September 26, 2023 • 49 mins
In this podcast episode, I’m joined by Scott Greenberg to discuss running injuries and how to get started working with running athletes.
Plus, we'll discuss some of the newer techniques Scott has been using, including the use of blood flow restriction training in this population.
Full show notes: https://mikereinold.com/running-injuries-with-scott-greenberg
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
On this episode of the sportsphysical therapy podcast.
I am joined by Scott Greenberg.
Scott is a physical therapist,the manager of operations and
the residency director for theuniversity of Florida Gators.
He's an expert at running andfoot and ankle injuries.
And in this episode, we're goingto talk about how Scott
developed this niche, how heworks with these athletes and
some of the new techniques he'sbeen working on with runners,
(00:21):
including using blood flowrestriction training.
Hey Scott.
Thanks so much for coming on thepodcast today and joining me.
Uh, how's everything going?
Everything's great.
Thanks for having me, Mike.
(00:41):
Appreciate it a lot.
Yeah, I've been looking forwardto this one because you're, you
know, one of the, the leaders ofthe academy, um, the sports
academy that, um, I think overthe years it, it's been fun to
see you present on some of thesetopics about runners and running
injuries and stuff like that.
So I've been really excited totry to get you on for this topic
because I, I feel like Ihaven't, I haven't really talked
(01:02):
much about running injuries overthe last few years in the
podcast, and I think it's longoverdue to have you on to share
your knowledge with us.
Right.
Uh, awesome.
I lo, I l I can talk running allday, so let's do it.
Which, which is a great answer.
I know that.
So, uh, let, let's jump in.
I, I know you've worked with alot of runners and so when you
(01:23):
work with runners, you deal witha lot of running injuries.
You, you know, the specifics ofrunning, running injuries, you
have to be really good at footand ankle, right?
Like, these are some of thethings that go hand in hand with
running.
Um, why don't we start, beforewe dip into some of those
things, like, I want to hearspecifically like, Like, how'd
you get started in this?
Like are you a big runner?
Did you specialize in this likeyourself as an athlete?
(01:44):
And then how did you pivot tosay like, oh, I'm gonna focus on
this for my professional career?
No, I think those are greatquestions and you know, I've
been going on being a PT nowgoing on something like 24
years, so it's been a long time.
So as I think back to how I gotmy start, um, Always loved
sports, always involved sports,played sports my entire life and
(02:06):
knew I wanted to have a careerprofessionally involved in, in
sports in some way, shape orform.
And physical therapy just, justspoke to me.
It just was what I wanted to doOnce I realized that being a
professional athlete wasn't inthe cards, right.
So, um, Went to PT school andcame out and again, knew I
wanted to do sports medicine,but didn't know exactly what.
So I think one of the thingsthat all clinicians should do
(02:29):
when they come out is really bea generalist more than anything
else.
Get yourself into a goodsituation, surrounded by a bunch
of smart people, um, and, andthen see where it goes from
there.
And then kind of just take itall in and see what speaks to
you.
And, um, for me, in my first twoyears, within the first two
years of practice, um, I've hadthe opportunity to see both
(02:49):
non-operative and operativecare.
Um, got to dabble a little bitin foot and angle, and it really
did interest me.
And when I took my second job,uh, which was, you know, a year
three post, post-grad, um,working with the team doctors
for the University of Florida,not as a physical therapist for
the Gators yet, but just workingin their clinic.
I wanted to figure out a way tofast track myself to be
(03:12):
considered the guy in something,right?
So I looked around and at thetime we literally had a, a true
sports medicine clinic.
It was, uh, four physicaltherapists, two athletic
trainers, two team surgeon, teamsurgeons, and one the non-op guy
that were all sports medicineall day every day.
And, you know, I was fortunateagain to be surrounded by some
really bright people, peoplethat have spent time working
(03:34):
with the Dodgers and people thatreally knew a lot about the
shoulder and the knee.
And I said, man, this is great,but you know, how can I stand
out and how can I kind of breakin to, to gator athletics, let's
say myself.
And, and then I, you know,strategically thought about it
and said, you know what?
The foot and ankle's always beensomething that's really
interested me.
The beauty about the foot andankle is that, um, you know,
(03:55):
every sport.
In some way, shape, or form, youcan even throw swimming in
there.
Cause a lot of our swimmers do alot of.
You know, on land runningconditioning type stuff, um,
they, we, we, they all run and,you know, understanding how
people run and, um, and how thefoot and ankle, um, you know,
uh, articulates with the groundand the implications it has.
(04:16):
You know, one of the firstcourses I took was when the foot
hits the ground, everythingchanges.
Right?
So classic, you know, the footand, yeah, absolutely.
So the foot and ankle andrunning mechanics kind of went
hand in hand for me in terms of,you know, kind of.
Getting my roots into somethingthat I can really stick my teeth
into and really, you know, saythis is mine.
Like I own this, uh, for thisorganization, for this, for this
(04:38):
group of doctors.
Let me be the guy.
And again, you know, it doesn'tjust get handed to you.
You have to actually show notonly the want, but you actually
have to be successful in whatyou're doing.
And you gotta go above andbeyond.
You gotta put the time in, yougotta go to the classes, you
gotta learn extra.
Um, and then at the end of theday, you gotta do a good job,
right?
You gotta do a good job.
And, um, I've been fortunate to,you know, uh, I think do a good
(05:02):
enough job where people give meopportunities.
And then when thoseopportunities come, you know,
you keep the door wide open andyou don't mess up, you do a good
job and you, um, you know, youtake advantage of those
opportunities and they lead tobigger opportunities.
My first opportunity came, um,as a result of me.
Um, fabricating foot associates,to be honest with you, that's
how my break into the Universityof Florida Athletic Association
(05:22):
kind of took hold, is that theyneeded somebody to do foot
orthotics.
And obviously I took someadvanced training in that.
Um, along with my foot and ankleknowledge.
It just made sense.
Right.
Um, back then, 20 years ago,Somebody had foot pain,
orthotics were automaticallyprescribed.
Right?
So I wanted to understand, yeah,I wanted to understand how
they're made.
Why are they so expensive?
You know, what can I do to, whatcan I do to facilitate this?
(05:46):
And, and, um, you know, Istarted, you know, I took, um,
uh, a certification as a, aboard certified P DOYs, which is
somebody that can modifyfootwear and modify shoewear.
And I started making orthotics,you know, from.
From much different than I dotoday.
Um, I used to start with, youknow, pieces of material and,
and actually heat'em up and, andgloom materials together and
(06:07):
grind them and post them andyeah.
And do the whole kit andcaboodle.
You know, pair of orthotics usedto take me two hours to make,
and if you're making a bunch of'em, you know, that's on your
time.
And, and I put that time in onthe weekends coming in a, coming
into the clinic at five o'clockin the morning to get this stuff
done, uh, because it wassomething that I was, a passion
of.
Mine turned into a passion andsomething that I really wanted
to.
To take advantage of.
And again, once you're kind ofknown for the guy to do the foot
(06:30):
and ankle stuff with orthotics,other opportunities kind of come
your way.
And, and over the years now, Ionly, I don't just see foot and
ankle stuff.
I see, you know, lower extremitystuff.
I do, I do my, my fair share ofACL reconstructions and such.
You know, I see my, my fairshare of hip pathologies.
Um, I try to keep it lower half.
That doesn't mean I've neverseen a shoulder in my day.
(06:50):
Um, but, but I'm, I'm, I'mhappiest when I'm treating below
the belt.
That's awesome.
I like, I like that.
I, I guess I'm the opposite, butlike, you know, like you, I
think you get pigeonholed inthings, right?
Mm-hmm.
And then we, you know, we onlyhave X hours a day now, right?
So like I can fill my scheduleup with baseball pitchers all
day and then, you know, it getsa little boring.
And to be honest with you on mypart, if like, that's all you
(07:10):
do, but, um, yeah, you know, Ireally like a lot of the things
you said there, and I thoughtthat was a great, you know, You
know, start this episode.
Um, we talk a lot about, um, youknow, trying to have a strong
niche in this profession.
If you're trying to stand outand you're trying to be the best
at something, it is really hardto be the best general
orthopedic physical therapist inthe world.
Mm-hmm.
(07:31):
You have to understand that, butit's hard to be the best general
ortho.
So I love how you said, let'sget a great orthopedic base, but
then pick something.
And I always tell people that,is it a sport?
Is it a joint, is it atechnique?
But like pick something likethat and I really love how you
did that.
Um, were you a runner?
Did you do track, I mean, I knowyou were an athlete, but like
what did you do specificallythat said like, I wanted to work
(07:52):
with runners.
I.
Huh.
My common joke, I, you know, Iteach a lot of running
continuing education courses andthat question always comes up.
And my joke is always, my jokeis I always, I only run when
chased.
Right.
It's my common statement I sayall the time.
Yeah.
So I laugh.
My history of works.
Yeah.
My, my history of, that's a goodjoke.
Courses I was, I was a, I was asoccer player, baseball player,
(08:13):
and then I wrestled in the, inthe interim.
Right?
So obviously soccer, lot ofrunning baseball, not, not as
much.
But, um, the wrestling was a wayfor me to keep myself kind of in
shape.
Obviously at five foot, youknow, seven, just like yourself,
Mike basketball's probably notin our cards, right?
So, right.
I said that in about sixthgrade, but yes, I like for, for,
(08:34):
for sticking with that longer.
So, so I realized that wrestlingmight, might work for me and.
And one of the things, you know,I've, I, I'm sure I take, I took
about 10 years off my life withall the wonderful ways of
cutting weight and running in asauna and wearing a wetsuit and
all that good stuff.
But, but you know, running wassomething I had to do a lot of
to, you know, lose 10 pounds ina day and a half, right?
(08:55):
So, running is, I have alove-hate relationship with it.
Um, I love.
The mechanical side of it.
I love the biomechanicalapproach to understanding what
something looks like when it'shappening at an efficient level
and what something looks likewhen it's not.
But in terms of myself runninglike the Lar, the longest, the
(09:16):
furthest I've ever run, I'vedone a a 15 K, and that's about
all I ever care to do.
Um, I think marathon training.
I love people that do it becauseit kept me in, you know, working
for a very long time.
Um, but I think it's a longrace.
I really do.
26 plus miles is, is long.
I think a half marathon distanceis, is a great, is a great
distance to kind of, to kind ofhave as a.
(09:37):
As a, as a goal for, for many.
But you know, the three, thefive Ks and, and such, the 10 Ks
are great distances.
And, and I think people candabble in, myself included,
dabble in those for exercisepurposes, to lose a couple of
pounds here and there.
Um, but, but that, that's myrunning, that's my running
history more for sports and asof necessity to lose weight.
(09:58):
And then as time has, has goneon more of a, just a basic
exercise thing, I'm, I'm notcompetitive with running at all.
I'll mute this up.
I don't know if you can hear,but my neighbors landscapers are
like going crazy right outsidemy window right now.
(10:20):
Very little.
I can hear it.
I'm like, what is the chances?
You can't hear it that bad rightthere.
I was gonna say, not terrible.
The, the noise cancellation isprobably pretty good.
I was gonna say like the, thedude is like literally right
there.
I was like, I'll get a spike theaudio.
I'll find, I'll find that nowand we'll get there.
So, alright, we'll keep going.
So, um, All right.
Scott, can I, can I share asecret with you?
Can you not tell anybody,although I guess the, all the
(10:43):
people listening to this arethere, but, um, I've, your
secret is safe from me, Mike,all of you listeners too.
Um, I've ran a mile like.
Twice in my life.
Like that's the mm-hmm.
That's the furthest I've everrun.
And that's, and it was becausethe bear got tired.
Right?
The bear got tired.
And, and I, I do not likerunning.
(11:03):
And I, and I gotta ask you thisalmost now, just because I feel
this is true for me, but like,like can everybody run?
Are some of us just built, likeour body's not built to
efficiently run?
So then therefore, like, Wedon't like it, we don't like the
way it feels.
Is, is that a thing?
Or, or, or can anybody be arunner?
Cause I know you just brought uplike, running for fitness and
exercise and even mental health.
(11:24):
I mean, running's awesome.
I wish I could do it, but I, Itruly hate it.
I is is there something to that,that not everybody is built to
run or did I just make that up?
No, I think, I think that's trueto a degree.
I think there are certain peoplethat are built not to run far.
Um, I think, you know, I will neI was not built, you were not
built to dunk basketball.
So it's just not part of ourdna.
(11:45):
It's not what we're capable ofdoing.
Um, I've seen some veryoverweight, unfit, uncoordinated
people run marathons, right?
We've all seen it.
Um, how long can they keep thatup for?
That's the really the debatablequestion.
I think everyone can run acertain amount.
