Aligning Return to Play to an Ecological Approach with Yuji Suzuki

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Welcome back to the Transforming Basketball Podcast. Delighted to be joined today by Yuji Suzuki. Yuji and I, uh, had some really enjoyable days hanging out in Portland. During the tail end of my season last year, we really just started diving into the future of how we think a return to play process could look like in the NBA.

But obviously these ideas through an ecological approach, and obviously these ideas apply to every level of basketball. And we just really enjoyed engaging in some very deep and authentic conversations. And I knew I had to get UG on the podcast. So, so good to have you with us, man.

Yeah, it's great to be here. It's always fun chatting with you. So I'm excited for this one too.

Absolutely. It's, it feels different not doing it over a salt and straw weird ice cream flavor, but we'll go for the Zoom. So, I mean, obviously I was, I was lucky, UG, because I'd followed your work for a long time. And it was just so fortunate that obviously you happen to be based in Portland and, and we basically every off day I had in that second half of the season, we were hanging out.

And just talking about how we believe ecological ideas have so much potential in the return to play process. So could you just introduce for the coaches or practitioners in other roles listening to this, just introduce your background and kind of what you actually do?

Yeah, so I am based in Portland, Oregon, or just outside of it. I am licensed as a chiropractor in the state of Oregon, but I also have my CSCS certification, which is more for strength and conditioning. And I've been kind of immersed in the ecological approach for the past 4 or 5 years, kind of just thinking about how it can be applied to my kind of specific niche of working with people in pain or people who are having obstacles or limitations in terms of movement.

And, you know, you have been a big influence on how I kind of think about some of these ideas. And we've talked about this before where I learned so much from coaches who are applying it in, in various settings, whether that's basketball or baseball or fencing, soccer, you know, some of these things, because we get to kind of think about what are the principles that transcend these sports and kind of speak the same language almost.

And I get to kind of think about it in terms of rehab and return to sport and performance in my, and just kind of combining with what I've been learning through school and stuff.

Great stuff, Ujji. So let's take a look at this return to play process. Simply, a basketball player gets injured and it could be something relatively minor from an ankle sprain to something more serious. You know, the most severe typically in our sport, things like ACLs, Achilles.

Could we quickly just outline the dominant approach In this return to play process and what we typically would see, and this is obviously basketball specific, but a lot of sports.

Yeah, I think the linear progression within the rehab process is certainly the dominant approach of, you know, it's this organism-centered approach where we're looking at the injured joint, injured muscle, kind of really zooming into that reductive one part of the organism. And forget to kind of take a look at the whole person to begin with, and even expanding outside of that to the environment that they are currently having to interact with, as well as the environments that they have to go back to.

Right. So a lot of dominant approach looks like just tissue capacity focused, right? We're trying to get the range of motion back, get the strength back, get the force production ability back. this cutting change of direction technique back. And that can sometimes leave a gap in our opinion through the ecological perspective in terms of getting back into a more open environment, alive environment of the sport, or even outside of the context of basketball, it applies people just going back to the day-to-day living life as well.

So what I often see, UG, is even like I'd say mine, you know, obviously it depends on the type of ankle sprain, but I'm using this as an example. We often see things like ice being used immediately and trying to prevent swelling through compression.

And, you know, I guess through the ecological approach, which is going to be the main basis of the rest of the podcast where we share the alternative, would you say this starts with attempting to restore the system degrees of freedom as early as possible, obviously in a safe way?

Yeah, absolutely. And I don't think ice and compression is necessarily a terrible thing, especially when considering timeline, right? Like, I don't, it's specific to the context of like, if somebody's needing to really get back to play, there might be different options or choices being made by physical therapists, athletic trainers in order to get them back to, you know, at least being able to go back to the field or the court.

But certainly I think there is ways to approach it from a kind of a constraints-led approach where we can set boundaries in terms of, hey, what are the places we don't want them to go? And what can we do without crossing those boundaries, right?

So even in the situations where, you know, somebody twisted their ankle, they're in high amounts of pain/swelling, we know that those are potential opportunities to have them interact with the task still, whether they're sitting on a chair or they're just standing in place, going through passing activities as a, you know, a pillar slash obstacle, or again, as a passer, just participating in these activities.

as much as possible, keeping them kind of attuned and sensitive to these representative activities, if that makes sense.

