Why Female Athletes Keep hurting their ACLs Despite Better Training- Holly Silvers-Granelli PhD, MPT

The ACL Isn't the Problem: What Youth Sports Is Getting Wrong About Female Athletes | Dr. Holly Silvers-Granelli

ACL injuries are reaching epidemic levels in youth sports, high school athletics, college competition, and professional sports. Female athletes are tearing ACLs at alarming rates despite better coaching, more strength training, advanced technology, and greater access to sports medicine than ever before.

So why are these injuries continuing to rise?

In this eye-opening episode of Crackin' Backs, we sit down with Dr. Holly Silvers-Granelli, one of the world's leading experts in ACL injury prevention. Her groundbreaking research has helped shape injury prevention programs used around the globe and recently gained national attention through her work featured in The New York Times.

But this conversation isn't about repairing knees.

It's about asking a bigger question:

What if the ACL tear is simply the warning light on the dashboard?

Dr. Silvers-Granelli explains why the real issues often begin long before the ligament fails—through movement patterns, neuromuscular control, youth sports specialization, recovery deficits, coaching practices, and athlete development.

We explore:

• Why ACL injuries continue to rise despite more training and sports performance programs
 • The hidden movement signatures that may predict injury months or years before it occurs
 • Why the hip, trunk, brain, and nervous system matter as much as the knee itself
 • The unintended consequences of year-round sports participation and early specialization
 • What parents, coaches, and athletes should be watching for right now
 • How force plates, AI, wearable technology, biomechanics, and video analysis are changing injury prevention
 • Whether we are approaching a future where ACL injuries can be predicted before they happen
 • The most important change Dr. Silvers-Granelli would make in youth sports tomorrow

Whether you're a parent, coach, healthcare professional, athletic trainer, physical therapist, strength coach, or athlete, this episode provides practical insights that could help keep athletes healthy, performing, and on the field.

Because the future of sports medicine may not be about treating injuries.

It may be about preventing them altogether.

About Dr. Holly Silvers-Granelli

Dr. Holly Silvers-Granelli, PhD, MPT, is an internationally recognized researcher, clinician, and educator specializing in ACL injury prevention, sports performance, biomechanics, and neuromuscular training. Her research has influenced injury prevention programs used worldwide and continues to shape how athletes are trained, screened, and developed.

Free Resources: FIFA 11+ Injury Prevention Program

The FIFA 11+ Injury Prevention Program is one of the most researched injury prevention programs in sports and has been shown to significantly reduce lower-extremity injuries, including ACL injuries, when performed consistently.

Official FIFA 11+ Resources:

• FIFA Training Centre – FIFA 11+ Program

• GetSet Mobile App

The PEP Program (Prevent Injury, Enhance Performance 

Link to article and 11+ for Kids program
 

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Transcript

Dr. Spencer Baron (00:06.431)
ACL injuries in women's sports, boy, are they making headlines at every level, from youth athletes to pros. But what if the ACL isn't the real problem? Today's guest is one of the world's leading leading experts on anterior cruciate ligament injury prevention, helping shape programs used around the globe.

Man, join us as we explore what these injuries reveal about how we are training, coaching, and developing athletes. Please welcome Doctor Holly Silver Scrinelli.

Holly Silvers-Granelli (00:43.326)
thank you for having me.

Dr. Spencer Baron (00:45.431)
It's great. Holly, let me ask you, you know, this might be a difficult question for you because you're all over the place on this conversation, but if I gave you the power to eliminate every ACL Terran female athlete tomorrow, what is the very first thing that you would change? N not in medicine, but in youth sports?

Holly Silvers-Granelli (01:08.076)
I think sports specialization. I think that has been

One of the major obstacles we're trying to overcome is that we have athletes that are specializing out far too early in their physiological developmental career essentially. So, you know, when when we were growing up, it was very, very common to be a two or three sport athlete. There were defined seasons, there was a lot of sport and movement diversity. Your physiology is still developing. We have these growing athlete athletes that are skeletally and physiologically and neurologically immature.

And we're treating them like elite NBA players, you know, playing playoff basketball. It's medically negligent. It is negligent. And I say that really strongly. Earlier in my career, I used to be a little bit more soft in my language. And now we're being firm because we have athletes, you know, I had a bunch of athletes just playing Surf Cup this past weekend, five, six games a tournament. If I told any one of my professional soccer players you're gonna play six matches in the course of 72 hours,

their heads would explode. And so why are we doing this to a developing athlete? So I think for my main

one of the main obstacles and it's it's difficult because it's a business, right? Where there's this engine behind tournament play and sports specialization and club sports for every sport. This is not unique to soccer or basketball. Maybe the one outlier is American football because it tends to still be a bit seasonal, which I love. but we have to have kids have better movement diversity and let them have seasons. One to avoid overuse injury, but secondly to avoid like emotional and psychological burnout.

Dr. Spencer Baron (02:49.87)
Terry, how happy are you that she s started out with the worst problem that we have in our offices?

Dr. Terry Weyman (02:52.351)
my god.

Holly Silvers-Granelli (02:53.156)
Ha ha.

Dr. Terry Weyman (02:56.278)
I I'm in love with this girl right from the beginning. I'm like, yeah, this is like the best thing ever. You know, a and and ba i based off of that comment, you know, we hear so much from all medical professors, not just the medical and orthos, but we'll hear carbon, PTs and everybody always focuses the knee, you know, how to build the knee stronger, but nobody's talking so much about the hip, the trunk, movement parents and even brain mapping. Can you elaborate a little bit on that?

Holly Silvers-Granelli (03:26.0)
I'm very excited about this and because I think what we've learned so I I'm a Ph I'm a P T but I have a PhD in biomechanics and I did my biomechanical studies fifteen years after I commenced my P T practice. So I was an older student or the matriarch of the program, if you will, but you know what was so amazing about that. I was able to like prove my own hypotheses, right? I had been practicing for fifteen years and it was wonderful to go back and say, you know, is is I know is what I know or is what I think to be true

What I know to be true, and we were able to really look at the 11 plus program in particular. So that was one of the injury prevention programs that we developed for FIFA back in 2005, and it is immensely, immensely effective at reducing not only ACL injury, but all soccer-related injury, including concussion. We have a paper and peer review right now looking at, and that has to do with having just better all better all-over movement control, like better trunk capacity when you're.

Going into a purposeful header, do you have neck flexor control? Are you able to synergize that with your rectus and your TA? Like, and these are all things like we can't look at this as a micro problem, it's a macro problem, right? It's not just the knee, it's not just a foot and angle issue, it's a it's an overall movement propensity issue. And you know, not to beat the dead horse, but essentially when you have kids playing one sport all year round at a very early age, we are missing immense opportunity for coordination and

neurological motor control. What is the prefrontal cortex doing here? And then what I what I've been really getting into more recently and partly because I had my own injury about a year and a half ago is really looking at the autonomic nervous system and how we we look at that not fear-based because you have to be careful here because when I when I talk and educate my athletes about HRV and heart rate and their sleep and looking at the components of deep core and REM, it's not to scare them, not to wake up and be like, my God

I didn't sleep well. My HRV's in the toilet. And it's not like I have to bubble wrap that athlete for the day. It's more like, okay, now I train smarter. I train smarter knowing I had a glass of wine last night. I traveled internationally last night. I I have a little bit of jet lag. I may be dealing with an underlying low-level cold. How is that affecting my autonomic surf nervous system? How does that affect my decision making on the field? How does that impact my injury risk for the next 24 hours?

