Latest / The ACL Athlete Podcast / 199 | Avoiding the Range of Motion Regression in ACL Rehab: Key Self-Tests for Maintenance

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199 | Avoiding the Range of Motion Regression in ACL Rehab: Key Self-Tests for Maintenance · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:06
  SPEAKER_00: So today we are diving into a question from an ACLer that I think is a good question.
• 1:12
  SPEAKER_00: And it is can I lose mobility after having gained it back if I start focusing more on strength?
• 1:19
  SPEAKER_00: So this is something that is a really good question because it's something that people don't think about necessarily, especially if they've achieved their range of motion, their extension, their flexion at the knee.
• 1:31
  SPEAKER_00: And so then usually sights are set on trying to gain strength.
• 1:36
  SPEAKER_00: And so the short answer to this question, can you lose it?
• 1:40
  SPEAKER_00: Yes, you actually can.
• 1:42
  SPEAKER_00: It's kind of goes back to that saying if you don't use it, you lose it.
• 1:46
  SPEAKER_00: But that doesn't mean it's going to regress significantly.
• 1:49
  SPEAKER_00: But this is something that we do see in a large population of ACLs.
• 1:54
  SPEAKER_00: There are some people who get through this and once they achieve it, they never have to worry about it again.
• 1:59
  SPEAKER_00: It's there and it's awesome.
• 2:01
  SPEAKER_00: But there is still a good chunk of people where they're trying to regain that range of motion.
• 2:06
  SPEAKER_00: And let's say once they do, that there is something where they will start to focus on strength.
• 2:13
  SPEAKER_00: Now, does this mean that you have to focus on one or the other range of motion or strength?
• 2:18
  SPEAKER_00: No.
• 2:18
  SPEAKER_00: A good ACL rehab program is usually tackling both, working on range of motion and strength.
• 2:26
  SPEAKER_00: Now, range of motion is a very big priority, a top priority post-ACL injury and surgery, a part of the goal of achieving a quiet knee, especially if we're talking about extension here.
• 2:40
  SPEAKER_00: That is numero uno for us.
• 2:43
  SPEAKER_00: It's very rare that we are not saying, hey, extension is your number one priority.
• 2:47
  SPEAKER_00: But with this, that is going to be very important for us, a part of this quiet knee.
• 2:53
  SPEAKER_00: You're also working on flexion as well.
• 2:55
  SPEAKER_00: I don't want this to seem like it's just extension.
• 2:57
  SPEAKER_00: You're working on both, but extension does get a higher priority here.
• 3:01
  SPEAKER_00: There's less focus on loading super heavy because you just had an ACL injury or surgery.
• 3:07
  SPEAKER_00: You're in that acute phase.
• 3:09
  SPEAKER_00: You're kind of in that what we call protection phase.
• 3:12
  SPEAKER_00: And personally, for us, you know, building out uh ACL framework, my 4R roadmap and framework.
• 3:19
  SPEAKER_00: This is our restore phase, phase one.
• 3:22
  SPEAKER_00: And so this is where we are focusing hard on a quiet knee along with some other pieces.
• 3:27
  SPEAKER_00: But quiet knee is a very big goal.
• 3:29
  SPEAKER_00: So that is going to be full knee extension, getting the quads active and firing alongside that knee extension.
• 3:35
  SPEAKER_00: So that goes hand in hand.
• 3:37
  SPEAKER_00: And then getting towards 90, then 120, and then towards full flexion.
• 3:42
  SPEAKER_00: That is technically a criteria for the quiet knee.
• 3:45
  SPEAKER_00: And then we're trying to get to zero levels of pain and swelling eventually in this process.
• 3:52
  SPEAKER_00: Now, is that immediate?
• 3:54
  SPEAKER_00: No.
• 3:54
  SPEAKER_00: Some people can kind of vary in those two symptoms.
• 3:58
  SPEAKER_00: But with that said, we want to make sure we decrease that and eliminate the pain and swelling.
• 4:02
  SPEAKER_00: That's a part of the quiet knee.
• 4:04
  SPEAKER_00: And in a sense, it's just kind of getting it quiet, right?
• 4:07
  SPEAKER_00: We're trying to get it back to its normal restored state.
