On this episode of the #AskMikeReinold show, I join the DPT class of McMaster University in Canada to talk about starting your physical therapy career off right. I answered a lot of great questions from this group that I think would be very beneficial for all to hear! To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 210: Starting Your Physical Therapy Career Off Right
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Show Notes
- My Inner Circle Online Mentorship
- The Best Career Advice for Students and Young Professionals From The Experts in the Field
Transcript
Mike Reinold: On this episode of the Ask Mike Reinold Show, I am joined by the physical therapy students of McMaster University in Canada to talk about some of my best tips and career advice for starting your physical therapy career off in the right direction.
Dianna Moulden: So I have three questions to start that the group has asked me throughout our time, and I thought I’d get your opinion on it. And then Brianna has some questions, and then we can kind of open it up to you guys using the raise your hand button. Okay. So the first question, in I think the first session I did with the group I had talked about saying yes to opportunities that came my way professionally. And so often now we hear, “You got to get better at saying no and protect your time and always say no.” But I mean, so much of my sport experience and my experience with teams was in exchange for a free meal and a tee-shirt.
Dianna Moulden: “So looking back in your experience, do you think of one opportunity that you said yes to that kind of changed the trajectory of your career?”
Mike Reinold: Wow, that’s a deep question too. That was actually a well-written question. That was really good. Yeah, it’s actually funny. We usually think about this from the flip side where we should say no more often, right? One of the probably most impactful books that I read in the last few years on that kind of topic was Ego Is the Enemy. Ego’s not necessarily a bad thing. Everybody thinks the word ego means bad, like the egotistical and the negative sense like that, but it’s about just why we do things. One of the big things I got from that is that we probably should say no more because oftentimes you’re saying yes for ego. So you could argue right now I should’ve said no to you when you were like, “Hey Mike, can you talk to my students for a half hour, right?
Dianna Moulden: Yeah.
Mike Reinold: But I don’t why I said yes. I just always say yes to things like this. It’s easy to give back and do little things like this. So we’re all home. We all have some spare time, so this is the type of thing that is helpful to do. But you’re supposed to say no more often, I think, is the key to life. So in terms of saying yes, I mean that’s I don’t know, that’s kind of interesting. It’s amazing as you go through your careers and you guys get a little bit more advanced how things layer on top of one another and a decision you make turns into a sequence of events. Actually, I sought out to work in baseball as a physical therapist because that was my passion at the time. I know Brianna has some questions about passion and stuff, but I wanted to do that.
Mike Reinold: I got lucky. I got my dream job. I got my dream job in my 20s, which is crazy. It’s sad that now it’s not my dream job anymore, but you never want to lose that dream. I got my dream job in the 20s and I think you could argue there, I remember specifically what happened, it’s again a sequence of events. But I put myself in a position where the Red Sox were looking for somebody like me. I remember I was speaking at the APTA Combined Sections Meeting. It was in Boston. It’s currently in Birmingham, Alabama, if you’re working at ASMI.
Mike Reinold: I remember I agreed to speak at CSM. You guys all know APTA. You’re all in Canada, right? But you know, APTA is still cool to you guys. I don’t know. But so the APTA, CSM’s a big meeting. There’s like 10,000 people at some of these meetings, but it’s funny, they don’t reimburse you for anything. You still have to pay. I’m not complaining here, but literally when I go to APTA CSM, they put me to work. I’m doing two talks a day. I’m jumping all around, and I have to completely pay all that out of your pocket. So sometimes you start to get annoyed at that process, but I said yes because it was like, all right, this is a good opportunity. It was free trip home, let’s be honest, going back to Boston.
Mike Reinold: It was a weird opportunity, but I gave a presentation. And in the audience was somebody that was affiliated with Mass General Hospital and they’d just started working with the Red Sox. They grabbed me afterwards and they were saying, “Hey, we want to talk to you.” So if I didn’t do that and I didn’t say yes to that opportunity, I think I may not have had the sequence of events that happened. To give you a good lesson from all this here, I think is it’s okay if you don’t know your master plan and your dream job right now. You’re not supposed to know that.
Mike Reinold: It’s okay if you don’t, but you try to have as much of a plan in place as you can. And when you have a decision come in front of you, should I do this or not, you just think, will this help me get to my endgame goal? I think that’s an important concept right there and that’s how you can make some decisions. That’s what I learned from that book, Ego Is the Enemy. As you can tell Dianna, I’m a terrible question answerer.
Dianna Moulden: No, that was great.
Mike Reinold: Go off on tangents a little bit, but hopefully that helped.
Dianna Moulden: No, that was great. Okay, next question. Depending on the specialty of physiotherapy you want to work in, there can be lots of gaps in knowledge within the educational program. Overall, I think exercise rehabilitation is very poorly done in our program and even just surrounding building programs and even exercises to give and prescription and that type of thing. It’s something that’s not discussed.
Dianna Moulden: “What do you think is important to know about programming and periodization of programming when you’re building a rehabilitation program for someone and do you think this is where your CSCS filled that knowledge gap for you?”
