Managing Diverse PT Caseloads

So , um , yeah , on the vein of uh , these podcasts come from a combination of what people ask us to help them with and then also what uh is actively between a lead and I's brain right now . We usually chat about stuff back and forth and then I have an idea .

I'm like sitting in the clinic , I'm like , oh , this would be a good topic to kind of chat about , or something like that . So this uh situation is in real time . The fact that champion in general has never been busier in our entire life .

So this time of the year in june where we kind of planned this for um , all the college kids are coming home from schools or wherever and they're working out fitness , pt , whatever , and then all the high school kids are now out of school and either finishing their seasons or are summer training with us , and so that leads to a large amount of people who have

surgeries at the end of season and they come back and they rehab with us for the first three months , or they had an injury during the year that wasn't surgical but it was annoying and they're trying to rehab that .

Or people on the strength side that are like training with us and are going back to school in September or stuff , and so , um , yeah , I don't know whether I'm just busier than normal or what , but I posted about this last week but I have like 45 people actively on my caseload right now and 25 of them are gymnasts from all walks of life , from compulsory to

elite , with like different schools . So I have like seven to 10 different colleges with seven people who had surgery from different surgeons with different protocols three of the same surgery , three different surgeons and protocols like two UCLs , two ACLs .

It's like a lot to manage and I avowed them all in two weeks when they all came home because they just all wanted to get in . So I had like a 30 hour work week where I did like seven to eight avows . And then I remember being like the next week I'm like well , this is like a lot to like process where everybody's up and like what ?

Like what do you need ? Like can you strength train with the coaches , and they're kind of like joint programs together to kind of keep them going . So on Sunday I had to spend two hours making a Google doc , which I'll share , which is essentially like how to organize my own brain around .

Like these are the patients that I have in this particular gymnastics bucket here's their surgeon , here's their date of surgery , here's their protocol precautions . Here's where they're at . Some did rehab at school before coming home . Here's their notes and what they've done with their trainer or with a different PT .

And like this is what the big rocks are that we're going to kind of tackle , because you know , some people are doing great but some people are still pretty sore and pretty struggling and you know we're trying to scratch our heads about it . So that's where it comes from .

I don you said , you know , when we were setting up these episodes , that you just got a huge influx of post-ops and that you have a lot on your mind . You know .

You know two to four weeks and they're just , I would say , normal treats quote unquote .

Whereas when someone's surgical , you're adding a lot , you're changing a lot , you're tweaking a lot , you're progressing people a little bit , and if you get a little mixed up , it's really hard sometimes in a busy day to know where someone's at , what they're doing and what happened last week when they were sore .

So this system is what I have done internally like for a long time and I figured it might be just useful to share it . So this is how I organize things and I maintain anonymity to make sure I was HIPAA compliant , um , but these are all my current caseloads . So um for gymnastics . So I have no like handful of people but essentially along the left-hand side .

These are just like their initials . It's their name when I'm not on a podcast , live with them , but their uh initials , their name , what level they're working , what college they're at or whatever they're doing , whether they're recruiting or whether they're junior or freshman .

And essentially , when I come up to this main thing , I have a approach of now I can just like click people as they come in . This is based on , like my Monday , tuesday , wednesday schedule , so Monday through Friday . So like these I think like four are Monday and then , like these four maybe are Tuesday or whatever .

But essentially , um , I try to uh get the information from them about , like at a glance , if I just look at this really quick , I know exactly what needs to happen with this person in the next visit or where they came from in the last visit .

So this situation um , she had a uh right ACL reconstruction , uh , bone patellar , bone grafts , a patellar tendinograph . She also had an LET on March 21st with Dr Ramapa . So I know that if I have a question I can just text Ramapa real quick or like get an email chain with somebody else .

Right , notes precautions At the time when this was earlier , it was like weight bearing , whatever as tolerated , because she has meniscus repair or crutches for four weeks . Weight bearing is tolerated , brace comes off at six weeks . She has a six weeks follow-up .

