25. Dave Tilley, DPT, SCS, CSCS - Part I of II: Simone Biles, Olympics & Shifting the Culture of Sport and Gymnastics

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Before we get into the show, let's talk about this week's sponsor, Deputy. At your practice, what happens when staff call out sick? How much time does it take to find a replacement who can fill in? If you need to cancel appointments because you're short staffed, what does that cost your practice? Deputy is a simple app that's helped more than 250,000 workplaces tackle this problem. Deputy makes it easy to schedule staff in line with patient demand, communicate schedules with your team and instantly find a replacement when someone calls out sick. To learn more and try Deputy app for free, go to doctorapotcastnetwork.com slash deputy. Our guest today is Dr. Dave Tilly. Dave is a former collegiate gymnast and has been coaching gymnastics for over 15 years. He has his doctorate in physical therapy and his board certified in sports physical therapy treating patients at champion, PT, and performance outside of Boston Massachusetts. Dave is an internationally recognized expert gymnast, sports medicine, and has consulted with programs ranging from the club to the elite level. He has successfully treated many of the world's highest level gymnasts for their injuries. Dave has a particular expertise in treating gymnasts, but with his strength and conditioning background as well as his deep passion for research, he loves to learn out on all things sports and health. But he also has a particular affinity for sportsmen in some fields such as workloads, Achilles tares, and cultural change. So in this two-part series, we dive deep into the world of gymnastics. Now Darshan, I know very little about this world, so you might find some of our questions to be rudimentary, but I'm willing to bet that most people also don't know as much. I mean, with the exception of the Olympics, this is a sport that does not get the limelight, at least not for many of the positive reasons. But considering the recent events of the Tokyo Olympics, we thought it was best to bring on a true expert like Dave, who not only competed at high level himself, but has worked with thousands of gymnasts in the last 10 years. Now in this episode, you will of course learn about Dave's background, but also the culture of sport, gymnastics in particular, and how placing unfair demands on athletes at a sensitive time in their lives can have implications for physical, emotional, and mental health down the road. You'll hear Dave's take on the Simone Biles situation and what we can learn from that. You will learn about something called the twisties, which is a terrifying yet evidently highly prevalent in the sport. And overall, we spent a great deal of time diagnosing the issues that led to the negative culture in this sport. But as you'll hear in the end, there is some optimism and although slow changes on the horizon. So without further delay, please enjoy this episode with Dr. Dave Tilly. All right. We're back on. Take two. All right. I'm bored. Dave Tilly. Hey guys. Good to be here. How are you doing? Doing well, man. Doing well. This is going to be a great talk, man. The last time I was through Connected was on Clubhouse. You know, they joined us for the, yeah, the RIP, man. You joined us for the medicine redefined group that we had over there. You know, me, you, Duwesh, well, I forget who else was on there. I think it was us for. Oh, yeah, yeah, audience wise, it was great. And then we kicked it off, kind of talking about sports medicine, PT, exercise, science, a lot of good stuff. And so that is definitely why we wanted to bring you on here to kind of delve back into that stuff. So Dave, why don't you tell our listeners who you are for those that might not know who you are? Sure. Yeah. So I always tell people that I'm pretty much just a nerd from Boston who enjoys reading books and helping people and kind of like gymnastics too. So I'll just kind of got mushed together. Did gymnastics my whole life coach since I was like 15? Another man's team at Central College and wanted to go into something that would help me stay involved in the sport a little bit. So I was kind of between different, you know, health care fields. Didn't really know thought about being an orthopedic surgeon, but didn't, didn't really think that was the best route for me. Because I like to spend a lot more time with people and kind of think through things. I'm not really a fast action like right on the moment kind of go kind of guy. You know, my best friend is in orthopedic. Or as a emergency trauma PA now works in ICU unit. He was in the PT department with me and both of us quickly realized that he was more on that side and I was not on that side. So yeah, it went more for PT, my sophomore year transferred and actually got rejected three times, which was dope first. But then got in my sophomore year and yeah, I'm in, went through that and then I did undergrad and grad at Springfield together for DPT and then kind of knowing that sports was a thing for me. I stayed involved. So I did a sports residency for two years and just in sports PT at home residency and then did a year of strength conditioning. So that was kind of all the way through to like 2015 and then yeah, I've been coaching and treating and all that kind of stuff and then 2013 and after I got out of school, it was like a very unique point of view. You know, someone who has been an athlete and coaches still and also is treating quite a few gymnasts at the same time. So I was like, I should probably try to share some of this information and be a cool way to share ideas and you know, at that time it was blogging. You know, blogging is a really good way to kind of organize your thoughts and just kind of like, it's your ideas out there. So started blogging and then people started asking me to do consulting work and kind of traveling and speaking. So that turned into maybe I should start a business out of this because I don't want the government to steal my money if it blows up in my face, but also I was paying a lot of money for content. I have tuned me too many courses in books I was taking. So I was like, I need to actually get some income to support this. So yeah, I mean, shift was born in 2013 and we're actually creeping up on our 10th anniversary in a couple of years here, which is mind-boggling to me. It started as like a really a blog and now it's a monster of whatever this is with a great team that helps out and some cool stuff we're doing. It's awesome, man. I wouldn't bring it back when when did you start gymnastics? So what age? Three. Yeah, it's three. I specialize. I specialize late. You know, I got a late start and I'm just kidding. But that's not that. Dave, I mean, that's not too crazy though. I mean, like you, from my understanding of it, gymnastics, you, you, you need to start around that age, right? Three, four, five at the very latest. No need, need is a strong. Okay. And these are the myths that we're here to dispel today. Yeah. So yeah. So what is it? Let me ask you this. What is a typical age entry level for, you know, somebody who is going to go to the collegiate level and do gymnastics? Sure. Sure. A lot of people do start gymnastics at a very young age because it's an incredible sport for like anybody. And this is not a biased opinion. This is like very being asked anyone whose young should do gymnastics. Even if it's like one day per week to jump around and learn stuff like the amount of body awareness and just global, you know, human performance development stuff you can, you can develop as a kid is amazing in gymnastics, right? So like that's that's most kids getting in gymnastics because it's a really good thing for young kids to do. There's energy. It's fun. There's trampolines or foam pits. You get to roll and flip. So like a lot of people start when they're young in that preschool age. Like I started at two and a half because my mom said I was just way too energetic and I was running around the house and there was a happened to be a local gym in my town that had what they called like a mom me in my shadow class. It was like a preschool class. My mom would take me in. You know, I would just like roll down the wedge and stuff like that. But then as the years go on, you know, you ascend up and do, you know, the four-year-old class, the five-year-old class, about like six for me. They were like, oh, you know, he's kind of got some talent. You know, would you like to have him do some team stuff? I'm like sure, whatever. Like I don't really know. So that was what started for me. But that's a typical track for a lot of people is like they start at recreationally when they're young just for fun. And as they kind of go up, they kind of maybe stick out as someone who's naturally flexible or, you know, has some good body awareness or kind of has a good kind of overall athleticism. You know, not that I was like a superstar six-year-old, I'm not trying to say that. But they just were like, hey, try team. I was like, okay. So then like, I kind of got put into the team bucket. But there's so many people who just like do other sports, do other stuff and start later. Like seven, eight, nine, ten, and do just fine. I mean, I don't think the age of entry