Yeah, exactly what he said. It's a pretty broad topic to try to unpack in 15 minutes, so I'm going to dive right into it. Best I can here, now that my clicker doesn't work. There we go. So I'm going to break this down into different risk categories and how we look at it. Talk about considerations and conditions within those groups. Go over some strategies that you can incorporate in your setting, may already use in your setting. Also give some examples of things that we do in our club that may not be unique to other clubs within the league and how we manage things. So what do you think? The biggest vulnerability for our at-risk athletes, I look at it as the first day training camp. I was lucky, I spent several years at the college level as a head athletic trainer. I was most amped up the first day of summer conditioning. The strength coaches are amped up. You haven't seen these guys for three or four weeks. What's going to happen? Then you work them out for eight weeks, give them two days off, roll them into training camp. At our level, we have something called the CBA, and that dictates our schedule. After the middle of June, we won't see them for four to six weeks. Doesn't make a lot of sense in how you ramp it up, and that's why Lee Weiss has so much work to do on his subcommittee. But I look at the first day of a training camp like opening a box of chocolates. You never really know what you're going to get. Win 20, lose 20, new diet, who knows? You often get the question from the coach, so who are we worried about? To me, until proven otherwise, we're worried about all of them, to be honest, until you prove it otherwise. A player has a contract. In paragraph five of that player contract is their salary. They will hold that club accountable for every penny they are owed. There's also sections where they have to do PR marketing. That club will hold the player accountable for that. There's also a section in their contract that's a little gray, often overlooked, and how do we hold them accountable? Because the days of the conditioning test are long gone. Troy Maurer, who is in attendance, I don't want to embarrass him, our associate head athletic trainer, has a T-shirt that he likes to wear during physicals the day before our first day of training camp, and it subtly reminds our players about the section in their contract that they sign, which represents that he will maintain himself in excellent physical condition. I think Julie just said it, the Wolf's Law. If you are physically and mentally not ready to meet the demands of the game, your underlying conditions will get exposed and exacerbated. That's what makes us most nervous. Now, on the flip side, we've got to hold ourselves accountable, too. We need to provide a healthy and safe environment for our players to not only perform at a high level, but to stay safe while doing it. I'll say, what are the categories we're talking about? Again, mental health, I was just talking to Dr. Yagnik. He said three, four years ago at this meeting, we never talked about mental health. I know this is an orthopedic-based conference, but you cannot ignore how all three of these play into each other, and I will touch on each one of these areas. What are some of the considerations in the mental health category? Again, not unique to several settings, not just at the NFL level, but again, for us, rookie transition, maybe it's a freshman. Someone's identity on the roster in college may be where they are on the death chart at our level. How much money did you get? They talk about that in the locker room amongst various things. How do we maybe manage some of these things? We talk about the EAP. Dr. Schwartz did a good job earlier. It's not just spine boarding and cold water immersion. We actually have a mental health EAP. The league mandates that we have that. We sit down once a year with all stakeholders from the GM on down, and we talk about when this player becomes suicidal, what are we doing? When he needs inpatient help, who are we calling, where are we going? We talk through those scenarios to make sure that we know what the game plan is when it happens. The league also mandates that we meet once a month to go over issues within our club. Our club actually will meet once a week with these department directors here. Anyone who touches the player is around the player. We will meet once a week and season issues on Tuesdays, and we'll talk about some of the trends and tendencies we see. Let's be proactive rather than reactive. That smoldering ember, we don't want to turn into a raging forest fire, so what can we do to get ahead of that? In those conversations, I may say, hey, little Johnny player here, I notice he's in Jasmine Grimes' office three, four times a week. Maybe I'm not the best person to approach him if I notice something's wrong. Maybe I go to Jasmine on my staff and say, hey, why don't you check in on Johnny, see what's going on, see how he's doing. Again, our mental health clinician's fantastic, but if he goes and taps that guy on the shoulder in the lunchroom, you may as well pull the fire alarm in the building. Something's wrong. He's talking to Dr. Seifer. We don't want to cause any undue attention to that player. We just want to do the best thing we can organically to help manage that. Beginning of the year, we will introduce our staff, mental health clinicians, whatever else. Yes, we have one mental health clinician, but I think we have a team of 30 therapists. A lot of times I think I'm more mental health clinician than I am athletic trainer on most days, and we all take part in the management of this. It's our time to reeducate our coaches in front office on how important it is to maintain the privacy of our players. It is actually against the licensure of that mental health clinician to breach that privacy, but the league will also fine us $500,000 in several draft