August 27, 2025 • 39 mins
Shownotes
We asked Jatin Ambengaokar about the importance of sleep in athletic and performing arts performance, how to measure workload in performing arts and other athletics, and the role nutrition plays in RED-S/RED-D
Timestamps
(7:35) Why is sleep important?
(9:59) How to improve someone's sleep
(14:14) How to measure workload
(20:31) Creating buy in on the importance of sleep
(25:55) Educating Stakeholders on the importance of sleep, workload, and nutrition in performance
(31:20) Interventions for RED-S/RED-D
Action Item: How can an AT start to implement workload, sleep, and nutrition monitoring/guidance in practice?
--
AT CORNER FACEBOOK GROUP: https://www.facebook.com/groups/atcornerpodcast
Instagram, Website, YouTube, and other links: atcornerds.wixsite.com/home/links
EMAIL US: atcornerds@gmail.com
SAVE on Medbridge: Use code ATCORNER to get $101 off your subscription
Want to host a podcast like ours? Use our link to sign up for Zencastr, the service we use to record our interviews: https://zencastr.com/?via=atcorner
Music: Jahzzar (betterwithmusic.com) CC BY-SA
--
-Sandy & Randy
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an athlete trainer comes
with ups and downs and we're here to showcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we're going to be talking about
probably the most forgotten big three of athletic performance
(00:25):
and injury prevention, and that is sleep, workload and
nutrition. I hope these aren't forgotten.
They shouldn't be, but I feel like when you talk to athletes
or talk to other people, sometimes those things kind of
get workloads, kind of get more mainstream.
But I feel like people often forget just the importance of
nutrition and sleep sometimes. At least our athletes do.
I feel like the importance of sleep isn't forgotten, it's just
(00:47):
the actual like. Execution.
Yeah, exactly. Especially if you're a student
athlete, Yes. And not only do we get to talk
about these big three, but we get to talk about with someone
who I am, I am personally so, soexcited to bring on.
I fangirled a little bit when I met, not only met Jatin and
(01:09):
Magonkar, but also when he said,Oh yeah, I know about your
podcast. I listen to your podcast only.
What? This is.
This is someone who I have literally.
I recognize his name because I have spent so much time reading
his research all through college, all through undergrad,
(01:31):
through grad school, you know, wanting to go into performing
arts and just knowing that he issuch has such a big impact in
this performing arts community. So actually getting to meet him
in person converse. So I actually going through this
whole process, we I also went back and and saw some emails
that we had exchanged back, way back when, when again I was
(01:55):
fangirling again because he is just so cool.
He is now a professor at the in the School of kinesiology
College of Education and human Development at George Mason
University. And then he's also a founding Co
director of the sports medicine assessment research and testing,
which is a smart laboratory. And he's the editor in chief of
the Journal of Dance medicine. That's amazing.
(02:16):
That's awesome. And I can go on and on about his
bio. I'm going to let you listen to
him. So is there anything else you
needed in this intro? OK, let's hear from John.
All right, kicking it off. With our first cryo breaker,
what element of athletic training represents you as a
clinician? This could be a modality, rehab
(02:37):
tool, tape, brace, etcetera. Any basically any tool of the
trade that represents you. Sure.
You know when we are treating oras clinician treating athletic
trainers, you always carry your Fanny pack, right?
It's got tape, it's got scissors, it's got wipes, it's
got old packs, it's got like dozen essentials.
People really joke about the Fanny pack look, right?
(02:58):
But really, when a performer andartist or dancer rolls their
knees, nobody's laughing, right?They're grateful to have what we
need when we need it. And so that's really what I
think represents me as a clinical practitioner, right?
We don't just have one tool. We have a whole set of evidence
based interventions ready to go.Maybe today it's sleep talk,
(03:20):
hygiene education for the exhausted core member.
Tomorrow it's nutritional counseling for someone showing
red symptoms or workload modification and rehabilitation
for a principal dealing with overuse.
Right. Just like the Fanny pack we have
to be. And I think I would like to be
prepared with multiple solutionsbecause every performer's needs
are different and some might think the comprehement SEM
(03:41):
approach is like too much. But when you are dealing with
the complex demands of performing arts, you're meet a
practitioner who's able to adapt.
So I think the Fanny pack, whichisn't glamorous, but it works,
right? And at the end of the day, when
the dancers are healthy, performing well, adoring
(04:02):
injuries, they don't care how I look.
They just care that I'm there for the need I need to help them
and keep them moving. I so that that I think helps
explain what I I think about myself as Fanny pack with
different tools and those tools keep changing and we need to
keep as a correct trainers advancing our clinical set when
we when we practice. That's awesome.
(04:22):
So does. That mean you're team Fanny or
team slain? Listen, Fanny pack all the time.
I go Fanny pack, keep my shoulders open.
I just can't pack so much more in a in a Fanny.
And usually we're not running onto the field.
I would love a sling back when we have more stuff we need to
(04:43):
carry on the field, but that's not in this setting commonly
done in the stage or something like that.
But so Fanny pack go Fanny, see.I knew we.
Were on the same side. I knew it.
There you go. I love that we always have
something for everything and it's like you always and even if
you know we're it's a it's a little flexible.
So you know, maybe you can't fiteverything in your fanning pack,
(05:06):
but you have something that can apply to different situations.
Absolutely. So another thing we like to do
on AT Corner is kicking it off with a story or some sort of
experience that you've had that kind of ties this together of
what we're kind of going to talkabout.
So whether that's sleep, workload, nutrition, something
along those lines, if you could kick us off.
(05:28):
Sure. So absolutely.
So I remember this case of a collegiate dancer who came to be
completely frustrated, like she was nailing her combinations in
the morning class but falling apart during evening rehearsals.
And everybody at class that kepttelling her try harder, focus
more, right. But as an athletic trainer, we
(05:49):
knew there was something else going on.
So something as simple As for had her track 3 simple things
for a wake. How much you sleeping?
What she ate for lunch and an energy level at 6:00 PM.
Turns out she was sleeping well,but eating a tiny salad for
lunch and then expecting her body to basically power her
(06:09):
through three hours of intense rehearsal with basically no fuel
in the evening. Right.
So we didn't change the entire diet, just asked her to add a
substantial afternoon snack withproteins and some carbs.
And within days, in the evening,she was able to land her gems
and get her combinations. And the solution then was really
what, what, what I would call itwasn't willpower, it wasn't
(06:32):
technique corrections. It was really treating the root
cause and addressing that issue of addressing our nutritional
habits. And that's what a cleric
trainers I think of of bring to the performing arts.
We can look at the whole person.We can use evidence based
assessments and find practical solutions that can really help.
So sometimes the answer is not necessarily in the studio, it's
(06:54):
how to prepare the body in orderto succeed.
So I think that's kind of an example where OK, yeah, yeah,
absolutely. So way to succeed.
A video to solve problems, thinkabout the person as a whole and
help them. Yeah, for sure, absolutely.
And that's why everybody and everybody needs an athletic
trainer. There you go.
(07:17):
I like it. I like it.
I completely agree. So something you mentioned was
that we that you looked into hersleep and even though her sleep
was was OK by the standards thatyou were looking at.
Can we talk a little bit? About why that?
Sleep component is so important.Oh absolutely, absolutely right.
(07:41):
So we as as clinicians, as humans, right, We need our 8
hours of sleep. 1/3 of our livesis slept sleeping hopefully.
And that sleep is crucial for tissue repair, memory
consolidation, hormonal regulation, host of different
biophysiological factors, all are essential for performance
(08:05):
athletes who really have to do this peak performance mentally,
cognitively and physically right.
And so it is very crucial for dancers, performing artists,
athletes to have good sleep quality and good sleep quantity,
right? Because both of them can affect
motor learning, can influence injury prevention and the
(08:27):
ability to execute what we like to call complex movement
patterns with precision. And in performing artists also
with aesthetic artistry, right, you need to be able to look
pretty. I don't care how Steph Curry or
LeBron James look. Well, they dunk, right?
