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We're back. Strength and Knowledge is back. I'm John Allen
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and in this episode, doctor Katie Debrowski and I discuss
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all things neuroscience regarding patient outcomes and physical therapy. Specifically,
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we break down controllable factors that alter a patient's nervous system,
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how to approach difficult conversations, and why performance focus rehab
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leads to better outcomes. Without further ado, let's get into it.
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Doctor Katie Debrowski, aka co owner of Olible Athletics, aka
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professor of neuroscience and an absolute beast in the weight room,
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Welcome to the Strength and Knowledge podcast. Pain and rehab
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is a very polarizing topic, and it is also a
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topic you are very passionate about. So why don't you
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give us a brief introduction of yourself and where this
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passion comes from for pay neuroscience.
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Well, thanks for that introduction.
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I like that.
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Yeah, thanks for having me too. I'm happy to be here. Yeah,
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my background in neuroscience before I ever became a physical
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therapist really set the stage I think for a lot
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of the things that I'm passionate about without I don't know,
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maybe quite knowing that it would get me to down
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the line become a physical therapist and intertwine it so
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much and what I do. But I think I've just
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always been passionate about this kind of intersection of human behavior,
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what our brains tell us to do, and how our
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body kind of exists in space, and just.
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All of that working together.
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And then, yeah, as I got kind of deeper in
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the rehab world, just really recognizing that pain is so
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much more than kind of just the initial thought of
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what we probably all had of it. Like if this
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you know, bad stimulus exists and we have pain, then
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the pain is our output and that's kind of the story.
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And as you know and as we all know, that's
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so it's just like scratching the surface of the story.
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And I think understanding how the brain and how we
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interact with our pain is really just what's going to
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set us up for success when helping people navigate it.
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Awesome.
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Yeah, that transitions nicely right into our first point is
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kind of like the initial like rehab set as a
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self like a lot of people think that the rehab
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setting can be threatening, can a lot of times change
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that perception of pain before the patient even walks into
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the room. So and also we know that like nervous
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systems produces pain as a protective output, not necessarily as
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a direct readout of like tissue damage. So my first
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question to kick as all is kind of, how do
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you convince an athlete or an individual that, like the
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doctor Google isn't always right and then that pain doesn't
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always equal rest.
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That's a good one.
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Yeah, I think I'm even shying away more from thinking
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of it as convincing people at this point, because if
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we really think about it, the things that we believe
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in the strongest, nobody's going to convince us otherwise, especially
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when it's about our own bodies.
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So I kind of think of this pivot as.
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Considering it more of, you know, how can I create
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an environment that decreases this person's threat, or how can
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I create an environment that makes somebody maybe get out
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of their head a little bit for their pain, And
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how can I do that in a way that almost
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like artfully is curating an experience where they don't even
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know that they're slowly putting their walls down and they're
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slowly becoming a little bit more okay with feeling sensation
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or okay with being in the setting that we're being
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in and I think that can be more successful sometimes.
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I think a lot of our goal in helping a
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client understand their pain can often be just over educating
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and talking at a person who when you're in a
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lot of pain, or you've been in pain for a
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long time, it can feel dismissive to be given a
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lecture about it or how it's.
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Not what they think it is, you know.
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And I think over the years, I've kind of transformed
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the way that I broach that subject, and I make
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it much more about creating an experience in an environment
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that bit by bit starts to maybe at over time,
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reshape this person's thought of what pain is, what movement is,
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is movement dangerous or not? Or is pain always tissue damage?
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Or is pain always harm? And I think that has
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a lot to do with the confidence of the practitioner
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as well as just the ability to communicate really clearly
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and directly. So it's stuff that I'm continually getting better at.
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I like to create an environment that's fun and a
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little bit silly and maybe doesn't take ourselves too seriously
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to kind of decrease that baseline level of threat. You know,
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if I'm staring intently at a client a second, they
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start moving and assessing them and making them feel like
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they're just one X mark on my clipboard away from
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doing something so wrong that we have to stop. If
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I can create an environment that's maybe not that aggressive,
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I think that helps a lot. So I think it's
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a lot about like getting to know the person in
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front of you, understanding what makes them tick, Understanding that
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it's probably not just their pain that brings them here,
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and it's probably also like the piece of their identity
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that they feel detached from because of their pain. And
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I think if I could start to unwind that, I'm
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going to get to know the person better and probably
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be able to meet them where they're at a little
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bit more.
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I think the subjective on your words, like you're kind
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of hitting on the point of like it should be
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used to build the rapport, build the relationship, find, like
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you said, find what they tick. As opposed to overqueuing
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overemphasizing perfect mechanics. Is there's no such thing as perfect mechanics.
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We know that there's always going to be some sort
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of compensations, and that's okay at the end of the day.
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But again, what's going to get people coming back, What's
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going to get them out the door for successful discharges.
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Is that relationship that you've built the comfortability with with
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the PT as well as the patient, and just that
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kind of that just has gone does very good with
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outcomes as well as just patient outcomes as well. When
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we discuss like pushing through like pain on the field
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versus like in the clinic, do you have any like
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tidbits on the kind of like where that fine line
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is whether we can continue to play through like kind
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of like maybe just a nagging injury versus like, Okay,
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we need to take a step back from from actually
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playing and take a few weeks off.
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Yeah, this is where it's It's obviously so dependent on
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the situation and if there are certain timelines that we
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have for somebody, you know, an athlete who is about
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to get drafted or recruited is a very different example
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than a fifty year old person coming into the clinic
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who doesn't necessarily have a timeline that's maybe dependent upon
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how much money they're going to make next year, where
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they're going to go to school.
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And I think that nuance is always important.
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We might have more leeway for somebody who kind of
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just has to get to where they need to go
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for their livelihood being on the line, or we might
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have really different considerations for somebody who because of how
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their pain is, it's really impacting their ability to go
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to work. Like all of those things really matter a lot,
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and there's a dramatic difference between how we would handle
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probably all of those situations. I think as a very
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general blanket idea that obviously this is a sweeping generalization
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and not the case for every case whatsoever. But when
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it comes to discomfort, the way I try to talk
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about it with a client, you know, if you have
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pain that is sharp, shoe intense, kind of stops you
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in your tracks, makes you change your facial expression, makes
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you really change, like how your body is moving in space,
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I'd say that's worth looking at and maybe revisiting what
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we're doing, or downshifting some things, or modifying things, or
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removing certain stressors and adding different ones that are maybe
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a little bit more tolerable. That's usually kind of some
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guidance I'll give. Or if pain continues to get worse
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the more you do, so if every rep that you do,
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or with every step that you take, or whatever activity
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you're doing, you notice that your pain is increasing, increasing, increasing,
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I'd say that's also probably time for us to go
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back to.
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The drawing board.
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When we have pain that tends to feel a little
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bit better, the more that we move prognostically, we see
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that as a good thing. We see that as, oh,
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your body's really responding to blood flow and contraction and
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all of that awesome stuff. And if it's getting more irritated,
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then that probably tells us that we need to maybe
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reevaluate what we're doing. If pain persists for like twenty
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four hours or more after the initial event that you
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think was related to your pain in the first place, again,
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probably something for us to revisit. It's really hard to
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give a perfect answer, but those are some parameters that
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I typically use with my clients.
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And we're going to kind of backtrack a little bit on, like,
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before the patient even comes into your clinic, what are
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some things that you're doing, either through social media, through
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the way the clinic is set up, through the way
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you've either the online scheduling link, whatever it may be,
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that you're kind of already kind of building this rapport,
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building this mindset that hey, we're here to train, we're
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not here this isn't supposed to be a doctor's office,
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isn't something that you're required to do, and can just
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talk touch on those points of kind of how you
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shape this perception before the patient even walks into the clinic.
