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May 09, 2023

Strength Principles in Rehab with Dr. Rayce Houser

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Dr. Yoni Rosenblatt: We got Rayce Houser with us, the True Sports Physical Therapy podcast. We're gonna get into a whole bunch, but before we do, and before we talk specifically about strength coaching and the way you weave that into your sports PT practice, tell us about Rayce Houser and how you got all the way from Eastern Oregon to Baltimore, Maryland.

Dr. Rayce Houser: So, did my undergrad at Pacific university to small D3 school kind of by the Portland area. Was fortunate enough to play four collegiate sports there. We'll save that for a different day. But...

Dr. Yoni Rosenblatt: Four collegiate sports? 

Dr. Rayce Houser: Four.

Dr. Yoni Rosenblatt: What were they? 

Dr. Rayce Houser: Football, basketball, golf, swim.

Dr. Yoni Rosenblatt: How many kids went to this school? Four? 

Dr. Rayce Houser: 1800.

Dr. Yoni Rosenblatt: 1800 and you're the best athlete on campus?

Dr. Rayce Houser: Jack of all trades, master of none.

Dr. Yoni Rosenblatt: As it pertains to hopefully athletics. You are... What does that make you? Jim Thorpe. Does that make you Bo Jackson? Does that make you Dion Sanders? Does that...

Dr. Rayce Houser: Bo Jackson.

Dr. Yoni Rosenblatt: Bo Jackson?

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: How's your hip? 

Dr. Rayce Houser: Good. I feel like I'm as strong as Bo Jackson in a way, or comparatively speaking.

Dr. Yoni Rosenblatt: I like that. Okay. Anyway, okay. You play a million sports in college, then what happens? 

Dr. Rayce Houser: Graduate, bachelor's of science, 2018. Go immediately into PT school at Pacific university. Graduate 2021 from there, I applied to a handful of different orthopedic residencies, had got wait-listed for some, got denied for some. Ultimately ended up at university of Maryland for their orthopedic residency. It was their second cohort. Fortunately, as soon as we started, we had heard they got accredited, which was nice.

Dr. Yoni Rosenblatt: You took that acceptance, not knowing that they were accredited? 

Dr. Rayce Houser: Yep.

Dr. Yoni Rosenblatt: Why would you do that?

Dr. Rayce Houser: I knew orthopedic residency was something that was super important to me. And I know it's really any sort of newer program. You're taking a little bit of a risk and it was a risk I was willing to take. Fortunately it worked out in my favor, finished that up September, 2022. And then was kind of perusing a bunch of different kinds of sports ortho clinics, kind of around the area and happened to find a really good fit with True Sports.

Dr. Yoni Rosenblatt: Glad you brought that up. Why was it a good fit for you?

Dr. Rayce Houser: I just remember, when I had my in-person kind of informal interview with Andrew, like we hit it off really well, we just meshed really well together. Just that conversation we had, it felt like he really valued what I had to offer, and I also valued kind of the company aspect in terms of essentially they're gonna allow you to grow in whichever way you kind of want to see fit and can also help push the company forward as well.

Dr. Yoni Rosenblatt: Yeah. And you've done incredible things pushing the company forward. It's been awesome to watch. First thing you did was give us this awesome backdrop to record this podcast. So I really appreciate that. Hopefully everyone's watching a video of this, or maybe hopefully not. But that's definitely true in terms of what we try to do at True Sports is give you a ladder and grow and pull the company along with you. Let me put you on the spot. What do you want to change about True Sports?

Dr. Rayce Houser: More involvement in journal club.

Dr. Yoni Rosenblatt: Okay. So Rayce founded our journal club, and it has been fascinating since he started it. Okay. That. What else you got?

Dr. Rayce Houser: So I know it's kind of been in the works a little bit about being affiliated with certain residency programs and potentially getting a True Sports residency up and going. I think True Sports would be a great fit for that. And I think if we can make that happen and potentially even be a part of that, that'd be a pretty cool to be part of that.

Dr. Yoni Rosenblatt: Awesome. I'll put that on your goals to crush. I think you'd be awesome at that. You mentioned Andrew, that's Dr. Andrew Livingston, who had followed a very similar path to you in terms of going through a residency, coming to a nascent sports PT business and practice and growing it like crazy and, and finding avenues to grow. So I love that. I love supporting that and I appreciate your feedback in terms of making it a better place to work, making it a better place to rehab. You've definitely done that for your patients and your athletes as I've watched both up close and from afar. Tell us about how you weave your strength and conditioning background into the way you treat and how important that is to you. And then how do you make sure that the best of those talents shine through in this rehab setting?

Dr. Rayce Houser: So I think the big thing is, having worked with, so, current strength conditioning, coach for the Pacific University baseball team and softball team.

Dr. Yoni Rosenblatt: You are?

Dr. Rayce Houser: Yeah. Fifth year working with them. And then...

Dr. Yoni Rosenblatt: How do you do that? 'Cause you live in Maryland.

Dr. Rayce Houser: Fortunately, I can do everything remotely through a team builder.

Dr. Yoni Rosenblatt: Cool.

Dr. Rayce Houser: Definitely makes trying to do assessments and those things a little bit tricky.

Dr. Yoni Rosenblatt: Now that's another podcast. How do you do that remotely? Okay. We'll get there.

Dr. Rayce Houser: And then also this current spring season just took over Eastern Oregon University baseball team as well for their strength and conditioning.

Dr. Yoni Rosenblatt: Division 1 program.

Dr. Rayce Houser: NAIA.

Dr. Yoni Rosenblatt: NAIA, where the real studs go to play baseball. Okay. And so you're handling all that remotely. And so that's, you being a strength coach, how do you pull that strength and conditioning aspect into your physical therapy day-to-day?

Dr. Rayce Houser: So I think one thing having been on the coaching side of things, having going through workouts myself, kind of have a good idea in terms of volume dosage, what sorts of exercises are gonna give me the best bang for my buck for what sort of adaptations I want to end up achieving.

Dr. Rayce Houser: So from there, we're just trying to meet the athlete with where they're at. So whatever information we gathered during the evaluation process, I have an idea of kind of what sorts of things they can tolerate from a strength standpoint rate of force development standpoint. Then from there it's like, "Okay, I see these deficits here. I'm gonna treat these deficits with, let's say it's quad strength. I have all these different avenues to strengthen the quad, whether it's open chain, closed chain, connect chain." And then from there it's just, "All right, what's gonna give me the best bang for my buck? I'm gonna do a squat, probably I'm gonna do leg extensions and then I'm probably gonna do some unilateral loaded stuff with lunges or Bulgarian split squats."

Dr. Yoni Rosenblatt: I hate that I'm gonna use this term, but it's all about the tools you have in your toolbox, right? 

Dr. Rayce Houser: Yes.

Dr. Yoni Rosenblatt: That, I hated that during grad school hearing that crap, but it really sounds like that's what it is. It's like, "Here's my goal and here are the tools I can use to fix it and address it." Now you bring up rate of force development. I want to dig into that because I think that's such a gap in the education of the PT versus the strength coach. Lucky for True Sports and the patients at True Sports. You are both. So you're gonna educate us on that and we'll dive right into that. Before we do that, tell me how you keep your scalp so clean? 

Dr. Rayce Houser: Scalp so clean. First I wanna give a shout out to Gillette ProGlide.

Dr. Yoni Rosenblatt: Okay. You're ProGlide guy.

Dr. Rayce Houser: And Barbasol as well. So hopefully they can give us a sponsor for the Podcast.

Dr. Yoni Rosenblatt: I love that.

Dr. Rayce Houser: But once a week, just Saturdays.

Dr. Yoni Rosenblatt: Once a week?

Dr. Rayce Houser: Once a week.

