On this episode of the #AskMikeReinold show we have a special live Q&A on Zoom with over 200 people to celebrate our 200th episode! We answer questions live. Thanks so much to all our subscribers, we wouldn’t have gotten to 200 episodes without you! To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 203: 200th Episode Live Q&A Celebration
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Mike Reinold: Welcome everybody to this really exciting night for us here at Champion PT and Performance, even though none of us are actually at Champion right now. We’re all at home because we’re doing this in the evening. But we are here celebrating our 200th episode of the podcast, which we are super excited about.
Mike Reinold: So, it’s one of those things that’s funny. So Lenny and I were texting with one of our friends, Dan Lorenz, which you guys might know. He’s got dry humor on Twitter and is always tweeting some really cool things. But he said, “Hey, congrats on the podcast.” He’s like, “It speaks a lot that you guys, you’ve been doing it for so long and there’s so much competition out there with different people out there that you guys made it to 200.”
Mike Reinold: And I was like, “Oh Dan, just because we have 200 episodes, it doesn’t mean anybody’s actually listening.” Right? We just keep… We’re prolific with keeping it up, but nobody’s listening to any of our podcasts. So, but no, in all honesty, we’re here because of you, of everybody on this call right now. You’re the reason why we’re here.
Mike Reinold: We started this… All of us have a presence online, right? You know everybody here, I guess I should make the intros too. I don’t know how this is going to look on the recording but again, Lenny Macrina. Lenny Macrina is here. Mike Scaduto down there. It’s like mega Brady Bunch board here. Dave Tilley. Dan Pope over there.
Mike Reinold: Way over there, Lisa Russell. This is our PT crew at Champion PT and Performance. And we… Nick, we may have to mute somebody. Is somebody not muted? I see a lot of people that are unmuted Nick.
Nick: Gotcha. Let me see where I can…
Mike Reinold: I just muted a couple of them. But we’re all here. We all have a big online presence. But you know what we said a few years back? We actually said, “Look, we write blog posts, we do social media posts, we put stuff out there. It’s what we’re thinking. It’s what we are doing, and want to teach you right at that time.”
Mike Reinold: But we said, “What if we completely flip this and you guys ask us the questions?” Instead of us just force feeding what we’re thinking right now, we want to answer the questions that you guys might have. And that’s why we started this podcast now four years ago. It’s been four years, been doing it almost every week, right? We do it probably 50 weeks out of the year, just skipping a couple of holidays.
Mike Reinold: So we did this for you and I can’t tell you how humbling it is to be still doing it four years later and so on. So I want to start it off with this. I want to start off with a toast, right? So, if you have a beverage… I know you do Derek. If you’ve got a beverage, if everybody’s out there… We were thinking about going all for this.
Mike Reinold: I want to do a toast, and this toast is to you guys, is to the listeners, the people that watch us on YouTube, the subscribers to our podcast. It’s you. Thank you for being here for us, because the fact that you keep submitting questions to us is why we keep doing it every week and answering it. So thank you so much for that. I’m going to have a-
Mike Reinold: Salud. So, without further ado, let’s get right into it. We’re going to start going a little bit more into faster-paced questions. We can all talk for a half hour about one topic, but if you have something, type it in the chat box, let us know what you want to talk about. Try to keep it a not crazy, “What’s your philosophy on fitness?” Right?
Mike Reinold: Try to keep it a little bit more specific so we can have some really quick, cool answers. Everybody ready? I like it. Let’s do this. All right, Nick, who’s first?
Nick: All right, I’m going to unmute Matt Miller.
Matt Miller: What’s up guys?
Mike Reinold: What’s up Matt? Oh perfect. What’s up? I see you there.
Matt Miller: How you doing?
Mike Reinold: Matt, what’s going on man? What can we answer for you?
Matt Miller: So my question was, a lot of the weighted ball stuff that I’ve been reading about, and you guys talked about, seems to be the benefits are getting that increased lay back, the external rotation aspect of it. Which also puts more pressure on the UCL, obviously. My question was is there a way to maintain a normal or safe level of lay back while also increasing the strength or the stability of the internal rotator muscles? To kind of have the best of both worlds where you get that velocity increase but also protect or decrease the stress on the UCL.
Mike Reinold: I like it. All right. Yeah, I’ll start off with that one. And I can tell you right now that Dave Tilley is excited. We’re starting this off with a baseball question.
Dave Tilley: I’m fired up.
Matt Miller: Obviously.
Mike Reinold: Oh Indians.
Dave Tilley: Just wake me up in an hour when I can watch baseball.
Matt Miller: Got the Indians on.
Mike Reinold: AL Central rivals right there. So, well I’ll start it off with this. So what we’re finding with the science of weighted balls right now is that they work probably by increasing that lay back, like you said. That is good and bad, right? And what we found over the course of our studies is that, not that just lay back goes up, but it goes up dramatically and quickly.
Mike Reinold: In an acute setting, we had people that use heavy balls, the one, two pound balls. Even at partial effort throws, they’d go up over five degrees of external rotation acutely. So it’s interesting. What’s happening, right? Are they stretching something out? Are they tearing something? I don’t know. Maybe chronically they are, but what they’re probably doing is desensitizing the GTL.
Mike Reinold: So then what happens is they have all that lay back and they throw on it and you’re taking an activity that is already extreme force and speed at end range and you’re making it worse. So they’re dangerous to an extent. Now, that doesn’t mean they’re not effective and it doesn’t mean you can’t use them, right? A five ounce ball is somewhat dangerous too.
Mike Reinold: I think it all comes down to the dose. But a lot of people are saying, “What can we do? Is doing that beneficial? Do you strengthen the ligament like that?” I don’t think a ligament adapts like a bone does with Wolff’s Law for example. And there’s some recent studies coming out right now that actually show that a UCL over the course of the season gets engulfed, but probably in a bad way.
Mike Reinold: So ultrasounds actually showing that if you diagnostically look at the UCL, there’s actually some dark areas in there and it gets engulfed and large over the course of the season in a bad way. Lenny, would you add anything to that?
Lenny Macrina: No, I think you said it well. I think we’re looking for that magic bullet versus… I know you know this Matt, but have we worked on everything? Arm care and strengthening and maintaining the range of motion. And yeah, in a perfect world, getting that lay back, but being able to work on some scap strengthening would be ideal.
Lenny Macrina: But I don’t think it’s that ideal. So I think we just need to… It’s going to be obviously individualized and that’s what we try to do at Champion. And so, that’s what we… We use weighted balls but not to the extent that I think other people are. So, there’s other things that we like to focus on.
Mike Reinold: Awesome. Mike, did you have something too?
Mike Scaduto: Yeah, just quickly, I would say screening athletes before they start a weighted ball program can be huge. There are some people that I think would benefit more from a weighted ball program and some people that may benefit a little bit less. So if you have someone that already has 160 degrees of lay back, and you want to add some more on top of that, that may not be best for that person.
Mike Scaduto: But if someone’s a little bit stiff into external rotation, they may benefit from getting a little bit more. And then the other thing I would say is continue to monitor their external rotation as they go through the program. If they start getting these really big jumps and it’s not correlating with philosophy or you think they’re at a higher risk for injury, you can always back off the program or you can stop the program at that point.
Mike Reinold: And think about it, right? It’s just like anything else in medicine. If you’re going to do something that is as close to as max strength as we can, you’ve got to monitor, right? Just like Mike said. You assess, reassess, you monitor the dosage. Thanks Matt. Who’s next, Nick?
Lenny Macrina: Thanks, Matt.
Nick: All right. We got Abby Gordon is next. How does Abby always… She’s the second one. She’s got good questions. What’s up Abby?
Abby Gordon: Hey guys.
Abby Gordon: I’m wondering about any tips for PTs who want to present more around the country or even bigger than that since you guys do that.
Mike Reinold: Ooh, I like it. That’s pretty good. Len, why don’t you.. I don’t know. Why don’t you start off with that one? How’d you get into presenting some stuff like that? And I’m kind of hearing maybe Tilley and stuff like that. I know you’ve been kind of thinking about doing more of that. But what are you guys thinking?
Lenny Macrina: Yeah, I mean I started off small, obviously. Probably an inservice, which everybody probably does. But at my facility that I was at in Birmingham, we did talks with our docs every Monday, Thursday and Friday. And so, I somehow weaseled my way into do a talk and it was an hour talk. And you get comfortable, people see you, and then you do a second talk. And then you get comfortable with that and you just…
Lenny Macrina: It’s good to find that opportunity, you know what I mean? Whether it’s doing something locally to the docs… But it shows interest. It shows that you care about the profession, you’d be trying to promote what you guys are doing at your facility and educate others. So I think once you get the snowball effect going, you’ve got to keep it going. So you’ve just got to figure out a way that person that’s influential in your facility or it’s a connection that you have…
Lenny Macrina: And again, we always talk about this. It comes down to connections, right? People you know. Can those people help you out and achieve your goal? And you’ve just got to figure out that person that can help you. For me it was Mike and Kevin and Dr. Fleisig and Dr. Andrews, allowed me to speak to them. And then next thing I know Kevin is like, “Oh, do you want to do another one?” And then next thing I know I’m helping Kevin with talks around the US and then I have my own course. So it’s somewhat luck but it’s also having connections to people that trust you once you prove yourself.
Mike Reinold: And true story too. We were waiting for Lenny to get rid of that Boston accent to see when he was ready to go to that natural… That next stage here. And after two, three years we’re like, “All right. We might as well unleash him to the world.” So, fun fact, Lenny and I were neighbors growing up. I don’t know why we talk so differently. But I used to sound like Lenny. So, what’s up? Anybody else have anything? Did I see another hand? Oh, Pope. What’d you have, man?
Dan Pope: And I’m not crazy about speaking internationally and it’s not really the main thing I want to push in my business, so take that with a grain of salt. But early on I really wanted to. And the big thing that helped me out was just trying to speak as often as I can and trying to put myself out there for free, for anyone that I think that I could be helpful with.
Dan Pope: For me, I’m in the niche of fitness and I knew a lot of CrossFit Gym owners just ’cause I was friendly and I love working out with those folks. So I just asked, “Hey, would you guys want to do a seminar for free?” And I would just put on about say mobility or forcing the snatch or anything along those lines.
Dan Pope: And two things, I think for one like Lenny says, it builds your network and has other opportunities. But you start getting better at it, you get more comfortable, you figure out what people like, what they dislike. And over the course of time I think that really helped me to get onto a bigger stage from the beginning.
Dave Tilley: Yeah, I would agree a lot. The last thing I was going to say, is just try to make sure academically you have stuff that’s unique and interesting. I think unfortunately as more and more people are speaking, it’s really easy to hear the same thing over and over. So, I found that things changed for me a little bit more in my ability to speak when it was new information that people are like, “Oh, this is…” That gets word of mouth passed on more.
