Helping New PT's Be Happier At Work

Physical therapy school prepares you with fundamental skills, but the gap between education and real clinical practice can be overwhelming for new graduates. This first-hand discussion reveals strategies to navigate the challenging transition as a new PT.

• PT school primarily teaches you to "not hurt people" rather than specific treatment protocols
• Feeling unprepared is normal when facing unfamiliar cases, especially post-surgical rehabilitation
• Chart review the night before seeing patients helps you prepare for unfamiliar conditions
• Basic, simple exercises are often more effective than complicated "creative" approaches
• Finding mentors is crucial for developing confidence and clinical reasoning
• Programming exercise should focus on addressing deficits rather than impressing patients
• Patients care more about getting better than receiving a precise diagnosis
• Continuing education should be targeted: 1/3 for immediate cases, 1/3 for common conditions, 1/3 for personal interests 

Check out our upcoming third cohort of the mentorship program with Mike Reinald at fitnesspainfree.com to learn more about our treatment approaches and protocols.

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Episode Transcript

Speaker 2 (00:05):
every day.
You essentially pay your duesby doing the harder thing when
it's the right thing to do.
All right, here we go.
We are back in action.
Dan.
Little, little diet root beer.
I'm going a little diet.
Dc alia, do you have any dietson your life right now?
no, I got matcha though oh,matcha kind of counts, that's
for sure.
Yeah, we had a big, a big, uhbig, tall boy DC day in the
clinic yesterday.

(00:26):
We had, uh, everybody was out,uh out in the afternoon, so it's
just me, kevin and Dan.
So lots of DCs, lots of snacks.
That's how you get by a sixhour afternoon.
So I'm fully caffeinated, I'mready to rip.
But yeah, Welcome to thepodcast again for the 30th time
in five years, yeah, man.

Speaker 1 (00:40):
Um'm a I don't know.
Have you ever counted, like,how many times people have been
on your podcast and see how manytimes?

Speaker 2 (00:46):
I think Nick.
Ruddick has the record Causejust cause we talk so much about
gymnastics in the early daysthat I think he's done like
eight or nine appearances backand forth or mutually between us
.
Um, besides that you'reprobably definitely up there I
feel like there's a couple otherpeople who are recurring
recurring as well, but I feellike Nick has the.
He's got to have like seven oreight.
Do you have anybody in yoursthat's been there multiple times
or no?

Speaker 1 (01:05):
A few.

Speaker 2 (01:05):
Yeah, I need to get more guests but, like lately, we
haven't been doing as manyguests cause I'm kind of lazy,
but I have some repeaters.
Well, you have Kevin.
So Kevin's like an iconic coachas it is.
You know, I'm lucky to have aLeah now before me was just
talking to this stupid cameraand hoping people liked what I
said, but now we actually have adiscussion.

Speaker 1 (01:22):
It does help, for sure.

Speaker 2 (01:23):
Yeah, not as a, as a.
What's the word?
Dry maybe is the right word?
Um, yeah.
So I figured, uh, this was agood one because we are uh
entering summer to new boards,to new grad world.
I feel like that's what.
What's going on now.
I know a lot of people aretaking their boards I think it's
July is the next one so we geta lot of questions from the
students around, like studyingand grad, mentorship and you
know, just entering the world,and I don't know, dan, I feel

(01:46):
like you and I have a similarstory where I was like really
confident that I knew what I wasgoing to do and get a job and
it was all go well and like myfirst two months, particularly
the clinic, were like anabsolute nightmare in terms of
like not feeling ready at all.
And so that's where theconversation kind of comes from
is trying to get some advice outthere to people who are going
to be entering the workforce andare a little overwhelmed, maybe
with the gap between whatclinicals gave them and then

(02:06):
maybe what they're going to doin their job.
So I don't know, what are your,what are your opening thoughts
before we dive in a little bitdeeper?

Speaker 1 (02:11):
Yeah, man, I had a good deal of Dunning Kruger, I
think.
When I first started I um, Idon't know, I thought I was
ready and I was very excited,but then I basically got
overwhelmed.
Similar to you, I'd have like afresh post-op rotator cuff tear
and I'd just be literally likeam I tearing this thing?
I don't know if this is good,be super stiff, she's yelling.

(02:33):
I'm like I don't know what'sgoing on, you know, and every
night I would just look at mypatient panel for the following
day and try to prepare, justbecause I really didn't feel
like I had the skills to just goout there and do a good job
from the get-go.
And looking back on it, I Iprobably did a bad job with a
lot of different patients.
You know, it's funny how I'lllearn something new and we went
over a whole bunch of hipdysplasia stuff, uh, just this

(02:55):
past week with Kevin and I'mlike, wow, I probably missed a
bunch of dysplasia.
I'm like I hopefully didn'tmiss a bunch of bone stress
injuries too in these, becausethey all present like similarly.
You know what I mean.
So yeah, there's a lot of thatand you know I can see how folks
are a little bit overwhelmedand scared coming out of it,
because it is a lot.

Speaker 2 (03:13):
Yeah, I just think I remember before, lee, I want to
hear your experiences.
But I just think I remember,like three months in, I got a
post-op like a massive rotatorcuff repair and I used like a
protocol and tried to do it andI really thought I was doing a
great job and I tried to followthe best I could.
But I just remember she came inone time and she was like super
flared up, like 100% my fault,I probably did it a little too
aggressive, exercise, loading orsomething, and she just uh, I

(03:34):
think she stayed with me as apatient, but I remember being I
felt terrible, you know, duringshe came in and she was like,
yeah, I'm really like I I can'tmove my arm, I'm like word, I
retort.
And I was like, oh my God, thisis the end.
I worked for three months andI'm going to lose my license and
this is the end.
But that actually is when Ibought Mike's course, funny
enough.
So we'll round about that later.
But, um Aaliyah, what was yourexperience?

Speaker 3 (03:51):
I mean, you went to residency right after but what
was your experience like divinginto residency and then like
dead set on neuro?
So I did like all of myundergrad and then all of well I
guess two years of grad school.
I was like all in on neuro, likeall my research was neuro,

(04:11):
everything I was interested inall my special courses.
So I really didn't flip untillike the end of my second year
and then I was like full panicmode, like got to learn about
sports and then I was trying toget like as many resources as I
could and then I changed like myclinical rotation and luckily
got one with you, which was ablessing, um, but yeah, it was
very stressful.

(04:31):
For that reason and that's whyI chose to do a residency
actually is because I felt veryunprepared.
I hadn't like done enough insports so I was like I got to
learn more and I like I didn'twant to go into it and just be
like a lot of people's storiesgetting put into a benchmark or
something and just treating waytoo many people a day and not

(04:51):
learning much, just trying toget by, and I really didn't want
to do that.
So I chose to do a residencyand apply to different programs.