Whatever it is Stitches come out two weeks , like all those precautions and protocols and the things I need to know are at the top so I can quickly at glance realize what's going on . And then for me , early post-ops .

But even as some of these cases we'll talk about , even like not post-ops that are just far out , that are six , eight months that have generalized pain , a lot of the important stuff comes from just basics , right Basic swelling , basic joint mobility , basic symmetrical , pain-free range of motion , basic pain-free active range of motion and then pain-free strength .

So in this girl's case , when she's three months post-op right now , this is really all we're focusing on right , she's really just in the middle part of rehab and she just needs to get strong . In this particular case she was the one we talked about in the last episode that did have some struggle with extension .

So I'm like all right , I got to measure cold hyper extension every time she comes in and I want to make sure that we get her at least eight to prevent , like , any serious issues . And she's strength training with us .

So now it's about we know she has to strength train hard three times per week and I want to make sure that what I'm doing in my side of the rehab is the more I would say spicy stuff that is more like dependent on medical based limitations and graph choice Right , and then do us , is free

to do all the stuff that I've done before in the first three months safely and that all the extra things that she doesn't have on her own .

So BFR , stem , the knee extension machine I want to make sure that when she's in , every single time she has access to all that kind of stuff , because that's how she's going to get her quad strength up quite a bit and kind of combat this little bit of AMI that she had .

So I kind of write out okay well , I know she had some AMI , so what are we going to do for that ? That's a huge impairment . Oh , sorry , the first part . So swelling she has a mild amount of swelling still , mobility restrictions , so self mobs quite a bit . She is close but doesn't have full , pain-free passive range of motion and a hyper extension .

She's close on flexion . So it's about in her home program on the day . She's not a champion , it's about got to get that knee propped up , got to hyper extend , it got to make sure it's all set , blah , blah , blah and then also doing some like knee bending on her own , some some towel bending , some quad rocking , just consistently throughout the day .

Thankfully she's not in school now so she has like unlimited hours where she can do it , but she had surgery in the middle of her spring semester for high school so she was very busy with other stuff . So finding times to make sure that she's doing this is really important , right , and then so that's it pain-free , passive range of motion .

She doesn't have full active range of motion because her quad is still weak . So we have to make sure we program open chain type stuff to get that full motion with a knee extension . And then she clearly doesn't have quad strength uh , symmetrical side to side . Not that I've strength tested it .

We'll strength test her in like another month , but she doesn't have that yet . So her whole program is based around okay , we have to get full motion in full strength . And I did a lit review with some of the other guys earlier , but I just remember looking back on the research like what is the best research supported ways to combat AMI , right ?

So ice pre-training is really good for 20 minutes , so we were doing that for a long time , but the priority is a , not a cyclops lesion , and not getting hyperextension loss . So although she does have AMI , the more important A1 is not losing hyperextension and the quad will come . There's many other ways to get the quad going .

There's not many other ways to get a cyclop to go away besides another surgery which we don't want . So she was doing ice for a long time until we realized that the AMI was probably at bay and that the hyper extension was kind of slipping . So we switch her to .

She comes in before her PT training session 15 minutes , 30 minutes early , or her strength session and does propped extension for 15 minutes . Um , and then she comes to me for PT or goes to do ash and then after she doesn't like 15 minutes at the end too as well , and then she has another one at her house at home .

So because her quad is weak she can't actively get her heel to full hyper extension . So it's a bit of an uphill battle to maintain that before the quad comes back . So we're trying to combat the AMI with that . Maybe it would be ice in somebody else's situation .

I have a few other patients who are not as behind , a little bit with the quad strength because their surgery was just an ACL , not an LAT . So maybe they're doing ice before . I have one girl who's like six or seven months out . She does ice before just to get her quad really turned on before she does some advanced strengthening .

