Latest / The Layback Podcast / Jess Geiger's Seminal Study on Forearm Strengthening and Panel Discussion (Ep. 66)

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Jess Geiger's Seminal Study on Forearm Strengthening and Panel Discussion (Ep. 66) · The Layback Podcast

0:00
Hey everyone, welcome back to the Lay Back podcast.
0:02
Just going to let you know right up front, today is going to be
0:05
pretty different. This is going to be likely the
0:08
last time you hear from me on this episode as today we are
0:12
actually going to be sharing our Tuesday, June 10th Zoom webinar
0:17
that we hosted for Jessica Geiger, a recent graduate of
0:23
Wake Forest Biomedical Engineering program where she
0:26
did research on the forearm flexor muscles and elbow joint
0:32
gapping changes that occur after a forearm strengthening
0:35
protocol. That forum strengthening
0:37
protocol was specific to Flexpro grip training.
0:41
Now joining Jessica is going to be Doctor Matt Fury as our
0:46
moderator of the webinar. And then panelists include Ryan
0:52
Yoshida and Dylan Newcomer. So Doctor Matt Fury previous
0:57
podcast guest, as well as the physical therapist.
1:00
Both Dylan Newcomer and Ryan Yoshida, they have been on the
1:04
podcast as well. Really looking forward to this
1:06
discussion. And then in a couple weeks,
1:08
we'll actually have Jessica on to share the more personal side
1:15
of the study. So maybe get into some details,
1:17
maybe things that she found really interesting or just kind
1:20
of how she reacted throughout the process.
1:24
Because so much in scientific research is hard data that we
1:28
don't really get to hear how the researcher felt throughout the
1:33
entire process. So we'll tackle that stuff down
1:36
the line. This episode is going to be very
1:39
analytical, very data-driven, and I highly suggest that you
1:44
tune in on a visual platform, whether it's YouTube or Spotify,
1:49
so you can watch along because there are going to be some
1:52
shared slides, there's going to be some graphs, and certainly
1:57
with a few people on it, it feels.
2:00
More. Comforting maybe to see
2:03
reactions or interactions throughout the process.
2:06
So thanks again guys for tuning in.
2:09
And as always, thanks for laying back with us.
2:13
All right, it's 11 O1 here. So I think we've we've got a
2:17
good, good group of of folks that have joined in our in our
2:20
list here. So some people are joining from
2:22
their calendar links, but we're going to be respectful of
2:24
everybody's time and get rolling.
2:26
So I'd like to welcome everybody.
2:28
Good, good morning, good afternoon.
2:29
Depending on where you're joining us from.
2:31
Thank you for joining us. This is going to be an
2:33
opportunity for us. We're hosting the webinar to
2:36
discuss some interesting research findings.
2:39
Jessica Geiger is going to be joining us and presenting some
2:41
of the work that she has been working on over the over the
2:43
past year. And really the purpose of
2:46
collecting everybody here today is to to get the expertise of of
2:49
Dylan and Ryan, who will introduce just shortly.
2:51
And we're here for a common goal.
2:53
Really our goal is to to try and collaborate to learn from each
2:56
other and seek ways for us to support our athletes, support
3:00
their performance while trying to minimize risk of elbow
3:02
injuries, which as we know, costs a lot of time, effort,
3:06
blood, sweat and tears. And it's unfortunate situation
3:09
for our athletes when we find them in in this in this
3:11
situation. And so a couple housekeeping
3:13
notes before we get going. This zoom call is going to last
3:17
an hour. We're going to be respectful of
3:18
everybody's time. Now that being said, we have a
3:21
chat opportunity here in the at the bottom of of your Zoom
3:24
screen. Please put any questions in the
3:26
chat. We're going to try and bounce
3:28
our questions off of our panelists.
3:30
We're going to answer anything that we can.
3:31
If there are questions that we cannot get to, we plan to
3:35
collect these in the form of a a delayed question answer Q&A that
3:39
will then circulate and to the folks who at RSVP.
3:42
So hopefully we can address everybody's questions or
3:45
concerns. The meeting will be recorded.
3:47
We're going to notify everybody how they can access this
3:50
meeting. But with that being said, 11 O3,
3:53
I think it think it's time for us to get started.
3:54
So first starters, my name is, is Matt Fury.
3:57
I'm an orthopedic surgeon in Baton Rouge, LA.
4:00
I'm team physician for LSU athletics and a clinical
4:03
instructor at the LSU Department of of Orthopedics.
4:06
Former baseball player who's always been passionate about
4:08
shorter elbow health and the health of the overhead athlete.
4:11
So this is certainly a passion of mine, but we are joined today
4:15
by really just a fantastic panel.
4:17
And so I'm going to do a brief introduction, but I'd also like
4:20
to hear them and give them the opportunity to introduce
4:23
themselves and tell you a little bit about their their purpose
4:25
and their mission. But first up is Dylan Newcomer,
4:27
who's a physical therapist, is the head PT over at Driveline in
4:31
in Washington. Originally was trained as a
4:33
strength coach and he is the owner and operator of athletic
4:36
potential performance physical therapy.
4:39
Dylan is a a good friend, somebody considered an expert in
4:43
the management of of UCL rehab. So I think we're it's a
4:46
wonderful opportunity to have him here and hear from his
4:48
perspective. But Dylan, is anything else
4:50
you'd like to for the people listening?
4:53
No, I think you hit for the most part on the head.
4:55
Like you said, I'm the BTI Dr. lineup in Seattle and I kind of
4:59
oversee all of the the operations here as far as
5:01
managing athlete health. I also get the opportunity to
5:04
run my own clinic inside the gym where I get to treat the local
5:07
Seattle Tacoma area and the athletes of, of that space.
5:12
My kind of journey with Flexpro probably began about about a
5:16
year and a half ago or so when I met with Darrell.
5:18
And ever since then, he and I have been constantly in
5:22
communication about how we can better use this piece of
5:24
technology to enhance the health of the athletes.
5:27
And it's been a very transformational experience for
5:29
me, both from a clinical standpoint and just learning a
5:32
ton from from all of the stuff that can come with this device
5:35
and, and the research that's backing it, which Jess will be
5:38
bringing to us today. So that's good for me.
5:41
I'll let Ryan take the show from here.
5:43
So I think Dylan brings up a good point.
5:45
We're going to introduce Ryan, but just for, for starters,
5:47
we're going to be discussing the Flexpro grip device as part of
5:51
justice research, which was performed at Wake Forest and not
5:54
affiliated with the company in, in any way.
5:57
And for, for us and for me personally as a panelist, I have
6:00
no financial conflict of interest with the device, more
6:03
of a conflict of passion and bias.
