So in an effort to start on time at 9.30, I think we'll start with the first session. So my name is Duran Naidoo. I'm from Edmonton, Alberta. Head team physician for the Edmonton Oilers for the past 20 seasons, and I also work at the University of Alberta. I'm a non-orthopedist, so I'm a physiatrist and do primary care support medicine. The program you'll see, and this was really an idea Brad had, is really organizing it into kind of before the game or pre-game care, on-ice care, so from emergencies to concussions to orthopedic trauma, post-game care and return to play, and then we have some special populations today with the young athlete and tomorrow with women's hockey. So we tried to organize it in that way. I think you'll kind of enjoy it. The first session today from 9.30 to 11 is really before the face-off and pre-game care. We're going to talk about some emergency preparation, mental health, talk a bit about performance, nutrition, all the way to strength and conditioning in the first 90 minutes. So the first talk is going to be the emergency action plan, and the NHL has something called a red bag, and Dr. Tony Colucci has been the physician with the Detroit Red Wings for 35 years, and you know, I'm not saying he's old, but you know, he's a good golfer. Lots of time to golf, I guess, and he also works at Henry Ford Health, but one thing I must say in 20 years that I've worked in the NHL, Tony has been extremely instrumental in changing medical standards, in changing the way we approach emergency care, and I think the NHL is the top league for that. So we thank him for that, and I've personally learned a lot. So Tony's going to come up and talk about the emergency action plan in the NHL Red Bank. Well, thank you for having me, Brett, Darren, thank you for having me. Let me just clarify the 35 years, I started off with doing the pre-season physicals, Patty, we have been with Patty for quite a while, and started off as pre-season physicals, morphed into being an assistant, then morphed into being the medical provider, then the director. So over the 35 years, I didn't go in, guns ablaze, and so I worked my way, stayed persistent, and I'm fortunate enough to be with the Detroit Red Wings in the position, and again, all the colleagues I have in the NHL and the medical, the decision making and medical standards that we run. So without further ado, is there a, is this the arrow, move this slide, okay. So the emergency action plan, you know, there's most of the physicians, orthopedics are probably driven as the medical directors for the medical providers for the teams. So every team and every athletic event, what do I mean by that? So every team has to have an emergency action plan, every event. So at LCA, I put up the emergency action plan for the hockey, however, we've had wrestling in the building, we've had figure skating in the building, so there's other events that they're going to come to that medical director. So they come to me and say, okay, we're going to do this event, well, I might have to put a different hat on or a different perspective of what do I need there. So that's what I mean by every team and every athletic event. Games and practices, totally different. What's the coverage, who's in the building, where's EMS, they're not in the building usually. So we usually, again, set that up, have that work through, have that algorithm to say what are our resources, where's EMS, who's in the building. Game versus practice, home versus visiting, all different. So usually when the home team's there, again, playoffs is a, I mean, you guys just got through it, Ed, so you understand as far as who's in the building, who's not in the building, who's delaying, you got media. So again, you have to put these different hats in different scenarios and combat each disaster that's potentially going to happen. Players and staff, so the idea is that we're going to manage the players and the staff as team physician, as an EAP plan, it's not just the players on the ice, it's what's happening in the locker room. We have coaches, we have staff, we have equipment people that are at a certain age, heart attack, a skate injury. I mean, anything can happen. I had a player almost get his toe cut off just because one of the guys had his skates on, stepped on his bare foot, and here comes a toe. Game didn't even start yet. So all these things come in, what do we do, how do we handle it, as simple as that was versus life-threatening stuff like an anaphylactic reaction, peanut, we have peanut allergy player. So again, those type of things that you have to be aware of. What equipment do you have? To Duran's point, the red bag. So the equipment that's available in the home locker room is usually pretty robust as far as resources. We have a crash cart, we have multiple AEDs all over the locker room and the home side. However, we've had issues over the years during the playoffs, Carolina, during the visitors, and the black aces we call them, the guys that aren't really starting, they're kind of back, but they were out skating, somebody jumped over, just inadvertently got the femoral artery, became a disaster. So what do we do with those, because sometimes visitors, are they in a different sheet of ice? Are they in a different building during practice? So we developed this red bag. The red bag has the eye gel for an airway, has an AED, has a vascular access, and has the tourniquet. Because of that injury, they have the tourniquet, the eye gel, and the AED, are the biggest three big components, they carry it. So when we used to be at the Joe Lewis, they would have to go off-site to a practice facility. I know that's pretty frequent in the NHL. We so happen that we have two sheets of ice that we're able to, in the same building, so it's not as arduous, but yet they don't have access usually to the home locker room that, so we have a red bag for the visiting team to be able to carry that for these emergencies. And when they come into town, they unload their equipment for game time at the main arena, but a lot of practice sheets are outside of the facility, so they come, get the red bag, bring it with them, so they can thwart any kind of disaster at the practice facility. Transportation, that becomes a challenge because it usually becomes contractual. You engage with your local EMS system, Canada versus U.S., it's always a challenge to say who's going to be covering, how many are covering. So again, get your transportation's all part of this program. Site plan, you want to put up very visible, very readable, very large, especially for us that have to wear glasses now, but you want an actual map of the building with egress, with arrows, clearly laid out, and a description of where, kind of written in dialogue to say what is going to happen, and then you want contact numbers, and you want that visibly displayed in the visitor's locker room, the home locker room, near the playing surface, and in the practice area. If it's at the practice building, have a whole different EAP plan. For us, it's by Belfour, which is another sheet of ice. You want to have that EAP plan all printed up, postered up, and then easily accessible and easily readable. You're going to have contact numbers in there because a lot of times the home team comes in, they do their thing, they're out of the building, trainers, everybody, practice, or the visitors come in, and you're the only ones in the building, the visitor's the only ones there, so if something happens, and we've had it happen a couple of times, my number's on there, so the medical director, the head trainer, all those people's numbers have to be on that sheet for contact so that we can kind of redirect things. We just had one after game coach on the plane collapsed, so I had to be redirected. I was on my way, but the phone numbers went, but again, we have a pretty good community in the NHL with our team docs, and I got a call by the trainer, and anyways, I redirected, went to the airport, I mean, went to the hospital that I knew they were going, and again, I have to do my job as the medical director to make sure I hand off and make sure that the player is taken care of, so a lot of those reasons that we have that information on the EAP written out. Egress and evacuation, it gets challenging for those that have new buildings, for those that have old buildings, they have other events in there, so they might have chairs, tables in the way, so you want to make sure that your egress is non-obstructed, and what's the evacuation plan as far as if anything more disaster, if it's beyond just the individual player, let's say there's a larger group that are involved, you have to have a proper way to have your resources set up for evacuation as well. So should be developed by the home team, so every home team, the medical director is going to be directed to them if it happens to be the ER doctor or the orthopedic most likely, you have to put together your team, devise with your medical staff, put it together, devise it, including your ATs, your EMS, your security, because they're going to be the ones that are going to help direct you, calling ahead while you're managing the player, everything else is going to be in motion, so the security are your best friends, I don't know, we call them great coach at our facility, but we're able to communicate part of it as well as getting the proper communication, and they line up the EMS, the transportation, the egress, crowd control, so they control all that, and the same way you get your trainers, all your trainers, everybody, assistant, the head trainers involved, because all hands on deck to get that player out to the nearest facility. The disaster that they had in Europe, I mean I think everybody is aware of the skate injury that happened in Europe, same idea, again, did they have an EAP, were there doctors, was there EMS, I don't know the whole answer to that, but I know we can always Monday morning critique it to say how do we prevent that, I don't know if there's a way to prevent it, but how do we address it, how do we attack it, and how do we combat that, so that's kind of how do we look at that, so anyways, practice, so practice is annually, displayed clearly like I said in the locker rooms, both home and visiting, near the playing field or sheet of ice, and both in the practice and game facilities. Key elements, workplace, risk assessment, like we just talked, creating an emergency response team, developing evacuation procedures, again, every building is different, you have plan A and plan