Holly Silvers-Granelli (05:55.262)
To 48 hours. This is the level of sophistication we could get to now because everybody has access via Aura, Whoop, Fitbit, a Garmin, Apple Watch, you know, or whatever. You know, in in team sports we have catapult and very sophisticated measuring or diagnostic metric systems. So I think that's what's really fun right now as a as a clinical scientist, as a as a clinician, really giving an it's an empowerment, right? I want to pass the baton back to the athlete.

So they feel they don't feel fear ridden, you know, especially in our female population. It's like, my goodness, I know I have six teammates that have torn the race yell. I I worked with an elite club in LA,

And there have been eight ACL tears on one age group team in the past three years. Like they're just waiting. I mean, it's it's it's nonsense. It's also it's it's bewildering and it's terrifying because you're just literally waiting for it to happen to you. And we need to change the script here. We have to say there is an immense amount of scientific research that has gone into this particular

injury, here's what you can do about it. Here's what you can really do about it because you can protect yourself. ACLs should not be normalized. ACLs are not a natural occurrence of sports participation. We collectively have created an environment to essentially make this more prolific than it needs to be. So we need to walk back, look back to 20, 30 years ago when this was not happening as commonly. What were we doing right then and what are we doing incorrectly now?

Dr. Terry Weyman (07:33.428)
You know, we had a guest, two guests actually, Tim Hewitt and Trent Nestler and and they both brought up the stats of it if you have a you brought it up a concussion within the first three years post concussion you have like an eighty six percent increased risk of an ACL. And I remember bringing that information to both my colleagues, PTs and Orthos, and they looked at me like I was the deer with the deer in the headlight look. They had no clue. And then you talk about the hip mobility and foot

strength and they're they're like they still preaching just ride a bike and develop hamstring strength to reduce your ACLs. And how frustrating is that for you when w when the research is out there and it's still not getting to the masses?

Holly Silvers-Granelli (08:17.889)
It's really difficult. and I think I I have a patient who's just this amazing clinician at Cedar. She's an MD PhD and she works in fetal medicine side. And she said to me one day, and it actually brought some solace to my heart because oftentimes I'm beating my head against what seemingly is like a brick wall, like we have data. We have a lot of data showing that we can mitigate risk. We can't prevent them all, right? There will be some unpreventable injury and we we recognize that it's part of playing sport. But she had said

To me, there was a they were looking at the utilization of dexamethasone to prevent essentially fee parental or female mortality during childbirth, and they came up with literally it was about a a a dose of dexamethasone that would cost a dollar twenty-five that would reduce infant and maternal mortality by 60 percent. And she said it took 20 years for that to become an actionable element of widespread utilization.

in the United States for maternal mortality. And I was like, why in God's name does it take 20 years to like recognize research, get it into

Outside of journal form and get it into readable form, into you know, podcasts like this, or the New York Times, or who wherever people are getting their information from, is 20 years acceptable? And she's like, it's just sort of what's been established. So in some ways, I got a little solace. I'm like, well, we're 26 years in, we're not we're not too far from that. But but what's mind-boggling to me is that we we we have the data, we have worked, partnered with the biggest sporting organizations in the world, FIFA and the IOC, US Soccer. We are now in

embedding it into coaching curriculums, but we still have reticence of coaches to

Holly Silvers-Granelli (10:05.164)
you know, it utilize injury mitigation. So I realized I think clinicians in general could be the worst salespeople imaginable, me included. So I'm like, I've got to work on my sales pitch. So we started looking at the performance metrics. They said, okay, look, if ACL mitigation does not excite you as a coach, which it should, but if it doesn't, we'll we'll consider that case scenario. How about we took talk about what happens to your team and individual performance as a result of utilizing this program? So when we developed the

11 plus we first studied it in women in Norway, young young women, about 14 to 18, and we were immensely successful. Like reductions of like 50% of injury, severity of injury was down, time loss due to injury was down. So then what was interesting, I think you guys will appreciate this, because this was like the mid-2000s. when we started presenting this data globally, I would get direct questions who were like, Holly, well, that's great, but where's your male data? And I did find a little irony in that because it

never is sort of studied in women first men. I'm like, okay, appreciate that because we can't extrapolate to another gender just because we b think it will work. We have to show some data. So we did this study in division one and division two men. And we what one of the more fascinating data points was, hey, let's look at the program in totality. And again, very almost identical to the female data, 72% reduction in ACL injury, 55% reduction in concussions, significant reduction, I'm sorry, in hamstrings.

significant reductions in concussions.

But what was fascinating from a neurological perspective, we said, what happens on the day of utilization? So we looked at the intervention group, so the male athletes utilizing the 11 plus, and the day of utilization, injury rates were even lower. Severity of injury was even lower because we're neurally preparing these athletes for competition. It's fascinating because a lot of times we'll get a criticism from the coach. Well, I don't want to do this on a competitive day. We'll only use it in training. And I'm like, you are missing an opportunity.

Holly Silvers-Granelli (12:07.675)
Because we know injury rates are higher on competition day, right? You're preparing the brain just like you would prepare a muscle, and it is of equal, albeit maybe more importance to prepare neurologically for sport than it is muscularly, we could argue there. But I really think you know at more than half of orthopedic problems or issues are are neurologic in nature, probably even a higher percentage. But the performance data was really fascinating. So we looked at wins, losses, and ties.

And what we found, not surprisingly, is the teams that had very good compliance, so utilizing the program two two times per week or more, were winning more. We're losing less. And so I'm like, aha, there's our carrot. So now we're gonna go to these coaches and say, hey, we had a division II team that won the national championship that year. Now, are we as a group, are we making these athletes better? I do think we are, and we have some data to show like some coordination and proprioceptive benefits.

Dr. Terry Weyman (12:48.689)
What?

Wow.

Holly Silvers-Granelli (13:07.695)
Some strength benefits, that's there. Does that translate into full technical prowess on the sport? That's a hard metric to measure, but that's arguable. However, you're winning more because your bench is full. You're looking down your bench and everyone's available to you. And look what happened to the Knicks this season. They were healthy, they were available for play, right? And we can look, you talk to any great coach, and what is their biggest asset is player availability.

Players that are healthy late in season. So that's what we have to say to coaches, like, hey, and I say, I plead with my coaches now, you're our on-the-field ambassadors. You are the most important person in the equation. We've done all the science, we've been pounding the pavement for 26 years. Now we have to, it is, it is your due diligence to do so. And we also talk to coaches in that, look, let's let's talk about your job description. Is it really very simple to say we want a coach that will do focus on player development and

tactics and strategy and look at formations and hey make sure we get some wins in the win column and less losses.

