Ask Mike Reinold Podcast

Ask Mike Reinold Podcast Archives

Each week my team and I answer YOUR questions on our podcast, The Ask Mike Reinold Show. Explore the archives below or click the button to subscribe and never miss another post.

Getting Back to High Level Activities with an Irreparable Rotator Cuff

February 6, 2020/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of the #AskMikeReinold show we talk about how people with irreparable rotator cuff tears can get back to high levels of function, including things like weight training and obstacle courses raises. We’ll cover if that’s a good idea and if we’re concerned about arthritic changes down the road. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 190: Getting Back to High Level Activities with an Irreparable Rotator Cuff

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Show Notes

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about getting back to high-level activities when you have an irreparable rotator cuff.

[Intro]

Mike Reinold: All right, what do we got for a question today?

Student: All right, we got Dillon from Montana…

Mike Reinold: Dillon!

Student: Big fan of the podcast. We have a 48 year old male with an irreparable infraspinatus, who is very active. What kind of outcomes should we expect as he rehabs? His goals is to eventually get back to Spartan Races. Is this feasible or will arthritis develop so bad he will need a shoulder replacement?

Lenny Macrina: Yes.

Mike Reinold: Two different questions but I like that. Is it feasible? Yes. All right, so a 48 year old patient with an irreparable rotator cuff, which is a conundrum. I just wanted to use that word in an episode today. So we’re in a conundrum, right? You have an irreparable cuff, which usually means it’s a pretty big cuff tear and it’s probably retracted, right Len? I mean, why else would it be a irreparable?

Lenny Macrina: Probably yeah.

Mike Reinold: 48 year olds, it’s probably not like ridiculously chronic. So it’s probably a large tear that’s retracted, meaning they don’t have a chance to put it back. And he wants to get back to high level activity, specifically a Spartan race. But if you’re a Spartan racer, you’re probably a fit person, right? You do a bunch of other things. So why don’t we start with that question and let’s do the two together because I think we will need to address the potential for arthritis down the road. But is it feasible for this person to get back to Spartan races? What do you guys think?

Lenny Macrina: Yes.

Mike Reinold: All right, great episode. How many times did we do that, Joe?

Lenny Macrina: Wrap it up! I would say yes, right? I mean, yeah, yeah Dan.

Dan Pope: There’s a lot of layers to this, I think. So one, I think it depends on where the person’s at. So I’ve seen some CrossFit athletes that have fully retracted rotator cuff tendons and they can still do CrossFit. They might have some pain, sometimes they might not have much pain. So I think it depends on the person that’s in front of you. My big concern is that, if they have too much rotator cuff damage over the course of time, do they get to the point where they have to get a reverse total shoulder eventually as opposed to a total shoulder replacement?

Mike Reinold: Right.

Dan Pope: And I guess it depends on which tendons are retracted, how many, that type of deal, which I don’t fully know, but I guess long story short, probably yes. But the other part is you probably do need to be careful and have that first checked out by the doctor frequently over the course of time to make sure they’re not progressing to the point where they can’t get regular shoulder replacement. Best case scenario.

Mike Reinold: Heck of a disclaimer right there. I like how you did that there. Just make sure your frequent check ins with the physician to make sure you’re on path. So Len, it sounded like you agreed, right? I mean, you agree it’s feasible, right? Why do we think it’s feasible?

Lenny Macrina: When you tear a tendon, other muscles can take over. So you have your posterior, you have your Teres Minor, you have other muscles that can definitely compensate and help. But I also think, not knowing the whole situation, is age, to have a 40 year old with an irreparable infraspinatus.

Mike Reinold: Oh wait, they said infra?

Lenny Macrina: Yeah.

Mike Reinold: Oh rats, I was going to base this all on supraspinatus.

Lenny Macrina: Very, very unusual. So, sounds like it may have been a freak injury but I would also try to get, not knowing the situation, a second opinion. Because nowadays, with internal bracing and tendon transfer, they can do it like, a lat transfer or something like that. I think there’s ways to get around this but maybe, maybe, maybe. But I would want to consult with like surgeons that specialize in these types of surgeries and really try to push them in that direction to give them the best opportunity to continue to train because they’re only 48 and if this was a 68 or 78 year old, I’d say, different story, work on strengthening, it is what it is and activity levels down. But this is a 48 year old. So I think there’s still a good opportunity to do more for this person than if they just got one opinion who said irreparable. But then again, not knowing the whole situation. But I think the body is amazing that it can overtake these issues and figure out a way to still perform.

Mike Reinold: The body’s a wonderland.

Lenny Macrina: My body’s a wonderland.

Mike Reinold: So, it’s kind of funny. So irreparable, we got that. Is it feasible to do these things? Of course everything’s feasible. I don’t think we should ever tell anybody like, you can’t or you shouldn’t or whatever. I mean, everything’s feasible. It just depends on where they’re at. Now I would just add, before we maybe get Mike and Lisa to chime in a little bit here, but like I would just add that the fact that it is an infraspinatus worries me a little bit, that not the feasibility is there, but maybe my optimism is less. I’m a little bit more pessimistic that this will go up. But again, anybody can do anything. It’s just whether or not it’s a good idea. So I don’t know. I think we covered the feasibility thing. Why don’t we switch gears and say, what are the chances of this person developing arthritis and how do we manage that, I guess? And does that matter? And those types of things. I mean, who wants to? Mike?

Mike Scaduto: Do you think, considering the mechanism of injury for the original cuff tears is important there? Because if it was a traumatic injury versus a chronic overused training type injury, it probably speaks to how you have to modify their training going forward. So if it’s somebody who was maybe training suboptimally and ended up tearing their rotator cuff to this point, you probably spend a lot of time educating them on how to modify their training going forward and that’ll be a big piece of their rehab. I don’t know. What are your thoughts on that?

Mike Reinold: I think that makes sense. If it was a snowboarding accident and it’s this freak accident and everything else is great, then yeah, absolutely. But yeah, if part of this attrition of the rotator cuff is from poor activities and things they’ve done in the past… but by all means, I think the feasibility question goes downhill and you could argue then also the chronic arthritis concept goes up, right? So that’s a good thing is understanding why this happened. Was it an acute traumatic like goofball kind of thing, or was it a chronic attrition that I think changes that? So a good point.

Mike Scaduto: If it was acute trauma, a traumatic injury, like what else happened? Did they dislocate their shoulder? It was an instability event, something like that could also play into the prognosis.

Mike Reinold: Right, that’s a good point. So put it all together. And I think that is going to be something that we consider with, is this person at risk for arthritis? Lisa, anything? I know we kind of covered a bunch, but.

Lisa Russell: Yeah, I mean, even just on the arthritis side of things, in terms of how it happened and what the trauma was and thinking short term traumatic arthritis versus longer term overuse, depending on what the mechanics of the shoulder end up being and I mean, you’re just educating the person of what they’re working with and how they need to deal with it and what to avoid or what you know. I guess that goes back to even the strengthening side of if we’re just working without surgery or like Lenny said you’d go back and find somebody else who can be more creative, but just telling the person what they’re working with and how to keep their shoulders safe.

Mike Reinold: Right. I think I liked what you said there was that, it’s almost like taking their symptoms into account to an extent to here and that’s probably the biggest thing that I would recommend kind of moving forward is that you take their symptoms into account. If they’re not having any symptoms and they’re super strong with the surrounding musculature, then I don’t see a reason why we should limit them, right? Because if you’re getting arthritis and it’s building up over time, you’re probably getting symptoms as well. It’s not like you’re developing raging arthritis behind the scenes, have no idea and then all of a sudden, one day, it’s too late, right?

Dan Pope: I don’t know, I looked into this research at one point because I felt like I didn’t have good answers for my patients, because you can’t have cuff pathology, right? And maybe not have pain, we know that. The other thing is that, most people after they have a rotator cuff tear, it continues to worsen over the course of time, right? It just gets worse and that’s kind of natural. What’s challenging is that, if you do get a retracted tear and you can’t do surgery on anymore, that may end up being a problem. The other problem is that we can’t really guess if people are worsening over the course of time and there’s a few variables that do. I think one of the things I was finding, smoking is bad, that’s going to make that tendon get worse faster and the other one was pain. So I do think there is some, I don’t know, some viability to the whole idea of let’s train but let’s be careful about pain, if things are worsening, go talk to the doctor and let’s make sure it’s not a worsening problem.

Mike Reinold: And like you said previously, it’s like, get a good relationship with a doc, maybe you’re checking in with them every now and then. If you want to use your body to the max and you have this scenario, then maybe you need to have more check-ins, just to make sure you’re not going in the wrong direction. But I think the problem, just to kind of summarize here, is yes, is it feasible? Of course it’s feasible. Is it a good idea? Maybe, maybe not. I mean, it really depends on the scenarios there. But what happens when you have a cuff tear, is that you’ve lost the complete dynamics of the glenohumeral joint. And it’s not going to work perfectly. Like Lenny said, could they compensate? Can others help? Absolutely. Could they do a good job of that? Absolutely.

Mike Reinold: But your room for error goes down, right? And then you just have a smaller cliff that you could fall off, that you just got to be careful with that. Because what’s going to happen with the cuff, is you’re going to lose that ability to center the humeral head and over time, you’re going to probably superior migrate. And that is where you’re going to develop your arthritis. But again, I think you’re going to know it’s coming, but don’t be the knucklehead that keeps working through it until you get a raging arthritic situation because then you’re going to really be in trouble. So, very feasible that they get arthritis. It’s probably actually likely, anybody thinking he has a chance of not getting arthritis, you know? And arthritis in the shoulder kind of stinks, so you know, something that kind of keep in mind.

Mike Reinold: So hopefully those tips help. Hopefully those were at least some things that you can have some conversations with, if you have somebody that’s very similar to that. So I think that’s actually pretty common as our activities, as we age, increase and as the activities we’re doing in our twenties and 30s increase. I think we’re going to see a lot more of this in 10 years or so. So thank you everyone!

Mike Reinold: But anyway, another great question. Thank you so much. If you have a similar question, head to MikeReinold.com and click on that podcast link and you can fill up the form to ask us a question. Hopefully we’ll feature it on a future episode. We’ll see you in the future.

