10 Year Anniversary Episode - #AMR380

Wow, I can't believe it's been 10 years!

It truly is an honor to be able to host a live episode celebrating the 10-year anniversary of our podcast. Thank you so much for listening all these years!

In this episode, we'll answer live questions from an audience of listeners, reflect on some of our favorite moments of the podcast, and give out some prizes and special discounts to all the listeners!

Special thanks to our amazing friends from Ancore, SmartCuffs, Suji, SportGrips, and mTrigger for donating the prizes!

To see full show notes and more, head to: https://mikereinold.com/10-year-anniversary-episode/

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Transcript

Ten-Year Milestone And Gratitude

SPEAKER_12 0:26

The Ask Mike Rhineland show. Helping people feel better. Move better. Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training. If you want to learn how to get started optimizing and enhancing performance, this is the course for you. Head to microneald.com/slash performance to sign up today. Welcome everybody here to can you believe it, the 10-year anniversary of the podcast episode. I don't even remember podcasts being a thing 10 years ago. Do you guys like what made us do this? I don't even remember why we started this at the beginning. There's no podcast I've been listening to for 10 years. Have you guys? BJSM like editorial maybe got us started. That's unbelievable. But seriously, uh, before we get into the show, just welcome back, everybody. This to me obviously is a truly special episode. Um, it's so humbling. Like, you know, we tease a little bit, you know, with with some of the the ads and stuff we put on social media about this that we're surprised, you know, that people still listen to us after 10 years. Um, and we do mean that. We're sincere when we say that, but um, it really is an honest uh um it is very uh an honor for us to be here. Um, what a huge milestone, right? 10-year anniversary of a podcast. Um, before we dive in, I I mean, you gotta say it, but I gotta take a moment to say a massive thank you to all of you guys, the listeners. Um, we started this podcast for you, right? I mean, we we decided at the time we were gonna make it uh a kind of a question and answer style uh podcast, which, you know, I think was a little different 10 years ago. I don't think people were doing question and answers, but it was it was about like, you know, all the the the cool questions that we get from people on the internet and social media all the time. You know, what if we were to share that? What if we were do to do that in a podcast where everybody could learn from those questions? Um, and that's kind of really where it came from. Um, and you know, we all went back today and watched the first episode and cringed, right? I think that's what most people do. So if you um, you know, if you're if you want to get started with a podcast, we'd say go right ahead because we didn't know what we were doing. We had terrible microphones, terrible, terrible cameras, terrible haircuts. Um, you know, it was just we just we didn't know what we were doing. Um, but you know, but we're here and we're here still because of you, the listener. So um, whether this is the very first episode that you're listening to or you've been here for the, you know, since the beginning, the first one ever with Lenny and the Gabinator and I, um, your support and and really the engagement are the reason why we'll we're still here a decade later doing that. So thank you so much. It's been incredible to be able to do this along so many like like-minded professionals. I think that's what we really appreciate about that. It's kind of like you find your tribe of people that think similarly. Um, but yeah, we're we're so grateful for that. Um also have to say, like, how grateful I am for you know the team at Champion. Again, like Lenny and I started this podcast 10 years ago. It was just Lenny and I. And now we we are we almost have to limit some staff because we don't have enough rooms in in the zoom screen sometimes to be able to answer the question. So um totally thrilled to have everybody here today and kind of go over the champion staff that's here today. But we got Brendan Gates, Dave Tilley, Lisa Lowe, Kevin Coughlin, Lenny McCrina, Anthony Videtto, Mike Scadito, Dewesh Podell, uh Dan Pope, uh, Noah Sprinkle for this is technically your first episode. Let's go, Noah, since you you were a student. But uh, you know, and there's there's so many more that have been on, but um, I want to give a special acknowledgement to them because really, you know, the whole backbone of this thing is is is all of us together sharing our experiences. And I think when you put a bunch of heads together and and you put us all in a room, uh, we have such a great variety of experiences and backgrounds that we can you know really offer some good advice for you guys. So um, you know, couldn't couldn't have done it without everybody here and in the champion crew. So thank you guys, and um, let's have fun tonight. Cool? Everybody ready?

Team Growth And Roles At Champion

SPEAKER_03 4:43

Mike, if I may, if I may, we'd be remiss if we didn't mention uh thank you to you um for all the hard work that you have put in um behind the scenes because you do a lot of the post editing and dealing with all that stuff, we'll say. So thank you for being persistent in leading that and leading uh the questions and and in and helping us to establish this. So again, um, you know, thank you.

SPEAKER_12 5:12

Did we script that ahead of time?

SPEAKER_03 5:13

That was we didn't script that, no, but I felt like it's natural.

Giveaways, Authentic Products, And How To Enter

SPEAKER_12 5:17

It's like I feel like Mike and Eli on the Chasing Scratch podcast right now, but thank you, Len. I appreciate it. Um fantastic, but um awesome. You know, again, thank you so much. Um, tonight we're gonna do a few things, right? We have some things that we wanted to go over and we wanted to talk about ourselves. Um, we have some crazy special prizes. I mean, my gosh, we've got over$2,500 in in free giveaways that we're gonna give out to people on this episode. I'm still not 100% sure how we're gonna do that, but we're gonna figure it out as we go along, just like we've been doing for 10 years. And um, and and really, you know, try to give back. Um, these are some of the companies that we use and love at Champion. And, you know, we never, you know, I've been pretty sincere over the gosh, 15 years I've been doing stuff online that we're authentic. Like we only talk about and we only you know recommend the products that we actually use. So we're gonna be giving away an Anchor Pro cable training system. That thing's amazing. We're gonna be doing um uh BFR sets from Smart Cuffs and Suji, which are the two brands that we're using the most now at Champion that have been great to us. Uh, we're gonna give an M trigger biofeedback device and a sports grip grip trainer. So, some cool stuff coming along that we're gonna get to. Uh, we're gonna open it up for questions. So we might as well talk about that now. So, for questions, we're gonna do two things, even though you know this might be a little bit chaotic now that we have you know hundreds of people on this right now. But um, we're gonna do two things. If you want to ask a question, there's two ways you can do it. One, just type it in the chat box and God bless you. Dave Tilley has has graciously volunteered. I'm kidding, I just I had to beg him to do it. Graciously volunteered to be the MC of the chat where we can answer some questions. So if you have anything along the way, something pops up in your head, just type it. Type it right away so that way um, you know, you won't forget it or something like that. And we'll try to hit as many questions as we can. If you want us to unmute you and have a conversation, which we'd love to, um, I'm seeing so many faces on this that were, you know, on past episodes as students, right? I'm starting to see more and more, right? Good to see Mac, good to see Eric. I can see some more faces coming in. I'm sure there's more on some other screens I'll get to. But um, yeah, if you if you have any questions or something, raise your hand with that raise the hand icon and we'll get to you as well. Is that cool? Awesome, cool. All right, so fire away, start typing, start raising hands if you want. Anything you want to talk about, we'll answer. And while you do that, we got a couple of things to start with, I guess. The first thing we're gonna start with is our first announcement that we have that we started talking about yesterday, a little bit online. But to celebrate, and a big thank you to all of you for being here for 10 years, we're offering 25 all of our online courses. So, all of my courses, courses I have on my own that I've built with uh Dave and Dan and Lenny, um, anything you want, 25% off. I'm gonna put a link in there right now. Use coupon code 10 years, and you can get 25% off any of our uh courses. I'm trying to figure out how to use the chat right now. Perfect. So you guys have it right there. So I just put that link in there, and then which is really cool, is Dave Tilley, Dan Pope, and Lisa Lowe have also graciously offered to have 25% off all their website stuff too, which is really cool. So Lisa just uh uh launched a new rowing uh educational item that you want to check out. Uh Dan's website, fitness pain free, has amazing resources and Dave Tilley's uh shift movement science thing. So the links are in the chat for that again. And it's honestly it's not an ad, like no big deal. Like, you know, if you don't if you don't want them, but for us, it's just a way to give back and say thanks. So 25% off everything, which is kind of crazy. We don't do that a lot. So that was our first big announcement. So I was gonna say, Dave, you tell me before I get into it, we got anything, or should I start with my? Oh, yeah, we already have four. Oh my gosh. All right, all right. So let's hit a couple and then we'll jump we'll and then we'll jump into to my question that I have for you guys. But what do you want to start with, Dave? There's a lot of pressure here on the first question. What do you think?

SPEAKER_11 9:38

Uh let's I think we do a general, non like directly clinical one first. And Scott just says, what book are you guys currently reading? Nice and offball to start.

SPEAKER_12 9:48

I love it. Len, you're muted by the way, just so you know.

SPEAKER_03 9:51

But I am muted. The kids were crazy in the background. Oh, I gotcha. I just noticed that. Yeah.

SPEAKER_12 9:58

Interesting. Okay, all right. Who wants to start? What book are we reading?

SPEAKER_11 10:01

I mean, mine's pretty meta because I'm actually rereading Ego is the enemy. You gifted me nine years ago when I first started the champion, and you had a big ego, I think.

