1 00:00:00,080 --> 00:00:02,320 Speaker 1: Joining us now on the program. We have talked to 2 00:00:02,400 --> 00:00:05,520 Speaker 1: him before. He is without question the gold standard when 3 00:00:05,559 --> 00:00:08,799 Speaker 1: it comes to athletic training the knowledge thereof in all 4 00:00:08,920 --> 00:00:12,000 Speaker 1: forms of athletics. As I mentioned, he has overseen the 5 00:00:12,080 --> 00:00:15,840 Speaker 1: athletic training or the medical staffs in planning for thirty five, 6 00:00:16,520 --> 00:00:19,320 Speaker 1: if not more, different major sporting events that have come 7 00:00:19,320 --> 00:00:26,440 Speaker 1: through Indianapolis. Ralph Frief joining us from REEF Executive Performance Solutions, 8 00:00:26,680 --> 00:00:28,319 Speaker 1: and I wanted to talk to you, Ralph about a 9 00:00:28,400 --> 00:00:31,800 Speaker 1: number of different injuries, just because this is the time 10 00:00:31,840 --> 00:00:33,879 Speaker 1: of year where you start hearing him and sometimes you 11 00:00:33,880 --> 00:00:36,760 Speaker 1: start hearing about injuries that people are not as familiar with. 12 00:00:37,000 --> 00:00:38,800 Speaker 1: I'm going to get to Tyre's Halliburton as well, but 13 00:00:38,840 --> 00:00:41,879 Speaker 1: I want to begin with this one. Joe Burrow is 14 00:00:41,920 --> 00:00:44,560 Speaker 1: now going to be out a month with turf toe. 15 00:00:45,280 --> 00:00:48,199 Speaker 1: And I remember Marshall Falk had turf toe at some 16 00:00:48,280 --> 00:00:51,159 Speaker 1: point when he was here, and I always just assumed 17 00:00:51,200 --> 00:00:52,560 Speaker 1: turf toe is like when you get up in the 18 00:00:52,600 --> 00:00:54,280 Speaker 1: middle of the night to get a glass of water 19 00:00:54,400 --> 00:00:58,560 Speaker 1: and you stub your toe on the foot rest that 20 00:00:58,600 --> 00:01:02,800 Speaker 1: you didn't realize was there. But what exactly is turf toe? 21 00:01:04,200 --> 00:01:06,959 Speaker 2: Yeah, well, it's great to be with you, Jake. And yeah, 22 00:01:07,000 --> 00:01:11,360 Speaker 2: that middle of the night stubbing the toe is where 23 00:01:11,120 --> 00:01:14,840 Speaker 2: you're basically jamming bone surface against bone surface. So it's 24 00:01:14,840 --> 00:01:18,880 Speaker 2: sort of a straight line impact turf toe. You get 25 00:01:18,920 --> 00:01:22,640 Speaker 2: into multiple angles. So in this particular case, quarterback Joe 26 00:01:22,640 --> 00:01:26,240 Speaker 2: Burrows was sort of crunched to the ground, his foot 27 00:01:26,280 --> 00:01:29,240 Speaker 2: and ankle got squeezed up, and he got a hyper 28 00:01:30,120 --> 00:01:33,600 Speaker 2: extension of his big toe. So if you imagine going 29 00:01:33,600 --> 00:01:36,160 Speaker 2: down and grabbing your big toe and just pulling it 30 00:01:36,400 --> 00:01:40,280 Speaker 2: up as far as you possibly can. And so he 31 00:01:40,319 --> 00:01:43,440 Speaker 2: had a significant injury to the plate or the bottom 32 00:01:43,480 --> 00:01:47,800 Speaker 2: of that big toe, and it's quite debilitating and a 33 00:01:47,800 --> 00:01:51,160 Speaker 2: lot of soft tissue injury. He ended up going up 34 00:01:51,200 --> 00:01:58,160 Speaker 2: to Wisconsin to see doctor Robert Anderson, a very very 35 00:01:58,160 --> 00:02:01,920 Speaker 2: good foot and ankle specialist, for that particular surgery. 