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Yeah, I like that question too, because I do think
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a lot of people struggle with sometimes the Okay, I'm
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trying to really make it clear that this is the
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way that I treat and I'm here to help and
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not tell somebody to just like immediately stop. I'm here
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to have an active treatment process, not necessarily only laying
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on the table, And sometimes if we don't make that
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messaging clear, it can be even harder for the client
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to understand what you're trying to get at with them.
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So I think, yeah, social media is a great tool.
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You know.
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Our messaging for Old Bull and myself is very clear
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that we're very movement based. We're very activity based, and
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our goal is to get people back to where they
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were and even beyond where they were. We try to
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be careful in our messaging to not always link it
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to fixing people and making them one hundred percent pain
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free and things that I think can conflate the rehab
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process and make people think that oh, if I still
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have discomfort, I must still be broken, and or that
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they think they're broken and fragile at all. Like we
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really want to try to get ahead of that messaging,
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so social media plays a big role with that. As
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soon as you walk in our gym, you can kind
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of see pretty clearly that it's not what you might.
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Expect when you go to a physical therapist.
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When you see a kettlebell that goes up to a
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towns and huge spot racks and there's loud rap music
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playing and everybody's having a good time, people are sprinting
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on the turf, I think you can kind of get
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that picture that we're a little bit different too. And
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then also I think just like telling people in your
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first evaluation or even if they're inquiring, like making it
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really clear and setting the stage of we do things
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a little bit differently.
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We're very movement based, and when.
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You walk in, you'll feel that like our goal is
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to not do things to you to temporarily maybe calm
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things down, but to work together to create a plan
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that starts to look like the demands of what you
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came in the first place unable to do.
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I think the more that we explain that.
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And setting the stage in your initial evaluation with somebody
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is an excellent strategy to kind of get people, oh, Okay.
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This is what we're about here. I'm here to work.
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This is going to be a different experience than maybe
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I thought.
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Yeah. I think around to a lot of times when
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I'm talking to either like high school athletes, high school
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coaches in the area that like, there's this misconception of
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physical it's trying to take you out of your sport,
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and a lot of I guess my question is, like,
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what do you think physical therapists and strength coaches and
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all of them can do better to kind of change
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the narrative and change this misconception that hey, the rehab
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people are trying to keep you out of your sport
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as long as possible. They're just trying to make money
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off of you. I can gain any tips on how
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to change this narrative For the field in general.
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I think first and foremost, we have to work together better.
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I think that in so many places, and especially in
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places when you would hope that it wouldn't be this divided.
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But as you look higher and higher up at collegiate
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sports and professional sports, you see a really big disconnect
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where the pts and the rehab staff are on one
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side and they and the strength coaches are on the other,
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and there's not a lot of communication, or maybe there
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is a little bit of ego on both sides, and
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nobody kind of wants to work together because each group
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believes that what they say is right. And I just
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think there needs to be more interdisciplinary communication and understanding
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of what the other profession does and does not do,
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or knows and does not know. A physical therapist unless
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they have sought other training or they came from this
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background in the first place, unfortunately doesn't actually really know
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periodization and program design. I think that's a flaw, but
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that's the reality. So I think if as physical therapist,
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we need to accept the fact that strength coaches know
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a lot more about things in this area than we do,
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and we need to seek to learn from them, and
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we need to understand why knowing periodization and program design
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is one hundred percent necessary to be a good rehab provider.
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I think there's this big disconnect.
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And then similarly from strength coaches to rehab providers, I
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think strength coaches need to also learn some maybe regressions
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or modifications or things that maybe don't fully take somebody
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out of their sport, but learning a little bit more
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how to level up and level down something instead of
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kind of going hard all of the time, Like that
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might be the perception of the weight room, and that
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might be the perception that the strength coach feels they
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have to keep up with, whereas a lot more of
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it could be working together andunderstanding the strengths that each
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of our groups bring. I think most issues come from
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lack of communication in life and relationships everywhere, but especially
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professionally when it comes to rehabbing an athlete. I think
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there's also, unfortunately still just a huge misunderstanding of what
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tissues need to get better. And it's not resting them,
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and it's not poking and prodding at them, there's no
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physiological change happening. So I also think that's a huge
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area of opportunity of like genuinely understanding principles of exercise physiology,
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what tissues respond to, how they improve, and how they
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only maybe temporarily feel better, and why that temporary feel
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good stuff isn't going to ultimately determine an athlete's success.
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And that brings you right into another point that I
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was trying to hit on and looking for your insight
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on is when rehab looks like ice and stem, but
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then like the return to sport process is chaotic and unpredictable,
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like there's clearly not going to be successful return Like
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the rehab didn't make the demands of the actual return
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to sport. So does to talk about a little about
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how like your rehabbing and how the obal athletics and
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all that kind of stuff prepares an athlete better to
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return to sport much more than like the ice and
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stem and let's sit on the.
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Table for forty five minutes to an hour.
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Yeah.
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I mean the way I think of it is kind
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of every time I'm doing something with a client and
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every time i'm you know, working with team members when
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they're working with clients, I always tell people like, I
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want you to ask yourself two questions. Is my intervention
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actually changing this person's physiology so we get are we
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doing enough to get an adaptation? And is my intervention
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also impacting their psychology? Are they becoming more comfortable? Are
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they becoming less fearful? Are they increasing their confidence? Are
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they learning that they can do something that maybe they thought.
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Was off limits.
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If the answer is no to either or both of
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those things, I'm not doing it and it's not appropriate
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and it's not going to move the needle. So if
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you ask that about ice, I think that gives you
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an answer pretty quickly.
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Physiologically, nothing is happening. We are not changed any tissue.
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We are not doing anything that's producing a long term change.
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And psychologically, similarly, I'm probably giving this person a bit
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of a crutch or a bit of a thing that
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maybe they get in their head thinking they need.
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I'm not building their confidence at all.
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I'm also not doing something that's putting them in an
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environment that's going to start to look like what they
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have to get back to on the field. So if
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I ask those two questions and the answer is no,
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I'm pretty quick to change whatever I might think that
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I'm doing, or I would encourage anybody to change what
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they think they're doing. We need to impart enough of
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a stimulus for muscles and tissues and bones and ligaments
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and tendons to change, and nervous system tissue. Like absolutely,
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if we don't have enough of a stimulus, we are
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keeping somebody where they're already at or further detraining them.
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Which is a huge issue and rehab because.
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Very often we get an athlete with a leg injury
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and they're told to just shut everything down.
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They have another leg, and they have two arms, and
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they have a core. So how are we.
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Getting people not only they're injured limb deconditioned, but the
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rest of their.
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Body deconditioned, And that's a huge problem. I think.
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I think we should always be searching for what are
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the things that I can do with the fullest intent
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possible that have nothing to do with this injury, and
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making sure that I'm still doing them so we're not
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getting big, like wide swept detraining as well.
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Do you approach like objective testing the same way as
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like kind of like what am I testing? Will this
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actually change anything I'm doing in rehab? Yeah?
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Absolutely?
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I think I think we're in an era where data
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is king every single person we work with, where it's
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like twelve wearables and tracks their sleep and tracks every
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contraction they take. And I think data is helpful, but
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I also think too much data is noisy, And I
353
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think if we're testing selection, if we're selecting tests, we
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have to make sure we're measuring what we care about
355
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we're measuring something that is actually representative of the thing
356
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we're saying it is, and if it's testable and if
357
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the change in the number actually means anything. So that's
358
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where using tests that are validated in the literature is huge.
359
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Something that a.
360
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Mentor of mine and somebody I've just always loved to
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work with and teach with, Craig Leebinson, always said, is
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have your patient show you their test. And while the argument,
363
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of course can be like, well, there's not evidence based,
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we don't know the reliability and validity of course, but
365
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at the end of the day, if there's something very
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specific that your patient has a hard time with, I
367
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should probably know I should probably see what it looks
368
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like now, and I should probably see what it looks
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like in the future when maybe we've improved some things.