Mike Reinold: Yeah, good question. I feel like our brains as individuals have surpassed what is in a PT curriculum nowadays. If you flash back 20, 30 years ago and you said, what’s physical therapy, I think most people think of it as the acute and subacute type things. And everything in our world’s based off insurance and stuff like that, so most people get discharged before they get to advanced phases. So it was like our profession just didn’t really care about that end. It’s like once you get your range of motion back, once you could take a bath, once you can walk, you’re discharged; you’re out, and the physical therapy is over.
Mike Reinold: I think that was physical therapy maybe in the 70s, the 80s, something like that back in the day as our profession’s evolved, but now as we’re working with more active people, especially when you talk about even athletes trying to get back to sport or something like that, they’re nowhere near ready for sport by the time they meet discharge criteria all the time. So I feel like our curriculums and our college educations aren’t really there to get us to that level, and you probably do need to seek some outside education to get yourself better at that.
Mike Reinold: Trust me. So yeah, I’m a couple of different societies of other physical therapists and we meet every year and we talk about things. One of our big meetings that we do every year is probably about 40 of us in this group. It’s called ICUS. ICUS was the first athletic trainer in the Greek Olympic games I guess or whatever, but anyway. We meet every year and we talk about things. Tim Hewitt, big ACL researcher, is in this group and stuff. We talk about different trends in our field. The big one right now is return to sport after, let’s say, ACLs. Everybody looks like crap at six months and we’re still letting them go back to sports. Then we’re wondering why we’re getting some of these failures.
Mike Reinold: When we ask our group and we look around and be like, “Hey, are your guys weak? Is your quad weak in your athletes after surgery?” Everyone in that room says no. But if you look at the systematic review that’s published that looks at things, everybody looks poor quality. I think what happens is certain groups of people that work with athletes have gone above and beyond their basic curriculum to learn advanced strength and conditioning and periodization schemes. To make a long story longer, you have to seek that outside right now because I don’t think our PT curriculums are getting us past three sets of 10 phase and talking about advanced periodization.
Mike Reinold: I would say your first step in this education process is probably a CSCS through the NSCA, which is just becoming a certified strength and conditioning coach. But trust me, that in no way is going to really make you that good of a coach. You can’t call yourself a coach or be a coach with that because you have to experience it. You have to actually train people and work with people. If you find yourself in a generic outpatient setting where you only work with people for six weeks after surgery, just realistically, you’re probably never going to get good at that because you don’t get to practice it every day.
Mike Reinold: If you’re not in that environment, then what you need to do is you need to get some friends that are in that environment. So maybe you know some personal trainers down the street or strength coaches at a gym nearby and you collaborate back and forth and you try to work with them a little bit. CSCS is like your book smart version of that, but then you still need a practical application. Ironically, we have a strength and conditioning internship at our place at Champion, which is mostly for strength coaches. I can’t tell you how many PT students or new grads we actually get that come and work with us for three, four months, depending on the season, as a strength coach. They’re not doing PT with us. They’re doing it as a strength coach. I think that makes you a more powerful physical therapist as well.
Dianna Moulden: Definitely. Okay, last question. So one theme we’ve discussed every week with this group is the importance of watching people move. And irregardless of the injury they came in with, just watching how they move and looking for compensation strategies within this movement. I’ve told the group the shift in my own practice when I first graduated. If you came in with a shoulder injury, I treated the shoulder and then injury was over and they left. I was getting referrals from a strength and conditioning coach for asymptomatic athletes and I was like, “You don’t have any pain? You’re fine. Get out of here. I’m too busy with people who have pain.” So I’ve talked about in part in taking your course as well, but the shift in my thought and treatment over the last 10 years.
Dianna Moulden: “In your own practice, are you seeing a lot more asymptomatic people seek out treatment, and do you think this is what’s going to be what we see going forward in private practice?”
Mike Reinold: I mean, I hope so. I mean that’s what we’re doing. I would say I don’t even know the percentage, but maybe half of probably the clients that we see are probably what you would deem healthy. So we’d like to call them suboptimal, but that means they’re not in pain. They’re not injured. They’re not postoperative, but they want to get better at something. Maybe they want to improve their mobility or their strength or whatever it may be, especially in the athletic world.
Mike Reinold: I worked for a lot of baseball players, obviously. Every time you pitch, you kind of hurt yourself. So it’s like you have a micro-injury every time you pitch because that’s just the nature of the sport. Our job is to mini-rehab you back because you’ve got to throw again in five days, that sort of thing. I think it’s the future. We talk about this in the spectrum of our healthcare models. Different states, different countries have different probably scopes of what they have here, but oftentimes the therapy, if this is the baseline, I can never tell in Zoom which is left and right, if this is a mirror or not a mirror, so I don’t know.
Mike Reinold: Let’s say this is baseline in the middle and let’s say this is the bad way. You have somebody injured. Our job in physical therapy is to restore them to their baseline. Well, what if their baseline’s crappy? Great, we just restored them back to their crappy selves and they’re probably going to get back to where they were before. So we got to go past baseline. Did that work left or right or was I backwards? I don’t know exactly where it was.
Dianna Moulden: No, that was good.
