Carlyn Stilling: Youth sport and injury data

Transcript - Carlyn Stilling, youth sport and injury data

Gary McCoy: [00:00:13] As we journey along the pathway of developing The Human Kinesome Project, we talk to veterans who have made quantifiable differences in human and athlete performance, but we also seek fresh perspectives from applied scientific practitioners emerging in the sports industry. Carlyn Stilling is a sports performance scientist in Calgary who, unlike many, measures the success and failures of her programs through athlete availability. Taking that level of accountability is rare, and to find a practitioner wholly focussed on building better athlete-centric models is also rare. When I heard about her programs, I couldn't wait to meet her and discuss her process, to which she graciously took the time to detail for us. Carlyn uniquely has an incredible research ethic, coupled with being a hands-on strength and conditioning coach. She's literally applying her research findings daily. With insights into injury surveillance, youth foundation training, and data from wearable technologies, Carlyn has made quantitative impacts at the University of Calgary in the sport of volleyball and provided insights to NBA Canada studying the effects of athlete training loads.

Gary McCoy: [00:01:37] Carlyn, it's awesome to meet you and thanks for taking part in this podcast today. We have a common friend in Tyler Fraser who works over at Kinetyx, and when he told me about you I was like, hang on a minute: there's somebody else who's quantifying their programs and their existence through athlete injury reduction, and hang on a minute, it's with youth athletes. I was pretty impressed. So I'm looking forward to us having a good chat today.

Carlyn Stilling: [00:02:03] Yeah, it's an honour to meet you and get to chat today. As a student of the workload area, I think I only read Catapult studies for the first few years of my time in school. And just how game changing technology has been has really surprised me, and to work with a pioneer in that area is awesome.

Gary McCoy: [00:02:26] Yeah, thank you. I mean, one of the things we were able to do at catapult was alter the narrative in sports with coaches from something very subjective to something very objective. And look, I know some of the work that you've done, we'll dive into here as well is kind of on that similar pathway. Firstly, how important is technology in your eyes for us moving forward? Because there's a lot of old coaches in a school that will totally resist any data that you show them, right? Their opinion is worth more than what your gadget tells me. How do you see that? Where do you see the future with technology?

Carlyn Stilling: [00:03:05] So I think that necessity breeds innovation. With the amount of youth athletes participating in sport and injury and then the monetization of sport and how important it is to have the healthy athletes. Their managers, strength and conditioning coaches, owners and different teams, club heads for the youth programs, I work with provincial teams, we all see a common problem and we're trying to solve it. And so when you talk about some of the older school coaches, I think because the technology wasn't available, they developed systems that worked really well for them and their values developed differently. So when I look at different coaches and ranges of people that I work with, I always assess where their values are at as a coach. And so is this coach a person that might value technology and innovation? And if they are, how do we incorporate this? If they aren't, is there a different value I could connect and sneak the technology and monitoring into? At the end of the day, if you tell a coach I can have more players available for training, for competition, you have more options, you have a much higher chance of success in that performance. So it's about a collaborative approach with these different people in those settings that can really vary based on the context, the resources available, and with what you're able to measure with technology now. I think you're still at the tip of the iceberg for what we're going to see with athletic performance, and specifically because with youth athletes, it isn't really being used and that is where such a huge amount of potential gets developed and where we can really have a good intervention point from an injury prevention perspective as well. So I think there's massive opportunity to improve our youth programs and then you'll see that filter up to the professional level.

Gary McCoy: [00:05:08] Look, I couldn't agree more. And, it's interesting, you're in a what we would deem or I think what you even identify as a high performance model for youth athletes and beyond. Let's talk about that a little bit. Firstly, how do you define that? Did you personally define it or was it a group of coaches or an institution that defined high performance, and how did they define that?

Carlyn Stilling: [00:05:31] So from a research perspective, we do define it pretty clearly between elite and non-elite athletes and maybe competitive or recreational. And that's something that we always look at. So what's that outcome we're going for? And so usually with high performance, there's common things we look at. Do we have something high functioning that's above the norm, above that standard deviation? Are we pulling or developing the best of the best in that area? Is it the highest level of competition? Are we in those maybe more prestigious competitions or arenas? And then again, there's a difference like performance as a high standard, whereas with recreational activity, we're looking more at participation and getting more people involved in sport.

Gary McCoy: [00:06:16] Yeah, that's really interesting. I mean, I've never really thought about it from the recreational, almost quality of life perspective. You know, this is something that you're staying within and working through because sometimes you'll find too, there's not a lot of difference between a high end recreational athlete and an elite athlete. Sometimes they are one or two steps away or one or two skill acquisitions away as well.

Carlyn Stilling: [00:06:40] Again, when you look at being able to be efficient, bigger, faster, stronger, that has a lot of different avenues to achieve those things for a person. And within each sport, you have a totally different culture and you have a different route to  what a high performance or professional setting might be, eventually. That context is so important. So, for example, with NCAA basketball, that's where you want to be if you're wanting to go to the NBA and getting picked up there. Whereas for volleyball, you actually probably want to go train in Europe after your university, leaving North America, to then come back and play on your national team. So those are two pretty different contexts of development and different systems you're working through.