Dr. Yoni Rosenblatt: 'Cause I spoke to one of your mentors here, Dr. Andrew Livingston. He's like, "Dude, Rayce shave his head every day 'cause it's always shiny."

Dr. Rayce Houser: No, you get to like...

Dr. Yoni Rosenblatt: Once a week.

Dr. Rayce Houser: Once a week.

Dr. Yoni Rosenblatt: Okay. Let me, if you're a ProGlide guy, I want you to look into a company called Supply.

Dr. Rayce Houser: Okay.

Dr. Yoni Rosenblatt: It's a life changer. And so they have different blades, but it's a safety blade. You cannot cut yourself. I've tried. I'm in every other day guy. Also I've gone to, I'm getting away from the aerosols. They make me nervous. You're not using the the brush yet? 

Dr. Rayce Houser: Not using the brush yet.

Dr. Yoni Rosenblatt: 'Cause you're young.

Dr. Rayce Houser: I'm sure I'll get to there.

Dr. Yoni Rosenblatt: You look like me, but you're much younger than me.

Dr. Rayce Houser: I have to look into the...

Dr. Yoni Rosenblatt: Supply.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Oh, it's a life changer. I want those guys to sponsor this pod 'cause they're not cheap. Okay, so thank you so much for enlightening us on your hair care or as I call it, scalp care. Let's dig in, clinically speaking 'cause you did an awesome job of kind of working through, as we prepped for the pod of giving me a couple examples where you've really had to use your strength and conditioning background, your education, possibly more importantly, your emotional intelligence, like your ability to meet that patient where they are. And one of the examples you came up with was looking at a case post-op ACL, and really two different populations, same demographics, but the difference in the populations is their training age. So walk us through the case, give us the pertinent details and then I'm gonna hammer you with questions.

Dr. Rayce Houser: Okay.

Dr. Yoni Rosenblatt: That's the difference is.

Dr. Rayce Houser: Allright. So we're gonna take two individuals here both of 'em are gonna be 16 year old females lacrosse players recovering from ACL reconstruction. We're gonna say they're 16 weeks post-op, have a bone-patella tendon-bone graft and no other concomitant injury or procedure. One of the girls has been doing sports performance training consistently since she was 11 years old. The other has no training history or experience. So when we start to look at the ways in which we want to strengthen this individual, let's say their hamstrings I know that person who has the training history of about...

Dr. Yoni Rosenblatt: Before we get into hammy.

Dr. Rayce Houser: Okay.

Dr. Yoni Rosenblatt: Range of motions money.

Dr. Rayce Houser: Yep.

Dr. Yoni Rosenblatt: Right. Everything looks really good there.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Anterior knee pain.

Dr. Rayce Houser: Minimal.

Dr. Yoni Rosenblatt: Okay, to be expected. It kills me when people are like, "Nope, no pain," because there's always something there when you rip out the middle of that patella tendon. So an expected amount of pain, any other factors that would change or slow my progression I'm just thinking. No, they're doing pretty good. Okay. So, and what have they done to date in rehab?

Dr. Rayce Houser: We've done all of our, we've normalized gate mechanics. We've tried getting or made sure we get our extension back, making sure we're doing our due diligence and making sure we get that quad symmetry up as quick as we can. Trying to control joint fusion, joint pain. And then from there it's just progressing load as they can tolerate.

Dr. Yoni Rosenblatt: Cool. Okay. So now we're in the loading portion. Now we're in the strength gain portion, right? 

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Have they run?

Dr. Rayce Houser: Haven't run yet, we'll say.

Dr. Yoni Rosenblatt: They have not run. Yeah. Okay, cool. Great, great clinical picture shoot. What's the difference between the way you're gonna address these 'cause your goal for today's session is posterior chain loading? Go ahead.

Dr. Rayce Houser: Okay. So for the girl who does not have a training history, I wanna give her a single leg RDL. I most likely this person's not gonna be able to get any sort of meaningful load into the hamstrings just because they don't have the requisite skill to perform a single leg RDL. So for me, it's not gonna be the best bang for my buck to essentially get strength in the hamstrings. Not to say it's a bad intervention, I'm not going to include it, but just understanding what the limitations are of set exercise. So I think to better target the desired tissue, in this case the hamstrings we need to try to modify it in a way, so we can actually get the stimulus to the hamstrings. So a couple modifications here. One's going to be do like a single leg hamstring bridge, either with the foot elevated or the shoulder and foot elevated on a bench. The other option would be to do like a single leg seated hamstring curl. Both of these are gonna be targeting the hamstrings in a more lengthened position, which is kinda the goal I want. I like option number one better because it's gonna be similar to that of the single leg RDL being more hip dominant. I'm likely going to develop kind of kinesthetic awareness to help with more of that sort of horizontal pelvic translation or translation during like the bridge that can help transfer that to the single leg RDL.

Dr. Yoni Rosenblatt: I love that the way you put that, the horizontal translation of the pelvis, I think is such a unique way to look at that movement pattern. Let me ask you this. Are you trying an RDL with this girl? I assume you've tried it at some point over the previous four months. You know she sucks at it. Do you even try to introduce it at the beginning of the session and wait for her to fail, or are you just like, "Hey, we're going to single leg bridge?"

Dr. Rayce Houser: So maybe it's where we're doing something where we're pairing the exercise together. One, I'm working on the skill aspect of like learning the skill for the single leg RDL. I'm gonna pair that with an exercise that's gonna be more output based, which in this case is gonna be our single leg bridge here.

Dr. Yoni Rosenblatt: Tell me what output based means.

Dr. Rayce Houser: I'm thinking more from like a stimulus perspective, like it's gonna be a stimulus where I can actually achieve a desired adaptation versus with the skill movement. I'm thinking I'm not getting any sort of like physiological adaptation, like strength or hypertrophy.

Dr. Yoni Rosenblatt: Good call. And I've struggled with this previously where it's like, I just want to do an RDL. And like, I'm trying to get this athlete to do an RDL, single leg RDL. And it's... They'll do a set and I'm like, "Hey, where do you feel?" And they're like, "My foot." So from an output perspective, you want them to rapidly feel that in the desired muscle. And so in this case, that's your hammy. Okay, so you go to that single leg bridge. And how are you... What's your first attempt at the single leg bridge? Like what is your setup?

Dr. Rayce Houser: I've been really using, or I've been really liking using like a 18 inch box to elevate at least to work through a little bit more range of motion compared to using the ground. 'Cause I feel like at that point, we're kind of already starting in a more shortened position with the hamstring. So I feel like we at least have a little bit more room to move into hip extension, starting with the foot elevated. If they can tolerate it, I would like to have them eventually get to the point where we're doing the shoulder elevated as well, just because I'm going to get more hip excursion versus having the ground as a limiting factor there.

Dr. Yoni Rosenblatt: Or horizontal translation, if you will. Okay, awesome. What's your knee angle?

Dr. Rayce Houser: Knee angle? It depends, for the long lever, I'm going to have probably between 30 to 60 degrees. If I got more short lever, I'm typically in 90 degrees of knee flexion.

Dr. Yoni Rosenblatt: Okay. See, I'm thinking shallower. If you're trying to replicate RDL, do you want to live in that 0 to 30? That's where my head went.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Is there a reason you wouldn't? 

Dr. Rayce Houser: I'm typically like, if I'm going more specific to the RDL, I'm thinking more of the 30 degrees, roughly, yeah.

Dr. Yoni Rosenblatt: Okay, so you're living out there.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Now, why are you pairing this with a seated knee flexion? Did you say that? 

Dr. Rayce Houser: So pairing the single leg RDL with the single leg bridge?

Dr. Yoni Rosenblatt: I'd say why you got your single leg bridge.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: And then I thought you'd mentioned the seated knee flexion.

