Thank you, Dr. Sills. We'd like to ask the rest of our panelists to come up, and please, if you have any questions, we'll start out some of the discussion. If you have any questions you'd like to ask for the group, please come on up to any of the microphones and feel free to do so. I did want to say on opening day of baseball, we're talking about football, and that shows how football is leading the way in terms of health and safety, and really all that we learn from the professional football level, we've really been able to translate down to our college in youth sports, and Dr. Sills' leadership has really been paramount to that, so we're very thankful for him really providing us all of this information, getting all of the teams involved in the different task forces, so I think an immense amount of information has come out here over this past couple of years that's really helped us take better care of our athletes. So I've got a couple questions for the group, we'll open it up here, and Dr. Sills just touched on it here at the end about who should be the head of the medical team, and there's a lot of voices in the room with each team of, whether it's the physicians, the team athletic trainers, the performance folks, is there a consensus amongst the group or thoughts of how that medical team should be organized, and I know there's some variability amongst teams and age groups. Well that's an easy one, it should be a neurosurgeon, just kidding, no I think there are room for multiple models as you mentioned, but I think there are a couple of key points, one is having all those disciplines that I mentioned, but having them integrated, and again if we're going to be honest in the room here as a family, we've got some of our clubs where there's great integration, where all of those leads of those areas are sitting down at the same table and they're reviewing the data on a weekly basis and they're talking about these issues and they're working very collaboratively, and we've got other situations where they're in different parts of the building and they don't cross paths. That's not healthy I think, so I think there are different ways to organize it, obviously I am biased that someone with a medical background needs to be, if you will, facilitating or overseeing that, but that person has to have some facility and some level of conversance with each of those disciplines, and I think that's the message I would give to this room, is if I'm training or looking to be a head of sports medicine, I need to get educated in some of the emerging issues in strength and conditioning, in sports science, in performance, so that I can effectively work with those colleagues. And then I think like any good team, it's about communication and collaboration, but everyone needs a seat at the table, and I think that has to happen in a formalized, organized way. Yeah, I think that's well said. I think there's been a paradigm shift in the way that the model has been since I started where it was the team physician and the head athletic trainer, and that's a very special bond that I think does not need to go away with this model. I think that the model, the shift is going towards performance-based and these type of weekly meetings looking at all the data, and I think it can be a good thing. It's happening, as many of you know, at the collegiate level, so as these players come in, as the coaches come in from college, they're used to it now, and so we're seeing that. I would say that we're one of the teams where it does work very well, and it's like with any corporation. It's about the people and people understanding their roles and letting everyone do their job and their specialty. One thing that needs to be understood, though, I think from a physician standpoint, is the understanding that when it comes to return-to-play decisions, it has to be the team physician that's making that final decision, because ultimately, that's where the liability is, and they have to understand and respect that, and they do, so whether you want to be involved with those weekly meetings as a team physician or not, I don't think that's up to you, but it's more that there has to be that understanding of your role when it comes to return-to-play decisions that everything has to be run by you, so take some communication, but the model is not going to go away. And Dr. Szilagyi presented some of the data that acknowledges power with the coaches and with the players in terms of reducing injuries, and Lee Weiss, who's here with the lower extremity task force, showing what those ramp-up periods look like for training camp, how that helps you to reduce injuries. Any thoughts on how to communicate with coaches at the youth and college level? Because this data has been very impactful, I think, to show how that ramp-up period versus the days when you used to come in and try to wipe everybody out the first couple days of training camp to see who could run the most and really get everyone into shape, so I think that ramp-up period has been very critical. Any thoughts from the different sports levels as to how to communicate that with coaches or how impactful that has been with coaches? Yeah, and along that line, let me ask Alan just one thing that sticks out. You talked about the Super Bowl champs having less overall injuries and the importance of the coaches. Have you taken it to the next level and visualized how practices are performed by those particular coaches? Can you tell us that we know that, you know, and I know Coach Reed from his days at Missouri was our offensive line coach for five years. He did coach differently back then, many, many years ago, so not just to point him out, but have you correlated the next level that the less injury rates have correlated with different tackling, blocking tackling techniques in those particular teams? Yeah, that's exactly where the work is going. So we have a mandate that all our teams have to share their sensor data with BioCore, our engineering firm, from all their practices. So again, players are wearing those sensors, all players, all practices, and so we've got the data on, you know, yards traveled, high-speed efforts, things like that. There's also a requirement to share some video. That's obviously a little more challenging. Our clubs guard that video like, you know, the Pentagon Guard's war plans, right? I mean, it's challenging. But I think with, again, part of this is helping coaches understand, look, we're not looking at the video to see whether you're running split-flow blocks or whatever scheme. We're just looking at what you mentioned. What are the drills? How's it organized? So the first wave of efforts has focused on obvious things like total