It makes complete sense. 'Cause what, what I'd say we often see, even at the highest level, UG, is I would say a huge gap with nothing in the middle where an athlete might do something very linear in terms of doing lane slides, coming back from an injury.

Like doing jogging laps, shooting a jump shot, passing on one leg, you know, and it's, they might do that and then boom, they go straight into live play. And there's often no, you know, bridge through using the CLA, constraints, small-sided games, constraint activities.

And I think what really stood out speaking with you is just how creative you can get designing some CLA activities, even very early on in the return to play process. And I think The best example here was your foam roller game, which I thought was so genius.

Could you just explain that for the benefit of the listeners, balancing the foam roller to ensure, you know, they didn't go too fast?

Right. So I think this is getting into kind of manipulating the complexity of the activity and the load and forces involved in the activity relatively independently. Right. So with, after an injury, obviously there's going to be thresholds that we don't want to cross in terms of maximum force that's involved to that joint area, because we want to ensure they're safe and we're not furthering the injury.

But that doesn't mean necessarily mean that we have to completely eliminate perceptual information involved. So this is an example that you know, I had thought about is like essentially create a box of a zone of activity area using a cone or whatever. This is just defining the space.

And it could be as simple as like a linear walking back and forth, jogging back and forth situation with another participant kind of either going parallel to you or going across in front of you. Now, you know, you're kind of going through these jogging activities, but while having to stay attuned to another person also navigating that space.

Now, the reason for a foam roller constraint, essentially holding a foam roller kind of vertically on top of a, of your hand. Now it's a balancing task that's added to the activity.

Yeah.

So that is going to constrain speed a little bit and complexity of change of direction because they can't just start sprinting off and surpass that threshold of forces involved because they, they, if they start running, they're going to drop the foam roller. So this is one way to set a boundary around those kind of a load threshold that we don't want them to cross.

While maintaining perception-action coupling as they have to start navigating spaces, right? Which we know is very, very important in sports, especially in basketball where you're just weaving around other moving humans.

That's fantastic, Yuji. So I think we've spoken a lot, and I wrote about this in the book about the siloed approach, which we see a lot, you know, in professional sport and I guess what we're getting at here is for return to play, you can do the same CLA activities that an ecologically orientated basketball coach could be doing just by having that shared conversation where maybe a PT, you know, an individual like yourself, a basketball coach, a strength coach, they're all planning these activities based on all these different factors.

And really we're just scaling constraints to ensure that You know, whatever we're coming up with, like the example you just gave, is at the right stage of the return to play process.

Yeah, 100%. I think that being able to speak the same language between coaches and rehab professionals and other personnel surrounding that team in support of, you know, the athletes basically, I think that's huge because we're not sending different messages. Between different professionals now.

We're speaking the same language, we're, we're speaking the same intent for the athletes of like, all right, we're gonna help you become a, a better problem solver in the context of basketball or whatever else that might be. And we get to all use our expertise knowledge to achieve that or in support of those goals of the athletes, right?

So true. And just on this note, Ujji, I think we talk a lot in basketball coaching about how there's no copy paste, there's no one size fits all. And, you know, we shouldn't just be using the same drills over and over again. How would that apply in your field in terms of, you know, really looking at more in a more individualized manner as opposed to, I guess, the dominant approach where PTs use kind of corrective exercises in the return to play?

It takes this moving away from prescriptive approach of, hey, we don't actually know what is the best way to move. The next best thing we can do is to provide them with a, or give them movement problems that is representative of the task that they have to get back to, scale it so that it's not too complex that they're failing all the time, or, or it's Not too much over their capabilities, right?

And being able to, again, encourage and facilitate their own learning process of figuring out how they can, you know, engage with this environment to solve that task.

And that, that kind of leads on to, I guess, the practical task, which we've spent a lot of time recently doing. We've basically taken a first stab designing an NBA return to play, not pro— I don't want to call it process, but concepts framework based completely on an ecological rationale.

And it was really cool because we, I have obviously this activities library from my time in Italy. And, you know, grateful for the time you spent, you went through the videos looking at how those could be used and how the constraints could be changed so that we could use those in a return to play.