Dr. Rayce Houser: So let's say for whatever reason, all they're feeling is their low back working with the single leg bridge.

Dr. Yoni Rosenblatt: I hate that.

Dr. Rayce Houser: I'm like, I'd rather have them feel that in their hamstrings. So instead, I know with the seated hamstring curl, it's going to be the lowest skill movement here. I know all I have to do is just bend and straighten their knee, and it's going to be super easy for me to set up, super easy for them to perform. I know if I dose it appropriately, they're going to get some sort of strengthening benefit out of it.

Dr. Yoni Rosenblatt: What's your dose when you say appropriately? 

Dr. Rayce Houser: Really, it doesn't matter the set and rep scheme, as long as we're getting to a RPE of, you know, seven to eight or above, making sure we, you know, our reps and reserve are maybe three, to between failure, somewhere in there.

Dr. Yoni Rosenblatt: Okay. Now I know you're not using that language when you talk to your 16- year-old. So how do you get that information from your 16- year-old?

Dr. Rayce Houser: Typically, I want them to go until they get like a moderate sort of burn in their muscles. I feel like that's probably the best way. Once they start to develop a training age, I think they start to understand what kind of, you know, how many reps they have left in the tank. But at this point, it's like moderate fatigue, moderate sort of burn in their... The desired muscle.

Dr. Yoni Rosenblatt: Okay. So that makes a lot of sense 'cause then you're meeting your patient where they are, right?

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: You've had four months to develop a rapport. So they know a little bit about the way Rayce Houser likes to train. And so they know what you're looking for. So I can definitely appreciate that. Now, as you... If you don't have a seated knee flexion, as many clinics don't, what other ideas you got? 

Dr. Rayce Houser: So we have a cable column that we use to hook up people to it's a Kaiser machine that's pneumatic resistance. Super easy for us to put the resistance to zero, get everything set up, increase the resistance and have them go at it. I think that's an easy way. The other option, if clinics don't have that, is just using manual resistance.

Dr. Yoni Rosenblatt: Okay. And you're just meeting them throughout the motion?

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Okay.

Dr. Rayce Houser: And I can match kind of their strength output throughout the movement to better kind of match their sort of, you know, whether it's fatigue that's starting to play and I can better match that. I don't like bands necessarily per se, just because I think most clinics, their therabands that they use don't have enough resistance to essentially achieve any sort of stimulus. So I think manual resistance tends to be better.

Dr. Yoni Rosenblatt: Okay. Okay. So, that makes a lot of sense in terms of some options. Any other options to hit that hammy?

Dr. Rayce Houser: Depending on what they have, we can use like sliders. If they have like a Sorenix roller, foam rollers, I think those are some options that we have as well.

Dr. Yoni Rosenblatt: Yeah. Yeah. I love that. I know very often like getting the athlete into that supine position, having them doing the single leg bridge, even with a deeper knee flexion, if you give them that unstable surface that they got to pin down. Like that forces that hamstring...

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: To really prevent that translation of tib coming out, I know that can be helpful. You ever use electric stim here?

Dr. Rayce Houser: Have been using some NMES on the hamstrings.

Dr. Yoni Rosenblatt: Okay. So educate us on why you're doing that and what the effect is.

Dr. Rayce Houser: So I've actually been using it more for range motion purposes, because I've had some people who have struggled with knee flexion. I'll mob them, we'll get some benefit, but it seems like when we have the hamstring kick on with knee flexion, especially with extra burst with the NMES, it seems like that kind of helps with arthrokinematics of getting them through deeper ranges of flexion. So that's been my primary goal for using NMES as of late.

Dr. Yoni Rosenblatt: That's in this population? Is that...

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Okay, cool. I love that you're talking about mobbing the knee and driving the tibia. What are you doing? Are you driving tibia posteriorly?

Dr. Rayce Houser: Posteriorly, yeah.

Dr. Yoni Rosenblatt: Okay. And what are you doing with superior hand?

Dr. Rayce Houser: Typically stabilizing distal femur there.

Dr. Yoni Rosenblatt: Okay, cool. A lot of times I will combine my posterior tib glide with an inferior patellar mob. So that's what my superior hand is doing. But do you have any reservation about ripping on someone's joint when they have a new ligament in there, or tendon become a ligament?

Dr. Rayce Houser: It'll depend on what graft they have. Like, if they're a cadaver graft, I'm gonna be less likely to, just because I'm the surgical fixation. But if it's bone patella tendon bone with the bony anchors, I'm not quite as worried about that.

Dr. Yoni Rosenblatt: I wonder if I'm wrong about what I'm about to say, but I have no reservation about that. I just feel like that, I don't know anyone that has torn their ACL mid mobilization, do you? You read a lot more literature that me...

Dr. Rayce Houser: And I mean all the researchers that we have in terms of strain on the ACL graft...

Dr. Yoni Rosenblatt: It's not happening.

Dr. Rayce Houser: Yes. So like, walking is the most stressful thing that we do when we've looked at research.

Dr. Yoni Rosenblatt: Okay. So, that ties into definitely a previous conversation I've had with Dr. West, see episode, I don't know, 11 or something. When we just, we talked about this antiquated look at what is stressing the graft, and I don't think it's joint mobs.

Dr. Rayce Houser: No.

Dr. Yoni Rosenblatt: So my answer would be no, I don't give a damn, I'm mobbing the hell outta that thing, if I think it's gonna help. I love your use of electric stim in that. Where'd you get that? Where'd you get that idea?

Dr. Rayce Houser: It was just something with someone who I've worked with, it was like, we weren't really getting any sort of, much improvement in terms of knee flexion and I was like, well shoot, let's just throw on the hamstrings. It was more initially for a strengthening intervention, but then as we were going through it, I'm like, shoot, we're getting to like 130, 135 or we were only able to get to 120.

Dr. Yoni Rosenblatt: Yeah. I think that's awesome and eyeopening. Maybe it's reciprocal inhibition, right? Maybe it's shutting down quad. Maybe it's waking up that hamstring in that deeper range so that you can get that active range, who knows?

Dr. Rayce Houser: Probably a combination of both is my guess.

Dr. Yoni Rosenblatt: Probably a combination of both. For sure, I love the idea of doing it early, right? I think you're talking about we wouldn't use that now to get range 'cause her range better already be there, but great idea to do it early to really help gain that range of motion. I've even seen benefit from using it as, like a gate theory. Almost like old school PTs would just leave their patients on stem to start, which in actuality was just so they could juggle other patients, but to leave that stem on while you're mobbing them at low levels to really block that painful stimuli, I've seen to be worthwhile. I haven't done that in a minute, maybe I'll get back into that.

Dr. Rayce Houser: This will be a little bit off topic, but in terms of quadriceps, AMI, I've seen some stuff where they'll, it's called like hamstring fatigue where they...

Dr. Yoni Rosenblatt: What's AMI?

Dr. Rayce Houser: Arthrogenic Muscle Inhibition. Essentially the quad is shut off. And in terms of helping to get that back on, we can use what's called a hamstring fatigue.

Dr. Yoni Rosenblatt: Love it.

Dr. Rayce Houser: Which essentially post-up ACL, we have the H reflex, which essentially the hamstring is just a little bit more tonic, so if we fatigue it maybe alters some like membrane potentials, maybe now it can't quite that same sort of contraction. And maybe that now gives us better access to the quadriceps kind of like reciprocal inhibition.

Dr. Yoni Rosenblatt: Exactly. And so that is an awesome use of some of these party tricks that I picked up in grad school. We kind of learned them for Emmanuel therapy purposes, that's an awesome use of understanding your neuromuscular system and using it to your advantage. What's your desired effect? Your desired effect is to increase your quad recruitment so you can load it, so you can do whatever, take some pressure off that tendon possibly, use whatever you got, I think is the lesson I really take away from that. So, okay. So when you have, let's jump back to our case. So you have this 16 year old, low training age, so now you've come up with a few different ways to load that hamstring, how do you gauge whether this training age is increasing so that you can get back to the point of doing your desired higher level lift?