Gary McCoy: [00:07:31] Yeah, hundred percent, and look, I realise that coming from like Major League Baseball into national team tournament play is a totally different set of circumstances. Where I have to adjust and even tell our athletic trainers, "Hey, we need a different approach. We need him back tomorrow. I haven't got a week." Right? You haven't got those time frames. And I guess the thing I always look for is, is the model athlete-centric? And by the sound of things, yours is. It's one of those ones that too often I've seen performance models that start with a flow chart, an org chart: director of high performance and strength coaches underneath and somewhere the athletes not even on the page. It's like, hang on a minute. You know, you forgot the most important variable here, which is that individual. It sounds like firstly, those combinations of all those things, pulling all that data in and looking at the athlete individually, is how you define high performance. And it probably applies, there's probably different markers at different times and different levels per athlete, I would guess.

Carlyn Stilling: [00:08:28] Well, yeah, I think just what their bandwidth might be for each person. I mean, that's one of the first things we learn in our physiology classes in our undergrad is genetically how different we all are, and then the spectrum of the potential. So whether it's I'm already showing up with predominantly more slow twitch or fast muscle fibres, OK, I might have an aptitude in a certain area. And it's not that I can train the opposite one that I am less dominant in, but I mean, I have an easier time, you know, going in one direction. And so I think when you look at that individual approach, it's paramount. And I'm very biased and say that also from my background, initially, how I got into training was personal training and only working with individuals and individual athletes. And my exposure to team training came later on in my career to the point it was almost overwhelming to then have to deal with 20 people at a time when I had been so used to that individual context for everybody. And so that's the approach I try to develop and try. Obviously, you don't have time to always, especially in a university level setting, to totally individually program. But it was, how much individualisation can I use in these settings? How can I work with athletic therapy and physiotherapy for, say, other rehab programs of these athletes? How can I look at the positional needs of these athletes? And that's where that technology really comes in, is that it allows you to quantify what that individual is doing. It allowed us to create profiles for different positions to allow for a little bit more of a fluid approach in some of these team settings. But, you know, there's other varsity trainers they're in charge of, you know, two hundred, four hundred, five hundred athletes at a time. You just don't have the time to sit there with each one.

Gary McCoy: [00:10:17] I think it's one of the critical deficiencies. And I want to talk about youth athletes and rate limiting factors there. But one of the critical deficiencies I see overall, I don't know whether it's just I came from a different culture in sports science out of Australia, and when I came to North America, there was very much a strength and conditioning, almost bully mindset that is being applied into elite sports. It was irrespective of the movement capability, incapability, asymmetry of the athlete and was more: Well, how much did he squat today? How much did she did lose today? Is she doing a bench press, blah, blah, blah? It's like let's put the athlete into the exercise. Let's not design the exercise for the athlete. And that was one of the, I think, biggest elements for me coming across was understanding that there wasn't a whole lot of individual approach to movement and understanding movement. And it's a journey that I've been on for the majority of my career, just trying to break down and identify firstly: rate limiting factors for a specific athlete to perform with a specific skill. If the coach is driving that tactically or strategically, but to that end, that just seems to be missing. But in youth athletes, that miss is a hell of a lot more critical than the top one percent of athletes I'm dealing with who have got a mastered motor pattern. Right? You've still got rudimentary motor patterns with youth athletes. Let's talk about that a little bit. I mean, tell me, how old are the kids that you're working with right now?

Carlyn Stilling: [00:11:51] I'll have athletes anywhere from age 10, up to 18 in our youth programs. Yeah, we definitely have a huge focus on that movement pattern training. And a lot of that is very evidence-based. So a big area that there is a lot of research in youth sport, out of the Sport Injury Prevention Research Centre is in neuromuscular training. And that is basically movement pattern training and incorporating that into warm-up. So it's along that thought of the FIFA 11+ type of programs and really focussing on that movement control. And so these programs were designed by physios, who had seen these deficiencies when they're treating the athletes, and they basically target the primary movement patterns that have been identified as helping reduce the risk of injury. Its basic movements when you look at these, it's: Can they run properly? Can they jump properly? Can they decelerate properly? Do we have some spine and torso stability, and then balance and proprioception? So that's probably the most commonly missed thing in the warmups, the intermuscular training, they really add in and cover the strength and proprioceptive or balance type training and asymmetry training that goes on in there. And just my experience of actually working through this winter on Zoom with lots of these young athletes, because we didn't have access to the gym and we were in full lockdown, it was incredible how much they improved by doing this body weight movement training and they came back into the gym ready to go. To the point some other strength coaches I've talked to, we were all like, "We're going to have a two week zoom thing before they come into gym next year", because it was so surprising how much they had improved in just a short time with that.

Gary McCoy: [00:13:39] It's amazing. And I looked at, I kind of cheated over the weekend. I'll look up Carlyn and see what she does, who she is. And so I jumped into a link to a YouTube video that shows you doing a warm up with your athletes. When I looked at that all it did was laugh. I was like, man, if you film my baseball pre-game, it's exactly what it looks like, right? It's like, let's get some mobility. We start everybody with foam roll activities and move on down to almost like myofascial sling motion movement and then proprioception, ensuring the force part of the equation is the last thing we'll bring in, some movement specificity. I think you're taking a scientific approach to injury reduction and that is rare so far in my experience over the last twenty years in the United States. That's rare. So, I mean, congratulations on that. And you've seen some you've seen some good injury reductions at youth at various levels because of this, correct?