Speaker 2 (04:58):
Nice and then you did your residency at CHOA and now
work at CHOA, so that wasprobably a smooth transition.
But when you first had yourfull like week of a caseload,
did you feel like you were readyto rumble and like you had a
good prep, or did you still feela little like head underwater?

Speaker 3 (05:10):
Um, I felt pretty prepared cause I went through a
whole residency program and Iwas treating the same population
that I had been treating likeresidency.
I got to see people one-on-oneand I was coming off of somebody
else's caseload.
So that's a little bit bitunique.
So I got like a very slow intro, but I mean even just starting
like even with starting one likepatient to just one therapist,
I was like still like I have noidea what I'm doing.

Speaker 2 (05:31):
So, yeah, like basic cases, sure, but like putting
all the things that you'velearned like into real life just
is a lot more stressful yeahyeah and I kind of lined up the
episodes, the three we're goingto do for the next couple of
weeks, kind of in the order oflike the topics that we're here
about, like the scary stuff whenyou're a new grad and maybe
some help with some of the acutecases or like managing a

(05:51):
diverse caseload.
But I've gotten to the pointnow where when people come to
champion, you know, I kind ofhopefully try to level set their
expectations.
One is that champion is so nota typical exposure in a clinic,
right, like some aspects arereally great, but we have the
dream and we're so lucky thatMike and Lenny have created a
place that we work out like that.
But one, it's not going to belike that.
And two is, you know, I don'tknow if it's a bad joke or not,
but I keep telling students thatlike I view PT school now more

(06:15):
and more as don't kill people,like that's kind of what you're
testing for is like neurocardio,ortho, you know, don't hurt
someone, don't like reallyinjure somebody, don't re injure
someone's cardiac issue or teartheir ACL, and like of course
that's that's a hyperbole, but Ifeel like a lot of the tests
and the study and stuff was alot more.
You know some criticalmanagement, but not like.
What do you do post-op daythree to post-op day 14 with a

(06:35):
fresh rotator cuff?
What are the best options?
Like?
Some of that was in there, butI didn't learn any of that.
After courses, mentorship,whatever, dan, I'm not sure if
you felt the same way, but nowthat I look back on it I feel
like I should have level set myown expectations that I would be
fully ready, you know.

Speaker 1 (06:48):
Yeah, I think, uh, for me I had like a big ego so I
thought I was like good to goand then, uh, when I got started
, I think that's when I kind offigured out and, to be honest,
it me, I just I really wanted tobe a good physical therapist
and then that, combined with merealizing that I wasn't as good
as I thought I was kind of ledme to more.

(07:10):
But I mean, I'm going to film acouple videos on Monday about
hip labral repairs and I'm justI was thinking back to my own
education on FAI and I feel likeI don't even know if we had a
section on it at all.
My only education on FAI and Ifeel like I don't even know if
we had a section on it at all myonly education on FAI, I
believe in PT school, was apresentation at CSM which kind
of piqued my interest.

(07:31):
I got interested in it.
I, when I got my first hiplabral repair, I was like I
don't, I don't know what I'mdoing.
Like this is hip surgery.
I didn't know you did surgerieson hips, right, and it's funny
because it's very specific whatyou end up doing with those
folks.
And we've been doing it foryears and years and years, and I
think we sometimes take it forgranted.
You know, a patient comes in.
We have to be careful for thesethings.
The surgery was this area.
That's why you have thesecontraindications, this is the

(07:53):
reason why we start weightbearing at this time, and all
those things are very, veryimportant.
But, like you said, pt schoolis not necessarily designed to
make you orthopedic specialistand it just takes time to
develop those skills.
I guess.

Speaker 2 (08:08):
Yeah, I think you know, maybe awareness obviously,
like we're doing now, is thefirst step, and the people who
tend to need to hear it the mostare the ones that get into hot
water and then probably seek outsome resources.
But so what do you think then?
Advice wise Dan, for likesomebody to avoid getting, you
know, blindsided with a fullcaseload or overwhelmed by stuff
they've never seen before.
Or maybe it's inevitable.
Maybe you know, like there'sjust there's going to be stuff
that you don't feel comfortablewith, and you know you're.

(08:29):
You're sitting in the clinicwith a five o'clock biceps
tenodesis eval, and you don'tknow what a tenodesis is, like
what.
What do you think people shoulddo to try to get, maybe stir
their anxiety down?
A?

Speaker 1 (08:39):
And I think there's just so many good things that
you can do.
Maybe I'll rattle off one ortwo and I'll let everyone else
speak, I guess.
But I think one of the thingsthat helped me out early on is
just to find a clinic that hassome decent mentors.
It doesn't have to be perfect,because I think a lot of folks
are looking for that perfectsetup.
They want to make sure theyhave like a full set up gym,
like every single person therehas their OCS, they have like

(09:02):
five hours per week that theycan actually meet up with their
boss and kind of talk throughcase studies, that type of thing
, and that is certainly nice.
But I would say, try to find aplace that has a few mentors
that are pretty good.
You can kind of run some ideaspast, and I think the other
thing is that you can look atyour case study or, excuse me,
your patient panel for thefollowing day and prep on that

(09:25):
night.
Right, and I did that probablythe first year as a physical
therapist and I wrote down aplan for every single patient.
But one of the issues that Iwasn't ready for is that when I
first started traditionaloutpatient, I thought everything
was going to be like okay, wehave a rotator cuff related pain
, then patellofemoral pain andthen we have plantar fasciitis.

(09:46):
And then I got in and I'mgetting these weird surgeries.
Like I got a ladder J and then,like I don't know, like a REMP
massage procedure.
I'm like what the hell is thisRight?
So I think a lot of it is thatit's hard to prepare for
everything, right, unless you goto a very specific clinic where
you know where you're going toget.
If you're able to justbasically prepare the night

(10:06):
before and look at your wholecaseload and be like, all right,
this person's coming in withthis surgery, I got to know what
this surgery is.
I should probably look at a fewprotocols and I still do that.
I mean, I just I had a distalbicep repair coming in and I've
treated a bunch of those in thepast.
But I was just kind of curiousif some of the research has kind
of changed.
Look at some of the guidelines.
So I just looked at a fewresearch papers like, ah, not a

(10:27):
whole lot different.
And what's funny is like thesurgeon completely disregarded
all the protocols I saw he wasmuch more aggressive and like
okay, let's, let's go for it.
Um, but that was something thatwas very helpful because I was
just scared, right, you'redealing with this, like every
once in a while I would get thissurgery I've never seen before
and I have to like excuse myselfreal quick.
You know, I'm like, oh, I'll dosome pendulums, I'll go to the
other room and look this upbecause I don't know what I'm

(10:49):
dealing with, um, but yeah, Ithink it helps out to just see
what your, your patient uhschedule is going to be like,
having an idea of what you'rebeing confronted with and then
just learning as you go.
So, essentially, looking thingsup if you don't know, before
you see the patient and thenkind of afterwards, doing some
review and then talking to yourcolleagues.
You know, I got this type ofinjury, what do you think?
Or this presentation what doyou think is going on with this

(11:11):
patient?

