Dylon Grzenda: Applying S&C Principles in the Athletic Training Room

Episode Transcript
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Speaker 1 (00:00):
Welcome back to another episode of the Brown Performance and
Rehab Podcast, powered by Isofit and Firefly Recovery. Isofit is
my go to for all things isometric strength training. For
more on Isofit, be sure to check out isofit dot com.
Episodes like this are made possible by Firefly, the official
recovery provider of the Brown Performance and Rehab Podcast. For

(00:22):
more on Firefly, be sure to check out Recovery firefly
dot com. This episode is powered by doctor Ray Gorman,
founder of Engage Movement. Learn how to boost your income
without relying on sessions. Get a free training on the
Blended practice model by following at Ray Gorman DPT on Instagram. Dylan,
Welcome to the podcast. I'm super excited to work with

(00:44):
you today.

Speaker 2 (00:44):
Man.

Speaker 1 (00:45):
Shout out to our amazing friends like Tyler Lasher for
getting us connected and making this possible. Man. For people
who aren't familiar with you and all the amazing stuff
you're doing, whether that be with you mass up there
in Massachusetts or that be in the education space ARC,
would you mind Phil meant a little bit about who
you are and all the great stuff you got going on. Man.

Speaker 2 (01:04):
Yeah, thanks Dan for having me My name is Dylan Grizenda.
I'm a current athletic trainer at UMAs Boston with their
sports med staff. I also am one of the instructors
for the ARC SO Advanced Rehab of course that Tyler
created a couple of years ago and teach my next
cohort at the end of June.

Speaker 3 (01:22):
First one went great in the spring.

Speaker 2 (01:23):
But been an athletic trainer for two years, been in
sports performance for about five years. I've done all everything
from kind of the private setting to on field working
with specific teams to now again college athletics, now in
sports medicine. So dabbled in a lot of that and
coming from strength editioning sports performance background, now mending that
into my sports medicine athletic training career has been fun.

Speaker 1 (01:46):
Yeah, No, that's amazing. I love when those two worlds
collide and blend together that way. And it's one of
those things. I've talked with a lot of individuals in
the past week, in particular strength coaches, because I was
at the CSCCA conference, and one of the things that
came up a lot is a lot of them felt
like they had had bad experiences with pts and AT's
in the past who just didn't seem to grasp this

(02:08):
concept of strength and conditioning and loading principles that way.
And it's one of those things that I think everyone's
had a bad experience with any kind of profession. I
don't care if it's a cairo ptat. None of us
are perfect by any means that way, and I'm not
going to claim to be everyone's cup of tea. But
one of the things I do think comes up a
lot is we need to have this importance or this

(02:30):
understanding as rehab providers of what it means to load tissue,
when you can load tissue, how you can load tissue safely,
and how that criterion of loading overlaps with the healing timelines,
if you will that way, I think the days of
just timeline progressions are over and the days of hey,
we actually have to meet specific criteria in order to

(02:52):
earn the right to progress are very much here that way.
I'm curious, just on your own end that way, how
did you go about initially developing your framework or to
kind of brand bring that strength and conditioning knowledge basis
that you have into your work as a rehab provider
that way.

Speaker 2 (03:07):
Yeah, I think coming from that sports performance background, like
it was a totally different background, and as I was
going through grad school as an AT student, I struggled
to grasp the concept of bridging those two gaps of
how can I take my current knowledge and experience and
you know, throw it into what I'm about to go
into the profession about to go into. And that's where
I bring up ARC. I took ARC so Tyler's course

(03:29):
when I was an AT student, and it helped kind
of grasp the concept of, you know, sports performance isn't
a lot on these timelines, as you mentioned right, it's
I worked a lot with one on ones in smaller groups,
so very individualized programs that were very adapting the needs
of these athletes. And then you get to school and

(03:49):
there's a lot of timelines, there's phases, there's all of this,
and it's great to understand too. But the bridge between
the two I struggled with initially. And then as you mentioned,
it's loading the two tissue. The word that we throw
around a lot in ARC is capacity, the tissue capacity.
And once I kind of saw the concepts of you know,
what I was being taught in school, and as I

(04:10):
got into the athletic training realm and then bridging that gap,
and again under this umbrella of sports performance, it's all
sports performance. Whether it's a healthy athlete that's trying to
get bigger, stronger, faster, or an injured athlete he's trying
to get back on the field. At the end of
the day, it's sports performance and that's the approach that
we need to take. And then it's then what is
the athlete capable of, what is their tissue capable of,

(04:31):
what is their you know, their body capable of, and
then working back from there and bridging the gap.

Speaker 1 (04:36):
When you say tissue capacity, what exactly does that mean
to you or how do you define that.

Speaker 2 (04:42):
If it's an injured tissue. Right, that starts with our
athletic training or clinician evaluation. Right, That's what we're doing
in our evaluation. What is the athlete capable of doing?
Are they able to do active range of motion? Passive
range of motion? Furthermore, we're manual muscle testing. What are
they capable of to what intensity? You know, what is
their pain tolerance. We're understanding all of that in our evaluation,

(05:03):
and then furthermore bridging that too. Right, sports analytics is
huge right now, we're using jump mats. Those are all
different lasers. All of those are different attributes, are different
technology to you know, then further test what the athlete
is capable of. And again that's why we're taking baseline testing.
Data Analytics is huge right now and it's it's something

(05:26):
that both I think both professions, both sports performance, athletic training,
sports medicine, can utilize to work together to again better
understand where this capacity is.