Carlyn Stilling: [00:14:38] Yeah, it's incredible to see the numbers. So, with acute injuries, depending on the sport and sex and age, it'll be 35 up to 70 percent reduction in acute injuries, especially for the lower limb injuries where you tend to have more catastrophic ones, the ankle and the knee. That is a very, very important number. And I'm at the point where I'll take a 10 percent reduction in anything. So, when you see 30, 35, in soccer is where you see some of the higher, higher numbers there. And there's just a bit more research in that area with the FIFA 11+ being a bit more established. But our basketball studies we did for the NBA and youth injuries in basketball, similar things, around that 30 percent zone for acute injuries. It's very promising to have an evidence based intervention that isn't relying only on an intuitive feeling that, yeah, I need to be working on movement. We can filter down to see what exercises we really can target these problems with and create a better situation for the athletes, but also provide the performance enhancements, because if you look at these movements and exercises, you will have a better jump. You will be running with more efficiency. So one thing they're starting to do now because try and sell a kid who's never been injured on injury prevention?

Gary McCoy: [00:16:09] Eat your broccoli.

Carlyn Stilling: [00:16:13] They're fine. They're never going to get hurt, right? They're tough and they'll roll the ankle and then go back on the court two seconds later. So, one thing we've try to switch a bit in the branding is that performance enhancement part of it and focussing on the player availability and that sort of thing with how we teach that and really connecting those movements to that athlete's why, which is they're showing up there to get better at their sport and to have a good performance on the court and in games.

Gary McCoy: [00:16:45] I continue to use the old car analogy. You know, it's always worked well for me, especially in a sport like baseball where there was such gross asymmetry. And you got an asymmetrical model, especially when you're playing every day. So not only do you have asymmetry in technical aspects of the game, you've got chronic asymmetry. So immediately that renders the human musculoskeletal system into a short on one side, potentially long or weak on the other. And if we're starting at that point every day, it's just rapid degradation daily for that athlete. So, one of the things we implemented with the Australian national baseball team was what we called a pre-flight checklist for our starting pitcher that had to have an extra 15 minutes on the table. We were to work up the kinematic chain to help maybe offset some of those initial musculoskeletal deficiencies before they went out to warm up and get that first pitch in and then had quantifiably strong, measurable effect to performance in the first inning. But look, I couldn't agree more even in that scenario with a 28- to 32-year-old athlete at the at the world level, it's got to be a discussion of: What's in it for me? How do you have that with a 10-year-old? Or do you even worry about it? Does a 10-year-old just say, “Carlyn, I'll do whatever you tell me to do.”

Carlyn Stilling: [00:18:03] It depends. A lot of them want to play and throw exercise balls at each other instead of training.

Gary McCoy: [00:18:12] So at that point, are you assessing them or assessing their parents’ inability to provide discipline? Which one do you assess?

Carlyn Stilling: [00:18:20] That's a tough one, I might get myself into trouble with that. I think with those this is just always been my style. I've worked with clients and athletes, but it is to find out what's important to them, what's the common language we can connect on. So, with those younger athletes, I'm always relating what we're working on to how it will help create a foundation for a skill that they're working on in practice. So, whether it's on court or on the field, we're always explaining the why. These newer iGen kids, they're always asking why, why, why, why, why? And that's great because that's actually how I was trained at the Canadian Sport Institute. I did my practicum there and every one of our programmes they would write and red pen next to what you had done for your programming, Why? Why are you doing this? How is this fit in? Is this appropriate for that athlete, this context? And there's a lot of athletes that if they can understand the purpose behind doing something, that helps them stay accountable and motivated and in moving forward with what you're asking them to do in training. The other thing, too, is that with those young kids, you have to make it fun because that's why they're showing up to sport. And one of the most important questions we can ask them is, “Hey, are you having fun?” I think there's a way of looking at some of the the youth movement training programmes. There's one in Canada. It's called Run, Jump, Throw, and they incorporate some of these movements and skills into fun games for the kids as well. And it's also with those kids knowing that they're competitors and that's why they're in sport. So, do we sometimes create a more competitive environment in that training? That point of, “ok, who can do this one the best” or, “how many reps can we do of this today” and that sort of thing?

Gary McCoy: [00:20:16] The other part of the equation, we would talk about the variability between chronological age versus biological age. Right? Not only 14-year-olds are the same, not all 16-year -olds are the same. And there are gender differences. And it's always seems to be in that period of body's changing. Hormones are changing. Motivation is changing. Interest is changing. Has that been a smooth journey through working with youth athletes or is that been something that you've got to consider it like every single day?

Carlyn Stilling: [00:20:52] Yeah, you have to look at it every single day. Is one of the most challenging parts of working with youth athletes is that on any given team, you're going to have sixteen different growth curves you're looking at. And that's also the issue in research. What age? Where are they in their peak height velocity curve or their peak weight velocity? You know, with that individual variation, what's the best thing for that person at that time?

Gary McCoy: [00:21:22] 10- to 15-year-olds: movement, pattern, symmetry. What are the things you're looking at? Do you look at do you look at them statically? Do you look at them dynamically? Are you looking at them against growth curves to say, yeah, their expression, their force expression or their power expression is about where I expect it? How do you baseline somebody?