Should Physical Therapists Squat and Deadlift with Their Patients?

January 30, 2020/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of The Ask Mike Reinold Show, we talk about if physical therapists should be loading up big movements like the squat and the deadlift with their patients. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 189: Should Physical Therapists Squat and Deadlift with Their Patients?

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Show Notes

Weight training for physical therapists

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about wether or not you should be loading some of the big lifts, like squatting and deadlifting, in physical therapy.

(Intro)

Mike Reinold: All right so Ricky Bobby from Talladega.

Student: My boss said to me that PT is not personal training. You need to stop overloading these patients with squats and dead lifts. These patients are injured. You need to take it easy on them. I thought the evidence of large muscle group training in addition to PT exercises is pretty clear. It was tough to hear, especially when I have older patients that lifting 80 plus pounds from the floor with amazing technique and a boost in confidence. My patients love coming to PT because they actually feel like exercise translates to life. What do you think about this?

Mike Reinold: Great question. You know what? I actually think the second half of your question, Ricky, you did a really good job with this because if you just said the beginning, who knows, maybe you’re squatting and dead lifting people inappropriately all the time. But you said you have older patients that are doing it with a moderate amount of weight with great technique, right? I think you gave us all the info you need, and they feel good about themselves afterwards. It applies to life. You biased the question in a great way. That was awesome. But that is disappointing that your boss says you shouldn’t be doing lifting with people. Mike, you want to start?

Mike Scaduto: I think I understand where we’re all coming from in terms of what we actually do with our patients. We do all these exercises with them. Could it be that the boss was saying that in insurance based model you can justify your treatment and was possibly not getting reimbursed for these treatments? Could that be? I don’t know. I’ve never worked in insurance pay.

Dave Tilley: Plot thickens.

Mike Reinold: Yeah. That could be really interesting that insurance is trying to get you back to baseline. Right? And maybe these things are advanced. I think you could document that well though that these are functional tasks. Squatting and hinging, right? I know that there’s ways to do it, but I don’t know. I feel like it’s deeper than that. I feel like his boss or, I guess it is a he. It’s Ricky. I feel like his boss is saying that he should stick to just generic PT treatments and not exercise and load people with the bigger lifts.

Dan Pope: Wow. Well obviously I love this stuff, right? I love doing this and you’re not going to hear me say, bad job.

Mike Reinold: Just the fact that you have your shirt on right now.

Dan Pope: I know.

Mike Reinold: It’s amazing.

Dan Pope: It’s tough. It’s 60 minutes worth recording is hard. I kind of came out of school with the same philosophy. I want to load everyone and have them all train hard. I would say that most people think they’re doing a good job generally. It’s kind of hard to really look at your treatments and figure out if that’s really the best thing for every single person or just your strong bias you really want to push towards people.

Mike Reinold: Right.

Dan Pope: There’s a chance you’re doing phenomenal. And I’d say keep it up and have a talk with your manager or your boss. Just let him know my patient’s doing phenomenally well, right?

Dan Pope: All the outcomes are great. This is what we want. What’s the problem? And then try to figure it out from there. The other thing is to think about is this really the best thing for all your patients? A lot of people right now are pushing a deadlift is the best thing for low back rehab. And it may be a phenomenal tool, but I’ve got to tell you, most of my older people I worked with, they didn’t want to deadlift. They didn’t want to squat heavy weights. They didn’t want to do that stuff. When I hear people telling me all my patients love squatting and they love deadlifting. Some do. A lot of them hate it. I think a big thing is that make sure you actually are giving the right thing for the person that’s in front of you.

Dan Pope: Look at your treatments and figure out if that’s really the best thing. I think a lot of times from outcome perspective, giving the exercise to the person who wants to do is probably better than just blanketly, you’re going to deadlift because it’s going to make you stronger and better life. Long story short, good job. I think it’s good that you’re squatting, deadlifting with your patients. Maybe take a hard look at what you’re doing and see if that’s truly the right thing for your patient. And then maybe talk to your boss and let them know, I’m doing a good job or maybe I’m not. And try to figure out what that problem is.

Lenny Macrina: I would say if you’re not, you have to communicate that with your boss and if there’s a fundamental difference in how you want to treat on how far out you are from school or how advanced you are as a PT itself, but sounds like there’s a fundamental difference. And if the communication isn’t working, then it might be time to update your resume and move from Talladega to Birmingham.

Mike Reinold: If you articulate it to your boss the way you just did it to us. It’s going to be really hard to kind of refute that. I wonder if there’s a little bit of a middle ground here. I think the trend on social media right now is just load, load, load. That’s all you need. That cures everything. You don’t need to really do physical therapy anymore. I wonder if that’s a bit of what’s happening here. I will say the first half of your question, that’s the first thing that jumped in my mind. You were one of those people that were ignoring the obvious stuff, like some isolated weakness, or some treatments, or some potential manual therapy. Things that you could do and just saying load, load, load. That’s all they need is progressive load.

Mike Reinold: And we all load our patients here, right? That is a fundamental thing that we do with everybody. We load that here, but we also don’t just load that. We think it’s pretty shortsighted to just think that the squats, the deadlift is going to fix everything. That being said though, it sure sounds like you’re doing it for a functional training technique later along in their program. Sure sounds like you’re doing it really well for me. I think you’re doing everything really well. I wonder if maybe perhaps, though, you just sugarcoated the question a little bit. Maybe you are doing it in too many people. What I would say is take a step back. Dan brought up some good points. There are some people that maybe don’t need that, or maybe they could do similar type things, or they don’t need to load it quite as much. Or they don’t want to, but then most people should have a progressive loading pattern. I think you got to put that together.

Lenny Macrina: I’m going to assume that you’ve spoken to your boss about this. But if you haven’t, maybe people have complained to your boss that they are lifting too much, and afraid that they’re going to hurt themselves by deadlifting because there is a perception in the lay world of bending over and lifting stuff up off the ground could hurt people’s backs. I don’t agree with it necessarily, but some people are probably afraid to do it. If you’re having people do it, maybe they do it for you and they say they like it, but maybe they’re going higher up and saying “I don’t know if I should be doing this.” Again, the conversation has to happen, if it hasn’t happened already.

Mike Reinold: Great. Maybe they’re saying, I want to work with another therapist because I don’t feel comfortable dead lifting with my low back pain or something. There’s probably more to this story, but I think there’s a general summary. I think everybody agrees, right? Do we progressively load? Do we use the main, big lifts with most of our patients? Yeah. We’re on board with your thought process in there, but I will say, though, that we do that in combination with the rest of our strategies. We’re doing things like we’re working on their mobility, their isolated strength, their neuromuscular control, and then they’re progressive loading. If you only focus on progressive loading, I think you may be missing the boat as well. That might be a little bit of what’s going on there too.

Mike Reinold: We load everybody, but that’s not all we do. Anything else? Any other tidbits or advice? I think Lenny’s right. You got to talk to your boss about that and clear up some of the confusion. But I don’t think any of us would do it different, right?

Dave Tilley: Nope.

Mike Reinold: Nice.

Dan Pope: I don’t like dead lifting.

Mike Reinold: Yeah. Dan doesn’t like to deadlift. Well Ricky, keep going with what you’re doing because we’re on board with what you’re doing.

Mike Reinold: Shake and bake, baby. But…

Dave Tilley: I want to go faaast.

Mike Reinold: Keep going with what you’re doing because I think your head’s right, but take a step back. Maybe he’s telling you something that may be going on there. Maybe you have to think about it as different strategies for different types of people. Great question. If you have more questions like that, head to Mikereinold.com. Click on that podcast link and ask away. We’ll do our best to get to each and every question that comes across. Awesome. See you on the next episode.

How to Develop a Physical Therapy Treatment Plan and Program

January 23, 2020/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of The Ask Mike Reinold Show, we talk about the steps we take to develop a plan with our patients and clients, and then build our programs. This is often a very daunting subject to students and new grads, but by following a simple systematic approach, you’ll get better in no time. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 188: How to Develop a Physical Therapy Treatment Plan and Program

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Show Notes

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about how we develop our treatment plans and our program strategies for our patients and clients.

Mike Reinold: All right. What do we have for questions today? Who’s up? I got it. Whoa. First day.

Austin: Yeah. I got it. All right. We got Ty from Sarasota. What’s up Champion crew? I love the content on this podcast and thanks for taking my question. I am a DPT student about to graduate in a few months. I feel that my school has done a great job teaching how to identify and diagnose pathology but is not given as much when it comes to treatment and program. Do you have any advice, resources, examples, et cetera on how I can better understand how to program treatment for a person coming to PT.

Mike Reinold: All right. That’s a pretty common question. I bet. Done a really good job with diagnosis, especially medical diagnosis. I think we’re getting a better understanding of that as we’re getting into the doctor of physical therapy and direct access and all that stuff.

Mike Reinold: So really good job with diagnostics. But now you’re confused with how to develop a treatment plan. Students quickly… I don’t know. King, what do you think? Do you agree with this question? How did you feel? Do you feel like you are prepared?

Mike Reinold: Were you… I mean do you guys feel you… go in order. Was there anybody prepared well for treatment?

Andrew King: I think our school did a great job preparing us.

Lenny Macrina: Go Hawks!

Mike Reinold: Why?

Andrew King: Because they give us a good idea of what to do like initially versus advanced and intermediate. So kind of where to start, what patients can tolerate and how to progress as and what to look for to progress.

Mike Reinold: That sounds like it’s pretty good right there. That understanding… I think that’s the basics of treatment. Understanding how to start, where to start and how to progress. I like that. That’s a good one. What about you guys?

Student: I agree with the question. My school focused a lot on the diagnosis did a great job and we learned the basic starter interventions but after that it wasn’t… Where I learned all, mine was the clinical experience, the less of actual in class besides like your basic starter.

Mike Reinold: So that’s a good point. So maybe you know this is another good reason to make sure you have good clinicals. What about you guys?

Evan: I think just my experience as a strength coach for the last four years has been able to implement into physical therapy pretty well.

Mike Reinold: That probably helps too because you already understood how to develop things like strength and power and mobility and stuff like that.

