. We've seen some successful areas and common injuries in baseball. And I think we're all talking about a research pathway that hopefully can, I think, is encouraging from my standpoint because they feel controllable moving forward. And I guess that's a great place to kind of get everybody's thoughts on that specific thing. And we'll just roll around the thing. I'll start with you, Dr. Freyhill. But where do we go from here? Like, where do we go based off of what we know to impact our players and keep them healthy and performing at levels we haven't seen in the game before? Yeah, well, I think, stick a couple different things. So stick it on the ways to monitor the flexor pronator stuff. We know, did you see there was a Hoshika? So I think it was like Sports Medicine and Physical Fitness or something, it was like 2020. And another one of those papers, so index finger and middle finger, long finger, and FDS are the most important value stabilizers. And that's been shown again and again. And I shouldn't say it like that much. There's not that much out there. But they've shown that it's-- basically the same type of findings and then Mulaney and that group from NYU and they've had some interesting stuff too, maybe the middle finger and its fatigue is the monitoring that is the most important potentially if you're just talking about the flexor pronator outside of everything else in the body. So I think that we've all talked about this. We're all aware of this as is every ATC that's going to watch this and listen to this. But how do you do it? And there's various ways and there's various tools out there that you can. But the thing that's interesting that gets into some hand literature that gets into some of this stuff, you know, I guess that Brian was saying about Keat Bar, is can you and you guys will have a much better idea than this, but can you just look at something and apply it to how it's being utilized? And what I mean by that is we know that tendon muscle tendon length optimization with regards to finger flexors can't, doesn't work well on a sphere. So we have ways of getting that those numbers, I don't want to say artificially, but getting those numbers, but maybe not the way they're being utilized in the sport. And how much, how do we weigh that? It's probably better to have those numbers than have nothing, but do we still need more pieces to that? Does that make sense? So I think that that's kind of where I struggle with some of this and a lot of the struggle comes because when I bring this stuff up, Brian will kind of point some things out that I maybe haven't thought about, but I think that's where we struggle. How do you truly monitor and then on a side note, and I'd love to get Steve's ideas on this and your guys ideas on this is you start talking about the pitch design. I mean, we've had a couple guys and I'm sure you guys have two in the past few years and they start having some forearm discufferant. We kind of drill down on it a little. It's just like you said, they're like, I was doing flat rounds and started playing around with this and then I went into game and threw it. I mean, it's unbelievable. But I wonder to myself, do you, is the better time, even with it's hard to do this with a big like eye because when the season's over, the season's over, it is a better time to try to do some of the design at the end of the season, is a better time. When you roll into spring training, you have some time there depending on how it's set up. But I'm not a huge fan of what's happening now with, you know, you're expected to come into spring training and be fully ready. I mean, that's six weeks. I mean, that's crazy to me. And again, I don't know, but it seems to me that if you are, if you're one of the six starters that's pretty much in line and you have a spot, it used to be where they would come in and they would be on a plan to ramp. Like they might not even start introducing breaking balls until three weeks in. And again, I don't know if it's wrong. And that's a different beast than the guy that's coming in trying to win the fifth spot that you guys picked up free agent and that's older. He needs to come in at ready or the younger guys that are coming in trying to get a bullpen spot, you know, different beasts. But do we need to get back to being so granular? Because I do think the times have changed. Guys are trying to get better. They're going to these different facilities. And again, they're doing it with good intentions because they want to be the best they can be. But where's the balance of how much is too much? When can we implement these things to start pitch designing, do it in a safe fashion, make them ultimately better, allow your team to win? But when, when does this all happen? Those are my, my big questions. Yeah, I'm like, I think, you know, clearly there are different scenarios to every picture that comes in, you know, you mentioned it. Like there's, you know, the guy who doesn't really have to fight for a job and then there's the guy who does. And, you know, I think in the ideal situation, no, they're not working on something in season that they, or that if they are going to work on something in season, that it's done in a way that you would do it preseason, right, so that you could, you could say, okay, I'm going to develop this. Here's how I'm going to implement it. And everybody's on board with helping you do that, as opposed to, well, I threw it in a flat ground. I throw it in a pen. No, I throw it in a game and they are, they're not necessarily ready. But I think just to kind of not switch the gear, but I think we need to define what soft tissue injuries are. Right. I think, you know, we see this, whether it's an oblique or a hamstring or a flexor pronator. And you know, our, you know, our guys know this, you know, I'm fascinated with the idea of what