B, training and drills, so you have to do this annually, get audited as well to make sure that average, sometimes you have new staff from anywhere, any one of those specialties from EMS to athletic trainer to your medical staff, and they have to be reoriented, new things come up to say how do we handle that, so again, train every year, the emergency communication, universal signal, we have this in our team, so we don't have every time somebody goes down on the ice, the whole crew doesn't go out there, so we have our trainer, if it's anything worse, they raise their hand, once that's done, everybody's out there, paramedics with their gurney, me, ortho, so we all go out there and address because I'd rather have you say we don't need you versus I go and we piecemeal it. My first aid and medical assistant, make sure you have the name of your health care facility address and contact, I have consultant's list, but that doesn't have to be readily available, I mean it doesn't have to be readily visible, it has to be readily available, on-site AED, practice and games as we have with the red bag, testing and updating emergency readiness plan on an annual basis. So again, medical care and transportation has to be reiterated, especially for catastrophic injuries, make sure we're following the standard of care, there's a lot of variability in every building, there's a lot of variability in every event, so make sure you review that every year, and then make sure you're aware of the EMS location, we have ours in the loading dock, but we have a gator that takes the player, if it's on the ice, they go to the Zamboni pit, gator, out to the loading docks and get them out, so that you know where the EMS location is and availability. Again initial encounters to stabilize and transport to the nearest facility, preferably a tertiary center, the intent is not to do the definitive care right there on the ice, it's to stabilize them and get them out, that's the intent. So again ATs, EMS, security, medical are all on board, medical staff should be certified, ACLS, ATS, we lease in the NHL, we make sure they have some form of training, proficient in airway management, and medical staff proximity to the playing surface, established communication devices, that's imperative, that's changed over the years, as well as like I said with airway management, having the ER doctors in the building in the NHL was imperative for airway control. Here's an illustration of what we would like in everybody's building for an EAP plan, EMS is the last thing I'm going to talk about, and then the NHL, two ambulances per facility, one's for the players, one's for the fans and everybody else, so players, staff, referees get the one ambulance that's on the playing surface area, the other one's for the fans. Once one of those get removed out, you've got to have a replacement come in before the game can technically get started, usually while you're wrapping things up, that second one's coming in to replace the one that's going to be leaving. So again, have this in place, make sure you communicate with your EMS providers before a season, practice, utilize your 911, we give the practice schedule to the EMS providers so they can be kind of floating around the arena knowing that practice is happening, so if there is a 911 dispatched, they're in close proximity. Again, egress, make sure to talk to the EMS that egress is clear from obstruction, easily available to locker rooms, that's not always possible, but clearly explain location, procedure prior to the start of the games. We always have a pre-game discussion with the other team before the game starts to say who's who, where's EMS, what's going to happen, who's going to run out to the ice, so everybody identifies themselves and security staff's introduced in position as well. Again, lastly, rehearse. Annually, it should be audited, make sure all medical situational scenarios are discussed, reviewed, you go through your treatment, what exactly from AED use to tourniquet to airway, stabilization is the main goal, and get them out, communication, make sure you have a proper communication if you're not right next to the sheet of ice or the playing field, transportation as we discussed, evacuation, and then include security, building ops, ATs, medical staff, EMS in these discussions and these scenarios that you practice every day. Any questions? Sorry about flying through that. Fifteen minutes goes quicker than you think. We'll reserve questions. Got it, okay, perfect, thank you. Thanks, Tony, and we'll have a session at the end of this first 90 minutes to ask questions, so please write your questions down. The next talk is going to be from Dr. Martin Mrazik. Dr. Mrazik is a registered psychologist and a neuropsychologist. He's at the University of Alberta in Edmonton where he's a professor. He's worked in the NHL since 2004 and the Canadian Football League since 2008. He was also the first Canadian honoured as a fellow with the Sports Neuropsychology Society for outstanding contributions to the field of sports concussions. You know, Marty's our first Canadian speaker. There may be a prize to see, you know, if you guys can sort out how many times a Canadian say A, I'll probably be the, you know, the culprit probably about 58 times you'll hear me say that today. But so, Marty is our first virtual speaker as well. So, Marty, you have the floor and thanks for talking today. Great, thanks for that kind introduction. Just want to make sure everybody can hear me okay. All right, so I'll just have you a little bit of my background if you can advance to the next slide, please. Great, so there's just a little bit of my background. So, thank you to Dr. Mrazik and the committee for having me. Just a little bit of my disclosures, my wonderful family and cute little puppy. If you can go to the next slide, please. Great, so we're going to follow up with that great talk from Dr. Kaluchi and really dive into the mental health emergency action plan. And what do you do when you have an emergency of the psychological nature? And I'm going to share a little bit of some of the lessons that we've learned from the Canadian Football League and outline a little bit of what we have as our mental health action plan and go from there. So, if you could advance to the next slide, please. So, just a little bit about the history. I've been very fortunate to work with great colleagues. So, just a little bit about the history of our mental health action plan in the Canadian Football League. And again, we started this several years ago. We really wanted to understand a little bit more of what's going on by way of the mental health component in the Canadian Football League. And unfortunately, COVID hits and that led to cancellation. But in the meantime, we were really working on proposing a mental health plan, which was done in 2021. And then, you know, we're very excited that by 2022, there was agreement on both of us from the CFL and the CFLPA. So, just to tell you a little bit about what this is about is our strategy involves three kind of general areas. And one of them was the emergency mental health action plan and specifically to deal with a crisis. And so, when you have any time you have a situation, we've had a few of those come up where a player is in significant distress. What do you do and how do you manage that? We also felt that what is important part of that is that every team has a qualified mental health specialist. I know in the world of professional sports, there's a lot by way of mental performance and mental health people. But we wanted to make sure that all our psychiatrists or psychologists were registered. And that really helps with just being connected to the provincial or to the state, you know, health programs. And so, that was really important that we've got the right people to be in those places. And of course, part of that, we wanted to make sure that every team had access to a specialist and that the standards were consistent across all the teams. Part of what we wanted to do as well is just to include screening data, which I'm going to show you at the end of the slide. But that was really helpful for us as well to understand a little bit more of what's going on. So, you can see here that part of our emergency mental health action plan is a couple of the key points is we wanted to define what that is. Players deal with a lot of things during the course of a season. Some of the unique aspects for the Canadian Football League is that we have over half of our players coming from different countries. And so just being displaced, being away from your normal support systems, all those kind of things, being not very familiar with the place that you're living in, that can add to the stress that players are dealing with. But when it comes to a crisis, we wanted to make sure that we had a good understanding of what it is we're looking at, not just concerns, but what is actual crisis. And then we wanted to really outline the specific steps. And so you can see that our flowchart there, really what we've encouraged every team to do is at the start of the season, to really hammer out the flowchart. And because in the world of mental health, it can be a little different, it's just really important for people that are really needed there in terms of the communication. And so what we've encouraged every team to do is have these conversations with your medical staff, with your mental health expert, with the coaching staff. What happens if a player discloses something to a coach or to an athletic therapist? What do you do? Who is the contact person? Making sure your mental health person, you know, everybody has their number in case of those situations. And then the unique return to play guidelines, which can be a little different after a psychological event compared to a medical event. And so what are those steps going to be? And so it does take a little bit of time to formulate this organization, but we found at the start of the year is really, really helpful to us. Again, we want to clarify what is an emergency issue versus what's a non-emergency issue. The things that we know from athletes is that there can be a lot of things, a lot of mental health challenges that athletes deal with that you can see listed there. In the league, the several crises that we've dealt with, one of them was in terms of depression and suicidal thinking, another one was a player went off his medication. And so he was really not doing very well, some quite psychotic disturbances. So those