Mike Reinold: So our goal is to get people better than baseline because oftentimes their baseline is poor and that’s why they’re probably having symptoms over time. That’s how we start talking about performance-based stuff and optimizing things is we want to make sure that we’re not just getting people out of pain, but we’re optimizing them. We teach our students this at Champion. It’s a couple things. When somebody comes in with an injury for an evaluation, we’re going to do two things. This is how I talk to the client too. I say, “We’re going to do two things.”
Mike Reinold: First thing, I’m going to look to see what’s broke, and then I’m going to say, “What’s suboptimal?” You’re coming in with shoulder pain, so the first thing I want to do is okay, is there anything structurally wrong with you. Is there a pathology I want to find? We’re going to do a specific evaluation for that, but then I’m also going to look to see what’s suboptimal. Many times people come in with shoulder pain and I’m like, “Hey, good news. Your shoulder looks fine. Calm down. You’re going to be okay. There’s nothing structurally wrong with it. You’re just a little overwhelmed.” But boom, I’ve got these four things that are suboptimal on our checklist and we’re going to start working on those. And then we’ll see what happens to your pain as that gets a little bit better.
Mike Reinold: I think that’s the future. Now, Blue Cross Blue Shield and insurance companies disagree with me. I also think part of the future of our profession, this is probably going to be more towards cash-based models as well. And not necessarily exclusively cash based, but just realizing that look, some things are covered by insurance and some things aren’t. When you go get your car worked on, if you have a major issue with your car, it’s probably under warranty. It’s covered, you’re fine. But stuff like an oil change isn’t covered. Rotating your tires isn’t covered, stuff like that. I think we have to get out of that mode where people think physical therapy or physiotherapy is just when you’re broke or injured or post-surgical and that’s the only time you can go see a physio.
Mike Reinold: That’s going to take a while. That’s going to take years of reform for us to get that across, but I think you can make that difference in your community when you settle down and you guys graduate and you get jobs because you can start to just get the word out there. Seriously guys, you have to live and breathe that. That has to be your motto. That has to be your byline for your business when you’re in there and that’s what we do at Champion. We help optimize people. That’s what we say. We’re trying to help optimize people. Then you become known for that.
Mike Reinold: Trust me, everybody goes through physio and they all think it stinks. You go four weeks straight leg raises. You work with the therapist for five to 10 minutes and then you beat it. We see that all the time, so it’s very underwhelming. They come to you and all of a sudden you’re looking at them more globally. Then you’re working on this, you’re working on that. Boom, they tell everyone, especially if you’re in sports or something like that. A golfer comes to us and their shoulder hurts. And then all of a sudden we increase their rotation and then they can hit the ball further. They’re telling all their friends and that’s how the snowball happens over time. You have to breathe that a little bit.
Dianna Moulden: Awesome. Go ahead, Brianna.
Brianna Bethune: Yeah, okay. You actually touched on a couple of my questions, so that was perfect. We’re on the same page there. One question I really wanted to ask, and I’ve asked other people it as well because I really like getting their input, but the question, the way I worded it was would you encourage a new grad to specialize in their area of passion right out of school or do you think it’s more beneficial to get exposure to generalized, say, ortho for maybe a few years first to get that foundation?
Brianna Bethune: And just to add a bit of a personal touch on it, for me, I feel like I’m starting to really find my niche and I’m excited by it, but I have that anxiety of jumping right into it out of school just because I’ve loved all my clinical placements. I’ve loved being in ortho, sports, the hospital, so I don’t know. I’m not sure if I want to take that leap right away. You know?
Mike Reinold: Yeah, no. I agree. And if anybody else’s name rhymes, like we have a Susanna or a Joanna or anything, they should all just jump in and ask questions. My opinion on that question has changed over the years. When I first got started, especially when I started my website, I started my website well over 10 years now. I’ll be honest with you, I got lucky. Dianna gave me some good praise with her introduction, but I got lucky.
Mike Reinold: I was just first to market with being a prolific PT online with social media and a blog and stuff like that, so I kind of got lucky. But when I first started that, I definitely got criticism from people that are just like, “That guys not a good physical therapist.” I’m like, “What do you mean?” It’s like, “Well, you’re not good at spine.” I’m like, “Yeah, no. I’m terrible at spine.” They’re like, “You’re not good at geriatrics.” I’m like, “Yeah, no. Yeah, I hate old people.” No, just kidding. Yeah. No, I’m not. So somebody would actually call me a bad physical therapist. It’s kind of funny, as I grasped that concept and I said, “I don’t want to be generic at everything. I want to be really good at a couple things.”
Mike Reinold: If you even just look at my website, I don’t teach things that I don’t feel like I’m really good at. There is no articles on my website about foot and ankle. Feet stink. It’s not a big passion of mine, so you’re not going to find some articles about foot and ankle because that’s not me. It’s shoulder and knee performance, basically. That’s what I do. I think you should do that. That being said, Brianna, though, you do have to learn some of the basics.
Mike Reinold: What I often tell people to do, you guys are probably too new at this. This is too big of a topic for you, too big of a scope, but maybe when you get three, four or five years into your practice, here’s what I want you to do. I want you to take a step back and I want you to do an audit of yourself. You’ll want to do your audit of your skills and your knowledge base and then figure out where you want to go from there, okay. I think that’s really important. The first thing you can do is you can look at joint-specific stuff. You say, I’m going to go through all the joints. What am I comfortable with? What am I not comfortable with? Then figure out if you even care.