SPEAKER_00 10:10

Yeah, was that passive aggressive?

SPEAKER_12 10:12

Totally my bad on that. I didn't know.

SPEAKER_11 10:14

Yeah, here, I bought this book for you. You should read this.

SPEAKER_12 10:17

I thought, I thought it was a good book. All right, ego is the enemy. That's a good one. What else you guys reading? I got uh I I don't read, but I I despise reading.

Live Q&A Opens And Chat MC Plan

SPEAKER_03 10:26

But ironically, but ironically, what Twitter account are you following? I am I am prepped right now. I have two books right here. Uh Breathe Golf, which is kind of uh uh uh how like the mental aspect of golf. And uh for those that follow Scott Adams on Twitter, he just died of prostate cancer. So I supported him uh and bought his book, How to Fail at Almost Everything and Still Win Big. So um, you know, two books that I will be reading on vacations coming up um in May.

SPEAKER_12 10:56

I just read John John McJill McKay's uh comment that Lenny reminds him of Ben the Flesh. And I said it could be worse.

SPEAKER_03 11:04

It could be worse.

SPEAKER_12 11:07

Oh, and then Sandy jumped in. Wow. Uh that's funny. Yeah, that's that's too good. I love it. All right, what that's a good one. What else? Who else is reading a book?

SPEAKER_09 11:17

It's funny to say that. Yeah, I'm I'm newly in a book club, which I'm pretty excited about.

SPEAKER_04 11:21

That's cool.

SPEAKER_09 11:23

Yeah, and we're reading, it's called uh Brief History of Intelligence, just kind of about like how intelligence evolved and how that relates to the development of AI. So pretty interesting. Not like the easiest, most intriguing read, but it is interesting.

SPEAKER_11 11:38

Only Kevin would use his brain all day long and study and then go home to do a book club to study and use his brain more.

SPEAKER_04 11:47

I'm reading Harry Potter. Oh, that's excellent.

SPEAKER_08 11:53

Kind of. I'm I'm really going slowly. Really, really slowly, but we're making our way through it.

SPEAKER_12 11:58

Where where are you at, Mike? Because last I thought I heard you were like three pages into the first book.

SPEAKER_08 12:02

I think I'm like 38 pages, and that was uh only because we had a power outage from a snowstorm and I couldn't do something else, couldn't get on the internet, so picked up the book.

SPEAKER_04 12:14

I got a library book for the first time in a while this weekend.

SPEAKER_03 12:18

What's a library? What do you mean a library book?

SPEAKER_04 12:21

Benefits of having a kid when it's cold outside, you gotta go somewhere. Um I picked up uh oh gosh, I'm gonna forget now. Because I was reading the price she pays, it's like uh mental health crisis and women's sports, um, but I couldn't read that and fall asleep. It's too much thinking. Um so I got lessons in chemistry, which was recommended by many. There's rowers in it, so I think that's why.

SPEAKER_06 12:44

Um watch the show. It was a good show.

SPEAKER_04 12:47

Yeah, I also heard it's a show, so I'll read the book and then there we go.

First Announcement: 25% Off Courses

SPEAKER_12 12:51

I is it bad to say that I'm not reading right now, but I've been I've been doing AI courses online for probably the last year, just trying to not fall behind in AI. So um I don't know if that's working. And then I don't I don't know if anybody saw my Instagram yesterday, but it was the epiphany of my career, basically. And I thought it was amazing. Instagram didn't show it to anybody. I thought this thing was going viral, but I made I made the um what's the thing called that comes at what's it what's it uh uh Puxitawny Phil, is that his name, coming out of his hole with a with a Patriots hat on, predicting you know a quick winter, but also a Patriots victory. But apparently it wasn't as cool as well.

SPEAKER_03 13:30

My wife, my wife did think that Punxitawny Phil wore a Patriots hat that day. So I'm like, I think that was in trouble. We're in trouble. We are in trouble. Exactly.

SPEAKER_12 13:41

If that wasn't obvious, I don't know what would be. So like we're in trouble. All right, Dave, we got a ton coming in. What do we got left now? I got like 15 here. Okay and Gag, let's go quick, let's hit him. Let's what can we do?

SPEAKER_11 14:19

We're just gonna go in chronological order. So Max says, Can you share if slash how you are using BFR for upper extremity with athletes and post-ops? And this is a good question to start with because I know the baseball crew has one thought, and I actually know that like Dan uses it a ton. And so I think that'll be interesting to see both perspectives.

Icebreaker: What We’re Reading

SPEAKER_12 14:36

You know, I I don't mind starting with, I just talked to our student Meredith about this today a little bit here, but like I don't know, I'm not overlywhelmed, uh overwhelmed with um how beneficial upper extremity BFR is. And I know that's that's a hot take these days. I think everybody wants BFR to be so popular and amazing here, but um, you know, you know, a few reasons. One is I I want to load tissue, two is I'm not convinced the proximal effects are that exciting. I don't, you know, the one study that kind of showed it on the cuff didn't overwhelm me. It wasn't the best study. Um, and you know, and I don't think we struggle getting some of those things um, you know, uh strong. So, you know, you're putting the cuff on a very, very sensitive area on the arm with your whole neurovascular structures that's just different on the leg. You know, for me, I just I I just haven't found a need to use it on my upper extremity patients. Um, Mike Scaduto, you want to share just real quick how how we use it on our baseball players post op because I think this is a great idea you started doing.

SPEAKER_08 15:31

Yeah, for upper extremity surgeries, um we developed a lower extremity blood flow restriction program that they can start uh around three weeks post-op. So for Tommy John's or for shoulder surgeries. Um so we're basically trying to mitigate any kind of muscle atrophy, um, you know, with the goal of promoting hypertrophy uh when they would be relatively untrained or detrained um otherwise. So they're using DFR because they can't hold a ton of weight in their hand, um, so they can't use a ton of load. Um and we're seeing like really good effects of that. Like basically they're able to get back into training when they're clear to uh load that surgical extremity and they feel like they haven't missed uh or haven't lost a ton of ground. Um also it's probably the highlight for some people, it's the highlight of their session, like immediately post-out. Like they feel like they're getting a pretty good workout in. Um some people dread it because it's it's lower body BFR, it's burns and it's like you know, uncomfortable. Um but I think a lot of people in the younger athletic population they they want to come to PT and feel like they're working hard. Um, so obviously we have the benefits of the BFR, but I think psychologically um it adds to their session and makes them feel like they they got a good workout in when otherwise they wouldn't be able to.

SPEAKER_12 16:43

Yeah, I love it. So like put it on the legs to get the systemic response, which I think is uh, you know, probably a benefit that we probably don't talk about enough for our upper extremity post ops. That, you know, really cool. Uh Dan, real quick, you want to just mention maybe some upper extremity use cases you use because I you probably use it the most on the upper extremity for us.

SPEAKER_10 17:03

Yeah, I like it a lot. I get a lot of folks that um want to go, either they're powerlifters um or they like just training in the gym. And classic thing for those guys that have shoulder pain is they can't really press heavy, but most other things feel pretty good. They can do most armwork, most rowing, all those exercises actually feel pretty good. Um, and twofold. So if you have a competitive athlete that needs to maintain their strength, let's say they have a like I just had a powerlifter this morning who's got nationals coming up, and one of the things that he's having trouble doing is loading heavily, uh, particularly with pressing movements. And we do know, and we have more studies in the lower body than the upper body, particularly with powerlifters, that we can maintain and build their strength optimally by using blood flow restriction training for a period of time, right? And that's really cool about that is that these athletes can't really push the movements they want to push. And it allows them to push those movements some. And I think that's from the standpoint of building muscle mass and strength, but also psychologically, you get people that like they're just so defeated, they can't do the movements they love to do in the gym, right? They feel like they can't get a pump, they can't make their muscles function the way they want to, and they're really sad about it. And when you have an injury like that, you probably have to unload it somewhat. So we can't just continue doing the same thing they're doing, kind of spinning their wheels, irritating the area. If we allow them to do something like, let's say push-ups with BFR, some lighter bench press with BFR, they're like, oh my God, it feels like my arms are going to explode. This is the first good workout I've had in a long time. Uh, we're kind of hitting two birds with one stone. We're kind of giving people what they want to do, we're rehabbing them, and we're still building strength and muscle mass at a high rate. So um, I would say I don't work a lot of throwers, so I'm not throwing these on any uh like post-op upper extremity thrower patients populations, but I think for my population, a lot of like lifters, they love it. And uh I think it's a really good solution for the problems.

SPEAKER_11 18:43

Awesome. What's up, Dave? What's next? Yeah, we're gonna start chopping these down because 21 just came through and that one answer. Um okay. Anna says, uh, what advice would you give a student, almost new grad, who has the goal of performing research into clinical practice? I read this question and like reflexively almost like revolted because of how much research stuff I've been in. So I may not answer this one. Just kidding.

