On this episode of the #AskMikeReinold show, I’m joined by Phil Page to discuss the current state of scientific evidence and journal articles in the physical therapy world. Not all evidence is good evidence. Here’s how to stay current with the best research.

For those interested in learning more, Phil has a presentation for my Inner Circle Online Mentorship group that digs in really deep on these topics.

To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 211: Not All Research is the Same: The Difference Between Good and Bad Research

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Show Notes

• See Phil’s presentations on understanding and reading research in my Inner Circle
• Tips on Reading Research Articles
• What is Evidence Based Practice

Transcript

Mike Reinold: Welcome back everybody to the latest episode of the Ask Mike Reinold show. I am with my good friend Phil Page. Phil and I just spent the last couple hours or so now kind of filming some presentations for my Inner Circle on research, which is one of the areas that I think Phil is awesome at. He’s obviously one of the people I’ve looked to over my career on how to learn, how to read journal articles and digest information from them and understanding good research and bad research. And I’ve seen him speak and do a bunch of things over the years. So Phil’s the man for that and I’ve been trying to get what for like, what was it two years you think Phil?

Phil Page: Two years.

Mike Reinold: Yeah, two years. I’m just like, “Hey man, you got to fill in these presentations for my Inner Circle. I think everybody would love them.” So anyway, thank you for doing that. If you’re not a member of my Inner Circle, you’ve got to check it out. But I also wanted to do a special podcast episode because him and I were talking and I have a lot of questions. So Phil, before we get started a little bit, just tell everybody a little bit about yourself.

Phil Page: Yeah, thanks Mike. So I am Research Director and Assistant Professor in physical therapy at Franciscan University here in Baton Rouge, Louisiana. It’s a new program. We’re just finishing up our second cohort. So it’s a new school and I spent the last 20 years working with Performance Health as their Director of Research and Education. And I’ve been a research geek since my first year of college. Many, many years ago as an undergraduate student athletic trainer, I did a research project as a freshmen, believe it or not. And I got the research bug and I’ve had it ever since. And so it’s really just been a fantastic ride for me to now be Research Director. It’s like a kid in a candy store, right? So I’ve got 40 students every year, they’re doing independent research projects. So at the end of the cohort, I’ve got 80 students involved in research at one time. I just I love, I just love this. It’s so much fun.

Mike Reinold: One of the things I give you a lot of credit for though is that you’re a PhD and you’re a research based kind of person here, but you’re very clinical. And I think sometimes we don’t have both of those put together. So I think you get to see a research article and the things that are being published from multiple perspectives because of that. And I think that’s super helpful. So that was neat. So I’m going to start off with this question.

Phil Page: Okay.

Mike Reinold: I want to go from here. I’m going to kind of ask you the questions, I think.

Phil Page: Sure.

Mike Reinold: I don’t know what this is. This is a weird episode, but we’re going to go with it. I remember when we were first getting started and we were younger in this profession, journal articles were golden. They were evidence, they were science. Everything about it was always perfect. So you went to a journal article and said, “This is perfect.” I feel like nowadays where I don’t know if things are becoming so diluted or we just have so many journals, but I feel like there’s a big difference now between a publication and evidence. Right? There’s so many publications out there. I’ve read so many articles over the last several years, especially the last five or so, that I just think this is not good research. This is bad research. This is not helping our profession.

Phil Page: Yep.

Mike Reinold: This is not helping us. What are your thoughts on this? Is it just me? Am I crazy thinking that?

Phil Page: No Mike, it’s tough. And I keep up with the literature. I’m fortunate enough to do that as my job. Right? So everyday clinicians that are out there working eight to five and seeing patients, it’s tough to keep up with the literature. And I get frustrated that there is so much out there first of all, that you have to sift through. Right? And a part of it, Mike obviously, is that there is that, I’ll publish or perish.” Right? So there’s this big push for academics to have to publish their works. I will tell you that, at least in the physical therapy world, it’s not that big of a push because in the [inaudible 00:04:15] criteria for physical therapy school, I think we only need two publications every five years or something like that. So in a way that’s good because it’s not flooding the market with all this stuff that may not be good. Right?

Phil Page: Now at what you’re seeing the other part of this, which I think is the bigger driver, is there’s two things. One is the international side of things where there’s more global influence with the internet that then ties into those journals that are for-profit journals. And you may call those predatory journals or I think there’s a subgroup called pseudo journals if you will, pseudo predatory journals where there’s now a market fee for publication. Right? Now, I’m not going to say that fee for publication is a bad thing because it does offer free access. But there are people that take advantage of that and that they allow articles to get through with very shoddy peer review. Okay?

Mike Reinold: Right.

Phil Page: So that’s one side of it, is that these articles these days, pseudo journals. You look at them and they’ll have very close names to the things that we’re reading every day and they want to make it look good. All you need is a word processing thing and an internet page to make it look like a journal. Right? The other thing is there’s a lack of quality reviewers out there. And there are some articles that get through the review process and I’m not sure how it does, but again there’s a shortage of people that are volunteering to review. Because a lot of us that are actually over here writing and teaching and clinically working, we don’t have time to add all these reviews. And I get review requests from journals I’ve never heard of before.

Mike Reinold: Right.

Phil Page: Like, “Would you mind spending a couple of hours to help out my journal that I’m profiting from?” Now I review all the time for our journals because I think it’s a service that we have to do. So there’s a lot of factors going into it Mike, and it’s really tough. But now what that means, Mike, is that you can’t rely on that article. You’ve got to be the one that actually looks at it and is able to evaluate it.

Mike Reinold: Right. And it’s funny because I was going to ask you about these predatory journals a little bit here too. From my perspective, I think you’re being nice. So you can be, you’re the guest on the podcast. You have to be a little bit nicer. There are, I agree with your sub tiers, there are predatory journals that are just terrible. They are just awful. And I mean, there’s typos. You can tell them it’s like really obvious when it’s a predatory journal. But I will say that yes, I like the for-profit journals. I like that they offer free access to the things. The peer review process is terrible-

Phil Page: Yeah.

Mike Reinold: -even for the best ones. Absolutely terrible in the peer review process. So even some of the bigger name ones from reputable journals that are now doing an online version, I’m getting away from because I continue to see poor methodology. So look at this point in time, there’s a zillion research articles out there. Remember we used to hoard those JOSBTs.

Phil Page: Yeah.

Mike Reinold: And that was like, you know what? You’d get that for the month and you’d read the whole thing. There are so many articles there right now that I just feel like we can answer any question we want and get whichever answer we want the harder we look. If you’re looking, does A do B, you can find yes and you can find no. Right?

Phil Page: Yeah.

Mike Reinold: So that’s why I think we just got to take a huge step back and just start sticking to the main journals. Right? Like the top ones in our profession. So based on that, what are your favorite journals that you read? Because I know a lot of my listeners and people that watch the podcast actually want to know this. They want to say like, “Alright. If there’s some good journals and bad journals, what are your favorites?” We won’t talk about the bad ones, but what are your favorite journals?