yards, duration, things of that nature, and I think those are the things that are easiest for coaches to obviously implement. We're trying to get to the level you're describing, which is what drills carry certain risk, but there's more work to be done there. But I do think, and to your question, Jim, that the general principles can apply, you know, at any level, is just this gradual ramp in duration and intensity, and that when you put the pads on, you've got to re-ramp. You've got to then go back down and go up again because you've added a significant variable that's going to add stress, and if you don't go back down in duration and intensity, you're going to see a spike in injuries. Great. Great. We have a question. Yeah. A question for, excuse me, for Dr. Smith. The level of participation for the injury reports seems very low. I mean, I think you said 5 percent, you know, participation level, so one, you know, seems low. Two, how do you get more participation? And even at that level, you know, is the data strong enough with that little participation? Right. I mean, the numbers, Michael, are high for that little number, but yeah, I mean, it was, I mean, the last year was up to 16 percent participation in the NCAA Injury Surveillance Program. You know, it's a lot of time, you know, and so the trainers are overworked, understaffed, you know, and college level is way different. We don't have the resources that the professional teams have in terms of number of trainers and such, so I think that's the biggest problem is just getting them to put it in, and the other problem is, at least I know at Missouri, sometimes, you know, our guys weren't putting it in for like a week or two later, you know, so stuff has happened, and it's not instantaneous because they're treating people after practice. You can imagine how it is, and they don't really trust maybe the student trainers to put it in, so the other problem is the reliability of the data, I think, because it may have been put in retrospectively quite a bit, so big problem, so, you know, everybody's got time constraints, but again, I think our problem at the collegiate level is the resources available and the number of trainers that can actually put the data in. They're putting it in, we're not putting it in, we're counting on them to put it in, and they're the ones seeing the injuries primarily, so, but it's a big issue, but I hope the data does still kind of apply, I mean, we definitely know that preseason is a problem, I think the NFL, you know, and ramp up is something that hasn't been that much of a focus at the college level yet, so this is all really important to bring it to the next level, and I think, you know, even to the youth sports, if you teach the coaches how to teach the younger kids how to block and tackle, they hopefully will carry that same technique as they go onward. Yeah, I can advocate and plug for that from the information we've learned from the NFL's EMR, we have 70 high schools with the trainers that are all university hospitals, employees in Cleveland that, all of them have a slimmed down version of an EMR, a data plan, an iPad, and part of their being part of our program of being one of the athletic trainers and being one of our partner schools is you have to put in that data. All of our schools get that report every year of, here's where you fit with these injuries exactly like this, and it's been very powerful to show, hey, your volleyball team sits down here versus your football team sits up here, and each school athletic director and the coaches get that each year, so I would advocate for that if you're part of a system or a school community, that data has been very powerful, and all of the trainers and all of the teams see that each year, so that's really helped our program all work as a family and essentially work as a unit or a league here together, which has been very impactful. So that's where I was getting to with the work Dr. Sills has done here with really formalizing all of that data, all of the teams putting it, I think can be very helpful, and it can be executed at the youth level, but it is hard with the school athletic trainers, they've got a lot of work to do, and they've got to figure out how to get this in, so we try to simplify it by giving them the data plan and the iPad and a really simple, slimmed down EMR version just to help keep that data coming in. And just one point on that, I would say, you mentioned the workload on the trainers, I was going to tease ours and say ours are underworked and overpaid for sure, and that's completely wrong. It's an incredible burden, and we have to pause and say it's the same way, our athletic trainers enter all this data that you see, and it is an enormous workload, enormous, and the payoff though, and I think the reason they're willing to do that is they see the return, that we're actually able to now really understand and categorize injury, and it also helps, you might have a year where you have three Achilles ruptures on one team, and everybody's losing their mind and saying, oh my gosh, what's wrong, what happened, McAdams forgot how to take care of people or something, there's this panic. Being able to have all that comprehensive data now lets you have a little bit of better perspective on that, and so there is significant return, but it does come at a tremendous cost, but I think ultimately, and kind of to your point, that's the only way you can really contextualize are we getting better, are we worse, and how safe are we, and again, going back to the coaches with the specificity of the data, but it is an enormous burden. And let me say this too, I have the greatest respect for athletic trainers, because the time you guys spend, you come there two or three hours before practice, and you stay late at night, your pay isn't terrible, I mean, per hour what you guys make is awful, and so it's hard to be on you for not filling out these reports, because all you do, and as docs, we come in late after clinic, we see the couple people that are hurt, or post-op, we're in and out, it's just, it's a burden of love that you guys take care of these players for us, and I personally really appreciate what you all do, because it's amazing how much time they spend. A couple additional questions here, one is, we talked about starting pre-season, but there's an off-season window where the collegiate athletes or the pro athletes are out on their own, and I know there's some educational initiatives from the NFL level, how to assist in training in the off-season, but a lot of folks have their own trainers, or their own groups to work with, and you want to make sure they don't conflict. Any tips or thoughts, how you discuss, educate with