is really the biggest determinant of who does well long-term. You know, I don't think that's true. It's a hard sport. So it takes a lot of time. That is for sure. It's definitely like the hardest part in the world. But I don't think it's something that if you don't go by three, four, five, six, seven, eight, nine, you're going to miss your shot. And I encourage people to do multiple sports when they're younger until they're like, you know, ten. And then from there, if they really like gymnastics, maybe think about it in a couple of years. Like it's not about going super hardcore early. Do you think that, let's say you have two athletes, one who maybe started much later in their life like at the age of, we'll just say relatively speaking, ten versus another one who started at the age of five. Do you think that cumulative dose, you know, that volume that builds up over years of time is that detrimental? Like in terms of when we're talking about developing injuries or, you know, predispositions risk, is that kind of more of a risk factor? Or do you think an athlete that started later in life who does greater volumes of training in a shorter period time is more detrimental? Yeah, I think at that age bracket, that's a great question. I think at that age bracket, like five to ten, I don't think that that's going to be a huge accumulative training load or concern for someone who does a lot of gymnastics because usually what you're doing at that age and level, if you have a coach, and most coaches are amazing, they're doing the right thing, they're incredible people, they're not doing crazy stuff, they're super young, it's basics, fundamentals, you're just doing a lot of strength work and having fun. So it's not so much the five to ten age bracket that is where people might get into hot water, it's the ten to fifteen bucket. That's really where we see the majority of problems come up because in a lot of people in gymnastics by age ten, you've been in some sort of town ID radar where you're actually, you know, doing skills that are challenging and you're doing things really hard. Like nine-year-olds in gymnastics that are really high level do some crazy stuff, right? And we all know that that's absurdly young age to handle some high forces. So I think from five to ten it's just kind of getting things together, but ten to fifteen is where things can really fall off the wagon and that's kind of where I think the majority of the work that we're doing in gymnastics is trying to focus on because we see a lot of people who do accumulate too many training hours and too much high level forces when they're not, you know, they're pre-puberty, they haven't gone through emotional or mental or physical development and they can't quite handle what the sport might have to offer for them if they want that path, which, you know, the sport handling could be physical forces, that could be emotional pressure, that could be the fear of gymnastics is real and there's a lot of other things that go with it, but yeah, I would say it's probably ten to fifteen is where things might get dizzy. How much this is going to be a difficult question to answer or maybe not? How much of it is, you know, when things get dizzy, as you said, the fact that, you know, individuals are probably the time when people are kids or children are going through puberty. So is it hitting the growth spurt, right? Losing some of that body awareness versus inappropriate training loads, technique issues and then culture. I know you spent a lot of time and this is one of your areas that you enjoy talking about versus, you know, how much training it is, how the conditioning works, the kind of feedback and the discussion that they have, how, like, is one more than the other that tends to get the wheels to fall out the wagon faster? Yeah, great question. I would say the biggest one that's obvious is puberty because it's inevitable, right? It's inevitable. Everybody goes through it. It's like always a period of time where somebody declines in their ability to do any sport, not just gymnastics. So I would say that that one's probably the most obvious and it's probably the most in people's minds. I think that we still have some work to do about normalizing puberty in our sport and many other sports, like baseball. I mean, obviously you guys know I work with some pretty high level baseball PT's. We see this in other sports like, you know, soccer. I think that that's unfortunately something that some not all coaches and parents and athletes view as like an annoyance, like a nuisance they have to deal with like, oh, puberty, I can't believe you're growing and maturing. Like some people have that mentality where like, oh, if I could just get this goddamn biology out of the way, I'd have a superstar, you know, and like, that's a really unhealthy way to take it versus like embracing that and saying like, well, one, this is normal and good luck stopping the strain. It's not going to happen. And two is that it's actually a good thing because that's where all of your strength and power and endurance performance benefits down the road come from when you have a natural system that matures and you get the, you know, the neuroendocrine response, you get the ability to handle these things, you grow actual, you know, muscle mass that can handle some of the high forces. So I think that's something that I guess intertwined with culture because it's a physical, you know, necessity and it's also inevitable, but it's very much in a cultural landscape if you don't treat that well. A lot of people do fall apart metaphorically in those years because they feel as though they shouldn't be going through puberty or they shouldn't be becoming a young man or woman or something like that happens. And so there's also still some stigma around that and our sport around what some people deem is aesthetically pleasing. And so that unfortunately, you know, sometimes gets thrown around as a huge problem. It damages a lot of young kids mental health when, I mean, we all know we all went through puberty, right? It's already awful as it is, but not alone, somebody making comments about the way you look or, you know, saying, well, your skills, if you just did this and like, you got to work harder, it's like, it's hard to work harder when your bones grow longer every month than your dimensions change and your hormones are all over the place. And now your neurological system has to recalibrate. Like, so I think it's getting much better. And there are, like I said, there are a lot of amazing coaches who handle puberty the best they can, like an absolute, you know, ninja. But unfortunately, it's still something that we see as challenging because one of my friends, Jason McCouse, he's a super high level dietician and nutritionist and he said this on a podcast that I had. He said, you know, gymnastics tries to make elite athletes that have the most chaotic time in their life, which is puberty. So like a lot of people are asking young kids who are clearly not quite ready emotionally or physically to handle this crazy sport. They're asking them to do things that are very, very challenging. And I think that's where we've seen some of the culture shifts a little bit. So, yeah, puberty and then a combination of the culture that kind of wraps up into the training load problem, which is like, we have to go now, we're going to miss our shot. If we want to make this team, we've got to be by this level at this age. And I think that narrative that's changing, thankfully, actually, as we saw in the recent Olympics is changing quite a bit. And I think a lot of people fear that if they don't go fast from 10 to 15, they're not going to get their skills. They're going to miss their shot for college scholarship. They're not going to get looked at by these big division one schools. And I think that starts the hamster wheel of, you know, do this, then, okay, now make this team, now win this meet, now go to this camp, now get on the radar of these people, and now sign, and then here you go, right? And I think that is a very dangerous path to put somebody on when they're young, because one, there's many other ways to go about it that are definitely different. But two is that you start to really create an ongoing snowball downhill of possible problems. Yeah, I mean, I think to say that these are unrealistic and unfair expectations to be put on children at the age of 11, 12, 13, 14 that tend to, most likely, have unintended consequences down the road as we're going to touch on later. But, you know, the women's gymnastics team that's happened over the last couple of years. But I want to take a step back real quick. I actually, one time, I remember when I was shadowing you, we had an athlete who you were treating and you were asking him what level she was for those of us who aren't involved in the world of gymnastics. How does that work? Explain to us what different levels are. What do they signify? Yeah, so levels are, I guess, the competitive side of gymnastics. I mean, there's a couple of things. One is that there's a huge non competitive part of gymnastics, like just recreational fun. But within the competitive domain, there are disciplines, right? So you have artistic, like artistic gymnastics is what I, most people are understand, which is