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So I think a mixture of objective testing that is
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well validated that tests the thing that you hope it does,
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as well as doing things that are actually tied directly
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back to your patient's goals and testing those things are
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also incredibly important if you are determining things that you
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want to test. This also might just take some research
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on your end. So if there's something a client wants
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to improve upon, I might have to find a way
378
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to test that, or I mighte to find a way
379
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to do that in my clinic, but it ultimately should
380
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blink back to what this person cares about.
381
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Yeah, I think the weight room is a great opportunity
382
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to test every session, like you're you're getting that objective
383
00:18:12.279 --> 00:18:14.200
test kind of like your mentor said, is like if
384
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they're having a hard time squatting, let's have them squat
385
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in a way that they will be successful. And if
386
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they're not successful, that's an objective test right there, they
387
00:18:22.079 --> 00:18:25.519
clearly are either offloading the knee, compensating at the hips,
388
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whatever it may be like that, that's an objective test,
389
00:18:27.799 --> 00:18:30.640
whether it's an actual number to it or just like
390
00:18:30.720 --> 00:18:33.000
the subjective and visual like that, that gives us insight
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on what we need to improve on with our rehab program.
392
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So another another great point and one.
393
00:18:38.079 --> 00:18:39.759
Final point that I want to talk about we kind
394
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of already hit on a little bit, is like that
395
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neurocognitive piece of rehab, like the confidence in movements, the
396
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confidence in returning to sport. I don't know if you
397
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want to touch on like how early you're getting into
398
00:18:48.559 --> 00:18:51.559
like this neuro cognitive demand of rehab how often and
399
00:18:51.599 --> 00:18:53.039
then kind of like the volume.
400
00:18:52.720 --> 00:18:54.880
Of it throughout this rehab process.
401
00:18:55.319 --> 00:18:58.119
I think kind of similarly to what I was speaking
402
00:18:58.119 --> 00:19:01.680
about earlier, with rather been making it like a very
403
00:19:01.759 --> 00:19:05.440
clear lecture that I'm giving or a conversation that I'm starting,
404
00:19:05.480 --> 00:19:07.240
like I want to talk to you today about the
405
00:19:07.480 --> 00:19:11.119
cognitive impacts of rehab, I'm kind of interweaving it with
406
00:19:11.200 --> 00:19:13.400
the experience that I'm creating and with the space that
407
00:19:13.440 --> 00:19:16.680
I'm creating for somebody to share their story. And you
408
00:19:16.720 --> 00:19:18.319
know a lot of times that I'm sure you can
409
00:19:18.359 --> 00:19:20.920
relate to this. You'll be taking a history and asking
410
00:19:20.960 --> 00:19:23.119
all the right questions and kind of just starting to
411
00:19:23.119 --> 00:19:25.599
scratch the surface of what this patient feels like. And
412
00:19:25.599 --> 00:19:27.359
then you get out in the gym and you start moving,
413
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and then they start talking and then they start sharing.
414
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So I think the more that we can just kind
415
00:19:32.880 --> 00:19:35.240
of develop rapport in a very casual way, in a
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00:19:35.279 --> 00:19:38.559
non forced way, and let people tell us their story
417
00:19:38.960 --> 00:19:41.319
kind of within the timeframe that feels comfortable to them.
418
00:19:41.559 --> 00:19:43.039
And again, a lot of times it is when we're
419
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exploring movement and they'll bring something up and we'll just
420
00:19:45.640 --> 00:19:47.519
kind of talk more about that as we're going through
421
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the rest of the.
422
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Session, and I think that's very true.
423
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For the cognitive side of it as well, Like you'll
424
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start to hear things where you realize, oh the way
425
00:19:55.759 --> 00:19:58.000
they said that, I can tell they're still scared, or
426
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oh the way they brought that up. I can tell
427
00:19:59.759 --> 00:20:01.920
this important to them, But the look on their face,
428
00:20:01.960 --> 00:20:03.880
they are not ready to be there. And I think
429
00:20:03.920 --> 00:20:07.079
as clinicians we have to be very masterful at collecting
430
00:20:07.119 --> 00:20:12.359
those data points and seeing their subjective reactions and responses
431
00:20:12.359 --> 00:20:15.240
to things, and understanding how that can paint a picture
432
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of their confidence level.
433
00:20:16.359 --> 00:20:16.960
Absolutely.
434
00:20:17.720 --> 00:20:20.960
I also really enjoy simply asking people, especially as we
435
00:20:21.000 --> 00:20:23.640
get to know each other better, zero two one hundred percent,
436
00:20:24.279 --> 00:20:26.119
how confident do you feel to get back to where
437
00:20:26.160 --> 00:20:28.400
you want to be right now? Zero two one hundred percent?
438
00:20:28.440 --> 00:20:30.440
How ready do you feel for what you want to do?
439
00:20:30.680 --> 00:20:33.559
Zero two one hundred percent? How positive do you feel
440
00:20:33.599 --> 00:20:35.960
about how your rehab is going? And I'll get those
441
00:20:36.039 --> 00:20:39.279
I'll ask those questions a lot throughout our entire process together.
442
00:20:39.400 --> 00:20:42.359
And I'll also say, okay, you said eighty percent, what
443
00:20:42.440 --> 00:20:44.240
do you think are some things that'll make you close
444
00:20:44.279 --> 00:20:46.640
that gap from eighty two one hundred and A lot
445
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of it is just being curious about the person because
446
00:20:49.559 --> 00:20:52.359
I can assume things that I think will make somebody
447
00:20:52.359 --> 00:20:54.759
feel more confident. But I might be giving them the
448
00:20:54.759 --> 00:20:56.960
thing they're the most scared of, or I might be
449
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giving them something that they've never had an issue with
450
00:20:59.640 --> 00:21:02.039
and they sell at it and cool. I think they're ready,
451
00:21:02.319 --> 00:21:04.279
and now maybe they're not. So I think a lot
452
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of it is just having a little bit of the
453
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freedom to straight up to ask your client, Like I
454
00:21:08.480 --> 00:21:10.799
think we get scared of doing that sometimes because we
455
00:21:10.880 --> 00:21:13.599
have this idea that I need to have the answer
456
00:21:13.640 --> 00:21:16.720
and present it and rather than saying like, hey, what
457
00:21:16.759 --> 00:21:17.680
do you want to do today?
458
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Or hey, what are you still kind of worried about?
459
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Like what are things that I can do to make
460
00:21:22.599 --> 00:21:24.440
us see if we get less worried about them?
461
00:21:25.160 --> 00:21:25.359
Yeah.
462
00:21:25.480 --> 00:21:28.160
I keep thinking of the conversation that I've had with patients,
463
00:21:28.200 --> 00:21:30.720
like with their parents sitting right there, and they just.
464
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Like they don't open up at all.
465
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They're like, yeah, yeah, good, it hurts, And That's what
466
00:21:34.920 --> 00:21:36.759
I'm getting out of them for this objective, and then
467
00:21:36.880 --> 00:21:38.480
the parent kind of goes back up to the front
468
00:21:38.880 --> 00:21:40.599
that we get out on the turf, do some either
469
00:21:40.680 --> 00:21:43.240
warm up, some like objective testing, whatever it may be,
470
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and they're like, yeah, I can't do this, this and this.
471
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And I'm like, okay, that.