SPEAKER_12 19:05

Yeah. Uh I don't know. What do you think, Len? I think like maybe you and I we started our careers off with a lot of clinical research when we were affiliated with a big red uh research institute. Yeah. Would you recommend for somebody that doesn't have that? Because I know we've we've actually struggled with that. Like, what would you recommend?

SPEAKER_03 19:22

Yeah, the question I I missed it a little. Like it was somebody who was who is interested in doing it and what what's our opinion? It was kind of choppy.

SPEAKER_12 19:31

How do you get started with clinical research as like somebody new new in the clinical research?

BFR Training: Upper Vs Lower For UE Cases

SPEAKER_03 19:36

Yeah, fortunately, our times in uh ASMI down in Birmingham, we had that ability to work with great researchers. So try to hook up with somebody who is doing that because you need uh IRB stuff and all that. So if you have that opportunity to or to be able to seek it out, uh definitely do it. Um it's a lot of work, it's not pretty, um, and it's additional to your you know, your regular job, but um earth shattering, earth moving, how much you can uh expand your career and get your name out there with that and present your research and and speak at meetings and and make your you know your world a lot bigger. So um go for it if you can and seek it out if you can at a local university or local, you know, like I said, an ASMI in Birmingham, and they're always looking for people to help crunch data and write introductions and all that stuff and be involved. So um, and then maybe give back also to some journals, um, IGSPT or something like that, where you can review a paper um and give your feedback on on a paper that's trying to be published as well, because it's a lot of work that goes into it. Um, like Dave just had a paper um that was uh accepted, um, and it's a ton of work as as you know, and we've published a bunch, and it's not not easy, but um I think it it definitely has pulled my career in a direction I didn't expect.

SPEAKER_12 20:53

Nice fire away, Dave. Don't stop.

SPEAKER_11 20:56

Yep. Um okay. Uh oh, yeah, this will be an easy question, not really like you know, much depth here past that went. What are your current thoughts on quad tendon autographs for ACLR? And um I can I can offer a two cent. I literally left the clinic after evaluating somebody. Um, I'll probably echo what Lenny's gonna say. Quad tendons are challenging to get the strength back, and then they are also very challenging with managing pain after. And I this girl was nine months out of an uh a quad tendon graft with a from a very good surgeon with a very good track record. And um, she's literally had pain the entire time in her quad tendon graft. Her knee doesn't hurt, her meniscus doesn't hurt, but her quad tendon graft site itself, when she tries to do harder strength exercises, continues to be painful. Um, and you know, Lenny and I have had conversations about people we've seen who just have like ongoing uh challenges just in general. So I can just say that mine tend to be a little harder to get the strength back and painful for longer. Um, but this person also had an LAT. But I mean Lenny is obviously the man here for this.

SPEAKER_03 21:59

Well, I mean, yeah, I mean uh some people on social media say that there's no difference. Like they just they they find they cruise, right? And I don't see that, and I get a lot of DMs because I'm very vocal on my there's certain platforms, Twitter or Instagram, about uh the challenges we'll say nicely, like Dave has been nice, uh the challenges of a quad tendon graph. They like like Dave said, the it's a struggle to get the quads back. There's an extra set of pain that seems to persist, um uh, but they are sought out by certain surgeons, and it's almost the newest thing, even though it's not really new. Uh we've been doing quad tendon grafts for decades, and it's just been revamped, repackaged into a new thing uh recently. And um, I don't know. I'm still a teletendon guy. I think the gold standard, we have 50 years of research on it. Uh, we know how to handle them. Uh the anterior knee pain is way overblown by surgeons, um, and they are a strong graft, and they do so well um with. you know, with our in our hands. So I I'm not a fan because of the persistence of the of the weakness that we see a lot. Then a lot of PT see this as well. So yeah. I wouldn't be surprised if there's a shift back to patelatendance from a lot of the quad ten insurgents.

SPEAKER_12 23:06

All right. 50 sorry I'm gonna ruin you, Dave. Uh 55 year old skier tears it. Well graph Len.

SPEAKER_03 23:16

I mean I treat in two right now that both have patelaton autographs.

SPEAKER_12 23:20

Alright. I was wondering if the if you'd sway quad a little bit on that for a little bit less.

SPEAKER_03 23:25

No, I wouldn't not no I would probably go hamstring before a quad tendon and a 55 year old which is weird for me to say the quad tendon has beat me down that much. Would you need a quad tendon in the room with us right now? I would consider probably an allograft before I consider no I was just gonna say would you go allograph? I'm not even Achilles cadaver graph you could convince me you could you could convince me one before he lets somebody get a quad tendon I I yeah I mean I don't know I don't even know if I would golf with an allograft I'd be worried about that but anyway.

SPEAKER_12 23:59

All right Dave.

SPEAKER_11 24:00

All right uh Kevin says given PT's training in differential diagnosis and red flag screening should PTs be permitted to order musculoskeletal imaging or does this push the scope of practice?

SPEAKER_12 24:13

I don't mind jumping in real quick I mean that's so beyond like us right here. I mean I don't know I mean it's starting to get adopted in some states I think we've had at least one state I know there's a couple out there that I just read with through the APTA I know they want it. I don't know the answer. I mean I do think some imaging will probably will probably reduce health healthcare costs instead of seeing like a bunch of numerous providers and I guess as like a leader in the APTA like myself in the past I'm probably supposed to say that we should but um you know I don't know I I I would like to see it in the future but you know I I just think I think it's a big topic and practice act stuff's just so hard to get across each different state.

SPEAKER_03 24:52

So I don't know that would be my two cents anybody have anything else or there would have to be substantial training like in MRIs and all just all that stuff. I think you have to have a better understanding. I think we get some basic stuff but I don't know I feel like there's a there's a little bit more needed but I'm not against it definitely not against it.

New Grads Doing Research: How To Start

SPEAKER_12 25:10

It'd be nice you know we'll get there a couple of states anybody you know I'd be I'd be interested if anybody uh practices in a state um that's been doing it or something you know put something in the chat I'd love to hear your experience because it's it's the it's the future I think we'll yeah we'll probably get there but you know um we'll see but yeah all right uh Brad says I am a new grad that just took his boards in January got the good news that I tonight I passed.

SPEAKER_11 25:37

Congratulations brother tonight let's go to that Brad's go Brad Brad's celebrating uh his his night out after boards with watching a podcast live nice for that and I think what does he have like 24 hours before student loans have to yeah right so I hope you enjoy a nice uh great job Brad yeah good job and we'll be starting my career as an uh outpatient clinic while also completing a sports residency through the company what advice would you give to maximize this opportunity while also keeping things manageable as a new clinician who I live that life it is rough you live that life I did that yeah that was too that's how I got my job at champion how do you make it I don't know time management oh wow yeah uh you gotta be very willing to sacrifice some hobby time that's the only way it worked I would study for two hours before clinic take clinic and then go home and I was coaching gymnastics and then on Wednesdays I would shadow you guys but um it's worth it I would definitely say it's worth it like I mean I love my job and my career and I think that what I learned in studying for the residency through the uh evidence in motion at the time was worth it. Um I was just talking to Meredith during Naval about how I wish the SCS would be a little less emergency medicine and a little more clinical practice of ACL, TJ, slap, strength conditioning um so I it'd be a hard for me to go back and do it again. I don't really know uh how much I'd be able to do back and forth, but um I think it was worth it. I just it demanded a lot of me for two years. You know I I I'm not proud to say it but I worked like 90 to 100 hours a week for the first two years when I was doing both.

ACL Grafts: Quad Tendon Vs BTB

SPEAKER_12 27:07

Yeah I saw that I you know what I I guess my biggest piece of advice here is I would just say that the concept of work life balance is important, right? And I know it's a generational thing too where it's becoming more and more important in an in I think in a positive way. The only thing I would say is like there's multiple ways to think of a work-life balance and I don't know if you should think of it as daily versus weekly versus monthly of quarterly I almost think of it quarterly with me I I I I dig in deep for quite a bit but then take a break and that's that's hard to do if you're working on if if if if you're trying to manage work life balance day to day I think it's going to be very hard to get ahead in either bucket. So kind of keep that in mind that would be my only suggestion for you is to try to you know realize that life is about sprints and recoveries and you know that's probably the best way if you're trying to get ahead professionally you know up I'll you know I guess I'll leave it at that yeah me no Dan wants Dan wants to jump in.