Phil Page: Again, it goes to … I think it goes to your interests. Right? So I am not treating patients every day. So my interest is maybe more on the biomechanical analysis side. Right? So journals like Journal of Electromyography and Kinesiology. I mean, that’s not something that every clinician is going to want to read but I’m using it as an extreme example. But I love, I’m biased, International Journals for Sports Physical Therapy. Full disclosure, I’m an Assistant Editor of that. But what I love about that journal and what Dr. Voight and Barb, we put together this journal that was practical and it was applied.

Phil Page: Now there’s that balance Mike, right? So the problem is if I want to do a really good internally valid study, I call those petri dish studies. They’re sterile and they’re well controlled, but what’s the external validity? There is none. So you have to give and take, right? So sometimes these articles may not be very strong scientifically or internally valid, but you’d give it up with that externally. So a lot of what we do with the IJSPT is you’ll see, it’s not a lot of hard science, it’s practical science. And there’s going to be bias, there’s going to be some issues with that.

Phil Page: And quite honestly we get a ton, I can’t tell you how many people, how many article submissions we get. I think Ashley Campbell had told me that we get like a hundred a month. Mike Voight could probably tell us. I mean, the numbers is insane. Do you know why I think we get so many? Open access.

Mike Reinold: Yeah. Because people can read it.

Phil Page: Pub med.

Mike Reinold: Right well, so pub med open access. But I think you nailed it. It’s a more clinical journal.

Phil Page: Yes.

Mike Reinold: And there’s a lot of differences out there. Over my career, I’ve seen the transition. I remember when PT Journal, which I haven’t read in over 15 years. Right? So I remember when PT Journal made that transition. I remember when JOSBT started to make that transition of less clinical. And I remember … so like Kevin Wilke and myself, we used to write tons of current concept papers and we’d always go JOSBT or something like that. And every CSM, APTA meeting, we would … like Gee Seminole, the editor at the time, he would always come home and be like, “Hey, Mike you had the most read article of the year again.” Right? Like everybody loves your article. And I was like, “Thanks Gee.” It’s clinical implications.

Phil Page: Yeah.

Mike Reinold: And I remember now JOSBT is kind of starting to get away with that. In the discussion, if you start talking like, “Well, I think this means,” or, “The clinical implications of this means this,” sometimes the editors say, “Hey, let’s not talk about that.” And I think people miss that, I think they want to get that and that’s why International Journal of Sports Physical Therapy is fantastic. I think sports health is doing a good job with that.

Phil Page: Yes.

Mike Reinold: That’s become one of my favorites now. For pure science too, for the people keeping track, I think AJSM, General Sport … excuse me, Journal Shoulder Elbow Surgery, Arthroscopy, The British Journal of Sports Medicine is doing a really good job. Those are some of our go tos. And look, there’s a million articles out there. You can read articles all day every day if you want. None of us have time to do that. Just pick like four of those and just stay current and you’re going to be in the upper 99% or 1%, whatever the good percent is. You’re going to be in the one of our field. Right? Does that make sense?

Phil Page: Yeah. And it goes, I also like more of the science stuff. Right? So MSSE, Mid-size Sports Exercise.

Mike Reinold: Yeah, good one.

Phil Page: Journal of Strength and conditioning Research tend to have some good stuff in it. But one of the things that I do is I just play the field. Right? So I actually subscribe to the table of contents for a lot of different journal articles and then I just look through every month and I go, “Yep. No, no, no.” And then that way I don’t really have to focus on one journal per se, with having a wide variety of them. But you do want to make sure that, as you said, that you’re focusing your topic. That’s the key thing.

Mike Reinold: Right.

Phil Page: I get all over the place, man. I got, “Oh, there’s a shoulder article. Oh, there’s a ankle. Oh my gosh, there’s an EMG article over. Oh my gosh.” But going back to what IJSBT does, and I agree with you 100%, they have that wide. We’ll do anything from an EMG study to an epidemiological study and some journals like JOSBT have focused in on these specific topics. So be careful in what you choose and don’t limit yourself. And again, follow Twitter with these updates too because there’ll be journals out there that I’ve never heard of or articles that I’ve never seen. And I’ll see one tweet about it and I’ll go, “Hey, I would’ve missed that if I had just stuck with one journal.” Right?

Mike Reinold: Right, right. Yeah. And getting together with some like-minded people on Twitter, for example. It’s like they’re helping you because we’re all going to read research together and tweet the articles you like. Right? So that way then you’re getting some help from others. And I always find things that yourself or Dan Loren’s or somebody like that is tweeting out and I’m like, “That’s amazing.” So one question, or another question I have for you, because I have a lot of questions, but for this episode at least. I want to talk about some of my disappointments in research with this episode a little bit.

Phil Page: Okay.

Mike Reinold: I am currently getting very sick of systematic reviews-

Phil Page: Oh.

Mike Reinold: -and metaanalyses. I’m getting very sick of them Phil. We are starting to dilute information and have these gigantic reviews that always end with no findings, right? I’m not kidding. I’m going to slightly make this up, but I’m dang close. This is close. There is articles that look like, “Does a special test mean you have a rotator cuff tear?” And then you’re like, “Okay.” And then you look at the methodology and there’s 40 studies and subjects range from age 20 to 90. Right? And you’re like jeepers there’s a big difference between a 20 year old and a 90 year old. Right? And then pathology goes from impingement to a full thickness tear with retraction. And then their conclusion is always like, “Well, we didn’t find anything.” Right? Well of course you didn’t find anything. Your subject pool is gigantic. Your pathologies are gigantic. It’s just, it’s a lot. So what can … tell me about this, am I wrong here?

Phil Page: No.

Mike Reinold: That there’s just way too much dilution going on.

Phil Page: I’ve done quite a few of these, actually.

Mike Reinold: The good ones, there’s good ones. I’m not saying they’re all bad because Mike [inaudible 00:15:45] always gets mad at me on Twitter when I say this. Because people feel like I’m talking about them. I’m not talking about them, but kind of if you put a lot of bad studies together, you just have one big, bad study.

Phil Page: I know. Well, the first time I heard this was at ICAS with Mal and Tim. And they were bashing systematic reviews left and right.

Mike Reinold: Oh no way. Really? So you said Mal with you and Tim.

Phil Page: Yeah, this was about three years ago. So I go, “What’s wrong with them?” And it’s because what had happened was systematic reviews became, they didn’t became, they are level one research. Okay. What happens is, and this is level one, which in your Inner Circle presentation I talked about how just because it’s a level one of evidence doesn’t mean it’s a good study. You have to have quality of a study. You have to go beyond the level of that, right?

Mike Reinold: Right.

Phil Page: So yeah, you will have very poor level one studies, meta analyses, all these kinds of things. Because if it’s built out of poorly designed search criteria, poor quality studies, it’s going to give you crap. Crap in is crap out. Right?

Mike Reinold: Right, right.

Phil Page: That’s what’s going to happen with a lot of these. Why are there so many? They’re relatively easy to do, right? So we all know that a clinical trial is not easy to do, right?

Mike Reinold: Yeah, takes a long time.

Phil Page: Systematic reviews are … they’re not easy, but they’re not as hard because you don’t have so many things to control. Right? Second thing is, again … let’s say number one is that they’re level one. Number two is they’re relatively easy. Number three is that they tend to be the most cited types of articles.

Mike Reinold: I know. Yeah, the journals love them.