Speaker 2 (11:11):
So yeah, yeah, I love it, aliyah.
What do you think?

Speaker 3 (11:14):
Yeah, I mean I agree completely.
I think having mentors orpeople that are willing to help
you like take a minute, stop,talk through it with you, make
sure that you feel comfortablewith it before you do like an
eval or a treatment session,whatever you're doing with that
patient, is really, reallyhelpful.
And then I think preparationkind of like you said, like
making sure you're I mean chartreview, like get on there, see
what you have the next day, likedon't come in unprepared.

(11:34):
And I think, aside from likepost-ops, maybe just with the
diagnosis.
I see this a lot with the newgrads just stressing out so much
about giving a diagnosis.
I feel like patients don'tusually care that much about
getting a diagnosis, like theywant to know what they need to
work on and how you're going toget them to the point to
wherever they want to be.
And so just taking a minute tostep back and assess your

(11:54):
deficits, find those deficits,tell them what they are and then
make a plan to get them betterand tell them what that is.
You don't necessarily have tolike diagnose what kind of knee
pain they have.
You know they have anteriorknee pain.
Okay, cool, like if you cangive them more information, cool
.
If you can't, because itdoesn't really fit into one
little hole, like that's okay.
And I feel like that for newgrads is really tough because

(12:16):
you're just taught to, you know.
Okay, if it's this, then I'mdoing this.
It's not like that in the realworld most of the time.

Speaker 2 (12:22):
Yeah, absolutely, and I think you're right.
I think both of you guys arereally spot on, which is, you
know, even with great troutreview and stuff, you're going
to get.
You know, some curve balls,right, like you're going to.
I've had multiple times whereyou know somebody comes in,
they're literally in a hugebolster sling or they have this
big knee brace and like, oh,like, did you have, like, yeah,
I had like a tenodesis, or likea rotic up repair, or like a

(12:42):
knee is really common, right,it's like coming from an AC on
the schedule and like, oh well,they did an LAT as well.
And then also they did likemeniscus repair.
They didn't know until theywent in there.
So I have ACL meniscus repairand you know an LAT.
And then you're like, oh God,did you get like an operative
person for an hour with like asurgery that's three times more

(13:04):
involved than you thought, nopostoperative notes and no
post-op protocol?
And I think in that moment it'sreally important to maybe have
in the back of your mind likewhat are some just basic things
that all knee surgeries need orall shoulder surgeries needs?
And you know we'll have anepisode in this that we'll film
to kind of help people out.
But like there's a lot of stuffstill do for most surgeries or
most acute management that's notgoing to compromise tissue,

(13:24):
because I can't tell you howmany times I used to like do
things that I think were right,maybe based on my intuition, but
not based on, like, thesurgical protocol or some good
literature.
And then you know, like in themiddle of the night, I like open
my eyes and like, oh my God,no-transcript, you know question

(13:50):
.
So like, let me, let me takethe night and look up at this
and I'll come back to you onWednesday when you come back in.
So you know, this is what Ithink right now.
But like, I'll definitely lookit up and see what's up and uh,
that's like.
Uh, here, mike and Lenny dothat all the time.

(14:18):
They're 20, 30 years into theircareer, but it's okay to say
like yeah, I don't know.

Speaker 3 (14:22):
I think too, with post-ops, the more that you can
get, like if you have theopportunity to sit in on other
people's post-op evaluations.
Because I think one of thehardest things for new grads
with post-op evaluations is allthe questions that they get.
They just like front load youwith like question after
question after question, andthere are sometimes difficult
questions to be able to answer,especially if you don't have a

(14:42):
lot of experience treatingsomebody from, you know, ground
zero all the way up to like sixto nine months post-surgery, and
so being able to like setexpectations and answer those
questions confidently I think isreally helpful.
So being able to sit in withsomebody and just hear all of
those questions and hear theanswers and like see how it goes
, is really helpful.

Speaker 2 (14:58):
Yeah, for sure, and I think you know some.
The next topic we can kind ofpivot into is, I feel like Dan
and I have done the mentorshipwith Mike and almost
overwhelmingly people have themost questions or problems with
the extreme ends of thecontinuum of care, right the
super duper day one to day 14.
And then it seems like oncethey get over the hump they can
kind of get through all the wayuntil like the advanced stage of
things and then like veryadvanced strength and
conditioning and return to sport.

(15:19):
It's also very stressful oroverwhelming.
Or somebody who comes in withjust like this weird dispersed
shoulder pain that has possibly49 different you know sources.
So, on the front end, like Dan,what do you think for advice to
new grads who are kind ofstaring at a down the barrel of
a high doctor based practicewhere they're seeing like a lot
of knee post-ops, a lot of, likeyou know, shoulder elbow, weird
stuff?

Speaker 1 (15:38):
Yeah, I guess, um, just to kind of like talk a
little bit about general rehab,I, when I was in school, it was
very much like you have thispathology, there's a specific
treatment for it, right.
I remember it was like, um,clinical prediction rules for
low back pain.
It was kind of like, all right,you come in and you have
radiating pain, okay, well, yougot to do a direction of

(16:00):
preference exercises right.
Like, oh, you have like apainful arc and you touch your
toes, that's a stability patient, right.
You got to do this veryspecific thing, right.
And it just kind of led to a lotof confusion about accurate
treatments, especially when itwas like a little vague.
It was like this might beridiculous, but it also seems a
little mechanical.
Should I give him a coreexercise?

(16:21):
Is this a bad thing, right?
And I think what I've fallenback on over the course of time
is that, as long as you don'thave, let's say, a bone stress,
injury or other medical redflags, uh, we just want to
promote folks being more activeand then giving some good
education surrounding their pain, trying to avoid things that

(16:41):
are provocative early on andthen trying to build them up
over the course of time and thatgoes for like a lumbar
radiculopathy, right, it goesfor, let's say, osteoarthritis.
Goes for, let's say, someonehas a more fresh meniscus tear,
although that might be more of ared flag situation, send back
to the doctor.