seem to be the typical ones. But just recognizing that there are a lot of mental health issues that can come at the start of the year. But again, as I said, we want to define what the actual crises could be. So here's a couple of key points that we have found to be really helpful. Obviously, ensuring the lines of communication are really clear. The lines of communication, what I've really learned is your athletic therapists are your frontline workers, and they are very helpful because they're working with the players every day. And those conversations that they have with the players when they notice that maybe a player is not doing well, and something happened in their personal life. And so the athletic therapists become a really key component of really making sure that if there's a concern that merits a crisis, that you're having conversations there. Again, the consultations between the mental health consultants and team physicians, what happens in a situation where a player is in crisis, and their safety issues, and again, where are the resources for them. It's also important to keep the coaches informed, but also respecting the confidentiality of the players. That's, of course, a big issue for players is they're always worried about whether health information is going to be shared with them or not. And so at the start of the year, when we outline this plan with the players, it's really important that they have a good understanding in the case of a crisis, who is going to know about it and who's going to be involved. One of the things we've also noticed, and again, the athletic therapists are just great for these kind of things, is just really watching for just unique behavior. Let's see if we can get Dr. Mrazik up for the last little bit, but one of the things we thought that was important here is from an athletic therapist, or if you're a team physician, are we actually really trained to deal with someone who gets on the phone with you and says, hey, you know, I feel like I want to, I feel suicidal. And I think, you know, has anyone had any, for those people in the room here, has anyone had any training in that, formally, Dr. Colucci, anyone else? And I think that's, as we get into this, you know, especially the athletic therapists who are our front line, how do you deal with this? You know, when we watch Law and Order, we watch people who are, you know, ready to jump from a building and there's people that talk to them in a certain way. So I hope that, you know, something like this mental health emergency action plan is a good step because you know who to call. But you know, I think that's something that we could look at incorporating in our training. And I think there's more of these kind of courses. I know in medicine, we have a lot of CBT courses, cognitive behavioral therapy for people with depression. But I think that's something that, you know, maybe if we can't get Marty up to finish his talk, then when we get back in the panel, because there are more of these types of courses. So do you, should we move to the next? Yeah. Okay. Okay, so our next talk is by George Mumford. So George, I met George about a year ago with the Edmonton Oilers. We had a new CEO who, you know, knew George and brought him as a mental, basically mental performance type consultant. So you know, George is AKA, otherwise known as a performance whisperer. He's a recognized speaker globally. He really works on incorporating positive psychology, mindfulness, philosophy, neuroscience, recovery, a lot of group dynamics he deals with and spiritual traditions from around the world. George has worked with the Chicago Bulls during their heyday with the dynamics on the team with Michael Jordan, Scotty Pippin, Dennis Rodman. And then he also worked with the Los Angeles Lakers during their championship days. So I've personally learned a lot from George. He's been great with the Oilers this past year, and he's going to chat a little bit about mental performance and also a little bit of how when he integrates with teams. And it's not only about the players, it's about the staff and the management from the top down. Okay. Thank you, Dr. D. Hello, folks. I have some slides. I don't know if it makes more sense for me to share them, and let me see. Okay. So I think I can share desktop. Okay. Can everybody see those slides? Yes. Okay. So I'm just going through them. This is so I have some friends at the University of Wisconsin. Okay. I'm not sure what that is about, but some research that I think would be important. And Dr. Druitt is obviously he's an orthopedics person, doctor. And so I was talking to them about the presentation, and I talked to my friend, Chad. And so I decided to share some of this with you. So this is the research that they've done, Mindfulness Training in Association with Improved Quality of Life in Female Collegiate Athletes. And you have all of this stuff there, but I want to get right to the data. So these are the major article that they're presenting is Mindfulness Training in Association with Improved Quality of Life in Female Collegiate Athletes. So the PCS is the Physical Composite Score. And you can see they're pretty much the same. It's a little different, but they're pretty much the same. And so when we go to the next slide, this is Mindfulness in Association with Improved Quality of Life in Female Collegiate Athletes, and you can see the control form. So basically what this is saying is, and I'll get to the findings, is that if you measure mental health over a 13-week period, which is about a semester, if you don't do anything, it actually goes down. You actually, as a function of time, that old saying that you're either moving forward or backwards, well, if you're not addressing your mental health, if you're not training your mental health, when I say mental health, I'm really talking about the mental, the physical, and the emotional, and spiritual, when you're not, anything that's non-physical. If you're not training it, if you're not doing the strengthening, the flexibility, the endurance training, and those areas, that as a function of time, it just, it gets, it worsens. And so as the season goes on, it gets worse. And so this is very important to talk about this, because if you use the mindfulness, then you actually increase, and you get more wellness, and your performance obviously is going to be improved as your quality of life is improved. So the two findings, and this is available for all folks, is really about on the days when athletes participate in the mindfulness training, they reported significantly better mood, energy level, muscle readiness, and readiness to train. And so we kind of know that. I think if you, I don't know how many of you folks are familiar with Yogi Berra, but Yogi Berra, he said that 90% of baseball is mental, and the other half is physical. And I would say that's the same with life. And I worked in a mindfulness-based stress reduction clinic for five years in the 90s, when this mind-body medicine was first coming out, and I got into this mindfulness training and working with different populations. So we know that when the mind is right, or when you're in a positive mind state, you perform better, is what they call positivity. I think Barbara Fredrickson talks about it. It's also called a happiness advantage. When the mind is at positive, the cognitive functioning is enhanced. But also what we don't talk about is how it impacts the immune system and our ability to just feel good. And when we feel good, we're able to tolerate discomfort, and actually there's a lot of benefits to that. I don't, I think everybody can agree on that. So the second finding, the day after athletes did mindfulness practice, the incident of acute injury decreased by 58%. Now this is probably a non-contact sport, you're talking about volleyball, but just think about it. We get research in other sports like ice hockey and the NHL, that the idea is that if we have the mind, body, heart, and soul, or we have this cohesion, or I would say another word for health is wholeness. When your mind, your body, your heart, and your spirit is in alignment, or it's at positive, then you're not going to be injury prone, and your ability to fight off disease and actually to prevent acute injury is really important. And I find this fascinating. So even if it's 1%, you can see how much that can be helpful. And so I'm reminded as I'm watching the Olympics, and Simone Biles, in the last Olympic, she was having challenges with her twisting. In other words, her mind and body weren't coordinated, or they weren't in alignment. And in that sport, if she takes the wrong turn or whatnot, not only could she have a severe injury, but she could end up dying. And so she had the fortitude to admit that she had some mental issues going on, or some issues preventing her from being focused on the task at hand. And so she took some time away, and then she came back, and she's even better than she was before. But her talking about mental fitness and mental well-being is really important. And you can see in that case where you can see the acute injury, if you're not in the moment on those different. And I would say this is probably the same for those extreme sports. But my point here is to say that there's a lot of value in exercising a whole person. When I talk about wholeness being the body, we get the body down pretty much. The mind, not so much of the mental. How do we deal? We're talking about mental illness, but we're also talking about mental ability to mentally be strong, flexible, and being able to endure, and being able to overcome adversity, and perform even at a higher level, despite the turmoil and the anxiety. And it's my experience, because I've been doing this for 40 years or so in different capacities in the medical center, whatever. My thing is that we need to accept the fact that if you're an athlete, you are going to experience a tremendous amount of anxiety or uncertainty. It just comes with it. It's just there. And our ability to embrace that, say yes to it, and work with it is really, really important. So I've worked with elite performers, but just talking about Simone Biles, she came back better than she would before. But this idea of wholeness, this idea of having someone that can help you understand your mind, body, and your heart. So for me personally, and maybe I'll just share a little personal story, how I got into this. I just celebrated 40 years of sobriety. When I was in college, I got injured and ended my career, and I got addicted