Austin: Yeah. Our program was just heavy on exercise, prescription, and stuff like that. And we were able to take courses for advanced interventions where we learned more programming and things like that. Having a sports elective too. So you have to learn more…

Mike Reinold: That’s good. So I think that’s part of the problem is we don’t have a minimum basis in college on what you need to learn. So I think a lot of people are very good at diagnostics and you spend a lot of time with that. And then with experience you get better with treatments. So… All right. Where do we start I guess, is the question on how to help somebody? Where do you go from a new grad and how do you figure out what to do with treatments? I mean, I don’t know. I get that we have a million directions we can go. And does anybody have initial advice you want to start with? And then we’ll go from there.

Dan Pope: I’ll start a little bit. I think part of it is that you have to have a population in mind. So for us, we all have specific niches. So if you have a six year old that doesn’t want to get back to anything in particular and maybe any old intervention will help for the low back pain. But do you have some with low back pain is trying to get back, let’s say a squat, apparel or something along those lines.

Dan Pope: There’s a very specific set of exercises you can start with and work your way up over the course of time. And at least for me and my niche, my population, I think Evan kind of hit it really well. I actually found that most of the students that I worked with in the past are not very good at exercise prescription, and they’re very good at kind of the basic stuff when they have to advance. They just have no idea how to do that. So for me, I think it’s really important to learn the basics of strength conditioning. And learn how to work with people from that perspective. So any resource from there would be helpful I think.

Mike Reinold: Right. So I guess that’s maybe one approach if you’re feeling insecure about your knowledge on how to help people with that is… Let’s start with that. Maybe instead of being so diagnostic specific, what you do is you start to think in your mind: “All right. How do I help people?” Well, we have to work on mobility. We have to work on strength. We have to work on their own muscular control. We have to work on endurance or power or whatever. Maybe you have all these domains. And you start thinking about each one of these, what do I have for strategies to improve mobility, improve strength, improve power. And then seek each one of those kinds of buckets out. Maybe that’s a good way to start based on what Dan said.

Dave Tilley: Yeah, I would agree. I think looking back on it, what I was kind of most insecure about was the initial treatment or plan of care after somebody has an acute injury. So I really didn’t know how to help. Someone who’s a post op joint for a knee or stuff, I felt a little bit how do I touch? I don’t mean to hurt you and I follow protocol stuff. So there was that piece of the medical side, but then I have.. Didn’t have a great mat of foundation for strength conditioning coming out of school.

Dave Tilley: And so I felt that was where people weren’t necessarily having surgery but they were hurt. They need strength programs. I didn’t know how to program well. So for me it was just finding mentorship for both of those things. Cause I knew that was what I was weak at mostly. So finding people online I think is really important. If you don’t have good finding people online. I followed your guys’ course and I felt like I didn’t have that immediate post op problem solved with my clinical education. So that was really help online. And then strength conditioning, I just shadowed strength coaches.

Mike Reinold: Yeah. And you kind of learn that way a little bit through that. I guess what it comes down to is a lot of times is we get caught up in the diagnosis and not what’s right in front of you and you start saying, well what do I want to do for treatment for to tell for memorial pain instead of taking a step back and just kind of figuring out what’s wrong with the person. And that’s our approach at Champion, which we tried to do is we try to look at them more holistically and then come up with a checklist of things they need and stuff.

Mike Scaduto: I think it definitely all starts with your assessment and your evaluation. And part of the evaluation assessment that we use is moving screen and I think we all use it to find out what they can tolerate in terms of what exercises they’re going to be able to tolerate. So there’s a squat and lunge, step down and things like that. So if someone comes in with knee pain and they can tolerate a squat and they can’t tolerate a single leg step down, then I’m probably going to have them do some squats and build up to this single list of down. So I think that helps guide your treatment plan. You find out what they can tolerate day one and build upon that and progress them over time basically.

Mike Reinold: So I think too that the point of what Mike said here is that we have a systemized approach here of how we look at people. And when somebody comes to us with say shoulder pain, we’re going to evaluate the shoulder pain and try to figure out if we can understand why and come up with a diagnosis. But that doesn’t mean that that is everything we do. That is part of it. The other thing we do is we try to figure out what’s sub optimal that maybe put them in that position. So maybe things that we can increase their functional capacity, not just perhaps work on their shoulder pain. So it’s almost like we have two buckets of treatments here is let’s help with their pain.

Mike Reinold: Well, it’s the reason why they’re here and their injury, and the precautions, and the strategies that are involved with that. And that’s what you learn in school. And then the secondary part is, okay, well let’s take a big step back. All right, they have knee pain. All right, well I know there’s things I can do to help them with their pain. Okay, good. Well, what else can I do? Oh, they can’t do a step down. Why can’t they do a step down? What happens? And then you figure out a strategy with that. Oh, they don’t have any ankle dorsiflexion. Oh, they, their hips are weak or whatever it may be.

Mike Reinold: And you find these things, you create this checklist of sub optimal things, and then at the end you take a step back and you figure out what you have. And when you’re young and you’re a student, you’re going to have a crazy checklist. There’s going to be things all over the place. And you’re going to have all these things, then what you need to do is just figure out what’s the most impactful things, what’s the thing that is going to give the most bang for the buck initially and start with that. And I think that’s our big strategy. Anybody… I think that’s a good strategy. What about when it comes into the actual treatment, what do you guys do for your programming. Do you have anything specific you guys want to add to that?

Lenny Macrina: I just want to add that I was fortunate when I did my student, it sounds like he’s a student, she’s a student already in a DPT program and you’re probably going out on clinicals to make sure you set your clinicals up at spots that historically have probably a bigger staff where you can bounce ideas off different PTs and just a staff that is respectful, that has a group of PTs that you really look up to and are known in there… Inviting their facility or known in their community. Cause I was fortunate. I got… I did an internship at HealthSouth but Mike and I had Kevin Wilke and probably 10 other PTs that I could bounce ideas off of and get in their minds and pick their brains and just observe from a distance what they’re doing. And I think that was very helpful.

Lenny Macrina: That’s how I got a lot of my base of exercise, which is watching other PTs, everybody saw it, copycats each other. And everyone’s doing the same stuff because you just follow what the other PTs are doing in your facility. So as a student you go on your internships, you got to have that in your head. That’s one of your goals is to get as many exercises under your, in your mind and in your notebook for your future. So I would definitely, try to really do that. I think these guys are hopefully doing that too. They just observing all five of us as we go and hopefully they are just putting little notes in their head, mental notes of what they could do for their patients in the future. So that’s one strategy that I’ve used and I’m always copying Dan, whatever Dan does out here.

Dan Pope: Of course. Yeah. I was kind of going back to what Mike was saying about the program. I think this is a little bit challenging because if you’re trying to work with an athlete that wants to get back to a higher level. Let’s say they have Achilles tendon problems. If you look at some of the Achilles tendon literature, it says, okay, do some sort of Achilles tendon strengthening somewhere between twice a day and every other day. So I think what happens is that you get a pretty good idea of what the baseline should be. But the high level stuff is what’s challenging for physical therapists. Figure out how to get back to it.

Dan Pope: So from a program perspective, what you said is figure out the needs. So does this person want to be able to run five times a week? Okay, great. That’s awesome. Five times a week, 30 minutes. Right now we’re doing three days a week worth of calf raises. How do I bridge that gap? So maybe three months down the line I’m running five days per week and then you start working backwards and just progressing and slowly over the course of time. And that’s probably been the way I’ve done most of my programming to help people get to a higher level.

Mike Reinold: I think that’s great. As a PT we often focus on what to do right now based on their limitations and what we don’t think of as the end. So Dan’s saying, start with the end in mind and then figure out a plan that builds on there. I like that. I think the only other thing I would add is that we have a really systemized approach on how we work with people here and we’ve done this over years because we figured out the steps it takes to help people get better. So, yes, a rotator cuff tear or Achilles tear or something or you’re going to have very specific things you do. But generally for people with pain that come in and they don’t have a specific type diagnosis or pathology, you just have hip pain, knee pain, shoulder pain, whatever it may be.

Mike Reinold: We follow a systemized approach and what we do is we try to break it down into three things. We talk about this a lot. This is in our Champion Performance Certification thing, but it’s mobility, control, and load. And that’s how we program when you just base it off those three things all the time and it goes in that order and they overlap. But we have to say, okay, what mobility restrictions do they have that we need to address? Great. Once that’s kind of tackled, or at least we’re working on that, what do we need for control. And for control, this is the typical physical therapy. It’s the isolated exercises. They have an isolated weakness of this muscle. They need dynamic stability of this joint. They have neuromuscular control deficits of this. That’s control. And then the third is then they have to load and that’s what we load the movement patterns that they need to get back into.

Mike Reinold: So when in doubt, come up with their checklist of things that are suboptimal and then could follow that progression, mobility, control and load. And when you do that, that’s almost your blueprint to develop a program for anybody. It’s actually easy to follow a postoperative protocol. Because it lays it out for you. It’s the person that comes in with shoulder pain. You can help them get out of their pain and then send them on their way. But they’re probably going to come back into pain because you didn’t really fix the underlying issues that they had with them. And that’s how we tackle those programs. So it’s going to take time, it’s going to take experience. But I think the more you practice that, the more you should get better at that.

Mike Reinold: So a great question. Another good one. If you have anything like that, just head to mikereinold.com and click on that podcast link. And you can fill out the form and we’ll see on the next episode.

Should Physical Therapy Clinics Have Productivity Standards?

January 16, 2020/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of the #AskMikeReinold show we talk about productivity standards for outpatient physical therapists. There are definitely two different perspectives on this, one from the therapist and the other from the clinic owner, but there is also an ethical line we need to be careful of not crossing. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 187: Should Physical Therapy Clinics Have Productivity Standards?

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Show Notes

6 Things You Do That Your Clients Hate

Transcript

Mike Reinold: On this episode of The Ask Mike Reinold show, we talk about how you should deal with productivity standards in your physical therapy clinic.

Evan: James from Minnesota, “What are your guys’ thoughts on handling productivity standards in private practice outpatient setting? I have expectations for billing four units in a 40 minute treatment session and expectations for starting patients at three times a week for 50% of overall caseload. I believe in putting the patient’s needs first and tailoring my treatment to meeting their needs. Love the show guys, keep up all the great work.”