But then also the prop extension helps and then vibration is helpful for AMI too . So while she's heating um , I take it off and then I work on her patellar mobility and she does AMI vibration to her quad to try to activate some of the neural stuff as well .

And then before she shrank trains she has quite a bit of um foam rolling on a vibration machine or something like that . So that's the most important , like basic steps for her . And then between me and Duesh I know we want to get a full spread three days of all the different movements she needs . So I've done step up , knee extension , split squats and NMS .

Burnout would be a far before . So Duesch takes all that in his program and , make sure , a whole body program . I take on the new stuff which is a step down , some TKE stuff , some some spicier , you know , lateral work which is maybe more on the LAT , and I take that . And then her home program is just all the stuff that we talked about .

So I had to sit down for like 10 minutes and work through her case mentally about like , does she have this ? No , what do we do for that ? Does she have this ? No , what does the research say for this ? Does she have this ? Yes , okay , ignore that or never move on from that . But that's kind of how I approach it is .

I sit down with each case and try to think about the things yep , cool . And then the other thing that I think comes along with this is you get a . Very quickly you realize that your caseload is shotgun across a whole bunch of different problems .

So , um , I don't know how many of these this was an old one that I've updated since then but maybe there's like six or seven that are at the top here . So first one , let's see . So we have an acl bone tenant bone . She's probably at 10 o'clock , 11 o have a uh gymnast who's a junior in college .

She had an Achilles 10 X and she has a protocol that did not come with her the doctor . Her gymnastics doctor is not her team doctor . So her other doctor did her 10 X , but her team doctor is different .

So she had a 10 X procedure with a different person that's friends with this surgeon to do the actual 10 X procedure , um , but neither of them really sent the formal protocol . She kind of had a range of exercises to do and she's going back to school .

So they were like , yeah , just like you know , do this kind of ish for a couple of weeks and come back and we'll see you . So I had to talk to a different doctor who does 10Xs just to make sure that we gave her a progression .

It was like stretch your calf and then do bump things down and start with , like you know , plantar flexion with a band and then seated calf raises and whatever . So so , yeah , so that was at 10 o'clock . Is this girl with a knee ? 11 o'clock ? Is this girl with Achilles ? 10 X ? Completely different surgery , different school , different surgeon .

Same kind of thing . Do you have swelling ? Do you have your joint mobility ? Do you have your passive range , your active range of strength , right ? All kind of no . So different types of uh progressions for that , things that I can do with her and then things that she's doing on her own as well in a home program . And then this girl navicular fracture .

She had a debridement six months ago . She's going to be a freshman at school . Um , she has a handful of things that are really , really good . But all her pain and her issues come up when she vaults . So she uh has going . She's in her return to sport program , she's back to full gymnastics .

But if she does too many uh , one and a half on vault she starts to get some

soreness at her foot . So completely different end of the spectrum versus the person who's missing the extension post-op week two right . So for her all these things are fine . Passive range is good , active range is good , maybe a little calf strength deficit , but it's negligible .

But all her issues come up with single leg uh , so single leg ply work or very high impact , um , two legged power work off a springboard . That's where she gets symptoms . So all her stuff . One of the strength coaches , mike , does her programming twice a week .

Um , we have to split all her stuff between the two of us and also make sure that she's getting the right dosage of workload right . So she needs to vault twice a week and not have symptoms the next day for us to go to three times a week .

And also , she has to tolerate all her single leg jumping , all her eccentric work , all her heavy , heavy stuff and not have a flare up of symptoms , which is where she's at now . She kind of had a flare up a month ago , backed off for a week and like all right , two times a week . She was also just doing way too much .

She was doing beam and vault and floor the same day . She was excited Soers and then five vaults and then five layout step outs and then on that day you can't do floor on a hard surface , nor can you do beam . So she's at 12 . And then we have a girl who is a slap repair .

