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Doug Kechijian on the PJ Medcast

Resilient‘s Dr. Doug Kechijian was recently interviewed for the PJ Medcast.

​PJ Medcast are the podcasts for PJ MED (Pararescue Medicine). Besides PJs, these podcasts may be useful to other Military, Law Enforcement and Civilian Medical Personnel involved in Tactical and Technical Rescue Medicine, and other facets of Operational Medicine.

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Better I’s, Y’s, and T’s

If you’ve ever been to physical therapy for your shoulder or have been a throwing athlete at some point in your life, you’ve likely been shown exercises like the I’s, Y’s, and T’s (see picture below). They are named this because the shape you create with your arms during the resistance exercises resembles those letters. These exercises are typically prescribed to activate certain muscles for scapular strengthening or stability purposes. Though they have their place in the field of rehabilitation at certain times, I think we can improve upon them. Here are some thoughts and an updated approach to training the shoulder blade.

I’s, Y’s, and T’s
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Professional Communication: Delivery and Context Matter

Debriefing missions and training iterations is standard practice among military and law enforcement special mission units.  Despite the best efforts of everybody involved, communication is an issue that consistently emerges as a limiting factor in operational performance.  During complex missions, leaders must filter a continuous stream of information from multiple sources to optimize decision-making.  The information is usually incomplete because the messengers are either too preoccupied with fulfilling their individual responsibilities (e.g. a medic attempting to stabilize a casualty) or too far removed from the reality on the ground.  During tactical scenarios, information must be communicated succinctly but sufficiently thorough to be of value.  These qualities are often at odds, especially when one considers the propensity for communications technology to fail at the least opportune times.

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Aerobic Fitness for Baseball: Part II (Application)

In Part I here, we provided the physiological rationale for incorporating aerobic development into baseball physical preparatory programs.  Here, we’ll discuss how to translate theory into practice.  To begin, we must dispel some common myths about aerobic development.

The first is that one can train the aerobic system, or any energy system for that matter, in isolation.

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Aerobic Fitness for Baseball: Part I

Questions by Andrew Ferreira, answers by Resilient’s Doug Kechijian

​​AF: Baseball is notorious for it’s slow pace and athletes that lack conditioning, why the need for a strong aerobic foundation?

DK: At first glance, baseball does not seem like a sport that requires much development from the aerobic system.  Baseball athletes certainly don’t need to be able to run a competitive time in a marathon but a requisite level of aerobic preparation is necessary.  The best baseball players are generally the ones who produce awesome amounts of force very rapidly (e.g. throwing a fastball or hitting a home run).  In the most extreme cases, however, baseball requires that power be repeatedly produced with little deterioration throughout the game.  The best starting pitchers, for example, are those who can throw as hard in the seventh or eighth inning as they can in the first.  The aerobic system/long term energy system helps to replenish the short term energy system associated with powerful, explosive efforts.  Fatigue compromises technique and biomechanical efficiency.  All things being equal, power athletes are more likely to be injured in a fatigued state because the nervous system develops compensatory strategies to delay fatigue.  Compensatory strategies may help to maintain power outputs (throwing velocity, base running ability, bat speed) but can put joints and soft tissues in compromising positions.  A well developed aerobic system attenuates the “need” for compensatory motor patterns because it delays the onset of fatigue.

AF: What is it’s relevance in terms of physical preparation, recovery, and on-field performance?

DK: The aerobic system can improve on-field performance for the reasons mentioned above but its relevance is even more substantial when the athlete is not competing.  Improving recovery is one of the biggest initiatives in the field of sports science.  There are compression pants, fancy ice machines, devices that allegedly stimulate areas of the brain associated with relaxation, nutritional supplements, you name it…the truth is, we don’t know if any of this stuff really works to improve recovery.  Think of a well-developed aerobic system as free recovery.  Biological power and the ability to produce energy is finite, like a bank account.  Athletes spend a certain amount of “currency” just to meet basic survival needs.  Aerobic fitness is associated with increased vagal tone and parasympathetic dominance.  This means that the “cost” of living at rest is less for the athlete with superior aerobic conditioning.  Athletic performance is costly from a biological perspective.  It induces a stress on the system that necessitates the need for a compensation that inoculates the organism against subsequent stressors.  Athletes who lack the requisite level of aerobic fitness for their respective sport are “competing” when they’re not playing relative to their more aerobically fit counterparts.  The aerobic system is the off switch that facilitates recovery after competitions involving explosive efforts.  Simply put, the biological cost of energy production is less the greater the relative contribution of the aerobic system.  Physiology is a trade off between efficiency and speed.  The aerobic system produces energy less rapidly than the anaerobic system but with less of a withdrawal fee.  Overnight shipping is more costly than ground shipping.  When less biological resources are invested to sustain basic function at rest, more resources are available to replenish energy substrates depleted during competition.

AF: How you would best go about regaining and establishing an aerobic foundation after a long season of deconditioning?  Is aerobic exercise in the traditional sense (jogging, biking, etc.) the preferred way or is there a more optimal means – e.g. cardiac output training?

DK: The heart is a “dumb” muscle so if the goal is simply to develop the heart’s ability to distribute blood to the working muscles, the means don’t really matter.  Energy utilization comes down to delivery and extraction.  In the aerobic system, the heart pumps oxygen-rich blood to the working muscles and the muscles must utilize this oxygen to produce ATP, the cell’s energy currency.  Both delivery and extraction must be trained to optimize the power of the aerobic system.  The delivery side of the equation can be trained with more generalized means since developing the pumping capacity of the heart is the primary objective.  Extraction should be developed with more sports specific movements since extraction is a local phenomenon.  In the next article in this series we will discuss specific ways to develop these different components of aerobic development for the baseball player.