472
00:21:47.440 --> 00:21:50.319
Paints such a better picture to me versus like just
473
00:21:50.359 --> 00:21:52.720
having that like oversight of a parent. Especially those high
474
00:21:52.720 --> 00:21:55.599
school athletes, they just for some reason, they just don't
475
00:21:55.640 --> 00:21:57.920
love the parent being there. And I'm always hesitant to
476
00:21:58.160 --> 00:21:59.839
have the parent come back in the first place because
477
00:21:59.839 --> 00:22:01.759
I just know how it's going to go. And again,
478
00:22:01.799 --> 00:22:03.279
it's just one of those things that it's like you
479
00:22:03.279 --> 00:22:05.119
said that they really open up once you start to
480
00:22:05.440 --> 00:22:07.839
when they start to trust you, but they also don't
481
00:22:07.920 --> 00:22:10.359
have an oversight. So again another great point that I
482
00:22:10.359 --> 00:22:16.160
appreciate you you delineating anything else on this neuro cognitive piece.
483
00:22:16.440 --> 00:22:20.240
Are you trying to say a lacrosse player, are you
484
00:22:20.279 --> 00:22:22.559
getting a lacrosse stick in their hand early? Are you
485
00:22:23.359 --> 00:22:26.400
really hammering just strength strength, strength, and leaving like the
486
00:22:26.519 --> 00:22:30.039
lacrosse specific stuff to their sports specific coach or are
487
00:22:30.119 --> 00:22:32.799
you kind of blending the gap between those two in
488
00:22:32.839 --> 00:22:33.640
the rehab setting.
489
00:22:34.519 --> 00:22:37.319
Yeah, it kind of depends like if they're working with
490
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a more sports specific coach. And they are still getting
491
00:22:40.200 --> 00:22:42.599
on the field. Then the work that we do together
492
00:22:42.720 --> 00:22:44.519
is I want to give them what their sport doesn't
493
00:22:44.519 --> 00:22:46.279
give them, and I want to give them the things
494
00:22:46.279 --> 00:22:48.720
that maybe we've identified that are areas of opportunity that
495
00:22:48.759 --> 00:22:50.920
are most appropriate for us to work on. That could
496
00:22:50.920 --> 00:22:53.279
be from a strength perspective, it could be from a
497
00:22:53.359 --> 00:22:56.279
rhythm and a coordination, the timing perspective. It could be
498
00:22:56.359 --> 00:22:59.960
from a deceleration practice type of perspective.
499
00:23:00.079 --> 00:23:02.359
It could be plios, it could be speed.
500
00:23:02.400 --> 00:23:06.480
Like, there's so many things that can keep the sport
501
00:23:06.519 --> 00:23:09.440
on the field and keep us working on the big
502
00:23:09.519 --> 00:23:12.119
rocks that will translate to the field. So it really
503
00:23:12.200 --> 00:23:14.240
just depends, like there might be drilled down the line
504
00:23:14.240 --> 00:23:16.920
where we bring the lacrosse stick in to keep it
505
00:23:17.440 --> 00:23:20.200
fun for the person or if they are maybe missing
506
00:23:20.200 --> 00:23:21.920
their sport and wanting to make sure that they get
507
00:23:21.960 --> 00:23:24.319
exposure to it. But it really just depends like a
508
00:23:24.319 --> 00:23:26.680
lot of nowadays, you know, so many of these kids
509
00:23:26.759 --> 00:23:29.279
have a position coach and have somebody that they're working
510
00:23:29.279 --> 00:23:31.920
on very specific sport drills with. And I think a
511
00:23:31.920 --> 00:23:35.400
lot of what our job is just general athlete development
512
00:23:35.720 --> 00:23:40.319
psychologically and physiologically in ways that don't have to detract
513
00:23:40.319 --> 00:23:43.079
from what they're already doing on the field, and can
514
00:23:43.200 --> 00:23:45.000
complement the things for why they came here in the
515
00:23:45.000 --> 00:23:46.519
first place. Like, I think that's a lot of what
516
00:23:46.599 --> 00:23:49.839
our jobs can be, but it's still, you know, within
517
00:23:49.920 --> 00:23:51.799
all of that, I want to make it relevant, and
518
00:23:51.839 --> 00:23:53.279
I want to make it fun, and I want to
519
00:23:53.319 --> 00:23:57.240
make it something that I can explain and I can
520
00:23:57.279 --> 00:23:59.839
make clear why it's related back to things that they
521
00:23:59.880 --> 00:24:02.240
have goals with, because you know, a lot of things
522
00:24:02.279 --> 00:24:05.200
that we do seem obvious to us because we're like, yeah,
523
00:24:05.200 --> 00:24:06.359
if I get you better at this, then I know
524
00:24:06.400 --> 00:24:07.240
you're going to be better at that.
525
00:24:07.559 --> 00:24:10.400
But sometimes the client, especially a youth athlete, doesn't see
526
00:24:10.400 --> 00:24:10.920
that connection.
527
00:24:11.279 --> 00:24:13.599
So I do think we have to explain a little
528
00:24:13.599 --> 00:24:17.160
bit or maybe share a bit why the connection is there.
529
00:24:18.240 --> 00:24:21.960
I think most parents also expect that, you know, if
530
00:24:22.039 --> 00:24:25.400
my kid is a pitcher and they're in rehab, shouldn't
531
00:24:25.400 --> 00:24:27.599
they just be doing like weighted ball throws and things
532
00:24:27.599 --> 00:24:29.880
that look just like pitching. And I think part of
533
00:24:29.920 --> 00:24:32.519
our job too is the education piece of Like I'm
534
00:24:32.559 --> 00:24:35.599
here to make your athlete really really robust and resilient
535
00:24:35.640 --> 00:24:38.759
and well rounded and not add more to the thing
536
00:24:38.799 --> 00:24:40.519
that kind of brought them here in the first place.
537
00:24:41.160 --> 00:24:44.160
That's a delicate thing to navigate, but I think we're
538
00:24:44.480 --> 00:24:46.880
I think doing a lot more of the general preparedness
539
00:24:46.960 --> 00:24:49.319
is really what our wheelhouse should be for.
540
00:24:49.960 --> 00:24:51.400
Awesome, Katie, thank you so much.
541
00:24:52.119 --> 00:24:54.759
Do you have any concluding thoughts on the topics we
542
00:24:54.839 --> 00:24:58.880
covered today, anything else you want, like rehab professionals, coaches,
543
00:24:58.960 --> 00:25:02.359
strength coaches, whatever, maybe that they really should know after
544
00:25:02.559 --> 00:25:03.640
listening to this conversation.
545
00:25:04.720 --> 00:25:09.039
I think neuroscience and neurocognitive things can seem intimidating.
546
00:25:08.799 --> 00:25:10.880
And I don't want people to think that they have
547
00:25:10.960 --> 00:25:13.720
to have this extreme background in neuroscience to be a
548
00:25:13.759 --> 00:25:17.000
really good clinician. But I do think understanding some of
549
00:25:17.039 --> 00:25:20.400
the psychological side of things really impacts how well we
550
00:25:20.440 --> 00:25:23.240
can work with people, and it doesn't have to be
551
00:25:23.440 --> 00:25:27.759
this really difficult pursuit of studying all of these complex things.
552
00:25:28.119 --> 00:25:31.119
I think if you just really make your mission those
553
00:25:31.160 --> 00:25:35.640
two questions, am I impacting physiology? And am I impacting psychology?
554
00:25:36.079 --> 00:25:39.279
I think if you ask yourself those things every time
555
00:25:39.319 --> 00:25:42.880
you are about to interact with your client or create
556
00:25:42.920 --> 00:25:45.599
a program, or intervene in some way, I think it's
557
00:25:45.640 --> 00:25:48.359
really going to help set you up for success without
558
00:25:48.359 --> 00:25:50.960
necessarily having to have like expertise in neuroscience.
559
00:25:52.119 --> 00:25:53.839
Awesome, thank you very much for your time.
