When Patients Aren't Getting Better, What Do You Do?

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Every day you essentially pay your dues by doing the harder thing when it's the right thing to do.
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You have an iconic radio voice on the next episode.
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But back in action.
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Um I actually have something important to say, and it's slipping my mind right now.
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But oh um I looked at the stats at the uh the last three episodes, and there's like a large amount of people who are starting to turn in like week to week.
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So I think the topics are useful.
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It was like uh a slow burn.
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It was like for a while, I think when we started, it was maybe like one or two that people do, but now it's consistently, I would say it's up there.
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It's up there like week to week.
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So um, yeah, I don't know.
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I we just keep randomly picking topics that I think we think are important.
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I don't know, is that right?
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So um if people do want specific topics, I think they should just like email us.
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So support at shift movement science.com.
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It's like an email address that I think takes all the uh incoming stuff.
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So yeah, feel free to message us because I'm definitely on a break from social media right now.
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So that's been wonderful.
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Cool.
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Yep, cool.
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It's really early for us, by the way, people that are uh listening.
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We uh usually record in the afternoon, but we're doing a very early morning grind.
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So I have quite a bit of caffeine next to me for the next two hours before I do more.
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But um, okay, so this first episode actually stemmed from me uh thinking uh there was a week in the clinic where we are treating a lot of ACLs, knees, ACLs, meniscus, uh, patellar tendon repairs.
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And um, we had a bit of a frustr, frustrating, unfortunate, I don't want to say a week, where three different clients from three different therapists had like some scares.
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So a girl that I treated for her second ACL went back at 11 months and literally cleared like every test you could possibly throw at this girl.
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And then she unfortunately got hit from behind while she was battling for a ball and felt like a uh a spook in her knee.
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And we definitely felt the worst of the situation that she retore her graft.
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But um, yeah, so for like 48 hours I was going through it where I was like really, you know, frustrated.
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I was kind of like going back through my notes about like, god damn, like what did we possibly miss?
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Her LSI was great, blah, blah, blah, yeah, yeah.
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Turns out she has a bone bruise and uh like a mild meniscus irritation.
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She didn't actually have a retail, which is great.
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But the same week, um, one of two other therapists at the clinic um had um also similar scares, a basketball player who thought she might have torn her ACL, re-tore her graft, another one who thought they maybe hit her meniscus uh retail or something like that.
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So it led me down this rabbit hole with Kevin actually.
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I was talking about like there's the side of PT, which I think when you're really like kind of hardcore PT, where you're trying to really learn a lot, help a lot of people, you take your job really seriously, you tend to carry some of the heavier cases with you when something doesn't go well or someone's not getting better.
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I think as new grads, this was me, and I'd love to hear your thoughts is that if someone didn't get better, I felt it was like a personal assault on my intelligence level and that like I was a bad PT because somebody wasn't getting better.
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Um, when unfortunately there are so many variables with injuries and with humans.
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Humans are complex and are challenging.
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So yeah, this this podcast came from me reflecting on like, you know, earlier years when I really used to take some of those things heavy when somebody wasn't getting better or somebody got reinjured or something happened.
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It's like, it's my fault.
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I did something wrong, I missed something.
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And there's definitely maybe a role to play on self-reflection, of course, but there's also a role to think about like all right, like what is a checklist of things I can go through to make sure that if someone's not getting better, um, what what can we do to kind of help this person, you know?
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I don't know.
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Did you have that experience when you were younger?
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Yeah, definitely.
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I feel like I've actually just now in the last like year or so been getting to the point where I I feel like I've been doing a little bit better with some of those things where I'm not putting it all in myself and and blaming myself for everything that's going wrong.
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Um, and I think that's come with like mentoring the new PTs that I have now.
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And when they're feeling that way, I'm kind of mentoring to them.
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Like this is not just like on you.
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Like, you need to make sure that you're checking all of your boxes, but a lot is also on the patient and making sure that they're doing what they're supposed to be doing too.