6:05
This is something that I care about, care about the health
6:08
part, throwing athletes and finding ways that we can
6:09
potentially minimize our risk. And I, I see that, you know, the
6:13
device could potentially be useful in this category.
6:15
So I just think it's important for conflict purposes to state
6:18
that for the listeners here. So now that that brings us to
6:21
our, our next panelist is, is Ryan Yoshida.
6:23
He's a physical therapist as well, former and will be
6:26
assistant rehab coordinator and a therapist with the Dodgers,
6:29
founder of the Armored Heat app, which is a fantastic resource
6:32
providing daily arm care strengthening is really
6:35
maximized his impact all over the game at at youth,
6:39
collegiate, professional level. So Ryan, thanks for joining us.
6:42
Give us a little more insight into your background.
6:45
Yeah, I know. Thanks for having me in.
6:47
Yeah, but you kind of hit the nail on how the intro from 2017
6:50
to 2022 was with the Dodgers. Various roles there from minor
6:54
league physical therapist and finished, as you mentioned, as
6:57
the assistant rehab coordinator and Major League side of things.
7:01
And then from there I, I started armored heat, which is an arm
7:04
strengthening mobility and recovery app.
7:07
We service, we serve individual athletes from the Major League
7:10
level down to the high school amateur level.
7:12
And then also at the team side of things on the college at the
7:15
college level. So that's kind of where my
7:17
passions been at, especially the last couple years.
7:20
And something that really drew me to this conversation
7:22
specifically was there was just I've seen we've all seen this
7:26
increase in injuries and so much of the the researcher bandwidth
7:31
was going after. OK, well, why are there more
7:33
stresses? Guys are throwing harder guys?
7:35
Is it the spin? Is it sweeper?
7:37
So much of it was on the cause side of things.
7:38
And then when you're looking at it not in a vacuum and in my
7:41
opinion is, is we're putting so much bandwidth onto things that
7:45
also make these guys better pitchers that they're going to
7:48
accept that risk a lot of times, like velocity, higher velocity
7:51
is going to the arm more stress. And then so we're putting so
7:54
much bandwidth and research into researching that side of things.
7:57
And now to see stuff coming out on and the other set of things
8:00
on how can we make these athletes as resilient as
8:02
possible to handle the stresses, I think that's a a much better
8:06
way kind of just going to mention to tie in having that
8:09
increased performance and then also be able to keep guys
8:13
healthy as well. So that's something that really
8:15
drew me into this and then the Flex program as well.
8:18
Thank you Ryan, I think we're going to dive into some of those
8:21
concepts too, as we have some follow up conversation, but it's
8:24
it's time to introduce really the reason why we're here is to
8:28
to kind of collaborate, analyze, discuss.
8:31
Jessica Geiger. So Jessica is she completed her
8:35
a bachelor's in mechanical engineering at Virginia Tech was
8:38
performing a master's in biomedical engineering at Wake
8:40
Forest. She is working with Kristen
8:43
Nicholson over at the Wake Forest pitching lab.
8:46
Doctor Nicholson is a assistant professor of orthopedic surgery
8:49
at at Wake. And I'm going to give Jessica
8:51
some opportunity to tell a little bit of background about
8:54
herself. And then she's going to
8:56
introduce her research project and provide us with a formal
9:00
research presentation that that we've all gathered here to to
9:03
hear and to learn from. So Jess, if you don't mind,
9:06
let's take the floor and introduce a little bit more
9:08
about you and then we'll get going.
9:09
I'm going to go ahead and just share my screen because I've got
9:13
this all in a presentation now. So thumbs up if you're all
9:17
looking at my slides at the moment.
9:20
Awesome. All right, so today I will be
9:23
presenting on some work that I did part of my master's thesis
9:27
titled form flexor muscle and elbow joint gap changes after a
9:31
form strengthening protocol, which we all know is the Flex
9:34
Pro grip. And so a little bit about me,
9:37
like I said, or like Matt said, I got my bachelor's degree in
9:42
mechanical engineering from Virginia Tech.
9:44
I got my master's degree in biomedical engineering through
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the, it's a combo program, the Virginia Tech Wake Forest
9:51
Biomedical Engineering program. And as it was discussed, I did
9:54
my research in the Wake Forest pitching lab.
9:58
And all of this research was a part of my master's thesis.
10:01
I did some other research as well, but I thought, I thought
10:04
the Flex Pro Grip was a great way to integrate my passion for
10:07
bio mechanics and injury recovery, prevention and just to
10:12
help out athletes and people in general.
10:15
I also was a data processing engineer with Kinetrax while I
10:18
was in grad school and completing my research.
10:21
And then in just about two weeks now, I'll be starting my new
10:24
position at New Balance in Boston, MA, where I'll be a
10:29
sports research engineer intern there, and I'm super duper
10:33
excited for that. And then before I do discuss
10:36
some of this research, I want to acknowledge a few people who are
10:39
massive contributors to this project and help me out a ton.
10:43
As I said earlier, Doctor Nicholson, she was just the core
10:47
person to this. She was my advisor, she was a
10:49
mentor. Overall, she was so amazing and
10:52
she helped me out so much with this and guiding me through the
10:55
process. Doctor Pexa from High Point
10:57
University, he helped me out a ton with the ultrasonography
11:01
side of this project as well as some of the statistical
11:05
analysis, giving me some advice there.
11:07
And then lastly, Blake Jones, he is a medical student, he's in
11:11
his fourth year and he was another helping hand on the
11:15
side. He was very, you know, he went
11:17
under the radar, but he helped me out a time just giving me
11:20
advice on doing thesis work but also research in general and
11:24
this project. So without further ado, I will
11:28
get started and this will be a little bit repetitive for you
11:32
all. As you know, baseball injuries
11:33
are extremely important to address as well as elbow
11:37
injuries. And as the pitching motion does
11:40
induce such a high stress to the medial elbow, we need to figure
11:45
out a way that we can eliminate these surgery or injuries.
11:49
So the common way we fix this is through the Tommy John surgery.
11:53
But this puts players on the injured list for over 74 days
11:58
and they can even not return to their sport.
12:02
And so there's many risk factors that we have identified like
12:04
pitch velocity, pitch volume and percentage of pitching,
12:08
percentage of fastball thrown as well as their pitching
12:11
mechanics. But this varies by style and
12:13
anatomy. Both impacting the valgus load
12:16
to the medial elbow. And before I get into this
12:20
further, I do want to discuss the difference between the
12:23
valgus and the varus torque as this is a term I'll be using a
12:27
lot. The valgus torque is the
12:29
external force that pushes the elbow outwards.
12:32
This stresses the medial elbow and it compresses the lateral
12:35
elbow. This is most prominent when the
12:37
pitcher is in their arm cocking phase and when the shoulder is
12:40
maximally external. Maximally externally rotated and
12:45
this high valgus torque can lead to UCL sprains or tears.