Speaker 1 (05:38):
It sounds like your own process of assessing an athlete
goes well beyond just your base range of motion and
manual muscle testing. I know you threw those out there
and a lot of us, myself included, to start there,
but it sounds like that's not where you end, if
you will, And that's one of the many things that
I think people misunderstand in this profession is you know,

(05:59):
a lot stop after the range of motion and the
manual muscle test, and sometimes you can get good information
from that, but for me, that's just a part of
the bigger framework, if you will, It's part of my assessment,
but it's not the whole assessment. That way, I think
it's important to get people up, get them moving functionally,
watch how they move, watch how they do different things,

(06:21):
see how they do what matters to them. And then
you also mentioned that you put some objective numbers to
things too, And I think it's one of those things
that at least I personally feel, imperfect data done in
a perfect way is far better than perfect data done
in an imperfect way. And what I mean by that

(06:41):
is it doesn't matter if your tool has like a
two percent standard of error. It doesn't matter if you
know you are like using like whatever tech you have
that way. Like some people might say, well, you know,
force plates are better than a jump mat, Well guess
what if you have a jump mat used to freaking
jump mat? Right, Like, use what you have. But if

(07:01):
you use that in a consistent way, with consistent setup
and an overall framework and approach to testing where you're
using the data to try and answer a question instead
of just collecting pages upon pages and numbers, you're going
to get so so far with that. And I think
that that curiosity to learn more about that, to dive

(07:22):
into kind of this like sports science realm, if you will,
is going to really push the profession forward and give
us new insights into injury management.

Speaker 3 (07:30):
That way, Yeah, absolutely, we can't get lost in it.

Speaker 2 (07:33):
It's a great tool for us to utilize, but just
like textbooks, right, it's not you know, it's great to
take the baseline rehabs that were learned in whatever schools
or programs that you're in, but we need to look
at the athlete too, and that is as you mentioned,
we can't get lost in data analytics and start looking
at the numbers rather than the athlete themselves. Right, it's

(07:53):
again finding the numbers that we need to utilize and
having a good format and a good program to utilize.
But don't get lost in it either. Don't get away
from the athlete and focus on.

Speaker 1 (08:02):
The numbers exactly. Now, how have you gone about educating
yourself to bring those sports science things into your own
clinical practice? Because this is a emerging area I see
in the clinical practice, yet a lot of providers get
overwhelmed by it early on. There's a lot of different
turns you can take with it. Obviously, a lot of numbers,

(08:24):
a lot of data, a lot of new tests coming
out all the time. How do you kind of navigate
that roadmap for yourself?

Speaker 2 (08:29):
Yeah, I think it's two different things. I think the
first one is kind of building a network. I think clinicians.
There's a lot of really great clinicians out there looking to,
you know, share knowledge.

Speaker 3 (08:39):
It's as someone who's been.

Speaker 2 (08:40):
In the athletic training sports performance field for only two
years and still finding my way through things and still
making plenty of errors, making plenty of mistakes and throwing
a lot out there to try to figure out what works.
Kind of reaching out to others who've got a jumpstart
on the data analytics is important. And then it comes
down to, you know, just try trying to stick with

(09:01):
the basics, just with everything, rather it's exercise, programming, whether
it's tools that we utilize. At the end of the day,
I have started to notice that the basics will always
work and stick with those basic numbers, you know, those
hop tests don't write. A hop test is something that's simple.
I always joke about in the art class that right
really it's just two pieces of tape a foot away

(09:22):
and you can get a lot of data from that
and it's just you just stop watch or even just
counting your head. As much as it's not as much
as a thousand dollars jump plate, it's still something that's
super simple and it does the job, and you can
get a lot out of that. So again branching out,
preaching out to others and creating this network where we
can bounce ideas around and knowledge off of. And then

(09:44):
also just staying with your basics, and not staying with
your basics, but really leaning on your basics, the foundation,
keeping it simple, understanding what those numbers mean, and working
with what has worked for a while.

Speaker 1 (09:55):
Now. Yeah, I love that. I mean one of the
things that comes up really really often when I'm talking
with people, and it doesn't matter if you're a PT
at Cairo, I feel like everyone talks about this is
they don't have as much of a budget as they
would like to have for different toys and tools and
that sort of thing. That way. But I actually look
at that as a bit of a blessing in disguise,

(10:17):
if you will, because if you can make it work
when you have access to nothing, it's a million times
easier when you do have that stuff. And I also
think you start to appreciate what you can do and
the effect that you can have just yourself, instead of
feeling like you're relying on all this tech and external things.

(10:37):
You just realize how much you can affect the body
literally with your own simple stuff that you have that way,
if you will. I think the other piece too, is
like what happens if your tech breaks down?

Speaker 2 (10:49):
Right?

Speaker 1 (10:49):
Are you going to go two weeks of just not
seeing anyone because your tech is broken? Or are you
going to lean into the knowledge base and skill set
that you built up earlier. So I think starting in
those spaces where you might not have access to everything
is actually a huge blessing in disguise because you kind
of learn how to improvise, how to make it work

(11:10):
when you don't have any of those things.