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Because I feel like a lot of the patients that I have that are having like poor outcomes are usually because they're not they're not showing up to PT or they're not doing their home exercises like they're supposed to, they're not stretching enough, something like that.
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Um, so from that standpoint where they're maybe having poor outcomes for different reasons rather than like maybe a re-injury.
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Um, I definitely used to feel like this is my fault, or like I wasn't educating them enough or giving them enough resources to do well.
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Um, and so I feel like as I've gotten a little bit like older in my practice, I've started to put a little bit less of that on my shoulders.
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Yeah.
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And then just in general, like with re-injuries and stuff, there's just always that risk of re-injury, especially in contact sports, you can't control everything.
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So trying to appreciate that as well when you're like returning someone back to sport.
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But I feel like for the the biggest thing, and this is what I always like tell like my other PTs, is like you need to make sure that you have done everything you felt like you could do before clearing them so that if they did get reinjured, you wouldn't come back to yourself and be like, Oh, should I have done that?
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Because did I test this or did I test that?
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Yep.
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Yeah, I think I it is a good um, I guess, base to start from, which is that when something like either happens where someone's not getting better or there is maybe a reinjury, the first thing I think a good therapist should do is have self-reflection for sure.
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So if somebody has like uh multiple thoughts of diagnosis in their head of like maybe it's a slap, maybe it's a cuffed hair, maybe it's a a joint strain or something like that, or like an instability event, is that maybe your initial thoughts of this being a cuff issue is actually not as much the case you thought.
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It's more of like a laboral issue.
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And it's like, okay, like what else do we need to do to pivot these things?
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And so I do think it's important to think about like what are other diagnoses things you've done, or like maybe your prescription of exercise is uh, you know, not accurate.
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I think sometimes like tendons or ligaments, a guilty mistake that I used to make is I think I underappreciated how long it takes ligaments and tendons to truly calm down after a really big flare-up.
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And so if you treat somebody for like acute back pain and you're able to give them stuff like Mackenzie stuff and core stuff and modify their daily life, sometimes people will feel sub significantly better in like two to four days, right?
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Just like getting out of the initial flare of.
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But if somebody strains a leg ligament or has like a really gnarly MCL, you know, strain, that is going to take weeks to calm down, even if they're doing everything right.
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And I think me, unfortunately, I would say, okay, we're ready to progress now because things are a little bit better.
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And I would kind of go over dosage, whereas sometimes people just need, you know, a bit of time.
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You know, you just need like a let's let's give you a handful of exercises to do, but then let's touch base in like two weeks, you know, like text me here and there, let's do your daily life stuff.
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As long as you're getting slowly better, you don't need to be in here every single time, every single moment doing it.
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So I do want to say that self-reflection is probably important.
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And and also, too, is you should lean on your coworkers for just outside opinions for sure.
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Because, you know, Mike and Lenny obviously are very seasoned, they've seen a lot.
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So sometimes like something scratches my head and I'm like treating somebody for an elbow thing, and I'm like, I don't know if I'm like getting this totally right.
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And just like a fresh set of eyes, um, Mike and Lenny have seen a thousand more elbows than me, probably.
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But that happens the other way too, is where someone who has an expertise in running, like Kevin, or someone who like has an expertise in um, you know, rowing and like low back stuff like Lisa.
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If I just like, hey, can you like take a look at this real quick?
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Like Kev looked at one of my gymnasts who had like some shin spunt stuff going on.
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And I was like, I don't know if this is like tibial cortex, like stress reaction concerns or like medial tibual stress syndrome.
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But Kevin has seen so many of those that he and I were able to quickly look and like he agreed with maybe it's more like soft tissue, but those things can go a long way just to have a fresh set of eyes.
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And I think clients like that you're going the extra mile, you know?
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Yeah, I definitely agree.
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I think getting like someone else to look at it, especially when you're so deep in the woods with it and you've known them for so long, they can like come in and kind of like see a little bit of an outside view and give you a little bit of like a new perspective on it.