They can dunk and they can be all sweaty.
I don't care. But when I, when I see a dancer,
(08:48):
I want him, her or they, they will have to maintain that, that
look that is visually pleasing also.
But there is similarly an aesthetic sport like gymnastics.
You need to smile, you need to be able to do all of that while
you are performing. And so that's another thing that
if you are not able to rest and recover, that mismatch between
(09:08):
ability to process multiple inputs, right, reaction time can
go down, decision making can go down, proprioception can go
down. And and what could be
potentially catastrophic for dancers who rely on that split
second timing and spatial awareness.
In addition, for long term, we've know and research clearly
(09:29):
suggests that increased injury rates exist in athletes.
We don't know enough about dancers and that's some of the
work we are looking at. But it is known to decrease
immune function factors. And again, both of those can,
across this season, cumulativelylead to a risk for higher
injuries. For sure.
(09:50):
So if you do have someone that you're like, Oh yeah, we're
seeing maybe the amount of sleeps not right or the quality
of sleeps just poor, How do you work on someone to improve their
sleep? Sure.
So, so starting first with recognizing that it is not a
problem to fix, but it is something that can be improved,
(10:14):
right? So once you start framing it as
like your dance will improve, your performance will improve,
you're going to get more binds, right then, right.
So I say sleep is performance medicine.
It's a quality sleep isn't really just resting.
You need to sleep because your body repairs itself.
You can consolidate new movementpatterns in your brain when
you're sleeping, you can learn better, right?
(10:37):
And it is really talking about this concept of thinking as to
picking that area of sleep, which is we don't want to tackle
everything, right. We are when we are looking at
talking to somebody getting buy in and we know there is
workload, we know there is nutrition, we know sleep is an
issue. Pick one area you sleep,
(10:59):
nutrition, workload, whatever you're seeing, right?
If you're seeing too many, for example, workload injuries,
ovaries injuries, start with that.
If you're seeing injuries or performance decrements in the
evenings, think about nutrition.If you're seeing in the morning,
there is fogginess, think about sleep.
So it's not necessarily one or the other.
(11:19):
It's a combination of where we are seeing the decrements or
where we want the performance tostart improving.
And if you're finding out the athletes are consistently
fatigued, maybe sleep is a placeto start at, right, irrespective
of their nutrition status. So I think thinking about where
we could be starting our entry into the pathway of disrupting
(11:43):
maladaptive patterns is, I thinkessential.
And so it can be as simple as toasking them to track their
sleep. We can get more sophisticated as
we talked later today about biosensors and how we can use
those, right. So those are objective measures,
but we also have subjective measures and some of the
research that we are finding is that objective measures like a
(12:04):
watch or a UDA ring or one of those devices, Nest trackers,
they are sometimes reliable but not always valid.
Again, if I'm not very broad strokes, right, and likewise
some of the sleep subjective measures can likewise be off,
right? People can really not track
(12:24):
themselves, right? I don't know how much I said
maybe I slept 6 to 8 hours, Maybe it's like 4 to 5.
I don't know really how much I slept.
I want to sound better. That's why I say add more hours,
right? And that might not always be the
case. So it's really try to trying to
think about what it is that you're seeing as an athletic
trainer, the patient is looking like, the dancer is looking
(12:45):
like, and then joining the pieces of the puzzle together to
see what the clinical picture seems for that person based on
what their goals are for their career, practice, rehearsal,
whatever performance, however itis that they want.
Did that answer the question? But did I go off no that.
Sounds perfect. That's.
Great. I was going to say, that's
(13:06):
really interesting. I didn't think of thinking of
the time of day that they're having like certain symptoms or
certain complaints. That's kind of a a nice hack to
kind of think about kind of guide your evaluation.
That's pretty cool. Absolutely.
I mean, if you're thinking about, say, for example, you
think of a marching band and thepeople marching band, they're
going to get up in the morning. So they probably have a good
(13:27):
breakfast and good, good proteincarb meal.
But if you're thinking like somebody we have, I was talking
to some colleagues who work withMadison Square Garden in the
Rockettes. I mean, they're going to go in
the evenings. They have a 7 O rock
performance. That's when then four O clock is
when they need to eat their carbs and proteins.
So you really need to be able tokind of think about how their
positioning is in terms of both sleep or sleeps also factor and
(13:52):
nutrition and the workload, right?
So Yep, absolutely your timing is is important to think of for
all of these. So workload is kind of one of
those keywords that you said in there.
I feel like sleep is pretty straightforward.
Like you asked someone how long they've slept.
They kind of have at least an idea of like what you were
saying, workload, it's kind of hard to measure.
(14:12):
So how would you go about looking at how much workload
someone has or kind of identifying that amount?
Sure. Absolutely.
Great question, right. And as practitioners, we are
recognizing we're working with technology, the joy of
technology and the bane of technology.
We have more technology, right? So a workload essentially,
(14:36):
right. Again, we are making
generalizations and we understand and different genres
like different sports have different needs and so on and so
forth, right. But for an example, we are
looking at when we think about collegiate level or three
professional dancers, we are looking at workloads about 20 to
24 hours that they have across the week.
(14:57):
When we are looking at professionals, we are looking at
50 to 55 hours a week. And when we are talking about
that workload and the amount of time that I'm talking about is
what we call working time, whichwhat we mean with that is there
in that maximum to vigorous moderate to vigorous physical
activity zone, the MVPA zone, right.
(15:18):
That's around that 65 to 85% of maximum heart rate.
So that's where a lot of the work.
So when we're talking about our heart rate, right, we have a 220
minus age seems to be our 100% Max.
And then, you know, go to near Max work is 95 percent. 65 to 85
is when you really can't even talk.
You can sing a song when you're working out. 65 to 55 is like,
(15:40):
yeah, when you can kind of talk.And below 55, you're just
cruising, strolling, nothing's happening.
So the the MVPA is the part thatwe are really what not worried
is the wrong word. What we really need to consider
right how much time is to spend being in MVP and that's the
workload that we are talking about.
And generally the answers will have two to three should have
(16:02):
two to three hours of that as a professional and five to six
hours of that as a professional.Anything more than that needs to
be then calibrated based on whattheir demands are.
So it can be as simple as askingthem how hard that work is the
last 30 minutes, how hard were you working on a scale of 1 to
10, right. Or we can use sensors and that
(16:24):
will give us a measure of eitherdirect heart rate or
acceleration that those units will calculate physical activity
and you can get some of that. So some of the work that we have
done and we've looked at, we have found in our dancers at the
collegiate level also, they havebought 7 to 7 1/2 hours of
activity within that MVPA zone, which is which is pretty
(16:46):
substantial amount of activity, but they're sleeping less than 7
hours a day. And you're like cumulatively now
that's a problem, right? Because we're seeing the system
that you're going to start seeing the system kind of go
down. So you're seeing October end
coming up and that's when systemstarts going down two months
into the performance season, right?
(17:08):
You're seeing March again being a problem month for performers
because again, two months down after the winter break.
So it's really thinking about what workload means and simply
asking them to track is a good start, then nothing else.
But then if you have the abilityto get some of these monitors,
some of them are really reliable, like the Apple
(17:29):
Watches, for example, pretty decent.
There's a device called Whoop which seems to do pretty well.
The OODA thing, I like it, but Idon't researcher.
I like it because it's easy. The issue is that the
proprietary software versus scholar and researcher, I don't
know what's in the black box, right, that gives me all of
those numbers. So that's a challenge, but it's
(17:51):
something to have, let me put it, it's just another tool,
right? But it should not be and cannot
be the end all and be all and obsessively looking at fitness
trackers. That's another end of the
spectrum that we want to avoid our athletes and tensors to go
into. So just monitor themselves in
the morning mental fatigue, evening mental fatigue, how they
(18:13):
feel is probably a good place tostart with workload.