Phil Page: And that’s why you get a lot of publications because the journal index factors are based on the number of citations. And so is your, sometimes your author index. Right?

Mike Reinold: Right. Yeah. It helps. It helps. I think you left out one too is a lot of times, and this is one of my problems with systemic reviews … systematic review. It’s been a long morning. I can’t wait to read the transcription of that. One of my bees or one of the things I’ve identified here is this is oftentimes a resident that’s doing this. And the senior author, like a well known orthopedic surgeon or something like that might have his residents all doing something and they’re doing a project, but they have no clinical judgment. So they don’t even understand that some of the methodology is poor or the implications they’re making are a little bit off. So I also think this is something where we’re seeing a lot of younger people also doing these types of projects too. And not that they’re not ready for it or they shouldn’t do it or anything like that, but they just don’t have the clinical judgment to say like, “Oh, the way that they measured range of motion may have not been valid.”

Phil Page: Right.

Mike Reinold: For example. So, you know what I mean? So I’m seeing that too, but.

Phil Page: Well no, you’re exactly right. It’s not as easy, and people confuse it with a literature review. Right? It is not a literature review. And actually there are different types of systematic reviews. And the problem is in order for you to do a good systematic review, you really have to have this … a pretty homogenous kind of grouping, right? Because what you’re doing is you’re creating a bucket of evidence. What you’re trying to do is make a conclusion based on similar studies-

Mike Reinold: Right.

Phil Page: -or reviewing these types of things. But to your point, you do have to look at those factors. And if you don’t know what you’re looking for, you’re not extracting the right information. Maybe you’re not even choosing the right articles. So where I’m heading Mike, where I think a lot of people need to be going, are scoping reviews. People don’t know what a scoping review is, but a scoping review is really a broader picture of the literature that really captures everything from our metaanalysis down to our narrative reviews down to our case studies, they include everything. We usually use scoping reviews with a body of knowledge that’s smaller. Okay?

Mike Reinold: Right.

Phil Page: If you don’t have five or ten articles that are worthwhile including in a systematic review, don’t do it. It should be a scoping review. You should expand that out-

Mike Reinold: Right, right.

Phil Page: -because you don’t have enough information to make a good conclusion from a systematic review. A friend of mine is an orthopedic surgeon in Texas, Brad Edwards. He’s done a lot of JSPS and he, I remember a couple years ago, he did a nice little editorial in there that talked exactly about what you’re saying. Is it’s time to stop publishing these systematic reviews that don’t tell you anything. It’s like they should be rejected.

Mike Reinold: Right.

Phil Page: I mentioned that you should not reject an article that’s not significant. A lot of times, sometimes articles are rejected because there’s no difference between the groups, which I think is wrong to reject. But when I have a systematic review that says, “We can’t make conclusions.” Don’t publish it. That’s the way I feel about it.

Mike Reinold: It’s actually, it’s a good point. If you can’t come to a conclusion, I think what happens sometimes is they come to the conclusion and the conclusion is that the body of the evidence is limited and more research is needed. Right? That’s what we see. But again-

Phil Page: Every time.

Mike Reinold: -using that example again, I’m not kidding. “Does manual therapy work for shoulder pain?” Holy smokes that’s a terrible clinical question because it never defines what manual therapy is. You don’t know the experience level of the person applying it. They’re grouping a bunch of interventions as one thing. And then again, you have patients aged 20 to 90 that all have different pathologies. And then they say like, “No.” You know what’s worse? This is what’s worse Phil. We’re going on a tangent here. Here’s what’s worse. Not only is it going to say that, everybody in social media is going to say this study says manual therapy does not work.

Phil Page: Yep. That’s right.

Mike Reinold: And that’s not what it said. That’s not what it said. It just says they couldn’t find anything. They’re going to say manual therapy doesn’t work. Well of course manual therapy, whatever on earth that means in that study over a wide variety of people with a wide variety of pathology, will do a wide variety of things. Right? Is that pretty accurate?

Phil Page: You can’t have it both ways evidence-based people. So evidence-based remember is not based on just a research paper. That’s a systematic review that has a bunch of bias in it. It’s not about articles that confirm your bias, that you think that manual therapy doesn’t work so I’m just going to stick with this one. It doesn’t mean that this article is against you so I don’t talk about it. Right? And it’s about adding the context of the situation of the patient and your experience. So manual therapy might work in certain people. Don’t throw it all out. I love the arguments with ultrasound. I’m a proponent of modalities in certain situations still.

Mike Reinold: Of course, of course.

Phil Page: There is evidence that supports it and then people will turn right around and go, “Well, this one doesn’t.” And I’ll go, “This one does.” Just like you said earlier, you can find something that supports you all day. But what you said earlier, which really hit home for me was the little things that you mentioned Mike about age range, definition of manual therapy. That’s what’s missing from clinicians to be able to look at those things and point that stuff out. Because like you said, a lot of times these articles aren’t written by clinical people. But at the same time, don’t throw it all out. It’s still good information for us to have. We just have to, again, as clinicians be a little bit smarter and learn how to be better critical thinkers. That’s where we need to do a much better job as clinicians.

Mike Reinold: Right. And I think you nailed it right there. That’s why I kind of wanted to hit this podcast episode with this as a little bit of saying like, “Look. Their evidence is amazing, research is amazing. But it’s not all perfect.” Right? There are some flaws in the system. To really be able to get the most clinical implications further we have to understand the good and the bad and stuff like that. So awesome Phil, thanks for joining us on another amazing podcast. Phil is actually a repeat customer now, a repeat guest.

Phil Page: That’s right.

Mike Reinold: Right? You’ve been given in the past. I stole him when we were at one of our society meetings in the past and we did some episodes. So it was good to have you back Phil and thanks again for your presentations for my Inner Circle. I know they’re all going to love it and I really appreciate it. If you have any questions for the podcast, for myself, some of my amazing guests that we have every now and then since we’re Zooming from home during all this stuff, head to mikereinold.com and click on that podcast link and fill out the form to ask us more questions. Please head to iTunes, Spotify. Rate, review, subscribe, all those crazy things you do to podcasts nowadays. And we will see you on the next episode. Thanks so much.

Phil Page: Thanks guys.

Athletes often need to perform their sports at end ranges of their motion. Here are some tips on how to safely load athletes at end range of motion. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 209: How to Load Athletes at End Range of Motion

Listen and Subscribe to Podcast

You can use the player below to listen to the podcast or subscribe. If you are enjoying the podcast, PLEASE click here to leave us a review in iTunes, it will really mean a lot to us. THANKS!

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Show Notes

• 5 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either
• The Mobility Episode – Is Too Much Mobility Good or Bad?

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about loading at end range of motion with our athletes.

Mike Reinold: For this week’s episode, we have a pretty cool question. I kind of like this one. Kind of excited to hear what Pope has to say, but Zach from Detroit asks:

Mike Reinold: -When dealing with athletes who have extreme range of motion demands for their sport, which is a lot athletes, how do you go about loading them in their end ranges of motion? So great question, Zach.

Mike Reinold: You can’t say that all athletes are hypermobile because that’s certainly not true. We’ve all dealt with a lot of hypomobile athletes out there. But I do think athletes tend to be more mobile than the general population. Even the people that feel like they may be a little bit stiff or something that may be a little bit more loose jointed than we think.