what we like men's and women's artistic is like the four events for women's, the six event for guys, we have rhythmic gymnastics or tramp and tumbling. There's many different disciplines at aerobic gymnastics, but the levels typically refer to kind of like progressive challenging of skills, right? So the more difficult skills get, we have a code of points that has a bunch of requirements for you to meet level one and level two and level three. And so once you get those skills and you compete them successfully, you can then start training the next level of skills. So someone who's a level four is probably a lot younger and is doing what we call compulsory routines. So the routines are the same for everybody. So every kid at the meet will do the same 92nd floor routine with the same dance, the same skills. And if you do well at those meets, you can then start working the harder skills. You get moved up by your coaches and team and stuff because you've demonstrated proficiency in those. So like level five, level six, level seven, and once you get to like level eight and above, it becomes what's called optional gymnastics where you actually make up your own routines based on skills you'd like to put in it because there's different ways to get a score, right? So typically what you see in the world of like elite gymnastics or college gymnastics is people who are constructing their own routines to try to get a certain score that's higher, right? And in the women's collegiate program at 10.0 and the elite system that's open ended scoring. So the harder skills you do and the better you perform them, you can have the higher starting score and they deduct 10th from that based on, you know, if you have execution errors or do you fall or, you know, that kind of stuff. So yeah, levels refers to the way that we categorize difficulty and how we create a system of progression for young athletes to kind of go up through. So what's the highest level that you can be at? So elite is what the Olympics are. So it goes one through one through and our system in the US right now for, you know, our development program, it goes one through 10 and then once you get to 10, you can test or do a compulsory in an open meet to test into elite. So you go to a meet, you have a certain, you know, situation with routines and compulsory is an elite and if you get a certain score at that meet, you're then qual, you're then like considered an elite gymnast and from there, you can then enter into the elite meets which qualify you to the, you know, national team and stuff like that. And then college is kind of a separate situation. It's like, you kind of go up through whatever level and you just go to college. Once you're in the NCAA, you're a collegiate gymnast and they have like division one, two, three, but there's all sorts of levels there, especially with like this club gymnastics two in college, it's not only about NCAA. So it kind of gets all mixed in there at the college level. Gotcha. I was just actually about to ask you that for like a D1 athlete. What level would they probably be at like a six seven or? No, yeah. So it ranges. So six, seven, eight, six, seven, eight, nine, I would say six seven eight is definitely probably someone who's like in high school still. I just kind of working now. There are people who go from like level eight to like division three programs or club programs. That's totally, you know, a great thing that a lot you got the option for, but typically the higher level like division one schools are someone who's level 10, like level nine, level 10, and then someone who's probably done a lead, a lot of elite gymnasts are the ones you see probably going to back to college, right? So like Jade Carey's going to Oregon and Morton, her it's going to Florida and rather McCusker's going to Florida, like a lot of the elites will also go into the college team. And like a really great example is like Michaela Skinner. She went to Utah for three years, competed as an NCAA gymnast and then stopped. So she wanted to try to go through Olympics again, stopped her junior year, tested back into elite and then went to went to the Olympics and want to sell her medal in this past took your Olympics. But it's just a little bit of a toss up because you have to either if you want to get a scholarship, you can't declare pro status. If you want to go to the Olympics and not take a scholarship, you declare pro and you get sponsorship stuff like that. But that's changing now with like the national image and likeness where now athletes can start to get some financial support off of their, you know, sponsorship deals. So, but yeah, that's I don't know if I answered your question. Gotcha. Yeah. So what's the what's the average age then for like let's say an Olympic athlete like the US women's team? Yeah, it's interesting. So it's actually trending, right? Like quite a bit differently. It used to be in the 50s and 60s is actually like much older, like in the 20s and so. And then as a whole bunch of stuff happened mainly is that a lot of the Eastern block Romanian methodologies started to come to America. It started to become younger and younger and younger. And there's a whole different discussion about why that actually happened. It wasn't for some different situations, but it was not great. But anyways, younger and younger, and then as we got to like the 80s and 90s, we saw some really young people, you know, you know, successfully. And I say that in air quotes, making it through is like Dominic Muciani was pretty young and Nadi Komenici is probably the most famous example of someone who was super young. And so that became like, okay, everyone's going to go younger and younger. And then what was happening actually behind the scenes versus what we saw at the surface level were two very different depths of problems, right? So like on the surface, you saw a lot of people making national team and competing and blah, blah, blah, and like doing so well in the fame, the Wheaties box and all that. But behind the surface, what we know now, which came out from the scandal is like just so much destruction, just collateral damage of the biggest degree from behind the scenes, which you didn't see, which was overtraining and injuries and abusive coaching styles and disordered eating again from some of the coaches, right? Like so many amazing coaches are doing the best thing. But unfortunately, some people went to very, very horrific length to try to make high level gymnasts. And that is kind of what happened in the last five years falling out, as we learned about a lot of the things that, and honestly, it was happening like people were speaking up for 20 years, but unfortunately the powers that be made it so that wasn't voiced. But what happened is that more and more we learned about it. And so now the age trend is going the other way. As we see more and more examples of people who are breaking very much that misconception. So you can go down a list of a ton of people right. The average age, I think of this year's Olympics for the US team was 20.9. But I think the average age of all Olympians was higher like in the mid 20s. So you see people like LA Black from Canada. She's 26, I believe. She's on her third Olympic cycle. Becky Downey is 29, I want to say. And she's gone through two Olympic cycles. She's I think she's trying for another one. We have people on the team like Mikaio Skinner, who's 24, Simone Biles is 24, entire Dutch team is older. A lot of the people from international are older. So there's multiple people now who are not only like, you know, being successful on the stage, but they're competitive on the successful stage of elite gymnastics. And so like the New Yorker Francis is a friend of mine who I done a podcast and she's she missed. She was on GB's reserve team. She was the alternate and then she tried to go for Jamaica. I had the highest score. Jamaica picked somebody else in 16 and she went again for five more years and she made it as an Olympian this year was her first year. She was an Olympian for Jamaica. And so like, you just see multiple examples of people who are like kind of breaking that misconception. And it's very, very good because it helps to inspire a lot of younger people like, yo, slow down at 13. Like we don't need to go crazy. Right. I saw I'm curious to know, is there a new trend now that most of these gymnasts are on their second or third cycle or was it always like that where you know, people had the opportunity to go two or three times and they were good enough to go two or three times the Olympics? Yeah, I think most people just did, you know, one because it was just so hard. It was so demanding and it was so brutal on their body. But I think the change that we see in culture and that, you know, that the shift in the way we're doing training loads, the shift in the way we're doing a lot of pieces with the way we approach coaching styles. I think it's allowing people to kind of get more years out of their career because they're feeling like they can go in a long haul. And so I think that, you know, there's a couple of things that are challenging. One is that not everyone, not everyone, very, very few people want to go to the Olympics or have the ability and the, you know, combination of the stars aligning to have