(17:01):
But all of these things that arescary or these diagnoses that
we're not completely certainabout the treatment is all going
to be pretty darn similar, andthat's one of the things I see
with patients sometimes.
I just I had this student thatstuck out one time that she was
from university where they'rejust very good at diagnosing
things.
I'm like I remember she wentthrough this evaluation like wow

(17:22):
, she's crushing it, right, andthen she just found out it was a
meniscus injury.
Then she's like excuse, both ofus for some reason, and I was
like what's going on?
I don't understand.
She's like all right, what's thenext step in terms of treatment
?
I was like you just got likethe best possible diagnosis, you
know?
Um.
So I think sometimes it's evenif people do have the right
diagnosis, they're kind of likegrasping at straws in terms of

(17:43):
what the most important thingsare to do, and I think a lot of
it is like okay, patienteducation, reassurance, backing
all the things that hurt andthen kind of applying a little
bit of exercise and over thecourse of time they can start to
improve.
So I would say that's the bigand most important thing.
I don't know, did you havesomething to say?
I don't want to keep ranting.

Speaker 3 (18:03):
Yeah, no, just to kind of piggyback off of that
too.
With the diagnosis thing, Ithink it's helpful to just
communicate all of that, likeeven if you're not sure on a
diagnosis, most like, if I'mlike between a couple of
diagnoses and I know it's likeokay, you have knee pain, I'm
probably going to treat itmostly the same way.
So I'll kind of communicate thatto the family.
I'll be like, you know, eachtreatment session we can just
see how it goes and if somethingnew arises then we'll take that

(18:24):
into consideration and see ifwe want to do anything
differently.
But you know, even if it's thisor it's this thing, then we're
probably going to do some squatsand we're probably going to do
some step ups and some splitsquats, like we're probably
going to get you stronger, getyour range of motion back, and

(18:45):
then, you know, if we find outmore information down the line,
cool, if we don't, hopefullyit'll get better, like.
So I think, education from thatpoint to the especially if the
patient is very diagnosisfocused, like they want to have
an answer for what it is and wejust don't have a great one for
them I think just bringing themalong with all of that
information and educating themon all that stuff is helpful.

Speaker 2 (19:04):
For sure, and I think you know the the best way to
kind of approach it is youshould have some sort of a con
ed, you know schedule in place.
You should kind of be up andreading.
But I remember early on I foundmyself a lot more what's the
word?
Like I could think on my feetand give better answers or
problem solve a bit more when Itargeted my con ed, you know
kind of split, so like one thirdtowards the things that I
absolutely had to read aboutbecause the cases were right in
front of me, and then a thirdabout the things that I was like
seeing all the time that Ididn't have just yet but I knew

(19:27):
were probably going to come inthe door ACLs, you know, rotator
cuffs, that kind of stuff andthen a third of your time you
can maybe tackle the stuff thatyou want to learn about
concussions or the more you caneducate yourself.
I think the best thing I'velearned from Mike and Lenny,
amongst many, is that, like Mikeand Lenny know anatomy and
biomechanics and pathomechanicsas much as the surgeons who are

(19:48):
doing surgeries.
Like Mike knows more about aTommy John craft, you know, than
a lot of surgeons probably doin depth, and so Mike really
understands the stresses ofthrowing and you know symptoms
and where they come from, and soif you can arm yourself with a
really good working knowledge oflike the anatomy, biomechanics
and maybe some pathomechanics ofthe common stuff that you're
seeing, I find that I cansometimes think a bit more fluid
on my feet and give betteranswers or have different ideas,

(20:10):
because I generally know, youknow, okay, the hip labrum is
impinged with these things andmaybe we should modify to this
exercise.
So I would really recommendthat people try to do a
consistent education of like anhour per day, of just rotating
through topics and when youactually apply that information.
Though to Aliyah's point,people don't need a dissertation
in the path mechanics of alabor repair right.
They want to know what theyneed to do and what they need to
avoid and just be a normalhuman, like I think it's really

(20:32):
missed on new grads that theseare people in front of you that
are in pain, but they have lives.
They're normal people.
You know, in the same way thatyou might know a lot about a
certain topic, but they justwant to, at the end of the day,
have someone who's nice and ishelping them do things that they
don't know how to do and justconsistently do a basic program.
You know, like you don't needto give people I really early on
I think my ego was trying tosound smart use big language and

(20:53):
give people these veryelaborate, complicated programs
that had multiple con ed coursesI had learned, but in reality
they just need to maybe not sitfor eight hours a day and just
lay on their stomach every oncein a while to get out of back
pain.
You know as basic as thatsometimes.
So yeah, that'd be kind of mytwo steps, but we already maybe
are transitioning here.
I don't know, dan, do you haveany more on the acute care side
of stuff, or is that pretty good?

Speaker 1 (21:12):
Well, I think you had said this previously I felt
like I wasn't really preparedfor post-op patients, which saw
a lot of that when I came out ofschool, you know, I thought I'd
be like diagnosing, likerunners and that type of thing,
and then I'd have like someonejust came in meniscectomy or
post-op knee replacement andthose are a little bit kind of
freakier, I think, and scarier.

(21:33):
What I will say is that when Igraduated, I don't think most of
the continuing education iscentered around post-op patients
, but I do think that there area few good resources for
specific areas, like I thinkKevin Wilk has some of the best,
like rotator cuff repair,post-op stuff.
Like I can't believe the amountof stuff I've learned from him,
as well as Mike, as well asLenny, and the other part is you

(21:57):
can go and you can look forsome of these pretty good
guidelines online.
You know there's some prettygood review articles about what
you're supposed to do early onpost-op.
And the other thing I will sayis that I think for the advanced
rehab there are some prettygood papers, but I think largely
a lot of the recommendationspost-op are pretty good for the
early stages and mid-stages, butthey don't really address the

(22:18):
return to sport very well.
So I would say you probably justwant to find some good sports
physical therapists and take acourse or two, see what they do
end stages um, I was.
We were just reviewing anarticle the other day about
post-op hip labral repair,because we're going through like
a hip kind of stint, I guess,and they had some great
information up front.
I was learning a bunch and atthe very end it was right here's

(22:39):
return to sports stage.
Maybe do some agility and boxjumps, you know what I mean and
like make sure you return tosport test, but like there's no
tests, you know what I mean.
There's like no guidancewhatsoever.
So I do think that it'sprobably worthwhile to get some
good courses on return to sportand maybe just listen to some
mentors have done it a lot Right, because I think that if we
listen obviously to Mike andLenny and they're big in the

(23:01):
baseball world and they have avery specific progression for
all their athletes back but ifyou start looking online you
probably won't find a lot ofthat good stuff in research
papers.

Speaker 2 (23:11):
Yeah, definitely Aliyah.
What do you think?