Um, Are there certain types ofbody morphologies that I feel
(12:06):
are putting them at greater riskpotentially for injury if they
run greater distances or run fora prolonged period of time?
I personally believe that.
Um, but, um, I think everyonecould run.
Um, I think we just gotta thinkabout this, and I talk about
this all the time with mystudents and patients.
You know, what we do as physicaltherapists is, is difficult,
(12:27):
especially if we're trying toreally come to the root of why
something happened, right?
But if we break it down tosimple terms, like if your
stress exceeds your capacity,Something's gonna break down and
you're gonna hurt.
Right?
So if we break it down to thosesimplest terms, that's really
what we're, we're thinking ofand what my capacity is and what
your capacity is, is verydifferent.
And what stresses we're puttingon those bodies is very
(12:48):
different depending on ourterrain, our, our movement
efficiency, our strength, ourrest, our recovery, all of that
plays into that.
So at any given time, cansomebody run?
Yes.
For how long?
I think that's where we reallystart to open up Pandora's box
of questions as to.
The true answer to thatquestion.
And, and I, I love, I love theanalogy or, or the concept of
(13:12):
the workload and capacity thing.
And then I've always thought ofthis at least like with, you
know, like my athletes withbaseball players and stuff.
That is, there are some thingsthat you can do mechanically
that will, um, that willincrease the stress that happens
during the throw.
So there are mechanical, uh,there are no, there's no such
thing as, Good or bad mechanics,just the mechanics just alter
(13:32):
the stress.
And there are mechanical changesthat you can do to apply more
stress.
So of course you would need morecapacity, but at some point in
time, I mean, efficiency of themovement is also important too.
Do you, do you agree?
Is that like one of the thingsyou look for in your runners
too?
Is there, is there abiomechanical efficiency that
helps optimize that ratio ofworkload capacity?
(13:53):
I, I do, I do believe that, youknow, I always tell people when
we're changing form, cuz we dochange form.
I, I am a believer in changingform and we can go down that
rabbit hole in a little bit.
But, um, I always say no changewithout consequence.
Right?
We don't change something andhave that, that that force kind
of.
Um, evaporate into, into thinair that stress evaporate.
It goes somewhere else andhopefully it goes somewhere that
(14:14):
our body can tolerate it.
Right.
And like you said, you know,there's no perfect pitching
mechanics.
We've seen, you know, the DanQuien bees back in our era, guys
throwing side arm, and it lookslike, it looks like it's gotta
hurt and it's not veryefficient, but he's very
successful at it, you know?
Right.
And then there are other peoplethat are more over the top that
also.
You know, either succeed ordon't succeed.
And, and um, same with running.
(14:34):
There are some things in runningthat we kind of hold true to
ourselves, right?
There are some running, I callit, um, non-negotiables.
For me, you know, running andlanding is close to your center
of mass is something that Istrive for every one of my
runners to achieve.
Um, that to me isnon-negotiable.
What part of the foot hits theground first?
(14:55):
That is something that we'regonna have a big debate on,
right?
And, and certain people feelstrongly one way or the other,
and we can get into the way Ifeel, but, but landing close to
your center of mass, um, is themost efficient way to run.
Are you gonna truly landunderneath your center of mass?
Probably not.
But you, the, the closer you getthe, the, uh, the, the lower the
braking forces, the, the, uh,short of the ground, ground
(15:17):
contact time, which thendecreases the amount of work
your body has to do.
Most running injuries in thedistance population occur when
the foot in contact with theground, right?
In sprinting, that's a littlebit different.
They're in contact with ground,far less, the force is far
greater.
Um, but in distance running it'smore contact with the ground
that creates the problem.
Um, so if we can limit thatstance time, get him landing in
a more efficient, under theircenter of mass position.
(15:39):
I think we're, we're achieving alot of good.
Um, I do also believe personallythat landing in a four foot
mechanics is probably mostoptimal for most people.
Um, you're not gonna see asprinter sprint on their heels.
It's just not, it's just notappropriate.
It's, uh, you may see somebodysprint on their heels.
They're not gonna be a goodsprinter, but the successful
sprinters Right.
Maybe an athlete, but not asprinter, right?
(16:00):
Correct.
Correct.
Yeah.
Correct.
So, so if you, you know, thehighest level, the fastest of
the fastest are landing on theballs of their feet.
Um, and for me, you know, in anysport, if you wanna make an
athletic move, you're gonna haveto push off your rear foot, roll
to your forefoot and cut offyour four foot.
Having somebody cut off theirrear foot is not, again, a, not
an efficient.
You know, um, functional, kindof powerful position to kind of
(16:22):
move into.
So for me, um, I just feel likeour body's more elastic, more
able to load and explode if it'sin that four foot position at
initial contact.
But again, not all four footcontacts are made equally.
Um, you can land on your fourfoot.
And, and the reason why, one ofthe reasons why I believe four
foot contact got such a bad nameis that people are forcing it.
And when you force a contact,just like anything else, it's
(16:43):
not natural.
You start to exhibit other non.
Appropriate, uh, patterns andactivate muscle activation to
achieve that.
So you oftentimes see excessiveplant reflection of the ankle
with a, with a force four footcontact.
When I have, when I teachcourses, and I, and I try to
demonstrate this point, I alwaystell people to stand up and I
have'em run in place.
(17:03):
And when they run in place,every single one of'em lands on
the ball, their foot.
And then when I ask'em to run ontheir heels, it's just not
natural.
They don't do it.
So I said, nobody told you torun on the balls of your foot
when I asked you to run inplace.
It's just natural.
It happens.
That's what we want to havehappen when we're running, and I
think all too often people startto hear things, oh, I need to be
a four foot runner.
They start forcing it.
They start reaching, they startextending their knee plan,
(17:24):
flexing their ankle, havingcontact way out in front of
their center of mass, whichagain, is not the goal of what
we're trying to achieve.
So how much time do you spend inthe clinic looking at running
mechanics?
Is this something that you doall the time?
You know, if so, like what aresome of the things you look at?
Like, I know this is an arealike with our podcast, where we
(17:46):
answer questions like we getthis question every now and then
because I think so many peopleare interested in like, how do
you get started looking atrunning mechanics?
I'd love to hear your experiencewith this and some of the things
you look for.
So, A couple things.
I definitely do look at runningmechanics.
I'll give you a little story.
So, you know, I've gone at theUniversity of Florida, we have a
very elite track program.
Um, cross country is not as goodas our, as our sprint team and
(18:09):
jump team, but we have a veryelite program.
We win in na, we win nationalchampionships very often.
And um, we've gone through acouple of distance coaches and
as everyone comes in, I alwaysask them, You know what, when
they're recruiting a, a givenathlete to come to Florida, what
are they looking for?
And one of the common thingsthat never comes up is form.
Um, it's always, you know, dothey enjoy running?
(18:31):
What do their times look like?
Have they missed a lot of timedue to injury?
Nobody ever speaks a form, and Ihave found that form is super
important and coached at a highlevel in the sprints and in the
jumps.
But in terms of distance, it'snot really coached.
They, you know, and that's nthat's nothing negative about
any one of our coaches.
It's just not something thatthey worry that much about.
(18:53):
They're more worried andconcentrating on building
programs, building trainingroutines, building workouts for
their plethora of athletes thatall are at different levels.
Right.
So, um, when I asked initially,is that something that I'd be
able to, to really work with ourathletes from the Florida, you
know, collegiate standpoint.
They were like, absolutely.
Um, So in the clinic, obvi,obviously I would do that, but
(19:15):
that was always something I'd,I'd hang my hat on.
And the fact that even at theelite levels, form and, and, and
mechanics is not somethingthat's really coached that much
in the distance population.
Baseball, obviously pitchers,that happens all the time,
they're coaching mechanics allthe time.
Why are we not doing this inrunning golf?
They're coaching it all thetime.
Why are we not doing this withthe distance population?
So I think part of it is becausethere is.
(19:37):
No right or wrong.
There are, well, let's say this,there's a lot of wrongs and a l
and, and fewer rights.
Um, but, but you know, for me, Ialways felt that it was really,
really appropriate to try to, totry to nip certain things in the
bud.
And, you know, the timing ofwhen you make changes is
oftentimes a big.
A big problem.
You know, the, the track crosscountry outdoor indoor season is
(20:00):
very long in the collegiate, youknow, the collegiate world, and,
you know, having the right timeto make those changes is, is
tough because you know, when youmake a change.
Is the body able to compensateand, and, and deal with those,
those, those moving stresses.
Now, those stresses that havenow applied to a different area,
um, and, you know, havingsomebody run 80 miles a week and
then all of a sudden changingtheir form and having'em
(20:21):
continue at that 80 miles a weekis, is not something that's
probably the brightest.
So if I were to tell my coaches,Hey, by the way, we're gonna
back this runner down from.
80 miles a week to, to 10because I changed their form,
it's not gonna go over verywell.
Right.
So I think the c the changes Imake in season are very, very
slight and very, very, um, smallin terms of the overall, um, you
(20:42):
know, scope of what changescould be made.
But, um, when run, when runnersare injured and not running,
that is the best time toactually incorporate a new
change into the, into theequation so, you know, obviously
when, when mileage is high, it'snot the optimum time to, to make
a change, but really the besttime to make a form change is
with a, with a runner that'sinjured and not running because
(21:03):
you're gonna ramp'em back slowand gradual anyway.
So why not to try to introducesomething that is, is going to
maybe make them.
I'm not gonna say less likely toget injured in the future, but
if you see a glaring problem,then why not address it then?
And, and getting buy-in at thattime is also the best time too,
because, you know, you know,runners are I when not even my
collegiate runners, my, myrunners that have been running
(21:24):
50 years and I try to introducea form chain.
They say, I've been running thisway my whole life.
You know, why am why all of asudden now is it a problem?
I say, well, you're not asstrong as you once were.
You're not as young as you oncewere.
You need more recovery.
And guess what?
You know, it's not, it's not.
If you break down, it's when youbreak down and you broke down.
So your way obviously isn'tworking.
Let's try a different way.
(21:44):
You know, so, um, that, that's,that's, you know, getting buy-in
is in anything is tough, butthat is probably, for me, the
best way to make that buy-incase is when they're injured and
trying to get back.
I, I think that's brilliant andthat's a great way of, of
thinking of it too.
So, um, all, so you have infront of you, you're looking at
them, you, what do you use a,you use a treadmill?
What, what do you haveTechnology.
(22:05):
Like, what do you like to do inyour, in your clinic?
So I think, you know, I've hada, a bunch of different things
over the years.
I think the tried and true waythat I tend to do it in terms of
trying to address the things Ineed to see is a treadmill with
a high speed camera, whether itbe an iPhone, an iPad.
Um, I find great results with 2Danalysis.
(22:26):
I think 3D analysis is great ifyou have the ability to do so.
Um, but 2D analysis is, is in myeyes more than sufficient.
I tend to look a lot at thesagittal plane metrics such as
stride length, um, uh, footinclination, angle, tibial,
inclination angle, knee flexionand initial contact, something I
(22:48):
call hip separation, angletrunk, lean stance time.
So those are all things that Ifeel like I can make a big
difference in and get a good,um, 2d.
Um, uh, picture for lack of abetter, better way to describe
it, of what I think they'redoing right and wrong and make
those changes That was awesome,Scott.
I really like your approach tothat and in trying to help
(23:12):
people with their form whenthey're injured.
Makes perfect sense to me.
I, I really like the way yououtlined that.
I think that's the, the mostlogical thing to do, to make
sure that we're not overdoing itwith them.
So if you have somebody in frontof you, they're in the rehab
process, like what do you use?
Do they, do they just run on atreadmill?
Do you have technology?
What are some of the things thatyou use to look at their
mechanics?
So over the years, I've, I'veused a lot of different things.
(23:33):
I've used everything from 2Danalysis to just my eyes, to 3D
analysis at times.
And, and honestly, the best wayto do it, um, at least in, in a
quick clinical setting for me,has been always 2d ana, um, 2D
analysis with, um, a high speedcamera of some kind, whether it
be an iPad, an iPhone.
I think you need video.
Think you need to be able toslow it down.
You know, whether you're lookingat at least 60 frames per
(23:55):
second, probably a little bitfaster, probably 120 frames per
second is probably better.
Uh, it's definitely better.
It's probably what you need.
Um, I think 2D analysis can getthe job done 99.9% of the time
now, if you're looking for Yeah.
You know, research level, um,quality type of analysis and,
and, um, sometimes I, I thinksometimes people get too, um,
(24:20):
caught up in.
Trying to make everythingperfect and symmetrical by
numbers.
And I think if you catch the lowhanging fruit, I think you fix
the majority of problems.
That's just my opinion over myyears of experience.