Or do we broaden that and is it, are you really responsible for player health, safety, and wellness as the number one component of a good coach, right? To look at these growing athletes and say, hey, when you're my age, when you're in your 40s, your 50s, your 60s, you still want to be athletic. You know, we know when you suffer an ACL injury in your early years in your teens or 20s, your mortality is impacted. You die earlier. And that's probably because of arthritis and life changes and you're moving less when you're 60 and 70.

So that is not acceptable. We can't accept this high rate of injury that's happening so early in life and just say it's a price of doing business because I find that personally medically negligent.

Dr. Terry Weyman (14:51.916)
love this.

Dr. Spencer Baron (14:52.97)
Yeah, no, I love this. This is now not to use fear as a tactic to motivate some of our our listeners and viewers, but you know, you mentioned earlier about the the excessive activity in one sport throughout pr you know, perennially. So you got, you know, f we have players whether it's tennis, soccer, lacrosse, they come in and they go, I only you know, I practice five days a week, and they go, that's great. What do you do on the weekends? competent.

So now you're talking seven days a week throughout the throughout the year, if it's not high school or a club sport, and these are young kids that are coming in. So I agree immensely. We we talk about cross-training, but here is an important factor that we that parents don't realize. As good as they their intention is to get the kid to do a cross-training, we had one actually the physical therapist in our office was treating a 16-year-old that was getting it.

It was a breaststroke swimmer that was preparing for junior Olympics her first time. And she was she was a rock star in swimming. But the parents said, you know what? What a great idea. Why don't we, why don't you cross-train, do some dip something different in a sport? Well, she did. Flag foot, flag football, tore the ACL, first time out there. Why? Because you took a a kid that it is in a non

weight bearing sport like like the breaststroke and that that strange movement that they that circumduction they do with the knees and their legs and blew it out. So with all that that's going on, wh how did how did this how did this come to a a a a a a a event an event where athletes are playing the same sport all the time?

Holly Silvers-Granelli (16:46.126)
Yeah, I think I think we have to say it's a business. I think it's honestly it's a financially driven model that is that behooves, you know, the people in charge from a capitalistic perspective because we're not benefiting our kids. I'll give you an example and this is a personal example. full transparency and the reason I got so embedded in the ACL injury world is those of you familiar with soccer, my brother in law is Tony Miola. So he's a three time World Cup athlete, played he's a goalkeeper for the US Men's National.

Team was drafted by the Yankees out of high school and he was the parade American, three three sport all American in baseball, soccer, and basketball. He was an enigma. Those athletes don't don't they aren't created now because we're not allowing them to be created. There won't be another Tony Miola because Tony Miola wouldn't be able to play three sports in high school and excel. We his kids are

equally amazing athletes and my sister to be fair the she they got good jeans on both sides she was an amazing athlete so they just had but when my youngest nephew who is a third baseman at Oklahoma State now when he was in high school his

Baseball coach was like, do not play basketball. You are going to get injured. We need you for the postseason. And my sister said, I think you need to talk to my sister because she will beg to differ. And we got on the phone and really had a great conversation about why it is important for young athletes to do more than one thing.

throughout the course of the year. When you take a baseball player, particularly a third baseman, who throws essentially just as hard as a pitcher, and you do not allow them to do something else other than that, we are going to create some problems as they continue in their career, right? So, and just to mention like what happens psychologically to these kids, the emotional and psychological burnout that comes along with doing something repeatedly since you're 10 years old, you know, over and over again. and a little anecdote to your story, Spencer, like I remember Lenny Kraselberg, right?

Holly Silvers-Granelli (18:46.684)
remember when he tores ACL on a treadmill, it's like I call them by mermaids. If you're if you're a fish, you have a little you have a little trouble with terrestrial sport, but we have to be careful there because we we train them accordingly because you need to be able to hike and walk. but there is this element of sport specificity, but

That was created and now we have to unravel it as opposed to let's give broad exposure to developing athletes throughout their development. So IAX, that huge club in Europe, perhaps I think the first club in Europe, if I'm not mistaken, to create the academy system, right? They they had the sort of developmental academy where you could be on campus or, you know, in Holland, obviously the the

Geography is a different, so you could commute in, but but there were some athletes that were sort of on campus going to school and then doing dedicated trading. So they they did a study and they looked at how successful are we at creating Premier League, Syria, Bundesliga players? Like how can we identify our youth in a way that if we're picking them out, if we're siloing these kids at like seven, eight, and nine, how successful are their careers in their 20s? And what they found is that they actually weren't very good at it when they were selecting that young.

Where they got really good at it was precisely 15.2 years of age. When they were taking kids that were playing netball and doing cross-country and playing other sports and having fun and being a kid and developing physiologically and letting their skeletal maturity happen without year-long stressors. They're biking and they're doing all of these things that are fun and they're they're part of their social cohort without being sideloped to an academy with kids from all over the country. That is how you do it.

of those guys like look at Holland he's a perfect example tearing it up for Norway right now and he played two or three sports going up to when his signing with Man City. There are so many examples. Patrick Mahones, there's so many examples of how to do it well. It's when we start playing one sport, that's where it tends to go wrong. So I really think we we as a community of professionals

Holly Silvers-Granelli (20:55.598)
We have to impress upon the coaching communities and the parental communities, because I think it's hard once you get on that train, if your kid is selected for a club sport and you're like, hey, you know, John is missing tournaments because he's playing another sport, he will lose his spot. So how do we counsel the parent to like maintain their child's spot on the roster when they're doing the right thing for their child, but they're going to be ostracized by

the the club. And that is the that is the difficult thing. And I have these conversations with parents all the time and I say, look, it's going to be difficult. I'm happy we we do these one-on-ones with coaches and I'm like, you are doing yourself such a great service to let this kid have exposure to different types of movement. This kid will be a star. or just be healthy. We'll keep it at that. I can't promise stardom but but we can say this kid will be healthier and emotionally more healthy and psychologically less burned out if we allow

a diurnal or triurnal component to their calendar. it just it just it's so logical, but we've gotten away from it and really I think sadly it's it's money driven because there is a lot of money to be made.

Dr. Spencer Baron (21:58.21)
Mm.

Dr. Terry Weyman (22:09.054)
You know, I'm so I'm so glad you brought that up, Holly, because I think parents have FOMO. They see somebody else, yeah, that that kid is rising and hired a trainer and hired the nutritionist. Well I I better do that 'cause I you know, I have to you know, he'll never make the Olympics if he doesn't, you know, start now at eight, you know. did you see that documentary or that that side thing at during the Winter Olympics where they went to Norway and they wanted to know why their athletes just crush it in the Winter Olympics and they they were

Dr. Spencer Baron (22:09.474)
I'll sorry.