Mike Reinold: Yeah. And I’m going to give you a bonus answer to this, Abby, because this is my biggest pet peeve where you can tell when somebody’s new at speaking like that. If you finally get to present somewhere, maybe a state chapter of your APTA or something like that. Or maybe you get lucky, you get something submitted to CSM or something like that. And you have a talk like, let’s say me on rehabilitation following Tommy John surgery, right?
Mike Reinold: Do not spend your first 25% of your talk talking about the humerus and the ulna, right? Going over bases. Stick to the strict thing that you are instructed to talk about. So, awesome. Thanks, Abby. Who’s next, Nick?
Lenny Macrina: Thanks, Abby.
Nick: Oh, we got May is up next.
Dave Tilley: May! May!
Kara May in the house. What’s up, Belmont?
May: Hi, guys.
Lenny Macrina: Virginia. Go, Virginia. Oh.
May: Okay. So I had said a baseball player for this, but for Dave, it can apply to any athlete. Have you ever had to manage an athlete on blood thinners during the season? And if so, how? Were you able to find a way to allow him or her to play in games?
Mike Reinold: Ooh, good one.
May: Personally, I have his going on right now, so I actually want to know.
Mike Reinold: I have, but I’ll see if anybody else… No one? No. So yeah, maybe that’s the athletic trainer in me, but you come across those things a little bit. So the number one thing, obviously as long as the physician’s cleared them to play, which I bet they would, right? It has to be controlled.
Mike Reinold: So the biggest thing we’ve always done, is we just did daily blood monitoring, honestly to just make sure that the dosage of their medication was right. Because especially at the pro level or collegiate level, their travel’s really weird, nutrition’s really weird. You can get all out of whack pretty easy with something like that.
Mike Reinold: So yeah, if you are caring for somebody that is on blood thinners, the biggest thing is just to monitor and make sure that their testing is there. If it’s uncontrolled, then you’re going to run into trouble. Make sense?
May: Okay. Yup!
Mike Reinold: Sweet! Nick, who’s next? I like it, Kara May.
Nick: All right, we’ve got Josh.
Mike Reinold: What’s up Josh?
Josh: Hi. Nothing much. How are you guys?
Dave Tilley: Good.
Josh: My question is after an athlete’s healed from an ACL torn, how would you mentally get them ready to get back onto the field?
Mike Reinold: Did you say MCL or UCL? I missed that.
Mike Reinold: Oh, ACL. All right, so if somebody is coming back from an ACL. Did they actually… Are they rehabbing it? Or is this you ran out on the field and their ACL was torn?
Josh: They’re kind of rehab.
Mike Reinold: Got it. So, all right. So, let’s see. We talked about this in a podcast recently. What do you guys do for somebody maybe that’s dealing with some maybe kinesiophobia or maybe some fear? What’s some of the biggest things we do? Lenny, why don’t you start with this one? You’re kind of our knee guy.
Lenny Macrina: I play mind games with them from day one after surgery. So I am building mental confidence in them in everything I do. So if they have an awesome quad set, they are going to know about it. And it goes from there for the next nine plus months. So it’s not at the end I’m like, “All right, how do you feel? You’re scared? All right, let’s work on that.”
Lenny Macrina: So I am building confidence the whole time, whether it’s through a leg raise or that they went up in their squat or they did something different and they felt good about it. I am building confidence the whole time and trying to get into their mindset to see how they felt about it, to see how they feel. There are questionnaires out there that you can give to people.
Lenny Macrina: But Tampa 11 scale or the ACL RSI, I use those somewhat. Not as much as others do, I think because I’m not really confident in my clients to give me honest answers to them. So you can monitor that. I know starting at three months out of surgery, a lot of PTs are using them and monitoring that about gaining confidence. But to me, I am just building confidence from day one. And it usually works with these people.
Lenny Macrina: You’re going to hit a lull and you’re going to tell the people, “You know what? It’s very normal right now to hit a lull.” But let’s do something and make sure we put them in a position that they’re going to feel good that next time, so they go back feeling good about it. So not a straight answer, but I think it’s one way that I do it.
Mike Reinold: I love it. Who’s next, Nick? Good question, Justin. But that was Justin, right?
Nick: That was Josh.
Josh: I’m Josh.
Mike Reinold: Josh. Sorry dude. My bad.
Josh: You’re fine.
Nick: We’ve got Gabe Morgan is up next.
Dave Tilley: Gabe!
Lenny Macrina: The Gabeanator!
Mike Reinold: Gabe! Now hold on a second. Now, I feel like we needed to… We should have planned this. So the Gabeanator. Say hi, Gabe so I can see you.
Gabe Morgan: Hey, what’s up man?
Mike Reinold: What’s up? I think… Yeah, there we go. I was going to say, you have to start talking for it to pop up on my screen. But so, Gabe was obviously our first student that was asking us questions on the podcast. So I think that means you’re famous. That’s my take at least.
Mike Reinold: But we got to watch Gabe grow up in front of our eyes from just a normal human being, Gabe Morgan right? To actually even changing his Twitter handle to The Gabeanator. So he really grew up in our eyes and everything. So Gabeanator, what’s going on man? Welcome.
Gabe Morgan: It’s good, man. Congratulations on 200 episodes. I kind of went in intermittently here and there. Sometimes the questions seem to repeat themselves every now and then. So I pick up when something new pops up. But 200 episodes, that’s a lot.
Mike Reinold: That’s awesome.
Lenny Macrina: Thanks, Gabe.
Mike Reinold: So be honest, when you were there for that first episode, were you thinking in your head, “There’s no way this thing… This isn’t going to work.”
Dave Tilley: These clowns will never make it.
Gabe Morgan: Honestly I was there to help you all out. So I mean if that helped y’all to get to 200, that’s why I was there for.
Mike Reinold: I think it was just me and you right, Len?
Lenny Macrina: Yeah.
Dave Tilley: I hadn’t started working there.
Mike Reinold: I’m like, “Wow. We’ve grown.” That’s pretty funny. So, Gabe what can we answer for you buddy?
Gabe Morgan: All right, so a little backstory here. I work with active duty army and most of the PTA’s tend to do treatments. And the hex bar deadlift is now a standard for their fitness test. So a lot of people are scared about performing a deadlift because there’s a lot of fear attached to back pain and deadlift techniques. So what is the easiest way to coach a hip hinge pattern for the low bar hex bar deadlift for someone that doesn’t have a coaching background?
Mike Reinold: Wow, so your standard is even a low handle trap bar?
Gabe Morgan: Yeah.
Mike Reinold: Wow. So that’s interesting. Why go trap bar? Anyway, that’s a whole nother story. But-
Gabe Morgan: Yeah, that’s another long talk there.
Mike Reinold: Anyway, Pope! You want to take that one? What do you think? How do you get somebody started coaching the hinge that doesn’t have a good coaching background?
Dan Pope: You got it. Are you saying the athlete has no experience hinging or the coach has no experience teaching athletes how to hinge?
Gabe Morgan: Both.
Dan Pope: ETA, I’m guessing in your case.
Mike Reinold: Both.
Dan Pope: Yeah, sure. So a couple of really easy cues I think are helpful… Or excuse me, are helpful for teaching a hip hinge are to try to stand close to a wall. So if you have a wall behind you and have athletes just reach their butt back towards the wall, that’s a really easy cue to help them to hinge, right?
Dan Pope: If you’re noticing that they’re getting a whole lot of flection in their lumbar spine while they’re doing it, I ask them to reach their chin forward and their hips back. And usually that creates a nice hinge, right? From there you can get a little bit more elaborate and just say, “Okay, I need you to sink down a little deeper or bend your knees a little bit less.”
Dan Pope: But those are probably the easiest to use that I teach people to try to hinge. You can utilize a dowel. And that’s probably the most classic one that people use for hinge, right? Put the dowel along someone’s spine and from there, reach the hips back so people can have an idea of how to keep some contact with that dowel and keep a neutral spine.
Dan Pope: But oftentimes I feel like you don’t even need that. I skip that step almost every single time. And then from there, arms are nice and long, get down a little deeper, grab onto the barbell. If things are not neutral at that point, reach the chest up a little bit more, hips back a little further, and usually that takes care of it.
Dan Pope: I know that’s super simple, but oftentimes the hinge is one of those movements that happens pretty naturally with a couple of easy cues. But I think also in the social media world, you would think it’s like you need to have two to three courses just to learn how to master the hip hinge movement. You know?
Mike Reinold: Yeah, and I would just add too, that the fact that it’s a hex bar, I think it’s really easy if somebody is unfamiliar to turn it into a squat pattern with a trap bar. So just, I think the big thing is just driving the hips backwards, right? So Dan gave a couple of good cues, like using external cues and using some external stimulus for that.
Mike Reinold: But it’s about driving the hips back. I think that’s the big key. So, thanks Gabeanator. Appreciate it.
Lenny Macrina: Thanks, Gabe.
Mike Reinold: One to 200.
Dave Tilley: See you at 400 buddy.
Mike Reinold: That’s impressive.
Gabe Morgan: Yeah, I’ll be there.
Mike Reinold: He’s asked questions on the first and 200th episode. Nick, who’s next?
Nick: All right, we’ve got Vince. Hopefully I didn’t miss that last name up.
Mike Reinold: What’s up, Vince?
Vince: What’s up guys? You nailed it. You nailed it. All right, so my question to you is right now I’m a first year SVT. Nice and simple. If you could go back in time and give yourself any advice before your first inpatient clinical or job, what would you have told yourself? Thanks guys!
Mike Reinold: Oh, thank you so much. Vince, I’d start it off. For me, that was mid-nineties. I’d probably say believe in Apple stock, right? It’s going to make a comeback. It’s… I think it’s going to be… They’re going to hire Steve Jobs back. Just trust me and it’ll all go. That’s what I would say. But I don’t know, who wants to start this one? What do you think? Let’s hear from a couple of different… How about Mike and Lisa? Mike, why don’t you start? What would you tell yourself now? All the great wisdom you’ve learned?
Mike Scaduto: Yeah, actually I think looking back at my experience, my second clinical was an inpatient in an acute care in a big hospital setting. And I really, in my mind at that point I’d kind of made up that I wanted to work with athletes. I was pretty hard set on doing that. So what I did was my shift at the hospital was 7:30 AM to 3:30 PM and then from 4:00 PM until closing at this gym I went and I shadowed at a gym.