Mike Reinold: Dave Tilley, everybody. Welcome to the show. Awesome. Mid-episode. I love it. It’s a good one for you.

Mike Reinold: So Dave, I want to send a huge apology to the crowd since I’ll have to repeat the question again for Dave. Just kidding. But all right, so Dave, this is a good question for you actually.

Mike Reinold: Zach from Detroit says: “When dealing with athletes who have extreme range of motion demands for their sport, how do you go about loading them in their end ranges of motion? So great question.”

Mike Reinold: Pope, why don’t you start this one? Because I know you have some good experience in this area and then Dave, gosh, I know you’re going to have some really good experience with this with gymnasts. And then obviously, Lenny and I with baseball.

Mike Reinold: Why don’t we start with Dan and Dave can start getting his blood pressure down and get him prepared for… Hey Dave, thanks.

Dan Pope: Well, I guess the athletes I have the most experience with is going to be with Olympic weightlifters. I don’t know that people often that Olympic weightlifters need extreme mobility, but we kind of do.

Dan Pope: We have to have a ton of overhead range of motion. You have to be able to squat super deep. And then you’re also at end range when you’re catching heavy, heavy loads. Right? So I do think that end ranges of motion are a little bit more stressful on the joints than say the mid range, right? So those end ranges tend to be the areas where people get hurt. So catching a snatch, sometimes the shoulder gets hurt, sometimes the hip, knee, whatever it is.

Dan Pope: The survey data even shows that. People come out of the hold and squat, that’s where people tend to get hurt. Right?

Dan Pope: So two things:

Dan Pope: 1. We have to be really conscious of the total exposures in those positions. I’m talking more from a coaching perspective when you’re trying to prevent injuries and not necessarily rehab. We have to be really conscious to amount of exposures, right?

Dan Pope: So we make sure that we have a consistent amount every week. We don’t have big spikes and we’re not putting ourselves in position. We’re overexposing that area, overusing that area.

Dan Pope: 2. The other thing is that you have to get super strong in those positions, too. So I think it’s a big time-balancing act for these folks because they have to get really, really strong in these positions. It’s important for performance and also injury prevention. Right? But if we overuse those positions, we also run into trouble as well. Right?

Dan Pope: So for me, I think that’s a good opportunity to take advantage of periodization. So maybe you’re off season, you’re temporarily unloading these positions and then you start ramping up over the course of time. You might have accessory programs once or twice a week where you are trying to strengthen the end range of the shoulder.

Dan Pope: Let’s say you’re working on waiter’s walks or you’re working on snatch bounds or something along those lines where we’re really strengthening the shoulder at the end range We’re working on things pause squats, we’re pairing the bottom position of the squat really well; But we’re also being very judicious with the application of these exercises.

Dan Pope: We’re not just throwing a ton of these movements without thinking about how the entire program operates together, I guess.

Mike Reinold: Keepers, Dan. You always come in very humble, like, “Well, I guess I could answer this,” and then you just lay the law down. Right? I mean just pure wisdom right there. So yeah, I mean, that’s amazing. I think Dan’s got a very… From the Olympic lifting section of this, that makes total sense to get some strength at end range in these positions and stuff that. That makes total sense.

Mike Reinold: I would include that as extreme end range to an extent. I think that’s super important. Gymnasts, on the other hand, may be a little bit different, right? Maybe a little different approach.

Mike Reinold: David, how do you approach getting these athletes stronger at their end range of motion?

Dave Tilley: Yeah, I’ll go with the lower body because Dan covered the upper body so well. So in gymnastics, the two ones that are most commonly thought about are like lower back and then the hip, right? So the spine being overextension causes the facet joints to become irritated and you get a spinal fracture, a stress fracture.

Dave Tilley: I think for that, it comes down to exposure, which is a huge one that Dan talked about too, is like when you add up how many times did gymnast may back bend during a practice or during a training week, it’s crazy.

Dave Tilley: It’s just with you guys and throwing. I think Dan probably has that too with overhead positions. Like you can quickly stack up way more than you’re ready for. So exposure is a big part of it.

Dave Tilley: But for me, I think that it’s all about trying to find other joints to try to take some of the load off, right? So maximizing the hip, the thoracic spine and the shoulder are going to help de-load that area.

Dave Tilley: The one that’s funky in gymnastics is the hip because if you look ballet or gymnastics or dance, they have really extreme ranges of motion. And the types of injuries that you get with the femoral neck full coming on the superolateral edge or kind of causing some labral stuff is compression based.

Dave Tilley: So for those athletes, it’s really about maximizing the soft tissue flexibility and trying to spare the laxity of the joints, the iliofemoral capsule and stuff that. That’s where people get into problems. They aren’t aware that you can be loose and tight at the same time.

Dave Tilley: Something I learned from Mike and Lenny in the baseball world is you can have a very stiff adductor complex and a very stiff rectus fem while still have a super lax hip capsule and that can cause micro instability of pinching on the wall.

Dave Tilley: So I think those are… We can’t screen the hip we can the shoulder, but we have to really have a good idea of radiology and some different things so we can look at what’s what.

Mike Reinold: That’s awesome, Dave. Great tips there from probably a sport that has the most extreme ranges of motion; because they have the ability to use that range of motion and then that’s part of that competition. They have to do that. Right?

Mike Reinold: Len, how about you in baseball? What’s your approach to loading people at end range in baseball? What do you think?

Lenny Macrina: Yeah, we do some. We definitely, I think for us in baseball, the shoulder is inherently a loose joint, so it’s a little easier than the hip. So we use a lot of rhythmic staves at end range, even starting off early postop putting them at end range, external rotation, internal rotation, different degrees of abduction and really working on the rhythmic stabilization to try to, “Don’t let me move. You stabilize that ball in the socket.”

Lenny Macrina: Because of that micro instability that Dave talked about that occurs in the hip, it happens even more so in the shoulder joint. So we’re trying to do everything we can to keep that humeral head within the glenoid.

Lenny Macrina: So whether it was a closed chain position, again, doing some rhythmic staves or don’t let me move you. So closed chain position is going to really approximate humeral head within the glenoid and then progressing to not a closed chain position. So open chain, so to speak some rhythmic staves.

Lenny Macrina: Then even I like to take an approach from Dan or even what Dave would do for the gymnasts and crossfitters and powerlifters is use some kettlebells and maybe get into an overhead position and in a stable position.

Lenny Macrina: So I’ll put them supine, maybe lying on the floor and holding something. Or if they’re doing some kind of kettlebell walk and then maybe doing a little rhythmic stave in that position as well. So again, you’re getting the approximation of the joint and then they have to stabilize. So that’s some ways that I to do it as well.

Lenny Macrina: But then we’re also doing some pretty heavy lifts. I’m not doing Olympic lifting with our guys, but I think anything that involves some kind of pole, some kind of deadlift, I really love. And I think the cumulative effects of doing all this stuff is going to cause just overall strength within the system.

Lenny Macrina: So just all that combined together I think is critical.

Mike Reinold: All right. So I’m going to be a bit of a contrarian here, although I think nobody said no, but then you all kind of said something else, which is kind of interesting.