She's 12 weeks out of a slap repair I'm sorry , 12 months out of a slap repair and she's end stage . She's fine , free of her conditions , but she has cuff tendonitis . She's a long standing cuff tendonitis , cuffed in the night . So she needs , you know , shoulder strength stuff . I gotta take her numbers again . I have to do thoracic mobility with her .

I have to do injection stuff mid-season . If it's not going to work out , I have to do some dry needling right , her home program is different . And then this girl is six months out of a ucl . This is the kid who I said uh fell and didn't know his protocol . I love him to death . He's a good kid but he's far out of a triceps repair .

And and then this person's a cuff 10 . I mean so like the schedule is all over the place capsular shift and if I don't put this stuff out in front of me and outline this thing , this guy has a C7 disc bulge , like so different than the other stuff I get so overwhelmed and I feel I feel like I'm doing a bad job .

I think is the only way to do it if I overwhelm myself so much that I can't remember the nuances of their surgery . But old me would just be like remember it all and like work harder . Right , but how the hell am I gonna remember ? Is 20 people on this list ?

How am I gonna remember 20 people with 13 different joints and 13 different schools and 13 different surgeries and surgeons ? Right , like it's impossible .

So I really support people trying to spend , unfortunately , extra time to map this all out , because every night when I see them on the schedule , I go through and I think about are we better or worse the same ? Are we moving in the right direction ? Did I miss something ? Do I have to read some research ? Like , where do I have to get help from ?

Do I got to call a doc , like all that kind of stuff is what I think about the morning of before I go in . Do you have any thoughts ?

I have so many of them right now that is really hard to keep everything straight , like remembering , like what their motion should be .

So I think , doing yourself a favor at the eval and making sure that you're getting the other side measurements so that know your comparisons for each side , especially for motion , and then also making sure that , like sport wise , for gymnasts and for other sports , you're just writing down everything that their goals are to get back to .

Like for a gymnast , I'll sit there and I'll write down all of their events and like all the skills that they're trying to get back to and then , like for other sports too , like what events they do within that sport or nuances that I remember with the goals that we're trying to get back to eventually .

Um , but then , just like I , I think I create like a good habit with all the post-ops that come in . Like every time they come in , they warm up , we take all of their measurements and then we get started .

So it's like a habit of like every time we're going to check and see where we're at , and I think it's helpful for you as a clinician to kind of like get yourself familiar with the things that we need to be working on , like , okay , maybe they weren't missing five degrees of extension last time , but today they are .

So we need to work on extension today , like that kind of thing . And then also just from an education piece for the patient as well , because they're also invested in their numbers . At that point too , they're like you know , they're tracking themselves too .

They're like oh , last time I was at 98 , today I'm at 103 and they're like get really invested and it's kind of fun . Yeah , yeah , doing yourself a favor of like keeping good documentation session to session , so you can really track their progress , because you might like miss somebody in the weeds .

If you're not doing that like you might you know four weeks later you're like , oh crap , you're like 12 weeks out and we don't have this , like why don't we have this ? Because we , we haven't measuring it or , you know , you just missed it somewhere along the way .

So , just creating the habit of taking those measurements and setting yourself up for success and having their protocols like ready wherever they are , like wherever you're going to plan , to keep them just like have them handy so that you know your dates , like at the eval . I'll set up like a we I'll set up like a .

We have a little like calendar thing that we have in Excel where you can like put the date of surgery in and it calculates out like two weeks , six weeks , eight weeks , and then like literally on that eval , if they have restrictions , I'll just write in there . It'll be like the date and it'll say when they can do this and the date when they do that .

So it's like really easy for me when I opened the computer , I'm like , okay , we're like three days away from this or two weeks away from being able to unlock our brace or weight bearing or whatever it is . So it just makes it like easy , accessible . You don't have to remember all the things about each person .

For the first three weeks probably , you're measuring those middle joint line type ones and you want to make sure centimeters are going down and quads hopefully going up . But like you have to have , I just use tables .

