Helping New PT's Be Happier At Work

Yeah , we had a big , a big , uh big , tall boy DC day in the clinic yesterday . We had , uh , everybody was out , uh out in the afternoon , so it's just me , kevin and Dan . So lots of DCs , lots of snacks . That's how you get by a six hour afternoon . So I'm fully caffeinated , I'm ready to rip .

But yeah , Welcome to the podcast again for the 30th time in five years , yeah , man .

He's got to have like seven or eight . Do you have anybody in yours that's been there multiple times or no ?

You know , I'm lucky to have a Leah now before me was just talking to this stupid camera and hoping people liked what I said , but now we actually have a discussion .

I know a lot of people are taking their boards I think it's July is the next one so we get a lot of questions from the students around , like studying and grad , mentorship and you know , just entering the world , and I don't know , dan , I feel like you and I have a similar story where I was like really confident that I knew what I was going to do and

get a job and it was all go well and like my first two months , particularly the clinic , were like an absolute nightmare in terms of like not feeling ready at all .

And so that's where the conversation kind of comes from is trying to get some advice out there to people who are going to be entering the workforce and are a little overwhelmed , maybe with the gap between what clinicals gave them and then maybe what they're going to do in their job .

So I don't know , what are your , what are your opening thoughts before we dive in a little bit deeper ?

I don't know if this is good , be super stiff , she's yelling . I'm like I don't know what's going on , you know , and every night I would just look at my patient panel for the following day and try to prepare , just because I really didn't feel like I had the skills to just go out there and do a good job from the get-go .

And looking back on it , I I probably did a bad job with a lot of different patients . You know , it's funny how I'll learn something new and we went over a whole bunch of hip dysplasia stuff , uh , just this past week with Kevin and I'm like , wow , I probably missed a bunch of dysplasia .

I'm like I hopefully didn't miss a bunch of bone stress injuries too in these , because they all present like similarly . You know what I mean . So yeah , there's a lot of that and you know I can see how folks are a little bit overwhelmed and scared coming out of it , because it is a lot .

But I just remember she came in one time and she was like super flared up , like 100% my fault , I probably did it a little too aggressive , exercise , loading or something , and she just uh , I think she stayed with me as a patient , but I remember being I felt terrible , you know , during she came in and she was like , yeah , I'm really like I I can't move

my arm , I'm like word , I retort . And I was like , oh my God , this is the end . I worked for three months and I'm going to lose my license and this is the end . But that actually is when I bought Mike's course , funny enough . So we'll round about that later . But , um Aaliyah , what was your experience ?

So I really didn't flip until like the end of my second year and then I was like full panic mode , like got to learn about sports and then I was trying to get like as many resources as I could and then I changed like my clinical rotation and luckily got one with you , which was a blessing , um , but yeah , it was very stressful .

For that reason and that's why I chose to do a residency actually is because I felt very unprepared .

I hadn't like done enough in sports so I was like I got to learn more and I like I didn't want to go into it and just be like a lot of people's stories getting put into a benchmark or something and just treating way too many people a day and not learning much , just trying to get by , and I really didn't want to do that .

So I chose to do a residency and apply to different programs .

So I got like a very slow intro , but I mean even just starting like even with starting one like patient to just one therapist , I was like still like I have no idea what I'm doing .

maybe some help with some of the acute cases or like managing a diverse caseload . But I've gotten to the point now where when people come to champion , you know , I kind of hopefully try to level set their expectations .

One is that champion is so not a typical exposure in a clinic , right , like some aspects are really great , but we have the dream and we're so lucky that Mike and Lenny have created a place that we work out like that . But one , it's not going to be like that .

And two is , you know , I don't know if it's a bad joke or not , but I keep telling students that like I view PT school now more and more as don't kill people , like that's kind of what you're testing for is like neurocardio , ortho , you know , don't hurt someone , don't like really injure somebody , don't re injure someone's cardiac issue or tear their ACL , and

like of course that's that's a hyperbole , but I feel like a lot of the tests and the study and stuff was a lot more . You know some critical management , but not like . What do you do post-op day three to post-op day 14 with a fresh rotator cuff ? What are the best options ? Like ? Some of that was in there , but I didn't learn any of that .

After courses , mentorship , whatever , dan , I'm not sure if you felt the same way , but now that I look back on it I feel like I should have level set my own expectations that I would be fully ready , you know .

more . But I mean , I'm going to film a couple videos on Monday about hip labral repairs and I'm just I was thinking back to my own education on FAI and I feel like I don't even know if we had a section on it at all .

My only education on FAI and I feel like I don't even know if we had a section on it at all my only education on FAI , I believe in PT school , was a presentation at CSM which kind of piqued my interest . I got interested in it . I , when I got my first hip labral repair , I was like I don't , I don't know what I'm doing . Like this is hip surgery .