that, right? Whether that's financial resources, whether that's the gym, whether the location, the natural talent, the coaching, it takes a lot there. But a lot of people want to just go to college and compete, especially in gymnastics and challenge there is that there's still a huge problem with early recruiting and, you know, the problems of trying to talk to people when they're really, really young. And I'm really good friends with a lot of the top programs and work with them and they agree that like we're don't want to do this. But like, you know, unfortunately, when you say, okay, everybody stop recruiting kids that are young, a lot of other teams who are kind of in the middle-ish tiers will take that as an unfortunate opportunity to recruit these people and try to get them to go. So a lot of the reasons that I've talked to coaches and I've learned a lot about this from their point of view, do work with high level, like level 10s and elites is, you know, they tell me I want to go to college and get a scholarship. It's my dream come true. Well, if that's the case, then like you need to be doing some pretty serious skills when you're 15 and 16 in order to do that, you have to be, you know, training when you're younger and hard. So there is a way to train those high level skills and get to that college level and get to that high level without, you know, running someone into the ground. And a lot of great coaches show that, right? Like Brian Carey's a great example, Jade Carey's dad, he's phenomenal. He seems like a phenomenal guy and they've done a great job bringing her together and she's, she's an Olympian. She's an Olympic gold medalist, right? But like, she reached an elite level, you know, she did all of her training, but in a way that was probably safe and healthy. And so I think we just need to listen to those coaches who have that different approach and who are very successful and be like, okay, what do we need to do? How do we share your education? Because you do need to train hard and you do need to train quite a bit to be successful on the college or the elite stage. But there are many different ways to go about that to make sure that someone is not like we just said at the age of 10, 11, 12, 13, you know, accumulating a lot of emotional stress and mental health problems and physical dangers that they then kind of carry with them the rest of their career and infusion limit them. So it's definitely changing and it's definitely a good thing to see, but there's certainly a lot of work to do to make sure that everyone is kind of following those best practices. Dave, we've kind of talked about this, this or used the word culture quite a bit already in the last 20 minutes that we've been talking and as you know, the name of the show or the word redefined is in the name of the show. And I think part of that obviously progression and growth is really important, right? We're doing things a better way. That's kind of what I'm hearing from you. But I think it's also important for us to understand how we even got here or why we got here. So we're not repeating the same mistakes again, right? So some of the things that it sounds like it's a culmination of different things whether it's poor coaching, growing style, training loads, just maybe lack of education, part of it was because athletes growing younger and younger. And if you don't mind touching into why that was, maybe dive a little bit deeper into why the culture wasn't as good. I mean, because you know, lots of other sports at the Olympic level, I mean, there's tons of sports, right? And and their international sports, we got track and field, we got Olympic weightlifting, we got just parallel thing, all kinds of stuff. But gymnastics and notorious for having this culture where, you know, you have more abusive style coaching, the volumes are really, the demands seem to be unfair as we've talked about. And the second part of my question for you is, is that unique to women's gymnastics? Because I don't often hear about it in men's gymnastics or maybe it's just a lack of appreciation from our part because, you know, men don't tend to report it as much. Which one do you think it is? Yeah. So the first part of the question is, you know, how did we get into this situation of a culture problem is multiple layers. But a few to name the least. So one is that, like we said, typically the athletes trend younger in age. And so there's more of a power differential. There's a much larger power differential between 12 year old and a 30 year old coach or 40 year old coach than a 22 year old professional athlete who's a swimmer and a 30 year or 40 year old coach, like a 22 year old female swimmer is autonomous. She can speak for herself. She understands, she's gone all through all these things and she very much understands mentally, emotionally, and physically, the cost of doing, you know, the sport and that kind of stuff. That's not the case for the 12 year old, right? So parents involved. But a parent is also oftentimes undue educated. They don't understand the sport. They don't really know. So they're just trying to do what's best for their son or daughter because oftentimes the kids just love gymnastics, right? And they want to be in the gym. It's fun for them. Their friends are there. They want to be involved. And so the parent is just trying to desperately do whatever they can to keep the kid happy inside the gym. And then they'll know a lot about the sport. So the coach is kind of the one who is at the mercy of saying, like, well, we have to do this or we have to do that or she has to train more. He has to do this or he has to go more. So that inherent power dynamic with someone who's younger is a huge catalyst for possible potential problems, right? Like a lot of people respect that. Like I keep saying, and they're wonderful. But a lot of people, unfortunately, that is where that power vacuum kind of exists where somebody can step in and do something that's that's unethical or a moral. So that's a piece of it. A second piece of it, I think, is the, unfortunately, the educational system that we have here in many places across the world is not really as great as it should be in terms of like license certification, you know, clinical mentorship. Like I preach to a lot of countries and programs that I work with that we should mimic the medical model actually to do this. Like, no, you have an academic coursework. You have a clinical coursework. You have someone who oversees you, you test out, what's the whole thing? You demonstrate your proficiency in skills, just like we did in medicine, right? So I think that that's a huge problem too as well because you don't have a lot of people who are getting guidance on, you know, how to do these things safely in an appropriate way in utilized science, right? Like third thing, like there's still a huge lack of evidence-based practice in gymnastics in general. Like there's a lot of progress being done, but there's just every sport like baseball and basketball and football loads and loads and loads of evidence-based practice being used, even if the research isn't there, they're extrapolating from other sports and they're trying to understand how can we apply this research and, you know, whether it's the educational problem, whether it's an ego problem, whether it's, you know, a variety of factors, a financial resources problem that just hasn't happened in gymnastics. I think it's a reason why shift is so popular because I try to just, you know, be a massive geek and share some tidbits of information, but that's a big one as well. And then yeah, I mean the most honest one that's a big elephant in the room is like just just the standard of moral and ethical guidelines just didn't exist, right? Like there's nobody, when you look, when you peel the back, the layer back on, you know, what's happening in the scandal that happened in the last five years, you know, you see a lot of people who were just straight up not holding people accountable for their awful actions and like, you know, we're chasing the money, the status, the fame, the metals instead of protecting young kids. And I think when you have, unfortunately, people in a position of power who are leading very much through their vices and not virtue, you know, that's where things completely fall apart. And so yeah, it's a lot of different factors, but in the same lens, you know, there are people who have done the right thing and are amazing and are showing us that it's possible, and it's not all bad. It's just that we still are in the very much the wake of collateral damage because a lot of people got hurt. And I think we we deserve to be in the spotlight of someone who needs some some serious overhaul, but it's it's just a very daunting task, you know. Yeah, and speaking of individuals who have been showing things, all the cool things that are possible, Simone Biles is as one of those individuals, right? And she's been everywhere when you look, particularly we just finished the Olympics and we're recording and, you know, obviously, this is what this she's been to the Olympics three times is it? This is this is this or second, this is the second cycle. And obviously one of the best gymnasts in the in the history of just gymnastics, not just American and women gymnastics generally, the