• 4:10
  SPEAKER_00: The goal is to have none of these symptoms and have full range of motion, get the quads active.
• 4:16
  SPEAKER_00: I'm going to also add within this, within this first phase, big part, is trying to get gate normalized and get the walking mechanics normalized so you're not kind of hobbling around or swinging the leg around and using that strength that you have incorporated with the quad work and getting the hamstrings involved, the glutes involved, the calves, but then also making sure that range of motion is kind of coming together, the co-contractions, all the things that happen with walking that we kind of take for granted, we want to make sure that that is worked on again.
• 4:50
  SPEAKER_00: Now, sure, it kind of seems like riding a bike with walking, especially.
• 4:54
  SPEAKER_00: You know, you just start walking again.
• 4:56
  SPEAKER_00: How hard is that?
• 4:57
  SPEAKER_00: But if you don't have the requisite range of motion, if you don't have the proper quad activation because your quads are actually pretty active while you're going through a gate cycle, and then making sure that you are able to decrease the pain and swelling, symptoms will play into that too.
• 5:15
  SPEAKER_00: Otherwise, you will kind of work to compensate around this.
• 5:18
  SPEAKER_00: So that is going to be our goals after an ACL injury and surgery.
• 5:23
  SPEAKER_00: And so then, with that said, we want to make sure that from a range of motion standpoint, some ACLers they might achieve this very quickly, especially the range of motion pieces.
• 5:36
  SPEAKER_00: Some people might take a while for a number of reasons.
• 5:40
  SPEAKER_00: It could be because of the injury itself, the surgery itself, the time between.
• 5:44
  SPEAKER_00: Sometimes people jump into surgery really quickly because the surgeon has a spot available.
• 5:49
  SPEAKER_00: You know, they aren't educated about waiting to let the knee calm down.
• 5:53
  SPEAKER_00: Um, maybe they are just trying to get it done because they want to get back to a certain time-sensitive thing, or they're at a good break.
• 6:01
  SPEAKER_00: So there are a lot of reasons why people might jump into surgery very quickly.
• 6:04
  SPEAKER_00: But with that said, that is something that factors into maybe their status going into the surgery.
• 6:10
  SPEAKER_00: Then maybe other procedures that happen in the surgery itself, meniscus, maybe it's an LET, maybe it is another ligament reconstruction and uh MCL.
• 6:21
  SPEAKER_00: There are a bunch of different things that can also happen with the injury that the surgeon might have to also help repair or do something in the knee in addition to the ACL.
• 6:31
  SPEAKER_00: You know, your pre-injury status also matters a lot, and your fitness level prior to getting injured, right?
• 6:38
  SPEAKER_00: Genetics play a role.
• 6:40
  SPEAKER_00: There are a lot of things that can just play into a lot of the things that unfold in this process for people in terms of getting the range of motion back, dealing with pain.
• 6:49
  SPEAKER_00: I mean, even think about work, for example.
• 6:52
  SPEAKER_00: Work can kind of play a big role or school in terms of maybe symptoms and how people are on their feet more versus not.
• 7:01
  SPEAKER_00: And then the other thing, the big one, is going to be, of course, the rehab and the guidance they're getting.
• 7:06
  SPEAKER_00: That can really impact you know, people getting range of motion back really quickly, or it might be the thing that takes a long time.
• 7:13
  SPEAKER_00: So lots of factors at play.
• 7:16
  SPEAKER_00: Regardless of the time is achieved, your extension inflection, you can lose some of it if you don't work on it consistently.
• 7:24
  SPEAKER_00: Now, with that said, in the earlier parts of this process, you're going really hard on this stuff, and then eventually it does pull back a little bit.
• 7:34
  SPEAKER_00: It's less of a priority once you do achieve it.
• 7:37
  SPEAKER_00: Now, as I mentioned, yes, it can regress some.
• 7:40
  SPEAKER_00: A good program is still working on ways to maintain this, but sometimes we work with people later and they end up saying they have it, and we go to assess this and they have like maybe 90% of it, or they said they regained it, maybe they were told that zero was okay.
• 8:00
  SPEAKER_00: But let's say that these some of these people they have regained full knee extension and full flexion.