I didn't know you did surgeries on hips , right , and it's funny because it's very specific what you end up doing with those folks . And we've been doing it for years and years and years , and I think we sometimes take it for granted . You know , a patient comes in . We have to be careful for these things . The surgery was this area .

That's why you have these contraindications , this is the reason why we start weight bearing at this time , and all those things are very , very important . But , like you said , pt school is not necessarily designed to make you orthopedic specialist and it just takes time to develop those skills . I guess .

Advice wise Dan , for like somebody to avoid getting , you know , blindsided with a full caseload or overwhelmed by stuff they've never seen before . Or maybe it's inevitable . Maybe you know , like there's just there's going to be stuff that you don't feel comfortable with , and you know you're .

You're sitting in the clinic with a five o'clock biceps tenodesis eval , and you don't know what a tenodesis is , like what . What do you think people should do to try to get , maybe stir their anxiety down ? A ?

They want to make sure they have like a full set up gym , like every single person there

has their OCS , they have like five hours per week that they can actually meet up with their boss and kind of talk through case studies , that type of thing , and that is certainly nice . But I would say , try to find a place that has a few mentors that are pretty good .

You can kind of run some ideas past , and I think the other thing is that you can look at your case study or , excuse me , your patient panel for the following day and prep on that night . Right , and I did that probably the first year as a physical therapist and I wrote down a plan for every single patient .

But one of the issues that I wasn't ready for is that when I first started traditional outpatient , I thought everything was going to be like okay , we have a rotator cuff related pain , then patellofemoral pain and then we have plantar fasciitis . And then I got in and I'm getting these weird surgeries .

Like I got a ladder J and then , like I don't know , like a REMP massage procedure . I'm like what the hell is this Right ? So I think a lot of it is that it's hard to prepare for everything , right , unless you go to a very specific clinic where you know where you're going to get .

If you're able to just basically prepare the night before and look at your whole caseload and be like , all right , this person's coming in with this surgery , I got to know what this surgery is . I should probably look at a few protocols and I still do that .

I mean , I just I had a distal bicep repair coming in and I've treated a bunch of those in the past . But I was just kind of curious if some of the research has kind of changed . Look at some of the guidelines . So I just looked at a few research papers like , ah , not a whole lot different .

And what's funny is like the surgeon completely disregarded all the protocols I saw he was much more aggressive and like okay , let's , let's go for it .

Um , but that was something that was very helpful because I was just scared , right , you're dealing with this , like every once in a while I would get this surgery I've never seen before and I have to like excuse myself real quick .

You know , I'm like , oh , I'll do some pendulums , I'll go to the other room and look this up because I don't know what I'm dealing with , um , but yeah , I think it helps out to just see what your , your patient uh schedule is going to be like , having an idea of what you're being confronted with and then just learning as you go .

So , essentially , looking things up if you don't know , before you see the patient and then kind of afterwards , doing some review and then talking to your colleagues . You know , I got this type of injury , what do you think ? Or this presentation what do you think is going on with this patient ?

And then I think preparation kind of like you said , like making sure you're I mean chart review , like get on there , see what you have the next day , like don't come in unprepared . And I think , aside from like post-ops , maybe just with the diagnosis . I see this a lot with the new grads just stressing out so much about giving a diagnosis .

I feel like patients don't usually care that much about getting a diagnosis , like they want to know what they need to work on and how you're going to get them to the point to wherever they want to be .

And so just taking a minute to step back and assess your deficits , find those deficits , tell them what they are and then make a plan to get them better and tell them what that is . You don't necessarily have to like diagnose what kind of knee pain they have . You know they have anterior knee pain .

Okay , cool , like if you can give them more information , cool . If you can't , because it doesn't really fit into one little hole , like that's okay . And I feel like that for new grads is really tough because you're just taught to , you know . Okay , if it's this , then I'm doing this . It's not like that in the real world most of the time .

I've had multiple times where you know somebody comes in , they're literally in a huge bolster sling or they have this big knee brace and like , oh , like , did you have , like , yeah , I had like a tenodesis , or like a rotic up repair , or like a knee is really common , right , it's like coming from an AC on the schedule and like , oh well , they did an LAT

as well . And then also they did like meniscus repair . They didn't know until they went in there . So I have ACL meniscus repair and you know an LAT . And then you're like , oh God , did you get like an operative person for an hour with like a surgery that's three times more involved than you thought , no postoperative notes and no post-op protocol ?

And I think in that moment it's really important to maybe have in the back of your mind like what are some just basic things that all knee surgeries need or all shoulder surgeries needs ? And you know we'll have an episode in this that we'll film to kind of help people out .