Now again, 3D gives you greatinformation.
There's no question, but thequestion is, um, how much is
that is truly really required?
(24:41):
When I'm looking at a runnerwith a, with a high speed camera
that's two-dimensional, and I'mlooking from the sagittal plane
and I'm looking at things like,uh, contact from center of mass.
Foot inclination, angle, tibial,inclination angle, knee flexion
at initial contact, knee flexionat mid-stance, uh, hip
separation angle.
Something I kind of talk a lotabout, uh, what trunk lean is,
(25:02):
uh, how long are they in contactwith the ground, if I can make
changes to any or all of thosedifferent variables oftentimes.
So those are all sagittal planemetrics.
Oftentimes I find that thefrontal plane metrics such as
like.
Knee valgus or rear footinversion, e.
E-version oftentimes take careof themselves because I think
oftentimes those are related to.
Prolonged loading or prolongedstance time and the body having
(25:25):
to deal with stress for a longerperiod of time.
So we know that pronation is away in which we deal with stress
and pronation oftentimes getspigeonholed to the foot and
ankle problem, but it's not,it's a, it's a lower, it's a
lower body really problem.
When you think about whathappens, the femur internally
rotates.
The, the knee goes into thisdynamic valgus, the tibia
internally rotates the calcanevert.
So all of this stuff happens.
(25:45):
Oftentimes, we just concentrateon the foot and ankle and say,
oh, the foot and ankle ispronating too much.
Let's stick an orthotic in thereand let's stick a motion control
shoe in there.
When in fact the foot's justdoing what the body's asking it
to do.
And by putting an orthotic in,or, or, or by.
Putting more of a stabilityshoe, you're really just
shifting the problem somewhereelse.
The problem may be that they'rein contact with the ground for
(26:06):
too long and they're askingtheir body to absorb stress and
shock, and now you've taken oneof the body's abilities away to
deal with that and creatingother problems.
So I oftentimes say like,patients come back to you over
the years, and I'm sure you'vedealt with this in the, in the
upper extremity mic, where apatient.
You see and you treat, and theydo well for a, a certain
problem, let's say plantar fasor plantar fasciitis, and you
(26:26):
treat'em successfully, youthink, and then they come back
the next year and you're like,Hey Scott, I wanna see you.
You fixed my plantar fasciitis.
Now I've got this hip issue.
Can you fix that?
Probably the, the problem withthe same all along, it's just
kind of presenting itself in adifferent way.
So, um, I think we, we, we gottastop chasing that a little bit
and, and really start looking atthe root of problems if we can.
(26:49):
I, I, I, I think that's anamazing, uh, thing that a young
clinician I think would reallybenefit from too.
And it's not about nitpicking,it's about finding those low
hanging fruit and then seeingwhat happens, right?
Seeing how many other thingsclean up.
I think some people take thatfor granted that a lot of things
will just clean up themselves.
So, um, I thought that, I, Ithink that's amazing.
(27:10):
I think that's, that's a reallygood approach.
You know, Bri, Brian Heder andCadence, not to interrupt you,
not to interrupt, but BrianHeder and Cadence.
You know, made such a, made sucha big, um, uh, uh, IM impact on
the, on the running medicineworld by his, his research
involving cadence manipulation.
And, you know, it's just one ofthose things that is so easy to,
(27:31):
to do for a right, for anybody.
An entry level clinician, anexperienced clinician.
It's something that is very,very tangible and has great
impact on movement efficiencyand movement mechanics and load,
uh, manipulation.
So, um, again, to, to reiteratewhat you were just saying, low
hanging fruit, why not Go forit.
(27:51):
Yeah.
Yeah, I, I love it.
And just because you broughtthis up earlier, I gotta ask cuz
I know there's a couple otherthings we wanted to talk about,
but I gotta ask, how, how hasyour use of orthotics evolved
over the last 20 years?
Cause I know you said you werehuge on it before you were
grinding away on the weekends.
Um, what, what do you donowadays and how often do you
use orthotics?
So I am probably.
(28:13):
I've been doing orthotics for along time and I feel strongly
that there's a place in ourworld as physical therapist for
it.
Um, you know, when I talk about,um, injuries, oftentimes I go
down my spiel of, you know, somuch of what we do is trying to
increase capacity, decreasestress, and shift loads, right?
And one way in which we caneffectively shift loads.
(28:34):
It's been shown time and timeagain.
Is via taping and orthotics.
Bracing.
It helps.
It shifts.
Loads.
Now, is there a perfect positionto put the foot?
We can debate that.
Um, but we know that by changinghow somebody's foot contacts the
ground or how it moves, once itcontacts the ground is going to
affect the entire chain and thewhole mechanics of that.
(28:57):
And if I haven't injured, uh,you know, when working with
athletes, you're working withbaseball players at high levels.
I'm working with runners andother collegiate athletes at
high levels.
Our job is twofold.
Our job is to get our, ourathletes on the field after an
injury as quick as we can.
And our job is to keep theminjury free as long as we can.
And if I can get both of thoseachieved by, um, putting an
(29:17):
orthotic in and deloading atissue that is under greater du
duress, why would I not do that?
You know, if I can put anorthotic into one of my runners
and they can go from six outta10 pain to three outta 10 pain,
and they can run.
Why would I not do that?
Now, that doesn't say I'm notgonna strengthen that.
Doesn't say, I'm not going to dothose other things.
(29:37):
Work on mobilization, make surethey're moving right, work on
their form.
But if I can get them from A toB quicker.
By just sticking a stupid pieceof, of, um, polypropylene into
their foot, into their shoe.
Why would I not do it?
You know, people always talkabout, you know, oh, it's gonna
weaken the foot.
No, it's not.
If you spend some time outsideof, of their activity
(29:59):
strengthening, you know howoften, and I joke about this,
like, you know, you go to thegym, you strength train, you
lift for an hour.
Let's say I'm gonna work on mychest for today.
I'm gonna do six exercises ofchest.
I'm gonna do some flies, I'mgonna do some incline, I'm gonna
do some flat bench.
I don't do chest 24 hours a day.
I do it for a little bit andthen I let my body recover,
right?
So why not let our bodiesrecover with an orthotics and
(30:21):
then strength train, right?
While we can, right.
I mean, the logic is so soundright?
You make it sound so simple.
Mm-hmm.
Right.
But people say these things allthe time, and I think, Scott, to
be honest with you, that's whatmakes you a good sport physical
therapist, because sure, youcould just go sit in the cave
and not do anything and justwork on.
Strengthening all day long, butyou also have to get these
(30:44):
people back on the field as fastas you can.
So to me that's sports, physicaltherapy.
That's how you put it together.
And, and I mean, you, you, youmade it sound so simple that I,
I chuckled a couple of timesbecause like, it's, it's that
obvious in front of you.
Yet people will argue that onthe internet all day.
Absolutely.
And, and again, I am a hugeproponent of strengthening and
we could talk about, you know,foot and ankle strengthening and
how I feel like blood flowrestriction therapy, which I
(31:07):
know is near and dear to you, isnear and dear to me.
I think it is the, yeah, the,the hidden gem of foot and ankle
rehab.
Whoa.
You know, Whoa.
That's, that is, that's, that'sa bold statement.
I, I'm telling you.
Think that's where we're gonnapivot the podcast.
All right.
Here we go.
Ready?
So, love.
So as, love it as you teach, asas you teach.
And, and I teach, you know, withregards to blood flow, in order
to get stronger, you have tochallenge the muscles at, or the
(31:29):
body at like 60%, 65% of yourone rat max, right?
You gotta put significantresistance through the tissue,
and we know in order to get.
You know, big or stronger hyper,hyper hypertrophic changes, you
either have to put tensionthrough the tissue or you have
to create that metabolic stressor, or cell damage sometimes.
So those are the three ways inwhich, and you know, if whether
(31:51):
you're injured and can't putthat mechanical tension through
the tissue or don't want to.
You know, creating that, thatmetabolic stress is, is ideal.
And we know with the foot andankle, you know, it's not like
you can lift a whole lot ofweight with, with your foot
intrinsics.
It's not like you can, you know,you know, TheraBand is not 60%
of your one rep max.
It's just not, uh, you justcan't grab a dumbbell with your
(32:14):
toes oftentimes to create that,that, that, that, that mode.
So for me, it's almost likewe're wasting an opportunity to.
To get that response by notputting the BFR on while doing
stuff like TheraBand training,while doing balance work, while
doing, you know, foot doming.
Why would you not take thatopportunity to try to squeeze as
(32:37):
much juice from that grape asyou possibly can?
Because I know people are notbalancing with weight vests.
I know they're not putting thatload through the tissue.
That creates that supportstructure that we need to kind
of keep our foot and anklestrong.
Wait, so I shouldn't bebalancing with Weight vest now?
Now I, I, I get.
You can.
You can, you can, but you can,you can balance with weight Vest
(33:00):
and be a par.
I love, I love that on a bosuball at the same time.
That's, that's right.
That's right.
I, I.
I, I think, I think that's ano-brainer too, because like you
said, it's, it's reallychallenging to, to get certain
areas of the body to work outwith high enough load.
And I think you've justidentified a very obvious, uh,
way.
So, so I assume you've beendoing this, are you doing this
(33:22):
non-op, you doing this post-op,you doing it on everybody?
Like, like what, what's thepopulation that you're doing
this in Most?
I typically do it with everysingle one of my patients.
And again, my population is veryheavily, you know, ne and below,
especially like shin and below.
And, um, there's, there'scertain things I'll stress more
with certain types of.
Operative situations.
I think it's wonderful forAchilles repairs.
(33:44):
I think it's wonderful for, youknow, brostrom, brostrom or
lateral ankle reconstructions.
But I do it with, um, medialtibial stress syndrome.
I do it with plantar fas.
I do it with.
Poster TI tendinopathy.
I do it with all of them.
Every single one of my patients,I wish I had, you know, at one
of my clinics that I treat, youknow, we have a BFR at every
(34:04):
single table, right at anotherone of them that, that I treat.
Uh, we only have one, um, at,at, at that particular clinic.
And literally part of thejuggling act that I do that
gives me the most stress istrying to determine what.
When and how am I gonna getevery one of those patients to
utilize that b f R at some, atsome point of the treatment?
Because there's multiple peoplein there, sometimes at one
(34:26):
times, you know, so I thinkthere are certain, certain units
that I think are, are, you know,that I use, that I really like.
I, I like the Delphi as the goldstandard, but I, I use Suji all
the time.
I'm, I'm a big believer in thecompany and the people there.
I like how you can do it detethered.
You can do, you know, both lowerextremities at the same time
with the Delphi.
You know, you need two units todo that.
(34:47):
Now I know there are plenty ofother brands out there, but, but
again, I think it is, it issomething that, um, we should be
taking advantage with ourinjured population.
I think it is something weshould be taking care of or
taking advantage of with ourin-season training of athletes.
What better way to give anathlete active recovery without
allowing them to totally neneglect their strength?
(35:09):
Why, why not put'em on a B bfrand not tax the tissue nearly as
much, but still get thatmetabolic response?
Um, mm-hmm.
I think it's great for our agingpopulation of, of athletes
because again, as we get older,our joints, our tissues, they're
not able to tolerate the loadsthat we once were.
And, and, and why not put thebfr on, challenge our body with
less loads and create a similartype of strengthening
(35:30):
environment.
Uh, well, I'm sold.
I mean, you got me.
I think that's amazing.
But, uh, te tell me a little bitabout like, how you use it for,
like, let's say I, I know it's,let's talk about an area that's
hard to like load maximally.
So say like you're working onlike, uh, you know, intrinsics
or, you know, even, even basicstuff like inversion, e-version
type stuff.
Like what, what do you do forlike set rep dosage?
(35:52):
Is it the classic protocols thatthey use, or do you do your own
thing?
Like what do you like to do?
I do my own thing.
So there's one, there's a coupleof tools I like.
There's something called theblackboard, which is in essence
a wobble board split into twopieces for the foot and ankle
where you can lock the heel upand allow the four foot to go
into inversion and e-version.
You can put it at a slightlyangular plane.
Um, and I'll have my, mypatients do sets of 30.
(36:13):
You know, cuz the goal of bfrthis magical 30 15 15 15 isn't
magic.
It's just a number to try tocreate some fatigue, right?
So, so whatever you do, If 3015.
1515 isn't taxing that tissueenough.
Then you're not doing, you'renot doing it justice, right?
So, you know, I'll do sometimeswith TheraBand I'll do sets of
(36:34):
60 with my TheraBand training,um, in my single leg stance
balance work.
I'll do time sometimes, likehave a catch right standing on
an AirX pad against a rebounder,and do sets of 30 seconds or do
sets of 30 tosses, or hold itfor a minute.