Mike Reinold: For me, I actually, same thing with me. About 10 years ago, I thought to myself, I’m not good enough at spine. I’m not comfortable with spine, so I went to every freaking course I could go to on spine. You know what I found out? I was probably pretty good at spine. Nobody’s good at spine. There’s no magic that you’re like, wow, I mean am I missing something? It’s not that. It’s more of a confidence thing. But go through each of the joints and say, what do I need to get better at? But if you’re in a practice where you never, ever, ever treat a spine, then you don’t have to focus on that. That’s your mode you’re in. That’s number one.
Mike Reinold: Then two is you go to activities. Maybe that’s sport. Maybe that’s like I want to work with football, soccer, baseball, whatever it be, that activity. I think you can do that. Then the third audit is skill. So it’s like hey, I want to get better with manipulations. I want to get better with soft tissue work. I want to get better with exercise prescription. So I want you to do a self-audit at some point at time and say, what’s your comfort level with joints, activities, and skills. That’s where you can find out where you want to go with your continuing education, but make it specific to the population in front of you.
Mike Reinold: To answer your question about passion and getting back with that here, I think you have to get to a point where you feel comfortable with your basic skillsets. And if you’re there and you’re comfortable and you want to stick to your passion, then I would definitely say, do that. I do not think we’re going to do any of ourselves or our profession justice if we continue to be generic physios and we can do a little bit of everything. I want you guys to be awesome at something or some things and roll with it. That’s fine. Let your coworker deal with all the spines, or let your weird PT friend that likes feet, let him work with that. You don’t want to deal with that, right? Think of it that way.
Mike Reinold: I think that’s how you want to get there. You may not be ready day one because it’s overwhelming that you have very little self-confidence probably that you’re going to be able to get people better, but once you start getting there, I definitely think we should niche out and we should be a little bit more passionate about where we go. Otherwise, life gets really boring, to be honest with you.
Brianna Bethune: Thank you. That was a really good answer. I have more questions, but I know Will has a really good question that I think he should ask. I’m going to pass it.
Mike Reinold: Nice.
Student: Put me on the spot. I like it.
Mike Reinold: What’s up, Will? This better be good or you’re going to be in trouble.
Student: Yeah, really. Well, I have a couple questions. I don’t know which one Brianna’s talking about, but I’ll ask one. One thing that I find a little bit tricky just on clinical placements is patients are often looking for a specific diagnosis and sometimes can’t really pinpoint what that might be. It’s more of a generic kind of issue. I was just wondering if you could touch on the role of patient education when there is not really that x-ray that says this is the cause or anything like that really?
Mike Reinold: Yeah, no. Good question, Will. You’re going to find that probably more often than you think. It’s really, I don’t want to say it’s rare because that’s not fair, but it’s not every day you’re going to say, “Oh, boom. It’s your meniscus. Your meniscus is the cause of all your trouble.” Because especially too, if you do, let’s say you come in and you diagnose it is a meniscus, well, what do you do? You’re going to do the same thing you were going to do anyway even if you didn’t have that meniscus diagnosis. It’s the same kind of concept.
Mike Reinold: What I always tell people, again, this goes back to what I was answering with that other one. You do two things. What’s broke? What’s suboptimal? And you educate them with that. You say, okay, let’s look pathological and be like, “You know what?” All right, let’s say a shoulder pain, person like that. “You know what? Looks like your cuff’s a little inflamed, but it doesn’t look like you have a rotator cuff tear. It doesn’t look like blah, blah, blah,” all those things. It looks like maybe you just overloaded. Your workload increased too much. You’re suboptimal in these areas. Let’s just focus on that. You don’t have to give them a diagnosis.
Mike Reinold: Now, if somebody does have a diagnosis and when you go to that what’s broke, what’s suboptimal, and you do have a what’s broke, like, “Ooh, your anterior capsule looks torn. You had that dislocation episode.” Then that’s different. You can have that, but I would say the vast majority of non-operative people are going to be nonspecific pain. So your goal is to get them just again that suboptimal checklist more than anything else. You just have to educate them with that. But trust me, from my experience, they may come in wanting a diagnosis, but you’re going to give them a plan, not a diagnosis. You know what I mean? You’re going to give them a, oh crap, that was awesome. Will just said that my shoulder hurts, but it’s because of A, B, C and D, and we’re going to work on all four of those things. And they’re going to be ecstatic.
Student: Awesome. Thank you.
Mike Reinold: What’d you think, Brianna? Was that the one?
Brianna Bethune: Yeah. That’s good.
Student: No. She just texted me and it wasn’t really the one she was asking, so can I ask it?
Mike Reinold: Yeah. What’s your other one, Will? Let’s get that one.
Student: Okay. Just as soon-to-be new grads, a lot of job descriptions or whatever say two, three years experience and so forth. How do you navigate going about that? Obviously, we don’t have experience applying for jobs, so what kind of… I don’t know. How could we sell ourselves to those types of job offers?