12:49
The varus torque is the internal force or the moment that resists
12:53
the valgus torque. This is generated by the UCL
12:57
itself and the surrounding musculature, specifically the
13:00
flex flexor pronator group. This stabilizes the medial elbow
13:04
against that valgus torque that the elbow experiences during the
13:08
pitching motion. Furthermore, looking at the UCL,
13:12
we know that the anterior band is the primary restraint to that
13:16
valgus force. And because the UCL is made of a
13:20
collagen fiber arrangement and those fibers are arranged in
13:23
parallel, it makes that ligament very good at resisting pulling
13:27
forces. It does not make it very good at
13:29
twisting, which as we know, a pitcher is rotating through the
13:32
motion and the ligament does twist and turn, and it's not
13:36
very good at that. So when and why do UCL's tear?
13:40
Well, they're most prominent to tear in that maximum external
13:43
rotation position, but also there are micro tears and that
13:48
can build up within the ligament from these high torques and
13:51
forces. That ligament doesn't
13:52
necessarily need to tear on one pitch.
13:55
This can build up, but the ultimate failure occurs when the
13:58
valgus forces exceed the UCL's tensile strength.
14:03
And so much of our literature has indicated that these tears
14:07
are caused by a torque that exceeds the UCL's tensile limit.
14:12
And high level pitchers are pitching at about 80 to 100 mph
14:16
and they're the torque that they experience is between 800 and or
14:22
880 and 100 Newton meters. Excuse me, but the ligament can
14:26
only withstand about 34 Newton meters.
14:28
So we need to address this through other methods.
14:31
And so today I'll be discussing how the Flexpro grip addresses
14:35
this through the muscle tendon units surrounding the UCL.
14:38
These are the primary dynamic stabilizers that can withstand
14:42
the force that a player experiences when pitching, and
14:46
they take off some of that 80 to 100 Newton meters that a player
14:50
will experience as the UCL can only withstand 34 Newton meters.
14:56
So like I said, the medial elbow is supported by this flexor
15:01
pronator group and they resist that large valgus force.
15:04
And in order to assess the strength of the elbow, we can
15:08
look at something called medial elbow ulnar humeral joint
15:11
gapping, which is something I'll be looking at in this study.
15:15
This will help us determine whether or not the elbow is well
15:19
stabilized and able to take on those loads.
15:22
And a good way that we can assess dynamic elbow gapping as
15:27
well as static elbow gapping is through ultrasonography.
15:30
It's extremely cost efficient. You're able to easily assess
15:34
dynamic loads. And so the purpose of this study
15:37
was to investigate changes in ulnar humeral joint gapping and
15:40
muscle cross-sectional area when utilizing the Flex Pro Grip.
15:46
So to begin, the Flexpro grip specifically targets 3 muscles
15:51
in the forearm, the flexor digitorium profundus, the flexor
15:55
digitorium superficialis and the flexor carpionlaris during the
15:59
three muscles we measured in this study.
16:01
Regarding my methods, this was a prospective cohort study.
16:06
There was a cohort that utilized the Flexpro Grip and then there
16:10
was a control group and this was all taken during their fall on
16:13
ramping period. The inclusion criteria for this
16:17
study was that they were all Division One male baseball
16:20
pitchers and that each participant had no pain and full
16:24
participation during their fall on ramping period.
16:28
Players were excluded from the study if they were either not
16:31
compliant with the protocol or were injured and not throwing
16:34
before or during the study or acquired an injury during the
16:39
study that did prevent them from training and enacting in their
16:43
normal day-to-day training. The variables that we measured
16:47
in this study were elbow gapping, forearm flexor muscle
16:50
cross-sectional area, grip strength, and forearm girth.
16:54
The materials we utilized were a GE logic ultrasound system.
16:58
This is what we used to measure the muscle cross-sectional area
17:01
as well as the elbow gapping. A 2.5 kilogram kilogram arm
17:05
weight was used to induce that valgus load.
17:09
A grip dynamometer which you can see on the bottom right hand
17:12
corner that was used to measure the grip strength and a manual
17:17
goniometer to place the elbow as well as a tape measure.
17:20
Just some general procedures. This data was collected prior to
17:24
and after a 10 week protocol. No measurements were made in
17:28
between. Also, some surveys were taken
17:31
before and after the protocol was completed regarding player
17:34
history, injury, participation, pain, injury and illness.
17:40
For the Flexpro Grip training plan, there was a The players
17:44
who utilized the training plan used a periodized ramp up
17:47
training protocol of the players, maximum voluntary
17:50
contraction, and completed AB and C days in which A days were
17:55
fingertip flexion of the four fingers combined, B days were
17:59
extension of four fingers combined, and C days were the
18:04
mid finger of the four fingers combined, all having some sort
18:08
of ulnar deviation, radial deviation, flexion and
18:12
extension. Regarding the data collection
18:15
procedures, grip strength was collected again with that
18:19
mandogoniometer and then the maximum forearm girth was
18:24
measured at the maximum point of the forearm before and after the
18:27
protocol. Ulnar humeral joint gapping was
18:30
measured in millimeters and measured in the loaded and
18:34
unloaded conditions at 30 and 90° of elbow flexion.
18:38
The 2.5 kilogram arm weight was utilized to induce the various
18:43
load there and this is. It was totally safe and OK to
18:46
use as this is about less than 110th of the load that pitchers
18:49
do experience when they are throwing for the muscle
18:53
cross-sectional area of the FDSFDP and FCU.
18:58
This was measured with the subject at rest lying supine
19:02
with the shoulder abducted at 90° and the elbow flexed at 30
19:07
and 9 or YEAH 30°. The location of the transducer
19:12
was placed at 20% proximal from the medial epicondyle of the
19:16
humerus to the ulnar styloid process.
19:19
Regarding the ultrasound processing, image J was utilized
19:23
to process these images, but you can see in ABC and D this is the
19:27
medial elbow. There were two images taken per
19:30
medial elbow condition and the side to side distance was
19:34
measured which was defined as the shortest distance from the
19:37
distal medial corner of the trochlea to the proximal edge of
19:41
the sublime tumor tubercle. Some measurements that were
19:44
calculated were D30 and D90 which is defined as the change
19:49
in gapping which equals the loaded distance minus the
19:53
unloaded. And so from here on out I will
19:56
refer to these terms as D30 and D90 at 30° of flexion and 90° of
20:02
flexion for the muscle cross-sectional area.
20:04
Each muscle was hand traced and outlined looking at their
20:09
fascial lines as well as their general shape.
20:12
But for this is for the FDPFCU and FDS and this was all done in
20:16
image J as well where they the program calculated the area.