I don't know if , like software is allow you to do that , but like I find that if I have like two or three tables from the very beginning , about like this is a swelling table , this is an active range of motion or a passive range of motion table and a strength range of motion or a strength table .

The strength table might not editing because it's not clear . You can't , uh , strength test somebody or dynamometry test someone early out of surgery . But I keep them in there so that down the road I can reference these things .

As you save a note and a new one comes up , I can see that over the course of four to six weeks the swelling has gone down , the motion has changed and how much they have , and then eventually when you get into , like the three to four month mark for a lot of people .

Or if you have someone who's not post-op and they're just coming in for a shoulder pain and you took their strength numbers , dynamometry wise , or you tested their quad and their hamstring LSI , torque numbers on a dynamometer .

You want to track those month to month and keep referring back to those because it shows progress , it has buy-in to your point exactly and it's really important to track those things .

If that's the main KPI or like key performance indicator is strength , quad strength , acl wise while you're saying to someone who's six months out hey , I know you got cleared to run and clear to do sports , but you have an 80% . You know strength differential side to side .

Um , it's probably not the best if we start you on cutting pivoting until we get this LSI number up , you can kind of explain with hard numbers while you're making that choice , not like well , I just don't think you should run right now . Right , you want to have a very firm .

You know this is the research shows us that we want to have a good 90 plus 95 LSI before we get somebody on very aggressive cutting .

So let's make a plan in place , let's measure this and then in a month from now , you know you have to have a lot of data behind the decisions that you make when you're working particularly with with athletes , and with high-level athletes because they think you're smart , that's great .

But if you tell them they're not gonna be able to train or do a meet or compete or something like that , you better have some pretty good rationale for why you know , and data helps a ton .

or I got to do more here , or I got to do more here , or I got to do less there .

Like it helps , like tracking wise , just making sure they're on track and , I think , setting yourself up at the beginning with the eval , kind of like what I was talking about , and then , like when you get to the point where strength testing like I'll look out like okay , on my table 12 months , okay , we're strength testing here .

And then , based on how they did , I'm like , okay , we're really behind . Or , like you know , it's 50% . Like , okay , we're not going to make significant gains , but I still want to test it in like three to four weeks just to make sure that we're improving . And then , like I pick a date . Each time I'm like , okay , when are you here ?

That's close enough to three or four weeks from now . I pick that date . I tell them , I say , on this day we're retesting your strength . So they know , we know if I forget , they remind me .

But , um , the best thing you can do is , if you know there's like certain metrics or things that you're going to test for like knee ACL or for like shoulder strength dynamometry or for whatever you want to have spreadsheets and tables that can help auto punch that , auto calculate that to make sure that when you put in new data it compares it to the old data .

They see like , oh , this was my number before , here's my number now . And one of our students in an in-service where he did it for ACLs and for like LSI and like quad testing , then somebody else has done it . I think Anthony did it for like shoulder strength measurements , right .

So we know that , like we want the ER , you know , to be at least 66% as strong as the IR , we want the you know the ER on each side to be symmetrical .

So if we put those numbers in in a table that's blank , when I fill in those numbers it auto populates this is the percentage of body weight , this is the ER ratio , and now they've done it with the quad stuff too as well . So we have like an Excel sheet we make in our Google drive . It's like all right , this is this girl's three month post-op number .

This was how much she weighed , this was how long her shin was , and then this is our LSI for quad , lsi for hamstring . Here's our torque angle and we have all that data in one column . And then in another month when she tests again , we just fill in a new data and we can see oh , she went from 71 to 74% LSI .

That's not a huge jump , but she actually jumped 80 newtons in quad strength . So that's a good thing , right Helps you make sense of a lot of data and it's very hard to sometimes figure out what is worth measuring . But you can be overwhelmed with how much you have to measure .