Mike Reinold: Wow, that’s pretty great. So, I like this. This is a good question on productivity standards which I feel like the cycle of physical therapy in this country kind of continues. Like, you see these big neck, big conglomerates get larger and then they all kind of like foul.

Mike Reinold: I don’t know what happens, right? But you get a big mass of HealthSouth and then things happen and then it disperses and you get these like waves and what tends to happen is you start with like a nice small private practice, right? And you do things right, you do things the way you want to do it, those sorts of things. And then over time you get into these big conglomerates and it becomes more about like less about the person and it becomes a business, right? And productivity standards, how many people per hour should you see? How many units should you bill? Stuff like that. Right. So, specifically to this one though, four units in 40 minutes? Is that legal? Yeah, I guess so. Right, right. So this is like pure hitting the limit of like how to maximize it.

Mike Reinold: And then the other thing is you should be seeing your patients three times a week?

Evan: For 50% of the overall caseload.

Mike Reinold: Yeah, so it sounds like what they’re doing in your environment is there, there’s probably a larger corporation type thing and they probably have some metrics that they know are the averages, right? So they’re trying to say, “Hey, you’re below the averages.” Right? And what they’re saying is hopefully is, this is the average, but if you do enter a situation where somebody is saying like, “Hey for every avow they should be scheduled three times a week initially.” Then yeah, that gets a little awkward. So who wants to start? I mean, you guys, Len, we’ve had some experience in the high kind of volume type thing. Like, did we have productivity standards like that or is it more just…

Lenny Macrina: I know later on in my time down in, Alabama we did and I was definitely, I was part of the management so we were challenged from higher up to relay the message to staff of where their units were, units per charge and we’ll charge just per unit and units billed per visit and blah blah blah and reimbursement. So we did, we tried to, relay it along. I don’t think I, certainly wasn’t like, a stickler, but I just did what I was told and, and it was what happened. But it definitely does happen. I think we’re definitely bordering on, a very gray area of what, what’s legal and not legal by telling people they have to come three times a week for a certain, fraction of the patients that you see. This just doesn’t sound right. Like who definitely needs three times a week? Not many people. Right? So…

Mike Reinold: It sounds like they’re, they’re making decisions based on the business.

Lenny Macrina: No doubt.

Lenny Macrina: I mean, I don’t know if I’m- we definitely don’t do any of that stuff here. We don’t even think we really have much productivity that we look at. We’re not, I don’t think we’ve ever told you guys do you have to see more people? It’s just, how it happens we have stats that we look at, we’re looking at trends and who comes in, but we’re certainly not telling them that they have to see more, never.

Mike Reinold: I think like from a business owner perspective, it’s not necessarily bad. Like let’s say, let’s say you were, billing a certain code, but you think that you could substitute it for a different code that would be ethically and logistically fine, but you would get more reimbursement. I think that’s appropriate, right? Because the clinician doesn’t understand that. So there are some games we typed up. We tend to play. Or billing like based on time if, if you don’t quite understand it. I think there’s, there’s a strategy towards billing that I think people get with productivity.

Lenny Macrina: I am on, I’m always scouring Facebook and looking at, the different groups and it’s amazing the lack of education and the lack of conformity amongst PTs and how to bill, how to bill private insurance versus Medicare. Is there a difference? Eight minute rule versus 15 minute rule. We are lacking severely in how to understand billing and what codes should be used for a manual and therex neuromuscular rhea. And if we can bill dry needling and if a Medicare patient is there, how that affects things. It’s, it’s all over the place. And I think, I think even management struggles to, to get that to trickle down to staff because I think people are still all over the place. And so I think fundamentally, we don’t know. We really don’t know. Yet we’re just trying to use these parameters to track and bill accordingly. So…

Mike Reinold: So, and that’s always a, that’s not necessarily bad, right? It’s just trying to maximize, the game here, right? But when does it cross the line, Dan, what do you think? When does it cross the line to what we’re starting to do isn’t in the best interest of the patient?

Dan Pope: It’s, that’s really hard. And obviously I kind of left a facility that was kind of like or physiotherapy associates, nothing against a company. I liked the company but I think that people, physical therapists in general, we have to have a little bit of empathy for the business. Right? And I think in general physical therapists are undervalued. So the reason why we got to see more and more people is to try and make money. Right? So we can pay for the overhead. So we’re in a tough situation from that perspective again, obviously I kind of left that type of facility.

Dan Pope: I like to be able to treat people less frequently cause I feel like that is optimal for a lot of people that I do see. But the flip side coin is that these business have to run and we have to value yourself as clinicians. So part of it is that, if you are able to see people more times throughout the course of the week. And you think that will actually benefit them further? I think that’s okay for more perspective, but I think as a physical therapist here, you got this, and I read this, there’s a term for this, I forget what they’re calling it, but you’re forced to see people more than you think you need to see them and when you leave at the end of the day you feel poorly for that. Right? But if you are able to actually fill that person’s time with stuff that’s very valuable and you’re adding to them and adding them from a physical therapy or wellness perspective, that might help you deal with some of those feelings. Right. What was your original question?

Lenny Macrina: But I think ultimately it’s the PTs decision to figure out if that’s appropriate. If you think you can add stuff two to three times a week and it’s going to help them get better faster and back to their goal, then fine, but not management telling them you have to see people three times a week and I know it happens. Trust me, I know it. Besides this question, I heard it a gazillion times in my career. It does happen. I don’t agree with it. It’s something that I hope will change. But.

Mike Reinold: Yeah, I mean, and every patient population is going to be slightly different like a post-operative person, like come in more frequently than a non-operative person, for example. Right? So I think we’re stating the obvious with some of these things. I think the question comes down to is just making sure that as a young clinician you understand that there is some part of a business behind it. I think Dan brought up a really good point is look, it costs a lot of money to run a business, right? And there’s a lot of financial risk that happens from the ownership group with running a business, right? There’s a lot that goes into this. So you have to understand that a little bit and you have to do your best to maximize how much profit you make. But if that is how you are making decisions on your clinical career, on your clinical decisions, then that’s where we cross the line. And it becomes a real, real problem, becomes very unethical.

Mike Reinold: So it’s one thing if you’re being educated on, hey, maybe there’s some ways that we can optimize revenue without sacrificing your clinical judgment. I think that’s completely appropriate. But if somebody is telling you to just see people more often than I think you’ve learned right there, that that is the type of business that you probably don’t want to be associated with or you wouldn’t have asked this question. Right, right? And I think a lot of people will feel uncomfortable in that situation too. And over time maybe that manager, that person will understand that that’s not the best way to do business. And hopefully, when all the therapists leave and they kind of keep replacing them with new grads and then churning them out and spitting them out and then moving onto the next one, they’re going to realize that that’s not the best sustainable business model over time. Right? So I don’t know.

Mike Reinold: Any other feedback? Let’s flip gears because we can talk about this over. Let’s flip gears and I didn’t want to interrupt you if you have more, by all means. But like if you’re in the situation, what’s our advice to that person?

Lenny Macrina: That’s what I was going to say. So flipping it a little, if it was me, obviously I don’t know, to me results speak volumes. If you get good results with your patients and your clients. And I think we do a pretty good job here. Word gets out. So I think management has taken it from a different view. They just get people in as much as possible. But I think the people will automatically come in if you are producing good results where you’re with your patients and they leave feeling good about how they’re progressing. And I only had to go to PT once and I felt amazing. That word gets out on the street in the community and then people want to come in and get that same approach because they know they’re going to get better faster than going down the street where they had to go two or three times a week.

Lenny Macrina: So I think you flip it that it’s the results that matter. Marketing is going to be important. Whether you go to a doctor or you going to some kind of a other facility, if you’re trying to be become nichey, you’re going to a crossfit facility, baseball facility where you’re spending time and learning and then that gets out into the neighborhood that you’re making an effort to make yourself better and you’re trying to get a certain amount of clients in or some type of client in. And so I think all that snowballs and I think that’s a better approach than just blanket three times a week.

Mike Reinold: Yeah, I think we’ve always established business here, and this is the same way of what we do online is we just do what’s right, right? We do, we do what we think is best and we do what’s right and we don’t ever focus on profit. And when you, when you don’t focus on profit, I think you end up having a better product and over time you become more profitable, right? So that’s a general strategy. The second you start making decisions for finances, it tends to just spiral out of control in the wrong direction because you’re making decisions for the wrong reasons. That’s not why any of us got into this. So anything else, Dan?

Dan Pope: I was going to say it. If you’re kind of going for what Lenny said, you probably need to communicate with the management a little bit. I think that’s a tough sell because I’ve kind of had this same conversation because you’re trying to get maybe people in the door get them better, faster, right? Giving them more autonomy. But if they don’t understand what you’re actually trying to do and they keep on looking at your numbers, it doesn’t make sense. They’ll be upset at you and meanwhile you’re not communicating what you’re trying to accomplish and then you’re going to go home and be upset at the end of the day and probably going to leave your work eventually. So if you communicate well with the that the managers, I guess it sounds like you’re dealing with right now, maybe you’ll feel a bit better at the end of the day and you’ll, you’ll hit some numbers that are more profitable and maybe they’re not breathing down your neck quite as much, I guess.

Mike Reinold: Yeah, I would say keep an open mind. And have a conversation with your manager first about, all right, well what do you think I’m doing wrong? Here’s why I’m treating this way. What do you think I’m doing wrong? Maybe there’s an educational opportunity for you here. So I would definitely say I would recommend go talk to your management and say, “Hey, I’m not comfortable with this productivity standard,” but instead of just immediately saying that they must be wrong, just ask like, “what am I missing here?” And let them try to explain it to you. And if it becomes really clear that all they care about is the money and not the person, then I think you just figured out a lot about that place and whether or not that fits your values and if you want to continue working there. But maybe during that conversation, like Dan said, you’ll kind of get like, like some thoughts and maybe you’ll realize, okay, no I think you’re right.