And then if you have the ability, get some sensors on
them and see how they are actually doing, where the
sensors can make the scene unseen scene for us as
practitioners. For sure.
Something that I kind of say along those lines when we're
using those fitness trackers is you can use it for more like
(18:37):
trends rather than the actual specific numbers on it.
Like don't get too hung up on the numbers.
Is that kind of like what you'resaying?
Absolutely, absolutely right. So we are really talking about
looking at it over a series of multiple recordings over a
general time frame, not at a specific time because we are
(18:58):
humans, right? I mean, motivation is going to
go down, exercise levels are going to go up or down, Life is
going to happen. And that device is going to
change how it records things. So you're really hopefully
looking at the trends. Yes, you absolutely correctly
identified not one day, because one day just gives us a
snapshot, and that might not be enough.
(19:19):
That's again compounded by weekday and weekend, right?
Because weekdays look different than weekends.
And so if you're really looking at one day, you could pick a
Tuesday, right? And you could pick a Sunday.
And they look very different forsome people, right?
For some people, 1 is a high activity and 1 is a low
activity. So again, looking at one day,
(19:41):
one time is not necessarily the way to do it.
You're starting to hopefully look at trends and see how the
system is responding both cognitively and physiologically
when you're putting your body through whatever it is that you
are putting your body through. And yeah, don't get hung up.
So that's another thing we tell hopefully people that maintain
your sleep hygiene, maintain consistent rhythms, optimize
(20:05):
sleep environments that are cool.
Have pre structured routines, but if you can't wake up, can't
go to sleep, don't obsessively do clock watching.
That is definitely not going to help you.
Don't 30 minutes. Look at it say Oh my God, it's
3:00 AM. Oh my God, it's 4:00 AM right?
That's that's sometimes counter.For sure, yeah.
(20:27):
So kind of along the going on the opposite end of that
spectrum, how do you get someoneto buy in on kind of the
importance of monitoring like sleep or using the trackers for
like workload or being more cognizant of their nutrition.
How do you get someone to kind of buy in to put it in the
effort for that? Sure.
So I think it's, it's really talking to them, explaining them
(20:51):
and connecting the dots for them, right.
So when you talk about injuries,for example, connect the dots,
say you know, we've seen that your hamstring starts tightening
up and I noticed that you're averaging 5 to 6 hours of sleep.
Let's see if the next two days you want to play special
attention and try to improve your recovery sleep and let's
see if the recovery in the body is able to recover and help this
(21:14):
issue resolve faster, right? So it's really trying to make it
more personal for them, right? Maybe ask them to rate their
energy level in the morning, afternoon.
What did you eat in the hours before practice?
How many hours did you sleep yesterday?
Were you a good sore or was it abad sore after your training,
right? So making them more aware, like
(21:36):
we all know, right? We all know sometimes the sore
is not a bad sore and you work out, but sometimes it's not
good. So getting them really aware and
the end goal for them, understanding what it is for
them. I think as practitioners, we
know that's really, really important, right?
So you're really talking to themabout these factors directly
(21:57):
impacting their technique, directly impacting their injury
risks, and their ability to be chosen or selected for the
performance and their ability tolearn new techniques and new
choreography. If they start tracking and
seeing the simple daily metrics connect with each other, and
(22:17):
then we can provide two or threepractical tips.
It's really telling them that you need to give your body what
it needs so that you can do whatyou love at the highest level
without the body actually being a factor that distracts from it
but helps it, and you can then be at optimal performance.
So that's the way I would position it.
Your body is the instrument. Take care of it and we'll take
(22:38):
care of you. It's about asking the right
questions and making them aware.Actually, I was just talking
about this with a colleague about how sometimes like people
are just not aware of what is going on.
And it's not like it's maliciousthat they're doing something
like it's just that they they have no idea.
So that's part of us as as clinicians is making them aware
(23:02):
and educating them about some things that can help improve
them. And then they can say challenge
accepted. That's totally and performing
artist an athlete mindset. Of challenge.
You gave me a challenge. Challenge accepted.
I love that, right? I love that because that's
exactly what we need to do. And and sometimes it's really, I
think and Randy would said pointing a spotlight for them on
(23:24):
what they need, right? And sometimes even they don't
consciously proactively verbalize it for themselves,
right? They're just doing the do.
And so maybe it's just a refocusing of saying, OK, what
is it that you have wanted to doand because of this performance
decrement, you're not able to door what is it that you want to
(23:45):
be? I want to do blah.
I want to, I want to be on 4 performances.
I want to be the principal. I want to be on whatever it is
the first first chair, fourth chair, third chair, right.
However, it is that they define the success for them and say,
OK, so there is a component which is the skill part, which
we don't, you know, that's you and your teachers and your
choreographers. But there is also the body part
(24:08):
and the mind part where we as athletic trainers can play a
very strong role in supporting them.
And, and they have like we thinkabout medical care support team
around the athletes. Similarly, we are part of the
medical their team around these folks and helping them see
that's what we are there for. And if they need to get to that
(24:31):
next level, explaining to them, especially in dances and
performing artists, that background is in there of
anatomy, Physiology, sports, healthcare, right?
That's just not necessarily always taught.
So for them, it's more about theart.
And I remember this case of a dance teacher asking me one time
in saying the issue of preparingA choreography piece.
(24:53):
And she was like, how high can adancer be when she jumps?
So that piece had more somethingof somebody being on a male
dancers shoulder and then jumping off of the dancers
shoulder and going down. So like is this 20?
Is this twen 20 centimeters? So I'm like 20 is fine.
Like it's 40 centimeters. OK.
I'm like 40 is like OK, is the shoulder OK?
(25:15):
I'm like, how tall is your guy? Right.
So they don't even think about that in physiological
biomechanical risk terms. They think about this as
performance. So just addressing the spotlight
and say, OK, you know, yes, there is a, there is a Lim,
there is an anatomical limit. I mean, you can do things, but
let's talk through them and see what's achievable, right.
(25:37):
So saying no more what's achievable.
And I think that's where we as athird trainers can really,
really support the performing arts and practitioners because
they don't have that background knowledge.
So kind of along those lines, kind of those stakeholders, how
do you educate those stakeholders about like the
(25:59):
importance of that sleep nutrition workload?
Because we kind of talked about the performing artists, the
athletes themselves. But but now looking outside that
picture, you know, maybe the athlete or the performing artist
is like, hey, I'm. I'm trying to like.
Help my workload but this is just so much.
Yeah. It's beyond me.
(26:21):
Yeah, yeah. So I think, I think looking at
the stakeholders in the in the issue here, right.
So looking at stakeholders like artistic directors and
choreographers, looking if there's a minor, looking at
parents, looking at the healthcare team and and the
performer at the centre of it, right.
So you really want to start using think what we call
performance focused language, right?
(26:41):
Not healthcare focused language,performance focused language,
right? Explaining how, for example,
recovery can enhance their creativity, right?
As a career. Look, if you want this
combination, you want to add a little more oomph, you know, the
shower moments you have when you're kind of chilling down or
we are thinking about something else, you need to provide time
(27:01):
for that, right? You want to have technical error
reduction. So wouldn't you like it if your
group doesn't need 17 practices to get that combo, maybe just
need 4 practices, right, to get that combination?
Wouldn't we all like that, right?
And then in addition, extending career longevity, right?
So how long do this one do you want this person to be right?
(27:26):
For choreographers then talking about performance rather than
restrictions. So rather than saying don't do
this because it's bad, don't overdo this.
Rather showing them the supporting these fundamentals
really will enhance the quality and the consistency of their
artists work, right? Showing teachers and directors
that when their dancers are, forexample, well rested and well
(27:48):
fed, they can last longer, make your mistake and perform at
their best for an extended period of time.
Wouldn't you want that, right? Smart load management is not a
big word. It's really recognizing body
mind connections. And you want to train when your
(28:10):
body and mind are sound together.