Dr. Rayce Houser: So I think it comes back to when we're teaching the single leg RDL, I'm probably gonna provide some constraints to that movement. Maybe it's, we have like a one foot on the ground, one foot on the wall, so not true single leg. But we're still in a kind of asymmetrical biased stance...

Dr. Yoni Rosenblatt: Dude, I love that because we hammer that in our forthcoming true sports ACL course. I mean just, the way to progress that posterior chain load, so that's awesome to hear. Okay. So you put the foot on the wall...

Dr. Rayce Houser: And I feel like that gives them con... Or another form of ground contact in a way to help with, kind of kinesthetic awareness. They're close to the wall, which I want them to push their rear end back towards the wall there horizontally. I think most times it gets taught where we're just kind of just bending forward versus the bending forward happening as a result of the horizontal translation.

Dr. Yoni Rosenblatt: Which way? 

Dr. Rayce Houser: Horizontal pelvic translation towards the wall.

Dr. Yoni Rosenblatt: Which would be posterior.

Dr. Rayce Houser: Posterior. Yeah.

Dr. Yoni Rosenblatt: Right. And that's getting your posterior chain talk. And you need that sucker talk 'cause otherwise, stuff's gonna start collapsing and now we're in the owl spine, right now we're in the T spine, whatever. So I think that's a great cue. I always say try to, like you're closing your car door with your ass, you're able to shoot that thing back to try to load it, and you're taking away, you use the term constraints, that's how I know you're a strength coach, but you're taking away these other things that the patient has to struggle through, which is balance, stability.

Dr. Rayce Houser: Other thing I like to use is, put a dowel in front. I'll put it kind of like, midfoot-ish area and have it in front so their shoulder has to travel down the front of the dowel without it tipping forward, 'cause if they are tipping that dowel forward, I know they're not getting that full translation posteriorly with their pelvis.

Dr. Yoni Rosenblatt: Yeah. I love that. Okay. That's awesome. And so all of that should light up hammy glute. Where do you, any other tidbits there on how you want to teach that thing? 'Cause this is something I've definitely struggled with in my career, and I'm sure people listening struggle teaching this.

Dr. Rayce Houser: I also find that maybe having a bit more pressure posteriorly in the heel tends to help a little bit better. So those are typically in, kind of my go-tos in terms of like what they're feeling, what they're doing, constraints I end up using, I know some people will use like a wedge and they'll reverse it so it's on like the forefoot, I'm a little skeptical if that's truly getting what we want. Like, are we just then more tensioning the sciatic nerve and some of the neural structures versus actually getting the desired effect of more load to the hamstring? 

Dr. Yoni Rosenblatt: Yeah. I I'm sure that's patient dependent. That sounds very unstable. Like, tough to control. Another thing that I like to do is put a band up above the knees. Through that move, or sometimes I'll add, like put a foot on the wall, band up above the knees, just find your hinge. And, the hinge just doesn't get taught, stressed. It's a tough thing to teach, but I've seen higher level athletes in their 30s who just can't hinge. And they're like, "Well, I've been deadlifting." I'm like, "Okay, how you deadlifting?" "Well, I'm a big hex bar guy." Okay. Like, well that's a hex bar squat. That's not a hex bar dead. And so thinking about ways to incorporate that, when you talk about training age, that is something that I would love to see. That's how it would almost grade their training age. From the one who's been training since 11, they should have that hinge. And then, you could load the crap out of them. Okay. Now, your 16 year old that has a high training age, you give them the RDL. They smash it. How are you progressing it?

Dr. Rayce Houser: Progressing it, we can go just overall more weight on the bar. I tend to, and this is, I'm gonna be more biased towards using barbells, especially like as an athlete, gets stronger, just because for most people dumbbells are gonna top out at a hundred pounds. In this case, I don't imagine this particular individual's gonna struggle with that, so I'm fine with using dumbbells or barbell. I like the barbell because at least gives me contact for Latin engagement as the bar kind of travels down the tibia. So if I keep kind of light pressure with that bar and the tibia, I know I'm getting some Latin game engagement for a little bit better lumbar stability there.

Dr. Yoni Rosenblatt: Yeah. Awesome. And again, making that whole thing taught, I think is important. Sometimes I'll put bands pulling anteriorly, like light bands, that those left have to engage against. I've seen that begin to work that posterior chain on athletes that are like, I never felt that, so maybe there's, maybe there's something there. Okay. So that's your posterior chain world. That's the way you would handle someone who can't do your RDL, your single leg RDL for sure, and ways to progress. Any other tidbits on that that you think is worthwhile to this audience that is just soaking up this information?

Dr. Rayce Houser: Some other things we can consider? You mentioned using the bands around the knees. Go band around the hip to help with pulling the pelvis posteriorly. I've also tried doing like cable pull throughs. But...

Dr. Yoni Rosenblatt: I hate those dude.

Dr. Rayce Houser: Some, I'm not a big fan.

Dr. Yoni Rosenblatt: They're just tough. They look weird, but they're tough.

Dr. Rayce Houser: Each individual, I mean, they're unique in ways that you have to come up with strategies to help them learn the hinge. Some people soak the cable pull through up really well, some it just turns into more of like a Jefferson curl. So honestly you just have to have kind of multiple strategies...

Dr. Yoni Rosenblatt: Thank you for not using the toolbox. [laughter]

Dr. Rayce Houser: Yeah. To use, 'cause you never know which strategy you're gonna have to use for which individual.

Dr. Yoni Rosenblatt: Yeah. Yeah. But, certainly worthwhile. I also like your use of sliders that you mentioned, 'cause it gives you just more of the ability to cue to pull, to pull into that thing. Also, keep in mind, and why don't you educate us on, what does your warm up look like for this session?

Dr. Rayce Houser: So we're 16 weeks. I would say we're probably doing some sort of extensive plyometric warm up at this point. Doing some pogos, I have to do some sort of hip stability kinda warm up as well. And then from there, if my main goal is, the single leg RDL is my main sort of thing I wanna get after, or at least hamstring loading is the main thing I wanna get after, then let's hop into the skill piece. We're gonna pair that with our output, and then we're gonna have some of our accessories, whether that's, more glute max, glute mead, some open connect chain, quad loading, maybe we getting some squatting pattern stuff or, lunge split squat stuff.

Dr. Yoni Rosenblatt: Now, that's your session or that's your warm up? That's your session. That's your session.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Okay. Stuff that I like to, if I know I'm trying to attack that posterior chain, are some of those isometric holds. Some of, like how do I put them in a position to really feel their ham, if that's my target. So, that would include either of those ISO holds, I like the idea of prone ISO holds for knee flexion, just make sure that that hammy kicks on, we know we see, like if I had a nickel for every time I had a patient freak out in a cramp when you're testing their hamstring stretch and prone. So that's a great way to start to kick those suckers on and prepare for that session. Now if we're going some plyo work, like if I think that's gonna be a piece of the session or the first thing that I do in the session, then I think my skips there are really important, I think like really understanding what a good B skip is. And like how I pull down and generate force rapidly. I mean that's a plyometric, right?

Dr. Rayce Houser: Yeah. Well, I think most people when they teach the B skip, it's more just like, oh, just kick your leg out. And that's kind of where it starts and ends.

Dr. Yoni Rosenblatt: It is hard to do an athletic looking B skip.

Dr. Rayce Houser: Yeah. It is.

Dr. Yoni Rosenblatt: And, are you good at those? 

Dr. Rayce Houser: I'm probably okay. I'm probably better than some, but not the best.