Mike Reinold: I think you’re giving the employers too much credit. They’re all probably googling a physical therapy job description template and just throwing it on a website. I think you’re giving them too much credit. I think everybody knows as a new grad, there’s going to be some work with you. There’s going to have to be some mentoring. There’s going to have to be some con ed that you get through. Most physical therapy clinics I know of tend to embrace that, probably more just because you’re cheaper labor, but they know it’s an investment in you over time. I would say don’t be intimidated by that.
Mike Reinold: I think what you can do for yourself is talk a little bit more about what you’ve done yourself to make yourself better than the other new grads. Does that make sense? You can say, “Hey, I’m… ” Especially if you’re finding a job that is in a realm that you’re really passionate about, like a clinic that works with, let’s say, a lot of high school athletes. You’re like, I love that. I just went to this seminar, or I’ve learned from these three people online. That’s how you set yourself apart with that. I wouldn’t be too worried about that little clause in the job description, Will.
Student: Nice answer. Thanks.
Mike Reinold: Yeah.
Student: All right, I’m done. I’m done.
Mike Reinold: That’s awesome. Well, we kind of said it before, but if you have a question, I think you can raise your hand, right? I’m always the host, so I don’t know. Is there a button to raise your hand? They’re like, “Raise your hand and then we’ll unmute you and you can ask a question.” Love to get some more. If nobody has any, maybe I know Brianna may have another one or two up her sleeve. You guys are quiet. This is your time to shine, right. Usually, what happens, somebody will nervously jump in and be like, “Mike, what do you think about the shoulder?” You’re like, “You didn’t prepare well for this meeting, did you?” Too broad, too broad.
Student: I have one.
Mike Reinold: Yeah.
Student: When you started, and Dianna already went through your long list of accolades, how did you really work to prioritize and balance trying to do everything and achieve your goals?
Mike Reinold: To be honest with you, my goal was always to work in baseball at the beginning, so that was my primary focus. I was trying to put myself in a position to do that. The first thing I did was… How many of you guys have heard of the American Sports Medicine Institute? I see a couple of nods in there. This was in the early 90s. This is before the internet, so I’m older than I look. I’m just really short, so I look youthful. At the time, they were the leaders in baseball sports medicine, so I said, “I got to figure out, how do I get in with that group?”
Mike Reinold: At the time, you literally just called people on a landline. So I called up Dr. Glenn Fleisig. He’s the research coordinator. He’s probably the number one expert in baseball pitching biomechanics. I just called him up and I didn’t know what to expect. Called him up and he’s just like, “Hi, this is Glenn.” I’m like, “Uh.” I was like, “Whoa, I didn’t think you were going to pick up.” I wasn’t prepared for that and I was just like, “Hey, I’m a physical therapist student. I’m from Boston. I really admire you guys.” I just put myself out there. So he’s like, “Come on down. You can do a research project with us. You can do an internship with us.” Great. Then yada, yada, yada.
Mike Reinold: That escalated. I remember, I did that and they’re like, “Hey, when you graduate school, do you want to move down to Alabama and work here?” I’m like, “Hell no.” I don’t want to live in Alabama. That’s a big difference from Boston. So I said no, but then they’re like, “Well, how about a fellowship with Kevin Wilk and Dr. Andrews?” I’m like, “Okay. All right. That’s pretty good. I’ll do it for one year.” And then again, yada, yada, yada. I’m there almost 10 years as it was just a good experience over time.
Mike Reinold: So yeah, for me, I sought out the people that I wanted to learn from and who I wanted to be a part with. I put that together. I’m getting off topic here again, Paula, but here’s a good nother funny story you guys can make fun of me about. I did the same thing with the doctor of the Red Sox, the Boston Red Sox. Again, I’m just an idiot student like you guys. I literally did the same thing. I called up. This is the 90s. He answered the phone. It was crazy. It was like, why is this guy answering the phone? He was so taken aback that I just called out of the blue to try to say, “Hey, I’d love to learn from you and meet you.” He’s like, “Tell you what, I want to bring you to a Red Sox game. Friday night, come with me. Come sit in my seats and we’ll talk.”
Mike Reinold: Here’s the mistake I made. This was later in my college career. I already had tickets to that game with all my friends and it was going to be a party. So I actually said, “Oh… ” I made up an excuse where I couldn’t do it because I wanted to go to the game with my friends. And then I called him back next week, never answered the phone ever again, so I lost that opportunity. Total side thing right there, but it’s like try to grasp your opportunity, but pick opportunity over your friends, maybe. I don’t know the life lesson from that, but hopefully you can learn from my mistake there.
Mike Reinold: All right, I promise I’ll have more specific answers going forward. They’ll not be so vague. Who else? Anybody else want to raise their hand? I don’t know if I can see anybody with raised hands. I don’t know if you want… Is that Benjamin’s got a thumb up? We’ll do that. Here, I’ll unmute you there. I think I’m unmuting you. Awesome. What’s up, Benjamin?
Student: Not much. A lot of people talk about walking and gait analysis as a really good way to functionally assess. Obviously, that’s something that takes a lot of practice. You focus a little bit more on the upper extremity. What’s a good functional test that you like to use and, obviously with your expertise, to try and see what might be going on with around the shoulder or upper spine? If someone comes to you with nonspecific pain or even to try and find how to optimize them?