560
00:25:54.359 --> 00:25:55.440
Yeah, thank you,
1
00:00:00.080 --> 00:00:03.560
We're back. Strength and Knowledge is back. I'm John Allen
2
00:00:03.560 --> 00:00:06.440
and in this episode, doctor Katie Debrowski and I discuss
3
00:00:06.559 --> 00:00:11.519
all things neuroscience regarding patient outcomes and physical therapy. Specifically,
4
00:00:11.599 --> 00:00:15.000
we break down controllable factors that alter a patient's nervous system,
5
00:00:15.199 --> 00:00:19.120
how to approach difficult conversations, and why performance focus rehab
6
00:00:19.239 --> 00:00:22.800
leads to better outcomes. Without further ado, let's get into it.
7
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Doctor Katie Debrowski, aka co owner of Olible Athletics, aka
8
00:00:27.079 --> 00:00:29.879
professor of neuroscience and an absolute beast in the weight room,
9
00:00:30.039 --> 00:00:32.960
Welcome to the Strength and Knowledge podcast. Pain and rehab
10
00:00:33.039 --> 00:00:35.320
is a very polarizing topic, and it is also a
11
00:00:35.359 --> 00:00:37.600
topic you are very passionate about. So why don't you
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give us a brief introduction of yourself and where this
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passion comes from for pay neuroscience.
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Well, thanks for that introduction.
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I like that.
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Yeah, thanks for having me too. I'm happy to be here. Yeah,
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my background in neuroscience before I ever became a physical
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00:00:55.520 --> 00:00:58.759
therapist really set the stage I think for a lot
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of the things that I'm passionate about without I don't know,
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maybe quite knowing that it would get me to down
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the line become a physical therapist and intertwine it so
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much and what I do. But I think I've just
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always been passionate about this kind of intersection of human behavior,
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what our brains tell us to do, and how our
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body kind of exists in space, and just.
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All of that working together.
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And then, yeah, as I got kind of deeper in
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the rehab world, just really recognizing that pain is so
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much more than kind of just the initial thought of
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what we probably all had of it. Like if this
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you know, bad stimulus exists and we have pain, then
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the pain is our output and that's kind of the story.
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And as you know and as we all know, that's
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so it's just like scratching the surface of the story.
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And I think understanding how the brain and how we
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interact with our pain is really just what's going to
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set us up for success when helping people navigate it.
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Awesome.
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Yeah, that transitions nicely right into our first point is
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kind of like the initial like rehab set as a
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self like a lot of people think that the rehab
42
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setting can be threatening, can a lot of times change
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that perception of pain before the patient even walks into
44
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the room. So and also we know that like nervous
45
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systems produces pain as a protective output, not necessarily as
46
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a direct readout of like tissue damage. So my first
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00:02:17.199 --> 00:02:18.759
question to kick as all is kind of, how do
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you convince an athlete or an individual that, like the
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doctor Google isn't always right and then that pain doesn't
50
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always equal rest.
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That's a good one.
52
00:02:27.199 --> 00:02:30.479
Yeah, I think I'm even shying away more from thinking
53
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of it as convincing people at this point, because if
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we really think about it, the things that we believe
55
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in the strongest, nobody's going to convince us otherwise, especially
56
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when it's about our own bodies.
57
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So I kind of think of this pivot as.
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Considering it more of, you know, how can I create
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an environment that decreases this person's threat, or how can
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I create an environment that makes somebody maybe get out
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of their head a little bit for their pain, And
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how can I do that in a way that almost
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like artfully is curating an experience where they don't even
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know that they're slowly putting their walls down and they're
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slowly becoming a little bit more okay with feeling sensation
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or okay with being in the setting that we're being
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in and I think that can be more successful sometimes.
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I think a lot of our goal in helping a
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client understand their pain can often be just over educating
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and talking at a person who when you're in a
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lot of pain, or you've been in pain for a
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long time, it can feel dismissive to be given a
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lecture about it or how it's.
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Not what they think it is, you know.
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And I think over the years, I've kind of transformed
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the way that I broach that subject, and I make
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it much more about creating an experience in an environment
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that bit by bit starts to maybe at over time,
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reshape this person's thought of what pain is, what movement is,
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is movement dangerous or not? Or is pain always tissue damage?
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Or is pain always harm? And I think that has
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a lot to do with the confidence of the practitioner
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00:04:03.039 --> 00:04:06.400
as well as just the ability to communicate really clearly
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and directly. So it's stuff that I'm continually getting better at.
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I like to create an environment that's fun and a
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little bit silly and maybe doesn't take ourselves too seriously
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to kind of decrease that baseline level of threat. You know,
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if I'm staring intently at a client a second, they
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start moving and assessing them and making them feel like
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they're just one X mark on my clipboard away from
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doing something so wrong that we have to stop. If
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I can create an environment that's maybe not that aggressive,
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I think that helps a lot. So I think it's
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a lot about like getting to know the person in
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front of you, understanding what makes them tick, Understanding that
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it's probably not just their pain that brings them here,
97
00:04:48.279 --> 00:04:51.079
and it's probably also like the piece of their identity
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that they feel detached from because of their pain. And
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I think if I could start to unwind that, I'm
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going to get to know the person better and probably
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be able to meet them where they're at a little
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bit more.
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I think the subjective on your words, like you're kind
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of hitting on the point of like it should be
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used to build the rapport, build the relationship, find, like
106
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you said, find what they tick. As opposed to overqueuing
107
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overemphasizing perfect mechanics. Is there's no such thing as perfect mechanics.
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We know that there's always going to be some sort
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of compensations, and that's okay at the end of the day.
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But again, what's going to get people coming back, What's
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going to get them out the door for successful discharges.
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Is that relationship that you've built the comfortability with with
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the PT as well as the patient, and just that
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kind of that just has gone does very good with
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outcomes as well as just patient outcomes as well. When
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we discuss like pushing through like pain on the field
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versus like in the clinic, do you have any like
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tidbits on the kind of like where that fine line
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is whether we can continue to play through like kind
120
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of like maybe just a nagging injury versus like, Okay,
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we need to take a step back from from actually
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playing and take a few weeks off.
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Yeah, this is where it's It's obviously so dependent on
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the situation and if there are certain timelines that we
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have for somebody, you know, an athlete who is about
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to get drafted or recruited is a very different example
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than a fifty year old person coming into the clinic
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who doesn't necessarily have a timeline that's maybe dependent upon
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how much money they're going to make next year, where
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they're going to go to school.
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And I think that nuance is always important.
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We might have more leeway for somebody who kind of
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just has to get to where they need to go
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for their livelihood being on the line, or we might
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have really different considerations for somebody who because of how
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their pain is, it's really impacting their ability to go
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to work. Like all of those things really matter a lot,
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and there's a dramatic difference between how we would handle
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probably all of those situations. I think as a very
140
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general blanket idea that obviously this is a sweeping generalization
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and not the case for every case whatsoever. But when
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it comes to discomfort, the way I try to talk
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about it with a client, you know, if you have
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pain that is sharp, shoe intense, kind of stops you
145
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in your tracks, makes you change your facial expression, makes
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you really change, like how your body is moving in space,
147
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I'd say that's worth looking at and maybe revisiting what
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we're doing, or downshifting some things, or modifying things, or
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removing certain stressors and adding different ones that are maybe
150
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a little bit more tolerable. That's usually kind of some
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guidance I'll give. Or if pain continues to get worse
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the more you do, so if every rep that you do,
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or with every step that you take, or whatever activity
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you're doing, you notice that your pain is increasing, increasing, increasing,
155
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I'd say that's also probably time for us to go
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back to.
157
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The drawing board.
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When we have pain that tends to feel a little
159
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bit better, the more that we move prognostically, we see
160
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that as a good thing. We see that as, oh,
161
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your body's really responding to blood flow and contraction and
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all of that awesome stuff. And if it's getting more irritated,
163
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then that probably tells us that we need to maybe
164
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reevaluate what we're doing. If pain persists for like twenty
165
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four hours or more after the initial event that you
166
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think was related to your pain in the first place, again,
167
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probably something for us to revisit. It's really hard to
168
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give a perfect answer, but those are some parameters that
169
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I typically use with my clients.