Speaker 3 (23:14):
So something that I struggled with a lot, I think
initially that Champion, I feellike, did a good job laying out
for me that I'd love for youguys to talk about.
It's just like we talk aboutdoing, like making a general
program, and so for you guys, Ifeel like one of the things that
I was taught especially withDarish as well at through like
the SNC program about like basicprogramming because I did not

(23:35):
learn that in school at all.
We were very much like.
The programming that we learned, I think was like a three week
long thing and it was literallyhow not to kill somebody, like
when to terminate exercise ontreadmill if their heart rate is
xyz or you know whateversymptoms they're having, like
hospital kind of situation, notlike basic programming, and I
feel like we're missing a lot ofthat in most like pt programs

(23:56):
like how did you can choose anexercise, but how should you
program it?
That's still something I'mplaying around with too, with
like my post like how to you canchoose an exercise, but how
should you program it?
That's still something I'mplaying around with too, with
like my post-ops, like trying tomake sure that I'm like
strengthening and hypertrophythe quad enough when they're
coming back from an ACL surgery.
So I'd love for you guys tojust kind of like generally talk
about like how you guys programlike basic programs for upper

(24:17):
extremity, lower extremity andthen, if there's any, like good
resources for new grads for that.

Speaker 2 (24:20):
Yeah, well for one, that's definitely a good future
episode we should do.
I just thought about that.
But yeah, briefly, I think Iwas in the same spot as it was
kind of like a little trial byfire, right, I think Dan and I.
I mean he can speak when heshares some thoughts, but we
kind of got lucky that we cameout of school when, like the,
the Charlie coaches of the worldwere really like great PTs,
were also really great strengthcoaches and they were just

(24:42):
running out the field for peoplelike Lee Taft and Eric Cressy,
who are also amazing strengthcoaches, who wanted to dabble a
bit and understand the rehabside of things.
So many of those courses Iremember taking like
lateralizations and you knowprogressions with Charlie and
seeing some online courses thatyou could really fill in some of
that blank space about likewhat do we do to help these
people?
And also, um, you know to Dan'spoint of spending time with
people who you want to try tolearn from shadowing clinics.

(25:05):
Most places are pretty coolwith you going just to hang out
and listen and kind of be there.
But I was the only PT in the200 person um winter seminar
with Eric Cressy at his facility.
I remember looking around andseeing all strength coaches and
I was like I can't believethere's no PTs here because I
don't know anything what to dowith these people when they're
six, seven, eight months out.
So definitely try to, you know,immerse yourself around those
people.
I have learned so much from youknow, jonah and the strength

(25:27):
staff, and I feel like I takemuch more than from the strength
side than I do even as a PT,just because I'm curious about
how they think and how theyprogram.
And so I guess my thought isthat, you know, we view
programming in the lens of thetissue or the pathology.
That's limited, right.
So our programming, say for anACL for example, is oftentimes
two of those days right are veryleg and core dominant right.

(25:47):
We're really not doing a ton ofupper body stuff until later.
So we're programming basedaround what the knee joint needs
to get to the setup for runningright or the setup of
plyometrics.
And I kind of always think about, you know, our programming is
like, all right we might havefor the lower body.
What are the main movementpatterns?
Squat, hinge, single leg, splitpelvis, accessory work how do
we fit those in two days?

(26:08):
Then upper body we'd have, okay, horizontal pushing and pulling
or vertical pushing and pullingand accessory work.
How do we fit those into twodays?
Whereas when you listen toDuesh and those guys talk about
it, they're thinking about, likesports performance.
You know all the athleticqualities, all the way from
mobility to plyometrics, topower, to strength and energy
systems, and it's just adifferent programming lens.
But we're very much dictated bythe pathology and what we need

(26:29):
to do, kind of to get that there.
So I would say, think about itthere and then you know also
it's hyperbole, but I always sayto people when we're teaching
them, like if you wanted to killsomebody and lose their license
, like if you want to lose yourlicense, what would you give
this person?
Like so, btb, acl, post-op wake, week 12.
Like what would you give thisperson if you wanted to blow
their knee up right, a superknee, dominant, sissy, slant

(26:51):
board squat.
Like okay, well, it's not downthe stairs, yeah, exactly.
And then the opposite is like,okay, well, like what do you
feel pretty safe about as apattern?
Like they'd never hamstringgrafts.
We can load the hamstrings up.
Maybe a hinge and a glutebridge is a good starting spot
and you work your way throughthat Right.
So I think that's kind of whereI approach.
It is the is the, theprinciples of loading and the
principles of the tissue infront of you, and what do you

(27:15):
need?
And then, okay, I have thesebuckets of patterns.
Maybe I double up on glutehinging type stuff twice a week
because that's what feels good.
So that's what I think, dan.
I'm not sure if you havethoughts there.

Speaker 1 (27:23):
Yeah, I'm super biased.
I love programming,periodization, strength and
conditioning.
I came from that background.
Right, I will play a little bitof devil's advocate because I
don't know.
I do feel for the universitiesand then them trying to teach
these things.
I think if you look broadly ourmedical literature and if you're
looking at mostly sedentaryindividuals, there's a large

(27:45):
variety of things that tend towork equally.
And I was just looking at someguidelines for knee
osteoarthritis.
It seems like you can doaerobic exercise, you can do
strengthening, you canstrengthen the quad, you can
strengthen the hips Folks tendto do better.
You can do yoga.
If you look at low back pain.
You Pilates, your corestrengthening.
You can do yoga again.
You can do aerobics.

(28:06):
A lot of stuff seems to workequally well for these folks.
So I can see, sometimes I feellike I'm like an elitist, like,
oh, you need to learnprogramming because that's going
to make you a better physicaltherapist.
And I think for the averageperson, just getting them moving
and choosing exercise they liketo do is probably going to be
the most important thing.
Right, get them to do something.
But then, when it comes down toworking with athletes, I think

(28:30):
it changes.
And again, I'm biased and Idon't think we have enough
research.
Like there's one study I canthink of off the top of my head
where they're looking at kind oflight load training more
frequently, so like doingexercises twice a day, every day
, versus programs where theyload heavier and they have a
little bit more rest in between,which would be like maybe more
strength conditioning, heavierloading and it did show a trend

(28:53):
towards being better with theheavier loading less frequently.
Right, but beyond that it's wedon't have a ton of research
showing that being very specificabout your programming is
better and sometimes it'sexactly the same.
But the other part is like andI'm sure you've read this, if
you read enough research likeyou're just like why the heck

(29:13):
did they use this set and repparameters?
You know, like rehab for FAI,and it's like they chose three
exercises, they three sets of 35.
And like the next study is likethey did five sets of 10.
And then they did like 10 setsof seven and they use all
different exercises and there'slike nothing is similar.
But you look at these twostudies and you're like I don't.