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Yeah.
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I've even done like when I have clients that are for whatever reason, like we can't figure out what's going on or they're just not getting better.
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I've even like gone down the route of having like a whole entire like re-eval.
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Yeah, and we just re-measure like everything.
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Like, I'll have them come in kind of in an eval slot and I'll just be like, let's just re-measure everything, let's set new goals, like let's make sure that we're all on the same page and like make sure that we're not missing something here.
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And that way we can kind of get like a fresh start, even from myself.
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Like I can restart a little bit more and start a new program.
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Yeah.
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And on that like reset of measurements or reset of like looking at the kind of stuff is like either after talking to a coworker, doing more research yourself, like I think that you might have a better pattern recognition of like maybe what to look for if something is particularly a diagnosis or a joint that you're not as comfortable or familiar with.
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Um, the best situation being is like Kev had a runner who um was more on like the hip dysplasia side.
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So she we thought he thought she had a bone stress injury.
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And so he was kind of looking at it from like a femoral neck issue, and that was ruled out completely.
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So now it's just like a really gnarly anterior hip pain.
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And he just asked me about like, okay, she has dysplasia, she had the x-rays done, and that shows that, you know, what would you do for this?
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And I've just seen so many dancers and gymnasts with the exact same clinical presentation as she had that I was able to just like literally tear through, like, okay, look at these things on the eval, these tests, these things, and see if those are problematic.
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And they were, and then, like, okay, this is what I would do for an Aval like to treat program, and blah, blah, blah.
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So it's just because of the nature of the people that I have seen, similarly to Kevin seeing so many shins, he's palpated so many shins for bone stress injuries that he literally knows exactly where to look.
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And yet, maybe I was slightly off.
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So um the fresh aval is really good.
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I I think back to your point, too.
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After if I'm going through a checklist of like, okay, we're we're on the right uh diagnosis topic, my coworkers also agree with that.
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I think that the harder thing to do sometimes, that the human like nature side of things is challenging, is like truly honest conversations about workload management.
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Um, I think that that is a really important area of the research that we know is important.
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But on the client side, it's it's really hard to not train and to not do stuff that you're not supposed to do.
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And especially when, you know, your social life, your family life, a lot of your you know, kind of identity is tied to your sport that you want to do, a lot of people are not being honest about their workloads or like what they're doing.
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I think, especially in the acute phase when I'm like, you're not supposed to really be walking a ton because your knees like kind of coming down from surgery, blah, blah, blah, but they're like, Yeah, but I like I have to get to class, and my buddies went out and I did this, and like we all went to the bar, blah, blah, blah.
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And like little things add up very fast.
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Um, and then also I think that people unfortunately, you know, ego is a hell of a drug sometimes.
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And so if you get someone who's back on their fitness and their workout plan, and you're saying, like, we need to do, you know, two days a week of strength training, you know, and slowly add up the weight, and then maybe one day on the weekend of doing like an interval program for running, um, but they're used to working out five days per week, being hardcore, you know, training super, super intense, it is very hard for that person to not throttle too much.
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And you have to get to the baseline level of like, are you truly following the program?
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One, did I write you a program that is accurately gonna dose you?
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And two, is are you actually following the workload program even though you're not in pain, or are you kind of like sneaking things in?
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Definitely.
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Yeah.
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I have a couple of kids that are doing that right now, and I've had like a couple conversations with them, like they're they won't give at all on what they're doing.
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And I'm like, Yeah, we're not getting better, and you won't give, and I don't know what else to do.
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Like, we cut out all like running and fly outs and PT because I'm like, I don't want to add to your extra load right now, and then they just won't stop playing soccer.
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Like, and I didn't even ask them to stop playing soccer, it was just like, let's maybe not play two games a day.
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Yeah, and like they're just like no, yeah.