Or, you know, I change it up allthe time depending on what I'm
trying to accomplish, how muchload I'm able to in, you know,
(36:54):
uh, in, in incur or, or, or pushon the system.
And again, if, if I'm doingbalance with somebody and they
continuing continue to have toput their other foot on the
ground.
Then, then maybe I need to gofor a longer period of time
because they're not stressingthat tissue quite as, as long as
I'd like'em to, versus somebodythat's able to, to really
balance for a long period oftime is really gonna fatigue
that tissue.
So I think it's very unique, butI do not stay pigeonholed to
(37:18):
that 30 15.
1515.
I do use it on occasion, Ithink.
You know, for open chain legextension, I think it works
great.
I think for some of the straightleg raises and hip abduction,
let's say, I think it worksgreat.
Um, but, but again, I'm notopposed to kind of changing it
up depending on, on the, on themovement, on the exercise, and
in the body part.
Yeah, I think that makes sensetoo.
(37:39):
There are certain groups who are30 15, 15, 15 is not going to,
that's they're not gonna befatigued at the end.
Correct.
So I like that.
I like the 30, 30 30.
I think that's a good option.
I, I like the time.
I, I, you know, I, I, I couldn'tagree more.
I, I, I like the way you, you,you focus more on the outcome
versus the process.
I think some people, they go toa course or they learn it online
(37:59):
and, and, and they say like,well, I have to do it this way.
Right, right.
Sometimes they don't use theirbrains a little bit.
I like how you're focused onlike, what's the goal?
The goal is to get some fatigue.
Right.
So, um, so, so awesome.
What, what about in, I know yousaid you use it in season, what
about in healthy Runners?
Have you done this at all forthe performance enhancement?
Like, like skew of this versusjust like getting back with
(38:20):
their recovery?
Like, and I, I know you talked alittle about how you could use
it as like a deload forrecovery, but anything specific
with performance enhancement.
I think so.
Yeah.
So we know runners typicallydon't run for, they run for
exercise, they don't exercise torun.
Right.
So getting a runner right to, toreally truly load their body is,
is a tough sell.
It really is.
(38:40):
So I, I think there is a placefor certain runners where they
could, I.
You know, put the BFR on theirlower body and do some squats
with some, you know, a 25 poundkettlebell and, and really
fatigue it out that way asopposed to, you know, people
don't have access to the gym allthe time either.
So, you know, right.
Do we have the ability to throwa bar in our back with, you
(39:02):
know, 2 45 pound plates oneither side and really go to
town?
Probably not, not everyone hasthat, but you know, not everyone
has bfr either, but they'rebecoming a lot more affordable
for the home use.
And I do think that.
It's here to stay.
I think it's something thatreally can, can benefit
everybody.
I really want to say everybody.
I think it, it can help withperformance.
There is no substitute for truestrengthening.
(39:23):
I wanna make that point clearand known, right?
If you can load the body withweight, load the body with
weight.
But if you need some time torecover or for whatever reason
you feel like that body can'ttolerate that load or wanna give
it a break, BFR is a greatoption.
Right, and we, we, that was oneof the first things we talked
about.
I don't even know how many yearsago now.
(39:44):
It was probably eight years agonow.
When we started looking at BFRChampion, we talked about it as
a team.
Like what are some of the thingswe need to be careful of?
One of the things was like, wellwait a minute.
Like if we do this too much,let's say an Achilles, right?
Like that sort of thing.
You don't want to deload that.
You don't, you don't, you don'twant to just always just
increase strength at a deloadbecause.
Then the tendon's not gettingthe correct.
(40:04):
Right.
And I think, again, sometimespeople, like, they don't,
they're not thinking outside thebox.
They're just like throwing it atthat.
So I, I, you know, I'm glad youbrought that up.
You have the load.
I'll give you an example of howadjunct Yeah.
I'll give you an example ofsomething too.
So I have a, an Achilles repairand a, and a pretty big football
player right now.
And one of the things that westruggled with is that, you
know, if we loaded themsignificantly three times a
(40:26):
week, Um, he would get a littlesore.
And so what we tried to do ismaybe do a Monday, Friday
regular load the tissue, andWednesday maybe load the tendon
and the calf, uh, with bfr doingless strenuous type of
activities to get that calf tokind of still get engaged and
try to benefit in other ways,but not put that same.
(40:49):
We'll call it tissue stressthrough the tendon loading the
tendon's important, getting thestress through the tendon.
But at some point an injuredtendon may not be able to
tolerate it, and that's wherethe BFR can come in as well to
allow that calf to then trulyget stronger too.
Cuz that's the thing you dealwith all the time with achilles
tendon, not tendon repairs isthat calf just goes to crap,
right?
Yeah.
Yeah.
So load it because you need toload it, but instead of just
(41:11):
saying, oh, you're getting sosore, let's just do it twice a
week instead of three times aweek.
Add that third day, but do itwith the bfr so that way it's
less and you still Exactly.
Uh, I nailed it.
Uh, that was awesome.
Uh, Scott, amazing episode.
This was awesome.
Uh, before I let you go, uh,high five at the end.
Five Quick questions, five quickanswers.
Tells me a little bit about you.
Not that I'm judging, buthere's, here's, here's question
(41:33):
number one.
Okay.
Um, I always, I always love tohear the responses, but, uh,
what are you currently workingon for like your own con ed,
your own professionaldevelopment?
Like what are you doing rightnow to learn?
Professional development.
So I'm, first of all, I alwaysgo down the rabbit hole of
YouTube.
I watch videos on YouTube.
I can spend hours upon hourslearning something like I was
watching the other day, like howto begin for, for a novice to 3D
(41:56):
prints, like what it would takefor me to buy a 3D printer and
all these cool little plasticthings I can make.
Right?
So, Um, that's one thing people,people that know me always,
people will that know me, alwaysknow I have something cooking in
the fire.
And it's like one crazy idea islike what it is, right?
So I actually read a book, um,called One Simple Idea by
Stephen Key, and it's about,it's about, um, How to take your
(42:19):
crazy ideas and instead of goingthrough the manufacturing
process yourself, like licensingpeople to get and take your
ideas that are hopefully notcrazy, that you can actually
make something off of.
So that was one thing that I,that I kind of, like I said, I
have ideas all the time and, andI just, I just, not that I don't
know how to get'em started, it'sjust that, you know, there's
just so many of'em that, youknow, sometimes you just need
(42:40):
to, you need to step away andmaybe just kind of come up with
the ideas, be the idea guy, andlet somebody else that knows
kind of the actual processbehind it make it happen.
So, Um, there's that, and I'mtaking a dry needling course
actually this weekend.
Actually, you caught me at agood time for that question.
Yeah.
Yeah.
Uh, fir, like first one, is thisyour first one?
First one, yeah.
Florida.
We're a little late to the,okay.
A little late to the game.
And, um, you know, still we'restill battling at our, at our
(43:02):
hospital with the, uh, insuranceramifications and reimbursement
questions, but, um, but it'ssomething I always wanted to do
and I think there's a time and aplace just like a lot of other
things in our, in our, in ourtreatment, um, right.
Uh, bag of tricks that, that Ithink we could utilize.
And it's just another thingthat, that I'd like to learn.
Cool.
Yeah, that's good timing.
I love it.
Awesome.
Uh, next question.
(43:22):
What's one thing that you'verecently changed your mind
about?
Ooh, I think, I think we talkeda little bit about, um, you
know, orthotics over the yearsand how I deal with running
injuries has definitely changedfor, for sure.
You know, back when I firststarted, you know, treating
runners in the early twothousands, let's say, you know,
somebody came in with faultymechanics.
We gave'em stability shoes, andwe gave'em orthotics, right?
(43:45):
Now I still believe inorthotics.
I, I've fallen away from thestability shoes, um, a little
bit in terms of the pronationcontrol, elevated cushion healed
shoes, the ones with a really,uh, large, uh, heel drop, you
know, greater than like 12millimeters or so.
I stay away from those.
Um, I do, I do feel, um, that,uh, orthotics still have a
place, but I've also gotten alittle bit soft on my forcing
(44:07):
everyone to be a four footrunner.
Um, kind of got away from that alittle bit.
I'd still believe it's the wayto go, but I think there is a
time and a place for somebody tomaybe not run as much on the
balls of their feet, especiallyif they're dealing with, you
know, Four foot pain if they'redealing with, you know, plantar
fascial pain, potentially.
Um, if they're dealing withAchilles pain, potentially,
those may be reasons why, forthe time being, I may allow them
(44:31):
to run a little bit more midfootrear foot as opposed to four
foot.
Um, but I do believe that tomake them a better runner, I do
believe that they need to run ontheir forefoot.
But to allow the injury to, tokind of calm down some, I have
softened and, and allow that alittle bit.
So that's one thing.
I love it.
That's great.
Um, you, you deal with a lot ofstudents, right?
(44:53):
What's your best piece of advicethat you love to give your
students?
Uh, I think we talked a littlebit about, uh, already, um,
stand out.
You gotta create, you gottacreate a way for you to
differentiate yourself fromothers.
You know, I, I, I run aresidency program here at uf.
I direct that and I have a greatstaff that, that helps me with
that.
But, Um, I have calls everysingle day from prospective
(45:14):
residents and they ask me, youknow, what is your ideal
resident candidate?
And I tell'em, I don't know theanswer to that.
You know, when, when we'remaking decisions for, for our,
for our who we're gonnainterview cause we don't
interview everybody.
Um, we interview probably, youknow, 10 out of an applicant
pool of this year we had in themid fifties.
(45:34):
So we're interviewing 10 out of50.
Um, We take two, you know?
How do you stand out on a pieceof paper?
What is it about you that makesyou unique?
You know, we have 50 qualifiedstudents that are all interested
in being a sports resident.
What is it about you that makesme read this and say, this is
our guy, or this is our girl, orthis is our student that we need
(45:55):
to kind of interview and kind oftake the next step with.
So I can't, I can't say, I saywe know it when we read it, but
I can't tell you what it is, youknow?
Um, because I don't know what itis.
I don't know what it is.
But you've gotta stand out in,in a positive way.
Don't stand out in a negativeway.
Stand out in a positive way.
I, I, so I like, that's anamazing answer.
That's the first, like, youknow, sometimes there's
(46:17):
recurring themes in theseanswers that I always ask
everybody.
I think that's a good one.
And since you're an idea guymm-hmm.
I think that's a t-shirt, right?
Stand out.
And that's just like, boom onthe t-shirt.
Like, yeah, let's get that goingon Etsy.
Let's get, I I don't laugh.
You're, you're gonna laugh whenyou hear this.
I have a Shopify.
Store where I have t-shirts andone of'em, uh, they're funny,
(46:38):
some of'em are, um, are PTrelated.
Most of'em P PTs, the originalFitness in Influencers.
I got that one.
I've got the, uh, um, uh, whatis it?
We know it hurts and that's whywe poke on it.
Something along those lines, youknow, so I can, I can definitely
add this to the list, so justlet's do it.
Dude, that is amazing.
(46:59):
Hey.
Yeah.
What, so you gotta tell mewhat's your, can we buy this?
Like, does this store exist?
Like Abso It does exist.
If you, if you go to, if you goto run safe run fast.com,
there's a link.
It'll take you right to myShopify store.
I mean, I'm in, I know, I know,I know.
I'm going from here.
I, those are amazing.
So, um, what, what, what'scoming up next for you?
Oh, goodness gracious.
(47:20):
We, I've always got something inthe fire.
I always do.
Um, I stuff that I, I'm notgonna talk too much about until
it actually happens.
Um, I don't wanna jinx it orwhatnot.
There's some stuff, there's somestuff going on.
Okay.
All right.
We'll revisit, we'll revisitthis, uh, at a later time and
we'll, we'll, uh, we'll, we'llcircle back.
(47:42):
On the next episode, but this islike the cliff hanger for the
end of the season.
I think that's awesome.
So, yeah.
Um, awesome.
Well, Scott, you, I think youjust mentioned a little bit, but
like, where can people find outmore about you?
Is it, you know, obviously yourwebsite, maybe you can, you can
say it again.
Mm-hmm.
Uh, social media, but where,where's a, a good way for people
to follow you?
Uh, probably either of those twosites, you know, Scott
Greenberg, uh, dot DPT onInstagram is a good one.
(48:04):
And then, uh, I have a website,uh, run safe run fast.com.
Um, and then that's the sameTwitter handle.
Run safe, run fast.
Um, those are the best ways tofind me.
Sometimes I'm active, sometimesI'm not.
I should be more active attimes.
I'm not as active as Mike is,but, uh, but I'm trying to build
up that Instagram following to,uh, to, to, uh, social
influencer status.