Mike Scaduto: And if you want to work with athletes, I think you can use that time during your clinical when you have some free time at the end or beginning, find a gym that’s close to the hospital and shadow there. I think you should definitely commit yourself and dedicate yourself to the inpatient clinical and learn as much as you can. But if you really know that you want to work with athletes, find a way to continue to work with athletes during that time and continue to grow towards your goal.
Mike Reinold: I think that’s great. Lisa, any other advice? What would you tell your student self?
Lisa Russell: Yeah, so I actually had my inpatient around the same time, it was my second clinical. And I think there’s a lot of value in learning that stage of rehab. I think there’s a lot of value in seeing what people need to do in order to come from whatever bottom level they’ve reached to put them in an inpatient rehab setting.
Lisa Russell: And I think being able to learn from the experiences you have with those people to carry forward into your athletes in terms of the little bit at a time that those people have to do to get better or the complicated backgrounds that they might have. But I think what I learned most out of that one was to be able to manage a lot of complicated things within a patient’s chart. Which I think you can carry that forward into any population. Any athlete that’s had a lot of surgeries or anything like that.
Mike Reinold: Yeah, it makes sense. I think there’s a lot of carryover from inpatient too. If you do want to get to outpatient, you’ve got to see what it was like those first few days.
Mike Reinold: The pain they were in, you get to probably read the off-note a little bit easier than you would have if you were outpatient so keep that in mind. One little tip that I did, my inpatient rotation was with Dr. Andrew. It was all Tommy Johns and ACLs, so that was pretty cool. If you can get in there or you can get into Tim Heckman’s place. I know he’s got all knees from Dr. Noyes and I know he’s on the call tonight but obviously try to get into an inpatient place that is maybe a little more specific to you too. That’s another one. Nice. Good answer, Vince. Good luck in school man.
Vince: Thank you.
Mike Reinold: Who’s next Nick?
Nick: We got Steve up next.
Mike Reinold: What’s up Steve?
Steve: Hey guys.
Mike Reinold: What’s going on?
Steve: Thanks for doing all this. And my claim to fame is I work with Abby.
Mike Reinold: That’s fantastic. I’m glad you’re not driving next to her. I’m still worried about Abby.
Steve: Right? All right, so you guys talk a lot about strength training and loading and periodization with the quads after ACL surgery reconstruction. But how about hamstrings? What’s your favorite go-to hamstring exercise for loading, for home exercise programs, particularly in light of right now, a lot of people can’t get to gyms.
Mike Reinold: Nice. All right. Who wants to tackle this one? I feel like we can all answer this. Whoever raises their hand first. Let’s see. So, I’m going to pick Len, though. So Len we talk quad all the time after ACL. Right? So, talk to me about hamstring.
Lenny Macrina: Yeah, I mean that’s definitely a focus in my head. Quads are definitely the king after an ACL. But I’m hitting quads, I’m hitting hamstrings, and I’m hitting glutes. So for me, in a perfect world, meaning we have jobs and we are working in a facility, I am dead lifting, I am doing Nordic hamstring curls, which people can do at home. That’s a great one to do whether it’s assisted with a band or if they can just somehow have somebody hold their feet at home. The Nordic hamstring curl has been shown to be a great exercise for the hamstrings. You can do ball rolls, so like a supine feet up on the ball, roll on the ball. You can do supine feet up on furniture movers like sliders and slide there, extend their feet out and extend the knees out and then bring their feet under. So I think there’s a bunch of ways for me to do stuff and be creative at home without needing a hex bar or some kind of conventional deadlift that we would typically do in a facility. So to me those are great hamstring exercises.
Mike Reinold: Tilley, did you have something?
Dave Tilley: Yeah, I’ll just weigh in that I learned this from Pope actually what he was doing. Instead of doing like single leg RDL with your foot off the ground, like balance might be the limiting factor. I think like kickstand RDLs are phenomenal because you can load them up quite a bit more and not be limited by balance. So just like heavy backpack, bunch of books, and just do a mid-shin kickstand RDL.
Mike Reinold: Yeah. And I just say like in baseball we’re starting to put a little bit more emphasis on hamstrings. Even with our pitchers because we’re starting to see a lot of baseball pitcher strain their hamstrings too, not just the position players. And we started testing, we started using things like the NordBoard from VALD, and actually trying to quantify all these things. And believe it or not, if you take a hamstring graft, so ACL or even Tommy John, you take a Chrysalis grafts and like that, you have some pretty persistent strength deficits in there that that’s got to mean something that’s got to mean something. So let’s see, Pope, what else do you got?
Dan Pope: All right. Real quick. I also think that we can probably get the hamstring trained a little bit in a more functional manner by working on things like sprint drills. I love ABC March, ABC skip, ABC runs, and this is dynamic. They don’t have to be the maximum level, and you’re training the hamstring for what it’s supposed to do functionally. And once you get to the point you’re able to run and it’s going to be great way to train the hamstring as well. So I think sometimes we’re thinking of all the exercises, they’re so important. It’s hard at the hamstring. Obviously they are. But we have to prepare the hamstring for what it’s actually supposed to do. So I think the springing can qualify for that.
Mike Reinold: Love it. Great. Go for the win. Nice. Awesome. Good question Steve.
Steve: Thanks guys.
Mike Reinold: What’s up Nick? Who’s next for us?
Nick: Alright we got Michael.
Mike Reinold: What’s up Michael?
Michael: Thank you for having us on here. This awesome.
Mike Reinold: Yeah man. Welcome.
Michael: So my question is, what advice would you have for people who are going to be in college and PT school for their future physical therapists. And what advice would you have for them to set up for a part in the job field. Kind of like how you did to work for the Red Sox.
Mike Reinold: Yeah. So I mean I think the biggest thing you do is like not everybody knows what they want to do while they’re in college. And I had a lot of classmates that thought for sure they wanted to get in sports and ortho. And then they did like a pediatrics rotation and they loved it and they changed their career. Right. So I’d say as a student, keep an open mind, but if you have something that you know is probably kind of your number one thing, the best thing you can do in PT school to set yourself up for future success is to get in at a good clinical site, right? So seek out people that are doing what you want to do, and learn from them and hopefully even integrate with them a little bit over time.
Mike Reinold: Right? So I always tell the story, that’s kind of what I did like back like in the nineties before this inner web thing was invented by all these smart people. We essentially had to make phone calls. And I remember I just called up Dr. Glenn Fleisig with ASMI one day, and like he answered like on the second ring. And now that I know Glenn, he doesn’t do that much at work. So I, it’s actually not a weird story anymore, but like, but at the time he answered and I sought them out because they were the experts in the field I wanted to be in. So I went to learn from them. So I think that’s the biggest thing for you, for you right there to to try to get started, Mike. Does that make sense? Okay.
Mike Reinold: So who’s next, Nick? Welcome Michael.
Nick: Alright we got Jay.
Mike Reinold: What’s up Jay?
Jay: Hey Mike, everybody. Great to be on the call. Thanks for, thanks for doing this. A couple of quick questions I posted for you guys. It was baseball related. Nick, I know you’re saying maybe let’s go a little less baseball but just you know, I feel like we’ve beaten the shoulder range of motion restrictions and T spine range of motion restrictions and these guys, just wondering your thoughts on possible cervical spine involvement. You know, restrictions and cervical extension or rotation that we’re seeing with some of these starting pitchers. And then also your thoughts on like the arm care programs and seeing this, this UCL injury prevalence, like still climbing despite what we’ve known, what we tried to implement, you know, what are your thoughts on arm care programs and trying to keep these elbows healthy and these guys, it’s a, it’s loaded and obviously there’s a lot of money at stake with these pro pitchers and even collegiate level. It’s a big issue for us.
Mike Reinold: Yeah. I’ll start with the second one and then I don’t know, we’ll see maybe like Lenny, Mike or somebody can take over and talk about some of the other things like kinetic chain basically. But for the second half of your question, both these injury rates still going up. You’re right, like so you know ASMI, the American Sports Medicine Institute, they have this Injuries in Baseball course every year, and it’s, I literally, I’ve been going to it, I’ve been speaking at it, I think it’s been like 21 years now that I’ve been going into a row. And I got up the other day when I was at the 20th, I got up and I was just like, you know what? This is my 20th year presenting here and injuries are getting worse. So clearly none of this is working, right? We’re wasting our time with these conferences.
Mike Reinold: But I think the big thing what’s happening, and I put this on an Instagram post, I think it was yesterday or the day before, is that we are just overdosing, right? So in the past there were people were throwing with less velocity. They were taking more time off and weren’t showcasing. They weren’t doing as much. So I think it was just what’s happening now it’s just we’re simply overdosing. If you look at all the studies at what correlates to injuries, we’ve tried to blame everything right? In the eighties we blame the split finger. In the nineties we believe the curve ball. In the early two thousands we blamed mechanics like inverted W’s and stuff like that. None of those things technically panned out. They all increased stress, but they didn’t correlate the injury’s workload correlated to injuries. And I think everybody on this call could relate to that. So I think that’s the reason why, so it’s not magical.
Mike Reinold: It’s not anything anybody’s doing wrong. These kids are doing too much. Right? And I don’t know how much we can do that, but who wants to jump in and say like, you know, we see like cervical stuff like all the time in there and it’s, you know, the muscles connect. Right? But Scaduto you want to jump in on that?
Mike Scaduto: Yeah, I would say definitely starting to see it more often or maybe look for it more often. And you know, maybe not necessarily cervical facet joints that are irritated, but a lot of soft tissue in the neck and a lot of traction related nerve based pain and nerve based symptoms that may be like indicative of thoracic outlet syndrome or something like that. People are kind of feeling it very proximately in the cervical spine or in front of their neck. I’m seeing a lot of upper trap tightness, a lot of posterior scalenes, middle scalenes. I’m kind of going into a subclavius and tech minor and stuff like that. I’m sort of seeing, I’m seeing a lot of people presenting with some soreness and tightness or maybe even some numbness, tingling, loss of sensation in their hand. We started looking up towards the cervical spine when we start looking more towards like a thoracic outlet based syndrome.
Mike Reinold: Sweet. Awesome. Thanks Jay. Good question. What do we got, Nick?
Nick: Hi, we got Tony Mitchell is next.
Mike Reinold: That was very formal, Nick. Nailed that one. What’s up, Tony?
Tony: How are you guys doing today?
Mike Reinold: Good, how are you?
Tony: Doing good. All right, so I have two questions. I don’t know if I’m allowed to ask you questions. Is that all right?
Mike Reinold: Well it’ll depend. Ask them first and I may ignore ones.
Tony: Yeah. All right, that’s fine. Okay, first-
Mike Reinold: Uh oh, might not be able to get any of them. Alright, Nick, who’s next and then maybe we can get Tony to reconnect. Who’s, who’s next on our list?