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So it's challenging sometimes to like figure out where the balance can be when they're not willing to give up some of their like sports activities, they just want to push through.
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Yeah, and and on the other side of that coin is I mean, I can think of a soccer player who I have who is in the middle of his senior season and he's going to college, and he's like literally his senior season is like really important to him, and he has raging patellar tendinitis.
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Like he has had like everything you could probably think about in terms of like didn't really handle a summer workload well, might have skipped some stuff, tried to rush into preseason, got like really flared up.
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And you know, we've we've between myself and doctors have ruled out like bone stress injuries and like serious stuff.
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So it really is truly just like a gnarly patellar tendon issue that he plays, it gets flared up, we treat him, it gets better, and then he wants to play again.
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And there is definitely a role to play and a conversation to have about like, okay, we're getting paid as PTs or ATs or whatever to like help people reach their goals.
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And if this kid's senior season is really important to him, and then he's gonna take all winter off so he can like train and do like rehab.
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Um, he has like arguably like seven more games left over the course of a month and playoffs and states and whatever.
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And he pretty much just told me straight up, he's like, No, I want to play.
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I was like, All right, brother, sounds good.
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Um, you're gonna be in pain, but like what we'll do everything we possibly can.
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But like if you want to play and you're gonna play, then my job is not to point my finger at you and wag, like, how dare you?
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Because honestly, I did some stuff like that too, bro, growing up.
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Like, I had like a fractured wrist in my senior year in college, and I was like, tape that thing up, or I got two more meats left and I'm done with gymnastics forever.
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Like, we're getting through this thing.
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So I get it.
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Yeah, I do too.
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I I feel like if as long as I've ruled out all of the like major, you know, injuries or ruled out that they're gonna have some sort of like major injury if they continue down the route that they're going.
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I've usually have that conversation with the kid and the parents and just be like, this is your choice.
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Like, if this is what you want to do, you might play yourself back up and we're gonna have to do a lot of work on the back end after you're done.
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But if this is what you want to do, like that's your choice to make.
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And as long as there's no like major things that could come from it, like chronic injuries down the line, then yeah, I think it's that's a really good point you make.
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It's really important that our role as PTs or whatever is to educate people on risk.
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Yeah, educate people on risk and what could happen and like the continuum of possible options, not uh guarantee like if you do this, you're gonna get hurt or like blame them or whatever.
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Um, many times when I see somebody for like acute extension-based back pain to start, I'll do an avowal and then I'll say here's like here's the entire length of things that could possibly happen.
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This could be a muscle spasm with like a really irritation, this could be a facet issue, a stress reaction, a stress fracture.
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And that's just like the entire list of things that could go not so great to great.
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And here are the different timelines for those things.
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And like because of this, let's try this for four weeks.
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Let's see how you feel.
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And if not, let's get an MRI.
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But just letting you know, if you keep training, you the risk of you going farther down the severity uh continuum is higher because you're you're you're pushing things a bit more when they're trying to heal.
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So yeah, I think that was a mistake that I used to make as a new grad, was like kind of like I don't know, like the Ivory Tower complex, I guess that would be.
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It's like you're the smarter person who went to school for five years, has a doctorate, and like you're kind of like speaking down to somebody.
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I think you'd be really careful about that is that you you they're a client who is paying you for your information services and your kind of like ideas, not uh telling them what to do or saying they should or should not.
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Of course, there's times when you're like, listen, I'm just be honest with you, this is not a good situation.
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And if you're growing, it's gonna get a lot worse.
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So people appreciate that honesty.
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But um, yeah, uh the other one that I think about a lot that comes to mind is in the age group of like 10 to 14, is that I think people unfortunately have very unrealistic expectations for how hard it is to get through that time period of puberty while they're growing and not have aches and pains and injuries, particularly growth plate injuries.
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So I see a lot of hamstring apophysitis, patellar tendon, Oscote slaughters, um, Achilles Severus disease.
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And, you know, they they literally, we have the right diagnosis, they're doing everything right.