36 00:02:02,560 --> 00:02:06,440 Speaker 1: Okay, and that surgery would it just be I'm going 37 00:02:06,480 --> 00:02:08,240 Speaker 1: to sound like an idiot here, Ralph. And now, first off, 38 00:02:08,280 --> 00:02:10,200 Speaker 1: I will tell you the thought of bending my big 39 00:02:10,240 --> 00:02:13,160 Speaker 1: toe backwards as far as it can go. I winced 40 00:02:13,200 --> 00:02:15,000 Speaker 1: along with everybody else when I heard that. And by 41 00:02:15,040 --> 00:02:16,920 Speaker 1: the way, speaking of WinCE, he's also going to get 42 00:02:16,919 --> 00:02:20,960 Speaker 1: playing time another injury JJ McCarthy of Minnesota. But is 43 00:02:21,000 --> 00:02:23,239 Speaker 1: it a matter of basically just putting the toe back 44 00:02:23,280 --> 00:02:26,080 Speaker 1: in place and then holding it there so everything around 45 00:02:26,120 --> 00:02:28,400 Speaker 1: it can heal because the toe is an area that 46 00:02:28,600 --> 00:02:30,280 Speaker 1: obviously is under constant movement. 47 00:02:31,320 --> 00:02:35,800 Speaker 2: Well, for that all great questions, Jake, And the issue 48 00:02:35,800 --> 00:02:40,679 Speaker 2: would be that upon further diagnosis, clear diagnosis of the structure, 49 00:02:40,760 --> 00:02:44,160 Speaker 2: with all the various imaging opportunities that are available, plus 50 00:02:44,200 --> 00:02:49,359 Speaker 2: the just the intuitive expertise of the physician, there's a 51 00:02:49,480 --> 00:02:53,240 Speaker 2: number of small pieces to that big toe that are 52 00:02:53,320 --> 00:02:58,080 Speaker 2: absolutely critical to function. So if it was if a 53 00:02:58,120 --> 00:03:01,000 Speaker 2: matter of maybe the tendon that if you were to 54 00:03:01,360 --> 00:03:04,320 Speaker 2: grab your you know, sort of push your toes into 55 00:03:04,320 --> 00:03:07,280 Speaker 2: the ground right now, all that force comes from tendons 56 00:03:07,280 --> 00:03:09,040 Speaker 2: along the bottom of the foot that go up the 57 00:03:09,080 --> 00:03:11,400 Speaker 2: back of the leg and so forth, and so he's 58 00:03:11,440 --> 00:03:15,399 Speaker 2: obviously damaged that to some degree. And so the other 59 00:03:15,440 --> 00:03:19,799 Speaker 2: element there are really two small bones think of them 60 00:03:19,840 --> 00:03:24,840 Speaker 2: as small BB's or pearls, called the cesmoid bones. And 61 00:03:24,880 --> 00:03:29,600 Speaker 2: those cessmoid bones are embedded within tendons, and they can 62 00:03:29,680 --> 00:03:34,960 Speaker 2: actually get cracked, can lose their formation or their place, 63 00:03:35,760 --> 00:03:40,520 Speaker 2: and those are so critical to the biomechanics and function 64 00:03:40,840 --> 00:03:45,440 Speaker 2: of the toe that if those were damaged, those needed 65 00:03:45,480 --> 00:03:51,360 Speaker 2: to be placed back in their original location and embedded 66 00:03:51,360 --> 00:03:56,280 Speaker 2: there through his surgical procedure. And so the cessamoid bones. 67 00:03:56,360 --> 00:04:02,680 Speaker 2: Think of it a little bit like IndyCar. It'd almost 68 00:04:02,760 --> 00:04:06,280 Speaker 2: be like your front end. I think push rods are 69 00:04:06,360 --> 00:04:10,680 Speaker 2: the rocker arm that absorbs force that's going vertical and 70 00:04:10,800 --> 00:04:15,400 Speaker 2: you want to go horizontal, and the sesmoid bones sort 71 00:04:15,400 --> 00:04:17,720 Speaker 2: of form that same function. You don't know they're there 72 00:04:18,240 --> 00:04:21,680 Speaker 2: until they're injured. And so that's my bet is those 73 00:04:21,760 --> 00:04:27,160 Speaker 2: sesimoid bones got displaced and surgically needed to be put 74 00:04:27,200 --> 00:04:31,480 Speaker 2: back into place. And probably the flexor tendon that caused 75 00:04:31,520 --> 00:04:33,640 Speaker 2: you to curl your toes up probably need a little 76 00:04:33,640 --> 00:04:34,640 Speaker 2: bit of repair as well. 77 00:04:34,880 --> 00:04:38,760 Speaker 1: You know what, Ralph, I like I could. I could 78 00:04:38,760 --> 00:04:41,560 Speaker 1: talk to you for six hours about this for two reasons. 79 00:04:41,640 --> 00:04:43,920 Speaker 1: Number one, I find it fascinating. Number two, you have 80 00:04:44,600 --> 00:04:46,880 Speaker 1: a unique ability to speak it into a language that 81 00:04:47,000 --> 00:04:50,240 Speaker 1: somewhat of my lack of intellect can grasp right. And 82 00:04:50,360 --> 00:04:52,160 Speaker 1: number three, and I think this is probably the most 83 00:04:52,200 --> 00:04:56,680 Speaker 1: important thing in like medical training. You just have like 84 00:04:56,720 --> 00:04:59,320 Speaker 1: this calming delivery about it, right where like it just 85 00:04:59,400 --> 00:05:02,520 Speaker 1: it's enjoyable to listen to, so I find it fascinating. 86 00:05:02,520 --> 00:05:04,840 Speaker 1: So I'm going to ask an additional question I had 87 00:05:04,839 --> 00:05:08,320 Speaker 1: not planned, and that's this because I think it's important 88 00:05:09,040 --> 00:05:11,240 Speaker 1: people that are listening right now on and we'll get 89 00:05:11,240 --> 00:05:13,160 Speaker 1: back into some of these NFL injuries roul Free in 90 00:05:13,200 --> 00:05:16,440 Speaker 1: a second. But for people that are weekend Warriors, people 91 00:05:16,440 --> 00:05:18,720 Speaker 1: that are let's say thirty five to fifty to fifty 92 00:05:18,760 --> 00:05:20,440 Speaker 1: five years old, that are going out to stay in 93 00:05:20,520 --> 00:05:22,440 Speaker 1: shape and they're running the mon on or they're maybe 94 00:05:22,440 --> 00:05:25,400 Speaker 1: going to the gym and lifting some light weights, what's 95 00:05:25,440 --> 00:05:30,120 Speaker 1: the most common injury that people feel a symptom for 96 00:05:30,279 --> 00:05:33,400 Speaker 1: and overlook that is actually something that they do need 97 00:05:33,440 --> 00:05:36,400 Speaker 1: to look into. And what's the most common one that 98 00:05:36,480 --> 00:05:40,880 Speaker 1: people freak out and think is debilitating but really it's 99 00:05:41,440 --> 00:05:44,000 Speaker 1: fairly innocuous and not something of concern. 100 00:05:46,160 --> 00:05:49,239 Speaker 2: Well, Jake, that's a yeah, that's a six hour question. 101 00:05:50,400 --> 00:05:54,479 Speaker 2: But many years ago, when I was at sensioned St. 102 00:05:54,560 --> 00:05:58,720 Speaker 2: Vincent Sports Performance, we saw a number of weekend Warriors 103 00:05:59,320 --> 00:06:02,480 Speaker 2: as well as the athletes, and we did some reverse 104 00:06:02,520 --> 00:06:08,520 Speaker 2: engineering and why were people coming in with various primarily 105 00:06:08,560 --> 00:06:11,680 Speaker 2: lower extremity injuries. My front of my knee, hurts, pain 106 00:06:11,800 --> 00:06:15,640 Speaker 2: under my kneecap, the bottom of my foot, plantar fascy itis, 107 00:06:15,680 --> 00:06:18,200 Speaker 2: those kinds of things. And when we did the reverse 108 00:06:18,240 --> 00:06:20,479 Speaker 2: engineering on that, we found out that it wasn't so 109 00:06:20,560 --> 