But like there's a lot of stuff still do for most surgeries or most acute management that's not going to compromise tissue , because I can't tell you how many times I used to like do things that I think were right , maybe based on my intuition , but not based on , like , the surgical protocol or some good literature .

And then you know , like in the middle of the night , I like open my eyes and like , oh my God , no-transcript , you know question . So like , let me , let me take the night and look up at this and I'll come back to you on Wednesday when you come back in . So you know , this is what I think right now .

But like , I'll definitely look it up and see what's up and uh , that's like . Uh , here , mike and Lenny do that all the time . They're 20 , 30 years into their career , but it's okay to say like yeah , I don't know .

They just like front load you with like question after question after question , and there are sometimes difficult questions to be able to answer , especially if you don't have a lot of experience treating somebody from , you know , ground zero all the way up to like six to nine months post-surgery , and so being able to like set expectations and answer those questions

confidently I think is really helpful . So being able to sit in with somebody and just hear all of those questions and hear the answers and like see how it goes , is really helpful .

And then it seems like once they get over the hump they can kind of get through all the way until like the advanced stage of things and then like very advanced strength and conditioning and return to sport . It's also very stressful or overwhelming .

Or somebody who comes in with just like this weird dispersed shoulder pain that has possibly 49 different you know sources .

So , on the front end , like Dan , what do you think for advice to new grads who are kind of staring at a down the barrel of a high doctor based practice where they're seeing like a lot of knee post-ops , a lot of , like you know , shoulder elbow , weird stuff ?

It was kind of like , all right , you come in and you have radiating pain , okay , well , you got to do a direction of preference exercises right . Like , oh , you have like a painful arc and you touch your toes , that's a stability patient , right . You got to do this very specific thing , right .

And it just kind of led to a lot of confusion about accurate treatments , especially when it was like a little vague . It was like this might be ridiculous , but it also seems a little mechanical . Should I give him a core exercise ? Is this a bad thing , right ?

And I think what I've fallen back on over the course of time is that , as long as you don't have , let's say , a bone stress , injury or other medical red flags , uh , we just want to promote folks being more active and then giving some good

education surrounding their pain , trying to avoid things that are provocative early on and then trying to build them up over the course of time and that goes for like a lumbar radiculopathy , right , it goes for , let's say , osteoarthritis .

Goes for , let's say , someone has a more fresh meniscus tear , although that might be more of a red flag situation , send back to the doctor . But all of these things that are scary or these diagnoses that we're not completely certain about the treatment is all going to be pretty darn similar , and that's one of the things I see with patients sometimes .

I just I had this student that stuck out one time that she was from university where they're just very good at diagnosing things . I'm like I remember she went through this evaluation like wow , she's crushing it , right , and then she just found out it was a meniscus injury . Then she's like excuse , both of us for some reason , and I was like what's going on ?

I don't understand . She's like all right , what's the next step in terms of treatment ? I was like you just got like the best possible diagnosis , you know ? Um .

So I think sometimes it's even if people do have the right diagnosis , they're kind of like grasping at straws in terms of what the most important things are to do , and I think a lot of it is like okay , patient education , reassurance , backing all the things that hurt and then kind of applying a little bit of exercise and over the course of time they can

start to improve . So I would say that's the big and most important thing . I don't know , did you have something to say ? I don't want to keep ranting .

So I'll kind of communicate that to the family . I'll be like , you know , each treatment session we can just see how it goes and if something new arises then we'll take that into consideration and see if we want to do anything differently .

But you know , even if it's this or it's this thing , then we're probably going to do some squats and we're probably going to do some step ups and some split squats , like we're probably going to get you stronger , get your range of motion back , and then , you know , if we find out more information down the line , cool , if we don't , hopefully it'll get better ,

like . So I think , education from that point to the especially if the patient is very diagnosis focused , like they want to have an answer for what it is and we just don't have a great one for them I think just bringing them along with all of that information and educating them on all that stuff is helpful .

Like I could think on my feet and give better answers or problem solve a bit more when I targeted my con ed , you know kind of split , so like one third towards the things that I absolutely had to read about because the cases were right in front of me , and then a third about the things that I was like seeing all the time that I didn't have just yet but

I knew were probably going to come in the door ACLs , you know , rotator cuffs , that kind of stuff and then a third of your time you can maybe tackle the stuff that you want to learn about concussions or the more you can educate yourself .

I think the best thing I've learned from Mike and Lenny , amongst many , is that , like Mike and Lenny know anatomy and biomechanics and pathomechanics as much as the surgeons who are doing surgeries .

Like Mike knows more about a Tommy John craft , you know , than a lot of surgeons probably do in depth , and so Mike really understands the stresses of throwing and you know symptoms and where they come from , and so if you can arm yourself with a really good working knowledge of like the anatomy , biomechanics and maybe some pathomechanics of the common stuff that

you're seeing , I find that I can sometimes think a bit more fluid on my feet and give better answers or have different ideas , because I generally know , you know , okay , the hip labrum is impinged with these things and maybe we should modify to this exercise .