Carlyn Stilling: [00:21:42] There's a few different ways which I've translated into my applied practise and the research setting we're looking at some of these things. So, we do assessments that have a combination of the dynamic balance, which would be your Y balance test or those types of things. Then we do static balance, a single leg balance on a foam pad with eyes closed, testing the proprioceptive system. We'll do the cardio testing or capacity testing on them check their strength. We also measure the leg length and all those sub-different anthropometric ones as well. You know, I think you just have a comprehensive battery of testing. Like I said, with the seated standard height and Mirwald type equations, those different ones can help give us pieces to the puzzle for that individual athlete. With the patellar tendinopathy study I worked on, we were looking at loaded ankle mobility, so looking at their dorsiflexion scores. And that's something we test in most jumping athletes now. And that's pretty standard to look at those and see if there's differences between left and right. And it's very interesting, obviously because they've had ankle sprains, how often you are going to see that mobility difference and the dorsiflexion or that standing calf stretch type movement, and it is really good to also have these tests as an opportunity to educate the athletes and get their buy-in to what you're actually doing in the programme. So, if you have a really good assessment that's tailored to their growth and development stage, and you can explain that testing and monitor improvement in that, that helps that buy-in for that age of kid, into your programming and what you're doing, if you can relate it back to a really good assessment.

Gary McCoy: [00:23:34] It's phenomenal. And I mean, one of the things I've looked at is we still have a big injury problem in sports. We have also a big data problem now, right? So, one of the things I've been trying to unlock for many years is: How do we get that data to become currency that we can transact upon, that we can make better decisions for that athlete? So, one of the people that I admire in our space, that I've done a lot of work in and around, we've been friends now for, I think 14, 15 years, is a guy named Dr. Marcus Elliott out of P3 in Santa Barbara, and he has another facility down in Atlanta that he does work with the Atlanta Hawks facility and does the NBA combine and he's tested now over 600 NBA athletes. So, of those 600 NBA athletes in his assessment, he does force plate and motion capture assessments on them and all these different battery of tests. And he finds, first ordered metric that aligns with the injury is this, this second ordered is this, third ordered is that, and it's creating such a beautiful pattern and profile that they can now, an NBA rookie coming into the league can be assessed and projected on, potentially what their risk of injury looks like versus even the analysis of performance. Marcus said something to me the other week that was pretty interesting. He goes, “I go to most NBA managers and coaches and owners and first thing they want to see is how high is that kid jump?” Second thing they want to see is, “how fast is he run down the floor?” And he goes, “well, yes, I could take all those things. But if you take a guy like Harden and look at him,” he goes, “he's going to be in the lowest of the low across the board.” But he's still an NBA all-star because his game is suited differently to different metrics. Is that something you look at with your participation at multiple levels in sports? Are you looking at different ordered metrics relative to how you design programmes?

Carlyn Stilling: [00:25:45] Oh, yeah, without a doubt, because what is going to make an athlete successful at the youth level versus the varsity versus professional? I think that's an evolving story for them on that spectrum of what's important for that sport at that time. Like you're talking about, with 10- to 15-year-olds, you're just trying to get them through the car crash of growth and development. And if you can get them through that in reasonable form at this point, we're saying that's successful. And that we don't have a ton of re-injury and that sort of thing. What I've really learnt, a big mentor for me in Calgary has been Dr. Reed Ferber, and he started the Running Injury Clinic and I very serendipitously happened to share office space with him right when he was starting that, and he was doing the things with the motion capture and biomechanical assessment. And I got pulled in to be subject in some of the studies. And so, I had never really thought about movement in that way just because the tools weren't available. Through their clinic, they actually also did the same thing with recreational and more competitive runners, is developing risk profiles and their profile of what was important for that more recreational runner was definitely going to be composed of different things then for the more professional runner and that higher level athlete. And so, I think what you're talking about is you're trying to figure out what gives you the most bang for your buck. What tells us 80 percent of the story and which factors can we narrow things down to make it simple and efficient? And that comes back to that high performance definition, which is that we are being efficient because you don't want to overwhelm an athlete or a coach with a 20-point intervention strategy.

Carlyn Stilling: [00:27:32] It's probably going to be OK, let's prioritise the plan. What are three to four things we can really focus on right now? And how does that fit into our yearly plan? At the varsity level, we would look at, I love university because I, I really get to work with those guys for five years and develop them and we can make a really nice long-term plan for that athlete. And we've had some successful athletes go through that program and you just see how each year as they develop, what is important might really change. So, for example, most guys in the first couple of years of university may not be playing a whole amount. So, training load and workload may not be the biggest risk factor for them for injury at that point. Yet when they switch into playing more in their third to fifth year, now that match load, we're looking at a competitive training load that is way more important now. And so even just within an individual, how risk factors can fluctuate on a daily basis. I think that's why we have a hard time projecting into the future about who might get hurt. We could probably guess that there are going to be injuries based on the sport and epidemiological research. We can know, hey, this might be the type, but can I say, oh, yeah, these ten totally? Not necessarily.