Nick: We got JP next.
Mike Reinold: Sorry Tony. Connect, reconnect though.
Mike Reinold: Reconnect on 4G. That’d be awesome. All right, who’s next? Nick?
Nick: I got JP.
Mike Reinold: What’s up JP?
JP: Hey, what’s going on guys? So I’m from San Diego, California and I just want to say first of all, congrats on 200 episodes and thanks for putting this on. This is legendary, so.
Mike Reinold: Awesome, thanks man.
JP: So my question is pretty general, I’m a PT student right now, but how do you guys go about restoring range of motion? Do you guys utilize like static stretching, dynamic stretching, PNF or something else? Just cause like our new understandings regarding the mechanisms behind stretching have me confused on how to do programs or like dose stretching in our patients.
Mike Reinold: Oh, I love it. That’s a good one. Who wants to start that one? Or who wants to take that one? That’s a good question.
Dave Tilley: Yeah, I can take this on. I deal with a lot of people like that’s their main goals is get like hyper mobility back or full range of motion stretching. And the biggest thing is you have to understand like the basic science and then take that with a grain of salt and actually apply things, right? I think people are stuck too much in the why it works. Does it work? And people like if you listen to social media, nobody would do anything ever. Like we would just stand there and look at people, right? Wouldn’t get anything done. So understand the mechanisms but then use a little bit of everything that’s affected from the research we know. And so Dan and I often talk to people in large group settings when we say like use a little bit of everything that you think kind of works from the research. It has good support and then maybe put it in a circuit versus just doing one thing for like 10 minutes. Right?
Dave Tilley: So maybe a little bit of soft tissue work real quick. Maybe a little bit of static stretching has some decent support behind it for a big systematic review that came out. Eccentrics are really good as well. And then I think people miss strength conditioning and just good exercise programming. Right? Those five things all have pretty decent support behind it for, you know, longterm mobility gains. So consistency over intensity is probably the most important thing. And I would just kind of sprinkle in a little bit for everybody.
Mike Reinold: Yeah. And they just realize that a loss of motion can have several different mechanisms, right? You could have capsular tightness, you could have soft tissue tightness, you could have a length issue, you could just have a tone issue. You could have a spasticity or regarding issue that needs more neuromodulation. So I think the key to really doing it instead of just trying a little bit of everything is trying to figure out exactly which one of those is the culprit, I guess is the one. So, but good question. Good luck in school, JP. Enjoy the weather down there. Jealous. All right, Nick.
Nick: We got Katul next.
Mike Reinold: What’s up, Katul? What’s up, brother?
Katul: So I have a couple of distal biceps tears in the clinic right now, and I saw another therapist do a supine bicep thing and that kind of made me think about what we learned about the ACL with pro and hamstring hang. So I was kind of wondering if there’s, if it’s just as dangerous to do a supine bicep hang as it is with the pro hamstring hangs with ACLs.
Mike Reinold: That’s interesting. So distal bicep and they just have them hanging. Just holding with gravity?
Katul: Yeah, just trying to get that extension. I’ve reversed it’s, I have them prone with relative super nation and I pushed down like I would do with the knee. I was just kind of, I was kind of wondering if there’s like any relation to that or if I was on the right track of thinking.
Mike Reinold: I know that’s pretty neat. You know like you know, Lenny and I’ve talked about the guy quite a bit. I think we both have posts on our websites that kind of talk about, you know, the position of, of a knee hang. The reason why we don’t like a pro knee hang for knee extension is because it’s, it’s often uncomfortable and you get some guarding in there. So I would say to answer your question, I think like whatever position allows them to relax so they can be in that position. I think that’s the one you want to go for. So if it’s prone supine, whichever way you have in there, whatever allows them to relax and not guard against the motion. Right. So in terms of like the safety, you kind of talking about the safety of it there, I think it just depends on what week you’re at.
Mike Reinold: Like the healing tissue type thing. Should you be just doing some gentle, like you can progress from just like the body weight to then actually adding some over pressure and maybe even some low load long duration. So I would say it’s safe if you’re doing it with the right load at the right time. And just pick the position that allows the person to relax and not guard against it. Sound good? Cool. Awesome. I was going to pitch that to somebody else, but I think that nailed it. So Nick, who’s next? Thanks Katul.
Nick: We got Bryce next.
Mike Reinold: What’s up Bryce?
Bryce: Hey, how are we doing?
Mike Reinold: Yo.
Bryce: I just wanted to ask, I’ve had a lot of ankle injuries during football and I was wondering what are ways to improve ankle mobility and ankle strength?
Mike Reinold: Nice. I’m going to throw this to Tilley again because we talked about ankle sprains and the first thing you said is ankle mobility is what he wanted to work on. So Dave works with a lot of hypermobile people that think they need mobility, but maybe they don’t. What do you think, Dave? What would you recommend that we do here with Bryce?
Dave Tilley: Yeah, I would say the other layer to this too is a lot of like gymnasts that I work with this destroy their ankles from landing really heavy. So it kind of leads to the important part of the question, which is a lot of reasons why you could have limited ankle mobility. So you know, I’ve had some gymnasts that come to me and like, Oh, I’m stretching every day, I’m doing everything I can. And they have a massive osteophyte in the talar dome because they’ve just like beaten their ankle up. So that’s one possibility. I’m not saying that you have that, but that’s like the joint itself could be a big problem, right? So if there’s an issue with the joint that’s a different problem you got to outsource but then pass that. If it’s an actual rehab problem, there’s the joint itself could be stiff and then the calf muscle or the soleus could be limiting.
Dave Tilley: So you kind of got to do some assessments there to figure out, you know, if someone does some glides on your ankle and it was like, Oh, it’s a, it’s a stiffness in the joint. You might have to do some more like you know, distractions and some joint mobilizations versus if somebody says like no, that looks pretty good. But like you know your calf is just super, super stiff and you might have to work more on the soft tissue stuff, which is kind of what we talked about before, which is some soft tissue work manually. Some eccentrics off a step, a real good as long as you’re feeling it in the back and not in the front of the joint. So I think the screening process is really important to know kind of what Avenue to go down first, if that makes sense.
Mike Reinold: Dave do you need to change the battery in your smoke detector? Is that what’s, no you’re the one talking I just assumed the microphone was picking you up. All right Nick, who’s next?
Nick: We’re going to go with Jeremiah. You’re up next.
Mike Reinold: What’s up Jeremiah?
Jeremiah: Okay. Can you all hear me now?
Mike Reinold: I got you. Yeah. What’s up man?
Jeremiah: Okay, so I have a question. So I’m an athlete and I have kind of like bad hips and so I’m wondering like what type of advice would you do? Would you give me for helping all my hip flexibility and mobility?
Mike Reinold: Wait, what sports do you play, Jeremiah?
Jeremiah: I’m a football player at Wittenberg.
Mike Reinold: Nice. Awesome. What position do you play?
Jeremiah: Offensive guard.
Mike Reinold: Got it. All right. So you’re a big dude?
Jeremiah: Yes I am.
Mike Reinold: Nice. That’s what I’m talking about good. All right, so Pope, what do you think? We’ve got a big offensive lineman, right? That you know, are you having some hip pain? You’re having some hip issues right now, Jeremiah?
Jeremiah: Yes sir.
Mike Reinold: Yeah. So we get a bunch of it, you know, things going on. So what do you think Dan? What do you recommend? I mean I know that’s kind of broad without being able to see it, but like what’s some of the things that you see in some of your athletes, especially some of the big athletes in contact sports?
Dan Pope: Yeah. Well I think there’s a couple of things. So for one, some of the tightness that you’re kind of feeling within the hip, I think a lot of that is probably related to pain and the tightness is not necessarily the muscle. I’m guessing, I don’t know. We haven’t evaluated yet, but I’m guessing while that tightness is really just the hip being cranky and irritated from playing your sports, you know. So yeah, you can work on some mobility, but I honestly, for folks that have irritated hips like yourself, I don’t push the mobility that much. I would rather have a program that’s going to strengthen all the musculature around the hip to make it stronger, more stable. Right. And back off with the move that bug it for a little bit. Honestly, it depends on what you’re trainings looking like, so I’m guessing you’re not doing a ton of it right now, and then what your goals are when you’re seasons start. That would be the way I’ve started anyway.
Mike Reinold: Yeah, and I, I would say I would just add in there for you Jeremiah, that oftentimes when athletes come to me with hip pain like that, one of the first things I’ll focus on is probably soft tissue mobility and less like actual hip mobility. Cause oftentimes like Dan said, the joint gets cranky, we start pinching and we start irritating a little bit more. It’s kind of more of the soft tissue for that. So you know, without seeing you, I think that’s a good focus though. Like a lot of people come to us, and they’ll come to Champion like yourself and they’ll say like, yeah, right now I’ve been working on my hip mobility for forever, but you know, every time I bring my knee up to my chest, I get this pinch. We’re like, so we say like, well you should stop that. And then we’re immediately smart people. Right. So like it’s oftentimes it’s less is more. That makes sense.
Jeremiah: Yes, thank you so much.
Mike Reinold: Awesome. Good luck. You guys going to be any good next year.
Jeremiah: Yes sir.
Mike Reinold: That’s what I’m talking about. I like that comment. What do you think about Gronk going to Tampa right now? Is that crazy?
Jeremiah: Yeah, that’s ridiculous.
Mike Reinold: We’re all up in Boston, and Belichick we still believe. Who’s next? Nick.
Nick: Ok, we got Nicole.
Mike Reinold: What’s up Nicole?
Nicole: Hi guys. Thanks for doing this.
Mike Reinold: Wait, hold on one second Nicole. Try that again and we missed it a little bit, it cut out.
Nicole: Can you hear me now?
Mike Reinold: Yes.
Nicole: Okay. I was just saying that I work with Marcus Cantu and he’s been telling me so much about you guys, so it’s cool to jump on here with you all.
Mike Reinold: Nice.
Nicole: I have a couple of questions. I was curious, what’s your return to play criteria for after-post ACL repair and also how long do you recommend they wear the ACL brace when returning back to their sport?
Mike Reinold: Those are good questions, I like those.
Lenny Macrina: Cue the Lenny Twitter rant.
Mike Reinold: I know everybody, we’re all going to get dow.
Lenny Macrina: Every body duck off screen. Lenny rant coming in in three, two, one.
Mike Reinold: And Len, I just, I don’t know if you’ve been looking around, but let’s just say, you know like Tim Hewitt is not on this call, but there’s a lot of smart people on this call that might argue back with you, so be careful.
