ACL injury & repeat injury in youth athletes with Eric & Elliot Greenburg | 2 hrs ago
0:00 – 05:14
Hi, I’m Alexa. You can now hear PT podcast. Using me just say, hey Alexa, launched PT, pint cast, or you could be nice and try saying, please for lunch, what is being polite? Dead these days to your episodes, just say, hey Alexa, launch PT pint cast, maybe throw in a please. At the end my monitor the -tudents are they need to be the change in practice. They need to be that Cadillac in the clinic. Don’t go into finicky the things that the clinic is doing if they’re things that you don’t necessarily jive with e that change. Bring the new culture two out there who, who may not know what is new in the research realm. So I really in power them to be that catalyst that change of the freshen taking your from the academic side of things into clinical practice. Get a chance to talk to the greenberg’s. Eric in Elliot Greenberg. No relation. They had a couple of publications about ACL rehab and best practices. We. Best practices, but are those best practices being put into practice? So did there. So they took a look at it from an orthopedic surgeon perspective, physical therapist, perspective, and really, ultimately wanted to see why or why not those best practices were being actually utilized. So we took a talk with those two guys at the same time in this episode take a listen. I think it’s got insights beyond just ACL rehab, right? Re really insights into where’s the fall off in best practice to actual practice. So we’re going to get into that with these guys episode brought to you by Owens recovery, science, a single source for PT’s looking for certification in personalized blood flow, restriction rehabilitation training and the equipment, you need to apply in your clinical practice Zach Ephron on social media, just see. And he’s going through ACL rehab, and using har-. So that’s, that’s kind of cool to see in the mainstream, and he did a little shout to his great physical therapist athletic trainers going through rehab. 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Welcome two hours your next episode of PT podcast starch right now bring it into to grow. Converge do not get confused. They are not related Elliott and Eric Greenberg. Welcome to the show guys. I’d give negative. Thanks. I have an excellent art. So we’ll start with Elliott Elliott. What’s, what’s your background, which are the audience know about you about what, what you do in your daily life daily life? I’ve kind of limit role. I work at children’s Philadelphia about three-quarters clinician, and about one quarter researcher here special interest in knee, and shoulder injuries particular ACL’s, because what I see a lot of glad heavy Elliott and Eric. What’s your superhero back story here, backdoor, the right now? I’m on Long Island and I may. In Europe, at the New York technology where I even the curriculum, it’d be program, but also treat the NYC athlete. And my current interest include working with obviously the population with lower injuries and running related injury. Excellent. So how’d you guys meet anyway? I mean I know you know Elliott, you’re, you’re at shop Philly. Eric, you’re in New York. But have you guys cross paths was was it the same conference and picked up the others name tag because you both have the same last name or what? Yeah, it’s kind of a long story, but. I we unknowingly you know, kinda sorta cross paths, a long time in our in our in our lives together. But we, we did end up. We worked together at shop for a little while. And that’s really how he really got. No each other and work together, and kinda, formerly Egypt. So both of you guys have special interests in lower shrimp, the injuries Elliott working with pediatric and adolescent, sportsmed. Eric doing the same with some college athletes, and being a practicing as well. How did you guys decide to get together and do some research, and then we’ll get into what it was and where the audience can find it. Burqa started on the research paths together while we were together at shop. We did come out with a more retrospective analysis looking at the pediatric strengthen front-row, turn in the pediatric athlete, and then it kind of bird into a little more while, and I remember very closely when Elliott our standing next to each other at CSM, how long it was it remember that in California, I think, when whenever the Anaheim yeah, yeah.