Dr. Terry Weyman (22:38.968)
were talking about well, we don't do participation trophies which everybody in the United States hates. But they they we just let kids compete and nobody wins, nobody loses, which people think of participation trophy, but we let the kids develop doing everything and having fun and it's always a family picnic and and when they race no they're cheering last place as much as they're cheering first. And they wait 'til the kid develops to find what

their passion is when they hit their middle and then they start focusing and driving and putting them into something. But from from fifteen under, they're all put in for fun. And there is no competition. They don't believe in competition. They believe in fun. And I thought that was extremely interesting because the kids develop so strong. That's why they dominate the Winter Olympics. That's why they're crushing it in in the World Cup right now. What do we intentionally besides

singling the sports. What we s especially give out the female athletes, what am we intentionally doing here that is causing so many ACLs in women? What do we that we need to change besides yearly sports? What else?

Holly Silvers-Granelli (23:46.575)
Yeah, that i I mean it's a great question. And I did see that documentary. And again, another, you know, proof in the pudding in terms of like, look, there are I I think we have to be really careful about reading information that feeds your own narrative, right? You're going to have the one-off, the the outliers of like people who, you know, were identified early and went on to elite, you know, performances. but for the most part, most of us sapient beings with normal genetics are are not gonna do well under

under those conditions we will do far better under exposures, broad exposures, right? So from a female athlete side

When we started getting into this work in again, this is the early two thousands, Edie Griffin, who's an orthopedic surgeon in Georgia, just an immense talent. I love her. She's very a visionary really. She put together this thing called the Hunt Valley Conference, which Tim Hewitt was a part of as well. And we essentially sat down and said, okay, let's just start identifying risk factors. We didn't know much then, right? So we looked at four risk factors. We specific for women. We looked at environmental risk factors. So that would include turf versus grass, you know, g

hardcore is it over ice or not? Like the looking at friction coefficients essentially essentially shoe wear choice. Then we looked at hormones in women, like what happens during the menstrual cycle, during ovulation when we have the peak in estrogen, a week later when we see the peak during luteal phase with with progesterone. Is that changing ligamentous properties? What do we do during those cases? then we had anatomic issues to consider like most women

Their interchondylar notch is gonna be a little more narrow than men's for the most part, generally. we talk about cue angle, hip width. I like to say hip width to femoral length ratio is different in women as opposed to our hips are wider, because that's not totally totally true. but also the ACL diameter is is tends to be a bit more narrow in women. again, these are non modifiables though, right? So but how do we how do we think about that in a way?

Holly Silvers-Granelli (25:53.369)
with the fourth risk factor, biomechanics, how do we now take all of those variables, some are modifiable, some are not, and how do we neurologically train, neuromuscularly train an athlete to offset the risk from some of those other variables?

Now we've been we've extrapolated that framework and we've now included genetics. So we know there are some athletes where they have had one or two parents Terranaceal or a sibling. What do we do with them? We don't we don't drive fear into them, we just say, okay, here's a certain set of genetic markers that are unique to you. How do we help you more? Right? You're gonna need a little extra guidance than maybe one of your teammates that doesn't carry that genetic or that epigenetic load. So we want to think about you a bit maybe a little bit differently. then we had the whole medical.

resources and acumen components. So in other words, this this became a little bit more popularized during the Women's World Cup in New Zealand and Australia a few years ago because

It was pretty shocking. When you looked at the number of talented players that were like Bologna or nominees that were not available for that tournament because they were out with ACL injuries, it was pretty shocking. It was like ten of them, ten of the top fifty. So that's a huge percentage of immense talent unavailable for

you know, their their biggest event of their lives. so we wanted to say, okay, are women being undersourced, under resourced from financially? we we we know about that from a salary perspective and that's been that's actually I think we've made a lot of headway in sort of sort of like women's equal opportunity in terms of funding opportunities. but also what what clinicians do does the w US women's national team have available to them compared to the US men's national team?

Holly Silvers-Granelli (27:38.229)
Like, are you getting, are you getting Terry's and Spencer's and Holly's and Burt Mandelbaum's or are you getting the B team? I'm not saying that in a disparaging way, but it's real realistic, right? So do they have access to medical excellence or are they getting people that are perhaps less qualified or less seasoned, less tenured? and then, you know, that famous, gosh, so it must be three or four March Madnesses ago when they showed the snapshot of like w the women's facility for the March Madness tournament, which consisted of a

Yoga mat, a Swiss ball, and a weight sack compared to the 25,000 square foot, you know, facility that the men had access to. And like, so that I think we've really made some immense headway there in terms of s shifting that script. Cause I think we've really in a very good way of taking care of that variable and still has some growth. But you look at the Michelle Kangs of the world dumping a ton of money into female research, and that that's been wonderful. This the seventh variable was

Which is newer, which we touched on earlier, is the autonomic nervous system, right? How does HRV, heart rate, how does sleep, how nutrition, hydration, all of these variables, which we know of, but how do we measure it? And how do we take that number? I really do love HRV because I think it's an incredible proxy for the autonomic nervous system in general. And how do we build that in, just like we would how many sprints did you do? What was your loading like for the last five days when we look at it?

Acute and chronic workload. Did you have a death in the family? Did you break up with your significant other recently? Like, how do we fit that in? Because it's important. And not to be hyperbolic, but I think there's been this bias. I what I teach my athletes, you have four pillars. When we think of our well, when we wake up for the day, how full is your well? Do you have a lot of water in your well? Are you are you halfway full? What's your gas tank like? So we have to think of there are emotional components to draining our well. For our student athletes, did you have a test?

Do you have an exam? Did you not perform well? you have your cognitive components to your well. Did like I said, did you have, you know, are you in the middle of finals? you have your social context. Did you go out? Did you have a cocktail hour? Did you have a big meeting with a group of friends? That can draw from your well. And for some of your introverted players, that will draw very deeply from your well. So you have to think about that. And then there's the physical component, right? Which we're all familiar with, and that's been our bias for years. How much did you drain yourself physically? But we've sort of

Holly Silvers-Granelli (30:07.718)
Not paid attention to those other three components to the well, and we have to because they play a very important role of how they impact the vagus nerve, how they impact HRV and heart rate. So all of that gives us a very high level of sophistication saying, yes, we know how to neuromuscularity train. We've we've proven that. We I I really do believe that. But have the people we weren't helping well, or the re injury rates, have we not been paying attention to the other components from the neurological aspect or the A and S.

particular to say, hey, we've got a real opportunity here to like even shift our numbers even higher with respect to protectionary efforts. And I think the data we're about to publish something in the next six months on this because it's really, really exciting. And I think that will be

Another another component to how we help athletes recognize how full is your gas tank, how full is your well, they can manage that and then they can say it doesn't mean we bubble wrap them. That doesn't mean you do not train for two days, you're you're off the field, your HRV is 42, you're not optimal enough. No, it means do I go in for that 50-50 ball on chaining or am I gonna like pull back a little bit because I know today's not my day? That's the beauty of it, because it's self-empowering.

That was a very long answer, I'm sorry, but that's yeah.

Dr. Terry Weyman (31:25.406)
No, that was beautiful.

Dr. Spencer Baron (31:26.24)
And a good one. No, no, that was great.