So we'll see.
(48:25):
Nice, that's awesome.
But Scott, that was amazing.
Thank you so much for coming on.
That was awesome.
Happy to do it anytime, Mike.
On this episode of the sportsphysical therapy podcast.
I am joined by Scott Greenberg.
Scott is a physical therapist,the manager of operations and
the residency director for theuniversity of Florida Gators.
He's an expert at running andfoot and ankle injuries.
And in this episode, we're goingto talk about how Scott
developed this niche, how heworks with these athletes and
some of the new techniques he'sbeen working on with runners,
(00:21):
including using blood flowrestriction training.
Hey Scott.
Thanks so much for coming on thepodcast today and joining me.
Uh, how's everything going?
Everything's great.
Thanks for having me, Mike.
(00:41):
Appreciate it a lot.
Yeah, I've been looking forwardto this one because you're, you
know, one of the, the leaders ofthe academy, um, the sports
academy that, um, I think overthe years it, it's been fun to
see you present on some of thesetopics about runners and running
injuries and stuff like that.
So I've been really excited totry to get you on for this topic
because I, I feel like Ihaven't, I haven't really talked
(01:02):
much about running injuries overthe last few years in the
podcast, and I think it's longoverdue to have you on to share
your knowledge with us.
Right.
Uh, awesome.
I lo, I l I can talk running allday, so let's do it.
Which, which is a great answer.
I know that.
So, uh, let, let's jump in.
I, I know you've worked with alot of runners and so when you
(01:23):
work with runners, you deal witha lot of running injuries.
You, you know, the specifics ofrunning, running injuries, you
have to be really good at footand ankle, right?
Like, these are some of thethings that go hand in hand with
running.
Um, why don't we start, beforewe dip into some of those
things, like, I want to hearspecifically like, Like, how'd
you get started in this?
Like are you a big runner?
Did you specialize in this likeyourself as an athlete?
(01:44):
And then how did you pivot tosay like, oh, I'm gonna focus on
this for my professional career?
No, I think those are greatquestions and you know, I've
been going on being a PT nowgoing on something like 24
years, so it's been a long time.
So as I think back to how I gotmy start, um, Always loved
sports, always involved sports,played sports my entire life and
(02:06):
knew I wanted to have a careerprofessionally involved in, in
sports in some way, shape orform.
And physical therapy just, justspoke to me.
It just was what I wanted to doOnce I realized that being a
professional athlete wasn't inthe cards, right.
So, um, Went to PT school andcame out and again, knew I
wanted to do sports medicine,but didn't know exactly what.
So I think one of the thingsthat all clinicians should do
(02:29):
when they come out is really bea generalist more than anything
else.
Get yourself into a goodsituation, surrounded by a bunch
of smart people, um, and, andthen see where it goes from
there.
And then kind of just take itall in and see what speaks to
you.
And, um, for me, in my first twoyears, within the first two
years of practice, um, I've hadthe opportunity to see both
(02:49):
non-operative and operativecare.
Um, got to dabble a little bitin foot and angle, and it really
did interest me.
And when I took my second job,uh, which was, you know, a year
three post, post-grad, um,working with the team doctors
for the University of Florida,not as a physical therapist for
the Gators yet, but just workingin their clinic.
I wanted to figure out a way tofast track myself to be
(03:12):
considered the guy in something,right?
So I looked around and at thetime we literally had a, a true
sports medicine clinic.
It was, uh, four physicaltherapists, two athletic
trainers, two team surgeon, teamsurgeons, and one the non-op guy
that were all sports medicineall day every day.
And, you know, I was fortunateagain to be surrounded by some
really bright people, peoplethat have spent time working
(03:34):
with the Dodgers and people thatreally knew a lot about the
shoulder and the knee.
And I said, man, this is great,but you know, how can I stand
out and how can I kind of breakin to, to gator athletics, let's
say myself.
And, and then I, you know,strategically thought about it
and said, you know what?
The foot and ankle's always beensomething that's really
interested me.
The beauty about the foot andankle is that, um, you know,
(03:55):
every sport.
In some way, shape, or form, youcan even throw swimming in
there.
Cause a lot of our swimmers do alot of.
You know, on land runningconditioning type stuff, um,
they, we, we, they all run and,you know, understanding how
people run and, um, and how thefoot and ankle, um, you know,
uh, articulates with the groundand the implications it has.
(04:16):
You know, one of the firstcourses I took was when the foot
hits the ground, everythingchanges.
Right?
So classic, you know, the footand, yeah, absolutely.
So the foot and ankle andrunning mechanics kind of went
hand in hand for me in terms of,you know, kind of.
Getting my roots into somethingthat I can really stick my teeth
into and really, you know, saythis is mine.
Like I own this, uh, for thisorganization, for this, for this
(04:38):
group of doctors.
Let me be the guy.
And again, you know, it doesn'tjust get handed to you.
You have to actually show notonly the want, but you actually
have to be successful in whatyou're doing.
And you gotta go above andbeyond.
You gotta put the time in, yougotta go to the classes, you
gotta learn extra.
Um, and then at the end of theday, you gotta do a good job,
right?
You gotta do a good job.
And, um, I've been fortunate to,you know, uh, I think do a good
(05:02):
enough job where people give meopportunities.
And then when thoseopportunities come, you know,
you keep the door wide open andyou don't mess up, you do a good
job and you, um, you know, youtake advantage of those
opportunities and they lead tobigger opportunities.
My first opportunity came, um,as a result of me.
Um, fabricating foot associates,to be honest with you, that's
how my break into the Universityof Florida Athletic Association
(05:22):
kind of took hold, is that theyneeded somebody to do foot
orthotics.
And obviously I took someadvanced training in that.
Um, along with my foot and ankleknowledge.
It just made sense.
Right.
Um, back then, 20 years ago,Somebody had foot pain,
orthotics were automaticallyprescribed.
Right?
So I wanted to understand, yeah,I wanted to understand how
they're made.
Why are they so expensive?
You know, what can I do to, whatcan I do to facilitate this?
(05:46):
And, and, um, you know, Istarted, you know, I took, um,
uh, a certification as a, aboard certified P DOYs, which is
somebody that can modifyfootwear and modify shoewear.
And I started making orthotics,you know, from.
From much different than I dotoday.
Um, I used to start with, youknow, pieces of material and,
and actually heat'em up and, andgloom materials together and
(06:07):
grind them and post them andyeah.
And do the whole kit andcaboodle.
You know, pair of orthotics usedto take me two hours to make,
and if you're making a bunch of'em, you know, that's on your
time.
And, and I put that time in onthe weekends coming in a, coming
into the clinic at five o'clockin the morning to get this stuff
done, uh, because it wassomething that I was, a passion
of.
Mine turned into a passion andsomething that I really wanted
to.
To take advantage of.
And again, once you're kind ofknown for the guy to do the foot
(06:30):
and ankle stuff with orthotics,other opportunities kind of come
your way.
And, and over the years now, Ionly, I don't just see foot and
ankle stuff.
I see, you know, lower extremitystuff.
I do, I do my, my fair share ofACL reconstructions and such.
You know, I see my, my fairshare of hip pathologies.
Um, I try to keep it lower half.
That doesn't mean I've neverseen a shoulder in my day.
(06:50):
Um, but, but I'm, I'm, I'mhappiest when I'm treating below
the belt.
That's awesome.
I like, I like that.
I, I guess I'm the opposite, butlike, you know, like you, I
think you get pigeonholed inthings, right?
Mm-hmm.
And then we, you know, we onlyhave X hours a day now, right?
So like I can fill my scheduleup with baseball pitchers all
day and then, you know, it getsa little boring.
And to be honest with you on mypart, if like, that's all you
(07:10):
do, but, um, yeah, you know, Ireally like a lot of the things
you said there, and I thoughtthat was a great, you know, You
know, start this episode.
Um, we talk a lot about, um, youknow, trying to have a strong
niche in this profession.
If you're trying to stand outand you're trying to be the best
at something, it is really hardto be the best general
orthopedic physical therapist inthe world.
Mm-hmm.
(07:31):
You have to understand that, butit's hard to be the best general
ortho.
So I love how you said, let'sget a great orthopedic base, but
then pick something.
And I always tell people that,is it a sport?
Is it a joint, is it atechnique?
But like pick something likethat and I really love how you
did that.
Um, were you a runner?
Did you do track, I mean, I knowyou were an athlete, but like
what did you do specificallythat said like, I wanted to work
(07:52):
with runners.
I.
Huh.
My common joke, I, you know, Iteach a lot of running
continuing education courses andthat question always comes up.
And my joke is always, my jokeis I always, I only run when
chased.
Right.
It's my common statement I sayall the time.
Yeah.
So I laugh.
My history of works.
Yeah.
My, my history of, that's a goodjoke.
Courses I was, I was a, I was asoccer player, baseball player,
(08:13):
and then I wrestled in the, inthe interim.
Right?
So obviously soccer, lot ofrunning baseball, not, not as
much.
But, um, the wrestling was a wayfor me to keep myself kind of in
shape.
Obviously at five foot, youknow, seven, just like yourself,
Mike basketball's probably notin our cards, right?
So, right.
I said that in about sixthgrade, but yes, I like for, for,
(08:34):
for sticking with that longer.
So, so I realized that wrestlingmight, might work for me and.
And one of the things, you know,I've, I, I'm sure I take, I took
about 10 years off my life withall the wonderful ways of
cutting weight and running in asauna and wearing a wetsuit and
all that good stuff.
But, but you know, running wassomething I had to do a lot of
to, you know, lose 10 pounds ina day and a half, right?
(08:55):
So, running is, I have alove-hate relationship with it.
Um, I love.
The mechanical side of it.
I love the biomechanicalapproach to understanding what
something looks like when it'shappening at an efficient level
and what something looks likewhen it's not.
But in terms of myself runninglike the Lar, the longest, the
(09:16):
furthest I've ever run, I'vedone a a 15 K, and that's about
all I ever care to do.
Um, I think marathon training.
I love people that do it becauseit kept me in, you know, working
for a very long time.
Um, but I think it's a longrace.
I really do.
26 plus miles is, is long.
I think a half marathon distanceis, is a great, is a great
distance to kind of, to kind ofhave as a.
(09:37):
As a, as a goal for, for many.
But you know, the three, thefive Ks and, and such, the 10 Ks
are great distances.
And, and I think people candabble in, myself included,
dabble in those for exercisepurposes, to lose a couple of
pounds here and there.
Um, but, but that, that's myrunning, that's my running
history more for sports and asof necessity to lose weight.
(09:58):
And then as time has, has goneon more of a, just a basic
exercise thing, I'm, I'm notcompetitive with running at all.
I'll mute this up.
I don't know if you can hear,but my neighbors landscapers are
like going crazy right outsidemy window right now.
(10:20):
Very little.
I can hear it.
I'm like, what is the chances?
You can't hear it that bad rightthere.
I was gonna say, not terrible.
The, the noise cancellation isprobably pretty good.
I was gonna say like the, thedude is like literally right
there.
I was like, I'll get a spike theaudio.
I'll find, I'll find that nowand we'll get there.
So, alright, we'll keep going.
So, um, All right.
Scott, can I, can I share asecret with you?
Can you not tell anybody,although I guess the, all the
(10:43):
people listening to this arethere, but, um, I've, your
secret is safe from me, Mike,all of you listeners too.
Um, I've ran a mile like.
Twice in my life.
Like that's the mm-hmm.
That's the furthest I've everrun.
And that's, and it was becausethe bear got tired.
Right?
The bear got tired.
And, and I, I do not likerunning.
(11:03):
And I, and I gotta ask you thisalmost now, just because I feel
this is true for me, but like,like can everybody run?
Are some of us just built, likeour body's not built to
efficiently run?
So then therefore, like, Wedon't like it, we don't like the
way it feels.
Is, is that a thing?
Or, or, or can anybody be arunner?
Cause I know you just brought uplike, running for fitness and
exercise and even mental health.
(11:24):
I mean, running's awesome.
I wish I could do it, but I, Itruly hate it.
I is is there something to that,that not everybody is built to
run or did I just make that up?
No, I think, I think that's trueto a degree.
I think there are certain peoplethat are built not to run far.
Um, I think, you know, I will neI was not built, you were not
built to dunk basketball.
So it's just not part of ourdna.
(11:45):
It's not what we're capable ofdoing.
Um, I've seen some veryoverweight, unfit, uncoordinated
people run marathons, right?
We've all seen it.
Um, how long can they keep thatup for?
That's the really the debatablequestion.
I think everyone can run acertain amount.
Um, Are there certain types ofbody morphologies that I feel
(12:06):
are putting them at greater riskpotentially for injury if they
run greater distances or run fora prolonged period of time?