Dr. Yoni Rosenblatt: Worse than others. Best B skip I ever saw was Dr. Tim Mahan. His B skip was magical, and I think that's how he became the director of player performance at Rutgers University, from his B Skip. It's really impressive, but a great hamstring recruiter if taught properly. Okay. So walk us through another awesome scenario from which we can learn how to adjust a given session to meet our patient in this presentation. That was such a long question. Let me rephrase that. Ready? 

Dr. Rayce Houser: Yeah. Yeah. [laughter]

Dr. Yoni Rosenblatt: Let's say, we have these same two athletes, but now you want to go over a squat load or a quad load session, how will you address those patients? Should we edit that part out or keep it up? Go ahead.


Dr. Rayce Houser: So, big thing I'm thinking of with squat is, so we add our hip hinge, which is our posterior pelvic translation, horizontally, I'm thinking of squat, I want more vertical translation of the pelvis or more vertical pelvic displacement here. I wanna try to maintain a more relative vertical torso, and try to maintain whole foot pressure throughout the movement. So let's say, the individual who does not have that training age, when she squats, she maintains kind of a vertical torso, but center of her pressure moves forward to the forefoot, I mean, essentially kinda resembles what a sissy squat would end up looking like. So at that point we're not getting the desired effect I want. We're still loading quad, but it's not the way in which I want it to. Like I want her to, to do a squat, and part of the reason that she might not be able to is, one, just from a mental representation standpoint, like an archetype, she doesn't have that sort of motor representation built in. So I think this is where machines start to really come into play because they can help really constrain the movement.

Dr. Yoni Rosenblatt: Okay. So, her fault, her movement fault as it, what does it look like with the sissy squat?

Dr. Rayce Houser: So essentially, you've seen the sissy squat where the, they come up onto the ball or foot and kinda go really far forward? Something similar to that, but not to the, that extreme.

Dr. Yoni Rosenblatt: Okay. But, and what's her torso doing? Is her torso staying off? 

Dr. Rayce Houser: Torso straight, but coming up onto the balls of her foot while she squats. Maybe going a cord of the way down and it's just not, I'd rather train that quad through more of a full range of motion.

Dr. Yoni Rosenblatt: For sure. Well now, before we get to how you would train it, I know you referenced or hinted at some machine use here, what movement faults usually create that? 

Dr. Rayce Houser: Could be a lack of dorsiflexion mobility potentially...

Dr. Yoni Rosenblatt: Yep.

Dr. Rayce Houser: Potentially, it could be that the quads are weak so essentially, once I get to that point there, it's like I don't wanna go any further down. I don't wanna work through any more knee flexion. I'm gonna get out of that.

Dr. Yoni Rosenblatt: I think this is a great opportunity to say they're missing dorsiflexion, here's your homework, right? Here's how you restore dorsiflexion. I'm not gonna spend time in the clinic doing that because I gotta load your quad.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: You gotta come up with exactly what the problem is with their dorsiflexion, is it motor learning? Is it gastroc? Is it solely... What is it?

Dr. Rayce Houser: Right.

Dr. Yoni Rosenblatt: Let's figure it out. I think that's like your higher level sports PT where you can get them working for you so that your next session is even better, but okay. So you want to just, her squat looks like trash, because of the way you described. So you still gotta get quad load and so you wanna go to machines?

Dr. Rayce Houser: Yeah. So, I like the machines because they're gonna constrain the movement. The hack squat would be my go-to example here where, the mat's gonna help me keep that vertical torso. It's gonna be fixed on a path where that's gonna help with the vertical translation. And then we have the platform where I can help maintain whole foot pressure, just adjust the foot placement on the pad there and we're ready to go.

Dr. Yoni Rosenblatt: Before you go there, do you try to coach 'em out? How do you try to coach 'em out or in, to the desired motion? 

Dr. Rayce Houser: Sometimes that might just be, using a heel wedge, using like an anterior load maybe that will kind of help get me the desire to... Response I want, whether... So essentially with the heel wedge we're getting, or able to access more relative dorsiflexion, yeah, more relative dorsiflexion. And the anterior load's gonna kind of help shift my center of mass backwards a little bit more. And if they end up leaning horizontally with their trunk, they're just gonna dump the weight because it's in the front of their body. So I think that's easy way to try to, at least try to constrain it to where I don't have to use too many cues, 'cause I think we start giving them all these verbal cues that they have to focus on.

Dr. Yoni Rosenblatt: That's a lot.

Dr. Rayce Houser: The less they can focus on one of those individual cues specifically.

Dr. Yoni Rosenblatt: Yeah, for sure. How about turning their toes or excellent rotating their hips out?

Dr. Rayce Houser: Yeah, I'll play with stance with, I'll play with toe out angle, just to see what sort of response we get there. Maybe it's a hip mobility issue that we're running into and maybe we just kind of play around with the stance and stuff and then maybe that gives us better access to certain positions.

Dr. Yoni Rosenblatt: I think this is also another opportunity to try electric stem. Let's see if increasing your quad activation supports your knee. Maybe it's a pain limited response, right? I've seen that a lot with patella femoral syndrome. Where patients just like won't get into it until we pop stem on it. Or even BFR. I've seen... Because we know it's increasing activation levels, right? So maybe that's doing a better job supporting the patella, but all good ideas there. Now if you don't have a hack squat, what are you doing?

Dr. Rayce Houser: Probably gonna go with a goblet squats. Like Zercher squats, front squats. I'm probably not gonna have them in a front rack position, but probably like that cross arm grip.

Dr. Yoni Rosenblatt: You sound like the front squat doc.

Dr. Rayce Houser: Front squat Doc.

Dr. Yoni Rosenblatt: Front Squat Doc, on Instagram.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: There you go. Okay. All good ideas. And so this is a 16 year old girl. She's probably got some coordination, right? What if this is a 45 year old sedentary desk jockey. Any other solutions that you might go to that are simpler to get to that squat form?

Dr. Rayce Houser: So if I'm seeing that same sort of compensation, maybe I put like a box or something directly underneath our hips where it's just like sit down, stand back up. Sometimes I've seen that result in where we get like too hingy at times, but I think it's worthwhile to atleast try it out.

Dr. Yoni Rosenblatt: Yeah. I think that's a great idea. Like the old sit to stand, right? And then like you said, you gotta meet your patient where they are. You just progress it right? And try to get 'em better with that. Okay. So once you kind of move through that, or let's say you do have access to machines, you're going hack squat, anything else that you're like, Hey, let's...

Dr. Rayce Houser: I think hack squat gives me the best. And it's probably the most readily available, like pendulum squat machines are similar in a way. But I would say the majority of people with probably don't have access to that machine, so.

Dr. Yoni Rosenblatt: Yeah. Yeah. And then how quickly are you going to a bilateral squat pattern in this ACL population? 

Dr. Rayce Houser: Regardless of like if their squat looks like crap or not? 

Dr. Yoni Rosenblatt: Yeah.

Dr. Rayce Houser: So I tend to be biased more towards unilateral or like unilateral stagger stance early on. So initially I might use a bilateral squat early on just for like a transition to tolerance to weightbearing and loading. But as soon as they have that tolerance, I wanna try to get out of that as quickly as I can to more unilateral exercises just because I can at least eliminate one avenue for compensation for taking stress off the quad. So typically once we get to 80, 90% quad LSI is when I start to have more of a 50/50 split with unilateral and bilateral exercises.

Dr. Yoni Rosenblatt: How are you measuring LSI and just tell us what that stands for.

Dr. Rayce Houser: LSI is Limb Symmetry Index and we're using the tin deck machine or the tin deck unit and...

Dr. Yoni Rosenblatt: Also, should be a sponsor of the pod, but go ahead.