And you had some incredible notes there and just things I would never have thought about. And I think that, would you say, Ujji, that's the first step in, you know, if an organization is shifting towards an ecological approach, that's a good practical step to maybe get staff aligned and maybe begin shaping what the alternative could look like?

Yeah. And just having these conversations is, I think, the most important part. Right? Like I couldn't have come up with any of these activities myself, but because I had something to work off of in your vast library of examples of CLA activities and essentially how you approach just accomplishing things that you want to accomplish with these athletes.

Now I get to think about, all right, how can I tweak this or in the context of somebody who is returning? To that activity, right? So instead of like, it's not like I can just give an athlete out of the thin air just a magical exercise to give, but being able to have conversations with coaches of like, hey, what do you think this athlete could use in order to kind of get back to what they need to be, or what are they lacking?

And start to incorporate some of those with the understanding of biomechanics as well as just biomedicine, right? So like figuring out, all right, here are the thresholds, here is what we want to accomplish. How can we marry these things together to give the most ideal activity in this particular situation, which will then get updated over time after application, right?

That's exactly it. And I think After this, after this, I want to actually read some of the amazing ideas you had and just build on it now. But one kind of thing I said to you when we, it was when we were getting brunch and I said to you, I had like an epiphany.

I was like, well, could we just take a lot of these small-sided games that I've done and really just change the speed intensity through scaling constraints? And then we've got a live, you know, movement problems in the return to play. And Obviously it sounds very simplistic, but surely just doing that, that provides a big competitive advantage, no?

Absolutely. I think these activities are great and inherently because of the constraints that you've utilized, you know, some of the activities will involve less load for the athletes, whether it's need for cutting or speed or just complexity in general, and those become really good entry points or progressions when they do, when an athlete does have limitations in terms of physical capacities and tissue adaptations.

That's it. So I wanted to look at those, Eugene. I want to maybe talk about some constraints which coaches listening will be familiar with, but I might touch on a few and it would be great if you could talk about the context of how you are looking at some of these constraints and what they might be useful for in a return to play.

So The first one we had was the blind series, which was the ball on the back of a defender facing the rim. And this was something we spoke about because you said it was, you know, it's minimal steps, reducing complexity. Could you just talk about why that might, something like that activity, this blind one-on-one, could be useful in return to play?

Yeah. So blind must shoot. I think it was the must shoot constraint that, you know, really kind of sparked my curiosity because Or they're not literally able to accelerate fast enough. So the forces are going to be constrained. It's going to be limited.

There's so much, again, force you can produce in that one step so that, hey, that deceleration need or deceleration demand is going to be lower for the offense and defense.

Right.

So that's kind of where my went to when I was watching that activity in particular. As well, it's not as complex as a 3-on-3 or 5-on-5 or whatever else that might be. It is constrained to one part of the game. So, you know, there's less demand in terms of decision-making, albeit they still do have to make decisions in terms of how much, you know, space you give that offense or, you know, how quickly you're moving, what's the strategy you're using to try to make that difficult for the offense or Vice versa.

That's exactly it. And it's, I think what we're getting at here is it's, it's the constraints just make this safe. We're not ever gonna say, all right, let's go play 3-on-3 immediately. It's, you know, we're being way more, you are being way more creative with how these constraints are, are being used.

So the next one I, I wanted to look at was the 2 basketballs, and I believe this was when the defender was actually dribbling or holding a basketball as well in a 1-on-1. Can you speak about what that kind of afforded just from a practical perspective, Eugene?

Yep.

So obviously this isn't perfectly representative of like an actual game situation, but because of that added constraint for the defender to have to dribble the ball as well, it is going to kind of slow down that activity a little bit, right? The defense cannot be as aggressive because they have this other task that they have to interact with.

So again, this would potentially present another opportunity to return an athlete as an offensive participant, or it could be defense as well. But again, it is going to constrain the intensity of the interaction between offense and defense by just adding that dribbling task for the defense.

Fantastic. And one which I really loved, Ujji, was talking about cutting. And obviously that's something we see a lot in basketball, whether it's a backdoor cut, a ghost cut, even a slip on a pick and roll. And that can be quite a tough movement in return to play.