SPEAKER_10 28:07

I think I don't know it's kind of a juicy one you know just jump in dude jump in I was like Tilly I think that part of it too is like there's this idea you need to have work-life balance if you really love what you're doing and you don't have a lot of responsibilities from like a family perspective or with your you know significant other that you're avoiding I think it's okay to go all in and I think that's probably what most of us did the start of our career you know I was like Dave I worked a million hours I tried to coach on the side I tried to run a business I try to train and compete and I loved all of it I think I had to I forced a stop now I have two kids and I'm a little one and uh it's crazy how much less time I have and looking back on it it's like I'm kind of happy I put that foundation in because I don't think I would be able to do half the stuff now that I used to be able to so yeah like don't freak out and overdo it and feel like you have to do these things but if you love it and you enjoy it and you want to get ahead it's it's a great time to to push you know well said I think that's well said okay next one uh what are some of the uh Travis what are some of the biggest challenges or evolutions that you have all made at champion um that you have made in the last 10 years for ACL rehabilitation gosh these are big ones is that Travis come on take on take a look that's a that's I I think for me I do a lot of ACL rehab we we got force place now we have a dynamometer um you know I was in Alabama we had an isokinetic device I've had to shift my thinking and being able to um you know uh use that testing and and help guide my my clinical practice so that was big for me is the ability to use more objective data than um you know what I'm used to versus which was basically just an isokinetic device.

Should PTs Order Imaging

SPEAKER_03 29:51

We test people at four four months six months and most people got cleared somewhere in between four and six months um based off of isokinetic testing. So that that was been a huge thing for me and the access to a gym now like a full gym where we have strength coaches that I truly trust and a ton of gym equipment versus just a wall some dumbbells um you know and maybe a TRX strap um we we can get people truly strong and stronger than where they were before surgery. So that's been huge for me the last 10 years.

SPEAKER_01 30:22

Yeah I'll I'll add to that a little bit too you know working on like the the late stage people and really getting them ready for sport um is trying to be really precise with what the needs of the athletes are and not just sit like you know resting on the fact that we're getting our athletes strong again or you know fast again or powerful again. But really diving deep into some of like the objective measures that Lenny's talking about and making sure that let's say RFD is really good, breaking ability is really good, ecentric control is really good and really testing that in multiple planes, meaning we're gonna do our force play testing say to test the vertical, do some of our 1080 resistance stuff to test some of our horizontal stuff and then really try to put it together and figure out what's missing within the athlete to make sure that they're really ready for what the demands of practice and what the demands of games are. I think sometimes we in the past were a little too general and just kind of rested on the fact that like oh the athletes are strong enough or stronger than before. We'd kind of let them fly. But we've definitely been a lot more picky and a little bit more um qualitative in what we're looking for with the the specific measures that we want.

SPEAKER_11 31:32

All right uh Blake says what does the profession need to focus on or what direction do you see it going in in the next 10 years?

SPEAKER_03 31:44

Reimbursement?

SPEAKER_12 31:45

Yeah insurance is brutal what did I just flip out about on Instagram? I forget um about the uh what they call it what's it called at the APTA where they have like that small group sessions that's very expensive to perform and uh they all get together for a weekend to come up with the same problem list that we've had for the last decade with no solutions.

SPEAKER_03 32:06

Sorry sorry God don't be critical I apologize it's supposed to be a fun podcast but uh yeah where reimbursements are low burnouts high right uh our student debt's ridiculous um if we don't tip that it's gonna be a bad future right yeah I have a I have a Twitter poll right now I asked if uh people recommend PT to high school or college students and sixty seven percent of the people that have answered the poll so far are saying that they would not recommend PT as a profession for people thinking about going to PT school.

Residency, Workload, And Balance

SPEAKER_12 32:36

So eye-opening that you know that you know two thirds of our hope maybe hopefully with a lot of people that are PTs that in that follow me on Twitter don't think they should get into our profession for the reasons that we talked about you know advocat advocacy from APTA andor reimbursement and and debt the return on investment people are recommending PTA school instead of PT school people are recommending PA school md school nurse practitioner um going to sales those are some of the responses I've gotten which is interesting going to sales yeah right yeah you know it's stinks right because look we are all we're all um we do this because we care right we're service providers I think you know you you gravitate to this profession because um it's rewarding right we all have a blast we have a blast at work I think everybody here on this this this phone call tonight probably has a blast at work so that's stinks so hopefully hopefully they can figure it out but that's a big topic and while Dave cues up on the next one I just I'm I'm gonna try my hardest here to keep tabs on some of our former students here but big shout outs to dom Travis Mac King Meredith and Brian Tara Corey Danny Jacob Ray Ray uh and Emmett I mean that I saw that I just noticed on here so I apologize. I'm trying to keep uh I'm kind of cheat calves but thank you guys for being here tonight. Um they're all part of it. I was also trying to look at photos and I was like oh my gosh somebody has a dog that looks just like mine and I noticed my wife was actually on watching and look at a dog that's my wife so hi honey but uh yeah sorry all right you're up Dave sorry yep uh okay Bryce would you still consider using BFR for an older patient with a resting blood pressure if 149 over 79 um he's had multiple knee surgeries and quite a bit of atrophy and weakness so I think he could really benefit from it but I'm not sure if it's safe for him.

SPEAKER_11 34:23

What's the blood pressure is that high 149 over oh god I delivered 149 over 79.

SPEAKER_12 34:29

You know the funny thing about BFR you ever try to get BFR cleared by somebody's primary care doctor it's like they don't know how to answer that question. So um yeah I mean I think it becomes uh you know yeah what is it relative contraindication is that what it says blood pressure yellow flaggy remember there's nothing better in this word world than loading an exercise BFR is a tool it is not the solution and referring that patient to their primary care doctor for some medication or something yeah that's actually that's a really good point right yeah good point there uh uh also shout out to Tim Heckman I gotta see all my other mentors in here that are on here I've learned so much from Tim over the years so good to have you part of here Tim Tim all right uh I'm just gonna keep ripping through we have like 30.

SPEAKER_11 35:17

Uh Jason uh have you had any experience with treating quad sparing TKE TKAs yet any different nuances that you're seeing with the treatment progression I was joking with Scududo today I haven't treated a TKE in five years.

SPEAKER_03 35:31

Yeah I'd say not not our world yeah me neither next I got one I got a ton in E right now but I don't think it's quad sparing and no and no hopefully it goes a little easier.

ACL Rehab Evolution: Data And Return To Sport

SPEAKER_11 35:42

Sorry um okay Andy obviously we deal with hypermobility a lot in sports medicine but recently I've had a few patients come with EDH so L Dan Lose syndrome any experience or advice for treating this population? I feel like this one is probably directly towards me I treat a lot of super hypermobile people and EDH is on there. I just got referred to one of our actually clients Katie great massage therapist referred somebody to us um I find that in general I don't want to um overgeneralize here but the the people who are having EDH they're a little nervous to work out because they're obviously symptomatic and so they generally don't have great uh instruction or programming for just basic uh exercise right the best thing that they can do is basic consistent exercise and compound movements um and really keep it super simple. Like these people do not need the most high level complex periodization stuff. Just basic compound training and a little bit of accessory work goes a long way for them. And oftentimes there's a lot of psychological nervousness or intimidation to the gym in general because they don't want to you know get hurt obviously but they've never really been in that setting because it's been challenging for them. So um that person who got referred to me will come for PT and I am going to introduce them to one of our lovely strength coaches and help make them a super basic, very uh kind of straight and narrow uh two-day strength program and really just focus on basic movements, having a good time in the gym, being around people that are cool to teach them how to move the right way. It's it's gonna be super super simplistic. Uh don't overwhelm them with complexity in any way shape or form.

The Profession’s Future: Reimbursement And Debt

SPEAKER_12 37:13

Love it okay uh we answered one in the chat so I'll skip this one um Hayden says when researching areas to open a sports performance clinic what are some of the key things that you look for in a community athletes next to athletes I'm just kidding niche populations that you like working in uh wow I mean we just we did this you know me I'm maniacal I had maps I had population densities I had uh uh the clinics in a square foot radius um Lenny knows I'm weird though but um yeah I would say for you you you if you're in an area that has a lot of local high schools a lot of sports teams the athletes that are there um but to Dave's point I think like if you specialize in one sport that you like I think like trying to be around like the areas where there are some like maybe travel teams or maybe some you know you know specialized training centers that might deal with that that's probably your best bet if you're trying to kind of start off strong. You know we're lucky up in Boston we have some pretty high densities but like I was I'm looking at like you know median incomes and stuff like that. I mean it's you know there's a lot that goes into it when you do it. But uh chat GPT I hate to say it these days you enter all that stuff in there and you just you ask chat pt chat p chat gpt to ask you what questions you need to ask it to uh formulate this and you'll be surprised at how um it'll help you find that so I'd say that but and then Dave let's take a break I think it's time for prize I think it's time for prize should we do prize I'm down I just I I just picked so basically I have I'm I'm putting all the names here and into a randomizer through chat GPT here and I'm getting it to um spit out what the answer is here. But so the first one here the first thing we're giving away is a sport grip grip trainer so these things are really cool. I mean it's a slab of metal with a little dial that makes it go harder or easier but how simple are some of the best things in the world right so um you know we started using these sports grips to just get a little bit more grip training I think it's really been really good but the winner of this one oh my god my screen just scrolled all right I got you crystal Busby what's up crystal congratulations you just won a sport grip trainer and I'm not good at this so I here's what you need to do to me. Why don't you message me right now and give me your name well I know your name I just said your name and your email address and I will hook you up with sports grips and they will uh send you out one but congratulations crystal I gotta write that down crystal buzz people nice all right all right back at a dame yep I I'm just gonna say now I apologize there's zero chance we get through all of these we have like 35 questions and we'll be here all night so I'm gonna try to pump it pump it do my best but um okay Gabby says how would you design a home program for a baseball pitcher in a late rehab who just started an interval throwing program do you focus on throwers 10 or do you include more stability exercises or general upper body exercises I'm looking to add more variety to the home programs but don't want to but want to balance not overloading the shoulder home program everything shoulder program total body strength and conditioning program but I would urge you to not have them work at home say work with them send them somewhere right like have them go work with like a strength coach or something in there but you know late stages they they got a lot of work to do so um I'll flip the question backwards a little bit and say the people that come to us that are maybe like underprepared that are six seven eight months down into the thing sorry line six seven months down into the um the thing is I would say they're they haven't been focusing on strength of their arm enough and they haven't even touched the weight in the gym. So full body strength and conditioning and a a solid linear loading shoulder program over several months and if you slowly build up with throwing you'll be good.