to pain meds and illegal drugs. And so when I got clean, one of the things I discovered was I had chronic pain. So that's how I got into this mindfulness. And just what really wasn't mindfulness, it was really, it was a cutting edge study being done by Herbert Benson and his facility over in Beth Israel Hospital. That's when mind, body, and medicine was first coming in. And I was taught to take personal responsibility for myself and to use my, to be a partner with my healthcare, not to just go and expect somebody to do something, but realizing consciousness how I use my, how I related to my experience of what I would call my self-regulation, my self-regulated thoughts, feelings, and behaviors, that by doing that, I became an active member in my recovery and my dealing with chronic pain, because I couldn't take pain meds. So I had to learn how to relate to it in ways where I wasn't walking around saying to myself, I was in pain all day yesterday. If I started paying attention and started using the self-awareness and realizing that if I create space between stimulus and response in that space, I had the freedom and power to choose. But we have this ability to step back and observe our experience in ways where we start to learn and understand when I do this, this leads to more stress. When I do that, this leads to more spaciousness or ease. And so I got into that. And of course, for me, if I want to learn something, I teach it. So that's how I got into this is going back to 1984. And so I've been using it and teaching people and helping people understand that prevention and maintenance is important, but more important is to get to higher levels of wellness. Because on one level, when I see stress is when something is demanded of us that is beyond our perceived resources. And so if you keep building wellness, and if you keep learning how to keep progressing, getting better and better, or like that chart showed, that you can keep going up and up and up and getting better at higher levels of wellness. So when the time comes to write a check, it won't bounce. And so that was my thing. So it was this continuous process of improvement, being able to continue to grow physically, mentally, emotionally, and socially, and spiritually, and having a purpose and a meaning. And all of these things matter. And of course, having a good mood and high energy and muscle readiness, you're ready physically to train, we could do that. So I don't want to talk a lot more about that, but I think it's really interesting. And as Dr. D talked about, when I worked with Edmonton, and I've been doing this for a lot of years, I wasn't just working with the individual. I was working with the whole community, this idea of relationships, because to me, it's about the relationships. And it's interesting, because there's a Harvard study that, let me see if I can pull it up, but it's really fascinating about this Harvard study that talks about this idea that they did a study over 84 years with 84% participation. So these are generations of people. And what the study found was that what led to a good life was healthy relationships, good relationships. And so we know this on some level, that it takes a whole village. But developing a relationship with myself requires me to have self-awareness, take personal responsibility, and then self-regulate, to understand I can regulate my thoughts, feelings, and behaviors, not just in relation to chronic pain, but just thriving in life in general, and learning how to continue to evolve and matriculate with all of the changes. Because it's very different, I could say, in the 1970s, in the 80s, in the 90s, compared to 2020s, it's a totally different universe. We have way more, all of the social media and everything, we have more distractions than ever. And so learning how to be able to self-regulate so that we get to self-mastery is really important. So it's not just the prevention of injury, but it's having a good quality of life, and developing good relationships, because that helps us go through the slings and arrows that we experience through life. People are going to get injured. You have people that you love that are going to get old, get sick, die. And just the idea of dealing with the moods, like with depression, ADD, dyslexia, all of that stuff. It's really important that we get really clear about the fact that we need to train and we need to prepare for that, but there's a lot of research out there that tells us probably thousands of studies on mindfulness or this idea of being in the moment, being able to say yes to life, embrace it, and then understand how do I relate to it in a way that empowers me, moves, and inspires me. So I don't know if I want to say any more than that, but I'm excited to be here. I've always been on the cutting edge of things, and it wasn't because I was smart. It was because I was in a lot of pain, and I had no choice but to look for something else. But I'm using that and my experience working with the NHL this year has been profoundly enjoyable. And, Doc, we haven't talked about this, but I suspect, I was talking to Jeff a little bit, we had a lot less man hours that we lost to injury this year than normally. So I'd be curious if we could start collecting data and realizing how much of this intervention may have had an impact on our ability to actually not really have to deal with a lot of acute injuries. So I'll stop there. And obviously, I don't know how this works, but I'd rather have more interaction with conversation than just talking about stuff. But I think this is a good place to start by sharing those slides. And there's a lot more research. But it really is a good opportunity for us to actually not only raise our performance, but also to raise our quality of life. Well, thanks, George. We've got a couple minutes. I want to ask you one more thing that I observed as a team physician that I felt you were able to help our players with this year. Is George still there? Yes, I'm still here. Is really, the players who are frustrated during a game, on the bench, body language, I saw a big change in a lot of our players. And I think part of it, my take was that looking at the gratitude, or looking at and being in the moment, can you just maybe in two or three minutes, just discuss that being in the moment, because I know you've worked with players like Kobe Bryant and Michael Jordan. And that's something that you've impressed upon our players. Maybe just chat about that. Yes. So being in the moment, because if you really think about it, the only time we have is now. Even if we think about what happened before, what might happen in the future, you're doing it in the moment. So being in the moment, we can control the moment. Right now, if you really think about it, there's really nothing wrong. But we have the ability, we have this ability to be self-aware, to step back and observe our experience, to get to make the connection between whether we're reacting to something when there's no space between stimulus and response. And we're really talking about the autonomic nervous system being hijacked and being in a fight, flight, or freeze, or in survival mode versus being in growth mode, which is this ability to just pause and reflect and create space between stimulus and response, but you have to be at positive. So being grateful, being curious about things, curious about this is happening, how do I relate to it in a way that helps me learn the lesson I need to learn? So it's really a way of just, and a lot of the times, it's just really simple, like make the next play. What's important now? The when. And being in the moment and just noticing, okay, there's tension there, whatever, but can I just embrace it and just breathe through it and allow it to be there, and at the same time, make plays. And sometimes making a play is sitting on the bench and changing your body language from negative, because you're frustrated, you're not playing, which is a sign that you care, but it's having an impact on the whole bench and the whole team. So being able to understand that and say, okay, and then having people around you that might be able to say, hey, come on, man, let's make the next play, you got this, and let's stay, let's be in the moment, let's stay in the positive, let's focus on what we want and on what we don't want. So there's a number of strategies that I work with people around, but it's really more about just creating an attitude of gratitude or getting in a positive mind state. They actually call it positive genius. This is what Sharon Accord, who wrote the book The Happiness Advantage, calls it. It's like when you're at positive, your cognitive functioning, your ability to see and not be reactive and to create space is enhanced. Does that make any sense? And so that's why I talk about gratitude practice, forgiveness practice, but really about just being able to observe experience. I made a mistake or something didn't go the way I wanted to. So then the question is, what do you need to learn in practice to be able to do it? But you have to have this growth mindset, this mindset that you can change and your brain can change just by how you direct your attention and how you train yourself, whether it's a forgiveness practice or a love and kindness practice. There's a lot of things we could do that can help us get at positive and be in the growth mode. Because when we're in the, and I'll just finish it, when we're in stress mode or in survival mode, or we're in that the sympathetic nervous system, nine thoughts out of 10 are going to be negative because it's predicated on the reptilian brain seeing danger. And we have to be able to get out of that and get into the growth mindset so that we get the positivity to three to one. But to compete at a high level, it's got to be around five or six to one. Does that make sense? And I mean, I can get into it more, but the autonomic nervous system can be, can be just by focusing on one thing, we can actually get out of survival mode into growth mode. So those are the things I talk about and the way we think or change in our thinking is a really good way to do that. Well, that's perfect. Thank you. Thank you very much. And if you can stay on until the end of the hour there for the questions at 10 central, that would be great. Thanks, George. Thank you. My pleasure. So we're going to, we're going to switch gears here. I think, I think it's already running, but if we can pause that. So our next presenter is going to be a pre-recorded talk. That's kind of