I personally believe that.
Um, but, um, I think everyonecould run.
Um, I think we just gotta thinkabout this, and I talk about
this all the time with mystudents and patients.
You know, what we do as physicaltherapists is, is difficult,
(12:27):
especially if we're trying toreally come to the root of why
something happened, right?
But if we break it down tosimple terms, like if your
stress exceeds your capacity,Something's gonna break down and
you're gonna hurt.
Right?
So if we break it down to thosesimplest terms, that's really
what we're, we're thinking ofand what my capacity is and what
your capacity is, is verydifferent.
And what stresses we're puttingon those bodies is very
(12:48):
different depending on ourterrain, our, our movement
efficiency, our strength, ourrest, our recovery, all of that
plays into that.
So at any given time, cansomebody run?
Yes.
For how long?
I think that's where we reallystart to open up Pandora's box
of questions as to.
The true answer to thatquestion.
And, and I, I love, I love theanalogy or, or the concept of
(13:12):
the workload and capacity thing.
And then I've always thought ofthis at least like with, you
know, like my athletes withbaseball players and stuff.
That is, there are some thingsthat you can do mechanically
that will, um, that willincrease the stress that happens
during the throw.
So there are mechanical, uh,there are no, there's no such
thing as, Good or bad mechanics,just the mechanics just alter
(13:32):
the stress.
And there are mechanical changesthat you can do to apply more
stress.
So of course you would need morecapacity, but at some point in
time, I mean, efficiency of themovement is also important too.
Do you, do you agree?
Is that like one of the thingsyou look for in your runners
too?
Is there, is there abiomechanical efficiency that
helps optimize that ratio ofworkload capacity?
(13:53):
I, I do, I do believe that, youknow, I always tell people when
we're changing form, cuz we dochange form.
I, I am a believer in changingform and we can go down that
rabbit hole in a little bit.
But, um, I always say no changewithout consequence.
Right?
We don't change something andhave that, that that force kind
of.
Um, evaporate into, into thinair that stress evaporate.
It goes somewhere else andhopefully it goes somewhere that
(14:14):
our body can tolerate it.
Right.
And like you said, you know,there's no perfect pitching
mechanics.
We've seen, you know, the DanQuien bees back in our era, guys
throwing side arm, and it lookslike, it looks like it's gotta
hurt and it's not veryefficient, but he's very
successful at it, you know?
Right.
And then there are other peoplethat are more over the top that
also.
You know, either succeed ordon't succeed.
And, and um, same with running.
(14:34):
There are some things in runningthat we kind of hold true to
ourselves, right?
There are some running, I callit, um, non-negotiables.
For me, you know, running andlanding is close to your center
of mass is something that Istrive for every one of my
runners to achieve.
Um, that to me isnon-negotiable.
What part of the foot hits theground first?
(14:55):
That is something that we'regonna have a big debate on,
right?
And, and certain people feelstrongly one way or the other,
and we can get into the way Ifeel, but, but landing close to
your center of mass, um, is themost efficient way to run.
Are you gonna truly landunderneath your center of mass?
Probably not.
But you, the, the closer you getthe, the, uh, the, the lower the
braking forces, the, the, uh,short of the ground, ground
(15:17):
contact time, which thendecreases the amount of work
your body has to do.
Most running injuries in thedistance population occur when
the foot in contact with theground, right?
In sprinting, that's a littlebit different.
They're in contact with ground,far less, the force is far
greater.
Um, but in distance running it'smore contact with the ground
that creates the problem.
Um, so if we can limit thatstance time, get him landing in
a more efficient, under theircenter of mass position.
(15:39):
I think we're, we're achieving alot of good.
Um, I do also believe personallythat landing in a four foot
mechanics is probably mostoptimal for most people.
Um, you're not gonna see asprinter sprint on their heels.
It's just not, it's just notappropriate.
It's, uh, you may see somebodysprint on their heels.
They're not gonna be a goodsprinter, but the successful
sprinters Right.
Maybe an athlete, but not asprinter, right?
(16:00):
Correct.
Correct.
Yeah.
Correct.
So, so if you, you know, thehighest level, the fastest of
the fastest are landing on theballs of their feet.
Um, and for me, you know, in anysport, if you wanna make an
athletic move, you're gonna haveto push off your rear foot, roll
to your forefoot and cut offyour four foot.
Having somebody cut off theirrear foot is not, again, a, not
an efficient.
You know, um, functional, kindof powerful position to kind of
(16:22):
move into.
So for me, um, I just feel likeour body's more elastic, more
able to load and explode if it'sin that four foot position at
initial contact.
But again, not all four footcontacts are made equally.
Um, you can land on your fourfoot.
And, and the reason why, one ofthe reasons why I believe four
foot contact got such a bad nameis that people are forcing it.
And when you force a contact,just like anything else, it's
(16:43):
not natural.
You start to exhibit other non.
Appropriate, uh, patterns andactivate muscle activation to
achieve that.
So you oftentimes see excessiveplant reflection of the ankle
with a, with a force four footcontact.
When I have, when I teachcourses, and I, and I try to
demonstrate this point, I alwaystell people to stand up and I
have'em run in place.
(17:03):
And when they run in place,every single one of'em lands on
the ball, their foot.
And then when I ask'em to run ontheir heels, it's just not
natural.
They don't do it.
So I said, nobody told you torun on the balls of your foot
when I asked you to run inplace.
It's just natural.
It happens.
That's what we want to havehappen when we're running, and I
think all too often people startto hear things, oh, I need to be
a four foot runner.
They start forcing it.
They start reaching, they startextending their knee plan,
(17:24):
flexing their ankle, havingcontact way out in front of
their center of mass, whichagain, is not the goal of what
we're trying to achieve.
So how much time do you spend inthe clinic looking at running
mechanics?
Is this something that you doall the time?
You know, if so, like what aresome of the things you look at?
Like, I know this is an arealike with our podcast, where we
(17:46):
answer questions like we getthis question every now and then
because I think so many peopleare interested in like, how do
you get started looking atrunning mechanics?
I'd love to hear your experiencewith this and some of the things
you look for.
So, A couple things.
I definitely do look at runningmechanics.
I'll give you a little story.
So, you know, I've gone at theUniversity of Florida, we have a
very elite track program.
Um, cross country is not as goodas our, as our sprint team and
(18:09):
jump team, but we have a veryelite program.
We win in na, we win nationalchampionships very often.
And um, we've gone through acouple of distance coaches and
as everyone comes in, I alwaysask them, You know what, when
they're recruiting a, a givenathlete to come to Florida, what
are they looking for?
And one of the common thingsthat never comes up is form.
Um, it's always, you know, dothey enjoy running?
(18:31):
What do their times look like?
Have they missed a lot of timedue to injury?
Nobody ever speaks a form, and Ihave found that form is super
important and coached at a highlevel in the sprints and in the
jumps.
But in terms of distance, it'snot really coached.
They, you know, and that's nthat's nothing negative about
any one of our coaches.
It's just not something thatthey worry that much about.
(18:53):
They're more worried andconcentrating on building
programs, building trainingroutines, building workouts for
their plethora of athletes thatall are at different levels.
Right.
So, um, when I asked initially,is that something that I'd be
able to, to really work with ourathletes from the Florida, you
know, collegiate standpoint.
They were like, absolutely.
Um, So in the clinic, obvi,obviously I would do that, but
(19:15):
that was always something I'd,I'd hang my hat on.
And the fact that even at theelite levels, form and, and, and
mechanics is not somethingthat's really coached that much
in the distance population.
Baseball, obviously pitchers,that happens all the time,
they're coaching mechanics allthe time.
Why are we not doing this inrunning golf?
They're coaching it all thetime.
Why are we not doing this withthe distance population?
So I think part of it is becausethere is.
(19:37):
No right or wrong.
There are, well, let's say this,there's a lot of wrongs and a l
and, and fewer rights.
Um, but, but you know, for me, Ialways felt that it was really,
really appropriate to try to, totry to nip certain things in the
bud.
And, you know, the timing ofwhen you make changes is
oftentimes a big.
A big problem.
You know, the, the track crosscountry outdoor indoor season is
(20:00):
very long in the collegiate, youknow, the collegiate world, and,
you know, having the right timeto make those changes is, is
tough because you know, when youmake a change.
Is the body able to compensateand, and, and deal with those,
those, those moving stresses.
Now, those stresses that havenow applied to a different area,
um, and, you know, havingsomebody run 80 miles a week and
then all of a sudden changingtheir form and having'em
(20:21):
continue at that 80 miles a weekis, is not something that's
probably the brightest.
So if I were to tell my coaches,Hey, by the way, we're gonna
back this runner down from.
80 miles a week to, to 10because I changed their form,
it's not gonna go over verywell.
Right.
So I think the c the changes Imake in season are very, very
slight and very, very, um, smallin terms of the overall, um, you
(20:42):
know, scope of what changescould be made.
But, um, when run, when runnersare injured and not running,
that is the best time toactually incorporate a new
change into the, into theequation so, you know, obviously
when, when mileage is high, it'snot the optimum time to, to make
a change, but really the besttime to make a form change is
with a, with a runner that'sinjured and not running because
(21:03):
you're gonna ramp'em back slowand gradual anyway.
So why not to try to introducesomething that is, is going to
maybe make them.
I'm not gonna say less likely toget injured in the future, but
if you see a glaring problem,then why not address it then?
And, and getting buy-in at thattime is also the best time too,
because, you know, you know,runners are I when not even my
collegiate runners, my, myrunners that have been running
(21:24):
50 years and I try to introducea form chain.
They say, I've been running thisway my whole life.
You know, why am why all of asudden now is it a problem?
I say, well, you're not asstrong as you once were.
You're not as young as you oncewere.
You need more recovery.
And guess what?
You know, it's not, it's not.
If you break down, it's when youbreak down and you broke down.
So your way obviously isn'tworking.
Let's try a different way.
(21:44):
You know, so, um, that, that's,that's, you know, getting buy-in
is in anything is tough, butthat is probably, for me, the
best way to make that buy-incase is when they're injured and
trying to get back.
I, I think that's brilliant andthat's a great way of, of
thinking of it too.
So, um, all, so you have infront of you, you're looking at
them, you, what do you use a,you use a treadmill?
What, what do you haveTechnology.
(22:05):
Like, what do you like to do inyour, in your clinic?
So I think, you know, I've hada, a bunch of different things
over the years.
I think the tried and true waythat I tend to do it in terms of
trying to address the things Ineed to see is a treadmill with
a high speed camera, whether itbe an iPhone, an iPad.
Um, I find great results with 2Danalysis.
(22:26):
I think 3D analysis is great ifyou have the ability to do so.
Um, but 2D analysis is, is in myeyes more than sufficient.
I tend to look a lot at thesagittal plane metrics such as
stride length, um, uh, footinclination, angle, tibial,
inclination angle, knee flexionand initial contact, something I
(22:48):
call hip separation, angletrunk, lean stance time.
So those are all things that Ifeel like I can make a big
difference in and get a good,um, 2d.
Um, uh, picture for lack of abetter, better way to describe
it, of what I think they'redoing right and wrong and make
those changes That was awesome,Scott.
I really like your approach tothat and in trying to help
(23:12):
people with their form whenthey're injured.
Makes perfect sense to me.
I, I really like the way yououtlined that.
I think that's the, the mostlogical thing to do, to make
sure that we're not overdoing itwith them.
So if you have somebody in frontof you, they're in the rehab
process, like what do you use?
Do they, do they just run on atreadmill?
Do you have technology?
What are some of the things thatyou use to look at their
mechanics?
So over the years, I've, I'veused a lot of different things.
(23:33):
I've used everything from 2Danalysis to just my eyes, to 3D
analysis at times.
And, and honestly, the best wayto do it, um, at least in, in a
quick clinical setting for me,has been always 2d ana, um, 2D
analysis with, um, a high speedcamera of some kind, whether it
be an iPad, an iPhone.
I think you need video.
Think you need to be able toslow it down.
You know, whether you're lookingat at least 60 frames per
(23:55):
second, probably a little bitfaster, probably 120 frames per
second is probably better.
Uh, it's definitely better.
It's probably what you need.
Um, I think 2D analysis can getthe job done 99.9% of the time
now, if you're looking for Yeah.
You know, research level, um,quality type of analysis and,
and, um, sometimes I, I thinksometimes people get too, um,
(24:20):
caught up in.
Trying to make everythingperfect and symmetrical by
numbers.
And I think if you catch the lowhanging fruit, I think you fix
the majority of problems.
That's just my opinion over myyears of experience.
Now again, 3D gives you greatinformation.
There's no question, but thequestion is, um, how much is
that is truly really required?