Because if either of those and the spirit, obviously, right,
That's also a part of the cognitive artistic process.
It's about really doing good to the body and mind so you can get
the output that you want. And you don't want to push hard
when you're dealing with performance pressure or you're
(28:31):
seeing your athlete go down. It can mess with a lot of
things. I mean, we talked about Reds
briefly, right? So it can Reds can, you know,
cause periods, issues with periods and menstruation can
lead to weaker bones, can more prone to stress fractures and
other injuries can make them more prone to mental health
(28:52):
issues, including but not limited to anxiety, depression,
low mood, right? Do we want all of that?
Not really. So how do we prevent that?
But let's act now so that we don't see this degradation,
degradation in your athletes performance, in your dancers
performance. And it's not that hard, like we
are not telling you to go to like a retreat for three months
(29:15):
and do all of this good stuff. It's simple take home things
that you can do at home. It's simple things that you can
tweak in practice. And it's simple things like
seeing me as an athletic trainerthat can help us get there.
Let's work together. Perfect.
Now I like that. I like that performance
(29:36):
language. Yeah, that's a good way of like
framing it for the non medical provider.
Well, then it also isn't coming from like an outside source.
Yeah. It's coming from their same
team, yeah. Absolutely.
And as athletic trainer, right the, and as a society, there is,
there is enough knowledge available on social media,
(29:58):
right? But you know, your, your, your
platform is in social media are doing its service to the, to
the, to the population right, ofathletic trainers.
There is, there is good information out there.
Not all of the information is good, but information does
exist, right? As athletic trainers.
Likewise, we have hopefully reading position statements from
the NATA, the CSM, attending webinars, reading and reviewing
(30:23):
podcasts, starting with small CEU courses in an area that they
are less comfortable with and then build from there, right.
So it's, it's, it's really recognizing that it's not a one
stop shop answer. It's more of a conversation and
the continual longer term relationship with the overall
idea of improving and enhancing their performance, their
(30:48):
longevity, their skills and their progress that we are going
to as a threat trainers, help them do better.
So you brought up about red ass or Reds and there's definitely
an interplay between workload nutrition with that with someone
(31:10):
that may have been diagnosed with red ass or maybe we're
we're worried about like, hey, they might be getting in that
way. How do you kind of now intervene
with like workload and nutritionhelp kind of manage that?
Sure, great question. So I'll, I'll, I'll start with
adding on. There is actually a dance
specific Red S system being developed called Red D, right.
(31:34):
So that relative energy deficiency in dance, right.
So it's there, right. So, so there are so that's good,
right. So that's good as far as
overarching Reds, right? It is a simple, and I say
simple, it's actually, it actually just simple
infographic, right, That that shows us in a cyclical format
(31:58):
all the different components of Reds, right?
So Doctor Nikki K, who's one of the world's leading founder
experts in this area, she had a couple of good papers.
Mount Doctor Mountjoy had a couple of good papers earlier.
The BJSM British Journal Sports Medicine has some submit
(32:18):
published some good submissions about Reds.
And the general idea, and this is something that we have
started to think about in our practice, is Green Zone, orange
zone, red zone, right. So Green Zone is like, yeah,
everything's OK. Orange zone is when you really
are what I think Randy, you weretalking about like when we have
the orange zones, I think thinking about what is the
(32:39):
issue? And so we bring out that chart
and say, OK, we have identified out of these ten different
things around the circle. These are the three things we
need to see because these seem to be issues.
And then as an athletic trainer with the dancer or the
performing artists or the athletes say, OK, for this
specific issue, who do we, how do we, when do we intervene,
(33:03):
right? Can I intervene in sleep as an
athletic trainer with you? Absolutely.
Well, but if you are showing stress issues and it's not going
away, we need to see somebody. If your periods are starting to
become irregular, we need to start seeing somebody, right?
If it's a mental health and I see you kind of go down, we need
(33:23):
to see somebody from a mental health perspective.
If we are seeing that you're excessively sore and you're not
able to jump up, we need to workwith the strength and
conditioning coach, right? If you are seeing that you get
many more Boo boos, then I'm here, right?
I can fix that, right? So I think it's recognizing
where the problem areas because everybody's not going to show up
(33:44):
with everything, right? They're going to show up with
hopefully, hopefully, but everybody is going to start
entering and going to show problem areas at two or three
places. And then again, as I said, the
athletic training toolkit, bringout our athletic training
toolkit, see where we can intervene and see where we can
collaborate with other medical care team members to help that
(34:06):
person. So I think that's what it is.
When we talk about inflammation,we say out of the five cardinal
signs of inflammation, if you have three or more, it's not a
good thing. Two or less, it's OK.
Similarly, if it's three or less, in this case, it's OK.
If it's more than that, we need to sit and have a conversation
with the athlete, person, dancer, whoever it is and then
(34:27):
think about we don't want this to become 4567 because that's
not good so. Awesome.
Are we ready to? Wrap it up with an action item.
Six times some action. OK, so something that we love to
do at the end is wrap it up, kind of put together something
(34:47):
that someone can take away from this podcast if they like a too
long, didn't read just like a sum up.
If there was 1 action thing thatyou can get out of this podcast,
how can an athletic trainer start to implement workloads,
sleep, nutrition, monitoring, guidance, something of the sort
in their practice? OK, so great question.
(35:10):
Let me think about it for like 2.
Seconds. Yeah.
Take your time. Because there's so many things,
right? OK, so I would say start small,
right? Pick 1 area.
Don't tackle everything at once.Choose either sleep or nutrition
or workload monitoring based on what you're seeing.
If you have a lot of overuse injuries that you're starting to
(35:32):
see, start with workload. If your athletes are
consistently fatigue in the morning and they're like start
with sleep tracking, right? If they're fading throughout the
day, start with nutrition, right?
And some of these questionnaires, some of these
basic Wellness things are free, easily available.
(35:55):
Use simple, simple fitness. Several, if not most people will
have some kind of fitness trackers with them.
Ask them to bring it to them. So I think that's an area where
I could, I would start with pick1 area that is important that
you see in that person and then go and do the research yourself
as an athletic trainer. Look at these statements that
(36:16):
are available. Take a course, take ACU credit
in that specific area and then get better so that you can
advise your athletes better. And it doesn't really need to be
super extensive. Simply ask how many hours did
you sleep? Tell me how you feel energy
wise. What did you eat 3 hours before?
(36:38):
Right. And asking two or three of these
simple questions, picking one area and then using simple tools
for using that in your clinical practice are something that I
would really request, suggest, strongly recommend athletic
trainers we push into our clinical practice as something
that can be take home points. Awesome, I like it.
(37:03):
I like it. Start small.
Yep, kind of like with the athletes.
I think a really cool take away from this interview was just
seeing how supportive and the facilitatory role that we as
athletic trainers have on the concept of sleep, workload and
(37:26):
nutrition, right? It really shows how we kind of
have our hands in kind of each pot and we're able to kind of
help get them to where they needto go and and be supportive when
they are kind of referred out tosomeone else and like how we can
help support their goals. And not only that, but it's
really nice to hear about someone who's actually done it
(37:48):
and been in the field and work with the not only the athletes
and but the stakeholders and thepeople who can change the
workload, not only the people who are doing the workload.
So it's nice to actually talk tosomeone who is not just in this
like theory idea, but actually can have some concrete ideas of
(38:08):
how they've changed it and how we can move forward and change
it in our in our respective areas as well.
For sure, and plus it probably doesn't hurt that he's also Team
Fanny. All right, Yeah, so if you guys
are new, we do a lot of different episode types here on
At Corner. We have interview episodes just
(38:28):
like this one. We have story episodes where we
bring stories in from real life athletic trainers and discuss a
various topic. Experience shares share all of
our experiences. And then we also have Cus on
this podcast and they're run mostly by Randy.