So I would really recommend that people try to do a consistent education of like an hour per day , of just rotating through topics and when you actually apply that information . Though to Aliyah's point , people don't need a dissertation in the path mechanics of a labor repair right .

They want to know what they need to do and what they need to avoid and just be a normal human , like I think it's really missed on new grads that these are people in front of you that are in pain , but they have lives . They're normal people .

You know , in the same way that you might know a lot about a certain topic , but they just want to , at the end of the day , have someone who's nice and is helping them do things that they don't know how to do and just consistently do a basic program .

You know , like you don't need to give people I really early on I think my ego was trying to sound smart use big language and give people these very elaborate , complicated programs that had multiple con ed courses I had learned , but in reality they just need to maybe not sit for eight hours a day and just lay on their stomach every once in a while to get

out of back pain . You know as basic as that sometimes . So yeah , that'd be kind of my two steps , but we already maybe are transitioning here . I don't know , dan , do you have any more on the acute care side of stuff , or is that pretty good ?

freakier , I think , and scarier . What I will say is that when I graduated , I don't think most of the continuing education is centered around post-op patients , but I do think that there are a few good resources for specific areas , like I think Kevin Wilk has some of the best , like rotator cuff repair , post-op stuff .

Like I can't believe the amount of stuff I've learned from him , as well as Mike , as well as Lenny , and the other part is you can go and you can look for some of these pretty good guidelines online . You know there's some pretty good review articles about what you're supposed to do early on post-op .

And the other thing I will say is that I think for the advanced rehab there are some pretty good papers , but I think largely a lot of the recommendations post-op are pretty good for the early stages and mid-stages , but they don't really address the return to sport very well .

So I would say you probably just want to find some good sports physical therapists and take a course or two , see what they do end stages um , I was . We were just reviewing an article the other day about post-op hip labral repair , because we're going through like a hip kind of stint , I guess , and they had some great information up front .

I was learning a bunch and at the very end it was right here's return to sports stage . Maybe do some agility and box jumps , you know what I mean and like make sure you return to sport test , but like there's no tests , you know what I mean . There's like no guidance whatsoever .

So I do think that it's probably worthwhile to get some good courses on return to sport and maybe just listen to some mentors have done it a lot Right , because I think that if we listen obviously to Mike and Lenny and they're big in the baseball world and they have a very specific progression for all their athletes back but if you start looking online you

probably won't find a lot of that good stuff in research papers .

It's just like we talk about doing , like making a general program , and so for you guys , I feel like one of the things that I was taught especially with Darish as well at through like the SNC program about like basic programming because I did not learn that in school

at all . We were very much like .

The programming that we learned , I think was like a three week long thing and it was literally how not to kill somebody , like when to terminate exercise on treadmill if their heart rate is xyz or you know whatever symptoms they're having , like hospital kind of situation , not like basic programming , and I feel like we're missing a lot of that in most like pt

programs like how did you can choose an exercise , but how should you program it ? That's still something I'm playing around with too , with like my post like how to you can choose an exercise , but how should you program it ?

That's still something I'm playing around with too , with like my post-ops , like trying to make sure that I'm like strengthening and hypertrophy the quad enough when they're coming back from an ACL surgery .

So I'd love for you guys to just kind of like generally talk about like how you guys program like basic programs for upper extremity , lower extremity and then , if there's any , like good resources for new grads for that .

I mean he can speak when he shares some thoughts , but we kind of got lucky that we came out of school when , like the , the Charlie coaches of the world were really like great PTs , were also really great strength coaches and they were just running out the field for people like Lee Taft and Eric Cressy , who are also amazing strength coaches , who wanted to

dabble a bit and understand the rehab side of things . So many of those courses I remember taking like lateralizations and you know progressions with Charlie and seeing some online courses that you could really fill in some of that blank space about like what do we do to help these people ?

And also , um , you know to Dan's point of spending time with people who you want to try to learn from shadowing clinics . Most places are pretty cool with you going just to hang out and listen and kind of be there . But I was the only PT in the 200 person um winter seminar with Eric Cressy at his facility .

I remember looking around and seeing all strength coaches and I was like I can't believe there's no PTs here because I don't know anything what to do with these people when they're six , seven , eight months out . So definitely try to , you know , immerse yourself around those people .

I have learned so much from you know , jonah and the strength staff , and I feel like I take much more than from the strength side than I do even as a PT , just because I'm curious about how they think and how they program . And so I guess my thought is that , you know , we view programming in the lens of the tissue or the pathology .