Mike Reinold: Yeah. I would say in my background when I was probably where you guys were, I got really into biomechanical stuff, especially with my interaction with ASMI and stuff like that. So I’m a big fan of biomechanics and how that works, but the more I learned, the more I realized that there are so many variations in the way people do things that it’s really hard to say, “Oh, you’re walking wrong,” or “You’re not walking right,” or whatever it may be. I’m trying to think of obvious examples in sports, but like a baseball pitcher, even a golf swing. There’s so many different ways people do that and they’re all successful. So it’s super hard to say what’s the best way to do things.
Mike Reinold: I’ve seen a lot of new grads also go through this assessment. Somebody’s like three weeks out of ACL reconstruction. They try to do a gait assessment. They’re like, “Yeah, you’re limping.” And the other person’s like, “Yeah, no crap, I’m limping. I just had ACL surgery three weeks ago. I know I’m limping. That’s not why I came to see you.” I look at those things, but what I started to do, Benjamin, I started to do it a little bit different. I started to say, “What do I want to look at in terms of a mechanical assessment or a movement assessment that will directly impact the way I treat somebody?” So not just look at somebody to look at somebody, but what will I do?
Mike Reinold: We took a big step back and we reverse hacked that thought process. We said, “Okay. When we write somebody a program, let’s say a comprehensive program.” So this is blending into performance therapy now too and performance training. We say, what do we do for exercises? We categorize things by movements. We don’t train muscles. We train movements. We broke it down. We have hinge, a squat, a forward lunge, a lateral lunge, a step, multi-segmental rotation, overhead reach, push and pull. That’s how we program.
Mike Reinold: If that’s how we’re going to program and that’s how we’re going to write your program, I want to assess how well you do in each of those categories. We came up with just our own little movement screen, and we did that in our Champion Performance Specialist program that we put together. This is how we look at those movement patterns and then if it doesn’t go well, this is exactly how I program. This isn’t a negative of some of the other systems like FMS and stuff like that. Those do a good job at looking at movement, but I don’t think they do as good of a job at telling you what to do if somebody’s not moving well.
Mike Reinold: So we tried to come up with an exact system. We say, “All right, if you can’t hinge, we’re going to do this manual therapy, these corrective drills, yada, yada, yada. Here’s how we’re going to load you, that type of thing.” I would say take a giant step back and there’s two things, gross movements like we just outlined, and then when you get past that, you can get specific. I don’t know if I’d go gait necessarily, but maybe running mechanics, throwing mechanics, hitting mechanics, sports-specific mechanics. That’s upper level stuff. That makes sense?
Student: Yeah.
Mike Reinold: I mean hopefully that wasn’t too vague, but I would say is take a big step back first and before you start nitpicking how somebody walks, for example, why don’t you nitpick how they move first and then see if any of that correlates to their out… Walking to me is the outcome. You have to look at their capacity to be able to walk before you even get there.
Student: Yeah. Thank you.
Mike Reinold: Then remember, you see somebody walking weird, you’re going to be like, “Yeah. Definitely not walking right.”
Student: Yeah.
Mike Reinold: And then have no idea what to do. So still, you have to figure out what you need to do. Awesome. Good question. Nice. Let me see. Oh, I see Brett. We have some thumbs up. Let’s go, is that Mara? Did I say that well, Mara? Nice.
Student: Yeah.
Mike Reinold: What’s up, Mara?
Student: So my question is, are there any major mistakes in programming that either new grads or PTs make that we should avoid?
Mike Reinold: That’s a good question. I’d say one of the biggest mistakes I see new grads make is we tend to under-load. I think that’s our bigger thing. Not that you want to go crazy and break people down, but I think we tend to under-load and not emphasize strength development enough. That’s again going back to what we talked about earlier with some of the questions. It’s like understanding different loading schemes and periodization schemes to try to get more strength out of people. You can’t just do three sets of 10 forever.
Mike Reinold: I think that’s the biggest programming mistake we tend to see is we just don’t get advanced enough. We’ve had athletes come to us from other facilities that are three months after ACL and they’re still doing straight leg raises. I mean I’m sure their hip flexor is ridiculously strong now, but there’s more to life than straight leg raises.
Student: Great. Thank you.
Mike Reinold: That sounds like a tweet. Should we tweet that, there’s more to life than straight leg raises?
Dianna Moulden: Sounds like a tee-shirt.
Mike Reinold: Yeah, exactly. We can do that. All right, who else? Anybody else? Maybe we’ll take a couple more. You guys got anything more exciting you want to talk about?
Student: I have a question. I just unmuted myself. I hope that’s okay.
Mike Reinold: That’s aggressive. I like it. That’s good.
Student: Sorry. I’m wondering, if you were interviewing someone for a job, what’s one thing that they could say in the interview that would make you want to hire them on the spot versus one thing that they would say and you would send them out the door?
Mike Reinold: Trust me, there’s a lot you can say that I would send you out the door for. Well, when we see students, I predominantly look at one category. It’s their growth mindset. That’s a buzzword now. That’s up there with change the narrative. Trying to think of all the other cool things I see on Instagram. This growth mindset concept here is believe it or not, I’ve seen a lot of students that have come in with opinions. That blows my mind. For example, we’re at Champion. I do ultrasounds sometimes. How many of you people think ultrasound’s awful? Right. Right. Most of you are just preconceived to think ultrasound’s awful because 20 years ago Blue Cross said it was awful, so now everybody says it’s awful because they don’t reimburse for it.