So he reads a bunch of research articles and he kind of
synthesized them, put them together and we talked about
(38:51):
them in a conversational format and bring them to you for the,
the newest ones are free and then the ones before that are
super affordable thanks to our partner athletic training chat
and clinically pressed. So make sure you go down the
show notes. There's a lot of cool fun stuff
down there. And if you have any questions or
(39:13):
you want to reach out to us or if you want to get connected
with someone we've had on the podcast, just just reach out.
We have all of our contact information down below or reach
out on our Instagram at A2 Corner podcast.
Do you have anything else, Randy?
Nope. That's perfect.
Thank you for helping us showcase athlete training behind
the tape. Bye.
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an athlete trainer comes
with ups and downs and we're here to showcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we're going to be talking about
probably the most forgotten big three of athletic performance
(00:25):
and injury prevention, and that is sleep, workload and
nutrition. I hope these aren't forgotten.
They shouldn't be, but I feel like when you talk to athletes
or talk to other people, sometimes those things kind of
get workloads, kind of get more mainstream.
But I feel like people often forget just the importance of
nutrition and sleep sometimes. At least our athletes do.
I feel like the importance of sleep isn't forgotten, it's just
(00:47):
the actual like. Execution.
Yeah, exactly. Especially if you're a student
athlete, Yes. And not only do we get to talk
about these big three, but we get to talk about with someone
who I am, I am personally so, soexcited to bring on.
I fangirled a little bit when I met, not only met Jatin and
(01:09):
Magonkar, but also when he said,Oh yeah, I know about your
podcast. I listen to your podcast only.
What? This is.
This is someone who I have literally.
I recognize his name because I have spent so much time reading
his research all through college, all through undergrad,
(01:31):
through grad school, you know, wanting to go into performing
arts and just knowing that he issuch has such a big impact in
this performing arts community. So actually getting to meet him
in person converse. So I actually going through this
whole process, we I also went back and and saw some emails
that we had exchanged back, way back when, when again I was
(01:55):
fangirling again because he is just so cool.
He is now a professor at the in the School of kinesiology
College of Education and human Development at George Mason
University. And then he's also a founding Co
director of the sports medicine assessment research and testing,
which is a smart laboratory. And he's the editor in chief of
the Journal of Dance medicine. That's amazing.
(02:16):
That's awesome. And I can go on and on about his
bio. I'm going to let you listen to
him. So is there anything else you
needed in this intro? OK, let's hear from John.
All right, kicking it off. With our first cryo breaker,
what element of athletic training represents you as a
clinician? This could be a modality, rehab
(02:37):
tool, tape, brace, etcetera. Any basically any tool of the
trade that represents you. Sure.
You know when we are treating oras clinician treating athletic
trainers, you always carry your Fanny pack, right?
It's got tape, it's got scissors, it's got wipes, it's
got old packs, it's got like dozen essentials.
People really joke about the Fanny pack look, right?
(02:58):
But really, when a performer andartist or dancer rolls their
knees, nobody's laughing, right?They're grateful to have what we
need when we need it. And so that's really what I
think represents me as a clinical practitioner, right?
We don't just have one tool. We have a whole set of evidence
based interventions ready to go.Maybe today it's sleep talk,
(03:20):
hygiene education for the exhausted core member.
Tomorrow it's nutritional counseling for someone showing
red symptoms or workload modification and rehabilitation
for a principal dealing with overuse.
Right. Just like the Fanny pack we have
to be. And I think I would like to be
prepared with multiple solutionsbecause every performer's needs
are different and some might think the comprehement SEM
(03:41):
approach is like too much. But when you are dealing with
the complex demands of performing arts, you're meet a
practitioner who's able to adapt.
So I think the Fanny pack, whichisn't glamorous, but it works,
right? And at the end of the day, when
the dancers are healthy, performing well, adoring
(04:02):
injuries, they don't care how I look.
They just care that I'm there for the need I need to help them
and keep them moving. I so that that I think helps
explain what I I think about myself as Fanny pack with
different tools and those tools keep changing and we need to
keep as a correct trainers advancing our clinical set when
we when we practice. That's awesome.
(04:22):
So does. That mean you're team Fanny or
team slain? Listen, Fanny pack all the time.
I go Fanny pack, keep my shoulders open.
I just can't pack so much more in a in a Fanny.
And usually we're not running onto the field.
I would love a sling back when we have more stuff we need to
(04:43):
carry on the field, but that's not in this setting commonly
done in the stage or something like that.
But so Fanny pack go Fanny, see.I knew we.
Were on the same side. I knew it.
There you go. I love that we always have
something for everything and it's like you always and even if
you know we're it's a it's a little flexible.
So you know, maybe you can't fiteverything in your fanning pack,
(05:06):
but you have something that can apply to different situations.
Absolutely. So another thing we like to do
on AT Corner is kicking it off with a story or some sort of
experience that you've had that kind of ties this together of
what we're kind of going to talkabout.
So whether that's sleep, workload, nutrition, something
along those lines, if you could kick us off.
(05:28):
Sure. So absolutely.
So I remember this case of a collegiate dancer who came to be
completely frustrated, like she was nailing her combinations in
the morning class but falling apart during evening rehearsals.
And everybody at class that kepttelling her try harder, focus
more, right. But as an athletic trainer, we
(05:49):
knew there was something else going on.
So something as simple As for had her track 3 simple things
for a wake. How much you sleeping?
What she ate for lunch and an energy level at 6:00 PM.
Turns out she was sleeping well,but eating a tiny salad for
lunch and then expecting her body to basically power her
(06:09):
through three hours of intense rehearsal with basically no fuel
in the evening. Right.
So we didn't change the entire diet, just asked her to add a
substantial afternoon snack withproteins and some carbs.
And within days, in the evening,she was able to land her gems
and get her combinations. And the solution then was really
what, what, what I would call itwasn't willpower, it wasn't
(06:32):
technique corrections. It was really treating the root
cause and addressing that issue of addressing our nutritional
habits. And that's what a cleric
trainers I think of of bring to the performing arts.
We can look at the whole person.We can use evidence based
assessments and find practical solutions that can really help.
So sometimes the answer is not necessarily in the studio, it's
(06:54):
how to prepare the body in orderto succeed.
So I think that's kind of an example where OK, yeah, yeah,
absolutely. So way to succeed.
A video to solve problems, thinkabout the person as a whole and
help them. Yeah, for sure, absolutely.
And that's why everybody and everybody needs an athletic
trainer. There you go.
(07:17):
I like it. I like it.
I completely agree. So something you mentioned was
that we that you looked into hersleep and even though her sleep
was was OK by the standards thatyou were looking at.
Can we talk a little bit? About why that?
Sleep component is so important.Oh absolutely, absolutely right.
(07:41):
So we as as clinicians, as humans, right, We need our 8
hours of sleep. 1/3 of our livesis slept sleeping hopefully.
And that sleep is crucial for tissue repair, memory
consolidation, hormonal regulation, host of different
biophysiological factors, all are essential for performance
(08:05):
athletes who really have to do this peak performance mentally,
cognitively and physically right.
And so it is very crucial for dancers, performing artists,
athletes to have good sleep quality and good sleep quantity,
right? Because both of them can affect
motor learning, can influence injury prevention and the
(08:27):
ability to execute what we like to call complex movement
patterns with precision. And in performing artists also
with aesthetic artistry, right, you need to be able to look
pretty. I don't care how Steph Curry or
LeBron James look. Well, they dunk, right?
They can dunk and they can be all sweaty.
I don't care. But when I, when I see a dancer,
(08:48):
I want him, her or they, they will have to maintain that, that
look that is visually pleasing also.
But there is similarly an aesthetic sport like gymnastics.
You need to smile, you need to be able to do all of that while
you are performing. And so that's another thing that
if you are not able to rest and recover, that mismatch between
(09:08):
ability to process multiple inputs, right, reaction time can
go down, decision making can go down, proprioception can go
down. And and what could be
potentially catastrophic for dancers who rely on that split
second timing and spatial awareness.