Speaker 2 (11:12):
Yeah, and it's also right as clinicians who are getting
in there. If there's any athletic training students or you know,
younger athletic trainers listening to this, it's develop on your own, right.
It's yes, it's great to throw in these video and
analysis programs that can break down angles and all that,
but it's also I've always enjoyed watching, you know, clinicians

(11:33):
who have been in the field for ten years take
a video on their iPhone and break it down on
their own, right.

Speaker 3 (11:39):
It's they don't need that now.

Speaker 2 (11:42):
That stuff is a tool and it's helpful, but also
just having the knowledge on your own to be able
to use your cell phone, take a video, slow it down,
and break it down on your own is important too.

Speaker 1 (11:55):
Absolutely. Now we've talked a little bit about the assessment
side of things. That way, after you've assessed an athlete,
maybe they're injured, maybe they're not injured. That way, where
do you go from your overall strength and conditioning integrated
into rehab approach that way, how early do you look
to load them and what exactly is loading in the

(12:17):
early phase kind of acute rehab that way, what does
that look like? How do you kind of go about
getting forced through a targeted area when you know their
overall capacity might be a little bit lower if.

Speaker 2 (12:28):
You will, Yeah, I think again, having a good evaluation
process where like for something like an angle, if they're
you know, making a past medium muscle testing, no special
tests are giving any red flags. That hopping and jumping
during the evaluation process is huge because then that kind
of sets the rehab up. If they can do a
double leg hop but they struggle to do a single

(12:50):
leg hop, then I know my rehab is working immediately
on progressing from double leg to single leg and progressing
the amount of volume that they can handle with that
same thing. It's it's developing this clinician experience of with
manual muscle tests, you're kind of getting a feel hands
on of like what the capacity you can load in
different directions and angles, and then how that carries over

(13:12):
to the rehab exercises.

Speaker 3 (13:13):
That you like to choose.

Speaker 2 (13:15):
But again, having a good rehab process that you know
really goes in depth, and it's not this all or nothing, right,
it's all right, I do hands on that traditional evaluation
and you know, you do a couple functional hops and
then I'm sending you back out to a two hour
practice in which you're running, jumping, cutting, it's you know,
hopping should be in it.

Speaker 3 (13:34):
Okay, they passed the hopping.

Speaker 2 (13:35):
Now we're progressing functionally to can you give me high
knees in a straight line? Can you do a skips? Okay,
you can do that. Can you give me a sprint forward?
Okay you can do that. Can you give me a
lateral shuffle? Can you shuffle in diagonals? And that should
be part of your evaluation process. And you're going through like, okay,
we could run in a straight line, but changing direction
was tough. Okay, we're going to do stuff in practice

(13:57):
in which you can run in a straight line and
you know, limit the volume in that, but I know
in the rehab process that that's what we're gonna do.
We're gonna really hammer a little bit more volume straight,
but really focus on change direction and that's going to
be where we start rehab wise, because that's where it
seemed like your capacity started to kind of fizzle out there.

Speaker 1 (14:16):
Yeah, it sounds like you take what I would call
a little bit of a vector specific approach. And I
think this is so overlooked and not discussed enough. Both
Sandoval brought it up in a past podcast episode we
did in the Fall, and I think it's one of
those things that can be so so powerful in your
work as a rehab provider. It's beyond just is it

(14:38):
strong and can it move? It's a matter of what
planes is it strong in and does that change when
we change the speed of the contraction or the type
of contraction if you will, And I'll give an example
of that. A lot of people will do this like
bent knee cave race thing, and a lot of people
critique it because they feel like there's not enough actual

(15:00):
stimulus to get load through the soldiest. However, I notice,
at least in my own personal practice, a lot of
athletes struggle immensely with the eccentric of that. Concentrically, yeah,
they can display force all day long, but they lack
the eccentric capacity. And I know that because as soon
as they start to lower their heel, if I make
them go slow and controlled, their whole leg starts quaking uncontrollably. Right,

(15:25):
we've all seen that before. Yes, it's just kind of
like that visual test where it's like, hey, you know, yes,
it's a sagittal plane motion. Yes, they might be quote
unquote strong based on a mangal muscle test, but clearly
we're lacking some kind of quality here, and I need
to build that quality up. And I'm not going to
build that quality up if all I'm doing is concentric

(15:47):
output focused straight leg cavareys is or something along those lines.
I have to be more specific, what position, what vector,
what type of contraction, and so on From there. I
think the more you just try to peel the layers back,
the less likely you are to miss stuff in your
assessment one in two, the better your programming is going
to be. My programming looks very different for every athlete

(16:10):
that I work with. It's very individualized because they all
have specific things that they need that are a little
different than the other one. And it might be you know,
the same kind of overall like skeleton of program, but
there's little things that are different, whether that be the
tempo that they're using to do the exercise, the actual
volume of the exercise like sets, reps, and so on

(16:32):
that way, whatever it is, there's little things that differ
from one athlete to the next.

Speaker 2 (16:38):
Absolutely, it's providing that best patient care that we can
and that's that's what's important. You see the athlete for
who they are.