does somebody look like after they've played in a game, whatever the soft tissue is. You pick the body part. We pick the flexor pronator and we're still working on getting this done. So I want to know when somebody says I have flexor pain after I've pitched and we get an MRI scan and it shows a demon in their flexor. Is that an injury or is that a response to what they did? Right. And we don't know that we, nobody can sit here and tell me that when, you know, an Olympic sprinter runs 100 and we were to scan him that day or the next day, would he have a demon as hamstring because he, he ran up a nine seven, right? So I think we need to define, you know, I know we're talking about prevention and we're talking about how to, how to accommodate activities, but we also need to define injury better. And so we need to know what a flexor pronator looks like after they've thrown 40 pitches or 60 pitches or 20 pitches. Did they, you know, what type of pitches did they throw? So I think we need to do a better job of all the things that we've talked about, but we really need to do a better job of defining when and if somebody has a soft tissue injury or this is their body's natural response to this. So that's awesome. Yeah, that's amazing. Steve, I think that that's going to be exciting to see what you guys find because I agree with you. I mean, subjectively, I would remember on days where I threw more sliders that, wow, and it feels like you get tar string in there. You know, I mean, it's just you have soreness, but again, is that a bad thing if you, you know, go, you know, go do some flushing or do whatever you do personally for recovery and then you come back the next day and and it's better. Is it was that is that a bad thing or was that just the response? Right. And then the question becomes, well, how, how many times can you do that? Does it worsen or is that just your response? You did a study couple and not to not in some of you have used these different types of recovery sleeves. I'm sure we did it with the kind of did a smaller study with the Stanford pictures that's in turned in now and have them do like a muscle soreness grade of their flexor after the game and and then they either got they got one of three different sleeves, but only one of them was the one that had this bioactive fabric, if you will. So again, it was underpowered because it was just a pilot, but it was interesting because the way that their flexor felt the next day and again, subject of soreness, but the literature and other parts of the body does support that that if you notice soreness, that's probably makes sense, right? There's probably more edema more whatever and there was a significant decrease even even though it was an underpowered study. So we had it in five places this year, five division one baseball programs and the seasons are ending obviously so we're starting to get that data back and I'm interested to see because I'll say I think the recovery piece is huge and one other point I'd love to get you guys take on and I don't know if I'm imagining this or not, but the running piece, you know, it's starting pictures. And those guys could run like deers because guess what, when they're starting, it's a boxing match and if they get into a long inning, the punches keep coming and those guys used to run, run, run, run, run, run in the relievers would be more some distance, but mostly sprint work. And I don't know why we've gotten away from that conditioning and again, you guys know much more than me, but it seems like that's a different piece that's kind of changed to a time. I would say on that front, the game has changed, right? The pitching economy is not rewarded as much as it used to be. And so you've got to maximize the kinetics on every pitch and how do you do that? Well, the strength conditioning model for that is a little bit different now. It goes back to can we train multiple systems at the same time and there's different periodization and all that. So yeah, I think there's, in my opinion, I think you can just the same discussion as performance and prevention. You can train them simultaneously, but going back to Steve's point about the study you're looking at on what is a lecture pronated look like after pitching when you're asymptomatic? I think that would be really impactful because that'll help showcase what the recovery is after pitching. And we know that high sprinting. high, you know, eccentric load takes two, three days to recover. So what are you doing in that time period of, you know, throwing afterwards? What are you doing from a recovery aspect to get yourself ready to pitch the next in the next start? That comes into play. It's not only just the kinetics of the pitch and the types of pitches and all that and the grips. It's, you know, how are you preparing your body to compete the next time? So I think that that's part of the dynamic here, which I find fascinating, right? Like we can talk about the tissue resiliency and the strength and all that stuff. But if you don't have the ability to recover, then you're constantly pulling away or withdrawing money from the bank. And at some point, it's going to, you know, go down to zero. So, you know, that's the multiple layer aspect that I think we can take to it. Dr. Phil, you mentioned the Mulaney study, which I thought it was a really good study. I liked it a lot. I actually think that p value is under what it should be because they're using an IAMU sensor to evaluate, quote, unquote, torque, even though they can't measure torque with that. And so, you know, I found one of their discussion pieces was fascinating. They said that that velocity was, was, and torque were not correlated. But I think it's because their measurement is not capturing the highest torques, right? There's a ceiling effect to the measurement tool they're using. And so