That's limited , right . So our programming , say for an ACL for example , is oftentimes two of those days right are very leg and core dominant right . We're really not doing a ton of upper body stuff until later . So we're programming based around what the knee joint needs to get to the setup for running right or the setup of plyometrics .

And I kind of always think about , you know , our programming is like , all right we might have for the lower body . What are the main movement patterns ? Squat , hinge , single leg , split pelvis , accessory work how do we fit those in two days ? Then upper body we'd have , okay , horizontal pushing and pulling or vertical pushing and pulling and accessory work .

How do we fit those into two days ? Whereas when you listen to Duesh and those guys talk about it , they're thinking about , like sports performance . You know all the athletic qualities , all the way from mobility to plyometrics , to power , to strength and energy systems , and it's just a different programming lens .

But we're very much dictated by the pathology and what we need to do , kind of to get that there .

So I would say , think about it there and then you know also it's hyperbole , but I always say to people when we're teaching them , like if you wanted to kill somebody and lose their license , like if you want to lose your license , what would you give this person ? Like so , btb , acl , post-op wake , week 12 .

Like what would you give this person if you wanted to blow their knee up right , a super knee , dominant , sissy , slant board squat . Like okay , well , it's not down the stairs , yeah , exactly . And then the opposite is like , okay , well , like what do you feel pretty safe about as a pattern ? Like they'd never hamstring grafts . We can load the hamstrings up .

Maybe a hinge and a glute bridge is a good starting spot and you work your way through that Right . So I think that's kind of where I approach . It is the is the , the principles of loading and the principles of the tissue in front of you , and what do you need ? And then , okay , I have these buckets of patterns .

Maybe I double up on glute hinging type stuff twice a week because that's what feels good . So that's what I think , dan . I'm not sure if you have thoughts there .

I think if you look broadly our medical literature and if you're looking at mostly sedentary individuals , there's a large variety of things that tend to work equally . And I was just looking at some guidelines for knee osteoarthritis .

It seems like you can do aerobic exercise , you can do strengthening , you can strengthen the quad , you can strengthen the hips Folks tend to do better . You can do yoga . If you look at low back pain . You Pilates , your core strengthening . You can do yoga again . You can do aerobics . A lot of stuff seems to work equally well for these folks .

So I can see , sometimes I feel like I'm like an elitist , like , oh , you need to learn programming because that's going to make you a better physical therapist . And I think for the average person , just getting them moving and choosing exercise they like to do is probably going to be the most important thing . Right , get them to do something .

But then , when it comes down to working with athletes , I think it changes . And again , I'm biased and I don't think we have enough research .

Like there's one study I can think of off the top of my head where they're looking at kind of light load training more frequently , so like doing exercises twice a day , every day , versus programs where they load heavier and they have a little bit more rest in between , which would be like maybe more strength conditioning , heavier loading and it did show a trend

towards being better with the heavier loading less frequently . Right , but beyond that it's we don't have a ton of research showing that being very specific about your programming is better and sometimes it's exactly the same .

But the other part is like and I'm sure you've read this , if you read enough research like you're just like why the heck did they use this set and rep parameters ? You know , like rehab for FAI , and it's like they chose three exercises , they three sets of 35 . And like the next study is like they did five sets of 10 .

And then they did like 10 sets of seven and they use all different exercises and there's like nothing is similar . But you look at these two studies and you're like I don't . I don't really know what to do and you can obviously take their set and rep parameters and try that , but sometimes doesn't make any sense .

You know , with the exercise progress they tend to use , so on and so forth . So I would like to see more of that .

But when it comes down to trying to gain something particular with your patient like I think one of the big no brainers is like if you have a post-op ACL where the quad is weaker , or you have a post-op Achilles where we know that calf just gets itty bitty , like there are so many principles that we can follow .

They're going to help build more strength and size , based on just basic strengthening and conditioning principles that we should probably apply , right , just more frequency , more load , certain set rep schemes , so on and so forth .

I think where I use my strength conditioning and exercise prescription knowledge the most is just trying to meet people where they are in terms of tissue irritability and their own goals , right . So we tend to work with a lot of fit people and they want to be able to work towards their strength conditioning goals or fitness goals , whatever they are .

So my job is like hey , how can I tweak your program as little as needed so you can still progress optimally and rehab at the same time ? And I think if you know how to kind of dose up , dose down , if you know what's set in rep range is best for strength versus hypertrophy , you can wiggle these things around really well .

And it's one of the reasons why I love blood flow restriction training so much just because we know that you can increase someone's strength and hypertrophy at a very similar rate to maximal loading . And we've seen this in power lifters , right .

So if I have a patient that comes in that has knee pain , they're like oh man , I'm so sad because I can't squat like above 80% of my one rep max . My knee kills me . I'm like well , if we just do blood flow restriction training for the next four weeks , you'll probably progress the same exact rate as if you just were heavy loading , right .