I I do have a question you are the voice of reason, so I'd love for you to comment on something that is very suspect and and sneaky in the word in the realm of overtraining. Now, yes, we we we all agree that you know one sport perennially is not good, but to cross train and be selective about which sport you're choosing. But you know what I you know, s I'm in South Florida and as like the Mecca of off season training.

training because there's so many athletes that come down here. But what I noticed was so frightening several years ago, and that is when when a a private coach or a trainer or a strength and conditioning coach is hired by an athlete to do weight training or or conditioning away from their, you know, the obviously, you know, when they're off season from their sport.

That coach or that strength trainer is looking to make a mark. And that mark is usually to overtrain or to show how rigorous the training is for that athlete. And I've walked away, I mean I've walked into this and seen, you know, players discuss how, man, training was hard. I don't know if I can, you know, come in tomorrow and all that.

detrimental is that to when the season starts? I would love that your thoughts on that.

Holly Silvers-Granelli (32:56.628)
that's immense. And I think there there's so many aspects to that question that I that I love because I think it it it really deserves illumination, right? It deserves the respect that we need to give it. one of the things I love about being a female clinician is that and and this is gonna sound reversely misogynistic and I don't mean to sound this way, but I think I have no ego in the in the game. You know, I I love what I do. There's no

And I mean this not in a hokey way. That I get no greater benefit as to seeing one of my players go back and play their first game. Like it it just I I just recently worked with one of our NWSL players and she had a long journey, like three ACLs over her collegiate career. She got signed and I was at her first game professionally and I literally cried and I I say that I am a sappy person by nature, but I was just so happy for her. And it's not about Instagram. This has nothing to do with me. I got so

Much joy out of her having joy. And as clinicians, that is our exact role. It is silent. It is private. It is like you're their proud aunt or uncle cheering them on from the sideline. You are not looking to make some indelible mark on their physiology and say, because I was the person who trained them the hardest. That is your ego, that is your narcissism, and that is your selfishness getting in the way of what is best for that player. So you need to be introspective.

and interoceptive and recognize you are doing a bad thing because you are being additive to the problem instead of

you know, mediating it. So the we're working with Tim Nokes, who is a surgeon in London, who has taken the PEP program. So the PEP program was one of the ACL prevention programs we developed first, specific for ACLs. We studied in Southern California. really effective program. And they took this and they created a program in London in the greater London area called Perform Better and they're doing this like really wonderful grassroots outreach within their academy

Holly Silvers-Granelli (35:01.276)
Within their grassroots community. He, as a postdoc student, that is, this I think this is brilliant, is looking at those three components narcissism, egotism, and selfishness in coaching. And I say that objectively, right? It's fascinating, right? How good? How good is that? And I I'm not exactly sure because I want to get into the nuance of his algorithm. I want to see how he's actually capturing the metrics in a numerical way. I don't know the nuance there. I'm so excited to read his doctoral dissertation. But

I think like if you look at the Pep Guardiolas, you know, the Mourinhos, like all the greats Zidans, like people who have had success and they have a lot of those elements, right? They're they're larger than life characters and they bring but how much of one of those qualities is too much?

Is is too much selfishness preventing you from saying, perhaps how I played as a player 25 years ago not optimal right now because we have better science and data t tell us otherwise, right? and just because you need to go hard, these kids are so soft today. Maybe that's really not the answer. Maybe it's like we are recognizing scientific metrics in a more sophisticated way than we were in the 70s and 80s, and that's probably the more logical answer. So I think as a coach, you have to recognize, hey,

I I tend to have a larger ego and that that makes me a good coach. But does that large ego make me a little

perhaps reticent to adopt something that might be a little more novel than when I was actually a player and being coached. And I think that is an important part of coaching curriculums. We have to like have this nice discussion with saying, hey, all of your qualities get you to this point. You're coaching Division I, you're coaching professionally, you're coaching at this level. And yes, those characteristic traits have gotten you to this point. However, there is a body of science here that is going to be protectionary that will actually help you in the win column.

Holly Silvers-Granelli (36:56.232)
So let's bring it all in, right? Let's bring it all in. So I think again, very long-winded answers for you guys. I could talk to you for ten hours, but it's but I think that's really a cool aspect to like how we're looking at coaching, how we're looking at their ability to integrate

Dr. Spencer Baron (37:04.355)
Love it.

Holly Silvers-Granelli (37:13.974)
sort of more novel scientific physiologic concepts that may have not been even measured when they were indeed playing and how we make those presentable and palatable in a way that will help them on the performance side. And the wonderful secondary benefit is those individual players are gonna really benefit from it.

Dr. Spencer Baron (37:31.486)
You i when you when you watch a game and the y you know, this is an answer for parents, but also for yourself is when you're watching game film of a

ACL, you know, an ACL injury happening. Or can you can you identify certain movement signatures that have existed, you know, maybe months or years beforehand, before the actual injury? Because what I before you answer, what you know, what I read some time ago, it was some research that they did MRI on those that had ACL tears and ACL and post-op ACL surgeries. And what they found, and and and I think Dr. Terry mentioned it earlier about map, you know, brain mapping. You know, you're

That it's starting to change brain patterns. So now the the surgery is is maybe maybe the surgery is done or there's been some rehab where most rehab is strength training, isokinetic testing. Remember the Cybex machine and how how, you know.

Fantastic. That was regarded at at some point. But there's so much more like proprioceptive movements and things like that. But how you know, they saw an MRI

facets of the the brain that had changed because somebody like if I put a rock in your shoe and you couldn't get it out right away, you're gonna limp or you're gonna walk funny. Imagine that athlete walking funny for for a year or two beforehand. Can you identify certain and now that's obviously, you know, a blatant image of what happens, but can you identify those changes and what should a parent be watching for?

Holly Silvers-Granelli (39:17.818)
A hundred percent. so this is this is a little bit of a controversial subject because if you talk to Dr. Raoul Bar, who I love from Norway, he he has been kind of firm on, hey, are we from a pre-season physical perspective or a pre-screening participation physical, are we able to identify high-risk athletes? And it's arguable, right? Because some of sometimes we can, sometimes we can't. So I think the sensitivity and specificity of our current testing protocol is not quite there yet.

However, I think there's immense opportunity. So in in continuing those, and and and in fact I think as we go further, we can continue to refine them. I'll give you two two stories because I think they're worth the anecdotal time. So when I was doing my PhD, I was at the University of Delaware, immensely sophisticated human performance lab. So we were doing, we were looking at the 11 plus program and we were looking at it from a pre-season, mid-season, and postseason perspective, like what are we actually changing?

To get these incredible changes in injury, right? And severity of injury. So we had two camps, we had males and females, but we had the intervention group that we utilizing the 11 plus, and then we had control groups playing D1 soccer that were doing their traditional warm-up. And what we noticed were a couple things. most of the changes were occurring in the hip. So to Terry, your earlier point, we were making more hip and trunk control pattern movements changes, which was essentially being extrapolating distally.