20:22
For my statistical analysis, I utilized R Studio.
20:25
A demographic T test was used to see if the two cohorts were
20:29
similar in terms of basic characteristics like height,
20:32
weight, and age, and this we'll see if the body size might
20:36
affect the results. For reliability, I calculated an
20:40
intraclass correlate coefficient, which tells us how
20:43
consistent the measurements were when repeated.
20:46
Which higher ICC is equivalent to a more trustworthy data set?
20:51
The standard error of the mean or SCM shows us how much the
20:56
numbers might vary by chance. A lower SCM is better precision.
21:01
I then completed a two way mixed ANOVA with an alpha at point O
21:05
5. This is a test that checks how
21:08
two things might affect the results, that being a flex pro
21:12
grip versus a control and I measured between group and
21:15
within time. So this assess differences
21:18
between the people within the two cohorts and the changes over
21:21
time within these cohorts. I also utilized A greenhouse
21:25
geyser correction, which is used when data doesn't necessarily
21:29
follow the rules of an ANOVA. This will keep the results
21:32
accurate. Lastly, I did some post hoc
21:36
testing within the SYNOVA. This is just some extra testing
21:39
to find out exactly where these differences are between the
21:41
cohorts. The Bonfaroni correction keeps
21:44
us from getting maybe tricked by random chance when there are
21:48
lots of tests that are being run.
21:50
And lastly, a Cohen Z effect size was calculated, which is a
21:54
way that we can measure how big the difference is.
21:58
This allows us to quantify it and it tells us if a difference
22:01
is not just real, but also if it's a meaningful difference
22:04
between those two cohorts. All right.
22:08
So this is what everyone's interested in the results and
22:11
discussion. So to start off, this is my
22:14
demographical data between the two cohorts.
22:17
So we actually had exactly the same amount going forward.
22:20
We had 18 in the Flexpro Grip group and 18 in the control.
22:23
Overall, there were no significant differences between
22:26
the Flexpro Grip and the control groups and weight, height or
22:30
valgus moment that those players experienced except for age.
22:35
But overall this indicates that the two cohorts were of
22:38
comparable anthropometric characteristics.
22:42
While age did show a difference, we saw that the Flexpro Grip
22:46
group was younger. They had more underclassmen than
22:50
the control group, which means they could have been less
22:52
trained and but we're not 100% sure about that one.
22:56
That's just something to note about that.
22:58
But looking forwards reliability, these the
23:01
reliability of measuring it showed amazing reliability.
23:05
I'm not an ultra stenographer, but I practiced a lot and I was
23:09
very consistent with my results. And so this high reliability
23:13
shows us that the measurements were reliable and that we can
23:16
trust what we are seeing. And the standard error of the
23:20
also remained low for their respective measurements.
23:24
This is the two way mixed ANOVA results.
23:26
And as we can see there were significant interactions between
23:30
the group and time for all conditions except for the
23:33
unloaded ulnar humeral joint gapping at 30° of flexion.
23:38
So this will not be included in post hoc testing.
23:42
So this is a very big table. I know it's extremely
23:44
overwhelming, but what we want to look at specifically are
23:48
these highlighted points. This is the significant
23:51
interaction effect class. So this is after we complete
23:53
that post hoc testing to eliminate any differences that
23:57
can occur. More specifically, I want us to
24:00
look at the Flex Pro Pre to Flex Pro Post.
24:03
These are where the most significant changes occurred in
24:07
my ANOVA testing and this shows us that there is an overwhelming
24:11
difference that the pre to post Flex Pro grip guys did show.
24:16
While there were some differences between the control
24:19
pre to control post, they're extremely minor and not of
24:23
significant value to us. Also looking at our Cohens, the
24:27
effect sizes, this was very telling.
24:29
This allows us to quantify and assess if these values are
24:33
meaningful and if the changes are meaningful.
24:36
And the flexible grip group showed an overwhelming amount of
24:39
moderate to large effect sizes from before to after their
24:44
protocol for the change in joint gapping, D20 as well as their
24:49
muscle cross-sectional area. The control group maintained
24:54
weak to small effect sizes. So this tells us, you know, this
24:58
cohort did not experience a significant amount of change.
25:01
So this is a really great slide. This really demonstrates the
25:05
changes that these two cohorts experienced.
25:07
On the left is D30, which again is that change in medial joint
25:11
gapping the loaded minus the unloaded at 30° and then on the
25:15
right is at 90°. The Flexpro grip group is in
25:19
that teal color and the control group is in the orange.
25:23
And for 30° of elbow flexion, the Flexpro grip group showed an
25:27
overwhelming decrease of about 42%, whereas the control group
25:32
actually increased their change in joint gaping at 25%.
25:37
At 90°, the Flexpro group group also decreased significantly at
25:42
43%, whereas the Flex or the control group increased about
25:46
13%. And the thing I love about this
25:49
graph is that these two cohorts actually started at an extremely
25:53
similar point. You can see they're they're
25:55
starting on the left is the precondition and they have an
25:59
extremely similar change in joint gapping for both 30 and
26:02
90°. But what we can see for both
26:04
conditions is that the Flexprogrip group had a
26:07
significant decrease in change in joint gapping size, whereas
26:12
the control group either increased a bit or they actually
26:15
maintained quite a linear changing joint gap.
26:19
Looking at the muscle cross-sectional area, the
26:22
Flexpro grip group again in that seal color showed significant
26:26
increases among all these forearm flexors.
26:29
For the FDS, the Flexpro grip group had about 21% increase.
26:34
For the FDP they had about 38% and the FCU about 11%.
26:41
Looking at that control, they maintained very non negligible
26:44
change under 10% change which to us was not significant and they
26:50
clearly did not have any decrease or increase here.
26:53
So in conclusion, what we found with all of these results that
26:56
the flexible grip is an effective training device.
26:59
This device allows for the players to have an increased
27:03
elbow stability as well as forearm strength.
27:06
This device helped that cohort decrease their own low humeral
27:10
joint gaping as well as increase that muscle cross-sectional
27:14
area. Some limitations to the study is
27:17
that this study only included Division One collegiate pitchers
27:22
and looking at other ages and sizes of players might be of
27:26
significance. Also, this study had a smaller
27:29
sample size of only 18 per cohort.
27:32
A larger sample size would allow us to understand how this is
27:36
changing more effectively among the players.
27:39
Also, I could not account for any muscle activation which may
27:42
have occurred when that weight was applied to the pitcher's
27:45
forearm. And lastly, sometimes the
27:48
ultrasound images, they're very difficult to measure and analyze
27:52
for those players who may have had Tommy John surgery.
27:56
And they weren't necessarily always the clearest, but I did
27:59
try my best every time. And lastly, I think some future
28:02
work would be great if you could get a large sample size.
