 Thank you, Dr. Reimer. I appreciate it. I've missed, not doing my job here. We got a couple other shout outs. Richard Penn from the United Kingdom has joined us at the symposium. Thank you, Richard. And Ike Eastburn has joined us. State champion, Cheyenne Mountain LaCrosse. And our final panelist, Dan Gardner. Dan is in his ninth season supporting Team USA as a strength and conditioning coach, working with medalists from the London, Sochi and Rio Olympic and Paralympic Games. He's also been an athletic development coach for the Golden State Warriors. And this is why Sam's not going to be invited to our employee basketball games. From Westfield State University, it was a four year member of the Ben's basketball team and the team captain. Sam, welcome. Before I begin, I just want to thank everyone who put a lot of time and effort into making this event happen. I want to thank you all who are attending for listening. Today, I'll be providing a general broad stroke overview of how I see and address injury prevention within our strength and conditioning program for U.S. Paralympic Sport. Let's kick this presentation off with a bit of a thanks session. Please play along if you can in the comfort of your own home. Let's just throw a theoretical situation here. Say you were working with the able-bodied triathlete. We'll pick on the bronze medal stand for this scenario. Let's just pretend all things considered training age, training response, training history were all equal. Let's say you were used to working with the able-bodied athlete on the left and one day was tasked with supporting the same athlete in the bronze medal stand in this scenario on the right. This athlete having a traumatic injury resulting in above-in-the-amputation. What might you consider when thinking about injury prevention? Maybe you're thinking about the difference in energy expenditure. Maybe you're thinking about how half the proprioceptibility of the foot are missing now. Maybe you're thinking about the overloading of the biological limb. Maybe you're thinking of specific considerations for the shoulder. Now that they can't use their legs, are they gonna overuse their shoulder or actually load the shoulders in a different manner in the swim? And let's do the same thing for a second scenario here. Say you're working with a long jumper maybe supporting as an assistant S&C with this particular jumper on the left. And one day you were tasked with working this jumper on the right who's in the T11 category, complete visual impairment. What are some of the things you might consider that might be important when considering injury prevention with working with the second athlete versus the one on the left? Maybe you're thinking of your communication skills, your queuing. Maybe you're thinking of the benefits of tactile learning. Maybe you're considering the balance and proprioceptibility that might be necessary for athlete with visual impairment or setting up a safe training environment. With these last two examples, do you think there would be more differences or similarities in your work with these two athletes? In its simplest form, these are the two main objectives when supporting athletes, for me and the staff that I work with. Ideally, we want to identify key risk factors and try to reduce the severity in incidents for potential injury. We'd also want to identify key performance indicators in attempt to support consistency and performance within them. Injury prevention and athletic development and sport performance go hand in hand. And if you do your homework, whether they have two legs or don't, whether they have afferent neural response or not, whether they can see or not, it's probably gonna be pretty much the same process. This is an overview of a modified system I've used for several years from providing S&C support to athletes of various sports. It's been an evolving system and I'm fortunate to now have help from three other coaches and together we utilize some of these principles for tender vent, resident and rotational programs that utilize our training sites in Chula Vista and our training center in Colorado Springs. So the first step in our process is to go through a sporting demands analysis profile. When considering injury prevention, it is important to understand the demands being placed on the athlete. Understanding the velocities, the forces, the joint angles that the athlete has to experience and training as well as competition. That should be a good starting point for us to understand what is going to be demanded of the athlete. When I transitioned from California back to Colorado Springs, I began working with several sports that I had never worked with before. It was imperative that I dug through the literature to help better understand sport, but also meet with the program director and the head coach as often as possible to pick up on their expertise. Something as simple as showing up to training and learning about the sport, the culture, the lingo, and witnessing firsthand the demands, I think is imperative. Understanding something as simple as the unique demands for let's say a C3 athlete, starting a kilo with one limb, versus let's say a C4 athlete and a kilo start with two limbs, one of which is a prosthesis. And then the unique considerations are working with a C5 athlete with upper body impairment. Working together as a collective staff to optimize technique while attempting to reduce the insults to basic biomechanical principles by playing to the athlete's strengths and minimizing their weaknesses can go a long