going, there we go. We'll see if, see if they can pause it there. There we go. So, so Ricky formerly worked in the National Hockey League as a performer for the past five years. So they're in the middle of training camp. He wasn't able to make this time. So he pre-recorded his talk on performance nutrition. And, and really he's going to focus on what, what the players do before competition, during competition, and then post-game. And it, it's an, I took a look at it yesterday. It's a pretty interesting, sophisticated look at performance nutrition. So you can go ahead and run the slides now. Hi everybody. My name is Ricky Ying and I am the performance nutrition director for the Las Vegas Raiders. Today, it's my pleasure to present to you on topic of game day nutrition at the American Orthopedic Society for Sports Medicine, NHL Hockey Summit. My career as a sport dietitian began in 2012 when I first consulted with the M10 Oilers Hockey Club, along with the M10 Elves Football Club. It was during that time when I first learned about the extreme differences in the game day nutrition strategies due to the various demographics of athletes involved in each sport. In 2017 and 2018, I went down to the U.S. to learn more about the American side of athletics, primarily focused in football, which resulted in an opportunity working with the Oakland Raiders, now better known as the Las Vegas Raiders. For today's topic of game day nutrition, I'm going to share with you the strategies that we currently use with our NFL athletes. There is a lot of information and strategies that can translate directly over into the hockey world. The three primary objectives we'll cover is pregame preparation, and this will be broken down into the demographic of the athletes that you're working with, which will have a direct impact on your fueling and fluid targets. Number two, we'll cover some in-game strategies, and number three, we'll look at post-game refueling strategies to help account for fluid losses, the impacts of appetite suppression on refueling strategies, along with strategies to help your athlete with calorie catch-up. In an effort to maximize pregame nutrition strategies, we like to break down our roster and see where our athletes come from. In collecting this information, this helps us to design a pregame menu that covers a variety of palettes and helps maximize opportunities for an athlete to fuel up going into a game. Here we have a pre-practice or pregame fueling plan from one of our 182-pound receivers. So this receiver presented to us with signs and symptoms of early fatigue and had difficulty getting through practices and games. His legs were persistently reported as being extremely heavy, and when we had done 24-hour food tracking or even three-day food records, we had him take pictures of what he was taking in, and it was revealed to us that his carb intake was extremely low and was even barely meeting a 0.5 gram per kilogram target. So for this athlete, we listed out his carb targets, which is in the orange table, and the range that we used was one to four grams per kilogram, one to four hours before practice. So we listed out the ranges in the fuel gauge so he could understand just how much carbs it would actually take for him to get into the green zone if he was to start the fueling process four hours before a game or practice. In the blue table, you see the foods that he listed out as carb-dense foods that he trusted and knew that he could tolerate going into a game. So through this, he was able to layer up these foods and build up his tolerance over time in order to achieve getting into the green zone the majority of the week. So when he was able to do so and was able to do so consistently, he felt great. He was able to get through the practices, but the biggest thing that we had to work with him on was adherence and consistency and being able to apply these strategies not only at home but on the road as well. So our pre-game or pre-practice fluid targets comes from the following 2020 paper from the Sport Dietitian's Australia Position Statement Nutrition for Exercise in Hot Environments. One to two hours before a practice or a game, we'll target sodium at 20 to 40 milligrams per kilogram, along with fluid targets at 10 milligrams per kilogram. We found this to be an effective strategy of not only training in the heat in Vegas, but in any activity where there's high anticipated sweat loss. To make these prescriptions practical, this would mean for a 200-pound or 91-kilogram athlete, two hours before practice or game, they would target 1820 to 3640 milligrams of sodium and 910 milliliters of fluids. In this scenario, we would round the fluid target up to one liter, so they would grab a one liter smoothie cup, add at least two packets of electrolytes, and they can pick a low or high calorie liquid base depending on what their meal looks like. Now we're going to transition into feeling an athlete during games or practices. Essentially, we're going to use practices to mimic game day scenarios. So what we like to do is identify what their tolerance is for carb and fluids during practice, which ultimately translates into game days. So our target for athletes usually ranges between 30 to 90 grams per hour. We like to promote as much carb ingestion as possible, and oftentimes in the Vegas heat, there are a lot of complaints of the mouth being extremely dry when they drink any carb-containing drinks, so we just have them ingest the carb and then do a water mouth rinse. As much as possible, we'll provide ice slurries with a variety of fuels inside a bottle for an athlete, and this could range from something like drip drop. You can sometimes add right stuff to the bottle, and so it's a small shot or bolus of fuel and electrolytes, and then if they want to chase it down with some extra water, they can certainly do so. We're now going to transition into post-practice refueling and rehydration strategies. The number one strategy that we like to use with athletes is to weigh them in and weigh them out. That way you can shed light on just the degree of sodium and fluid losses that they have lost during practice, and it's an indicator of just how effective that their hydration strategies were during practice. Any athlete that's lost more than two percent of their weight, we advise them to not just drink water to replenish their weight. We see that quite a bit when we have our rookies in. We do want to ensure that everything that they're drinking consists of electrolyte, carbs, and ideally with protein added to it to help with the recovery process. Here we have an example of a feeding or a meal plan for one of our athletes developed by our former assistant Ryan Kerr. So this starter presented to us because his weight was slipping throughout the in-season due to the volume that he was taking on. When Ryan did the three-day tracking with the athlete, it was revealed that the athlete would eat six times a day, but there were multiple bouts of appetite suppression, especially surrounding practice. As a result, Ryan built this plan for him and modified different textures and consistencies of foods and worked to find foods that the athlete could trust and could tolerate, especially going into a practice. So what you see here is the athlete would arrive between 5 30 to 6 a.m. They would start with a high calorie smoothie, and we had to do the smoothie because his appetite was not there in the morning. So we had to work on maximizing density of calories and having a meal that was very easy to drink down. Once 7 30 hit, the athlete's appetite actually came back quite strong, which is why we went back to solid foods. As he got closer to practice, we wanted to go back to foods that were very easy to tolerate and grab and go due to the meeting schedule leading up to practice. After practice, the athlete would go back to a high calorie smoothie because in the vaguest heat, his appetite would get suppressed, and that was the only way that we were able to get his calories back in. And the rest of the afternoon, his appetite would return, hence going back to solid foods and solid feeds to round off the rest of his day. In applying these strategies, we were able to get the athlete's weight back up, and this was purely based on being able to identify appetite suppression gaps throughout the athlete's day. As part of wrapping up post-practice or post-game recovery nutrition, I want to highlight the slide created by our former assistant Ryan Kerr, and this is often a slide that we share with our rookies. And when they first come in, they're at the under the assumption that recovery nutrition occurs simply one to two hours post practice, when in reality, it's everything else that they put into their body for the rest of the day and even the next morning going into their next practice. And that's where we work with our athletes and we do three-day tracking where we have them take pictures of all of their intake, not just before, but after practice as well. And we also look at their weight trends over time. If we have an athlete that's slipping in weight and we start to look at where the underfeeding episodes may occur, and that's where we work with them to identify, is there new calorie-dense snacks that we can introduce? Can we modify the textures of their major meals to make it a little bit more palatable and easier to down? And additionally, are there opportunities for liquid calories that they can consume, or are they offsetting a lot of calories because they're getting full simply from drinking water? And this wraps up my presentation today on game day nutrition. Dr. Nadeau, thank you for the opportunity for letting me present to this group. If any of you guys have any questions pertaining to the slides or the information presented today, please feel free to reach out to me via email. Thank you. Here, work with the nutritionists regularly with their teams. Okay, so I mean, I think for those of you who don't, Ricky's a great resource. He's got a lot of athlete plates for different sports, different weights, different positions, and they're pictographs. This is what you should have, when you should have it. And he's very, very evidence-based, as you saw, and also very willing to share and collaborate. So, you know, his email was up there for a reason, so please take advantage of it. I think that his presentation on the athlete plate has made its way through a lot of junior hockey in Western Canada anyways, and you can see him up on the board. So, please take advantage of that, as