Mike Reinold: So I think I’m going to be a contrarian yet agree with everybody, which is going to be, does that make sense? But how about this one right here? Here’s what we learned in baseball a little bit here about loading and end range.

Mike Reinold: This is what we’re seeing a little bit here. A lot of people in baseball right are loading an end range with weighted balls, right? And what they’re doing is they’re applying that loaded end range with weighted implement to try to get more load at that end rage, to build strength at that end rage, the build some load right there.

Mike Reinold: You know what I think we’ve noticed happening is that it actually destabilized them because it was the end range of the motion and they work on either loosening or damaging their static stabilizers or desensitizing the GTO or whatever it may be in that position.

Mike Reinold: It just makes me wonder:

Mike Reinold: 1. The concept of strength training in general;

Mike Reinold: 2. The concept of end range.

Mike Reinold: We’re seeing things where people are getting the end range and then forcing into more range of motion, which man, that’s like, like Dave kind of mentioned, it’s really… You’re going to have Sarman’s whole concept of the relative stiffness where you’re just going to get compensation, something’s going to happen. You’re going to jam. It’s your end range, right?

Mike Reinold: So we’ve learned things with the concept of striping where if you strengthen throughout a good amount of the range of motion, that’s when you’re going to get carryover. That’s where you’re going to get it.

Mike Reinold: But in this position, I don’t think I necessarily need strength. I think I need dynamic stability and I need end range control, not load. I think that’s a big difference right here. And believe it or not, I think all of you said that even though you didn’t. So how do you define load? Right?

Mike Reinold: But I think everybody wants to load, they want to get to end range using baseball. Let’s use gymnasts because this is absurd, right? That’s like getting them into a max prone extension and then trying to extend more.

Dave Tilley: Yeah.

Mike Reinold: It makes no sense. We would never do that. It’s not that they need to develop load in that position. They need to be able to control getting into that position and stabilized if they get into that position.

Mike Reinold: So I actually think we’re overdoing the concept of loading at end range. Dan probably said it best, but I also think, that’s the least end range. We’re talking about overhead. That’s the end range of your normal motion. Right? So you should be strong and stable in that position.

Mike Reinold: But again, even when you snatch, there’s all a generation. Right? And then control. It’s load control. Right? You got to think of it that way.

Mike Reinold: It’s not necessarily how strong can I get here? Can I jam it back into more extension, but can I stabilize in this position. Right? I mean, am I wrong?

Dave Tilley: I have just one thing I know that Dan-

Dan Pope: Dave’s, yeah, you are right. You’re right.

Mike Reinold: You could be wrong.

Dave Tilley: There’s something I know we all do that I think we missed over. Dan and the gymnasts do this a ton. I know in baseball, it is crazy how much prep drills and technical work and strength.

Dave Tilley: But there’s so much prep work in Olympic lifting before you snatch. There’s so much temple pause, e-centrics with squatting and overhead pressing that I think Olympic lifters and gymnasts do a ton of e-centric to prepare their joints for end range.

Dave Tilley: Guys will do slow tempo dips from the age of four to 30, before they ever do something crazy. Right? There’s so many years of extreme preparation that goes before they would just bounce dips at end range to further their shoulders. So that’s all I want to say.

Mike Reinold: Yeah. It’s a great point.

Mike Reinold: I feel like just right now, the trends right now, at least in social media, it’s getting the end range, forcing it into more end range and I think, yeah, definitely.

Mike Reinold: I think a lot of people that know me know that I don’t love the sleeper stretch for baseball players because you get the end range and just jam you, just torque the thing out of it.

Mike Reinold: So I think a lot of people are going to regret all this end range of motion torquing they’re doing on their hips in a few years. I think that’s going to come back to bite a lot of athletes. I think we’re pushing that a little bit too much.

Mike Reinold: I think the same thing would happen in the spine and the shoulder if you’re doing that. Right? So I feel the concept of loading and end range is a bit overplayed, right?

Mike Reinold: Let’s get as strong as we can within the functional range of motion and then be able to control and stabilize end range. I don’t know. That would be my goal.

Mike Reinold: Dan?

Dan Pope: This is probably just too much here, but I think for a lot of folks, stiffness is protective. Right? We are talking about getting stronger, stronger, stable back here. Of course, we need to be able to prepare the positions and need to be loaded. But the other part is like, we might want some stiffness. That might be a good thing, to have a little bit stiffness. It protects the joint.

Mike Reinold: It’s end range for a reason. Right? It end range for a reason. Right? So it’s either osseous or it’s protective from capsulate or something that.

Mike Reinold: We’re not talking about somebody with a restriction in their mobility in mid range and we’re trying to get him back to normal. We’re talking about end range. And I think that’s the big difference.

Mike Reinold: So I may be wrong. I may change my mind. If so, we’ll do a future podcast episode. It will be fantastic, but I don’t know. Maybe that’s just nomenclature because again, I think you guys all talk about loading end range, but I think we all said the same thing, even though it’s loading. I think it’s more about control and stabilization than actually loading and getting there.

Mike Reinold: What I don’t want to see is people laying on their stomach and trying to get end range load. No, I just had a cramp. I don’t even know what muscle cramped right there. You’re not supposed to do that. Right?

Mike Reinold: So I don’t know. Something to keep in mind. So great question. Thank you so much.

Mike Reinold: Another good episode. I appreciate it. Good feedback from everybody. Thanks Dave, for joining us. We appreciate that. And keep asking.

Mike Reinold: Head to Mike Reinold, click on the podcast link and fill out the form to ask us some questions, anything you guys want to talk about. Rate and review on Spotify and iTunes, and we will see you on the next episode. Thank you so much.

Getting started with social media is a great idea while still in physical therapy school, but there are some good ways and bad ways to do this. Here are our tips to be successful, while staying authentic. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 207: How to Build Your Social Media Presence as a Physical Therapy Student

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Show Notes

• The Good and Bad of Education on Social Media
• Social Media for Physical Therapists and One-on-One Therapy
• Should You Use Social Media as Your Primary Source of Continuing Education?

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about some ways that you can start building your social media presence as a physical therapist, or even a new grad.

Mike Reinold: So our question today is from Ben from Maryland. Ben says, excuse me, “What is your recommendation for students who want to build their social media presence with educational content before they graduate? Is there a way to do this safely and ethically?”

Mike Reinold: So, man, I’m sure. The group of us has a decent social media presence that I think we can give you some good advice. I’m going to jump in with the first part of that before you guys go, and then we’ll ask you guys. I’m going to talk about the safety of that. Yes. I think it’s completely safe. I don’t think anyone’s shown that you could catch COVID by posting to Instagram. So I do think you’re completely safe. I don’t think anything’s going to happen to you.

Mike Reinold: No, in all honesty, I think what you asked in terms of the safety question of that, maybe there’s some liability issues, or maybe there’s some things about using some images of people like your patients or something like that. I would say what the safety thing is, is I think most people think social media is not medical advice, right? I have seen some people that have put a disclaimer at the bottom of their Instagram posts. I still haven’t. Right? But I kind of refer everything back to my website. I do have disclaimers there, but I would say right now, don’t let something like that bog you down. If you want, you can always end with a sentence that just says, “This is for entertainment and education and not medical advice,” but I’ll knock out the safety question.