whole issue with her taking some time off and citing mental health as reasons we now have more of an understanding what was going on behind that. But at the time, the backlash that she got, I mean, I you couldn't turn on a different channel on TV. I don't usually watch TV, but even in the waiting room and like the patients are everybody talking about it, right? I mean, it's understandable. It's a worldwide event and everybody's participating. I'm curious to get your take on it. I mean, you are involved in this and heard a lot of people play armchair, I don't know, armchair, quarterbacks right for armchair gymnasts here. Keep an expert. Yeah, keep an expert. Yeah. What are your thoughts? When you first heard the news, like she took step back, what went through your mind? Yeah, so I mean, like everybody, I mean, the biggest problem that came out here first was that people are just so quick to judge and jump to conclusions and assume they knew it was going wrong. So I woke up at five o'clock in the morning and I watched team finals live with my teammates on Skype, right? So we were watching it live. And of course, like why she leaving? What's going on? Like is she heard? Is she not? Like what we don't know? And it's like, oh my god. So everyone has that same gut reaction, but like what's going on? And I think that the more that you learn about it, wanted a huge lesson and not jumping to conclusions, right? Because nobody has any idea what's going on in someone's bios of life, right? And so like, let's be frank here that like there could have been something happening that we don't know about that comes out later and it's devastating. And I actually believe and I think this is true. I don't want to quote it fully, but I believe her aunt passed away shortly before the Olympics or before trial. So it's like I hope a lot of people who are quick to judge took their foot out of their mouth and realized that they made a mistake because like, it's terrible. I mean, it's awful. But that being said, the misconception of why she pulled out, I think the media unfortunately was so fast to put it out and spin it that they kind of maybe misinterpreted what was really going on. So what my understanding of the situation, I don't know someone personally, I just know friends who are friends with Simone and you know from what she has come on said. So the twisties are really one of the reasons why she stopped, right? So the twisties sounds like an innocent name. It sounds like, oh, that's so fun. But the twisties essentially are like, um, vertigo and steroids. So when you do high level gymnastics, right? You flip twist and you kind of go through the air and stuff like that. It's very easy to lose your sense of where you are, how many twists you've done and how many flips you've done, right? So that is what the twisties are. And we have a lot of pro athletes that come to our facility champion and a lot of them immediately asked me about what I thought about this. And I was like, this is the only thing I can compare it to. Like if you're on the beach and you try to surf a wave, like a body surf a wave, and you get caught by the rip tide. And so you just get like thrown completely like ass over teakale. You don't know which ways up, down, side to side, you're just like getting thrown and then you hit the sand eventually and you're gonna kind of pop your head up and like, what the hell just happened, right? Like you have no idea which way it was up down. It's terrifying, right? It's literally terrifying to have that loss and perception in vertigo. And the other thing that people have said this up, like going to pool, really deep pool and you just like close your eyes and free float. You don't know which way is up and down in front of back. So like you lose your equilibrium perception. And so that's what happens in gymnastics sometimes when you flip and when you twist, right? So when you flip and twist really fast, you can lose that sense of equilibrium. That is what the twisties are. It's a loss of that perception in the air. And so you think you've done two flips and you open up and you've done one or dangerously one and a half to your neck, right? And so same thing with twisting. She does a two and a half on vault, which is her vault. So she goes backwards up the table, back handspring to do your Chanco Amanar as a two and a half twist. So she's supposed to do two and a half revolutions of a twist before she lands. She thought she was done at one and a half, you know, or she didn't know where she was. So that like the actual process that happening is terrifying. I've had that before and many of my friends are however, it is so so dangerous, right? Because you think you're done with your flip and your twist and you open up and you're not and you break your leg, like people have literally died on vault, like landed on their neck from issues like this and died. And so like the chance of you continuing to do the thing over and over again, when you have lost your equilibrium and you don't know where you are, broken legs, broken neck, like you can get seriously jacked up. And so that was the reason that she stopped during team final because of a physical risk of her health. And I think that's what the media was so fast to put out that nobody understood is that this was a physical danger issue, right? And like this is the equivalent of like someone is warming up, right? And they like break their arm, right? And they're trying to keep swinging or keep doing something, right? Or like they blow their Tommy John like them out and they're trying to pitch 99. And every pitch is like agonizing off on the risk of high, high harm is so high. You wouldn't be like, yeah, man, go get it. You know, like you wouldn't be like gladiator mentality. And so that's what that's what was happening, right? So I think from my understanding and my understanding of situation is that she knew she had the twisties. Unfortunately, it doesn't like you don't know this is coming, right? This just comes like literally out of nowhere. It can really just happen spur of the moment. And I've had some serious issues of this, but it takes months to recover with like some softer landings and you got to go back and do drills and the basics of fundamentals. So in the moment of the warm up and in the warm up gym, she started having this. She couldn't really get her sense of equilibrium. And so, you know, she went out and tried to warm up. And that's when she, the famous like she did the one and a half. And I was like, whoa, what happened to warm up? And then she didn't didn't compete, right? Because she thought she was going to get really dangerously injured. And so in that moment, I think there are a couple things not to belabor the point. But one is that she took a step back from the team competition because she knew she was probably going to bomb, right? She was probably going to blow it for the team in the process of getting massively dangerously injured. So she gets hurt, right? Or something happens. Everyone's like, oh, bummer, she got hurt. She has to live with that injury, right? And that's huge. So her speaking up for her own health and that point was a really good point. But also she was saying, like, if I do this and I get lost in three out of my four events or all my events that require twisting, I'm going to possibly fall on all four events and we're going to get fifth or six. And I'm going to cost the team metal for everyone else. So that was the whole situation from my understanding. She had the twisties, she was going to get seriously injured and that she didn't want her chance of her problem to blow a metal for the other team. The twisties, how common is it to, I mean, is it, I know it's clearly very dangerous from what you've described, but how common is it? Is it a pretty routine thing that gymnasts experience? Yeah, I have, I don't know a single gymnast who's never had it in some way, shape or form. The only people who might not have it are people who are not naturally good twisters. They do more flips in their skills. I have teammates in mind that never really were good at twisting. And so they just did a lot of flipping skills or didn't do floor and vault. But yeah, almost everyone I've ever talked to has some case of it and usually what happens is it comes out of nowhere. You like get lost in some twisting and stuff like that and then it takes you like anywhere from like a week or two down to like two or three months to get back to like kind of get your basics back around. Wow, that's wild, man. Yeah, I mean, having positional and body awareness when you're flying just twisting your body. I can't imagine why that would be important, right? You know, you know, what's impressive about that situation? I know that some of the narrative has been either, she quit. Yeah, right. Well, it's been that, but you know, at least the people who have appreciated the mental health aspect of it are coming and, you know, given a hand or round of applause saying, oh, listen, mental health, she's appreciating that. But from what you're describing to me right there, I mean, how often is it that both you and I, we see athletes, we know that they're injured, but again, they want to play and you have to save the athlete from the cells, right? You have to pull them out. Like, nope, this