Dr. Rayce Houser: Yes it should. I like to test at 90 just in terms of creating torque to body weight ratios. It makes math a lot simpler. So I'll use that and typically also I've seen that if I have, let's say 90% LSI at 60 degrees of knee flexion, I might have between 80 to 85% of limb symmetry at 90. So just kind of stressing the importance that typically are deficits in quad strength and deeper ranges of knee flexion tend to persist longer than those in shallow ranges of knee flexion.

Dr. Yoni Rosenblatt: Okay. Love that. Great tidbit. Here's what kills me. Not that you asked, but I'm gonna tell you anyway. When we bring in candidates to work at True Sports, one of the things we do is we send them a case and we have them work through the case and I'm the patient, whoever's interviewing was the patient. Did you go through this?

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: I hope you did it. Okay, good. So was your case an ACL case?

Dr. Rayce Houser: Yep.

Dr. Yoni Rosenblatt: Okay. So what kills me with the ACL case, 'cause we see more ACLs than anything, is when just valuable minutes are spent trying to teach a squat to an... A bilateral squat to an early post-op ACL, it's never gonna look good. Your ass is always gonna go over to the unaffected limb. It's such a waste.

Dr. Rayce Houser: Yes.

Dr. Yoni Rosenblatt: Tell me if I'm wrong.

Dr. Rayce Houser: I'm right there with you. Like I said, it's just a transitional period. As soon as they tolerate load, tolerate weightbearing, I'm snapping out of it immediately. We're gonna progress to a split squat sort of position. I can adjust load or the distribution of weight between the front leg and the back leg. Let's then progress to a Bulgarian split squat, then let's progress to more of a true unilateral movement.

Dr. Yoni Rosenblatt: Yeah. Live in there and I would say even first go round, it's gonna help with tendon resiliency and accommodation and robustness. If you can get them into a single leg wall set as soon as possible. I'm not saying to blow their BTB up, but being really smart about that. But stop coming in to interview and teaching squat mechanics, it's gonna look like trash. So okay, good. I'm glad I'm not wrong about that. Okay. So those are some of the ways that you're working through your quad dominant movements in that strength session. You ready to go to our plyo world?

Dr. Rayce Houser: Yeah, it's gonna be fun.

Dr. Yoni Rosenblatt: It's gonna be awesome. If there's one thing us PTs could get better at and learning from guys like you as a strength coach is this plyo world. This rate of force development which I know you're gonna call RFD in like 26 seconds, but I'd just like to spell those things out for people. Okay. So same training. This is a great time. This four month window. I like, hopefully we got there earlier.

Dr. Rayce Houser: Yeah. Yeah.

Dr. Yoni Rosenblatt: But let's say we didn't. Let's say they started PT elsewhere and we had to clean up some other stuff, we see that all the time. Pretty common. This is her plyo session. This is her first plyo session. Talk to me about how you're introducing plyometrics to your novice training age.

Dr. Rayce Houser: So I'm thinking I need to have a good idea of physics from this standpoint. So big thing I like to consider is the, essentially the impulse momentum theory. Where impulse force times time, momentum mass times volume, essentially impulse is gonna result in a change in momentum.

Dr. Yoni Rosenblatt: Impulse is gonna change?

Dr. Rayce Houser: Momentum.

Dr. Yoni Rosenblatt: Momentum. Okay.

Dr. Rayce Houser: So let's say...

Dr. Yoni Rosenblatt: Sounds simple.

Dr. Rayce Houser: Let's say I have them do a drop from either a six inch or a 12 inch box. I know that that drop is going to result in a specific velocity that they end up having to stop once they hit the ground.

Dr. Yoni Rosenblatt: Put the brakes on.

Dr. Rayce Houser: Now, so I know with the time component, essentially the momentum's gonna stay the same regardless of the situation. So now it's just manipulating the variables on the other side of the equation, which is gonna be force and time. So initially I'm gonna cue them to have a softer landing 'cause I think that's gonna result in probably a little bit longer contact times, gonna help disperse the force a little bit more. So we're gonna have less peak force which might be a better way to start and kind of get them acclimated to some of those impacts and collisions as we're introducing plyometrics.

Dr. Yoni Rosenblatt: I love that. Now this is... So we're talking to your novice, right? How do you tell Lucy, the 16-year old girl who's never been in a gym until four months ago, that this is gonna be the movement. How do you teach that? 

Dr. Rayce Houser: So we're probably starting with snap downs. Essentially it's just doing a squat, but we're dropping into that squat in a fast way. Then we progress to stay on our tippy toes, dropping down fast. Once we get there, then all right, maybe we have some sort of low platform we step off of. Essentially if we kind of have that squat kinematics built in, essentially is just landing in that position in a faster movement velocity, so.

Dr. Yoni Rosenblatt: Yeah. I think that that really simplifies it. One of the main limiting factors here is handling that anterior translation of the knee especially in this BTB population, right? So that shin angle and that's why I like introducing, pushing that shin angle early, right? And queuing that and giving them targets to hit with that knee as they come down because it's just gonna prep him for this. This is like such a pivotal moment in their rehab. Number one, celebrating the successes in there. Even if it doesn't look awesome, like pick out the positives there. I think it's so beneficial, especially to your 16 year old athlete and two is like what have we done to prep towards that? You got to look from the beginning and say, that's the movement I want. How do I prep the athlete to do that? So I think that's just something that we kind of glossed over. So. Okay. Now are you starting with a depth drop? 

Dr. Rayce Houser: Day one of...

Dr. Yoni Rosenblatt: Day one.

Dr. Rayce Houser: No.

Dr. Yoni Rosenblatt: You said you did your snap downs.

Dr. Rayce Houser: Oh yeah. We've done snap downs. I like to do the 6 inch or like dropping off of like some like small shallow platform. Just we take the jumping component out of it. Let's just focus on landing right now. Does it mean later in the session we may not, or does it mean later in the session that we won't end up using maybe like a seated box jump or something to then work on more of our rate of force development, but landing on the box, we can decrease the ground reaction forces that we have to land on.

Dr. Yoni Rosenblatt: Okay. And that's one of the things that I learned from really your outstanding podcast called?

Dr. Rayce Houser: Residents Of The Round Table Podcast.

Dr. Yoni Rosenblatt: Residents Of The Round Table Podcast. There's so much great information there. But one of the things that was highlighted recently was the fact that we can't just live with one given metric or one given goal or one given theme with it, we need to make sure that we're attacking strength. We're attacking rate of force development. We're attacking hypertrophy. Those have to be happening symbiotically, concomitantly, together. Something like that, right?

Dr. Rayce Houser: Concurrently.

Dr. Yoni Rosenblatt: Currently, yes. Concurrently. Concurrently. And I think that's what's gonna allow your athlete to reach the milestones that we want. If we just wait for hypertrophy or one given value, we're in really big trouble. We're going to kind of be behind the eight ball. That's one of the things that I recently spoke about. We had an athlete working with us before he went back to his NFL team. And so he was with us for five months, ACL, meniscal repair, ALL, and the dude was relentless. Would come in daily to work and just rehab. And so when he got back to his club, he saw guys where their programming wasn't this focus of concurrent progression. It was here are the milestones. Here's what we got... And they're behind, right? And so being able to like drag your athlete along, understand that there will be symptoms. How do we mitigate those? How do we progress through those is super important. Okay. That was a long digression. But coming back to our plyo education, if that's the way you're dealing with the novice, does it change with someone who has a little bit more expertise?

Dr. Rayce Houser: We can probably progress them a little bit quicker through some of the heights that we end up using. I'm still gonna be mindful just because they've, you know, haven't quite, or they've lost a little bit of some of that tolerance too, some of those impacts and collisions and high forces. But I can likely progress them through the heights of the boxes quicker. Probably transition them to landing in a unilateral stance quicker as well. So those are just some of the considerations that I'm thinking about.