But if you didn't understand some of these principles , like , you might tell that person to stop doing everything for weeks and then they end up going backwards and then once they can pick up some strength training again , maybe we give them a larger rep and reserve .

There's been some cool studies that show if you're even like somewhere between four and 10 reps away from failure , you still build strength maximally . So that power lifter that comes in it's like so distraught that they can't lift heavy anymore because they feel like you're gonna lose all of their strength .

We have so many options to help them when their main goal is strength , but if you don't understand any of those programming principles , you're not going to be able to help that person through that process as well as if you did understand them .

This is like a pretty classic , you know , strength conditioning paper that Dan and Scott Morrison put out that essentially is walking through a lot of what Dan's talking about related to like sets and rep schemes and like periodization and trying to offer people some like guidance on what to do .

If you didn't come from a traditional CSCS or strength conditioning background , there are a lot of papers that offer you great literature on like you know what are the basics of periodization and you know what are the basics of set and rep ranges .

Why would I choose , you know , six reps versus 12 reps to Dan , dan's point , and how can we measure , you know , fatigue in a healthy way that's just hard training versus getting somebody injured .

And you know , with this I think what always comes to mind for me is I find myself , especially before we get into like the advanced phase of rehab , like and again , we'll do a , we'll do an episode on this next , but it's like I'm just going through a checklist in my mind about does this person have , you know , symmetrical , uh swelling ?

Does this person have symmetrical patellar mobility ? Did they have symmetrical knee hyper extension inflection ? They have symmetrical strength ? If none of those things are true , then that's all you work on . You know , it's like it doesn't have to be very complicated . I think sometimes there are cases that require quite a bit of mental horsepower to work through .

You know what might be going on , but sometimes in the case of like an ACL with a weak quad , it's , like you know , pretty simple . It's simplicity and then on top of that is consistency , right ? Well , okay , for we know it takes about four to six weeks to truly add some , some mass .

So let's make sure this person is sleeping , eating well and then training three times a week with moderate set and rep ranges at moderate intensity , and that's the training effect they they feel after is normal .

And I think if you just take those basic principles and be a bit patient and apply them to most populations of , like you know , stretching every day to get your flexibility up , if you need to get some motion back , or long load duration twice a day for four weeks to get your hyperextension back , these things are really basic in principle , but I think it's hard

for new grads because they don't feel like they're doing anything . They feel like they're educating person and like , all right , we'll have 45 minutes of this person . I did soft tissue heat and like gave some advice . Like now , what it's like doesn't have to be that crazy .

Pick three exercises and just do a nice basic linear periodization and Mike's always famous list with like cuff stuff is like add one pound a week to all your shoulder exercises for six weeks and then we'll retest your strength and you're probably stronger and your ratios higher .

It's not like you know we're doing this quantum physics equation to figure out your undulating periodization reps . You know what I mean . Is that helpful , leo ?

Doing like crazy things . I like crazy , crazy , but you know , just like different things . Like you don't want to have a person like do a clamshell you know exactly . I feel like I'm over this . I'm not going to be a clamshell PT yeah that kind of debate . It is hilarious but yeah , I feel like it's .

It doesn't have to get so complicated like treat the depth , find the find the deficits , treat the deficits and you know . You pick basic strengthening exercises that they need , especially in my world .

I'm working with pediatrics , so their training age is so low , so I don't need to choose these like crazy exercises or exercises that they don't even know very well or have never done before , like RDLs , are like the hardest thing to treat or to teach anybody and then to have them do it .

So I usually get on it pretty early if that's something that's new to them .

But I think sticking to the basics and just trying to remember like that paper I love that paper , I read that at champion , so you should share that with everyone , cause I think that's a really helpful resource , because I think you can get really bogged down by all of the things that you could do , when in reality , doing like the simple basic stuff that you

might not feel is doing a lot or that you might feel like it's not enough , is enough .

, and it's funny you mentioned , you know , instagram , because that's a good segue . For the last little like five minutes here is , you know I came out and maybe Dan can explain his thoughts . But like I came out and very much the not joints , all functional time of like , whatever that was SFMA , fms , was super popular .

So , um , I swung so far into , like the global kinetic chain type stuff that I realized very quickly that I didn't know how to treat a post-op knee right , cause when a post-op knee comes in three days out , you ignore 85% of the global movement exam and do a joint eval .

And thankfully , at that time , you know , I bumped into Mike and Lenny and got you know , set up a champion where I'm like , oh , like , they're masters at joints .

And then they added the kinetic chain on top of that , not the other way around , and so it took me a while to kind of swing that pendulum back the other way of like not just what looks good on Instagram , but also like what is the basics of these things .