(29:34):
I don't really know what to doand you can obviously take their
set and rep parameters and trythat, but sometimes doesn't make
any sense.
You know, with the exerciseprogress they tend to use, so on
and so forth.
So I would like to see more ofthat.
But when it comes down to tryingto gain something particular
with your patient like I thinkone of the big no brainers is
like if you have a post-op ACLwhere the quad is weaker, or you

(29:57):
have a post-op Achilles wherewe know that calf just gets itty
bitty, like there are so manyprinciples that we can follow.
They're going to help buildmore strength and size, based on
just basic strengthening andconditioning principles that we
should probably apply, right,just more frequency, more load,
certain set rep schemes, so onand so forth.
I think where I use my strengthconditioning and exercise

(30:21):
prescription knowledge the mostis just trying to meet people
where they are in terms oftissue irritability and their
own goals, right.
So we tend to work with a lotof fit people and they want to
be able to work towards theirstrength conditioning goals or
fitness goals, whatever they are.
So my job is like hey, how canI tweak your program as little
as needed so you can stillprogress optimally and rehab at

(30:44):
the same time?
And I think if you know how tokind of dose up, dose down, if
you know what's set in rep rangeis best for strength versus
hypertrophy, you can wigglethese things around really well.
And it's one of the reasons whyI love blood flow restriction
training so much just because weknow that you can increase
someone's strength andhypertrophy at a very similar
rate to maximal loading.

(31:04):
And we've seen this in powerlifters, right.
So if I have a patient thatcomes in that has knee pain,
they're like oh man, I'm so sadbecause I can't squat like above
80% of my one rep max.
My knee kills me.
I'm like well, if we just doblood flow restriction training
for the next four weeks, you'llprobably progress the same exact
rate as if you just were heavyloading, right.
But if you didn't understandsome of these principles, like,

(31:25):
you might tell that person tostop doing everything for weeks
and then they end up goingbackwards and then once they can
pick up some strength trainingagain, maybe we give them a
larger rep and reserve.
There's been some cool studiesthat show if you're even like
somewhere between four and 10reps away from failure, you
still build strength maximally.
So that power lifter that comesin it's like so distraught that

(31:46):
they can't lift heavy anymorebecause they feel like you're
gonna lose all of their strength.
We have so many options to helpthem when their main goal is
strength, but if you don'tunderstand any of those
programming principles, you'renot going to be able to help
that person through that processas well as if you did
understand them.

Speaker 2 (32:03):
Yeah, and to that point I mean something that's
really helpful is there's greatpeople who have helped publish
papers Dan Lorenz and manyothers and I was pulling this
paper up here but I didn'trealize this paper is 10 years
old, right?
This is like a pretty classic,you know, strength conditioning
paper that Dan and ScottMorrison put out that
essentially is walking through alot of what Dan's talking about
related to like sets and repschemes and like periodization
and trying to offer people somelike guidance on what to do.

(32:25):
If you didn't come from atraditional CSCS or strength
conditioning background, thereare a lot of papers that offer
you great literature on like youknow what are the basics of
periodization and you know whatare the basics of set and rep
ranges.
Why would I choose, you know,six reps versus 12 reps to Dan,
dan's point, and how can wemeasure, you know, fatigue in a
healthy way that's just hardtraining versus getting somebody
injured.
And you know, with this I thinkwhat always comes to mind for

(32:46):
me is I find myself, especiallybefore we get into like the
advanced phase of rehab, likeand again, we'll do a, we'll do
an episode on this next, butit's like I'm just going through
a checklist in my mind aboutdoes this person have, you know,
symmetrical, uh swelling?
Does this person havesymmetrical patellar mobility?
Did they have symmetrical kneehyper extension inflection?
They have symmetrical strength?
If none of those things aretrue, then that's all you work
on.
You know, it's like it doesn'thave to be very complicated.

(33:07):
I think sometimes there arecases that require quite a bit
of mental horsepower to workthrough.
You know what might be going on, but sometimes in the case of
like an ACL with a weak quad,it's, like you know, pretty
simple.
It's simplicity and then on topof that is consistency, right?
Well, okay, for we know ittakes about four to six weeks to
truly add some, some mass.
So let's make sure this personis sleeping, eating well and
then training three times a weekwith moderate set and rep

(33:30):
ranges at moderate intensity,and that's the training effect
they they feel after is normal.
And I think if you just takethose basic principles and be a
bit patient and apply them tomost populations of, like you
know, stretching every day toget your flexibility up, if you
need to get some motion back, orlong load duration twice a day
for four weeks to get yourhyperextension back, these
things are really basic inprinciple, but I think it's hard

(33:50):
for new grads because theydon't feel like they're doing
anything.
They feel like they'reeducating person and like, all
right, we'll have 45 minutes ofthis person.
I did soft tissue heat and likegave some advice.
Like now, what it's likedoesn't have to be that crazy.
Pick three exercises and justdo a nice basic linear
periodization and Mike's alwaysfamous list with like cuff stuff
is like add one pound a week toall your shoulder exercises for
six weeks and then we'll retestyour strength and you're

(34:10):
probably stronger and yourratios higher.
It's not like you know we'redoing this quantum physics
equation to figure out yourundulating periodization reps.
You know what I mean.
Is that helpful, leo?

Speaker 3 (34:18):
yeah, no, I agree completely.
I I see that a lot in new gradsthat I've been coming in and I
also did it myself where I camein and you're excited and you,
you're like ready to treatpeople and I just wanted to
choose like the most creativelike out there exercises.
You know, like you see a newone on instagram, you're like,
oh, I gotta try that.
Doing like crazy things.
I like crazy, crazy, but youknow, just like different things

(34:40):
.
Like you don't want to have aperson like do a clamshell you
know exactly.
I feel like I'm over this.
I'm not going to be a clamshellPT yeah that kind of debate.
It is hilarious but yeah, Ifeel like it's.
It doesn't have to get socomplicated like treat the depth
, find the find the deficits,treat the deficits and you know.
You pick basic strengtheningexercises that they need,

(35:00):
especially in my world.
I'm working with pediatrics, sotheir training age is so low, so
I don't need to choose theselike crazy exercises or
exercises that they don't evenknow very well or have never
done before, like RDLs, are likethe hardest thing to treat or
to teach anybody and then tohave them do it.
So I usually get on it prettyearly if that's something that's
new to them.
But I think sticking to thebasics and just trying to

(35:23):
remember like that paper I lovethat paper, I read that at
champion, so you should sharethat with everyone, cause I
think that's a really helpfulresource, because I think you
can get really bogged down byall of the things that you could
do, when in reality, doing likethe simple basic stuff that you
might not feel is doing a lotor that you might feel like it's
not enough, is enough.