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They're not training as hard, they're not doing stuff, they're trying to back off.
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And it just it takes so long to calm down because they are actually growing during the time in which the tendon is pulling on the bone the most.
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So I've literally had people with high hamstring is apoplecitis issues.
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I'm like, here, here's a program, here's what we're gonna do.
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But until these strength tests are negative, these hop tests are negative, these are whatever negative for pain, um, you're probably not gonna be ready to go.
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And it literally might take three months.
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Yeah.
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Now I know you don't want to hear that, um, but you're 12 years old, you're growing like a weed, and like your legs are growing so fast in comparison to these muscles and tenants they can't keep up.
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And you can do everything under the sun and you're still gonna be waiting.
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So, like it's a it's a hard conversation, but I think I think sometimes people are scared to tell people the reality that like it's growth is just such a brutal time for like a lot of these aches and pains, and it's not something to work through, right?
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That's like another thing, like, oh, it's just growing pains, work through.
00:15:51.360 --> 00:15:54.879
It's like, no, that's a bone stress injury that is extremely painful.
00:15:55.120 --> 00:16:07.519
Yeah, I actually was just having this conversation with a coworker because I feel like the like growth plate injuries just get played off like so much, like the amount of parents that come in and are just like, oh, it's just growing pains.
00:16:07.600 --> 00:16:08.879
Like we thought it was just growing pains.
00:16:08.960 --> 00:16:11.039
So we were just like, whatever, keep going.
00:16:11.120 --> 00:16:19.039
Like they just get played off like they're nothing, but they really could like lead into something like really bad that it takes a really long time to recover from.
00:16:19.279 --> 00:16:25.759
And the I have a kid right now who has a hip hypothesitis, and he just keeps like having flare-ups, like big flare-ups.
00:16:25.840 --> 00:16:31.519
Um, will it get all the way better and then he'll go out and something will happen, and then we're back in the same hole.
00:16:31.600 --> 00:16:40.960
Um, so his timeline has been pretty frustrating, and we just had to have a really hard conversation about not pushing to get back for the end of this football season and trying to keep us on track.
00:16:41.360 --> 00:16:43.120
Like, I was like, what is your priority here?
00:16:43.279 --> 00:16:48.480
I was like, we can push, like we can do it, and we can get you back in for probably the last game if you wanted.
00:16:48.559 --> 00:16:55.120
Um, but there's always that risk of you pushing too fast and having an injury again, and then we're out for track season.
00:16:55.600 --> 00:17:01.759
Like, which option do we want to push slower and focus on track, or do we want to like, do you want to push really hard and see if we can get you in for football?
00:17:01.919 --> 00:17:08.400
And like, I usually leave that up to the I talk to both the patient and the parent about that, and I I was like, let me know what you want to do and we'll figure it out.
00:17:08.559 --> 00:17:08.880
Yeah.
00:17:09.119 --> 00:17:17.359
I think I was listening to last week's episode when it came out, and we were talking about how like sometimes, unfortunately, we have athletes who are like chronically plagued by injuries because of early specialization.
00:17:17.599 --> 00:17:24.000
So, like, they are doing their sport, they're competing, but like literally a third to half their seasons every year are limited by injury.
00:17:24.240 --> 00:17:27.359
And there's a girl I can think about, she's a she's 12.
00:17:27.519 --> 00:17:29.440
She is super good at gymnastics, man.
00:17:29.519 --> 00:17:30.960
She is like a female, right?
00:17:31.359 --> 00:17:35.440
But she had severus when she was 10, which turned into a stress reaction in her heel.
00:17:35.599 --> 00:17:44.720
So she got better after six months of waiting, trained for six months and came back and was doing front talks on beam and flared her leg heel and bone bruised her leg MTT.
00:17:44.880 --> 00:17:47.680
So she like was almost all the way better, but then she got hurt again.
00:17:47.759 --> 00:17:49.839
And again, that was because she was growing really fast.
