 So my name is Scott Tashman. I'm the Director of Biomedical Engineering here at the Stedman-Philipon Research Institute. I'm also a professor of orthopedic surgery at the University of Texas in Houston and I think my career has been devoted to developing advanced techniques for assessing mechanical function of the tissues in the body, joints, ligaments, tendons, muscles and clearly the mechanics play a big role in injury. The forces that specialty athletes expose their bodies to put all of their joints and tissues at risk and understanding how, what sorts of forces those tissues can withstand, how we can train individuals to increase those limits and how we can try to alter the way they do their sports that minimizes the injury risk is all part of the kinds of things where we can apply biomechanics to injury risk. In a downhill skier, you know, there's some injuries we can't prevent through training. You know, someone hits a rut in the snow and goes flying. We're not going to keep that athlete from falling, but some of the non-contact injuries that occur not only in soccer or other sports that we're aware of, but even in skiing, you see these injuries that happen to skiers when they're in extreme body positions that actually cause them to fall rather than result from the fall, that maybe there's ways we can look at specifics of how those, like their intercruciate ligaments being loaded in those extreme positions, know what muscles they need to work on training or neuromuscular training to alter the way they use their muscles or perhaps small changes in body position that might make just enough difference to alter the forces so that when in one case they tear their ACL, in the other case they don't. Well, we actually do a lot of our studies without, you know, in the more recreational athlete population, not just the elite athletes. It's true that the Stedman Clinic as a whole has treats a great number of elite athletes, but they also treat every day weekend warriors like me. You know, I tore my ACL a number of years ago, and it's really a much bigger population. So in terms of societal impact, we can have a bigger impact treating all athletes. Elite athletes are really in a world by themselves because they can do things with their bodies that mere mortals like you and I can't even dream about. We can watch them on TV. And so in some ways the injury prevention approaches may be different for the recreational athlete than they are for the elite athlete. And we're working towards both. But in terms of how what we do in the lab, yes, we have a very well-equipped, expensive to build laboratory with exotic equipment. But our goal is to identify, using everything we can throw at the problem, what the factors are that are related to injury risk, what, you know, what results in abnormal loading to the anterior cruciate ligament and puts it at risk, and how can we modify someone's behavior to reduce that risk. Or in the case of the Stedman Clinic in particular, we're also very focused on how once someone's had an injury, we keep them from getting a new injury. So looking at how that tissue that was repaired, whether it was an ACL replacement or rotator cuff repair, when that repair is ready, when that tissue is healed well enough, that that person's ready to go back to this extreme level of athletic activity. And we feel that if we understand all of the issues involved, using all of the resources we can throw out at the advanced imaging capabilities we have, we can then from that information devise simpler tests, that we can then take that technology, boil it down to the minimum necessary data, and develop systems that can be used in in clinical environments. I wouldn't say that that's happening in general, but it's like everything else. Some centers and some coaches are much more aware of the issues. I think at most of the major universities now, there's pretty good awareness in the training and coaching programs as to many of the factors related to injury. There's always room for improvement, because there are a lot of things we don't even know at the highest levels. But you know, maybe there's high schools in some places that aren't aware of some of these issues. And in terms of the return to sports, again, there's a huge variation from expert centers like the Stem and Clinic and like other academic medical centers, where people are using performance-based criteria and everything they know to judge when their athletes are ready to go back. But there's other places that say, well, yeah, you're six months out from your ACL reconstruction, so you're good to go. Without really doing a thorough assessment of that individual patient's healing status and neuromuscular performance capabilities. So it's there's a disconnect between the centers that are at the forefront and some of the areas where perhaps there isn't the same level of expertise. I like to say that I can assess anybody's function, but the higher the more elite an athlete is, the more difficult it is for me to say, this is what makes you a great athlete, because each individual elite athlete has found a way to make their body, their physiology, work for them. And they've optimized, at that level, they've gone beyond simple, you know, if you're teaching someone basic golf, you know all the things that they need to know to be a decent golfer. But when they get to a certain level, it's them and how they learn how to use their bodies. Yes, they need expert coaching and all those things, but there has to be a part of it at the elite level. I think this is just personal opinion that they've found the best way to use their body. You know, the example we saw last night with the amazing speaker we had, she should never have, from a biomechanical perspective, she shouldn't have been able to achieve the level she did, and yet she overcame her functional limitations. So that's a classic example of what I'm saying that each athlete, so the answer to your question is no, I can't say what a perfect athlete looks like, because sometimes it's an imperfect body that's performing at a level beyond, way beyond expectations, and then it's the athlete that's somehow making that happen. Oh yeah, so attitude and motivation clearly play a critical role in all aspects of injury recovery and injury prevention. So you can say down the road we've designed the perfect, that we believe is the best possible intervention for athletes in a particular sport. Do this training and your injuries are, your risks, we're never going to eliminate injuries, but we can reduce the risk significantly. That athlete has to want to do the training. If it's a child, their parents have to want their kids to do the training. In terms of injury recovery, we all know how important a rigorous rehabilitation program is. And, you know, in today's environment where maybe your physical therapy only pays for a certain number of visits, and then it falls on you to do these exercises at home to continue to build those muscles that protect your ligaments and tendons. If the athlete doesn't put in the effort, there's only so much the clinician can do. So it is a combination of expert diagnosis, treatment, rehabilitation, and effort and motivation from the athlete to get back to where they want to get to. I think Dr. Tim Hewitt, who's here from Mayo, summed it up very well in his presentation, that we're no longer in a world where a therapist can solve a problem completely, or someone with biomechanics expertise can solve it, or an orthopedic surgeon can solve it, or a biologist like Dr. Hewitt can solve it. We need to work together because you need to incorporate all of these aspects to heal these athletes. And these meetings give us a chance both through our formal presentations, but equally, if not more important, the time we spend together during the breaks and the meals and, you know, just over casual conversation to exchange ideas and to learn from each other and to form collaborations and work together, because that's ultimately the way we're going to make the most progress in the injury prevention field, is to build teams with expertise across the board, where we're taking advantage of everything we know, we're each learning from each other's insights, and we can really move the field forward. Well, I think in many of these areas, our solutions are data driven, and the more data we have, the better answers we can get. And the USOC and the IOC are both at the forefront of injury surveillance. So they collect a huge amount of information on their athletes, and they have very good histories of injury. So understanding what factors contribute to the development of injury is a critical part, and our collaboration with these organizations helps give us access to some of that data that we can use to help understand what drives injuries, what drives re-injuries, and that really contributes to our ability to focus on those particular aspects that we might be able to address to reduce injury, and which athletes are at the highest risk, where should we target. So I think one of the aspects of that collaboration that is most important to me is access to information about the athletes, and also the potential to work with the coaches and trainers and athletes at this level. When we get to the point where we think we have interventions to work, we have a population and a relationship where we might actually be able to take these advances and help improve the health of our best athletes.