00:06:24,200 Speaker 2: much running on the flat surface of the monon. It 110 00:06:24,320 --> 00:06:27,359 Speaker 2: was when a limb might fall down north of the 111 00:06:27,480 --> 00:06:31,440 Speaker 2: river and broad ripple and fall across the monon and 112 00:06:31,480 --> 00:06:33,800 Speaker 2: you had to jump over it. And it was that 113 00:06:34,120 --> 00:06:39,160 Speaker 2: motion that was unnatural, that that jumping mechanism put an 114 00:06:39,200 --> 00:06:44,039 Speaker 2: additional strain on your body. That's in this methodical locomotive 115 00:06:44,200 --> 00:06:48,200 Speaker 2: kind of motion that caused that injury. And it's that 116 00:06:48,440 --> 00:06:53,159 Speaker 2: it's that that thing you feel, whether it's a sharp 117 00:06:53,200 --> 00:06:55,280 Speaker 2: pain or it's a dull ache, or it feels a 118 00:06:55,360 --> 00:06:58,640 Speaker 2: little bit fat and swollen, but you really can't see 119 00:06:58,640 --> 00:07:01,560 Speaker 2: it when you get home or the next day. That's 120 00:07:01,600 --> 00:07:06,279 Speaker 2: something you ought to have looked at because you might 121 00:07:06,400 --> 00:07:11,640 Speaker 2: be dealing with a tear of meniscus in the knee 122 00:07:11,640 --> 00:07:15,720 Speaker 2: that you just didn't think couldn't have happened. But those 123 00:07:15,760 --> 00:07:18,400 Speaker 2: are the kinds of things that that really create issues. 124 00:07:18,480 --> 00:07:22,880 Speaker 2: And we could go on and on there. There's you pick, 125 00:07:23,040 --> 00:07:25,760 Speaker 2: you pick a joint or a soft tissue in the body, 126 00:07:25,760 --> 00:07:27,720 Speaker 2: and we could talk a long time about it. 127 00:07:28,120 --> 00:07:31,240 Speaker 1: Well the okay, So to get to the point of, 128 00:07:31,920 --> 00:07:33,520 Speaker 1: you know, all of a sudden feeling like kind of 129 00:07:33,520 --> 00:07:35,560 Speaker 1: that that quick burn, that little pop where you just 130 00:07:35,600 --> 00:07:37,880 Speaker 1: think like whoa. You know, in the case of Tyre's 131 00:07:37,880 --> 00:07:41,520 Speaker 1: Halliburton with an achilles you know it's obvious and it's debilitating. 132 00:07:41,560 --> 00:07:43,880 Speaker 1: You could see that. Everybody saw that in that game 133 00:07:43,920 --> 00:07:48,760 Speaker 1: we talked to you. Then, in regards to Tyre's Halliburton's recovery, 134 00:07:48,920 --> 00:07:51,920 Speaker 1: I want to be clear, Ralph Reef, for your protection, 135 00:07:52,000 --> 00:07:55,160 Speaker 1: I guess you know you are not individually to my knowledge, 136 00:07:55,200 --> 00:08:00,120 Speaker 1: working with Tyre's Halliburton, but speaking in generate in generality 137 00:08:00,160 --> 00:08:03,640 Speaker 1: about a recovery from that sort of an injury. If 138 00:08:03,680 --> 00:08:07,480 Speaker 1: that took place some now three months ago for Tyrese 139 00:08:07,520 --> 00:08:10,720 Speaker 1: Haliburton and he is now out of the boot, that 140 00:08:10,760 --> 00:08:13,600 Speaker 1: would appear to be on schedule, ahead of schedule. Is 141 00:08:13,600 --> 00:08:16,720 Speaker 1: there any way to kind of analyze from afar what 142 00:08:16,760 --> 00:08:17,600 Speaker 1: that means? 