Right to protect the knee, which we know to be immensely impactful. So that was nice just to sort of okay, we can sort of corroborate our thoughts there. But

W I was working with this one Division I athlete, and the irony of irony is her father was a sports medicine, non-operative sports medicine specialist. And I literally stopped a third of the way through the testing because I said, In good conscience, I can't continue the test with you because I really feely believe you're going to tear your ACL during this testing. And I wrote a long letter to her specific athletic trainer, to her father. to her. I pulled her aside and she was a little upset. And I said, No, no, no, listen, you have a

Holly Silvers-Granelli (41:25.564)
immense opportunity here. Like we we're gonna dodge a bullet here. And lo and behold, a month later she wound up tearing. there are movement patterns that you can you can identify that are immensely deleterious. And if they're doing that in a controlled lab, we have a problem, right? Because when you bring them when you bring into speed and competition,

But what you said about the brain, which is fascinating, so the way I like to explain this, if we think of like the motor cortex here to here, right, headband and then the prefrontal cortex, under traditional, like non injured, non painful circumstances, if we just talk

really general, these are non-specific numbers, but I tell my athletes, say for example, in the non-injured seat, you have 10% of your motor cortex devoted to your right knee, 10% to your left. When you have pain or you have an injury or you have an ACL surgery, all of a sudden that 10% becomes 40%.

Now, my job with you to rehab you is to get that 40% down under 10%. I have to almost overcorrect so that when you get back on the field, you have the hard drive space to now extrapolate what the heck is going on around you. Where's that ball being deflected? Where am I making my run? How's that defender coming onto me? And that goes for every sport. This is not just specific to soccer. So if I don't have the hard drive space available to me, then I am at an immensely higher risk. The same thing why we have

immense risk after concussion because your brain is still operating under an injured state. So when we first started practicing and we're getting players back in like five, six months post, it was wild that we didn't have a higher retail rate than we do because we know the brain takes about 18 months, two years to fully normalize. And that's with doing dual and triple task activities. And this is with some like real sophisticated like nuance within the rehab sector. So that's how I explain it because people

Holly Silvers-Granelli (43:19.576)
I think Patrick Mahones will become a become a a case in point. Like he's out there in OTAs right now with an ebrace on, he's five months post. And we will get questions from parents. Why can my son or daughter not be doing the same? one the I don't know all the nuance of Patrick's case. I have nothing to do with it and I'm just observing. But I would say, okay, well he's getting treatment ostensibly every day, multiple times a day. But there's a

There's a portion of the neurologic system and the biological healing that we just cannot speed up. Like it is it is what it is, right? For all intents and purposes and for all of the brain trust on this particular call. I don't think any one of us can say we don't have a sophisticated way to speed up the healing curve so much that we could have someone returning in fourteen months and someone in given the same injury. So I think

A lot of my patient education comes around let's teach you about how your brain is so involved in this injury, why it's so important. secondly, I love Kate Webster's work on like the fear and confidence perspective because you can have an athlete that's biomechanically testing beautifully, right? Force plate data looks good, all of our whet whether using dynamometry or isokinetic testing, we're looking at all of their movement patterns. They're look they're passing our sixth movement screen really well, they're dominating with their hip versus their knee, trunk movements.

looking beautifully, but I give them a return to sport questionnaire and they're still fe th they are still fearful.

Then my goodness, we are holding that athlete out of competition because at that point they are the center of this board meeting and their ability to not have fear when they go back to the field or to not have 100% confidence in their knee and their ability to perform, that has to supersede everything. So those are other things we need to consider the psychological aspect of this injury, particularly if it's a reinjury, right? And we're seeing these more and more. I'll have a 16-year-old

Holly Silvers-Granelli (45:15.716)
She's on her second ACL. This is it's devastating, right? It's absolutely devastating. We're talking about and how are they thinking they're gonna get back out there? And the other interesting thing that we don't consider in youth sports, I've started talking about this, is like not only are we rehabilitating this injury, now I have to get that 15 year old back to 16 year old soccer. The games left her behind, right? She's lost a whole year of development in addition to coming back from a really you know, a really pretty traumatic or

Orthopedic surgical intervention. So now yeah. So

Dr. Terry Weyman (45:48.34)
Hey Holly hey Holly you for a second you mentioned b you started going to it talking about that your testing that there's two main things you look for that are precursors. What are those two things?

Holly Silvers-Granelli (45:53.464)
Yeah. Yeah.

Holly Silvers-Granelli (46:01.635)
I look for so from from a biomechanical perspective, we so I look at this is how I do my and again there's no gold standard. This is also interesting because I think this is always like shifting within the literature too. What are the best tests to do, how to do it. I think we all have our unique way of doing it, which probably isn't great either. But the way I think about it is I'm a biomechanist, so I like biomechanics. I look at I have force plate analysis, so I'm looking at various jumps, I'm looking at deceleration, which is incredibly important because if you cannot decelerate.

Accelerate well, we we have a big problem, right? A lot of injuries, particularly American football, happen with that mechanism. I'm looking at strength parameters. Now it is not just quad and hamstring, it is not just quad and hamstring. You have to look at lateral hip, external rotation, ABAD, plantar flexion, dorsiflexion. Look at everything like it's a holistic injury. This is a holistic breakdown. The poor knee just took the brunt of it. So, and each athlete will present a little differently. So, you have to be do your detective work and find.

Find, find the missing link. And there may be a few missing links. So you have to do your due diligence. Test multiple muscle groups. And then I talked about the psychological component. But I also utilize a lot of EMG because it is my technical capacity to test the neurological system. And we can look at, okay, because I think what's interesting when we look at when we look at force plate data and if we just look and we kind of look at peaks, right? We're looking at rate of force development and those things.

What I love about EMG is not, I like to get into the granular new nuance and look at the peaks of like look at how much motor unit potential we're actually creating throughout a certain muscle group, but how well can they hold that peak, right? This is really important with hamstring literature. So if you look at hamstring biceps femoris and semis, right, and you're looking at doing a Nordic or a Russian, some sort of eccentric component, and they hit a high peak.

And they can maintain the peak and they slowly come down the curve, that's a good contraction because they can hold the contraction over time during a sprint. If you're looking at it and they peak and they drop off the face of a cliff, well, we have a huge problem because that's the player who's gonna have the hamstring strain in the 60th minute on their 14th front of the game. So, so we have to look at the nuance there. Look at the shape, look at the impulse under the curve. All of these things are so important. So that so Terry, I'm sorry, I'm giving you another very long-winded.

Holly Silvers-Granelli (48:25.11)
Answer, but all of it's so technical in how we look at things. So I would say it for the general clinician, and even if you don't have access to a sports performance lab, you do not. I have valid force plates, I love them, they're very inexpensive from a monthly subscription perspective to have, and you and they will give you some training on how to utilize them well in your clinic. do handheld dynamometry, it's it's wonderful, and you can at least have some baseline strength data and you can test multiple muscle groups.

I use the trigger, I love that AMG device, they're a little over $400. Very, very palatable costs associated with doing some real sophisticated return to play and return to training testing that will give you another level of nuance that is outside of the general quad to hamstring ratio, and you looking at the glutes, looking at the nervous system because it's so important. That I really fully believe if we were clinically to adopt a little bit of the

that more ubiquitously our reinjury rates would fall precipitously.