SPEAKER_11 41:06

Cuckoo this one's got Kevin just screaming his name so we're going here. Mark says what do you think of carbon insole running shoes for high school runners? I have been wanting to wear them I have some wanting to wear them for all track workouts.

SPEAKER_09 41:20

Yeah uh I I saw that I think they're super popular right now um I think for every single workout that doesn't make a ton of sense just because you're trying to get like peak performance out of it and not every run is intended to be uh at that level of performance. I also think there's been some research coming out showing that it's it's not that it's reducing injury necessarily it might shift where people are getting injured. So we are seeing slightly higher rates of bone stress injuries especially in the metatarsals. So I would just be cautious with that. And and also uh those shoes just don't have a very long life so they're probably burning through shoes which might not be the best idea anyway. So I think they have a place um and in track they tend to be racing in spikes anyway. So I'm not sure how applicable it is uh or if it's something that they feel like they need to spend money on. But they're definitely fun to use and there's a performance benefit so no doubt about it.

BFR Safety, TKA, And EDS Coaching

SPEAKER_03 42:18

Okay um Katie says in my 20 plus year career I'm seeing my very first patient with long thoracic nerve palsy I'd love to hear the panel's expert advice on activating SA without dominating rhomboids and upper trap thanks that's thanks that's a rough one anyone want to jump in on that that's a tough one um stem you know try to try to try to find some spots where you can get the serratus to activate um you know general shoulder strengthening program um don't aggravate the shoulder um put them in positions where they're gonna succeed in the movements that you're trying to attain it's a tough one you need you just need that nerve to uh you know slowly regenerate but I I've I've had some success you know with time and trying to utilize STEM and things of that nature to try to get some uh overload to the muscle and trying to get some activation but it's it's a tough one time and that's oftentimes a very impatient and long drawn note process.

SPEAKER_12 43:15

Yeah some wire feedback maybe good call yeah yep m trigger wait is that should we segue we'll segue perfect segue are we are we about to give away an M trigger uh uh the only thing I would add to that is I've actually some low level closed chain exercises I think work really well for uh upper upper uh rotation of the scap so like quadruped rock backs I think just so simple we never think of that as being in an upper extremity exercise but quad rockbacks and even some like um like serratus slides on the wall and stuff like that but closed chain tends to work a little bit better at first I'd say that so and then let's do it let's do it let's do the M trigger right should we do it Dave yeah I'm in while we queue up the other one all right next up on the prize list an M trigger biofeedback device for anyone that may have a long thoracic nerve injury uh on this here but biofeedback you know it's one of those things that I think we probably don't use enough we just talked about it a champion in an in service yesterday about how we probably need to be using it more in the clinic here um fell out of favor it was real popular in the 80s and maybe little 90s but you know didn't get research as as like um insurance carriers just like stopped you know you know paying for it so it kind of fell out of favor because like the devices were all you know hard to do and expensive but m trigger came out very affordable device that you can use there's an app on your phone it's excellent we use it all the time for biofeedback stuff it's so cool but you definitely need to check it out so the winner of this one are we ready for this one is Rebecca Glendy Rebecca Glendy Again, DM me, Rebecca. You just won an MTregger biofeedback device. Congratulations. Was that like a DJ, Dan? I think did you like that? It's pretty good. I gotta write all this down. This is crazy. So perfect. All right, keep going, Dave.

SPEAKER_11 45:08

Yeah, this one definitely screams maybe like gays of edetta who are fresh here. What advice would you give PTs looking to break away from a traditional insurance-based model into cash-based?

SPEAKER_02 45:20

Yeah, I mean, I can start here. Um, I I think you know, just having a big network is really helpful. Um, and kind of what Dan said about trying to kind of take advantage of all these opportunities early on and get around, kind of like Dave said, into some shadow positions. Um, if you can go to a local cash clinic. Um I think the more you put yourself out there, hopefully the the better chances you have uh of getting an opportunity. Um and then finding some great mentors you know that you look up to. So I certainly consider myself lucky to look up to all these guys here. Um and so I think just taking advantage of as much as you can is gonna give you the best opportunity to hopefully get into that role. Uh and then continuing to, you know, research the things that you're interested in, um, and try to create these little you know niche areas that you can become a you know a little bit more of an expert in in terms of sports and things like that. Um certainly helps your your resume.

SPEAKER_05 46:23

Yeah, I would I can just add real quick, um, you know, I think social media might be a great way to market yourself if you are starting your own clinic. Uh thankfully at Champion, you know, we got a lot of help from Mike and Lenny to start, and then you know, we can kind of build our own um kind of clientele from there. But like, yeah, I I think having a a some guidance from mentorship is super important, like Gates said. Sweet.

Opening A Sports Clinic: Market Fit

SPEAKER_11 46:49

Um okay, Adrian says, Congratulations. Thank you. Uh been listening for years, and I love you all. That's very kind of you. Um, was excited when Lisa came on, yeah, rowers. One of my favorite quotes was Dan Pope saying that if you tweak your back, it's the cost of doing business and the elite level of sports. Is there any other advice? Um, are there any other explanations that you give your patients to help them if they are pain-focused, pain prisoners? What's your go-to? Yeah, this is a good one. Maybe Lisa can do it because the rowers are a little uh self-brutal sometimes. I think we all deal with uh people who are riding the lightning, so to speak.

SPEAKER_04 47:22

Can you summarize the very end of that? I got it.

SPEAKER_11 47:25

Yeah, I think they're saying, sorry. I think they're saying uh what how do you consult with people who are like uh like high-level athletes that are training in sports like rowing or endurance that are like they come with some pain and uncomfortable?

SPEAKER_04 47:36

No, honestly, I feel like one of our old strength coaches, Jonah, once said to me basically, like, sports are inherently bad for you. And so like things are not always gonna be perfect. Um, at some point when he and I were working about with one of my rowers, that it was just like, well, rowing as much as rowers row is not actually healthy. I was like, you are very correct, it is not. Um, so I I do think I always think of it as like our job as long as it's safe and they're not gonna like completely destroy their body, but then even if they are giving them the knowledge that that's a potential, um I feel like I try and keep people doing what they like as their sport at most cost, right? Like within within reasonable health. I feel like if people come in, if rowers come to me with like, you know, raiding all the way to their toes, like can barely move kind of back pain. Like obviously rowing with that is not like overly doable. But if someone has back pain that they can kind of ride the waves of and continue to race and they're in their like senior collegiate season, you know, that's where it's like I'm gonna give you the knowledge of what's happening with your body and kind of like help you through it.

SPEAKER_11 48:46

Cool. Uh another very uh easy answer topic here. Would you recommend a brace over a leg sleeve for ACL return to play? Bo. Boo. Brace versus non-brace is something we've been talking a lot about.

SPEAKER_12 49:00

Yeah, I mean the the the sleeves kind of like, you know, why not? I like sleeves, but like I guess the real question is brace.

Prize Drops And Winners

SPEAKER_03 49:06

What do you think, Lon? It depends on the person. That's kind of where I've shifted now. Is uh, you know, the brace has a purpose for some, um, but if they're relying on the brace to return because they don't have the strength, and that's a huge problem, then we they probably shouldn't be playing. But uh depends on the sport. If they do a lot of sliding, the brace gets stuck in the ground oftentimes. Um but if they are, you know, there's no uh mental um, you know, fear going back. Um they feel strong, they pass all the tests, then they should be good to go if they've had a good surgeon and a good PT course. So um not against the brace, but um the brace should not be a crutch to allow them to get back.

SPEAKER_11 49:46

Um Joseph says shockwave therapy promising or just another placebo modality.

SPEAKER_03 49:53

I mean, it's been around for a while, so it's not just I would say it's more than just promising.

SPEAKER_12 49:59

That seems like a clickbait. Yeah, right.