28:05
I mean 50 plus players would be amazing for both cohorts.
28:09
Also, I think it would be interesting to have some more
28:11
frequent check in measurements. Like I said I only measured
28:14
before and after that 10 week protocol, but perhaps a weekly
28:17
check in or bi weekly check in would help us understand more
28:21
how the joint gapping as well as muscle cross-sectional area is
28:25
changing over time. Lastly, I think this would be an
28:29
interesting study to look at with players who may have
28:32
already sustained elbow injuries versus those who do not.
28:36
My study contained players who did all, I already have a Tommy
28:39
John surgery as well as players who do not have that.
28:42
So I think that difference there would be very interesting to
28:45
assess. So thank you so much all for
28:49
listening and now we'll take some questions.
28:51
I have my contact information in the bottom left hand corner if
28:55
anyone needs to reach out to me, but I'm happy to start up the
29:01
panel now. Jess, thank you so much for your
29:05
number one, all your hard work that went into that study,
29:08
that's a labor of love for sure. And so you should be applauded
29:11
for all the work that you did. We're going to get to a couple
29:13
questions. We already have a few brewing in
29:15
the chat and I think 1 real quick that we should get to
29:19
Jess. There's a question for some
29:20
clarification on the participants between the two
29:23
cohorts. Did they go through a
29:25
standardized throwing program during the fall for their ramp
29:28
up or were they allowed to do their preferred or team directed
29:31
program based off of their distance intensity?
29:34
Basically, question regarding baseline characteristics between
29:37
the two cohorts. Can you clarify that?
29:40
Yeah. So again, they were both of
29:42
Division One collegiate level. They were instructed to follow
29:46
their fall on ramping training that their pitching coach or
29:51
head coach provided to them. I did not oversee what their
29:55
fall on ramping contained, but I do know that they did have some
30:00
sort of intensive training and they were both on ramping for
30:03
their spring season. But it's an important point,
30:07
right? It's a good question to bring up
30:08
is that there isn't there's an observational nature to the
30:11
study, right. And so there are some other
30:13
exposure factors that can contribute here with regards to
30:16
what their individual workloads were in their team environments
30:19
and how that may have an effect on the findings.
30:21
That being said, I think yeah, the statistical analysis that
30:25
you did does demonstrate with the Co ND analysis the size of
30:30
the effect here. And you would think that some of
30:32
these would be smaller factors while but you found moderate to
30:35
large effect on some of the muscle cross-sectional area.
30:38
Couple follow up questions for you, Jess.
30:41
Number one, why did you decide to measure gapping at 30° and
30:45
90° of flexion? How were those decisions made?
30:49
Definitely great question. So the elbow was measured at 30°
30:53
because studies in the past have shown this is where the medial
30:56
elbow does experience the highest amount of valgus and
30:59
varus load and the UCL is most exposed to that force.
31:04
However, I wanted to also measure at 90° because when
31:08
pitchers are throwing, they're typically up in that 90° of
31:11
elbow flexion. And so this is where pitchers
31:14
are most commonly experiencing their varus and valgus loads to
31:19
the medial elbow. And so that is why I measured at
31:22
those angles. Great.
31:24
And and why do you think that you saw a a significant shift in
31:29
joint gaping between the training group?
31:31
What's your, what is your, you know, post analysis here?
31:35
How do you hypothesize it that effect was seen?
31:39
So we didn't see necessarily a ton of significant difference
31:44
between the standalone measurements.
31:46
So if we're just looking at 90° of elbow flexion unloaded or 90°
31:51
of elbow flexion loaded. However, what we're concerned
31:55
with when baseball pitchers are throwing is how their elbow
31:58
joint is opening up and closing as the the throwing motion is a
32:02
dynamic motion. And we want to understand how
32:06
the ligament is being exposed to forces and undertaking loads.
32:10
And so I think with the Flex Pro grip group, because they
32:14
strengthen those forearm muscles, they were better able
32:17
to withstand the load. And so when their elbow was
32:21
opening up and being exposed to that valgus load, the medial
32:25
elbow did not need to open up as much because their forearm
32:28
flexor muscles were taking on that load instead of the UCL
32:32
itself. Do you think it was the
32:33
underlying change of the flexor musculature that's why we're
32:36
seeing joint gapping differences?
32:39
Yeah, I think because the the flexor muscles were able to bear
32:43
that load more instead of the elbow being exposed to it.
32:46
And so because the forum flexors were taking on that load, the
32:50
elbow did not need to open up as much.
32:53
Fantastic. Well, look, what we're going to
32:55
do is, is we're going to recap from the panel side of things
32:59
some initial takeaways from Jess's presentation and we're
33:03
really getting some questions stacking up in the chat here too
33:05
as well. There's a lot of interest in and
33:07
people would like some follow up.
33:09
So hopefully we'll work through that.
33:10
For me personally, I think Jess, again, you did a fantastic job.
33:14
I think this is some great work where, you know, we think about
33:17
how can we modulate stress to the medial elbow and what is
33:20
what is modifiable and what's not right.
33:22
And we know that the velocity demands are not really
33:25
modifiable at this point. The stress is going to be seen.
33:28
You know, how can we affect that.
33:29
And so we know the underlying ligament changes over the course
33:33
of the season with regards to thickness elasticity, but we
33:37
don't really know how to intervene there or if there are
33:40
things that we can do to change the properties of the ligament.
33:43
But it would make sense that the overlying flexure pronator
33:46
musculature is ripe for attack as as clinicians and therapists
33:50
and and training staff, the opportunity for us to to
33:53
strengthen the muscle group to diminish the underlying stress
33:56
that's being delivered to the ligament.
33:58
So I think that what you've shown in this study, which is
34:01
really well done was that there's a potential that we can
34:04
treat with a training protocol, which we'll get to a little bit
34:07
later and potentially intervene upon the overlying musculature.
34:10
Why don't we start with with Dylan?
34:12
Dylan, can you go with give us your initial takeaways after
34:16
hearing justice presentation? Yeah, I mean, my initial
34:19
takeaways are that this is, you know, based off of all the
34:22
research that went into the development of the training
34:24
protocols, this is kind of what I would expect to see.
34:27
And I'm happy to see kind of as the the outcome.
34:30
I see a few questions in the chat that are asking about
34:33
specifically flex program. But I, I think it's important
34:36
that the take away is that the style of training that was done
34:40
doesn't necessarily demand that the Flex program be involved,
34:43
but that it's that we're attacking the tissue in a very
34:45
specific manner that creates these changes in the tissue that
34:49
is potentially going to protect the UCL better.
34:51
But the Flex program just offers an easy way to do it because
34:54
it's specifically designed for that.
34:56
And later on, we can jump into a few of the other questions about
34:58
what that protocol actually looks like.