way to help with injury prevention, in my opinion. Okay, step two, having an elite athlete health profile or medical screen I think is imperative as well. Trying to answer questions like what is the most prevalent injury in the sporting population? And what injury causes the most time loss to training and competition? What is the athlete's individual injury history? And what are the specific impairments or disability profiles of that athlete? All of this information helps us to identify potential risk factors that our coaches might want to be aware of before working with an athlete. Then looking at population norms, taking literature or experiences from working with let's say able-bodied sprinters and runners in track and field. Over time, we might see that internal range of motion at the hip decreases throughout the longevity of their career, whereas in para sport, we actually see the exact opposite. External range of motion due to gait and specific considerations of gait with para populations decreases and internal hyper range of motion might not be as strong of a consideration. So making sure you break down the sport within para Olympics, I think it's important to make sure that you don't make false assumptions by just comparing them to the able-bodied counterparts. So step three, the trainability assessment. Taking the framework from the AAA or the PCA, we've actually kind of recreated our own movement screen. Obviously not one movement screen might be off the shelf ready for these four different athletes pictured here as a visual. For us, it's imperative that we identify what can an athlete do before we start training. How does the athlete move? Working with para pops and new athletes, whom you sometimes have never seen move before, I think it's critical to design an assessment to identify what athletes can do so we can spend less time worrying about what they can't do. We can then use the objective information we gather from areas like active range of motion, grip strength, pushing versus pulling strength, along with the subjective information we gather around squatting technique or landing technique as examples. And we as a staff can start to better understand where we're going to start with our initial program for the athlete. We can then track the athlete to themselves over time and see if there's any improvement. We can also compare them to their sporting mates to see what potential movement strategies and efficiencies might be most common. We can even compare them to other sporting mates in different sports with similar impairment or disability profiles and see is there a common trend that we might want to identify in the future or help us get better at our actual craft. All this information can now be overlayed with our EHP information or our medical screening information so we can paint a more specific picture for the individual's unique considerations and hopefully have deeper conversations amongst our medical and performance staff around the athlete keeping them at the center of the puzzle. Now that we've learned a little bit about the sporting demands, we have some medical screening information, we have a trainability assessment in place and movement information for the specific athletes. We can start to worry about getting to work and actually putting the plan in place. In the simplest terms, we progress in the following manner. We go from general, unloaded, slow and simple movements and we progress athletes when appropriate over time to more specific, more loaded, faster, more complex movements. If you don't have a logical training progression in place, good luck with the whole idea of injury prevention. Again, in general, in the simplest terms, we look to provide a balanced stimulus in the weight room. We do squat with ambulatory athletes, but we don't force any one specific squat on all the athletes we work with. We do like to learn how to hinge. Here's an example of a male double-blown knee amputee athlete pulling off the pins and a female double-above in the amputee using support while going through a hinge and pattern progression. We do like to do single-leg stance work. Here's an athlete with complete drop foot who was told he'd never be able to balance a one leg, performing a single leg bodyweight squat with external load for multiple reps. We do push, but we spend more time pulling, especially with our seated populations. Again, if we're considering injury prevention within our programming, if an athlete's constantly pushing in their day-to-day operations and locomotion, we wanna try to offset that as much as we can with loading in the weight room. We do brace and rotate, and sometimes with athletes, let's say with SCI, we may have to get a little more creative with how we perform those duties. And we teach landing before we teach shopping progressions, especially with our visually impaired athlete population. The classification system of the training means can help you as the support staff member and the sport coach have deeper conversations and make sure you're actually working towards a unified goal. It's imperative to be working together and keeping the athlete at the center of the performance puzzle versus pushing and pulling in opposite directions while the athlete doesn't benefit from either of your work. General preparatory exercise could be something as simple as this rollout progression here, demonstrated by a T-13 athlete with visual impairment. Specific preparatory exercise, something like a power clean here demonstrated by the same athlete. Maybe from the sport, you