is not safe. I cannot clear you to return to play it at this time. And you know, here you have an individual who spent the last five years, thanks to COVID, preparing for this one event. And again, it's probably going to get gold if she does. And is saying, you know what, I am not the best person to go out there for, of course, you know, for my own safety reasons, but also because I'm going to cost my team, like putting the team above all. I mean, I, again, I haven't, I haven't had my pulse on this, probably like you have, but again, that's part of the conversation that I haven't heard. So, me, to me, that stands out as like, just as awesome, right? Yeah. I mean, it makes people like my job. I mean, my one of my attendings was covering, he was covering the judo stuff over there, but like, as a physician, like, that's awesome. I really appreciate you making my life easier and not making this difficult decision because the hardest thing to do as a physician is when there's an athlete right there and they don't look right. And you can see that like, concussions, right? This happens to me all the time with concussions. I'll see kids on the sideline and wherever I'm like, no, I'm sorry, you don't look right. They're like, no, no, and they'll be able to clear it, but you have to make the difficult decisions. I'm saying, I'm sorry, you can't go back. So, I mean, that's, that's really awesome. Yeah, for sure. And I think there's a couple of things. One is that for her to speak up and say, you know, my health is priority physical, primarily, but then also mental as well, like the dangerous part you mentioned, like that alone is incredibly courageous and impressive because I think, unfortunately, like, what people don't realize, I mean, every gymnast that I know, like, obviously, was like, wish it didn't happen, was upset, but the same time was like, oh, I understand. You know, like, I, like, the people who I heard about on talk show radios who are saying, like, someone called her like a greedy sociopath who is an embarrassment to America. And I was like, bro, you need to take a hard look at your life. If you think that is what's going on, but that person has literally never done a forward role in their life, right? The people who are involved in gymnastics completely, like, as soon as we've learned more again, the lesson is, is pause and reflect. Don't jump on Twitter and just shoot your mouth off. It's like, once you finally learn, like, oh, the twisties, that sucks. That's, that's really unfortunate timing. That's pretty much the worst thing that can happen to you at the biggest day of your life possible in your career. And you understand that you suck, it sucks. You wish you didn't happen, right? Like, think about all the people like broken bone, injury and warm-ups. So they get like, man, that sucks. You know, that's unfortunate. It's part of sports, though. That's how it rolls. So that piece alone is a big piece of it. The secondary piece, which is huge, is the example that it sets on how important, you know, speaking up for your own health is, but then also mental health in general, that was a huge conversation I got triggered. It was crazy, man. I was driving home today from the clinic. And I watched a manual at you. I talked a little Wayne about mental health off of the backbone of this story. The first thing he said, it was like, yes, Simone Biles. And I forget the tennis player. Her name just gave me right now. But she spoke up as well. And like, that triggered a little Wayne to talk about a conversation with a manual atcho. And in that conversation, he's there for the first time ever. He tried to kill himself when he was 12 because of mental health problems. And his, like, his parents, like, the police officers found him, like covered in his own blood. And then he became like his, his former, you know, it's crazy. It's like the fact that like she was able to speak up and say, this is important. And now so many people who are able to speak up for is important on the general scale. But back to what we talked about before with the scandal and stuff, is for so many years in gymnastics, and nobody understands the ripple effect of this culturally on gymnastics, which is why it's really important to might mean it means so much is in past years, athletes did not feel comfortable speaking up about their own health, right? And that caused a massive wake of destruction in so many way shapes and forms, whether it's the abuse cases or the injury cases or whatever else. So for her to speak up and say, no, this is not okay. And then for her teammates and the coaches to respect that decision and say, like, it's okay. We got your back no matter what. Like that speaks volumes for the chains that need to happen in gymnastics. And I think if you're not involved in gymnastics, you don't understand that. And if you don't, if you've never had mental health problems, and I have, you don't understand what that means to say, like, it's not okay. And I need some help, right? Like I think unfortunately, people are to the perception of the situation is so far off from what the reality is. And again, nobody but some own vials knows what's going on. So who are we to judge? And even the ones that most close to her, her teammates and her coaches who learned about it and the physician with her, they don't even know what's going on, right? And of course, we find out something like her aunt passes away. Like that's back there, you know? Yeah. No, it's absolutely wild. This is the first time I'm actually hearing about the twisties. Like I had no idea because the media twisted, if I could say the story, it's not. It's a story in terms of fully making a mental health picture, right? And I think because mental health is on the comma, more and more people are talking about it, but unfairly, in my opinion, made it about mental health, when it was truly something physical, right? Like, this was a physical danger in the NFL. If you get hit to the helmet, you're out for play, you're getting evaluated, right? MLB, if you're getting hit by a pitch, you're right, a 100 mile for hours, you're going to get seen. And so I think in that context, it really opens people's eyes up, right? When they say, wow, that's scary to think about that. I mean, I'm no gymnast, but I was a stuntman kind of for a dance team back in college. So I was doing like that flips and things like that. And I bailed out a couple times, right? Like in the middle of the air, it is scary. And I can only imagine doing like three twists and three flips right there. And it's really interesting because Chris Bosch, you know, basketball player from Miami Heat and Toronto Raptors, was just got interviewed by Tim Ferriss. And he kind of looks back on his career and Tim Ferriss asked him, hey, what's the one thing you want like the public to know? And he says, the one thing I want them to know is to understand that us athletes also have lives, right? And that we're not a Monday to Friday job. We're also working the weekends. We're also working the all season. But human being things happen to us, right? And that's kind of what you just described with Simone Biles, right? Or on passing away. And who are we to judge kind of what's happening in her life? But to touch on the mental health aspect, because of course this is now a byproduct of it, right? I'm sure when she gets back, she has to say, man, I have to retrain. I have to get comfortable again. I believe it was your first episode of your podcast, The Shift Movement. Was that that was about mental toughness? It was interesting because you brought someone in and it was, I don't know what the age range of those of those girls were, but it seemed very young. So how important is it to talk about mental health and teach mental health in gymnasts, right? What age are you starting this and what type of exercises are you using to develop mental toughness? Yeah. So I think the first thing that you have to remember is why gymnastics is so hard is like the fear in gymnastics is so real, right? Like from a very young age, you're doing things that are very, very possibly dangerous for your health. And there's, I don't want to undermine your discredited other sports like so much, which are extremely dangerous, but comparatively to some other sports, like the risk of possibly getting seriously injured and every turn is very high for gymnastics. So sometimes like, but like, there's other sports where like, yes, you can play, you know, tennis or you can play baseball and stuff and like they're hard, they're dangerous, you could get hurt, but there's a chance of you catastrophically injuring yourself is lower comparatively gymnastics. So in a very young age, you are exposing that fear to a lot of kids. And that's where the first kind of like spark of mental health happens. It's like, there's this thing called the mental block in gymnastics where like maybe you fall on a skill you're training or you get hurt or like you start the fear becomes real. And it's very hard for your body to do it, like you freeze, right? Like fight, fight, freeze, right? You just freeze and you can't do your skills. And so that's usually the first time that a lot of these conversations come up as around fear and skills and stuff like that. And then also, as we talk about with puberty, there