(24:41):
When I'm looking at a runnerwith a, with a high speed camera
that's two-dimensional, and I'mlooking from the sagittal plane
and I'm looking at things like,uh, contact from center of mass.
Foot inclination, angle, tibial,inclination angle, knee flexion
at initial contact, knee flexionat mid-stance, uh, hip
separation angle.
Something I kind of talk a lotabout, uh, what trunk lean is,
(25:02):
uh, how long are they in contactwith the ground, if I can make
changes to any or all of thosedifferent variables oftentimes.
So those are all sagittal planemetrics.
Oftentimes I find that thefrontal plane metrics such as
like.
Knee valgus or rear footinversion, e.
E-version oftentimes take careof themselves because I think
oftentimes those are related to.
Prolonged loading or prolongedstance time and the body having
(25:25):
to deal with stress for a longerperiod of time.
So we know that pronation is away in which we deal with stress
and pronation oftentimes getspigeonholed to the foot and
ankle problem, but it's not,it's a, it's a lower, it's a
lower body really problem.
When you think about whathappens, the femur internally
rotates.
The, the knee goes into thisdynamic valgus, the tibia
internally rotates the calcanevert.
So all of this stuff happens.
(25:45):
Oftentimes, we just concentrateon the foot and ankle and say,
oh, the foot and ankle ispronating too much.
Let's stick an orthotic in thereand let's stick a motion control
shoe in there.
When in fact the foot's justdoing what the body's asking it
to do.
And by putting an orthotic in,or, or, or by.
Putting more of a stabilityshoe, you're really just
shifting the problem somewhereelse.
The problem may be that they'rein contact with the ground for
(26:06):
too long and they're askingtheir body to absorb stress and
shock, and now you've taken oneof the body's abilities away to
deal with that and creatingother problems.
So I oftentimes say like,patients come back to you over
the years, and I'm sure you'vedealt with this in the, in the
upper extremity mic, where apatient.
You see and you treat, and theydo well for a, a certain
problem, let's say plantar fasor plantar fasciitis, and you
(26:26):
treat'em successfully, youthink, and then they come back
the next year and you're like,Hey Scott, I wanna see you.
You fixed my plantar fasciitis.
Now I've got this hip issue.
Can you fix that?
Probably the, the problem withthe same all along, it's just
kind of presenting itself in adifferent way.
So, um, I think we, we, we gottastop chasing that a little bit
and, and really start looking atthe root of problems if we can.
(26:49):
I, I, I, I think that's anamazing, uh, thing that a young
clinician I think would reallybenefit from too.
And it's not about nitpicking,it's about finding those low
hanging fruit and then seeingwhat happens, right?
Seeing how many other thingsclean up.
I think some people take thatfor granted that a lot of things
will just clean up themselves.
So, um, I thought that, I, Ithink that's amazing.
(27:10):
I think that's, that's a reallygood approach.
You know, Bri, Brian Heder andCadence, not to interrupt you,
not to interrupt, but BrianHeder and Cadence.
You know, made such a, made sucha big, um, uh, uh, IM impact on
the, on the running medicineworld by his, his research
involving cadence manipulation.
And, you know, it's just one ofthose things that is so easy to,
(27:31):
to do for a right, for anybody.
An entry level clinician, anexperienced clinician.
It's something that is very,very tangible and has great
impact on movement efficiencyand movement mechanics and load,
uh, manipulation.
So, um, again, to, to reiteratewhat you were just saying, low
hanging fruit, why not Go forit.
(27:51):
Yeah.
Yeah, I, I love it.
And just because you broughtthis up earlier, I gotta ask cuz
I know there's a couple otherthings we wanted to talk about,
but I gotta ask, how, how hasyour use of orthotics evolved
over the last 20 years?
Cause I know you said you werehuge on it before you were
grinding away on the weekends.
Um, what, what do you donowadays and how often do you
use orthotics?
So I am probably.
(28:13):
I've been doing orthotics for along time and I feel strongly
that there's a place in ourworld as physical therapist for
it.
Um, you know, when I talk about,um, injuries, oftentimes I go
down my spiel of, you know, somuch of what we do is trying to
increase capacity, decreasestress, and shift loads, right?
And one way in which we caneffectively shift loads.
(28:34):
It's been shown time and timeagain.
Is via taping and orthotics.
Bracing.
It helps.
It shifts.
Loads.
Now, is there a perfect positionto put the foot?
We can debate that.
Um, but we know that by changinghow somebody's foot contacts the
ground or how it moves, once itcontacts the ground is going to
affect the entire chain and thewhole mechanics of that.
(28:57):
And if I haven't injured, uh,you know, when working with
athletes, you're working withbaseball players at high levels.
I'm working with runners andother collegiate athletes at
high levels.
Our job is twofold.
Our job is to get our, ourathletes on the field after an
injury as quick as we can.
And our job is to keep theminjury free as long as we can.
And if I can get both of thoseachieved by, um, putting an
(29:17):
orthotic in and deloading atissue that is under greater du
duress, why would I not do that?
You know, if I can put anorthotic into one of my runners
and they can go from six outta10 pain to three outta 10 pain,
and they can run.
Why would I not do that?
Now, that doesn't say I'm notgonna strengthen that.
Doesn't say, I'm not going to dothose other things.
(29:37):
Work on mobilization, make surethey're moving right, work on
their form.
But if I can get them from A toB quicker.
By just sticking a stupid pieceof, of, um, polypropylene into
their foot, into their shoe.
Why would I not do it?
You know, people always talkabout, you know, oh, it's gonna
weaken the foot.
No, it's not.
If you spend some time outsideof, of their activity
(29:59):
strengthening, you know howoften, and I joke about this,
like, you know, you go to thegym, you strength train, you
lift for an hour.
Let's say I'm gonna work on mychest for today.
I'm gonna do six exercises ofchest.
I'm gonna do some flies, I'mgonna do some incline, I'm gonna
do some flat bench.
I don't do chest 24 hours a day.
I do it for a little bit andthen I let my body recover,
right?
So why not let our bodiesrecover with an orthotics and
(30:21):
then strength train, right?
While we can, right.
I mean, the logic is so soundright?
You make it sound so simple.
Mm-hmm.
Right.
But people say these things allthe time, and I think, Scott, to
be honest with you, that's whatmakes you a good sport physical
therapist, because sure, youcould just go sit in the cave
and not do anything and justwork on.
Strengthening all day long, butyou also have to get these
(30:44):
people back on the field as fastas you can.
So to me that's sports, physicaltherapy.
That's how you put it together.
And, and I mean, you, you, youmade it sound so simple that I,
I chuckled a couple of timesbecause like, it's, it's that
obvious in front of you.
Yet people will argue that onthe internet all day.
Absolutely.
And, and again, I am a hugeproponent of strengthening and
we could talk about, you know,foot and ankle strengthening and
how I feel like blood flowrestriction therapy, which I
(31:07):
know is near and dear to you, isnear and dear to me.
I think it is the, yeah, the,the hidden gem of foot and ankle
rehab.
Whoa.
You know, Whoa.
That's, that is, that's, that'sa bold statement.
I, I'm telling you.
Think that's where we're gonnapivot the podcast.
All right.
Here we go.
Ready?
So, love.
So as, love it as you teach, asas you teach.
And, and I teach, you know, withregards to blood flow, in order
to get stronger, you have tochallenge the muscles at, or the
(31:29):
body at like 60%, 65% of yourone rat max, right?
You gotta put significantresistance through the tissue,
and we know in order to get.
You know, big or stronger hyper,hyper hypertrophic changes, you
either have to put tensionthrough the tissue or you have
to create that metabolic stressor, or cell damage sometimes.
So those are the three ways inwhich, and you know, if whether
(31:51):
you're injured and can't putthat mechanical tension through
the tissue or don't want to.
You know, creating that, thatmetabolic stress is, is ideal.
And we know with the foot andankle, you know, it's not like
you can lift a whole lot ofweight with, with your foot
intrinsics.
It's not like you can, you know,you know, TheraBand is not 60%
of your one rep max.
It's just not, uh, you justcan't grab a dumbbell with your
(32:14):
toes oftentimes to create that,that, that, that, that mode.
So for me, it's almost likewe're wasting an opportunity to.
To get that response by notputting the BFR on while doing
stuff like TheraBand training,while doing balance work, while
doing, you know, foot doming.
Why would you not take thatopportunity to try to squeeze as
(32:37):
much juice from that grape asyou possibly can?
Because I know people are notbalancing with weight vests.
I know they're not putting thatload through the tissue.
That creates that supportstructure that we need to kind
of keep our foot and anklestrong.
Wait, so I shouldn't bebalancing with Weight vest now?
Now I, I, I get.
You can.
You can, you can, but you can,you can balance with weight Vest
(33:00):
and be a par.
I love, I love that on a bosuball at the same time.
That's, that's right.
That's right.
I, I.
I, I think, I think that's ano-brainer too, because like you
said, it's, it's reallychallenging to, to get certain
areas of the body to work outwith high enough load.
And I think you've justidentified a very obvious, uh,
way.
So, so I assume you've beendoing this, are you doing this
(33:22):
non-op, you doing this post-op,you doing it on everybody?
Like, like what, what's thepopulation that you're doing
this in Most?
I typically do it with everysingle one of my patients.
And again, my population is veryheavily, you know, ne and below,
especially like shin and below.
And, um, there's, there'scertain things I'll stress more
with certain types of.
Operative situations.
I think it's wonderful forAchilles repairs.
(33:44):
I think it's wonderful for, youknow, brostrom, brostrom or
lateral ankle reconstructions.
But I do it with, um, medialtibial stress syndrome.
I do it with plantar fas.
I do it with.
Poster TI tendinopathy.
I do it with all of them.
Every single one of my patients,I wish I had, you know, at one
of my clinics that I treat, youknow, we have a BFR at every
(34:04):
single table, right at anotherone of them that, that I treat.
Uh, we only have one, um, at,at, at that particular clinic.
And literally part of thejuggling act that I do that
gives me the most stress istrying to determine what.
When and how am I gonna getevery one of those patients to
utilize that b f R at some, atsome point of the treatment?
Because there's multiple peoplein there, sometimes at one
(34:26):
times, you know, so I thinkthere are certain, certain units
that I think are, are, you know,that I use, that I really like.
I, I like the Delphi as the goldstandard, but I, I use Suji all
the time.
I'm, I'm a big believer in thecompany and the people there.
I like how you can do it detethered.
You can do, you know, both lowerextremities at the same time
with the Delphi.
You know, you need two units todo that.
(34:47):
Now I know there are plenty ofother brands out there, but, but
again, I think it is, it issomething that, um, we should be
taking advantage with ourinjured population.
I think it is something weshould be taking care of or
taking advantage of with ourin-season training of athletes.
What better way to give anathlete active recovery without
allowing them to totally neneglect their strength?
(35:09):
Why, why not put'em on a B bfrand not tax the tissue nearly as
much, but still get thatmetabolic response?
Um, mm-hmm.
I think it's great for our agingpopulation of, of athletes
because again, as we get older,our joints, our tissues, they're
not able to tolerate the loadsthat we once were.
And, and, and why not put thebfr on, challenge our body with
less loads and create a similartype of strengthening
(35:30):
environment.
Uh, well, I'm sold.
I mean, you got me.
I think that's amazing.
But, uh, te tell me a little bitabout like, how you use it for,
like, let's say I, I know it's,let's talk about an area that's
hard to like load maximally.
So say like you're working onlike, uh, you know, intrinsics
or, you know, even, even basicstuff like inversion, e-version
type stuff.
Like what, what do you do forlike set rep dosage?
(35:52):
Is it the classic protocols thatthey use, or do you do your own
thing?
Like what do you like to do?
I do my own thing.
So there's one, there's a coupleof tools I like.
There's something called theblackboard, which is in essence
a wobble board split into twopieces for the foot and ankle
where you can lock the heel upand allow the four foot to go
into inversion and e-version.
You can put it at a slightlyangular plane.
Um, and I'll have my, mypatients do sets of 30.
(36:13):
You know, cuz the goal of bfrthis magical 30 15 15 15 isn't
magic.
It's just a number to try tocreate some fatigue, right?
So, so whatever you do, If 3015.
1515 isn't taxing that tissueenough.
Then you're not doing, you'renot doing it justice, right?
So, you know, I'll do sometimeswith TheraBand I'll do sets of
(36:34):
60 with my TheraBand training,um, in my single leg stance
balance work.
I'll do time sometimes, likehave a catch right standing on
an AirX pad against a rebounder,and do sets of 30 seconds or do
sets of 30 tosses, or hold itfor a minute.
Or, you know, I change it up allthe time depending on what I'm
trying to accomplish, how muchload I'm able to in, you know,
(36:54):
uh, in, in incur or, or, or pushon the system.