Mike Reinold: But there’s studies that show that if you can tweak the settings and you can do an ultrasound on a ligament, and it may promote healing. So if I have a baseball player, he has a partial Tommy John sprain and we’re trying to get him back, I want to throw the freaking kitchen sink at him. Why wouldn’t I do an ultrasound on his ligament if I can show in a rat that their MCLs healed faster if I did a pulse ultrasound on their ligament?
Mike Reinold: We have a justification for why we do it. We’re a little bit different because we don’t really care about the insurance model, but we’ll have a student come in and just be like, “I can’t believe you’re ultra-sounding them. You can’t do that. That’s stupid.” And we’re like, “All right, you’re fired.” But no, they come in with preconceived opinions that they have because social media right now is super influential. A lot of you guys are learning from social media, which blows my mind. It’s just not a good place to learn. It’s more like edutainment than education, but they come in with those preconceived things.
Mike Reinold: So if you come to me with a growth mindset and say, “Look, in the last six months here’s the two, three things I’ve done to grow and I can’t wait to grow more. I want to learn how you guys do things. I want to be mentored by your staff. I can’t wait to grow.” But with confidence. Not like, “Ooh, I’m afraid. I’m scared. I don’t have self-confidence in myself. I need to learn more.” It’s more like a, “No, I’m excited to learn. I want to grow.” That’s the key to me. If you come in with a fixed mindset where you actually think with your one, two, three years experience that the last 80 years of our profession was all wrong, that’s not going to fly. That’s not going to go very well, so be careful with that mindset when you go in there.
Mike Reinold: I find too if you have two strong of an opinion too early in your career, you tend to try to justify that opinion in your future thoughts rather than having an open mind about whether or not you were right or not because you don’t want to be proven wrong. So keep that in mind. To answer your question, growth mindset I think is the way to do it, but an excited growth mindset. If you look at our staff at Champion, you look at our people here, I think we’re all studs. Everybody there is an exceptional person at their job because they choose to. Nobody’s a nine to fiver. Nobody’s just trying to get in and out. They want to be the best they can.
Mike Reinold: You guys know Dave Tilley, shiftmovementscience.com? He’s one of our PTs, a big gymnastics guy. You should see the crap this guy is reading. It’s insane. He’s like chemical reactions in brains. This is during his lunch break. It’s insane. We all just laugh at him, but he’s just such a leaner that he wants to do that at all times. That is what we’re looking for in our young hires.
Student: Thank you. That was a really good answer.
Mike Reinold: You guys are going to think, wow, this guy is really not professional. I’m too casual.
Dianna Moulden: They’ve heard me every Friday, so they know.
Mike Reinold: For me it’s trying to help. It’s trying to help, right? This is the reality of what’s real out there. Even the little things you learn in school like special tests and stuff you learn in school, half of them don’t work the way that you think they do because it’s not all text-book based. So you got to get some experience with those things. You have to keep a growth mindset. It’d be pretty important. All right, how about one more? What do you got? Who’s going to be the finale? Better be a good one. We’re going to end on a good strong one. What do you guys think? I think we should randomly pick somebody that has their video off and just unmute them and see what noises we hear. That could be good. What do you think? Dianna, I’ll let you pick someone.
Dianna Moulden: Okay, gosh.
Mike Reinold: Oh boy, everyone’s flipping their videos off.
Dianna Moulden: I know. Everybody is going to drop in numbers.
Mike Reinold: Everybody’s like, “Got to go.” Leave meeting, leave meeting.
Dianna Moulden: Does anyone else have a question? Brianna, do you have a question that you didn’t ask?
Student: I think Daniel raised his hand there.
Mike Reinold: Did you see one? I didn’t see it.
Dianna Moulden: You know what’s funny? So Julian unmuted himself. Julian, do you have a question? Because you would’ve been the person I would’ve picked to unmute.
Student: Man, I have my camera on.
Dianna Moulden: I can’t see you, but I was just going to scroll through list and find you and unmute you.
Student: I’m in a new house today, by the way.
Mike Reinold: I like it. I like the background.
Dianna Moulden: He has a new house every week that he’s in.
Mike Reinold: That’s funny.
Student: I think Daniel did have a question though. I saw him raise his thumbs, so he’s saying his question.
Mike Reinold: I don’t see Daniel. Let me see. Oh, there we go.
Student: Right, unmute.
Mike Reinold: Oh, okay. I got you. What’s up, Daniel?
Student: Can you hear me?
Mike Reinold: Yeah, I can see you now. What’s going on?
Student: What I was wondering, so you have obviously strength and conditioning experience. You’re coming in or working as a PT with the CSCS, which not necessarily everybody will have. So what I’m wondering is if you can speak to working in a team environment with, let’s say, the strength coach for the Red Sox or whoever it is, is prescribing programs to athletes and there seems to be a discrepancy. Or based on your experience, your knowledge, you feel there might be a conflict with what they’re being given to do day in, day out in the training versus what their rehab might entail and how you might go about dealing with those conflicts if they even arise, or if at that level strength coaches just kind of know what they’re talking about and you take it as is.