Dr. Yoni Rosenblatt: Yeah. Does it change your docent? Are you doing more reps with one versus the other?

Dr. Rayce Houser: It depends. Like if I have like the same height with two of the same individuals, but different training ages, I'll probably dose the person with the higher training age with more volume. But if I end up, let's say the novice has the 6 inch box and the one who's been training for five years has the 12 inch box, I might probably dose them pretty similarly.

Dr. Yoni Rosenblatt: Okay. Yeah. That makes a lot of sense. Now where do you go from there? 

Dr. Rayce Houser: We can go a bunch of different directions, whether we start to incorporate different planes of motion, where that's like frontal plane, eventually getting into transverse plane. Bilateral to single lateral. Whether we start adding like some jump or some jumps on top of that, where it's like, are we posed for a brief second or two jump? So essentially we have multiple different avenues that we can go. I don't necessarily think one is right or wrong.

Dr. Yoni Rosenblatt: Yeah. Walk me down that last avenue. 'Cause I think that's a really interesting one.

Dr. Rayce Houser: The jump pause. So yeah, I think I'm thinking like in terms of like true plyometrics, like those ground reaction forces gonna be pretty high. So as we're still continuing to build up our tolerance to some of those, like more intense variations, just one way to kind of help mitigate ground reaction forces, disperse some of the forces just to have them pause at the bottom of that jump or pause at the bottom of the land and then go up and jump after that.

Dr. Yoni Rosenblatt: And so I think that's a great way to do that. Educate us on joint excursions.

Dr. Rayce Houser: Yeah. So I'll go like long coupled versus short coupled plyometrics.

Dr. Yoni Rosenblatt: What the hell does that mean? It's sounds genius, but go ahead.

Dr. Rayce Houser: So I'm thinking long coupled, gonna be a little bit longer, larger joint excursions, a little bit longer ground contact times whereas short coupled gonna be a little bit more less joint excursion and shorter ground contact times. I'm thinking longer or the long coupled pogos or plyometrics earlier on, just to kind of help with dispersing force more. Whereas as we get closer to returning to sport, I'm thinking more towards the short coupled plyometrics as we're gonna need to be able to redirect force pretty quickly and very rapidly.

Dr. Yoni Rosenblatt: That's gold. Like that last minute is gold in terms of understanding return to sport, in terms of grading your plyo program. Where'd you get that information?

Dr. Rayce Houser: So part of it was the podcast with Joey and Robert with Residents Of The Round Table. But I think also understanding like what qualities are needed to succeed in sport. Like imagine if all we cue, like if we look at a football player making a cut, if all I did was work on like soft landing, having those longer ground contact times, like the defender, they're trying to evade, like it's not gonna happen.

Dr. Yoni Rosenblatt: Yeah. You can blow them up.

Dr. Rayce Houser: Yep. So typically the best athletes who we see can redirect force quickly. So I need them to be able to stick that and get out of it. Which is not to say that having some softer, like landing stuff later on is detrimental, but I think we definitely need to shift more of our focus a bit more towards like sticking the landing and having more of those quicker ground contact times to be able to redirect force quickly and rapidly.

Dr. Yoni Rosenblatt: Yeah. And I mean, the truth is you use the term stick the landing. When I say stick the landing, a lot of times I mean, stay in that position, right? Land softly. So I would just use it differently, but I think eight years ago when I was teaching plyometrics and boxing, it was all about soft landing. And then you start to look at your athlete, you're like, where does that even show up? And so now you're giving a great explanation of when we say, I want you to drive down into the ground. Produce force in a different direction. Now you're getting more sports specific. And so there is room for the soft landing or in my vernacular, stick the landing.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: But it should be progressed to drive through that box, try to put a hole in that box. And then I would almost go through my teaching process, my progression process, again. When we graduate from the longer, right? And the deeper angles perhaps.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Go back to two legs, one leg, multiple planes, stuff like that. Now you're really getting your athlete accommodated to those things. It's really amazing. The first time I really saw this in action was working with NBA guys. They, I hate to typecast and generalize. They can't squat to 90, right? They're just so tall. You look at the defensive back, the most athletic person I have ever worked with was a guy, his last name's White. Wide-receiver. He couldn't put his heels on the ground when he walked into the clinic. I don't think his heels have ever touched the ground. And so his Achilles tendon just so goddamn tall, and he's living in this anterior pelvic tilt and he's... I mean, he came in for back pain, right? Because like, he's so arched, but my point is, if I asked him to land softly, he couldn't do it. And so what does that translate to the most explosive athlete I'd ever seen. The dude literally stood in front of me and just popped into a back flip.

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Because he was just like a taut rubber band. So see where you use the term archetype. See what your athlete, what's he working with? What does he need? What does his sport demand? And then start to build your program around that. I think it's really exciting and I think what fascinates me is that dude, to be built like that, to compete at that level. The same sport, the same team, the same training age. You look at the linemen, a lot of them don't look like that.

Dr. Rayce Houser: No.

Dr. Yoni Rosenblatt: And so they are built to absorb very often. It's what they do for a living often. Not always, but often. Let's make sure, if I'm a strength coach, I might be thinking, how do I fill in the gap, right? How do I train him to be more explosive or give him more pop? You know what's really crazy is when you see the athlete that can do both. And that's scary. Those are your pitchers. Those are your major league pitchers. It's scary. Although Sam Cook was a punter for the Ravens. That dude could do both. It's crazy.

Dr. Rayce Houser: Sneaky. Yeah.

Dr. Yoni Rosenblatt: Sneaky. Yeah. So anyway, that's obviously, I'm still fascinated by that and got passion towards that. So super interesting. Okay. Anything else you wanted to hit on that plyometric progression? I think that was so enlightening to me and I've been doing this for a bit.

Dr. Rayce Houser: No. I think those are some of like the kind of overarching principles in terms of things to consider when reintroducing and then subsequently progressing plyometrics.

Dr. Yoni Rosenblatt: Yeah. So beautifully, I might add. You hit your posterior chain loading concept in these two different populations. Your anterior chain or your quad specific quad dominant movements, and now you're plyometrics, I think that's such a well-rounded look at where this ACL rehab should be, where a session should be. I'm just uber impressed that we talked about training ages. How good you are at this at how many years out of school? 

Dr. Rayce Houser: Two essentially.

Dr. Yoni Rosenblatt: Two freaking years out of school. We're lucky to have you here at True Sports Rayce. That's incredible. You have an incredible future ahead of you. Educate those listening on one secret that lowered your learning curve to get to where you are now.

Dr. Rayce Houser: So I think the biggest thing is working with people as a personal trainer, as a strength conditioning coach, working out yourself, I think it shows you ways in which to program different strategies to use. Like I think the biggest benefit for me has been like, as I've gone through programming for the baseball and softball teams, like the first year I think I had like 14 exercises they would do. Like, it was overkill. And then next year it's like, all right, what seems like overly redundant? Let's take some of this stuff out. All right. Now we're paired down to 12 exercises. And essentially that list kind of kept getting shorter and shorter. But some of the different qualities we're hitting was kind of growing larger and larger. So I wasn't fully or solely focusing on strength for four to six weeks. It was all right. Maybe strength is kind of the primary goal that I want to achieve, but some of my secondary goals are rate of force development, some of those things. So we're still getting a little bit of everything. We're probably going to improve across the board on all different qualities, but strength is probably gonna be the thing I'm gonna see the largest jump in.

Dr. Yoni Rosenblatt: It's awesome. It's great advice. I think what I just heard is there's true genius in brevity, right? And the more you can peel away, I mean here you got 45 minutes, one on one, a lot of clinics you would kill for 45 minutes.

Dr. Rayce Houser: Yeah. Oh yeah.