143 00:08:18,280 --> 00:08:22,520 Speaker 2: Yeah, certainly, and yes I have no affiliation with Tyrese 144 00:08:22,560 --> 00:08:29,840 Speaker 2: Haliburton's recovery, healthcare, etc. So I appreciate you you mentioning 145 00:08:29,880 --> 00:08:33,600 Speaker 2: that the just to put that in perspective what you said. 146 00:08:33,640 --> 00:08:38,360 Speaker 2: His surgery was actually three months ago today, Okay, the 147 00:08:39,000 --> 00:08:44,199 Speaker 2: sixteenth of June, and so what's that ninety two days 148 00:08:44,240 --> 00:08:47,000 Speaker 2: if I counted right. His surgery is the following Monday 149 00:08:47,200 --> 00:08:49,720 Speaker 2: at the Hospital for Special Surgery in New York City 150 00:08:50,640 --> 00:08:53,240 Speaker 2: on Monday to twenty third, So he's eighty two days 151 00:08:53,240 --> 00:08:57,960 Speaker 2: out from that repair of the Achilles and we don't 152 00:08:58,000 --> 00:09:02,000 Speaker 2: know what else was done or the exact type of procedure. 153 00:09:02,040 --> 00:09:06,760 Speaker 2: There's you know, there's there's different ways of making spaghetti sauce, right, 154 00:09:06,840 --> 00:09:09,640 Speaker 2: and so there's different ways of repairing the Achilles tendon 155 00:09:09,720 --> 00:09:13,320 Speaker 2: as well. But he went to the Hospital for Special 156 00:09:13,320 --> 00:09:16,960 Speaker 2: Surgery for a reason. The person there is really good 157 00:09:17,040 --> 00:09:20,079 Speaker 2: and they've done a lot of high level athletes who 158 00:09:20,080 --> 00:09:24,800 Speaker 2: have made return to sport, and so he is on schedule. 159 00:09:24,880 --> 00:09:28,160 Speaker 2: That's my opinion. I saw some social excuse me, I 160 00:09:28,200 --> 00:09:31,640 Speaker 2: saw some social media stuff. I've seen him at Fever 161 00:09:31,760 --> 00:09:40,520 Speaker 2: games walking round, excuse me, and he is on schedule, 162 00:09:40,840 --> 00:09:45,480 Speaker 2: is my sense. And I did notice on social media 163 00:09:45,520 --> 00:09:49,160 Speaker 2: that he's wearing a strap around his knee, and folks 164 00:09:49,200 --> 00:09:53,160 Speaker 2: may have seen that too. That's a firefly scrap that 165 00:09:54,120 --> 00:09:59,280 Speaker 2: continuously puts this gentle pulse of electricity into the paranial 166 00:09:59,400 --> 00:10:02,480 Speaker 2: nerve which is on the side of the leg, and 167 00:10:02,520 --> 00:10:05,280 Speaker 2: it stimulates blood flow throughout the whole lower leg and 168 00:10:05,360 --> 00:10:09,160 Speaker 2: into the Achilles tendon area. So one of the big 169 00:10:09,200 --> 00:10:14,080 Speaker 2: things that can reduce a good repair, to reduce the 170 00:10:14,200 --> 00:10:17,520 Speaker 2: optimal outcome, is the amount of blood flow that you 171 00:10:17,600 --> 00:10:24,679 Speaker 2: get into the areas sort of to bathe that surgical repair, 172 00:10:24,760 --> 00:10:29,600 Speaker 2: you want to bait it in good, rich blood, and 173 00:10:29,640 --> 00:10:32,360 Speaker 2: without activity you can't do that. So being in the 174 00:10:32,400 --> 00:10:38,080 Speaker 2: boot is necessary. But to have this continuous stimulation through 175 00:10:38,120 --> 00:10:43,120 Speaker 2: this firefly strap is an excellent way to get that done. 176 00:10:43,120 --> 00:10:45,319 Speaker 2: He can use that on an airplane, riding in a car, 177 00:10:45,480 --> 00:10:48,640 Speaker 2: sitting in a chair. He can use it all the time. 178 00:10:48,720 --> 00:10:54,400 Speaker 2: So he's got this continual activity that is assisting his 179 00:10:54,480 --> 00:10:58,440 Speaker 2: body with repair. By all indications, he's on schedule. 