Mike Reinold: Well, you would hope they do. I think that’s the key. Because when you build a team, you have to build a team of like-minded people that all bring a different skillset to the table. Hopefully, you’ve built the right team and you’re close, but collaboration’s the key. And that’s part of some of our core fundamentals at Champion that we built here is that we wanted to have a bunch of multidisciplinary skillsets working together. That’s why we have a gym. That’s why we have PT and we kind of integrate the two together.
Mike Reinold: Could I write somebody’s training program? Yeah, absolutely. I mean I’ve done it plenty of times, but I’d rather hire a coach that’s really good at programming to be that person. But the key comes down to this, it’s collaboration. This is sometimes where young physical therapists, physios, get into trouble a little bit, especially with sport coaches versus strength coaches, start to step on toes and all of a sudden you think you’re a golf mechanical expert and you’re trying to tweak somebody’s grip or swing or something like that. Oftentimes it’s about stepping on toes a little bit.
Mike Reinold: The way we do it is pretty simple. At Champion, it’s pretty simple. If I have somebody that’s working with me exclusively and they want to start getting into the gym, I don’t go out there and say, “Hey, do A, B and C,” because then I’m telling them how to do their job. What I go out there and I say is, “Hey, I want you to focus on this and I want you to avoid this.” I don’t tell them how to get their job done. I just say, “I want you to focus on… Let’s get some good glute development and we need some posterior chains cranked,” or something like that and then let them run with it. If the team’s set up well and you have the right people in place, then that is going to work itself out.
Mike Reinold: What you’re going to get in trouble as a young clinician is you come in there and you start overstepping a little bit and you start telling them exactly what to do. That’s going to really be stuffy to them and it’s not going to really go well, especially in a collaborative team environment like collegiate or pro sports or something like that. Just surround yourself with good people and I think that helps. Awesome.
Student: Thank you.
Mike Reinold: Yeah. Good question. I like it. Tell you what, I want to leave you guys with this one thing because this is what I’ve been telling my students a lot here. And I’ve done this a little bit online, but I probably need to get a little bit more formal. I’m trying to put together a free course for students and new grads that go over even some of these questions we’re talking about, because everybody has the same questions. But I want to leave you guys with this. This is the development process that I see and where you guys see in this phase.
Mike Reinold: As you progress through your careers, you go from… Everyone wants to be an expert right away. You have to develop in this order. It starts with knowledge, then skill, then experience, and then judgment. That’s the big, big, big key right there. You’re never going to be an expert at your craft, even if it’s just a niche type thing or a diverse thing, you’re never going to be specific to that.
Mike Reinold: Let me explain. So knowledge, you’ve learned that in school. You got your book smarts. You have that. You have knowledge. You could always get smarter. Don’t get me wrong, but you have knowledge. But you don’t have a ton of skills yet, assuming you guys don’t. Maybe you guys are starting. You’re starting to get a little bit of skills in school and your clinicals, but it takes you a couple years to get some skills out in the clinical setting too.
Mike Reinold: So knowledge comes first, then skills, but you still have no experience. Then in your head you’re going to be like, “Oh, okay. All right. Geez, last time I saw something like this, it went like that.” And you can start making some opinions a little bit stronger based on that. So you need some experience and then finally you have judgment. Everybody wants to proclaim expertise on Instagram nowadays and seem like an expert, but you have to go through those four phases, knowledge, skill, experience and judgment. That’s how you become finely tuned with your craft and you start feeling good about yourself.
Mike Reinold: Just remember what phase you’re in right now. I would say the biggest phase you guys need right now is skills and reps. We say that all the time is just keep trying to find what skillset do you think you’re most deficient in? Do that little mini-audit and get better at that skill while you’re getting reps. Then in three to five years you’re going to look back and you’re going to be so confident in yourself because now you developed those things. You’ve got a little bit of judgment, and then you can start becoming a little bit more of an expert in a small portion of our field. Then that keeps just layering itself on.
Mike Reinold: So just keep that in mind with that development because I think then you can really focus on what you probably need most right now, and for now it’s probably reps. So just get out there. Remember, when everybody graduates, they all feel unsure of themselves, right? They’re not truly confident in their skillsets, but you guys know way more than you think. You just need experience. You need to like, okay, let me get this person out of shoulder pain, and then you’re like, “Yeah, I did it.” And then you’ll know what to do next time and then that’ll get better and better every time. Make sense? Awesome.
Mike Reinold: Well, thank you so much for having me. And obviously, for Dianna and Brianna for being a part of the organization of this and all the great questions, all the great videos. I’m not bitter about half of you that never turned their cameras on, but thanks so much for doing this. Heck, I’m easy to find online. So if you guys have questions down the road, just reach out and good luck with your upcoming careers once this pandemic ends, right?
Dianna Moulden: Yes. Thank you so much, Mike. This was invaluable to the group.
Mike Reinold: Awesome. Cool. Thanks, guys. Take care. Have a good day. Social distance bump. Let’s do it.