• 8:07
  SPEAKER_00: And then when we go to assess it later in this process, when they come to us, they only have like 90% of it.
• 8:13
  SPEAKER_00: What gives in this?
• 8:14
  SPEAKER_00: Well, if the program shifted and didn't have check-ins with range and solely focused on strength, for example, then that full extension or that heel pop or the flexion can regress a little bit, not drastically.
• 8:28
  SPEAKER_00: It's not like you're gonna see this massive regression.
• 8:31
  SPEAKER_00: Then there might be something else going on.
• 8:33
  SPEAKER_00: But let's say it just regresses a little bit, and that little bit matters a lot, especially when we're talking about full terminal knee extension that impacts the pressure on the patella, the patellar tendon, just kind of the resting state of the quad.
• 8:47
  SPEAKER_00: And also there is a lot of connection between not getting that full knee extension back and then more short and long-term impacts to the knee from strength all the way to osteoarthritis down the road.
• 8:58
  SPEAKER_00: Now, does this mean that if you don't have it now and you're far in this process, that you're you're doomed for that?
• 9:04
  SPEAKER_00: Not necessarily.
• 9:05
  SPEAKER_00: And this is something that can still be worked on and achieved.
• 9:08
  SPEAKER_00: But with that said, it is important to regain that terminal knee extension.
• 9:12
  SPEAKER_00: It is very important.
• 9:13
  SPEAKER_00: And then for flexion, for example, um, the importance here is like, especially like let's say if you like yoga and you want to sit back onto your heels and you can't get all the way down, or you got to bend over to be able to get something off the ground.
• 9:28
  SPEAKER_00: Uh, maybe you're a teacher, maybe you have a little kid and you need to get down on the ground with them.
• 9:33
  SPEAKER_00: Maybe you are an Olympic weightlifter and you got to get into a full squat position just for general weightlifting in general.
• 9:40
  SPEAKER_00: Like you would want to make sure you have access to that.
• 9:42
  SPEAKER_00: And then let's also talk about sprinting, for example.
• 9:45
  SPEAKER_00: We need that full flexion for that heel recovery to come through and the hamstrings to kick out in order to make sure that we can get that full cycle and sprint well.
• 9:54
  SPEAKER_00: So knee flexion does matter a lot, and so we want to make sure that we can get that back.
• 10:00
  SPEAKER_00: So range of motion is going to be key and to maintain that.
• 10:03
  SPEAKER_00: So now, with this, we are assuming, of course, range of motion is achieved.
• 10:11
  SPEAKER_00: And one thing I do want to add, we are excluding anything happening in the joint later, like scar tissue, cyclops, other issues arising.
• 10:20
  SPEAKER_00: Let's just say that you're able to gain that range of motion, and then later on in the process, it just kind of regresses, but there's no barrier to it necessarily.
• 10:29
  SPEAKER_00: It just wasn't focused on.
• 10:31
  SPEAKER_00: So if we're assuming that that range of motion has been achieved, flexion and extension, matching the other side, the uninvolved side or the contralateral side, opposite to the ACL injured or operated side, then it just regresses back.
• 10:45
  SPEAKER_00: We typically see this with extension more than flexion because extension is a little bit harder for people to get, especially early, and then flexion could kind of linger around.
• 10:55
  SPEAKER_00: It kind of depends on the person, but the regression typically happens more with extension.
• 11:01
  SPEAKER_00: So, how do we address this and keep an eye on it?
• 11:03
  SPEAKER_00: You're like, all right, let's make this practical.
• 11:05
  SPEAKER_00: What do I need to do?
• 11:06
  SPEAKER_00: I know you've been talking about it, Robbie.
• 11:08
  SPEAKER_00: So we need to teach you and what we do for our athletes ways to self-assess and test it.
• 11:16
  SPEAKER_00: And what is the end goal?
• 11:17
  SPEAKER_00: What does that look like?
• 11:18
  SPEAKER_00: What does it feel like, and where it needs to be?
• 11:21
  SPEAKER_00: And then you can always check in on that, whether that is early, post-injury, post-op, mid-stages, and even late stages.
• 11:29
  SPEAKER_00: So this is something I teach all of my athletes, and it's something that is super, super important for knee extension.
• 11:35
  SPEAKER_00: We're going to teach athletes the heel pop test.