And then you said how a lot of athletes say they don't feel right about cutting. Could you just talk about some of the really creative solutions you had in this specific scenario?

Yeah, I think cutting is one of the most difficult things because the way we've been approaching it is trying to break it down. What are the forces involved? What are the shin angles? What are the speed and stuff like that? And I think those things are still very, very important.

We should measure force production, and if we are seeing glaring deficits, you know, physical therapy, a rehab process should address those things, right? So I'm not advocating for ignoring those things, but at the same time, a more maybe ecological-friendly approach to practicing or returning to change of direction or agility is to utilize potentially different surfaces.

Now it's easy to say All right, specificity, they have to do it on court, but obviously that doesn't give the athlete as many or as wide of a range of the movement problem. So what we can do is potentially have them perform these activities in, in a kind of a gym type of floor, hardwood floor of basketball court versus turf versus carpet.

And they could even kind of try to, we could even introduce variability in terms of shoes that they're wearing, right? So one day they could be wearing gamers, but another day they could be wearing athletic street shoes or tennis shoes or whatever. Now they are having to again become more adaptable in terms of the constraints of the situation.

So they're not just practicing one movement solution per se. Now they're kind of just having to figure out, okay, In under this set of constraints, how can I figure out how to just effectively change direction? So that's kind of where my head went to when you were kind of just talking about that.

This is great. I really enjoy this because I know we're going quickly, but just having these practical examples, I think, are so valuable as opposed to us just rattling through the theory. Because this is, I mean, even if a coach has A player on that high school team who has an ankle sprain, just trying some of these things are gonna be so much more advantageous than, you know, the dominant approach, maybe putting them in an ankle strap and just doing very prescriptive corrective exercise and boom, 5-on-5, there you go.

Which is probably more dangerous when you think about it. And what I loved, UG, too, is how you actually started designing new activities completely based on, you know, just Your creativity and the ideas you were seeing. And I think that's a key part of it because then I talk about that too in terms of design new activities based on rate limiters, things you're seeing, don't just copy paste.

And I think, yes, of course you have similar injuries that will be occurring, but I think, would you say there's so much scope through this framework for you to design completely new activities? And I think that's just so much more interesting for the athletes where they know maybe every day coming in.

Yeah.

If they're injured, they're actually going to do something different with you as opposed to having this routine of the exact same exercises in and out. Maybe they might actually look forward to doing this stuff.

Yes, absolutely. I think being able to just be adaptable as a coach or therapist, I think is an important component to providing the best type of support for the athletes. And I think you're right, a very, like variability in terms of activities that they're Performing, right?

Like we don't want them to ever be complacent in terms of just getting good at this one exercise. That's kind of what we are trying to combat with this ecological approach is that things we know about transfer, we can't just have them practicing one particular movement and expect them to thrive in a more open environment where they have to just couple their movement to changing constraints and the information that they're picking up.

And just to kind of touch on this part as well, it's a constant process of updating these activities, right? So, you know, I came up with these ideas after watching your videos, and we could try these out, but it sometimes, some of them are not going to work at all, right?

Like they're going to just kind of result in movement behaviors that are completely unexpected with a certain athlete.

Yeah.

And we have to just scrap it or we have to change it up. I think it's this kind of humbling understanding of like, okay, this is a good idea, hopefully at least, but it has to get better with practice and in process of just updating it.

That's completely it. And I think on that note, usually the first thing I say to kind of eclipse this siloed approach and have this more unified organizational framework is Literally just having more time having these conversations, which you already mentioned, but then actually working together.

So what we often see is maybe the staff involved heavily in that return to play, mostly the PT, maybe the strength coach, I'd say in an NBA context, they kind of only really get involved with the on-court when there's a problem. And then it's done.

And as soon as the athlete's good, maybe another week, boom, and then they're kind of removed from the equation. But how I look at it is continuous where, you know, someone like yourself, or you'd be in all the on-court player development, you know, regardless of whether the player's injured or not, seeing how we manipulate constraints.

Maybe you'd even have amazing ideas to manipulate constraints, even though you're not a basketball coach, just with your knowledge of the theory. And then I think when an injury does happen, you are way better suited to jump in through this framework, design really good activities, know where the athlete is at.