Mike Reinold: But now I want to hear from you guys. What do you think is the best approach for physical therapy students to start their social media presence? Popester, let’s hear it.

Dan Pope: I’ll answer this one. When I actually started doing this, when I was in PT school, and it’s because I just really, really loved physical therapy, fitness, wanted to share what I was learning, and I think it was also additive to my career. So it just really fit well, right? So for a new student that’s similar to where I was at that point, I think it’s a great idea. I think one way you can accomplish a couple of different goals at once is to use your social media as a way to learn yourself, and then share that information to the world. So I think, and this is where I was when I first started making social media, I didn’t want to put the cart before the horse, right? You have someone who’s, I don’t know, like a Mike Reinold of the world, who has a ton of experience, putting out a lot of information. Right?

Dan Pope: And you’re like, how do I put out my own information? I have no experience, right? I’m not even a physical therapist yet. What am I doing here? But you can use that as a learning experience. You can help people by producing, let’s say, social media post that reviews a specific article on a specific niche topic that you like. Let’s say the concussions or something along those lines. You can go through, find what you find is relevant. You’re learning a ton. You’re sharing that information. You’re bringing it to the world. So, you’re not necessarily saying you have all this experience, and this is the right way to do things. You’re providing value. You’re building yourself. You’re building your brand, and you’re helping people around you as well. So that’s kind of how I would go about that.

Mike Reinold: I love it, Dan. I think that’s the best. That’s the best approach right there. And I think we say this all the time, but it’s worth repeating all the time. Our social media presence, our blog posts, our blog presence and all that stuff, I still say to all of us, it is primarily for our benefit. It’s yes, we educate others and stuff like that. But it’s to keep us fresh. It’s to keep our minds growing, right? And there is no doubt in my mind that I am better at my job and what I do because of how much education we do. It just keeps you sharp, right? That’s why you go to a huge conference and presentations, and you see all these speakers, and you think, man, how are these guys on top of all the research? How do they know everything? It’s because they love it. And that’s what they do all the time. It’s for them. They’re cutting edge, because they’re always on top. So I love that. Who else wants to add to that? Mike? What do you got?

Mike Scaduto: Yeah, I would say we obviously have a lot of students that come through Champion as clinical students, and I end up following a lot of them on Instagram, and some of them do put out content while they’re a student. And I think, what’s the one thing that you’re an expert at while you’re a student is being a student. So I’ve had a couple students that put together posts that are aimed at other students. Maybe it’s advice on how to study for the board exam. Maybe it’s how to avoid being stressed as a clinical student, and how to manage your stress over time. So those are things that you’re currently going through. You may not be an expert at rehabbing a post op shoulder right now. So maybe you can put out content about that, but maybe that’s not your expertise. Right now, you’re an expert at being a student, so helping the students around you is kind of a good way to go around it, go about it and putting out content relevant to that.

Mike Reinold: Man, that’s that’s excellent, Mike. I mean, you speak to the target audience that you can relate to, I think is amazing, right? We’ve seen so many students try. We kind of talk. It’s like the proclaim or the fake expertise, right, when you have no clinical experience. Right? So they fake this expertise and try to come across like it’s a definitive post, right? Or when they start a big change the world initiative type thing when they don’t have any clinical experience, right? Those are going to be really challenging if you don’t have enough to kind of go about it, so share your experience with us. I think that’s amazing. Talk to the same group of people that you’re peers with. I love it, Mike. That was good. What else? You guys got anything else? I got a couple things, but Len, what do you say? Anything?

Lenny Macrina: No. I mean, I think what Mike said was great, because I think as you become a PT, you evolve, right? And your blog posts will evolve too. Your blog posts, your social media. And I know Mike had said it, but we say it to students all the time is what you’re learning now, people want to hear about it. Believe it or not. You think it’s useless and wasteful, and maybe you think you’re way behind everybody else, but you’re not, because trust me, there’s a lot of people that are in your similar boat. More than you ever, ever would think. So, if you’re not, like Mike said, you’re not a post op shoulder expert, but what are you reading right now to help you to become that? And then write about it.

Lenny Macrina: And then in two years, you’re writing about what you do to treat a post op shoulder, right? And then in five years, you’re going to look back and be like, whoa, I can’t believe I did that. This is my evolution. This is what I’m doing now. So I think it’s a great way to show, and you can look back and look at your evolution as well, but it’s a great way to show what you are doing to help yourself, and it’s going to help others.

Mike Reinold: Yeah. And be humble. Be humble about it, right? That you are growing, and you are learning. Don’t proclaim false expertise or try to trick people, because people with clinical experience like us, we can see the lack of authenticity. We can see right through it. And I’m telling you, some prominent people on Instagram right now, I look at some of their posts and I’m like, I can’t wait for three years, for them to look back at this post, because yes, it’s like textbook right, but it’s not clinically right. It’s just not what you see in real life. So Lisa, heck, you’ve kind of just started up trying to booster your stuff. What’s your strategy, because I think you’re in a similar situation of building right now. What’s your strategy?

Lisa Russell: Yeah. I mean, I feel like I’m kind of doing sort of a lot of what Dan was saying. I mean, I’ve been doing a lot more research than I usually have time for and learning a lot of more of the actual need for what rowers need in particular to work on injury prevention and the science behind it and not just the, oh, my teammates always have this problem. And I mean, I think it’s exactly what everybody’s been saying. I’ve been kind of going through sort of this process of reading a lot of articles and pulling it together and being like, okay, so based on this chunk of articles, all these people with low back pain, here’s the problem that everybody has. And here’s what we do about it. And it’s been fun for myself to discuss what I’ve found and why it matters and how to relate it to rowing, and then how to relate it to masters rowing and juniors rowing and just everything in between.

Lisa Russell: And I mean, I think the social media side of it has been a lot more challenging than I expected it to be. It’s way more time consuming than any of you all make it seem. At least at this point. So I mean, I think at this point it’s been really valuable for me. I think I’m going to come out of this whole quarantine period way ahead of where I would have been if I hadn’t had the time to do all of this and built the pattern of looking at research more and all that kind of thing. So I think for that reason, it would be interesting as a student to start that pattern, that habit almost.

Mike Reinold: Yeah. And don’t forget Lisa, right? You have a lot of experience with rowers.

Lisa Russell: Yeah.

Mike Reinold: Especially with yourself. You are not just going out there and talking about plantar fasciitis. You’re talking about rowers, something that you have some expertise in. So I think that’s great.

Lisa Russell: Right.

Mike Reinold: Mike, did you have something else? Yeah.

Mike Scaduto: Yeah. This is probably tying back into a previous episode, but I would say probably one of the first things that a future employer does is search you on social media. So just make sure that what you’re putting out there is appropriate. And if you’re putting out information that may be very controversial, that just be prepared to maybe answer questions about that in an interview, and, or, just keep it in mind that people are going to be looking at that, potential employers. And you want to put your best foot forward on social media.