00:17:50.000 --> 00:17:52.079
And she's just a tiny little thing, wasn't growing yet.
00:17:52.160 --> 00:17:54.480
So she has not a lot of muscle mass to absorb these forces.
00:17:54.640 --> 00:17:58.000
So you could argue that maybe it was her heel plus her MTT.
00:17:58.160 --> 00:17:58.720
Same thing.
00:17:58.880 --> 00:18:00.720
Three months in a boot, got all the way back.
00:18:00.880 --> 00:18:03.519
As soon as she got back for a season, she hurt her foot again.
00:18:03.599 --> 00:18:11.200
So she had three years in a row where because she's so that was 10, 11, and 12, because she's just like growing and she's not quite over the hump yet.
00:18:11.279 --> 00:18:13.519
She's not as like muscle mass protected as she needs to be.
00:18:13.599 --> 00:18:15.680
And she's doing really hard skills at a high level.
00:18:15.839 --> 00:18:19.759
Um, she just literally keeps getting flared up, and her mom is just so she feels bad.
00:18:19.839 --> 00:18:22.079
But then the girl is so frustrated, obviously.
00:18:22.160 --> 00:18:38.960
But that was a perfect situation of something I was like remembering last week is like she kept not getting better because we hadn't we had had an honest conversation about workloads and we also talked about growth, but she just it had not sunk in yet that she's like, you know, excited with her friends, she wants to go back, she's this little phenom, she's doing all these hard skills.
00:18:39.039 --> 00:18:42.160
Um, and now she's actually strength training with us, which is great.
00:18:42.319 --> 00:18:54.640
So she's I don't know if she's taking a little bit less of a season this year or what, but I'm like, I was like, girl, you need to take a break, get strong, like and to her mom, I was like, she has to like just have time to get through puberty.
00:18:54.720 --> 00:18:56.480
You know, she's just got to get a little older and mature.
00:18:56.559 --> 00:18:59.519
She's a late bloomer, she's 13 now, and she still looks like she's 10.
00:18:59.680 --> 00:19:03.359
She just hasn't quite hit her growth spurt yet, like fully for muscle mass.
00:19:03.519 --> 00:19:12.880
And so we had another girl who was also in a similar situation of like 12 hurt, 13 hurt, but still hadn't really hit the growth curve.
00:19:13.039 --> 00:19:15.680
And then 14, I remember she left for a season and came back.
00:19:15.920 --> 00:19:21.519
She came back, like she left like maybe four inches shorter, you know, like quite a bit less muscle mass.
00:19:21.599 --> 00:19:23.519
She came back, and I was like, bro, what happened?
00:19:24.160 --> 00:19:24.559
You eat.
00:19:24.720 --> 00:19:26.720
And I talked to her mom, she's like, I don't know, six months.
00:19:26.799 --> 00:19:29.680
She went from like little little this person to like a full-on woman.
00:19:29.759 --> 00:19:30.799
And I was like, damn, bro.
00:19:30.880 --> 00:19:32.160
Like she like grew like crazy.
00:19:32.400 --> 00:19:33.359
But she's like strong now.
00:19:33.440 --> 00:19:36.079
She's like very strong and she was able to help handle gymnastics more.
00:19:36.160 --> 00:19:39.599
But some people are just late bloomers, man, and like you just can't fight that uphill battle, you know.
00:19:39.839 --> 00:19:40.480
No, yeah.
00:19:40.720 --> 00:19:47.599
It's such a hard like thing too, because it's so it can be different in different people, and it's hard to know like when you're gonna hit that phase.
00:19:47.680 --> 00:19:54.640
And for for us to just tell somebody like you just gotta wait till you're grow, like you're done growing, is such a hard thing to say.
00:19:54.799 --> 00:20:03.920
Like, it's not that you're not gonna be better, but like you might continue to have flare-ups and your growth plate injuries until you are done growing, which is like especially in boys, it takes so much longer.