Mike Reinold: Like okay, maybe, maybe if I did see people a little bit more often I would have better outcomes. Right? Because they might be comparing you and your frequency of visits and your outcomes or something like that. You never know what they’re comparing. I’d say hear them out first and let’s not immediately take it as an insult. Right? And hear them out first, but then it’s no big deal. Don’t get stressed out, don’t get flustered about it. Hear them out and see what they have to say. And then you make a decision. Is this business doing it the way I want to do it and do I want to be a part of this? Right? It makes sense? Awesome. All right, good question. I mean, tough situation to be in, right? And it stinks that sometimes we are, but you never know, right? Maybe they’re about to go out of business.

Mike Reinold: Maybe their lease just went up and who knows, right? Maybe they’re about to go out of business. Figure out the situation in there and figure out what’s going on and ultimately always do what’s best for the person in front of you. Otherwise, you got into this for the wrong reason. And plus there’s way better professions to make money than being a physical therapist, right? None of us got into this to be rich, right? We did this because we want to help people, so hopefully that helps. So if you have questions like that, head to mikereinold.com click on that podcast link and you can fill out the form and ask us more questions and we’ll see you on the next episode.

How Physical Therapists can Specialize in Sports Rehabilitation

January 9, 2020/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of The Ask Mike Reinold Show, we talk about ways that a physical therapist can start specializing in a specific sport. There’s a lot that goes into the evaluation and treatment of sports injuries, here’s how to get started. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 186: How Physical Therapists can Specialize in Sports Rehabilitation

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Show Notes

5 Tips for Landing a Sports Medicine Job in Professional Sports – https://mikereinold.com/landing-job-in-professional-sports/
How to Work with Professional Athletes – https://mikereinold.com/how-to-work-with-professional-athletes/

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about how you can start specializing in specific sports rehabilitation.

Mike Reinold: All right. What do we have for questions, Ryan?

Student: We have Chris from New York. He says, “Hi guys, I’m a young physical therapist, less than two years out of school in an orthopedic setting and I’m looking to specialize in baseball related injuries and rehabilitation. I was wondering what your best advice would be to move toward a specialization such as baseball.”

Mike Reinold: All right. So two years out of college.

Student: Two years.

Mike Reinold: Is that what it was? Good. So pretty common question I think that we have. And I don’t think we need to talk about baseball, right? We can all talk about anything we want, but I guess the question is the young clinician two years out wants to start specializing in some sport or some activity. This one specifically baseball. Probably a good question. And I’m glad you’ve done it this way ’cause we have students and young clinicians all the time that come through and immediately want to specialize in something. And I kind of like how you’re two, three years out of school. You kind of learned a little bit of everything, right? Doing some general kind of approaches and now want to get a little bit more specific. I like that.

Mike Reinold: So who wants to start? I mean, let’s answer this as a kind of how to specialize into a niche population, right? Or as Dave would say a niche population.

Lenny Macrina: Classic.

Mike Reinold: Who wants to start first?

Dan Pope: Want me to do it?

Mike Reinold: Wow, man. I don’t know. I definitely would take a poll by the audience. Doesn’t sound like Dan’s into it, but yeah.

Dan Pope: Yeah.

Lenny Macrina: Dude, how’d you get into baseball?

Dan Pope: So when I was 14… No… I actually played baseball a little bit, but I can’t throw anymore. Any way, I think what’s really important is you have to be embedded into the community that you want to be a part of, right?

Dan Pope: So for me, I do a lot of fitness. I also did a lot of CrossFit. So the first thing I did is I was a CrossFit coach, right? So if I want to try and be within this community, I have to actually be within this community first and foremost. And part of that is networking with a lot of local coaches. So what I did is I did a ton of going from CrossFit gym to CrossFit gym speaking to the coaches, talking to them a little bit. If they’re sending athletes to me, I communicate back with them. We collaborate a little bit over the course of time. I also allied myself with different surgeons in the area that knew about fitness and knew about kind of the physical, or excuse me, the surgery side for the fitness population as opposed to just like regular surgery I guess. And that was really helpful and that was really good for getting more people in the door for me that were specific to CrossFits I guess.

Mike Reinold: So it sounds like what what you did, you took the approach of… And you actually became a CrossFit coach although that was before you were a physical therapist, right?

Dan Pope: Yeah.

Mike Reinold: You were doing some strength stuff back in the day.

Dan Pope: Yup.

Mike Reinold: Before you were PT, but what Dan did was he not only joined the community, which I think is a very valuable tip, right? Join the community. So that way you understand the culture, you understand the experience, you understand even the passion, right? Like a lot of people want to get into something like fitness, right? But then don’t enjoy working out. Well, that’s going to be really challenging because it’s not going to be very authentic that you don’t train yourself. How are you going to work with advanced level trainees? I think that that’s an important concept, you know?

Mike Reinold: So you have to understand the techniques. You have to understand the specifics of that particular thing. But also, I think you said this really well, the culture and the community. I think that’s a good one.

Mike Reinold: So who else wants to talk about maybe… Like Dave, maybe with gymnastics. How much do you think your being a gymnast and knowing not just the culture, but how to communicate to these athletes? How much do you think that’s important that you have the experience to talk to these athletes that you work with?

Dave Tilley: Yeah, I think that’s probably the biggest thing in terms of being able to like develop rapport with a person. I think that we see this in here all the time. Whether it’s you guys with baseball and crossfit and Mike with golf, it’s like the second that you start speaking their language and you understand their terminology. You understand what their competitive situation looks like. You understand their goals. You can have a very different conversation with them that I think allows them to feel comfortable. And one sharing all of their problems with you in terms of why it hurts or what they’re maybe not telling their coach, what they’re not telling their parents, but then also they probably have much more buy in terms of actually following what you prescribed to them.

Dave Tilley: And so, I mean blessing or a curse, we’ve had people in here who have probably gotten similar advice than you’ve gotten elsewhere in physical therapist. But because you put it in a context of baseball or golf, they’re like, “Oh, okay. Like this person understands what I’m trying to get back to or they’ve done this themselves they understand it.” So I think it’s really important because one, you can never… like I said, have rapport that person. But two, is that you can be a pretty good communicator between the whole party of people involved, the parent, the coach, and then obviously you, yourself as the therapist, and the athlete. If you guys have common language, it’s easier to talk about problems.

Mike Reinold: Yeah. And the other concept I think too is that you understand their life and their future expectations, right?

Dave Tilley: Sure. Sure.

Mike Reinold: So we deal with this a lot in baseball, right? We may have an athlete that sees a doctor and because it’s magically week eight, right? They can start like a throwing program or whatever it may be for whatever that was. When we often times… We sit down and we talk about, “Well what’s your strategy for the year? When do we need to be ready? What’s the most important part of your year? Is it the spring or is it the summer?” And we kind of have like a more… Almost like a concierge level discussion with them that we can help guide them because we know their goal is to get a college scholarship or to get drafted or whatever it may be for your sport. We know that that’s their goal.

Mike Reinold: Where a lot of times doctors and other physical therapists, they’re just, “Well it’s week eight.” And I can do this exercise now, right? And it’s very simplistic with a timeline versus understanding the broad scope of not only their injury right now, but their competitive season and their career if that’s important. Mike, what do you think on… What’s your experience with golfers? I mean obviously you’ve done a great job. Ton of golfers in here. Something you’re passionate about. I think they all see that you’re a very average golfer on Instagram if they follow you, but what…

Mike Scaduto: There’s so many come backs. I would say the big thing, and this is a little more in general than just golf specific, is recognizing what your primary referral source is going to be. So for golf, if you want to work with golfers who are looking to improve their performance or if they’re injured… The primary referral is probably going to be the golf coach and for baseball a lot of times it can be a pitching coach and baseball coach. If you want to work with a lot of post-op patients, if you want to work with post-op shoulders is probably going to be more the surgeons. So then you have to network within those referral sources. But you have to identify first.

Mike Scaduto: So for golfers you have to… Or at least in my experience was we kind of infiltrated I guess a golf instructor that gives lessons that we aligned with and we kind of took lessons from him from while. And then, eventually started talking about what we do. And then, kind of grew a relationship that way. But it wasn’t like we were trying to convince him to work with us. We kind of just worked with him a little bit and got to know him. And over time we developed that relationship.

Mike Reinold: Because you guys shared a lot of shared values, right?

Mike Scaduto: Shared the values.

Mike Reinold: Like you shared how to help people, right? And you’re doing it for the right reasons. I think that’s a great example, right? Is putting yourself out there. So Dan said, “Become a coach.” Mike said, “Well go work with those coaches.” Right? Because you want to understand what the coach is teaching. So we’ve all done lessons with particular golf instructor around our area. We understand the way he thinks. So if he sends us one of his clients to look at them, we know how we can then articulate what we’re going to do that aligns with his instructional strategy. So it’s this easy kind of connection with that. Len, anything to add?

Lenny Macrina: Yeah. Everybody summed it up really well. I think a couple of points that I’d like to make is you don’t have to play the sport in order to be a master in it. But I think-

Dave Tilley: Still hope for baseball.

Lenny Macrina: …definitely. Right. Exactly.

Mike Reinold: You have a doctorate in it.

Lenny Macrina: But I think it definitely helps to be able to talk the talk obviously. So I never played major league baseball, but I’ve treated a lot of major league baseball players. But I understand the sport. I can treat a gymnast, but I would definitely defer to Dave for more of the specific terminology.

Lenny Macrina: I think of it in two different ways. I think of it learning locally. Learning locally with doctors, learning locally. Especially for baseball, learning locally with like Mike said pitching coaches, hitting coaches, just coaches in general. Get in that relationship and then more of a broad educational thing. You want baseball. I’m going to challenge you again like I challenge somebody else. Go to Atlanta in January and go to the injuries and baseball course from ASMI. And learn from the best, what we think of the best, in baseball that are educating on that. So bring that back with you and network in that fashion.

Lenny Macrina: Go to Mike’s baseball website, the elite baseball website. And you can learn from there. And so, I think-

Mike Reinold: He must have it bookmarked.

Lenny Macrina: …have that so you’re always reading those blog posts and reading research. And then, you start putting content out and then people recognize you as a leader in your area. So I think there’s a bunch of different avenues that you can take that the guys have mentioned. And I think it always comes down to networking. When in doubt, just have relationships with people and that will open up doors for you.