Lenny Macrina: Right. I know, but we’ll do our best we’ll be politically correct. I think the research is still not there yet. Right? So we say like top tests and we say, you know, Biodesix tests isokinetic tests. We say all these different tests, we don’t know. Right. So that’s why I think our reach care rates are so high. There’s many different reasons. Sure. Insurance issues, quad weakness persists. So what about tests that we do? For me, I like to get some kind of quad strength index. So for me it’s isometric test using a handheld dynamometer but I’m not using my hand so to speak. I have them kick into it in the hand. It’s, they’re pushing basically into the table because I don’t want to have to stabilize. So I use that and then I’m just watching them for nine months. Honestly I take a very rogue approach so to speak.
Lenny Macrina: If you look at compared to social media. If you have an isokinetic test, I think that would be a great way to get some quad and hamstring strength. I recently spoke to speaking to Tim here, Tim Hewitt on his Facebook page and he’s still a proponent of pop test and I said, I surprised him, and I don’t want to speak for him, it’s on Facebook. But he did say that it’s kind of a legacy thing for him cause he was in Cincinnati with Frank Noyes when they developed that. So he still has a love for the hop test. I don’t use hop test. I think I’ve used it once in my career. So, I try to get a quad index somehow, whether it’s isokinetic or isometric. And I watch my athletes throughout the whole process and I am digging into their minds as much as I can. Honestly, like I said earlier, I’m playing mind games on my people to figure out how they’re feeling and so they can’t pull a fast one on me.
Lenny Macrina: But otherwise maybe like depth jumps and kind of depth jumping and looking at the in assessing their motive, how well they can jump and land. Slo-mo video is a great way to look into that as well. But otherwise the research is not screaming anything is adequate right now, unfortunately.
Mike Reinold: Yeah. And I would just say like, Lenny’s not saying don’t do anything.
Mike Reinold: I think what he’s saying is that, you know, do a thorough assessment here, but just realize it’s okay if you’re, if you don’t do everything, if you don’t have access to an isokinetic or you don’t do everything. Nothing has been proven to be perfect so you’re not missing out on the boat. I think the biggest thing by doing all these tests is you’re just going to look at the person, you’re going to see them do a few of these movements and you’re just going to say they’re not ready. You know what I mean? Like because we have this talk a lot with return to play. We get together and some of these like big groups, like some of our colleagues, we have this like ICOS society where we talk and we get together.
Mike Reinold: And it’s funny, but you ask like the Kevin Wilkes of the world, the Bob Mangions, like the Russ Pains like the Mike Boyds. It’s like all these guys, you ask them, they’re not struggling to get their athletes back. They’re not struggling with quad weakness. They’re not struggling with that. Now. Maybe that is just a patient selection, right? That they’re just getting higher level people but just like keep that in mind. It’s just something to think about when you’re going through that. So and just quickly on the brace, Len-
Lenny Macrina: I like braces. The braces don’t have to be for all. I leave it up to the athlete. I’d probably say the first season back probably where the brace it’s, you know, see how they mentally feel with it. Maybe a year at the most I think. But I think that first season back, if they feel like they need it then I’m all for it. But if I’m getting a really good sense that they don’t need it and they think it’s going to hinder them and their position and then their speed and all that, then I just kind of make sure that they are super strong to be able to handle the forces. The brace is kind of more of a mental kind of crutch than anything else really.
Mike Reinold: Unless you’re like Jeremiah and your alignment, then you’re probably going to wear the brace for a long time. Right. But also good questions.
Nicole: Thanks, guys.
Mike Reinold: Who’s next, Nick?
Awesome. Good questions. Who’s next? Nick.
Nick: Tony Mitchell
Mike Reinold: Yes, Tony, it’s going to be better. What’s up man?
Tony: How are you guys doing? Here I am.
Mike Reinold: Yeah, that’s good man. What’s going on? What can we do?
Tony: Right. So, like I was saying. So I know there’s a lot of certifications out there for people who trying to become experienced conditioning coaches or personal trainers and I just wanted to hear what do you think some of those certifications do you recommend for those trying to start their career in those kind of fields?
Mike Reinold: Yeah. Great, great question. I’m going to say for this one, for the certification that you think is best for you, it’s going to be the one that you jive with their educational curriculum the best. Right? So I’d say the three big ones, and I don’t want to leave anybody out, but it’s a NSCA obviously, NASM, and probably ACE are probably like the three big ones in there.
Mike Reinold: ACE to me is a lot more just personal training. NSCA is probably the most scientific, physiology-based, most hardcore. And then, NASM in the middle is kind of more that practical, corrective exercise specialist, sort of thing. Now there’s a lot of blur in between those. So that may not be a perfect answer, but I would look at each of their curriculums because the answer is it doesn’t matter. Right? You can probably get all the same jobs with any of those certifications. You could probably still get licensed in your state if you need to. You don’t even need to be licensed in your state in Massachusetts. Right? My mother can be a personal trainer tomorrow if she decides to, she just needs to make a business card.
Mike Reinold: Right? So it just depends. So I would say don’t pick it because you’re trying to impress somebody, pick it because you like their educational curriculum a little bit. And that’s kind of how I would go for that. Cool?
Tony: Thank you. I appreciate that.
Mike Reinold: Yeah. Dan, did you have anything to add to that?
Dan Pope: Say it depends on where you want to work. Figure out where you want to work, figure out what the requirements are, and get what they need and then find a place that you can kind of shadow a mentor to learn the good stuff. Because that’s when it really… That’s where it really occurs. Doesn’t really happen with the certifications as much.
Lenny Macrina: I think also Boyle’s right? Boyle’s certified strength coach would probably be another option too. Right?
Mike Reinold: Yeah, I don’t know if that’s going to lead to any license thing though. I think that’s the only difference though with the different ones. I took it more as that was the question. I think the only one that has like something where some professions required is probably the NSCA one. So again, if you’re trying to go collegiate or pro, I mean oftentimes they require it. Like in professional baseball, you need to have a CSCS if you want to work in pro baseball. So keep that in mind too.
Mike Reinold: All right, Tony?
Tony: Yep, I appreciate it.
Mike Reinold: All right. Good luck, man. Who’s next? Nick.
Nick: All right, we got Chuck Roland next.
Mike Reinold: What’s up, Chuck?
Mike Reinold: Oh, yeah. I didn’t even notice that.
Chuck: How are you doing? Good.
Mike Reinold: How’s it going?
Chuck: Can you hear me?
Mike Reinold: What’s going on? Yeah, there you go. I see you. Yeah, you popped on the screen. What’s going on, Chuck?
Chuck: Great. Congratulations on 200.
Mike Reinold: Thank you, sir.
Chuck: I work with the D1 university fencing team. The strength and conditioning department doesn’t even know I exist. The head coach brought me in after I demonstrated a particular type of resistance stretching. For the past two seasons, I’ve taught the team resistant stretching and I’ve actually stretched the starters. This fall, we’re going to have 48 fencers on the team. I was wondering how do you think I should go about introducing CPS?
Mike Reinold: And getting them going with the Champion Performance movements assessment that you’re talking about there. You know what I like what you’ve done so far, Chuck, is you got integrated in with the team, right? So you have some buy-in, the coach is supporting you. That’s going to be super helpful for anybody that’s trying to go in with them there. So you have a particular style of training that has been effective for you. And I respect that because there’s so many ways to skin a cat. So I love that. So you have that right there.
Mike Reinold: What anything, any type of movement assessment in any type of pre-season screening can do, whether it be ours, our Champion Performance Specialist, one or anyone’s FMS, anything. What it can do is it can run people through a screen in a relatively quick fashion and help you identify areas to try to optimize them a little bit more, right?
Mike Reinold: So instead of everybody on the team getting the same program, what you can do is you can start, and maybe it’s not even everybody’s getting a specific program, but maybe you can have some buckets like, Oh, for everybody that can’t hinge for everybody that has a terrible overhead breach, right? Those are big things that are probably important in fencing. They’re going to get these two specific drills and this loading exercise for example. Right? And then you bucket the team. So what any type of movement assessment will do for you is to help them screen so you can start individualizing them. And man, that’s going to be super powerful for you, Chuck. And it’s just going to take one season and then everybody’s going to see it too and they’re going to love it and they’re going to be super, super grateful for you, man.
Chuck: That’s what I hope.
Mike Reinold: Awesome. Good luck, Chuck. Thanks for the question man.
Lenny Macrina: Good luck.
Nick: All right, we got John Harris is up next.
Mike Reinold: Hey John.
John: How’s it going?
Mike Reinold: Good.
John: So my question was with the way the world and really the fitness industry and all that, it’s kind of moving more online now. How do you personally scale and grow in that sense? And then, how do you also maintain that human connection when you’re not in person?
Mike Reinold: I think you get the million dollar question right now, which everybody’s trying to figure this out. My emotions as a fitness business owner, right? My emotions have gone all over the place through this process. Luckily for us like Champion, we have an online training platform that we had prior. So that obviously helps that we weren’t scuffling to get through really fast to start something. But I’ll be honest with you, it’s not going to replace in person connections. And at first I was thinking this is going to be devastating.
Mike Reinold: Then I went through this period where I was like, people are going to be afraid to come back. I think that my current emotion, and I’ll probably change this tomorrow when Lenny slacks me new statistics like he does every day lately and it gets depressing. But I think my current feeling is that people are going to sprint back into the gym right now because I think people are missing the connection. People are missing the bond that they have, not only with the coaches and personal trainers, but also the other clients that they get to see. This becomes their community and their lives.
Mike Reinold: So what I would say is, I was just listening to my buddy Pat Rigsby’s podcast, he’s a great fitness business guy. And what he just said right here is, I think this just brings out the fact that even if you end up going online or hybrid model or something like that, it’s not about just like selling templates and getting people workouts.
Mike Reinold: Most people aren’t buying an exercise. You can get that stuff for free on the internet. They’re buying the connection. So you got to figure out a way to create a community, even if it’s online, and to be able to communicate with them and be there for them. That’s what people want, right? We all know how to exercise. None of us still want to do it. Right? I know Dewey is on here somewhere, someone’s going to get mad at me for that. Right? Nobody wants to work out, right? So it’s not that we don’t, it’s like you need that kick in the butt and that accountability, I think it will be very helpful. Right? That makes sense.
John: Definitely. Yeah. Thank you.
Mike Reinold: Awesome. Good luck. Who’s next? Nick?
Nick: You got Vince.
Mike Reinold: What’s up, Vince?
Vince: Hey, can you hear me?
Mike Reinold: Yeah, what’s up Vince?