for, you know, when we get into the research side of things, when you look at a biomechanics, that's the other piece is how are they measuring stress? And we know IAMU sensors will, there's a ceiling effect. They won't be able to capture the highest level. So, you know, the maximizing the spin rates and the velocities, not only the fastball, but all the other pitches, we may not be capturing that peak torque that we think we are, which I'm kind of interested to see what your guys' thoughts are on that because that's another layer of this is, you know, how do we help identify whether a guy is putting more stress on his body? It kind of depends on how you're measuring it. Yeah, that's a really good point, Paul. And Steve is all you guys review. And that's why these papers and these studies go out for review. And like Steve, with all of his experience and one he's done from a research standpoint is it's, you know, I learned so much just from looking at the reviews that he's made on some of these baseball studies. And you know, it's easy. And we all feel full-pray to this. It's easy to see something that came out and read the abstract and say and hold wave that flag and lose sight of the methodology at times. And you know, we all know these different devices that were out there early because the literature got flooded with a particular device that you know was quite frankly later debunked by Chris Camp of just of trying to say these are torques that are being seen by the media elbow. And they're all based on these kind of big database associations. They weren't even real. I remember being at Michigan working with some of those biomechanists. And they would give them some of this research and they were laughing. They're like, what you guys, these are your top journals and you guys are publishing on devices that have one sensor. You can't measure torque with one sensor like that. What's going on? So I, the point of saying that is that I think it's easy to forget how important the methodology is and are we truly seeing what we're seeing. And that's why I think some of the big retrospective databases and just trying to grasp that some kind of association is a little bit questionable. And depending on the types of stats you can run, and surely I'm not a statistical guru, but different stats can be employed, if you will, or employed, that can alter things. It's such a fascinating discussion. And as you can tell, there's a passionate group about something we really care about. And there's so many different dovetails that we can go off on. Maybe this calls for a second episode at some point down the line as we kind of have some more research come out. But maybe we'll just kind of cap this thing off with just some final comments from everybody. I can see Brian's been like chopping at the bit here for the last couple minutes. He's got some thoughts on a few of the things they've just come up. So maybe we'll just go around around the room here a little bit and just get some final thoughts on where we're at and maybe where we're going. So far away, Brian. No, I think Dr. Cohen said something. It was just, you know, unbelievably, like it just kind of resonated a little bit in terms of like, you know, he wants to know what those tissues look like. You know, after different stresses. And does an MRI look normal? Does it look abnormal? I've been victim too often than not sometimes at the of getting a scan too soon. And you don't know if there's true injury or not true injury. At the same time, I had the privilege in honor to review an article for AJSM about and is coming out of Japan. And they looked at the tissue. They did the same sheer wave tissue hardness of the flexure tendon at 24 hours post 48 hours post 72 hours post. And it was fascinating because they took it and they okay, that data can tell us how to possibly train and how to recover. The problem there's there's a lot of holes in that study that I think they just needed to clean up in terms of like how it can, you know, truly be effective. But it was a huge start. And I thought it was fascinating because the data is coming out there. And Dr. Cohen has this, you know, how the thought process of like, if we know how something potentially is going to look, then we can potentially know learn how we can train it and with what, with what tools to implement. And that is where it goes back to my point of like the actionable items that we can take to practitioners is what we need to continue to push forward. And it's stuff like that that just gives me really excited because we can actually take some of that learning and implement as opposed to be like, oh yeah, look, we did a great job because we got them back after Tommy John for 18 months versus 17 months or whatnot. And that is great. Had ourselves in the back, do this, do that, but it's not moving, pushing the needle to help guys get better. And Dr. Cohen just, I mean, thank you for bringing that up and taking those steps and Paul and Joe again, thank you for what you guys started a couple of years ago and growing on and that's just kind of where I'm at with that because it's stuff that we can help push this needle. And that's what we need to get to. Paul, give us your thoughts. Yeah, I would say we know that the injuries are going up and it was prediating any of the changes in balls and you know, attack and all that stuff, right? Because prevention may not have been on the forefront performance and retrospective thinking it was. So how do we take all this information and and put it into a prevention model? And I do think that's where things are going to go, right? We, I think the league is going to prioritize and value starting pictures who can go deep into games and can pitch, you know, 182, 180, 280 years of relievers, being able to go multiple days and row and be able to stay healthy but