Mike Reinold: So I like it. Relationships are a big one. Immersing yourself into the environment and community I think is huge. But I think Lenny just really nailed it with that end point. You need to become a huge student in that specific genre, right? If that’s what you want to get into, right? So you have to learn everything. Read every book, every article that comes out, every expert that you can learn from, go to courses and actually master that. So you actually have to be very passionate about this to be able to sustain doing this because you’re going to put a lot of effort to this.

Mike Reinold: But then on social media, that is what you should be focusing on, right? If all I put on social media was low back pain people? Guess who would come find me and want to work with me? Low back pain people, right? So it’s whatever you put out there and establish yourself as someone that understands that and you’re constantly promoting that, right? Dave’s all gymnastics on his social media feeds. You never will check Dave out because you heard about them and think, “Oh wow, this guy doesn’t know about gymnastics.” But if you’re all over the place and you’re doing a little bit on the ankle and then a little bit on the spine and a little bit on the shoulder and then an overhead athlete and then you have a total knee patient, that’s fine, but you’re not developing that specificity. So I think that’s… Educate yourself very specifically and then educate others very specifically on social media. I think that’s how I’d probably wrap it up, right?

Mike Reinold: So great question. We get similar questions a bunch. I think it’s important to kind of address that. So hopefully that answered your question. If you have more like this, head to mikereinold.com and click on that podcast link. You could fill out the form and we’ll keep asking… Oh no, we’ll keep answering questions.

Using Physical Therapy Interventions with No Evidence of Efficacy

December 19, 2019/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of the #AskMikeReinold show we talk about what to do when physical therapy interventions have little to no evidence showing they are effective. This is actually pretty common, here’s how we decide what to do when there is limited evidence. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 185: Using Physical Therapy Interventions with No Evidence of Efficacy

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Show Notes

How to Best Integrate Evidence Based Practice
The good and bad of continuing education on social media

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about how we choose some of the PT interventions that we do when there isn’t enough scientific evidence available.

Mike Reinold: Trey, are you the question asker today?

Trey: I am.

Mike Reinold: Fantastic. What do we got today? Trey?

Trey: David from San Francisco. How do you determine which PT interventions you perform when there’s little to no evidence available?

Mike Reinold: Ooh, good question. That’s a big one. Yeah, and it’s funny like I kind of got the sense reading the question a little bit too. You know, this is one of the biggest things I’m seeing on social media right now. It’s not the post, it’s the reactions to the post on how confused everybody is.

Mike Reinold: Well, so how do you choose what interventions you do when we don’t have evidence of it. So I’ll start off by by saying a lot of people do have this quest to only do things that have strict evidence-based validity, right? So something that has been shown in a research project to be, you know, valid for example. And everybody has the quest to do that. And I think that’s like a great quest, right? That you should try to do that all the time. But I think the reality of it, especially in our field, especially in healthcare, especially with the way our clinical trials work, it’s nearly impossible to do a well controlled study on the majority of things we do. So even though like we’re trying and we’re doing our best with research, it’s really hard to conduct these studies. So you know, oftentimes we’re faced with things where maybe it’s a new technique or an intervention that people are talking about on the internet or maybe it’s something that’s old but we still haven’t validated in there.

Mike Reinold: How do we decide what we do and don’t use in our clinical practice? Who wants to start?

Dave Tilley: I was just giving a broad overview in saying I’ve always tried to approach it at like 85% of what I’m doing in clinic is what’s available up to this point. Evidence based research from mentors of mine or things I’m reading or good RCTs or whatever, and then 15% you want to be somewhat creative and innovative and have new ideas in mind. Like I remember when blood flow was first coming, becoming popular. I didn’t really know a lot about it, but I knew I wanted at least like try a little bit on myself and like play around a couple of patients who were like pretty safe. And then from there the research flows then you’ll get that becomes part of your 85% as a research gets better, but you definitely should be investing almost all of your time and things we know that are pretty solid scientifically.

Mike Reinold: Right. So 85% of your time, but I’m going to say 85% of what you do is probably not validated through science.

Dave Tilley: Yeah. Well I guess theoretically I would say it’s not like an RCT, and a couple of blind controls, but at least like the sciences, like the histology studies are there, the rat models are there, that something is available that helps you out.

Mike Reinold: I’ll give you that because that is how we determine a lot of like what we do is it’s, but people are going to argue that that’s not scientific.

Dave Tilley: Definitely better than just swinging it.

Mike Reinold: Exactly. So, so I think that’s a good start is like a lot of what do, and like a lot of our protocols that we write for after a surgical procedure are based on some of the understanding of, of tissue, right? And understanding of physiology and how things heal.

Mike Reinold: So we may not know that this is effective at that, but then we have a theory based on some of our basic science that does it. So I actually think that that’s a good approach. A lot of people are going to argue that that’s not valid though. The social media people that are ‘nope there isn’t a trial that says that’s good,’ even if you maybe have like a basic science theory as to why.

Dave Tilley: Yep, And I would say that if you, if you get really honest with yourself and you’re examining what you’re doing and how much like elite level evidence there is, you’re going to have very little to do in the clinic.

Mike Reinold: And I think that’s the main point here. So Dave I think has a great first strategy right there is if we don’t have pure evidence on it, then we base it as much as we can on our, on theories based on what we understand is the basic science, right?

Mike Reinold: So that’s a good first strategy, right there is is we do our best understanding things. That’s why like we do EMG studies, right? And a lot of people critique EMG studies, you know, for various reasons and rightfully so to an extent. But again it’s like we’re never going to know if exercise A is the best exercise for this intervention, right. But we base it on as much sound scientific principles as we can. Dan.

Dan Pope: Yeah, I was just going to say that it would help if who was asking the question?

Trey: David.

Dan Pope: David gave us some better information about the specific person from or you know, what kind of intervention their trying, and I can definitely see this. I work with so many fitness people and a lot of times I get jealous of like let’s say baseball players or maybe even runners.

Dan Pope: There’s quite a bit of research on how to treat those problems. You know.

Mike Reinold: Right.

Dan Pope: If I have someone who has like impingement, rotator cuff tendinopathy and all the available evidence is in six year old individuals that don’t do any sort of fitness activity and I got like a 23 year old that wants to like bench press 400 pounds, it’s very challenging. Right?

Mike Reinold: Right.

Dan Pope: And there’s no research out there about people who want to bench press 400 pounds. You know that have shoulder impingement, there is some, some research there, but very, very little. That becomes very challenging. And one of the things I borrowed a lot from you guys is that there is some available evidence for baseball players. You guys have done a lot of that and we can extrapolate a little bit from other populations that are kind of athletic, right?

Mike Reinold: Right.

Dan Pope: So a lot of what I do is take prior research study, so one good example is patellofemoral pain syndrome and runners, right?

Dan Pope: Or let’s say like field sport athletes. I apply a lot of those principles of rehab to my athletes who are squatting. They’re not running, but they have patellofemoral pain from squatting. So we can extrapolate at least a little bit from that perspective. You know.

Mike Reinold: I like that.

Dan Pope: Yeah.

Mike Reinold: So, so taking the basic science right and then maybe taking a similar population or a similar pathology or something. I think these are good strategies, right? Cause again, I think a lot of the students and new grads are saying like, well I want to know if this exercise is good for shoulder impingement in this person. Right. And I think this is, you know, Dan taking like maybe from other sources or from other pathologies and applying that, right? Like if we have a study on tendinopathy in the knee, right? Maybe we can apply that to tendinopathy in the shoulder for example without having a definitive study. Right. Who else? Anyone else want to ..

Dave Tilley: I kind of want to hear what Mike says. Sorry go ahead. But he’s like brand new out of school. So I feel like he’s…

Lenny Macrina: There’s so many variables to try to consider.

Mike Reinold: A few years.

Lenny Macrina: and there’s so many. When you do it, you sit, sit down and try to do a research study. Right? Let’s just go basic. So Mike and I have done a bunch of research on, especially baseball, but various topics and when you’re trying to cope with inclusion criteria and exclusion criteria and all the variables that could be affecting the independent and dependent variables, nearly impossible to control for everything.

Mike Reinold: Yeah.

Lenny Macrina: So if you’re trying to conduct basic research and try and extrapolate that to people who have emotions and stresses and everything else, we throw everything out the window, you just, you got to, you got to be able to interpret it and then you throw it at the wall and see what sticks, with your patient population. And if it works, great. I think it just comes down to movement and education and being good to people. I think that usually is going to hit 99% of,

Mike Reinold: there it is.

Lenny Macrina: Get them moving, get them moving.

Lenny Macrina: Being good to people. Get them moving comfortably and then, and then educating on why we think that that helped and how they have hope.

Dave Tilley: Mike graduated last week so.

Mike Reinold: Mike’s been a therapist for several years now, but Mike any thoughts and now that Dave’s thrown into the fire.

Dave Tilley: It’d be interested,

Mike Scaduto: No, I mean if I’m, if I’m considering a new intervention and I don’t have the years of clinical experience, I only have like a week or two to go back on. So I guess I look at it, like, is there a major safety concern? So something like is there going to be like an ethical issue if I use this on my patient, if not, I’ll go to the best available evidence. Just kind of look at what evidence is there, how we can utilize it and if there is limited evidence then you have to go based on the experience that you have, or you have to consult with somebody and ask their opinion on it, who has more clinical experience.

Mike Scaduto: So for blood flow restriction for example, which is relatively new and a couple of years old in the literature and yes we’ve been using clinically, we’ve been using it for a little while and that kind of like asked you guys like what what your opinion on it is like what some of the signs you kind of take a step back. So I think it doesn’t have to necessarily be one study that says ‘this is the best intervention for X’ and you can use a couple of different resources to kind of like form your opinion on it and then you can try it and form your own experience with that modality if it’s modality and you can see if it works for your population.

Mike Reinold: I think that’s great.