180 00:10:59,679 --> 00:11:03,880 Speaker 1: Ralph Reef is our guest again Reef Executive Performance Solutions, 181 00:11:04,480 --> 00:11:07,200 Speaker 1: and of course Ralph Reef dot com that's ore ei 182 00:11:07,559 --> 00:11:10,360 Speaker 1: f f Ralph reef dot com where you can read 183 00:11:10,520 --> 00:11:14,080 Speaker 1: more about his work, also his speaking and the work 184 00:11:14,080 --> 00:11:16,920 Speaker 1: that he's done in terms of training. Ralph. One last 185 00:11:16,920 --> 00:11:18,640 Speaker 1: one for you here. We hear a lot about this 186 00:11:18,679 --> 00:11:22,080 Speaker 1: with NFL quarterbacks right now, and that is concussion protocol. 187 00:11:22,160 --> 00:11:24,920 Speaker 1: You know, we're all familiar with the fact that a 188 00:11:25,080 --> 00:11:28,439 Speaker 1: player shows symptom of a concussion, they go into the protocol. 189 00:11:29,280 --> 00:11:31,760 Speaker 1: Is there any sort of a baseline when it comes 190 00:11:31,800 --> 00:11:36,560 Speaker 1: to concussions of you know, is that the hardest one 191 00:11:36,640 --> 00:11:40,600 Speaker 1: I guess to put a blanket statement on because does 192 00:11:40,640 --> 00:11:45,360 Speaker 1: it seem to have the widest spectrum between the severe 193 00:11:45,600 --> 00:11:47,800 Speaker 1: and the not as severe, but all having to kind 194 00:11:47,800 --> 00:11:51,680 Speaker 1: of be treated the same, because when you're talking about neurologically, 195 00:11:52,120 --> 00:11:54,240 Speaker 1: you have to be very careful, more so perhaps than 196 00:11:54,280 --> 00:11:56,240 Speaker 1: other areas well. 197 00:11:56,760 --> 00:12:05,080 Speaker 2: Severity of a concussion should not come into the initial diagnosis. 198 00:12:05,600 --> 00:12:09,040 Speaker 2: A concussed brain a brain that moves from side to 199 00:12:09,120 --> 00:12:12,000 Speaker 2: side within the skull and it sort of washes back 200 00:12:12,040 --> 00:12:15,480 Speaker 2: and forth on a microscopic level. That's what creates the 201 00:12:15,559 --> 00:12:20,400 Speaker 2: bruising or the concussion to the brain tissue when it 202 00:12:20,480 --> 00:12:24,400 Speaker 2: hits the wall of the skull. And so to determine 203 00:12:24,440 --> 00:12:30,720 Speaker 2: the severity is really not done at the time of 204 00:12:30,760 --> 00:12:33,720 Speaker 2: the injury, whether someone's knocked out or whether they just 205 00:12:33,800 --> 00:12:35,839 Speaker 2: walk off the field and all of a sudden they 206 00:12:36,080 --> 00:12:40,080 Speaker 2: ask their teammate a really unusual question, okay, or the 207 00:12:40,120 --> 00:12:46,199 Speaker 2: spotter upstairs notices an imbalance and posture and so they 208 00:12:46,240 --> 00:12:49,560 Speaker 2: red flag the person. The severity of the concussion really 209 00:12:49,600 --> 00:12:53,040 Speaker 2: comes down the road, and it really is how long 210 00:12:53,120 --> 00:12:57,839 Speaker 2: does that concussed brain take to heal? How long does 211 00:12:57,880 --> 00:13:03,000 Speaker 2: it take to recover to normal function. So severity, unfortunately, 212 00:13:03,720 --> 00:13:08,240 Speaker 2: is hard to manage. It's hard to say whether going 213 00:13:08,280 --> 00:13:11,440 Speaker 2: to be out five days, ten days, you know, any 214 00:13:11,559 --> 00:13:15,800 Speaker 2: multiple of that. And so the baseline is done. There's 215 00:13:15,800 --> 00:13:19,040 Speaker 2: a number of different ways that NFL teams, collegiate teams, 216 00:13:19,120 --> 00:13:24,119 Speaker 2: high school teams, all sports around the world baseline brain activity. 