Dr. Yoni Rosenblatt: And so like how do you get to the point, best bang for your buck and how do you get that patient to help you? But for you, it was a few years of trying to understand like, how do I peel away that which is extraneous, right? And so you did it as a personal trainer, you were a strength coach. We were talking before we hit record on how readily accessible this information just is now. And so tell me who you follow that you think is a worthwhile follow.

Dr. Rayce Houser: One, True Sports.

Dr. Yoni Rosenblatt: Oh, thank you.

Dr. Rayce Houser: Two, myself.

Dr. Yoni Rosenblatt: You follow yourself. Okay.

Dr. Rayce Houser: No, but I think one, Jordan Shallow the Muscle Doc, he's a great person to learn in terms of...

Dr. Yoni Rosenblatt: Nice guy too.

Dr. Rayce Houser: Yeah. Just a overall...

Dr. Yoni Rosenblatt: But really nice guy.

Dr. Rayce Houser: Framework.

Dr. Yoni Rosenblatt: And a monster.

Dr. Rayce Houser: Yes.

Dr. Yoni Rosenblatt: But nice guy.

Dr. Rayce Houser: Yes.

Dr. Yoni Rosenblatt: By the way, this ties into our previous pod. Dude's a Chiro.

Dr. Rayce Houser: Yes.

Dr. Yoni Rosenblatt: But it's like, but adding the strengthening condition to whatever the hell you do is worthwhile, but, okay, Muscle Doc.

Dr. Rayce Houser: I think Grant Fowler, he's another good one. I think he's like Fowler Fitness SPT. No, he is not a student physical therapist.

Dr. Yoni Rosenblatt: I would've harassed him to work here already if he was.

Dr. Rayce Houser: But no, he has a great framework. Continues to kind of challenge traditional dogma within strength conditioning. So I think he's also a really good follow as well.

Dr. Yoni Rosenblatt: Awesome. That's great. I mean, just a wealth of information. So Rayce Houser, thanks so much for your time. It's time now for our lightning round.

Dr. Rayce Houser: Yep. Oh-oh.

Dr. Yoni Rosenblatt: Ready?

Dr. Rayce Houser: Ready.

Dr. Yoni Rosenblatt: What book, not science or strength and conditioning related, are you currently in the middle of?

Dr. Rayce Houser: So I just started it.

Dr. Yoni Rosenblatt: And by Lightning Rounds I meant...

Dr. Rayce Houser: Lightning.

Dr. Yoni Rosenblatt: Lightning.

Dr. Rayce Houser: Oh my gosh. Why am I... I'm blanking on the name of the book right now. Oh my gosh.

Dr. Yoni Rosenblatt: We're gonna edit this out. We're gonna put your answer right in. No, I'm just kidding. What's it about? You gotta google it. What?

Dr. Rayce Houser: I'm gonna have to google it. It's been... If This Is A Man by Lemo Previ.

Dr. Yoni Rosenblatt: Primo Levi?

Dr. Rayce Houser: Yeah, Primo Levi. There we go.

Dr. Yoni Rosenblatt: Yes.

Dr. Rayce Houser: Essentially it's about I believe Nazis and internment camps during World War II.

Dr. Yoni Rosenblatt: Dude, are you just saying that because I'm wearing a yamaka? 

Dr. Rayce Houser: No.

Dr. Yoni Rosenblatt: Okay.

Dr. Rayce Houser: No. No, Jordan Shallow, he was the one who people had asked him what book he would recommend reading, and I saw that and I was like, "Sweet, let me pick it up." So.

Dr. Yoni Rosenblatt: Awesome. Okay. My recommendation is immediately following that, if you can stomach any more Nazi crowd would be, Man's Search for Meaning. You read that yet? 

Dr. Rayce Houser: Yeah.

Dr. Yoni Rosenblatt: Did you read that yet, Man's Search for Meaning? 

Dr. Rayce Houser: No, I have not. Not that one, no.

Dr. Yoni Rosenblatt: Oh. Viktor Frankl. Yeah. It's awesome. Okay. Great. Next question. Ready? 

Dr. Rayce Houser: Ready.

Dr. Yoni Rosenblatt: What do you wish strength coaches were better at?

Dr. Rayce Houser: This is gonna be kind of tiptoeing a fine line, but I think it's understanding that they are not physical therapists. They should be able to modify things when things are painful but I think the issue starts to run into when they start trying to fix and manage things as if they're trying to treat the patient, essentially treat their pain. I think that's where kind of the buck stops is, they have knee pain, let's say they're doing a front squat. All right, let's modify to a back squat, see if that helps. If we're still having pain with X, Y, and Z with all these modifications, all right. I think that's when they should have like a good network of PTs who they trust, who they can be like, "All right, go see this person."

Dr. Yoni Rosenblatt: Okay. Good answer. What do you know now that you wish you knew when you were 20?

Dr. Rayce Houser: I would say it was just, it'd be a framework in which to view movement exercises from, to be able to categorize and then be able to like plug and play interventions that are gonna give me essentially the best sort of stimulus for the adaptation I want to achieve.

Dr. Yoni Rosenblatt: More tools?

Dr. Rayce Houser: Mm-hmm. 'Cause you see a lot of stuff that's all fluff that looks cool, but in terms of trying to achieve the desired adaptation, it's like, we think it does, but if we look at it and dig a little bit deeper, it's like, it probably doesn't do what we're thinking it does.

Dr. Yoni Rosenblatt: Okay. What would you say is the number one predictor of academic success in physical therapy training?

Dr. Rayce Houser: Oh my gosh, that's a loaded question. I think it is honestly, come down or comes down to the personality of the individual. Like for me, I'm kind of a perfectionist, so, and I'm very competitive as well, so, I wanna get good grades not only to like compete against myself, but I wanna be the alpha in the class. So I would say that's probably where that stems from. And then I... My girlfriend's gonna love this, but I hate when we have like a debate.

Dr. Yoni Rosenblatt: Is she gonna listen? 

Dr. Rayce Houser: Hopefully she does. She probably will because I'm on it.

Dr. Yoni Rosenblatt: Yes, yes. Not because of the usual content, but go ahead.

Dr. Rayce Houser: She's that cute PT, so.

Dr. Yoni Rosenblatt: Oh, okay.

Dr. Rayce Houser: But no, we'll be having like a conversation and kind of debate about a couple things and I hate it when she like makes a point where it's like, "Yeah, you're right."

Dr. Yoni Rosenblatt: Okay, fair. I love that. Okay. And what is better about the East Coast than the West Coast?

Dr. Rayce Houser: I would say everything being so close together is one. Like, New York's three hours away, Philly's hour and a half. DC is an hour.

Dr. Yoni Rosenblatt: Dude, this is a commercial for people to join True Sports. I love that, okay.

Dr. Rayce Houser: I was gonna say from a physical therapy perspective, it seems like sports, more sports ended clinics are more prevalent out here than the West coast. I'm sure like once you get down towards like Cali and Arizona, that probably changes a little bit but by far it seems like especially around here, sports clinics are much more prevalent.

Dr. Yoni Rosenblatt: Yep. Yeah. For sure. I think that's true. Rayce, super eye-opening. I appreciate your time. I appreciate your attention to detail. You've been awesome for the company. You've been awesome for my own clinical growth, so I'm not just saying that because you look like me. I really appreciate everything you've brought. Where can people find you? 

Dr. Rayce Houser: Can find me on Instagram at the Front Squat Doc. I'm on Twitter, but not very active, so Instagram's my primary platform. And then also go give the Residents, the Round Table podcast a listen as well.

Dr. Yoni Rosenblatt: Yeah, it's really gold. So appreciate your time. Can't wait to continue to learn from you.

Dr. Rayce Houser: Appreciate it Yoni.

Dr. Yoni Rosenblatt: Thanks, Rayce.


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