• 11:39
  SPEAKER_00: So essentially, what this is is it's going to check the box on terminal knee extension.
• 11:43
  SPEAKER_00: So that basically means our very end range of knee extension, our quads are active, and we can get there actively.
• 11:50
  SPEAKER_00: If we can do that, we check the box, right?
• 11:52
  SPEAKER_00: And so, with that said, what I usually do is have athletes sit on the ground, not on carpet.
• 11:58
  SPEAKER_00: Like we want almost like hardwood floor, not on a bed, something where there's a pretty even surface, not a lot of give to it.
• 12:06
  SPEAKER_00: And you're just going to do a heel pop or what basically a quad set on your uninvolved side.
• 12:12
  SPEAKER_00: And so that heel should rise a little bit off the ground.
• 12:16
  SPEAKER_00: So the back of the knee is touching the floor, and then you are gonna have that heel rise, and you can almost slide like a piece of paper or just something super thin underneath the heel, and that heel should pop up off the ground for majority of athletes.
• 12:31
  SPEAKER_00: Not everyone perfectly, but I would say, you know, 90-95% of people, based on range of motion, they get a little bit of hyperextension.
• 12:39
  SPEAKER_00: So what that means is when that quad contracts, it's going to kind of push the back of the knee into the surface that you're on, and your heel is going to slightly lift off the ground, and there's gonna be a little bit of space under your heel.
• 12:52
  SPEAKER_00: That is the heel pop test.
• 12:54
  SPEAKER_00: And so we do that on the uninvolved side to get an idea of like this is our goal.
• 12:59
  SPEAKER_00: And then we have the athletes work on this on the involved side.
• 13:04
  SPEAKER_00: Now, there are different strategies to do this, like passively lifting up with a strap, over pressure, bag hang type stuff.
• 13:11
  SPEAKER_00: So there's a lot of different strategies to work on this, but at the end of the day, that's our goal to get the athlete back to.
• 13:17
  SPEAKER_00: And once they have mastered that, then they are in a good place to just check in on that and maintain it.
• 13:25
  SPEAKER_00: For knee flexion, we teach our athletes a tall kneeling sitback.
• 13:29
  SPEAKER_00: So basically imagine you are on both knees and you're just kind of standing tall on both knees, and you're just gonna sit your butt back onto your heels.
• 13:39
  SPEAKER_00: And so almost think of it as kind of like that yoga pose, like a child's pose, but you're not rocking your arms back.
• 13:45
  SPEAKER_00: You can use that as a bridge, if you will, and that's the way we work on knee flexion.
• 13:50
  SPEAKER_00: But the true test is to be able to be tall kneeling, standing with your head just as tall as it can be and your torso straight.
• 13:58
  SPEAKER_00: You're on both knees on the ground, and then all you're going to do is sit back onto your heels with your butt touching your heels.
• 14:05
  SPEAKER_00: Now, does that feel normal side to side?
• 14:08
  SPEAKER_00: And so often what people will feel with this, if it doesn't feel the same, is that they'll feel some tightness in the front of the knee, kind of like a balloon feeling.
• 14:17
  SPEAKER_00: They might feel like one of their hips kind of hikes up a little bit to get into that position.
• 14:23
  SPEAKER_00: They can feel kind of like less pressure on one keel versus the other, or they're kind of leaning to one side.
• 14:29
  SPEAKER_00: So a great way to look at this is you could actually video yourself from the back side and look and see is this something where my kind of hip hikes up, or am I sitting back comfortably?
• 14:42
  SPEAKER_00: And then we're going to check in and make sure we compare side to side.
• 14:46
  SPEAKER_00: Now, there's two things we want to look at.
• 14:48
  SPEAKER_00: One is how does it look for the heel pop?
• 14:51
  SPEAKER_00: We're looking, can it rise to the same height as the other side, the uninjured or uninvolved side?
• 14:59
  SPEAKER_00: One caveat is someone who is hypermobile and they can get minus 15 degrees, minus 20 degrees.
• 15:05
  SPEAKER_00: We might not be looking for perfectly even heel pop because we don't need that excess heel pop.
• 15:11
  SPEAKER_00: We might be just aiming for, you know, around 10 degrees minus in the negatives.