217 00:13:24,679 --> 00:13:29,439 Speaker 2: And there's an impact testing which was intended in the 218 00:13:29,559 --> 00:13:35,880 Speaker 2: University of Pittsburgh Medical Center Pittsburgh. Obviously UPMC has the 219 00:13:35,960 --> 00:13:39,080 Speaker 2: Impact test. There's a Sway balance test, there's a SCAT 220 00:13:39,200 --> 00:13:43,400 Speaker 2: six score. These are all things that we in healthcare 221 00:13:43,800 --> 00:13:47,840 Speaker 2: baseline and if there's moms and dads listening, or an 222 00:13:47,920 --> 00:13:50,280 Speaker 2: athlete that just got out of college says, oh, yeah, 223 00:13:50,280 --> 00:13:52,920 Speaker 2: I had that done as a baseline, that's very common. 224 00:13:53,320 --> 00:13:58,440 Speaker 2: So then it's measured their progression or deterioration is compared 225 00:13:58,440 --> 00:14:03,360 Speaker 2: to that baseline repeat the testing and you put the athlete. 226 00:14:04,160 --> 00:14:07,119 Speaker 2: You'll hear a lot about maybe a five step sequence 227 00:14:07,160 --> 00:14:11,440 Speaker 2: where they've got to go through a walking activity, get 228 00:14:11,480 --> 00:14:15,320 Speaker 2: on a bicycle at a sub maximal level, and then 229 00:14:15,720 --> 00:14:18,880 Speaker 2: recover and do the symptoms still stay well, what are 230 00:14:18,880 --> 00:14:25,360 Speaker 2: the symptoms? Headache, can't focus, just don't feel good, foggy memory, 231 00:14:26,480 --> 00:14:29,800 Speaker 2: can't balance on one leg. And so you wait until 232 00:14:29,800 --> 00:14:32,840 Speaker 2: those symptoms pass with low level activity, then you go 233 00:14:32,920 --> 00:14:36,720 Speaker 2: to high level activity, Jake. Some athletes can just click 234 00:14:36,760 --> 00:14:40,160 Speaker 2: through those things on twenty four hour segments and they 235 00:14:40,240 --> 00:14:45,120 Speaker 2: can be back really fast. Other athletes they don't respond 236 00:14:45,200 --> 00:14:48,520 Speaker 2: as well. And even to sit in a team room 237 00:14:48,840 --> 00:14:54,320 Speaker 2: and study is really really difficult. Now you're into severe injury. 238 00:14:54,840 --> 00:14:58,320 Speaker 2: And so that's why at the high school and college 239 00:14:58,400 --> 00:15:03,880 Speaker 2: level we put a lot of academic restrictions on student 240 00:15:03,920 --> 00:15:09,040 Speaker 2: athletes because of it will actually make the concussion symptoms 241 00:15:09,120 --> 00:15:12,280 Speaker 2: linger a little longer. Not that that's a free pass 242 00:15:12,320 --> 00:15:15,800 Speaker 2: to get out of class, but you know, these are 243 00:15:16,440 --> 00:15:21,680 Speaker 2: serious situations and so the concussion progression is truly unique 244 00:15:21,720 --> 00:15:22,720 Speaker 2: to that individual. 245 00:15:23,320 --> 00:15:26,640 Speaker 1: Ralph, I appreciate the explanations and the time, as always, 246 00:15:26,640 --> 00:15:29,840 Speaker 1: would love to have you back on as inevitably. Unfortunately, 247 00:15:30,360 --> 00:15:33,040 Speaker 1: we see more injuries over the course of the season, 248 00:15:33,120 --> 00:15:36,280 Speaker 1: but for now, enjoy the remaining fabulous weather outside and 249 00:15:36,280 --> 00:15:37,400 Speaker 1: hopefully we'll talk to you soon. 250 00:15:37,440 --> 00:15:40,200 Speaker 2: All right, Amen, take care of Jake, Ralph 251 00:15:40,200 --> 00:15:42,200 Speaker 1: We've joining us on the program.