Vince: Hi. I’m from [inaudible] so I’m a physical therapist here. All you see here is private clinics, so they have little gyms or maybe no gyms available, okay. Mine has maybe a little gym. And I just noticed that you guys at Champion’s kind of have this big gym around, which is really cool. I really like it. So I was wondering if that is something that is kind of a standard or one of a kind in the US or in the state you’re in. And that’s something that I would love to have here in Quebec.
Mike Reinold: Yeah, no, I… That’s a great question and I mean I can answer that a little bit here too, I’d say. I don’t know if it’s the standard, I think it’s becoming more common, but it certainly wasn’t the standard. But when we started Champion, one of the key things we had a few, I think differentiations that we wanted to really make sure we stuck to, but one of them was this, and if you’ve ever been an employee in our PT clinic, you’re going to know what I mean when I say this, but we built a gym and added physical therapy to it, not the other way around.
Mike Reinold: So oftentimes what you have is, you’re renting office space on the fourth floor in a building with drop ceilings and curtains around treatment tables and stuff like that. And you’re like, I got an idea. Let’s start fitness. Let’s put a squat rack in here. Right? That’s going to be cool. Right? And nobody wants to work out in that environment, right? So what we wanted to do is we wanted to provide a full service for people where they could do every aspect of that. So we thought, well, if we’re just going to put a squat rack in an office building, that’s not going to be what we want. So we did the exact opposite. If you make a gym and then add PT to it. And I know maybe that’s just semantics. I think it makes all the difference in the atmosphere and the vibe and the place and I think that’s what works. That makes sense.
Vince: Yeah, that does make sense of that. So you would have those things on the same floor? So the gym and the PT place or…
Mike Reinold: You could. It was funny I think, Lenny and I were designing Champion at the beginning and we had the treatment tables out in the open because we’ve always been out in the open and we had the treatment tables out in the open as part of the gym. And then we just stumbled into our current space. And it happens to be in a private room, but there’s all windows so you don’t feel like you’re in a bubble. Even though we are. We think the gym’s the bubble, right? Because we’re in the PT room, we think they’re the bubble and they’re definitely looking at us like we’re in the bubble the whole time.
Mike Reinold: I see our coaches smiling when I say that. But I actually like having the separation but being together. So I don’t know if I’d like it on two different floors, to be honest with you.
Vince: Yeah, I think I like on the same floor, that’s a…
Mike Reinold: Yeah, we’re out there half the time, right? We’re out in the gym half the time working on people. So thanks, Vincent. Who’s up Nick?
Nick: All right, we got Sierra Hackinson is next.
Mike Reinold: What’s the up, Sierra? What’s going on?
Mike Scaduto: What’s up Sierra? How’s it going?
Dave Tilley: The ultimate throw back episodes.
Mike Reinold: How was spring training, Sierra? Did you get any days in?
Sierra: I was there for about 10 days.
Mike Reinold: Nice. Okay. That’s awesome. So Sierra was-
Sierra: I wanted to stay for the quarantine and they’re like, nobody’s staying.
Mike Reinold: Yeah. Yeah. So Sierra was one of our strength and conditioning interns last year. She’s also an athletic trainer, so she got a job with the Padres this winter. Unfortunately, you have to work in pro baseball for 10 days. Congratulations.
Sierra: I’ll go back next summer or whenever things decide to happen. My question was kind of baseball related, but I’m going to make it more general because I’m curious what you guys have to say. But working with an athlete who’s returning from an Achilles tendon repair. The current situation is a right handed pitcher, left Achilles tendon repair about five months. But in general, especially with like athletes where it’s a little more dynamic like gymnastics, what is your guys’s really specific return to full play criteria? What are some of the risks you’re thinking about when you’re trying to make that decision?
Mike Reinold: Nice. All right. Who wants to take that?
Dave Tilley: Yeah, I mean I have two right now so I can kind of weigh in. I have, I think, maybe somebody else’s too, but yeah, it’s tough because Dan and I had a long conversation about this, like the return… From two different surgeons, really high respected doctors in Boston, you get the five months, they’re like, all right, good luck. Five functional activities. You’re like, all right. That’s kind of a big aggressive jump we’re taking here.
Dave Tilley: So I think the literature they want to say, single leg calf raise test is obviously probably what people are most going for. So calf endurance, stuff like that. I think that’s pretty well respected. And then, we have some single leg jumping assessments, but I don’t think that’s enough. I think that’s when it becomes more about working with strength coaches and being like, what’s the natural progression if you had this person in front of you, what would you do to help them get more fit in general? So I learned a lot from Dan and from the strength coaches we have, but a lot of… They should be able to tolerate pretty good double leg bounding first, in multiple planes of direction.
Dave Tilley: And then you should be able to work up to single leg jump and sticks with no amortization phase. And then the, hardest stuff they should be able to do is run and have a quick turnover time and have repeated jumps. So that should probably happen over like two months. But that’s all these athletes I’m working with now from like six to nine months. And it was kind of just like a wild west a little bit. We’re just going based on strength conditioning principles.
Mike Reinold: Yeah. You get to build up workload slow with those ones, Sierra. That’s a tough one, right? Just keep this in mind too, that Achilles tendon’s that thick for a reason, right? There’s so much stress that goes through it. So you get to build up your workloads with that one. But I feel like every time I’ve had an Achilles I’ve felt probably just like you, right? Where you’re a little uncertain. Especially, younger in your career. And they end up doing well, but I, trust me, I even doing this for over 20 years now, I… They’re coming back and running that first time and you’re holding your breath a little bit. I don’t know, maybe it’s because Achilles rupture’s like my worst fear personally.
Dave Tilley: First hurdle session you’re like, everybody just brace for it.
Mike Reinold: Yeah, I’m not even doing hurdles. I’m out. But awesome. Thanks, Sierra.
Sierra: Thanks guys.
Nick: All right, we got Seth is up next.
Mike Reinold: Hey Seth.
Seth: Can you hear me?
Mike Reinold: Yeah, what’s up man?
Seth: All right, so this question’s coming from an athlete with a history of ankle injury. Do you have any advice to strengthen the ankle to prevent future injuries for someone with loose ligaments?
Mike Reinold: Good question. Who wants to tackle that one?
Mike Scaduto: I can start it off if you want.
Mike Reinold: Yeah, let’s hear it, Mike.
Mike Scaduto: So I would say if you look at ankle sprains, particularly inversion ankle sprains and the ATFL is implicated in those types of injuries, we know that there’s a decrease in proprioception. So our joint awareness in space. So that is definitely key to restore that that can influence our balance, that can influence power, jumping ability and stuff like that and landing ability. So it’s definitely important to address that. I think one of the easiest ways is start with baseline strengthening using a TheraBand. We’ve all done like four way ankle type stuff. And then progressing a balanced program where we’re adding different challenges to their single leg balance activity. Maybe we put them on an Airex pad. We do stuff like that from a proprioceptive standpoint, we’re probably getting good input into the system and learning how to balance again, I guess.
Mike Reinold: Yeah. And it’s probably more so, it’s more than just strength, I think is the answer Seth, for you. It’s about the coordination of it, the neuromuscular control of it. That’s why a lot of people feel unstable over time. You can have decent strength, right? It’s not hard to get the ankle strong, but to have that balance and coordination is often why people feel weird afterwards. But yeah, good luck, Seth.
Seth: Yep. Thank you.
Mike Reinold: Yeah, you got it man. What’s up, Nick?
Nick: We got Antonio Monterosso.
Mike Reinold: I thought you were going to say Brown. I was going to say, is he going to Tampa too?
Dave Tilley: Just say Bandera. Actor.
Mike Reinold: What’s up, Antonio? Come on, Nick. Can we take a moment right here to give Nick Esposito a round of applause. I mean… What a great MC. I mean, you are doing a really good job, but…
Nick: Thank you.
Mike Scaduto: He’s got to be sweating over there right now though.
Nick: Got spotlights behind me.
Mike Reinold: All right, who’s next, Nick?
Nick: We are literally almost out of questions.
Mike Reinold: Oh that’s fantastic. I like it. All right, so let’s do last call if you get some more questions, that’s good. We’ve got a few more minutes. I like it. This is exactly why we’re here. You guys brought a bunch of amazing questions for us, so maybe we’ll take, maybe take one more if we can get one more in. Who wants to be the last one? Now I’m scrolling through. I’m looking at faces right here. I see some good people. What’s up, Megan? Megan, you look so studious with your glasses on. I don’t know if I’ve ever seen you with glasses on. I like it. That’s awesome to see some more people driving. I’m still… I’m worried about you people. Don’t be driving like Abby was.
Dave Tilley: There’s people at the beach, man. Steve’s at the beach right now.
Mike Reinold: I like it. There’s some good beaches. Yeah, right. That’s perfect. I saw a lot of familiar names on here and really there’s… I’m not kidding. I’ve recognized some names on here like Jeff Lemon and stuff like that. Jeff’s been commenting on stuff of mine for 10 years now. Right? So thanks Jeff and all you guys. I’m just seeing a lot of familiar faces, right?
Dave Tilley: We got a rowing question. Got to get back to them.
Mike Reinold: -Been interacting. So thank you everybody for that. All right, let’s do it. Last one. Make it a good one, Nick.
Nick: Actually, let’s get the rowing one in. I think that’d be a good one.
Nick: Let me unmute them. So Patrick is up next.
Mike Reinold: What’s up Patrick?
Patrick: Hey guys, can you hear me?
Mike Reinold: Yes.
Patrick: Great. My picture’s not coming up on my screen. So I rowed at Syracuse University in undergrad and we had a fair amount of rib injuries while I was there. I never have one on my own, but I was wondering when you guys would see them, how you would progress them back or if you have like return to sport criteria when they could go back? For us, it was basically training room, fighting with our coach to have them sit out longer than they really could depending on what time of season it was. So I know Lisa has a rowing background.
Lenny Macrina: Did Lisa put him in the crowd? Lisa planted it.
Lisa Russell: I didn’t.
Mike Reinold: I also noticed his Pat, I was like…
Lisa Russell: Yeah, so Pat, funny story is I actually found Lenny because I broke my ribs. It’s that nice little connection.
Lisa Russell: So I’m just reading your question again just to make sure I get all the pieces. But I mean, rib injuries and rowing are not quite actually as common as rowers might think they are. They happen because of overtraining, essentially, and increasing your training volume too quickly. Generally they’re more common in females than males. But it’s really… The return to sport piece of it is really symptom based. Everyone heals at different rates. I’ve had teammates who took longer than I did and I’ve probably worked through some that I shouldn’t have. It really just depends on the severity of it and how well the person takes care of themself to recover from it. I… Yeah, I don’t know. It’s a scary… It’s like the scariest injury in rowing because it’s really… It puts you out really bad. Your only option for cardio is biking and you can’t even breathe that hard.