Speaker 1 (16:43):
That's what it's all about. Man, you have to treat
people as people at the end of the day. So
it sounds like a lot of your initial framework is
really diving into what vector or what specific qualities does
that athlete need, and then how do I go about
giving them that specific quality. I know a lot of
AT's are going to listen to this and they're gonna say, well,

(17:05):
you know, I'm limited on time or I'm limited on equipment,
So what do you do from your own strength and
conditioning kind of implementation into this rehab side if you will,
If you are short on time with your athlete, or
if you don't have access to all the equipment that
you might want to have in your at room. That way,
how do you still kind of what I call ball
on a budget if you will.

Speaker 3 (17:26):
Yeah, I think organization is key. Everyone jokes.

Speaker 2 (17:29):
I carry around a notebook that has like all the
programs for the day. But that's, you know, I enjoy
what I do, and it's you know, after work and
on my train ride into work every day, like writing
down what I want these athletes to do, and.

Speaker 3 (17:42):
It gets modified.

Speaker 2 (17:42):
There are times where I write, you know, six exercises
and the athlete comes in and I'm only you know,
They're like, I'm only in here for fifteen minutes before I.

Speaker 3 (17:49):
Got to scoot off the class. All right, we bumped
down to these four.

Speaker 2 (17:52):
But I think being organized is huge coming from that strength.
Nditioning sports performance programming is something we would sit down
and have a two hour meeting about what do we
want to program these athletes for the next six weeks.
And it's something that you know, in AT I get it.
It's that it's we're not building, you know, six weeks
programs that are two days, but it's a lot more flexible,

(18:14):
but it is you still get a program, you still
get to write it down. And I think that sometimes
in our realm we get lost in time and days
get busy, and it turns into an athlete shows up
and they're like do this and then do that, and
so trying to stay on top of it and at least
having a plan in your mind and where you want
the athlete to go over the course of the week
is important, and it's something that you know, I write down,

(18:37):
you know, plans if this athlete comes in, they do this,
And sometimes they don't show up, and that's fine, but
at least I'm organized enough to know that I have
a plan for that athlete for the day, rather than
again they show up that hey, I'm here for twenty
minutes and you're like, well, mini bands over there, and
you know, we got some ankle weights over there. I

(18:57):
guess we'll do this, and we're kind of again thrown
at the wall and kind of going through the motions
a little bit.

Speaker 1 (19:02):
Absolutely, I think it's so essential to have that kind
of pre built plan for the day. And as you mentioned,
they might come in in a different state and you
can adjust. But I think going in without a plan
is planning to fail if you will. I think, yes,
there are acute things that change day to day, there
are flare ups that happen, and so on that way,

(19:22):
but you have to know where you're going at the
end of the day. You have to begin with the
end in mind. That's something that comes up a lot
in the strength and conditioning space, right they have an
end goal and then the reverse engineer plan to get there.
In the rehab space, we should be doing the same
thing a lot of times, though we lack the progressive
element in my opinion, and I think the more you

(19:43):
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Speaker 2 (20:38):
Yeap, And I think writing things down and you brought
up a huge point of like it doesn't need to
go from like exercise A to exercise M. It's just
all right, we did exercise A yesterday. Let's add a tempo,
let's add an iso, let's add an e centric portion
to that. So you don't have to go crazy. It's
not like you need to come up with brand new
exercises every day of the week for however long they're

(21:00):
injured or seeing you. It's just have an idea and
where they're at, and then how can we progress it
via tempo va load, via you know ecentric work, you know,
adding an ISO at the end. Maybe you do the
same exercise for the same reps they did yesterday, but
then they do a ten second hole in the last rep.

Speaker 3 (21:17):
How can we can just continue to progress it that way?

Speaker 1 (21:20):
And as you mentioned earlier, understanding the basic fundamentals and
the role that they play, like I don't really reinvent
the wheel with anything that I do, or at least
I don't think I do right like you mentioned, you know,
a leg race or something along those lines, Like you know,
I might not love three sets of ten straight leg rays,
but I love straight leg grays overcoming isometrics where they

(21:40):
push as hard as they can into something that's not
going to move. I absolutely love that. I give that
out quite often. There's a lot of different ways to
program the same thing, like you mentioned, and I think
sometimes it's just your willingness to take those basic fundamental
things and play around with them and manipulate small little
variables that go into them, like you mentioned a lot

(22:01):
of them. I would say. The other thing I'll play
around with is the overall positioning of other joints. Right,
So take your straight leg grays again, you know, the
external rotation versus internal rotation, small differences. I would say,
I'll also have people sit upright, so bring the trunk
closer to their leg. I'll also have people kind of
bring their opposite knee towards their chest. There's a lot

(22:22):
of different ways you can modify that to kind of
progress it and regress it. And I think you get
a lot of skill and success in your rehab provision
by learning what is level one and what is a
level one hundred and every level in between, all these
basic fundamental things like even if it's just the straight
leg grays again going back to that example, probably beating

(22:44):
a dead horse here, but take your notebook like Dylan has,
go in there and ride out you know, basic straight
leg grays, and then ride out the craziest progression of it.
You can think of one that you might not even
be able to do yourself, and then fill in the
gaps from there and go to town. That kind of
stuff makes you so much more successful in prescribing exercise
as a rehab provider in my opinion.

Speaker 3 (23:06):
Yeah, absolutely absolutely.