picks if we breach some kind of information of their personal nature, mental health wise. They take it serious, and they do that to send the message to the players, hey, listen, use the resources we're giving you so you can trust what's going on. As we move to general medical, again, not unique to high school collegiate settings, things that you see and deal with, Dr. Gritter did a great job earlier talking about heat on us. What is unique to our environment? We're taking a free agent from, say, Cleveland in November. He's been playing in 30 degrees. It's still 100 degree heat index, and we will pull that player aside and say, today is not the day to be a hero. We need to get through Wednesday practice so we can make it to Thursday. We'll get some eye rolls, 50% of them in our room in a full body cramp, so again, things that we need to make note of as we're managing these guys. I'm not going to go into EAP. Dr. Swartzon did a great job with that. I will show our healiness tent, how we set that up, the conditions card. Every one of us on staff have a conditions card of any underlying things that our players have on the field, so we have quick reference. It's hard to remember it all, and I'll show the quick reference to that. Before training camp starts, if a player has sickle cell, weight loss issues, whatever it may be, I'll go to that position coach before training camp, educate them on what that player has. We have seven athletic trainers on the field. We'll have doctors on the field. We'll have EMTs on the field, but if I can get all 30 coaches, well, 32 now, Joe and Julie, I don't know how many you have in our room, but we have like two coaches every player I feel like now. Well, let's get 30 sets of eyes on them, so we have a whole village taking care of these guys, and we're all on the same page. I love our coaches, but we have to remember they are former players, and their attention span sometimes is short as we go deep into training camp, so I'll use the first injury report as an opportunity to not talk about all the IR guys, rehab guys, whatever. I'll talk about our watch list players, the players we're concerned about, and I'll take advantage of that. That example, again, here's an example injury report. Disregard the guys at the bottom right. We once again couldn't get our chief medical officer and NFLPS leadership ready for camp, so they start on IR. Dr. Waldrop, esteemed foot and ankle doctor, is sore again from his beach vacation. Dr. Yagnik and all the perfect surgery he does, his hands are sore, but we will skip past that, and I draw your attention to the esteemed names of many PFAS members as examples of players. Again, hey, coaches, these are sickle cell players. These are the guys we're worried about with heat illness, weight loss, whatever it may be. Again, the first two weeks of camp, we're going to have a low threshold, quick trigger. We'd rather shut them down for a period or two than lose them for a week or two, and I'll try to do this the first day before training camp. Here's our heel and ascent. You see our cold immersion tub there, and then we have a bin with rectal probe, oxygen, AED, fluids. Underneath the lid of that, we'll have a list of player weights, underlying conditions. Our ambulance is actually stationed right next to this in training camp, so if we have to dunk a player, if we have to transport a player, it's quick access in case I don't have my card on me, or the assistant doesn't. So we can tell the EMT crew going to the hospital, hey, remember, this guy is allergic to red dye or whatever it may be, just so they're aware of that. Under orthopedic cases, again, this is not all-inclusive, not limited to these cases. There are some unique things that we deal with that maybe the high school and collegiate setting doesn't deal with, the degenerative joints, the aged veteran. I think Pete's going to talk about movement screen stuff later. Things that we need to manage, okay? Joe brought up a great point, keep the main thing the main thing. However, if we can get our coaches on our side and make them feel like they're helping make the decisions, it also makes things a little easier. I will ask that coach, hey, listen, we've got some running backs we're trying to manage. Talk to me about what your thoughts are. When do you want to see this guy? And he may say, well, you know, this player is trying to make the roster. It'd be nice to see him by game three, the preseason. Well, if we think he was going to be ready two weeks earlier and say, hey, man, I think that's a great idea. We'll take the extra week now that we know we were given, hey, we need him for game two in the preseason. It's not realistic. He's only seven and a half months on an ACL. He's not going to be ready. So we manage those expectations early. But I'll find out too, hey, this guy needs team reps because he's not a good learner in the classroom setting. So he needs as many team reps as he can get. So that tells me, all right, instead of using all the volume at the beginning part of practice, let's backload his volume and get him more into team reps as we're trying to transition him back on the field. Strength coach philosophy. I will brag on our guy all day. We have, we are almost best friends. All right. And that makes it easy. Not everybody has that. Some of your strength coaches may want to squat a guy five times a week. Probably not the smartest thing in training camp. Maybe that's a good time to talk about, hey, let's back it down to two. Or if you're going to squat the running backs, say on Tuesday, why don't we back it up to the day before their off day so they have a full day off their legs as we're trying to especially return guys coming off surgeries. Individualize. All right. All players like to feel special. Lee did a great job talking about the ramp up periods that have gone on in the NFL in the first few