35:00
But biggest take away is that when you intensely train the
35:03
forearm flexors and the correct way, you create an adaptation
35:06
that is most likely going to protect the UCL better.
35:10
And Ryan, how about you initial takeaways from Jess's
35:13
presentation? Yeah, great job Jess.
35:15
And really when my, my brain goes straight to like
35:18
application wise and boil it down like the simplest math
35:22
problem, like what's going to not prevent that metal elbow
35:24
from opening up. You have the Bony aspects of the
35:28
joint, you have the ligament and you have the flexor musculature.
35:31
And so which is trainable, I think we can confidently say
35:35
like the Bony part's not going to be super trainable UCL to
35:38
Matt's point, like maybe we don't know yet, but the flexor
35:41
musculature very trainable. And so now it's like, OK, well,
35:44
now which protocols can most effectively do that to off
35:48
shield to shield some of that stress off the the like I'm in.
35:50
So that was kind of my initial take away.
35:52
Agree. Just just to clarify, there was
35:54
a question in the in the chat. So just your your findings were
35:57
that there was increased cross-sectional area of the
36:00
overlying flexure pronator musculature after a training
36:04
protocol and in addition to the increased cross-sectional area
36:07
there was decreased joint only humeral joint space gapping
36:11
scene. So.
36:12
So just to change in joint gapping the loaded minus the
36:16
unloaded condition. Yes.
36:18
So just to clarify for some of the folks in the in the chat
36:21
here. So the idea is that the
36:23
overlying flexure pronator is being trained and having a
36:26
beneficial effect, whether that's stiffness or other
36:29
muscular properties, right? They weren't directly measured
36:32
here, but affecting the underlying on the humor joint
36:34
space gapping. So we do have a couple of
36:37
questions that we would like to get through and please keep them
36:40
coming within the chat there. There were multiple questions
36:43
about the protocol. I think we what we should say is
36:47
we should give an overview of the training protocol.
36:49
And Jess, maybe you can give a little insight and we'll have
36:51
Dylan weigh in too as well. However, you know, this is is
36:55
separate, this informational event, research event is
36:58
separate from the company itself.
36:59
And so I know that the company would be happy to set up a
37:02
follow up call and go through the protocol in detail, maybe
37:06
for informational purposes. But why don't we have Jess?
37:08
Can you give an overview of the training duration, what was
37:12
done, how much time was spent in the individual sessions for the
37:15
athletes while they were doing that?
37:16
And and Dylan, maybe you can chime into as well.
37:19
Yeah, it definitely would. If you want more in depth detail
37:22
about the training protocol, talk to Flexpro Grip because I
37:26
don't work for Flexpro Grip, but I do know that they had their AB
37:30
and C days, again all of which maintained radial deviation,
37:35
ulnar deviation, flexion and extension and they trained 3
37:39
times a week and again those were those and sea days.
37:42
Their measurements were calculated based off of their
37:46
fastball velocity and so they had a progressive onload or on
37:51
ramping training. So they started very low with
37:54
the amount that they would grip and they would increase
37:56
progressively throughout that 10 weeks.
37:59
And I know that they would still train after the fact, but I
38:03
strictly stuck to that 10 week protocol.
38:06
But I guess Flexprogrec can speak more on the nuances of the
38:11
training program and the specific movements and
38:15
measurements that are are made there.
38:17
I can provide anything else to add.
38:19
Of that extra specificity there, the the A day is specifically
38:22
going after the FDP tendon, the b-day is more of the extension
38:26
and radial owner deviation and the C day is more mid finger
38:29
flexion. All of the training protocols
38:31
are utilizing A1 Rep Max and then training Max is based off
38:33
of a percentage of that. And the whole purpose is to
38:36
ensure that we're meeting a sufficient level of percent MVC
38:41
with our training reps that we are able to induce the stiffness
38:44
adaptation in that flexor tendon is really what the the ultimate
38:49
goal of the protocol is. Ryan, can you chime in just on
38:53
the take what what Dylan said and how you take this into your
38:57
practice, how you take this into developing your programs,
39:00
developing your your arm care? How do you incorporate this?
39:04
Yeah, I think I would say it, it really depends.
39:07
I know a lot of our teams, they also use Flex Pro Grip.
39:09
So that makes it very easy. They work really well hand in
39:12
hand. And then the chance that they
39:13
don't, I think you can use a lot of these same principles
39:16
training, not using the device and and really to Dylan's point,
39:20
if you're loading the that muscle, muscle tendon unit with
39:23
enough load, then you're going to get that adaptation over
39:26
time. And I think that's the key on
39:27
like how you're dosing it in. So I think this protocol is
39:30
great and and the ability to dose it in and then allow that
39:33
muscle tendon unit to recover and adapt and then reload it.
39:37
And can you speak on not just the dosing, but the role of
39:41
isotonic contraction, isometric, how we're challenging the
39:44
muscles? And then Ryan, why don't you go
39:45
1st and then and then Dylan, you also have some background from
39:48
your strength and conditioning side too as well.
39:50
Is there a more beneficial way to to attack this musculature?
39:55
Yeah, I think we're still really early, probably too early to
39:58
know. And I think they are leading
40:00
the, you guys are all leading the.
40:01
The way in terms of the research, and it seems like the
40:03
at least the initial research that I've went through is this
40:06
isometric contraction is very effective at specifically
40:10
loading that the tendon aspect of it.
40:12
And just kind of if you, if you think about it's like if you
40:15
stretch a muscle tendon unit or activate a muscle tendon unit,
40:20
likely the the stress, how much stress is going to the tendon is
40:23
going to depend on how much, how much contraction there is in
40:26
that muscle. So if you can create a really
40:29
stiff muscle, now that tendon is accepting more of that load and
40:31
you can truly load that portion of it.
40:34
And so I don't think I can give you a clear answer on the
40:37
eccentric versus concentric versus isometric.
40:39
But of the research that's out there, it seems like isometric
40:42
is doing a very good job in terms of loading it.
40:44
And then also, as you can see in just as research, improving that
40:47
stiffness and decreasing some of that gap and that happens at the
40:50
medial elbow. And I think think that there is
40:53
some research that has shown like concentric, eccentric,
40:57
isometric, all, as long as they're above the percent
41:00
threshold, I think they can induce the changes.
41:02
I think the, the nice thing about the isometrics is that
41:05
one, it kind of comes with a lower fatigue cost. 2, It's an
41:08
easier way to kind of meet the time thresholds.
41:10
A lot of the research points to like at least three seconds of
41:13
tension being held on the tendon.
41:15
So isometrics isn't a nice way to do that, whereas you don't
41:18
have to worry about changing joint ranges of motion and
41:21
tendon lengths and all that fun stuff.