Mike Reinold: Yeah. Be prepared to answer questions about that. If you even get the interview. Because your social media presence can certainly turn people off. So, awesome advice. I think that’s the biggest thing, is share people your experiences. I’ve had this conversation with many students that try to proclaim expertise or have poor authenticity with their posts and stuff like that. It’s be humble. Stick to what you’re good at. And we always talk about this with the evolution of us to become an expert over time. Everyone wants to be an expert next week, right? They want to get it in here, right? But it goes through these phases, right? You have to gain knowledge. You have to gain skill. You have to gain experience, and then you finally get judgment, right? Are you sick of hearing me say these things yet? Right?

Mike Reinold: But those are the four things to do. So you have to figure out which phase you’re in. If you’re a student or a new grad and you just have knowledge, you better not be making posts about skill or judgment, right? Because you don’t have any of that yet. You make it about knowledge, right? So share you just did a lit review on the best special test for rotator cuff tears. You can post that. And you can say, “Here’s some tests,” and tell us what’s the specificity? What’s the sensitivity? Right? Because those are knowledge based things that you are going through at this time. A new article comes out, EMG of the rotator cuff, right? You can make a post, here’s the top three exercises for the superspinatus based on this article. That is a knowledge based post that you’re sharing as you learn.

Mike Reinold: Don’t jump steps and start talking about experience. I always tell this to everybody, but don’t. Again, your call. This is not how I educate. And maybe I’m biased, because the people that email me, no one’s going to yell at me via email. They email me and say they connect to my education style. But my education style is just to share with you what I’m learning and what I’m doing and what I’m currently going through. What I don’t do is spend my whole social media presence telling you what everybody’s doing wrong, right? Because I humbly don’t know any of the answers. Right? I’m just giving you our best guess at what we’re doing right now. And hopefully it can be something to help you.

Mike Reinold: So, hopefully those are some good tips for you to get started with your social media presence. I recommend you do it, right? This is the whole if a tree falls in the forest and nobody’s there, it doesn’t make a sound, right? But that’s okay. That’s fine. There’s a difference between starting this and then building a following. Those are two different conversations, to be honest with you. That’s a whole nother episode, right? Starting it is equally as much for you and your patients as it is for your potential audience down the road. Keep that in mind. It’s still for you, even if nobody’s listening yet, but they’ll get there.

Mike Reinold: So, awesome. So, great question again. Thank you so much, Ben. I hope that helps. If you have a question like that, head to mikereinhold.com. Click on the podcast link. Please go to iTunes and Spotify rate and review. I don’t even know if you can rate and review us on Spotify, but if you can, do it. Otherwise, do it on iTunes. I think that’s helpful. I don’t know why I say that every episode. And we will see you on the next episode. Thanks so much.

On this episode of the Ask Mike Reinold show, we talk about the 5-step system that we are following at Champion to prepare to safely re-open our physical therapy clinic and gym during the COVID-19 pandemic. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 205: Reopening Your Physical Therapy Practice or Gym After COVID-19

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Transcript

Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about our systemized approach to how we are going to handle the re-opening of our physical therapy clinic and gym from the COVID pandemic, and a bunch of tips on what you can do as well.

Mike Reinold: We have a nice question today that’s probably going to be timely for a lot of people. I know it’s certainly going to be timely for us in Massachusetts at Champion, but our question today comes from Lisa, from Indianapolis.

Mike Reinold: And I wonder what her situation is, but she asked, what should practices be doing now to prepare to re-open after the COVID shutdown? And it’s a great question. I love to answer to this from the physical therapy perspective, maybe we’ll throw in some pearls from fitness here and there, but yeah, what can people be doing now? We’re shut down. That’s the scenario. And we’re going to get ready. Hopefully our government, I know in the state of Massachusetts, we’re talking about some guidelines. Hopefully we’re going to get plenty of heads up on some of the restrictions that we’re going to have to follow. But that’s what you have to follow. I think there’s a bunch of other things we can do to best prepare as well. So who wants to start this one?

Lenny Macrina: I guess I will. Because you and I have been talking multiple times a day, trying to figure this out. We are scouring the web. We are trying to read what states around us are implementing. We are way behind on this stage because our situation in Massachusetts has been so bad. So we kind of follow New York, New Jersey, but New Hampshire and Rhode Island and Connecticut are opening. And so we’re trying to see what their government is doing and then seeing how it can affect us. So with that, I would say, look around at states in your area, states that have similar caseloads of viruses and try to figure out how it can apply to you. With that, it looks like masks, some kind of face covering is going to be critical. So your staff is going to have to wear them.

Lenny Macrina: You’re going to have to have new practices in place in your facility where people coming in are going to have to wear something. You’re going to have to have hand sanitizer, clean hands all the time, a ton of soap. You’re going to have to maybe consider taking temperatures. I think airlines are doing that right now. So we have purchased some infrared thermometers that are arriving soon. So we’re going to try to monitor people, try to monitor their symptoms. You may have to update your paperwork. So now people may become…

Lenny Macrina: Yeah, there you go. Perfect. You are a human, you are the average human temperature. Although I thought they increased the temperature of the human, is now a little higher now, but I don’t know. So we’re using CDC guidelines and what airlines are using too. I think it’s 100.4 is considered a critical number, but you do your own research.

Lenny Macrina: What was I talking about? Oh, we’re talking infrared thermometers. So you’ve got to monitor that, monitor their symptoms, you’re going to have to monitor your staff and how they feel and you have enough supplies for them. What happens if somebody gets sick? What are the implications if a client gets sick, if a staff member gets sick? You’re going to have to be cleaning. Do you shut down? You’re going to be planning for that. So there’s so many different things that you’re going to have to really consider. That’s just the tip of the iceberg. I got off my train of thought.

Mike Reinold: I hope you’re taking notes Len, because we’re going to have to do all those things ourselves. So I know that was a big brainstorm session, which was probably pretty helpful. But, yeah, Lenny brought up a lot of points. I think a lot of them are going to be regulation based. So I think one of the first things you need to decide right now if you’re trying to open up a place, is your level of comfort with the minimum regulations. So say for example, you’re in a state that says masks are optional. I think you need to then consider yourself, that what do you think is comfortable? I think it’s completely okay for you to require a mask if you want to. So at Champion, where our physical therapy is open pretty restricted now, but we’re open a little bit.

Mike Reinold: And in the state of Massachusetts it’s recommended, or it was at the time a little bit, I think it’s not now, but it was recommended you wear a mask, but you didn’t have to, which it super vague. So we just required it because we thought it was the right thing to do. So be prepared to be looking up your state regulations, and Lenny kind of said this right here, is look at your surrounding states, because I know in New England, they formed a pact because if you’re Mass and Rhode Island and New Hampshire, and you’re those states, you’re all different recommendations, we all live within a half hour of all those states. So people are going to be bouncing around and it’s going to be super confusing.

Mike Reinold: So look at your surrounding states to start getting some heads up on the regulations and then decide if you’re comfortable with that, or if you want to make your regular regulations even tighter. So I like that. What else, anybody else have anything for this? I know this is kind of a business question and Lenny and I have been doing it. And heck if you guys have comments as employees, like what you want to see employers and stuff doing and stuff, let us know too. But Dan, what do you got?