05:15 – 10:04
Book that we has had this idea like, you know, we’re coming out with all these recognitions, but we really don’t know what it is that peaky are actually doing out there in terms of whites, specifically, a C L rehab returned to play return to sport return to life. Yeah. So when we were working together at shop, we do a lot of these functional and strength testing on patients that we weren’t really seeing. And when we were talking to them while they while they were coming in. You were getting again, gambit whole gambit as far as what they were doing regarding every in along with what kind of critique. Syrian that they’re, they’re practicing teachers were using this got us to thinking about, you know, yes, there are recommendations and guidelines out there, but is there that much variability out there in nickel practice? Gotcha. So you’re seeing what all the research was, and that’s what you’re doing at CSM, but you’re saying what’s actually being done, what where’s, where’s the translation? What’s the hand off from research and best practices to what’s actually being done with athletes? Yeah, I think yeah. And I think it also kind of reverse too, because we had that kinda unique experience at shop. Where are surging kind of require their patients to come the are there teams are to make sure they are functional testing program, where they the L part of that is, it’s great because we get interacted patient that we’re not treating on a day-to-day basis, we’re seeing at three months post op or six months and saying, all right. Tell me what you’re doing. And we hear from the patient’s perspective, are they are they following of, like, what we would consider to be best practice guidelines what have they done? Maybe prior to come. In and the patient, assessing aunts. And then, and then we give to CSM we hear what all this really great research is saying, man, we should be doing. We should be doing more. We shouldn’t do, and it’s like, but, you know, the, the patients that we have coming in from outside, our walls, or maybe not even doing happened that too. So it’s like, you know, it really spurred that idea what, what happened was the general practitioner that seeing, you know, maybe mostly maybe low back pain, or older patients when they get kind of SEAL that walkner door, you know, that they may not be a specialist in these the what is what does that person doing to make decisions about returns person, the play I like how it was formulated, organically, guys standing there together at, at CSM and saying, hey, what about this? Why don’t we take a look at the cool part was you guys went and follow through, and you wind up doing it. So, so talk about what happened next after that moment, when you actually follow through, we kind of formulated the idea, and we brought together, what we’ve dealt with a really good team, people with orthopedic surgeons that we work with here at job, and in PT’s, and we kinda got the, the survey. Of what we wanted to the question that we wanted to ask formulated together. And then we thought, hey, great idea, not only look at what therapists are doing. But on the other side, we look at the PD surgeon, they’re doing as well. So he came up with this idea of maybe the three sixty degrees, scope of people that are involved in, in these rehab decision, seeing what if kind of the Philip how to be in the orthopedic surgeons are kind of the overall directors, they’re the ones that are delivering the protocols for their patients. And, you know, saying this is what should be done. You know, we should see what they think about package patterns TT’s, or the one we’re in the trenches were the ones that actually were applying testing. But we feel should be best. You know what is what the P T say we wanted to kind of see what are both sides would say. And then maybe the compare contrast and draw conclusions from that. Unlike the more like a time line and being able to see again, what’s, what’s best practice. That’s great. But what’s actually being done on both ends in terms of the orthopedic surgeons and then the follow through with the, the physical therapists after? The surgery. So, so how’d you guys approach it and, and what you guys fine. Let’s get into the nitty gritty yet for one of the biggest things that we found was that there was a large variability, not physical therapist, but also with the orthopedic surgeon, and I think it really probably under floors, or underestimates, the ability out there, because the sample that we took from was the sports section with exception in private practice section, or what formerly known as those sections, I should say with their new name changes. But it’s a pretty, if you think about it a homogeneous sample of people, you would think that would be in the know of the current landscape of the literature, who would probably under floors, or under made the, the true, very villi out there similarly that we, we found even more variety in the orthopedic population, certain population, and that was the sample of pediatric orthopedic surgeon from the research and sports medicine group prison. Group, once again, a very homogeneous sample that tends to be a little bit more up to date with their with their current recommendation. So we, we were, we were quite quick deprived prize, the degree of Billy that we found, so, so I just want to stop you there to make sure I understand what you’re saying, and make sure the audience gets it too.