Mike Reinold: I think it’s a great approach, too, because I don’t know how else you do it. I mean there’s, there’s so much gray out there. So I go, I always call it like the light system. I call it like a red light system, right? But essentially like if there’s a, if there is a trial that shows that you what you want to do is ineffective and it shows ineffective, not lack of conclusion but ineffective, then you shouldn’t do it. There’s a trial that shows that it is effective, then you should do it, but 85% using Dave’s number something. It’s all going to be in the middle and you’re going to have to like play with that a little bit. But one thing I want to caution everybody, maybe we’ll end the episode on this. One thing I want to caution you on is that a lack of a conclusion does not show in effectiveness and I think that’s one of the things that we’re struggling with right now, especially on social media because I’m not kidding.

Mike Reinold: We’re seeing things like systematic reviews that show that like manual therapy doesn’t work for shoulder pain, but what does that mean? Right? How do you define manual therapy? Who did the manual therapy? What type of manual therapy, were they all the same experienced person? Was this like this? You combine all these studies on manual therapy, but how do you define that and then how do you define shoulder pain, and then what was the diagnosis? The right patient population? I just wrote an article, I think it was the impingement article, but I did a system that showed a systematic review. I think that the patient population range from 25 to 68 that’s absurd. That’s absurd. So of course the conclusion is is going to be, it’s inconclusive that they couldn’t find anything. It’s so diluted of a study, that you’re not going to find any.

Mike Reinold: So a lack of a conclusion. Right. So inclusiveness does not mean it’s ineffective.

Mike Reinold: And I think that is where the majority of young clinicians are struggling the most right now is that they’re getting confused by a systematic review or a meta analysis or whatever that may show that there was a lack of findings and then they’re saying then it must not be effective. That’s not what that study says. It either didn’t have the right power, it didn’t have enough control or it’s too diverse of a patient population for the subjects in that study. Right? I mean, but I mean like you guys agree, right?

Dan Pope: Yeah, it makes sense.

Mike Reinold: I mean, so we’re seeing that quite a bit and then people are saying, well manual therapy doesn’t work for shoulder pain and whoa, there’s like lots of complications in that. So I’m not saying you know, pro manual therapy or anything. I’m just saying that studies like that are not helpful and a lot of people are taking that to the wrong endpoint. If that makes sense. So keep that in mind and I think that’s what you do. You do your best. Mike I think laid it out really well. Everybody has some good stuff. Dan, you want to add to that?

Dan Pope: One thing I will say, and I know we don’t want to drone on for too long, but I think when people are so evidence-based, they stop critically thinking. And the problem is that we got to use our brains to figure out why this person got hurt. And you can also use your brain to figure out how to get better based on the principles you know, as a therapist, and when you’re always looking at literature and you’re not doing anything that’s not evidence based, I think we lack the ability to use our brains to that point. We’re not actually utilizing all of our critical reasoning skills to get that person better. When you know, evidence helps with that process, it shouldn’t hinder you.

Mike Reinold: Yeah. Evidence has to drive us, but you also can’t be paralyzed by a lack of evidence. I think that’s like the biggest take home. So, awesome. So great episode. Another good question. I think a lot of people have that question. And I think that’s a pretty common thing. So good one. We really appreciate it, David, right David? We appreciate that one. If you have a question like that, you can head to mikereinold.com click on the podcast link and fill out the form to ask us more questions and we will try to answer it on a future episode.

Is the Sleeper Stretch a Thing of the Past?

December 12, 2019/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of the #AskMikeReinold show we talk about using the sleeper stretch to restore internal rotation range of motion in the shoulder. There are probably more “cons” than “pros” with this stretch, but more importantly, probably better techniques we can do anyway. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 184: Is the Sleeper Stretch a Thing of the Past?

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Transcript

Mike Reinold: On this episode of the ask Mike Reinold Show, we talk about the sleeper stretch and if it’s a thing of the past or something that we still use here at Champion. Do we have a question from the audience today?

Student: We do. Brady from Iowa: Is the sleeper stretch a thing of the past? If so, what other options are there to address gird in overhead athletes?

Mike Reinold: So I’m going to throw it on the students here because I think I get why people are saying this, right? People still recommend the sleeper stretch. And you’re probably getting a script from a drug doctor that says do the sleeper stretch, right.

Lenny Macrina: I got one yesterday. But I don’t want to date the podcast, but if we could somehow pan the camera, which we’re not to the whiteboard. I put this on my Instagram and Twitter recently because I literally got a script from a doctor that said gird poster capsule, tight, sleeper stretch were the three things in a 13 year old softball player.

Mike Reinold: I’m going to send a script to a doctor with a patient that says do a meniscectomy. Just send it to the doctor when we send him in there.

Lenny Macrina: So we still get these in our area.

Mike Reinold: Did you guys learn sleeper stretch in school and did they say it was like a thing like you should use it?

Lenny Macrina: Do they teach it in school though? Is it a part of the curriculum or this is a social media thing?

Dave Tilley: I was never taught it.

Student: I wasn’t told it.

Student: We went over it one day in school as an option to increase IR but not really a specific application for [crosstalk 00:03:59].

Lenny Macrina: It could be that they’re just presenting all of the options. Right.

Mike Reinold: And don’t forget in the early two thousands there were some articles about how this was the greatest thing in the world.

Lenny Macrina: Sliced bread.

Mike Reinold: Right. So if you were to Google this and you were actually to like go on Pub Med or something, you would actually find articles that say it’s pretty good.

Lenny Macrina: Yeah.

Mike Reinold: But Brady, in all honestly you got dig in and read some of these articles that have on the website because we tackled some of the negatives as a sleeper stretch. So sleeper stretch is fine I guess. It’s torquing your arm into internal rotation but it really just assumes that your approach to restoring the range of motion is just to torque where there’s a lot of other options we could potentially do before we just started torquing it. And there’s a lot of negatives to the sleeper stretch to like the position of it. You could argue it’s an impingement based position. You could argue that the arthrokinematics of the joint are kind of awkward and it’s really sore. But I think the kicker that I always kind of tell everybody with this is, and this is kind of to answer your question, is the sleeper stretch bad or whatever he said is when you’re doing a stretch and you feel this sharp pain on the front of your shoulder and people are like, ah, yeah, that’s it.

Mike Reinold: That’s the feeling I want. I always tell him that that’s the equivalent of you flipping on your stomach and me stretching your knee and instead of feeling a nice stretch in the quad, you’re feeling a sharp pain on your tibial tuberosity. And you’re like, yeah, that’s it. Keep pushing. And that’s what we want. We would never do that with the knee. Right. And that’s kind of the same thing with the shoulder. So to answer your question about baseball and stuff, if you immediately just assume you do sleeperr stretch with somebody that has tight internal rotation, then you’re missing the boat potentially on this complete population of people on whether or not they even have a loss of internal rotation or if gird is normal. So based on that, let me open it up to you guys. Is there a population that you think sleeper stretch may be still applicable? Like rotator cuff repair or osteoarthritic or a adhesive capsulitis like a frozen shoulder or what do you guys think? Does anybody still do this?

Mike Scaduto: It definitely wouldn’t be where I would start at. I don’t think I’ve ever given a patient a sleeper stretch. I mean with like a rotator cuff repair, it doesn’t seem like a great position that you want to do.

Mike Reinold: Probably opposite.

Mike Scaduto: Definitely start with a way more gentle approach in terms of less aggressive stretching. Probably start with soft tissue, passive range of motion [crosstalk 00:06:13]. And if you’re getting some capsular tightness maybe do some low, low long- duration, but maybe not in that provocative of position, like the sleeper stretch. So probably not.

Mike Reinold: It seems like we’re jumping right to a really aggressive thing by going sleeper.

Dan Pope: I guess one thing I learned from you guys over the course of time, thank you very much and one thing that Lenny mentions a lot is that the posterior capsule is not necessarily a super robust structure.

Dan Pope: It’s not something that’s probably going to be limiting range of motion of time. So if you assess the capsule and maybe it is really stiff, maybe do you need to address it? The other part is that what is limited in turn rotation if that’s actually occurring, right. So we can work on some of that musculature and maybe do a cross body stretch or something that’s not going to irritate the joint further. We’re probably going to be more effective because the reason why I’ve in turn rotation of limitations, maybe not that capsule and even if it is capsule, probably not the intervention that you want choose first. Right.

Mike Reinold: Right.

Lenny Macrina: Let’s think about, we’ve talked about the capsule in the past and previous episodes and how we think we can potentially try to stretch it out is a prolonged stretch with a light load, right? So low, low long-duration. Are we going to have somebody lie on their side for 15 minutes and do a sleeper stretch and try to get posterior capsule stretching and just the concept just doesn’t make sense.

Lenny Macrina: And like he said, this is a very small population that may get a millimeter or two thickening of the posterior capsule that’s already the thinnest portion of the capsule anyway. If you look in the anterior and inferior portions of the glenohumeral capsule. So I think we’re missing the boat and we put a paper out in 2008 but if we’re talking baseball players that showed immediate changes in internal rotation, you lose internal rotation from throwing. There’s no way the capsule is becoming tight right after throwing, right? If we think it’s muscular tendonous and that’s probably where we should be targeting our efforts is in the muscle and the tendon, not the capsule. So I think we just, we completely missed the boat. We’ve gotten on this sleeper stretch thing and I’m guilty. I helped coauthor paper with Kevin Wilt and trying to come up with a modified sleeper stretch, put him in an open pack position [inaudible 00:08:05] roll him away so you’re not really lying on the shoulder joint.

Lenny Macrina: And I just think I’ve gotten away from it 100%. I know I hate to use this term but I never give it to anybody anymore. It’s not the most effective way in my opinion. I think this stretch, horizontally deduction has been shown to give similar results if not better results with people that have tightness in the back of their shoulder. Posterior shoulder tightness not posterior capsular tightness. We keep calling it the capsule and we’re giving it the wrong name I think from the get go.

Mike Reinold: So even if you have a limitation in IR, then the next question always comes down to what about a home exercise program? Because you can’t do manual therapy, can’t do soft tissue, that stuff.

Mike Reinold: And I think what Lenny’s getting to is just cross body kind of horizontally deduction is probably even better for that. So even the people that say, well but is sleeper stretch a good home exercise program? And I still think no. So we never ever use sleeper stretch here and I’ve never used sleeper stretch almost my entire career. I think the first time I did it a few times it’s like this is all wrong. I just had this, none of this makes sense, right? So I never really did it. I do not have problems with maintaining internal rotation in my people, especially baseball players. So is it a thing of the past? I think so. I think it really is. We don’t use it. And I would say we get a lot of people that come here that maybe were getting therapy elsewhere and one of the first things we do is we tell them to stop doing that.