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And we're going to kind of backtrack a little bit on, like,
171
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before the patient even comes into your clinic, what are
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some things that you're doing, either through social media, through
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the way the clinic is set up, through the way
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you've either the online scheduling link, whatever it may be,
175
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that you're kind of already kind of building this rapport,
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building this mindset that hey, we're here to train, we're
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not here this isn't supposed to be a doctor's office,
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isn't something that you're required to do, and can just
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talk touch on those points of kind of how you
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shape this perception before the patient even walks into the clinic.
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Yeah, I like that question too, because I do think
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a lot of people struggle with sometimes the Okay, I'm
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trying to really make it clear that this is the
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way that I treat and I'm here to help and
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not tell somebody to just like immediately stop. I'm here
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to have an active treatment process, not necessarily only laying
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on the table, And sometimes if we don't make that
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messaging clear, it can be even harder for the client
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to understand what you're trying to get at with them.
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So I think, yeah, social media is a great tool.
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You know.
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Our messaging for Old Bull and myself is very clear
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that we're very movement based. We're very activity based, and
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our goal is to get people back to where they
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were and even beyond where they were. We try to
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be careful in our messaging to not always link it
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to fixing people and making them one hundred percent pain
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free and things that I think can conflate the rehab
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process and make people think that oh, if I still
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have discomfort, I must still be broken, and or that
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they think they're broken and fragile at all. Like we
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really want to try to get ahead of that messaging,
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so social media plays a big role with that. As
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soon as you walk in our gym, you can kind
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of see pretty clearly that it's not what you might.
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Expect when you go to a physical therapist.
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When you see a kettlebell that goes up to a
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towns and huge spot racks and there's loud rap music
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playing and everybody's having a good time, people are sprinting
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on the turf, I think you can kind of get
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that picture that we're a little bit different too. And
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then also I think just like telling people in your
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first evaluation or even if they're inquiring, like making it
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really clear and setting the stage of we do things
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a little bit differently.
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We're very movement based, and when.
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You walk in, you'll feel that like our goal is
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to not do things to you to temporarily maybe calm
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things down, but to work together to create a plan
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that starts to look like the demands of what you
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came in the first place unable to do.
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I think the more that we explain that.
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And setting the stage in your initial evaluation with somebody
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is an excellent strategy to kind of get people, oh, Okay.
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This is what we're about here. I'm here to work.
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This is going to be a different experience than maybe
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I thought.
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Yeah. I think around to a lot of times when
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I'm talking to either like high school athletes, high school
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coaches in the area that like, there's this misconception of
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physical it's trying to take you out of your sport,
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and a lot of I guess my question is, like,
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what do you think physical therapists and strength coaches and
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all of them can do better to kind of change
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the narrative and change this misconception that hey, the rehab
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people are trying to keep you out of your sport
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as long as possible. They're just trying to make money
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off of you. I can gain any tips on how
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to change this narrative For the field in general.
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I think first and foremost, we have to work together better.
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I think that in so many places, and especially in
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places when you would hope that it wouldn't be this divided.
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But as you look higher and higher up at collegiate
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sports and professional sports, you see a really big disconnect
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where the pts and the rehab staff are on one
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side and they and the strength coaches are on the other,
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and there's not a lot of communication, or maybe there
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is a little bit of ego on both sides, and
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nobody kind of wants to work together because each group
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believes that what they say is right. And I just
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think there needs to be more interdisciplinary communication and understanding
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of what the other profession does and does not do,
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or knows and does not know. A physical therapist unless
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they have sought other training or they came from this
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background in the first place, unfortunately doesn't actually really know
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periodization and program design. I think that's a flaw, but
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that's the reality. So I think if as physical therapist,
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we need to accept the fact that strength coaches know
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a lot more about things in this area than we do,
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and we need to seek to learn from them, and
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we need to understand why knowing periodization and program design
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is one hundred percent necessary to be a good rehab provider.
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I think there's this big disconnect.
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And then similarly from strength coaches to rehab providers, I
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think strength coaches need to also learn some maybe regressions
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or modifications or things that maybe don't fully take somebody
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out of their sport, but learning a little bit more
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how to level up and level down something instead of
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kind of going hard all of the time, Like that
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might be the perception of the weight room, and that
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might be the perception that the strength coach feels they
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have to keep up with, whereas a lot more of
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it could be working together andunderstanding the strengths that each
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of our groups bring. I think most issues come from
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lack of communication in life and relationships everywhere, but especially
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professionally when it comes to rehabbing an athlete. I think
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there's also, unfortunately still just a huge misunderstanding of what
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tissues need to get better. And it's not resting them,
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and it's not poking and prodding at them, there's no
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physiological change happening. So I also think that's a huge
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area of opportunity of like genuinely understanding principles of exercise physiology,
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what tissues respond to, how they improve, and how they
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only maybe temporarily feel better, and why that temporary feel
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good stuff isn't going to ultimately determine an athlete's success.
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And that brings you right into another point that I
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was trying to hit on and looking for your insight
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on is when rehab looks like ice and stem, but
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then like the return to sport process is chaotic and unpredictable,
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like there's clearly not going to be successful return Like
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the rehab didn't make the demands of the actual return
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to sport. So does to talk about a little about
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how like your rehabbing and how the obal athletics and
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all that kind of stuff prepares an athlete better to
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return to sport much more than like the ice and
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stem and let's sit on the.
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Table for forty five minutes to an hour.
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Yeah.
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I mean the way I think of it is kind
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of every time I'm doing something with a client and
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every time i'm you know, working with team members when
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they're working with clients, I always tell people like, I
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want you to ask yourself two questions. Is my intervention
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actually changing this person's physiology so we get are we
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doing enough to get an adaptation? And is my intervention
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also impacting their psychology? Are they becoming more comfortable? Are
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they becoming less fearful? Are they increasing their confidence? Are
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they learning that they can do something that maybe they thought.
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Was off limits.
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If the answer is no to either or both of
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those things, I'm not doing it and it's not appropriate
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and it's not going to move the needle. So if
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you ask that about ice, I think that gives you
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an answer pretty quickly.
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Physiologically, nothing is happening. We are not changed any tissue.
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We are not doing anything that's producing a long term change.
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And psychologically, similarly, I'm probably giving this person a bit
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of a crutch or a bit of a thing that
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maybe they get in their head thinking they need.
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I'm not building their confidence at all.
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I'm also not doing something that's putting them in an
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environment that's going to start to look like what they
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have to get back to on the field. So if
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I ask those two questions and the answer is no,
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I'm pretty quick to change whatever I might think that
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I'm doing, or I would encourage anybody to change what
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they think they're doing. We need to impart enough of
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a stimulus for muscles and tissues and bones and ligaments
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and tendons to change, and nervous system tissue. Like absolutely,
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if we don't have enough of a stimulus, we are
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keeping somebody where they're already at or further detraining them.
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Which is a huge issue and rehab because.
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Very often we get an athlete with a leg injury
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and they're told to just shut everything down.
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They have another leg, and they have two arms, and
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they have a core. So how are we.
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Getting people not only they're injured limb deconditioned, but the
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rest of their.
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Body deconditioned, And that's a huge problem. I think.
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I think we should always be searching for what are
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the things that I can do with the fullest intent
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possible that have nothing to do with this injury, and
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making sure that I'm still doing them so we're not
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getting big, like wide swept detraining as well.
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Do you approach like objective testing the same way as
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like kind of like what am I testing? Will this
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actually change anything I'm doing in rehab? Yeah?
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Absolutely?