But if you find a couple of really important things on the strength side , they do like CMJ 10 hop . You know things like depth drop stuff with with loading from valve um vault .

But if you have those things in line and you just sit down and make a table that is repeatable , use over and over and over a spreadsheet Like you , save hours of your life in the clinic over time . And then quickly , as soon as you punch the numbers . You can turn the computer around Like all right , here's our numbers are at .

You know we're doing good here , we have some progress here and like it's it's one of the best buying things I've ever done is giving like involvement in , like this is what these numbers mean . This is why it're good to do these things , but I'm not letting you do these things yet . You know it's like your goals are this .

I'm trying to help you get there as fast you can , but safely yeah , there's a really cool acl calculator .

I'll have to find the thing so you can like link it in the show notes or something it also has like fun diagrams . So I don't really use it that much , because we already have like our flow sheets for our documentation and like comes out , pops out into a table , um . But this one has cool like diagrams of .

It will like show you in a pie chart , like okay , you're here and you need to be here . Everyone else is here and you're like you got here .

So it's like kind of fun for like an educational piece from like for the kid or the patient and the family so you can kind of see like okay , this is where you are , this is where you need to be , you know , like helps them . Yeah , you know where they are in space .

Some people are really hardcore and they want that , but most people just want to know am I making progress or not in the things that matter ? And what do I need to do ? Or like what's the plan Right ? So the analogy I always give to people is making a psi change at the level of the belt which causes hydraulic .

I'm like dude , I have no idea what you're saying . That's what's happening when you explain to somebody this in-depth lsi with torque ratios and the patellar tendon graph , like I'm looking at this guy . I'm like okay , can you , can we fix it ? Like I just don't want to die on the highway . Like how much , how , how long do I need to leave my car here ?

What do I have to do ? And like and then he'll tell me like all right , leave your car overnight . And then when you drive on the road , you know , do this and this and tell me if it clicks , I'm like sounds good , I'll see you in a week . You know that's all they need 're talking about . This is research-based . There's data behind it .

But like what's my plan and how do I know if I'm following the plan , yes or no ? What things should I avoid ? That's about it . That's what most people want to do . You know , and then people follow the rules .

I mean , in general you're doing like the same kinds of things , it's just a different joint right , like you're still making a four inch motion , having full strength you pick some functional tests that you want them to pass before you return them to running , jumping sports stuff .

And you just like those things , create your tables and then like if it's an ankle , you're doing that , there's shoulder , you're doing that

. So I feel like setting yourself up organizationally , especially if you're like newer . That way you can kind of like organize your brain better yes I think . I mean I work in a clinic that I think has I have a pretty high like volume of patients , like I'm seeing like 14 plus patients a day , so I'm overlapped with lots of different diagnoses .

Post-ops , non-post-ops have , like you know , a seven-year-old with ankle pain that doesn't want to walk because it hurts , and then I'll have , like you know , a six-month-out post-op that we're working on starting to like run and jump again , you know .

So like simple math of like one 60 divided by one , 70 is what percentage compared to the other side , of how much shoulder flexion I'm missing , or whatever else it is .

So sometimes not only is it like useful for you to organize yourself , but then if you can do just basic out of a hundreds or side to side comparisons of like percentage of side to side , they see like oh , I'm 81% as strong as my left side . That's it , that's all I care about .

They don't need to know that I need 105 degrees of shoulder ER at 90 degrees , but 105 degrees at 45 is not going to happen . Like they don't understand that at all . So for your own educational simplicity , try to sometimes normalize things and things they understand . You know , green is good , yellow is not good , red is oh , that's okay , you're 70% .

It means that you're doing really well and it just takes time .

I have now like okay , you have this diagnosis , I like know what I want to do with you , but I feel like that just comes with time . I don't feel like all aside from like organization and like getting your reps in advice about like different patients and caseloads .