Gary McCoy: [00:28:49] Yeah, no. And I understand that entirely. The promise of machine learning and artificial intelligence has been around this metric people call injury prediction. Right? Can we predict if someone's going to get hurt or not? And it's like, well, are you measuring the quality of the travel accommodation mattress that they're sleeping on? Are you measuring the quality of turbulence on an air flight which could brace somebody? There’re so many factors that we don't measure that play into injury. That's why the smartest terminology is always that injury is a multifactorial process. There's a lot of things that bleed into it. But to that end, I think anyone who says they can predict injury, is that's the first red flag for me quite often, because while you cannot predict injury, you can identify risk and load and load monitoring. I think as you mentioned earlier, at the very tip of the iceberg here, the very first thing that we were bringing into the United States from a sports science in North America in general, from a sports science perspective, was this ability to measure load and load patterns. And even to the point where some of the load application scores, like from Catapult and stuff really don't apply to every sport. They apply to sports where you're running and moving a fair bit. If you've got a fair bit of linear translation, those schools will work out pretty well. But if you're an NFL lineman, that's a totally different bag, a bag of worms, so to speak. You know, we're opening up so many different metrics. But let's talk a little bit about load monitoring, because I know you've been using VERT and you've done a fair bit of work in and around this area. Have you found, Carlyn, that there are hard and fast kind of algorithms around the load that you're looking at and saying: OK, well, here's where I want a chronic load pattern and acute load pattern? Do you look at that by team position or by individual? How do you assess that?

Carlyn Stilling: [00:30:57] In exploratory analysis we would look at both and see what's happening to the teams. And I think it's important to look at that because each person contributes a certain percentage of training load to that team. And so, your training load, when you have 12 players out of practise versus 10, that distribution of load can sometimes change. So, there is some interactive effect in there of what's happening on the team level. And ultimately, you are doing team training and you have a match schedule that you're trying to balance. The best way to look at injury data for, especially when just as you mentioned, all the risk factors that can go into a person's chances of getting injured, you do have to look at that individually. So, I think you have to pay attention to the situations where you have teams that have a lot of injuries, and you need to look at what's going on there. What's the pattern or trail leading you to maybe a training methodology, a schedule, certain type of training they might be doing? You know, whether it's as a team, are they all pretty fatigued? What are the types of injuries? And then, on that individual level, one of the biggest or the biggest predictor of future injury is previous injury.

Carlyn Stilling: [00:32:10] And so, you know, knowing that individual's own risk profile, I think is very important as you're trying to help them navigate either return to play or move through the different training loads. And so currently where we're out with the literature is looking at their Q chronic workload ratios and the relative training loads. So what did I do this week? How did I build up to that over the last maybe three to four weeks? And where we're moving on, the analysis side of that is starting to get starting to take advantage of that machine learning, starting to take advantage of different analysis strategies, at a higher level of stats. That is way above me. I have a I have a very lucky post-doc machine learning person that helps me with a lot of the data we look at, Dr. Lauren Benson, she’s out of the USOPC now and she just does gymnastics with the data and can really clarify which variables are probably the most important and doing stepwise elimination to test out these different models of what could help us with those individuals' risk profiles.

Gary McCoy: [00:33:21] Yeah, I hear you. And it's a really interesting kind of conundrum. Do you take what you perceive to be an optimal genetic potential for a specific athlete and look at the demands that are potentially going to be placed upon them at a certain game tournament time structure and try to reverse engineer that based upon where they are now? Or do you take the data and just go, OK, here are the metrics, here's the data in terms of this presentation and let's move forward day to day. I think there's a few different potential approaches to that. I've always been of the former, it's try to reverse engineer this and look at the demands on the athlete. When you're in a high skill sport, like baseball. That's a lot easier to do because the running loads don't matter as much as the throw loads and the static rotational nature of those athletes, I mean, there's a lot of different metrics I look at per se, other than say something like volleyball, basketball where that rate of deceleration would be a key indicator, I would think, relative to potential risk of injury. And again, it's qualified by what data you have access to, right? So, having said that, what do you think is the biggest gap?

Carlyn Stilling: [00:34:38] You can't track what you're not measuring. And I think that's where that opportunity again, when you come back to injury burden and showing the coaches those numbers of like: Hey, this is how many weeks we're missing players or this is how many athletes we're missing. And there's individual accountability also on the athletes with these numbers in the sense of using that technology to monitor their own jump loads, but their teams as well. So, for example, when in volleyball, if we're missing two middles or a setter, the load of practise doesn't necessarily change. Now, those players are suddenly training way more. And that's actually where we've started to chase the trail, and the data of some of these cycles of injuries and teams happening is did we have players experience a 30 percent increase in load all of a sudden out of nowhere? And then then that person was out, and then the person that stepped in for them, that was another big increase and then they were out. And so, I think having that data to look at those numbers for external and internal load and looking at practise lengths and that sort of thing. That's where I spent a lot of time in coaching development, is getting them to look at those numbers, assess objectively what actually happened, what did I think was going to happen? Do I have numbers to support that? So one of the neat things we did with the Volleyball Alberta programme one year is I did the coach RPE and then what they thought each position was because in in volleyball we have really different movement needs for different positions.

Carlyn Stilling: [00:36:13] And so what do you think those assessments are for you, and then when you compare it to the players, this is again anecdotal at this point. But in my experience, the higher-level coaches have a much better awareness of what load they're imposing on their athletes and the effect of it and reading it and just seeing the intangibles. Like you're saying: How did they move here? How did they come out of that drill? What's the expression on their face? What's going on there? And then not only could they either adjust the session at that time, in the context of their general training plan, but could they make up for it or adjust the next day if something unplanned happened?