weeks of training camp. We actually get more deliberate with that with players coming off surgery on how we manage them. How do we do that? We use return to play calendars. And we'll actually map out July and August. Again, be adaptable, be flexible. Joe just talked about that. The best laid plans often don't work out. But if we can be deliberate about showing where we're going and providing that roadmap, I think it can help everyone. All right. So the coach says, hey, we need to get him in game three preseason. So let's count backwards. Maybe we start loading him up with individual or team periods a week and a half before. Individual periods a week before that. Running and cutting a week before that. So we'll count backwards on where we're trying to go to establish our goals. We'll start talking about these things in May and June to make sure that the coaches are hearing it early and not coming to training camp where everything's like shaking up a snow globe. Let's start talking about these plans early so we can get some things down to get our blueprint. Our coaches actually will map out the practice script for the first three, four weeks of training camp. So I know the running back that needs reps and third down. Let's not bring him down on the day that we have third down reps. Let's bring him up on that day so we can get him incorporated into the part of the offense that he needs to learn, be a part of. When the coaches come back from vacation and the players arrive, we'll finalize these things and also give a copy to the player coordinator and position coach. Last but not least on this, I tell you, Stefani Bell, I think she's here, right? If I had $1,000 for every time she announced, and did a great job on ASP and physical therapist, that a player underwent yet another perfect surgery, successful surgery, my kids' colleges would be paid for. I cannot wait, and there will be an orthopedic doctor be my hero if he says, ah, that ACL graft didn't really quite get the right angle today. Hey, that home run Liz Frank screw, I hit a double or triple on that Liz Frank home run screw. It would be a hero. I think we had five off-season surgeries this year. Uribe and Yagnik did all of them. They called for an update. I said, let me guess. It was a little worse than them or I said. You're a baller. You tacked it all down. It went well. So when this guy has swelling in five months, it's probably our fault, and he said, you're exactly right. So we do take a lot of pride though in protecting these surgeries and putting these players in position to have success because when they do, doctor looks good, we all win, and it is important to us as athletic trainers to do that. Here's an example of our running group last year, a little bit loaded, a guy coming off an allograft transplant, a guy that's bone on bone, and he said, oh, by the way, I usually swell the second, third week of camp. Now the guy coming off ACL, you look at the bottom here, these rookies, see in college these rookies are probably the bell cows at their position. When they get to our level, we need them to be on every special teams, and if they're not on special teams, they probably need to put a jersey on and run down on scout kickoff. So their volume is going to be a lot higher than they're used to. So as we try to manage the top three running backs coming off surgery, we also don't want to increase the injury burden on the bottom three, and we end up causing more problems than we're solving. So it's a lot of pieces of the puzzle that we try to put in place, and you see the calendar here, roll to August, busy calendar, may not make a lot of sense to you. Our practice schedule is usually one to 14 periods, so GPS things that Joe will talk about, we get with our strength staff, we talk about what typical load they would get coming off an off day. We don't want to spike them. Let's ooze them in and then ramp their volume up the second day. You look at August 3rd there, right? You see all those running backs are lifting because it's the day before an off day. They were supposed to lift on the second, hey, let's lift them on the third, let's individualize their plans to make sure it's laid out the best way for them. Look all the way down to the bottom right corner, the last preseason game, that's usually when vets like to put visors on and, you know, put their sandals on and take a vacation. We actually have found benefit to our guys that have not been in to activity, put your pads on, go through the pregame warmup, get your routine down, put them in the first series, script a pass to them, let them get tackled, pull them out. You've checked every box. They feel better going in the first regular season game, and that's really paid off dividends on some of the guys that we've returned. Take home points, again, it sounds like a broken record from other things you've heard. All these are so important. Not one is more important than the other, but it's all a part of planning as best you can, being ready to adjust, doing the right thing for the players, and hopefully everything falls into play. I can't get off without thanking our doctors. We have some unicorns in that picture, and I can't thank them enough. We could not do our jobs without the doctors. I speak for all the athletic trainers. Sometimes you become our family. You are our family in season. My wife, I think she hopes that I talk as favorably about her at work as I do my own doctors at home, and I assure her that I do, and Troy and Jasmine will back me on that. These guys are phenomenal. I couldn't do it without them. I really appreciate them. Dr. Whiting is here, our neurosurgeon, she's here somewhere. She deserves that credit too. Part of this, Maria, Alex, all the fellows, such a great job in doing what we can for our players. Thank you.

athletic trainer

health and safety

NFL

risk categories

at-risk athletes