he's very, very willing to collaborate. Our next talk, we're going to, will be the last talk of this session, and it's going to focus around the warm-up. So, we have Joel Robinson, who's a head physical therapist for the Boston Bruins, and he started with Boston in the 2017 season. He did his postdoc PT residency through Vanderbilt and Belmont University in Nashville, and he has a Bachelor of Science degree in athletic training and also a doctorate in physical therapy, both at Grand Valley State University. So, again, this is another virtual presentation, and Joel, we look forward to your talk. Awesome. Thank you. I appreciate it. Hopefully, you guys can all hear me. Really appreciate AOSSM for allowing me to present. All right, can you guys see my presentation at all? We cannot see it, Joel. Strange, sorry about that guys. Oh. All right, there we go. There we go. All good. Sorry about that. I know there's technical difficulties around here. All right, so I'm presenting right now for the dynamic warm. I like to call it more of a movement preparation because that is what we're trying to do. Um, and we'll talk about that in a bit here. Um, I'm sure Robin says, you introduce me as the school therapist for the Boston Bruins. No disclosures to announce at all and so the 1st question is, why do we. Form a warm up well, if you look at the, which is kind of the gold standard for conditioning, it's to mentally and physically prepare the athlete for the demands for the sport training or the athletic event, or the lift, whatever their activity they're doing afterwards. Right? So we're just trying to. Get them ready from an injury prevention standpoint from a performance standpoint. To prepare them for what they need to do, I think the key words here are mentally and physically. Everybody thinks of a warm up or a movement. A movement session as just physically preparing them for stretching or just getting warm, but you really, it adds the mentality of it too. If you're getting in the mindset, maybe before a hockey game to prepare for that event. So, when we look at traditional warm ups. Everybody's coming through this, I remember high school football for me, right? You go on, you jump on the bike for 5, 10 minutes just to get your temperature up, increase your blood flow. Then all of a sudden you, you statically stretch, maybe do a little tricep stretch, hamstring quad stretch. Let's try to increase your range of motion or just get them warm again and get to get more flexible and it's really a short duration 5 to 10 minutes and then you jump right into the activity. Well, when we look at specifically like, static stretching, we see in the research that really doesn't reduce any risk of injury for athletic populations. And theoretically, we can go in more in depth with this. They could actually increase the injury risk prior to activity because you're increasing your passive range of motion, but not increasing your active range of motion. Think about again, I like to use football analogies because they're a little easier to think of. Think about a kickoff and a player is running down the field to make a tackling over strides and he pulls his hamstring. Well, maybe he had 90 degrees of passive hamstring flexibility. But actively, he can only get 60 degrees, at least 30 degrees of range of motion that he can achieve, but he can't actively control it, which could lead to injury. This is what we're talking about static stretching. If I get someone statically stretched and get the range of motion up from 90 degrees to 100 degrees for their hamstring, but they still can only control 60 degrees of that range of motion, that extra 10 degrees isn't helping anything. And also, when we look at performance, the static stretch can actually negatively affect strength and power immediately afterwards. Greater than 60 seconds stretch has the most detrimental effects. If it's just a passive stretch of holding something for 30 seconds, there's really no effect either way. So looking again at the traditional warm up, we're seeing minimal improvement in performance. We're seeing really no injury benefits and minimal mental preparation as you spend 5-10 minutes just increasing your heart rate and tissue temperature. So why are we even doing a warm up in the traditional sense? So what's been missing from this traditional warm up is we're not looking at the specificity of movement that the athlete's about to prepare for afterwards, say it's a practice, game, or weight training session. The direction of movement, is this going to be more of a weightlifting section where most movement is in the sagittal plane, frontal plane, or is it a multidirectional type lift or practice in a game would be more multidirectional in nature. The coordination of what they have to do to control their body for whatever is awaiting them after their warm up, the velocity that the movement has to occur in, and also the force that they're about to achieve, whether that's going out and ripping some slap shots right after their warm up, that's going to be a little bit different of a warm up than if they're just going out there for like a skills skate where they're flipping pucks over a pad. So I don't use the term warm up, I use the term movement preparation because I think one, the nomenclature of warm up kind of denotes that old school kind of mentality of just getting your tissue warm. That's what it's called a warm up for. Whereas movement preparation, it more gets the mental prepared for what's to be achieved. We're trying to tell them, okay, we're preparing you for the action that's about to occur. So how it works as far as the goals go for a movement preparation is we're trying to increase blood flow, mental focus, joint range of motion, more actively than passively, increase that nerve impulse transmission, or how fast that muscle can contract afterwards to be prepared for movement, and then increase the resilience. And the goal is obviously injury prevention from my side as a physical therapist, athletic trainer, but also from a performance side, you want that warm up to help in every facet possible. I just wanted to note that we do in Boston do rehab exercises before our movement sessions. And these prehab sessions are usually individually tailored to our athletes. We look at their range of motion, flexibility, activation, and strength of all of our players during the preseason with various tests. And then based on those tests and the results of those tests, we utilize certain exercises to be performed for them prior to their movement activation. We also do these checkpoints of doing the same test throughout the year, two or three times to see if they're gaining or losing, for instance, hip range of motion and trying to prevent a more serious situation from occurring before it happens. We like to use the prehab as before the warm up or before the movement preparation, because also when you look at warm ups and movement preparations, it's really the only activity that guys are doing consistently almost every single day. Their practice might change from a practice or a game or a skill session or maybe just training for a day, but they're always doing a warm up before these things, so we can get a lot of reps in to increase neuromuscular control prior to their activity prior to the warm up. So it gives us a lot of reps. Now we talked about static stretching already, but when we look at dynamic stretching, now we're looking at increasing passive and active range of motion. So for that hamstring example I gave earlier, now say they have 90 degrees of passive flexibility of their hamstring. When they start with you, they had 60, but now you actively got it, so they have 70 degrees. They still have 90 degrees total range of motion as far as passively how far they can go, but now actively they close the gap a little bit and there's only 20 degrees of unusable range of motion. Theoretically that may help in order from an injury prevention standpoint. We also see in the research that dynamic stretching improves passive stiffness and improves muscle force and power, so there's really no reason not to do dynamic stretching. When we look at the first bullet point, increasing that passive and active range of motion for up to 90 minutes after activity, this research was done by them just doing a warm up and seeing how long after activity it goes back. My assumption is if you do a dynamic warm up with dynamic stretching and then you go from that right to hockey, you should be able to keep that range of motion until your body fully cools down. When we look at the order of operations for our movement activation or warm up, we're looking at general movement at first. There is benefit to increasing your tissue temperature and blood flow by riding the bike for five minutes, by doing anything you can to increase the tissue temperature. That's because it increases blood flow, increasing oxygen to the muscles, and increasing energy systems development. Right from general movement, we like to go right into core slash hip activation emphasis. The way I explain to our athletes, when you're doing a powerful movement, you want good core and hip stability, mostly core stability, while you can move your extremities. This allows you to transfer energy from your lower to your upper body or upper to lower body. The way we do this is we do dead bugs, planks, planks with a leg lift, things where you have to actively control your trunk while your extremities move. I give the example of it's like shooting a cannonball off a canoe when these things aren't in sync and you can't activate your core while your extremities move. You can shoot the cannonball off the canoe, but the canoe is going to go one way, which is your core, and the cannonball is going to go the other way, and the cannonball is not going to go nearly as far. You can make that canoe, your core, into land, and we have a good solid base. That cannonball is going to go way further, you're going to have way more power, and you're going to be able to transfer that energy a lot better. After our core hip activation, we go into dynamic stretching, which we've already talked about. Now we're working on flexibility in an active way throughout the entire body. But more specifically, we set up our dynamic stretches based on the activity to follow. So instead of doing a bench press, we're going to do upper body dynamic stretching, mostly in that sagittal plane. Now if they're going out there and they're skating, we're thinking dynamic stretching in a multidirectional