41:23
And then lastly, it's just it's something that can easily fit in
41:26
to anybody's routine. And like I said, Flex Program is
41:29
a device that allows you to easily do it, but you don't need
41:32
the device to come up with creative ways to try to
41:34
stimulate the tendons. It's just a way that allows you
41:36
to measure it and be a little bit more precise in both terms
41:40
of like joint positioning and intensity.
41:42
And for those purposes, Dylan, I also like it too in the post
41:44
operative to appear that it makes me feel more comfortable
41:47
introducing some of these strengthening activities earlier
41:51
than we have traditionally because I don't have quite as
41:53
much concern with regards to joint positioning and, and and
41:56
motion there. And we can dose it, right?
41:58
That's what one of the values here is that we can measure, we
42:00
can dose it and we can really expose them to the stress
42:03
they're going to need to see, but in an earlier and
42:06
controlled. So Jess, we do have a couple of
42:08
follow up questions about the study itself, which I think are
42:11
important. In particular, there was 1
42:13
panelist, I'm sorry, one attendee who asked about do we
42:16
have any follow up? Was there any longitudinal
42:20
follow with regards to how the decrease gapping played out for
42:23
injury throughout the season? Did we reassess their joint
42:26
gapping towards the end of the year where there's were these
42:29
changes sustained? And also there's a question
42:31
about the cohorts itself. Can you give a little more info?
42:34
Were they from the same team or from various collegiate teams
42:37
with regards to their initial division?
42:39
The Flexpro grip group was 1 university and the control group
42:44
was another. They were both within the same
42:47
area. The ultrasound images were taken
42:50
just once before and after that 10 week protocol.
42:54
There wasn't any follow up after the fact.
42:56
However, a fun little fact from this study is that within the
43:01
ten week protocol, I had to remove four players from the
43:06
control cohort due to them acquiring injuries throughout
43:10
that 10 week protocol, whereas in my Flex Pro Grip group, there
43:14
was only one removed because he didn't follow the Flex Pro Grip
43:18
protocol. So no, there was not any latter
43:23
follow up with them simply because of time.
43:26
But if there were more time, that would be something
43:29
interesting to assess and to analyze if that joint gapping
43:34
was maintained and if that musculature size was also
43:37
maintained after the fact. And it's an important point,
43:42
right, that that there were different exposures in the two
43:44
cohorts too as well. So there are some other factors
43:46
that may contribute to some of the baseline changes that we're
43:49
seeing, although it is a fairly confined period of time, 10
43:53
weeks right, with the training effect.
43:54
But but there, there are limitations here and there are
43:58
opportunities for further study that that I think controls some
44:01
of those factors. There was a question about what
44:03
age should we start training these specific muscle groups.
44:06
Ryan, you want to want to weigh in there.
44:09
Yeah. And I the same thing applies to
44:11
kind of armor. It's really hard to put like an
44:13
age on something just with the different and develop the
44:16
different variation and the development of each kid at young
44:19
ages. But the fact that to your point
44:22
same thing as as post surgical is like the fact that if we're
44:25
implementing it with isometrics, you can definitely have a much
44:27
greater control of how much we're load we're putting through
44:31
everything. And so I think as kind of the
44:35
rule of thumb, because early as they're getting serious about
44:37
the spore, whether it's 11-12 years old, I don't know what
44:40
what Daryl and Adams kind of thought on it is, but I think
44:42
that's a really good age to start it.
44:44
And then definitely through high school, it's it's green light
44:46
from there on out. I think it's you got to get
44:48
started early with the youngest athletes.
44:50
We have a lot of people here from from professional baseball
44:53
and seeing seeing the downstream effects of what's happening at
44:56
the youth level, but I think starting taking ownership of
45:00
keeping their elbow shoulder and elbow healthy.
45:01
I think it's the biggest emphasis in these in these
45:04
younger cohorts. Look, we're here because of
45:06
justice research. That's that's what we're here to
45:08
talk about. I really follow up on some of
45:10
the questions from the from the group about it.
45:13
Just another question, were you blinded as the ultrasound tester
45:17
on which players were assigned to each group when you're
45:20
testing kind of pre and post 10 weeks of training?
45:22
Was this blinded or unbinded? The measurements specifically
45:28
believe I was sort of aware it really just said the subject
45:34
number and the condition. So honestly, not really, but for
45:38
reliability specifically, I also did not know I did a randomized
45:44
number thing where I went through which cohort was I going
45:47
to pick, was I going to pick pre or post and was I going to which
45:51
participant was I going to do? So that was all completely
45:54
blind, just to make sure all of my measurements were reliable,
45:58
of course, and that I wasn't being biased towards any of my
46:03
measurements. Is there?
46:04
How long is it? Is this an exercise day?
46:08
Dylan, if we're going through an A day or AB day, can you give us
46:11
some more detail there? What does it take for an athlete
46:15
to sit down and and complete one of the the workouts?
46:18
It's about 10 minutes. So each each protocol starts off
46:23
with doing a four finger, one Rep Max and then you have
46:25
training reps at a a specific percentage of that.
46:28
And the 10 week protocol, I believe that you use Jasper's
46:31
the strength cycle, which is the just kind of the 10 week on ramp
46:35
if you will. So it starts at 50%, works its
46:38
way up to 70% over a few weeks. You do that for all four
46:42
fingers, then you do it for each finger individually where you do
46:44
a one Rep and then some training reps and then that protocol
46:49
exists throughout all of the exercises.
46:51
It just changes which tendon we're targeting.
46:54
So whether we're doing radio owner mid finger or fingertip
46:57
flexion or extension, it's that same kind of one Rep Max to
47:01
training percentages of being held for a longer duration is is
47:05
kind of the way that it's set up.
47:06
I'm also now finding more and more questions in the Q&A part,
47:09
not just also in the webinar chat.
47:11
So again, for, for folks who we have not been able to get to
47:14
their questions, thank you for your, for your interest.
47:16
We're going to circulate this amongst the panel and send out a
47:20
transcribed question answer, which hopefully we can, we can
47:24
address some of this. Can Ryan and Dylan weigh in on
47:27
the importance of the force length relationship in training?
47:31
Training the flexion printer in extension of the fingers versus
47:33
flexion finger posturing during the delivery?
47:37
Should we be attacking these muscle tinting units in certain
47:40
positions? Yeah, I mean, I, I'm not kind of
47:42
I'll, I, I'll punt this one to Dylan, 'cause I kind of was
47:44
taking his brain on it not long ago.
47:46
But from what we were gathering is the more you can create
47:50
preset tension in that muscle tendon unit.