Speaker 2 (35:44):
Yeah, for sure, and it's funny you mentioned, you
know, instagram, because that'sa good segue.
For the last little like fiveminutes here is, you know I came
out and maybe Dan can explainhis thoughts.
But like I came out and verymuch the not joints, all
functional time of like,whatever that was SFMA, fms, was
super popular.
So, um, I swung so far into,like the global kinetic chain
type stuff that I realized veryquickly that I didn't know how

(36:06):
to treat a post-op knee right,cause when a post-op knee comes
in three days out, you ignore85% of the global movement exam
and do a joint eval.
And thankfully, at that time,you know, I bumped into Mike and
Lenny and got you know, set upa champion where I'm like, oh,
like, they're masters at joints.
And then they added the kineticchain on top of that, not the
other way around, and so it tookme a while to kind of swing
that pendulum back the other wayof like not just what looks

(36:28):
good on Instagram, but also likewhat is the basics of these
things.
And I think clamshells are theperfect example because, like,
there is a time and a place whenclamshells are like the worst
possible thing you can givesomebody if they're like really
far along the way.
But I'm treating two, threemaybe like post-op label repairs
with acetabuloplasties andwhatever they're like three
weeks out and it's likeclamshells, sideband walks, glue

(36:50):
bridges it's like that's itlike and they're and it's not
like I always think about.
I also have three acls right andthey're trying.
These kids are trying to do aleg raise one or two weeks out
and they're like sweating theirtongues out like hard bro, like
sometimes a basic leg raise withlike quad inhibition and some
pain and stuff is.
That's that's it, you know.
And so there is a time and aplace when you can kind of poo

(37:16):
poo clamshells the vein of youknow high quality education and
you know social media versuscourses and stuff.
Uh, I love, dan, if you haveany thoughts on that past thing,
but then also to kind of shareyour thoughts on how to get high
quality education, becausethat's, that's a sea of
information out there.

Speaker 1 (37:29):
Yeah, I guess to answer your early question, um,
I guess when I graduated too, wewere in like the movement phase
.
It's so funny to see like thedifferent phases now and look
back on them.
But like movement was huge,right, the selective functional
movement assessment, functionalmovement screen and it's funny
because like we had a biodex inthe corner of our clinic and
never used it, like we chastisedit, like it was a bad thing.

(37:50):
Now I'm like dang, I wish I hada biodex.
I really wish I had a biodex.
Yeah, it's pretty funny.
But I, you know, I got into thispoint where I was just wanting
to give people fancy, coolexercises.
I same thing, didn't reallywant to be the clamshell guy.
Right now I get to the pointtoo where I'm just like giving a
new program to a patient everysingle time they came in, and I

(38:12):
don't remember what point.
I kind of stopped this.
But I remember Mike had saidlike you know, is that how you
train?
Would you do that, you know?
And I was like no, I wouldn't.
I would write a program andjust do it for like four to six
weeks and then I would switch tosomething else.
So I was just giving peoplethese complicated programs
because it kind of felt good.
And it felt good to me, right,it wasn't necessarily better for

(38:33):
the patient, right, it justfelt like I wasn't delivering
quality unless it was somethingthat was like new or fun or
exciting or something alongthose lines.
And going back to what you hadsaid, it's like, well, you know,
clamshells they get a bad rapbut they're important, you know.
And at the very beginning ofrehab, like especially for like
FAI, like folks that have FAI,and this goes post-op and non-op

(38:57):
it's like, okay, these guys arehaving a hard time controlling
flexion rotation with axial load.
Clamshell takes away the axialload and the forces are a lot
lower and you're probablyintroducing a very good exercise
along that spectrum to get backto wherever you want to do.
And if you just jump straightinto exercise, like I don't know
, lmn, whatever, further down,you run the risk of kind of

(39:20):
flaring them up, right.
And then it comes back to theidea of isolation, which is
hilarious to me because back inthe day it was all movement and
we're going back to isolation.
If you want to isolateinfraspinatus, right, let's say
that someone has shoulder painand you're concerned that the
infraspinatus is weaker.
Like we know you train theinfraspinatus when you bench
press.
The bench press trains the pecs.

(39:42):
It trains the deltoids and abunch of other muscles.
Right, if we're concerned thatthe balance between the muscles
is poor, we're not reallyhelping out that infraspinatus
by doing bench press.
It's like the squat versus theknee extension.
It's like, well, you use thehip when you squat, are you
targeting the muscle you want to?
So I think sometimes we just youhave to give the boring

(40:04):
exercises if they're mostappropriate with your critical
reasoning and maybe for kind ofnew grads that can rest assured
that their critical reasoning isaccurate.
If they're being kind of boring, I still feel bad I'm.
I'm like, all right, we'redoing clamshells because the
most boring exercise.
I'm sorry, but gotta do them.
Man, you gotta eat yourvegetables, right?
kind of deal so yeah, um yeah,and I think you would ask the

(40:28):
question about social media orlike the best way to kind of
navigate that yeah I think it'shard, you know, and man, I, I
wouldn't really want to be a newgrad right now because there's
so much information that's outthere right now.
I feel like you're constantlybombarded with things.
Um, one of the things that'stricky with social media is that
very polarizing arguments arepopular, right, and I think that
people preferentially see those, and they're they're like more

(40:50):
triggering than regular posts.
They become more popular andyou basically have, like these
camps that are extremely againstone another.
Like don't do any manualtherapies ever, that's like the
worst thing you could possiblydo, right, and like shaming
people for doing manualtherapies.
Another camp thinks that they'relike amazing, you know, and
pain science was like this for awhile Like you have to do pain

(41:13):
science education, right, thisis the most important thing.
If you're not doing that,you're doing a disservice to
your patient.
And it's just tricky, because Ifelt like when I was a new grad
, because I consume a ton ofinformation and I probably
consumed too much, I was likeaddicted to learning, but the
way I treated it was like wildlydifferent from each week, right
, and that's not good.
Like we probably want to havesome sort of base foundation.

(41:34):
Then, once we build a strongfoundation, we can start taking
in additional things rightTaking in a little bit of PRI
taking in a little bit of likeSFMA, taking in some
biomechanics, right you knowwhatever else it is.
But I do think that it'sprobably good to find a couple
mentors early on.
You probably have to vet thosefolks.
Hopefully they do produce somesocial media.

(41:55):
One of the things that makes mereally sad nowadays is I think
that some of the best mentorsare not good social media
marketers.
I think one of my favorite guysis Rob Manske.
Rob Manske has got thisridiculous resume as a physical
therapist.
He's super smart and then hehas a podcast for IGSPT and has

(42:16):
some of the best surgeons in theworld on them and every single
episode on YouTube is likeepisode one IGSPT, episode
number two, igspt.
And I don't even know what's onthese freaking episodes.
I can't even search.
They're like this is for hippain or this is shoulder pain.
The social media marketing isso bad that you're not even
getting the best people in theworld's information.