Speaker 1 (23:08):
And you mentioned earlier that the AT in my opinion,
also has a role just beyond injury management and more
also in return to sport decision making in addition to
helping in the performance kind of umbrella if you will
keeping the athletes performing at the level that they want
to be at even if they're not injured that way,

(23:30):
what's your approach or how does your loading parameters change
when athletes do get towards that late stage, end stage
of your rehab progression that way, And how do you
kind of integrate that in with the existing strength and
conditioning work that they're already doing.

Speaker 2 (23:45):
Yeah, I think having good communication, but it's also that
sports specific that's like my favorite stuff is that late stage, right,
because a big part of it is, yes, their body
is physically you know, recovered and developed and getting to
the capacity that they need to be. But then men's
they're an athlete, and there's a huge mental component to all. Right,
there's you know, challenging exercises in the at room or

(24:06):
in you know, the gym or in the weight room
to actually doing their sport and if you can get
them on the field, and again that.

Speaker 3 (24:13):
Might be just generic louder work.

Speaker 2 (24:15):
It might just be you know, going through running form
or just getting out there and doing some exercises. But
that's like a huge component as well, and it's it's
part of my job that I enjoy the most is
getting out in the field and competing a little bit
against the athletes and doing these you know, drills that
they would be doing and maybe at fifty percent to
start with in low volume. But again that's like the

(24:35):
fun part of the job is being creative on the
field as well and bridging that late stage gap of
getting these athletes to be back to you know, the
athletic capability that they've they've worked so hard to achieve.

Speaker 1 (24:49):
Absolutely, so it sounds like you actually do the work
of hitting the athlete back out on the field and
working with them on field, which is something that in
my opinion, I don't hear enough people doing. And again
this is speaking broadly to multiple professions here. A lot
of them are still relying on the timeline component alone,

(25:09):
or they do one single return to sport test day.
You know, numbers look good, good to go, go back
at it. And it sounds like you're a little bit
more strategic in that you get them back on the
field and kind of build layers over time instead of
just kind of pulling back the curtain and saying, go.

Speaker 2 (25:26):
Yeah, it's not all or nothing, right, There's there's return
to play, and then there's return to you know, competing
at one hundred percent just because an athlete is able
to get through a practice, are they competing at let's say,
if the championship games the next day, competing at the
best percentage and the best capability that they are at.
And there's a huge difference between those two layers right there.

(25:47):
So it's understanding again it's not an all or nothing.
It's this communication is going to be huge and it
always is a huge thing. But for me talking with
the coaches of like, all right, it's not all or nothing.

Speaker 3 (25:58):
In practice.

Speaker 2 (25:58):
You know someone who's return or newly returned to practice
and return to game of they'll do this drill, do
this drill. I think this might be a little bit
too much for them, maybe mentally, maybe physically, who knows,
maybe volume wise, but you know, they'll do this drill,
to this drill. During this drill, they'll come over to me,
they'll work on shooting. It's also for us as clinicians
being you know, learning about sports in general. Right. It

(26:23):
was someone that when I started working at a gym
Athletes Acceleration and North Attleboro is I learned so much
about running form, about building up and working that movement
side of running form, breaking down what sprinting looks like,
and from ankle knees hips, all of that I learned
so much. And right this weekend, I'm working with women's tennis,
a sport that I normally don't work with and haven't

(26:44):
worked with a lot, But I'm asking so many questions
about the rules, the lingo, all of that's to just
be again, this is all things that I can utilize.

Speaker 3 (26:52):
So when I if I work a worth an.

Speaker 2 (26:55):
Athlete, a women's tennis athlete, and they have a practice
and I'm giving a practice plan, I don't know what
nothing means. I know what this means. I know what
that means, I know the demands of this. It's also
understanding this, you know the layers of sports and being
around athletics.

Speaker 1 (27:10):
Absolutely, it's not as simple as again going back to
that example before, it is not just well, nine months
have past, you passed your biodex and some hot testing,
you're good to go. There's so much more to it
than that. And I think this is the kind of
thing that will separate what I talked about initially where
people say, well, you know, I had a bad experience

(27:32):
with this provider. Again, very agnostic in what provider it is,
ptat kiro whatever. If you get to this point and
you say, well, it's good enough, or you say, well,
you know, I think it's good. I'm just gonna let
them go and hope for the best. The spray and
prey approach really does not work here. And I think
your ability to take those extra steps and bridge the

(27:55):
gap between, as you mentioned, return to play clearance and
return to desired level of performance can really make or
break your success and the athlete's success. Right, A lot
of athletes go back, they start playing and they just
don't feel right, or they're not performing at the level
that they want, whatever it is. And if they're just

(28:16):
constantly being told you're good, you're good, you're good in
a way, at least to me, it almost feels like
we gaslight the athlete, right. It's like, you know, they're
sitting there telling you it doesn't feel right, or it's
not normal, whatever it is. To me, that's the check
engine light. That's the warning sign going off that we
need to look at things a little bit more in depth.
And so many of us make the mistake of not

(28:36):
doing that. And I mean, I do my best, but
I probably miss stuff. We all probably miss stuff, but
we have to be willing to make the attempt and
make the effort to bridge that gap, to really provide
for what the athlete is specifically returning, to educate ourselves
on how we can best provide for them in that stage,
and always be assessing things right, Like you mentioned how