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I think I think we're in an era where data
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is king every single person we work with, where it's
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like twelve wearables and tracks their sleep and tracks every
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contraction they take. And I think data is helpful, but
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I also think too much data is noisy, And I
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think if we're testing selection, if we're selecting tests, we
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have to make sure we're measuring what we care about
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we're measuring something that is actually representative of the thing
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we're saying it is, and if it's testable and if
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the change in the number actually means anything. So that's
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where using tests that are validated in the literature is huge.
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Something that a.
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Mentor of mine and somebody I've just always loved to
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work with and teach with, Craig Leebinson, always said, is
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have your patient show you their test. And while the argument,
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of course can be like, well, there's not evidence based,
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we don't know the reliability and validity of course, but
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at the end of the day, if there's something very
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specific that your patient has a hard time with, I
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should probably know I should probably see what it looks
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like now, and I should probably see what it looks
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like in the future when maybe we've improved some things.
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So I think a mixture of objective testing that is
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well validated that tests the thing that you hope it does,
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as well as doing things that are actually tied directly
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back to your patient's goals and testing those things are
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also incredibly important if you are determining things that you
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want to test. This also might just take some research
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on your end. So if there's something a client wants
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to improve upon, I might have to find a way
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to test that, or I mighte to find a way
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to do that in my clinic, but it ultimately should
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blink back to what this person cares about.
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Yeah, I think the weight room is a great opportunity
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to test every session, like you're you're getting that objective
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test kind of like your mentor said, is like if
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they're having a hard time squatting, let's have them squat
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in a way that they will be successful. And if
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they're not successful, that's an objective test right there, they
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clearly are either offloading the knee, compensating at the hips,
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whatever it may be like that, that's an objective test,
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whether it's an actual number to it or just like
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the subjective and visual like that, that gives us insight
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on what we need to improve on with our rehab program.
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So another another great point and one.
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Final point that I want to talk about we kind
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of already hit on a little bit, is like that
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neurocognitive piece of rehab, like the confidence in movements, the
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confidence in returning to sport. I don't know if you
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want to touch on like how early you're getting into
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like this neuro cognitive demand of rehab how often and
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then kind of like the volume.
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Of it throughout this rehab process.
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I think kind of similarly to what I was speaking
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about earlier, with rather been making it like a very
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clear lecture that I'm giving or a conversation that I'm starting,
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like I want to talk to you today about the
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cognitive impacts of rehab, I'm kind of interweaving it with
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the experience that I'm creating and with the space that
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I'm creating for somebody to share their story. And you
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know a lot of times that I'm sure you can
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relate to this. You'll be taking a history and asking
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all the right questions and kind of just starting to
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scratch the surface of what this patient feels like. And
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then you get out in the gym and you start moving,
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and then they start talking and then they start sharing.
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So I think the more that we can just kind
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of develop rapport in a very casual way, in a
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non forced way, and let people tell us their story
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kind of within the timeframe that feels comfortable to them.
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And again, a lot of times it is when we're
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exploring movement and they'll bring something up and we'll just
420
00:19:45.640 --> 00:19:47.519
kind of talk more about that as we're going through
421
00:19:47.559 --> 00:19:48.160
the rest of the.
422
00:19:48.119 --> 00:19:50.480
Session, and I think that's very true.
423
00:19:50.319 --> 00:19:52.680
For the cognitive side of it as well, Like you'll
424
00:19:52.680 --> 00:19:55.759
start to hear things where you realize, oh the way
425
00:19:55.759 --> 00:19:58.000
they said that, I can tell they're still scared, or
426
00:19:58.200 --> 00:19:59.759
oh the way they brought that up. I can tell
427
00:19:59.759 --> 00:20:01.920
this important to them, But the look on their face,
428
00:20:01.960 --> 00:20:03.880
they are not ready to be there. And I think
429
00:20:03.920 --> 00:20:07.079
as clinicians we have to be very masterful at collecting
430
00:20:07.119 --> 00:20:12.359
those data points and seeing their subjective reactions and responses
431
00:20:12.359 --> 00:20:15.240
to things, and understanding how that can paint a picture
432
00:20:15.240 --> 00:20:16.319
of their confidence level.
433
00:20:16.359 --> 00:20:16.960
Absolutely.
434
00:20:17.720 --> 00:20:20.960
I also really enjoy simply asking people, especially as we
435
00:20:21.000 --> 00:20:23.640
get to know each other better, zero two one hundred percent,
436
00:20:24.279 --> 00:20:26.119
how confident do you feel to get back to where
437
00:20:26.160 --> 00:20:28.400
you want to be right now? Zero two one hundred percent?
438
00:20:28.440 --> 00:20:30.440
How ready do you feel for what you want to do?
439
00:20:30.680 --> 00:20:33.559
Zero two one hundred percent? How positive do you feel
440
00:20:33.599 --> 00:20:35.960
about how your rehab is going? And I'll get those
441
00:20:36.039 --> 00:20:39.279
I'll ask those questions a lot throughout our entire process together.
442
00:20:39.400 --> 00:20:42.359
And I'll also say, okay, you said eighty percent, what
443
00:20:42.440 --> 00:20:44.240
do you think are some things that'll make you close
444
00:20:44.279 --> 00:20:46.640
that gap from eighty two one hundred and A lot
445
00:20:46.680 --> 00:20:49.519
of it is just being curious about the person because
446
00:20:49.559 --> 00:20:52.359
I can assume things that I think will make somebody
447
00:20:52.359 --> 00:20:54.759
feel more confident. But I might be giving them the
448
00:20:54.759 --> 00:20:56.960
thing they're the most scared of, or I might be
449
00:20:56.960 --> 00:20:59.359
giving them something that they've never had an issue with
450
00:20:59.640 --> 00:21:02.039
and they sell at it and cool. I think they're ready,
451
00:21:02.319 --> 00:21:04.279
and now maybe they're not. So I think a lot
452
00:21:04.279 --> 00:21:05.880
of it is just having a little bit of the
453
00:21:05.960 --> 00:21:08.480
freedom to straight up to ask your client, Like I
454
00:21:08.480 --> 00:21:10.799
think we get scared of doing that sometimes because we
455
00:21:10.880 --> 00:21:13.599
have this idea that I need to have the answer
456
00:21:13.640 --> 00:21:16.720
and present it and rather than saying like, hey, what
457
00:21:16.759 --> 00:21:17.680
do you want to do today?
458
00:21:17.920 --> 00:21:19.880
Or hey, what are you still kind of worried about?
459
00:21:19.880 --> 00:21:22.519
Like what are things that I can do to make
460
00:21:22.599 --> 00:21:24.440
us see if we get less worried about them?
461
00:21:25.160 --> 00:21:25.359
Yeah.
462
00:21:25.480 --> 00:21:28.160
I keep thinking of the conversation that I've had with patients,
463
00:21:28.200 --> 00:21:30.720
like with their parents sitting right there, and they just.
464
00:21:30.640 --> 00:21:32.400
Like they don't open up at all.
465
00:21:32.440 --> 00:21:34.920
They're like, yeah, yeah, good, it hurts, And That's what
466
00:21:34.920 --> 00:21:36.759
I'm getting out of them for this objective, and then
467
00:21:36.880 --> 00:21:38.480
the parent kind of goes back up to the front
468
00:21:38.880 --> 00:21:40.599
that we get out on the turf, do some either
469
00:21:40.680 --> 00:21:43.240
warm up, some like objective testing, whatever it may be,
470
00:21:43.319 --> 00:21:45.720
and they're like, yeah, I can't do this, this and this.
471
00:21:45.640 --> 00:21:46.920
And I'm like, okay, that.