Gary McCoy: [00:36:51] Amazing. Two things you bring up that I think you've identified a big gap in our marketplace. One, coach education around physical systems metrics. Secondly, if we are back in a remote setting, the ability through data for the athlete to potentially coach themselves, along the framework of what the coach edict manifesting. It's always interesting to me, but I'm catching up with him this week, actually. There's two guys I really respect in North America on this. Dr. Ben Peterson, who's head of performance for the 49ers. We're both meeting at Austin FC with our buddy David Tenney, who heads up the soccer, sits on a board for FIFA. He's just been a brilliant soccer high performance director for a long time. And we talk about this stuff consistently and continuously. Where are the gaps and what are the things we need? What are the missing elements? One of the reasons they kind of follow me because they know if I'm working on a technology project, it's got to be serious and it's got to have merit, like Catapault did, Kinetyx will also. And it's you know, we're looking at this thing around human movement and creating these individual profiles that are all relative to the thing we should be looking at first. How do we create ground reaction force? What is that? You know, what are the factors that potentially limit that and limit your quality of movement and consistency and repeatability of activity? These are all the metrics I think we've got to dive into and really understand so that we can project on an athlete, whether they're a youth athlete, or whether they're somebody who's performing at the top of their game. The human body is a cat and mouse game constantly, and I think looking at things dynamically, it's great that you've got a resourceful team around you that can analyse data and give you that dynamic view as opposed to a static assessment view.

Carlyn Stilling: [00:38:49] The sports science side of it, we can't go in, and I have to just observe. And that's a huge challenge of being in the research world, is to just sit back and let it go. Whereas in the applied setting, I do have that opportunity. So it was kind of good because I was doing my master's research at the same time I was implementing. I was like, hey, I learnt this, let's do this with the provincial team or university team. And so I did get a chance to do my science on the athletes in live time. And it's a lot more flexible. So that parallel was really great. And I think that's exactly what it is. It's a continuum, it's changing. I think we have so much untapped data to look at still. This is where I come back to my love of biomechanics people. If you have those guys there helping you with the modelling to go through that data, you don't get overwhelmed. Like, my background is in physiology and as a coach and I was a coach, then I became a physiologist and went into the training side of it. And from from that mindset, as a coach. I'm a great assistant coach. I never want to be a head coach. I love hanging to the side and the head coach has a lot going on. So if you can have those people that can do the correct statistical analysis, that can help deal with the data in that live time and make it easy for coaches to understand, I think that's a really effective way to address some of the gaps that we see.

Carlyn Stilling: [00:40:20] And then the other thing, just looking at the injury surveillance side, the biggest gap there that we don't even do that. And it's not even happening in youth sports. It's not the norm to track even their workload, not the norm to even track. They'll just say, oh, yeah, like 16 players were off the court by day three of provincial cap. And so I was like, OK, first thing we're going to do is actually measure what is going on here with the surveillance. And we're actually using more updated methodologies for that as well, which I think as our injury methodology improves, we're going to be able to actually answer these questions better. But our injury definitions have changed over the last ten years, not including the overuse injury continuum. We're missing about ten times, we're underestimating injuries by about ten times, to the point of in our NBA study, we found that the overuse injury burden was almost as bad as the acute injury burden. And we don't, this is the thing, we don't understand that relationship very well yet of the overuse injury to the acute injury. I think we all assume there's something and there is an association.

Carlyn Stilling: [00:41:33] But the research, because we've lacked this correct definition of what, or a more inclusive definition versus just being time lost but starting to track some of these aches and pains and tendinopathy specifically early on. We need sensitive tools like the Oslo Sports Trauma Research Centre questionnaires. We need validated ones. So, we're not just asking whatever we think might work, like there has been some work that's gone into, again, if we're going to take the time to ask these questions, how are we going to do that? How are we going to phrase it? And then how many questions are we getting as close to the right answer as possible? And I would just say like and say especially in sports, like basketball, you're having injuries very underreported. And we don't even know what the burden really is as our methodology develops, but also the culture of the sport. So, yeah, it's pretty interesting to get even to say the culture of basketball. They're just like: literally I saw a kid I sprain their ankle, hold an ice pack on it, and then five months later they're out hobbling around, running around. And, you know, normally, I guess I'm the researcher sitting on the bench. I was like, I probably might have pulled that kid out, but like, I just have to watch, I can't do anything here.

Gary McCoy: [00:42:53] The consistency of data is really poor generally when we're looking at the epidemiology across the board. I mean, it's really inconsistent from the high levels on down. But to understand the individual mechanisms of injury and to, like we always say in our research, that we're looking back from that date of injury when that happened, we're looking back that two weeks, is something that happened in that two week window. It could be that far back. That has been an indicator that we were on path to injury back then. What is it? How could we have offset it? Could we have offset that? These are all questions that are still unknown because we don't even know the injury report. We don't even have a differential other than a perceived scale of the difference between soreness and pain. Some soreness is a good thing if we're in an adaptive period, right? And some soreness, if it's non-inflammatory related needs to be, it can be a good thing, right, if we're in a tournament, et cetera, et cetera. So, I think, yeah, it's creating that the consistency of language and getting the consistency of reports is going to be the first place that we can start to really spin data around and have a look at it and get closer to understanding where risk is. There's no question.