(29:00):
having an athlete go out and shoot, it's like, hey,
look as their shooting look today compared to the last
few days, how does it feel to them? Just start
asking questions and just don't stop right. I had a
lacrosse girl I was working with that we noticed that
with her split dodge right on days where her knee
was really sore and achy and just didn't feel one
hundred percent, which you know, unfortunately, we can't always have

(29:21):
every athlete feeling on one hundred percent of the time.
There's going to be bad dates they happen. But on
days where she was not feeling one hundred percent, her
split dodge took a significantly more east to west route
than a north to south route. The angle was drastically different.
And you mentioned the iPhone video before. It's not perfect,

(29:43):
but I took iPhone videos and it was like significantly
different just on those days that she wasn't feeling one
hundred percent in her knee. So naturally that was something
that we changed, we worked on. We added different things
to her kind of warm up routine, a lot of
isometrics to kind of help take need from like a
five to a one, if you will comment down a
little bit, get it feeling a little bit better, get

(30:05):
us more comfortable in that position, and work from there.
So I think that this phase, in particular, your ability
to provide for athletes here can really dictate a lot
of the success of you as a provider.

Speaker 2 (30:18):
Yeah, it's just being a good teammate with these athletes, right,
It's as you mentioned, right, if we're if the athlete,
because I've been there, you know, the athlete doesn't feel
right and they're being told no, no, no, you're good, they're
gonna I mean, these athletes wear everything on their shoulders.

Speaker 3 (30:31):
They're gonna be like, what's wrong with me? What am
I not doing right?

Speaker 2 (30:34):
And we don't want that, right, it's are we setting
them up for failure by telling them they're fine and
something isn't going right?

Speaker 3 (30:40):
And it's also.

Speaker 2 (30:41):
Again communicating with the athlete hopefully with that woman's are
women's across athlete Like they notice it as well, and
it's this back and forth camaraderie in teamwork with the
athletes of like, hey, that didn't look right, and they're like, hey,
that didn't feel right, and you're like, all right, together,
let's figure out what's going on.

Speaker 1 (30:56):
Yes, the teamwork approach. I love that you brought that up.
And as you mentioned, it's common to see those situations
where you know, the athlete mentally is kind of bringing
things up even after they've checked all the boxes, if
you will that way, I'm curious. Have you ever been
in situations where it's the opposite, where hey, maybe the athlete,

(31:18):
maybe the athlete is so ready to go, so gung ho,
geared up, everything subjectively is checked, but objectively they're not there.
It's kind of the opposite situation, if you will, where
instead of physically they're good, mentally we have some concerns
or things don't feel right. What do we do when
mentally the box is checked, we're all in ready to go,

(31:39):
but physically we're not there. How does that change things? Yeah?

Speaker 2 (31:44):
I think it's this is where like it's so much
you got to have you know, do what you can
use your networks. Right when I got Ryan graduated school,
I worked with two ACL patients. One of them was
on the earlier clearance side, Like we're talking real real soon.
You know, physically they were you know, strength wise where

(32:06):
they needed to, but movement wise, I didn't think that
they were there. And that's where again you have kind
of objective analytics of we used an iPhone, we broke
down some stuff, we did some hop tests, other hop tests,
and it was okay, we see some discrepancies and it
was easier to talk with the athlete. I'm like, hey,
maybe we give this one more month of really rebuilding

(32:29):
or not rebuilding, but building the foundation movement wise where
we need to before we send you out into a game.
And again, it's one of those things where I think
if I didn't use videos, if I didn't use some
other you know, objective tests, that would have been a
harder conversation because the athletes being told by other clinicians
and you know, other people in their lives that they're
good to go, and you're someone that you know, maybe

(32:51):
if you don't have the best relationship and these are
newer athletes, to me, that I'm telling them, no, you know,
this doesn't look the best. I don't think that we're
one hundred percent ready, And you're just going off a
word of mouth. That's a tough conversation versus you know,
being able to take an iPhone video and see you know,
unaffected side versus affected side and break it down and
they're looking at the video going, yeah, I see what

(33:11):
you're saying, Like my knee is caving in a little
bit when I do that movement, or you know, I'm
taking you know, twice as many steps to break down
when that's my lead leg versus you know, my unaffected leg.
So that is where data analytics make some of these
conversations and some of this you know, technology allows these
conversations to be a little bit better. Even just testing

(33:31):
makes it makes these conversations a little bit easier. But
have you know, find out what the athlete's feeling, find
where they're at, you know, find where they want to be.
And also, don't just go off a word of mouth,
like give them something to work off of too. Don't
just say, you know, I'm the dictator of whether you're
playing or not, or I'm the dictator of your future.

(33:52):
You know, do as I say, like, you know, use
all of these tools that we have to have a
good conversation with these athletes.