players, or the performance folks that are working within the off-season, how to marry those programs, so everyone's working together here as you walk into the first day of training camp? Good luck. At the pro level, I mean, that's their time, you know, I will say that most of them, to get to that level, I'll speak for the pros, they know their body, they know how much rest they need after the season, and they know what they need to do to get right before the camp, they do take care of themselves for the most part, there's a few anomalies each season where you may have to have someone look at particular players, but by and large, they've got their people that are working with them, and there's a lot of great organizations out there and groups that we know about that work with them and get them ready, so we really leave that to them. Yeah, from the youth level, and even the collegiate level, the challenges, you may finish your baseball, travel, soccer, or baseball season, you have a weekend, and then you start football the next day, so it's always really challenging, and the better your team is, the further that sport ahead of you goes into the playoffs, makes it really tricky to switch over and convert sports that quickly. Yeah, I think that's actually, you bring up a really good point, and I think that's a bigger challenge, I mean, at the collegiate level, there is no off-time anymore, I mean, it's almost a 12-month, I mean, my son's a college baseball player, it's a 12-month season, you know, essentially, in terms of all the difference, so I have worries a little bit in the opposite direction, that there's not enough or a structured, organized downtime for youth and college athletes built into the calendar, it's a little different for us, actually, to know that there is some time off. Yeah, it's a huge problem, it's my weekly life, which is not ramping up, but ramping down, you know, because every sport's now full year, and kids want to play multiple sports like their parents did, who did it in an individual season, so, add the club team element to it, and, you know, anything that's not surgical is a major overuse issue for me. Yeah, the overuse and sports specialization issue, whether I try to remind all our youth families at the pro level, there's an off-season, right, look at your calendar, when's your child's off-season, or when's your scholastic athlete's off-season, and it's very shocking when you bring that up and you look at the calendar and say, when's your breathing window, and even if it's these little micro-breaks, so I would advocate for that, because that's built in at the pro level, I think our youth and adolescent athletes are facing that even more without an off-season. A final couple questions, so when it comes to injuries, injury happens on Saturday or Friday, Saturday, Sunday, and that next morning you see everyone and the coach or the GM says, well, how long are they going to be out, how are we going to get them back, right, what's that, any discussions, we all work, we have incredible athletic trainers that we work with to really help us guide that, discussions on how you have that communication of, is this a one week, is this a three week injury, context of how you develop those relationships with your team leadership? Yeah, I mean, I think that comes back to the model as well, and it's an additional challenge with the model initially, because it used to just be the head athletic trainer and the team physician, they'd come together with a plan, and now you've got many other people involved, but I think with the right communication that all can be done, it's about having a unified front and not wavering on what you say, so a lot of times, for example, on Monday morning, so after a game, the players in there or the coaches wander in while they're still reviewing the MRI and still trying to look at the player, and it's just like, you've got to just keep them, say, go away, I'll talk to you in a little bit, I need to evaluate the player, and don't be so quick to give a diagnosis and show you know what's going on, and that's what I see a lot of times with the fellows, they want to show, I know what they have here, and it's like, okay, but just step back, let's look at everything, let's look at what other players we've had that have had this injury, how long did they take, so that's a great example for the coaches and the player to know other examples and really get all your ducks in a row and then present it as a unified front. That's my biggest push, is don't be in a rush to give them a timeline, and the other thing is that mother nature doesn't always follow timelines, so you have to have some leeway on that, and most coaches in management understand that, but just have a unified front and give yourself some wiggle room. I think the other key point there, Tim mentioned, you know, I have fellows too, to really educate the fellows is don't say anything, you know, everybody always tells you, wow, he's torn his ACL, you know, I think it's really important that they kind of lay low and let you make the, you know, consult with them in the room with the trainer and get your game plan together, but they can mess you up just as much, because the player hears something from the fellow or if the fellow was at practice and he told the player, well, you're going to be out two weeks or whatever, and then I come along and, no, you're going to be fine, and then all of a sudden now we've got a problem. So I think it's not just the doc to the coach, the trainer, but the people that might be helping you, residents or fellows that might be covering practice in my case, I think that's another issue to really educate. One source of unified information, it's okay to take a breath and collectively put together that information, that way as the data comes out, you can confidently say as a group that that's what we're doing. And with social media, it's instantaneous. I mean, once you tell the player, it's like all of a sudden I see someone come on the phone, they've got a grade three biceps femoris, I go, really? I was still trying to figure out if that was grade two or three. And so it's out there right away, so you better have a good plan. And our final couple of minutes, any other questions from the audience for the panel? All right, we have a brief break here, just wanted to encourage you to, part of this meeting is to be very interactive, so I encourage everyone to interact or if you have any questions for the group, and then to visit the exhibitors here in the entryway, so thank you, great way to kick off the meeting with this panel, so thank you very much.

medical teams

integration

communication

injury prevention

off-season training