Carlyn Stilling: [00:44:14] Back to what you're saying about pain. I mean, pain is a whole other construct, that is super interesting. And my sister, she's a physiatrist and so we'll talk about pain and how people experience that differently and that being a part of the injury definitions is a limitation. And especially because, so our work we did with the patellar tendinopathy research for the basketball was looking at tendinopathy with ultrasound. So, you're going to have people who have no pain pathology, have no pain, but they have a tendinopathy pathology. And so, you’ll be like, why did that person get injured? They were never sore, and their tendon ruptured or whatever. And it's that was a huge thing I learned. I had no idea you could have this tendon pathology with no pain symptoms. And so, I think that's where we get the radiologists in there looking at some of this stuff a bit more and understanding for these athletes what's actually going on when, yeah, they may not perceive that or maybe, again, that pain tolerance might really fluctuate between different people. Yeah, I think we've seen it in different athletes. And so, then you're like, OK, well at what point are they, is that individual now starting to report pain.

Carlyn Stilling: [00:45:31] And maybe I see it in their movement before they're reporting pain. And I think that's where the force, so like just things like, you know, being able to have the field technology where they're wearing it in the competition situations, say with the VERT has been really good because we'll measure their force on landing. We'll measure that jump height, we can see live time. So I had an athlete who turned out to have a partially herniated disc and he was jumping four inches lower than normal. And I could see it, I could see he does not look OK. And then I had the data to support that. And he was just so accustomed to the pain that he didn't think enough to say, “hey, I'm not good.” And that's the whole thing with pain. It's like, do you have someone that's sort of used to it? Is this a catastrophic injury? Did it just become catastrophic? Is the nerve affected? And that's why I like to work on these problems. So, I think there's a lot to dig into on those some of those subjective measures and understanding pain a bit better.

Gary McCoy: [00:46:43] Yeah, if you can get a factual statement out of your athlete or something very truthful as to how they're feeling, fantastic. The subjectivity reports to me are brilliant. I mean, they're a brilliant look through their lens at how they are feeling around things. And I see a lot of value in there. And looking at to your point in your studies in the RPE et cetera, et cetera. So, yeah, look, I think they are highly valuable combined with data and getting everybody speaking the same language around this will be a minor miracle. And that's when I think we'll begin the evolution of sports performance. Is when we can stop there and at least know what those rate limiting factors are for that next level of performance. Some sports are going backwards in terms of performance. Some are accelerating key performance markers at really high rates, and somewhere in between, there's a slew of injuries we've got to solve, we've got to solve for in the middle of that.

Carlyn Stilling: [00:47:40] Oh, exactly. And I think the whole other piece of it is because we have all this technology available, we have to figure out ways to implement it in, you know, as a seamless way as possible. And I think that just because, this was a fatal assumption we actually made with our youth studies that we assumed they were just going to fill out the injury surveillance on the apps, they were just going to, because they're so tech savvy, they would just like do what we wanted them to do on the technology. And actually, one of our our big study we did on 500 basketball players, we had to switch to paper and pen with a team designate to get their RPEs and their attendants and their injury. We had to switch the whole, we had this really fancy app that was like perfect. 20 percent of the kids used it. And if we had it on Snapchat, I think it would have been way more effective because I learnt very quickly, Snapchat is better than texting, which is better than email. Don't bother. Because we're like, oh, we'll call them. OK, we'll text the idea. If you could have the ethics to go into Snapchat with research, I mean, yeah I would do that. So, so, so they, just those kids, they just move so quickly, use the next big thing. They've, they've already gone by the time we get there. And so, I think with the youth athletes on just collecting that data run into so many issues we didn't or see because we assumed they would just like technology.

Carlyn Stilling: [00:49:15] We assumed they would think, oh yeah, that's cool, let's just do this. And, you know, out of that, it pointed me towards some of our technology adoption models that are out there. And there's a nice developing body of research in that area. But looking at, OK, how can we implement this, create the common language, how do we build that trust within the teams and how easier these technologies to use? Can we adjust them on the engineering end? Or so, for example, are these how much we have to charge this, so on and so forth? Like there's a lot of barriers to these, they're disruptive technologies. So we're coming in, we're changing the game. We're changing how these athletes think and work. And I think ultimately, like you're saying, that athlete centred model, when I've been able to get the athletes to buy in and see how important that is, they're begging for a VERT device. I literally have them just be like, when do we get them? Are we going to be able to use them this season? Oh, this is so cool. And they start to know their own bandwidth. And it's, sort of like with people wearing heart rate monitor. After a while, you kind of get an idea of where your heart rate is based on how you're feeling. Well, we can do that same thing in training on what their jump count, jump height. And there's guys for sure within a few months I could they would probably guess within ten jumps of where they were at while in a practise.

Carlyn Stilling: [00:50:48] And I think that's a really neat way to build the autonomy of the athlete. And for me, the biggest effect I can make is to create an athlete that can monitor themselves, stand up for themselves, ask the question, say how they're feeling and that they can, they can get to the right person to access the help that they might need and know who that could be and understand the scope of practise of the different professionals that are available. And if there is something going wrong, it's not a burden to be carried on their own shoulders till it's too late. So, I would say with the youth athletes, if all of us youth trainers, if we can start to build these habits into them, they're going to show up to your college and pro levels, more adaptable athlete that has a bit better awareness or has some tools in their toolbox that make it easier for you guys to work with them at that later stage. And I think ultimately that's something where we need to have that consistency with the athlete development goals for how to how to empower them to take care of their own health, because I have I can't make them sleep eight hours a night. I can't make them drink all the water they need to and eat healthy food. It's just to help guide them towards: what are those things that are going to help them be successful?