10:04 – 15:09
So you’re saying this groups free homogeneous you figured it, would they be more well informed because these are the people who go out of their way to not only be members but to be section or academy members and seek out the research, so they should have been sticking to or at least be closer to the best practice guidelines that have been put forth so far. But you saw variability, which you’re saying really really, really highlights how much variability was out there that you couldn’t even reach at xactly yet. Okay. I just didn’t wanna make sure I, I want to make sure I understood that. So it’s okay that is that is pretty telling what were some of the results you want to get into some of the some of the highlights. And some of the things that you guys found that maybe surprise you or didn’t surprise you. If you think about the decision. Making profits or what you’re the tools. You’re using from, from time based parameters to some type of strength criteria to some type of stumps performance measure to maybe some type of patient outcome measure or psychological attachment or contract dry. I mean, the variation existed across all of those, but even some of the more kind of would you consider maybe more concrete things like time we’re not even agreeing on time when the progress patience right now and you think that there’s probably the better most amount of research looking to support like those simple those, those type of concrete things. But we can’t even agree. And then when you start drilling down into the details about well, are reassessing strength and a lot of everybody agreed like. Yeah. Strength is important. But then we asked, how are you assessing strength that then variability just started from there? Right. And some people there was a large proportion of the sample PT’s that, you know, just relied on manual muscle testing to progress their patients and kind of what the literature showing is that, you know, we’re not going to be able to. Identify these higher levels of gases. Pete that may exist for these patients, when they’re strong but they’re just not strong enough using now montage, tonight’s lesion. But then when people are using either more objective measures, like handle their no mama tree. Or there’s availability rice the testing the standard that which they’re holding them to the variability just continues to progress where some people required seventy five percent. Maybe limbs imaging index and some people were maybe above one hundred percent. It’s there’s just, you know, the organizer surprised they as we drill down. You know, the win the details of what we’re doing and everyday practice, we can agree on broad strokes. We can agree that strengthening important, the man when you start like measuring strength like how you’re actually applying and doing that. That’s really different from everybody. Do you see in the framework is there? But how you actually apply and actually measure things like time or strength, which everyone pretty much agrees on being important factors to take into consideration when you start. Looking even smaller there. That’s where you see even more the very variability come into play. Yeah. Yeah. Eric, what do you want more like the devil? That was in the house a little bit like he talked to finishing tonight and nobody’s gonna argue that strength that meet strength. This is not going to be important. But I think once you start to, to hammer down on to power, they testing or something the strength of, of, of their patients. Are you really comparing apples to apples when when you start to go across different clinics, clinician and patients? And I think it really does create a little bit confusion, not just in the PT population in the clinic population. But Auckland patients to talk with one another, when they’re like, oh, yeah. I think cleared how they took your or yeah, they, they hooked me up to this machine four times. And, and I have to get at least ninety cent and the other person’s like oh, I’ve never done that before. And they’re back on the field plan already. I think it really does create a little bit of confusion within the society as well as are we really treating the same patients across different clinicians in clinic. And practitioners in the same profession. You know, right. That’s and that’s a great example of when you get to patients together, and they say, oh, we have the same injury, we must have done the same type of rehab, or at least hit these big big benchmarks. And when they’re different that’s confusing. And again, I get it, you know, patients are different from patient to patient. But if this is what best practices are, how come there’s so much variability? What were you able to hone in and either measure and ask, or at least if not speculate? Why is it? Why, why do we take it upon ourselves to, to have so much variability within the PT arm of the survey that we thought he’d be able to get one of those details? We, we tried to look at commision doctor that maybe influenced some of their him their decision that the us. So we had we kind of broke people down into, like either, high volume or low volume practitioners, where we said, anybody that treated more than ten miles per year. We accounted for them at high volume. Actitities and those less than that were low volume. We looked at certified specialists versus not certified specialists. And we don’t think years of clinical experience, and you know, if we if we use, we don’t know what that program is or, you know, like like you said, a few times we have our current, you know, Beth standard that we have our practice standard.