plane. After dynamic stretching, we go into movement integration. This movement integration is specificity of movement, and it's what we utilize in orienting great neuromuscular patterns into what they've been doing. Think of hopping, skipping. For us, it would be multidirectional before practice. Crossover skips, maybe side marches, things that get them just neurologically into what they're about to do for movement. And then the last thing we do is neural activation. Think fast twitch, nerve impulses, quick feet, line jumps, things where you're just increasing that neural drive to the muscles for fast twitch fiber activation. So when we look at programming, this is just an example of the movement sets and reps we do for each one of these different phases during a warm-up. It is to be noted that you want your athlete to be fresh after the warm-up. You don't want to over-fatigue them. So every athlete's a little different. You need to understand that. And you also should know that that's why there's a range of 2 to 4, for instance, movements for hip activation, 4 to 8 for dynamic stretching. It's all based on the athlete, their tolerance, how much experience they have in this field. And we see that if you over-fatigue an athlete prior to activity, then you can have detriments to your performance. So how do we choose volume and selection? Well, it depends on the intensity of the session afterwards. Again, are we doing just a nice, easy skill skate, or is it going to be a really hard practice because we just lost the day before? So we should prepare them for whatever activity is about to be had, and also what the capacity of the athlete is. Every warm-up should be in that 10 to 30-minute spectrum, in my eyes, just depending on these two things. A small or a light skate afterwards might be more 10 minutes. A hard back skate, we might want to really prepare them 30 minutes to try to prevent injuries as much as possible and increase performance as much as possible. So when we look at volume and selection, we're looking at that selection based on exposure during the training session. I already kind of mentioned that there could be linear, lateral, or multidirectional phases to their movement afterwards. Think, again, linear, sagittal plane, squats, bench press because they're doing a lift after their warm-up, or multidirectional, they're skating after their warm-up. And also based on the type of training that they're doing, it's going to look different, too. I'm not going to do a lot of neurological activation for weightlifting. There's going to be a few, but I'm not going to try to get those fast-twitch movements as much as if they have a practice afterwards. So when we look at examples, this is why I have kind of examples of exercises for preparing a team lift with a sagittal plane focus. So the core hip activation, we're looking at bird dogs, boot bridges, dynamic stretching, we're looking at single leg RDLs, plank to overhead press. For integration, now this is where we teach those neurological movements. We're actually doing squats and push-ups. We're teaching them, we're focusing on maybe slow reps of, okay, this is how we want our body to be positioned to prepare them for the activity to follow. So they're primed and ready to go as far as the neuromuscular system. And then afterwards, we're looking at that neural activation. Post-activation potentiation is a big term we use a lot from the nerve activation because we know that neural activation can increase your power immediately afterwards. So we might do squat jumps and clapping push-ups to really get those nerves firing to increase the weight they can move during our session. Now when we take that and we compare it to a multidirectional focus or a practice that we're going to perform after our warm-up, we see that it's a totally different exercise, but it still flows in the same manner. Our core glute activation is more sidesteps, right, more frontal plane-based. Banded skaters are a multidirectional phase. When we go to dynamic stretching afterwards, now we have a world's greatest stretch, which is a very rotational-based dynamic stretch from a multidirectional focus, and a side lunge stretch because talking, we want to make sure the groins and everything on that frontal plane are good and primed and ready to go. When we start our movement integration and teach those neuromuscular systems how to do new movements or just improve the movements they already have, we're looking at lateral marches, crossover skips, things again that we're just ingraining in that situation. And then our neural activations will be more quick feet, base rotations where you really rotate side to side in a multidirectional. Again, you see the focus before sagittal plane, we're doing very sagittal movement-based warm-up. Now all of a sudden practice, we're getting very multidirectional focused in order to increase the activation that we have coming from the session after. So references and then questions we'll have afterwards. Thanks, Joe. Thanks for all the pictures as well on that, giving examples of the specific exercises. We have about 15 minutes for questions. What I'm going to do for the first about two or three minutes, just get Dr. Moraszek to summarize kind of the rest of his slides. And Marty, are you on there? Yeah, can you hear me? Yes, I can hear you. Great. Sorry, not a great connection between Canada and the U.S. here. Sorry about that. I'm not sure exactly where I got cut off, but basically to summarize for our emergency action plan, one of the things that we did, I don't know if I got cut off before was mentioning, we do a screening assessment of our athletes with the BSI-18. And we found that to be a helpful tool. It's completed anonymously at the start of the season. And what we've learned from that is that there's about two to three players per team that come into training camp with ratings that are in the moderate to severe range. So, as we would expect, the majority of players are doing pretty well from a mental health standpoint. Better screening has definitely told us that there can be a few players that are at greater risk. And so, obviously, that's important information to know, to check in from the mental health consultant with the player, just to make sure that they're doing okay. So, overall, again, we've learned a lot from having a league-wide emergency action plan. The communication piece, having each team kind of forge out their own plan has been really helpful and been really important. So, I think that kind of summarizes the main issue, again, sort of about the connect conditions before. So, I'll turn it back to you, Duran. Perfect. I'll start the questions. When we got cut off, we talked a little bit about, you know, what should, you know, sport med physicians, athletic therapists, how can they train or are there things to help them prepare for if they get a phone call from an athlete saying, hey, I'm at home, I'm suicidal? I asked if anyone had had that training and really there was no one outside of a physician who had had that. Do you know of anything that people can do? Yeah, great question. And again, this is where I think your mental health consultant can be really important. I'm not aware of any online crisis intervention programs, per se, related to hockey. So, I can definitely, you know, talk to some colleagues and do that. Essentially, what we've learned from a psychological perspective, the main approach that we take is just to be an active listener and reflect things back and just to really get a sense of what is the source of the stressor and then have the player, like, you know, asking them fairly directly, you know, what their intentions are. Because we kind of cross that threshold, whether it be a need to call 911 or have direct intervention when people have an activated plan. A lot of times people have thought about suicide or that's on their mind, but there's no active plan component to that. And that's a really big part of that. It's just really flushing that out. So, again, not aware of any direct programs. But again, if you have a psychological consultant, they'll have that background. That's great. There was a question that came up, I just saw in the chat for Joe. And it was about how do you warm or rewarm someone up in between periods, Joe? Do you have any advice on that? Yeah, it's something, I think it's difficult at times. It depends. If we have someone nagging with injury, we utilize hot packs quite a bit as just keeping the tissue temperature up. I think a lot of the research shows that if you are already warmed up to the point before I played a period of hockey, let's say, as long as you can keep that tissue temperature up to a certain threshold, it still has good effects on power performance. And then also decreasing the chance of injury as much as possible. So, even static stretching at that point, you're already nice and warm. It's not going to be detrimental at that point. And you just usually get them up. They do active movement. Some guys jump on the bike, and they just cycle. So, really at that point, it's just try to keep your tissue temperature up and not let yourself cool down as much as possible. That's great. Thank you. Brad, there was a question from the chat that came your way. Got it. This one's for George. Somebody asked, George, for folks that would like to implement some mindfulness practice with their athletes, but they don't know where to start, where would be a good resource or a place to start? Yes. Well, yeah, well, they can actually, I can help them with that. They can come to my, go to my website, georgemuffet.com. Or if they, you know, contact me directly, there may be organizations in their area, I could send them to. But a good place is, yeah, is to just contact me and we can help them with that. Or my organization, I should say. Yeah. Yeah. Thanks. Question that came up for Tony, Dr. Colucci, where should the AEDs be ideally located in arenas? Obviously, you know, thinking about non-NHL arenas, if you're covering a high school game or a junior game, and how many do you think they should have on hand ideally? Should I hit this? Yeah, you can hit that button. Yeah. So the AED should be close proximity to the field of play or the ice surface during the game, during practice. The trainers keep that with them. I know our trainers, and I think most trainers throughout the league, carry one with them on the plane, in the hotel room, wherever accessible. During the arenas, make them accessible to the playing surface. We