00:20:04.079 --> 00:20:04.559
Yes.
00:20:04.799 --> 00:20:17.279
So it's just kind of it's a hard thing when you don't have like a specific timeline for something and you're like trying to tell them like you just kind of have to like modify based on your pain, and that it's not like as simple as like, oh, in four weeks you're gonna be here to go.
00:20:17.599 --> 00:20:17.839
Yes.
00:20:18.079 --> 00:20:21.839
And um, I think when I talk with gyms, I tell them that it's one inevitable.
00:20:21.920 --> 00:20:25.519
Like, I don't it doesn't matter whether you want it to happen or not, or me or it's gonna happen.
00:20:25.680 --> 00:20:30.799
And it's just when it happens, it's in like it's part of you, whether it's 10, 12, 14, whatever.
00:20:30.960 --> 00:20:32.000
You say it's inevitable.
00:20:32.160 --> 00:20:34.319
The other thing is you reframe it to like it's a good thing.
00:20:34.480 --> 00:20:42.000
Like it's actually a really good thing that you grow because all your heroes and all the things that you want to do are on the other side of growth, puberty, and getting there.
00:20:42.079 --> 00:20:49.599
So oftentimes there's someone they look up to, and I'm like, I'm telling you, Simone was not doing triple doubles, you know, on hard floors competing than when she was 12 years old.
00:20:49.680 --> 00:20:58.079
She might have been doing them for fun off tumble track, but her little body could not handle those forces till she was like much older, much more mature, had more muscle mass, blah, blah, blah.
00:20:58.319 --> 00:21:05.920
And the third thing I think you have to tell people is that if you uh try to work through it, it's almost always gonna backfire.
00:21:06.000 --> 00:21:17.039
And that's more the coaching and the parenting thing is like telling them, like, listen, like you're gonna have six months where like it feels like everything's going wrong, but it can be used as an opportunity to work on other things and kind of get somebody ready, right?
00:21:17.200 --> 00:21:19.119
So strength train, you can do basics.
00:21:19.200 --> 00:21:24.240
Like, there's so many great coaches I know that are like, yeah, I've worked with 10 generations of 10 to 14 year old kids.
00:21:24.319 --> 00:21:38.960
And I just accept the fact that for six months, somewhere along those four years, the world's gonna implode and like they're gonna lose all their skills, they're gonna get all their less flexibility, and we're gonna just accept that and know that's part of training and use that as a time to back off and kind of work on basics, work on flexibility.
00:21:39.039 --> 00:21:44.079
And uh yeah, I mean, I think that like literally every kid who's ever done sports has to go through this, and so we're no different.
00:21:44.240 --> 00:21:48.079
Yeah, hopefully that will become a little bit more normalized within just like it is, yeah.
00:21:48.559 --> 00:21:49.519
All sports, yeah.
00:21:49.759 --> 00:21:50.079
Yep.
00:21:50.400 --> 00:21:54.240
I think at the early specialization conversation has allowed that to also become more of a thing.
00:21:54.400 --> 00:21:54.640
Yeah.
00:21:54.799 --> 00:22:03.279
Um, okay, so in recap, so if we're having someone who's not really going well, so reflect on your own treatment stuff as a therapist, do another eval, maybe like Aliyah said, that's great.
00:22:03.440 --> 00:22:06.240
Talk to your coworkers, see if they can give you a fresh set of eyes.
00:22:06.319 --> 00:22:09.279
Um, talk about workloads, talk about rapid growth.
00:22:09.359 --> 00:22:22.720
Um, personally, for me, I think uh I was taught by some really smart uh recovery specialists that 80% of your uh injury, healing, rehab kind of recovery comes from sleep, fueling well, uh hydration, and stress management.
00:22:22.880 --> 00:22:28.079
So 80% of your recovery um is like, are you sleeping eight plus high quality hours?
00:22:28.319 --> 00:22:29.680
Probably no kid says that yes.