• 15:16
  SPEAKER_00: So that is going to be a very specific situation, but for 90, 95% plus of people who are listening to this and going through it, you're going to be aiming to match the contralateral side.
• 15:28
  SPEAKER_00: And that is going to be your gold standard for this process.
• 15:31
  SPEAKER_00: And so we'll do that for the heel pop.
• 15:34
  SPEAKER_00: Is the height of those heels even?
• 15:36
  SPEAKER_00: And then I'll have people do heel pops with both sides.
• 15:38
  SPEAKER_00: Um, I had an athlete uh the other day do this.
• 15:42
  SPEAKER_00: And at first she was like, Yeah, I got this, like it look, it looks the same.
• 15:45
  SPEAKER_00: And then we tested it, and I got her do it on her uninvolved side, and then she held it and then she did it on her involved side.
• 15:51
  SPEAKER_00: And she had been working on quad sets for a while, had gone to PT, been working through some of this stuff and exercises somewhere else.
• 15:59
  SPEAKER_00: And then they come and we assess this, and we're like, we're not all the way there yet.
• 16:03
  SPEAKER_00: And she was able to feel it, but also see it.
• 16:06
  SPEAKER_00: And so that's gonna be really important because sometimes people think they have it, and we need to make sure we do a very, very detailed check-in and test on this.
• 16:15
  SPEAKER_00: So the heel pop's great for this.
• 16:17
  SPEAKER_00: So we're gonna look at how does it look, how does it feel?
• 16:20
  SPEAKER_00: Same thing with the tall kneeling sit back.
• 16:23
  SPEAKER_00: And as I had mentioned, the gold standard for you is your uninvolved side.
• 16:27
  SPEAKER_00: And for anyone that tells you zero degrees extension is okay, go listen to my podcast where I talked about that.
• 16:35
  SPEAKER_00: Um, we often hear PTs or surgeons are like, yeah, zero is good.
• 16:39
  SPEAKER_00: And it's like, no, it's not.
• 16:41
  SPEAKER_00: Your knee actually goes into hyperextension majority of the time for most people.
• 16:46
  SPEAKER_00: And so we want to make sure we regain that because that impacts the quad contraction, it impacts your gait mechanics.
• 16:53
  SPEAKER_00: It also impacts like the carryover into strength and just movement in general.
• 16:58
  SPEAKER_00: So we want to make sure we regain that range of motion that we have access to in order for it to carry over to other tasks we want to do.
• 17:08
  SPEAKER_00: Now, then we want to make sure that we are having checkpoints throughout the process where we're able to assess this knee extension, knee flexion, and our athletes can check in and test it themselves.
• 17:21
  SPEAKER_00: And if it regresses, we plug some work back in.
• 17:24
  SPEAKER_00: And ideally, a good program that continues to keep checking in on it is what you're working with.
• 17:32
  SPEAKER_00: Now, that's where we want to make sure the athlete doesn't need to necessarily have dedicated work.
• 17:37
  SPEAKER_00: They might have to have it plugged back in if it does regress, but a good program is tackling this, and this might be through triple extension type positions, needing terminal knee extension with it, or maybe triple flexion-based positions and work where it might be assisted deep squats, for example, or some sort of knee over toe type position where we're working on it and getting comfortable, or maybe some rock backs.
• 18:00
  SPEAKER_00: So lots of different ways to tackle and work on this without having to directly do this later in the process.
• 18:07
  SPEAKER_00: But if we need to pull out the isolated work that we were doing immediately post-op or post-surgery, go for it to be able to regain it and then just work on maintaining it.
• 18:17
  SPEAKER_00: The one note I did want to mention is that if you're dealing with kind of ebbs and flows of swelling in your knee, even the slightest bit, you might not even be able to see it, but there might be some joint fluid in there that can impact these positions and your range of motion.
• 18:35
  SPEAKER_00: And that's okay, but we want that to go away over time, where it is consistently non-symptomatic, it doesn't feel that puffiness, and it's a good environment in the knee because that will help carry over for the long term.
• 18:51
  SPEAKER_00: But in certain scenarios, we can see where people might be getting back to some jumping and impact, maybe some running and they're building that up, some higher intensity training, or maybe they're building up volume and intensity back to sports and re-integrating back.