15:09 – 20:08
But we know if those are ideal hopefully change as we continue to learn more. But if we lived up to characteristics of the clinicians relative to the decision, they were making it seem like certified specialists were more likely to follow either which beat, of course, board certified specialists more likely to follow those kind of current practice guideline, and also those clinicians that were that were into our high volume clinicians seem to kind of follow more those best practice standards. So jor Beth is kind of what we’ve only result is that meeting. Those conditions are maybe more tied into the current literature or maybe by into the current literature more maybe see the investment in their practice going out. Of the way there, that’s a self selected group, which we started talking about the top of the show. These are people who say when your SAS, or when you’re seeing high volume, I’m I better, I better be doing the best because I’m practices wise because I’m seeing so many of these types of patients, these specific type of patients each and every year variability in terms of testing, I could imagine sometimes would have to do with ability of Quebec. Right. Each practice setting is going to be different. Yeah, definitely. And I think Becky him about a up in some of our speculation that people that had can be high volume a, you know, probably see the investment in an economic Donna, Mamata, or even like a handheld on a monitor roof with someone who may maybe in a facility where they’re not being as many of those types of patients may not be willing to invest in something because there’s no cost benefit for them or return on their investment in the long term. And obviously, there are other financial issues that you come across. Basis issues potentially. So I think there’s a lot of confounding issues that could arrive that can reason why someone is not using this type of instrumentation where can work in the audience, find this and, and download and kind of consumer themselves want to make sure they get access to it. Yes. The PTA survey published in jail at BT in October issue. Twenty eighteen and me surge in order big surgeon arm of the study was just published last month on in the orthopedic journalist sports medicine, Zingo them, and you can download that, that’s a full tech there, you can download full text there. No problem. What, what was the what was some of the attitudes of people who participated in this after the, the results will reveal work were they shocked were they surprised to were they, you know, pledging to, to change their practice because they saw such variability or anything come out of that, you know, I don’t think it was that surprising. I think I think disturbing survey kinda showed what everybody coming, Verdy thought. Victor knew existed that there’s variation out there and everyone’s like, wow, I, I knew it was variable. But I didn’t think it was very -able. You know what I think that was kind of, like just reinforced them the some of the thoughts, we did get a couple of emails from people like saying, hey, this is this is really nice really enjoyed remiss kinda good study, but I don’t know air and different Binyamin that no you know what it was interesting. I think you’ve gotta lar- a lot of publicity on social media platforms almost like the like a shock value of you need to do better. You know, by no means do I think you are. Is it is it bulletproof is it the best thing out there? Is it catching all people who may be at risk? But, but at least it’s the best we have at this point. But it seems if people aren’t even doing that at this point. So how could we really say that it’s not doing what it claims to be doing? If people aren’t there aren’t really doing it. So I think it, it really gained some headway on, on the media platform of saying, hey guys, let’s do a little bit better out there. I like that good. Take a quick break want to thank our sponsors are east medical staffing for keeping the show on the air. They find jobs, whether you’re gonna do so Adelphia or Long Island or anywhere you want to do a beach a lake. He wanna go mountains. He want to ski you can do that. That’s the cool part of variability in our in our profession is people need PT all over. So go do what you want where you want to do it. And Arias get you set up a U, R, E US, medical dot com. Not only just having the positions. But as well as being with a walkie through all the pain points. What do I do if I’m licensed in New York? But I want to go work in California for a couple of months they’ve got people on board to help you walk you through that. So you’re not on your own housing. How do you find where to live and is the person that use hiring you? They pay for that. They’ve got someone to walk you through that as well. The thing that could knit freaked me out the most was taxes. If you live in New York, but you’re temporarily working in Colorado. What do you do again? Arias has someone for that as well. So check them out, if you want to do a short term placement or look into relocate long-term, a U, R, E US medical dot com. Where, where would you guys go if you could go anywhere in the fifty states, if you do exactly what you wanna do what state, haven’t you been to that? You would give shot for thirteen weeks.
20:09 – 25:05