And then critically, when the return to play is finished, you're not just done. I think you're continuously there in the several weeks and months after the injury, watching, continuing to be involved in the process. What do you think about that?

We've kind of touched on, or in our previous conversations, how system can be a constraint to applying some of these approaches. Because again, the constraints for the physical therapist or chiropractor or rehab professional is real in that team setting, right? Like if they're overwhelmed with a bunch of athletes who are requiring, you know, workup, right?

They might not have time to be able to attend those practices. And I think that's where a top-down understanding for the benefit of this unsiloed approach, this integrated approach is huge because it starts there. If a coach or a therapist is Overwhelmed with just one part of their job, how can they go and just watch practice?

Or how can they go to the therapy room and ask for updates or, you know, share ideas? And I think that's one of the frustrations that you shared with me was like, there's no room for integrating these approaches because where you're fighting against the system sometimes.

That's it. And I think it's redefining that system and change in the constraints of an organization where the lines are more blurred and you're having this team of, yes, you're always going to have specialists, but more of these generalists who can dip in and out.

And that's kind of what's promoted internally. I think that's the only way you can really achieve this.

Yeah. And, you know, I'm kind of talking about these problems, or, and we are kind of talking about these problems, but I'm somebody who Like, I know that there are hundreds and thousands of therapists who are very well equipped to treat ACL, treat ankle sprain, you know, much more than I am.

But I think I'm where I'm maybe different is that I have this understanding that I've kind of built up of the ecological perspective. And I can kind of make suggestions in terms of, hey, like this minor change that is not going to take away from your current intentions, but it might be able to align it a little bit better to this updated contemporary motor learning and skill acquisition approach, right?

So I don't think it takes a whole lot in terms of like, we're not trying to change the whole process here, but we can tweak the things within that approach and align it better to the motor learning and skill acquisition, you know, literature basically.

That's it. I think a lot of teams kind of have KPIs, UG, to assess the performance of a medical team, of player health. And I think one thing is we can't just assume that it's the player health staff who are responsible for everything because it's not, it's everyone.

And again, this is the siloed approach. It, you know, if the coaches are not periodizing practices and running high stress practices the whole time. Then you can't blame someone in player health when it's really something stemming from a coaching staff. And I think that's where it's very difficult to have these very fixed KPIs to evaluate because it just starts becoming reductionist unless you have the, you know, really specific metrics, I believe.

Have you thought at all about that? I don't think we've spoken about that.

It's a very difficult conversation because we, you know, at that level, With that amount of financial investment, it's like we need to keep track of something and eliminate risk as much as possible, right? But at the same time, we know that human health, performance, winning, right?

Those are all part of dynamical systems, right? It's not like we can take one part of it to improve the whole thing, right? And when we try to focus too much and chase efficiency in one part or one metric, that doesn't necessarily lead to the improvement of the entire system.

So I think, you know, not just the ecological side of things, but this dynamical systems understanding within an organization is needed, albeit quite difficult to implement in reality, I'm sure.

Yeah, I guess, I guess it's, you know, acknowledging that the team is a complex system. It's, it's going to be unpredictable and there could be several different underlying factors leading to one thing. And I think that's an interesting one that I think we'll do some more thinking on just in terms of how you could actually quantify that this stuff is having a, the difference that I believe it really could have.

So, Ujja, you know, really grateful for you taking the time. I think the first of many appearances on the podcast and your involvement with Transforming Basketball. But where can coaches, practitioners listening to this find out more about you?

Yeah, I'm most active on Instagram and X. On Instagram, I think my handle is @yujgains, so Y-U-J-G-A-I-N-S. And on X, it's @yujisuzukidc. And again, I'm applying these things with the mindset that these need to be improved. Right. So any, I enjoy these discussions with people like you and people who are listening, please feel free to kind of reach out and kind of share your thoughts, ideas, and maybe we can kind of bring not just basketball, but sports and movement practices forward together.

I think that's kind of where I would like to see things going.

Absolutely agree. UG, thank you so much. Appreciate it. And I look forward to talking soon.

Yeah, thanks, Alex. This was fun.

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