And I think clamshells are the perfect example because , like , there is a time and a place when clamshells are like the worst possible thing you can give somebody if they're like really far along the way .

But I'm treating two , three maybe like post-op label repairs with acetabuloplasties and whatever they're like three weeks out and it's like clamshells , sideband walks , glue bridges it's like that's it like and they're and it's not like I always think about . I also have three acls right and they're trying .

These kids are trying to do a leg raise one or two weeks out and they're like sweating their tongues out like hard bro , like sometimes a basic leg raise with like quad inhibition and some pain and stuff is . That's that's it , you know .

And so there is a time and a place when you can kind of poo poo clamshells the vein of you know high quality education and you know social media versus courses and stuff .

Uh , I love , dan , if you have any thoughts on that past thing , but then also to kind of share your thoughts on how to get high quality education , because that's , that's a sea of information out there .

But like movement was huge , right , the selective functional movement assessment , functional movement screen and it's funny because like we had a biodex in the corner of our clinic and never used it , like we chastised it , like it was a bad thing . Now I'm like dang , I wish I had a biodex . I really wish I had a biodex . Yeah , it's pretty funny .

But I , you know , I got into this point where I was just wanting to give people fancy , cool exercises . I same thing , didn't really want to be the clamshell guy . Right now I get to the point too where I'm just like giving a new program to a patient every single time they came in , and I don't remember what point . I kind of stopped this .

But I remember Mike had said like you know , is that how you train ? Would you do that , you know ? And I was like no , I wouldn't . I would write a program and just do it for like four to six weeks and then I would switch to something else . So I was just giving people these complicated programs because it kind of felt good .

And it felt good to me , right , it wasn't necessarily better for the patient , right , it just felt like I wasn't delivering quality unless it was something that was like new or fun or exciting or something along those lines . And going back to what you had said , it's like , well , you know , clamshells they get a bad rap but they're important , you know .

And at the very beginning of rehab , like especially for like FAI , like folks that have FAI , and this goes post-op and non-op it's like , okay , these guys are having a hard time controlling flexion rotation with axial load .

Clamshell takes away the axial load and the forces are a lot lower and you're probably introducing a very good exercise along that spectrum to get back to wherever you want to do . And if you just jump straight into exercise , like I don't know , lmn , whatever , further down , you run the risk of kind of flaring them up , right .

And then it comes back to the idea of isolation , which is hilarious to me because back in the day it was all movement and we're going back to isolation . If you want to isolate infraspinatus , right , let's say that someone has shoulder pain and you're concerned that the infraspinatus is weaker . Like we know you train the infraspinatus when you bench press .

The bench press trains the pecs . It trains the deltoids and a bunch of other muscles . Right , if we're concerned that the balance between the muscles is poor , we're not really helping out that infraspinatus by doing bench press . It's like the squat versus the knee extension .

It's like , well , you use the hip when you squat , are you targeting the muscle you want to ? So I think sometimes we just you have to give the boring exercises if they're most appropriate with your critical reasoning and maybe for kind of new grads that can rest assured that their critical reasoning is accurate .

If they're being kind of boring , I still feel bad I'm . I'm like , all right , we're doing clamshells because the most boring exercise . I'm sorry , but gotta do them . Man , you gotta eat your vegetables , right ?

kind of deal so yeah , um yeah , and I think you would ask the question about social media or like the best way to kind of navigate that yeah I think it's hard , you know , and man , I , I wouldn't really want to be a new grad right now because there's so much information that's out there right now . I feel like you're constantly bombarded with things .

Um , one of the things that's tricky with social media is that very polarizing arguments are popular , right , and I think that people preferentially see those , and they're they're like more triggering than regular posts . They become more popular and you basically have , like these camps that are extremely against one another .

Like don't do any manual therapies ever , that's like the worst thing you could possibly do , right , and like shaming people for doing manual therapies . Another camp thinks that they're like amazing , you know , and pain science was like this for a while Like you have to do pain science education , right , this is the most important thing .

If you're not doing that , you're doing a disservice to your patient . And it's just tricky , because I felt like when I was a new grad , because I consume a ton of information and I probably consumed too much , I was like addicted to learning , but the way I treated it was like wildly different from each week , right , and that's not good .

Like we probably want to have some sort of base foundation . Then , once we build a strong foundation , we can start taking in additional things right Taking in a little bit of PRI taking in a little bit of like SFMA , taking in some biomechanics , right you know whatever else it is . But I do think that it's probably good to find a couple mentors early on .

You probably have to vet those folks . Hopefully they do produce some social media . One of the things that makes me really sad nowadays is I think that some of the best mentors are not good social media marketers . I think one of my favorite guys is Rob Manske . Rob Manske has got this ridiculous resume as a physical therapist .