00:22:30.079 --> 00:22:31.920
Are you fueling enough inadequately?
00:22:32.160 --> 00:22:33.440
Most kids have trouble with that.
00:22:33.839 --> 00:22:34.720
Are you hydrating enough?
00:22:34.799 --> 00:22:39.359
And then are you having time where your stress is like managed and low and you're not thinking about school or gymnastics?
00:22:39.519 --> 00:22:41.039
Um, I am just gonna be really honest.
00:22:41.200 --> 00:22:43.359
I know that's almost impossible to do in young kids.
00:22:43.599 --> 00:22:47.599
That is like really hard to do in young kids and even college kids, I would say, that really struggle with that.
00:22:47.759 --> 00:23:00.799
Um, but if you have someone who's literally just uphill, you know, not getting better over and over, it's worth at least two weeks of telling them, like, listen, I know it's really hard to sleep and kind of take care of your nutrition and blah, blah, blah.
00:23:00.960 --> 00:23:08.960
Maybe we talk to a dietitian if somebody's concerned for red S, of course, if someone's like got bone stress injuries, but it's like you haven't gotten better in eight weeks and you're frustrated.
00:23:09.039 --> 00:23:10.960
I'm probably a little frustrated, you want to play.
00:23:11.119 --> 00:23:16.400
So we need to try to think about like what are all the variables that we can control for the next two weeks to try to move the needle.
00:23:16.480 --> 00:23:18.480
And let's try to like prioritize this.
00:23:18.559 --> 00:23:21.680
Like off your phone, go to sleep at 10, wake up at six, right?
00:23:21.759 --> 00:23:28.799
Like, try to meal prep, try to have a water bottle at all times, try to talk to your like registered dietitians or whoever on staff can help you, or we'll get you somebody that can talk to.
00:23:28.960 --> 00:23:31.839
And like just running all the variables to make sure.
00:23:32.000 --> 00:23:35.920
And then if all that stuff after two weeks, right, you're still not like anywhere.
00:23:36.079 --> 00:23:39.680
I tend to lean into like talking to physicians about like, do we need a re-imaging?
00:23:39.839 --> 00:23:47.119
Um, some people have a really flared up joint, and it's like, do we need like a 10-day dose back of corticosteroids or like oral steroids to see if that helps, if it's appropriate.
00:23:47.279 --> 00:23:53.279
Um, there have definitely been times when the diagnosis is right, the workload stuff is right, and someone is just like going through it.
00:23:53.359 --> 00:23:57.920
Like it's just like I think backs are probably the big the hardest one because it's really hard to not use your spine.
00:23:58.000 --> 00:24:00.079
Yeah, but you can put your ankle in a boot, you can walk around.
00:24:00.160 --> 00:24:07.519
But I've had people who like are doing literally everything right, they're not training, but because they're just using their spine all day long, they're like a neuritis or a flare-up of sciatica.
00:24:07.680 --> 00:24:18.720
And uh, those people go to um a non-op physician, they get a dose pack, or they get a corticosteroid ejection and like literally the heavens open for 10 days, they feel amazing and they're able to exercise and tolerate their PT program much better.
00:24:18.799 --> 00:24:20.319
And that's kind of what got them over the hump.
00:24:20.720 --> 00:24:22.079
Yeah, I agree completely.
00:24:22.960 --> 00:24:23.119
Cool.
00:24:23.200 --> 00:24:23.839
Anything we missed?
00:24:24.240 --> 00:24:25.200
We got a good little list.
00:24:25.359 --> 00:24:29.680
Hopefully, new grads out there that are nervous can find this episode and can have some guidance.
00:24:31.119 --> 00:24:31.359
Cool.
00:24:31.759 --> 00:24:32.720
Yeah, that sounds pretty good.
00:24:32.880 --> 00:24:36.559
We'll wrap that one up there and then we'll talk about some preseason training in the next one.
00:24:36.880 --> 00:24:37.279
Bye-bye.