(42:37):
That's like actually out there.
So I think you probably have tovet the people that you're
listening.
You know, do they see patientsRight?
Do they see the specificpopulation that you work with?
Have they been around for awhile?
Have they published so on andso forth, and then I'd probably
just try to get a couple peoplethat kind of jive with the way
that you like to treat at firstand get your baseline down,

(42:59):
develop that a little bit andthen you have a little bit of
experience to base what elseyou're consuming on Instagram.
Right, you can be a little morecritical of certain things.
You can even be critical ofresearch.
I've read enough research wheresometimes I'm looking at
something like this doesn't lookright you know what I mean or
like that's a bias or whateverit is, but someone else reads it

(43:22):
for the first time and thenthey change their entire
practice or something alongthose lines.
So, um, yeah, I guess, finding afew good people on social media
, following them for a period oftime, learning, getting good at
the basics, realizing there'sno like silver bullets at least
I haven't found it yet anywayand then expand over the course
time.

Speaker 2 (43:41):
Yeah, I love that and I'll piggyback quick and then
Aaliyah can have.
The last word is yeah.
I think the way you feel aboutRob Manske is how I feel about
Mike Ryman.
You know I love Mike and he issuch a good educator, but he's
just a tad dry sometimes youknow, he's his delivery, his
delivery process, because he'ssuch an academic, you know, he's
so good at research and so goodat stuff.
I took his hip course and youknow I had a couple extra cups

(44:03):
of coffee when I was readingjust because I wanted to pay
attention.
It was so good.
But then, yeah, you just find alittle monotony.
But shout out, mike, if youlisten to the podcast you're
amazing.
But yeah, some people'sdelivery style is like Mike's so
good at teaching and he's sosmart and treats so many people,
you know, versus havingsomebody who's super animated
and is like really up in hisface, just not Mike's
personality, which is fine.
So, yeah, I would totally agreewith you.
I would say in each kind ofdiscipline or area of PT maybe

(44:26):
it's like shoulder, knee, ankle,whatever hip there's a handful
of people that tend to have alot of experience and have a lot
of life.
You know, knowledge around,like treating, both of the hard
skills of the protocols and thetissue, but also the soft skills
of how do you kind of navigatetough times.
So I kind of have like bucketsin my mind of people who I
generally lean on for those thatI want to think about If I have
some back questions.

(44:46):
It's like Stu McGill's work.
If I have some stuff on the hip, it's Mike Ryman and Mike Voigt
and Ashley Campbell and them,then Mike and Lenny, for I kind
of have these like buckets and Ispent, you know, a good three
months on each joint when Ifirst got out trying to really
understand that well, and thathelped me a lot.
You know, try to get highquality sources of information
between courses and research andyou know some of the social
media stuff.
So yeah, aliyah, any partingthoughts?
Is that Marvin down there?

Speaker 3 (45:07):
Yeah, he's being very needy right now.

Speaker 2 (45:09):
It's all good.
Yeah, any thoughts from yourend before.

Speaker 3 (45:13):
I think just the biggest thought is, when you're
a new grad, like just expectthat you're going to have to do
extra work.
If you want to be a good PT,you're going to have to put in
extra work, probably outside ofyour regular clinic hours, if
you want to make improvements.
It's just whether that's chartreviewing and doing extra
research before you see apatient that you haven't seen
before, or if that's like takingextra educational courses, it's
definitely worth it.

(45:33):
It's definitely worth it Likeextra work at the front end to
find like a good you knowfoundation for yourself of how
you want to treat and who youwant to follow and what kind of
research you want to look into,and that kind of stuff, cause I
think that helps a lot.
I think once you get a littlebit further down the road, you
just kind of get into yourgroove and you don't you know if
you're not actively trying tolearn more stuff, you kind of
just get a little stuck.
I think so.

Speaker 2 (45:54):
Yep, very good advice .
Yeah, I think, and also viewthat in a lens of obviously, the
more you learn, the better of aclinician you are, the more you
help people and that's awesome.
But also you're happier at workand you're happier in your
daily life when you feel likeyou know what you're doing and
you're confident in yourskillset.
And you know I'm I'm veryfortunate now and I think mean

(46:14):
Like I generally enjoy treatingpeople and going to work and
it's fun to help people and haveanswers when they maybe had a
tough road ahead of them.
And you see something that's agap.
I've seen 39 spondys in the lastmonth.
Like I have a pretty good ideaof how to help you, um, and it
makes your day and your overalllifestyle much more enjoyable
than panicking about the fouro'clock avow and then worrying
about the five o'clock treat.
You know, like at first it's alot of anxiety if you don't know

(46:36):
that.
But as you put more work andmore reps in, you get a lot of
experience and patternrecognition and if you don't
have years under your belt, youhave to do that via other
people's careers, learning,education and research.
So, yeah, it's, it's dual, youknow dual, selfish and selfless
of.
Yes, it helps people.
You do a good job on it, youknow.
So, yeah, I think that's awonderful place to end right in

(46:56):
the around the 45 minutes.
But, daniel, sir, how can welearn more about you and all the
things you do?

Speaker 1 (47:02):
Fitnesspainfreecom.
Yeah, no one goes on websitesanymore, but you can find on
social media.

Speaker 2 (47:06):
Social media is great .

Speaker 1 (47:13):
I mean you kill it with social media, because I've
always hated it, but it's likethe most important thing, so
I've just become what I hate.

Speaker 2 (47:20):
Yeah, you just got to curate.
You got to curate a feed ofwhat you know is useful, you
know.
So, yeah, and then also on thatline, I think when this episode
comes out, we're probably amonth away from launching the
third cohort of the mentorshipthat Dan and I and Mike Reinald
do, which I keep saying Dan, Iwas very blown away with the
first cohort that people joinedand the second one.
We had equal as much, if notmore.
So we're doing something right.
But essentially, if you want tolearn from us for six weeks and

(47:44):
just get a fire hose ofinformation of how we treat and
like what we do and ourprotocols and you know a lot of
discussion there's a lot ofdiscussion back and forth around
cases that people have in, butthat's pretty fun.
I actually enjoy doing that,dan.

Speaker 1 (47:58):
Yeah, me too.
I feel like I'm learning moreabout how to help people all the
time.

Speaker 2 (48:02):
That's a great question.
The first few cohorts.

Speaker 1 (48:04):
We just got more and more information about what
people are actually in troublewith.
It allows us to keep making itbetter.
So it's been a really uniquecourse because it's ever
updating and evolving.
And it's ever updating andevolving and it's all kind of
changing based on what we learnmore about over time.

Speaker 2 (48:19):
Totally yeah by the third round.
Now we kind of have the wheelssqueaky.
You know, we actually have likea understanding of how to do it
the best way, so shall be fun,but we'll leave it there for now
.
Dan, thanks for coming on.
Aliyah, thanks for coming on.
We'll see you in like sevenseconds when we film another one
.
Alrighty, guys.

Speaker 3 (48:36):
Take care.

Speaker 2 (48:36):
Bye-.