In addition, for long term, we've know and research clearly
(09:29):
suggests that increased injury rates exist in athletes.
We don't know enough about dancers and that's some of the
work we are looking at. But it is known to decrease
immune function factors. And again, both of those can,
across this season, cumulativelylead to a risk for higher
injuries. For sure.
(09:50):
So if you do have someone that you're like, Oh yeah, we're
seeing maybe the amount of sleeps not right or the quality
of sleeps just poor, How do you work on someone to improve their
sleep? Sure.
So, so starting first with recognizing that it is not a
problem to fix, but it is something that can be improved,
(10:14):
right? So once you start framing it as
like your dance will improve, your performance will improve,
you're going to get more binds, right then, right.
So I say sleep is performance medicine.
It's a quality sleep isn't really just resting.
You need to sleep because your body repairs itself.
You can consolidate new movementpatterns in your brain when
you're sleeping, you can learn better, right?
(10:37):
And it is really talking about this concept of thinking as to
picking that area of sleep, which is we don't want to tackle
everything, right. We are when we are looking at
talking to somebody getting buy in and we know there is
workload, we know there is nutrition, we know sleep is an
issue. Pick one area you sleep,
(10:59):
nutrition, workload, whatever you're seeing, right?
If you're seeing too many, for example, workload injuries,
ovaries injuries, start with that.
If you're seeing injuries or performance decrements in the
evenings, think about nutrition.If you're seeing in the morning,
there is fogginess, think about sleep.
So it's not necessarily one or the other.
(11:19):
It's a combination of where we are seeing the decrements or
where we want the performance tostart improving.
And if you're finding out the athletes are consistently
fatigued, maybe sleep is a placeto start at, right, irrespective
of their nutrition status. So I think thinking about where
we could be starting our entry into the pathway of disrupting
(11:43):
maladaptive patterns is, I thinkessential.
And so it can be as simple as toasking them to track their
sleep. We can get more sophisticated as
we talked later today about biosensors and how we can use
those, right. So those are objective measures,
but we also have subjective measures and some of the
research that we are finding is that objective measures like a
(12:04):
watch or a UDA ring or one of those devices, Nest trackers,
they are sometimes reliable but not always valid.
Again, if I'm not very broad strokes, right, and likewise
some of the sleep subjective measures can likewise be off,
right? People can really not track
(12:24):
themselves, right? I don't know how much I said
maybe I slept 6 to 8 hours, Maybe it's like 4 to 5.
I don't know really how much I slept.
I want to sound better. That's why I say add more hours,
right? And that might not always be the
case. So it's really try to trying to
think about what it is that you're seeing as an athletic
trainer, the patient is looking like, the dancer is looking
(12:45):
like, and then joining the pieces of the puzzle together to
see what the clinical picture seems for that person based on
what their goals are for their career, practice, rehearsal,
whatever performance, however itis that they want.
Did that answer the question? But did I go off no that.
Sounds perfect. That's.
Great. I was going to say, that's
(13:06):
really interesting. I didn't think of thinking of
the time of day that they're having like certain symptoms or
certain complaints. That's kind of a a nice hack to
kind of think about kind of guide your evaluation.
That's pretty cool. Absolutely.
I mean, if you're thinking about, say, for example, you
think of a marching band and thepeople marching band, they're
going to get up in the morning. So they probably have a good
(13:27):
breakfast and good, good proteincarb meal.
But if you're thinking like somebody we have, I was talking
to some colleagues who work withMadison Square Garden in the
Rockettes. I mean, they're going to go in
the evenings. They have a 7 O rock
performance. That's when then four O clock is
when they need to eat their carbs and proteins.
So you really need to be able tokind of think about how their
positioning is in terms of both sleep or sleeps also factor and
(13:52):
nutrition and the workload, right?
So Yep, absolutely your timing is is important to think of for
all of these. So workload is kind of one of
those keywords that you said in there.
I feel like sleep is pretty straightforward.
Like you asked someone how long they've slept.
They kind of have at least an idea of like what you were
saying, workload, it's kind of hard to measure.
(14:12):
So how would you go about looking at how much workload
someone has or kind of identifying that amount?
Sure. Absolutely.
Great question, right. And as practitioners, we are
recognizing we're working with technology, the joy of
technology and the bane of technology.
We have more technology, right? So a workload essentially,
(14:36):
right. Again, we are making
generalizations and we understand and different genres
like different sports have different needs and so on and so
forth, right. But for an example, we are
looking at when we think about collegiate level or three
professional dancers, we are looking at workloads about 20 to
24 hours that they have across the week.
(14:57):
When we are looking at professionals, we are looking at
50 to 55 hours a week. And when we are talking about
that workload and the amount of time that I'm talking about is
what we call working time, whichwhat we mean with that is there
in that maximum to vigorous moderate to vigorous physical
activity zone, the MVPA zone, right.
(15:18):
That's around that 65 to 85% of maximum heart rate.
So that's where a lot of the work.
So when we're talking about our heart rate, right, we have a 220
minus age seems to be our 100% Max.
And then, you know, go to near Max work is 95 percent. 65 to 85
is when you really can't even talk.
You can sing a song when you're working out. 65 to 55 is like,
(15:40):
yeah, when you can kind of talk.And below 55, you're just
cruising, strolling, nothing's happening.
So the the MVPA is the part thatwe are really what not worried
is the wrong word. What we really need to consider
right how much time is to spend being in MVP and that's the
workload that we are talking about.
And generally the answers will have two to three should have
(16:02):
two to three hours of that as a professional and five to six
hours of that as a professional.Anything more than that needs to
be then calibrated based on whattheir demands are.
So it can be as simple as askingthem how hard that work is the
last 30 minutes, how hard were you working on a scale of 1 to
10, right. Or we can use sensors and that
(16:24):
will give us a measure of eitherdirect heart rate or
acceleration that those units will calculate physical activity
and you can get some of that. So some of the work that we have
done and we've looked at, we have found in our dancers at the
collegiate level also, they havebought 7 to 7 1/2 hours of
activity within that MVPA zone, which is which is pretty
(16:46):
substantial amount of activity, but they're sleeping less than 7
hours a day. And you're like cumulatively now
that's a problem, right? Because we're seeing the system
that you're going to start seeing the system kind of go
down. So you're seeing October end
coming up and that's when systemstarts going down two months
into the performance season, right?
(17:08):
You're seeing March again being a problem month for performers
because again, two months down after the winter break.
So it's really thinking about what workload means and simply
asking them to track is a good start, then nothing else.
But then if you have the abilityto get some of these monitors,
some of them are really reliable, like the Apple
(17:29):
Watches, for example, pretty decent.
There's a device called Whoop which seems to do pretty well.
The OODA thing, I like it, but Idon't researcher.
I like it because it's easy. The issue is that the
proprietary software versus scholar and researcher, I don't
know what's in the black box, right, that gives me all of
those numbers. So that's a challenge, but it's
(17:51):
something to have, let me put it, it's just another tool,
right? But it should not be and cannot
be the end all and be all and obsessively looking at fitness
trackers. That's another end of the
spectrum that we want to avoid our athletes and tensors to go
into. So just monitor themselves in
the morning mental fatigue, evening mental fatigue, how they
(18:13):
feel is probably a good place tostart with workload.
And then if you have the ability, get some sensors on
them and see how they are actually doing, where the
sensors can make the scene unseen scene for us as
practitioners. For sure.
Something that I kind of say along those lines when we're
using those fitness trackers is you can use it for more like
(18:37):
trends rather than the actual specific numbers on it.
Like don't get too hung up on the numbers.
Is that kind of like what you'resaying?