What bait haven’t I been to? Well, I was thinking more of that. I have been to Florida gator, we go down to Pensacola Beach, Florida every odd year for a week, and that is one of my favorite places in the United States. But opera played the haven’t been to having not ally. They had not been there, I would probably pick some somewhere in the mountain bikers aggo could Pacific northwest. Well at school party where the fifty states check him out. You are US medical dot com. Extent stay tuned. The we’ll be right back to the P T on cast. If you look at for education passed your physical therapy degree, look no further than Brooks. H L, Brooks rehabilitation institute of higher learning you could find out more Brooks, I h l dot org continuing education along with residencies and fellowships residencies in Orthopaedics, geriatrics, women’s health, neurologic PT, pediatrics, sports, and fellowship opportunity as well. So look into it if you’re looking to expand your knowledge base Brooks, IHL dot org to the typecast with Jimmy MacKay question. How was the how are the views or how was the reaction you guys mentioned, some kind of shock value on on social media saying, hey, come almost a rallying cry. But we, we need to do better. Let’s do better. Was there any reaction from the orthopedic surgeons since they’re the kind of the first touch point in the patient, and then they pass them off to us betcha they expect us to be doing best practices? What was their reaction to the results? I haven’t seen much reaction to the there’s a lot more talk about it and probably considerable Eric. And I of fly in within the realm when we did present it that at conference. We got a lot of really good feedback. We actually won best paper award at the prison conference the year, we did present this at that conference. I think there was there was a lot of kind of good Baillieu in, in the in the paper and the topics. And you know, we’re hoping that maybe it’s going to help drive Johnston change where beating side and change things around to so, so, so alternately. I guess the question to ask, is how do we do better? You know, we have these academies, now we specialize, we have best practices is there anything that you would that you, if you could make may wave. Magic wand that you put into play. How can we do better? I did a residency at the. I did a residency at the at the university of Delaware did for threatens there under the guidance of insider macadear who’s been acute advocate for the tests. You know, you need to test the folk and there’s been research out there that said, don’t, don’t need an kind of garner monitor to assess quad strikes you all you need is in the extension, machine that every clinic was throwing out a few years back and now the starting to get them out of the trash. So I think it comes down to, you know what take the time out. It’s worth your while for the information that you get just to do repetition, maximum testing if that’s all you have is you have a handheld item ometer, you use both types of testing, but I think it’s taking the time out and maybe sacrificing other parts of your of your treatment to really get the data that you need to make educated decisions. And that’s a valuable thing, right? Giving up some time. But if if, if what you’re presenting his is correct, which we, we would assume that would be since its best practices that time is well, spent, we’ll we’re going to say sorry to cut you off yet. I agree. I think engage in this conversation is actually helpful in getting some of the some of that social media. No on your your, your show. You’ve talked about kind of lag time between evidence to trickle down everyday practice. And I think that the social media conversations really helpful with and they can push us that people probably wouldn’t have picked up the paper or read it beforehand. And there’s there’s so much stuff about about ACL coming out. I mean I mean hundreds of papers every year to try and I get that. But I think trying to just these maybe maybe helped reinforce some of this, you know, the current standard that we think are the best to try to help, you know, get that out to general practitioners that don’t specialize an easy else, but probably Seeven majority of easy L patients because they make up the majority of the general practices that are out there, and maybe helping to adopt you know, the doctor and the guidelines that are that are being put forward. We’ll look at Alex, look the positive at least there are best practices, right? And we’re pushing we’re pushing up professor. Towards finding out what is best that’s great. That’s a great problem to have is. How do we know? How are we going to disseminate that and make sure it gets put into play? At least we got that first part least, we’re really, really paying attention to the first part. Now, if we as you just mentioned, continue to have those conversations, maybe hopefully it’ll help that second part with this emanation last thing. I wanted to ask Eric, you’ve got a unique situation in terms of, of working with students any strategies to encourage students and new clinicians to adopting best practices, and making the change in current practice patterns, to hopefully as they progress in their careers continue that and then teach other students to change the profession.
25:05 – 30:18
Yeah. You know, I had as a an instructor in professor at this point, I tend to utilize a lot of media and podcasts, some of your own actually and other types of logs and things like that after screen through them with my Hyun because I feel like it’s very powerful to hear it from the door at both. So more. Digestible for them than reading the text books. Hearing me talk about it up there. So I utilize that empowers them to get engaged in conversation with the people who are actually putting out literature, and the people who do have experience aside from hearing it from myself as a sage on the stage. I also my mantra to the students are you know they need to be the change in practice. They need to be that, that, that catalyst in the clinic, don’t go into finicky the things that the clinic is doing if they’re things that you don’t necessarily jive with he that change. Bring the new culture two who’ve been out there who, who may not know what, what is new in the research realm. So I, I really encountered them to be that catalyst that change of the profession, taking it from out of the academic side of things into clinical practice love it. Be the change. Right. It’s not gonna change unless you take what you exactly what it is take what you learn in school, and your clinical rotations and actually, start to do it love that last. Part of the show is the parting shot. It is the parting shot. The Portland shot is brought to you by rock tape more than just the tape company. Rock tape is a movement company, tools and education for medical professionals, if you look at