are multiple other reasons why you could have mental health problems, right? There's anxiety, there are the fear of like judgment of other people. There's all sorts of problems with like pain disorders and all sorts of things related to like the fear of performance and feel a failure. Like so many of the things, I think a lot of gymnasts unfortunately, the sport is very much has a perfectionist mentality and unfortunately has a comparative mentality, right? You're judged. It's literally called a judge. A judge gives you a score. So I think that that creeps into a lot of people and they get like comparative stuff when you're young and you're going through puberty, like I said, when you get the whole different conversation that a lot of my friends have talked about, especially like high level dietitians have talked about like body image and you're in a leotard and there's people watching you. Like there's a lot of threads here that could possibly become mental health problems. And I think a lot of those tend to give a lot of young gymnast depression issues when they're upset about their performance, they're upset about feedback, they're upset about something with their life. Like there's a lot of pieces that come into it. So all of these get tied into a young age with gymnastics. But in terms of how do you deal with that, I mean, you have to know your lane, right? Like things talking about technically correcting a skill to make sure you feel confident in the technique to not fall on your head. That's definitely a coach's role, right? Coaches are experts in teaching these skills and planning these practices to make sure you're going through progressions. You're strong enough and you're physically fit enough and you prepared for what you're going to do. But then again, the pieces that come down to anxiety, depression, eating disorders, body image dysmorphia, those are clearly things that are required to help of a licensed practitioner in mental health. So psychologists, psychiatrists, physician, stuff like that, I think and that's where the sport is changing. We're more interdisciplinary cares happening and more evidence-based cares happening. But we still have a lot of work to do there in normalizing, you know, getting other professionals involved at an early age to work through these things and normalizing the fact that you should talk about your fears, you should talk about your anxiety and depression right in the right context, right? Like with the proper setting and space and stuff like that, but I still think, unfortunately, this is not just gymnastics, this is all sports. The thing that was the most frustrating with me with the Simone Biles situation was the selfishness of some of the consumers to expect her to risk her physical health for the cost of a gold medal or representing USA. And it's honestly like gladiator blood sport. Like a lot of like the American culture around some of youth sports and not youth sports, but more older sports is like flip a football and think about like some other context sports. It's like they want to see carnage, man. People want to see knockouts. They want to see huge hits. They want to see just devastation, right? And it's like, like you said, dogs, like these people have lives. Yes, they're athletes and yes, they choose to be involved with this, but like this isn't like a, you know, we should expect them to just dismantle themselves for our entertainment. It's sports. You should play sports. Sometimes injuries happen in sports, bad things happen in sports, but expecting carnage is a completely different thing. And I think that's what was so frustrating is like, like I said, her choices were continue, possibly destroy myself and get injured, right? Second option, pull back from my, or you know, go through with it, bomb for the team. She gets blamed by everybody, right? Pull out from my own health. She gets blamed by everybody, right? And then one's like, you know, yeah, but she could have won all their medals. Like she could have possibly, what is she broke her neck? What is the moment? I was broke her neck on the Olympic stage because you had the twisties. What is she broke her leg? You know, people were like, oh man, that's such a bummer. It's so sad, right? And then she goes on her life with this injury and everyone else is like, okay, when's tennis on, you know, bummer about later, when's the next match? And like that's unfortunately that you don't see that, you don't humanize the athletes. And I'm passionate about this topic because you and I endorse and everybody, right? We see the other side of that equation. We see the person in a leg brace for six months with us who's like completely crushed their identity and now they have to live with this and it's a huge whack to their mental health, right? So I think that's where it all ties together. But it's just frustrating sometimes to see people who are so eager to criticize and so eager to say like, yeah, well, you choose this as a sport, your professional athlete, you live from my entertainment. That's what pro sports is. It's like, I think you should seriously reconsider your relationship with sports. Right. And like, I know this happens in basketball all the time when, you know, somebody like I'll just pick on Kweiland or he's in my favorite player. But, you know, if he's taken off because his knees bummed out or something like, oh, yeah, well, you know, he's making 20 millions out of this year. So for some reason, he should go ahead and sacrifice his health or someone ball should risk being a tetra-politic for the rest of our life because she's at the Olympics at the highest level. And she's representing USA. Exactly. Oh, well, you're representing USA. Yes. Yeah, exactly. You know, I think it's safe to say that last probably six to eight years, maybe longer than that, for sure, have been a roller coaster for women's gymnastics, right? I think that one of the things that you touched on before, you mentioned with Larry Nasser, for those of you guys don't know, we're not going to dive deeper into it right now. But feel free to Google it, absolutely disgusting. Basically, physician, completely, you know, violated and sexual assault cases throughout multiple members. I think I mentioned to you, Ali Reisman actually was one of the keynote speakers for AMS SM. Two or three years ago, awesome, awesome speech. I highly recommend for people to YouTube that if you get a chance, very powerful. But one of the things that's interesting with this one, Biles, I think at some point that she had talked about, that she came back because even that whole situation is an ironed out, right? I mean, and US gymnastics did not handle it well. And part of the reason she wanted to come back is so like, you know, the light doesn't just, you know, go away on that, right? She wants to keep shining light on that, say, hey, this situation has been handled properly. You can't just hide it, you know, just brush it under the rug. But as a male provider, male coach, you've been coaching for a long now over a decade, 20 years almost, yeah. Yeah. And how many of your athletes, both as patients in the physical therapy room at a champion and with your gymnastic push shift, would you say, what's the breakdown in terms of male versus female athletes? 70, 30 probably 70 females. Yeah, yeah. So I think as male providers, and particularly all of us, right? Both Darshan, Osteepats, we did a lot of manual therapy. You do a lot of manual therapy in your treatment protocol. How do we navigate that? Obviously, it's, it's, it's a much more of a sensitive topic now, where everybody is playing defense a lot. And like, how did that change your practice, where you concerned, where you have more conversations? What are you doing? Yeah, I mean, I think obviously prior to that, I was trying to be, I already knew the situation that I was in being a male coach and a male medical provider and all that kind of stuff working with females. So I've always been extremely 100% trying to respect all patient, you know, communication, explaining stuff. Obviously, like informed consent being like to the highest degree about why we're doing stuff and why I want to, you know, kind of get involved. And I think that like, you have to take that to another level in terms of your over communicating, your over discussing your any possible thing that might be commissioned as over an ethical boundary, you just don't do. You know, I mean, I'm not going to take the chance of possibly, I never treat patients alone. I never don't have a parent involved, right? We have video cameras on when we have certain procedures to just consent for the normal like training room to make sure everyone knows, everyone can see everything at all times, right? Like always going on. So we're, I'm always trying to like fully explain what I'm doing way before I ever do anything at all before I even put my hands on a patient. And then also with that, I'm explaining why we're doing certain things like like shoulder motions, stuff like that, magic passive range of motion like soft tissue work on like upper back and stuff like that. It's like I'm working on this area for this reason. Is that okay? Here's how we're going to do it. We're going to drape a towel here. I'm going to use this tool and this thing. I'm going to