performing at the same time. So I think it's up to us and everyone else to try and boil all this information back in. But I think communication is limiting factor. You take all the information you want. But if you don't have what I think Joe mentioned earlier, if you don't have that daily kind of pass by discussion of saying, hey, listen, I'm looking to doing this. I want to do this. We don't have all the answers, right? We have to take our partners and pitching coaches and our strength coaches and mental skilled performance on skill acquisition. And how do we do this appropriately and add time and and prospectively look at how do we build stronger tissues that I think that that involves the offseason and involves spring training and involves stuff Dr. Fereal talked about is, but you know, what's your plan going into spring training? Is it to compete day one or is it to ramp up for the season? Just having those pro active discussions, you know, I think are the difference maker until we get more, you know, concrete data to say, okay, this is the exact program you should be doing. That's pie in the sky. I don't know. I don't think we'll ever get there. But that's a goal. So Dr. Cohen, you know, you just kind of summarize your thoughts on better understanding, but any final comments from you would be great. Yeah, I mean, I guess in some ways, I do go back to the CL again. You know, my daughter who you guys know, to some degree who's a bioengineering major, you know, we're driving in the cars. She said, why are there so many ACL injuries? And can we prevent that? And I said, yes, we absolutely can. There are there have been plenty of models that are programs out there that show that we can delay. We can decrease the rate, you know, Mike's published in the journal, all these numbers of, you know, prevention programs. But people don't utilize them. So I go back to the UCL. Are there ways to prevent UCL injuries? Yeah, I do think that there are. The question is, are people going to actually implement that into what they do and the answer to that is probably not? So I do think we gotta continue to do the research on all the things that we've talked about today, soft issues, you know, and preparation. But obviously until somebody says, well, I'm going to, I'm gonna modify what I do to help myself. We're probably fighting upstream on this. And, but I think that there's value in what we're doing. I'm not suggesting by any stretch that we were thrown in the towel here, but I think that we need to do a better job of educating, you know, from top to bottom. And if we do that, we have a chance. If not, we're gonna keep fixing people and we'll get them back. And, you know, and they will end up doing some of the same things that they did. And I'd see points of what we're doing here today, right? It's the continuing and a research side of things is continuing to communicate and educate and the value that hopefully we can all bring to that, you know, conundrum. Dr. Friel, we'll end with you on final thoughts. Again, thank you for your commentary. Thank you for all your research and everything everybody's doing, but I'll leave the floor to you to wrap us up today. - Yeah, all right. Well, thanks again for having me. And, you know, it's a feel honored to be, you know, and know so many in P-Bats and have spent time with so many ETCs that are just incredible. And, but I think that you guys all summed it up very well. I think that the thing that that's what most exciting to me and poll alluded to this is I think it's exciting times in the fact that, you know, we, on the physician and medicine side, or on, you know, we all want to have injury prevention, but, you know, we also want performance. And it's, you know, I mean, in my mind, and I've said this a numerous times and I have to tell parents every week, look at it, I'm not trying to curtail anything that you're, go on and make a ton of money and have a successful, major league career. But the question is how, you know, all these things marry. And to me, it shouldn't be a performance side and a injury prevention side. These, these heads shouldn't, but it's kind of like when the sports analytics started really coming in heavy, you know, I don't know, a decade ago, like teams really start taking it on. And then you'd watch a game and you're like, "Well, that's a team that makes all their decisions, you know, in-game decisions based on analytics." And then you'd have other organizations who didn't implement it as much. And I think, and I think that the truth is probably somewhere in the middle, there's some feel to it and there's, you need all these pieces. And I think that that's what's exciting to me and to see where this will go is we need everyone to come on board together and realize that it shouldn't be, you know, the performance versus injury prevention or shouldn't be the coaches versus the sports medicine staff in certain ways, but it should, everyone's working together to allow investments to pay off and hopefully pay off by winning. That's what I got. - That's great stuff. Yeah, I really appreciate it. It, listen, in the middle of the season, we're also busy in taking the time that we get together and have this discussion, I think is really impactful. So I appreciate each of your time. Appreciate us all getting together and talking shop, and we know we love all of these conversations. It feels like very similar to what we're doing in the training every day, talking about things like this and bouncing ideas off of each other. So to be able to record it and spend some time this morning with each other, I think is really great and mental out to me. So thank you each for your time today. And that'll wrap up this episode of the research rundown. Join us next time on the Inside Athlete Training Podcast. Have a great day. (upbeat music) [BLANK_AUDIO]