Gary McCoy: [00:52:10] Carlyn, they're lucky to have you. That's all I'll say. The fact that you use the word empower. I've heard coaches say, “I'm going to help him do this.” That's belittling, right? I mean, you want to empower them, get behind them, have them stand alone, as you indicated there. I thought that was wonderfully put. Just absolutely beautiful. Well, I can't thank you enough for your time today. What's next for you? Are you saying I want to stay in my current role? This is going to be it, my life's work is going to be right here. Where do you go next?

Carlyn Stilling: [00:52:49] Well, I definitely have found a love for the sport science avenue of things and solving this problem of workload and looking at how we can better help our organizations support athletes, and so I think looking for those different environments that allow me to come in as that sports scientist and maybe not purely just as the strength coach. That background definitely helps me, but I think there's a lot of opportunity in these different realms to step in. And so, one thing I've started to do is more consulting for teams and just being able to help a head coach. A coach I'm working with, that's with a team in Europe, I'm starting to work with and helping him start right off the bat with some good foundational things he should be tracking and that sort of thing. And then how and then how to help inform the decision making a little bit better. So, I think that's a that's a big spot where we can help other organizations get set up on systems, education and knowledge translation is a huge passion of mine because it is something like at least 7 to 10 years by the time something's on a paper, but before it gets out into regular practice. And so especially with the things we're doing in neuromuscular training, workload monitoring, can we get that information out to the right people? Is there a policy change that needs to be affected in certain places? You know, what are the different levels of that primary, secondary and tertiary intervention points where we can fit in? So, I could see my role really evolving depending on where I'm asked to enter at that point.

Carlyn Stilling: [00:54:39] Am I being asked to help with the rehab side of things? Are we really focussed on the prevention side or are we trying to improve our practise? You know, and I think that's where, again, I'm never going to predict my own future because these devices weren't invented a few years ago, and I literally sat in the dean of kinesiology's office and said, like, “I'm never doing a masters and I don't want to do that and I'm never going to go back to coaching.” Like I was actually working in clinical and rehabbing joints and people with joints and hip issues. And so, I was like, oh yeah, I like this rehab side. And I never thought I was going to come back to sport. And that's all I've done the last eight years. I never thought I was going to do research. So, with caution, I say I will be in the kinesiology field and see where the innovation takes me. And just I'm very open at this point. And I stopped saying, I'm not going to do that. And half the people I told I was never doing grad school, I get to walk by them every day and I’m just like carrying devices and they're just like, yeah, I told you so.

Gary McCoy: [00:55:49] So I love it right there. You'll be forever part of our community here at Kinetyx because we're on that same journey. We don't know what we don't know. And coming into this, I remember saying to our CEO, president, I said, look, I'm not interested in answering questions. I'm interested in asking better questions. That's the key, right? Is that's the only way this this evolves is for the individual athlete and for teams and for sport in general is if we can really ask questions and it starts with how do we reduce injury? And a lot of it is going to start with where you're at right now at the coalface of youth sports.

Carlyn Stilling: [00:56:25] Yeah, I think it's going to be very exciting to see where this field goes, because I think you have a lot of practitioners who, every person I've interacted with is very passionate about this, these types of questions and and generating better ones. And from the strength and conditioning role standpoint, can we be doing our jobs better and reverse engineer that performance? And that's where wearable technology has changed my practise a lot. In being able to have actually what that field measurement is. So we have high ecological validity of what's going on out there. And can I now work back and prop this athlete for what I know they're going to be seeing the game and a tournament and a match and? And then how who are those other people I need to engage and what collaborative partnerships to help evolve and support that that system a little bit more. And so I think that's where as the technology continues to be developed, like I said, you're you don't know where that question might take you. But I think strength coaches, we can get way better information thanks to this versus, oh, I just did a vertical jump test at the start of the end of the season. And so now I'm like, oh, I get those data points all the time and I can really go back and evaluate things with a lot more information and, and a bit more objectivity than I used to. So I think I think that's where it's taking that objective standpoint to challenge our own biases. And one thing I always like about qualitative research is that at the start of the article say what their biases are and they say, I am this person, this this this. I think that's something we in quantitative research need to really do more of. And it would be great if we added that in, hey, these are my biases. That I'm walking this and not that it's bad, but just be aware of them.

Gary McCoy: [00:58:25] Well, yeah, and it's like this one of the beauties, again, the strength and conditioning conferences everyone's got their, these certification letters behind their name. I know the USA weightlifting bias. I know the CSCS bias. I know the NASM bias. It's almost like, you know, it's different churches of religion, is what this becomes. And I think to that point in in closing, yeah, it'd be hard to work with you because I think we think exactly the same way we're going to learn nothing, we would learn nothing. We think the same way.

Carlyn Stilling: [00:59:01] Mean, I think sometimes you need someone to encourage you. So you're like, hey, I'm not totally in outer space. Sometimes I wonder? I'm like, where am I? Am I on the right track?

Gary McCoy: [00:59:06] Am I an idiot for thinking this way, or does somebody else think this way too? We're the island of misfit toys that comes to, you know, trying to solve these problems. So anyone who wants to jump on that island, that's what this podcast is for. We want to find them. Now, let's find this next level. Mate, we will keep in touch. I can't thank you enough for today.

Carlyn Stilling: [00:59:32] Likewise. Thank you so much.

Gary McCoy: [00:59:38] Thanks for listening to the The Human Kinesome Project our music is provided by the incredibly talented Joanna Magic. I hope you'll join our community at Discord.gg/kinetyx. Team, the game is just beginning.