Absolutely, absolutely right. So we are really talking about
looking at it over a series of multiple recordings over a
general time frame, not at a specific time because we are
(18:58):
humans, right? I mean, motivation is going to
go down, exercise levels are going to go up or down, Life is
going to happen. And that device is going to
change how it records things. So you're really hopefully
looking at the trends. Yes, you absolutely correctly
identified not one day, because one day just gives us a
snapshot, and that might not be enough.
(19:19):
That's again compounded by weekday and weekend, right?
Because weekdays look different than weekends.
And so if you're really looking at one day, you could pick a
Tuesday, right? And you could pick a Sunday.
And they look very different forsome people, right?
For some people, 1 is a high activity and 1 is a low
activity. So again, looking at one day,
(19:41):
one time is not necessarily the way to do it.
You're starting to hopefully look at trends and see how the
system is responding both cognitively and physiologically
when you're putting your body through whatever it is that you
are putting your body through. And yeah, don't get hung up.
So that's another thing we tell hopefully people that maintain
your sleep hygiene, maintain consistent rhythms, optimize
(20:05):
sleep environments that are cool.
Have pre structured routines, but if you can't wake up, can't
go to sleep, don't obsessively do clock watching.
That is definitely not going to help you.
Don't 30 minutes. Look at it say Oh my God, it's
3:00 AM. Oh my God, it's 4:00 AM right?
That's that's sometimes counter.For sure, yeah.
(20:27):
So kind of along the going on the opposite end of that
spectrum, how do you get someoneto buy in on kind of the
importance of monitoring like sleep or using the trackers for
like workload or being more cognizant of their nutrition.
How do you get someone to kind of buy in to put it in the
effort for that? Sure.
So I think it's, it's really talking to them, explaining them
(20:51):
and connecting the dots for them, right.
So when you talk about injuries,for example, connect the dots,
say you know, we've seen that your hamstring starts tightening
up and I noticed that you're averaging 5 to 6 hours of sleep.
Let's see if the next two days you want to play special
attention and try to improve your recovery sleep and let's
see if the recovery in the body is able to recover and help this
(21:14):
issue resolve faster, right? So it's really trying to make it
more personal for them, right? Maybe ask them to rate their
energy level in the morning, afternoon.
What did you eat in the hours before practice?
How many hours did you sleep yesterday?
Were you a good sore or was it abad sore after your training,
right? So making them more aware, like
(21:36):
we all know, right? We all know sometimes the sore
is not a bad sore and you work out, but sometimes it's not
good. So getting them really aware and
the end goal for them, understanding what it is for
them. I think as practitioners, we
know that's really, really important, right?
So you're really talking to themabout these factors directly
(21:57):
impacting their technique, directly impacting their injury
risks, and their ability to be chosen or selected for the
performance and their ability tolearn new techniques and new
choreography. If they start tracking and
seeing the simple daily metrics connect with each other, and
(22:17):
then we can provide two or threepractical tips.
It's really telling them that you need to give your body what
it needs so that you can do whatyou love at the highest level
without the body actually being a factor that distracts from it
but helps it, and you can then be at optimal performance.
So that's the way I would position it.
Your body is the instrument. Take care of it and we'll take
(22:38):
care of you. It's about asking the right
questions and making them aware.Actually, I was just talking
about this with a colleague about how sometimes like people
are just not aware of what is going on.
And it's not like it's maliciousthat they're doing something
like it's just that they they have no idea.
So that's part of us as as clinicians is making them aware
(23:02):
and educating them about some things that can help improve
them. And then they can say challenge
accepted. That's totally and performing
artist an athlete mindset. Of challenge.
You gave me a challenge. Challenge accepted.
I love that, right? I love that because that's
exactly what we need to do. And and sometimes it's really, I
think and Randy would said pointing a spotlight for them on
(23:24):
what they need, right? And sometimes even they don't
consciously proactively verbalize it for themselves,
right? They're just doing the do.
And so maybe it's just a refocusing of saying, OK, what
is it that you have wanted to doand because of this performance
decrement, you're not able to door what is it that you want to
(23:45):
be? I want to do blah.
I want to, I want to be on 4 performances.
I want to be the principal. I want to be on whatever it is
the first first chair, fourth chair, third chair, right.
However, it is that they define the success for them and say,
OK, so there is a component which is the skill part, which
we don't, you know, that's you and your teachers and your
choreographers. But there is also the body part
(24:08):
and the mind part where we as athletic trainers can play a
very strong role in supporting them.
And, and they have like we thinkabout medical care support team
around the athletes. Similarly, we are part of the
medical their team around these folks and helping them see
that's what we are there for. And if they need to get to that
(24:31):
next level, explaining to them, especially in dances and
performing artists, that background is in there of
anatomy, Physiology, sports, healthcare, right?
That's just not necessarily always taught.
So for them, it's more about theart.
And I remember this case of a dance teacher asking me one time
in saying the issue of preparingA choreography piece.
(24:53):
And she was like, how high can adancer be when she jumps?
So that piece had more somethingof somebody being on a male
dancers shoulder and then jumping off of the dancers
shoulder and going down. So like is this 20?
Is this twen 20 centimeters? So I'm like 20 is fine.
Like it's 40 centimeters. OK.
I'm like 40 is like OK, is the shoulder OK?
(25:15):
I'm like, how tall is your guy? Right.
So they don't even think about that in physiological
biomechanical risk terms. They think about this as
performance. So just addressing the spotlight
and say, OK, you know, yes, there is a, there is a Lim,
there is an anatomical limit. I mean, you can do things, but
let's talk through them and see what's achievable, right.
(25:37):
So saying no more what's achievable.
And I think that's where we as athird trainers can really,
really support the performing arts and practitioners because
they don't have that background knowledge.
So kind of along those lines, kind of those stakeholders, how
do you educate those stakeholders about like the
(25:59):
importance of that sleep nutrition workload?
Because we kind of talked about the performing artists, the
athletes themselves. But but now looking outside that
picture, you know, maybe the athlete or the performing artist
is like, hey, I'm. I'm trying to like.
Help my workload but this is just so much.
Yeah. It's beyond me.
(26:21):
Yeah, yeah. So I think, I think looking at
the stakeholders in the in the issue here, right.
So looking at stakeholders like artistic directors and
choreographers, looking if there's a minor, looking at
parents, looking at the healthcare team and and the
performer at the centre of it, right.
So you really want to start using think what we call
performance focused language, right?
(26:41):
Not healthcare focused language,performance focused language,
right? Explaining how, for example,
recovery can enhance their creativity, right?
As a career. Look, if you want this
combination, you want to add a little more oomph, you know, the
shower moments you have when you're kind of chilling down or
we are thinking about something else, you need to provide time
(27:01):
for that, right? You want to have technical error
reduction. So wouldn't you like it if your
group doesn't need 17 practices to get that combo, maybe just
need 4 practices, right, to get that combination?
Wouldn't we all like that, right?
And then in addition, extending career longevity, right?
So how long do this one do you want this person to be right?
(27:26):
For choreographers then talking about performance rather than
restrictions. So rather than saying don't do
this because it's bad, don't overdo this.
Rather showing them the supporting these fundamentals
really will enhance the quality and the consistency of their
artists work, right? Showing teachers and directors
that when their dancers are, forexample, well rested and well
(27:48):
fed, they can last longer, make your mistake and perform at
their best for an extended period of time.
Wouldn't you want that, right? Smart load management is not a
big word. It's really recognizing body
mind connections. And you want to train when your
(28:10):
body and mind are sound together.
Because if either of those and the spirit, obviously, right,
That's also a part of the cognitive artistic process.
It's about really doing good to the body and mind so you can get
the output that you want. And you don't want to push hard
when you're dealing with performance pressure or you're
(28:31):
seeing your athlete go down. It can mess with a lot of
things. I mean, we talked about Reds
briefly, right? So it can Reds can, you know,
cause periods, issues with periods and menstruation can
lead to weaker bones, can more prone to stress fractures and
other injuries can make them more prone to mental health
(28:52):
issues, including but not limited to anxiety, depression,
low mood, right? Do we want all of that?