So now I can do it , but early on I would say that I was definitely a couple of joints were a little more intimidating to me and I was not afraid to ask coworkers for help if they have experience .

Like I think at my first job I worked with a person who was like a pretty good running PT and at that time I really did not understand foot and angle that well at all . So I would either lean on them about like , hey , what do you think about ? Like this Achilles tendinopathy ?

I don't treat a lot of these , you know , is this is my plan normal , is it not ? Or just like you're probably in better hands with somebody else because they really know high distance running , and that happens now all the time . I mean I treated a girl , um the husband .

The husband I treated he was a power lifter , but the wife was a long distance runner and she wanted to come see me because she just knew me from his case and like , wanted to work with me , which was cool . Um and like , all right , I can help you get back to like the average stuff and I can get you out of pain acutely .

But like after two or three visits , probably better if you , if you see Kevin and just kind of give him your whole situation because you're better in Kevin's hand , who literally runs competitive marathons the same way you do , to understand tempo and pacing and running and all that kind of stuff .

And even so , when I made her first program , I just asked Kev I was like hey , like what would you do for return to running program for a first person who has the eventual goal of a competitive marathon ?

He's like , oh yeah , no problem , I got like this program and I've made this protocol , I made a return to running program and so that's the strength of having a coworker staff with a diverse set of , you know , people is like Lisa treats a about this girl who had a pretty stiff knee every day . I was like Lenny , like what do you think ?

Feel this real quick for me ? Is this like normal ? Would you say yeah , and he was like , you know , it's a little bit let's , it's really hammered pretty home . And last week he checked and was like , yeah , it's pretty good , other people , you know , give people to other people and people send people to me .

Anthony yesterday in the clinic was like , hey , this kid's got a spondy stress reaction , um , flared up a throwing . Can you just chat with them real

quick and let us know whether you think we should go to the doctor ? It's like , yeah , I figured a thousand spondys I probably have a better pattern recognition than see as many as me , you know . But things that I no problem , but if Anthony hears them , maybe it's not the same register , same way with Mike and elbows and stuff . So that would be it .

Lean on other people . Delegate your case one or two here there to other people and then learn from their case how they treat them . If you don't have access to that , research books as much as you can to try to learn , or online mentorships are great . Online forums , chat with people .

You know there's a lot of great things online that you can follow with people .

But like I've seen some cases that come from two or three other people who , like you know , I'm super grateful they fly in for a one time console and it's like a very complex case or an elite who has an old spondy and they have nerve issues and they're trying to make a team and like it's not easy .

So with those higher complexity cases there's nothing wrong with asking around and getting opinions from different people . I referred someone to Ellen , uh , who was a complex spine case that had some like possible bone density issues and she got told by a surgeon like yeah , never do gymnastics , ever again .

And I was like I don't think I agree with that , but I'm not a surgeon , how can I say not to do that ? And so Ellen was able to kind of have a level head around that being a doctor and understanding that case and she's doing great now but like it took Ellen and her opinion . Then there's another .

There's like a PA , another doctor locally , ellen and me all kind of like what do you guys think you know , and that's a regular level nine case . It wasn't something crazy , so there's nothing wrong with . I need help . I don't know . Hey , what do you think about this ? And just talking over cases for sure , yeah , it can only make you better . Totally yeah .

But you know , lenny and Mike are mentors of mine and I considered idols when I was in grad school and you know them asking for me advice is like you know , that's cool to see that they're still humble and they want to just help the patient . They care more about that than you know , mike , knowing this or that Cool beans , cool beans .

All right , hope that was helpful . We'll get these three out and then I don't know when we'll film the next ones down the road , but if people have questions about these episodes , instagram for us or email is fine , and if you want an episode covered like a certain topic , you want more on email , instagram too , as well .

I think we're pretty open to chat about whatever . So we're doing good . I think this is our 12 , six , nine , it's like up to 10 or 12 that we've done , so I think we're cooking .