SPEAKER_03 50:02

That's perfect. I like I kind of like it. Um, I mean, I think it's effective. Like there's some research that shows like propantroitis and and you know, teninopathies and stuff like that. So um I'm into it. Promising.

SPEAKER_00 50:17

Agree.

SPEAKER_11 50:18

Um, okay. Do you have any recommendations on how to approach colleges about establishing school insurance contracts when you are already treating multiple athletes from their programs, or do you recommend staying out of networkslash cash? Considering we treat half of one campus, I think we're probably good to answer this one. A local box at school.

Late-Stage Throwers: Total-Body Strength

SPEAKER_12 50:35

I'll I'll tell you from from our experience, we're just we we do not have a contract with the local universities. They just they just do it themselves through secondary insurance. So, you know, the athletes pay us, I believe they submit it to their primary, they get it accepted or rejected, and then the school picks up the secondary from it. So it's not a formal relationship. And um I'm not against a formal relationship, uh, a formal relationship. I just think there's some complexities there, and it's gonna be there's gonna be some headaches there. So, you know, if you're starting off and you're like dying to get some college athletes and you think that'll help you, maybe, but like I I would I I think we we just get people because we get people, not because we were we have an insurance contract with the college. Yeah.

SPEAKER_11 51:18

We can uh we can two birds one stones here on some supplement questions. Uh Chris and Mitchell both have questions. One is are you guys getting into any recommendations about uh supplements like creatine? And then another one is thoughts on peptides. I work in a PT clinic in a gym setting and have many patients ask about BPC five 157 and TB500.

SPEAKER_12 51:36

So hot right now. So hot.

SPEAKER_11 51:37

And yeah.

SPEAKER_12 51:39

Uh Dewey, you want to start with creatine? What do we do with creatine? Uh take it all the time for the rest of your life.

SPEAKER_01 51:47

Good for your brain, right? No, I mean it's so it's so heavily studied, right? Like the benefits physically, and then now everything that we're learning about the the brain. Um, I think there's a lot of good. I think they're even starting to look at it for like like pregnancy and stuff, and like even like helping with fertility issues and stuff like that. So there's a there's a lot of good potential for creatine. We know the baseline of it's gonna help you with power output, it's gonna help you with regeneration, uh, maybe even a little like you know, strength building. Um so I I try to get all my athletes to take creatine five grams a day forever. Yeah, no, no real negative.

SPEAKER_12 52:24

And then Dave, why why'd you single out Dan on the peptides?

SPEAKER_11 52:27

The BPC 517, because he was talking about him yesterday. You know, he's like a study he keeps bringing up that's like uh what is it that Dan knows more than that? It's like one study came out in like mice or something, he was like so blown away. I heard it like seven times in one week, he told patients.

Carbon Shoes, Shockwave, And Supplements

SPEAKER_10 52:40

Well it's like extremely effective in rodents, you know. Um, and it's probably helpful in humans, but there's there's really no human trials. I think there's one with oral BPC157 for stomach ulcers, and it was helpful, but we just don't have the research in humans. So um very, very interesting. I hope there's more research coming out. In terms of like actual supplements, I do recommend for patients for pain, and this is mostly in like the knee and hip osteoarthritis world. I do think there's some utility of things like ginger, uh curcumin, turmeric, vitamin D, even collagen, can be helpful for those folks. So if you're a lot, some patients are kind of getting having a hard time getting over the hump. There is some research that some of those supplements are as effective or a little bit less effective than like an NSAID. So we're constantly working with patients that don't want um interventions that are going to hurt them, uh bean surgery or drugs, corzone injections, that type of thing. And sometimes I recommend those. I think they're safer and helpful.

SPEAKER_11 53:33

So cool. Um good one here, a little bit different. Um, how do you address patients that struggle to progress beyond the activation stage with isometrics and low-level isotonics due to pain or flare-ups so they can move more towards hypertrophy, strength, and power? I'm guessing this is in the realm of tendonopathy. Um, that's my gut. Um, so yep.

SPEAKER_12 53:54

Take a step back, work on the pain, right? You're going too fast. Um, I think that's a that's a top one. There's a couple of things you can do to try to like neuromodulate pain to start, right? Those sorts of things. You know, maybe like Dan could talk about that in the realm of or Kevin in the realm of tendinopathy, but I'll start by just saying like take a step back. If if you have somebody with unrelenting tendinopathy pain that you're trying to push too hard, you know, it it's the whole concept of like, are you pushing too fast? So, you know, standard numbers we give is like work three, maybe four out of ten discomfort is probably a good stimulus to actually you know facilitate some healing. You know, one out of ten might not be enough, but five, six out of ten might be too much if you can't load. So, but I don't know what strategies do you guys do to start a session off? Maybe, maybe that's the good second thing.

SPEAKER_10 54:42

You want to do it, Kevin?

SPEAKER_09 54:44

Well, yeah, I was just gonna say that um kind of like what I've experienced, and I think some of the research supports this, and I I know that we've talked about this, Dan, is like isometrics don't always work for people. Um, there was that study where like the patellar tendon with Ebony Rio and and her colleagues that showed a big pain reduction, but that's failed to be replicated in a lot of other types of tendinopathy. So I think at Champion we play around with it and try it and see if it seems to be helping. Uh, but if it's not and their pain is worsening, which I think can happen with isometrics, especially at certain tendons, um, like the, you know, I'm thinking of like an insertional Achilles or something like that, those don't always respond well to isometric isometrics. So we might bail on it there. Uh, but I think the other thing that Mike said is if we are talking like tendons, it, you know, it depends how much pain they're having. And if it is a three or four out of 10, that is uncomfortable. Um, but that might be needed, and that's okay to kind of work through. And then you check their 24-hour pain response. Um, but if it's, you know, kind of excessive past that or it's not getting better in a time frame we would expect, then like Mike said, we got to kind of figure out why and maybe take a step back before we load through it even more.

SPEAKER_11 55:58

Yeah. Cool. Let's get um I'm smiling because I'm actually thinking of Noah as I read this question out loud. Uh, when working with high school athletes, how do you manage working with school's ATs andor parents to make sure everyone's on board? I have one player in particular who's very vocal, pushy dad who acknowledges what I say in person and pushes his kid to do something different when not in the clinic. Uh, I've been mentoring Noah through a situation uh of this of this um example, I guess I should say. Anyone can weigh in there? What do you think, Noah?

Tendinopathy Progressions And Pain Dosing

SPEAKER_06 56:29

Yeah, so yesterday I was talking to a dad. I told him him and his son through this whole six-week program that we had mapped out. They agreed.

SPEAKER_07 56:38

They walk out to the waiting area by the time the kid puts his sweatpants back on, uh, they call me over and they say, yeah, we know we're not gonna do that. We're gonna we're gonna keep going. So at that point, I just kind of tried to modify and adapt to their schedule. Um to the best that you can. I've just been explaining to them the registry that they could come across in the future if they continue to push through things, kind of break things down into saying, you know, here's our different buckets of kind of stress that we're filling up and we're trying to add to this bucket. So we need to kind of take this bucket down, um and then from there kind of let them make their decision if they're not gonna go with your advice.

SPEAKER_12 57:17

Yeah. I would I would just add, like, you know, Kevin, you want to remember your first week working at champion where I asked you to look at my back. You remember what you want to tell the story of what happened?

Parents, ATs, And Return-To-Play Decisions

SPEAKER_09 57:28

Yeah, so I wasn't nervous at all. It was my first week working at champion, and uh Mike was having some back pain and asked me to evaluate him. So uh yeah, I think we went through a pretty good assessment, pretty lengthy assessment. And uh Mike was at this point that he's kind of still at when he has time, right? Golfing a lot. And uh that is the main driver of his pain. Um, and when he's not golfing, his back feels a lot better. Uh and like Dave jokes about, you know, he knows all the right things to do for sure. Uh, but my recommendation was uh maybe alternating days of like on golf, on golf, off golf. Um, so basically saying reduce the activity you want to do. Um, but that was a good lesson for me. With you know, Mike kind of made it a good learning point where we work with a lot of athletes who, even though for Mike it's like recreational golf, who don't have the ability to or don't want to take time off. And there's a lot of other avenues I think we can explore to keep them doing what they want to do. Uh, and that's definitely the role that we play, I feel like in high, especially high-level sports, um, where you know, kids have, you know, it's a it's early spring and a baseball player is having pain, uh, yeah, that might might be a time that we consider shutting down, but it might also be a time that they can't shut down. Uh, or some of the professional athletes we see that are getting a paycheck, um, you know, it's their livelihood. So whether we think they're risking more pain or not, I think like Noah was just talking about, if we educate them on the potential risks, um, it's kind of up to them at the end of the day, I think, to make the decision for themselves. So I should have let Mike make the decision there. I I can't I can't golf prematurely.

