 would like to turn it over to Dustin for our last Q&A of the day. Dustin, take over. Alright, thank you for that phenomenal panel and especially thank you Michelle for taking that time to present to us. We don't have a ton of questions for Michelle, everyone just loves you and it's cheering you on. Michelle, I have a question to start you off and I don't see you on the there you are. Michelle, do you think that sprint training helped you as a thrower? He said sprint training. Yep, when you trained as a sprinter earlier in your career. Yes, I did. I did think that sprint training helped a lot because it helped with that explosive power because as a shot putter I am trying to create as much power in a seven-foot ring. So, learning how to react like you do on the blocks, you have to react as soon as you hear the gun go off. That really helps my reaction time in the ring. So, I didn't sprint as far as the sprinters did but they had a hard time beating me for 10-20 meters. And then Michelle, we're curious. We had a good presentation today from Bahati Van Pelt with the USOPC about athlete career and education and we're interested knowing what your plans are. We know you've got these Tokyo games now pushed off a year. After that, what are you going to do? Well, my plans is I'm still working on my plans but I have a girls camp that I have called Youth Throw Girl for its confidence camp and it's for young female athletes from junior high to high school where I pour into them not just as athletes but who they are as young women. We have different classes for them just to kind of build their confidence in who they are on and off the track. So, that's one of the things that I really am going to dive into after I'm done throwing as well as speaking. We're, we can't wait to learn more about that as you build that out even more in the next few years. So, if you talked about the lack of quality training for female athletes and how strength is a risk factor that we should be looking at and you were, it was a middle of the night in Australia but skiing snowboard, Gillian Bowers from skiing snowboard presented today and she showed that strength is protective for ACL injuries in their database. What do you think we're doing? I mean you called it out a little bit but could you expand on what do you think we're doing wrong when training female athletes and how we can get better? Yeah, so you know it's tough to hear what I'm going to say which is when we identify something like this that we can fix we feel like we want to fix it immediately but the the truth of the matter is that this fix is a long-term thing and and that strength development although we can do it in blocks or over a couple of years when we have an older athlete really this needs to happen a lot earlier in their career because it is the mix of that strength along with learning to use that strength which would be motor coordination that really has to happen it has to kind of marinate over time and I do think the strength immediately can help but it's not the whole story so I didn't want people to think that that's that's all we need to do it'd be nice if we could do that but the reason I highlight that is because the alternative or what we really need is actually more of that 10-15 year plan of strength and motor coordination development for the athlete but in simple it is definitely protective but the strength itself has to be manifested with things such as your pre-activity and and we we've looked at that previously and pre-activity prior to the event is really that mediating factor for preventing the event being an ACL tear from happening because the ACL is just like a seatbelt right but if you're driving around a car and the car is your body and your car has made a glass no one cares you have your seatbelt on and our musculature and the ability to pre-activate that musculature before you hit the ground or before you hit an unexpected event is indeed the integrity of the car the seatbelt if you're worrying about the seatbelt that's the last case scenario so that's why I try to focus on the external factors and not relate back to even if the ligament is affected maybe by estrogen and I do think that that's a tenuous link it's whether there's factors that contribute to the event prior because the ACL tears in 15 to 50 milliseconds and so that is not active enough time for the ligament to even care it actually has to be pre-activity the musculature and so strength has to be there but then the ability to call on that strength needs to be there so there are multiple layers to it thank you Dr. Ackerman and Dr. Oleko will let you take this one one at a time we have a million questions around birth control how does birth control interact with a manaria or a ligament area how does it affect your screening for red what should athletes think about when choosing a birth control does it affect performance I'm confident you guys could talk to us about this for many hours can you give us each your most important points on the topic Dr. Ackerman will go with you first I love how you're going to keep us in check good point so there's so many things to talk about birth control first of all my focus with reds I think it's really important to realize you can't accurately screen about menses if somebody's on the pill now of course a lot of our athletes are on a birth control pill so if we're worried about low energy availability we should certainly be asking them did they get normal periods before they were on the pill why were they placed on the pill was it because they weren't getting a period or was it because they needed it for birth control reasons what was their weight when they were put on the pill and then what pill are they on so we never want to prescribe someone a birth control pill to give them a menstrual cycle back but we do have to work with athletes who need birth control pills for birth control and contraceptive reasons you guys so much so I completely agree with everything that Dr. Ackerman has said it really comes down to the why so why you know is contraception being initiated why is that taken into consideration is there a true menstrual dysfunction is there a contraceptive need just keeping in mind if there is you know dysmetorrhea or PMS the birth control of the contraception can help to negate some of the negative side effects or the troubling side effects that can happen as a result of that dysfunction so the idea is to try to decrease that so that the athlete can you know perform to the best of their ability true if there is a concern for irregular menstruation or female athlete triad or res that will be masked with the birth control so when it comes to prescribing you do want to make sure that you're individualizing you know that treatment to the athlete and to the overall goal and there's a bunch of different types of birth control I think oftentimes we tend to think of just the pill that there are patches and rings and you know larks or implants as well as depot and so there's a myriad of different contraceptive options that can affect the cycle in different ways but ultimately it comes down to the why and if you're having menstrual dysfunction that's affecting your performance then being on a birth control could potentially help your performance because you're not dealing with that dysfunction anymore. Thank you and unfortunately we only have time for one more question and Michelle after your last response people want to know how they can get involved with your camps yes you can go to shotdiva.com which is shltdiva and my camp information is there and you can find all the information on it shotdiva.com and I think a lot of people are interested in volunteering and hoping out thank you all for an excellent panel we're going to kick it over to charlie who's going to close out the day for us Dr. Nymphias, Dr. Alika and Dr. Ackerman thank you so much and hopefully I can share your content with my marathoner wife and my two daughters hopefully that's okay and Michelle thank you for inspiring us and being such a great ambassador for our mission and our movement so this is wrapping it up we're going to be done here what a transformative day my last two shoutouts our last two shoutouts Frank Nagayan from Stanford thank you for joining us today please say hi to John Denny for us and Scott Thurston from the Tampa Rays baseball team thank you for joining us and thank you for sending Joe Madden to the Chicago Cubs first of all thank you to all of our presenters for your gift of time and your gift of knowledge thank you to the sponsors and the underwriters today that made today possible conduct proof point proof point biologics valid performance the Steadman-Philippone research institute and clinic and the United States Olympic and Paralympic Foundation thank you all for your underwriting of today's virtual presentation and symposium and then finally 4,800 participants joined us today they gift us with their time and hopefully left with some incredible knowledge based on the incredible content and the unbelievable presenters we will see you in Vale next year at the fifth annual injury prevention symposium April 28th through May 1st registration materials will be coming out in the near future and we're looking forward to doing this again in person and celebrating the fifth anniversary and in closing we again wanted to thank the medical providers first responders and all essential employees that are doing so much and doing so much heroic efforts and support of everybody impacted by COVID-19 again thank you for participating today and everybody be safe