Dr. Spencer Baron (49:30.542)
I I wanna ask you about wearables 'cause they're

massively popular these days. You mentioned earlier about, you know, you you spilled up, you Whoop, O Ring, Apple Watch, all that that people are getting so consumed by and I agree that there's benefits to, you know, monitoring HRV and all that. But we we had Stacey Sims and and Dr. Abbey Ryan Smith out of Chapel Hill on and they they both had mentioned something about, you know, a lot of the data is is driven by men and yet women are using it. But more importantly, more importantly

Is women were much more sensitive and acute to their own personal feelings of, you know what, this doesn't feel right. So they can look at a watch and and say, Yeah, you got good sleep or your HRV looks good or good, you know, good job, or a terrible job sleeping. But you know, the they're losing their sensitivity to their own, you know, feeling of what's going on in their own bodies. And women are much more sensitive than men. Any thoughts or comments?

Holly Silvers-Granelli (50:31.355)
I completely agree. I think this is so interesting 'cause I think women in general have a higher level of interoception, right? We we just tend to be a little bit more tied to our bodies and sometimes that's an immense benefit and sometimes there's some downside to that. So when I'm working with my with my particularly like my high school and college age athletes, sometimes there can be a little bit of a preoccupation with like, I feel this or I feel this and like there's a conversation like, hey, you know what? Everything may not feel perfect. Like we we pay attention.

We respect symptoms, but we don't pay it too much agency where it deters us from moving or or or progressing. So so there's a little bit of education there. On the flip side of that, sometimes I have high school collegiate aged males that disregard everything. And they're like, I'm ready, Holly. Like I'm and I'm like, yeah, not quite. Not quite. Like we're gonna so there's this this bravado cavalier slash excessive interoception spectrum that I

And I I always say like I try to wear two hats of like the psychotherapist completely I say that in vernacular fun. I'm not

by any means trained to be a psychologist. But I I I really have to read my patients well, right? Like I have to understand who's going to push, who's going to underreport, who just wants to get back to the field as opposed to who may over-report and needs a little bit of my guidance and education and hand holding to say, hey, this this is okay. This is actually part of the process of healing. And to feel a little patellar tendon or quad tendon or proximal hamstring when you're coming back from something so involved. This is a normal part of like biomechanical

training

Holly Silvers-Granelli (52:10.283)
That is where the wearable conversation is really important. And I think I alluded it to it earlier. You don't want to drive fear and panic with a wearable. If it's if you know you didn't sleep well and you wake up and look at your watch and it stresses you more, yeah, that's not the that's not what we're trying to do here. It's it's like use it as an ally, not a foe, right? I look at my watch and I say, Okay, I just traveled across the country. I had a glass of wine last night, I know my HRB may not be optimized, so this is the day maybe I

Don't push myself athletically, or hey, I'm doing this great podcast with two new friends, so I'm cognitively really engaged. I'm gonna pull back from my well a little bit. That's just smart. That's just smart. I'm not bubble wrapping myself from life. I'm just saying, hey, I'm gonna deal the variables in front of me and then do the best with my capacity. So I think, like to take the fear, extrapolate the fear out of it, it's like everything's part of our equation. And I like to teach all of my athletes, they're like their own little mini PTs and

Biomechanists. They understand things. So then when they go to their respective clubs, if they wind up going professional or division one, that they can bring this information with them and they're really, they're really empowered by it. That's I think my my word for the day is just like making your athletes feel empowered and less fearful of the participation. I just wanted to share this one quick thing. I heard a story. I was in clinic on Monday, and I had an athlete tell me that some of her clo she's an ECNL player, so playing very high-level soccer, that some of her clubs.

Club players that have been verbally recruited as sophomores are opting not to play in club junior year for the risk of getting hurt and not being able to play collegiately. And I'm like, are we here? Like, this is where we're at, folks. That we are not gonna participate for a year to bubble wrap ourselves, miss a year of development, miss a year of social aspect. So you can go play D1 and be undertrained? This is insanity. I I would

gobsmacked and I said this has got to stop really and not to be hyperbolic I really just mean that but this is really something we need to consider here because when you have kids making this decision at 15 and 16 to say I want to preserve my collegiate career so I'm not gonna play for 18 months we have a massive problem because they've lost faith in the system. They do not think their club can protect them and that is what we have to circle back. That is our message to the clubs

Holly Silvers-Granelli (54:37.433)
Your club your kids do not trust you anymore. Thank you.

Dr. Terry Weyman (54:37.696)
Wow.

Dr. Terry Weyman (54:41.216)
Hm. You know, on that on that note, do you see with all the research coming around that we will get to a point where we can predict ACLs before they happen and what does that future look like?

Dr. Spencer Baron (54:41.342)
Yeah.

Holly Silvers-Granelli (54:53.431)
yeah, I do. I think like I mentioned earlier, I think as the sensitivity and specificity continues and I think where clinicians get better a little better with data reporting and that gets a little bit more sophisticated, I think I think we will be able to and as we can map the brain, like as we it so again it's a little clunky now, you have to go into a pretty academic lab and look at and H waves and like do some so that's like Ryan Zarzicki, Dustin Grooms, Meredith Sheput doing great, great work in this arena. But I think how do we bring that to the

And that's where I think those smaller devices, there's a lot of them, like Noraxin, Trigger, Dorse V, a lot of companies, which I have no financial relationships with at all. I just like them. But that's where you can bring a little level of sophistication to your particular practice and be like, okay, hey, we're we're noticing a little differential in your ability to reach a peak and maintain the peak. And that will give us a little glimmer of like what's going on. Or your right to left differential, or your quad to hamstring ratio or quad to glute looks a little bit distant.

And let's do some work there. So I think that will continue to evolve. We continue pushing the envelope. And I say to all the clinicians listening, I am still an active learner in my field, right? I you guys paid me an incredibly flattering comment when we started this podcast, but I read every day. I am learning every day from all of you because I continue to evolve my practice. I don't do things today that I was doing five years ago because I've evolved out of them. I've learned better.

So please don't get dogmatic, don't get entrenched in your own thought patterns. Continue to learn, continue to read, and continue to evolve your practice because it just helps every young 15-year-old that will eventually show up into your practice that that's really suffering.

Dr. Spencer Baron (56:40.77)
That's great. And I that's why I think the curriculum in some of the schools, medical, even chiropractic, is is a little antiquated and they're teaching still teaching the same darn thing. Whereas you're absolutely right, to continue constantly and never ending improvement. That's in what we we absolutely believe. Hey Terry, you know you know, now is would be a good time to go into the rapid fire questions. Do you mind if we go over the hour?

Holly Silvers-Granelli (56:48.485)
Totally.

Holly Silvers-Granelli (57:08.595)
I'm fine, yeah.

Dr. Spencer Baron (57:09.654)
Yeah, yeah. Terry, good? All right, all right. Well, this is one of our favorite parts. It's the rapid fire questions. Holly, I think the real challenge for you is to actually answer briefly.

Dr. Terry Weyman (57:11.634)
I'm good.