have one in the locker room. In that red bag, we have the AED in that, which is following the visitors wherever they go. So they're in good proximity, within probably 50 feet. The standard is within three minutes of accessibility, just for the fact that if you have a code. So in that red bag, we have an AED, the eye gel for an airway, an ambu bag with oxygen source, manual suction, quick clot, tourniquet, are the basic features that we have in the red bag. Perfect. Yeah, this is kind of a follow-up question, Tony. So how do we scale this EAP or mental health EAP at the youth level? I mean, most of, there's usually not an athletic trainer. There may be a team physician around somewhere, or hopefully a mom or a dad that can help. But how would somebody working in a hockey association make sure that the young athlete is protected with a good EAP? A great question. So I've been fortunate enough to be, my sons went to Catholic Central, it's a local school, but again, Catholic Central, private school, accessible to a lot of resources financially, as well as in the community. So scaling down just from what's the best thing for the player, having all the equipment at the side of the field or the ice, having that to your accessibility, making sure you have your ABCs available, because anybody can do it, from an ABC, ambu bag, oxygenation, and to be able to stop the bleeding. So that's going to be your two biggest things, is airway circulation, stop that, a 911 access. If EMS isn't at the field, then you have to have a 911 and have people in line to say, I'm going to be managing the player with the ABCs. You're contacting 911 and get them going, especially if they're not there readily available. Yeah. So, Dr. Raz, the same thing. I mean, like, what would somebody do in terms of mental health EAP or mental health screening as sort of that youth hockey level? One of the things that projects that I'm working on is just that, is to, you know, really work on a validated mental health screening system for that. So that's one of the projects that I'm working on. I would say for, if you feel free to email me, and I'm about to follow up with that. One of the studies that a couple of my grad students have worked on, is we actually find that the, using the SCAT as your baseline for concussion evaluation, there's a number of questions there that relate to emotional functioning. And we've actually found that those pick up pretty well with players who might be having more of a concern with mental health issues. If you want, I can send you the papers that we've published on that. But it's that, because it's a tool that's already been used for concussion, it can be very helpful for screening of athletes. So feel free to follow up with me, put my email contact in the thing there. But that's also another way, cheap, not expensive, it's free, all those kinds of things. So hopefully that helps. Martin, this is Tony Colucci. What's your, because I see a challenge just in the NHL regarding transparency versus privacy. And just how, you know, I've had this discussion with multiple of my colleagues. It's, I'm wrestling with it, because I think for, concussion wasn't the same type of thing. It was kind of the secret, let's not talk about it. Now, we're seeing a lot of it. Now, we're putting it out on the table, we discuss it, we put in resources, we put in help. And I think we're at this precipice of this same thing with mental health, to say, we have to merge into transparency to be able to put in resources, to be able to extend these people's career that are suffering with mental health. Yeah, absolutely. And I would agree that, you know, when I started working with the owners, with Duran, over 20 years ago, we saw the trend of concussions. And I feel the same way that the discussions about mental health are certainly trending in that direction. It's a tricky issue. You have players association, you have confidentiality issues. I don't think there is any easy answers. But what I would say is that just being upfront with the players. So again, what we've learned from the CFL is just having the open conversation of a mental health performance and letting them know that this is going on and letting them know who the people are to talk to. It's helped. We really haven't had too many controversial issues when players have sought out the mental health consultants and then are dealing with that person. I've always encouraged with the player that if there is an issue that requires medical attention, that we need to have a conversation with the medical people. And we're very upfront with that, just so they know that, again, the details of what they're sharing with you is different than their need for treatment. So if medications involved, if they're going to see somebody, just that the players know that they need to let the medical staff know that, you know, this is what's going on. The details of what they're sharing is different, but they are getting treatment that they are going for us, you know, support and so on. So I think just we have to be very upfront and players need to know that. Again, the confidentiality of what they're sharing is very different than that they're sharing something and that they're getting treatment. Duran, I don't know if you have any comments because I know we've talked about this issue quite a bit. Yeah, I mean, my feeling is the confidentiality is important and trying to identify to the player who is the circle, who are the circle of people, whether that's a head AT, head team, physician that has an idea of who knows. And I think trying to develop that circle that, you know, more than one person knows that there might be something going on. Anil had a question. Yeah, I'm Anil Ranawat from the Rangers. I'm a stupid picture. I can't use this button. What we now, this is for George and for Martin, we are using a GRIT score a lot in a lot of different avenues, whether it's a West Point cadet or a orthopedic surgery resident. And or so GRIT is really one of these other buzzwords. How does GRIT affect you, Martin, in terms of your, you know, your pre-evaluation? And how does a GRIT score, George, affect mindfulness? Because that's really, you know, it's similar but a little different. And what do you guys think? Well, I'm not sure what you mean by GRIT score. Is that some kind of measure? Yeah. Yeah. So, to me, the practice of mindfulness and the practice of beginning where you are, it doesn't really matter what the score is unless you're doing pre- and post-testing. It's really more about understanding the situation and the person and helping them to be able to overcome, to develop more resilience. And really basically what that, so the score doesn't really matter unless you want to do pre- and post-testing. It doesn't matter where you are. You can get better. You can get more GRIT. But it has to be, there has to be specificity of what we would call deliberate practice or pre-practice. You know, it's one thing to have GRIT, but GRIT, why and where and why is it important to have GRIT? You know, the overall GRIT is helpful, but some of us have more GRIT in some areas than others. But it's really about getting to a place where you're cultivating or developing more GRIT as a function of just whatever you do, wherever you go. Does that make sense? Yes. Yes. Marty? Yeah. I would add to that that I think that when it comes to, like George said, just understanding what the player nuances, because every player has a different, you know, conceptualization of what is GRIT and how to play, you know, with a great mindset. What I do find is that a lot of players, I think they're worried about, if they're anxious, if they're not playing hard enough, that there's something wrong with them and that they get, you know, that becomes the focus of it. And so, you know, I've learned so much from George when he takes a team approach and really, really has them really think through the concepts of mindfulness. That's a great starting point, because when it comes to having a calm mind, when it comes to having clear thoughts, that's when you can really, I think, better understand and better appreciate what the player is actually going for. Is it anxiety that's driving them, or is it that they're just really, you know, looking to increase their performance? I think a lot of players would probably have a mild degree of anxiety that they're dealing with, and that's why they feel this need to do more. So, really getting a good understanding of where they're at at baseline, you know, just kind of clarifying and asking important questions, I think that can be very helpful, too, because there's so much variability, there's so much individuality, and so you really have to get a good sense of what is going on with the player, and then from there, you can really take those interventions. So, I found that to be helpful. George, I don't know if you have any other comments on that. Yeah, no, it's really, you got to begin where you are, but you have to have an accurate assessment of where you are, and that could be, you know, having peer post-testing of some kind of value where the tool is important, but also just to observe them and to really, you know, start where they are, and then, you know, here's where we are, and this is where you want to go, and then the process will be pretty obvious, you know, what to do, but there has to be, you know, you have to have an accurate assessment of where they are now. Well, great. I'd like to thank Tony, Marty, Joe, George, and Ricky for the first session. We're going to have a break now. Virtual learners, you don't need to sign off the Zoom link, but if you do, it's the same link to return, and we'll begin the next session at 11.15 where we'll be looking at the young athlete care. Brad, is there anything? Yeah, the only thing I would say is one of the great things about this group of speakers is they're super accessible, and I think all of them already have said, you know, if you have questions, you want to develop a program, you want to start something in your community, just call them, email them, and they'll help. I know Tony would help with an EAP. I think the speakers we've had this morning are super accessible, so I think it's one of the advantages of developing this network. So, we have 15 minutes, and then we'll see you back.

Duran Naidoo

sports medicine

athletic care

hockey

pre-game care

on-ice emergencies

concussions

orthopedic trauma

return to play

emergency action plan

mental health

mindfulness

dynamic warm-ups