And again, if, if I'm doingbalance with somebody and they
continuing continue to have toput their other foot on the
ground.
Then, then maybe I need to gofor a longer period of time
because they're not stressingthat tissue quite as, as long as
I'd like'em to, versus somebodythat's able to, to really
balance for a long period oftime is really gonna fatigue
that tissue.
So I think it's very unique, butI do not stay pigeonholed to
(37:18):
that 30 15.
1515.
I do use it on occasion, Ithink.
You know, for open chain legextension, I think it works
great.
I think for some of the straightleg raises and hip abduction,
let's say, I think it worksgreat.
Um, but, but again, I'm notopposed to kind of changing it
up depending on, on the, on themovement, on the exercise, and
in the body part.
Yeah, I think that makes sensetoo.
(37:39):
There are certain groups who are30 15, 15, 15 is not going to,
that's they're not gonna befatigued at the end.
Correct.
So I like that.
I like the 30, 30 30.
I think that's a good option.
I, I like the time.
I, I, you know, I, I, I couldn'tagree more.
I, I, I like the way you, you,you focus more on the outcome
versus the process.
I think some people, they go toa course or they learn it online
(37:59):
and, and, and they say like,well, I have to do it this way.
Right, right.
Sometimes they don't use theirbrains a little bit.
I like how you're focused onlike, what's the goal?
The goal is to get some fatigue.
Right.
So, um, so, so awesome.
What, what about in, I know yousaid you use it in season, what
about in healthy Runners?
Have you done this at all forthe performance enhancement?
Like, like skew of this versusjust like getting back with
(38:20):
their recovery?
Like, and I, I know you talked alittle about how you could use
it as like a deload forrecovery, but anything specific
with performance enhancement.
I think so.
Yeah.
So we know runners typicallydon't run for, they run for
exercise, they don't exercise torun.
Right.
So getting a runner right to, toreally truly load their body is,
is a tough sell.
It really is.
(38:40):
So I, I think there is a placefor certain runners where they
could, I.
You know, put the BFR on theirlower body and do some squats
with some, you know, a 25 poundkettlebell and, and really
fatigue it out that way asopposed to, you know, people
don't have access to the gym allthe time either.
So, you know, right.
Do we have the ability to throwa bar in our back with, you
(39:02):
know, 2 45 pound plates oneither side and really go to
town?
Probably not, not everyone hasthat, but you know, not everyone
has bfr either, but they'rebecoming a lot more affordable
for the home use.
And I do think that.
It's here to stay.
I think it's something thatreally can, can benefit
everybody.
I really want to say everybody.
I think it, it can help withperformance.
There is no substitute for truestrengthening.
(39:23):
I wanna make that point clearand known, right?
If you can load the body withweight, load the body with
weight.
But if you need some time torecover or for whatever reason
you feel like that body can'ttolerate that load or wanna give
it a break, BFR is a greatoption.
Right, and we, we, that was oneof the first things we talked
about.
I don't even know how many yearsago now.
(39:44):
It was probably eight years agonow.
When we started looking at BFRChampion, we talked about it as
a team.
Like what are some of the thingswe need to be careful of?
One of the things was like, wellwait a minute.
Like if we do this too much,let's say an Achilles, right?
Like that sort of thing.
You don't want to deload that.
You don't, you don't, you don'twant to just always just
increase strength at a deloadbecause.
Then the tendon's not gettingthe correct.
(40:04):
Right.
And I think, again, sometimespeople, like, they don't,
they're not thinking outside thebox.
They're just like throwing it atthat.
So I, I, you know, I'm glad youbrought that up.
You have the load.
I'll give you an example of howadjunct Yeah.
I'll give you an example ofsomething too.
So I have a, an Achilles repairand a, and a pretty big football
player right now.
And one of the things that westruggled with is that, you
know, if we loaded themsignificantly three times a
(40:26):
week, Um, he would get a littlesore.
And so what we tried to do ismaybe do a Monday, Friday
regular load the tissue, andWednesday maybe load the tendon
and the calf, uh, with bfr doingless strenuous type of
activities to get that calf tokind of still get engaged and
try to benefit in other ways,but not put that same.
(40:49):
We'll call it tissue stressthrough the tendon loading the
tendon's important, getting thestress through the tendon.
But at some point an injuredtendon may not be able to
tolerate it, and that's wherethe BFR can come in as well to
allow that calf to then trulyget stronger too.
Cuz that's the thing you dealwith all the time with achilles
tendon, not tendon repairs isthat calf just goes to crap,
right?
Yeah.
Yeah.
So load it because you need toload it, but instead of just
(41:11):
saying, oh, you're getting sosore, let's just do it twice a
week instead of three times aweek.
Add that third day, but do itwith the bfr so that way it's
less and you still Exactly.
Uh, I nailed it.
Uh, that was awesome.
Uh, Scott, amazing episode.
This was awesome.
Uh, before I let you go, uh,high five at the end.
Five Quick questions, five quickanswers.
Tells me a little bit about you.
Not that I'm judging, buthere's, here's, here's question
(41:33):
number one.
Okay.
Um, I always, I always love tohear the responses, but, uh,
what are you currently workingon for like your own con ed,
your own professionaldevelopment?
Like what are you doing rightnow to learn?
Professional development.
So I'm, first of all, I alwaysgo down the rabbit hole of
YouTube.
I watch videos on YouTube.
I can spend hours upon hourslearning something like I was
watching the other day, like howto begin for, for a novice to 3D
(41:56):
prints, like what it would takefor me to buy a 3D printer and
all these cool little plasticthings I can make.
Right?
So, Um, that's one thing people,people that know me always,
people will that know me, alwaysknow I have something cooking in
the fire.
And it's like one crazy idea islike what it is, right?
So I actually read a book, um,called One Simple Idea by
Stephen Key, and it's about,it's about, um, How to take your
(42:19):
crazy ideas and instead of goingthrough the manufacturing
process yourself, like licensingpeople to get and take your
ideas that are hopefully notcrazy, that you can actually
make something off of.
So that was one thing that I,that I kind of, like I said, I
have ideas all the time and, andI just, I just, not that I don't
know how to get'em started, it'sjust that, you know, there's
just so many of'em that, youknow, sometimes you just need
(42:40):
to, you need to step away andmaybe just kind of come up with
the ideas, be the idea guy, andlet somebody else that knows
kind of the actual processbehind it make it happen.
So, Um, there's that, and I'mtaking a dry needling course
actually this weekend.
Actually, you caught me at agood time for that question.
Yeah.
Yeah.
Uh, fir, like first one, is thisyour first one?
First one, yeah.
Florida.
We're a little late to the,okay.
A little late to the game.
And, um, you know, still we'restill battling at our, at our
(43:02):
hospital with the, uh, insuranceramifications and reimbursement
questions, but, um, but it'ssomething I always wanted to do
and I think there's a time and aplace just like a lot of other
things in our, in our, in ourtreatment, um, right.
Uh, bag of tricks that, that Ithink we could utilize.
And it's just another thingthat, that I'd like to learn.
Cool.
Yeah, that's good timing.
I love it.
Awesome.
Uh, next question.
(43:22):
What's one thing that you'verecently changed your mind
about?
Ooh, I think, I think we talkeda little bit about, um, you
know, orthotics over the yearsand how I deal with running
injuries has definitely changedfor, for sure.
You know, back when I firststarted, you know, treating
runners in the early twothousands, let's say, you know,
somebody came in with faultymechanics.
We gave'em stability shoes, andwe gave'em orthotics, right?
(43:45):
Now I still believe inorthotics.
I, I've fallen away from thestability shoes, um, a little
bit in terms of the pronationcontrol, elevated cushion healed
shoes, the ones with a really,uh, large, uh, heel drop, you
know, greater than like 12millimeters or so.
I stay away from those.
Um, I do, I do feel, um, that,uh, orthotics still have a
place, but I've also gotten alittle bit soft on my forcing
(44:07):
everyone to be a four footrunner.
Um, kind of got away from that alittle bit.
I'd still believe it's the wayto go, but I think there is a
time and a place for somebody tomaybe not run as much on the
balls of their feet, especiallyif they're dealing with, you
know, Four foot pain if they'redealing with, you know, plantar
fascial pain, potentially.
Um, if they're dealing withAchilles pain, potentially,
those may be reasons why, forthe time being, I may allow them
(44:31):
to run a little bit more midfootrear foot as opposed to four
foot.
Um, but I do believe that tomake them a better runner, I do
believe that they need to run ontheir forefoot.
But to allow the injury to, tokind of calm down some, I have
softened and, and allow that alittle bit.
So that's one thing.
I love it.
That's great.
Um, you, you deal with a lot ofstudents, right?
(44:53):
What's your best piece of advicethat you love to give your
students?
Uh, I think we talked a littlebit about, uh, already, um,
stand out.
You gotta create, you gottacreate a way for you to
differentiate yourself fromothers.
You know, I, I, I run aresidency program here at uf.
I direct that and I have a greatstaff that, that helps me with
that.
But, Um, I have calls everysingle day from prospective
(45:14):
residents and they ask me, youknow, what is your ideal
resident candidate?
And I tell'em, I don't know theanswer to that.
You know, when, when we'remaking decisions for, for our,
for our who we're gonnainterview cause we don't
interview everybody.
Um, we interview probably, youknow, 10 out of an applicant
pool of this year we had in themid fifties.
(45:34):
So we're interviewing 10 out of50.
Um, We take two, you know?
How do you stand out on a pieceof paper?
What is it about you that makesyou unique?
You know, we have 50 qualifiedstudents that are all interested
in being a sports resident.
What is it about you that makesme read this and say, this is
our guy, or this is our girl, orthis is our student that we need
(45:55):
to kind of interview and kind oftake the next step with.
So I can't, I can't say, I saywe know it when we read it, but
I can't tell you what it is, youknow?
Um, because I don't know what itis.
I don't know what it is.
But you've gotta stand out in,in a positive way.
Don't stand out in a negativeway.
Stand out in a positive way.
I, I, so I like, that's anamazing answer.
That's the first, like, youknow, sometimes there's
(46:17):
recurring themes in theseanswers that I always ask
everybody.
I think that's a good one.
And since you're an idea guymm-hmm.
I think that's a t-shirt, right?
Stand out.
And that's just like, boom onthe t-shirt.
Like, yeah, let's get that goingon Etsy.
Let's get, I I don't laugh.
You're, you're gonna laugh whenyou hear this.
I have a Shopify.
Store where I have t-shirts andone of'em, uh, they're funny,
(46:38):
some of'em are, um, are PTrelated.
Most of'em P PTs, the originalFitness in Influencers.
I got that one.
I've got the, uh, um, uh, whatis it?
We know it hurts and that's whywe poke on it.
Something along those lines, youknow, so I can, I can definitely
add this to the list, so justlet's do it.
Dude, that is amazing.
(46:59):
Hey.
Yeah.
What, so you gotta tell mewhat's your, can we buy this?
Like, does this store exist?
Like Abso It does exist.
If you, if you go to, if you goto run safe run fast.com,
there's a link.
It'll take you right to myShopify store.
I mean, I'm in, I know, I know,I know.
I'm going from here.
I, those are amazing.
So, um, what, what, what'scoming up next for you?
Oh, goodness gracious.
(47:20):
We, I've always got something inthe fire.
I always do.
Um, I stuff that I, I'm notgonna talk too much about until
it actually happens.
Um, I don't wanna jinx it orwhatnot.
There's some stuff, there's somestuff going on.
Okay.
All right.
We'll revisit, we'll revisitthis, uh, at a later time and
we'll, we'll, uh, we'll, we'llcircle back.
(47:42):
On the next episode, but this islike the cliff hanger for the
end of the season.
I think that's awesome.
So, yeah.
Um, awesome.
Well, Scott, you, I think youjust mentioned a little bit, but
like, where can people find outmore about you?
Is it, you know, obviously yourwebsite, maybe you can, you can
say it again.
Mm-hmm.
Uh, social media, but where,where's a, a good way for people
to follow you?
Uh, probably either of those twosites, you know, Scott
Greenberg, uh, dot DPT onInstagram is a good one.
(48:04):
And then, uh, I have a website,uh, run safe run fast.com.
Um, and then that's the sameTwitter handle.
Run safe, run fast.
Um, those are the best ways tofind me.
Sometimes I'm active, sometimesI'm not.
I should be more active attimes.
I'm not as active as Mike is,but, uh, but I'm trying to build
up that Instagram following to,uh, to, to, uh, social
influencer status.
So we'll see.
(48:25):
Nice, that's awesome.
But Scott, that was amazing.
Thank you so much for coming on.
That was awesome.
Happy to do it anytime, Mike.
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