Mike Reinold: And that was one of the thing that helps get them better, I think in my mind is they keep aggravating it by doing it more and more. So like I said, Brady, I apologize from the beginning again sort of. But head to my website. There’s a ton that you can read about that on the sleeper stretch. And I think you kind of digging a little bit on and make that decision yourself if it’s even the best thing to do. Even if it’s an option, is there a better option? Right. Does that make sense? So good question. Appreciate it. Head to mikereinold.com, click on that podcast link to ask us more questions just like that, but try to read my website first to answer the question yourself before. Anyway, sorry Brady, and then we’ll be sure to answer them. See you on the next episode.

The Best Ways for a Physical Therapist to Start Learning About Weight Training

December 5, 2019/in Ask Mike Reinold Podcast /by Mike Reinold

On this episode of the #AskMikeReinold show, we talk about ways physical therapists can learn more about weight training, and use that knowledge to start working with high-level fitness athletes. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 183: The Best Ways for a Physical Therapist to Start Learning About Weight Training

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Show Notes

Dan Pope’s Fitness Pain Free Certification Program

Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about how physical therapists can learn more about weightlifting, Olympic lifts, power lifting, etc. So that way, you can help your patients with that sort of stuff.

Mike Reinold: All right. Who’s got this question?

Ryan: I got it. Aaron in Tacoma. “Are there any weightlifting certifications or courses that you recommend for physical therapists? We received a tiny amount of instruction in PT school on things like barbell squats, dead lifts, bench press, etc. And I feel that this would be very useful when working with athletes. Thanks for any info.”

Mike Reinold: Aaron. I think it’s actually pretty cool that he had some exposure, probably more than most people are. And I think that’s pretty good. So I think that’s a great concept, right? And I would say one of the more popular questions we get on this podcast and continuously get, and we don’t answer anymore, is should a PT get a CSCS? And we can potentially talk about that too when we get into this.

Mike Reinold: But I like the concept. You want to learn more about the lifts and stuff like that. Let’s start by answering his question directly. Is there a certification? So CSCS, anything else like that? An official USA weight lifting type thing. What do you guys recommend? I don’t know. Has anyone gone through any of them? Dan, have you gone through any of them specifically?

Dan Pope: I haven’t done USA weightlifting.

Mike Reinold: Because some of our coaches have, and so we all share the knowledge in there. But is there any certification or even a con-ed program you’d recommend?

Dan Pope: We do. Well, I’m biased. I’ve been preparing my entire life for this question.

Dave Tilley: Yeah, what if I wanted my my fitness very pain-free?

Dan Pope: Yeah. Yeah. I mean this is one of the reasons why I went to PT school in the first place is because I loved weight lifting. I loved weight training and I just felt like there wasn’t a lot of good information out there on how to help people have pain that want to get back to these lifts. So I went to school and then tried to figure all this stuff out myself. First and foremost, Dave and I just, we both worked for a company called Power Monkey Fitness and they had these seminars throughout the course of the world. They have a camp twice a year in Tennessee and their goal is how to teach these movements appropriately.

Mike Reinold: Great.

Dan Pope: It’s not just you want the glyphs, although it’s very much they want the glyphs, but it’s also all the basic gymnastics movements, running, rowing, everything that you see from a fitness perspective that people are doing in the gym.

Mike Reinold: What about power lifts?

Dan Pope: They don’t go over specifically power lifts for power lifting, although they go over the squat in depth.

Mike Reinold: Squat, but not deadlift bench?

Dan Pope: It’s just not designed for how to deadlift for deadlifting.

Mike Reinold: Got it. Okay. So Power Monkey, great resource for some of the only lifts in gymnastics, which is, huge nowadays, to do that. So building off that, and I know you’ve got more in your head, but building off that, like what about CrossFit? Like going through a CrossFit level one cert?

Dan Pope: They do. They go over all those movements. I’m CrossFit level one. Are you, Dave, anyone else Crossfit level one?

Mike Reinold: Nice.

Dan Pope: Yep, big time. The certification does prepare you on how to teach these lifts pretty well. That’s a big thing. So you’re going to be in front of a class, how do you teach these progressions well? How do you have simple progressions and help a novice get to a proficient level with the lifts? So it’s pretty good from a baseline perspective, you’re not going to go super in depth from nitty gritty perspective in terms of programming, how to perform lifts for legal athletes, small tweaks to change for those high level people. They’re definitely going to give you a really good baseline for the Olympic lifts and then some of the basic gymnastics.

Mike Reinold: It could be a good baseline for a new grad type thing. Good, those are only lift baseline, anything else?

Dan Pope: Certification wise, there’s a few right now. So John Rusin has a course out right now. Ice is also Zack Long barbell physios course, and then also Quinn Henoch has a few courses right now for Olympic weight lifting as well as powerlifting. So if you’re looking for certification right now, those are some good guys that I trust. I haven’t been to the courses myself, but they’re catered more towards physical therapists.

Mike Reinold: What about the USA weight lifting certification?

Dan Pope: That’s another good one, I haven’t been through it. I have a lot of friends that have done it and a couple of our, I guess coaches here have done as well and they have good things to say. I think that’s going to be a little bit more comprehensive in terms of specifically olympic weightlifting, but you’re not going to find the power lifts, you’re not going to be talking about the bench press. It’s not going to be relevant from that perspective.

Mike Reinold: So from the power lifts, I’ll jump in with a couple that I always recommend. So one is our friends in Massachusetts here, but Greg Robbins, Tony Delvecchio, they’re the strength house but they do live seminars around and they have a great website, but they teach the big three all the time. So I don’t know, there’s probably… Think about if you have any other recommendations for the big three-

Dan Pope: Greg Nuckols is a real big guy.

Mike Reinold: Yeah, Greg Nuckols, they have good programs to teach. That’s the power lift. So you know, squat, deadlift, bench type thing.

Mike Reinold: The other one that I think is actually pretty good, it’s a little bit less like training for competition, but more training for the right technique and functional is Strong First. And I don’t know if anybody has gone through that, but Strong First certifications, they get a bunch of good stuff like kettlebell based stuff and they also have the good the main lifts and they include press and stuff like that. So I think Strong First, as a physical therapist, is maybe one of the first ones I would gravitate towards, and kind of go from there.

Dave Tilley: Dean Somerset in Antonio, have the complete hip and shoulder blueprint. I think they talk a lot about that stuff. It’s not all that, but there’s some of that stuff in it.

Mike Reinold: So tons of con ed, a few certs in there. Anybody else have any other suggestions or ideas? I mean, I don’t think the CSCS is going to teach you this, right?

Dan Pope: Yeah, I don’t think so. I think the big thing is that we want these certifications. We want to learn more about it. Probably one of the best things to do to learn these lifts is to go practice those lifts.

Mike Reinold: Bingo.

Dan Pope: I’m guessing you’re already doing it at this point, but find a gym that has a really good coach, right? Or a really good community or culture there that focuses on the lifts you want to improve and practice those lists on a very regular basis, and then potentially go out there and coach a little bit if you want to.

Mike Reinold: Right. I honestly, when I read this question, I thought that was going to be our answer. Right? And, and you want the cert, right? So you can study for this. Like you get your CSCS, you can study for this here, you’re still not going to be able to teach it really well. You’re still not going to able to do it. You need to do it. So you need to join a gym that embraces that culture and loves it, and you need to be part of that. If you can’t do it, how can you teach it? I always say that all the time. So join it. It doesn’t matter what it is near you, if it’s a Crossfit gym or if it’s just it’s own private facility. I don’t care what it is, but go there and learn and experience it and do it yourself. And I think you’ll have a much better understanding of how you can then apply that to your population as a physical therapist. Right? Make sense?

Mike Reinold: So, Dan, in all honesty though, we mentioned a bunch of great resources, you’re a great resource. So I’ve learned a lot about these things at fitnesspainfree.com. What do you have in the works for people that want to learn more about this stuff?

Dan Pope: Yeah. So obviously if you guys want some information right now, you can just go over to my website. I talk a ton about injury mechanisms for the lifts, how to get back to these movements after you get hurt, proper technique, all that stuff. I just finished up last night, although it won’t be out for a few, probably four to let’s say eight weeks, depending on when this is released.

Mike Reinold: Oh, wow. I thought you were going to say months. But I love that you said weeks. That’s awesome.

Dan Pope: No, I just finished up my full Fitness Pain Free Certification last night myself. Right? So look out for that. But basically, I feel very strongly that physical therapists don’t have a great resource for how to apply these movements properly from an injury perspective. So I’m talking about how people get hurt in the gym, right? And how to progress back out of pain and get back into movements they love and how to stay injury free for the longterm. So look out for that in the next, let’s say four to eight weeks.

Mike Reinold: And that was a great blurb. But I’ve been watching Dan build this for a long time. I know this is going to be awesome. It’s like the summation of his career and everything. But essentially he’s going to teach you how to do the lifts, how to coach the lifts, how to tweak the lifts, how to get people back to the lifts. And it’s going to be pretty dang good. So keep an eye out for that.

Mike Reinold: But I think, summary, putting it all together, I think what we need to do is we got to consider that it’s not just getting a certification, so going to USA weight lifting or something like that and getting a certification. But it’s also learning the basics behind it, right? Doing it yourself so that way you’re in a gym and a part of a community that’s doing it and practicing it on yourself and then helping others and then going through a program like Dan’s that’s going to kind of tell you how to tweak it and how to put it together for the person in front of you that may be your patient. So you’ve got to understand how to do it, learn the basics. You’ve got to do it yourself. And then figure out how to tweak it for the person that wants to do it better or get back to it. Right?

Dan Pope: You got it.

Mike Reinold: Make sense? Awesome. So another great question. We appreciate it. If you have any more questions like that, please head to mikereinold.com. You can click on that podcast link and fill out the form to ask us more great questions like this, and we will see you on the next episode.