Speaker 1 (34:00):
Yeah, make it one of those conversations that everyone is
at the table for, not just you steering the ship,
but as you mentioned, invite the athlete to it. Also
invite the other stakeholders, right, Like, I think it's best
when it's a team decision on return or the team
decision of what to do, instead of just one person

(34:21):
having all that weight on their shoulders. Right hey, get
strength coach involved, get team doc involved, get everyone involved
that way, because it's possible one person misses something, but
it's a lot more unlikely that a team of five
to ten people miss something, especially when the athlete is
included as part of that. So I absolutely love that

(34:42):
you do that in your kind of practice and wheelhouse there, Dylan,
what do you feel like allowed you to get to
this point in your career so quick that you've been
able to learn and integrate these things so successfully, Because again,
you know, I know a lot of providers are going
to listen to this and they're going to say, this
sounds great, but I don't know where to go or
I don't have the roadmap or I don't have the knowledge,

(35:03):
whatever it is that way, How do you feel like
you're able to integrate this so seamlessly that way? And
what are your kind of your advice and resources for
others that are trying to kind of level up their
own kind of practice.

Speaker 2 (35:15):
Yeah, I think it's surrounding yourself with other like minded individuals.
It was I was blessed with you know, the gym
that I used to work with the staff. There was
great We're always pursuing greatness, We're always working together as
a team like that was the same thing. Wasn't like
you know, Dylan coaches middle school these times. You know,
Pat is coach in high school at these times, and
we were you know, two separate individuals. It was we

(35:37):
were this team. Everyone was sitting at the table. As
you say, input was important, and it was asking questions
and I felt like my questions were you know, taken
with respect. And that's a huge part of it as well,
is just asking questions and finding Again going back to Tyler,
Tyer was this athletic trainer who who again took that
strength editioning sports performance side, and he talked a lot

(36:00):
about how he applies it, what's his mindset to it?
And I remember finding you know, Tyler's account in grad
school and and just like going through everything and listening
to podcasts, and I remember a YouTube, you.

Speaker 3 (36:12):
Know video that was like an hour long.

Speaker 2 (36:13):
I like watched and wrote down you know, notes about
that talk for like three times, like just seeing where
his head was at and how he approached things. And
then you know, mentors. I had to go up a
bunch of really good preceptors through grad school and the
network that that branched out too. It's, in my opinion,
sports performances is a lot of ambitious individuals who are

(36:36):
really looking to work alongside with other individuals.

Speaker 3 (36:40):
And there's very few times.

Speaker 2 (36:41):
On LinkedIn social media that have reached out to someone
a total stranger and been like, hey, you know, I
saw that you post about this. What's your thought on this?
Or why did you do this? Or why do you
do this? And anyone's been rude about it or even
ignores it. Usually I get very respectful answers, you know,
and and it's and people looking you know, and okay

(37:01):
with me picking their brain, and even some people are like, yeah,
let's get on the phone and let's chat about it.

Speaker 3 (37:06):
So don't be afraid.

Speaker 2 (37:07):
It's you know, admitting when you don't know something, admitting
that you know you're when you're wrong, or you again
you're not.

Speaker 3 (37:15):
You don't have.

Speaker 2 (37:15):
Endless amounts of experience in something is going to set
you up for success them pretending like you do and
just you know, googling it behind closed doors.

Speaker 1 (37:24):
Oh my goodness, I love that you brought up the
googling it behind closed doors. It's one of those things
that I think as I was first coming out of school,
like I thought, oh, well, you know, school taught me
I can practice autonomy, and autonomy I can practice independently,
and I can kind of, like you know, do all
these things, do it all myself. I've got all this knowledge,

(37:46):
I've got, you know, all these degrees and whatnot. I'm
ready to go. And it took less than a month
to realize like, oh shoot, I don't know nearly as
much I thought I did. And as you mentioned, the
networking effect was so much more impactful to me than
the googling effect. And I'll be honest, I hate googling stuff,
like I really don't want to like have to sit

(38:06):
there and sort through the weed. So what's good and
what's not good. And I think having that network and
a robust like group of people around you to offer
their insights and perspectives, especially when those people come from
a diverse array of backgrounds, that way makes your own
clinical practice significantly more impactful. And I think, as you mentioned,
being high in respect but low in ego enough to

(38:30):
admit when you come up short, enough to admit when
you still have more to learn, I think the more
open and honest you are about those things, the better
it goes for everyone. Right. I don't think anyone's expectation,
at least I've never seen it on a job hiring
is must have it one hundred percent together, one hundred
percent of the time and get everything one hundred percent
right always. I've never seen that. But if you do

(38:54):
come up short and you don't own it, you come
up short and you don't communicate it with others and
talk about how you're going to strategically learn from it
so it doesn't happen again, those conversations go a much
different way. So understanding that as long as you're high
in respect, low and ego, and always humble enough to
look for what else you can do to learn but

(39:15):
also provide value to others. You're going to be successful
in your career regardless of what profession you're in.

Speaker 2 (39:22):
Yeah, it's understanding the why. Right when you google something,
you're really not getting the why behind it. And right,
we're given great textbooks through at school. But I remember
the first time that you know, a major injury. You know,
I got the rehab in the textbook right here, but
the timeline isn't adding up.

Speaker 3 (39:37):
You know, this.

Speaker 2 (39:37):
Athlete's on this month and it says that they should
be good for this, but what's going on?

Speaker 3 (39:41):
Like, then, what do we do? Right?

Speaker 2 (39:42):
That textbook's great when the timeline goes as planned, but
as you mentioned, right, this athlete's on month five, and
then they said on month five in the textbook that
this is where they should be. What do we do
now because we don't have the why. It's written out
there and it's a good foundation, but understanding the why
of they should be doing this exercise is because of

(40:03):
this reason or because of this state is huge.