Lisa Russell: So it’s a scary one. And the fact that your team had a lot of them means your training plan essentially wasn’t the best.
Mike Reinold: And that’s kind of what I think of injuries like that all the time. It’s like it’s a rib fracture is not a stress reaction like that. It’s not an acute injury in somebody like a rower. It comes down to your workload, right. So you got to figure out why your workload puts so much stress on you there. So I don’t know. So I don’t know, the crowd may get to get mad at me here, but we still have well over a hundred people online. It was funny when we put the call in for last call. What did we just get? Like 10 more questions there? That was awesome.
Nick: Yeah, we had quite a few.
Mike Reinold: I mean, who still wants to do it?
Mike Scaduto: Get it.
Dave Tilley: Let’s do it.
Mike Reinold: All right, the Gabe-inator says do it.
Dave Tilley: I gotta grab some whiskey. I’ll be right back.
Mike Reinold: Let’s keep going, Nick. Let’s keep going.
Nick: All right, let’s go Frank Alexander, you’re up next.
Mike Reinold: Hey, what’s up Frank?
Frank: What’s going on, Mike? What’s going on guys?
Mike Reinold: Hey, good to hear from you Frank. How you been?
Frank: Not too bad. My question is we’re all in the same boat, busy practices, families all the other fun stuff that goes into it. How do you devour the amount of research that’s out there in an efficient way?
Mike Reinold: That’s a great question. And it’s an important one too because there are so many journals now, right? Like it’s… I’m getting overwhelmed with the amount of journals that are coming out now and how many articles are being published. And I’ll be honest, so, Frank and I, we work with a lot of baseball players. We get these things. I’m telling you, the baseball research, I would say I read the… I go right to the methods and I’d say 75% of the articles, I don’t get past the methods. I just say this isn’t a valid study.
Mike Reinold: So we see that quite a bit with that. It’s like the barrier of entry to be published nowadays is a lot lower than it used to be. And peer review is going downhill. You have these open access journals where you can submit an article and they can get published in a week if you pay him 1,500 bucks. It’s crazy right now. So my biggest tip, especially for some of the young crowd that comes into this right, and they’re like, where do I get started? Is just pick… Start with four reputable journals that you want to follow consistently.
Mike Reinold: So I’d love to get some other thoughts. So I’m going to say for the PT crowd, JOSPT although I’ll be honest with you, it’s been a while since I’ve gotten a good article out of JOSPT. I remember like about 20 years ago when physical therapy, the journal of physical therapy was starting to go downhill. And I remember I was at like dinner with a bunch of JOSPT people. I’m only saying this because I’m a sports guy, by the way. It’s not that it’s a bad journal, it’s just not sportsy anymore. But I remember when PT was turning into not relevant anymore and I haven’t read PT in 20 years. Right? So now I feel JOSPT’s getting a little too broad for me. I’m starting to really appreciate Sports Health a little bit more and probably a AJSM still the best. British Journal of Sports Medicine’s amazing.
Mike Reinold: So that’s my first tip. Is stick to like four core journals and just read them every month. My second tip is I use an RSS reader still. I’m like one of the only people that remember when an RSS feed is on the internet, but every-
Dave Tilley: Like the Dewey Decimal System?
Mike Reinold: Yeah, right. Every journal has, it’s called… Well, every website has an RSS feed, but you can subscribe to a service like Feedly, F-E-E-D-L-Y. Feedly. And what you do is you get all the table of contents for the journals you want to follow and you submit that URL into it, and every time a new articles added it gets pinged into there. So now you have like your own little reader. So that’s like my routine. I’ll flip open Apple news. I’ll check out some of the recent articles. What’d the stock markets do that day? Let me open up Feedly, what new articles came out today? That sort of thing. That’s what I would recommend doing.
Mike Reinold: Anybody else want to jump on next? I know everybody has their own style on how they stay current.
Dave Tilley: I just follow authors that are in my interest areas, so like I study some weird stuff words like, hip microinstability, and there’s four or five surgeons that are pumping out research and I just tagged them in PubMed.
Mike Reinold: I like that, right? Anybody do topics in PubMed where you subscribe to a topic? Yeah, Dan said he did, Derek?
Derek: I’d do that for like squat or bench press…
Derek: … or throw them in there and they gave me an alert once a month and I can look through that stuff.
Mike Reinold: Yeah, meet me that journal article. That’s usually where I say to do things. I’m going to tell you one thing not to do is do not stay current on research on Instagram. I think that’s the worst place you do because you’re just getting jaded opinions from people in a snapshot of time. I don’t think that’s the way to do it. But anyway, great question Frank, what else we got Nick?
Nick: We got Christina.
Mike Reinold: Hey, what’s up Christina?
Christina: Hey, I had a question. I kind of piggyback on something else, another question I saw somebody ask, but I was laid off from my op patient ortho PT clinic like I’m sure a lot of people were. So then I started kind of thinking like, “Well, do I really want to work there?” I’m like, “What should I do?” What are your thoughts on residencies and mentorship versus just getting a broad swath of continuing education moving forward? If you feel like you’re just kind of floating along and you’re maybe not like progressing or improving or becoming a PT that you think you may be, could be as quickly as you could be?
Mike Reinold: I guess my biggest piece of advice to start this off with is, decide what you want to get better at. What I try to tell people to do, and this is a great opportunity, right? You work in outpatient, you actually have a little sabbatical, right? How often do we get to have a time like this? Take a step back and do a self audit and say like, “What am I good at? What am I comfortable at? What am I not so comfortable at and do I care” right? And then, how can I get better at those sorts of things.
Mike Reinold: This is where you get to do that. And then, I think the method of you achieving that doesn’t matter, if it’s through a residency, if it’s through con ed courses, if it’s through online courses like, I don’t think that necessarily matters, but decide to put your energy right now into that. What I don’t want to see you do is blindly do some random residency just because you’re not sure what to do. I think that would be my biggest tip. Anybody else?
Lenny Macrina: Yeah, I agree. I think residency could be good ground, how long have you been out of school and what your years of experience, how many years you’ve been out, how many did you practice?
Dan Pope: Say it again?
Lenny Macrina: I mean, you know your own situation have to take a huge pay cut and working long hours and can your family sustain that? Yep. That’s an issue, but I think self-learning I mean, put yourself in a position where you are the happiest, there’s no guarantee the residency is going to be that route. I think we’ve said that over and over again on previous podcasts. It’s a good option, but I still think some self learning and finding that, that niche of that, that’s really passion for it. Who I think it’s going to drive you a lot further than anything else, I think.
Mike Reinold: Nice. Awesome. Well thanks, good luck. Sorry about the layoff.
Lenny Macrina: Yeah,
Mike Reinold: Good luck.
Christina: Thank you.
Nick: All right, we got Ian Stout is up next.
Mike Reinold: Hey Ian.
Ian Stout: What’s going on guys?
Ian Stout: I’ve been working with an athlete that has undergone bilateral labral surgery. She’s about 16 weeks out, so she’s doing awesome. After the second one, she’s getting into more of shooting for a sport, she’s a basketball player. I was wondering if you had any protocols or anything, any thoughts on returning her to her sport safely?
Mike Reinold: Nice. Who wants that one?
Mike Scaduto: Yeah, that’s a good question. I mean, I can start. You said bilateral or was it a revision labral repair?
Ian Stout: I believe one was a little more posterior and the other one was anterior. Both pretty good ones a little more limited than the other. What’s range in motion, but overall-
Lenny Macrina: Are they doing them at the same time?
Mike Reinold: I was just going to ask that. How far apart are they?
Ian Stout: I believe 16 weeks apart.
Mike Reinold: I was going to say it was this like the week before the Covid shut down or something, they were trying to jam the whole thing in there, but yeah. Interesting.
Mike Scaduto: That was like an awkward pause. But anyway, they’re there four months out of labor repair surgery. I guess you could start with where we hope they are and we hope that they have restored full range of motion if they’re still really tight and having trouble with overhead mobility and getting up into a jump shot, I think that’s definitely where he needs to start restoring range of motion, soft tissue and then dynamic stability. We probably are advancing more towards a strength and conditioning program around four months. We could probably do some weight bearing stuff. We could probably do some pressing activities in the gym. I think getting them generally stronger and then probably working a little more high level dynamic stability drills that are in relation to their sports would be something that you could try, especially if they’re having trouble getting up into the shooting position. I don’t know if some get a little creative with it.
Mike Reinold: Yeah, without seeing them moving and so far apart, I think the question is does one limit the other one like with some of the functional things you can do, that’s going to be the big curve ball. Awesome. Good luck with that. That’s a tough one Ian. I don’t like the complicated ones like that. Yeah, we let the students worry about those kinds of people, those are too much but no, awesome. Thanks Ian. Good one. Nick, while you’re getting the next one. I just happened to glance up and I saw Vincent asking for a friend, is keeping bad for you? The answer is yes. All right, who’s next? Nick?
Nick: We’ve got Steve Lutz is up next.
Steve Lutz: Hey, what’s going on guys?
Mike Reinold: Hey, what’s up Steve?
Steve Lutz: Hey. First of all, you guys have been a really big influence in that the way that we treat our patients in the clinic, we really appreciate it. It’s not just me, it’s a whole group of about 10 guys that are really relying on your information.
Mike Reinold: Awesome. Thanks Steve.
Steve Lutz: The question I had was, how do you handle conversations with patients after you’ve evaluated them? Do you try to identify a structure that’s maybe irritable, like your shoulder hurts because your rotator cuff is weak or there’s impingement or something of that nature and what’s like the plan of care and treatment?
Mike Reinold: One of the things that we came up with at Champion, and I think it’s just because we have some higher level athletes and even higher level like ortho people, right? We tend to have people that want to get the most out of their bodies. That’s kind of what we say a little bit. What we kind of did with them is like, our traditional physical therapy just looks at the source of the pain or the location of the pain and just like structural issues, right? We tend to say, “We want to look both structural and functional” Right? And what I say to them and because I try to like speak in terms that they can talk to them.
Mike Reinold: It’s like, “Larry, you came with shoulder pain. All right. The first thing I’m going to do is, I’m going to try to figure out is anything broken? Does anything need to be fixed or whatever.” I don’t say the word fixed, that’s weird. But like, what’s broke, like what’s the issue going on? And then I say, “What’s suboptimal?” what we’re going to do is we’re going to find what might be the issue, but then we’re going to start a checklist of suboptimal, and then we’re going to put that together. When we put that together, I think that usually results in the best outcomes. And then when you have that discussion about the plan of care, it’s like a breeze, right? Because as you brought him through that assessment and you’re saying, “I know your shoulder hurts, but wow, look at your thoracic spine how it doesn’t, move well. Right? Let’s play a game like slugs down and raise up like no good. Right. Sit up tall and raise up like way better. Right?”