47:53
So it would be like a finger extended and wrist extended
47:56
position for a finger flexor that would was kind of
47:59
essentially presetting the load and then now the the contraction
48:02
would be even greater. So I'll pump that one to you
48:04
doing. Yeah, I believe there was a
48:07
recent paper and Darryl may be able to circulate this post that
48:10
showed that like the standard grip dynamometer wasn't
48:13
fantastic. And my argument is that this is
48:16
almost like trying to measure somebody's one Rep Max squat
48:19
strength from the most shortened position, which would be like
48:22
1/4 squat versus going all the way down on the squat or
48:25
lengthening out the tissue as much as you can.
48:27
These are two very different positions.
48:28
And so I think the extension aspect of it is pretty important
48:33
in terms of both training as well as kind of having the
48:36
strength in a specific position that's more applicable to what
48:39
the the fingers are going through whenever you're
48:41
throwing. I think it's a great point and
48:44
but we can use it as an opportunity to to at least touch
48:47
on some other work that that we've done, Dylan, where we've
48:50
looked at how flexor pronator strength may change in certain
48:54
positions based off of supination versus pronated
48:57
forearm positions. And so this brings up a good
48:59
point is that this is a dynamic movement guys.
49:02
You're, you know, the overhead delivery, the arm is, is it's
49:05
not a static thing. We're not laying in 30 or 90° of
49:08
flexion, flexing the flexor pronator mask.
49:11
We've got to measure, we've got to strengthen in different
49:13
positions and, and people may be vulnerable in certain positions
49:17
of finger length. And so that's an interesting
49:19
question. I think you brought up the, the
49:21
handheld dynamometer. There was a study done that
49:23
showing, you know, no correlation between hand grip on
49:26
the grip dynamometry dynamometer with injury wrist that was done
49:30
in pro ball a couple years back. We've got a couple minutes left,
49:34
Ryan. Any final thoughts as we start
49:36
to wind down here? Nothing specifically that comes
49:38
to mind other than just being excited.
49:40
Like I kind of mentioned in the initial aspect of, I think it's
49:44
going to be great to really put a ton of focus here on how we
49:46
can really make the the throwing arm as resilient as as possible.
49:50
So I know this is just an initial step and it really opens
49:53
the doors to a lot more research being done, but I think it's
49:56
really exciting for the entire baseball world.
49:58
Dylan, what about you after getting Jess's research?
50:02
I echo what Ryan said and it's nice to see that when we when we
50:06
come up with a training protocol that we think will make a
50:09
substantial change, that it's nice to see that we we have the
50:11
the expected effects. And I think this opens the door
50:15
for a lot more questions to be answered and later studies that
50:18
continues to push this needle forward for better and more
50:21
resilient health for the elbow. Just before you give some of
50:25
your closing thoughts, I have a you know you get a unique
50:28
opportunity to ask a researcher about their work.
50:31
What were your expectations going forward like when you
50:33
started this project? What did you expect to find?
50:36
Is this consistent with your your true gut hypothesis or what
50:40
did you believe was going to happen?
50:42
I was a little bit skeptical. I honestly really didn't think
50:46
it was going to work. And when I was running my R code
50:50
and I outputted my graphs and did my ANOVA's, I was like, Oh
50:55
my gosh, okay, this did work. And you know, visually it's hard
50:59
to tell on the ultrasound images, but when you really
51:02
crunch those numbers and look at the statistics, it is really
51:05
cool to see how different those two cohorts were.
51:09
And again, when I go back, I, I'll go back to the slide that I
51:14
absolutely love. I think this side's really cool
51:17
because it shows that those two cohorts actually did start at a
51:21
very, very similar point. Again, they're both Division One
51:24
collision athletes, but that flexprogrep group had such a
51:28
drastic decrease as the control group really just either maybe
51:33
increased a little bit or just maintain the same position.
51:36
And I thought that was really, really awesome to see.
51:39
I found it fascinating, honestly.
51:41
But again, yeah, I really didn't think it shouldn't work at
51:43
first. I wasn't convinced.
51:45
I agree. I mean, I think this is a really
51:46
cool chart here and there been some questions from the from the
51:50
chat about what about other factors that have happened
51:52
during this ten week period and could they also be at play?
51:55
And I think it's fair, right? It's, it's very fair.
51:59
But what you do know is that there's a utilization of a 10
52:01
week structured program here and these changes we're seeing, you
52:05
know, how can you improve this in the future?
52:08
Obviously a randomized study where some of these other
52:13
environmental and exposure factors kind of fall out, the
52:16
randomization. That being said, it's, it's hard
52:19
with some of the evidence that is accumulating to just
52:23
randomize a group when we, when we think that there is something
52:26
that can be beneficial that can be intervened upon and to kind
52:29
of withhold that that treatment from a, a cohort.
52:32
It's, it's a challenging thing to do, but I think that your,
52:35
your study is fantastic. You did a great job.
52:38
I think you should should really be applauded on this.
52:40
And and so, you know, we're going to be respectful of
52:42
everybody's time. We've got a lot of busy folks
52:45
here that have joined us. And I want to thank first of
52:48
all, Jess, thank you for for joining us for presenting your
52:51
work, for all the work that you did in order to, to put your
52:54
study together and understand how hard of a study that is to
52:58
perform and to execute. I think you really should be
53:00
congratulated on on your work and thank you for joining us
53:03
and, and sharing with us today for for Dylan and and Ryan,
53:07
thank you again for for joining us sharing your expertise.
53:10
I appreciate you guys as as friends and colleagues to bounce
53:14
things off of and to learn from. Thank you to all the the guests
53:17
who joined us and who are interested.
53:20
I think this is cool because we're here for all for the same
53:22
reason, right? We believe in in doing whatever
53:25
we can to help the throwing athlete population try to find
53:29
ways to support them while they're striving to to push
53:32
their bodies. But how can we also, you know,
53:34
help them in a way that we can decrease the injury rates that
53:37
we're seeing? And we hope that this event here
53:40
is one of many and will become sort of a series where we can
53:43
discuss research, we can we can brainstorm, we can collaborate
53:47
and find ways that we can improve the health of a throwing
53:49
athlete. We've already got some ideas to
53:51
discuss, some future studies that we've done, both the
53:54
retrospective in nature looking at the utilization of the
53:57
flexible grip with regards to injury risk.
54:00
And then some of the things that we hinted along with with Dylan
54:03
with regards to how flexor pronator strength may change in
54:06
certain positions, which is from the pitch design perspective,
54:09
likely of high interest to everybody here.
54:11
So again, I want to thank everybody for for joining us.
54:14
Thank you for the great conversation.
54:15
We're going to go ahead and go through the chat and try to
54:17
answer some of the things that we were unable to get to today,
54:20
which we apologize. But again, thanks for joining
54:22
us. Thanks for everybody's passion
54:24
here and hope we can just continue to push the game
54:26
forward.