actually identify getting your hips through in a jump as a specific preparatory exercise. Maybe you wanna work on a sub-component of the competition exercise, like placing an athlete in a safe environment where they feel comfortable expressing optimal force output and hopefully having some fun in the process of doing so. And then seeing how all this works together to support the athlete in the competition when it matters. This is how he did it. Isaac, John, Paul, already have the world record. Wow. That was a few moments. It would be seven centimeters coming into this if he can clear it from his previous world record. That is a jump and a half, and Paul will admit. All this was good and well below. Let's not forget something as simple as program attendance. Let's not forget the importance of consistency. Can we get athletes to show up? Can we get athletes to show up on time? Can we get athletes to show up on time with the intent to get better every single session? If you don't have that in place, you're probably just gonna be monitoring a program that's not gonna be very useful. And I'm not really sure that's gonna help you with injury prevention in the long run. So now that we've gone through those first three steps, we've got a program in place, then we can start worrying about athletic assessments and monitoring the actual response of those programs. I think two often coaches jump to wanting to worry about monitoring, they wanna worry about testing before they've actually done their homework to put a program in place that's most appropriate for the individual athlete. Something as simple as a counter movement jump, can feed into four different buckets to tie multiple staff members together to hopefully work with the athlete and keep them at the center of the performance puzzle. Again, moving from the lab to specific training, if we can work together, hopefully we can get more information out of the training sessions and competition sessions and not have to always rely on testing in a lab setting. Here's one example of a swim athlete performing an athletic assessment, in this case, narrow a counter movement jump. This particular athlete was having some severe knee issues. Using the counter movement jump, we're able to actually have an assessment point in place to better communicate between sports medicine staff and performance staff. On the bottom right of this chart or report, you can see that we use the KAI, shout out to Dr. Jordan, who's also on this presentation panel today. As an anchor point for us as a staff to focus on and hopefully have deeper conversations around this individual. In our first assessment, she demonstrated over 30% bias in her concentric abilities. Over time, we were able to close that window down to within a 5% discrepancy and the athlete was then able to get back to swimming it in the breaststroke event in the pool and has since broke two world records in that event for her classification. Here's another quick example this time from a road cycling athlete. Now when the athlete first came to town, they were reporting a 70-30 split of watts on their right crank being 70 and left crank being 30. As training accumulated, they're reporting significant hip pain and their ratio actually got as high as 80-20. We started to use objective measurements to quantify our unilateral strength training approach and with the intention to create some more symmetry in her bilateral deficit scores and I cemented strength test. The athlete was then able to go to nationals and keep under a 60-40 split through the most critical race moments of the competition. They were also able to report no hip pain after that competition. And three weeks later, they went on to represent USA and the World Team and come back with hardware with medals around her neck. And then just to tie it all together, the concept of reducing common risk factors while trying to enhance common performance metrics that have been identified as critical for that athlete. The whole idea of injury prevention, athletic development or strength conditioning being one and the same. It doesn't have to be two separate roles. It doesn't have to be two separate programs. It can all just hopefully be blended together to keep the athlete's best interest at heart. Working together with other professionals, I'm lucky to work with Liz Broad here on the left. We have an example of anthropometric profiles for athletes. All that goes into consideration as well. Obviously, body composition and lean mass indexes are critical, keeping athletes healthy and safe along with looking at their performance metrics and making sure that we're hopefully producing the most potential force at the right body weight for something like cycling. And then here on the right, we have a final example of an athlete's kind of overview as we monitor to the process of their training. Here we kind of saw that the athlete was dropping below 80% of their actual prescribed training. And that allowed us to start an intervention, jump in place just in time for competition season and make sure that they were getting back to all the training sessions. Sometimes removing some work from an athlete's program because you didn't have it right as a coach is the best way to help keep them safe and healthy. Enclosing in these unique times are our new standard, our new normal. I'm reminded of Albert Hubbard's quote, don't take life too seriously, you'll never get out of it alive. I hope everybody out there is staying safe, staying healthy, and I appreciate all of your time and attention today.