SPEAKER_12 59:10

So what I told Kevin was, and I said, You're gonna you're gonna find this a lot in sports medicine. But essentially, I've chosen you, and and you can remember this is what happens to all of us on this call. And I'm like, Kev, I chose you, I hired you to help me golf more, not less, was the phrase I think I said. And I I just want you to remember that in sports because that's an important thing. Now, sure, sometimes you get to take one step back to take two steps forward, but remember that concept, and you get to at least like hang that carrot out there so they understand that that's a big one with these athletes because then they don't want to stop. So um, but Kevin got me over the hump. We did it, Kev. You did a good job. Yeah, would you ready, Kev, now? Strong, quite strong. It's good, it's good. But yes.

SPEAKER_11 59:53

Um, okay. Uh Jessica says, Do you have any single-level ALIF or other spinal fusion middle-aged athletes that have returned to doing really well or whatever they want to do? And I can I treat a ridiculous amount of uh back stuff, and I have seen a ton of fusions of people who do just fine. Um, the thing with uh people who are middle-aged and getting fusions is they have to have a much uh more in-depth conversation about like level setting their expectations for like the immediate future of what they want to get back to and what that's gonna be first. You know, rotational sports or like skiing, for example, with lots of compression is not tolerated well in those people. Um, but if they're willing to get back to like general strength training first, you know, cardio walking, kind of a fitness program, and then work their way into sports later, um, they're probably gonna be okay. It's just that those um people tend to have a lower training age uh at that point in their life. And so it's a little more challenging to get back to like very intense sports. So, yes, just give them a really good explanation before their surgery, pre-op or whatever that it's gonna have a nice long progression to get back to the stuff that they probably love the most. And that just is what's required to let the bone heal. You know, it's a pretty big surgery.

Fusion Patients: Expectations And Progression

SPEAKER_12 1:00:57

All right, Dave. I got a couple quick things first before we get we get going. Two things. One, while we're doing this, we're checking out some stuff to just you know, again, get excited about in here. So wanted to give you guys some updates. So in 10 years, I don't know if this is good or not. We've had 2.6 million people listen to our podcast. Isn't that crazy? I was just looking up the stats. So 2.6 million people, and then what do you guys think? What's the what's the number two country outside of America? Would you say I used to say Australia? Yeah, I used to say I used to say UK and Australia. Number two is Canada. Let's go, let's go. Can I guess that's good? Yeah, pretty good. North, Canada, Australia, United Kingdom were were the big ones. That was the Jonah effect. Chicago. It is Chicago. Who said Chicago? Me, I totally guessed. Do you uh well you also have podcasts, maybe there are a lot of podcast listeners in there? That's pretty crazy. That's very crazy. Yeah, crazy. But 2.6 million. Thank you, people. I just give you thank you again. Yeah, um, and while I have you, big announcement when I have here. So you're learning from from Dan Pope, Kevin Kaufman. One of the biggest questions we get all the time from people is how do we return people back to sport? I think it's one of the missing links in rehab is helping people kind of get back to sport. So we're we're we're in the process, we're putting together a nice uh new online educational program on return to sport after um ACL. So an ACL return to sport course, a complete guide to criteria-based testing and advanced rehabilitation after ACL. It's coming in March, so I just said it out loud. So that means it now has to happen. So a lot, a lot, a lot of pressure on Dan, Kevin, and I in here. But we have that, and I'm gonna put a link in the chat right now for the the brand new pre-sale list that just started. Anybody that signs up for this gets a VIP discount that they can get going on this when it launches in May. We will let you know, but it's gonna be a really cool course because these two guys are studs, as you guys know, and it's in the chat group. So check it out if you're interested in that course. Come check it out. We're working on it. Um, and should be ready. May we say May, right, guys? Yeah, I think it's May. Kev May. I like it. Maybe that'd be May. It's wow.

SPEAKER_11 1:03:27

That was pretty cool, Dave.

SPEAKER_12 1:03:29

All right, keep keep going, Dave. Keep going. What do we got?

SPEAKER_11 1:03:31

Okay, I think realistically we can get through three more because we're already 10 minutes late. Um, okay.

SPEAKER_12 1:03:36

We got more prizes too, but keep going.

SPEAKER_11 1:03:37

And then we'll get a prize. Uh Mitchell says, uh, do you have any advice for connecting with local docs or providers starting a new insurance-based clinic in Charlotte and have been struggling to meet with docs for lunches or even get past the front desk in most offices? Lisa, maybe you can talk about whips. I feel like you're you're right in this wheelhouse right now.

SPEAKER_04 1:03:56

Um, I mean, sure. Part of that's been like a long-standing relationship, though. I would say that's the tricky part. But yeah. Um, and I I don't know. I feel like Dan did has done a lot of like meeting docs over time, and I feel like Lenny and like too, but I don't know.

SPEAKER_03 1:04:12

Yeah, yeah.

SPEAKER_04 1:04:13

I mean I mean at the moment I am, but yeah.

SPEAKER_03 1:04:16

I would say what helped me was going with a patient to their follow-up appointment. Um, the front desk can't keep you from going in. You're going with the patient who wants you to go with them, and it was a huge door opener for me to get into more ACL world with um, you know, when I moved back home to Boston from being in Birmingham for over a decade. So I literally went with a patient to her post op visit, and this whole it just opened up a whole world of um, you know, referrals from that doctor and others. So um, yeah.

2.6M Listens And New ACL RTS Course

SPEAKER_10 1:04:51

One thing I was gonna say too is uh it's I think it's kind of like dating, although I haven't been on date in like 20-something years. Um you're gonna get rejected. Like it definitely happens. There's some doctors just like trying to develop a relationship and just fall flat on my face. And there's been others where I'd have like a brief contact and all of a sudden they're sending me like a crazy amount of patients I never expected. So I would say keep trying as best you can. Patient appointments, see if you can shadow for the day, office hours, surgeries, all that good stuff. You'll find a few that you really resonate with, and you don't need a million, but you get a couple that really refer back well, and that it really helps out a lot. So and also use your colleagues because I think that we have a really good group of surgeons we use because each provider has a good relationship with a specific doc, you know. So maybe in your group of people you work with, you have a network there.

SPEAKER_11 1:05:37

Yeah, if you if you tend to see a lot of one thing, so you know, Lenny with ACLs or you know, me with backs and stuff like that. I think you see a lot of patience for that thing. And hopefully, if you're doing a great job referring people to that doctor when new people come in your door, um, you get a nice little working relationship back and forth.

SPEAKER_12 1:05:54

Um, Dave, we're gonna do a prize. We're gonna do prize, we're gonna do two prizes. We're gonna do the BFR sets right now. So we got the big BFR sets from two of our favorite companies, brand new BFRs with uh wireless technology apps, you know, crazy stuff that they have nowadays. Crazy things, right? But um, two of them. So the the two that we're using the most that we like the best right now are smart cuffs and suji. Just really good quality. I think the size of the cuffs are you know scientifically validated to be the good size, very durable for the clinic. I mean, we've been using them for years now, so like you know, we can tell you that these are very good for the clinic. Um, and both the devices are great. So, first one smart cuffs set is going to Chris Riley, Chris with a K. I don't know if we have more than one Chris Riley on here, but Chris Riley, you've got the smart cuffs and Tony Brown, you got the Sujis. Congratulations, please. Private DM me.

SPEAKER_11 1:06:51

Sick. Um okay. Tara says, How often are you finding sports slash groin injuries are related to pelvic floor? Uh male specifically, do you all refer out uh for this if you are hitting a roadblock in care, or are you able to treat in clinic? Um I think Kev, I'm not sure if you might know via Dom. Kev's wife is actually not to put her on blast, but is a great pelvic floor therapist.

SPEAKER_09 1:07:14

Yeah, she doesn't uh treat males, so uh yeah, it's okay.

SPEAKER_00 1:07:18

That's really something I'm not in the area.

Building Doc Relationships That Last

SPEAKER_09 1:07:21

Yeah. I think I feel like we see a lot just with our um soccer population and like running cutting population, a lot of hip and groin injuries, but as it relates to the pelvic floor, uh that definitely could be something I'm missing. Uh so if you guys have a good rack in the area, that'd be good.

SPEAKER_11 1:07:40

Yeah, and I think there was another question earlier I I got I lost somewhere, but essentially was saying like, how long do you treat a hip or a back injury before you consider a surgical case? And I think my general timeline is like four to six weeks. Like for most things, I'm trying to see if workload modification, good PT, you know, regular communication, and maybe like uh medicine with a doc can like get symptoms to calm down. But if in six weeks, if someone literally hasn't moved the needle at all, despite all the best efforts, um, I'm probably thinking like, okay, let's at least get imaging and see what's going on here. I'm not sure how everybody else feels.

SPEAKER_10 1:08:10

That's a solid recommendation.

SPEAKER_12 1:08:14

Dave, pick out maybe the next best. Give me the top three remaining, and then we'll do the one final prize, and then we'll wrap it up for the evening. By the way, thank you, like Mike Scudo, Kevin Coughlin, anybody else? I see you guys like answering some questions in the chat. Excellent idea. Like, feel free, champion crew, while Dave's doing stuff like answer, because that was awesome to see.