472
00:21:47.440 --> 00:21:50.319
Paints such a better picture to me versus like just
473
00:21:50.359 --> 00:21:52.720
having that like oversight of a parent. Especially those high
474
00:21:52.720 --> 00:21:55.599
school athletes, they just for some reason, they just don't
475
00:21:55.640 --> 00:21:57.920
love the parent being there. And I'm always hesitant to
476
00:21:58.160 --> 00:21:59.839
have the parent come back in the first place because
477
00:21:59.839 --> 00:22:01.759
I just know how it's going to go. And again,
478
00:22:01.799 --> 00:22:03.279
it's just one of those things that it's like you
479
00:22:03.279 --> 00:22:05.119
said that they really open up once you start to
480
00:22:05.440 --> 00:22:07.839
when they start to trust you, but they also don't
481
00:22:07.920 --> 00:22:10.359
have an oversight. So again another great point that I
482
00:22:10.359 --> 00:22:16.160
appreciate you you delineating anything else on this neuro cognitive piece.
483
00:22:16.440 --> 00:22:20.240
Are you trying to say a lacrosse player, are you
484
00:22:20.279 --> 00:22:22.559
getting a lacrosse stick in their hand early? Are you
485
00:22:23.359 --> 00:22:26.400
really hammering just strength strength, strength, and leaving like the
486
00:22:26.519 --> 00:22:30.039
lacrosse specific stuff to their sports specific coach or are
487
00:22:30.119 --> 00:22:32.799
you kind of blending the gap between those two in
488
00:22:32.839 --> 00:22:33.640
the rehab setting.
489
00:22:34.519 --> 00:22:37.319
Yeah, it kind of depends like if they're working with
490
00:22:37.440 --> 00:22:40.200
a more sports specific coach. And they are still getting
491
00:22:40.200 --> 00:22:42.599
on the field. Then the work that we do together
492
00:22:42.720 --> 00:22:44.519
is I want to give them what their sport doesn't
493
00:22:44.519 --> 00:22:46.279
give them, and I want to give them the things
494
00:22:46.279 --> 00:22:48.720
that maybe we've identified that are areas of opportunity that
495
00:22:48.759 --> 00:22:50.920
are most appropriate for us to work on. That could
496
00:22:50.920 --> 00:22:53.279
be from a strength perspective, it could be from a
497
00:22:53.359 --> 00:22:56.279
rhythm and a coordination, the timing perspective. It could be
498
00:22:56.359 --> 00:22:59.960
from a deceleration practice type of perspective.
499
00:23:00.079 --> 00:23:02.359
It could be plios, it could be speed.
500
00:23:02.400 --> 00:23:06.480
Like, there's so many things that can keep the sport
501
00:23:06.519 --> 00:23:09.440
on the field and keep us working on the big
502
00:23:09.519 --> 00:23:12.119
rocks that will translate to the field. So it really
503
00:23:12.200 --> 00:23:14.240
just depends, like there might be drilled down the line
504
00:23:14.240 --> 00:23:16.920
where we bring the lacrosse stick in to keep it
505
00:23:17.440 --> 00:23:20.200
fun for the person or if they are maybe missing
506
00:23:20.200 --> 00:23:21.920
their sport and wanting to make sure that they get
507
00:23:21.960 --> 00:23:24.319
exposure to it. But it really just depends like a
508
00:23:24.319 --> 00:23:26.680
lot of nowadays, you know, so many of these kids
509
00:23:26.759 --> 00:23:29.279
have a position coach and have somebody that they're working
510
00:23:29.279 --> 00:23:31.920
on very specific sport drills with. And I think a
511
00:23:31.920 --> 00:23:35.400
lot of what our job is just general athlete development
512
00:23:35.720 --> 00:23:40.319
psychologically and physiologically in ways that don't have to detract
513
00:23:40.319 --> 00:23:43.079
from what they're already doing on the field, and can
514
00:23:43.200 --> 00:23:45.000
complement the things for why they came here in the
515
00:23:45.000 --> 00:23:46.519
first place. Like, I think that's a lot of what
516
00:23:46.599 --> 00:23:49.839
our jobs can be, but it's still, you know, within
517
00:23:49.920 --> 00:23:51.799
all of that, I want to make it relevant, and
518
00:23:51.839 --> 00:23:53.279
I want to make it fun, and I want to
519
00:23:53.319 --> 00:23:57.240
make it something that I can explain and I can
520
00:23:57.279 --> 00:23:59.839
make clear why it's related back to things that they
521
00:23:59.880 --> 00:24:02.240
have goals with, because you know, a lot of things
522
00:24:02.279 --> 00:24:05.200
that we do seem obvious to us because we're like, yeah,
523
00:24:05.200 --> 00:24:06.359
if I get you better at this, then I know
524
00:24:06.400 --> 00:24:07.240
you're going to be better at that.
525
00:24:07.559 --> 00:24:10.400
But sometimes the client, especially a youth athlete, doesn't see
526
00:24:10.400 --> 00:24:10.920
that connection.
527
00:24:11.279 --> 00:24:13.599
So I do think we have to explain a little
528
00:24:13.599 --> 00:24:17.160
bit or maybe share a bit why the connection is there.
529
00:24:18.240 --> 00:24:21.960
I think most parents also expect that, you know, if
530
00:24:22.039 --> 00:24:25.400
my kid is a pitcher and they're in rehab, shouldn't
531
00:24:25.400 --> 00:24:27.599
they just be doing like weighted ball throws and things
532
00:24:27.599 --> 00:24:29.880
that look just like pitching. And I think part of
533
00:24:29.920 --> 00:24:32.519
our job too is the education piece of Like I'm
534
00:24:32.559 --> 00:24:35.599
here to make your athlete really really robust and resilient
535
00:24:35.640 --> 00:24:38.759
and well rounded and not add more to the thing
536
00:24:38.799 --> 00:24:40.519
that kind of brought them here in the first place.
537
00:24:41.160 --> 00:24:44.160
That's a delicate thing to navigate, but I think we're
538
00:24:44.480 --> 00:24:46.880
I think doing a lot more of the general preparedness
539
00:24:46.960 --> 00:24:49.319
is really what our wheelhouse should be for.
540
00:24:49.960 --> 00:24:51.400
Awesome, Katie, thank you so much.
541
00:24:52.119 --> 00:24:54.759
Do you have any concluding thoughts on the topics we
542
00:24:54.839 --> 00:24:58.880
covered today, anything else you want, like rehab professionals, coaches,
543
00:24:58.960 --> 00:25:02.359
strength coaches, whatever, maybe that they really should know after
544
00:25:02.559 --> 00:25:03.640
listening to this conversation.
545
00:25:04.720 --> 00:25:09.039
I think neuroscience and neurocognitive things can seem intimidating.
546
00:25:08.799 --> 00:25:10.880
And I don't want people to think that they have
547
00:25:10.960 --> 00:25:13.720
to have this extreme background in neuroscience to be a
548
00:25:13.759 --> 00:25:17.000
really good clinician. But I do think understanding some of
549
00:25:17.039 --> 00:25:20.400
the psychological side of things really impacts how well we
550
00:25:20.440 --> 00:25:23.240
can work with people, and it doesn't have to be
551
00:25:23.440 --> 00:25:27.759
this really difficult pursuit of studying all of these complex things.
552
00:25:28.119 --> 00:25:31.119
I think if you just really make your mission those
553
00:25:31.160 --> 00:25:35.640
two questions, am I impacting physiology? And am I impacting psychology?
554
00:25:36.079 --> 00:25:39.279
I think if you ask yourself those things every time
555
00:25:39.319 --> 00:25:42.880
you are about to interact with your client or create
556
00:25:42.920 --> 00:25:45.599
a program, or intervene in some way, I think it's
557
00:25:45.640 --> 00:25:48.359
really going to help set you up for success without
558
00:25:48.359 --> 00:25:50.960
necessarily having to have like expertise in neuroscience.
559
00:25:52.119 --> 00:25:53.839
Awesome, thank you very much for your time.
560
00:25:54.359 --> 00:25:55.440
Yeah, thank you,