He's super smart and then he has a podcast for IGSPT and has some of the best surgeons in the world on them and every single episode on YouTube is like episode one IGSPT , episode number two , igspt . And I don't even know what's on these freaking episodes . I can't even search . They're like this is for hip pain or this is shoulder pain .

The social media marketing is so bad that you're not even getting the best people in the world's information . That's like actually out there . So I think you probably have to vet the people that you're listening . You know , do they see patients Right ? Do they see the specific population that you work with ? Have they been around for a while ?

Have they published so on and so forth , and then I'd probably just try to get a couple people that kind of jive with the way that you like to treat at first and get your baseline down , develop that a little bit and then you have a little bit of experience to base what else you're consuming on Instagram .

Right , you can be a little more critical of certain things . You can even be critical of research .

I've read enough research where sometimes I'm looking at something like this doesn't look right you know what I mean or like that's a bias or whatever it is , but someone else reads it for the first time and then they change their entire practice or something along those lines .

So , um , yeah , I guess , finding a few good people on social media , following them for a period of time , learning , getting good at the basics , realizing there's no like silver bullets at least I haven't found it yet anyway and then expand over the course time .

You know I love Mike and he is such a good educator , but he's just a tad dry sometimes you know , he's his delivery , his delivery process , because he's such an academic , you know , he's so good at research and so good at stuff .

I took his hip course and you know I had a couple extra cups of coffee when I was reading just because I wanted to pay attention . It was so good . But then , yeah , you just find a little monotony . But shout out , mike , if you listen to the podcast you're amazing .

But yeah , some people's delivery style is like Mike's so good at teaching and he's so smart and treats so many people , you know , versus having somebody who's super animated and is like really up in his face , just not Mike's personality , which is fine . So , yeah , I would totally agree with you .

I would say in each kind of discipline or area of PT maybe it's like shoulder , knee , ankle , whatever hip there's a handful of people that tend to have a lot of experience and have a lot of life .

You know , knowledge around , like treating , both of the hard skills of the protocols and the tissue , but also the soft skills of how do you kind of navigate tough times . So I kind of have like buckets in my mind of people who I generally lean on for those that I want to think about If I have some back questions . It's like Stu McGill's work .

If I have some stuff on the hip , it's Mike Ryman and Mike Voigt and Ashley Campbell and them , then Mike and Lenny , for I kind of have these like buckets and I spent , you know , a good three months on each joint when I first got out trying to really understand that well , and that helped me a lot .

You know , try to get high quality sources of information between courses and research and you know some of the social media stuff . So yeah , aliyah , any parting thoughts ? Is that Marvin down there ?

It's just whether that's chart reviewing and doing extra research before you see a patient that you haven't seen before , or if that's like taking extra educational courses , it's definitely worth it .

It's definitely worth it Like extra work at the front end to find like a good you know foundation for yourself of how you want to treat and who you want to follow and what kind of research you want to look into , and that kind of stuff , cause I think that helps a lot .

I think once you get a little bit further down the road , you just kind of get into your groove and you don't you know if you're not actively trying to learn more stuff , you kind of just get a little stuck . I think so .

very good advice . Yeah , I think , and also view that in a lens of obviously , the more you learn , the better of a clinician you are , the more you help people and that's awesome . But also you're happier at work and you're happier in your daily life when you feel like you know what you're doing and you're confident in your skillset .

And you know I'm I'm very fortunate now and I think mean Like I generally enjoy treating people and going to work and it's fun to help people and have answers when they maybe had a tough road ahead of them . And you see something that's a gap . I've seen 39 spondys in the last month .

Like I have a pretty good idea of how to help you , um , and it makes your day and your overall lifestyle much more enjoyable than panicking about the four o'clock avow and then worrying about the five o'clock treat . You know , like at first it's a lot of anxiety if you don't know that .

But as you put more work and more reps in , you get a lot of experience and pattern recognition and if you don't have years under your belt , you have to do that via other people's careers , learning , education and research . So , yeah , it's , it's dual , you know dual , selfish and selfless of . Yes , it helps people . You do a good job on it , you know .

So , yeah , I think that's a wonderful place to end right in the around the 45 minutes . But , daniel , sir , how can we learn more about you and all the things you do ?

So , yeah , and then also on that line , I think when this episode comes out , we're probably a month away from launching the third cohort of the mentorship that Dan and I and Mike Reinald do , which I keep saying Dan , I was very blown away with the first cohort that people joined and the second one . We had equal as much , if not more .

So we're doing something right . But essentially , if you want to learn from us for six weeks and just get a fire hose of information of how we treat and like what we do and our protocols and you know a lot of discussion there's a lot of discussion back and forth around cases that people have in , but that's pretty fun . I actually enjoy doing that , dan .