Not really. So how do we prevent that?
But let's act now so that we don't see this degradation,
degradation in your athletes performance, in your dancers
performance. And it's not that hard, like we
are not telling you to go to like a retreat for three months
(29:15):
and do all of this good stuff. It's simple take home things
that you can do at home. It's simple things that you can
tweak in practice. And it's simple things like
seeing me as an athletic trainerthat can help us get there.
Let's work together. Perfect.
Now I like that. I like that performance
(29:36):
language. Yeah, that's a good way of like
framing it for the non medical provider.
Well, then it also isn't coming from like an outside source.
Yeah. It's coming from their same
team, yeah. Absolutely.
And as athletic trainer, right the, and as a society, there is,
there is enough knowledge available on social media,
(29:58):
right? But you know, your, your, your
platform is in social media are doing its service to the, to
the, to the population right, ofathletic trainers.
There is, there is good information out there.
Not all of the information is good, but information does
exist, right? As athletic trainers.
Likewise, we have hopefully reading position statements from
the NATA, the CSM, attending webinars, reading and reviewing
(30:23):
podcasts, starting with small CEU courses in an area that they
are less comfortable with and then build from there, right.
So it's, it's, it's really recognizing that it's not a one
stop shop answer. It's more of a conversation and
the continual longer term relationship with the overall
idea of improving and enhancing their performance, their
(30:48):
longevity, their skills and their progress that we are going
to as a threat trainers, help them do better.
So you brought up about red ass or Reds and there's definitely
an interplay between workload nutrition with that with someone
(31:10):
that may have been diagnosed with red ass or maybe we're
we're worried about like, hey, they might be getting in that
way. How do you kind of now intervene
with like workload and nutritionhelp kind of manage that?
Sure, great question. So I'll, I'll, I'll start with
adding on. There is actually a dance
specific Red S system being developed called Red D, right.
(31:34):
So that relative energy deficiency in dance, right.
So it's there, right. So, so there are so that's good,
right. So that's good as far as
overarching Reds, right? It is a simple, and I say
simple, it's actually, it actually just simple
infographic, right, That that shows us in a cyclical format
(31:58):
all the different components of Reds, right?
So Doctor Nikki K, who's one of the world's leading founder
experts in this area, she had a couple of good papers.
Mount Doctor Mountjoy had a couple of good papers earlier.
The BJSM British Journal Sports Medicine has some submit
(32:18):
published some good submissions about Reds.
And the general idea, and this is something that we have
started to think about in our practice, is Green Zone, orange
zone, red zone, right. So Green Zone is like, yeah,
everything's OK. Orange zone is when you really
are what I think Randy, you weretalking about like when we have
the orange zones, I think thinking about what is the
(32:39):
issue? And so we bring out that chart
and say, OK, we have identified out of these ten different
things around the circle. These are the three things we
need to see because these seem to be issues.
And then as an athletic trainer with the dancer or the
performing artists or the athletes say, OK, for this
specific issue, who do we, how do we, when do we intervene,
(33:03):
right? Can I intervene in sleep as an
athletic trainer with you? Absolutely.
Well, but if you are showing stress issues and it's not going
away, we need to see somebody. If your periods are starting to
become irregular, we need to start seeing somebody, right?
If it's a mental health and I see you kind of go down, we need
(33:23):
to see somebody from a mental health perspective.
If we are seeing that you're excessively sore and you're not
able to jump up, we need to workwith the strength and
conditioning coach, right? If you are seeing that you get
many more Boo boos, then I'm here, right?
I can fix that, right? So I think it's recognizing
where the problem areas because everybody's not going to show up
(33:44):
with everything, right? They're going to show up with
hopefully, hopefully, but everybody is going to start
entering and going to show problem areas at two or three
places. And then again, as I said, the
athletic training toolkit, bringout our athletic training
toolkit, see where we can intervene and see where we can
collaborate with other medical care team members to help that
(34:06):
person. So I think that's what it is.
When we talk about inflammation,we say out of the five cardinal
signs of inflammation, if you have three or more, it's not a
good thing. Two or less, it's OK.
Similarly, if it's three or less, in this case, it's OK.
If it's more than that, we need to sit and have a conversation
with the athlete, person, dancer, whoever it is and then
(34:27):
think about we don't want this to become 4567 because that's
not good so. Awesome.
Are we ready to? Wrap it up with an action item.
Six times some action. OK, so something that we love to
do at the end is wrap it up, kind of put together something
(34:47):
that someone can take away from this podcast if they like a too
long, didn't read just like a sum up.
If there was 1 action thing thatyou can get out of this podcast,
how can an athletic trainer start to implement workloads,
sleep, nutrition, monitoring, guidance, something of the sort
in their practice? OK, so great question.
(35:10):
Let me think about it for like 2.
Seconds. Yeah.
Take your time. Because there's so many things,
right? OK, so I would say start small,
right? Pick 1 area.
Don't tackle everything at once.Choose either sleep or nutrition
or workload monitoring based on what you're seeing.
If you have a lot of overuse injuries that you're starting to
(35:32):
see, start with workload. If your athletes are
consistently fatigue in the morning and they're like start
with sleep tracking, right? If they're fading throughout the
day, start with nutrition, right?
And some of these questionnaires, some of these
basic Wellness things are free, easily available.
(35:55):
Use simple, simple fitness. Several, if not most people will
have some kind of fitness trackers with them.
Ask them to bring it to them. So I think that's an area where
I could, I would start with pick1 area that is important that
you see in that person and then go and do the research yourself
as an athletic trainer. Look at these statements that
(36:16):
are available. Take a course, take ACU credit
in that specific area and then get better so that you can
advise your athletes better. And it doesn't really need to be
super extensive. Simply ask how many hours did
you sleep? Tell me how you feel energy
wise. What did you eat 3 hours before?
(36:38):
Right. And asking two or three of these
simple questions, picking one area and then using simple tools
for using that in your clinical practice are something that I
would really request, suggest, strongly recommend athletic
trainers we push into our clinical practice as something
that can be take home points. Awesome, I like it.
(37:03):
I like it. Start small.
Yep, kind of like with the athletes.
I think a really cool take away from this interview was just
seeing how supportive and the facilitatory role that we as
athletic trainers have on the concept of sleep, workload and
(37:26):
nutrition, right? It really shows how we kind of
have our hands in kind of each pot and we're able to kind of
help get them to where they needto go and and be supportive when
they are kind of referred out tosomeone else and like how we can
help support their goals. And not only that, but it's
really nice to hear about someone who's actually done it
(37:48):
and been in the field and work with the not only the athletes
and but the stakeholders and thepeople who can change the
workload, not only the people who are doing the workload.
So it's nice to actually talk tosomeone who is not just in this
like theory idea, but actually can have some concrete ideas of
(38:08):
how they've changed it and how we can move forward and change
it in our in our respective areas as well.
For sure, and plus it probably doesn't hurt that he's also Team
Fanny. All right, Yeah, so if you guys
are new, we do a lot of different episode types here on
At Corner. We have interview episodes just
(38:28):
like this one. We have story episodes where we
bring stories in from real life athletic trainers and discuss a
various topic. Experience shares share all of
our experiences. And then we also have Cus on
this podcast and they're run mostly by Randy.
So he reads a bunch of research articles and he kind of
synthesized them, put them together and we talked about
(38:51):
them in a conversational format and bring them to you for the,
the newest ones are free and then the ones before that are
super affordable thanks to our partner athletic training chat
and clinically pressed. So make sure you go down the
show notes. There's a lot of cool fun stuff
down there. And if you have any questions or
(39:13):
you want to reach out to us or if you want to get connected
with someone we've had on the podcast, just just reach out.
We have all of our contact information down below or reach
out on our Instagram at A2 Corner podcast.
Do you have anything else, Randy?
Nope. That's perfect.
Thank you for helping us showcase athlete training behind
the tape. Bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!