• 19:07
  SPEAKER_00: Sometimes long trips can play into this, high step counts, as we all know, can influence that knee, the status and the state of that knee and the puffiness and tightness it's feeling.
• 19:17
  SPEAKER_00: So if you're dealing with that, even if you're mid and late stages, now it shouldn't be an excessive amount of swelling, but if it feels kind of tight, especially with that tall kneeling rock back, that could be a player in this.
• 19:29
  SPEAKER_00: And sometimes people will do their heel slide or pull their heel to their butt while they're sitting, and they're like, look, I've got it.
• 19:35
  SPEAKER_00: And then we have them do the tall kneeling rock back, and then all of a sudden they kind of feel that tightness or discomfort or that last little bit, that you know, 5% of knee flexion that just doesn't feel right, or it feels feels a little stiff, if you will.
• 19:50
  SPEAKER_00: So just something to note for those of you who are working through this and trying to figure out, well, what's going on here, right?
• 19:56
  SPEAKER_00: And of course, always talk to your medical professional, your physical therapist, your coach, surgeon to just kind of check in with this stuff and see what is going on because everyone's case is so different.
• 20:08
  SPEAKER_00: But I just want to make sure that you know we tackle this question because it's a good question.
• 20:13
  SPEAKER_00: It's also one where we want to make sure we check in regularly with these tests I mentioned.
• 20:19
  SPEAKER_00: There are other ones that exist, but to me, it's simple to explain to my athletes the heel pop test, the tall kneeling rock back.
• 20:25
  SPEAKER_00: And those are ones that you can regularly do to check in and see if that's okay.
• 20:30
  SPEAKER_00: And for us, we still assess that even in mid and late stages, just because we check the box and the earlier stages, we're still going to look at this stuff later on just to make sure it is still there because we do not want to let that regress and we don't want to leave any stone unturned, right?
• 20:47
  SPEAKER_00: So, this is of course working alongside strength in this process.
• 20:51
  SPEAKER_00: So you can do both, but priorities may shift depending on where you're at timing-wise and the phase.
• 20:58
  SPEAKER_00: So just note this if you are somebody in this process, just do the check-in and see can I do the heel pop test?
• 21:05
  SPEAKER_00: Can I do a tall kneeling sit back or a rock back onto my heels and assess one how it feels and assess how it looks.
• 21:14
  SPEAKER_00: Make sure that heel pop height is even on both sides.
• 21:18
  SPEAKER_00: And then make sure that that knee feels really solid when you go to sit back on your heels.
• 21:23
  SPEAKER_00: And if it doesn't feel the same side to side, then therefore maybe there needs to be some more intentional work.
• 21:29
  SPEAKER_00: It doesn't matter where you are in this process.
• 21:32
  SPEAKER_00: We want to make sure that thing feels like the uninvolved side.
• 21:35
  SPEAKER_00: And that's our goal, and that's gonna help you in the long run.
• 21:39
  SPEAKER_00: So I made a very, very long episode about how to maintain your mobility and if you lose it.
• 21:47
  SPEAKER_00: Um, so I hope that this was helpful.
• 21:49
  SPEAKER_00: I want to make sure I'm as detailed as possible for you guys to make sure you can understand this, understand the ins and outs of it, ways to check it, and make it very, very practical.
• 22:00
  SPEAKER_00: If you have any questions, you know where to find us.
• 22:03
  SPEAKER_00: You can hit us up in the show notes.
• 22:06
  SPEAKER_00: There are different mediums to connect with myself and the team.
• 22:11
  SPEAKER_00: Um, you can send us an email, Instagram, be able to even do fan mail through this, which is pretty awesome.
• 22:18
  SPEAKER_00: Getting messages from people.
• 22:20
  SPEAKER_00: Um, if you want to propose some sort of podcast episode title, you could do that in the show notes.
• 22:26
  SPEAKER_00: All the details are there.
• 22:28
  SPEAKER_00: And the resources, people we work with, and the services that we provide.
• 22:33
  SPEAKER_00: So if you need any help or assistance, we're here to help support you.
• 22:37
  SPEAKER_00: Until next time, team, this is your host, Robbie Patel, signing off.