push here. Like you have to overly explain every single thing you do to make sure people feel comfortable at all times. And I think especially with like coaching your massacres is sometimes even more so because if you've ever watched training in gymnastics, things are so dangerous. You spot a lot of people spotting refers to putting your hands on someone to help them through a skill so that they possibly don't get injured if something goes wrong. When you're first learning a skill that happens a lot like you're spotting quite a bit from the waist or grabbing your arms or grabbing your legs to try to help them. And you have to again overcommunicate everything about like I'm going to when you do this skill, I'm going to grab your hips and help put you on the bar and then safely guide you to the ground as a safety thing, right? And like I think that's what you have to always kind of understand. But you also have to put in hundreds and hundreds and hundreds of hours to make sure you understand the proper technical things that you're doing. And there's times when you know someone falls or slips and you grab them quickly and something might happen, you might brush against their body something like that and you immediately say listen, I'm sorry, I completely apologize that wasn't meant to be. You were going to fall. I'm so sorry like let's go make sure we tell everybody about this and we write an incident report and we talk to your parents and I will write this up. I'll talk to your parents and they come after I'll make a phone call the dad or mom if you need like it's so aggressively over the top that I'm about that kind of stuff because it's happened before, right? It's just like someone's falling to their neck and it doesn't you don't even think you're just like and you just like you try to save someone, right? And I have had that happen. But again, I'm always coaching with people. I always have people around me. I'm always doing things with my boss or my supervisor there. 99.9% of the time when something could possibly be your risk. I'm like, I think we should get a female coach for this. You know, I think we should have somebody else do that. I've passed patients off too. And they're like, I'm not comfortable with a male metaphor. I'm like, totally fine. At least it's here. Somebody else can treat you. Like I'll find I'll call somebody somebody for you who is more appropriate. Like I treat a lot of hips and a lot of lower backs and a lot of shoulders. And so like you have to just be like I said, completely transparent with everything you're doing and be overly cautious all the time. Yeah. And and to your point about spending hundreds hours to make sure that you understand the skill and the technique behind it and just the technical aspects of spotting and coaching. I mean, I would even say this you need lots of experience to acquire the skill of communicating appropriately, right? And I mean, communicating with and making sure that you're using the right words to express, hey, what you're going to do and why it's important. And to make the patient or the athlete comfortable and kind of establish that report with you that, hey, this person has the best intention and there's nothing malicious about this. And so yeah, I mean, to those of you who I would say is I've been very lucky in it's not me tuning your horn that I had the opportunity to shadow you for a couple of days is really cool because I know very little about gymnastics and it's just always something, you know, fascinating and super cool and I can see the gymnast body speaking of I don't know much about it, but I remember I wanted to do iron cross and I was practicing a lot because obviously, I mean, what's cooler than an iron cross, right? I know right to be able to do that. And number one thing, like can you do a cross and can you do a backflip? That's what everybody asks. Yeah. Can you? You probably can, right? Not anymore. I can do a backflip. Yeah, that can do a cross anymore. But that's our tour my labor. So don't try that at home people. Anyways, I digress. You know, we spend a lot of time talking about maybe the negative aspects, right? There was a little bit of positivity in there, but I'm curious. What are you optimistic about moving forward? Are you touched about how the culture is improving? We are having some of these conversations. They're at the forefront and people like Simone Biles who opened the door. So little Wayne can have these awesome conversations. But what are you optimistic about when you look at USA Gymnastic, when you look at the culture of gymnastics worldwide? Yeah. So definitely, I think for me, I think the most optimistic thing is that I think we are finally starting to talk about the real issues. Like we're actually digging at the real probs. I think for a long time growing up, particularly because shift was like very much from like 2013 to 15 before like a lot of the skin and stuff came out in 16 is like, I felt as though when we would have conversations with people, I would consult with people like we'd kind of be dancing around the real problems, right? People would ask about strengthening injury prevention and stuff like this is clearly a cultural problem. Like the people on staff here need to have a harsh reflection on their morals and their ethics and you know, take some time maybe to go to their own mental health provider and get some mental health help with fears, insecurities, anger management issues. Like I saw a lot of that stuff and I felt like we weren't really fixing real problems. So that's what I'm most excited about. It's the last four years in particular. I've been like, okay, we're really peeling back Pandora's Box and opening up to figure out what's wrong with the situation to fix it. I'm definitely excited by like I said, more like open communication around like interdisciplinary teams, like a lot of coaches are getting the help they need education-wise. They're getting providers who are very useful to help them offload some of their problems because a lot of coaches are asked to be like 47 different things. They have to know about, you know, gymnastics trainings, training and conditioning and also flexibility and then some stuff about nutrition and mental health and like it's just too much for them to handle. So it's cool to see the interdisciplinary stuff start to happen and then it's also really cool to see like actual science being used, you know, people like basing their practices off of periodization and training loads and proper flexibility methods and like, you know, real like hardcore science that we've had in other areas. And I think the biggest thing for me is positive and is exciting is seeing, again, more coaches, like I said, who are great examples of doing the right thing and coaching kids in a healthy way that they generally care about the athletes well-being and are willing to have a spine and stand up and make that hard decision. Like Amy Borman is someone's first coach. There are multiple times when she had stood up against, you know, someone possibly being injured and saying like, no, we're not going to compete this meter, this and that. So like, you see more and more examples of that of that coming out. And I think it's cool because now we're seeing a lot more coaches lead with like inspiration over intimidation, right? They're much more transformative. They're much more forward thinking they're not just hardcore. Do it because I said so. This is the way we've always done it kind of like, you know, abusive techniques. And those, you know, like I said, those 80 to 85 to 9 to 95 percent of coaches who are amazing humans doing the right thing every day you don't hear about because they're too busy working. Their platform is getting elevated to help people recognize like, oh, there's great people out there who are doing amazing things and we should follow their lead. So those things are all definitely exciting for sure. What a great show with Dave Tilly. Now, this episode was packed with conversation regarding culture change, learning about the history and the future, which is critical if you want to redefine our approach to a better one. But make sure to tune in again next week when Dave comes back with part two, which is more focused on common injuries in gymnastics and we walk through the injury to performance continuum. By the end of this series, you'll come to appreciate if you haven't already that Dave is one of those rare individuals who's continuously doing his part to shift the culture of gymnastics, sport and medicine. And before we end, here's a quick reminder. If you want to boost efficiency across your practice and make staff scheduling easier, try the deputy app. You can try this award-winning technology for free by going to doctorpodcastnetwork.com slash deputy. That's doctorpodcastnetwork.com slash deputy. But before we sign off, please remember the important disclaimer here that everything in this podcast is for educational purposes, only it does not constitute the practice of medicine, nor should it be considered not good advice, no physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. However, if you enjoy the show, please be sure to subscribe, review and share with anyone who you think will gain value from this as well. Until next time, thank you for listening.