it help, your patients, go stronger longer. Checkout rock tape dot com. You guys have an opportunity to leave one one sentiment with the audience before you go who wants to go first with their partying shop Erica, you kick it off that. All right. So, I guess my parting dot would probably be addictive. Festive, we could do with younger. Patients is its neck with them understand that they’re not an eight the pair, their person who had an affair, and in dealing with kids and dealing with adults. You know you need to manage each person’s differently by using the evidence as your guide, but understanding that you need to tell about intimate independence to the person. And if you could just connect with that person, you’re, you’re, you’re gonna make that person better, regardless of, of. What you do as long as you’re you’re, you’re letting Evan guide you love at Elliot. You’re up and parting shot when he got I think just making sure you continue to grow as a clinician, you know, I think seeing a lot of as the ovation in unfortunately thing, a lot of them hail or have re injury or or secondary injury has has driven me to want to get better. You know. And I think just kind of continuing to grow as condition, and, and, and use those, those events or in that let learning to, to better yourself for the next person around is, is an important thing love that before we go. I’m just you. You’re prescribing podcast episodes, as homework or is outside learning to students love to hear that. I am. I and actually I get made fun of by my other faculty members because of it. But obviously, I listen to a lot of them my forehand. I don’t just give it to them, but I feel like it’s a lot more digestible for them. They can do it while they’re driving into school. They could do it while they’re working out. So. They can work it into their, their everyday life. And it also brings them. They stumble upon other things within that podcast. And it’s more student directed learning after that because they’re like, oh, I listen to this on certain podcast. And then I saw another episode that I was in it really interests me. So it starts to get them on that self directed learning which which is so important for when they do graduate is, how do they, you know, now the information coming to them, they have to go out and seek it? So it teaches them that new skill. You know, selfishly a love to hear that because I host a couple of different podcasts. But I like it because as the as the guy with a degree in communications you’re talking or you’re trying to facilitate a conversation, the way your audience listens. And you’re listening the way your audience talks, and that’s a way to facilitate great conversation instead of what you mentioned earlier being the sage on the stage. That’s a presentation. Right. Some people do learn really well from presentation myself, I’m a conversation guy, obviously. So, you know, selfishly hey, love love to hear that. You’re prescribing assigning podcast episodes, maybe one or two for my show to students, but just love the fact that you’re open to and Anna do want to highlight you mentioned it twice that you do screen through that. Anybody with a microphone create a podcast super easy. But I love the fact that you’re screening it and highlighting. Hey, pay attention to this, and they do after that, if they trip across an episode that hasn’t been screened they need to take that upon themselves because there’s a lot of information in less than great information out there to. Absolutely. I think that’s the most important thing. Is that you’re, you’re, you’re really screening through it to make sure because there’s a lot of stuff out there, that, that maybe you doesn’t really job with the intentions of, of what you want them to get to learn and last point, I’ll make love that too, because once they graduate, they don’t have a professor down the hall or they aren’t running into someone each and every week.
30:19 – 32:32
We’re having that information brought to them, they need to start to seek it out. And think, you know, handing over day of a blog to read or. Podcast, listen to or video channel follow. That’s a great digestible way as we mentioned before, of getting information. Once you start working forty hours a week when you graduate gentlemen, want to say thanks very much for your time. Don’t think it will be the last one. We have you guys on the show, but etc. Service episode with everybody. On the P T cast is a product of p t pint cast LLC it is hosted and produced by p t podcasts. EEO Jim McKay, and CBO sky, Donovan from Marymount university, we talk PT, drink, beer, and record it this has been another poor from the PT pint cast the PD podcasts in ten for educational purposes. Only no clinical decision making should be based solely on one source while Perez, taken to ensure accuracy, factual errors can be present. More on the show at PT podcasts dot com. We’re home on the internet t-, pine cast dot com created by build PT. Build PT provides marketing services, specifically for private practice, PT’s website, development and hosted inviting content marketing solutions PT clinics across the country. See with good PT can do for you. Today dot com. The PT pint cast proudly supports the Travis mills foundation on April tenth twenty twelve United States army staff sergeant Travis mills of the eighty second airborne was critically injured on his third tour of duty in Afghanistan by while on patrol losing portions of both legs, and both arms. He is one of only five quadruple amputees from the wars in Iraq, and Afghanistan to survive his injuries, thanks to his amazing strength, courage, and incredible will to live the heroic actions of the men in his unit. The prayers of thousands and all the healthcare providers at the Walter Reed Army medical center. Travis remains on the road to recovery. He founded the Travis mills foundation, a nonprofit organization formed to benefit and assist. Combat injured. Teran’s. Travis lives by his motto never give up. Never quit to support the Travis mills foundation. Or to find out more visit Travis mills dot org.