Holly Silvers-Granelli (57:20.507)
You you've gotten the trend of my verbosity. My business.

Dr. Terry Weyman (57:22.048)
Ha ha ha.

Dr. Terry Weyman (57:25.718)
Yeah, that's the 'cause she you know, she brought that up twice that she if you have a glass of wine like Gracia V. So you know, I just think she party last night before she hung out with us and you know I can't that's a No, no bubble wrap.

Dr. Spencer Baron (57:25.742)
my gosh. I no, it's fascinating. I love it.

Dr. Spencer Baron (57:35.779)
That

Holly Silvers-Granelli (57:39.163)
Right.

Dr. Spencer Baron (57:44.75)
A and she doesn't believe in bubble wrapping yourself. There you go. Right. Rap no bubble wrap. Although that's

Holly Silvers-Granelli (57:49.369)
That's right, that's right, that's right.

Dr. Terry Weyman (57:51.102)
Lots of lots of wine and no bubble wrap, you know, she's my cat girl.

Holly Silvers-Granelli (57:53.722)
There you go. Yeah. Yes. Well, d I'll just tell you one quick th my ma I'm at I'm in the house I grew up in. My mom sadly had a cerebellar stroke about a month ago. So there's no prouder role in my life right now to be her PT. Like it's it's really been it's been yeah, so yeah. Mm-hmm. I did not. We're doing stairs. I I brought no wine for her.

Dr. Terry Weyman (58:08.807)
that's awesome. That's awesome.

Dr. Spencer Baron (58:11.448)
Did did you bubble wrap her by any chance? No no okay.

Dr. Terry Weyman (58:17.78)
Hey Spencer I g Spencer, I got goosebumps on that one. I lo yeah, I love that one. Yeah, that's awesome.

Holly Silvers-Granelli (58:21.627)
yeah.

Dr. Spencer Baron (58:21.929)
yeah. That's cool. All right, maybe she needs a glass of wine. All right, so anyway

Holly Silvers-Granelli (58:25.851)
Exactly.

Dr. Spencer Baron (58:27.854)
One of those things have to h help, right? All right. Wha all right. Rapid fire questions. The a there's five of them and the answer if you can make it somewhat brief, but it I will be honest with you, sometimes it tends to get a little lengthy. But if you're ready for question number one, here we go. You ready? Ready, Holly? Alright. Between force plates, wearables, AI, video analysis, biomechanics, and movement screening, what excites you the most?

Holly Silvers-Granelli (58:31.514)
Ha ha.

Dr. Terry Weyman (58:32.039)
Right, right.

Holly Silvers-Granelli (58:46.501)
Okay, I'm ready.

Holly Silvers-Granelli (58:56.879)
Uh-oh. all of it. I don't know. I'm like, I'm a Venn diagram. I'm a Venn diagram person because I truly believe I'm gonna keep this short, but I truly believe you will have an athlete that fits in each one of those circles with perhaps not the overlap. So if you get too dogmatic in one of those arenas, you may miss helping others. So keep it a broad spectrum.

Dr. Terry Weyman (59:00.416)
She's gonna pop. She's gonna pop.

Dr. Spencer Baron (59:00.426)
We got her, Terry. We got her.

Dr. Spencer Baron (59:21.07)
Good. And that really is a testimony for the wearables that people like live their life on. But all right, very good. Question number two. All right. One, one exercise every girl athlete should master. here we go. I think we got her, Terry. What was that? very good. actually, very good. Very good. Question number three: one youth sport trend you'd eliminate tomorrow.

Holly Silvers-Granelli (59:26.064)
Yes.

Holly Silvers-Granelli (59:35.735)
Eccentric hamstring. Ecentric eccentric hamstring. Yeah.

Holly Silvers-Granelli (59:49.901)
Early specialization play multiple sports.

Dr. Spencer Baron (59:53.624)
She's doing pretty good, huh, Terry? Right on. Question number four. Most overrated injury prevention strategy. What would that be? Mo and then most so the most overrated and then what is the most underrated injury prevention strategy?

Dr. Terry Weyman (59:54.825)
I see crushing it.

Holly Silvers-Granelli (01:00:10.233)
Okay, overrated would be to hire multiple people and do multiple you're essentially overloading yourself to prevent injury, because we've seen that, right? And I would say the most underrated is looking at free programs such as 11 plus pet program that are done as dynamic warm-up programs take no additional time, are free on the field and prepare you for competition directly thereafter.

Dr. Spencer Baron (01:00:39.31)
She is scoring big. All right, question number five, the last one one thing. Every coach that's that that is listening can start doing this week.

Dr. Terry Weyman (01:00:39.318)
Crushing it.

Holly Silvers-Granelli (01:00:51.887)
You are a scientific ambassador. Please use the science we've developed. Use these programs. They're free. They will prevent injury. They will reduce injury time loss, and they will allow you to win more. Keep winning.

Dr. Terry Weyman (01:01:06.653)
Dr. Spencer Baron (01:01:06.818)
That's great. Holly, do you i i I remember reading in the Times piece about you and the exercises or the s is there something that people can refer to online that you suggest?

Holly Silvers-Granelli (01:01:18.913)
Absolutely. Great question. Yes. So and and maybe we could even provide some links if you guys make that available. So

Dr. Terry Weyman (01:01:24.466)
Absolutely. Abs absolutely.

Dr. Spencer Baron (01:01:25.395)
yes. that's great.

Holly Silvers-Granelli (01:01:26.785)
Okay, we so we filmed this. I've I've done this for US Club Soccer so we can provide a full video of the 11 plus and the pet program. They are free. and then we partnered with the ioc, the Olympic committee, and they created a app called Get Set. So G-E-T-S-E-T. It's available for iOS and Android. It is free. If you download the app, if you look at football, because it's international, that is the entire 11 plus program filmed, ready to use on the field.

Today.

Dr. Terry Weyman (01:01:59.495)
incredible. That will be on our description for sure.

Dr. Spencer Baron (01:01:59.714)
Gosh. You know, I just gotta end this by

Yeah, absolutely. I I I wanna end the this program on just telling you what a gift it is to have you on this show to inform the public what they are so unaware of in so many facets. You know, I read this New York Times piece. You were I read it and it was a titled something about women and it why are why is there such an increase in ACL injuries amongst women? I'm reading all about your work and I'm going, my gosh, I wish we could have

On the show, this would be unbelievable. And boom, Dr. Terry figures out a way to get to you. Thank you so much.

Holly Silvers-Granelli (01:02:41.317)
So wonderful. I really enjoyed our conversation. So thank you for having me as a guest. It's really fun. Thank you. I appreciate that so much. I love what I do and I hope that shows.

Dr. Terry Weyman (01:02:46.536)
Yeah, you're wonderful. Awesome.

Dr. Spencer Baron (01:02:52.874)
It yeah, yes. Yes.

Dr. Terry Weyman (01:02:52.979)
it does.

Dr. Terry Weyman (01:03:03.998)
Lance.

Dr. Spencer Baron (01:03:04.852)
Slats.