Mike Reinold: You can show them that on the fly. I think immediately they’re going to have this great buy in and they’d be like, “That Steve guy, he knows what he’s talking about.” Right? I mean, “He works on a beach like that guy’s amazing.” Right? I think that’s what they’re going to say. Awesome, thanks Steve. Who’s next? Nick.
Nick: Caroline Bear.
Mike Reinold: What’s up Caroline?
Mike Reinold: What’s up Caroline? How are you?
Caroline: Good. How are y’all?
Mike Reinold: Good. I recognize you from social media too. What’s up? What’s going on. I love seeing faces with this. I actually get to see people, this is cool. What’s going on?
Caroline: Well, me and my classmates have definitely enjoyed this, the past couple of weeks, so thank you guys. We’re talking about one of the articles, I think it was talking about, they looked at New York high school baseball players and 50% or so were saying that they believe they should have the Tommy John without even having an injury. We were talking about like, just the lack of education, like are you guys as PT’s getting into high school systems and doing in-services and just kind of letting them know that you’re there and like want to help along with their care. And if you are doing that or know of people doing that, are there any obstacles that you find with that process?
Mike Reinold: That’s a great question. That was Frank’s study right Len, like I am … Frank just asked a question about the research, but that was part of his study that did that, so that’s awesome. Right? See that’s pretty cool. See Frank people read your stuff. That’s awesome man. But it’s common, right? Like us in the rehab world, we tend to stand on our soap boxes and try to tell the world these things, right? But nobody cares about injury prevention, right? We did something at Champion, we trick them. Are you ready for this?
Mike Reinold: We give them a performance enhancement program, but you know what it is? It’s the same thing. But don’t tell them that, right? Because no one will buy an injury prevention program, but they will buy a performance enhancement program and we build it together. When we give talks and we go out to the public and try to talk about this sort of thing, we talk about how to enhance their performance, how to get the most out of them?
Mike Reinold: Obviously, staying healthy is one of the ways. Obviously, can’t make the team on the DL or they can’t make the team in the tub. Back when you used to have those big jumbo hot tanks, hot tub tanks. We work it in with that but to get in the door I usually go that. I know we get a lot out of, so Dave with gymnastics maybe, I don’t know, you want to comment a little bit more on that? Like, how do you get into your crowd of athletes before they’re injured?
Dave Tilley: Yeah, it’s very similar to kind of what Mike said and this is, I learned this the hard way when I was trying to start to do more in the Gymnastics World Sports Medicine side is like, you have your idea of the things you want to change and you want to help out with like Mike said, when it comes from the user side hearing it, they don’t really care. I think the important thing is to try to identify the performance issues that they know, are going to be hot topics for them. In gymnastics like, “Oh, we need to sprint faster and we need like more flexibility.”
Dave Tilley: You try to like build a program that gives them kind of what they want in the beginning and as you build more trust, maybe the second, third time you talk to like, “Hey by the way, if we change your strength program a little bit you might really get more power out of it.” Because like that’s a hot topic in gymnastics because they don’t want to externally load. I kind of slowly kind of build a relationship and work our way in. And then finally, okay by the way, can we talk about the way they land? And like something else like that. I would say ease in with the hot topics that they might latch on to.
Mike Reinold: Yeah. What’s up Dan?
Dan Pope: And not to belabor this question too much, but I think what’s probably going to be helpful is to try to get in the coaches ear a little bit. Having been in the fitness industry, it’s a little different than a sport, at least in the fitness world, a big problem is that people get hurt because if they get hurt, they basically lose their business, it doesn’t look good for the gym. Getting in the coaches ears, always had trust and rapport with the coaches, the people that influenced the actual programming that the athletes are going to be performing. And just giving them an idea of what’s good, what’s not so good.
Dan Pope: If they’re the one distributing information every single day, because obviously the athletes, you have to trust the coach, whoever is a trainer that’s in front of them. That’s probably going to have a bigger impact because it’s hard if you’re going to be working 40 hours a week as a PT, you’re going to go spend your extra time like, trying to lecture in front of, I don’t know, auditorium athletes that we can’t really gather together. It’s just hard to do that.
Mike Reinold: Awesome. Yeah, that was great. Nick, we got one more question. Let’s make it last call. My man, it’s been 90 minutes. We did this, this is an hour and a half. It was like a movie. Right? This is awesome. Can we even put this on the Apple podcast, I don’t even know, do they go that long? But we’ll find out. We’re going to break the internet with this episode. This is going to be awesome. All right, Nick, last call. Let’s do last question. What do we got?
Nick: We got Doug.
Mike Reinold: What’s up Doug?
Doug: Doug. Hey guys, appreciate everything that you do and Mike, thanks for the shout out to Jeff Lemons. He and I have known each other for 18 years worked together. We really appreciate all the things you guys do and have put out.
Mike Reinold: Thanks Doug.
Doug: Yeah, my question is, I know a former athlete who’s in her mid thirties now, she had bilateral ACL surgery when she was in her early teens, so she’s 20, 20 plus years now. Is having issues with arthritis and so this kind of could probably go to anybody who’s got had arthroscopic surgery, chondral impact injuries, anything along that line. But she asked me about stem cell therapy as an option for her. I don’t have a lot of experience with that. I wondered if any of you guys have had any experience with stem cell therapy, first of all, and then also what your thoughts are on it as a treatment. It’s pros and cons versus like Synvisc injections and PRP and that kind of stuff. Anything like that short of surgery?
Mike Reinold: Sure.
Dave Tilley: I really want your recliner, that’s all I want to say.
Doug: I’ll ship it to you.
Mike Reinold: And you know what Doug? I feel for her too because I’d probably be thinking the same thing. I definitely have an answer and I also saw Derek shaking his head, so I know I got to be careful. I don’t want to do it, but I have some thoughts. Does anybody else want to jump in before I do? I feel like I’m talking too much. No, I don’t. Sorry, go ahead.
Lenny Macrina: Like I say, it’s not what I would jump to right away. I mean, it’s just not what I’m seeing in the research, it hasn’t … I think there’s hope for it. I really do that. My biology background that was my undergrad is, I would love for it to be kind of this wave of like we can inject something and cartilage grows and it’s like real cartilage or something, but I just … I personally have been, people can chime in, but I definitely haven’t seen it.
Lenny Macrina: I mean, I’m assuming she’s done a physical therapy program. You’re working with her and all that. We’re working with strengthening and brands and kind of unloaded brace, something like that. Depending on where the arthritis is in her knee medial side versus lateral side. You can kind of load them with some kind of heel wedges and try to unload the joint or something like that or some kind of tele stabilization brace. But I don’t know if I would tell somebody to go get two, three, four or $5,000 injection with what I’m seeing in the research. You know what I mean? I don’t think insurance is really covering that stuff. I don’t think it’s where I would probably center.
Mike Reinold: Pope, what do you think? Do you have any experience with this stuff?
Dan Pope: I used to work close to Centeno Schultz down in Colorado and it was actually tough. I couldn’t speak to the docs, I had a ton of questions. It’s very new to me but they would inject themselves everywhere and it was very expensive for the patient. I really didn’t know if it was going to be beneficial beyond physical therapy, but they did really trust is what therapy sent us there. But that being said, a lot of athletes and individuals that have some sort of pain or injury, often times that’s one of the first things they jump to it’s like, “Oh man, I hurt my knee, I got to get stem cells because this guy or this person got it.”
Dan Pope: At least for me, I’m usually telling athletes like we have to have a really comprehensive training program for you to go down that route. And then the other part is that, at least from what I’ve seen, I have no idea if these athletes got better because of the stem cell injection because the physical therapy. At least I can speak from that. It’s all anecdote myself. But I did see a lot of stem cell patients.
Mike Reinold: I think that’s part of what’s happening right now Doug is that, you see stuff like a pro basketball player or somebody is getting it done. The general public then thinks like, “Oh, I want to do that.” But what they don’t realize is that these guys that make millions and tens of millions sometimes they’ll do anything to feel better, even if it’s just an incremental benefit, to them money’s no object. Theoretically, it’s not that they thought that was going to necessarily put them over the edge. I saw a lot of older athletes towards the end of their career start trying it like on rotator cuffs and knees and stuff like that. I can’t say that anybody’s had good outcomes from it. I don’t think anyone’s had anything bad either, but certainly nothing like magical.
Mike Reinold: I think the technology’s just not there yet, but I have a lot of smart friends like some of the good physicians, like at Rush, that I work with a bunch with the White Sox out in Chicago like Dr. Brian Cole, is really starting to get advanced with some of the stuff. I think that we’re going to see this become valuable in our generation. I don’t know what that means, but at some point in time we can. I don’t know, I know there’s some like … There’s different things like the FDA like doesn’t want us to clone humans, There’s like all these restrictions on what we do with stem cells in America, that’s why some of the athletes go to Europe to get different things here. That’s another issue we have to face.
Mike Reinold: To answer your question is, I don’t think we’re there yet with stem cells. I certainly wouldn’t do it unless she had just like a huge financial bank account in the background. I think same thing with PRP. That’s probably not going to be your answer either. Maybe some CBD oil. I’m just kidding. I mean, I don’t know if there’s something magical and I know she’s grasping for stuff. I think we do the best we can to just get her to be able to absorb that load. Maybe offload it, like Lenny kind of said and unless she has infinite money, probably say like we’re probably not ready for that yet.
Mike Reinold: Cool.
Doug: Appreciate it guys.
Mike Reinold: Thanks Doug. And thank all of you guys. Honestly, that was amazing. Thank you so much for coming out for something like this. Lots of good faces that we recognize. Lots of good friends, former students and interns. Everybody kind of joining us here. Thanks again because we’re doing this for you. We hate listening to ourselves speak, I’ll be the first to tell you that. We’re doing it for you. Right? I have to sit down after we recorded these and prep them to get them ready for production and stuff like that. I have to listen to it more than once and it’s awful. Right? Thank you so much. We hate listening to ourselves Thank you so much for being part of this journey with us. Maybe we’ll do this again on the 400th episode. What do you guys think?
That is four years from now. Who knows?
Mike Reinold: That’d be awesome. But thanks again and this was amazing. Keep spreading the word if you’re a student or a new grad or something like, get your friends involved because I know a lot of them probably have very similar questions that you have here. If we can answer some of the things that maybe they have some doubt on and some overwhelm then that’d be fantastic. Let’s do this. Let’s end with the world’s largest internet social digital thing, elbow bump. Let’s all do this together. This is going to be the screenshot of the podcast episode. Awesome. Thanks everybody. Have a good night.