Speaker 3 (40:06):
It's the most important.

Speaker 1 (40:07):
Part of it all, right, And understanding that the textbook
might have been written five to ten years ago and
the rate at which knowledge is coming out is significantly
faster than that. Right, Like we still say nine to
twelve months for ACL, for example, and I always say,
you know, I'd rather start saying twelve months because athletes

(40:27):
hear the nine and they just stop there and it
magically has to be good to go by nine. We're
seeing research come out now that the bony element of
healing following an ACL injury, right, the impact of the
injury itself, in addition to drilling tunnels, might take up
to two years to actually return to prior level of
strength in some of these athletes. So you know, we've

(40:49):
been saying nine to twelve months, but it might need
to be longer for certain ones just from a bony
side of things, and they might not love to hear that.
But our knowledge of the these injuries is evolving and expanding,
so as a result, our own rehab approach needs to
evolve and expand we have to stay up to date.
And no one can stay up to date with every

(41:10):
single study that comes out every day because it's just
too much information. But again, I think leaning into the
network of people that you know and doing your best
effort to stay up to date with the changing times
and understanding how does that change? How does that impact
my work as a rehab provider? Because people read studies
and it's like, oh cool, great, you know, nothing changes.

(41:32):
It's better when you read it, understand it, and then
say here's what I'm going to do about it. Or
maybe it just reaffirms what you've been doing so far
and it doesn't change anything per se. It just reinforces
the actions you've been taking even better. Right now you
have additional kind of like to stand on as far
as why you do what you do, so always learning,

(41:54):
always looking for more, asking yourself, hey can I change
what I do? Is it all good to go? And
again you know, I know we talk about the strength
and conditioning side of this, but in reality, these are
things that can apply to really any profession. Right. A
lot of ates I talk with pts even have some

(42:14):
kind of like side hustle endeavors now and if that's you, great,
But if you take these principles that we've discussed, you're
going to be successful in any of them, whatever they are.

Speaker 3 (42:24):
Yeah, it's just it's all sports performance.

Speaker 2 (42:26):
I think when I was able to understand that we're
all sports performance coaches, from coaches on the sideline to
pts to ATS to strength editioning coaches, we're all trying
to get these athletes to perform at the best level.
It makes it easier to connect, It makes it easier
to work together, makes it makes it easier to look
at each other as a team.

Speaker 1 (42:47):
Absolutely, Dylan, I feel like we could probably talk about
these kind of things and just the overall high performance
approach to rehab all day long that way. Is there
anything we missed as we were chatting or anything else
you want to bring up?

Speaker 3 (43:01):
I don't think so.

Speaker 2 (43:02):
I think this was a good kind of conversation about
a little bit of everything. I think, you know, individuals
can hopefully take what we talked about and and kind
of dive into more on whatever kind of caught their attention.
But it's as you mentioned, it's it especially I'll talk
for athletic training. Athletic training is in a really good position.
I think that the future is exciting.

Speaker 3 (43:22):
It can be exciting.

Speaker 2 (43:23):
I know it's an industry in which it hasn't really
found fully what you know it's persona yet, but hopefully
any younger ATS and AT students listening are soon to
be future AT students. Kind of going with an ambitious
mind that it's more than just what it was a
decade or two decades ago, and it's exciting to see

(43:45):
where it's going to go and the clinicians that come
out of it.

Speaker 1 (43:48):
Absolutely, absolutely, man, I couldn't agree more. For people who
want to find out more about you, and maybe they
want to find out more about the arc that way,
where can they find you at?

Speaker 2 (43:58):
They can social media, so Instagram, which is just my
first name d y l o n last name Grizenda
seven public, so feel free to shoot me a message.
My email is also DJ Grizzenda. My last name is
zero seven at gmail. Feel free to send me an email.

Speaker 3 (44:16):
And then LinkedIn. I'm very active on LinkedIn.

Speaker 2 (44:19):
I remember a year ago someone telling me that I
should get into LinkedIn, and I think I just got
over a thousand connections this month, So very active there
as well. LinkedIn for those not using, and I recommend it.
It's a lot of where I connect with other clinicians
now more than social media, which was social media was
a big one last year for me, but LinkedIn is
where I've connected with the most.

Speaker 3 (44:39):
People and it's also growing as well.

Speaker 2 (44:42):
I don't know how much you're on LinkedIn, but people
are posting videos, they're posting you know, talkover clips. So
it's kind of a cool space now where I learn
a lot off of LinkedIn. It's beyond just the research
papers that I feel like I was seeing maybe a
couple of years ago, but it's definitely a cool space
to grow.

Speaker 3 (45:00):
So LinkedIn's a great place to reach out to me
as well.

Speaker 1 (45:03):
Absolutely, I love that. We'll link to all of that
in the description below as well. That way, if you
didn't quite catch that, you can just click there and
see that and see everything Dylan is up to and
learn more about the arc that we referenced a few
times here. Dylan, this was awesome. Appreciate your time, man

Speaker 3 (45:18):
Absolutely, I appreciate it, man,

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Dylon Grzenda: Applying S&C Principles in the Athletic Training Room

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