Dan Pope: I know we’re maybe a little bit different situation because we’re out of network providers, but I think it would also be important for in network as well, is that you probably want to make sure, if you haven’t been doing this already, checking in with your patients, checking in with maybe some of your referral sources, how the surgeon’s doing, what’s going on in terms of you guys seeing more patients eventually just to make sure that when you open the doors, you actually have hopefully some business. You’re not just prepared against COVID, you’re also able to make some income, I guess is the ultimate goal. Yeah.

Mike Reinold: That’s great, Dan. And you should be using this opportunity to stay in touch with people, to see how you can help. We’re a service based industry. You got to kind of keep that in mind here. And remember this, there’s going to be two things that your referral sources and your patients are going to want to see. One is, are you open or not? That’s it. That one’s pretty easy, but this is healthcare. They have issues, they need to come in. Are you open or not? That’s easy. But what they really want, they want to see that you have a plan in place that they are going to be safe in your facility. And that you’re going to have to figure out a way to articulate that to both your referral sources and your potential patients, both new and returning. So that’s one of the big things you should be preparing for now is how can I get this message across that you can be comfortable at our facility when we’re allowed to open again? I think that’s huge. So Mike, did you have some tips?

Mike Scaduto: Yeah, I was just going to go along those same lines. I think there is going to be some level of anxiety from the patient’s perspective, going back into a healthcare setting, whether it’s an outpatient physical therapy clinic or just a regular doctor’s office. So I think you have to have policies in place that are clear and be able to articulate that to the patient, to put them at ease and then follow through with those policies when you’re there. And sometimes it can be a little bit difficult and you have to be strict with the policies. And I think that’s in everyone’s best interest and it’s in the company’s best interest in the long run. So, having policies, communicating them to the patient effectively, communicating them to the other employees effectively. And I think that’s something that Champion did a really good job throughout, was the communication aspect of what’s changing and what’s still unknown, I guess. So you can still have some questions, but you’re working to address those.

Mike Reinold: Yeah. And remember we’re a service based industry. You got to have a little empathy here with these people here. And everybody’s in a different situation. If you’re one of those people that think this is all fake and nobody’s going to really get sick and stuff like that, you better not be articulating that to anybody because your clients probably think the opposite. So you got to be really careful. And like Mike said, this is the time to be harsh.

Mike Reinold: Two scenarios again, we haven’t talked about this yet. We’ll assume this is us talking about it right now Mike. So we have one scenario, one of my patients, we got the mask situation, and just I’m in the room, I’m working on one person, they’re super conscious of this and already a little skiddish being there, and a patient just walks in and walks right by us, like two feet by us, and just walks in, no mask or anything like that. I’m like, “Hey, you got a mask?” And he’s like, “Oh yeah, yeah, yeah, no, I got it right here.” I’m like, “Okay, well, are you going to use it?” And so, we kind of chewed him out a little bit.

Mike Scaduto: Yeah. And I think that’s appropriate to do. I think definitely remind people of the policies. I will say that potentially people don’t read signs that are on the door. So, even if you text them beforehand, it may be a good idea to remind them as soon as they get there. Yeah. It’s a tough situation because people maybe breeze through the signs and stuff that are on the door. And I guess it’s up to the clinic to enforce the policy at that point.

Mike Reinold: Yeah. But hopefully you tell them once and if you make it stern or strict enough. Like that, for example, that patient’s been completely fine. Now, on the other hand, I had a similar situation with a PT student that will be nameless. We only have one right now. But he did the same thing. He walked right in and he didn’t have his mask on. It was in his backpack. So I was just like, “Hey, you going to put your mask on?” He’s like, “Oh yeah, yeah, yeah.” I’m like, “Ah.” Especially as a PT, it’s not your first day, no excuse, you got to be careful. So we’re going to be in that. So, this is the first time we’ve talked about that. I was going to slack you that Mike, sorry. But yeah, it’s okay to be snark. So, all right, I’m going to let you in on Champions five step system for reopening. Ready? This is how I think. But we’re doing five things to prepare.

Mike Reinold: One, we’re preparing our facility. And that’s the big thing. Do you have cleaning supplies? Do you have appropriate spacing? Do you have everything you need to be able to start business? When this first happened, we had a staff meeting. We were still in person because it was just so brand new, but one of the first things we said, Lenny and I were talking about it to the staff, and we said, “Hey, if this is like a zombie apocalypse, in a zombie apocalypse the number one resource is probably going to be food. Well, we’re in a pandemic, a health pandemic right now. Our number one resource right now is cleaning supplies. If Champion runs out of cleaning supplies, we’re going to starve. And then we have to close.” If we don’t have hand sanitizer, we don’t have cleaning supplies, we have to close, because then we can’t conduct our business. So prepare your facility and get that stuff ahead of time. If you haven’t done it now, it’s probably too late and good luck. But prepare your facility. That’s number one.

Mike Reinold: Two, prepare your systems. So what is your cleaning system? What is your inventory system? What is your staff check-in system? Where they come in, we’re going to answer three questions. Do you have a fever? Do you feel ill? Were you around anybody that feels ill or has COVID? It’s got to be no, no, no, temperature check, sign, you get to work today. Those sorts of things. Prepare your systems with clients. Same thing, prepare updates to your professional liability waivers that you’re going to have. Because we’re going to now have to include viruses and pandemics to our liabilities. We’ve never had to do that before. So prepare your facility, prepare your systems.

Mike Reinold: Three, prepare your staff. Don’t assume that your staff knows that A, the patient needs to come in with a mask, and B, that they have the power to yell at them if they didn’t wear the mask like we were just kind of saying. Prepare your staff on the protocols, the cleaning system. Everything you need to know so that we are top notch. We have to convince the outside world that you’re going to be safe in our facility.

Mike Reinold: Four then comes up to that, prepare your clients now, your patients. So that’s sending out emails, sending info out to your referral sources. Here is how we’re going to assure your safety. That’s an important one.

Mike Reinold: And then lastly, this is the curve ball, prepare to act quickly when things change. And I know Lenny and I have learned several lessons in the last few months that we will definitely do differently next pandemic. Hopefully that never happens. But we’ve learned a lot and you have to prepare to act quickly. Okay.

Mike Reinold: So that’s our five step system to prepare for this. And trust me, there’s a lot that goes into each one. But hopefully that all makes sense. Mike, did you wave, did you have a little something?

Mike Scaduto: Five steps.

Mike Reinold: Five steps. That’s our five step Champion, COVID, reopening activation plan, systemized fashion system.

Dan Pope: So, a lead magnet. That’s awesome.

Mike Reinold: I know. Do I always think lead magnets? I always think blog post headlines, but…

Dan Pope: Got to sign up.

Mike Reinold: That’s how I think, we’re doing a free webinar tomorrow. That’s just how I think. I’m very systems mindset based thing. But if you do that, you cover all your bases. So, Joe, no that’s not Joe, that’s Lindsay. Lindsay, I hope Indianapolis isn’t as bad as Boston, but hopefully you do the right thing and you introduce this well. And hopefully some of these tips can be applied really to anybody, both fitness, physical therapy, I mean all the same stuff for the gym too. So great question. Thank you so much. Everyone be safe. Thank you so much during this time, to continue to listen. Be sure to rate or review us on iTunes, Spotify. Head to our website, ask us more questions and we will see you on the next episode. Thank you so much.