SPEAKER_08 1:08:35

Okay, I've been absolutely deep in the chat all night. Great. My eyes are my eyes are bleeding.

SPEAKER_12 1:08:44

I love it. Keep going, thank you.

SPEAKER_11 1:08:46

Um, okay, yeah, we got three here that I think encapsulate um most of the other ones I was trying to weave through too as well. Um, Tony, uh, happy to be on with you. You two, can you elaborate on knees over toes concept, especially when athletes perform with this myth? I got a little the end there. Uh knees over toes um phenomena. I guess that's the question.

SPEAKER_12 1:09:07

Tony, who just won the suji. Wow, Tony got his question pick and won the suji. Good job, Tony. Oh wait, so what what all right? So what's our what do we got on knees over toes? Is that yeah?

SPEAKER_11 1:09:18

I think uh can you explain the knees over toes concept and why it's like you know, something I'll jump I'll jump in real quick.

Knees Over Toes: When It Makes Sense

SPEAKER_12 1:09:24

So biomechanically, we do know that there's increased patelf femoral joint reaction forces when your knees go over your toes, right? Did some doctors and therapists in the 80s and 90s freak out about that? Sure, right? Is there extra stress? Yep. Is that stress too much? Maybe sometimes, sometimes it's not, right? But to say like everybody can and should do it, I think is a little short-sighted as well. I want everybody to go check out the knees over toes guys on Instagram when we're done with this. I want you to go check it out. He's got one thing that most humans don't have. You know what it is? The champion crew knows, right? What's knees over toe guy has that most people don't? Incredible dorsiflexion, dorsiflexion, right? So for him, yeah, it's completely different. But he's his like, you know, top of his foot can hit his shin. So yes, he can go knees over toes, he can do pistol squats better than most humans, but that doesn't mean you should be, right? So you just got to keep that in mind. Like when we're looking at biomechanics of exercises and stuff, it varies for the person, and there's a lot of stuff throughout the whole kinetic chain. Anything with mechanics, there isn't a good way there or there isn't a right way and a wrong way to do everything, but there is a way that will have the least amount of stress with the highest amount of output. Keep that in mind.

SPEAKER_11 1:10:35

Um, okay, two more. Um what would be your main areas of focus for rehab for flexor tendon strains? Are you seeing this as a warning sign for potential UCL sprains and or tears?

SPEAKER_08 1:10:49

Yes.

SPEAKER_11 1:10:50

Yes, yes, yes.

SPEAKER_08 1:10:51

I was in the chat. I I chimed in on that one for sure. Um I would say if someone comes in and they tell me they have a flexor tendon strain, I'm always suspicious that they potentially could have a UCL injury as well. So gonna do all the UCL tests. Um, we're gonna keep monitoring that, especially when they get back into throwing. Um MRIs aren't perfect if they had an MRI and it came back clean for the UCL. And it depends who's reading that MRI as well, if it's a baseball specific doctor that really knows what they're looking for in the UCL versus you know general uh orthopedic surgeon. Um so those are the conversations I'm having with the person, honestly, on day one. Like, yes, you've been diagnosed with a flexor tendon strain. Um, we're gonna check out your ligament as well. Uh that could change how we treat this. But I think um if you're throwing, if you're continuing to throw with a flexor tendon strain, I mean that's definitely putting more stress on the ligament. Um, you know, if it's difficult to dynamically stabilize uh the elbow. So um, yes, I think it's the the shortest answer possible.

Flexor Strains As UCL Red Flags

SPEAKER_11 1:11:56

True. All right, last one. Um Danielle, I'm almost two years post-sports residency and currently working alongside many manual therapy fellows. What advice would y'all give for deciding if a fellowship is worth it?

SPEAKER_12 1:12:09

Wait, so you're post-residency?

SPEAKER_10 1:12:11

Yeah, this is Danielle, I think.

SPEAKER_12 1:12:13

Oh, like Danny, Danielle?

SPEAKER_10 1:12:14

Yeah, just in the middle of answering this one typing wise. Sorry. You put you put you.

SPEAKER_12 1:12:19

Wait, what was that, Dan? You just started answering it.

SPEAKER_10 1:12:21

Yeah. I obviously haven't done uh a fellowship here, but I've looked into it and I've done like pieces of it um depending on like is it's like a fomp, there's all different types of like different um certifications and third and uh specialties you can get. Um I had said that it seems like people who go through these do really well, they like it, they learn a ton. So I think they're probably are worth it, depending on which one you're looking into. I just think that they're very expensive. There's big time commitment. So you have to see if maybe your time is better spent elsewhere. Um, we want to make sure that what you're investing is worth it for you specifically, and it might be worth it, it might not be. My other thought, too, is that like we learned so much about kind of non-specific effects of some of our manual therapies. I'm not sure if you're considering doing like a manual therapy fellowship. Um, but from my knowledge of some of these um fellowships are very, very specific about how we manipulate joints in different positions. And one of my thoughts was like, I feel like we're moving away from this idea of being super specific with the manual therapies and they're really hammering it down. But the other thing I've heard too is that a lot of the manual therapy uh programs are not pushing that agenda anymore either. So, you know, it's just some pros and cons of what I've thought about in the past and why I decide not to do it. But I mean, they do seem like they'd be beneficial.

Is Fellowship Worth It After Residency

SPEAKER_12 1:13:35

Yeah, I'll just relay the advice that I always say, like, you know, residencies and fellowships, if if you know, there's there's it's just like barbers. There's a lot of good ones, there's a lot of bad ones probably too. Um, you know, you if you pick the right one that helps you get to the place you want to be faster, I think that's the outcome you're trying to purchase, right? By doing that, right? Is in one year's time, do you get like three years of skill and experience? And if that's worth it for you and you have the finances to do that, but gosh, Danny, get a job. I mean, you've just finished your residency and you want to do a fellowship. I mean, don't you guys want to make money? Like, um, you know, I I would say most of you don't need that. You're everybody here on this call is more skillful and more knowledgeable than you give yourself credit. Remember that, right? You listen to our podcast, right? So, but like, you know, in all honesty, like you you do it. You just you is a little self-doubt sometimes in there, but you have it, you know, chasing you know, tens of thousands of dollars of things like to to to help with like a little imposter syndrome or something like that is is you know, I I think you guys can do it. So hang in there. I'm not talking about you specifically, Danny. Sorry, but uh but you know what I mean. Um, you know, keep that in mind with those things because I think that's important. I see a lot of people just rushing into these things because they don't know what else to do with their with their their career and they don't they don't know what to do. And I just hate to see you going into more and more debt when you can just get started. I think you're ready, right? So I'll I'll leave it at that. But um awesome, Dave. What an MC. Can we give a round of applause for Dave Tilly? MC. That was good. He was doing it for our sports PT mention mentorship. So you know he earned the the nod again tonight. He got the call from the pen to do that.

SPEAKER_11 1:15:13

Whoa, I don't even know what that is, but haven't blinked in 50 minutes, but I'm here for it.

Grand Prize And Closing Thanks

SPEAKER_12 1:15:17

That was cool. Zoom, that was good. I don't know what happened, but that was amazing. All right, grand prize. We got one more prize. This is the Anchor Pro Cable Training System. This thing's like, I don't even know, it's like 750 bucks, 800 bucks. This thing's big. Um, I will say this is one of the best inventions in fitness in the last X years, and it just happened to be a kid that was just local to us, you know, in the Boston area in his classmate in school. This was their school project. And I remember when he came to us, he had this like little thing, it was like this big, and he's like, Yeah, no, it's like a cable machine. And he looks over at like these crazy cable columns that we have over there and our Kaiser machines. He's like, No, it's a cable machine, and he's holding it like this. He's like, This thing's great. And I remember we started playing with it, and we're like, Oh my god, this is awesome! All the pro athletes that are around at that time, they all walked over, they used it, and they're like, Do you need investors? Like that was the first thing they said. So, um, and he didn't because the thing's so successful. So, this thing's amazing. If you haven't checked it out yet, you really should. But an Anchor Pro Cable Training System, and it goes to Dustin Craver. Congratulations, Dustin. That's a big one. So, Dustin, uh, hit me up in the DMs, please. I'm I'm not gonna end this until you um you send me your email, please. And um, that'd be amazing. But congratulations. But champion team, thank you for being here, taking time out of your night for this. Everybody here listening, everybody that's gonna be listening to the recording of this in a couple of days on there. My gosh, 2.6 million people listening over the last 10 years is bananas. I don't I don't even know. I don't even know what to say. So it's such an honor, it's so humbling to be here. We've said it from day one, 10 years ago, even though the first many, many, many episodes were terrible. If you keep asking questions, we'll keep answering them. So if you guys got more for us, we'll keep doing it. Um, you know, we're here for you. So anything you want to talk about, just head to micronnald.com, click on that podcast link and ask away, right? Awesome, cool. Thank you so much. Here we go. We'll do this again in 10 more years. Everybody in peace. Cool, cool. Thank you so much. Have a good night, everyone.